I started battling cystic acne in middle school when my hormones first entered the chat. At 12, my dermatologist prescribed topicals. The following year, I was using Proactiv and taking antibiotics. I avoided my reflection, brushed my teeth in the dark, and kept my eyes down in conversations. By my junior year of high school I went on Accutane, which meant monthly blood work and lips so dry not even Aquaphor could quench them. When I packed my bags for college, I brought birth control pills and a shiny new prescription for Spironolactone, an oral medication that is used to treat high blood pressure and can help clear acne by blocking androgen hormones.
The combination worked, and my skin stayed mostly clear throughout my twenties. Still, I never forgot the way acne had once ruled my life. I washed my face every night, no matter how drunk I was, and studied my reflection carefully, monitoring my jawline for signs of impending breakouts. I gobbled my pills gratefully, a nightly offering to the unpredictable hormones raging beneath my skin’s surface.
A decade after I started taking Spironolactone and the pill, I began to experience irregular bleeding. I saw specialists, had ultrasounds, and tried acupuncture. When my gynecologist finally took me off both sets of pills, my cycles went back to normal immediately. I was both relieved and nervous. Left unchecked for the first time in years, my hormones were now free to run rampant.
Sure enough, I began to experience an increase in hormonal breakouts after going off Spironolactone. The occasional lone pimple or cluster of whiteheads wasn’t nearly as bad as the cystic acne I battled in high school, but I was propelled back to the feelings I’d experienced as a powerless teenager. It didn’t matter that I was now in my 30s and in a secure relationship; I was terrified of being swallowed whole by acne again.
My obsession with skincare quickly ramped up in 2020. The isolation of the pandemic didn’t help. I stared at my skin all day on Zoom meetings. I became engrossed with beauty influencers who posted their skin routines and flawless selfies online. I asked everyone I met what they used on their skin, and promptly changed my own routine accordingly. I read about seven-step regimens, watched Gua sha massage tutorials, and researched expensive serums. There were new skincare routines for every season, countless holy grail ingredients that people swore by, and an endless parade of influencers touting the benefits of botox, slugging, and ice rollers.
“Social media recommendations are often what we consider anecdotal evidence,” explains Dr Elyse Love, MD, FAAD, a Manhattan-based board certified dermatologist. “This means one person tried it and loved it. For aesthetics, this type of advice can be helpful, but it often leads those with true skin concerns (eczema, rosacea, acne) down a rabbit hole of trying product after product after product.”
I had taken up residence in this rabbit hole. Skincare was all I could think or talk about, much to my husband’s dismay. I switched cleansers, over-exfoliated, and wasted hours researching, trying, and returning products that weren’t right for my skin. I went to bed reading about one product, then woke up and ordered another one. I tried to keep all the buzzy ingredients straight ≠ hyaluronic acid, vitamin C, vitamin E, AHAs and BHAs – but my brain was drowning in skincare jargon. Were oils good? How many acids were too many? What was a peptide and ceramide?
“Our society has become obsessed with skin and skincare in an unhealthy way,” says Dr Love. “The baseline knowledge of the average patient has increased in the past two years as people spend more and more time consuming content. The question, though, is how much does the average person really need to understand about skincare? Skincare hacks are the new diet hacks, and they promote a superficial relationship with your skin and your body.”
My relationship with my skin was rooted in a fantasy of quick fixes and one-size-fits-all perfection. I would take any pill or try any product that promised to make my outsides look good. When I considered simply going back on Spironolactone even though my doctor had cautioned against it, I realised I was willing to jeopardise my health for my vanity. I thought about my skin constantly: In the morning, I pulled away from my husband to examine my face in the mirror. I I struggled to focus during conversations, wondering if people were judging my complexion. Eventually, my mental gymnastics pushed me to a breaking point. I was sick and tired of comparing myself to others, wasting money, and chasing one quick fix after the next. I needed help.
I started by finding a dermatologist. I learned that I had rosacea, hormonal acne, and sensitive skin, all of which played a role in how my skin reacts to different products. It was also comforting to hear that hormonal acne is common in adult females and not just something that affects teenagers. Next, I worked with an esthetician to create an appropriate skincare routine for my skin type. Once my plan was in place, I made a commitment to stick with it for at least three months.
“Skincare doesn’t have to be complicated,” explains Matthew Miller, esthetician and owner of Matthew Miller Skin in Los Angeles. “Keep it simple, be consistent, and stick to a regimen. When you’re caught in that vicious cycle of irritation and breakouts, scale back to the basics: a gentle cleanser, moisturiser, and SPF. And remember that it can take two to three months to see the proper results from products.”
Caela Bulzing, founder of the Los Angeles-based studio Caela Esthetics, agrees. “Educating yourself about the ingredients that work best for your skin type and sticking to a routine is the key to amazing results. Remember that everyone’s skin is different, and what works for a celebrity or someone endorsing a product may not work for you. ”
For the first time in two decades, I also tried tuning into my body and paying attention to how my skin reacted. When a holistic doctor suggested that I try focusing on my gut health and seeing how it impacted my skin, I realised that I had never stopped to consider that my complexion was providing clues about my overall wellbeing. I cut back on dairy and gluten and incorporated supplements and probiotics. Within two weeks, I noticed a difference in both my digestive health and my skin.
Even more significantly, I began to heal my thinking. For years I had been running from the shame I experienced as a teenager with cystic acne. Having “bad” skin triggered core beliefs that I was unlovable, less deserving than others, and a failure. I needed to rewire my brain to believe that my worth was not determined by my appearance. Whenever I had a negative thought about my skin, I tried to replace it with a gentle reminder of my intelligence, humour, and kindness. In the moments when I felt the most self-conscious, I tried to get out of my head and be of service to the people in my life. And I also began opening up about the anxiety and shame I experienced. I had spent years wanting to be invisible because of my skin, wishing I looked like anyone else, then berating myself for being so self-obsessed. But now, I was done hiding.
“We need more people to show their flaws,” emphasises Miller. “No one has perfect skin, regardless of what you’re seeing on your screen. Skin is not porcelain: it has texture, scars, and fine lines. Even breakouts are totally normal. If we remember this and show real skin more, it will lead us to be kinder to ourselves.”
Skincare is often associated with self-care. For me, self-care meant stepping away from my phone, understanding that no single product is the answer, and working to meet myself where I am. I still experience hormonal breakouts from time to time and ask people what they use on their skin. But now, I ask them how they feel about their skin, too. It turns out that most people are also seeking their own versions of perfection. Our blemishes are just one small part of a much bigger picture.
