Everything I Did to Heal My Adult Cystic Acne

my skin today (no make up)

Alright let me start this post with a big fat *DISCLAIMER*– acne is a complicated and complex medical condition, and should always be treated with the care of a licensed dermatologist. What worked for my skin and my body may not work for you. From hormones to digestion to genetics, there are many, many factors at play in treating acne, and unfortunately there is no one-size fits all approach or magic bullet fix. That said, I KNOW how hard it is to struggle with acne, so I want to share as much information as I can about my acne journey, in the hopes that it can help you in some way. As always, consult a doctor before adding or removing supplements to your routine (especially when we are dealing with hormones).

MY SKIN HISTORY

Okay so a little background on my skin. I suffered from moderate-severe acne in high school. My acne was always around my mouth / chin /jawline. My sophomore year I was so desperate to cure it I got on a daily antibiotic prescription, which I took for probably 6 months (so cringey to think about – are we surprised at all i’ve had so many gut issues? -___-). Eventually my skin chilled out, and I was pretty much acne free from 17-18 all the way through 26 (beginning of last year). My skin was SO good for a while – I got compliments all the time – and could load my face up with WHATEVER and never broke out. Sure I’d get the occasional hormonal pimple (again around my mouth) but that was it. I used every serum and every face oil with no issues.

Then around spring 2018 my skin started getting BAD. Worse that it had ever been. I had cystic acne around my mouth but also on my cheeks (new for me). I was never without several active acne spots. I still don’t know what caused that change – there’s nothing I can point to. My digestion wasn’t great so it could have been that, or just hormonal changes of getting older. Anyway, I got on a prescription topical (clindamycin) that sort of helped, and a WAY too strong Retin-A (.06%) that made my face peel and go crazy. Acne + peeling. It was a sexy time. Again, my skin chilled out for a while, but then came back with a vengeance.

Around the holidays of 2018, my skin started getting worse and worse. And by January, I had full blown cystic acne on my cheeks and chin. I spent at least 30 minutes each morning icing my face and then spackling on as much concealer as possible, with no success. This time around, I had a strong feeling it was hormonal (I went off birth control in July with no issues to my skin, but got back on in September) so of course I starting researching and coming at it from EVERY ANGLE. So, there’s the list of EVERYTHING I did to clear up my skin. Because I did it all, there’s no way to point at one specific thing to say “this fixed it!” but this is the combo that worked for me.

WHAT IS ACNE AND WHAT CAUSES IT?

When trying to cure acne, its helpful to understand what it actually is. Acne is no simple issue, but I’ll try to give a high-level summary. To put it simply, acne results when hair follicles become clogged and with excess sebum (oil) and/or dead skin cells that become infected / inflamed with p. acnes bacteria. Excess sebum production can be caused by many factors, including genetic predisposition, hormones (especially androgens) and diet.

When working to heal my acne, I was focused on reducing sebum production by regulating my androgen hormones, preventing clogged oil glands and reducing topical congestion in my skin. To do this, I combined both topical changes, as well as diet / supplement changes to support hormone regulation, digestion, liver function, and overall reducing inflammation. 

STARTING WITH THE BASICS

First things first, there’s no getting around the benefits of a clean diet. My diet was already pretty clean, so didn’t make many changes here, but wanted to call out the basics.

