When I first started medical school, I was hoping that at the end of it I would have a few answers to my questions:
1. Why was it that for several years in high school, I would become nauseated and have belly pains so bad I dreaded to go to class - every weekday, like clockwork, from 7 AM to 9 AM?
2. Why did I have acne, and what can I do to get rid of it?
The answer to the first question is probably that depression and anxiety can manifest as physical symptoms, particularly in young people. As for the second, I don't really know, but my skin has slowly, slowly improved.
Over the years, only three things have actually made a discernible difference in my skin: hormonal birth control, topical retinoids, and salicylic acid. I thought that coming off birth control would cause a rebound in my acne and asked my PCP to prescribe me spironolactone (I got an IUD, which does not provide the systemic androgen suppression that my combined estrogen and progesterone birth control did). Being the intrepid medical student that I was, I decided to see what my skin would do without hormonal birth control and without spironolactone, and to my surprise...it looked fine.
I've used a topical retinoid (Differin, available OTC) since college, and it's really the only thing that reliably keeps closed comedones away. Because of the prophylactic anti-aging benefits, I see no reason to stop using a topical retinoid, and my next adventure will be to see if I can get tretinoin prescribed for a lower cost than Differin (this could be a gamble, and I'm not sure if this will pan out.
All of this is to say my acne is actually, for the first time in my post-pubescent life, mostly gone. This great source of teen and young adult angst and self-confidence issues is...gone. By my standards, at least, since I know some people in my life with truly flawless skin. For some people, my skin with all its post-inflammatory hyperpigmentation, is the worst it could ever look for them. For me, it's the best it's looked in over a decade.
So why am I trying new skincare? Simply put, my goals are changing. I've locked into a routine that reliably keeps my acne at bay, but now I have PIH to tackle, and skin tone to even out. I want to prevent aging - and I would like to add I am a religious SPF user for years.
Before isolation, I bought a few items from The Ordinary, and also received some from a friend who was going to start Curology. With this unexpected windfall, I saw the opportunity to try a bunch of products, fuck up my skin, go back on my progress, and experiment. When the pandemic hit and it became clear I was going to spend my days at home, I decided to try these out.
So this is what I ended up doing:
AM: Niacinamide + Zinc, moisturizer, SPF
PM: cycling between Differin, Vitamin C, and Mandelic Acid; moisturizer
Preliminary thoughts are that I'm tolerating Niacinamide + Zinc after an initial breakout that resolved. The Argireline actually works, but now that the lines I was concerned about are gone, I stopped using it and am saving it for later. Jury is still out on the Vitamin C and the AHA, but again, because I started all of these around the same time, it's hard to say what did what, other than my skin does actually seem better. That's what before and after pics are for, after all.
Once I'm done with the Mandelic Acid, I'll start using my Lactic Acid in its place. I'll try out that AHA+BHA mask eventually. I'll do it slowly, and try to be meticulous about tracking how my skin reacts. It seems pretty contrary that I'm going from a relatively simple skincare routine to one that is more complex, with new products, but I'm doing so to address the reality that my skin has changed. The old problems have resolved, and now I can address the other things.
