Photo Illustration. Photo: Getty Images
Micaela English
Jun 08, 2018 @ 9:00 am

The morning of my birthday, I was tipsy with excitement. I had cloud-nine evening reservations and a new floral jumpsuit hanging in my closet that made me feel equal parts Catwoman and Serena van der Woodsen. I felt great, confident—until I looked in the mirror. There they were. Some were in cluttered clusters, others were little villages of raised red bumps that lived on my forehead, cheek, and chin. There were the white peaks screaming to be squeezed. But the worst, the pimples that hurt so much I wanted to cry, were the deep rooted ones—they were so swollen, cherry red, and infuriatingly impossible to clear up.

Welcome to my maddening spell of adult acne at age 33.

Frankly, my skin has been embarrassingly worse in the past two years than during any breakouts I experienced in my teens. Back then, the abscesses on my face were a complementary accessory to my teenage angst, temporary eruptions that surfaced along with my newfound menstrual cycle and diet of Swedish fish and high school cafeteria bagels. My skin quickly cleared up after a trip to the dermatologist, who dried out my skin with acne pads that felt like they were burning my face off. They sucked. But they worked.

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Fast forward to my 20s and, while you couldn’t pay me to relive my 20s, I had pretty flawless skin. It wasn’t until I graduated into my 30s—the decade in which I ironically began to feel so much more comfortable in my own skin—that my complexion erupted. At first, it didn’t make sense to me. My lifestyle had drastically changed between my 20s to my 30s and very much in the wellness junkie direction: Those 26-year-old 3 a.m. nights out were replaced by weekend nights spent drinking peppermint tea and reading new age-y books. Strings of first-date drinks were swapped with spin classes. And pizza as an appetizer, well that one stuck around, but gluten-free. My blotchy, bumpy, downright painful skin made no sense. I lived a healthy lifestyle, dammit, and I wanted that “I’m a devotee to the religion of self-care, put collagen powder in my coffee, and take Taryn Toomey classes” glow.

It turns out your hormones don’t give a shit about whether you’ve attended the GOOP summit this year.

The bad guys started to rear their ugly head at 31. My face felt like that whack-a-mole arcade game. Once I finally got rid of a zit, another would pop up somewhere else. I tried every acne product I could find on the market: cartoonish bubbling sulfur masks, gritty charcoal cleansers, stinging salicylic serums, medicated spot treatments that dotted my face in what looked like a calamine lotion constellation. I was booking expensive treatments at every new facial spot that promised glowing skin. For a time, I eliminated entire food groups on the Whole30 diet. That semi-worked temporarily, but I still was getting pesky zits and I was hungry. Note to those with skin issues: don’t waste your time and money; just go to the dermatologist.

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I finally paid a visit to Yoon-Soo Cindy Bae, MD, a professor at NYU’s Department of Dermatology and an associate at the Laser & Skin Surgery Center of New York, four months ago. As I threw my hands up in the air, asking why my acne was so dreadful, Dr. Bae (everything is cool about her, including her name, her office, and her enviable style) explained that my issues were “multifactorial, but essentially our skin can become more sensitive to our hormones and therefore develop hormonal acne.” Then, she said, “Yes, acne sucks. Have you heard of Spironolactone?”

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Courtesy Micaela English

I had. It’s been described as a “miracle pill” for hormonal acne in women, even though it’s traditionally used as a treatment for high blood pressure. What’s behind the magic spell? Basically, it blocks a hormone in your skin called androgen. “Androgens like testosterone and dihydrotestosterone (DHT) can affect sebaceous glands in your skin. The pill Spironolactone works as an anti-androgen that blocks the androgen receptor and inhibits androgen biosynthesis,” Dr. Bae elaborated. I was nervous to take anything ingestible—a pill felt more serious than a topical cream—but I was pretty desperate, so I got started. What’s behind the magic spell?

After a blood test to ensure that my potassium levels were normal, Dr. Bae prescribed me a low dosage of Spironolactone and an over-the-counter Differin gel (a retinoid gel) to use at night, which she says “helps treat acne, prevent acne as well as fine lines, so it is a must.” She also prescribed a topical mixture of benzoyl peroxide and clindamycin. “When topical benzoyl peroxide is used with topical clindamycin, the effects are synergistic, meaning that these medicines work better together than either one alone,” she explains. “This combination is great for spot treatment.”

