SKIN UPDATE #5: 0.04% to 0.1% Tretinoin, 6+ Months of Spironolactone, Professional Microneedling

My last skin update back in the summer 2020, I was using 0.04% Retin-A Micro for 1 month, and started taking Spironolactone. Since then, I have done 3 professional microneedling sessions for my acne scars, got prescribed the highest strength of Tretinoin, and have experienced a few side effects from Spironolactone.

For further context, please check out previous posts!


ACNE – 0.1% Tretinoin, 6 months of Spironolactone

As mentioned in my previous skin update, I noticed a huge improvement in acne control since upgrading to 0.04% Tretinoin from 0.3% Adapalene. A lingering pimple on my cheek finally disappeared, if I breakout, it’s not as inflamed and disappears very quickly. I’m now at the highest strength of 0.1% Tretinoin, and I did find my skin breaking out a bit from using it daily, so I cut back to using it 4-5 days of the week and it seems to be the sweet spot for my skin needs. Overall using topical prescriptions Retin-A Micro and Aczone have really boosted the clarity of my skin and I’ve been really happy with the results!

For Spironolactone, I experienced some annoying side effects the first 3 months of taking 4 tablets of 25mg. I was very dizzy for around two weeks, to the point where I had a few close calls of fainting. The second most annoying side effect was spotting. I’m not talking one week (which did happen), I’m talking an entire month. AN ENTIRE MONTH OF SPOTTING! I really wanted to give up at this point lol. However I stuck through it for 3 months, got my blood tests done (all good), and have currently found my sweet spot dose of 2 tablets daily. I noticed when I tried to go down to 1 tablet and I carb cycled that week, I would get breakouts – albeit not as large or inflamed as they used to be! With 2 tablets I notice I rarely break out and my skin has not felt uncomfortably inflamed from active acne in a long time! Overall Spironolactone is helpful at controlling breakouts particularly when I have too much carby foods, but other than that my skin seems well controlled with my regular eating habits plus the use of Retin-A Micro and Aczone.


SCARS – Microneedling Treatments

Yes, I FINALLY got professional microneedling done! I did all 3 sessions and plan on writing up a separate post on what both the medical esthetician and I have noticed prior to the treatment.

For those of you who have read previous skin updates, I mentioned that I would be getting treatments at my dermatologist’s office. However I went with the medical esthetician who’s certified in microneedling because I know her personally, and she has been in this profession as an educator and consultant for decades. Having said that, it also didn’t cost me $1525, but I saved up expecting to pay a high amount either way!


PLAN OF ACTION

  • Continue taking 50mg of Spironolactone – I have been thinking of discontinuing because I know how my eating habits effect my breakouts, this has just been a bandaid for my indulgences.
  • Use 0.1% Tretinoin forever – Seriously, I have the peak of its strength, my acne is under control, and all I can do at this point is be patient and consistent for well aging benefits.
  • Still apply Aczone (5% Dapsone) day and night – I’ve noticed this year using it consistently has greatly contributed to my acne control. So if it ain’t broke, don’t fix it.
  • Since I have completed 3 sessions of microneedling, I was told to wait 8 months to do more if needed. In the meantime, I can do other treatments (not like I can anymore).

And that’s it for this update! It’s probably the quickest one I’ve ever done, but I guess that’s a good thing – less things to complain about and pay attention to lol. I have to say, with a shit show of a year 2020 has been, at least I’ve come to the point where I am quite content with my skin – at age 30!

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