My Skincare Routine for Hormonal Cystic Acne, 2016 Edition

My Skincare Routine for Hormonal Cystic Acne, 2016 Edition

“Where do you get skin like that–from your parents or does it come in a bottle?”

Umm.

Reader, I think the earth sort of wobbled under my feet when I heard that. I was wearing expensive, amazing foundation at the time, but I haven’t heard an in-person skin compliment from a [female] stranger no matter what fancy base makeup I was wearing since…gahh, maybe high school?

Yeah, I’m one of those people who had great skin in high school and then got cystic, hormonal acne once I turned 30. Chances are, your story is similar if you’re here reading this post. Welcome, put your feet up. This one is long because it’s the most important post I write each year and–WOW–do I have some major finds to share.

For a long time, I thought I’d have hormonal acne until, you know, my hormones finally agreed with me that they need to not. My mom similarly dealt with hormonal acne at my age. Plenty of people with great routines do, too. Given that I wasn’t willing to take prescription pills that drastically alter my hormones, I believed that I’d have to accept things the way they are. Were.

What a difference a year makes. One year ago I reluctantly shared my routine, expressed doubts in the products I recommended, and sounded a bit resigned to the hormonal acne life. I thought I’d be living with the same skin no matter what for at least the next decade until my warring hormones decided to chill out and move to a golf course or give up drinking/start doing yoga.

I’m not done with my journey yet, but I’m not resigned anymore.

comparison
Oh, the glamour. By the way, my hair is dyed in the last photo–that’s not a color correction trick. I grabbed these photos because they have the best lighting and camera resolution of the bunch–this isn’t meant to be a true before and after, just a rough overview of how much my skin has changed.

About my Skin

I’ve realized that I have naturally great skin if you overlook the acne. Before the hormonal acne and fairly harsh ways I’ve tried to deal with it, I had glowy, resilient skin that required virtually nothing but an occasional wash. It’s always been a bit oily by the end of the day and I doubt the sebaceous filaments on my nose will ever fully go away if I’ve learned anything by observing people at family reunions, but overall I have been blessed. Even my years of playing tennis in the sun without sunscreen haven’t come to collect their payment in wrinkles yet (those were balanced by many more years of writing and researching diligently in dark historical archives).

Last year I found my routine exhausting. It was exhausting to write about, a pain to do, and I often fell asleep before completing my night steps (as I admitted in my post). Finding anti-acne actives that are gentle has changed so much. I’ve realized that I can have a simpler routine that gets done faster and results in better skin as long as my actives aren’t crazy harsh and are applied in the right ways to minimize skin destruction. My goal is to do the minimum necessary to have great skin–I have so many things I want to do other than skincare.

Four Things that Changed My Skin

Four things had to happen for my skin to change–and I’m not sure that it could have changed without all four being pursued at full speed all at once:

  • Prescription acne medication and my dermatologist
  • AHA/BHA
  • Spearmint/not super drastic hormone changes
  • Kbeauty skincare

Determining Where to Put Your Skincare Products

If your routine has steps I don’t mention and you’re confused about where to put everything, check out my visual guide to skincare routine order–there’s even a printable PDF version.

visual guide to skincare routine order
click to see the visual guide

Introducing New Products

A few guidelines for those of you hoping to drastically change your routines.

Patch test new products before applying them to your whole face. I sometimes, uhh, patch test with my whole face due to an intense need to maintain my punk rockness despite not being at all punk rock and it has led to some pretty terrible results, especially where anti-acne actives are concerned. Ok, let’s be real, I am currently kinda scaly due to a bad run-in with some benzoyl peroxide. Don’t be me, the lizard queen: patch test. Learn more about patch testing.

It’s a good idea to give each new anti-acne active (AHA, BHA, Curology, other prescription medication, benzoyl peroxide) 6 weeks of testing before adding another new one. If something irritates your skin upon introduction to your routine, pull it immediately, back off the actives until your skin isn’t irritated, and then consider trying it again later. I like the six week rule because it usually means I see how my skin responds to something over the course of 1.5 hormonal cycles and keeps me from burning my face off due to too much, too fast. Over-exfoliation is terrifying.

