Acne on chin/jawline — feel like I've tried every treatment possible, feeling hopeless, and currently on Spironolactone. Resorted to decreasing bupropion dosage after 2.5 years to try to help, but I feel even worse.

Hi everyone!

I've (21F) been taking bupropion for almost two and a half years now, and this medication is great for me (despite a few side effects). Tried other traditional SSRIs before, which were just awful. Right when I started taking it, within days I noticed breakouts on my chin and jawline. I didn't think too much of it because it wasn't too terrible, especially because I was taking short-release 75 mg 2x a day. 2.5 years later, I was up to 300 mg XL daily, with constant deep, painful breakouts on my chin/jawline and I'm convinced it is from bupropion. It seems hormonal, because it improves once a month and looks flawless maybe one day a month, but is always actively breakout otherwise. I have an IUD, and am positive that does not have anything to do with my acne. I am not considering switching B/C methods for this.

I am seeking advice from anyone who has experienced acne like this from bupropion and has tried different treatments and finally found something that worked.

I feel like I've tried every treatment under the sun, and now am finally resigning to tapering down/off the bupropion because the acne is just too much and has been a large blow to my self-confidence. It's been 14 days on 150 mg XL instead of 300 mg XL, and I'm pretty miserable. I've been so tired every day, but not tired enough to sleep, and I have insomnia at night so I can't fall asleep early. I'm so tired I've stopped being able to work out in the mornings entirely — which makes me feel more tired and more depressed, and I can't work out at other times because of my complex schedule. It's a bit of a brutal positive feedback loop. In the past few days, I've started to feel depressive again, which is worrisome, and I'm scared if it continues at this rate I'll have to go back up to 300 mg. I have a great dermatologist — one of the smartest in my medical neighborhood — and am seeing her next Friday. Still, any advice from others who have gone through this would be so helpful, thank you.

Before I met with my dermatologist in my first year of taking bupropion, at the time, I was using the Herbivore blue lapis serum and blue tansy exfoliating mask (which I previously loved), but switched to the ordinary niacinamide + zinc and azelaic acid for price point reasons and the acne. When it didn't work, I tried Krave Beauty's Great Barrier Relief, which did not work and irritated my skin more. I also tried Paula's Choice for a while, which didn't work. I then used Curology for 8 months (Azelaic Acid 1%, Clindamycin Phosphate 1%, Niacinamide 4%) and paired it with Noble Formula 2% Pyrithione Zinc Bar Soap with argan oil once at night. I used a gentle pre+probiotic facewash in the mornings.

After a year, I wasn't seeing any improvements, and had also bumped the bupropion to 300 mg XL. So, I saw a derm, and immediately began using prescription tretinoin and azelaic acid on a daily basis. I have worked up my tolerance to tretinoin for over a year now, and am on a 3-day-on, 1-day-off cycle of 0.05 tretinoin; I tried every day, but it irritated my skin and made it flaky. I use 4% Panoxyl benzoyl peroxide wash on my face every morning and their 10% counterpart on my chest/upper back every morning. Still, no improvements. In fact, I have an ample amount of scarring along my jawline and cheeks despite my use of tretinoin with sunscreen.

I've now been taking 100 mg of Spironolactone daily for the past 8.5 weeks to try to help, and as I said, I decreased the bupropion to 150 mg XL two weeks ago. My breakouts have improved slightly, but are still pretty prevalent, and I'm not feeling good tapering down from the 300 mg. I have another derm who treats my excessive sweating from bupropion lol who said I may want to consider Accutane. I really don't want that, and my therapist thinks it's a ridiculous idea to try to put someone with a history of MDD/PTSD on Accutane. I really don't want Accutane, but am at a loss. I don't even think my acne is severe enough to warrant a cycle of Accutane — it's just sooo stubborn and treatment resistant.

My moisturizing routine has stayed the same from the start of my acne when I began taking the meds: snail mucin, a gentle, non-irritating K-beauty moisturizing cream, and — in dry conditions — another gentle, non-irritating K-beauty moisturizing balm. I don't believe any of these are the problem and do not wish to change this routine. I am also using the EltaMD daily sunscreen for acne, which I like. Again, I'm pretty positive B/C is not an influential factor.

It does not help I have very sensitive skin that gets irritated very easily. I had fairly clear skin and. a normal amount of acne before this. It would be so awesome if anyone has any advice they can provide. I am tired, frustrated, hopeless, struggling with self-confidence, and not to mention, out of a lot of money spent on different products! I'm seeing my derm next week. Thanks anyone for any insight you can provide!!! I would so so appreciate it.

TLDR: Bupropion gives me bad breakouts, but it is really great for my mood. Spent a bunch of $ on different products, but nothing seems to help, and my scarring is worse. Currently taking 100 mg spironolactone, tretinoin, azelaic acid, and benzoyl peroxide. Decreased bupropion dose, but feel pretty miserable. They mentioned putting me on Accutane, which I DO NOT want!!!