TRUE STORY: I HAVE CYSTIC ACNE Follow Claire's journey as she attempts to get rid of her cystic acne. Was she able to find a cure? January 26, 2012 by Claire Hapke, as told to Jane Chung Every morning, I look into the mirror, and my heart drops. Staring back at me is a 25-year-old woman whose face is covered in bright red pimples and inflamed cysts. Even though it's been years, I still cringe at the sight of my skin ... and then I force myself to wash my face and get dressed, even when I feel like crawling back into bed and hiding under the covers. No, I'm not being over-dramatic. I have cystic acne, and if you've got it I bet you can relate. If you don't, just know that it's a severe form of acne where you get painful and inflamed cysts filled with pus (fun, right?). In high school, it felt like I was the only girl who knew what it was like having real acne. All of my girlfriends had clear skin, so it pissed me off when they complained about one tiny zit. I would think, "Really? Do you want to compare faces? Because we can. I'll win. Every. Time." I tried everything to get rid of it. Oral medication just made me feel bloated and hormonal. Proactiv didn't get rid of a single pimple. The ONLY time my acne got better was when I started Acutane (a pill-version of retinoid, with very risky side effects). The forehead acne disappeared, but nothing happened to the pimples around my mouth and chin. After I was done with Acutane, I started taking Spironolactone (an antiandrogen that helps regulate hormones) in addition to birth control pills. This helped with the acne around my mouth, but not much. That's when I decided I didn't want to be taking pills for the rest of my life. I was sick of filling my body with meds, and felt so frustrated I still had daily breakouts. For the last two years, my current "regimen" has been washing my face with a salicylic acid cleanser. And that's it. My boyfriend, Ben, tells me he loves me no matter what my skin looks like. But I'll admit, sometimes I doubt that. And either way, I know I won't really feel good about myself until my acne is gone. It's time to do something about it. My last-ditch effort is a big one. I'll be working with Dr. Ava Shamban, owner of the Laser Institute-Dermatology in Santa Monica, Calif., to try to cure my acne once and for all -- and I'll be sharing every step of the way with you. Why Shamban? She's the celebrity dermatologist on "Extreme Makeover" (and author of "Heal Your Skin"), and lucky for me she gives women those same treatments off-camera too. I'm willing to do anything to have her treat me -even if it means taking pictures of my bad skin and putting them on the Internet sans Photoshop. Desperate? Maybe just a bit. Keep reading to see what happens next in the journey to cure my cystic acne and stick around for the end, when I share how you can do (almost) the same thing at home. Called out by the pro As soon as Shamban sees my face, she calls me out, saying I've neglected my skin. I'm embarrassed, and I can feel my face turning red -- which probably makes my acne look even worse. And in that moment, 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 my acne is mainly hormonal. She calls it "red and active" acne, with a lot of 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, she puts me on an extensive four-step treatment plan, which includes everything from topical creams to laser treatments. Buh-bye, laziness Phase one of Shamban's plan: Oral and topical medication. She prescribes three different at-home topical creams for my skin: Finacea, Aczone, and Acanya. Finacea decreases the production of keratin, a natural protein in your skin that can lead to the development of acne. Aczone's main ingredient is Dapsone, which is an anti-infective to help prevent infections in the cysts. Acanya is a topical antibiotic that kills acne-causing bacteria. Shamban also gives me an oral prescription of Spironolactone, which is the same pill I stopped taking two years ago. I know I said I was done with meds, but I'm so fed up with the way my skin looks. Plus, I remember that Spironolactone sort of worked for me in the past, and Shamban thinks there's a good chance I'll get better results when using it with these topical creams. Shamban also gives me a strict, four-step regimen to stick to: Wash, Medicate, Moisturize, Protect. Not easy for a lazy girl like me. Usually, if I'm already in bed and realize I forgot to wash my face, I think, "Screw it, I'm just going to sleep." Wish me luck. Least relaxing facial ever Two weeks later, I'm back at the office for phase two: A facial. My first thought? "Sweet! Spa day!" I go in expecting to hear Enya playing and to be handed a plush spa robe. But right