When Shamban sees my face, the doc is brutally honest. "You only use a cleanser? You're being lazy with your skin." OK. She didn't say those words exactly, but that's what she was intimating. I can feel my face turning red -- which probably makes my acne look even worse. And I'm fighting back some tears. I feel like an ugly, hormonal teenager again. What's wrong with me? Why am I still dealing with this problem? But she's right. By only using cleanser, I have been lazy with my skin.
Shamban tells me that my acne is primarily hormonal. It's "red and active" with indented scars beneath the fresh acne. Usually oral acne medication combined with birth control helps keep hormonal acne under control, Shamban says. But when I tell her I've already tried that combo and hate the idea of needing an Rx, the doctor puts me on an extensive four-step treatment plan, which includes everything from topical creams to laser treatments.
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Phase 1: Oral + Topical = Acne-Be-Gone
Shamban isn't messing around. The first part of my treatment is to toss my salicylic cleanser and use three different at-home topical creams: Finacea, Aczone, and Acanya. Here's the breakdown: Finacea decreases the production of keratin, a natural protein in your skin that can cause acne; Aczone is an anti-infective to help prevent infections in the cysts; and Acanya is a topical antibiotic that kills acne-causing bacteria. Shamban also prescribes Spironolactone, the same pill I stopped taking two years ago. But the doctor thinks the combination of the oral and topical medications will deliver better results this time.
The takeaway I've passed to my girlfriends dealing with zits as well: The key to treating acne at home is to stick to a strict four-step regimen -- wash, medicate, moisturize, and protect.
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Phase 2: My Torture Facial
After two weeks of adhering to Shamban's strict regimen, I go back to her office for a facial. I'm thinking it's going to be the ultimate doctor visit, like a relaxing spa day with Enya playing and detox tea served at the end. But I hop into the facialist's chair and I'm immediately engulfed in a stringent smell that makes me choke -- a far cry from the lavender and eucalyptus I was expecting. And the process begins.
The facialist, Tanya Eubanks, first exfoliates and steams my face. Then she uses her gloved fingers and a medical needle to perform extractions. And it is as painful as it sounds. The worst part is when I hear the noise of the needle pricking each cyst. It sounds like a tiny burst of air, which might not seem bad, but all I can think about is all the gunk coming out each time, and it makes me cringe. By the time she applies a mask to reduce redness, I've lost all feeling in my face.
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Was the Numbness Worth It?
After the facial, my face looks like I'd just come back from a week laying out on a beach on the equator, but Eubanks promises the redness will calm down in a few hours. By lunchtime, my face feels really clean and tight. The bumps have gone down a lot, and my co-workers are even telling me that my skin looks smooth. I can't stop smiling the rest of the day.
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Phase 3: I'm Officially a Science Experiment
A couple weeks later, I'm back at the derm's office for the next phase in my journey to clear skin: I'm getting a chemical peel. Eubanks says this liquid nitrogen peel will "help stimulate my skin, bringing the acne to the surface layer," which will help the next part of my treatment -- the lasers -- actually work.
The facialist begins by applying retinol and salicylic acid-soaked strips across my face. Once the strips have dried, she takes them off and applies a high-frequency light, which is anti-bacterial and anti-inflammatory. It feels like tiny, prickly shocks on my skin.
But the shocks are child's play compared to the next step of the peel: The liquid nitrogen. Eubanks assures me that it's safe as she dips q-tips into the chemical. It hurts more than I can express, and I'm scared out of my mind -- but not as scared as I am when I see my face the next morning.
Dealing with acne as an adult is like a cruel joke. Shouldn't acne be something you leave in your past, along with scrunchies and bad taste in boys? And I'm not talking about the monthly hormonal zit or two. I see bright red pimples and inflamed cysts all over my face, all year round.
Even though I've been dealing with cystic acne for years, I still cringe at the sight of my skin when I look in the mirror. Every morning, I force myself to wash my face and get dressed, even though I feel like crawling back into bed and hiding under the covers.
And yes, I've tried everything to get rid of it. Oral medication. Proactiv. Even Acutane, the strongest form of acne treatment available, and one that has very risky side effects. Each time I try a new treatment I'm filled with hope. And each time that treatment doesn't work, I'm crushed.
The only thing that's sort of worked is Spironolactone, an anti-androgen that helps regulate hormones, in conjunction with birth control pills. But popping two pills a day was making me feel like a geriatric, so I stopped taking them and started a new, way simpler regimen: I wash my face with a salicylic acid cleanser -- and that's it. And the acne is back in full force.
A few weeks ago I decided it was time for a last-ditch effort. Why now? I just got into a new relationship. My boyfriend, Ben, tells me he loves me no matter what my skin looks like. But I'll admit, sometimes I doubt that. And I know I won't really feel good about myself until my acne is gone. So I make an appointment with Ava Shamban, MD, owner of the Laser Institute-Dermatology in Santa Monica, Calif. Shamban is the celebrity dermatologist on "Extreme Makeover," and the author of "Heal Your Skin." If she can't help me, I'm afraid I'm un-helpable. But here comes that hope again.
