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Cystic Complexion Crisis

By Amalah

Hi there Amalah!

Love your blogs, love your advice at the Smackdown, which is why I’m writing. Back in November, I got some zits on my right temple. No big deal, really, but they were the nasty bright red and sort of oozy grossness kind. About five of them, in a Cluster of Ew. So, I figured, what the heck. My parents have money, and they love me a lot, and they were asking what I wanted for Christmas. I requested the Philosophy gift set you listed in the Holiday Gift Guide. I opened it December 25 and began using it that very night. I started with once a day–previously that had been enough to maintain the status quo for my face since I very rarely wear make-up. Then I started using Purity twice a day about a week later.

Fast-forward a month, and… my face has freaked the hell out. Yes, I am among that lucky 10% of the female population for whom, apparently, these products do not work AT ALL. I’ve even had to add a benzoyl peroxide topical acne treatment–first time since my teens–just to keep the pimples under pseudo-control, which really just means stop many more from appearing since the ones I have had SINCE THANKSGIVING are still there. I woke up this morning and I had two new lovelies on my chin, where I haven’t broken out since my mid-twenties (I’m thirty-two, if that means anything). That isn’t even counting the fact that my facial lines are more obvious since I started using Hope in a Tube. No, really. My exceptionally unobservant husband squinted at me this morning and asked, “Did you always have those lines from your nose to your mouth? And that one on your forehead?” Not till the past two weeks, buddy.

So. Aside from donating the face wash, and line cream, and serum, to my best friend with the naturally clear and lovely skin, which is next on my agenda, what the heck is wrong with my skin? I can’t afford to drop a bunch of money testing products on my face with four kids and one-and-a-half incomes, so I’d like to know: is there a common factor among those of us for whom Philosophy just is not effective at all? And is there one thing that does work for us? At this point I’m ready to go back to Neutrogena but if you tell me there actually is something that will eliminate the Final Five constantly being reborn on my right temple, I might be willing to try it.
Thanks in advance!



It sounds like your skin is going through a transition — some fundamental change in body chemistry or hormonal shift. It could be age related or a reaction to stress or even something in your diet. Maybe salicylic acid is your nemesis. It can be really, really difficult to pinpoint the reason your skin “freaks out” and starts behaving like it did in high school again, and unfortunately, no, there is no “universal” reason Philosophy doesn’t work for some people and no guaranteed Option B I can recommend. Your skin sounds STRESSED OUT and a bit wild-cardish, so I’m not really inclined to start rattling off expensive alternate brands right off the bat.

In fact, I’m going the “get thee to a dermatologist” route, because of the Final Five. They sound possibly like cystic acne — the toughest and most persistent form of acne out there. If they are cystic (red, pus-filled, painful), a slap from the drugstore and Sephora are not likely to do very much, and too much messing around with them yourself can lead to scarring. Tell your doctor you’ve had the same five nodules since November and OTC products are making things worse. A dermatologist might recommend cortisone injections or prescription-strength treatments. (If you get Retin-A for your zits, go ahead and use it on those fine lines in place of a wrinkle cream.)

If your doctor doesn’t give you a specific regimen besides the shots or a topical treatment, head over to and start reading all the articles under “Get Clear.” I like the regimen this site lays out because it’s possible to implement it fairly cheaply, using inexpensive products so it’s not quite the blow to the wallet like when a four-piece kit from Philosophy or Murad or Dr. Perricone doesn’t work for you. It’s also much gentler to 30-something skin than something like Proactiv.

You’ve already got the Benzoyl Peroxide treatment — recommends a 2.5% formulation — so now you just need a gentle face wash and a moisturizer. If Neutrogena served you well in the past, Neutrogena it is. Think of the Final Five as a separate freak occurrence — your former skin care routine probably didn’t cause them. A hormonal imbalance or some other underlying problem probably did. Were the holidays a particularly stressful time for you last year? Did you notice any change in your cycle? Change something in your diet? Eating a lot of candy or processed foods with partially hydrogenated oils or high-fructose corn syrup? These are all things that I’ve been able to nail down as causes for skin-related freak-outs in the past.

