Acne isn’t just a teenage plague!

Acne breakouts, especially deep, cystic pimples, can drive you crazy.  It's not only how it looks, large cystic pimples hurt, and they can scar.

Acne, in your late 20s, 30s, and 40s, is often the result of stress and changing hormones. Even one large pimple, in the wrong place at the wrong time, can be a big problem for days!

Hormones and stress

Hormones can shift oil production into overdrive and cause breakouts, even if your skin seems dry.  Oil becomes trapped in the pores with P-bacteria, resulting in pimples, both regular and cystic.

If your breakouts appear regularly and are serious, see a dermatologist or even your gynecologist.

Regulating your hormones can help. If the pill, or other medications, has failed you in the past, seek medical recommendations from trusted friends. These days there is a good solution for everyone. Find a doctor you are comfortable talking to and who listens. Do not put up with bad acne. Get the right doctor!

Hormone therapy is only one approach to clearing acne.

Retin A and Accutane

Doctors use Vitamin A for treatment. Retin-A is a vitamin topical and Accutane is an oral drug; both are used to treat acne. Both work very well and have many benefits, but they can be drying and have side effects. If you have heard about bad side effects, go to a well-recommended dermatologist, or other specialist, to discuss your options. These drugs are not an option if you are pregnant, trying to get pregnant, or nursing.

Acne photo-light therapy

Clearlight is a photo-light therapy that kills P-acne bacteria.  It requires several weeks of 25-minute treatments, but it is non-invasive and can be very effective.

For isolated breakouts you can try light therapy at home. Home devices use blue light and heat to help clear acne.

They are not as effective as Clearlight but they can work well on isolated pimples. We found them much more effective than heat devices, such as Zeno, which made some pimples worse.

DolceDolce has tried several home acne treatment devices. We found the Tanda Power Zap and Klima’s Magic Wand to be the most effective of those we tried. You can find both online.


Peels can help reduce acne breakouts by keeping pores open.  Peels are often used in tandem with medication to treat ongoing breakouts.  Peels can also improve the look of past scarring, help to reduce hyperpigmentation, and soften fine lines.

Anything beyond a light cosmetic peel should be applied in a doctor’s office. Deep peels can cause scarring and other serious complications needing medical supervision by a skilled doctor.

Cystic pimples – the magic cure

 A tiny injection of cortisone from a skilled injector can make a cystic pimple disappear overnight.  It is even possible to get these “monster-eruptions” injected before they fully bloom, when you first feel them begin to tingle or throb. Getting a large cyst injected is not just an exercise in vanity, although it does avoid a big mess that can last days or weeks. These are the pimples that can scar and pit. Injecting then properly avoids that problem, but find a skilled injector or the injection can leave a scar.

Injections of cortisone or Kenalog, as it is also called, saved my skin and sanity for years until Dr. Kevin Sliwowicz of The Toronto Acne Clinic finally cleared up my skin with Clearlight. Until Clearlight, a variety of treatments kept my skin clear, except for the occasional painful and potentially-scarring cystic pimple.


Antibiotics and Lasers

All types of acne can be difficult to treat, and there isn’t really a cure. If you are lucky, it does taper off.

Your treatment can stop working if your hormones or stress levels change, which is why you need a doctor who is dedicated to helping you keep your skin clear.

Not all dermatologists are interested in acne, so be sure to find a doctor who is, and who knows a lot about it. Acne is challenging and can be depressing if your dermatologist is judgmental, disinterested, or ill-informed. A bad doctor can push you over the edge when you are upset or frustrated about your skin. 

The best acne doctors offer many different options and they warn you that acne is tricky.

Tips to help shrink a big pimple when you can’t get an injection:  

Apply ice, not heat. You are dealing with a deep inflammation and you want to cool it down; hot compresses eventually burn delicate skin.

Rub the area with a small amount of over-the-counter cortisone cream.

Leave your face alone.  A cyst it will not break, so don't squeeze it. If it is driving you nuts, apply more ice.

Call a derm who injects.