Why I Built a Less-Is-More Routine After Dabbling With Prescription-Strength Skin Care

My skin hasn’t given me any real trouble since it was ransacked by puberty, Polycystic Ovarian Syndrome, and the hormonal acne that came with it. At age 16, I found Biologique Recherche P50 ($106), and by using it religiously for nearly ten years, I’ve come to have an amicable relationship with my complexion. Then, 2020 happened. With the onset of COVID-19, my skin began mirroring the trash fire happening out there in the world. It became overly sebaceous, irritated, and resistant to any of my usual treatments.

Given that my basic knowledge of active ingredients is pretty robust (at 18, I began interning at Into The Gloss, and I have been in the beauty world since then) I can peruse beauty aisles without needing much direction. However, the mountainous pimples, cysts, and small whiteheads that were now dotting my face called for a dermatologist’s expertise. The doc gave me some pretty standard advice: stop touching your face, avoid unnecessarily fragrant products, and do patch tests (i.e. rub a small amount of product on a small area before using it all over). Then, they prescribed me a new regimen that included three Rx solutions.

I would take doxycycline twice a day. “Tetracyclines, including doxycycline, have shown to improve acne, often more quickly than topical agents, due to their antimicrobial and anti-inflammatory effects,” says Rachel Nazarian, MD, FAAD. The hope with starting doxycycline is that, “even with a short course some patients will show quick improvement,” she says. I’d also use clindamycin, which is a topical antibiotic cream, and I’d top it all off with a prescription-strength retinoid. This was meant to help subdue my breakouts as well as diminish the dark spots or scars from past pimples, and improve the overall complexion of my skin.

I started the routine at the beginning of September and by mid-October my skin looked better, giving me some peace of mind. 2020 is a turbulent and difficult time, and yes, my skin is a relatively superficial issue; however, it also seems like one very minuscule aspect of my life that I shouldn’t have to worry about while everything else disintegrates into detritus. But given that my body is a cage that gives me no reprieve, and I tend to be a poster child for the “common side effects” of prescriptions, I was prepared for some of the minor occurrences like skin sensitivity and occasional headaches that could purportedly result from the three-part regimen.

I did start to get some headaches, but I chalked it up to my antidepressants and moved on; however, by the end of October the headaches escalated into skull-thumping migraines. I spent one especially gruesome evening crying in bed while Bob Fosse’s The Little Prince played in the background. After freaking out sufficiently (and chugging Gatorade for some reason?), I made appointments with every specialist I could think of, starting at the optometrist, who quickly confirmed that something was up: My optical nerves were swollen. She suspected I had something called a “pseudotumor cerebri”—a condition that causes increased pressure on the brain—and referred me to an ophthalmologist and neurologist who quickly agreed that was my diagnosis.

Obviously, I was terrified because no one wants to hear the word “tumor” in a diagnosis, but it’s actually less horrifying than it initially sounded. “Pseudotumor cerebri is caused by a build-up of cerebrospinal fluid—which is just fluid inside our brain that cushions everything—in the spinal column and skull which puts pressure on the back of the eye and increases the overall pressure inside the skull,” says Lauren Rineer, OD, New York City-based optometrist. This pressure was causing migraines, and some of the other side effects I’d experienced.

After I stopped crying into my mask, my doctor and I began going through my extensive list of prescribed medications, and when I got to doxycycline he stopped me: “Ah, there it is. You need to stop taking that immediately.” The not-so-fun side effects I experienced, as a result of taking doxycycline, are so rare that they’re usually found deep in the fine print, but according to Dr. Nazarian and medical studies, my experience is not unheard of or impossible. I stopped the prescription and I felt the literal tension in my head decrease and the migraines begin to subside.

I decided to (at least temporarily) lay off any prescription skin care and my skin reacted by returning to being a piece of shit, but I have taken things back into my own hands. Now, my main focus has been on repairing and gently treating my skin. I am continuing to see a dermatologist, and I ask him to sign off on products before introducing them into my routine. Case in point: He told me to avoid salicylic and glycolic acid, while my skin barrier heals, since these help to slough away dead skin cells and I am looking to build a stronger barrier.

“Many times, our first instinct is to attack a skin ‘issue’ like acne or hyperpigmentation really enthusiastically with lots of exfoliating and stripping ingredients,” say Claudia Teng and Olamide Olowe, the founders of Topicals. “Most times though, your best course of action is to instead focus on nurturing your skin, which will better help to manage the inflammation and root cause.”

So for the first time in ten years, I have decided to stop using P50, or any tone, because my skin has been so irritated for so long that I am heeding the advice and being gentle to it. Now in the mornings, I use Topicals Faded Serum ($36) which has been doing the heavy lifting of replacing the retinoid. The brand only has two products, and I assume it’s because of the care and thought put into each one. Faded was created with skin of color in mind, and I credit its quick-working powers to this fact. It’s also been extremely gentle on my skin and caused none of the irritation I experienced with the Rx retinoid.

I follow this up with a gentle moisturizer: My current go-to is Mario Badescu Hyaluronic Dew Cream ($26) and First Aid Beauty Intense Hydration Cream ($34) every other day to help with any dryness. Once a week I wash my face with a benzoyl peroxide wash if my skin feels oily or congested, otherwise, I use this HoliFrog Tashmoo Water Lily Nourishing Milky Wash ($38) so it feels coddled and soothed. Then I rub Milk’s Melatonin Overnight Serum ($36) all over my face and pass out.

The skin on my chin still feels a little clogged, the dark spots have not completely faded away just yet, and I still get little whiteheads dotting my face. But these things are improving. “Over-the-counter ingredients may absolutely be sufficient for many people with acne,” Dr. Nazarian says. “It’s just best to speak to a board-certified dermatologist to ensure that you are choosing the right ingredients for your acne and skin type, and monitoring any potential irritation or side effects which are possible even with over-the-counters.” It may take more time than a prescribed routine and my skin is by no means “fixed” but for now I’d rather navigate OTC products than subject myself to the endless list of “may experience” side effects.

BTW: Dermatologists are sharing how COVID-19 related lifestyle changes have impacted skin here

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