I've had moderate to severe acne for 13+ years; I get angry when I read pamphlets and online articles that glibly reassure adolescents that they'll outgrow pimples as soon as they leave their teens, since I'm 31 and clearly not yet past that stage. Acne for women is often hormonally based, which is why birth control pills are often prescribed to help combat it, and it can last as long as the hormones do ... yes, until menopause. Eek.
When I started trying to get pregnant, I decided to do my fetus a favor and forgo all acne treatments -- no oral or topical antibiotics, no potentially harmful creams or ointments. I would go cold turkey. I hoped that maybe by some miracle my acne had cured itself while I wasn't looking. My resolve lasted about a month, until I ended up back in my dermatologist's office inconsolable. I couldn't do it -- there had to be something I could keep using that wouldn't hurt my baby but would let me keep my dignity.
People who've had a few zits here and there don't understand what having a face full of acne is like. There's a very real physical discomfort, since often the larger pimples reach down into the nerves. And then there's the emotional and psychological component, because, obviously, our faces are the things people most focus on and, like it or not, judge us by.
In the course of my quest to pop the pimples, I had tried everything out there: several families of antibiotics, many topical gels and mixtures, different facial cleansers, and birth control pills, which I was now off, of necessity. My dermatologist actually OKed quite a bit for pregnant and nursing mothers, but I was still wanting to minimize the chemicals my child might be exposed to, so I wanted to stick with something topical and among the least risky.
Fortunately, I came across my savior, www.acne.org.
I have no affiliation with this site or Dan, who runs it. It would be fun to get kickbacks and all, but it's not happening. But I will still shout its praises to the skies. Awesome, awesome site.
And the regimen Dan came up with is so simple that I kicked myself when it worked.
That's it. Yeah, duh, I'd used that before umpteen times, in umpteen preparations, from over-the-counter Oxy 10, to facial pads, to prescription cleansers that bleached my dark-blue towels, to refrigerated mixtures with topical antibiotics. When I looked back at my treatment history, though, I realized that the common factor for the times my skin looked its best was the presence of benzoyl peroxide in my routine. When it slipped back into horribleness, my dermatologist or I had cut the bp out.
So it all made sense, and I gave Dan's regimen a go. There was a very small part of me that hoped it wouldn't work and prove that all my years (over 10 at that point) of paying for office visits and copays and expensive prescriptions had been a wash. That my trial of the very strong Accutane and its attack on my liver was completely uncalled for.
But, mostly fortunately, the benzoyl peroxide regimen did work, just as Dan said it would, and I'm still using it now. My dermatologist and both midwives gave it a green light for pregnancy and breastfeeding; you can do your own research of its safety -- as with all drugs, there are very few studies of its effects on the unborn or nurslings, but the general consensus is that it's never been proven harmful, and I've been reassured by my research. It's topical, so it mostly doesn't absorb into the bloodstream, and the chemical conversion into oxygen wouldn't be harmful to a fetus or in breastmilk (or, at least, that's my understanding). Thomas Hale and kellymom agree with me.
So, you can go to www.acne.org and see videos and more in-depth instructions, as well as advice, forums, user galleries, others' stories, and product reviews, not to mention the opportunity to buy Dan's products he's developed specifically for the regimen. He donates some of his proceeds to a cool charity that counsels teens on skin care, and his products are made in the US and aren't tested on animals. I've only ever used his bp gel (more below), but I'd welcome others' comments on the cleanser or moisturizer.
For now, though, I'll go ahead and give the basics here, as I practice them:
1. Wash your face with a mild cleanser like Cetaphil or Purpose (my fave, but Cetaphil is available at Costco for über-cheap). Let dry. [ETA: Acne.org now has its own cleanser.]
2. Slather on benzoyl peroxide anywhere you ever get acne. Really use a LOT, much more than the "thin layer" most products recommend. You can scale back on the amount after you get a feel for how much your skin needs, but at first -- more is more. Let soak in until your face feels dry again.
