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How to Destroy Acne ~without accutane~

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Why without accutane? It somewhat worries me that people advise accutane when someone asks how to reduce acne while on cycle, without knowing the actual severity of their acne. Accutane should be the complete last resort for acne.

Accutane has been connected not only to the short term side effects that we all know of (stomach discomfort, dry skin/eyes/lips, liver effects, joint pain) but also to severe, potentially permanent side effects such as: joint pain, Crohn's Disease, Irritable Bowel Syndrome, depression, sexual side effects, dry skin, nosebleeds, reduced healing ability, etc. Accutane is structurally similar to Vitamin A, and most of these effects are related to Vitamin A toxicity. Research accutane side effects, and Vitamin A toxicity before getting on Accutane.

Sure there are plenty of people running 20mg ED/EOD that don't report sides, but is the Steroids community the best bet for long-term safety type stuff? We have people running grams of gear blasting for years without coming off, people running tren as a 'cruise,' people running superdrol for years with never coming off. I guess people think well if I'm running steroids, fuck it i'll run accutane too, but I don't think that's necessarily the right mindset, everyone has their own level of risk and people deserve to know the issues that accutane to cause as well as ways to alleviate their problems without accutane.

Steroids and Acne

Unfortunately, any amount of steroids is going to increase acne if you are predisposed to it. Some hormones will affect people differently, some get more acne on tren, some test, some NPP, etc. Regardless of E2, you will get acne from steroids.

EstrogenE2 high or low can both cause acne, and acne may result even from having normal estrogen levels just due to the androgens in your system. Aim for consistent E2 levels, this will lower your chance of acne the most.

DHT and acne

I've used nizoral before and had a similar effect with head and shoulders (which apparently works on fungal acne, do not know how to identify it though.)

Ketoconazole or Nizoral are typical anti androgens. Get the benefits of stopping DHT from binding to the sebaceous gland without ingesting an anti-androgen.

Lifestyle habits and washing habits for Acne

Firstly, a great resource is and it's subsequent forums and this includes much general consensus from acne groups.

Refrain from using harsh washes or activities that will increase inflammation of the skin (#1 reason for acne). This means:

  • Do not use alcohol, sulfates (soap), acne bead scrubs, overly drying washes. instead use gentle cleansers, ( has one), sulfate free, and wash your face very lightly and splash water to wash it off. PAT to dry DO NOT scrub.

  • Do not touch, scrape, or pop your acne. Don't run your dirty fingers over your acne. Do not spend time pushing out plugged comedones, black heads, white heads. Do not excessively press and pop pimples that are not popping, even if the end result it pops. If it takes more than 15 seconds for it to pop, leave it alone until its ready instead: if you must, only pop pimples that are easily popped and ready with clean hands right before you wash it. A warm shower can make it easier to pop but scalding hot water may be negative to skin moisture. However it is more ideal to never pop pimples

  • Do not sleep on dirty bedsheets or pillow cases. Do not re wear dirty shirts, or continue wearing a gym shirt that you just worked out in. instead, shower/rinse immediately after gym and put on a clean shirt. If you go home after gym and shower that is usually fine too. Replace bedsheets 2x a week and pillow cases EOD (flipping the pillow after the day to get double use)

  • Do not excessively wash your skin, it leads to overdrying. If possible, wash your back/face with a gentle wash 1x a day at the max. If you need to take a second shower before bed due to general day sweat, rinsing with water and wiping with hands is completely fine.


  • As counterintuitive as it sounds, over washing can lead to acne. Your aim should be to maintain a certain level of stability with your skin. This means overwashing will dry out your skin and cause acne. You must completely avoid normal soap and sulfates.

  • Consider a salicylic acid wash or benzoyl peroxide wash (the OG proactive uses this) and using 1x a day max. If they dry out your skin stop for a couple days. Some people find success with a benzoyl peroxide wash, but I think salicylic acid is better as benzoyl peroxide is a generally better treatment for leaving on skin. Others have the opposite opinion.