For regular skincare like toners, essences, and sunscreens, it makes sense to introduce a new product no more than every 2 weeks. Not only does that give your wallet a break, but it means you can see if the product is causing clogs or really helping your skin without wondering which of the five new things you slapped on at once is responsible for your skin’s change in condition.

How I’m Disclosing Press Samples and Products Bought at a Discount in this Post

I like to be really transparent about how I’m getting products. In this post, products with stars next to their names in their introduction headers are either products I once received as press samples or products I’ve “purchased” with the help of referral credit.

Products with three stars (***) were once sent to me as press samples. I’ve since repurchased them with my own money and I’m under no obligation to talk about them here.

Products with two stars (**) were purchased using store credit earned by the blog due to referring new customers to the shop. In most cases, the amount of referral credit I had matched or almost matched the price of the product. That said, I’m under no obligation at all to review or discuss these products, and regular customers without blogs and social media accounts are able to earn the same credit by referring their friends and contacts to the same shops.

Products without disclosure stars were purchased by me using my own cash money.



My Typical Morning Skincare Routine for Hormonal Cystic Acne

morning skincare routine for hormonal cystic acne

My goal in the morning is to get out of the house and to work sort of on time while also getting anti-acne acids and sunscreen on my skin. It’s a challenge, so I’ve trimmed my routine to the essentials.

Low-pH non-foaming cleanser: Glossier Milky Jelly Cleanser

Review: Glossier Milky Jelly Cleanser
click the photo to see my full review of Glossier Milky Jelly Cleanser

I spread two pumps of this low-pH, non-foaming cleanser on my dry face each morning and then rinse it off with plenty of warm water. It’s super gentle and I’ve noticed my skin being a lot calmer since I started using it. For more info check out my review.

Glossier Milky Jelly Cleanser: Glossier

pH-Adjusting Toner: Mizon AHA & BHA Daily Clean Toner

mizon aha bha toner
click the photo to shop on Amazon

For ages I wondered if this often-in-short-supply toner could possibly live up to the hype. Yup. It’s nothing particularly exciting and the AHA and BHA won’t be enough to exfoliate your skin, but it just plain works well. It smells fine, the pH is right for prepping skin for acids, and it’s lightly moisturizing. Why Mizon keeps bringing this in and out of retirement I don’t know; don’t fuck with the classics.

I keep my toner in an airless pump bottle because it’s a bit easier to use than the original bottle. I squirt a few pumps into my palm and then paint this on my face with my fingers and let it dry.

Mizon AHA & BHA Daily Clean Toner: Amazon

BHA: Paula’s Choice Resist Daily Pore-Refining Treatment 2% BHA**

Paula's Choice Resist 2% BHA
click the photo to see my full review of Paula’s Choice Resist 2% BHA

BHAs go into pores and bust through clogs (they’re oil-soluble, so they can slip behind enemy lines) and exfoliate on the surface of skin. The problem is finding the right one.

This BHA is absolutely amazing for my skin. For ages, I’ve been testing BHAs, desperate to find something that didn’t dry my skin, didn’t leave an oily film, and didn’t smell terrible. I ended up trying 11, and this is the no-contest winner: a BHA from an anti-aging Paula’s Choice line.

I also keep this BHA in an airless pump, in part to avoid dumping too much of the precious into my hand and also in part to avoid accidentally leaving the cap off (which can result in potency-changing evaporation). I squirt a few pumps into my hand, use the other to paint it on with my fingers, and let it dry.

Paula’s Choice Resist Daily Pore-Refining Treatment 2% BHA: Paula’s Choice (new customers get 20% off by clicking my referral link) | Amazon | Nordstrom | Dermstore | Beauty.com

AHA: Paula’s Choice Resist Daily Smoothing Treatment with 5% AHA**

paula's choice resist daily smoothing treatment 5% AHA
click the photo to shop on Amazon

AHAs can’t quite go into oily clogs and pores the same way BHAs can, but I find them essential for forcing closed comedones (those below-the-surface bumps) to come to the surface and surrender their clogs at last.

I’m not certain that this daily AHA is the absolute best for my skin. There’s certainly a bit of sting when I apply it and I’m not sure how I feel about the lotion format. On one hand, it’s nice to have it leave my skin in good shape and on the other, it’s a bit annoying that my skin’s need for moisture is satisfied by an AHA. How lame. I have other, nice products that could be doing that work!

