Why do I still have acne?

[Kg147]

Hello,

I am new to this forum, but I really hope I can find some answers! I have always had spots - the deep painful kind that don't usually come to a head, but about a year ago I had a massive flare up. I had little bumps all over my face, as well as many deep cysts/spots. It really impacted my self-confidence and I am thinking about my skin 24/7.

I was very desperate and was put on isotretinoin which I have been on for nearly a year at 40mg/day. I am due to finish my course this week and I am absolutely terrified it will come back.

On paper, I am not someone you would think would get acne. I do not eat dairy products, I have recently cut out gluten, I have cut out all refined sugar (using dried/fresh fruit, honey, or maple syrup as sweeteners). A typical day in my diet is: porridge for breakfast, a rice and veggie bowl with fish or eggs for lunch, dried fruit/a nakd bar for a snack, fish with veggies and potato for dinner, and dried fruit in the evening if I feel like it. I drink lots of water (2 litres a day), and raw honey with lemon both in the morning and at night. I also drink a bit of red wine. My guilty pleasure/treat is either hot cacao sweetened with maple syrup or raw brownies made with paleo ingredients.

I supplement with 25micrograms of vitamin D in the morning, along with ferrous fumarate twice daily. I take my isotretinoin with lunch. I am also on an anti depressant as I have had very severe anxiety and OCD.

However, even on isotretinoin I am still experiencing deep painful spots (i always have at least one at any one time).

I am 21 years of age, however only started my periods this year, but they are now regular and heavy. I spoke to my Dr, but she put it down to me having a low weight due to a previous eating disorder (despite me being weight-restored for 4 years now).

Other symptoms i struggle with include: slow healing (my acne spots and scars, as well as scratches and bruises linger for months), being constantly cold, feeling tired especially after eating even if I have just had a nap (I have to have at least once a day), sugar cravings, constant hunger even if I have just eaten, heartburn and also drastic mood swings.

I am very frustrated as I have had to put a stop to my whole life due to my acne, but I am struggling to understand it. I feel like I have no control over my body. Oddly, the onset of the massive flare of acne i experienced coincided with the development of very fine white hairs all over my face and back which I have never noticed before.

Sorry for the rant - I am just at my witts end! My grandmother had her thyroid removed as she had nodules grow on it, so I wonder if my problems are related to my thyroid?

I have had blood tests which showed the following:

Inflammation: CRP HS = 0.38mg/L

Iron: ferritin = 20.9ug/L

Vitamins: vit B12 = 79.9pmol/L, vit D = 55.3nmol/L

TSH = 1.9mIU/L

Free T3 = 4.41pmol/L

Free thyroxine = 11.2pmol/L

Thyroglobulin antibodies = 22.4kIU/L

Thyroid peroxidase antibodies = 132kIU/L

Thank you for taking the time to read all this!

[greygoose]

It does sound very likely that you do have a thyroid problem, yes. And you probably have Hashi's and your nutrients are low. But, we cannot interpret your blood test results without the ranges. Results without ranges are meaningless, because they vary from lab to lab. So, if you could add them, please, someone will say something intelligent.

[Kg147]

Thank you greygoose - sorry I didn't realise ranges were lab-specific!

Inflammation: CRP HS = 0.38mg/L (range<5)

Iron: ferritin = 20.9ug/L (range 13-150)

Vitamins: vit B12 = 79.9pmol/L (range>37.5), vit D = 55.3nmol/L (range 50-175)

TSH = 1.9mIU/L (range 0.27-4.2)

Free T3 = 4.41pmol/L (3.1-6.8)

Free thyroxine = 11.2pmol/L (12-22)

Thyroglobulin antibodies = 22.4kIU/L (<115)

Thyroid peroxidase antibodies = 132kIU/L (<34)

[SlowDragon Administrator in reply to Kg147]

High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

Ft4 is BELOW range

Ft3 is very low

Ask GP for referral to recommended thyroid specialist endocrinologist

Email Dionne at Thyroid UK for list of thyroid specialist endocrinologists

[e-mail]

Ferritin is very very low

GP should be doing full iron panel test for anaemia

Ask GP to test Serum B12 and folate too

How much meat do you eat?

