I want to preface this blog by stating that I am not a Doctor. I am, however, a nurse and in this post, I am speaking solely on my personal experience.
My Skin’s Younger Years
As a teenager, I really never had an issue with acne. Every now and again, I would get a blemish or two during that time of the month. It would heal within a few days and I would go on with my life. I always felt bad for my friends who battled heavy acne and were left scarred. Both literally and figuratively.
During my teenage years, I really never got into makeup. There was no Instagram, Facebook or even Internet! For me, makeup was for special occasions and not for every day use. When I became a young mom, I did not have a lot of extra time – or money – to put into makeup. Additionally, my career path at that time was not existent. I had jobs. There was no need to look made up on the regular.
My Skin’s Mature Years
Fast forward thirty years as I progressed through my degrees and subsequent career, the need to maintain my professional demeanor and appearance grew. But then it happened. My face became a war zone. I was engaged in the battle for clear skin. There I was an adult woman with a professional career but with a face filled with painful bumps and dark red spots. It was debilitating. It was embarrassing. I felt helpless that my skin turned on me and there was nothing I could do.
My symptoms came on suddenly. It was as if a switch was flipped within my body and my face paid the price. I would go to work in the AM with a clear face and within a few hours, I would feel pain. Sometimes it would throb. Sometimes the pain was upon touch. This pain was unlike any other pain I had ever experienced. It was deep. Like up against the bone deep. Many times it would also itch. Painful itches.
I tried so hard not to touch the bumps but often it was incidental. For example, answering the phone or even eating or talking would activate the pain sensors. The cysts would come on so fast- within hours. The worst thing about them is that they would stay for weeks and months at a time. To the left is an awful, candid profile picture where you can see the acne. It was hard to even find this picture because I realized that I stopped taking pictures of myself.
I found it quite difficult to concentrate at work. If I was meeting a vendor or presenting to an audience, all I could think of was how bad my face my looked. I felt the pain with each syllable. I grew very self-conscious. Then I started to keep makeup with me at all times in an attempt to cover it up.
What is Cystic Acne?
According to the American Academy of Dermatology (the AAD), a growing number of women in their 30s, 40s, and 50s are suffering from this form of adult acne. Much of the research points to increased stress, family history, products used in makeup and skin care, medication side effects and fluctuation of hormones due to menopause or polycystic ovarian syndrome.
All forms of acne are some type of inflammation. Pores become blocked by oil, dirt, or even dead skin cells. This causes the typical, raised bump of a acne. There maybe some small infection involved when the head of the blemish develops into a whitehead or a visible pocket of pus. These may be uncomfortable and can be handled with topical treatments in most cases.
What sets cystic acne apart from regular acne is the depth at which the inflammation occurs in addition to the breadth of the infection. This is why it hurts so much. Think of it like a volcano – it may be small at the surface of the earth yet may have deep penetrating pockets of lava far below the earth’s crust. This is similar to cystic acne.
Additionally, cystic acne may never come to a head. This is because the infection pocket is so very deep. Instead, assuming you do not touch it, what you get is a very slow healing lesion. The top layer of the skin remains intact but you can visibly see the blood tinged pus as it starts drying out. This can take weeks to months to heal.
Honestly my journey was a lot longer than what it should’ve been. I’m a nurse so I should know better than to put off healthcare.
One thing I have noticed about nurses (and perhaps moms) is that we put ourselves last. In the medical world, it’s a proverbial joke about nurses having many UTIs (urinary tract infections) because they must “hold their pee” since they’re too busy taking care of patients who may have UTIs. Always taking care of the needs of others.
When this first started occurring, I thought these were just really large blemishes and that they would go away on their own. Instead, they lingered and lingered. It would take months for these to heal and new ones kept forming. It didn’t matter the time of the month- every phase of my cycle was fair game.
I never had any experience with this type of acne so initially I was dumbfounded. I researched and researched and finally came upon the answer. During this time, I tried a lot of products. I even became a Sephora VIB Rouge member!
This list of things I tried included three types sulfur based over the counter medications, coconut oil, tea tree extract, salicylic acid based medication, benzoyl peroxide based medications, and a various amount of face washes and masks. Not to mention the makeup to cover it all up.
The list of things I tried was exhaustive and expensive! Finally, I gave in. There was absolutely nothing over the counter that would touch my face. Coming to the realization that I needed something to attack the acne at its deepest level, I called and got an appointment with a dermatologist.
The Dermatologist and Treatment Protocol
Getting an appointment with the dermatologist took a while. All in all about 2 months from calling to the actual appointment. It was worth the wait- albeit I should have done it sooner. After my initial examination, we decided to move forward with an oral antibiotic and a topical cream consisting of a combination of a retinoid and benzoyl peroxide.
The decision to start a potentially lengthy treatment of oral antibiotics was not an easy one. According to the CDC, at least 2 million people are infected with antibiotic resistant bacteria. Of these affected people, over 23,000 died as a direct result. Largely these resistant strains are the fallout from years of the over-utilization of antibiotics.
When it comes to antibiotics, it is usually best practice to start with a broad spectrum and hope that it is able to take care of the infection. the term broad spectrum just merely means that it is effective against a large variety of organisms. Only if these do not work or are not warranted for a specific organism, do you then move on to more advanced antibiotics.
The doctor started me on tetracycline. Not only does this medication have an antibiotic property but also it also has some anti inflammatory properties as well. This is a bonus when treating cystic acne. We began with a 3 month plan of this medication. But this didn’t last.
One of the side effects of tetracycline is dizziness. Boy did it hit me hard. I am not usually one to have a lot of side effects from medications so I really thought this would be an easy thing for me to take. The first day I took the medication, I felt like I was drunk. You know the type of drunk when you close your eyes, the world is spinning so fast you may puke? Yep. That kind of feeling. It was awful.
The dermatologist quickly changed my medication to minocycline which is a very close cousin to tetracycline. However, because of the slight chemical variation in its makeup, I was able to tolerate this antibiotic after a few days.
We coupled this antibiotic with a topical cream called Epiduo. It contains Adapalene which is very much like Vitamin A in that it helps skin renew itself quickly. Therefore, those red marks would disappear quicker. The other ingredient is benzoyl peroxide which has an antibacterial property to help keep the skin free of bacteria.
The Light at the End of the Tunnel
During this time, I stopped all other over the counter treatments. I continued to wash my face with a gentle cleanser and follow up with a mild moisturizer (both cetaphil). Treatment continued for 9 months. My doctor really wanted me to stop after 6 months but I was having such good results, I begged for an extension.
Within the first month, the cysts were becoming fewer and fewer. The topical cream was helping to eradicate the red blotches and promote healing. Things were finally looking up!
This all took place about 5 years ago and I have been cystic acne free since. I get an occasional blemish every now and again due to my cycle and hormone fluctuations but these are usually small and heal easily.
The one residual effect on my face is that I have some areas of hypopigmentation where I was scarred from the cysts. Most times, my makeup hides the discoloration but in the summer it gets a little tricky if I am in the sun. These areas of my face do not tan at all.
These spots are the last reminders of what I went through. I am so glad it was just a season of my life. The most important take-away that I would like to impart is to make that appointment with the doctor sooner rather than later. Don’t tough it out and ignore your body. Don’t waste time and money trying all of the latest and greatest. Give yourself permission to put you first and take care of you. It is OK and necessary to do this!