Saturday, November 26th, 2011

By John, Skincare Contributor

John describes himself as eccentric–you might find him having a conversation with himself or making “A Beautiful Mind”-like movements while doing so. He’s a stickler for accuracy, so you might find him correcting one thing or another! His goal is to answer questions and provide unbiased, meaningful, and insightful information.

At 21, he is an aspiring dermatologist and will return to school next fall to get those plans moving. John enjoys singing, playing piano, hitting volleyballs, playing video games, and chatting with friends. Some day, he’d love to try more adventurous activities, like skydiving and mountain climbing! Check out his blog, The Triple Helix Liaison!


2007 & 2008

John’s Journey to Fight Acne

I began following a regular skin care regimen about a year ago. At the time, I was experiencing quite resonating ideological and emotional shifts regarding school, my personal life, and relationships. They somewhat darkened my perspective and drove me to behave irrationally and impulsively, which lead of course to grave consequences and regrets. On top of all that, I had to handle my profusion of non-inflammatory and cystic acne. Consequently, I thought quite basely of myself.

The first photo was taken around 2007, when my acne was less cystic but still severe. The second photo was me in 12th grade (around 2008), when I started getting cystic acne. See how the right cheek and side of the nose folded as I winked? That’s because the cysts were so distended that they forced my skin to overlap. The camera’s flash does wash me out, so my condition appears better than it actually was.  To make an extremely long story short, three magical ingredients helped to rid my skin of acne. In order of discovery, they include:

  • Salicylic Acid:  I first encountered salicylic acid (SA), a lipid-soluble aromatic compound, in the form of Step 2 of the Clinique 3-Step system (skin type 4). I began with the Clinique 3-step because it was cost-effective, reputable among friends, and Blair Fowler loved it. The system helped somewhat, but after a few months, my skin worsened. From what I now know, repeated exposure of the alcohol content present in Step 2 had irritated my acne so intensely that it overshadowed the alleged effects of SA.
  • Benzoyl Peroxide:  I turned to other products to use in concurrence with the Clinique 3-step. First, I tried treatments from Neutrogena and Clean & Clear containing 10% benzoyl peroxide (BP), an antimicrobial ROS-generating compound, which should have improved my condition drastically, but due to the high amount of irritation involved, only improved my condition slightly. Since some studies suggest that lower concentrations of BP work just as effectively as higher ones, without the additional irritation, I next tried the Acne.org 2.5% BP product. Unfortunately, the reduced concentration had no positive effect on my skin.
  • Glycolic Acid: By this time, I was already familiar with Paula Begoun’s review website Beautypedia. However, I had never seriously considered using her products because one, the gaping conflict of interests was too impossible to ignore, and two, I hated that her products always received the highest rating possible. However, I was desperate. I purchased the 2% SA liquid treatment, as well as the 8% and 10% glycolic acid (GA) products.  Within two months, my acne had been reduced by at least 75%.

My postulations as to why the introduction of glycolic acid, which is typically better for dry and mature skin, worked so well for my adolescent and oily skin include the following:

  1. Due to the long-term damages of having severe cystic acne, my skin’s natural ability to exfoliate had been damaged,and therefore, functioned erroneously. This is evidenced by the daily buildup of gunk or sebum that would come off in thick layers when I gently scratched my face in the shower. I’d include a picture, but that would probably be gross. Its consistency is best described as a hybrid cream-wax that was sometimes bluish and other times yellowish.
  2. Partly due to its low molecular weight and water-soluble nature, GA is quite adept at exfoliating the surface of the skin. For my skin, this meant thinning of the statum corneum (SC), which had that excess “gunk,” which in turn allowed for the SA to actually penetrate into the pores and induce desquamation at those sites.
  3. Furthermore, the new Paula’s Choice (PC) SA product is a better formulation than the Clinique product mentioned above because of the vehicle and penetration enhancers used. The PC product employed methylpropanediol and butylene glycol to enhance penetration. The Clinique product employed denatured alcohol and butylene glycol. Although denatured alcohol is quite effective at enhancing penetration, it is too volatile, meaning that it evaporates quickly. Once the vehicle becomes volatile, SA becomes significantly less effective. Not to mention that in high amounts, denatured alcohol is irritating.
  4.  The GA, which reduced the excess sebum on the skin, also allowed for the BP to penetrate more deeply. As you can see, GA was the critical component necessary for effective treatment.

*Please note that though changes in stress level, diet, and exercise probably played major roles in the improvement of my condition, they are not addressed because they cannot be easily quantified and therefore, elucidated.

After my skin was basically clear, I set out to repair some of the damage done by my decade of untreated severe acne and lack of daily sunscreen use. There are two ingredients that have largely retextured, rebuilt, and refined my skin. In order of discovery, they are L-ascorbic acid (vitamin C) and retinol (vitamin A). Vitamin C stimulates collagen production while retinol, upon conversion to tretinoin—the active metabolite that the skin utilized, inhibits the expression of enzymes that break down collagen. So the therapy is two-folded. While these two fantastic ingredients exhibit several other beneficial properties, that’s for another time!

Check out John’s current skin care routine! 


Current


Current

Current Skin Care

Right now, I have very oily, acne-prone, mildly-sensitive skin that is occasionally flaky and dehydrated in certain areas like around the nose, mouth, chin, eyes and between the eye brows.

If you have any questions, concerns, or opinions feel free to comment below on this post or contact me on my blog!

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177 thoughts on “John’s Journey to Fight Acne

  1. Avatar of Lianne Lianne

    Yay! A science based skin care article! Paula’s Choice 1% sa lotion is my hg, it’s made SUCH a difference in my skin. Blackheads be gone!

    Can’t wait to see more from you!

  2. Avatar of Mahnaz Mahnaz

    great post !

  3. What an excellent article! I too have suffered from severe cystic acne in the past and can relate to your experience. Especially the part about how the lesions actually changed/inhibited your facial expressions. My treatment was very different. All OTC remedies worsened my condition so I sought treatment from a dermatologist who put me on a regimen of antibiotics and retin-A. It completely healed my condition. I was 18 at the time, and through my young adult life, still experienced breakouts. Finally at 34 years old, my derm put me on Accutane, which permanently cured my condition. For those unfamiliar, Accutane comes with some risks and some undesirable side effects. Interested readers can find more info here: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000532/

    • Yes, the combination of antibiotics and retin-A address different stages of acne and is quite a potent treatment. I’m thrilled to hear that it worked for you. Accutane of course, is the closest thing to a cure for acne since it is the only drug that can regulate sebum control. And without sebum, acne can’t exist. :]

      Unfortunately, it does have severe side effects, especially for pregnant women.

      Thanks for commenting Sarah!

  4. Me

    Wow, until i saw your before picture and the other one now where you have peerfect skin i didn’t have any hope for myself lol. I really do hate my skin :/

    • Never stop hoping and trying! As cliche as that sounds, it’s completely true! I would go so far as to say that it’s not a cliche but a universal human experience that’s part of our essential fabric, haha! Thanks for commenting Me!

  5. Amazing post! I love how detailed you talked about both the science behind the products as well as your own, candid experiences. I’ve been struggling with acne since middle school (I’m not in college) and although my skin was never extremely serious, it’s never been fully healed either. I’m usually not into entire skincare lines (I tried the Clinique 3step and the toner really killed my skin) but I’ll check out Paula’s Choice because of your review :D Also, I commend you for researching and trying to solve your skin problems because I rarely see guys care about their skin at all :)

    • I don’t like shopping from one line either, but PC product just happen to all contain excellent well-documented ingredients at an affordable price, which is the only reason I use these products. Not because they’re all from a single line. It’s not a perfect line, but it’s pretty dang good.

      On my blog, I have a more in-depth explanation of why I use each product. You can find that on “My Story & Routine” page found on the top right part of the homepage of my blog. There is also a list of FAQs that people ask about my routine, one of which, is why I use so many PC products.

      Thanks for commenting!

  6. Leah

    Wow, this is one of the first articles I’ve read that really explains cystic acne treatment in detail. I have battled cystic acne for years now (I’m 23), and finally seem to have my skin under control at the moment.

    I look forward to your future articles. Have you considered writing more in depth about scar repair?

    Thanks,
    Leah

    • Leah, scar repair, especially significant ones, involve deeper chemical peels and laser surgery; basically things that you can’t do at home. However, I will take your suggestion into consideration, and will most likely do a post on this on my blog. My next post for Temptalia will most likely be an in-depth explanation of the steps of acne, and which ingredients address which steps. Of course I’ll be explaining each ingredient as well.

      However, there might be a holiday-related post before said post, just depending on how Christine schedules everything.

      Anyways, thanks for commenting!

      • alison

        just so you know, i’d love to see a post on this too. i’ve been pretty much acne free for about six months, but the marks, while somewhat faded, are still visible. i’d love to know what i can do at home for them, and what treatments are effective so i know where to spend my money!