So. Dermatologist to check out the Five. 2.5% benzoyl peroxide (or other dr-recommended treatment), gentle (non-acne-specific) face wash, moisturizer. Don’t pick or squeeze or touch. And next year: Ask for cash.

Photo by gagilas

About the Author

Amy Corbett Storch


Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Ama...

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Amalah. Also, it’s pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to [email protected].

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.

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  • Anya

    March 22, 2010 at 11:55 am

    I love love love Stridex Power Pads for a very gentle, 2.5% benzoyl peroxide application. No irritating ingredients like alcohol or witch hazel, very easy to use. Super gentle cleanser built in, gentle enough that you can use them after a regular face wash but decent enough to use on their own too, if you don’t need to remove much makeup or sunscreen. Also nice because unlike many other face wipes that claim to not need rinsing, with this one thats actually true–I never feel like I need to rinse after. They can be a little hard to find in the stores but I know Amazon sells them with free shipping!

  • Amy

    March 22, 2010 at 12:02 pm

    Try putting some Lotrimin on the zits (yes, the stuff for athlete’s foot). They may be fungal, and not truly acne (even though they look exactly like zits), especially considering that they’re so localized and so persistent.
    I wouldn’t put it all over your face – only in the affected area.
    Oh yeah, get the cream, not the spray.
    I’m liking Biore’s skin care stuff, and it’s reasonably priced. I’m in my early 30s too, and my skin went all wonky a couple years ago for no obvious reason. The moisturizer is light and doesn’t feel greasy.

  • kenandbelly

    March 22, 2010 at 12:12 pm

    FWIW, if only one area of her face is having a persistent issue, it might also be worth it to think about whether there is some sort of trigger object that started coming into contact with that area. A phone? A hand when you sleep? A headset? A snuzzle from her kitty? If there is something, whatever it is, sanitizing it needs to become part of her regimen.

  • heels

    March 22, 2010 at 12:33 pm

    Though a dermatologist visit is still a good idea, they may actually be a form of the herpes zoster virus. If you had chicken pox, you have the virus in your body forever; it’s what causes shingles. I normally have very clear skin, but I started getting what seemed like pimples at my temples and on my chin and they would NOT go away, no matter what I did. I finally went to a doctor who told me that they were zoster outbreaks because I was so stressed, and that I needed to start relaxing, drinking more water, and applying abreva to the afflicted areas. It worked like nothing else, and they haven’t come back. Another suggestion that didn’t work as well for me, but may work for you, is to try vitamin c cream. It helped a bit, at first, but the abreva was what knocked it out. Zit creams only made it worse.

  • Sian

    March 22, 2010 at 12:33 pm

    I have so much in common with the questioner that for the first part I actually wondered whether I had written the letter myself and blacked it out. Suddenly cystic acne, Philosophy for Christmas, never wears makeup, that’s me to a tee!
    In the end, the only thing that helped was medication. In my life I’ve tried every department store, drugstore, over the counter, and prescription topical medication and none of it did a thing. So with heavy heart I started taking the Minocin (minocycline) that my doctor prescribed. It’s an antibiotic and I was worried about the long term health effects, but my face was so painful I couldn’t touch it.
    It didn’t take long to see a significant improvement and after a few months the cystic acne had cleared up completely. My doctor took me off it about a year later and despite my fears I didn’t break out again. Now a prescription topical cream deals with any stubborn visitors and I’ve gone back to my regular skin care routine.

  • Laura

    March 22, 2010 at 12:36 pm

    Um, Philosophy has NEVER worked for me either! I’m not convinced it’s as great as all the hype because I break out EVERY SINGLE TIME I TRY IT! Go to a dermatologist and get him/her to perscribe you a treatment regime. Your skin will thank you and you’ll be happy! 🙂

  • kate

    March 22, 2010 at 12:50 pm

    I agree that a dermatologist – or maybe even someone in alternative medicine – might be your best bet. Acne on your face is caused by so much more than just what’s on the surface or slighly below. For instance, the acne that pops up on your chin and around the bottom of your mouth? Often caused by issues related to digestion. I’m definitely not an expert here, but have found so much help by looking at my whole self – and not just the places which on the surface appear to need the most help. Good luck!

