Problem: I have a problem with cystic
acne, which I only get monthly right before my period.
My dermatologist has me using Cetaphil Daily Facial Cleanser
for Normal to Oily Skin, Cleocin T Lotion (a prescription
antibiotic) in the morning and Differin Cream at night
(which I use every other night). Is there anything else
I should be using or doing?
Solution: Cystic acne, whether chronic
or intermittent, is one of the most frustrating types
of acne lesions to deal with. Not only are cystic acne
breakouts painful, but the extent of damage they're capable
of inflicting often goes beyond the reach of topically
applied products. What happens in cystic acne is not a
pretty picture. It is typically triggered by a surge in
hormones, such as occurs during a woman's menstrual cycle.
For some unknown reason, the skin's oil glands become
hypersensitive to this cascade of hormones, and react
by overproducing sebum—so much, in fact, that the oil
gland itself becomes engorged, swollen, and hardened with
the excess. Unable to push the extra oil into the lining
of the hair follicle (which leads to the surface of the
skin via pores), the gland bursts underneath the skin.
This causes acute inflammation and irritation, and leads
to the redness and soreness of cystic acne. Because these
lesions start so deep in the skin, scarring is an all-too-common
side effect.
Although I think the products your dermatologist has
you using are worthwhile for many degrees of acne, they
are probably an unsuitable solution for combating cystic
acne, even though yours is a not a daily occurrence. As
acne becomes more severe, the options one has for treatment
gradually diminish. Many dermatologists regard cystic
acne as the most severe type of acne lesion, and, when
pressed, admit that treatment options are limited to oral
drugs such as Accutane and sulfa-based antibiotics—both
bona fide options, but not without some risk. Neither
would likely be recommended in a case like yours, where
cystic acne ebbs and flows with the monthly cycle.
A potential option you may want to pursue with your dermatologist
is oral hormone therapy, a topic I touched on in The Beauty
Bible. It's possible that your cystic acne is tied to
an increase in testosterone production during your menstrual
cycle. Drugs known as anti-androgens (an example is Cimetidine)
are able to block the effects of androgenic hormones.
The downside is that these prescription drugs are not
without side effects, and as such are generally prescribed
in low dosages. The hypertension-taming drug spironolactone
(brand name: Aldactone) also has anti-androgen effects
and is yet another hormone-balancing possibility to discuss
with your dermatologist. However, the trade-off of long-term
use (required with hormone blockers) may not be worth
the relief from intermittent cystic acne. Conversely,
you could also consider estrogen therapy if tests determine
that there is an imbalance in your body's levels of testosterone
and estrogen.
In the meantime, I advise you to keep your skin-care
routine as simple as possible, and avoid the use of overly
heavy, thick moisturizers in the areas where cystic acne
occurs. The cleanser you're using is a fine option; but
make sure you are using an effective sunscreen during
the day (possibly a foundation with an effective SPF and
moisturizing only those areas of your face that are dry).
It is difficult to suggest the use of standard topical
anti-blemish treatments if cystic acne is exclusively
what you're dealing with. However, regular exfoliation
with a salicylic acid (BHA)–based product will keep debris
from building up in the hair follicle (pore) lining, which
will provide a clear pathway that gives swollen oil glands
a better chance of expelling excess oil into the pore
lining rather than beneath the surface of the skin.