A Zit That Keeps Coming Back -By Alyssa Shelasky
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. On 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 :
1. 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.
2. 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!
NATURAL FIX : Controls, excess oil, The Body Shop Tea Tree Oil, ₹695
3. 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!
ALL-AROUND SKIN PERFECTER : Retinol attacks acne and aging. Skin Laundry Night Renew Treatment, amazon.in, ₹6,517
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.
1. 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.
2.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.
3. 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.
4. 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.
5. 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.
Serious Acne All the Time -By Liesa Goins
Mornings were the worst. I felt dread before I even opened my eyes. I knew what I’d see in the mirror, but each day, I hoped it would be different. It never was. My teenage face was still crowded with painful acne cysts ranging from red to purple, like a Martian landscape. I hated looking at myself, so I could hardly blame the reactions I got from others.
Strangers at the grocery store told me what I’d done to cause my acne (used too much hairspray, drank too much soda). My classmates gave me a group lesson on how to wash my face while I fought back tears and listened. Once, a boy asked me out, only to call me later to tell me it had been a dare. As a result, my guard was always up, my stomach always churning. I avoided eye contact at all costs. I didn’t eat pizza in public, afraid I’d hear the obvious comparison. There are virtually zero pictures of me at this point in my life. My acne made me feel totally isolated. Sure, I knew other people had bad skin, but no one’s was as severe as mine. It felt like a punishment. What had I done to deserve this? I wondered. I thought it would always be this way, something unchangeable, like height. I just wanted to disappear. So much so, I hoarded enough medicine (prescription painkillers, cough syrup, anything) in the event I just couldn’t face another morning. I wasn’t being overdramatic. Clinical depression may be two to three times more likely if you’re waking up with breakouts daily, according to a study in the Journal of Cosmetic Dermatology. Luckily, I never had the chance to do anything dire. My mother—and a doctor who prescribed me a controversial treatment—saved me in time. The medicine was called isotretinoin, sold under the brand name Accutane, explained Esta Kronberg, MD, my new Houston-based derm. It had only been FDA-approved for a few years, and she had just started prescribing it. As she took pictures of my teenage face, I tried not to feel too hopeful as she explained how this daily pill took an entirely different approach to treating the condition. It was specifically effective on the cystic bumps that I was suffering from. Isotretinoin works through a variety of mechanisms, but the primary one is that it decreases proliferation of cells in the oil glands, in part through apoptosis— or programmed cell death, says Diane Thiboutot, MD, professor of dermatology at Penn State College of Medicine. Since the oil feeds the specific form of acne bacteria (called P. acnes), once you take away the food (oil), you take away the inflammation. Within the first month, my skin began to clear. In nine months, I was completely clear. Seriously. (The only side effect I experienced: my skin and lips became extremely scaly due to decreased oil production. It’s common.) While my skin underwent a miracle transformation, so did my day-to-day. Once I felt people weren’t staring at my skin, my confidence increased. My mom said I started to smile more. I even tried out for a play. (Months before, just the idea of being onstage would have put me into a panicked state.) The following year, I met my first boyfriend and went on my first date. About 85 percent of those on isotretinoin see similar success to mine, according to the American Academy of Dermatology. “To date, the efficacy of isotretinoin has not been superseded by any other treatment,” notes a 2009 review in the journal Dermato-Endocrinology. I knew about Accutane’s troubled reputation — the drug has been linked to severe depression. But it completely lifted mine, if not saved my life.
What Are You Watching?
Zit-popping videos are racking up serious Likes. Nicole Catanese explores what’s beneath the trend. In the dark corners of YouTube and Reddit, acne is having a moment. Type in blackheads and enter a black hole of extraction videos. Some of these homemade films have racked up several million views. But when Cali-based derm Sandra Lee hit the scene in 2014, amateur hour was clearly over. Known as Dr Pimple Popper, Dr Lee’s high-def clips have amassed 1.6 mil Insta followers.
So what’s the draw?
Bonding Over Blemishes Sometimes seeing something icky—but authentic—can make you feel better about yourself. “It’s exciting to see others participate in behaviour that is usually seen as gross,” says Matthew Traube, a psychotherapist who specialises in body-focused repetitive behaviours. “Seeing a doctor popping pimples validates the behaviour and sends the message that you don’t have to be ashamed of it.” Click Away the Stress “People tell me that they need my videos to relax,” notes Dr Lee, “and that they help them sleep at night.” Kriti M., a 29-year-old @DrPimplePopper fan, queues one up every night before bed. “It sounds bizarre, but they help me unwind,” she says. “There’s a sense of accomplishment to a great pop.” Really, who can’t relate to that feeling of satisfaction after popping a blackhead or bump lurking just beneath your skin? “Most of my patients describe relief while they are picking,” explains Traube. For chronic skin pickers—indicative of a larger mental health issue—these videos may offer an outlet. “Just like watching someone bite a lemon might make your mouth pucker, watching someone get extractions can also produce a physiological or emotional response or release,” says Traube. It sounds odd, but it gives some a clean slate.
We tried several products to bring you some of the best and topselling blemish fighters!
A drugstore icon, this salicylic acid–infused wash has kept excess oil at bay since 1993. Neutrogena Oil-Free Acne Wash, purplle.com, ₹549
In the event of an acne emergency, reach for benzoyl peroxide. It helps unclog pores, control oil, and reduce redness, stat. Clinique Acne Solutions Emergency Gel-Lotion, ₹3,270
Zit stickers? Kind of. Laced with salicylic acid and tea tree oil—and hydrating hyaluronic acid—these clear dots are more like mini spa treatments. Peter Thomas Roth Acne-Clear Invisible Dots, amazon.com, ₹1,609 approx
Ah! That cooling sensation and gentle exfoliation action leaves skin feeling smooth and clean—never stripped. Clean & Clear Deep Action Exfoliating Scrub, amazon.in, ₹1,335
This magic pencil with Marula oil, beeswax and salicylic acid is a long-wear formula with concealing and healing power! The Body Shop Concealer Pencil, ₹750