  7. Wren

    Thank you for sharing this, John. I’m so glad you’ve found what works for you and frankly it’s nice to see the issue of acne addressed on Temptalia. I struggled with bad acne for years and finally cleared it with Accutane. I enjoy this blog now, but I never would have when I was suffering with bad skin because I hated putting extra products on my face and doing anything to look prettier, because I always felt like I looked like trash no matter what. I think it’s awesome that you want to be a dermatologist. I’ve dealt with several derms, and all but one has never suffered with acne and has been totally unsympathetic to what it does to your self-esteem. Best wishes to you.

    • Thanks for the encouraging words, and I’m glad that you’ve cleared up your acne as well and much earlier than I did, too!

      Thanks for commenting!

  8. Nina

    Hi, John,

    Your skin looks amaaaziiing now! May I know your exact routine when you were using Paula Choice glycolic acid treatment? My other half has adult acne and I plan to get him some skincare products as the other two over-the-counter treatments mentioned above do not work. Hopefully glycolic acid is the answer for him.

    • Well currently, I only use a 10% glycolic acid treatment on my face once a week, on average. But remember, when I first started using glycolic acid, it was used in conjunction with SA and BP, because alone glycolic acid isn’t very effective at treating acne.

      It’s all about combination therapy. And since men typically have thicker skin, ask him to use the glycolic for a few days at night, and use the SA and BP during the day. If he’s going out, make sure to use sunscreen because all three ingredients will make the skin more susceptible to UV rays.

      Thanks for commenting!

  9. alison

    Thanks for sharing! I finally got my acne under control about a year ago (figured out it was mostly hormonal, plus stress and sensitivity), but my sister still struggles with cystic. I’d looked into paulas choice before, but was also turned off by the obvious conflict of interest going on – good to hear it might actually be a good product. I may reccomend the 8% GA product to her.

    • Definitely! I mean I first was like, PC must be a scam or something because why would she review and recommend other products. But the ingredients in her line are mostly all well-documented and I can say, are very effective. I’m not saying I agree with everything Paula believes in, but 7/10 times, she’s right on the dot.

      Thanks for commenting!

  10. Avatar of Ashley Ashley Sarah

    Welcome to Temptalia! I checked out your blog already and have left you some comments. I can’t wait to read more of your work, here and there!

    • I know!! I already responded to a few of them, and I appreciate your feedback so much! Like I said before, I wish every reader took the time to write as much as you do! Haha. xD

  11. Luna

    I’m so glad that you did this post on skincare. I’ve been curious about Paula’s products for a while and reading this helps me a lot. I’ve also noticed a huge difference in my skin after I started using Olay’s Thermal Mini Peel which has glycolic acid in it. I have dry skin though and it works wonders.

    • Hey! Just remember that you don’t want to judge products based on what line they come from. Instead evaluate them based on their ingredients, and personal preferences such as texture, absorption, etc..

      Thanks for commenting!

  12. Linda

    This is great post . definatly the best from guest posts . really usefull , not another one teenager teaching makeup . sorry, that freaked me out .
    Thank you write more please :)

    • Wow… you flatter me, truly. I’m just happy to get the chance to write for Temptalia, thanks Christine again! I don’t really care for comparisons, I just want to help you guys out.

      Thanks for writing!

  13. Ashley

    Holy crap… that’s so many products :/ When I was still using products, my routine usually consisted of just one cleanser, one lotion, and maybe a mask. If my cleanser wasn’t also an exfoliant, I’d throw in a scrub. But being water-only (head to toe now, for the most part), any list of products seems quite long to me. And just to clarify, going water-only is what cleared up my moderate-to-severe acne that I experienced in 2010/2011. Before that, I only had mild to moderate acne that was very mild for a few years with the use of just a simple, non-medicated cleanser (LUSH’s Herbalism, so it is targeted towards acne) and simple lotion (although all lotions broke me out in some way). I personally don’t see how a skincare routine that is so extensive could be beneficial to one’s psyche or skin! Even just using a few cleansers switched around for me caused me to experience quite a number of issues. I can’t imagine something like this for my poor skin.

    • Avatar of Gina Gina

      Everyone has different skin :) what might wreak havoc on yours is probably extremely beneficial to him.

    • Ashley, it IS a ton of products! Haha. If you count them all, there’s like 20 different products! :] But remember that I only use about 4-5 in one go. I just have a lot of products in each category for many reasons. I actually go into detail about why I use a specific product on my blog. It’s located on the “My Story & Routine” page found on the top right corner of the homepage. There’s also a list of FAQs that I’ve been asked regarding my routine, and I do answer things like why I use so many products, and why so many are from PC.

      Thanks for writing! And Gina is right, we all have different needs for our skin types.

      • Avatar of melissa Melissa

        I totally agree. I learned long ago to keep a variety of products in my cabinet, since with combo/oily, sensitive and breakout prone skin, sometimes you have to use one product on the tzone, and a different one on cheeks, and also a spot treatment somewhere else. Personally, I was mostly clear until I had my first child, then it became cyst city.I was done with trying all of the otc products and after trying a few things, derm gave me accutane-it took two rounds to clear me. It cleared me for a couple years, but after another pregnancy I was right back where I started. I brought back all my old otc remedies, but at 37 decided to just go back to the dr. He gave me spiro, antibiotics and a topical and was confident I would be set. Nope-after being in his care for months, I have just started another round of accutane. He says my skin’s ability to make acne is impressive, lol.

        • Dang that’s too bad! But look on the bright side, at least Accutane does work for you! Wouldn’t it be kind of crappy if you were allergic to Accutane? :[ THanks for sharing your story, and hope you get clear soon.

  14. Saffy

    This is a great post! I love reading about the science-based side of skincare.

  15. Julia

    This is such a wonderful article, I hope to see more from you soon! I love thoughtful and accurate skincare articles! I would also like reviews or articles on other products you’ve used throughout the years–ones you liked, but maybe didn’t love, and why.

    • Hey Julia! Thanks for the compliment. I actually have detailed explanation of why I use each product on my blog. It’s located at the “My Story % Routine” page on the top right corner of the homepage. I also posted about 10 different product reviews, which you can also find on my blog. It’s a new blog, but I’m building it up as efficiently and quickly as I can! Expect much more solid content in the coming months!

  16. Liz

    I have to commend you John! The article is great, very informative, articulate, yet personal. Many people fail to realize the psychological affects severe acne can have on people, especially teenagers. I am very lucky in that I rarely break out, but knowing many people that suffer from cystic acne I know the emotional toll it can take. Hope to see many more articles from you!

    • Thank you Liz! Acne can certainly leave severe physical and mental scars! Want to know a secret? I’ve actually never been on an official date before. HAHA! I know right? I’m so lame, but yeah, acne is a hugely impacting condition.

      Thanks for commenting and you are so lucky to rarely break out!

      • Avatar of Cathy Angelcat47

        John,I am old enough to be your mom almost twice over;i,too,still suffer from acne and really enjoyed your article.Two things I want to tell you:YOU are NOT lame;many older than you have not had their first official date.And I’m sending you a big hug for your bravery in sharing your story both in prose and pictures.

        • Thank you Angelcat! I’m actually not embarrassed to talk about that since it’s compeltely true and I’m okay with it. I’m a bit tpp busy right now for a relationship. Friends are wonderful though, especially close ones. Well derp John! Haha.

          Thanks for your extremely kind words! Have a good one.

    • Avatar of artemis artemis

      yes…agree :( it’s really frustrating to think about my skin problems

  17. Avatar of gidget1212 April

    I love the acne.org system and have been using it for about three years now. I wish more people knew about it. The most important thing is to follow the program and be very diligent about being gentle to your skin and not irritating it. I also started using the acne.org AHA+ lotion and the Clinique clarifying lotion as supplements to the program about a year ago and the addition of those has made my skin as close to perfect as I think it will ever be.

    • The Acne.org system isn’t wholly complete I would say, but it’s definitely sufficient. But then again, no OTC system can be complete for everyone since people respond to different types of treatments and combination. But if it’s working for you, don’t stop! Make sure to use sunscreen, and I would recommend using an antioxidant-rich serum/moisturizer and maybe start adding retinol into your night-time routine.

      Thanks for commenting!

  18. This post could not have come at a better time! I am SO fed up with my skin. I’m 26 years old, and my skin is worse now than it was a decade ago. Nothing seems to work. I have tried myriad BP and SA products, and while some of them have helped a little bit, my acne never goes away. The effects seem to be temporary, too. I’m really hoping that adding a product that contains glycolic acid will be the key for me! It seems like we have similar skin types. My skin is dry and gets flaky, but I’m also extremely acne prone and I have sensitive skin. So many acne products are geared toward oily skin, but those products are too drying for me. Either that, or they irritate my skin. I live in a dry climate, so that doesn’t help the matter. I’m really hoping this will work for me! Your skin looks amazing now. I can only hope that mine will look as good!

    Like someone above me said, I really like that you combined your personal experience with the products as well as the science behind them. I’m a stickler for scientific facts. I like to know how things work and why they work that way, so this was very informative. Thank you! I am totally bookmarking this.