• Remove dairy – Again, I’m already dairy-free, but dairy can be a BIG culprit when it comes to acne. Many studies have shown a correlation between dairy consumption and acne. The mechanism behind this is thought to be dairy’s stimulus of IGF-1 (insulin-like growth factor 1). IGF-1 stimulates androgens (male hormones which are known to stimulate sebum production). Serum levels of IGF-1 have been associated with acne severity.
• Limit Gluten / Sugar / White Carbs – I’m already gluten free and limit sugar and carbs, but removing these can be helpful for both balancing blood sugar and hormones (less blood sugar spikes = less inflammatory insulin response)
• Remove pro-inflammatory fats – I’m all for a high-fat diet, but it has to be the right kind of fats. Highly processed / damaged omega-6 polyunsaturated fats and trans fats that you’ll find in foods like canola / soybean / vegetable seed oils are highly inflammatory. On the contrast, omega-3 fatty acids are highly anti-inflammatory and can help balance the ratio of omega-3 to omega-6s. Cut out the processed fats and stick with avocados, olive oil, fatty fish, and pasture-raised and grass-fed animal products.
• Rethink caffeine  – Depending how you metabolize caffeine, it could be helpful to remove. Caffeine can be taxing on the adrenals, and can stimulate the release of stress hormones (cortisol) which can stimulate the release of blood sugar. I switched to matcha (about 1/4 the caffeine of coffee) during my healing phase.
• Rethink alcohol – Honestly, my acne was at its worst during dry January, so cutting it out didn’t make a difference for me. But obviously alcohol is very taxing on the liver, so while trying to support your liver in detoxing, the less alcohol the better.

GENERAL LIVER / SKIN SUPPORT

Next, there are the supplements I was already taking to support overall health, but have specific skin-benefitting properties.

• OMEGA 3s – highly anti-inflammatory
• CURCUMIN – also highly anti-inflammatory
• BEEF LIVER – very high in bio-available (preform) vitamin A – studies have found low levels of vitamin A in patients with acne. Most vitamin A in our diet is in the form of beta-carotene, which your body needs to convert to the usable form of vitamin A found naturally in animal products such as liver
• MILK THISTLE – supports antioxidant activity in the liver
• GLUATHIONE – our body’s main antioxidant – huge for liver support
• B COMPLEX – methylated B vitamins to support Phase 1 liver detox

HORMONE SUPPORT

Alright this where I made some major changes. Since all signs pointed to my acne being hormonal, I was focused on balancing my hormones and reducing androgens (male hormones linked to excess sebum production). My dermatologist wanted to put me on an androgen blocker (spironolactone) – which is a pretty intense drug – so I wanted to take a natural approach first. If you’re dealing with hormonal acne, talk to your doctor about the options below.

• DIM – Diindolylmethane is a compound found in cruciferous vegetables, and is crazy helpful for balancing hormones. To majorly oversimplify, DIM encourages estrogen to metabolize into the “good” estrogen metabolites, rather than the “bad” ones. DIM also acts as an aromatase inhibitor, meaning it prevents some testosterone from being converted into estrogen.
• RAW ZINC –  Zinc supplementation has been shown to help acne patients, and serum zinc levels have been correlated with acne severity. *Note: zinc supplements can be very hard on the stomach and cause major nausea – I love the brand linked and have had no issues taking their zinc with food
• FLAX SEEDS – I added a tbsp of ground flax seeds to my daily chia seed pudding to help balance hormones.

SKINCARE CHANGES: TOPICAL OVER THE COUNTER

• MONTHLY FACIALS – When my skin was really out of control, I knew I needed a professional. With the level of congestion in my skin, having a professional be able to clean it out was game changing. Facials are definitely not cheap, but if you can swing it, I highly recommend. If you’re in SF, go see Shari at Pac Heights Skincare – she offers “mini-facials” which make regular facials much more affordable. Plus, she really knows her stuff when it comes to nutrition and treating acne holistically.
• REMOVING ALL OILS – With one look at my skin, Shari (my esthetician) knew I’d been using oils on my face. I was shocked, as I used to be the biggest lover of facial oils, but she says she sees girls all the time with congested skin and acne from using face oils. Here’s the thing guys – natural does not equal non-comedogenic. Many ‘natural’ skincare and beauty products are full of oils, which can very pore clogging / congesting to the skin. This isn’t the case for everyone (I used to be able to load my face up with oil with no issue), but if you’re fighting acne, this can be a key step. I went ham on all my skincare and make up products and removed EVERYTHING that had any oil in it. It was a sad time, but it helped my skin like no other. This is a great list of comedogenic ingredients.
• FOREO CLEANSING DEVICE – Man do I love this thing. I swapped out my Clarisonic (which can harbor bacteria in the wet bristles) for a Foreo Luna cleansing device, which is made of antimicrobial silicon to prevent spreading bacteria.
• ICING – Ice is excellent for removing inflammation in the skin. I’d use an ice roller or just an actual ice cube on my face and focus on active acne spots to calm my skin.
• LYMPHATIC DRAINAGE – I’m a HUGE fan of gua sha tools for supporting lymphatic drainage and helping to remove congestion in the skin. Just be careful with active acne not to spread bacteria.