  • Consider washing your back with no soap at all if you haven't gotten extremely dirty. Your body maintains a natural ph and good bacteria that lessen the ability for bad bacteria to colonize and from acne. Simply rinsing off and not washing at all can do wonders due to the reduced inflammation on your skin.

  • Wash lightly, do not scrub, do not rub hard. Your objective is to clear the previous medicine from your skin and remove any layer of acne promoting containment on your skin. (Bacteria from sweat, pollution, clogged pores, etc.)


This is where it gets to the good stuff. I'm so fucking surprised barely anyone here knows about the best treatments for actually removing acne.

Test all medications first in a small part of skin before dousing yourself with it. BP, azaelic acid tend to be the biggest culprits of redness and differin to a lesser extent.

  • Benzoyl Peroxide 2.5% (gel version is best) - there is no evidence that stronger concentrations are better, and they generally just dry out the skin more. Benzoyl Peroxide is the holy grail of treatment because bacteria never get resistant to it. It provides an oxygen rich environment that is impossible for bacteria to live in. Issues with BP = sensitivity to sunlight, redness on skin, allergic reaction (under 5% have this) so take away = start slow when using benzoyl peroxide, EOD at first, then ED. 2x a day if your body can handle it. It also bleaches clothes, so if you put it on before putting on clothes you need to let it dry, and probably have a white t shirt/white sheets.

  • Adapalene (brand name Differin) is a 3rd generation retinoid that specifically targets the mechanisms that produce acne. It prevents the formation of comedones by 50-60% according to studies. Retinoids are structurally related to Vitamin A - and accutane is a retinoid. Differin is a topical retinoid and since being applied to the skin it does not absorb through the blood stream (as shown by studies significantly insignificant amounts get through). So, you're basically taking topical accutane. Differin has always been the most effective acne medication for me in permenantly reducing the amount of acne I get, and after a year of diligent use in my teens I never got pimples anymore. Additionally, Adapalene increases the efficacy of other popular acne treatments such as topical clindamycin and benzoyl peroxide.

  • Topical clindamycin: clindamycin is a popular antibiotic, but when used topically for acne treatment it significantly boosts the efficacy of adapalene and benzoyl peroxide. However, tolerance increases pretty quickly, and I only recommend using it when a breakout occurs, or for spot treatment of specific pimples. It's useful l usually sold in combination with benzoyl peroxide 5% but it's in your interest to get it separately because 5% BP is over drying and this way you can regulate your tolerance to it

  • Curology (prescription) 4% azelaic acid . (precursor to salicylic acid) 1% clindamycin, 4% nicotinamide. I've read good things about this from skin care addiction but have not used myself. Studies show nicotinamide being as effective as 1% clindamycin without resistance.

  • Salicylic acid option: a slightly weaker option than benzoyl peroxide, but still effective. Be sure the lotion it's mixed with is quality and you might find something useful. You might be better off finding it in pure gel. However BP has shown in studies be more effective and the combo treatment with differin is promising.

  • Jojoba oil: widely considered the best type of oil to moisturize your skin because it is very similar to the natural oils that we produce. It's a favorite on /r/skincareaddiction

zinc 20-50mg for 3 days after breakout you can't stay on high zinc forever but I do this when I get a breakout and it's pretty effective. Lots of anti inflammatory properties in zinc. 10-20mg is about a maintainece dose. I like to use zinc-carnosine complex because it has the added benefit of restoring stomach lining and reversing damage from spicy food etc. No heartburn since using it.

Adapalene is prescription only, but should be over the counter soon. it also comes in a mixture formula with BP called epiduo

Clindamycin is prescription as well. Benzoyl peroxide can be found anywhere. For all of these drugs you should be aiming to get the gel versions. If you go to yourdermatologist and ask for them you should probably be able to get everything that you want.

