Photos 1-4 day 1, photos 5-6 day 3, photos 7-10 day 6. Photo 11 is from 7 months ago for reference.
After about 3 years of obsessively trying to fix my skin, including strict routines, extreme diet restriction, and even a 7-day water only fast, I think I might have been treating the wrong condition the entire time.
Most of what I thought was acne may actually be perioral dermatitis (POD), and I’m currently 6 days into zero therapy (ZT) trying to reset my skin.
I would really appreciate outside opinions because I feel like I’ve been stuck in my own head about this for a long time.
Backstory:
I started skincare in high school with mild acne. I went to a dermatologist and built a very strict routine: cleansing twice daily, Epiduo in the morning, tretinoin at night. I was also told not to use moisturizer, so my skin was constantly dry.
At first, my acne improved, but never fully went away. There was always at least one new pimple.
At some point I became convinced diet was the issue so I went all-in:
I completely cut sugar, processed foods, dairy, carbs, seed oils. I ate only whole foods I prepared myself, and I did OMAD and multiple prolonged 3+ day fasts.
After a few weeks, my skin became completely clear for the first time since I started skincare. I also started using a moisturizer. I started with CeraVe PM Ultra Lightweight and eventually switched to La Roche-Posay Toleriane Double Repair Face Moisturizer with Niacinamide.
That moment honestly changed everything because for 4 months straight afterwards my skin stayed completely clear.
One day, 4 months later, I randomly broke out, and obsessed with recreating my clear skin, every time I broke out, I would eliminate another food from my diet. It became a cycle of: something would seem to work temporarily, then I’d break out again, and I would cut another food out again and repeat.
Eventually, my diet became extremely restrictive, but the breakouts never fully stopped.
Pattern I didn’t recognize at the time
Looking back, almost all of my “acne” over the past few years has been in very specific areas:
The corners of my nose, nasolabial folds, around my mouth and chin, and between my eyebrows.
I also had constant dryness and redness in these areas no matter what I used. At the time, I thought more moisture would fix it or that it was still diet-related.
Things started getting worse
When I got to college, I initially had another stretch of completely clear skin, even while eating more variety (still dairy free keto but I ate a few things cooked with canola oil).
But once I had more free time and access to my room following the end of an intensive summer program I was a part of, I started reapplying moisturizer throughout the day, especially on the dry areas around my nose and mouth. Not long after that, I started getting bumps and irritation again.
From there, it spiraled back into trying to control everything: my food, routine, and lifestyle all over again, despite having loosened up after a prolonged clear period. But nothing consistently worked.
Dermatologist + turning point
Over winter break, I went back to a dermatologist mainly because of redness (I also have keratosis pilaris rubra, which on top of an irritated barrier made me almost a glowing red even when my skin was clear).
He suggested I stop tretinoin and Epiduo and prescribed metronidazole, mentioning perioral dermatitis.
This was the first time I had heard that term, but I didn’t fully look into it at the time.
After stopping retinoids, my skin initially stayed clear, but then I started breaking out in places I hadn’t in years (forehead, cheekbones), and everything felt unstable again.
What changed my perspective
After months of frustration, I finally stopped focusing on food and started looking deeper into my skin itself.
A few things clicked:
My skin barrier has likely been compromised for a long time
Most of my breakouts were in classic POD areas
Products I was constantly using (niacinamide, hyaluronic acid, retinoids) can all trigger or worsen POD
Reapplying moisturizer multiple times a day may have been making things worse, not better
I also realized that even when I did get “acne” over the past few years, before now, they were mostly just small, fast-forming bumps in those same areas. I just did not recognize them as something potentially different.
What pushed me to try Zero Therapy
After giving up on metronidazole I tried to incorporate Epiduo but with a lot more moisture. I bought the big CeraVe Daily Moisturizing Lotion so I could put a lot on since it is cheap, which made my skin dewy, but I got more painful POD like bumps and my skin was still chapped despite being layered in moisture.
About 2 weeks ago, I went back to my original routine without moisturizer again (Epiduo + tretinoin). Then one day, I used a moisturizer again (CeraVe PM with HA and niacinamide), and the next morning I woke up with:
multiple painful bumps in my usual areas
extreme redness
chapped, irritated skin
This reaction was worse than what I had been experiencing while using two retinoids daily without moisturizer.
That was the breaking point for me.
Current routine (Zero Therapy)
For the past 6 days:
rinse with water morning + night
no cleanser
no moisturizer
no actives
Only exception:
hypochlorous acid spray whenever a pustule hardens and falls off as an antimicrobial (sprayed only directly on location).
What’s happening so far
First few days: extreme dryness, flaking, tightness. Lips also became very chapped (which was new for me).
Now:
Redness is starting to go down, areas around my nose are no longer painful for the first time in a long time. Some bumps in POD areas are coming to a head very quickly and resolving fast.
However:
I do have some breakouts on my forehead and cheekbones that look more like actual acne. This is what I am most unsure about.
My current thinking
I’m fairly confident that at least part of what I’ve been dealing with is POD. However, I also think I may have some mild acne separately.
What I’m unsure about is: whether the acne I am seeing now is just my skin adjusting or if I’ll eventually need to treat that separately.
Plan going forward
I’m committing to ZT for at least 3+ weeks and then adjusting based on what happens:
If POD doesn’t improve → consider doxycycline while continuing minimal routine
If POD improves but acne worsens → may also consider doxycycline
If both improve → continue ZT longer
If POD clears → slowly reintroduce products
In the case of 3 and 4 I plan to reintroduce in this order:
Vanicream Gentle Facial Cleanser first (no HA or niacinamide)
then Vanicream Moisturizing Lotion (no HA or niacinamide)
then potentially The Ordinary 10% azelaic acid [azelaic acid, from my research, seems like it would be the most well rounded active for my skin concerns]
Final note
I know this is long, but this has honestly taken up a huge part of my life over the past few years.
I’ve also been working on not letting my skin control my life anymore. I’ll still go out, see friends, etc, but I do want to understand what’s actually going on so I can handle it better long-term.
Questions
Does this sound like POD to you, or a mix of POD + acne?
Has anyone had similar reactions to niacinamide / HA / moisturizers?
Does my ZT approach make sense, or am I overcorrecting again?
If you read all of this, I really appreciate it. I plan to continue to update over the coming days/weeks/months.
[Just a note, I had originally written a huge summary of my experience with skin over the past few years and how I ended up where I am now but it was many pages long so I did use AI to help me shorten it into something I could post] Let me know if any of you are interested in seeing the original story and if you have any other questions.