A question about skin, and also about anxiety

September 17, 2019 9:00 AM

I'm having a fairly minor cosmetic skin issue that I'd really like to solve. I'm also having intense and disproportionate anxiety about it that I'd reallyreallyreally like to solve. Looking for advice on either/both of these issues.

Quick background on the skin part: prior to my mid-20s, my approach to skincare was pretty much "put some Olay moisturizer on, wear sunscreen sometimes." I had no skin issues to speak of. Then I got a Mirena IUD and after about a year started getting little flesh-colored bumps (non-inflamed acne, basically) all over my forehead. I was very puzzled and briefly dipped into the skincare Reddit, where I absorbed some info about chemical exfoliants. After that, my approach evolved to "moisturizer with SPF in the morning, different moisturizer with some glycolic acid in it at night." 

(Specific products, if that's helpful: Jack Black Double Duty moisturizer and Alpha Hydrox/Alpha Skin Care 10% glycolic lotion. I've been through countless bottles of both.) 

This seemed to work great, so I just... kept doing it. Eventually I needed to replace my IUD -- I didn't think much of it at the time, but of course it starts the hormones back up at a higher level. In a bit of very unfortunate timing, I got all excited about getting into "real" skincare right around the IUD year mark. My not-very-scientific theory is that I put a bunch of random new stuff on my face at the exact time that my body was most vulnerable to the IUD hormones, setting myself up for a perfect storm of skin sadness. 

Anyway, this time around the bumps are on my cheeks/jaw area, but otherwise the same deal -- small and numerous, flesh-colored, not particularly visible except in certain light, will give up a tiny bit of white stuff if I squeeze REALLY hard (but I try to avoid that!). Initially I FREAKED OUT and briefly tried an OTC retinol, but it made my face feel terrible so I stopped. Then I spent too much time on Reddit and reverse-freaked out about over-exfoliation and spent a while just slathering myself with my fiance's regular non-acid moisturizer. THEN I got super frustrated and pissed off and had my IUD pulled (which I posted a question about a few weeks ago -- I've had plenty of other IUD-related issues, so this isn't quite as impulsive as it sounds). 

At this point I've just thrown up my hands and gone back to what I'd been doing for years, except now my skin kind of sucks AND I'm hyper-aware of all of its flaws in a way I wasn't before. I struggle with anxiety generally, and this has caused a massive flare-up like I haven't experienced in years. It's like the problem-solving part of my brain has totally malfunctioned, and I'm constantly second-guessing things (maybe this glycolic lotion is secretly bad for me!), worrying that it's something else that I'm not treating properly ("fungal acne" is apparently a thing?), obsessing in front of the mirror, feeling weird guilt about how I did this to myself and it's all my fault, spiraling about how my skin is ruined forever, etc etc etc.

I realize this is long-winded, sorry. I guess my actual question is two parts: 

1. Does anyone have thoughts or advice on the skin aspect of this? I've determined that I have zero interest in an elaborate skincare routine, but I wonder if I should be approaching this differently (or if I should just make like my mom and sister and use only plain Aveeno lotion and nothing else forever, ahhhh). 

2. Does anyone have experience dealing with this particular flavor of anxiety? It's very obsessive and all-consuming, but ultimately it's about something that I can't actually control AND is relatively minor. I take a low dose of Lexapro and I'm working on finding a permanent therapist, but I've struck out with that so far. In the meantime, I'm really frustrated!

Also -- and I realize this is somewhat burying the lede -- I'm getting married in just a few weeks. I feel like an absolute mess right now and I'm terrified that I will carry that into my wedding day. And as desperate as I am to fix my skin, I'm way more concerned about being fully present to marry my amazing fiance, regardless of what I look like.  

(Side note: please don't direct me to the skincare subreddit, it fuels my anxiety like nothing else! I'm here and not there because I know this isn't just about my skin and I've always found Metafilter to be very wise when it comes to the intersection of anxiety + other stuff.)

posted by catoclock to Health & Fitness (10 answers total)

For 1. - Get a facial at a good spa/salon! The esthetician can give you advice specific to your skin. It may seem expensive but buying the wrong skincare products is, too - and a few weeks before a wedding is the perfect time to do it.
posted by beyond_pink at 9:12 AM on September 17, 2019 [1 favorite]

I know there's a lot of great info on the reddit skincare boards, but I find they breed a lot of obsession and anxiety. When I read them before I got all riled up about my pore size and dull skin and whatever.