SKINCARE CHANGES: TOPICAL PRESCRIPTIONS

• ACZONE – This prescription topical worked great for me. I used it in the mornings, and had no irritation / side effects. It’s known for helping prevent cystic acne.
• RETIN-A* –  Holy LOVE. Once I got on the right dose of prescription Retin-A (Tretinoin), it was a game changer. Retin-A is the prescription level of retinols (that you’d find in a Sephora), and is a derivative of Vitamin A. Retin-A increases cell turnover which is great for clearing congestion from the skin and preventing pores from being clogged with dead skin (which can cause acne). The first couple weeks suck (you will peel and look insane), but once your skin adjusts, its awesome. As my dermatologist told me “you’ll hate me in 2 weeks, like me in a month and love me in 3 months.” I think this was a huge help in clearing the congestion and now helping with scarring. *Retin-A is not recommended during pregnancy, and you should take extra measures to keep your skin out of the sun when on Retin-A to prevent skin damage

SUMMARY // TOP TIPS

Again, I pretty much threw everything at my skin at once, so hard to pinpoint any one major factor, but I’d say my top changes were:

1. Removing all oils
2. Getting regular facials
3. Adding hormone balancing / androgen suppressing supplements
4. Adding the right prescription topicals

my skin today (make up, obvi)

UPDATE NOVEMBER 2020

Since it’s been over a year since I published this, I wanted to share a couple new favs in my skincare routine. I still keep it very simple, 100% oil-free, and have focused on medical-grade products that give results. *Not all of these are ‘clean’ beauty – CeraVe contains parabens – but for now, they work great and never make me breakout. Still on the hunt for a good, natural, oil-free moisturizer.

Morning Skincare:

• La Roche Posay Cleanser ($) – Simple, hydrating, doesn’t dry out skin. Perfect with my Foreo cleansing device
• Thayer’s Witch Hazel Toner ($) – Love this all-natural toner to balance skin’s pH before serums
• SkinCeuticals C E Ferulic ($$$)– Holy grain serum that gives skin serious brightness while evening texture & tone. I’m on my third bottle and am hooked for life.
• SkinCeuticals HA Intensifier ($$)– Serum aimed at supporting skin’s hyaluronic acid levels for dewy, moisturized skin
• *If breaking out (rare these days luckily!) – Aczone – prescription topical for cystic acne
• CeraVe moisturizer* ($) – This is technically made for night, but I love it post-serums – SO hydrating
• CeraVe SPF moisturizer* ($) – Daily, oil-free SPF that I apply on top of the night moisturizer

Evening Skincare:

• La Roche Posay Cleanser ($) – Simple, hydrating, doesn’t dry out skin. Perfect with my Foreo cleansing device
• Thayer’s Witch Hazel Toner ($) – Love this all-natural toner to balance skin’s pH before serums
• Prescription Retin-A ($ w prescription) – Prescription Retin-A is a major skin GAME CHANGER. Plus if you go through your dermatologist, it’s SO CHEAP with insurance. A tube that lasts me a year is only $5 with insurance. Note: Retin-A is not approved for use while pregnant
• CeraVe moisturizer* ($) – Perfectly hydrating ontop of Retin-A, which can be very drying

Have you guys struggled with adult acne? Any skin tips you’d share?