Q:

I never had issues with acne in high school. At 22 I've suddenly developed tons of small cysts on my face. Any advice or solutions?

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Answers (13)

EXPERT
Daniela Ferri (Licensed Esthetician, Acne Specialist) answered
When people in their mid 20s start to experience an acne problem they didn't have in high school, there are normally three explanations.  One, the start of new skin care routines in anticipation of "getting older" involving many clogging moisturizers and makeup.  Two, introduction of birth control in college or later, for actual birth control purposes or hormonal problems associated with conditions such as PMDD or PCOS.  Three, new stress from starting out on a career, which is a different type of stress than even occurs in college. 

I'm guessing that these cysts are along the sides of the chin and mouth going up to the outer jawline?  Acne on the sides of the chin up to around the nostrils is mostly caused by increases in oil production from hormonal changes due to either menstrual cycle, conflict stress, or both.  The pores around those areas are slightly smaller than the rest of the face due to facial contours, but the oil glands are a little bigger.  When a skin care routine at home causes dehydration or clogging, the skin can't get rid of the excess oil and blackheads develop that turn into blemishes.  Some blemishes involve more stuck-in oil than bacteria, which irritates the lining of the pore and creates inflammation.  This is what we call an "undergrounder".  The pore gets sensitive and therefore gets more easily irritated if oil gets stuck there again.  This is why they happen in the same place every month.

There are several solutions to this, including balanced cleansing and toning, non-clogging moisturizers and makeup, weekly clay masks, chemical exfoliation including fruit enzymes and/or fruit acids instead of irritating scrubs, and acne remedies tailored to your skin's condition.

If you'd like a personal analysis, I do skin care consultations by email, with full evaluation and sample packet.  Please visit my web site at www.daniela.com or email me at skin911@daniela.com. Adult Acne is my special area of expertise, it's all I do. :)
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lauragunn commented
Take evening primrose 1300 mg every day. It helped balance my hormones and no longer have those deep facial cysts that last for months. I have been taking it every day for about 4 years...
Brawnskeen commented
This was very helpful as I am suffering from the same jawline acne in the same place (along the jawline). It's so annoying.
EXPERT
Princess Carey ("Coach P."), RHN (Registered Nutritionist & Health Coach) answered
I am sorry you are dealing with this. I use to struggle with cystic acne. It seemed nothing worked, not even the prescribed medication. I begin to live a semi-vegetarian life style and saw a huge positive change in my skin. Did you know that vitamin/mineral deficiencies can also cause acne?
Eat foods with Zinc. Zinc controls oil glands. Nuts, seeds, carrots, poultry are all great sources of zinc.
Vitamin A is necessary because it prevent over active sebum production. 
Spinach, liver, pumpkins and apricots are great sources of vitamin A. 
Your B vitamins and  vitamin C works as antioxidants. They flush out bacteria and help with the reproduction of new skin cells. Great sources for B vitamins are poultry, peas, beans and green leafy veggies. 
Great sources of vitamin C are pineapples, oranges, sweet potatoes, mangos and red peppers. 

Avoid sugar, caffeine, saturated and trans-fats.
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EXPERT
Dr. Sophia Yen (Adolescent Medicine board certified, pediatrician) answered
It could be adult acne. It could be something else. Go see a dermatologist or at least your general doctor.
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EXPERT
Princess Carey ("Coach P."), RHN (Registered Nutritionist & Health Coach) answered

