Today we’re doing something a bit new and different. I’d like to introduce you to our friend Andrea, who has asked to share her story with you. It gives great insight into much more than first meets the eye. At first, you may notice that it’s a story I’m sure many of us are familiar with (I know I am…ugh) and that’s dealing with crazy adult acne in your 30s (or 20s or even later.) And I’ll be up front and say that we, of course, are not doctors. We do not mean for you to take this post as direct medical advice, though if adult acne is a problem for you, you may find some of what Andrea has to say to be helpful information to take to your next dermatologist appt and ask about. But medical advice? No. Far from it. On the contrary, I want you to read this post and apply it to your life in whatever way it seems most appropriate.
Maybe it is from the view point of dealing with adult acne, a dermatological battle you never thought you would win, and gives you renewed hope. Maybe you’ll find that it applies to another medical situation in your life and gives you the encouragement to fight on, seek other opinions, and not to settle until you have an answer you are truly happy with. Or perhaps it resonates with you on an entirely different level. Today I invite you to take charge of your life friends. It’s your life to live right? Don’t wait another minute. Get living. ~Lauren
Face to Face with Prescription Beauty ~Andrea
Let me be upfront; I am not a mother.
This renders me unqualified to give the parenting advice and mommy tips that Lauren and Mandy can, but I am a woman over 30. That age seems to be a great equalizer when it comes to the pursuit of beauty.
Predominantly we try to correct damage or maintain youthful glows. But another dominant thing that comes into play, one I didn’t expect, happened to me starting 8 months ago.
Treating it was a journey and I was unprepared for its impact not just on my skin but on my emotions.
Some of those women have had acne before (like me) but for others, this is their first bout. Though I have had mild acne since middle school, this acne was different.
I have been in the care of a dermatologist since I was 12. Each year since then, I have gone to the doctor at least two times. I have been blessed to be able to do this. My parents, my mom in particular, made my skincare a priority. I have been on topical gels, lotions, and a range of oral antibiotics ever since. (I did protest the antibiotic use because of the possible side effects, but these did work well for me and account for why I went to the doctor regularly. A good doctor will closely monitor her patients on oral antibiotics.)
This July I was on medicine and under a doctor’s care when my acne struck full force.
I had never experienced cystic acne before, but this can be more typical of women in their 30s. It is a time when the skin becomes drier, cortisol (stress) levels are often high, and hormones are fluctuating (due to pregnancy or menstrual cycles). This is also an age when hormone problems can arise. The skin, and acne breakouts, can signal polycystic ovarian syndrome (PCOS) and other imbalances.
Unlike teenage acne that is in the T-zone, hormonal acne falls along the jaw line, chin, cheeks, and jowls. In my case there were large hard painful knots of inflammation and deep papules. My face just hurt. My self-esteem was plummeting, and I was becoming less and less willing to go out into public.
Since I was in a doctor’s care already, I made an appointment. She changed the oral antibiotic prescription to a different one, and I tried it for 4- 6 weeks only to have my face worsen. Then I made another appointment; this one left me demoralized.
I felt a premature sense of relief in the exam room. The nurse practitioner, who had been managing my care for over a year, came in. She began asking questions, but rarely looked up from her touch screen tablet while I explained my outbreaks. I told her I had been having cysts under my skin on my face and in various parts of my body (back, shoulders, near my spine, etc). (This was nodular cystic acne and I know now it was turning into acne vulgaris, which is severe.)
“No, you’re not.”
As bluntly as that, she said I was wrong. I insisted.
“No. That kind of acne is big. BIG.” She held up her hand to show a circle the size of a nickel. Just what I had been experiencing.
“Yes. I have that. It’s gone down now, but you can still feel where it was, here.” I lifted my shirt to reveal the knot next to my spine.
She looked away at her computer.
This continued for far too long. I decided to lead her to some helpful information. I asked about diet, stress, alternative treatments, things to do, and things to avoid.
She said none of these things were linked to acne with clinical research and completely dismissed their relevance and effectiveness. I asked about the treatment plan I was on and if she was going to change it. I was told no, it would stay the same. She stood up and led me to the door.
“Maybe in 6 weeks you’ll be better.” And then she laughed. Laughed.
I paid my 50 dollar co-pay before crying.
