Since it started around her mouth-- is it possible she has a food allergy? That can cause rashes and breakouts on the face. Just an idea.

If the prescribed medications don't work within a month or so, she should try a different dermatologist. She may also want to get blood work done, especially a hormone panel. It seems strange they had no diagnosis for her at all, especially with an onset in her 30's.

Skin problems are so difficult to deal with, and as you say, hard on the self-esteem. I've dealt with varying levels of acne/rosacea for years, and feel like I could be a dermatologist at this point :-) My son is starting to get little pimples at the age of 9, and it absolutely breaks my heart.

Violet this sounds like the acne from polycystic ovarian syndrome (PCOS) there are other skin symptoms but some women develop cystic acne on the lower face, jawline, chin.
Acne coming on after early adulthood with no skin issues and the type of lesions you describe would point to hormonal. If she has any issues with her period or weight gain have her look into this.
Of course impeccable diet with no sugar and water water water; but diet and antibiotics are not cures for hormonal issues.

My 30 year old daughter has been dealing with the same type of thing for the past several months. She never had any skin problems as a teen. She is a healthy eater and exercises regularily. She has been depressed and upset about this skin problem. She also hated leaving the house for work and social events. She thought the skin problem might be hormonal but she has had no issues with her period or weight gain. Her baby is 18 months old so she thought it was a little too post pregnancy to be that.
She did go to a dermatologist who prescribed Retinaol A, antibiotics and some specific face wash. After more than a month on these things, her face was worse than every and she had ended up with 2 yeast infections. She was miserable. She quite the antibiotic. The doctor then recommended a different medication (sorry, can't remember the name of it) but after reading up on it she decided not to use it.
After much research she has started taking high potency Oil of Primrose, and switched to completely natural skin cleanser. She does still use a Retinaol A cream but only only half the time/amount previously prescribed.
She started noticing improvement soon after taking the Oil of Primrose tablets. The painful cysts and breakouts are almost completely gone. She still has lots of redness and some scaring but is seeing slight improvemnt with that too. It's been quite a few days since she has called me up crying about skin problem.
Maybe the Oil of Primrose might work for your daughter too. It's worth a try.

Failing all that, perhaps instead of a dermatologist, an appointment with an endocrinologist might be in order.

I am so sorry for what she's going through. Skin issues can be so challenging!

Do the cysts come and go or only go if drained?

How heartbreaking. I have super dry skin so rarely have had that kind of trouble but DH struggled for years.

Could it be MRSA or staph? I think it often looks like severe acne.

I also would look into the allergy angle. DH's skin issues were always much worse in the fall and he hasn't had too much trouble since he started taking allergy pills. He spends a lot of time outdoors and we think the acne might have been his skin reacting to mold or pollen. It's not unusual to develop allergies as you get older.

Has she had any prednisone? It's not a long term solution and it isn't good to take it very often but it was a lifesaver for me when my allergies were unbearable. It's good for inflammation as well.

Edited to add:

Hibiclens works great on MRSA and acne. It's OTC and available at drugstores.

Here is a link that might be useful: Hibiclens

This post was edited by deee on Wed, Dec 10, 14 at 8:30

The more we learn about the human microbiome, the more reluctant I would be to try antibiotics without a diagnosis of a bacterial infection, esp for any length of time as it could easily make the situation worse rather than better.

I agree that drinking lots of plain water is essential.

I also agree with seeing an endo as hormones can play an essential role in skin health.

Finally, (like a broken record) I'd suggest she try meditation. It is a powerful weapon in both stress reduction and boosting immune system function...both of which can help her skin condition, whatever it is.

Here is a link that might be useful: skin microbiome

Just my 2 cents worth, but what about seeing her regular physician (instead of dermatologist) and having a full physical, blood panel, etc. in case it is something such as staph, etc. or caused by an allergy. Her regular doc can do all the preliminary testing and if necessary, send her to a specialist.

thanks for all the suggestions and support, people. I don't think she has a regular doctor -- she's a Portland hippie and is more apt to self treat with apple cider vinegar and honey. Or kombucha, or something. The evening primrose oil might be worth a try, though.

I am not sure what all she has tried. It does seem likely that something is off kilter hormonally--. Is that what an endocrinologist does? -- she's always been thin as a rail, but has gained weight recently. I agree that a dermatologist would be treating the symptoms, and not the cause.

Wish I could be there for her.

This post was edited by Violet.West on Wed, Dec 10, 14 at 11:13

I feel so bad for her! I hate when I even have a cold sore on my lip and just want to hide. As a mom, I also feel your pain in not being able to be there for her.

It does sound like cystic acne, which can be brought on by hormonal changes. I agree that she needs a second opinion.

I do hope it is resolved very soon. Hugs to both of you.