This AHA is packaged in an airless pump, which would be great, but it’s impossible to know how much is left unless you…I guess weigh it and know how much an empty bottle weighs. LAME.

I squirt three pumps of this into my palm and then use my hands to slather it all over my face like any other lotion. After that, I wait at least 15 minutes (usually more) before applying any other skincare to give my BHA and AHA time to work.

Paula’s Choice Resist Daily Smoothing Treatment with 5% AHA: Paula’s Choice (new customers get 20% off by clicking my referral link) | Amazon | Nordstrom | Dermstore | Beauty.com

Androgen Blocker: 2 Spearmint capsules

spearmint capsules for hormonal cystic acne
click the photo to shop at Amazon

First off, a disclaimer: I’m not a doctor. Well, I am, but a doctor of philosophy in history, not a medical doctor. I can’t give you medical or dermatological advice. Things I discuss from my own routine and experiences don’t constitute medical advice and you should check with your dermatologist and doctor before using anything that might, say, change your hormones or how they’re received by your body. Women who are pregnant, plan to get pregnant, or are nursing should especially check with a medical doctor before taking something like this. From my understanding, men should not consume spearmint because it will impact their male sex hormones.

For my skin, I really feel like spearmint capsules were the turning point. My Curology dermatologist suggested that I could take spironolactone (spiro), which was made to help treat the effects of high blood pressure and heart failure but also blocks the androgens (male sex hormones) that cause women with hormonal acne to get blemishes in the beard-zone. From what I’ve read online, it can work amazingly for some people and for others it can lead to muscle loss, wacky periods, and a lot of peeing throughout the day. You also need to get tested every six months to make sure that it’s not causing too much potassium and other things to remain in your body or leave your body.

Ok, real talk, oversharing time: I take zero prescription medications right now aside from my Curology topical medication. I’m not against it or anything at all, but I just don’t need any at the moment. I like not having side-effects and needing to see a doctor to get a new prescription or dealing with the pharmacy on my lunch hour. I’m shockingly healthy and only 33, so I’m going to just enjoy this while I can.

Adding a pill with a pile of potential side-effects to possibly fix my skin just isn’t my style. In addition, while getting pregnant is somewhere below “circumnavigate the world in a mop bucket” and “visit Transnistria” on my goals list, shit happens, and spiro can cause major hormonal issues in fetuses carried while taking it. At one point in late 2015 I got so frustrated that I considered asking my dermatologist to write me a prescription for it–but for some reason that I can’t remember I just kept plugging along.

I’m glad I did. In early December my dermatologist, Dr L at Curology, mentioned that studies suggest that drinking two cups of spearmint tea per day might help women with hormonal acne banish beard-zone zits by reducing the amount of androgens circulating in the blood.

I like that kind of tea, not the other kind of tea.
I like that kind of tea, not the other kind of tea.

I gave the “country club mom rejection smile” to the chat window while thinking about the taste of two warm cups of spearmint tea sliding down my throat. Urgh. First off, as my [Russian] husband says, I’m American as apple pie. I do. not. drink. tea. Certain kinds are fine, I suppose, but drinking two cups of spearmint tea religiously each day, LORD. I really doubted that I could stick to tea, but off I went to Amazon to try to find some anyway.

What popped up and got the wheels turning for me was spearmint capsules. Now THAT I could do. I take a variety of vitamins and probiotics each morning, so throwing two spearmint capsules in the mix wouldn’t be hard. Reviews from people with PCOS (polycystic ovary syndrome) reported that they saw less hair and oil in the beard zone. DING. FREAKING. DONG.

These days I take two spearmint capsules with my other supplements in the morning after applying my acids. It took a few months to see results and there’s still purging due to old clogs but OMG YES AT LAST FREEDOM. My side effects include: occasionally minty morning burps and more painful cramps at that TOM (nothing ER-worthy, just the sort of pain that other women complain about but I didn’t really have before). Other side-effects I’ve ruled out.

