September 2007
Dear Paula,
I am a 26-year-old female in graduate school. I lead a very stressful life and I have aged substantially over the last three years. I still have breakouts, usually due to stress and hormones. I have these consistent small bumps in my skin so it looks rough. My pores are so huge that I can see them in a mirror standing three feet away. I also have a lot of blackheads on my chin and nose. I am starting to develop cysts around the jaw line that don’t go away. Some cysts have been around for more than a year. There is discoloration in my skin some redness around the cheeks mostly. I have tried everything: benzoyl peroxide, salicylic acid, glycolic acid, skin-care lines like Murad, Shiseido, DDF, and more. Nothing seems to work. My skin is very temperamental. I have an oily T-zone, but it dries out fast due to some harsh products that I might use or the weather. When it gets dry I’ll break out and the skin will be flaky. I don’t know what to do. I was hoping you could recommend a skin-care regimen for my face, neck, and back (as I have major breakouts there too). Please help!

Katy, via email

Dear Katy,
Whenever someone tells me they use everything, my initial reaction is to always want more specifics. Were they well-formulated products, did they contain irritants, did you also use moisturizers that were too emollient for your skin, or was the cleanser too irritating or the ingredients too harsh and on and on. Lacking more details, if you have indeed used “everything” and they were appropriately formulated (which seems truly unlikely, but anything is possible), then your next step would be to see a very good dermatologist to help evaluate what is happening to your skin. In some ways it sounds in part like rosacea and in part like a type of cystic acne or some other systemic skin condition. None of that can be treated with skin-care products alone. Until you get the right medication and understand what makes your skin happy, there isn’t much else to do.

In the meantime, there are a few steps you must always follow. Do wash your face with an extremely gentle cleanser, use a clean washcloth at night with the cleanser to be sure you are getting all your makeup off, and wear a sunscreen during the day. A foundation with sunscreen that only uses the actives titanium dioxide and/or zinc oxide would be best because they pose no risk of irritation or sensitizing the skin.