So here's the scoop - in high school (2004-2008) I had what I would consider a very average amount of teenage acne. That is to say, I had a few blackheads on my nose and chin, and a few superficial (topical) blemishes most of the time, but never a full-face breakout.
Slowly, from 2008ish to 2011ish, my acne worsened. It began with more superficial blemishes, and in my mid-20s cystic, painful acne began to develop. Around 2013 (age 23) I decided enough was enough and began to get really serious about healing my skin, meaning I began to implement strict skincare routines in the hopes of clearing things up.
After 3 years of trial and error, I began to feel more desperate. Nothing was working, but I was getting very good at covering up all kinds of skin issues with cosmetics. More on that another time.
This first photo was taken (age 26) after using several extremely gentle Dermalogica and Bare Minerals products for a few (3+)months, paired with 2x/weekly exercise and sun exposure. I took this with the intention of it being a pretty good "before" picture to be paired with a gorgeous, perfect "after" picture, once I'de gotten a few professional microderms(silk peels).
You can see quite a bit of superficial texture, but no active breakouts, no dry flakes, and a very happy smile. This was a very hopeful Sara!
Soon after this photo was taken, I got my first microderm and had the WORST cystic breakout of my life. I was devastated. There are no pictures. It was extremely painful (physically and emotionally.) After that experience I had many feelings of hopelessness in regards to my skin, and developed some more serious self-esteem issues.
This photo was taken about 2 months later, when most of the largest cysts had shrunk. This was meant to be my Rodan+Fields "before" photo. I dropped a lot of money on that skincare system and was again feeling VERY hopeful that this new thing was GOING to work!!!
This photo was taken 3 days later. You can see that the larger cyst on my forehead had shrunk, but that the other active sites had not done much healing yet.
This is a little over two weeks from the would-be R+F "before" picture. A lot of my redness has gone down, however the sides of my face are still riddled with angry, cystic acne. At this point I am still letting the system do its thing. It takes about 8 weeks to see real results, although usually not full results from a skincare regimen.
So this next one is at the end of 2 months, perhaps a bit longer. My would-be "after."
You can see that there is still a lot going on with my skin. At this point I reached out to my R+F consultant about getting a refund. She was wonderful and so was R+F.
I really believe if you are suffering from TOPICAL acne, this system is fantastic. It uses a combo of sulfur, salicylic, benzoyl, and zinc to reduce oil, kill bacteria, heal, and protect from the sun. It is also good to mention that this was the least irritated and flaky my skin has ever been using an entire anti-acne line, compared to Proactive (benzoyl base) or Clinique (salicylic base). But I still looked like this, so they kindly returned my investment.
Something many with cystic acne can relate to in the above photo is HOW EXCITING it is when you have a little whitehead, like the little shiny one on my cheek/jaw. Those are so fixable, compared to the red, angry stuff that lies below the surface. We think, "If ALL my pimples were like this, I would never complain!"
This photo is being included to show you the other side of my face, and how different they could be at any given time. It is also good to compare to what I look like today.
Flash forward about 6 months to 3/15/18, with 2 months of oral spironolactone and topical clindamycin - I looked like this:
My second set of labs cleared me to start isotretinoin!!!!
4/10/18 (one week on Claravis, 40 mg)
Less superficial texture, deeper cysts are healing, very little new activity
*I should mention that all of these photos were taken at least 10 minutes after cleansing and moisturizing, or I would have appeared to be a tomato-person.
In the meantime, here are a few UNCOMMON TIPS that may help heal acne:
Tip #1 - Nourish Your Acid Mantle
Your acid mantle, or hyro-lipid barrier, is a little understood layer of your skin. This is a combination of your natural sebum (oil) and sweat, that mingle together to create good flora (bacteria). This flora helps protect your skin from outside invasions, some of which cause breakouts.
Internal:
Regular exercise (read: sweat!) is essential to creating this good flora. A fun, time friendly way to incorporate more sweat into your busy schedule is through more frequent intimate encounters. That's right, you can mattress mambo your way to healthier skin.
External:
Many topical acne products can be more harmful than healthful because they strip away the sebum necessary to create your skin's first line of defense. Generally, your skin doesn't want anything foreign to reach your internal body, and without a strong, intact acid mantle, your skin may be become unnecessarily reactive, or sensitized. This means it could be more likely to break out when using a new skincare or cosmetic product. Basically, when that happens, it's your skin saying, "WHAT IS THIIIIIIIIIS!??!?! THROW DOWN THE DRAWBRIDGE, SAVE THE QUEEN!!!!" (Your internal body is the Queen.)
Tip #2 - Manage Inflammation
Many people with moderate to severe acne can feel inflammation all over the face, while those with mild to moderate may be able to feel only areas of inflammation/irritation. It can be difficult to discern whether something is treating inflammation if you feel it all over, but weekly photos of both sides and the front of the face can help you visibly see what's helping and what's not.