I agree that a general physical is in order with a complete blood work up...perhaps with an internist. If he/she recommends a dermatologist or other specialist I would follow their prescribed regimen with an end date...i.e if no improvement in one month or 3 months,etc. after that, I think I would try to get an appointment at a teaching hospital.

missymoo12 that was the first thing I thought - PCOS! Haha maybe because that's all I've been thinking about lately....

I think a full blood workup is a good place to start and yes an endocrinologist would be able to help.

EDIT: also FWIW, Clinique's Even Better works great for the scars.

This post was edited by Swentastic on Wed, Dec 10, 14 at 12:06

DD definitely needs a regular doctor. That should be the first step.
Actually, the endocrinologist might be a great idea - someone I know discovered she had type 1 diabetes after getting a yeast infection. Blood sugar was tested, and it was over 500.
The food allergy and hormonal changes should be explored.

I had cystic acne when i was in my mid-20s. It wasn't that bad, but not having had acne as a teen, it was incredibly annoying. Mine was determined to be hormone related. I went to a couple of different dermatologists for treatment as I moved from one state to another during that time. One dermatologist actually worked on the cysts themselves - I can't remember now, but she actually injected them with something. I only had that done a couple of times, but I had to go immediately home b/c my face looked like a battle zone for the next 12-18 hours. I also had a topical creme for them. The other dermatologist just used a variety of topical cremes. I don't recall ever having to take any oral medication for it. On the bright side, it didn't last very long - maybe a year, but I didn't have a horrible case of it. Now in my mid-40s, I occasionally get a one or two red scaly patches, but nothing that is horribly noticeable.

I hope she is able to find successful treatment.

My daughter was in a very similar situation 10+ years ago (when she was about 25). She had the blood test and was diagnosed with polycystic ovarian syndrome (PCOS). Her skin was perfect as a teenager and through college.

She is on a birth control pill that keeps it under control. She also gets facials once a month. Her skin stays clear.

She is also super healthy and does not like having to take the birth control pill but when she goes off it, her face starts breaking out again.

Hugs to your daughter!

Violet,
I would start by looking at her diet...she might have some sensitivities for certain foods. I know for me it was dairy products, specifically, milk. If I had it to do over again, I would have cut it out much sooner.

Second, I agree with others here that it could be hormone related.

I hope it gets better for her. I know how difficult it is when you don't know what the cause is.

lovestowalk - if she really wants off BC, tell her to talk to her doc about metformin. Its a diabetes medication but it helps control the hormone imbalance caused by insulin resistance. We're trying for kids so BC isn't an option, and the metformin has been great. Since I've been on most of my symptoms have disappeared.

What I find absolutely crazy is how prevalent this issue is (PCOS - the most common endocrine disorder affecting young women), and how many docs know very little about it.

It may be a long shot, but it may also be worth having the lesions/cysts biopsied. It may be worth asking for the fluid to be cultured as well. My mother had absolutely terrible cysts that went beyond acne. They did clear when she hit menopause. She also had a doctor misdiagnose a terrible rash as psoriasis which turned out to be the skin manifestation of celiac disease which is abbreviated as DH. A biopsy can confirm it. Cultures of the fluid can tell if and what bacteria are involved.

She really needs to see an endocrinologist or a functional medicine practitioner (which may be more her speed if she's on the hippie side).

Has she had any dental work recently? I read that sometimes during dental work, toxins can be released (dental toxicity) due to mercury in amalgam fillings. This might be totally bunk science, but I would be looking at everything if I had a mystery ailment.

Here is a link that might be useful: Functional Medicine

Violet,

Please google "hidradenitis superativa" or "hs skin disorder" and see if this sounds similar to what she is experiencing. It is autoimmune condition and unfournately there is little known about it in this country. It can at times be related to PCOS. If it turns out to be this particular condition, there is no treatment by way of conventional medicine. Diet is the only way it can be controlled. The diet to follow is the autoimmune protocol diet and it absolutely works. I hope you all are able to pin point in short order what she may have and that it is something temporary and easily treated. If it is HS, she will have to live with it forever. But again, the diet works remarkably well. i would happy to talk with you about it more if this sounds like the potential issue.

Is her weight gain something she's noticed happened when everything else stayed the same? In other words, was the weight gain explainable or not? (If not, I would suspect PCOS.)

She should definitely see a doctor and get a full work-up. However, reassure her that it's only for INFORMATION. Once she knows what's going on (or at least, what isn't), she can choose the path that best works for her. As some said, traditional medicine may not work . . .but that doesn't mean other methods won't.

Skin issues are often only a symptom of what's going on. Seems like so many of them are related to inflammation at the root.

these suggestions are so helpful! I'm going to talk to her, and find out what she has already tried and done, and try to come up with a sensible plan of attack.