I agree with the advice on seeing as aesthetician. Leave the decisions to the pros!
posted by noxperpetua at 9:30 AM on September 17, 2019 [3 favorites]

Definitely go see a highly reviewed and recommended aesthetician, and maybe even think about going to see a dermatologist? I had the same issue (IUD + anxiety + skin care woes) and after trying years of over the counter things or products I read about online, I finally went to see a dermatologist who prescribed the right set of things.
posted by something_witty at 10:09 AM on September 17, 2019 [1 favorite]

I second the dermatologist recommendation. I had pretty bad hormonal acne (primarily around my chin/upper neck, though sometimes on other parts of my face) and I had/still have the Mirena. It was significant enough that my dermatologist thought Accutane was a possibility, but suggested I try spirolactone (by prescription) first, which fixed the problem almost entirely. It may not be the right solution for you or it may not work as well for you as it did for me (a friend tried it and didn't have any results), but I think it is worth speaking with a dermatologist who may have prescription or other suggestiosn.

If it reassures you, my skin was pretty bad in my late 20s and has only improved to the point that a decade later, I'm pretty happy with it.
posted by Caz721 at 10:16 AM on September 17, 2019 [1 favorite]

YES! To both your questions. I am very anxious about my Melasma and REALLY over did it on glycolic creams right after a tca peel, earlier in the year. My skin was PISSED! Some stern words from my esthetician about being careful about what I put on my face in the future, her recommendations, and a few weeks sorted it out (not the Melasma, but the very irritated skin) what you are describing is millia (spelling?) and go get a hydra facial (if your dermatologist agrees) but facials sorted out my Millia. Less is probably more. Hopefully you were learn from this and go easy down the road. I certainly have.
posted by catspajammies at 10:23 AM on September 17, 2019

If you have good insurance just go see a dermatologist. Your copay will be less than an aesthetician's consultation, and you'll get access to medical grade stuff, no sales pitch, and expert advice.

I will recommend one product I find totally amazing: this facial sunscreen which I see has just come out with an unscented version, which I will be trying next. This one is so totally unobtrusive I honestly sometimes wonder how it can be working, but it feels so good compared with any other product I've tried, I'm sticking with it.
posted by fingersandtoes at 11:17 AM on September 17, 2019 [3 favorites]

Part 1:
My skin does that - get all these white bumps - when my skin barrier has been compromised and I'm losing too much hydration (trans-epidermal water loss or TeWL). The extra production of sebum is the skin's reaction. And that gets clogged up.

I'd stay away from the glycolic acid for a while. At least a week. If you must use an acid, then maybe a gentler one like mandelic acid or a PHA.

These are things that have helped me when my skin is like that. They're all pretty cheap and I don't use them daily, nor all at once: good old cortisone ointment, aquaphor, jojoba, and La Roche Posay Cicaplast baum b5 (slightly pricier, $14.99 on amazon). Again, I use these at night on occasion.

Unless you live somewhere really dry, using a toner or moisturizer with hyaluronic acid helps keep skin hydrated.

You haven't mentioned what you use for cleanser. I recently switched to baby wash (eucerin is my favorite) and my skin is much happier. Really hurt the self-esteem since I've been making my own soaps for years. But it was a good decision. And cheap. Just don't use bar soap (ph is too alkaline) and make sure it's gentle. Nothing that makes your skin feel squeaky clean.

