When Acne Torments You As An Adult
Image by Jena Ardell.
By Brianna Bell
“Have you tried that soap I bought you?” my mother asks, expertly chopping a red onion while I roll my eyes behind her back. I’m a 34-year-old mother of three, and I’ve been battling a persistent case of adult acne for months. My Mediterranean mother is asking if I’ve thought of washing my face.
The acne, which is concentrated on my cheeks, feels different than what I’ve experienced in the past. The spots are hard and painful, and there aren’t any whiteheads. No matter what I try, it just won’t go away. Eventually, I get an appointment with a dermatologist and am diagnosed with nodular acne. Nodular acne is sometimes referred to as cystic acne, but I’ve come to understand that the two are different. Nodular acne feels harder, with fewer top-layer cysts. Both types are extremely painful, though.
“Nodular acne tends to be more inflammatory, deeper, and more painful or itchy,” says board-certified dermatologist Dr. Kseniya Kobets, MD, director and assistant professor at Montefiore-Einstein. She says that the onset of nodular acne may be related to internal health issues, like hormonal changes, menstruation, diet, or inflammation.
I didn’t have acne when I was a teenager, and now it feels like I’m paying the price for my clear fifteen-year-old skin. I know that my hormones are shifting. I’ve got night sweats, mood swings, period changes, the list goes on. It feels like I’m too young to be going through perimenopause, but I was also only 10 when I had my first period.
“Adults may also be affected by nodular acne since perimenopausal and postmenopausal women have fluctuations and changes in hormones which can exacerbate hormonal acne,”says Kobets. She recommends that anyone struggling with this form of acne decrease the use of topical products known to cause clogging, including Vaseline and silicone-based dimethicone.
According to a story from Byrdie about menopausal acne, hormone shifts and stress are primarily to blame for its onset. “Levels of estrogen, the so-called female hormone, plummet rapidly during menopause, throwing off the delicate balance of androgens, most specifically testosterone,” they report.
While I had a mild case, it was still persistent and extremely difficult to treat. I tried a few drugstore acne washes, but they didn’t clear my skin. The first dermatologist I visited prescribed retinol, typically used for its anti-aging properties, however that didn’t work either.
“Since nodular acne is deep in the skin, topical treatments may not address the root cause. A multifaceted approach is best,” says Dr. Richard Bottiglione, MD, board-certified dermatologist and founder of Dermatologist’s Choice Skincare. Bottiglione recommends topical acne solutions, such as products containing benzoyl peroxide or glycolic acid, one of the most effective over-the-counter exfoliating acids available. “Retinol is the inactive form of retin-A, which makes it ineffective in addressing difficult skin concerns.” Instead, Bottiglione uses active Retinoic acid (aka Tretinoin), non-neutralized glycolic acid, and trichloroacetic acid to treat both acne and anti-aging concerns.
Both Drs. Bottiglione and Kobets noted that anyone experiencing nodular acne should be aware of the inflammatory symptoms associated with it. Dr. Kobets says that patients may require systemic medications, like the broad-spectrum oral antibiotic doxycycline, or spironolactone, a medication that treats hormonal acne in women.
“Nodular acne usually requires prescription intervention…Dermatologists can prescribe antibiotics, Accutane, or spironolactone,” Bottiglione says.
My case was mild, so I didn’t require an oral prescription to clear my skin. Instead, I found myself at an expensive medical skincare clinic, where an esthetician recommended a medicated acne line. I now rely on three products: a face wash containing 2% salicylic acid, an acne spot treatment with 1% benzoyl peroxide, and a gentle moisturizer.
I’ve also gone in three times over the past few months for a jet peel treatment — an unrelaxing, but seemingly effective, facial. In a 2019 review, Elle referred to the jet peel as “a car wash for your face.” According to the JetPeel website, the powerful device “generates pressurized air, which is accelerated in order to manipulate liquid into fine misty jet streams…[which are] applied to the skin surface.”
The experience left me looking and feeling dewy and refreshed, and the fact that the device was able to penetrate deep into the skin’s surface using active ingredients like salicylic acid seems to have worked, for me at least. (As with other cosmetic procedures, it’s best to seek out licensed dermatologists or board-certified plastic surgeons to avoid complications.)
Dr. Bottiglione isn’t quite as convinced. “A jet peel uses air technology to apply ingredients on the skin. It is highly unlikely that the jet peel technology allows ingredients to get to the dermis, but it may be allowing ingredients, like salicylic acid or benzoyl peroxide, to go deeper into the pores. This may be of slight value for nodular acne,” he says, and added that oral medications that travel through the blood will be the most effective.
I’ve learned that treating acne isn’t a simple one-step approach. I had to try multiple products and approaches, and of course, listen to the experts. It’s been three months since my mom asked me if I washed my face. Recently, she commented that she’d forgotten about my acne woes — my skin is finally clear.