    • Thank you Ashely! You know, you’re like the 3rd Ashley that’s commented so far! Haha, that’s so awesome. But thank you for your gracious comments! They definitely made me smile! I hope that glycolic works for you with the other two. Be careful not to over-irritate your skin though! Pay attention to your skin, because acne is an issue of sensitivity for oily skin types, additional irritation can cause inflammation and worsening of your condition. It’s all about finding that perfect balance between irritation and efficacy. And of course, you can always email me or comment on any one of my posts if you have additional questions. I’m here to help, always!

      Thanks for writing! xD

  19. Angel

    Congrats on the clear skin! You look great!!!

    I have to share my recent discovery: La Roche-Posay Effaclar Duo Dual Action Acne Treatment. I share this for those of you who have tried it all, to no avail. In three days of use, I have cleared up cystic acne that has been on my jawline for over four months.

    Now I know we all have different skin, and not everything works for all of us, but this has been like a miracle in a tube for me. I have tried several antibiotics (had a horrible flu-like reaction to Solodyn), Retin-A, laser treatments and multiple prescription topicals including Duac. Not to mention every acne line under the sun, every version of salicylic acid, sulfur products and peels. I have very bad reactions to Retin-A. It NEVER cleared my skin, only dried it out and made it itchy and red. This is after 3 months of use. And I’ve tried it twice. Peroxide based topicals have never done much either. They always made my skin red and dry. My best luck has been with the PTR line, but even this stopped working for me several months back.

    I was ready to go on Acutane, my last ditch effort, even though I’m scared of it. My dermatologist had run out of options. Until 4 days ago when I stumbled upon the Effaclor Duo. I read an article about it. It said the peroxide had been micronized to penetrate deeper, and it’s combined with LHA, a gentler but somehow stronger form of salicylic acid.

    I read a bunch of reviews online. A few people had strong reactions to it, including very red skin. But the majority of reviews were so good, they sounded too good to be true. I started with a very thin layer on night one. Put it all over my face and jawline. Next morning, my skin actually looked smoother. The redness had diminished a bit and the cysts were flatter. Since I had no reaction, I applied it twice on day two. Woke up next day and I could not believe my eyes. My skin looked better than it has in six months! So day three, I applied it three times. (BTW this layers under my sunscreen and makeup perfectly, no pilling or grittiness). Needless to say, it’s day four and I’m just astonished. I have no new acne popping up, and the cysts I had are much flatter and drastically less red. My skin actually feels so much smoother. I’m not totally clear, there are still a few stubborn cysts on my jawline. But they are smaller, smoother and less red.

    I just had to recommend this. For someone at her wits end, this has blown me away. And it’s simple. I wash my face with Purpose and then put this on. Then sunscreen and eye cream. Simple yet effective. I bought it at CVS for $35. A bit pricey, but nothing when I add up all the tons of other stuff I’ve purchased in recent months. It will last a LONG time. You just need a little bit and it goes on very smoothly. Hope this helps someone out there. Best of luck to anyone suffering with acne. Acne just sucks!

    • Well thank you very much!

      What a fantastic reply! Thanks for taking the time to write all that out! It looks like you’ve had bad reactions to virtually every well-documented acne treatment. It sounds to me like you also have very sensitive skin. And it would make sense that LHA would work for you.

      LHA is a newer exfoliant that is more gentle than SA in the sense that it does not require a very low pH in order to function. LHA is able to exfoliate at a pH of around 5.5, while SA needs a pH at least as low as 3.5ish.

      Also, another reason why LHA probably worked for you is because LHA is definitely a mutant ingredient! Well, in the sense that it has characteristics of multiple treatments combined, though more gentler and less effective than any particular category comparison. For example, it is slightly antimicrobial like benzoyl peroxide. It is also lipid soluble and works at loosening the proteins that hold corneocytes together at the membranes like salicylic acid. Finally, it also helps renew the extracelullar matrix like tretinoin.

      It is certainly a promising ingredient, but like all ingredients, cannot produce miracles, at least not for everyone. But I’m SO thrilled that it worked for you. Thank God you didn’t have to resort to isotretinoin!

      Thank you for commenting!

  20. Avatar of artemis artemis

    i’m happy for you! you;re a cutie and you were one before too :) can’t wait to afford to use all of those treatments someday, i read a lot about Paula’s products :D
    my skin is like yours currently only i also got some acne(which wouldn;t be that bad if it didn’t leave marks…) and blackheads (i hate them a lot) :)) i just took some blood tests to see if i got hormonal problems…that would explain mine…but, i’ll wait to see the results :D

    • Aw you’re so sweet. Yep make sure you get those test results and don’t hesitate to ask your doctor any questions or concerns that you have. It’s better to be wrong than not know.

      Thanks for the compliments and the reply!

  21. Sabrinna

    wow, awesome article! really helpful! I shall check out Paula’s Choice. I have tried clinique and did nothing for me. I am currently using Murad (which is a salicylic acid based system) but only tried glycolic acid in Brazillian peel. Its sort of working but i havent cleared up fully at all. Thanks for this great article!

    • I don’t want you to check out Paula’s Choice because I use that line a lot. I want you to fall in love with her products because of their ingredients and effectiveness, not the brand. And while the Brazillian peel is a good product, you can certainly find ones for less $. I mean, really, $80 for 4 applications?!

      Anyways, thanks for commenting!

      • Sabrinna

        Ah, i meant i will see the items Paula’s choice have and see if they will work for me :) i dont necessarily buy products because theyre well know and such but i buy and use them if they work for me. And youre right, brazillian peel is expensive, it was just the item introduced to me by an SA at sephora and I happened to try it out.

  22. Lucia

    This is an awesome post – probably one of the most helpful I’ll ever read on here.
    I want to congratulate you on your perserverance and the results really show your commitment to recovery.

    I was wondering what your thoughts were on hormone-related skin issues. My skin is controlled by hormones, being a woman it’s obvious when it’s worse and I was wondering about asking my doctor for a hormone controlling pill?

    I’m definitely going to get some acid from Paula’s Choice. At the moment my skincare regime is not working for me at all.
    I use clinique 3-step for combination-oily skin, but I also use pro-active moisturiser, pro-active cleansing mask, tretinoin and benzoyl peroxide as well as taking 4 oxytetracyline a day. But having been on this regime for around 18 months, I have seen no improvement. I also used clinique’s pore refining solution which has not done anything.

    I’m just concerned about combining the BHA, AHA, tretinoin AND benzoyl peroxide as I’m so prone to dryness when I use the latter two products.

    To anyone who has not inherited cursed skin genes, I hope you’re thankful for every carefree day! People really don’t understand the personal impact skin issues can have on you – I tried to tell my GP about how bad it makes me feel, but she just said I was over-reacting, which I really hate.

    • Thank you for your kind words Lucia. You should definitely ask your doctor about birth control pills to control your acne. Hormones, especially for women, are major contributors to skin conditions and health! Don’t be afraid to ask.

      Like I said in my post, I also started out with the Clinique 3-step. My major problem was the alcohol content in step 2, which was so drying. I’d avoid that if I were you.

      You are definitely using a lot of products, and I’m guessing that they are drying you out and causing a lot of irritation. There’s the alcohol from the Clinique 3-step, the proactiv moisturizer that has benzoyl peroxide, the mask which has sulfur, on top of tretinoin! I mean that is a LOT! Make sure that you aren’t using the benzoyl peroxide and tretinoin at the same time, as in like at night-time because benzoyl peroxide denatures and inactivates tretinoin.

      I’d recommend that you use alternating therapies. For example, use salicylic acid just during the day, and then rotate benzoyl peroxide, tretinoin, and AHA at night-time since the latter three seriously make you more sensitive to the sun, not to mention that tretinoin is inactivated by sunlight. And make sure to keep taking you oxytetracycline perscription. Also, never EVER forget sunscreen, especially when you’re using so many sun-sensitizing products.

      From there, you can adjust accordingly depending on what your doctor tells you and what your skin tells you. And you may want to seek a dermatologist instead of a GP since one, a dermatologist will be better equipped to to personalize a more acknowledge your psychological issues. Stress is certainly a factor for flare-ups, and that GP is careless to not address it.

      Thanks for commenting, and if you have any more questions, let me know. I’m here for you guys.

      • Whoa I have no idea what I wrote in the second to last paragraph! I meant to say, “…a dermatolgist will be better equipped to personalize and tailor a routine for you and two, will more likely acknowledge your psychological issues.” xD Sorry about that.

      • Lucia

        John thank you so much for your reply, I’m finishing term in a few days and heading straight to my GP and then to a dermatologist.
        You’ve inspired me to just take control, stop complaining and get on with sorting the problem out.