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Emilie R. answered
I've started getting breakouts a lot more recently than before, I am also 22. I just recently was referred to a skin-care line for sufferers of adult acne. The brand is called Dermalogica and the line targeted specifically for Acne-prone skin for adults is called Medibac. I use the Clearing skin wash usually 2x every day (morning and night), and at night after I wash my face I use the overnight clearing gel. The combination of the two on my VERY sensitive skin works like a charm. My skin is very sensitive and I have literally tried EVERY drugstore face wash/pimple cream that you could think of and then some. I've wasted so much money on that garbage you can find in retail department stores it's a joke anymore. I shop for my beauty products at Ulta, and I was referred to the brand Dermalogica by not just one but the majority of the employees who work there. I figured I'd give it a try, and asked the cashier if I could return the product if I wasn't achieving the results I wanted. And she said yes, so I saved my receipt just in case. Sure enough about a month later my skin is clearer than it's been in years. I was told by multiple sources including skin care experts, that acne around your chin area and underneath your nose is usually caused by hormones. Dermalogica products aren't that cheap, but a little bit does go a VERY long way! I wouldn't even be taking the time out to write this review if I didn't swear by this brand. I would definitely recommend it to anyone with sensitive and/or acne-prone skin. They carry a kit with trial size bottles of the clearing skin wash, sebum clearing masque, clearing mattifier, overnight clearing gel, and concealing spot treatment. It's $42 for the kit but honestly after trying all the items in the kit I've found that the clearing wash and the overnight clearing gel work the best, the other products in the kit didn't seem to do anything for my skin. I also bought another item separately from the kit, called Special Clearing booster, and whenever I see a pimple appearing, which since I've been using the Dermalogica line is VERY seldom, I apply this over the area where the pimple is and I notice a HUGE difference the very next day. The good part about the clearing booster is you can wear it under makeup and it won't clog up your pores or cause you to break out more. Which is definitely a plus since I wear make up every day. I hope this helped you out some! Good luck to you! :)
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EXPERT
Daniela Ferri commented
Emilie, that's fantastic ! :) Almost all Ulta stores have salons now, many have Estheticians doing facials and waxing, and Dermalogica is the brand they use in the facials. I would encourage anyone shopping at Ulta to ask if they have an Esthetician on staff, and if they do, consult with them, since it's the Esthetician that will have the most training in the way Dermalogica products work, and of course, in the way the skin works. For those who don't have Utla stores in their area, or a skin care salon that understands acne issues in adults, this is why I came up with my Eval by Email service. It's like getting a virtual facial. lol By the way, if it seems the rest of the kit doesn't really do that much for you, it's possible those items are too weak at this time. But if you're clearing, it may not matter. :D
Teresa W. answered
Sounds like the hormone-caused acne I'm dealing with now. I'm on Depo-Provera to manage my migraines (it has none of the cardiac or neurological implications of other BC, which is important for me), but the progesterone-only BC has thrown my hormones and skin out of whack. 