Part of the problem is she doesn't have the money to swan around and take all sorts of tests and try every medical discipline in the book (who does these days). She has insurance, but that doesn't cover everything, of course.

And I am going to encourage her to get to the bottom of it. It may not be a life-threatening condition, but it's certainly life altering. How do you succeed in getting a job, for instance, when everything is staring at your face (or you think they are).

If she has gained weight recently without changing her diet, she may be hypothyroid which can be associated with skin disorders including a kind of eczema, in addition to a lot of other metabolic problems (long heavy periods, constipation, low bp and heart rate, dry hair, etc.) An endo would be able to check her with a simple blood test. (TSH and Free T4).

This post was edited by AnnieDeighnaugh on Wed, Dec 10, 14 at 15:45

Violet - I strongly suggest that she try the hibiclens that I linked above. It's not a cheap cleanser but it is inexpensive compared to a Dr. visit. Our family has had great luck with it for skin issues and it has many positive reviews. You could order a bottle and send it to her if you think she won't be inclined to spend the money.

Dee

I also second the hibiclens suggestion from Dee. It really does help.

I'll definitely look into the Hibiclens.

Magdalena Lee, the functional medicine looks a bit squirrelly -- reviews says too much reliance on unneeded tests.

Annie, the skin microbiome link took me to a sign in page. ?

Violet, she needs to find a doctor who will help her work with her budget-- someone she feels comfortable being upfront with. She can explain it covers the basics and not beyond. If she needs a specialist, it's really helpful to get recommendations from people who are in the medical profession themselves. If the dr (or nurse) has personally used another dr, that is a great sign.

If she can find a holistic MD,I would start there.

I think we all hope to find one of those, anele. Not too easy in today's medical climate.

I think we all hope to find one of those, anele. Not too easy in today's medical climate.

I had cystic acne for 15 years and found it was solely due to artificial sweeteners of all kinds- Aspartame primarily and later Splenda (soribitol) when it took over. It took ten years to really diagnose this - and, no doctor I ever saw thought diet or food accounted for anything outside of diabetes or something major, btw.

Anyway, if I have anything with aspartame or soribitol, within a week I will get a cyst above my neck.
Every few years, I have a diet coke, and pay for it.

Can't even imagine what it does internally.

Just a thought.

It may indeed be diet related, but I'm pretty sure it's not due to artificial sweeteners. She's All Organic All the Time out there in Portlandia. I did suggest she try elimination diets for caffeine, yeast (including beer), etc.

I had an intern while I was teaching that had polycystic issues and terrible problems with acne. Once she got her hormonal issues in balance, the acne went away. Not sure what treatment she had but I know she certainly felt better, both physically and emotionally.

I know you've had a lot of feedback already, but I thought I'd chime in as well. I had something similar happen to me a few years ago, about mid 30's. I had never had skin problems, not even in my teen years, until then. I started breaking out, only around my mouth, chin and jawline. It was very distressing, and nothing I did helped. I finally went to a Dr. and he gave me a prescription for Locoid, a hydrocortisone cream. I can't remember what exactly he said it was, but the cream worked, and I've not had any problems since.

Back in the day, I had a lot of experience with an endocrinologist and they're not scary guys. I was initially referred because of a persistent rash on my chest, up the neck, but not on my face. Other very bad symptoms started setting in; being exhausted, and losing (not gaining) 43 pounds in a couple of months, having trouble walking.

After much testing, I was diagnosed with Addison's Disease and prescribed Cortef/Hydrocortone - symptoms and rash disappeared within three days of starting the pills. Yes, it's a steroid which many people are loathe to take, but it's a better alternative than having all your organs shut down one by one and dying. I'll be maintained on the Rx for life.

Not meaning to scare you, violet, but an endocrinologist can uncover many things going on in the body that other types of doctors have absolutely no experience with... let alone referring one to a specialist when out of their depth.

Violet, my post disappeared or I must not have hit send, but I would start with the ins. covered doctor, and go from there. If she is not getting anywhere, then I would do a self-pay consultation with a homeopathic MD. I found one in her area (Dr. Soule) but have no idea how good he is. Anyway, that isn't the starting point, just good to know there are options, if that makes sense. She just shouldn't give up.

Duluth, wow-- Addison's Disease. My dear friend, who was really more like a cousin to me, passed away from it. She was 10 and I was 12. It was undiagnosed. She was half Mexican, half Irish. Her mother (Mexican) was very pale . . .as was she. VERY pale. She came home from a trip to Mexico and her skin was unusually dark-- in a tone that I've never seen anyone with. Along with this, she had symptoms like licking pickles, licking the salt off potato chips. Her test scores went down. They put a cot in the classroom for her. Etc., etc. The doctors would NOT believe her mom. They said she was fine. Said she needed her tonsils out (now we are amazed she survived the operation). Said she got dark because she was Mexican. Doctor appointment after doctor appointment, and they turned her away. As her parents were sitting down to discuss what they would say at the doctor's appointment (scheduled for the following day)-- they were not going to leave without answers-- she went into cardiac arrest and passed away. I miss her dearly.