Spearmint Tea Studies cited by my Dermatologist

Dr L at Curology said that these studies didn’t study hormonal acne and oiliness in women directly, but the conclusions might apply to acne and/or oiliness. As a result, my use of spearmint capsules is TWO steps removed from the original studies–but I find it to be working really well on skin that was otherwise stuck.

The studies:

Effect of spearmint (Mentha spicata Labiatae) teas on androgen levels in women with hirsutism.”
Phytother Res. 21, no. 5 (2007): 444-7.

Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized trial.Phytother Res. 24, no. 2 (2010): 186-8.

I’m not surprised by the ability of a common mint to change skin and hormones–when I was studying the history of women and children, we learned about how women in the past controlled hormones that prevent implantation by embryos using Queen Anne’s Lace seeds harvested at the right time and used some resins from plants as non-poisonous abortifacients. That something as prosaic as spearmint could contribute so much to start to end my skin struggles seems wild, but also surprisingly plausible to me.

I think that this case demonstrates the importance of having a dermatologist who is aware of recent and recent-ish scholarly research, as well as a dermatologist who doesn’t just glance at your skin and hand over a stack of prescriptions. While I’ve never been in the same room as my Curology provider (it’s a teledermatology service), I feel like this is what medical care should be.

Again, talk to your dermatologist and/or medical doctor before taking a supplement like spearmint that could change your hormones.

I take Swanson brand spearmint capsules because they have good reviews and they’re easy to buy on Amazon Prime. There may be better capsules that are more organic or measured or whatever out there, but these are working well for me now. It took about a month to start to see less oil and new acne. The improvement is more apparent as time goes on, but it’s subtle, so take skin tracking photos to better notice changes. Purging of old clogs could make it look like you’re not making progress, so notice where you have closed comedones (below-the-surface bumps with no white head) and don’t be surprised if those are purged out even when your hormones are being reigned in by spearmint. To get truly clear skin those old clogs need to come out.

And in case you’re wondering, no, the studies don’t indicate that other mints will act like spearmint to block androgens; the properties are specific to spearmint. Other mints will probably just give you minty burps from time to time.

Swanson Spearmint: Amazon

Acne-Calming Essence: Leejiham LJH Tea Tree 90 Essence

leejiham ljh tea tree 90 essence
click to see my full review of Leejiham LJH Tea Tree 90 Essence

This is the stuff for my skin, the ultimate. My acids and Curology handle the clog-clearing and blemish-busting, so this comes through and calms inflammation like nothing else I’ve ever tried and provides a bit of moisture. See my full review for more info.

I apply three droppers-full to my face: one on each cheek and one on my forehead and slather it everywhere with my fingers before allowing it to dry. You can use less! I’m something of a product dumper.

Leejiham LJH Tea Tree 90 Essence: Amazon | eBay | KoreaDepart | TesterKorea

Light Gel Cream: SN Plant Stem Cell Cream***/CosRx Oil-Free Moisturizing Lotion (with Birch Sap)**/Joseon Beauty Cream

sn plant stem cell cream joseon beauty dynasty cream cosrx oil-free lotion

I don’t get super fancy with my creams during the day, I just look for something under $25 or so that’s a gel-cream and provides some light hydration. When I want a smooth, almost matte base for makeup I use Beauty of Joseon Dynasty Cream. When I want more hydration but some oil control I use SN Plant Stem Cell Cream. When I just need lots of moisture due dryness and flaking from my actives, I bust out CosRx Oil-Free Moisturizing Lotion (with Birch Sap). I don’t need three creams, but since I have them, I just pick whatever seems best for the day.

I apply about a dime-sized amount and spread it all over my face and let it dry before moving on to sunscreen.

Find it at:

SN Plant Stem Cell Cream: TesterKorea (90ml) | Amazon (not Prime, 90ml) | Amazon (Prime, 50ml) | eBay

Beauty of Joseon Dynasty Cream: Memebox | eBay | BeautyBoxKorea

CosRx Oil-Free Moisturizing Lotion (with Birch Sap): Amazon | Memebox | Cupidrop | BeautyBoxKorea | eBay | Wishtrend

Sunscreen: Bioré UV Aqua Rich Watery Essence SPF 50+ PA++++

Bioré UV Aqua Rich Watery Essence SPF 50+ PA++++
click the photo to shop on Amazon

(By the way, don’t freak out if your sunscreen arrives in a blue bottle–mine is a special edition rose version that’s mostly sold out now.)