when I walk in, I notice how quiet it is. Not a good sign. I lie down on a hard table, and I'm engulfed in a stringent smell I can only define as "medical." That's when it hits me -- this isn't about relaxing. After exfoliating and steaming my face, Tanya Eubanks, the facialist, starts to do extractions using her gloved fingers and a medical needle. Yep, it's as painful as it sounds (kind of feels like she's trying to squeeze off my chin). But 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 I can imagine 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, and I'm thrilled I don't have to hear the needle anymore. Extractions aren't pretty ... My skin looks really red after the facial, but Eubanks says that will go away after a few hours. My face feels really clean and tight, but still pretty sensitive. On the plus side, the bumps have gone down a lot, and I feel like I have a pretty glow. For the first time, my co-workers notice how smooth my skin looks. I can't stop smiling the rest of the day. Liquid nitrogen on my face?! Once my skin calms down after the facial, I go back to the office for phase three: A chemical peel. Eubanks says it helps stimulate the skin and push the acne to the surface, which makes it easier to treat with lasers. I lie down on the hard table, and have a flashback to how painful the facial was. Hopefully this isn't as bad ... Eubanks starts by applying retinol and salicylic acid-soaked strips across my face. Once the strips have dried, she takes them off and begins to apply a high-frequency light to my face. The light is both anti-bacterial and antiinflammatory, and it feels like tiny, prickly shocks on my skin. Finally, she comes at my face with a mega-sized Q-tip covered in liquid nitrogen, which I knock out of her hand. Liquid nitrogen on my skin? Is that even safe? She assures me it is, but I'm not so positive when I see my skin the next morning ... What's yellow and peels? (I'm not talking about a banana) The good thing about chemical peels? There's not that much down time. I just need to stay out of the sun for a few hours, and Eubanks tells me to take a break from my topical medication for several days. The bad thing? The peeling ... OMG, the peeling. Eubanks says my skin will be slightly yellow for 30 minutes after the peel, due to the retinoids. That's an understatement. I walk out looking like a highlighter. After a few hours, it starts to look like a strong sunburn and my skin smells like alcohol. The next morning, my skin literally peels off in sheets. Luckily, it's the weekend, so I don't have to go to work looking like this. Notso-luckily, it's Thanksgiving weekend. Which means I'm visiting my family for the first time in weeks. And they're meeting Ben for the first time ever. When my mom seems me, she's shocked. "What happened to your face?!" I give her a hug and tell her what's going on, hoping it'll get her to quit staring. Well, it gets worse. That night, I'm cuddling on the couch with Ben when I get up for a drink. I come to a complete halt when I catch a glimpse of myself in the mirror. My face looks like it's melting off. I run to the bathroom and ask Ben (through the door) why he didn't say anything. "I didn't want to make you feel bad," he says. See why I love this guy? We spend the rest of the night laughing and peeling off my skin together. (Gross, I know, but he's with me for the long haul.) Once the peeling is over, I can't believe how good my skin looks. Guess it had to get worse before it got better? Sayonara scars Finally, it's time for phase four of Shamban's plan: Laser treatments. This is supposed to help with the acne scars ... also known as the bane of my existence. Even when my skin is having a good day, it still looks red and blotchy from the scars. In fact, it really bothers me when people say, "Your skin looks so good today!" I know my acne scars are still there, so my skin obviously doesn't "look good." Why lie? And yes, I know some people cover up their scars with makeup, but I feel like it'll make my acne worse and draw more attention to it. I just really want the laser treatment to work, so I don't have to worry about this ever again. Lisa Beaulieu, the acne specialist, applies a numbing ointment to my face and makes me wear these funny-looking goggles before giving me the treatment. She decides to use a combination of the V-Beam and Smooth Beam laser treatments. The V-Beam laser helps with the redness and stimulates collagen in my skin, and the Smooth Beam plumps up the indented scars. Even with the numbing cream, the lasers feel like someone's snapping a rubber band against my skin. Maybe she didn't put enough ointment on? Let's amp it up Beaulieu says my face will be swollen, or "quilt-y" as she calls it, and to expect small, square-ish marks on my skin where the lasers hit. But it's not that bad the first time. In fact, there are hardly any marks at all, so I wonder if it even worked. I know my acne is pretty stubborn, but is it really stronger than a freakin' laser? I'm inwardly cursing my skin until Beaulieu says she used the lowest frequency for the first treatment, so I shouldn't expect much change. Over the next month and a half, I go back three more times. She uses a stronger frequency each time, and it gets more painful. The last one hurts like hell, and I walk out with chipmunk cheeks. But I'm excited because that means it's working (right?). Save the best for last It's time for the final phase: Photodynamic Therapy (PDT), aka the strongest laser they've got. I'm a little scared -- Shamban calls it an "intense procedure," and says "absolutely no contact with the sun," for the entire weekend, unless I want to know what it feels like for a vampire to burn. However, she says my skin will look the best it ever has seven to 10 days after this final treatment. That's all I need to hear. Shannon Sher, the tech assistant, applies a topical levulinic amino acid all over my skin. Over the next hour, the damaged skin cells absorb the medication. Then, I stick my head into the PDT machine to expose the treated skin to the blue laser light -- this destroys the scarred cells while leaving the healthy cells untouched, Shamban says. I think it's going to hurt, but it doesn't. I just feel a bit of tingling, and there's some swelling afterwards. But right away, I notice a huge difference. My skin looks super tan and glowing. When Ben sees me, he asks, "Did you go on an overnight trip to Cabo without me?" This makes my day, and I don't even care that I'm stuck at home for the rest of the weekend. I spend it on the couch with Ben, watching all three "Lord of the Rings" movies. But I'll be honest -- most of the time I'm not even paying attention to the screen. I just keep thinking of what my skin will look like in a week ... The final reveal It's been 10 weeks since my very first consultation with Shamban, and I can't believe how far I've come. Not just with my skin (which looks amazing), but also with my own confidence level. When I used to look in the mirror, my acne would be the first thing I noticed. But now, my skin isn't something I think about all the time. It also makes it so much easier to open up to people, because I don't assume they're just staring at my face. Although, it turns out, they are (in a good way). This morning I notice Ben staring at my face, and out of the blue he says, "Claire, your skin is SO clear," and he touches my cheek. I almost start to cry. Thinking back to my first date with Ben last year, when I was so self-conscious of my skin, this is a huge deal for me. To keep my skin clear, and reduce the few remaining scars I have, Shamban tells me to continue my at-home program of topical creams, oral medication, and birth control pills. This isn't an easy decision, because I remember how much I despised taking pills, and I'm definitely not planning to be on medication forever. But it's working, so I think I'll stick with this regimen and not give up as easily as I did before. And even though I still question why this is something that I have to deal with and other people don't, I finally feel a little bit of hope after seeing how much better my skin looks. Next: See how much each treatment cost and get at-home alternatives Cost roundup (and other tips) I'll admit, if I didn't have a beauty editor as a friend, this wouldn't have been cheap. Below is a breakdown: Facial: $50 to $80 If you can't afford regular facials, give yourself a DIY facial at home with these tips. And think about investing in a Clarisonic Mia Skin Care Cleansing System, $103 -- it works well on smaller pimples, blackheads and minimizing pores. Peel: $50 to $300 If you have oily skin or severe acne, Shamban recommends getting several peels before your first laser treatment. For a cheaper option, try using an athome chemical peel kit like IQ Natural Complete Glycolic Acid Chemical Facial Peel Kit, $25, or a sulfur mask like DDF Sulfur Therapeutic Mask, $38. Laser: $500 to $3,000 For most acne patients, Shamban recommends at least three laser treatments, every two to three weeks. Photodyamic Therapy: $800 to $3,000 For the best results, Dr. Shamban recommends that acne patients get two to four treatments, three weeks apart. Finally, watch the amazing Shamban answer your skin questions in this exclusive video. http://www.beautyriot.com/makeup-beauty/true-story-i-cystic-acne-g9961-page12
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