"This might actually be the healthiest client I've ever treated."
That's what I thought after speaking with a young woman who was doing everything she could to figure out why her skin was breaking out.
She was eating well, researching elimination diets, investigating inflammation, and even looking into how emotional trauma might affect her skin health.
She had experienced some teenage acne through high school and college, but at 22, her skin had taken a turn. Over the previous year, she developed severe acne that just wasn't improving.
She was trying to figure out what was wrong with her body.
After listening to her medical history, discussing her skincare habits, and asking quite a few questions, I finally told her:
"There's nothing wrong with you. You just have acne. And I can help you with that."
Today, she's acne-free, and we've moved on to treating her acne scars.
Here's how we got there.
Can You Be Healthy and Still Have Severe Acne?
Absolutely. And this is something I wish more people understood.
Acne vulgaris is one of the most common skin conditions, affecting teenagers, young adults, and adult women well beyond their teenage years.
You can eat a balanced diet, exercise regularly, manage your emotional stress, and have excellent skincare habits while still struggling with persistent acne.
According to the American Academy of Dermatology's acne guidelines, acne treatment needs to address several biological processes.
Acne develops through a combination of:
- Excess oil production from the sebaceous glands
- Dead skin cells accumulating inside hair follicles
- Acne-causing bacteria, particularly Cutibacterium acnes
- Inflammation within the skin
- Hormonal changes that influence oil gland activity
When excess oil and dead skin cells become trapped inside hair follicles, clogged pores form. These can eventually develop into inflammatory acne breakouts, including painful nodules and cystic acne.
Hormones can influence this process, but having acne doesn't automatically mean you have hormonal imbalances or an underlying medical condition.
This is an important distinction, especially for adult women who have spent years searching for answers.
Is Your Acne Caused by Hormones, Diet, or Stress?
When someone develops adult acne, hormones are often the first thing they suspect.
Hormonal fluctuations during puberty, pregnancy, and the menstrual cycle can stimulate oil glands and contribute to acne flare-ups.
Some women notice new breakouts around their menstrual cycle, while others experience acne regardless of where their hormone levels are.
Certain medical conditions, such as polycystic ovary syndrome, can contribute to hormonal acne. When symptoms suggest an underlying issue, evaluation by a healthcare provider is appropriate.
Diet is another area that gets a tremendous amount of attention.
The American Academy of Dermatology's research on diet and acne suggests that high-glycemic foods and certain dairy products, particularly cow's milk, may worsen acne in some individuals.
However, eating greasy foods doesn't automatically cause acne, and restrictive diets aren't necessary for everyone.
Lifestyle changes can support overall health, but there's no universal acne diet.
The same goes for stress. Emotional stress may aggravate existing acne, and the emotional distress caused by severe breakouts can significantly affect mental health.
I always want to understand the whole person when developing a treatment plan.
But I also want clients to know they don't have to spend years searching for something wrong with their bodies before they can start addressing their skin.
Her Skincare Routine Before Coming to Skin+
When this client first contacted me, she was already using quite a few different products.
Her skin care routine included:
- Clearstem Hydrating Barrier Cleanser, Hydroglow Moisturizer, and You Are Sunshine Sunscreen
- Siv Biome Balancing Serum
- The Ordinary Niacinamide 10% + Zinc 1%
- The Ordinary Azelaic Acid Suspension 10%
- Bioderma Micellar Water
- Occasional raw Manuka honey face masks
She was investing in her skin and using products with some beneficial active ingredients.
For example, azelaic acid can help with acne breakouts, inflammation, and dark spots left behind after blemishes heal.
But here's something I explain to clients all the time.
Using good skincare products doesn't necessarily mean you're using the right products for your acne type.
You can purchase popular acne products, combine multiple over-the-counter products, and still struggle with stubborn acne.
The ingredients, formulation, frequency of use, and how those products work together all matter.
I explain this further in my article on choosing the right exfoliating acids for acne.
My first step is evaluating the severity of acne, identifying the different forms of acne present, and developing a customized plan.
What I Saw During Her First Skin+ Appointment
Her first appointment was March 30.
She had significant inflammatory acne across her cheeks, but what concerned me just as much was the amount of non-inflamed congestion underneath the surface.
I could both see and feel numerous clogged follicles.
Some of these were already developing into inflamed lesions, and I anticipated additional breakouts might appear as treatment progressed.
This combination of severe inflammatory acne and deeper congestion influenced every decision I made about her treatment.
I needed to address the active inflammation while working on the congestion contributing to new breakouts.
I also wanted to support her skin barrier throughout the process to minimize unnecessary skin irritation.
The Skin+ Treatment Plan: Why I Chose These Products
I started her on a customized home-care routine using Skin+ products.
Her morning routine included BP Active Wash, CytoClear, NourishRX, and sunscreen.
In the evening, she used BP Active Wash, CytoClear, HylaVera, and Acne Gel.
Each product had a purpose.
Benzoyl Peroxide for Inflammatory Acne
I incorporated benzoyl peroxide because of the significant inflammatory component of her acne.
Benzoyl peroxide helps reduce acne-causing bacteria and is one of the most established topical acne treatments.
Our Skin+ Acne Gel is designed to target acne-prone areas, while BP Active Wash provided an additional cleansing treatment for her initial inflammatory breakouts.
CytoClear for Congestion and Exfoliation
Our CytoClear Mandelic Acid 3-in-1 Serum contains mandelic acid, azelaic acid, and lactic acid.
I selected this combination to address congestion, dead skin cells, and uneven skin tone.