It’s been one year and I’m still using this Biore sunscreen–I’m not even bothering to look for something better because I’m so happy with it. It’s incredibly powerful, leaves no white cast, and feels like regular skincare. If the thought of daily sunscreen has you pulling back in terror, this might be the one to change your mind.

I aim to squeeze at least two almonds worth of sunscreen on the back of my hand and then apply it to my face and neck. I give my sunscreen about 10 minutes to sink in and dry for maximum protection; I need it due to all the actives I use.

Bioré UV Aqua Rich Watery Essence SPF 50+ PA++++: Amazon | eBay

My Typical Evening Skincare Routine for Hormonal Cystic Acne

evening skincare routine for hormonal cystic acne

My goal in the evening is to remove my makeup, get some Curology on my face, and give my skin enough moisture so it doesn’t look like flaky trash the next day.

Oil-Soluble Cleanser: Leejiham Dr’s Care Cleansing Oil

Leejiham LJH Dr's Care Cleansing Oil
click the photo to read my review

Out of more than 20 oil cleansers I’ve tried, this is the best for my skin. It’s thin, emulsifies really well, and washes away cleanly. It’s not terribly exciting, but whaddayagonnado. Check out my review of 15 oil cleansers and learn more about the battle royale winner, Leejiham Dr’s Care Cleansing Oil.

I use two pumps of this oil and massage it into my face for about 30 seconds to loosen up my base makeup and a bit of my eye makeup. I don’t stress too much about eye makeup because I wear so much that removing it requires another step anyway. Once I’ve massaged the oil in, I add water to emulsify the nasty oil-makeup-sludge and wash it all away. I rinse until the water is clear.

Leejiham Dr’s Care Cleansing Oil: KoreaDepart | TesterKorea | HKC Plaza

Low-pH Water-Soluble Cleanser: CosRx Good Morning Low pH Cleanser***

CosRx Low pH Good Morning Gel Cleanser
click to see my full review of CosRx Low pH Good Morning Gel Cleanser

My cleanser-hating skin loves this low-pH cleanser formulated with gentle surfactants. I like to use the CosRx cleanser after oil cleansing because–while it’s very gentle on my skin–I feel like it has enough cleansing power to remove any lingering traces of oil and makeup. For a full account of my journey into cleanser hell and review of the CosRx Good Morning cleanser click here.

I squirt a peanut-sized dot of this cleanser into my hand, mix it with water, and apply the bubbly mixture to my face and then rinse with lots of water.

CosRx Good Morning Low pH Cleanser: Amazon | Memebox | Cupidrop | Soko Glam | JolseWishtrend | KoreaDepart | BeautyBoxKorea | TesterKorea | eBay

Makeup Remover: Laneige Lip & Eye Remover Waterproof

Laneige Lip & Eye Remover Waterproof
click the photo to shop on Amazon

On days where oil cleansing and water-soluble cleansing don’t remove all of my makeup (in reality, my tarantula-leg-inspired mascara) I use Laneige’s fabulous dual-layer silicone makeup remover to take off the last traces. It’s extra great for contact lens wearers like me–oil cleanser near my contacts is a mess, but the Laneige remover doesn’t cause issues.

After I’ve dried my face I shake up the remover, apply it to a cotton square, and swipe the cotton on the areas of my face where I still have visible makeup, especially around my eyes. Then I rinse again, to make sure that I don’t have any cleanser residue hanging out on my skin.

Laneige Lip & Eye Remover Waterproof: Amazon | TesterKorea | eBay

Wait 30 min

I find that if I apply my prescription face medication immediately after cleansing, my skin sucks it up too fast, too deep and I start getting dry, flaky skin. If I just wait 30 minutes or so to let my face get back to normal, my Curology hangs out on the surface of my skin like it should, and my skin ends up looking a lot better.