  • J.S.

    March 22, 2010 at 1:33 pm

    Oh, wow! Thank you *so* much for answering my question, Amy. (And commenters.) This opens a lot of avenues to try that wouldn’t have occurred to me. You are probably right about the cystic acne, and yes, the holidays were exceptionally stressful this year what with adding another child to the mix and my family descending upon the house en masse, so I’m sure you’re right about that having been a major factor. Please don’t feel responsible; I know these products work wonders for almost everybody and my BFF has already fallen totally in love with them, so all is well. 🙂

  • Annabelle

    March 22, 2010 at 2:02 pm

    My goodness, J.S., how did you get in my head? I am having remarkably similar problems. Had similarly Horrible (yes, with a capital “h”) reaction to Philosophy products. My face hasn’t looked this bad in, well, ever. I even contemplated writing in to this column, it was getting so bad. So, thanks!
    My current strategy (only 3 days in, so we’ll see) is to completely back off the harsh products and scrubbing and see if my skin calms down at all. Who knows whether it will work…I can say that it’s not WORSE in the 3 days since I started, and that’s saying something, since it was getting worse day by day by day…

  • Jess

    March 22, 2010 at 2:12 pm

    I’ve been a loyal ProActiv user for almost 10 years and it is the only thing I’ve really loved and has been able to get my skin to the point where people started complimenting me on it. My problem with it? I don’t want to spend all that money and I wanted something that would be quicker to remove makeup at night as well. Also…I started having wicked breakouts on my chest and back….
    At the same time my fiance went to the dermatologist and brought back small sample sizes of Dove Beauty Bar and I started using that…..LOVE IT. Works well in the shower for chest and back and has been the only non proactiv thing to not make my face FUHREAK OUT (I tried Philosophy as well after reading this blog and HATED. HATED. HATED IT. ). I would say try something really mild like Cetaphil or Dove Beauty Bar and try to get your skin back to normal before trying something fancier…and a trip to the derm never hurts.
    For what it’s worth I also use CVS brand 2.5% benzoyl peroxide after…

  • Crabby Apple Seed

    March 22, 2010 at 2:35 pm

    My skin tends to react this way to really anything that is supposed to help clear things up. The more I ramp things up, the worst it gets. Scaling waaay back (as in, only cetaphil face wash and clinique or neutrogena moisturizer and absolutely NOTHING ELSE) worked miracles.

  • shayna

    March 22, 2010 at 2:47 pm

    Get thee to the dermatologist before you use ANYTHING else topical on your skin. I had nodular cystic acne for years (and probably will again, someday, sigh). If that’s the problem you’re having, no amount of topical agents – and certainly not drying OTC ointments – will be of much use. I often found that even prescription agents simply “preserved” my sores, as you described, rather than clearing them up, and it was not at all unusual to get cysts that took several (painful) days to appear and literally MONTHS to subside.
    For a lot of people, myself included, cystic acne has a substantial hormonal component, even if the problem arises in adulthood. Birth control pills or other hormonal contraceptives are fairly benign options for most people, and can make a dent in your pimple population, which might be worth a shot as well.

  • eva

    March 22, 2010 at 11:38 pm

    Great column! I also have horrid acne at age almost-34 and Philosophy, while I gave it a good try, really did nothing except exacerbate the problem. I went to Clinique’s 3 step Acne line and have seen some improvement since starting a couple months ago, and am going to try Murad’s line next – one great Amalah recommendation has been to take advantage of the trial packs! I do plan to hit the dermatologist more seriously after I’ve had this baby (September!) and finished breastfeeding (probably September 2011, sigh). When I saw her last month she basically said nothing but prescription drugs will clear it up, but encouraged me to try whatever seemed to be doing the best job of keeping the zits at bay.
    Anything else you can publish to remind us that adults get acne, bad acne, too and we are not alone, would be great. It is such a difficult topic because everyone I know has long since outgrown their acne and has, if not perfect skin, at least generally smooth and consistent skin by their mid-30s.

  • Stephanie

    March 23, 2010 at 9:20 am

    Just a thought…could a hair product be exacerbating the problem? I know that when I use hairspray (which is a rare occurrence) I sometimes break out near my hairline.
    But definitely see a dermatologist.

