The Power of Prescription Skin Care
Once called an 'advertiser's wet dream', I am hopelessly susceptible to marketing hype. Tell me a story, throw some B.S. percentages and clinical sounding pseudo-science jargon (peptides! amino acids! etc.) and you got me HOOK LINE and SINKER. I FALL FOR IT ALL!!! Growing up in a rural area where the closest mall was an hour and a half away, 80 - 95% of clothing and Christmas shopping was done through catalogs. Hours would be spent pouring over item descriptions and images; choosing, ranking and pining over not only the objects themselves, but the experience those objects promised. When you can’t try something on, you have to imagine what it looks and feels like; and with that comes a narrative, a story of what life will be like having or wearing that object: “Everyone will like me!” “I’ll be so relaxed and cool!” were common sentiments leafing through L.L. Bean and Land’s End. Perhaps unsurprisingly with such brands this was never ever even a near possibility, but believe me there were more things going against me than just clothes.
I refuse to believe any normal person did NOT have a f*$king awful time in middle school, so don’t think I’m asking for any sympathy. I am simply trying to establish that it was inevitable that I would be a prime target for marketing, particularly marketing that promises an experience or result that makes one feel prettier, cooler or more confident. (In other words, the core marketing strategy of 99.999% of all beauty and skin products).
I am, however, aware enough that marketing is... marketing. From angering instances like the 'pink tax' to humdrum benign exaggeration of product abilities (e.g. I had a recent experience looking at the different types of Sensodyne toothpaste and discovered ‘MultiAction’ & ‘Daily Protection’ have the exact same ingredients!) product descriptions can be (and often are) exaggerations or just plain inaccurate. La Mer is my favorite example of this, and something I try to think of whenever I read glowing testimonials of something (ahem, looking at you Glossier)* and then look at the ingredients.
So, while I do think that there are OTC products that accomplish a LOT for people, I am definitely biased towards prescription treatments. Prescription medication is not free from marketing and hype either -- I recently stayed at a hotel right next to a big convention center that was having a medical conference and I have never seen so much square footage of advertisement in my life. EVERYTHING had an ad on it: door handles, escalator stairs, toilet paper dispensers. There were also creepy posters like "Stop by booth 905 for free coffee on Mycyclodril, the number one treatment for IBS!" which introduced the hard reality of my doctor prescribing me a treatment in the promise of free beverages like a starved undergraduate during welcome week. Call it pro-American ideological bias, but I will begrudgingly give the FDA and co. enough credit that they are there for a reason and 'prescription strength’ means what it does for a reason.
Enter the two products that changed my life: spironolactone and Epiduo. I’ve struggled with acne to various extents throughout my life (from about 13 onwards) and if an OTC product for acne exists, I've tried it. I did Proactive, Cetaphil, Neutrogena, Clearasil, Stridex, Avene. Murad, Sunday Riley -- basically any random product with some derivative of Salicylic Acid and/or Benzoyl Peroxide has took a turn on my skin. Things were not that bad (just the normal surface level stuff) but around my third year of graduate school cystic acne hit me HARD. Painful, impossible, scarring cystic acne. So I went to my GP and she prescribed a run-of-the-mill 0.05% retinoid cream (I think it was called Tretinoin?) and spironolactone pills. The retinoid was to increase skin cell turnover and the spironolactone to regulate my hormones to prevent cysts from forming.** It took some time to kick in and stung, but the retinoid was a true game changer. It was no-nonsense sharp metal tube that introduced me to the powers of chemical exfoliation and I will forever be grateful. The spironolactone took even longer to really notice, which makes sense in that its entire purpose is to prevent something noticeable like cystic acne. I did start to get (noticeably) less flare-ups.