Prescription Skin Medication: Curology**

curology bottles
click the photo to get your first month of Curology free

My prescription–0.018% tretinoin, 1% clindamycin, and 8% azelaic acid–wasn’t enough to clear up my hormonal acne alone, and my dermatologist prepared me for that reality. When your hormones are pumping out oil and clogs below the surface, there’s only so much a topical medication, even a powerful one, can do. What Curology does do is brighten my skin quickly after I have hyperpigmentation due to blemishes, which is really great. Now that my skin is thriving, I appreciate the turbo-charged brightening of Curology more than ever. I also like that tretinoin is in the mix, fighting signs of aging. Curology also lends a certain amount of stability to my skin, preventing me from collapsing into a major breakout of out nowhere. That said, I think that having a dermatologist who gives good skin advice such as suggesting spearmint tea is even more valuable than the medication he prescribes. For my skin, a prescription is part of the puzzle, not the key.

I apply two pumps of this to my face each night and spread it on carefully all over my face, avoiding my lips and avoiding my undereyes every other day.

Curology (US only; use this referral link to get your first month of Curology free)

Wait 30 min

I like to give my Curology 30 minutes to sink in without piling anything else on so it doesn’t slide around my face and cause dry or irritated skin in weird areas, as Kerry from Skin & Tonics has mentioned. Trust me, I’ve given myself retinoid burns on my neck and have had ridiculously peely lips. This waiting step, unless I’m wildly pressed for time, is important.

Essence: Sheet Mask or Essence

ljh leejiham lovemore mediheal sheet masks
click the photo to shop for sheet masks on Amazon

I like to give my skin a hit of watery moisture before bed by applying either a sheet mask or more LJH essence. Which sheet mask? Ehh–anything from my drawer that seems interesting that night. Sheet masks are basically water, butylene glycol, and glycerin, so I don’t stress too much about the flavor and just go with one that’s comfortable and has an essence that feels nice (I prefer things that are on the thinner side, both sheet and essence). I like the newish LJH hydrogel, LoveMore silk masks from Taiwan, and Mediheal kbeauty sheet masks, but I have tons of others that I like, too. This step is a chance to get creative. I leave my sheet mask on for as long as possible (I sometimes even fall asleep wearing one), but I let myself take it off after 15 minutes if it doesn’t feel great.

Sheet masks: Amazon | RoseRoseShop | VutyDesign | Global Interpark

Cream or Balm Rich in Emollients: Blossom Jeju Pink Camellia Soombi Blooming Cream** and/or Hanyul Ja Cho Moisturizing Balm

blossom jeju pink soombi cream hanyul ja cho moisturizing balm
click the photo to read my review of Hanyul Ja Cho Moisturizing Balm

Strange as it sounds for a person with oily skin to say, I really like emollient-rich creams and moisturizing balms. My acids and Curology can combine sometimes to give me dry or peeling skin in some areas, so some dry skin relief is very welcome. The Hanyul balm melts from a solid chapstick-like thing into a thin oil that’s kind of similar to Leejiham cleansing oil. I slather on a pea-size chunk of it before sleep to lessen flaking and help my skin bounce back from my prescription medication. Blossom Jeju Pink Soombi cream is really amazing–it has camellia japonica seed oil in it, and it manages to sink into my skin to leave it feeling almost dry-ish (the oil is really cool). I apply about an almond-sized chunk of this and wake up with oil-reconstituted dead skin flakes that I can roll off in the shower with my fingers. It’s disgusting, cool, and the only way I exfoliate these days.

Blossom Jeju Pink Camellia Soombi Blooming Cream: Glow Recipe | Birchbox | Anthropologie | Cult Beauty | k-beautyholic

Hanyul Ja Cho Moisturizing Balm: Amazon | Jolse | VutyDesign |TesterKorea | eBay

Best wishes

Good luck to you, if you’re dealing with serious acne caused by hormones. It sucks. Take tracking photos, do what works for your skin and your life, and just keep moving if you’re really set on changing your skin. It may work or it may not, but just do your best and keep living. Go to the party. Love yourself.

I have other acne-related posts on the blog and will still be dealing with my skin issues for a long time, even if it looks like (fingers crossed) the worst days are over.


Disclosure: This post contains affiliate and referral links. Clicking those links before you shop means that fan-b receives a small commission or store credit, which helps to support the blog. Please see my full disclosure for more information.