My doc suggested a natural estrogen supplement and/or adding more soy to my diet, and I use the oil cleansing method for my suddenly-very dry-and-soap-sensitive skin. I replace soap with a daily coconut and olive oil scrub with fine salt and a touch of castor oil to pull out impurities. When I keep up with the hormones properly, eat as little fast food as possible, and clean my skin with the oil, my acne is at a minimum. I'm still getting it under control and other factors are still irritating my skin. 
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EXPERT
Daniela Ferri commented
I would be careful of the coconut oil - it's getting a lot of positive attention these days, but it is a proven pore clogger. Castor Oil is not pore clogging at all, Olive Oil is very slightly. My suggestion is that you make your oil cleansing blend with mostly Castor Oil, replace the coconut oil with Jojoba oil, and then add a touch of olive oil. Make sure you do not rub too much with your wash cloth, and add the salt only two or three days a week - it can really be quite scratchy and can eventually lead to Milia, which are those little pearl-like bumps underneath the skin that don't come out unless they're punctured. As for the irritation you're still experiencing, this could be aggravated by the salt. By the way, a big reason why this is working for you is that softened skin doesn't get backed up with its own oils quite as much, and backed up oil is very often what causes the irritation inside pores that lead to blemishes. :)
Teresa W. commented
Daniela, the problem with the castor oil is that it's really drying in large amounts and really difficult to spread, and jojoba is really expensive. But what I'm trying right now seems to be working pretty well: the Josie Maran argan oil kit. I've been using it for just a bit over a week now, and I've added just a tiny bit of tea tree oil into the mix for any infection, and with a mild, non-drying topical antibiotic and an estrogen supplement (my Depo-Provera seems to be a factor, so I have to supplement and balance the hormone), my skin is doing fairly well. I suppose I'll see how it goes over the next few weeks. Now I'm just going to have to find something else for the rest of my skin - Josie Maran didn't have a body wash, and I don't know if I could afford it.
EXPERT
Daniela Ferri commented
Very true about castor oil, which is why it's great when mixed, and I totally understand about the expense of Jojoba oil. The question in my mind always is, what is the acne sufferer trying to achieve with oil? If it's to combat dryness, an oily skin is not missing oil, therefore dryness would have to be coming from lack of water in the skin. This would either be due to water loss, or lack of water being attracted and held to the skin from outside. If it's for cleansing, the issue would be what might get left behind. In order to make sure nothing is left behind, methods to fully remove the oil might be harsh. If this method works well for you over a six month period, that's fantastic. There is a likelihood that your mix of hormones are making you sensitive, which is something I've noticed in many, but sounds like a necessary component of your overall health care. This means what has to be addressed is a dehydrated skin whose integrity has been compromised making it sensitive. Your skin has basically become broken or prone to become broken. Cleansing has to be gentle without too much scrubbing, water temperature for washing or showering must be kept warm or room temperature, and moisturizers must have ingredients that attract and bind water to the skin. I'm with you on the body wash problem - all of them out there seem to be either too harsh, or have harsh detergent hidden by emollients that create a film on the skin to fool the consumer into thinking their skin has been dealt with gently when it very much hasn't, and the softness ends up coming from this film that eventually actually prevents water from coming in when it's meant to prevent water from being lost. Yuck. I'm looking, though ! When I find something I'll let everyone know! :) I will look into the Josie Maran kit - I like her stuff. It's working well for you, so I'm intrigued ! :) Let me know how it goes in the next few months.
Teresa W. commented
My doctor and I aren't really sure what changed with my skin to suddenly make it so sensitive, so we're just trying to adapt something that works, so I'm going with things that are as gentle and as natural as possible. I have seen a difference with my skin since switching to the Josie Maran stuff on my face, and I'm using straight EVOO on my body right now, with the occasional non-soap body wash. It's working pretty well at getting a lot of crud off my skin - including the latex paint I'm using in the remodeling we're doing! I'm saving up some money to buy oils and a shea butter from Mountain Rose Herbs (they're all organic and you can buy in large quantities) to try mixing a cleansing cream with some of the good cleansing oils I've seen online in my research and some of the ingredients from Josie Maran's kit. I've got avocado, macadamia, neem, and soybean oils on my list, which I plan to put a bit of castor into as well. I'm going to mix small batches to see what combo I like best, and I figure I can use exfoliating gloves or a pouf when I need a bit of scrubbing. I'm still seeing some of the hard little bumps on my face, but I see what you mean about the coconut oil being a problem. My skin flares up a little every now and then, but not as badly as it did before recently. I'll keep this updated as to how my skin's doing with the experiments.
Teresa W. commented
By the way, the Josie Maran kit ROCKS with blackheads!
pinlynne33 answered
I had the same issue about six years ago. I linked to dairy products, especially those that the cows are given hormones or something else. I avoid them now and I don't get the cyst acne. When I slip up and eat something with dairy in it, I see the consequences pretty fast! I use coconut, almond, or rice milk now. All of those products do have calcium so your not skipping out on that part of nutrition. How it gets better. :)
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EXPERT
Daniela Ferri commented
Indeed, many have found that cutting out dairy does a lot to clear the skin. My theory, however, is that it's not the hormones in the milk, but the iodine. For this reason, I not only advise my clients to cut out dairy in the case of cystic acne, but also iodized salt, kelp, calves liver and asparagus. However, in those that don't have cystic acne, this doesn't seem to make as much of a difference. So excited you're clearing ! :)
lucym answered
Acne seriously is one of the worst things to experience in high school. I'm in college now, and it's finally clearing up, but high school was a nightmare. I just found this awesome article about having acne in high school, and I'm referring all of my younger friends to it. I wish I read this in high school, it'll help! http://theclearskinproject.com/acne-article/high-school-and-acne/
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bsapp91 answered

I had such bad acne in high school. I never paid attention to what I ate but instead relied on medication to clear my skin. it would usually clear my skin up for a few weeks, then my skin would break out again. Once I changed my diet to more organic and clean my skin started to clear up on its own. no medication. Now my "bad days" are if I break out with maybe a pimple or two! Im still dealing with the scars, but changing my diet has helped more than anything else.
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Alissa M. answered
I am 20 years old and have struggled with acne for as long as I can remember. I get extremely frustrated as I have wasted so much money on so many different products from the drug store and every time they have left my skin irritated, red, and dry as if it is just too harsh on my skin. I am now even on a gluten and dairy free diet. Just yesterday, I went to Ulta and was given my first facial. My Esthetician was very helpful and encouraged me to try Dermalogica's MediBac Clearing Kit. This is my second day using it and I have already noticed that my skin is less irritated and calmer. My number one dream and goal this year is to acquire clear skin, I have suffered too long. What I can't understand is the fact that my skin always retains clogged pores. I have sat in front of the mirror for over 30 minutes just trying to open them. Therefore, although Dermalogica is pricy, I figured I should at least give it a try as I would probably end up using the same money on products that claim to work. I am exhausted with this struggle and just want it to end! I enjoy reading everyone's thoughts on this same subject as I would love to just avoid BC pills and heal this as naturally as possible. 
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Leizel R. answered
I'm 27 and experienced adult acne for 2 years. It was seemingly random, but I tried all sorts of supplements to help my skin. Went on birth control, tried different teas, herbs, improved my diet, did facial masks/enzymes, saw a holistic practitioner... Without any improvement UNTIL I STARTED CUTTING DAIRY out of my diet. 