Things went along well for about a year and a half on the GP prescribed treatments. I still would get the occasional zit but no demon cystic bumps. I also would get bothered by blackheads and pick at my face (I know! I know! You shouldn't do this! Ever!) but it was okay. Then came summer 2016. I had recently reduced my spironolactone treatment to one pill a day (per doctor recommendation just to see if I could wean off)*** and had decided to try the Sunday Riley Luna oil. I don't know what happened -- I think it was a stressful period maybe? -- but I got the WORST cystic acne attack EVER. HUGE HUGE HUGE angry bumps on either side of my chin and even one near my nose. I was so depressed and frustrated and made an appointment with my home town dermatologist. **cascading harp scale**
I realize why dermatology is a thing, and why it really makes a difference to go to one over your GP. My GP was on the right track, but my dermatologist refined and elevated that path. He put me back on two pills a day and upgraded my retinoid to Epiduo, an adapalene and benzoyl combination gel. LIFE WAS NEVER THE SAME. It took some time (those cysts were really really bad) but Epiduo saved my skin. I've used it religiously every night ever since, and have not had any cystic issues. My skin is so good I am not even really tempted to pick at my face, because the blackheads have shrunk and are not as noticeable. I visited my dermatologist again this summer and he suggested I vamp up to Epiduo Forte, which has a stronger percentage of adapalene and my face is even more snatched. It's awesome.
Some of the downsides: depending on your insurance, seeing a dermatologist or getting these prescriptions can be cost prohibitive. HOWEVER, my insurance doesn't cover Epiduo Forte so I pay out of pocket $80. I regularly lay down $20 - $30 on OTC creams and have in the past paid over $100 for skin care (**cough** Sunday Riley **cough**) so $80 for a cream that I know works is not a deal breaker.
Another downside is the sensitivity these high powered retinoids introduce. There will be redness (more on that below) and you have to be SUPER careful about the sun. I wear 50+ sunscreen every day (even if I'm inside!) and become a little frantic (bordering on paranoid) about getting burned. You have to be careful about what other products you are using too -- I try to stick to cleansers that don't have soap or other irritating ingredients (some personal favorites for evening are Hylamide's High-Efficiency Face Cleaner or Glossier's 'Milky Jelly' cleanser and Niod's Sanskrit Saponins in the morning) and can find a lot of products (such as Glossier's priming moisturizer or Biore's Aqua Essence sunscreen) pretty drying. There are also some unexpected side effects like the inability to tolerate stronger salt water. I was swimming in a saltier part of the Aegean sea this summer and two minutes after diving in my face started to burn like CRAZY. If you rinse with fresh water right after swimming this is mitigated a bit, especially with less intense salt water, but again -- I'm vain enough that I prioritize a clear face over sea excursions any day.
It took me a while to get a handle on the redness too (there was about a year where people thought I was either loaded or sunburnt) but the Ordinary's redness regime of Niacinamide 10% + Zinc 1% and Alpha Arbutin 2% + HA alternated with Cosrx's Advanced Snail 96 Mucin Power Essence really helped. I also use Peach and Lilly's amazing 'Chubby Cheeks' mask every couple of weeks (which also has niacinamide and snail mucin). I also use other chemical exfoliants like the Ordinary's Glycolic Acid 7% Toning Solution
(nightly!) which to be completely honest I am not sure is the best idea, but as long as my face stays clear I will continue my regimen of merciless chemical barrage. UPDATE: I stumbled across some posts on 'over-exfoliation' which is kind of scary (see this particularly terrifying post) so I've decided to stop doing this and dedicate some moisturizer-only days, pulling back on the glycolic acid to once every one or two weeks. Thanks r/SkincareAddiction!
So, despite a lack of romantic ingredients, prescription pills and cream are the products that saved my skin. Give them a chance! ¯\_(ツ)_/¯
*Scroll down to 'Part Two' of this review for a nice critique of Glossier's representative program.
**Unfortunately, this means hormonally configured male persons can't benefit from spironolactone. :(
***Spironolactone is pretty safe, but some can have a side effect of too much potassium in the bloodstream. If you're on spironolactone you just have to go in and get your blood checked every once and a while (more often than I do lol).
****Since I started with Epiduo Forte the Ordinary serum duo has also become a little drying so I just placed an order for their Azelaic Acid -- however just realized this is not intended as a daytime application (like their niacinamide and arbutin serums) sooo... we'll see how that turns out.