SKIN UPDATE #4: Switching From Adapalene (Differin) to Tretinoin (Retin-A), Taking Spironolactone, Acne Scar Revision?

Sun’s out, lockdown is sort-not-really lifted here in Ontario, and I saw my dermatologist for the 2nd time. My 1st visit was back in October 2018 so I was definitely overdue for a follow-up of how my skin has been. It was quite a productive appointment, so I thought I’d share what’s new in my pursuit to clearer skin!

Previous Skin Updates:
Skin Update [#1] December 2018: Acne + Scars
Skin Update [#2]: August 2019: My Skin’s Progress so Far!
SKIN UPDATE #3: 1+ Year using Differin

Recap of what I’ve been doing since January 2020:

  • Using 5% Dapsone (Aczone) day and night
  • 2 at-home microneedling sessions with the Banisher 2.0
  • Eating High Fat Low Carb (Keto) and working out consistently
  • Visited dermatologist – prescribed 0.04% Tretinoin (Retin-A Micro) and Spironolactone

ACNE

Staying consistent with Aczone for the past 4 months has really helped to control my acne. Reflecting more, this is the first topical prescription I have tried that had a minimal adjusting period. It reduces inflammation quickly, prevents painful large breakouts (my last update I had that huge AF cyst -_-); It also plays really well with other actives – Adapalene, Tretinoin, L-Ascorbic Acid, AHA, BHA. Despite my concerns and initial redness in the first couple of months using it, Dapsone has been fairly easy to use in my routine and had the most minimal to no side effects from *knocks on wood*.

Alongside my nightly use of 0.3% Adapalene (Differin), eating Keto and working out consistently has also contributed to my skin’s clarity. I found most of the time my skin stays pretty clear, I don’t get a painful cyst during my period, and any inflammatory breakout subsides quickly. My guess on this is that my hormones are becoming more balanced.

The one huge issue I have been having with my acne though is when I just want to indulge in something sweet and/or carby. I don’t eat many carby foods anymore, but on the off days when I do (say once every 2 weeks), my skin is NOT having any of it, and I break out no matter what. Why not just eliminate sweet/carby foods completely? Cause I’d like to enjoy foods like gelato once in a blue moon, or not be picky at a family gathering when someone has spent an entire morning and afternoon cooking.

5% Dapsone, Spironolactone and 0.04% Tretinoin

After discussing with my dermatologist what my eating habits are, digestive history, oral medication history, and my future plans, she prescribed me Spironolactone and bumped my Vitamin A prescription to 0.04% Tretinoin (Retin-A Micro (RAM)). I have read many positive experiences about Spironolactone and I’m excited to see how it contributes to my skin’s health. For the 0.04% Tret, I asked the derm if it was actually “lowering” the dose since most studies compare 0.3% Adapalene to 0.05% Tretinoin; She said 0.04% Tretinon is still stronger than Adapalene so it should have a better effect for acne prevention and of course, preventative aging benefits!

I’m really hoping that 5% Dapsone, 0.04% Tret and Spironolactone together will show greater improvement in my skin clarity and health, especially on my cheat days :3


ATROPHIC SCARS

The original reason for my appointment was for a consultation on Acne Scar Revision. In short, the 2 options presented to me were Microneedling (3 sessions to start) or Fraxel laser (also 3 sessions, not sure if she meant Halo – Hybrid Fractional Laser or ProFractional). However because I am still breaking out, I must wait to clear my face again (maybe a month or 2) until I can book a treatment. In the meantime, I’ll continue the at-home microneedling. Once my face is more consistently clear, I can book an appointment. I’m leaning more towards microneedling because 1) the down time is only a day 2) 3 sessions would cost me $1350, whereas Fraxel is $1000 PER SESSION, and I would need to do around 3! So given that, I’d rather pay for 6 microneedling sessions.


PLAN OF ACTION

I only just started my new prescriptions, so my plan of action is just to follow what my derm told me to do:

  • 100mg of Spiro daily to start; Decrease the amount by 25mg once acne looks more controlled until I only take 25mg daily.
  • 0.04% Tret twice a week; Increase the usage as tolerability goes up
  • 5% Dapsone day and night
  • If in a month my skin has cleared up, I can book an appointment for an Acne Scar Revision treatment

I am definitely still continuing Keto (and working out) – I have never seen such a drastic change in my gut health and I feel a lot better and healthier. My derm is aware of my lifestyle choices so I trust she wouldn’t have prescribed Spiro otherwise.


And that’s it for this skin update! Not as complicated, but still a work in progress.

If you’ve ever been on Spiro or currently taking it, let me know how it’s been going for you in the comment section down below!

xo, M