Skincare Scoop: How I Manage Hormonal Acne

Today begins a new five-part “spring cleaning” weekly skincare series answering all the questions I receive about my skincare routine. Some of the topics I’ll be covering include: my morning and nighttime skincare regimens, beauty tools I love, pregnant/nursing skincare products, including “clean beauty” favorites. Today’s post I am starting with my history of acne. As much as I didn’t want to write about this first topic, I feel like it’s a big part of my skincare decisions. I also know there are probably lots of people out there who struggle with this and may benefit from hearing my story. So here we go!

My first sign of cystic acne was in 7th grade when I developed a painful under-the-skin bump on my chin. My mom told me to leave it alone, but I just couldn’t. I thought if I could pop what I thought was just a big pimple it would subside. Wrong!

There was no popping this pimple. It was so deep under the skin that made myself bleed, infected the area, and – duh -made it look SO MUCH WORSE. I was mortified and tried to avoid eye contact in the middle school hallway for nearly a week to avoid people looking at the injury on my face.

Starting then – and for the rest of my teenage years – I was baffled as to why some of my friends, who barely washed their faces, had perfect skin while others like me, who  did everything from Clinque’s 3-step system to spending my hard-earned high school money on Erno Lazlo products(used by Jackie Kennedy), suffered from these long, painful breakouts.

It wasn’t until I was 21 and about to get married that my OBGYN told me that birth control would help my breakouts. I began to realize that my painful breakouts weren’t because I wasn’t washing my face enough, but because of my fluctuating hormones. But it wasn’t actually until my second miscarriage at 29 that I was told the root cause of my acne all those years: I had Polycystic Ovarian Syndrome

What is Polycystic Ovarian Syndrome?

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. According to the May Clinic’s website, “women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels; the ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.” I was told that PCOS often occurs in obese women which is why I was probably undiagnosed for so long. It also can cause infertility and miscarriages. Perhaps I will share about that another time.

Anyway, it is the excess androgen from PCOS that can causes the cystic acne, which is common on the chin and jawline. When more androgens are produced, the skin’s oil glands react by producing an excess of sebum (oil). The increased amount of oil traps bacteria which then multiplies causing major inflammation. Everyone has bacteria on their face; but people with PCOS or hormonal acne are more likely for that bacteria to turn into an inflamed area.

Can you have cystic acne without PCOS?

Yes. A surge in hormones or hormones that are “out of whack” can cause cystic acne, which is why cystic acne often appears in adult women. But if you have PCOS chances are you suffer from cystic acne.

What is the difference between a regular pimple and cystic acne?

A pimple is when your a pore gets clogged with oil and dead skin cells, causing the area to be red and swollen. A blackhead is when the pore remains open (so it looks grayish black). A whitehead is when the pore remains closed. Cystic acne is when a cyst forms around the area of inflammation and occurs deep in the skin and does not come to the surface. You can tell because it’s painful to the touch.

Oral medication for Cystic Acne

• Birth control
• Oral Antibiotics
• Anti-Androgen Medication
• Accutane

As a teenager I was prescribed antibiotics which mildly helped, but eventually they stopped being effective (and I didn’t really want to be on oral antibiotics for years and years anyway). The birth control pill definitely helped, because it regulates hormones, but it had other side effects. And like antibiotics, when I stopped the pill the acne came back.

There are other oral medicines, too, but the only thing proven to really stop cystic acne altogether is Accutane. Because I got married so young I was hesitant to be on anything that might cause birth defects and other serious side effects). Looking back, though, I kind of wish I had used Accutane before I had children. It probably would have saved me years of internal turmoil about my acne. This Atlantic article sheds light on what she calls a “scorched Earth” skin campaign but with good results. See a recent article in Allure with before and after pics here.