        • Wow you are so very welcome! I’m quite moved that you find my inspiring. Definitely never stop trying because you don’t know what kind of happiness and joy is at the end of your long journey! I’d give you a big hug if I could. :]

    • alison

      obviously this isn’t a scientific experiement – it’s just one person’s experience – but i developed bad adult acne when i was 24. it continued for a few years. i’d been told that it was hormonal, since it was on my cheeks and jawline. (is that where yours mostly is? jawline/cheek acne tends to be hormonal.) i thought i could combat it using products, but not much worked. (i won’t say i tried EVERYTHING, but i tried quite a bit.) i switched my BCP to yaz and my acne cleared up completely in two months. i almost NEVER break out now. i thought i’d never see the day when i would be able to be like ‘oh darn, i broke out’ because i got ONE blemish.

      it’s worth a try, at least!

      and that is terrible about your GP saying that. if it was me, i’d find another one. :/

      • While I agree that this is just my personal experience, I’d say that it’s wise to see what aspects can be applied to other people’s problems. I mean it’s through individual personal experiences that we as a society can conceive the broader and more general essences that we all can benefit from. I’m thrilled that YAZ works for you. And I know that this message is directed towards Lucia, but I guess I love to talk!

      • Sue

        Like Allison, I too developed acne when I was older: perfectly clear skin until the age of 19. I knew it was hormonal because if there was anything I cared about physically, it was my skin. After 2 years of breaking out, I finally caved in and spoke to my doctor about taking either Yasmin or Diane-35. For 2 years I refused to go on birth control solely for reasons other than contraceptive purposes, but I realized my skin was causing me more stress, and that made me break out more as well. I started taking Yasmin(which also has the sister pill Yaz) a month ago and I’ve only had a minor blemish in the most stressful month I’ve ever had. I highly recommend reading more about the side effects before deciding. Recently Yaz has come under fire due to reported cases of blood clotting incidents, etc. The FDA also issued a warning about BCPs containing drospirenone. However, one needs to be very critical of what information is released in these lawsuits. I recommend using medlineplus for more info. Just be wary that certain personal characteristics will predispose one to experience more/less side effects. Also, if you choose to take BCP, please monitor your psychological well-being. I’ve noticed that at around the 3rd week of pills, I was experiencing a lot of depressive thoughts and a couple of friends have felt the same way. Hope this helps!

        • That’s fantastic information and I’m sure everyone greatly appreciates your contribution! With any prescription product, the more one is informed the better as these treatments can cause serious side effects. Hormone treatments for women decrease the level of androgens, which regulates sebum production. However, because it is a hormone treatment, it may unwittingly trigger other reactions such as depression like Sue said.

          Anyways, thanks for commenting!

        • Lucia

          Thanks so much for this comment Sue – it seems we have had a pretty identical experience, with problems starting at 19. I honestly thought I was weird or maybe it was because I was using the wrong foundation that I was breaking out but apparently not.
          I have heard about depression and weight gain as side effects, but I would say that I am in a similar boat to you, again – the stress (and distress) that my skin causes me, the way in which it pretty much stops me from leading a normal life (as in, not allowing anyone to see me without makeup) means the effect of clear skin would HOPEFULLY counteract any other emotional issues.

          I’ll take this advice to my doctor and hope for the best :)

          I feel optimistic for the first time in ages now about sorting things out, thanks for this again John and everyone who has commented – so helpful!

      • Lucia

        Yes Alison I’m actually very similar to you. I had pretty much clear skin when I was a teenager and it was only when I was around 18-19 that it got worse; I’m now 21 and it’s the worst it’s ever been, always controlled by hormones. I’m absolutely just going to try the pill anyway – I don’t need it for contraceptive uses which is why I think I haven’t been given it before.

        And yes, I am not going back to that GP! She also misinformed me on things John has enlightenened me on, especially regarding blackheads and pores. She just said ‘deal with it’ basically, whereas I think, um, no I shall not!

        Thanks so much for this post, it’s really convinced me to just go ahead and ask :) And congrats on getting your skin under control!

  23. Hey everyone! This is John, the author of this post… xD

    I’d just like for you all to know that in the “Current” picture, I AM wearing foundation, concealer, and powder! You guys are all commenting how great my skin looks, and while I agree that it’s come a LONG way from what it was, my skin is not that perfect! Haha! If only! That’s just the result of great makeup (which includes the Laura Mercier Silk Creme Foundation set with MUFE Super Matte Loose Powder), camera angle, clever lighting, and subtle editing!

    I also changed the contrast and brightness of the photo to once again, enhance my complexion. I want to be as honest as I can be with you guys, so yeah! Once again, from the rooftops, my skin is NOT that amazing! Also, remember that good skin appearance doesn’t necessarily mean that the products in my routine are good, though I can assure you that they are!

    Remember to judge products based on their ingredients, not their advocators, which is why I review in detail why I choose to use these products in my routine. You can find said reviews on my blog under the “My Story & Routine” page. There should be SIX parts!

    Thanks for reading this far everyone!

    • Dame Elizabeth

      Because of you I use silk creme and I cannot thank you enough!! I’ve just got my third bottle of it the other day and it’s truly a wonderful foundation that I’d never have tried if I hadn’t read one of your posts on foundation on this blog last year.
      Thanks so much, once again!!

      • Haha no problem! It is pretty dang marvelolous! A second repurchase isn’t insane considering there’s so many foundation just beggging us to give them a try. xD

        Thanks for commenting! I always enjoy reading your replies.

  24. Camille

    how come you never tried accutane??

    • Because I’ve never had to! It seems that I had such bad skin because I never had ANY skin care routine at all. I stated in my Temptalia Skin Care Contributors Intro that I always believed my mom’s saying that if I just washed my face more, etc.. basically a lot of misinformation. My skin probably wouldn’t have been that bad if I saw a dermatologist from the start. But yeah, that’s probably it. But who knows. If you have any questions, let me know.

      Thanks for commenting!

  25. Karen Stauss

    Excellent post! I look forward to reading more from you.

  26. Jenn

    Wow, thank you for posting this. I have never had any acne problems but my younger brother unfortunately suffered terribly from these issues. I am going to give him this information to see if it may help him. Especially your after-care, your skin has improved so well, perhaps it could help him too. :-)

    • Hey Jenn,

      You should definitely do that! And make sure to tell him that there’s nothing wrong with a guy taking care of his skin. xD Also keep in mind that there’s a 5 year difference between my photos and that the current one does have makeup. Read my comment above about what I put on and did to the photo.

      Thanks for commenting!

  27. Kirsten

    Fantastic post! I am an esthetician and still found this helpful. Best of luck in school for dermatology–I am considering the same :)

    • Wow, that is a compliment! I love this communal feeling of sharing information! I’m glad that you actually learned something from this! Thanks and hopefully you’ll be going to med school as well. xD

  28. Avatar of Alisha Alisha in WI

    Where is the like it or leave it?! I love your scientific approach. I myself just discovered beautypedia/paula’s choice a couple months ago. I also wasn’t sure about trying her products at first. Nothing seemed to work for me so I finally decided to extensively (and I mean extensively) look into other alternatives because with over 10 years of seeing dermatologists, I still could not completely get rid of it where they are looking at it as “oh it could be much worse”. I tried differin, finacea, duac, antibiotics, accutane, and many more creams/gels including over the counter. And yes, accutane did help and reduce but after I went off it acne slowly crept back just not to the extent before. I actually enjoyed having dryer skin, because it reduced my oily skin to “normal” skin. I had never thought to try the glycolic acid but I think I might now. I would love to see more from you!!

    • You’re very welcome Alisha! Dermatologists typically don’t recommend glycolic acid for acne-prone skin because studies have demonstrated that salicylic acid reduced the number of comedones more greatly than glycolic acid, and salicylic acid also has an anti-inflammatory action. Glycolic acid is reserved usually for sun-damaged dry skin types because it helps achieve a more lustrous and hydrated epidermis because it just exfoliates the surface of the skin. However, it just depends on what is causing your acne. In my situation, glycolic acid just helped enhance the penetration of the salicylic acid.

      I’m actually very surprised that none of your dermatologists recommended glycolic acid. But yeah, try it out, and use it with moderation. It can be quite stinging.

      Thanks for commenting!

