What I wish I knew during my cystic acne breakout and how I finally got rid of it
**This is a personal story of how I got rid of my cystic acne. It is not meant to be taken as medical advice. Consult with your doctor or dermatologist before beginning any course of treatment.
I never got pimples as a teenager. At worst, I had minorly oily skin that a toilet seat blotter could easily handle. Then, around age 23 I was hit with a DEBILITATING CASE OF CYSTIC ACNE. Like, painful under the skin large red bumps all over my jaw and chin! VERY FUN STUFF!
I went crazy buying all sorts of acne washes, masks and creams from drugstore brands to top-tier stuff at Sephora. I used this black tar thing that was supposed to coax out the zit. I used these ridiculously expensive alpha beta peels. I bought $100 moisturizer that a Sephora clerk claims “fixed her friend’s face.” I even did pyramid-scheme face products that CLAIM to give you baby skin. The desperate trial and error phase went on for about a year. In the meantime, my skin was covered in red bumps and was flaking off from all the salicylic acid I was dousing it in.
Finally, I got health insurance and saw a real dermatologist and learned that my cystic acne was especially affected by my hormones. According to Dr. Julia Tzu, founder and medical director of Wall Street Dermatology, (who did not treat me, but provided insight for this article), “Adult onset cystic acne often has more of a lower jawline/chin distribution, whereas teenage acne follows more of the T-zone distribution. The lower face distribution often argues more for a ‘hormonal’ cause and hormonal treatments are hence more effective.”
I also learned that because the cystic acne is “under the skin” as opposed to say, white heads, of course putting topical products on the top of my skin wouldn’t do much. “Cystic acne consists of a deeper inflammatory response. Topical medications can help with cystic acne to a limited extent, but are more often used as an adjunct treatment than the main treatment,” says Tzu. Translation: stop putting products on top of your cystic acne, it’s a waste of money.
Here’s what FINALLY fixed my face. All of these are just suggestions of what worked for me, ultimately bring them up with your doctor.
Spironolactone: Spironolactone is a drug that helps rid your body of unneeded water and is usually prescribed to people with too much fluid build-up. But as a BONUS, it also acts as a hormone blocker and it’s THE thing that saved my skin. I’ve actually been on it for three years and every time I see a doctor I ask if it’s chill that I’ve been on it so long and they always reassure me it’s fine. However, taking this drug requires monthly or tri-monthly blood tests before you can get a refill. The major side effect is an increase of potassium in the blood. You also cannot attempt to get pregnant while taking spironolactone. If your acne is really bad and you think it could be hormonal, ask your doctor about spiro before they start suggesting heavy stuff like Accutane.
Antibiotics: Dr. Tzu says, antibiotics are used in acne patients “in whom I do not suspect a major hormonal component. My favorite antibiotics for acne are doxycycline, minocycline, and erythromycin. Some dermatologists also like to use bactrim.” Oral antibiotics can kill bacteria that causes acne. However, since my acne was basically siamese twins with my hormones, I didn’t find antibiotics to be super helpful. A word about antibiotics: Dr. Tsu says they can lose their efficacy, “If the patient is noncompliant with the antibiotic regimen and skips doses routinely.”
Prednisone: Predniose is a corticosteroid that will reduce the inflammation surrounding the pimple. I did a one-week round of prednisone and it completely cleared up a breakout I was having. I wanted to use it all the time but my dermatologist told me that too much of it can lower your immune system and refused to refill my prescription. Booo.
Hydrocortisone injections: Hydrocortisone injections are injected directly into the zit to reduce inflammation. They are a lifesaver for the large cystic zits that appear to have no head and are so painful they have their own pulse. After injection, swelling should go down in a couple hours. For a solid three months, I’d get 10 injections all over my face every two weeks because I LOVE PAIN! (lolol, jk, no I don’t). However, if you inject an area too often or with too much of the cortisone, it can leave an indented scar, which often happened to me.