Adapalene (used first) followed by clindamycin, and benzoyl peroxide, is the holy trinity of destroying acne. If using these 3 medications is causing you to get overly dry skin, you probably want to drop everything but always continue adapalene usage as it improves your skin over time and reduces your ability to create new comedones. If you can only take adapalene 1x a day is fine. 2x is better. It's better to use a thin layer of it everywhere (more just overdries) if your skin is sensitive from overuse, just spot treat with it for a while but you really want to throw it on everywhere


Use a non-comodegenic moisturizer. The oil you should be using on your face in my opinion is jojoba oil. Cetaphil and CeraVe make great facial moisturizers. Use these after treatment in combination with jojoba if jojoba oil is not enough.

Dietary Factors

  • Many people swear that cutting out dairy reduced their acne. Considering the amount of hormone derivatives pumped into cows, it is a reasonable assumption. Since many of us are putting hormones into our body anyways, it might not matter, but most people get reduced acne from cutting out Dairy.

  • Cutting out Sugar & Fructose can reduce acne. Inconsistent blood sugar levels are related to acne, and high amounts of sugar provide a good environment for bacteria to proliferate. Try it out.

  • Eating more veggies. Try it out, fuck it, it might help.

Generally diet cannot cure acne on its own, but if it helps, it's worth it. If something you're eating is creating acne, it's probably not something you want in your body anyway.

Hope you guys enjoyed this post, if you get anything out of it: GET ADAPALENE! it's the most effective treatment for preventing further acne (and reducing current). It's basically topical accutane.

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Message Board Discuss Pantethine and B5 for Acne

After reading Dr. Leung’s article, I then did a Google search for acne and B5, and found a large amount of information on message boards posted by people suffering from acne trying various treatments including pantothenic acid.  I found that many, but not all, of these acne sufferers had success with vitamin B5 (Pantethine) which did work for many of them.  However, a common complaint was that the large amount of pantethine (10 grams) was hard to take, causing gastrointestinal gas and bloating etc.

L-Carnitine Used as Booster

Obviously, the major difficulty with Dr Leung’s Vitamin B5 protocol is the large amount of B5 required.  It would be advantageous to reduce the B5 dosage to a more reasonable level.  Considering the biochemical pathways involved, this would be possible with the addition ofL-carnitine, which transports fatty acids across the mitochondrial membrane where they can be oxidized.

Transport is Rate Limiting Step for Faty Acid Oxidation

According to the biochemistry of fatty acid oxidation, “Transport is RATE LIMITING STEP for oxidation of long chain fatty acids.”  

See the diagram below which shows the importance of L-Carnitine in transporting the fatty acid (the Acyl Group is the fatty acid chain) into the mitochondrial matrix.(1,2)


Above diagram courtesy of wikipedia showing L-Carnitine transporting fatty acids into the mitochondria where they can be oxidized. Carnitine transports long-chain acyl groups from fatty acids (Acyl group) into the mitochondrial matrix, so that they can be broken down through β-oxidation to acetate to obtain usable energy via the citric acid cycle.

Reducing or Eliminating Acne with Pantethine and L Carnitine

Using the modified Leung B5 protocol with Pantethine 750 mg with 250 mg of L Carnitine three times a day, we have noted excellent success rates in reducing or eliminating acne.  An added advantage is a good cosmetic result with smaller pore size and smoother skin.  The vitamins are safe with no adverse side effects noted.

A College Student with Acne

A college student under my care was making preparations for her upcoming wedding when she noticed some new acne lesions on her face.  We immediately began the Pantethine and L-Carnitine.  Her acne cleared up immediately, and she was quite pleased.  By now, we have a number of satisfied patients who have used this program to clear up acne.  I myself have used the program and can report that it works quite well.

Also Used for Weight Loss

Since this anti-acne regimen is essentially a fat burning protocol, it is also useful for weight loss.

No Adverse Side Effects

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