Four months into this routine, I still get a casual pimple here and there (mostly related to stress, lack of sleep, and that pizza I was talking about), but my skin has made a Cinderella-like change. My simple (though not not time-consuming) plan from Dr. Bae, plus pills, plus using the skincare ingredient charcoal truly changed the condition of my skin in mere months. Now, I go makeup free most days and never wake up wondering what game of whack-a-mole is ahead.

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Below: The routine that finally cured my adult breakouts.

Morning Routine (6 minutes)

Pills: In the a.m., I take 50 MG of prescribed Spironolactone, with lots of water as it’s a diuretic, and you’ll find that you're either thirsty all the time or have to pee all the time.

Cleanse: I start mornings with a refreshing splash of water rather than a true cleanse.

Treat. Next, I apply a prescription cream mixture of Benzoyl Peroxide and Clindamycin and let it dry.

Eyes: I use cult-favorite Ole Henriksen Banana Bright Eye Cream for an under-eye, dewy glow. It has these little shimmer pearls in it that give your eye the perfect radiance, (you won’t even need concealer, seriously).

Hydrate: I tried a lot of day creams during my research to find the perfect cocktail of products,and Beautycounter’s Nourishing Day Cream takes the cake as the simplest, most hydrating, and non-fussy day cream in my book. There’s no fragrance and, most importantly, it doesn’t make me break out!

Nighttime Routine (10 minutes)

Pills: 50 MG of Spironolactone with water.

Cleanse: I use Fresh Soy Cleanser (full disclosure: I used to work there) with my Foreo Luna 2 Cleansing Brush. Soy Face Cleanser totally cleans out what the day has done to skin but is gentle and doesn’t give it that tight, dry feeling that I get from other cleansers. The Foreo brush gently scrubs my pores and rids my face of every last bit of Manhattan. Bonus: one side of the cleansing brush is a massager, which I use to stimulate blood flow on my face.

Treat. A pea size of Differin gel, a potent retinoid gel that helps keeps my acne at bay. Once a week, I will indulge in my favorite, strong acne-clearing pads by Cane+Austin. I use the 20 percent glycolic acid solution.

Hydrate. If I need a deep dose of moisture, I love the hormonal acne line Knours. Its super thick and moisturizing One Perfect Cream smells herbal and clean, like it was just plucked from your garden. For a lighter dose of moisture, I love Kate Somerville’s Oil Free Moisturizer, which has this great milky, soothing texture.

Eyes: I apply Environ Vita Peptide Eye Gel under my eyes, which instantly cools. While most gels leave a strange residue under my eyes, this one soaks in and I wake up looking like I got 8 hours of Zzzs, even if it was more like 6.

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The Extras

Facials: I get a true facial—extractions and lymphatic drainage massage—once every six weeks from Cleo Rallis at Exhale Spa Central Park South. Cleo is an extraction queen and is the fairy god mother of making sure my pores are extra clean. She also noticed a difference in my skin, since I’ve been on Spironolactone.

Balancing Mask: Masking is like doing an extra credit project for your skin, and charcoal has been my favorite ingredient to keep my skin extra calm, specifically the Beauty Counter No. 3 Balancing Mask. There's a reason this mask is a best-seller—it only takes three minutes to dry, and I can see the difference in my skin immediately afterward. My hormonal pimples that still arise tend to look smaller after. There’s also the refreshing peppermint smell that gives your skin a minty-clean feeling.

Charcoal mask: I use the Amareta Earth Mother Detoxifying Charcoal Mask. This line of products is developed to sync up to your hormonal cycle, the perfect answer to my skin woes. The jars are beautiful and you can feel the gentle activated charcoal mask detox your pores. I like to wear it while in the bath.

There you have it—a skincare story with a happy ending, at least for now. It’s only been four months, so I know I’m in the honeymoon phase, but here’s to hoping this routine and I are built to last.

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