      • Ah! This is what I had a question about! (I’ve been reading all the comments to make sure no one else brought up the traditional aversion to glycolic acid in dermatological treatment of acne…) I know this wasn’t a reply to me, but thank you for it anyhow! :)

        I’m not even vaguely surprised that a dermatologist wouldn’t recommend GA. You’d be amazed at how crooked or outdated most of them are. My mother had a skin cancer diagnosis a year ago and went to a dermatologist for the first time to get Mohs surgery, so after she was better, I went to him for my acne treatment. Not only did he act unprofessionally in the middle of surgery with my mom – that should’ve been a clue right there – he’s been inappropriate with me in-office, and none of the female nursing staff that’s been in the room with us has ever said a thing. :/ Ugh, it’s horrible, and that’s not even criticizing his lack of scrubbing up, lack of glove usage while touching active acne sites, and lack of general knowledge. /rant

        Anyhow, he actually put me on M.D. Forté’s Facial Cleanser II (15% GA) when I first saw him. I don’t know how the delivery system works in this line compared to the one you use, but oh my gosh, it hurt me so badly! The Cleanser II isn’t even marketed by the company for first-time GA users – he just told me to buy it because they didn’t carry Cleanser I in his office! I’d like to try GA products again, but after the extreme pain of the M.D. Forté experience – and the fact that, oddly enough, my skin type actually hasn’t reverted even after 8 months of discontinuation – I doubt I’ll try it again. :’[ Since the irritation and redness spread to my neck without usage in that area, I wonder if I might not have an allergy…

        Like everyone else, I just wanted to share my small experience and thank you for the wonderful post. c: I’m so glad you’ve found a regimen that works for you! Some people feel that lots of products can be stressful – and they can (especially if they don’t seem to even work particularly well, grumble) – but you can channel so much stress into your morning and nighttime routines, I’ve found! To me, a routine has been like a twice-daily anchor in my life and even helped my poor sleep schedule a bit. Because the treatment of skin issues needs to be holistic, it’s a wonderful thing, don’t you think?

        Your post reminded me of a quote that I remember (and I never remember quotes). It’s from a book from this doctor with a Christian-based treatment system – I don’t actually like him much, honestly, and I believe he has such wonderful titles as “What Would Jesus Eat?” (really). I remember him for his brief chapter on adrenal fatigue syndrome (academic props to him for actually weighing in on it) and this quote. He attended a lecture in medical school of a former dermatologist who later became a psychiatrist. He asked the lecturer why he made this change, especially so late in his career, and the lecturer said, “It became clear to me through years of practice that we are weeping through our skin.”

        I thought you might appreciate the quote – not sure why. :) I think a radical change in your skin – and willingness to share it, and willingness to help others – shows that you’ve overcome more than the pain of cystic acne. We don’t know each other, but I’m still really proud. <3

        Thanks again!

        • Wow, that rant was definitely necessary! It’s quite informative and scary… It’s really a dang shame that many derms and just doctors in general, especially those in private practice and aren’t as strongly regulated as doctors in a hospital, don’t keep their knowledge base up to date. But not even that, such conduct that you described would be appropriate for disciplinary action at a hospital.

          Now, you may just have very sensitive skin and/or that 15% glycolic acid is a very strong concentration for first-time users. Although the fact that it’s in a cleanser makes me wonder… but I’ll get to that in my next Temptalia post.

          And I love that you describe your routine as your anchor, your one source of order in this ever-doubtful world. And the treatment of acne, should be holistic! Aside from combination therapies, it should also involve aspects like nutrition, exercise, and stress management. I’d like to think that all problems should be addressed holistically. Even things like cancer, though I don’t want to offend anyone about that, so I won’t go there.

          The quote is quite intriguing as well and thanks for thinking of me! Haha. Although, I typically don’t enjoy quotes because I don’t believe that empty platitudes can inspire or trigger much change, at least not for me. There has to be experiences and ventures behind the meaning of such words, otherwise they are (once again) hollowly empty. But it is an elegant summarization.

          And thank you for the compliment! You wrote a reply that’s almost as long as my post and I definitely commend you for that. I’m so glad that I’m writing on Temptalia. It includes such a highly reasoned and consciously alert group of readers. I’m just happy to be a part of it all.

          Thanks for commenting!

  29. Frances

    Thank you so much for this post, John.

    I had flawless skin through high school but in college, BAM, cystic acne all down my cheeks. I had no idea how to handle it, and tried squeezing it(!!!) over and over to no avail. I used to wear so much makeup, which only exacerbated the problem. And I live in Asia so people feel at liberty to comment and offer all kinds of “advice”, arrrrgghhhh!! Parents refused to let me visit a derm (I live at home). Eventually it cleared up when I turned twenty and mercifully, I have no major scars but I’m still terribly self-conscious about my skin.

    I’m going to check out glycolic acids and sunscreen. Can’t get Paula’s Choice here, but I’ll look out for the specific ingredients. Wonderful post and thank you so much!

    • That is very insightful and I’m glad you’re taking away the fact that it’s not Paula’s Choice products that are great, but the ingredients that they contain! You are a clever one! xD And definitely look into sunscreen and glycolic acid, because they are wonderful!

      Thanks for commenting, and don’t squeeze!

  30. jessica

    john, i am suffering terrible acne. i had good skin for a while and it all went downhill. what are some of the products that you recommend i try first from PC’s line to combact my cystic acne? I have a very oily, sensitive, and acne prone skin. no matter how well i take care of my skin, i keep breaking out non-stop. I hope to hear from you soon!

    • Well, I would be happy to help you, but I don’t think I can with such limited information. If you really want me to give you a more accurate recommendation, I would like for you to go to my blog, and look up the Template for the “(Come Out) With your Skin Care Routine” series, where you submit a list of questions for you to answer including your current routine, so I can better assist you. Thanks and I hope I can help you!

  31. Avatar of Lily Lily

    Woah! I poste before asking for an “after” picture, I guess I was the only person who couldn’t see one! Your after picture was definitely cemented your status as skin care expert.

    • Lily I’m flattered that you think my current picture is great! But read above about what I say regarding how I shot and edited the picture. My skin isn’t actually that perfect, but looks like it is thanks to makeup among other things!

      And just because someone has good skin doesn’t mean the products they use are good. Companies want you to believe that, which is why they have those flawless models and actresses as their spokesmodels. It’s all about the information and research that a person or product can provide and be substantiated; basically peer-reviewed.

      Thanks again for commenting!

  32. grace

    Hi John
    My skin is too bad with acne, i only notice a few acne pimples when i eat junk. BUT my skin is VERY Oily…are there any drugstore products your reccomend?

  33. Avatar of Cat Cat

    Not much to say but I thought this was an excellent article and I especially liked how it was more scientific oriented when explaining the three magical ingredients. I also like that you included all the products, so people reading will have a lot of options to look into! Luckily, I feel my acne is finally in control… at least for now!

  34. Jeri

    wow ur skin looks great

  35. I have gotten my acne pretty much under control at this point (26) but I still loved reading this. I loved the scientific perspective and detail incorporated. I would love to have a dermatologist like you that really understands the skincare options and doesn’t throw another prescription my way!

    • Aw you are very sugar! Get it? Haha. I definitely hope to have patients as appreciative as you in the future. Thanks for writing!

  36. Avatar of Love Ann Love Dougherty

    Thank you for a thoughtful and insightful look into skincare and acne treatment. Your experiences and the detail with which you write about them are much appreciated. THANK YOU!

  37. Avatar of Liz Liz

    This was a fantastic read. I don’t have acne issues but my nephew does, I’ll be sure to pass this along to him. Thanks for the fantastic info!

    • No problems. Remember, if you aren’t too busy, try to corroborate the information that I provided with other repuatable sources so that you can make a MORE informated decision. I hope he find it useful! And if he’s too shy or whatever reason to ask questions or post on here, I know that you will do those things in his stead! Thanks for writing and for your compliment!

  38. Leenie

    You should try tea tree oil, its all natural and it works for all skin types use a little at night before bed it kills the bacteria that causes acne, its a great product for fighting acne and inexpensive, I swear by it.

    • While tea tree oil does have some documented and conflicting properties, it just doesn’t have quite the same volume of evidence touting its efficacy. It seems to be a less irritating version of benzoyl peroxide, so if it works for you, don’t stop using it. I personally will not switch over to it because one, I’m pretty satisfied with my routine, and two, I rarely break out now that I take care of my skin.

      But thanks for the input and thanks for commenting!

  39. Alexis

    I suffer cystic ance and I find this post very uplifting and inspiring. Thank you for posting.

  40. Sam

    Hi John!
    I am also extremely oily, and have had severe acne since the age of 4 (no lie, the fact that I’m native american is the only reasoning for this given to me by doctors) and cystic acne since the age of 9. I’m now a freshman in college. I was wondering, what do you use for oil control? I’m very sick of being an oil slick and prescription/OTC products not working!

    • Hi Sam, the only treatment than has been shown to control sebum is Accutane, so you may want to inquire about that. In addition, birth control/hormonal treatments may be appropriate for you as well.

      However, if you just want to manage your excess oil, especially under makeup, I would suggest the Smashbox Anti-Shine, or the OC Eight as primers. And make sure to use a more matte foundation like Estee Lauder Double Wear (though that maybe be too cakey), and make sure to set with a powder. You can also try clay masks every few days, just depending on how oily you feel because clays like bentonite are excellent at absorbing surface oils. I don’t like them personally because my skin always feels flaky and dry after applying them. Also, Phillip’s Milk of Magnesia can also be applied as a mask, or if you are very adept at blending, can be applied very thinly under your foundation as your primer.

      Let me know what you think! And thanks for commenting!

      • Sam

        Perfect! I know my derm has been thinking about putting me on oral medication specifically for acne, but since I have stomach issues he has been hesitant and has yet to get me off antibiotics that I’ve been regularly taking for a few years now. I do use milk of magnesia under my foundation, it does an okay job, but thank you so much for your other suggestions and good luck with school!

