u/Electrical_Thinker

I had extremely big cystic acne, black heads and white heads for most of my life since I started my teenage years, after trying everything I said screw it and started low low dose of isotretinoin 10 mg and took it for yeas and I had almost 0 acne issues for years, I did not even have purge.

I stopped taking it due to other health reasons and after long break and start of getting same kind of acnes again this time with hyperpigmentation and dark spots because why not I waved white flag and started tretinoin therapy and at first it was normal but now almost 7/8 weeks in I noticed that I am breaking out with similar kind of acne.

Is my skin purging or I am having bad reaction? I noticed here that people say you purge for at least 12 weeks normally and if you have cystic acne you can purge for upto 6 months. I don't know what to do honestly as I also have isotretinoin pills due to my prescription and I was advised to wait for month of two if my conditions wont change then I should start taking it back but the side effects are scary and I desperately want my skin to adopt to tretinoin.

My routine:
AM:

1. Cleanser
2. Moisturizer
3. 15% Azelaic acid cream on dark spots and acne areas
4. 50+ SPF for acne prone and oily skin

PM:

1. Cleanser
2. 0.025 Tret gel with 1% Clindamycin
3. Moisturizer

Hi everyone,

I’m dealing with a frustrating situation and could really use some input.

My skin was basically perfect while I was on a very low dose of isotretinoin. After stopping, my acne came back. This time it’s a mix of cystic acne, whiteheads, blackheads, and now post-acne hyperpigmentation as well.

My dermatologist prescribed 0.025% tretinoin at night, and honestly the results have been great overall. The problem is during the day.

My SPF is quite drying(but it's what I need), so if I don’t use a moisturizer underneath, my skin gets flaky and visibly peels. But when I do use even a very lightweight moisturizer, I start getting tiny pimples and whiteheads that stick around for days. If I extract them, they leave dark spots, which just adds to the hyperpigmentation issue.

So I’m considering adding azelaic acid (around 10% or lower) in the morning. I’ve tried 20% before and it caused burning and peeling, so I’m hoping a lower strength might help with both acne prevention and dark spots without irritating my skin.

Current routine:

AM:

Cleanser

Very lightweight moisturizer

Oil-control SPF 50+

PM:

Cleanser

0.025% tretinoin

Moisturizer

Has anyone dealt with something similar?

Would adding azelaic acid in the morning help or just make things worse?

Appreciate any advice or experience you can share.