Treatment resistant acne

[SpazTheCat]

Hi,

Just looking for a second opinion on the cystic acne I’ve been dealing with and a plan to re-introduce testosterone. The back ground is a little long but pertinent, I think.

Back in May I started a course of prednisone for an ulcerative colitis flare up. About 3 months after that, I started on TRT. I felt more terrible than usual with the flare up and had my testosterone checked. It was 240 ng/dL. I’ve been using the 20% compounded cream. 100mg to the scrotum in the AM and 100mg to the scrotum in the PM. Had a total testosterone ~1400. The prescriber did not measure DHT but I think we all know it probably was crazy high. I reduced the dose down to 50mg AM and 50mg PM as I felt a little off/bloated/edgy on that high of a dose. Felt great after the dose reduction.

During the treatment with prednisone, my skin was great. No cysts, just the normal pimple here and there. But, every time I tried to taper the prednisone down, I’d get pretty bad cystic acne. This occurred both before I was on the testosterone and after I was on it. The distribution was also rather strange. Odd places like my neck, bridge of my nose, orbits of the eyes in addition to just my face in general. So, I thought it was more related to the prednisone than the testosterone.

I finally stopped the prednisone the 2nd week of December and the acne peaked at that point and spread down to my chest in addition to my face.

I had been working with a dermatologist since it flared up in December (he also felt it was prednisone related and not the testosterone). Nothing seems to work. We’ve been through pretty much every topical treatment on the market. The only thing that brings them down is an injection with kenalog. Oral antibiotics and accutane are not options due to the UC. Oddly, the chest pretty much cleared up on it's own after about 4 weeks of being off the prednisone.

I finally decided to stop the testosterone. Within 3 weeks, it was pretty much gone. Not totally but I went from 1-2 new cysts per day down to 2-3 in the course of a week. So, seems pretty clear that the testosterone is playing part in this despite the thought that it was related to prednisone.

I’m now contemplating restarting the testosterone. I was thinking of starting with 50mg applied to the inner thigh daily and see how the acne does over 1-2 weeks. If it doesn’t increase, then I’d start bumping up the dose, wait 1-2 weeks, and repeat until it flares up or I hit 150mg daily.

Does that sound reasonable? I proposed that plan to the provider managing the testosterone and got a rather unhelpful response that didn’t directly answer my question. But, did imply it was a stupid idea and if I am prone to acne on testosterone, I’ll just have to deal with acne regardless of dose. Seems to me I should be able to find a dose that doesn’t cause a really bad acne flare. Maybe, I’m wrong…

I guess my other option would be to give it another couple of months to see if whatever craziness the prednisone did to my sebaceous glands resolves. I still think that the prednisone has something to do with this.

Thanks,

Andy

 

[sammmy]

Looks like prednisone can cause acne, including fungal acne. When you stop it, your immune system starts cleaning up infections that may have multiplied. Your skin then flares up with "acne" at places where there is an infection to clear up. Acne spreading down on chest sounds like fungal acne. Your dermatologist should have tried topical antifungals.

Can Taking Prednisone Give You Acne?

Steroid acne or prednisone acne can be a side effect of treatment with these drugs. See what it looks like, why it happens, and how you can treat it.

www.verywellhealth.com

What Is Fungal Acne?

Fungal acne leads to breakouts, itching, and irritation on the skin’s surface. It's often confused with common acne. Learn how to treat fungal acne.

www.verywellhealth.com

 

[sammmy]

Your restarting T sounds reasonable. If acne appears, consider the possibility that it is a fungal type acne - testosterone increases sebum production which can feed the yeast on the skin.

Steroid-induced fungal acne (malassezia folliculitis) is treated with topical antifungals, such as ketoconazole shampoo, or an oral antifungal, such as itraconazole.

 

[Systemlord]

I finally decided to stop the testosterone. Within 3 weeks, it was pretty much gone.

So, seems pretty clear that the testosterone is playing part in this despite the thought that it was related to prednisone.

Topicals testosterone is going to increase DHT, more than injections. Maybe try injections which doesn't produce as much (DHT) ance as topical treatments.

 

[SpazTheCat]

Thanks for the responses. We did talk about fungal acne but my dermatologist ruled that out based on appearance. But, given the persistence, it’s worth pushing that idea a bit more.

Fun fact, you can use a black light to help diagnose fungal acne at home. That’s basically a Wood Lamp.

Thanks,
Andy

 

[Gladiator]

Take zinc

 

[nodoctor]

Clearly not the root cause, but a whole food plant-based vegan diet has conclusively shown to reduce all kinds of acne, which has been my personal experience as well.

 

[SpazTheCat]

Thanks. I do already take zinc and Niacinamide.

True on the vegan diet and it probably would be helpful for ulcerative colitis as well. But, I just can’t seem to get there. Just not disciplined enough to make that a permanent thing. It has driven me to a more plant based diet than a lot of people, though.

 

[sammmy]

Some people get rid of colitis on carnivore diet.

The current "science" claims that only vegetarian diet works but nutritional medicine currently does not have a high credibility, nor a good understanding or treatment of chronic digestive diseases. The same "science" claimed in the past that heart disease is caused by eating fat, while recently it becomes more and more clear it is from eating too much sugar.

 

[nodoctor]

Aside from anecdotal evidence, I would be shocked if you can back either of those claims with any long running double blind, placebo crossover studies.

 

[sammmy]

Contemporary medicine is so limited in its understanding and cure of chronic conditions, that a lack of double-blind placebo controlled studies does not mean a claim is not true.

When you get one of those unexplained conditions, you have the choice to wait 100 years for someone to fund such a study or simply follow anecdotal reports and hope they are true in your case.

And that's what patients literally abandoned by contemporary medicine do. Some did get rid of horrific immune driven conditions, no guarantee it will work for everybody but worh a try when there is no a sure alternative offered by western medicine.

 

[Nixter]

I've found my TRT acne to be very stuborn as well. One thing that's worked quite well is B5, aka, pantothenic acid. 3000mg/day, split morning and night

 

[SpazTheCat]

I've found my TRT acne to be very stuborn as well. One thing that's worked quite well is B5, aka, pantothenic acid. 3000mg/day, split morning and night

Interesting. Easy enough to try. That is quite a dose, though. Did it really require that much? Have you tried lower doses?

 

[Nixter]

Interesting. Easy enough to try. That is quite a dose, though. Did it really require that much? Have you tried lower doses?

It's the "normal dose" for B5 used for acne

 

[Nelson Vergel]

Guidelines of care for the management of acne vulgaris

Background Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older. Objective The objective of this study was to provide evidence-based recommendations for themanagement of acne. Methods A working group conducted a systematic review and applied the...

www.excelmale.com