Ask a doctor on the topic of Dermatology

Acne and hyperkeratosis do not go away.

July 6, 2013 | 30,00 EUR | answered by Dr. med. Kathrin Hamann

It's embarrassing to ask for the third time, but I don't know what to do anymore.

Unfortunately, my suffering is still not over and I don't know what to do. I have consulted various naturopaths as recommended (see my other questions regarding acne), adjusted my diet, detoxified, etc. I can't get rid of my acne.

Internally, I am completely healthy. Even my testosterone levels are completely normal.

At this point, I am mentally so exhausted that I hardly leave the house anymore. My relationship is suffering greatly. I can no longer actively participate in life. After work, I hide at home. I feel watched, stared at, uncomfortable when the oil runs over my face.

I will briefly describe the problem and what I have done:

26 years old, acne for 2 years due to improper care. Self-inflicted through daily exfoliation. Unfortunately, I only recently realized that I am partly to blame. I never had skin problems. I also don't know why I used that exfoliator back then, probably because there were 2 pimples bothering me. I always thought you had to scrub away impurities. Skin became drier, but at the same time oilier.

Currently: Very oily skin, which is also very dry and cornified (my entire forehead is covered with a layer of horn and underneath there are probably 500 bumps). I have 3-4 inflammations on my face. They are really minimal. Cheeks are clear. Only affected are the areas on either side of the nose and the entire forehead including temples.

All the dermatological medications: Aknemycin, Differin, BPO etc. only dried out the skin even more. It became even more cornified. It was red and itchy. I also got inflammations due to these irritations. I was shuffled from dermatologist to dermatologist. Isotretinoin is contraindicated (colitis) and even if it wasn't, it's not an option for me. Neither is the pill. I tried 4 different pills and didn't tolerate any of them.

Zeniac LP helped me a lot. It dried out my skin, but most of the bumps disappeared. Unfortunately, it was not permanent. I developed a large itchy eczema and was advised by a dermatologist to stop using it.

Estheticians made it worse because they didn't know the skin type "Dry oily skin" correctly and treated me for oily skin. This led to irritations and more pimples.

I took Minocycline and Ichthraletten. (Both without success).

After everything was gone, I was treated with Cleanance K from Avene. My skin did not react well to it, and I had strong inflammations on my forehead and even stronger cornifications. After stopping, everything was back to square one. "Only" the bumps.

Then, at the advice of a dermatologist, I used a pure AHA product with glycolic acid. Unfortunately, the same deterioration as with Cleanance K from Avene occurred. This leads me to conclude that I am allergic to glycolic acid. It is present in both products.

BHA products have not improved or worsened the situation as they are not very effective at removing cornifications. They are more intended for blackheads.

Another dermatologist has now prescribed me absolute "rest". I clean my face with La Roche Toleriane Cleansing Milk and moisturize with Avene Clean Ac. In terms of inflammation, it is much better, but blackheads are increasing and the oiliness doesn't stop. The cornified layer is still there.

What else can I do? Should I stay away from acids? How can I remove these cornifications that clearly lead to my blackheads? They won't normalize on their own, right?

Would lactic acid be suitable for me? How is it possible that acids stimulate cornification in my case when they are supposed to thin the cornified layer? Eucerin has milder products with lactic acid, would that be worth a try? Doing nothing further will not make it better in the long run, and the blackheads will continue to increase along with my cornified skin.

Or do I have to accept it? Should I seek psychological treatment to deal with it? I can't imagine accepting it.

It's terrible to be stared at. I wear very little makeup. I just cover up a bit with powder so that I feel somewhat presentable, but you can tell that people are staring at me and thinking things. I work in an important position, have a lot of customer contact, and want to advance in my career, but already colleagues/bosses are telling me that this won't work. What happened to me, etc. Something needs to be done finally. I'm not 13 anymore.

Is there really nothing else

Dr. med. Kathrin Hamann

Good day,

Your question has been in our system for quite some time, but no one has responded to you yet. I think that providing a helpful answer is very difficult.
So far, all the applications you have used have greatly affected your skin. Stress is only making it worse.

In your case, I believe that the current "rest treatment" - really not applying anything artificial - is the right approach. There should be a period of 3-4 months where nothing except water touches your skin.

The combination of dry-oily skin is often a result of skin cells not knowing how to handle all the well-intended "applications of creams, ointments, lotions, etc." It's like trying to train an animal while simultaneously praising and punishing it, which results in a confused and frightened animal that no longer responds appropriately and becomes unpredictable.

So in this case, I would prescribe complete rest for your skin. Do not use anything chemical, neither alcohol nor moisturizing ointments, not even lactic acid. Pure water without soap or anything else is important for your skin to calm down. Initially, this may lead to an increase in the oily film. Use water and soft terry towels to gently "dab" - do not rub. Then, wash the towel.

Additionally, try to strengthen your nerves: meditation, autogenic training, try to ignore the condition, even if it's difficult. Often, this approach leads to better results than constantly applying creams or tinctures.

From experience, I can also recommend the internal use of Thujaglobuli for strengthening. Take 3x5 globules a day for at least 3 weeks - Thuja occidentalis D12. Please do not use it as a tincture, only as globules.

Please give your skin rest - meaning absolutely no chemicals, nothing that needs to be bought.

I am happy to help you further.

Best regards,

Dr. K. Hamann