        • Wow you must be super oily! From personal experience, I’ve found Milk of Magnesia to be quite potent

          But yeah, try the OC Eight product. The Smashbox one actually uses Milk of Magnesia and combines it with other polymers, etc.. to make it more blendable, but it’s essentially the same thing.

          I hope things work out for you and thanks.

  41. Avatar of Valerie Valerie

    I’ve had cystic acne twice and now I’m left with scars, they look like dents, that make my face look skinnier than it was, what can I do?

    • I have some dent-like scars on the left side of my face and there’s nothing that you can really do about them, especially if they are severe. Vitamins A and C, and glycolic acid have definitely lessened their appearance for me, but nothing short of a massively strong chemical peel or peels (which you can’t do at home), laser surgery, or an actual operation can dramatically reduce the appearance of scars. Unfortunately, something as severe as that needs to be addressed by a dermatologist. Like you, I have some of those scars, and will definitely get some “surgery” in whatever form when I save enough money in the future.

      I’ll most certainly do a post about this on my blog in the future, just so everyone can understand this subject more clearly.

  42. Avatar of Kathryn Kat

    I appreciate the explanation of what is actually going on. Thanks for writing all that.

  43. I had acne as bad as you in my teens and twenties. I am Asian. Tried everything and every brand under the sun during those times from the drugstore, to name brands and prescriptions and tons of salon facials. I still get occasional bumps and it clears away with Retin A which I have handy. I found that moisture was essential even when I had acne and not to be harsh on the skin. Stay away from alcohol toners and related products. I then started using non-akalline soap also. Anything not to strip the skin of it natural sebum so that the body feels the need to produce more oil. Back in those days, there wasnt anything fancy as now. I still wish The Body Shop still made the Pineapple Wash (Vitamin C). I think the pineapple’s natural glycolic acid helped diminished my scars and was very gentle on the skin while gently exfoliating at the same time. Today, I have combination skin. Though it is still somewhat oily in the middle of the day, I dont do not add powder to conceal the oil. My skin is no longer greasy feeling like when I had acne. If I feel the need to apply more makeup, I rather clean the skin properly and redo the makeup because I also put reapply moisturizer. I am actually thankful today that I had acne during my youth because I do not have deep fine lines around my eyes, the scars from acne are gone, and that my skin is very soft to touch and no lines either. I do however do not skimp of my skincare products. My toner is still alchohol free from Mario Badescu whose has lots of products geared from acne/combination skin. I still use some non-descriptive non-akaline soap, but occasionally have other cleansers and gentle scrubs from Clarins and La Mer. I used eyecream even when I had acne. La Mer may feel thick and tacky on the skin, but my skin seems to accept it well without any breakouts. Paula’s Choice sounds like a wonderful brand…but that was not available back then. The bottom line is to be gentle on the acne skin, avoid alcohol toner like Clinique and akalline soap, and to use a light moisturizer even with acne. One day, as I was told years ago, you will be thankful that you had acne.

    • These are definitely some good points to remember. And I know that having acne, meaning having oily skin, will keep your skin more youthgful. But acne itself ages the skin because it’s forcing your skin stretch and distend… not to mention lots of scarring if it’s cystic.

      However, I am thankful for having acne because now I actually know what I want to do with my life. It’s like I’ve found my favorite past-time and can actually make a living out of it; plus it’s not a selfish occupation either. So that just makes me feel better all around as a person.

  44. Cecilia

    Hi :) this post gives me hope! Can you tell me what products you would recommend from PC’s for starting out? I don’t want to go overboard. I get cystic breakouts at least twice a month that seem to last forever and then scar. Also, deal with clogged pores and large pores and sensitive flaky skin that can also be oily. So pleasant. Thanks

    • Hey Cecilia,

      It’s difficult for me to recommend products based on such limited information. But it sounds like you have excess sebum as evidenced by your flaky skin and clogged pores. But your acne could be caused by anything! However, since your question is limited to what products to try from PC, instead of what can I do with my acne, I would simply recommend the 10% glycolic and 2% liquid BHA just to see how you respond. Start gently and incorporate them slowly into your routine.

      Please, please understand that I can only guess since I don’t have more information from you. If you want a more accurate recommendation, you should submit a request on my blog for me to review your routine. There’s a list of questions that I need answered as well. Here is the link:

      http://thetriplehelixliaison.wordpress.com/2011/10/16/come-out-with-your-skin-care-template/

      Thanks for commenting!

  45. Karima

    Excellent article! It is rare to find an article that talks on the one hand about the science behind all that stuff and that is on the other hand really interesting to read. I really appreciate that you gave an objective opinion and I’m really happy for you that your skin has changed so dramatically. I’m wondering what you think of microdermabrasion….I have a set from Lancome for “home use”. It contains a microdermabrasion “creme” and a vitamin-c based creme that you should use after exfoliating. Personally I think it really helped me to refine my skin and get rid of some acne scars (or at least it made them less noticeable) but I don’t know if it is “good” for my skin. Please continue writing articles on Temptalia! Thank you :)

    • You’re welcome Karima! Microdermabrasian kits at home are usually just forms of mechanical exfoliation like the Clarisonic. They can slightly reduce acne scars (well hyperpigmented ones, not physical ones), and the vitamin-C, depending on what form is present, can lighten them as well. I’m not familiar with the Lancome one, but if it’s working for you, why stop using it?

      Maybe I’ll do a post about the efficacy of home microdermabrasion kits… we’ll see. xD

      Thanks for commenting!

  46. Maria

    Awesome article! I love the breakdown of the 3 ingredients. I’m definitely going to share this with my sister who can really benefit from this information! Great job! :D

  47. Christine

    I really enjoyed this article. Very informative.Keep up the awesome work I am looking forward to more articles from you!

  48. Meredith

    John, your skin looks amazing! Bravo!

    Thank you for this thoughtful AND thorough article. Although I don’t have acne all over, I want to try a GA product in my T-zone and will check out Paula’s Choice because of you.

    Also, could you recommend a good body sugar/exfoliator? The ones I have tried in the past have been too harsh. Thanks again!

    -Meredith

    • Haha Meredith thank you! Remember, I only use PC because of the ingredents that she uses. I don’t like sugar scrubs because they get messy and exfoliation can be uneven. Plus it’s difficult to reach areas like your back, if you aren’t very flexible like me. xD If you look at my routine, I use the Salux body cloth. I think it works very well and gives me good, even exfoliation!

      Thanks for commenting.

  49. Such a thorough and inspiring post. I’m re-posting this link on my facebook page and looking to your next post about reversing the damage done over the years. Thank you for sharing with us!

    • Hey Cassandra! Thank you for doing that! You definitely don’t have to. Also I’m actually planning to make my next Temptalia post on the stages of acne and what ingredients address what stage(s). However, I can do the post that you’re talking about on my blog. Or it could be the Temptalia post after the acne stages one. We’ll see I guess. I just don’t want to keep you waiting. Let me know what you think.

      Thanks for commenting!

  50. Avatar of Sam Sam

    Awesome post John! I really enjoyed the way you blended facts with your personal experiences and opinions.

    I was planning my Life-Changers post around acne and teen skincare, but was worried the topic would be too repetitive. Now I see we bring different things to the table. :)

    Best of luck to you, and I can’t wait to read more!

    • Thanks Sam! Definitely write about teen skin care and acne! The more information available to the readers will only give them more options to pick and choose from so that they can create their own routines. Just letting know that for my next Temptalia post, I plan to write about the stages of acne and which ingredients address those stages and how they do that. I hope once again, that we’ll approach this universal problem from different perspectives. And you can always email through the group to contact me. Maybe we could combine posts, who knows.

      Thanks for commenting!

  51. Cassi Teague

    Thank you!!!!!!! Very helpful!!

  52. S

    Hey John,
    Your journey is very inspiring. I have suffered (and am still suffering!)from acne and rosacea. I’m definetly going to check out some of the products you recommended. :) At the moment, I am trying to use the most basic products (Cetaphil-like cleanser) and seeing what it will do for me.
    Looking forward to more articles!
    P.S.: I am actually a med student, although I would never specialize in dermatology (although the hjours and pay are pretty good). I’m leaning towards OB/Gyn or GP.

    • That sounds great S! I’m sure that you will do well. And it’s quite logical and practical to start simple and slowly build your way up so you know exactly what you’re dealing with and how your skin is responding to any given treatment/product.

      Thanks for commenting! I hope med school isn’t too hard. Haha.

  53. dallasbrowneyes

    Thank you for the informative article and WOW your skin looks great now! i have very sensitive acne-prone skin, and Paula’s Choice cleanser, toner, salicylic acid and moisturizers are pretty much the only products that have helped me.

    • That sounds fantastic! And remember… like I said above, I am wearing foundation in my current pictures. xD Makeup is amazing! Well derp right? I mean that’s how I found Temptalia in the first place. Haha.

