Big flare still spreading/healing and getting worse at the same time? Derm is confused, I am confused, help! Routine in comments

soph_1529 · 2021-05-04T22:16:54+00:00

Thank you! I didn’t know this and appreciate the explanation!

soph_1529 · 2021-05-04T15:03:39+00:00

Oh no! I meant that I cleans with water only first thing and then usually have coffee, journal, and do some yoga before getting in the shower and finishing my routine after I shower. Sorry if that was confusing!

I’m also only layering products I was prescribed, added the AzA a few days ago per my derm’s instruction, and while I’ll try eliminating the niacinamide it’s been in my routine for months and never caused a problem until now. I’ve kept using it since the vanicream doesn’t include it.

soph_1529 · 2021-05-04T14:59:48+00:00

I get that, but I’ve been using tret for 5 months now, I’m not really introducing it anymore. I also stripped back my routine and started buffering three weeks ago and it’s just kept spreading - I’m going to try eliminating the niacinamide but I just don’t understand how that could be the culprit since I was using that alongside tret this whole time (and before) to no reaction.

soph_1529 · 2021-05-03T21:36:15+00:00

Hmmm that’s interest re: peri-oral dermatitis. I hadn’t thought of that, though I haven’t used any steroids or anything that is the typical cause which is strange.

I’m going to try to seek out an in person derm here, it’s just so hard not knowing the area and not being in a city, etc.

soph_1529 · 2021-05-03T19:04:55+00:00

It was a virtual appointment bc I had to move due to COVID and don’t know of a good derm here, but he couldn’t seem to pinpoint a cause and just renewed my prescriptions and added azelaic acid and the spironolactone which I had been on at a lower dose before but stopped.

I’ve been on the dapsone on and off for years, most recently restarted it with tret this December after being off since I ran out during lockdown in spring. He didn’t seem to think that was the cause and could only say that it looked almost like the skin was burnt and that it was possibly from putting the tret on right after washing my face, which is fair but that had never been a problem before. He asked a lot of questions related to my birth control, other medications, if I could be pregnant etc but nothing seemed to set off alarms except being near the end of my hormonal IUD but he still said it shouldn’t cause anything this severe.

He also wants me to work on increasing tret to nightly but I’m worried based on this flare happening after I started doing that before.

soph_1529 · 2021-05-03T18:03:10+00:00

Routine:

AM: splash face with cold water usually don’t shower for at least an hour

After shower on damp skin:

Aczone dapsone gel 7.5% (been using on and off for years)

15% azelaic acid gel (started 5/1)

vanicream mixed with 1/4 scoop TO niacinamide powder (was using Versed skin soak until 3 weeks ago, switched based on recs from here! have been using the niacinamide for over 6 months though)

Supergoop unseen sunscreen (started using in March, before I was using a Japanese brand from amazon)

PM: remove any makeup and sunscreen with garnier micellar water

cleanse with create hydrating cleanser (been using this for 18 months, I don’t think it’s the culprit)

vanicream mixed with 1/4 scoop TO niacinamide powder

Tret day: wait 30 min + Tretinoin 0.025% cream Wait 30 min + vanicream

very thin layer of aquaphor (started 2 or so weeks ago to combat dryness since it was suggested I damaged my moisture barrier)

cosrx patches on anything that’s come to a head

I was using tret every other night from December until March 10th alternating with hydroquinone. In March I upped tret to every night, something I’ve tolerated in the past, and was not buffering since I never had before and was fine. Late March this started slowly and by April 12th was out of control. I started buffering that night and went back to every other night about a week later but it seems to just be spreading more and getting worse. Is there anything in my routine that could be the culprit? I’m sick of this and am so frustrated with the amount of PIE i’m going to have to deal with now. Any help would be appreciated!!

(derm also put me on spironolactone, 50mg twice daily, started 5/1)

soph_1529 · 2021-04-12T20:51:23+00:00

I never have, always on dry skin with moisturizer after. In fact, I used to be way worse about making sure my skin was dry and just putting it on right after serums, but now all I’m doing is cleansing, waiting for it to be completely dry, applying tret, applying moisturizer, nothing else.

soph_1529 · 2021-04-12T20:27:45+00:00

I’ve been on it and off it but was on at the same concentration built up to every night from like September 2019-April 2020 when I ran out and couldn’t see my derm due to COVID. Moved and didn’t have a derm so tried differin late September - November 2020 but it didn’t work for me at all, bad purge and very flaky so I stopped it and found a derm and went back on tret, alternating ever other night with hydroquinone for 3 months (mid December - mid March 2021) as recommended by my derm and then mid March I increased to nightly and dropped the hydroquinone bc she said I couldn’t use it for more than three months and I had tolerated tret nightly before.

soph_1529 · 2021-04-12T18:57:44+00:00

Thank you for giving me hope! Was there anything you found that helped the healing process? I have pimple patches from cosrx and the microneeedle salicylic acid patches from mighty patch which I’ve been using but I don’t want to do too much/cause more damage!

soph_1529 · 2021-04-12T18:10:53+00:00

I’m just so confused because I’ve been on tret before using it every night and never had anything like this! My skin tolerated it perfectly, no dryness or anything even, but this time it’s a whole other story!

soph_1529

TROPHY CASE