About skin, revisited.
Just about a year ago, I wrote a post about my skin, specifically about coping with adult acne at the (then) age of 37. It was tough to write, but I’m glad I did it. I have spent a lot of years of my adult life feeling ashamed for not having great (or even good) skin, and for not finding solutions in the simple, natural methods that have worked for so many. At the time I wrote that post, I’d been following a regimen recommended by my dermatologist for about six months — and my skin was looking pretty good. Not perfect, but I felt better about my face than I had in many years. The only prescription I was using at the time was a combination topical antibiotic/retinoid called Ziana, and it was working really well for me.
This past June (almost exactly one year after after I started the regimen and the Ziana), though, something changed. Suddenly my skin was getting lots of clogged pores, and I was started to get cystic breakouts again. It seemed like it was overnight, and it was very upsetting. First I worried that I’d developed an antibiotic resistance, then I worried my Clarisonic was harboring bacteria (even though I clean it thoroughly after every use and change the brush head as recommended)…I panicked. I waited a couple of months and blamed stress. I blamed lack of sleep. And then I stopped being dumb, and I went back to the dermatologist.
I don’t know why I waited so long. I guess it was that sense of shame again, like the doctor was going to tell me I was doing something wrong or that I was apparently untreatable and was destined to a lifetime of looking like a goblin. She didn’t say either of those things, of course (tip: if you doctor calls you a goblin, find another doctor), but instead said that she suspected the dosage of tretinoin in Ziana (.025%) was too low for me. OK!
So here’s what I’m using now. It’s been about two months, and HELLO! My skin looks pretty good, and every day it looks better. I still have a lot of discoloration from past breakouts, but it’s fading gradually and is relatively easy to cover in the mean time. I don’t think I’ll ever think I look good without makeup on, but at least now I don’t think I look diseased when I walk in the bathroom in the morning. At age 38, I can finally even bring myself to be around a friend (AT HOME! Let’s not get carried away…) in the evening after I’ve washed my face. That’s big for me. I think it’s been about five weeks since I’ve had any sort of breakout, and even then it was minor.
Anyway, here’s the current product lineup:
1. Neutrogena Fresh Foaming Cleanser
Yeah, on some level I still feel like this is chemical-laden, unglamorous garbage and I kind of do wish I could wash my face with, like, virgin coconut oil and fulvic-enhanced mineral water (heh), but it’s $5 and it works so I just don’t even care anymore. I use it twice a day, once in the morning, then twice at night — once to remove makeup, then again right after with my Clarisonic.
2. Clarisonic (20% off at SkinStore.com right now, FYI)
I always come back to my Clarisonic. Whenever I think it’s failing me, it turns out it was actually something else. Like I said, I’m diligent about keeping it clean and changing the brush head (I always use the ones made for delicate skin). I love my Clarisonic, and I feel badly for ever doubting it. I’ve actually had a couple of terrifying dreams in which I find myself Clarisonic-less, which is admittedly kind of sad but also very telling and let’s just blame stress for everything.
3. Kiehl’s Midnight Recovery Complex
This incredible serum has mostly taken the place of my former favorite, Huile Prodigieuse, as a nighttime treatment. I still use Huile Prodigieuse during the day if my face feels tight, and it’s great in my hair, but the older I get the dryer my skin…and I needed something more intensive. I’d gone through a couple of sample bottles of the Midnight Recovery Complex when it was first introduced and really liked it, but I didn’t fork over the money for a full-size bottle until last June. It’s wonderful stuff. Magical, even. I only use it at night, and because I just need 2-3 drops to cover my whole face, one bottle will last a really long time.
4. Kiehl’s Creamy Eye Treatment with Avocado
Yep, my old standby for the past five years. As much as I hope to someday find an eye serum that can rid me of my undereye circles, this cream remains the only one I’d found that truly keeps my eye area hydrated in the colder months. No matter how many other eye creams I bring home samples of, I always wind up coming back to this one. Again, as with most Kiehl’s products, the price tag is offset by the generous amount of product. One jar of this eye cream lasts me almost a year.