      Thanks for writing!

  54. Avatar of Sam Samantha

    Thanks for your post, I’m 24, did a round of Accutane, and my acne’s been coming back over the past few months…glad to have some new stuff to look into.

    • Good luck and be very cautious. And don’t hesistate to ask me for more specific questions/directions. And since you are using a perscription, don’t hesistate to ask your doctor about this post or any other information. He/She should be there for you! xD

      Thanks for writing.

  55. happybadfish

    I love Paula’s Choice, saved my skin. I have super dry flaky skin that has been damaged from the sun and I seriously don’t know what I would have done without Paula’s Choice. I was constantly looking for products to work for my skin, every month buying something new to try. Now I know what works and I love my skin!

  56. Adelita

    Hi John,

    I have very oily yet dehydrated skin, with blackhead problem and actually an acne-prone skin gal which is now cleared completely (thanks to Paula’s Choice BHA 2% Liquid!)
    But…, despite my love for salicylic acid/BHA (I use it for almost 2 years), now it causes eczema my dehydrated skin! I change my Paula’s Choice BHA 2% Liquid with the lotion form, the 1% lotion formula, only put it on every other day, 2 times a week, once a week, but whenever I put it back it always had tihs eczema. What frustates me is I can’t live without my BHA because I’m afraid my acne will come back and my blackhead will go crazy. Do you have any suggestion what acid I can use beside my Paula’s Choice AHA 8% Solution (Glycolic Acid)? Because while it makes my skin smooth, it won’t do a thing to my blackhead & pimples.

    Thanks! ;)

    • Hey Adelita,

      I’m glad that you listen to your skin and stopped using the 2%. Now if the SA using causing you to become very dry and trigger bouts of eczema, I’d recommend you to not use it. It has cleared you before, and now that you are clear, don’t be afraid to let it go. I’d recommend you start incorporating retinol, not tretinoin since that would probably be too irritating, into your night-time routine. Retinol is fantastic because it helps normalize your skin’s natural ability to exfoliate by loosening the corneocytes from sticking together. In addition, it also makes your skin appear more youthful as well. I mean it’s a double-whammy! You can continue using glycolic acid with the retinol, just make sure not to use them at the same time since GA denatures and inactivates retinol. Not to mention that they operate optimally at vastly different pH levels.

      Thanks for commenting!

  57. Heather

    I have bad skin but I know it isn’t really cystic acne. I need to see a derm but I have no insurance. :( I feel like I’ve tried everything but I still get breakouts, and I end up with really bad dry flaky patches.

    BAH. I hate my skin.

    I’m glad you found something that works. :)

  58. dom

    thanks John for sharing your story! glad to see and hear that your skin’s getting better. i used to have cystic acne when i was younger and my dermatologist placed me on Ro-Accutance which helped tremendously. right now i’m back to having combination skin which, depending on the product i’m using or my environment, may turn oilier. paula’s choice is not a brand we get here in asia though – what other internationally-available brands would you suggest on using that may be similar to paula’s choice?

    • Hey dom!

      I wouldn’t recommend anything based on brand alone since I’m such an advocate of knowing what ingredients a product contains. I want you to try and love products based on their ingredients, not their “label.” Also, I’m not really sure what drugstore (instead of department store) products are available in Asia. Perhaps you can ask our local contributors for information regarding this topic.

      Oh, and I believe you can get PC products online since they do ship to Asia. I don’t know how expensive the shipping is, so I’m sorry I can’t help you there. :[

      Thanks for commenting, and I hope I haven’t disappointed you. Please let me know if I can be of any more help.

  59. Kokomo

    Good God! You are ridiculously wordy, my friend…but so glad to hear you are doing better these days! What an improvement. Your pictures speak volumes. No need to further express yourself in clinical articulation. Keep up your regimen! ;)

    • I know, I know. It’s not the first time I’ve heard that… But thanks anyways. And while I realize that my pictures convey meaning, without words there’d be no way to explain how I got from A to B. Lol, but I get what you mean. I’d just like to give the readers a picture that is wholly complete, but not unnecessarily so.

      Thanks for commenting.

  60. First off I have to throw a shout-out to your vocabulary because it is FANTASTIC!! Not a compliment you hear every day I’m sure, but it needed to be said! You have an excellent writing style! Second, you did an excellent job tackling your skincare issues and it definitely paid off hugely for you, the difference is night and day!

    • Haha really? I was afraid that I was being too articulate… I was worried that it would discourage readers to want to say anything. But I guess I was wrong. Jeez, everything you’re saying is a compliment, so all I can say is thanks (10x)! :]

  61. Carolyn

    Wow John, I really appreciate this. Your story sounds VERY similar to mine; I started on salicylic acid (and it irritated my skin so much), moved onto BP, downed to 2.5% BP but I found results there. I then went on to GA and that’s what really cleared it up all the way. I just wish this post had existed back when I began my search for a good routine lol.

    • Your story is quite similar to mine and I too wish that I had something like this way earlier. It’s one of the main reasons why I’m writing posts: to prevent others from going through what I had to with accurate information.

      Thanks for commenting!

  62. Anne

    BRAVO. Well-researched, well-written! John, I could kiss you.

  63. Crystal

    Hi,John,

    I am very impressed by your professionalism. I didn’t have serious acne problem like you did, but my T-zone is very oily and has problems like blackheads,whiteheads and comedos. Recently I become a fan of Paula’s Choice and hope that her product can help me with all that problems.
    I tried the 2%BHA liquid twice a day about 45 days ago and it really made part of my pores clearer and my skin smoother. At the same time my comedos come and go but go and come again!!!And it causes some more whiteheads (not too much, just a bit more) and my skin feels dehydrated. Just three days ago, I began to use the 5% Glycolic Acid product at night instead of 2%BHA which I still use in the morning. Now I feel better that my skin would not be as dry as before and 5% Glycolic Acid really helps to cure my whiteheads but not my comedos yet. My comedos still appear time after time.
    I read that you mentioned Benzoyl Peroxide in your article and recommend to use it together with BHA and AHA, but frankly speaking I don’t know what that ingredient is.(I am from China and English is not my mother launguage so it’s hard to understand the professional vocabulary) I don’t know whether that ingredient can really help to cure my comedos. If so, which paula’s product contains that ingredient? And how do I use it together with BHA and AHA? Or in my case, BHA and AHA is enough for my problem while I just use them both too short period to cause good effect.
    Sorry for my not really literate expression and hope that you can understand my meaning. Thank you so much in advance.

    Crystal from China

    • Thanks Crystal! And your English is great. I’m Chinese and I can speak it fluently, but I WISH I could read and write it. So you’re pretty phenomenal.

      Now 2% salicylic acid can be quite drying if you use it everyday, especially if you don’t moisturizer properly. I’ve certainly experienced that.

      I would recommend that you keep using the AHA in the nighttime and the BHA in the morning. From what I understand, you’ve only been using this combination for three days, so try it for a while longer. You should be seeing a more distinct improvement soon.

      Now benzoyl peroxide treats acne differently than HAs (Hydroxy Acids). While HAs work by loosening the corneoctyes, benzoyl peroxide works by generating ROS (reactive oxygen species) that kill P. Acnes (the type of bacterium present in acne), which of course is anaerobic. However, because benzoyl peroxide creates free radicals, it can be very irritating and drying, and with long-term use, will age the skin prematurely. So if you do want to use benzoyl peroxide, make sure you really need it.

      So yeah, keep using the AHA and BHA for a little longer before going to the benzoyl peroxide. If choose to do so, use the benzoyl peroxide at nighttime. Make sure to wear sunscreen during the day.

      I hope this helps, and good luck.

    • Oops I forgot to say which Paula’s Choice products contain benzoyl peroxide.

      The CLEAR Regular Strength Acne Fighting Treatment contains 2.5% BP.

      The CLEAR Extra Strength Acne Fighting Treatment contains 5.0% BP.

      You certainly don’t have to use PC products. Try looking for products that contain benzoyl peroxide that’s more readily available in China.

      • Crystal

        Hi, John,

        Thank you so much for your detailed explanation! Glad to know that you are Chinese too but I guess you must be born and grow up abroad and that’s why you can speak good Chinese but not good at reading and writing. No problem, it’s very easy to learn how to read and write Chinese when you can speak it fluently.

        Actually, Paula’s Choice has already entered China market and it’s very easy to purchase it through website. You know what, because of your professional article and your impressive four photos, you are now very famous within the PC fans in China. We all call you ”犀利哥” in Chinese which means something like “professional and smart guy” in English. ^_^ . One of the china PC product sales assistants who sent me your article keeps saying that the CURRENT you are very handsome. ^_^. See, you have big fans in your motherland. HA.HA.

        As you mentioned the BP can be very drying and will age the skin prematurely, I decided to keep using the BHA and AHA combination for a little longer time like you recommended and see how they work later.