Shortly thereafter she passed away, my father had a dentist appointment. Our dear friend's death was weighing heavily on his mind, and told the dentist her symptoms. The dentist immediately diagnosed her with Addison's Disease. We could never figure out how the dentist knew, and these doctors-- for years-- did not.

If only we had information back then as we do now. So glad you were diagnosed and are OK.

I have known a couple of people who had what it seems you are describing, one man and two women. The man and one of the women were helped tremendously by a protracted course of doxycycline or tetracycline. Both medications are really cheap as they have been on the market a long while. I'm not advocating this treatment, just passing along the info. There are problems associated with antibiotic overuse but I would consider this condition to be well worth it--- if in fact an antibiotic would help.

Since it is a skin condition I would start with a good dermatologist, perhaps one associated with a practice of teaching professionals at a university.

There is a woman who sings with our choral society who has a similar condition and it is terribly distracting when speaking with her. She is a music teacher and I can only imagine how difficult it is for her in a class of middle schoolers. She's not a friend, per se, and we've never discussed her condition. I assume that as an educated person with good insurance she has seen all manner of physicians. I wish your daughter the best with this difficult problem.

Sorry about the link. It's weird. I found the article via google, but when I try to link in, I get the sign-up page too.

IAC, here's another article...hopefully this will work.

The point is, while it's very early in research, they are starting to understand the importance of balance between the good and bad bacteria and our immune system for treating and preventing disease, including those of the skin. Unfortunately, today's antibiotics don't distinguish between the good and the bad.

Here is a link that might be useful: skin microbiota and immune system

I agree that it is most likely to be helped by dietary changes, predinsone treatment, and cortisone and allergy meds.

Regardless of the cause, treatments that reduce inflammation are bound to help.

And if you suspect allergies, look at a T.R.U.E. test. The PA at my dermatologist did this. It pinpoints topical allergy triggers so you can learn what they are and avoid them.

Their website has a lot of amazing information you could access as well.

I am strongly allergic to the preservatives used in liquid soaps and cleaning products. It is even used in organic labeled products. Mesochloroisothiazolanone. It is in EVERY shampoo sold at regular stores.

Also suggest that she not use mouthwash, and use toms of maine toothpaste, and add coconut water liquid probiotics to her regimen as it works on the mucus membranes in the mouth and lips as you take it.

If she has an acute reaction in her mouth to gargle with liquid children's benadryll.

Also if she has recently changed birth control brands of pills this can sometimes cause reactions.

ha! mouthwash. When I scoffed at her making her children do oil pulling (gargling for 20 minutes, really?) and suggested mouthwash, she lambasted me for suggesting she fill her children with chemicals.

Some very good suggestions here. I'll update when I have a chance to talk to her.

My sister had acne all her life. She gave up wheat,dairy, sugar all artificial colors and preservatives.when she changed her son's diet. No acne ever since then. No medications and no special creams. There are so many chemicals in food that can be causing this. I would give it a try and see what happens. She also avoids gmo foods.

This diet also helps with arthritis and any other inflammation in the body.

Wheat is hard to give up. Harder than sugar. Medications don't always work and have side effects. Try a food remedy first but it will take a few weeks to see results. It sounds like nonsense but my nephew with autism stopped stuttering when his diet was changed to eliminate added chemicals in foods. If he gets chips or candies and cookies at school with added colors, etc. his stuttering and hyper behavior returns.

Just a short update -- I did have the chance to talk to my DD and go through all y'alls excellent suggestions. I thought she might be mad that I talked to a bunch of internet strangers/wise women but she seemed appreciative. I urged her specifically to get some blood work and hormone panel work done and source an endocrinologist.

Heartbreaking comments from her: "I was super excited about my 30s until this happened." And her children saying, "We're almost used to your face being all red now, Mom."

I'll let you know if she finds any relief. I appreciate all the support.

Violet, I have a very good, compassionate dermatologist in the Portland area if your daughter would like another opinion. I know he would refer her to another specialist if he thought it were in her best interest. Please let me know.

Small blood arteries may alter as a result of diabetes. Diabetic dermopathy is a term for the skin conditions brought on by these alterations. Dermopathy frequently appears as scaly, light brown spots. These blotches could be oblong or round.

Could it be Perioral Dermatitis? If you think so, I can share some experience.

ETA: Who is at risk of getting perioral dermatitis?

You’re most at risk if you’re a woman between 25 and 45 who uses topical steroids, face creams and more.