Topical Treatments for Cystic Acne

• Salicylic acid – these never really helped me
• Topical antibiotics in conjunction with benzoyl peroxide – this didn’t have a big effect either
• Retinoid/Retinol – I use this now in combination with other things

People without cystic acne often don’t understand that treatments for normal acne have little to no affect on cystic acne. Yes, I’ve tried Proactiv. I had high hopes in Rodan and Fields’ Unblemish along with just about every other expensive acne treatment I’ve tried. This is the thing: most topical acne treatments are not enough because the root cause of cystic acne is hormonal and the infected area is deep down in the skin where topicals don’t always reach.

What has Worked for Me

When my acne gets better I often wonder “Is it something I am doing or are my hormones just changing?” It’s hard to know but after over twenty years of struggle, here is what I think has made the most difference:

1. Communicating with my doctors

Finding and regularly seeing a great a dermatologist, who understands my medical history and concerns about being on certain oral medicines, has been super helpful. (I see Dr. Claire Reddick in Dallas.) I also saw a reproductive endocrinologist at one point about my PCOS after we had several miscarriages. (If you have PCOS I recommend seeing one, particularly if you are of child-bearing age.)

2. Regular facials

Getting a facial every 4-6 weeks has been a key, I believe, in maintaining clear skin the past few years. I have been going to the Pure Beauty Spa at Neiman Marcus Northpark for several years and Lulu, the esthetician I see, totally “gets” my hormonal acne and treats my skin accordingly.I think part of the reason facials work so well for me is because Lulu uses machines that kill the bacteria deeper than what what normal topical cleaning can do.

First, the high-frequency tool she uses that kills bacteria deep down in the skin (in the layers that topical creams can’t reach) is a game-changer. I have never tried the home version but would definitely consider if I wasn’t getting regular facials.

Second, the LED light tool does a similar thing but on a deeper level. Here is a highly rated home version. And here is one highly rated by Neutrogena. These two tools not only help prevent breakouts but make such a big difference on existing cystic breakouts.

Tip: if you book a facial make sure they have these machines. I hate when I get a facial and the esthetician just puts on a bunch of masks and leaves the room for 20 minutes;).

3. Retinoid/Retinol cream

Most dermatologists will recommend a retinoid (Retin-A or Tretinoin are commonly prescribed). If not for acne, then for fine lines and wrinkles. I know some people don’t like retinoids, but overall they have been beneficial to my skin. And I only use a pea sized amount of prescription retinoid a week. (More than that makes me peel like crazy.)

For over the counter, I would recommend this Obagi  as it’s one of the highest concentrates you can get over the counter. I know a lot of people like the Rodan and Fields product as well.

4. Chemical Peels

When my cystic acne was TERRIBLE in my 20s my dermatologist recommended chemical peels to not only help with cystic acne but the scarring it left behind. While peels certainly have negative side effects (peeling, redness) the overall result can be amazing for both acne and fine lines. I haven’t had one in years but am getting one in a few weeks and I’ll share about it!

5. Reducing my dairy intake

I don’t think it’s proven but many suspect dairy products can worsen hormonal acne. I LOVE milk but I do notice that when I don’t drink it my cystic acne is so much better.

On a similar note, I wish I could say eating healthy and drinking a lot of water has helped me. Maybe they have helped but have not been a solution on their own.

6. Over the counter treatments

Topical treatments like salicylic acid and benzoyl peroxide never really helped my cystic acne. But in recent years I’ve found that there are some topicals that seem to reduce at least the inflammation. Lately I have been using this Mario Badsecu drying lotion on any pimple I feel forming, including cystic ones. I’ll talk about this in a future post but this Skinceuticals clay mask is a game changer for getting impurities to the surface. I also hear Beautycounter’s Balancing Facial Mask is amazing, too.

7. Beauty tools

In addition to the machines mentioned above I also regularly use a Clarisonic and PMD and just start using the Glo Pro. Believe it or not, all serve different purposes to keep bacteria from getting trapped. I will be sharing more about these in an upcoming post so be sure you are on DoSayGive’s email list if you want to read more.

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Every story is different when it comes to cystic acne so feel free to share your story or what has helped you below. And just to be clear: I am not a doctor and am not recommending anything for anyone. Just sharing my story and what has worked for me!

Photo: Sweet Memory Photography

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