Persistent Acne at 21: Exploring Causes and Treatment Options

Acne keeps appearing..?

I would like to ask the doctor, I am already 21 years old, but I still frequently get acne on my face.
I have been experiencing this since puberty, and it used to be localized, but now it is almost all over my face.
Until last year, my menstrual cycle was very irregular, and I took traditional Chinese medicine to regulate my body, which has been more normal since the end of last year.
I have stopped taking the traditional medicine and am currently using the medications prescribed by my dermatologist, including two topical treatments and DOXYCYCLINE, but there hasn't been much improvement, as I still keep getting small pimples.
I have tried to identify allergens and suspect that food allergies might be related because whenever I eat eggs, I notice one or two pimples appear the next day or that evening.
However, even when I avoid eggs, I still get acne, just not as frequently.
It’s really discouraging to have pimples popping up one after another.
I would like to ask the doctor if there are any other reasons, besides food, that could be causing my persistent acne and if it could be related to hormonal imbalances.
I have seen a dermatologist many times without any effective results.
Additionally, if I want to undergo food allergy testing, which department should I visit, and what would the approximate cost be?

Xiao Zhu, 20~29 year old female. Ask Date: 2009/04/06

Dr. Yang Hongzhi reply Internal Medicine

Acne is generally not closely related to food allergies; only in rare cases is it associated with endocrine issues.
However, in such cases, it is usually accompanied by other physical symptoms, such as masculinization or irregular menstruation.
It is advisable to consult a dermatologist, and if the dermatologist recommends seeing another specialist, then you should follow that advice.

Reply Date: 2009/04/06

More Info

Persistent acne can be a frustrating issue, especially when it continues into adulthood. At 21 years old, experiencing ongoing breakouts can be attributed to several factors, including hormonal imbalances, dietary influences, and skin care practices. Let's explore these potential causes and treatment options in detail.

Hormonal Factors
Hormonal fluctuations are one of the primary causes of acne, particularly in young adults. Conditions such as polycystic ovary syndrome (PCOS) can lead to hormonal imbalances that cause increased oil production in the skin, resulting in clogged pores and acne. Since you mentioned having irregular menstrual cycles in the past, it might be worth discussing with your healthcare provider whether hormonal testing is appropriate for you. Treatments such as hormonal contraceptives can help regulate hormones and reduce acne for some individuals.

Dietary Influences
You noted a possible connection between your diet and acne flare-ups, particularly with egg consumption. While food allergies can contribute to skin issues, it’s essential to differentiate between true allergies and food sensitivities. Common culprits in acne include dairy products, high-glycemic foods (like white bread and sugary snacks), and certain fats. Keeping a food diary can help identify patterns between your diet and acne flare-ups. If you suspect food allergies, an allergist can perform tests to determine specific sensitivities.

Skin Care Products
The products you use on your skin can significantly impact acne. Some ingredients can clog pores or irritate the skin, leading to breakouts. It’s crucial to use non-comedogenic products, which are specifically formulated not to block pores. Additionally, over-exfoliating or using harsh scrubs can irritate the skin and exacerbate acne. A gentle skincare routine that includes a mild cleanser, a suitable moisturizer, and targeted treatments (like benzoyl peroxide or salicylic acid) may be more effective.

Medications
You mentioned taking doxycycline, which is an antibiotic often prescribed for acne. While it can be effective, it may take time to see results, and it’s not uncommon for some individuals to require additional treatments. If doxycycline isn’t providing the desired results, your dermatologist may consider other options, such as topical retinoids, which help prevent clogged pores, or isotretinoin for more severe cases.

Stress and Lifestyle
Stress can also play a significant role in acne development. When under stress, the body produces more cortisol, which can lead to increased oil production and inflammation. Incorporating stress-reducing activities such as yoga, meditation, or regular exercise can be beneficial for both your mental health and skin.

Seeking Further Evaluation
If you’ve seen a dermatologist multiple times without improvement, it may be time to seek a second opinion or consider a comprehensive evaluation of your skin and overall health. A dermatologist can provide insights into whether additional treatments or lifestyle changes are necessary.

Allergy Testing
If you are interested in food allergy testing, you would typically see an allergist or immunologist. The cost of allergy testing can vary widely depending on the specific tests performed and your insurance coverage, but it generally ranges from $200 to $1,000. It’s advisable to check with your insurance provider to understand your coverage options.

Conclusion
Persistent acne can be multifactorial, involving hormonal, dietary, and lifestyle components. A thorough evaluation by a healthcare professional, along with a tailored treatment plan, can help address the underlying causes of your acne. Remember, patience is key, as finding the right combination of treatments may take time. Don’t hesitate to advocate for yourself and seek further evaluations if necessary.

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