Internal:
People with any food sensitivities may find that strict avoidance of those foods may reduce redness associated with acne. Common causes are dairy, gluten, eggs, legumes and berries. The only way to be certain you have a food allergy is to be tested for it. Some people may also find Borage oil effective for reducing "puffy" and red, inflamed skin. Be sure to ask your pharmacist about interactions with conditions and other medications before trying this supplement. Bonus: borage oil may also reduce/prevent hangovers for some people.
External:
Inflammation and redness can be exacerbated by dryness that many topical acne products can cause. Though generally we want to reduce oil (aka food for acne bacteria), remember that a little oil is fine, and indeed necessary for overall skin health. If your skin is tomato red after using your current skincare regimen, consider replacing one acne fighting product with a soothing product, or adding a soothing treatment to your routine to negate some chemical irritation. Again, time is needed to determine whether this is helping.
Tip #3 - Be Your Own Expert/Stop Asking Around
I'm sure I'll get some kickback for this, but please stop asking the staff at Ulta or Sephora, or any cosmetic counter how to "fix your skin." Very few, if any, of those people are licensed experts, let alone medical professionals. In fact, many licensed individuals know little to nothing about skincare because their background is in spa services, not chemical performance. Stop asking your hairdresser, wax or nail tech, and lash ladies. As a licensed cosmetologist (ND), I can tell you the board exams (written and practical) in regards to skincare are absolute jokes.
Ask your esthetician. And I'll be honest, even they might not have helpful feedback. Again, the emphasis for these individuals when it comes to the performance of skincare products is in safety and spa services, not science. You can think of this as "how it feels" as opposed to "what is ACTUALLY does."
Ask your dermatologist. Keep in mind, though, that as medical professionals they are sometimes limited in what they can legally recommend, as it pertains to diet.
One way to discern whether a professional (healthcare, or otherwise) has your best interest at heart is if they are willing to make recommendations outside of "their" line, meaning they might not offer it, but they will tell you where you may find it.
When I am asked for advice, whether it be about skincare or beauty items, I make it a point to ask many more questions before answering. This way I can establish context, including, but not limited to: the person's skin type, how much water they drink, their general diet, level of activity throughout the day, what they are already using, if they have any allergies or sensitivities, whether their skin feels tight/itchy/greasy, if they know the difference between a manual and chemical exfoliant, how they protect from the sun, how much time they are willing to spend on this, and so on. Something I like to tell people is, "You might really like something that has (insert ingredient here), because it helps your skin (insert performance trait here)." It is my hope that clients are more likely to do more research about the ingredient and its uses. Knowledge is power.
Remember, even though a product is meant to behave a certain way, that does not mean it will behave that way for you, or work with your routine. Ultimately, only you know what feels good. In general, I recommend avoiding products that are causing you pain. Tingling = probably ok, burning-fires-of-hell= probably NOT ok.
Tip #4 - Patience, Gentleness, Loving-Kindness
Patience:
Be sure to give all new regimens at least 2 months to work, otherwise you're wasting your time and money.
When you're ready, see a derm. Seeing a derm is not "giving up," but merely using all the healing tools available.
You may find that really taking your time with your skincare in the morning at at night will shift the mentality from "fix it" to "nourish it," which I can tell you from personal experience simply feels better.
Gentleness:
Apply all products with very gentle pressure. Lots of motion and gentle pressure remove stubborn cosmetics much more effectively than scraping it all away. If you struggle to remove your cosmetics at night, try using a precleansing oil or micellar water to remove the bulk before applying your usual cleanser.
Loving-Kindness:
Remember that breakouts are just your body's way of protecting you from harm. Try to heal it, rather than beat it into submission.
On particularly painful skin days, try a clay mask of some kind to draw out deeper sebum and impurities, remove with a warm washcloth, and then gently apply a cooling or soothing mask. This way you can purify without over-drying.
Products I Love for Repairing/ Maintaining My Acid Mantle:
This system worked well after Retin-A left me feeling raw, very red, and very flaky. Keep in mind, I am naturally dry, so if you are more combo/oily, a less intense moisturizer might be better for you, perhaps Dermalogica's Active Moist?
Dermalogica Ultracalming Cleanser (repairing/maintaining)
Sanitas Vita Rich Serum(repairing)
Sanitas Topical C Reparative Balm (repairing)
The following is what I'm using now, again, with naturally dry skin and moderate cystic acne:
Beautycounter Nourishing Cream Cleanser (maintaining)
Murad Mult-Vitamin Infusion Oil (maintaining)
Beautycounter Nourishing Day Cream (maintaining)
I hope you found this useful and informative! If you have any questions or feedback please feel free to reach out via the CONTACT page of this site. I love hearing from you as it helps me serve you better.