3. Moisturize. I prefer a combination of AHA lotion (like Alpha Hydrox with 10% Glycolic Acid) to prevent flakiness (a great idea when using benzoyl peroxide, which definitely can bring on the flakies) and then a gentle moisturizer with SPF like Neutrogena Moisture. [Acne.org now also has its own AHA lotion and moisturizer, too, plus a nice organic jojoba oil.]
4. Repeat every 12 hours (twice a day).
If you're just trying this, it might take a few weeks to see an effect, but I can almost guarantee you will.
I'm sure there's somebody out there whose skin is resistant to benzoyl peroxide, but I think most cases of acne would benefit from this regimen, particularly if other avenues are out for you due to pregnancy or breastfeeding, or simply personal preference or convictions. For instance, I had already sworn off my dermatologists' (I have been to at least half a dozen) strong preference for chronic oral antibiotics after a yearlong bout of yeast infections and a permanent resistance to a whole family of antibiotics had set in -- yikes! I think Accutane can be a wonderful drug for people who are prepared to risk the potential rare but serious side effects, but it's out out out for any woman in the midst of childbearing. And hormonal methods like birth control pills are, logically, contraindicated when you're not trying to control birth, and when breastfeeding they can have a negative effect on milk production. So I like that benzoyl peroxide is a nice, relatively safe option for gestating and nursing women.
And did I mention cheap? No office visits, no prescription costs -- I can't believe how much less money I spend now on my face! You can try out the regimen with any drugstore bp you come across (or Proactiv or whatever), but if you decide it's right for you, I recommend Dan's own bp gel sold through acne.org (or, ETA, on Amazon). No, seriously, I'm not affiliated with him -- I just really like his 2.5% clear gel. It goes on without any white pastiness, dries pretty quickly, and is less drying than the 10% stuff, which is about all you can find at drugstores. You can sometimes find 5%, but usually the 2.5% is the most expensive, or requires a prescription. His bp gel is much cheaper per ounce than anything you'll find at the drugstore or by prescription, which is a big plus in my book.
One more benefit of benzoyl peroxide vs. other options (antibiotics, etc.) is that you can't become resistant to it because it's a physical reaction of exposing the bacteria to oxygen. It will work every time. I hated having treatments that once worked gradually fail on me.
One negative of bp and a piece of advice if you go the benzoyl peroxide route: Use white face towels and pillowcases, and let your skin dry before getting dressed. It WILL bleach fabric. Seriously, I invested in all white sheets because I was tired of having my side of the bed look all faded and gross. You can use bp for chest and back acne as well, but really let it dry before getting dressed and just suck it up that you're going to end up bleaching your shirts at some point. Be prepared to go for the all-white look or replace your clothes more frequently. Or you could try some sort of undershirt idea.
Here's my own experience for how the benzoyl peroxide regimen works: If I don't follow the regimen to the letter, even getting off by a few hours instead of doing it as close to every 12 hours as I possibly can, it shows by having pimples pop up again, so I know it's the bp keeping everything under control. When I don't use benzoyl peroxide (such as when I went cold turkey when I was TTC), I get small pimples completely covering my forehead and at least a dozen large ooze-filled ones all over my chin, along with isolated beauties on my cheeks and nose. When I do use bp, and allowing for slip-ups of fudging the schedule once or twice a week, I often have a completely clear face, with occasional chin blemishes, one or two at a time. It is SO much better that I now feel confident to run out to the store without makeup if I so choose, something I would never have done before my bp days. I titled my post "the cure" for acne, because I like to be dramatic, but of course it's not really a cure -- but as long as you keep doing it, it's the next best thing!
All right, that was my acne testimony! I hope I can convince even one fellow sufferer out there that THERE IS HOPE! It's not something you ate (probably), it's not your dirty face-washing habits, it's not resting your chin in your hands (probably), it's not your greasy hair (probably) -- it's just your hormones, and you can do something about it. It doesn't have to cost a fortune or compromise your insides or those little ones you care for. Love yourself, and zap those zits.
[ETA: I've added in some links to the Acne.org products on Amazon, though you can also buy them through the site.]