Here's What to Do If A Zit Keeps Coming Back

I BLAME ETHAN HAWKE...not just for turning me on to a lifetime of scruffy boyfriends but for setting off a recurring volcano of a pimple. As a journalist, I was assigned to interview Hawke, my ultimate celeb crush. The week before the gig was stressful, between work, dating, life. The day of the interview, I woke up with a huge zit on my left cheek, where I usually break out when I’m crazed.

I went to our Q&A self- conscious, hiding half my face. That stress zit was now popping up every few weeks, whenever things got tense. I’d had it—so I went for help. Here’s what the pros told me.

 

I TRIED...The Doctor

My first stop was logical: a dermatologist. “I see it all the time,” said Anne Chapas, MD, of Union Square Laser Dermatology in NYC. She told me that inflammatory pimples—like the one on my face—have a talent for coming back, as they’re often triggered by hormonal changes. “Underneath the surface of each pore is a sac-like area consisting of the hair follicle and sebaceous gland,” says Dr Chapas. “With every hormonal wave, this area can inflate with oil, bacteria, and white blood cells.” If this inflammatory response is intense enough and deep in the skin, a nodule or cyst can form. The clincher? “This type of acne is very hard to treat.”

Was a top derm in New York saying there’s no hope? Not exactly. “One great option is a topical prescription antibiotic and anti-inflammatory called Aczone; a gel works well on hormonal acne,” she says. If the problem persists, you can actually extract the ‘sac’ underneath the bump—it’s an office procedure with local anesthesia, stitches, and maybe a small scar.

I definitely wasn’t up for surgery and wasn’t sure about a prescription just yet, so I held off.

 

I TRIED...The Naturalist

One of my greener friends suggested I see Karuna Sabnani, a naturopath in NYC who employs therapies like meditation and nutritional changes. Sabnani said to me, “You want to know how you’re doing in life? Look at your face. If you’re eating badly, hanging out with the wrong people, working a job you hate...it shows on your skin.” The mind-body-skin connection made sense, but...could she kill my pimple? No promises. Sabnani did, however, have some advice for preventing the next one: “You should drink plenty of water and no alcohol, and stop eating anything fried, processed, sugary, salty, or sour.” Whoa. “Get good rest, and lower stress levels. If you’re not centred, your skin will express that.” This seemed unrealistic. I could eliminate some toxins, but a girl’s gotta live!

As for my IRL pimple, she suggested applying a dab of raw honey. It brought the pimple to a hard, pointy head. But total destruction? No!

I TRIED...The High- Tech Facial

When I heard there was a new spa in town that could zap my zit quickly without all the Zen, I ran.
A 15-minute appointment at Skin Laundry—an LA- born spa concept, in cities like New York, California, and Arizona—promises ultraglow-y, clearer skin with the wave of a wand. While one session won’t erase an active eruption, it aims to reduce the inflammation and prevent new ones. The treatment uses a YAG laser, which deeply heats the skin, temporarily shrinking the oil glands. It also kills bacteria. The next step is an IPL (intense pulsed light) laser, which helps improve skin tone and boost collagen. The lasers prickled a little, but it was relatively pain- free. It didn’t even leave me red or puffy. After four sessions, the zit disappeared, never to appear again. Admittedly, I’ve maintained weekly appointments. Now that I’ve stopped worrying about pimples, I have the mental real estate to start obsessing over something new—anti-ageing!

IF YOU NEED AN RX

When over-the-counter products aren’t cutting it, your derm may recommend one of these potent meds. Here’s a primer.

Topical Antibiotics: For powerful pimple-fighting effects, derms often prescribe an antibiotic like clindamycin in conjunction with benzoyl peroxide (either separately or in a combination product). Dapsone (aka Aczone) is a newer alternative that’s applied as a stand-alone therapy. “Topical antibiotics are usually well-tolerated, which makes them great starter treatments,” says Gervaise Gerstner, MD, a dermatologist in NYC. Applied once or twice daily, these gels and lotions can begin to reduce flare-ups in as soon as a few days.

Retinoids: In addition to improving fine lines, texture, and tone, prescription retinoid creams and gels are known for their skin-clearing powers and can take two to three months to work. The original topical retinoid is Retin A, but there are several different versions on the market.

Oral Antibiotics:“Because they’re working from the inside out, they can be more effective than topical forms,” says Rebecca Kazin, MD, of the Washington Institute of Dermatologic Laser Surgery. (Two popular pills are minocycline and doxycycline.) But, like all antibiotics, they can come with side effects, like an upset stomach, sun sensitivity, and yeast infections.

The Pill: If your acne is driven by fluctuating hormones, a birth-control pill reduces the level of androgens, lowering breakouts.

Spironolactone: This diuretic (which can cause you to pee more) was originally developed to help lower blood pressure. But doctors quickly realised that it cleared acne, because it acts as a hormone regulator. “It works exceedingly well for acne along the jawline, neck area, chest, or back that fluctuates with the menstrual cycle,” says

Dr Kazin, who initially puts patients on it for a three- month trial.

Isotretinoin: This potent drug (flip the page to learn more) shrinks the oil glands that help bacteria breed. It can result in serious side effects (including birth defects), which is why users need to take regular, monitored pregnancy tests. Some derms won’t consider putting patients with moderate acne on it until they’ve exhausted other options, including systemic antibiotics for three months.

—NICOLE CATANESE

BY ALYSSA SHELASKY

This article was published in the August 2016 issue of Cosmopolitan India.