There were many red flags that I experienced in that exam room. Did you notice them? The lack of eye contact, the corrections, etc. Taken one at a time they could be rationalized, but collectively for me they were dealbreakers. Had I not seen all of the red flags for what they were and experienced them all at once, I may have meekly followed the same treatment plan, but I became indignant. Indignant enough to know I had been medically mismanaged and mistreated and that I needed to seek help elsewhere.
Interestingly, I decided to return to the dermatologist who treated me in my adolescence. The same practice that kept my skin clear as a teen got to tackle the same problem again.
It took a few weeks to get in, but since I had been a patient previously, it was somewhat expedited. When I got to the nurse practitioner, I was having the clearest skin I had had in weeks. “Clearest” is a relative term. I had at least 7 active papules/ pustules. When I told her this was the best skin day in months, she began asking me questions. There was no computer in the room, just her and me. She was looking me in the eye and at my skin, and I was having a hard time being looked at. (As I said, my skin clarity had, in a troubling way, deeply impacted my emotions, which is not uncommon.) She asked what topicals I was on.
I was on my standard skincare cocktail:
Clecin-T gel (clindamycin phosphate gel) 1%,
Retin-A (tretinion cream).01%, as well as the oral antibiotic
Doxycycline, which I returned to after Erythromycin had failed.
I was washing my face with a product with 1% salicylic acid, using a toner with tea tree oil, was not wearing makeup, had cut dairy out of my diet, was sleeping 8-9 hours a night and exercising regularly to reduce my cortisol levels. I was trying anything I knew to do.
I explained the nodules and the pain and she immediately agreed with me. “Yes, it is cystic acne,” she said, “I can see the red marks. I am not happy about this.”
Then she said words I had been longing to hear for months, “This is what we can do.”
She explained multiple options and combinations of options for me. New drugs, prices, rebates, how to work with insurance costs. She assured me we would find something that worked.
What worked, or what was the start of something that worked, was oral spironolactone.
It is designed as a diuretic to reduce fluids around the heart in people with hypertension and congestive heart failure, but has dermatological side effects. Spironolactone is arguably possibly safer than taking antibiotics and an option for women with hormonal acne because of its impact on androgen levels. (It can upset Potassium levels, so this should be monitored by a simple blood test.)
Another topical I was prescribed was Aczone gel 5%. It has anti-inflammatory properties and can help protect the skin from damaging itself when it rushes to heal lesions quickly. (Often it is the body’s eagerness to heal itself that causes scars.) My nurse practitioner gave me a rebate for this drug, since it is very expensive currently and has no generic.
And I continued to use Retin-A’s generic, tretinoin cream.
Note: This requires a note from the doctor to approve after 30, if it is for acne treatment. Without this approval, Retin-A costs at least 100 dollars because it also acts as a wrinkle treatment. Retin-A is seen by insurance companies as only a cosmetic use and it is charged accordingly.
Follow-up with any dermatologist is key. While I had a new treatment plan, one that was helping, it wasn’t fully optimal. After 6 weeks, I scheduled an appointment to return early. I felt sheepish and vain in not being happy with my skin, because it was vastly better, but the hyperpigmentation ( the marks acne left behind) was concerning me. My skin is very fair, and I was (and am) unable to conceal my deep dark red marks with makeup.
When I went in the nurse practitioner asked how I was doing. I broke down and asked if my face was covered in scars or if it was going to heal. Certainly it looked uneven and pocked. I could no longer tell and had been spending far too much time looking up acne on the Internet and feeding myself worst-case scenarios. She scrutinized it and ran her fingers across my face.
“I think these will heal completely in 7 months.” She pointed out a few places of concern, where the collagen might not return, but it was not as bad as I had thought.
She changed one of my topicals, Retin-A, and swapped it with Tretin-X, which is a retinol with a bleaching agent to help the hyperpigmentation. She increased my dosage of spironolactone, and scheduled the potassium blood work test.
We also discussed the possibility of microderm abrasion, but she understood this procedure might be out of my budget. She said some Flex Spending Accounts can count toward cosmetic procedures and to investigate that angle. Finally she made me promise not to hesitate to come in if I am concerned or when I think a product isn’t working well enough. I promised and scheduled my next appointment.
That was early December. As I write this it is the first week of January, my skin is clear of new acne, but marred. I am much wiser on what to look for in a professional, what standard of care I know is available, and what to tell other women. And after 6 full months of struggle, appointments, and products I have a renewed sense of hope.