Birth control: There’s a myth that all birth control helps acne. Birth control that ONLY contains progesterone can actually make acne worse. So far, there are three birth control brands that have been FDA approved to treat acne. They are Ortho Tri-Cyclen, Estrostep and YAZ (however, YAZ is the same birth control you always hear people suing about, so I’d stay away). I personally found Ortho Tri Cyclen Lo (not FDA approved, but in the Ortho Tri-Cyclen family) really helped me. I tried to go off it and four months later my skin started breaking out again, so unfortunately I had to go back, which sucks because I hate trading in clear skin for mood swings, meltdowns, and general hormonal insanity.
Face wash: My dermatologist made her own brand of face wash that was anti-bacterial and contained salicylic acid. Anti-bacterial does what it sounds like it would do and salicylic acid is the most common anti-acne ingredient because it’s highly effective at unplugging blocked skin pores. Once I stopped breaking out, I switched over to a very cheap and very basic Cetaphil cleanser with no salicylic acid. Once the breakouts stopped, I basically only had to use very basic cleansers and moisturizers which meant I was saving a lot of money.
Sulfur based spot treatments: Sulfur dries out the skin, is anti-microbial, and sloughs off dead skin cells. Benzoyl peroxide burns my skin. Salicylic works okay, but to cover the actual zits, I caked my skin in a sulfur based spot treatment. Sulfur based treatments are sometimes referred to by beauty brands as “drying lotions.”
Toner: Oof, I HATE toners. Toners are supposed to rid your skin of any lasting dirt or impurities after washing but because most are formulated with alcohol, they can be incredibly drying. My derm prescribed a very drying toner that I mixed with crushed-up antibiotics. During the cystic era, I didn’t care that I was drying out my skin with the alcohol-based toner because my skin was just one giant oil slick, but once the breakouts were fewer and far between, I ditched the toner. I haven’t used a toner since. I once had a facialist tell me to just wash my face twice and skip toner altogether. I’ve been doing the two-wash method for about two years and it’s working pretty fine.
My skin is now…normal. It’s dry-ish in the winter and can get oily throughout the day, but in general, I can now use cheap drug store products on my skin with no adverse reactions. I still have to take spironolactone every day and am still on birth control, but otherwise I maybe get one or two zits a month.
However, when you have cystic acne, it’s nearly impossible to escape without any scarring. Because I squeezed my zits, I’m still trying to get rid of broken capillaries under the skin and indentation caused from over-use of hydrocortisone.
Tretinoin: Trentinoin is used for treating active acne, post-acne marks and as an anti-aging cream. Once my acne was gone, I got a Trentinoin prescription to help speed up the skin cell turnover process which in turn would help eradicate the indented scars AND the red marks. It basically makes your skin make new skin way faster than normal. The dermatologist that cleared up my acne didn’t love trentinoin, said people get too addicted to the results and then end up with paper-thin skin like all those Real Housewives you see with luminous but borderline translucent skin. I still have a ton of red marks and to be honest, I feel like the trentinoin is making my skin so photosensitive it might actually be worse in the long run. So I stopped using it after a year.
IPL photo facials: I was told by a dermatologist who specializes in laser treatments that in order to get rid of the indentations on my face and the broken capillaries I would need a series of IPL photo facials. IPL photofacials use intense pulses of light to stimulate collagen production. They were very expensive and they definitely got rid of all the indentation, but did absolutely nothing for the redness and the broken capillaries. I also think it made my skin so sensitive to light that I now have a lot of sun damage on my forehead. Ugh. I got five IPL sessions but really I could have, and probably should have, stopped after three. However, IPLs are very expensive and should really only be administered by a dermatologist. They are offered at med spas, but some med spas use such a low setting it’s a waste of money and others are administered incorrectly that you leave with burns.
Remember, all of the above advice was stuff I learned when I finally saw a doctor. I wish someone had wrote about this when I was suffering, so I could have spent way less money on creams and serums that were no help. Don’t try to treat acne in the beauty aisle of your drug store and ask for professional help!