Mandelic acid is particularly useful in many acne-prone routines because it provides exfoliation that can be adjusted to the client's tolerance.
Hydration and Skin Barrier Support
I incorporated NourishRX and HylaVera to maintain hydration and support her skin barrier while using acne treatments.
This is especially important when working with ingredients that can cause dryness or irritation.
In fact, these are the types of products I discuss in my blog, 3 Must-Have Products for Inflamed Acne That Won't Quit.
Different acne types need different combinations of active ingredients, and I don't start every client on everything at once.
Professional Chemical Peels and LED Therapy
Along with her home care, we began progressive chemical peels and extractions every two weeks.
I adjust peel strength and treatment techniques based on how the skin responds.
She also purchased the Omnilux Clear LED mask, which uses blue and red light. I directed her to use it daily as part of her individual treatment program.
LED therapy was an additional component of her plan, not a replacement for targeted acne treatments.
The First Two Weeks: When Her Acne Got Worse Before Improving
At her second appointment on April 13, we saw the kind of mixed response I had been watching for.
Some areas were already showing reduced inflammation, while others, particularly her cheeks, had more inflamed breakouts.
People often refer to this as skin purging.
However, new breakouts during treatment aren't always true purging. Sometimes they represent existing acne becoming visible, natural acne fluctuations, or skin irritation.
I had anticipated additional inflammatory lesions because of the significant underlying congestion.
And I had prepared her for that possibility.
What impressed me most was her attitude.
She didn't panic, start adding random spot treatments, or abandon her skin care routine.
She trusted the process and communicated with me.
Of course, worsening acne should always be evaluated rather than automatically considered a sign that treatment is working.
By April 24, Her Skin Was Already Calming Down
At her April 24 appointment, we were seeing a noticeable reduction in inflammation.
This was an exciting point in her acne-clearing journey.
We continued with her customized topical treatments, progressive peels, and extractions.
And she continued following her home-care instructions consistently.
By May, almost all of her inflamed pimples were gone.
That's when I decided it was time to adjust her routine.
We discontinued BP Active Wash and transitioned her to our gentler Pro B5 Wash.
I also introduced Skin+ Daily A, our retinoid treatment, to continue addressing congestion and support skin turnover.
Retinoids help normalize how skin cells shed inside follicles, reducing the formation of new clogged pores.
The goal was to maintain her progress while continuing to improve her skin.
If you're wondering how long professional acne treatment typically takes, I explain the different stages of clearing in How Long Does Acne Treatment Take? The Real Answer.
What About Prescription Acne Treatments?
There are many effective acne treatments available, and the right treatment depends on the individual.
The American Academy of Dermatology's clinical guidelines recommend evidence-based treatment options including benzoyl peroxide, topical retinoids, and certain prescription topical antibiotics.
Other treatment options include azelaic acid, salicylic acid, and hormonal medications.
For moderate-to-severe acne, a board-certified dermatologist may recommend oral antibiotics or other prescription medications.
For some adult women, combined oral contraceptives, commonly called birth control pills, or other hormonal medications may be appropriate.
In severe cases, particularly when acne causes permanent scarring or significant emotional distress, isotretinoin may be recommended.
These oral medications and topical medications have different benefits, risks, and potential side effects. Treatment decisions should be made with an appropriately qualified healthcare provider.
At Skin+, my focus is developing individualized acne treatment programs using targeted home care and professional treatments, while recognizing when medical evaluation or prescription treatment is appropriate.
Her Skin Today: Acne-Free and Ready for Scar Treatments
Today, this client is acne-free.
We've now moved into the next phase of her skin journey: addressing the acne scars left behind by years of breakouts.
She's already completed her first microneedling treatment.
Microneedling creates controlled micro-injuries that stimulate collagen remodeling and can help improve certain types of depressed acne scars and uneven skin texture.
I explain the treatment in more detail in Microneedling for Acne Scars: The Next Step After Clear Skin.
Other scar treatment options may include laser therapy or chemical reconstruction techniques, depending on the type of scarring.
For example, TCA CROSS for Acne Scars may be an option for certain deep, narrow scars.
At Skin+, I want significant inflammatory acne controlled before beginning scar revision.
We can then focus on improving skin texture and the appearance of residual scarring while continuing to manage acne.
What I Want You to Know if You're Struggling With Acne
One of the reasons I wanted to share this client's story is because I see so many people blaming themselves for their skin.
They've tried lifestyle changes, eliminated foods, purchased countless OTC products, and followed every skincare tip they've seen online.
And they're exhausted.
If this sounds familiar, here are a few things I want you to remember.
Your acne is not a reflection of how healthy you are.
More products don't necessarily mean better results.
Your skin type, acne type, and treatment history matter.
And consistency is an important part of achieving clearer skin.
I also want people to understand that acne isn't necessarily cured; it's managed. Even after the skin clears, maintaining an appropriate routine helps reduce the likelihood of recurring breakouts.
Whether you're dealing with teenage acne, hormonal acne, or persistent adult acne, getting the right treatment plan early can help reduce inflammation and the risk of scarring.
Healthy skin is a long-term investment, and sometimes you need professional guidance to figure out what actually works for your skin.
This particular client has been one of my favorites to work with because she trusted me, followed her program, and stayed consistent.
Seeing her progress from severe acne to clear skin is exactly why I love what I do.
If you're struggling with stubborn acne and don't know where to start, I'd love to help.
Visit Skin+ to learn more about our customized acne programs and book your first appointment.
Individual results vary. This client's experience reflects her specific skin condition and treatment program. Professional evaluation is recommended for severe, painful, scarring, or treatment-resistant acne.
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