I had the good fortune of sailing through high school with only the occasional breakout — nothing that a dab of over-the-counter benzoyl peroxide couldn’t fix in a couple of days.
With my teens and 20s far behind me, I figured that any pimples I’d get would continue to be a once-in-a-while occurrence. I thought my skin and I were basically in the clear.
I was dead wrong.
Last year, I stopped taking my birth control pills, and a short time after that, I noticed a painful and angry red bump under my skin. It wasn’t like other pimples I’d had before — it was bigger and never came to a head, so there was nothing to “pop.” I put my usual benzoyl peroxide on it, but it not only didn’t get any better, it got worse — growing redder and angrier by the day, like I’d just managed to tick it off even further. The drugstore medicine wasn’t touching it.
So I did what any beauty editor does — I made a beeline for my dermatologist, who confirmed that I had adult cystic acne. At a point in my life when my skin care regimen was focused on two main things — sun protection and fighting fine lines — acne, let alone cystic acne, wasn’t exactly on my radar.
Turns out I’m far from alone in the acne-out-of-nowhere category. “Adult female acne is traditionally defined as acne developing in women above the age of 25,” Joshua Zeichner, MD, the founder of Zeichner Dermatology and director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City, tells Yahoo Beauty. “However, unfortunately, it is not uncommon for it to show up for the first time even in your 30s or 40s.”
The causes of cystic acne
So what causes cystic acne to rear its ugly head? “There are many causes for cystic acne in adults,” Kristina Goldenberg, who is one-half of the husband-and-wife duo at Goldenberg Dermatology in New York, tells Yahoo Beauty. “These include hormonal changes, diet, stress, use of [certain] makeup or skin care products, and, of course, genetics.”
Regular pimples and cystic acne share the same common causes. “Acne is caused by a combination of oil production that clogs pores, sticky skin cells within follicles that lead to blockages, acne-causing bacteria, and inflammation,” explains Zeichner. “The same factors lead to all types of pimples, but in some more severe cases, patients develop deep, painful cysts.”
More than likely, my going off oral contraceptives — and the hormones fluctuations that ensued — was the source of my skin woes. “Pregnancy, breastfeeding, starting or stopping birth control pills, or getting an IUD can all lead to changes in hormone levels that lead to acne,” says Goldenberg. “Being a woman by definition means our hormones are going up and down every cycle. Oral contraceptives help minimize these fluctuations in hormone levels. In fact, dermatologists often use oral contraceptives as a treatment modality for acne. When you stopped your oral contraceptives, hormonal fluctuations resumed — stimulating an increase in oil production — and gave rise to acne.”
And let’s be honest, as a full-time working mom of twins, I’m no stranger to stress and not getting enough sleep, which doesn’t do my skin any favors. “There is a good body of data showing a relationship between stress and acne,” Zeichner says. “For example, students have been shown to break out during testing periods in school.”
What you eat can also influence how your skin is behaving. “I advise all my patients to either stop dairy altogether or only consume organic dairy products,” Gary Goldenberg, MD, of Goldenberg Dermatology, tells Yahoo Beauty, noting that dairy can cause inflammation. However, Zeichner notes that yogurt and cheese have not been associated with breakouts. Goldenberg adds: “Meat and poultry should be antibiotic- and hormone-free. I also recommend a daily probiotic and ask patients to consume more anti-inflammatory foods.”
Goldenberg also recommends showering immediately after working out to remove the sweat that can clog pores, as well as keeping pillowcases clean, avoiding too much alcohol, and getting stress levels under control (which is easier said than done).
Acne-fighting treatments that work
Topical medications are typically the first line of defense against acne. And because acne has multiple causes, it’s common for derms to put you on more than one medication. At first, my dermatologist prescribed two topical creams: adapalene (0.3 percent), which is a retinoid that exfoliates dead skin cells and prevents clogged pores that can lead to breakouts, and a topical anti-inflammatory, Aczone. I used both, in layers, twice a day, religiously.
Even on this new doctor-approved plan, I would still get a single cystic breakout near my nose or chin, apply the medicine, and then wait a week as it slowly disappeared. The snail-like pace was frustrating, but at least some progress was being made. And I could use makeup to try to cover up the redness.
But one morning in April, my skin took a turn for the worse: I noticed four cystic pimples in an arc across my chin, like a constellation. I’d never had four simultaneous pimples in my life. A few days later, more appeared, bringing the total to eight. Eight!
I didn’t recognize my skin in the mirror anymore and felt self-conscious. I’d also had enough. I hustled back to my dermatologist, who switched my regimen to a topical antibiotic and topical tretinoin (0.05 percent), and she prescribed a short-term course of oral antibiotics (minocycline) to help wipe out the stubborn bumps. Within a few days, I started noticing my skin clearing up and breathed a sigh of relief. Within a week, nearly all the breakouts were gone.
Chemical peels, which can be done as often as once a month, can also help fight acne, so two weeks later I went back to my derm’s office for a peel with retinol — the coup de grace to eliminate any remaining bumps. I walked out of my derm’s office that day with glowing, makeup-free skin — and finally felt like myself again.
It was a relief knowing that when the first skin-clearing regimen wasn’t really tackling my problem, there were other options in my dermatologist’s arsenal. In fact, there are plenty — it can just require some trial and error. Other acne-fighting tools include light therapy, which is typically performed in a dermatologist’s office. However, “light treatments have become popular over-the-counter now as well,” notes Zeichner, who recommends Neutrogena Light Therapy Acne Mask ($35). “Red light helps reduce inflammation, while blue light kills acne-causing bacteria.”
For stubborn cystic acne, multiple sessions of laser therapy — such as photodynamic therapy (PDT), which shrinks oil glands and kills the bacteria that bring on acne — can help. There’s also the prescription drug Accutane, which can cause serious side effects, including birth defects, if users become pregnant while taking the medication, but is highly effective at eliminating cystic acne. “Accutane treatment usually controls, and in many cases cures, cystic acne,” notes Goldenberg.
Bottom line: If your usual pimple-clearing regimen isn’t working, that’s a sign it’s time to see a professional. Those irksome breakouts aren’t going to go away on their own, unfortunately, and can even leave pigmentation changes and scarring in their wake. “If your skin is not improving within two to four weeks of using over-the-counter products,” says Zeichner, “you should make an appointment to visit your dermatologist to discuss prescription treatment options.”
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