        Really want to read your other articles but it’s so strange that I cannot open your blog. Could you please give me your blog’s link again? Or maybe our internet cannot reach your blog. Anyway, thank you very much again!

        Crystal

        • Hey again.

          I’m not sure if learning Chinese is so easy. I’ve gone to Chinese school before here in the States, and the language just baffles me! I have trouble, probably due to my laziness, when it comes to memorize each character. The fundamental building blocks for Chinese are vastly different from English, or Spanish (which I took in high school), and obviously any other Latin-based languages. So yeah… Chinese is hard. Haha.

          And I’m very flattered of your compliments. It’s wonderful to know that I have fans abroad. I hope I can help everyone out equally.

          The address for my blog is:

          thetriplehelixliaison.wordpress.com

          I can’t fathom why you can’t access it. Maybe try subscribing to my RSS feed? I’m not sure that will work since it’s rooted from the same website. I don’t personally use any RSS readers… so don’t hold that again me. :]

          Let me know if you have any more troubles, and good luck once again.

          • Crystal

            Dear John,

            Sorry, I tried many times but cannot reach that link :( , and I have no idea how to subscribe to your RSS feed. But anyway, Thank you so much for your kindness.

            Good luck to you too and hope to see your wonderful articles again soon. :)

            Crystal

            • That is so lame!! I’m going to contact WordPress and see why that is and what can be done about that. Seriously, that’s very lame! :[

              Since I don’t have your contact info, I will post on this post when I found it, if I ever do.

            • Hi Crystal, so I just found out that back in 2003, China initiated a control measure entitled as “The Great Firewall of China.” Basically, the Chinese government censores and blocks many types of sites (like blogs) that they deem inappropriate and might encite thoughts of individualism and free will, etc… Without going into the detail, there are many ways to bypass this “firewall.” However, most of them are quite complicated and requires intimiate technical knowledge.

              However, I found a way that is slightly less technical.

              Here’s is a link that is details relatively easy ways to get free access to “prohibited” sites.

              http://www.randomwire.com/how-to-bypass-the-great-firewall-of-china

              If you scroll down this page, you should see link for the “Tor” program. After you click it, should be quite simple to start. Here is the link for the actual Tor site that includes detailed FAQs and installation guide.

              https://www.torproject.org/about/overview.html.en

              I know that this probably more trouble than it’s worth (i.e. just to read my blog.) But I’m putting it out there for you and others just so you know that there are other options available for you.

              And Tor is completely legal and virtually untraceable so you won’t get in trouble.

              I hope that helped and let me know if that works for you.

            • crystal

              Hi, John,

              I do do appreciate your help,but you know what the most terrible problem is!!! I cannot even open the two links you recommended above. I guess our government blog those links too. :( Well, it’s not strange that happens, we cannot reach some famouse website like facebook either here in China. What a great pity!
              My email address is nancy_chunyi@hotmail.com and it’s my MSN Messenger account too. I don’t know whether you use MSN Messenger too, if you use it, it would be great that you can add me.
              Thank you so much for all your effort. And if possible, I hope we can chat through MSN.:)

              Crystal

  64. Avatar of Rosie Rosie

    I suffered from moderate acne and was on retinal for years until last year. I was going through a stressful time and began to get cystic acne (so painful). Then I realized I needed to change my skin routine. Now my skin routine is wash with Neutrogena blemish and wrinkle cleanser and apply 5% bp in the mornings and then apply Obagi 50 spf. At night I wash my face with Neutrogena acne cleanser (if I wore makeup then I wash with fresh foam cleanser by Neutrogena) then apply 5% bp and apply sulfur treatment to any blemishes I notice. If my skin is dry at night, I’ll apply glycerin and water mixed.

    • That sounds like a good routine, even if it is singularly focused in the sense that you’re treating your acne from one approach. But if it works for you, that’s fine. I’d just like to note that, because of how benzoyl peroxide works, long-term use can age your skin prematurely. The free radical production isn’t as high as something like hydrogen peroxide, but I still wouldn’t recommend using it unless you have to. I don’t anymore.

      I’d recommend considering switching to hydroxy acids and see if that handles your acne effectively. Also you can consider switching back to retinol or retinal, because other than treating your acne, it also has beneficial properties.

      Thanks for commenting!

  65. Melisse

    Thanks for this great article!

    Just want to know your thoughts on Renee Rouleau’s products and Skin Ceuticals (especially the C+AHA product)? According to RR’s website, I think my skintype is type 3.

    • Um it wouldn’t be practical for me to review her entire line. If you have a particular product in mind, you can ask me and I’ll put it on my request list to review!

      On the other hand, the Skinceuticals C+AHA product is quite easy to review since the ingredients list is relatively short. I won’t enumerate of why and how each individual ingredient is good because that would take forever.

      Basically, this is a fantastic product… to an extent. Yes, it allegedly contains 15% L-Ascorbic Acid and a 10% blend of glycolic and lactic acid. There’s also a dash of bioflavonoids, though it doesn’t state which ones specifically, and sodium hyaluronate which is a great humectant. Each of these ingredients have a plethora of research demonstrating their benefits.

      However, here’s the problem. One, the pH of this product is unknown, and all three acids require a pH of at least as low as 3.5 to function. So you can test this yourself with pH paper or if you have a more sophisticated equipment at your disposal, go for it. If the pH is indeed above 3.5, then this is definitely crap.

      Two, if this is in the appropriate pH range, the vehicular base, which is water, will ensure that this product oxidizes very, VERY quickly, especially the L-ascorbic acid. When L-ascorbic acid becomes doubly oxidized, it becomes pro-oxidant instead of antioxidant.

      Finally three, the packaging of this, which is a dropper bottle, will FURTHER ensure that this oxidizes even MORE quickly.

      With all that in mind, is this really worth $132/oz? In my opinion, no. If you insist that you need an expensive Skinceuticals product, I’d recommend the CE Ferulic serum, though that product isn’t without its own faults.

      I hope that helped and thanks for commenting!

  66. anupam

    hi John, wells that indeed enlightening.i have been suffering from cystic acne for the past 6/7 years and it worse after my daughter was born 4 years back.i am 35 and a half.and still struggling with acne.Living in India its tough to get hold of the products you have mentioned.i am desperate to find a cure but cannot go on accutane as i am planning my second baby.its the last resort my dermo has suggested.

    • Well this is certainly a dilemma. It sounds like you have hormonal acne and both traditional treatments would not be appropriate for you since you plan to have a second baby. Accutane and birth control pills are out.

      However, that doesn’t mean that you can’t ask your derm for other treatments like topical retinoids, oral and topical antibiotics like tetracycline and clindamycin-benzoyl peroxide.

      Also you don’t have to use these Paula Choice products. Just look for the three ingredients I mentioned in products more readily available in India.

      Let me know if I can be any help and (super) early congrats on your new baby! :] Thanks for commenting.

  67. Jessica Peng

    you’re skin looks amazing now! :) My cousin has quite bad cystic acne and she’s never found a cure for it. She’s 20 now and in Asia so I don’t know if it’s more environmental or whatnot…but I’ll definitely refer her here!

    • Thank you Jessica!

      And while this post can help others with acne, I think she should go see a dermatologist first. xD I can only help through words, while a dermatologist can help through sight, sense, and words. Usually. Also apparently my blog can’t be viewed by people from China, and I’m not sure if that applies to everyone in Asia as well… I’m looking into this problem, so sit tight.

      Thanks for commenting.

  68. Wow, great that you finally got it under control!
    My boyfriend is turning 30 and has severe acne too, but he has sort of given up hope of getting rid of it. I’m definitely going to check out the products you used!

    • Thank you! And yes, please help your boyfriend out. If he has anymore questions, I’m here to help. You can always post on his behalf if he doesn’t want to. Lol!

  69. Jess

    Christine, THANK YOU for featuring this comprehensive article on your website.
    John, this is probably the best article on acne I’ve ever read. In my 10 year battle with severe acne, I’ve tried just about everything, and recently went the prescription route. Anyway, i’ve bookmarked this page so I can always come back to advise that makes sense! Oh yeah–maybe I missed it, but what kind of vitamin c do you use? Topical or oral? Thanks so much–your skin looks amazing!

    • You are quite welcome! Thank you for your kind words.

      And although oral vitamin C has many significant benefits like reducing the risk of certain cancers, increases wound healing capabilities, only topical vitamin C can actually stimulate collagen. Keep in mind that not all topical vitamin C products are created equally.

      I hope that helps and thanks for commenting!

  70. oh my gosh! josh, first let me congratulate you on what i know has been a long journey on getting your acne under control. as someone who used to also need an extensive skin care regime to keep my breakouts under control, i certainly understand what you are going through! i would love to start a dialogue here though about the important role that diet plays in acne on two main levels – oil production and inflammation. understanding and controlling these factors through your diet means your skin will be healthy by itself without the need for elaborate skin care products. it’s a system i know works because i’ve lived and breathed it for over a decade. please check me out for more information – everyone should think about exploring this before heading to a derm. the answer lies within you! :)