I found out that there's tons of hormones in milk products and congest your digestive system, which can cause cystic acne. Whenever I slip and have cheese, or spinach dip or anything with dairy, I break out 1-2 days after. I still take supplements and take good care of my skin, but also stay away from dairy when I can help myself.
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grneyedgirl321 answered
Since I was 14 years old, I have had issues with acne, oily skin and the like.  It wasn't a lot of acne but mostly the kind where you would get large knots, two or three of them on your face, usually one in the cheek area, one on my chin, maybe an occasional one on my forehead and sometimes one on the side of my nose near my nostril.  Not all of these at the same time but one or two.  They would be so painful and I dreaded feeling them coming on.  I saw dermatologists, took antibiotic treatments, tried all the over the counter acne treatments and to no avail.  This off and on acne went on for years, through puberty, my teenage years, when I was pregnant and into my adulthood up until 2 years ago. Now at 52 years of age, I'm am completely free of acne. I do not normally endorse any products, but I tell anyone that I can, that will listen to at least try ProActive Plus, once. This system is simply amazing and my friends have been in disbelief at the difference it has made in my skin.  I WISH this was around when I was growing up.  I wouldn't have the scars that I do now.  I do not work for ProActive or any of it's subsidiaries, I don't sell it.  I simply use it and recommend anyone that has problems with acne to try it at least once.  Keep in mind that you have to use it everyday, twice a day to begin and you need to give it at least a month to a month and a half. Now that my skin is clear and free of acne, I only have to use it once a day and that's at night before bed. I am a super busy person (single mom, full-time college student getting a Bachelor's of Nursing, and I work) but I have learned to incorporate this into my daily routine and I am so thankful to have found it.  If you think it is expensive, here's the deal. It is a little expensive starting out, around $50.00 initially but once you get on the program, it only costs me $18.00 a month for 6 months of the year, so basically $9.00 a month. I will give up my specialty coffee drinks, I will give up vacation every year...I will even give up new clothes and shoes but I won't give up my ProActive Plus.  It works that good for me. 
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grneyedgirl321 answered
I wanted to add... it's been proven that almost all acne is bacterial. I have hormone imbalances even now but because the acne is bacterial, the Proactive works and the hormone imbalances don't affect it one way or another. We all walk around all day with germs on our face and skin from touching things then touching our face and body, and we get germs on our face and skin from pollutants in the air all around us. The only way to keep those germs from causing harm to our skin is to wash our bodies and face with substances that will kill the bacteria.  My substance of choice is ProActive and my face loves me for it!
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EXPERT
Daniela Ferri commented
Actually, bacteria only become involved as long as air runs out of the pore and they have a chance to thrive, since they are anaerobic, meaning they are killed by oxygen. The reason ProActiv works for many people such as yourself is that Benzoyl Peroxide not only kills bacteria, but also cuts oil and exfoliates the pore from the inside out, "flushing" the pore out. This means it will keep acne at bay even when bacteria is not involved. The bacteria involved in acne lives deep inside the pore, not outside of it. Other bacteria on the surface of the skin can get involved in more serious acne cases, but it's not usual. The idea that acne is caused by not cleaning the face enough and killing all bacteria is an old myth. It is absolutely not true. What has been proven is that all acne starts out with a condition known as Retention Hyperkeratosis. Oil mixes with dead skin cells that, for a still unknown reason, are more sticky than they are in people who are not acne prone. I repeat - the only time bacteria become involved is when the impactions that form from Retention Hyperkeratosis, and in many cases swelling from the inflammation this can cause, blocks the pore to the extent that oxygen runs out of the pore. It's this air-free, warm environment that causes bacteria to thrive and creates infection. Benzoyl Peroxide is one of the best medications for stopping the process of Retention Hyperkeratosis.