On to the prescriptions…
5. Retin-A Micro
I actually use a generic version of this, which I think came out to something like $8 for three big tubes with my insurance. My dermatologist prescribed it in .04% retinoid strength, which is nearly double what I was using before in the Ziana (.025%). Unlike Ziana, it does not contain an antibiotic. I use it nightly only, never during the day. Retin-A works by increasing the rate of your skin’s cellular turnover, which means pores are less likely to clog, decreasing pore dilation and (of course) breakouts. It also boosts collagen production, so fine lines and sagginess are diminished. And it really works. Apparently I won’t see the full effects until I’ve been on it for the better part of a year, but it’s made an enormous difference in the clarity and smoothness of my skin already. There was an adjustment period in the form of breakouts and dryness when I started using it, but it wasn’t horrendous — probably in part because I’d already been using a lower dose of retinoids for a year before starting. I do have some adjustment advice, though…
Anna’s Retin-A tips:
✚ Wait at least 10 minutes (preferably 20) after washing your face to apply it. Really for real. Retin-A and water are not friends. If you don’t wait, you are just asking for over-dryness.
✚ ONLY USE A PEA-SIZED AMOUNT. That means a standard green pea, not a chickpea or a lima bean. PEA-SIZED. Squeeze it into your hand, dot it all over your face (avoiding the eye area), then rub it in. It’s not a spot treatment or a mask. Take it easy.
✚ If your skin is getting really dry, apply a light moisturizer first as a barrier. I always put my Kiehl’s serum on right after washing, then wait 20 minutes before applying the Retin-A.
✚ If you feel like you need to skip a night, skip a night. In fact, you might want to start out only using it every other night until your skin adjusts. Everyone is different. Pay attention to how your skin is reacting, and know that the adjustment period of flaking and breakouts is NOT forever.
✚ USE SUNSCREEN during the daytime. Retin-A increases your skin’s sensitivity to light. Don’t mess around with this one. Please.
6. Aczone Gel
Aczone gel is a relatively new medication, but its active ingredient, dapsone, has been used as an anti-inflammatory/antibacterial for a long time…including as a treatment for leprosy. And hey, if it’s good enough for lepers, it’s certainly good enough for me! Seriously though, I’m amazed by this stuff. It’s a gel formula that goes on really nicely, and it’s kept me totally free of any cystic breakouts that Retin-a alone can’t prevent. I use it twice a day (at night after applying Retin-a, and in the morning under my makeup). I saw pretty much immediate results when I started using Aczone — by the next morning anything inflamed on my face had calmed down, and I haven’t had a recurrence since. I don’t even have any tips for using Aczone because it’s so gentle and (at least for me) totally non-irritating.
One downside to Aczone is that it’s new enough that there’s no generic option, and the price tag ($200 for a one month supply!) is prohibitive if you either don’t have insurance or if your insurance won’t cover it (mine won’t, and I have really good insurance). That said, there are coupons you can download to reduce the cost (man, the prescription drug industry is soooooo, so super shady…). I was able to get a three month supply (90g tube) for $25, which is totally worth it. If the coupons stop working…well, let’s not think about that.
So that’s it, really. I still have not found a sunscreen I love, so I won’t share a recommendation. That said, if you have one you love that’s broad-spectrum and nice under makeup, I’d love to know about it! My favorite sunscreen (a lightweight spray from Paula’s Choice) was discontinued a couple of years ago, and I’ve been wandering aimlessly through disappointing alternatives ever since.
One more thing for those of you who have had to deal with similar skin issues: If something isn’t working (even if it used to work!), don’t give up. If you can go to a dermatologist, do it. There are so many options for treating problem skin, and I really, truly believe that improving your emotional health through dealing with those problems is incredibly important. It’s not just about vanity, and there’s not going to be one thing that works for everyone. This has been a very long struggle for me, and I am under no illusion that this is going to work for me forever. I have to do something, though, and it’s a massive relief to have found the right thing for me…for now.