B12 is often linked to acne

[SlowDragon Administrator]

High antibodies confirms you definitely have autoimmune thyroid disease

But

Looks like your acne medication may possibly be implicated too as causing central hypothyroidism

Insist on referral to endocrinologist

jddsjournal.org/article.asp...

hindawi.com/journals/cripe/...

Until then, clinicians should be more cautious when prescribing isotretinoin to patients with a known family history of autoimmune disease.

karger.com/article/pdf/345680

Autoimmune disorders may be triggered by oral isotretinoin treatment. Clinicians prescribing isotretinoin should be aware of the possible association between isotretinoin intake and concomitant autoimmune thyroiditis and OMG.

endocrine-abstracts.org/ea/...

[Kg147 in reply to SlowDragon]

I didn't realise isotret could interfere with the thyroid! Thats really interesting- thank you!

[SlowDragon Administrator in reply to Kg147]

Doubt your GP will be aware either

[Workingitout]

I had acne into my 30’s which was caused by poly cystic ovaries, PCO syndrome. It is also associated with excess hair on your body, face etc. I think the route cause is hormonal and may all be linked with autoimmune condition affecting the hormones, pituitary gland etc. Mine got worse with dairy products so good to hear you are avoiding dairy.

[Kg147 in reply to Workingitout]

Thats really interesting! My mum had PCOS, but i have had a hormonal profile and this came back as within range. I've researched ways of managing PCOS anyway and am hopefully doing so through diet and exercise.

[NWA6]

You were 21 before having your first period!! Did they investigate? Have you had these blood test through GP or privately?

Your FT4 is not even in range?

For sure you have Hashi’s. Do you have any other symptoms of Hypothyroiod?

Acne was the bain of my young life!! I was on Roaccutane twice. Chemical peels ect. These treatments did help but really all along I probably had Hashi’s. I wasn’t diagnosed till I was 34. Once I started Levo that was when my skin first became clear! 🙌

Acne was painful and debilitating and humiliating for me.

[penny in reply to NWA6]

I had the same thing and didn’t get rid of my acne until nearly 50 years of age (the really bad spots started when I was 18) when I was, at last, diagnosed with hypothyroidism and treated with Armour thyroid. I can recall the years when my face was distorted with painful, blind spots and how awful this made me feel. I too was given roaccutaine, which worked while taking it but the spots came back immediately on cessation. I do not think that my thyroid hormones were ever tested. Sadly one cannot turn the clock back.

[NWA6 in reply to penny]

And you know what my GP kept saying when I said it was a Thyriod symptom? She denied there was a link and said that probably i was taking too much thyroxine and that was causing overproduction of sebum and causing these blockages. She would not accept what was really happening which was that I wasn’t a good convertor and needed T3. We had many a falling out. I haven’t seen her in nearly 2yrs 🥳

[penny in reply to NWA6]

When my Armour Thyroid became unavailable I was put on levothyroxine and became thyrotoxic as I was not converting to T3. I noticed in my medical records that a GP had twice tested my T3 and it was 0.03 and then 0.01 (I think) no ranges, but nothing was done. I found that because my T3 was so low my brain did not work and therefore I did not know that I was so ill. Sounds odd, but that is how I would describe it. Each day was just a battle to get through and there was no energy or brain power to think of anything else. Goodness knows how I held down a job and did a degree. Had I not been so ill I could have done so much better.

[Kg147 in reply to penny]

Im glad you found that it was T3 that you needed I'm! I'm actually finding the same thing with regards to brain fog/being barely able to function. I managed a placement as part of my degree but I look back and wonder how I got through it.

[NWA6 in reply to Kg147]

Just bear in mind that most people don’t need T3. They do perfectly well on the optimal dose of Levothyroxine

[Kg147 in reply to NWA6]

I had to get the blood tests privately in the end as the doctors kept saying I was within the range for the basic thyroid function test and not taking it any further, but my mum pushed me (thank goodness) to get private tests which have shown im not in range at all!

Acne is awful, im glad you have managed to get to a happier place with your skin! Hopefully I'll follow close behind.

[flaccus in reply to Kg147]

I’ve done several thyroid tests through the NHS and they’ve all come back within range as well but my acne is still very bad. Can I ask what type of tests you did privately? I should do the same. Thank you