  • Erin

    March 23, 2010 at 9:42 am

    A friend of mine had something similar to this and her doctor put her on an antibiotic that cleared her right up.
    I’ve also found that once the pimples open up, Neosporin (cream, not ointment) will help them heal faster.
    My skin went nuts on me when I went off the pill, and I’ve found the Boots No. 7 line to be AMAZING. My skin is clearing up, and the oily combination products have halved the amount of grease on my nose while still moisturizing the dry flaky areas (also on my nose. Sigh.) I used Neutrogena for years, but it just wasn’t cutting it with the change in hormones. The No. 7 line costs about the same as Neutrogena, and controls the oil a lot better for me (which has helped clear up the acne).

  • maggie

    March 23, 2010 at 12:32 pm

    I’ve been using the regimen for a while now (on and off) and it has done wonders for my skin. Glad to see you recommend it Amy. Not only is my skin clearer but it feels smoother as well. I use Purpose gentle face wash and Neutrogena on the spot treatment for the benzoyl peroxide and Neutrogena oil-free moisture. I thought my skin would dry out, but it is actually more moisturized than ever.
    FYI, I am mid-30’s, never had a problem with acne until recently when I got a huge bindi-type zit that left a scar. UGH.

  • MM

    March 23, 2010 at 12:57 pm

    I am not a dermatologist, but…a very similar ‘Final Five’ on my left temple happened to me right after I got married eight years ago. They were very red, pussy and Just. Would. Not. Go. Away. Since I have very fair skin, when I went to my dermatologist that summer I had him check it out. Basal Cell Carcinoma. One appointment and a Mohs tiny scar later, all was (and still is) clear. Knock wood. That was at age 30. So go, go, go to a dermatologist NOW!

  • Kim

    March 23, 2010 at 2:50 pm

    I have had similar issues in the past and agree with other comments. I scaled back to using only Cetaphil face wash and Aveeno moisturizer. Still not perfect, but much better. I have a tendency to over use the acne killing products which causes more damage with drying my skin out anyway.

  • Mel

    March 23, 2010 at 3:29 pm

    I’m going to stick up for Philosophy here, since I’ve tried oodles of harsher products, thinking that harsher HAD to be better for fighting zits. And the hard stuff worked when I was a teenager, but my skin got worse. All through my 20s I was dealing with this crap. I started using Philosophy around the time I turned 30 and I haven’t had nearly as many breakouts.
    I don’t think I will ever have great skin, but a nightly wash with Philosophy and moisturizer have actually helped a lot.

  • Kate

    March 23, 2010 at 10:44 pm

    Hi-I just wanted to chime in with my experience because I had never heard of it before it happened to me. I have really fair skin and never had many pimples at all. In my mid-twenties I started breaking out with what I now know was cystic acne. Anything I tried to put on my skin made it worse with dryness, redness, and allergic reactions to boot. (I continued to use my Differin cream at night..the lowest dose in a cream form.) I went to my dermatologist who tried all the antibiotics which did nothing. Even cortisone injections wouldn’t shrink the pimples and they would remain there for months. Finally, my doctor recommended switching my birth control and trying a prescription of spironolactone which works to control hormone-triggered breakouts. I was already on birth control pills, but my doctor switched me to Yaz, which I know a lot of people don’t like but I haven’t had any problems, which also has a low dose of something that acts like the spironolactone. After about one month of this treatment I stopped getting any new pimples and my old ones started to heal. I continued this treatment for a year and stopped the spironolactone and continue to take the Yaz. I have been clear ever since. Sorry for the book here, but I know that I struggled with this for a long time and it was really frustrating. I hope you find a good solution and good luck, J.S.

  • Emily

    March 24, 2010 at 9:41 am

    Go to immediately and take their product recommendation quiz. They will send you free samples (in my case, they sent enough to clear up my skin entirely and I had time to order products before they ran out).
    They have this stuff called ‘buffering lotion’ and every time I see the signs of a cystic pimple popping up I put a dab on at night for two nights in a row and that sucker is gone!