Part 2:
As far as anxiety goes, yes, I have become slight-obsessively anxious about things like skin. 99.99% of the time, the source of the anxiety is elsewhere and re-directing it to something less important is my way of dealing with it. Maybe because it's less overwhelming. Maybe it's because I feel like I have more control over the trivial(ish) matter than the real cause. IDK......I do know that taking a magnesium malate or glycinate supplement in the morning really helps the broken-record thoughts.
Planning a wedding is pain in the ass. Keep in mind that you are not responsible for anyone else's happiness on that day. If things go wrong, meh, it doesn't really matter. In the end, it's just a few hours out of the day. What does matter is that you are happily married to the right person. That's it.
Sending good vibes your way.
posted by Neekee at 11:35 AM on September 17, 2019 [1 favorite]

The reddit skincare subs have a wealth of information, surrounded by equally-compelling misinformation. I'm prone to anxiety and obsession, so I've also found it unhealthy for me a lot of the time. I can't get rid of fixations very easily, so I've been redirecting it in healthier-for-me ways: actually seeing my dang doctor & having meds prescribed & asking a million questions about what do I do if the meds don't work, and reading published papers instead of randos online. I've also distracted myself by finding a less self-critical thing to pour myself into (in my case, a video game that my friends are excited about).

For me, it helped to know in advance of going to the doctor what the treatment might be. In my reading, I found that the first line treatment was usually some combination of benzoyl peroxide, antibiotics (usually topical, sometimes oral), retinoids, and spironolactone (if unwanted testosterone is a possible factor). It seems that benzoyl peroxide used alongside antibiotics prevents antibiotic resistance; additionally, a lot of the unpleasant side effects of BP (dryness, irritation, fabric bleaching) can be avoided (and with most benefits retained) by using it as a wash rather than leaving it on.

My acne has gotten 85ish% better in the last three months, with topical antibiotics + bp, then bp + oral antibiotics (for cost reasons, mostly). I additionally used a cheap/fancy liquid containing zinc and niacinamide, which I'm pretty sure only helped a little bit (10%?) but it sure felt fancy.

With regards to "fungal acne"/malassezia folliculitis, a fast and cheap, if not 100% accurate, test is putting ketoconazole (otc antifungal medication; nizoral shampoo is easy to get) on a patch of it for ~5 minutes, then washing it off. It's not 100% accurate (sometimes false positives, sometimes false negatives), but generally things that are fungal will improve very quickly, like within a day. A dermatologist's office can conduct a test that's more accurate and doesn't take too long; I think it's called a KOH test.
posted by you could feel the sky at 11:56 AM on September 17, 2019

Re #2: I also have had a lot of anxiety about my skin, and it's definitely magnified in combination with other stress. I've kind of given up going to doctors about it because nothing they have offered so far has made a lasting difference (various topical antibiotics, tretinoin, salicylic acid...). Maybe I just haven't found the right dermatologist? I'm usually incredibly skeptical of skincare internet and advertising, and interacting with it causes me a ton of anxiety, too, so I usually try to avoid it.

Re #1: The one thing that has actually made a substantial difference for me is the Niacinamide+Zinc from The Ordinary. Like, I went from a permanent seething breakout on my jawline to just occasional individual zits per month after using it for a couple of weeks. I think it's reduced my overall redness a lot, too. I never expected anything to work so well - that's something that happens to other people, not me. fwiw, this meta-analysis from 2010 says that there is reasonable empirical evidence and a mechanistic model in support of niacinamide treatment. (disclaimer: I don't feel totally qualified to evaluate the supporting data myself.)

This is how I use it: I wash my face with something gentle and unscented (currently using Cerave), then after my skin dries a bit I drop half a dropper onto my fingers and apply it all over my face. Then after that dries or absorbs, I follow up with the Ordinary's lotion with "natural moisturizing factors" and hyaluronic acid. Even though there are multiple steps, it doesn't take a lot of time. I just alternate with the other things I do in the morning/evening like brushing my teeth or hair and getting dressed.

I've also gone on and off benzoyl peroxide, which has helped over time in the past. I use the 2.5% formulation from acne.org and apply it only in the morning, after I've gotten dressed, to minimize bleaching of my hair and pillow cases. I use a lot less than they recommend (I use about the same quantity that I would use for toothpaste) and only apply it to the lower half of my face. I've stopped using it at various points when I get too upset with the bleaching (like when I start to notice it in my hair or neckline of my clothes, or I wreck someone else's pillow case) or when the product that I have has degraded and I forget to order another container.

Also, I wonder if the tiny whiteheads mean that you were using glycolic acid too often?
posted by esker at 1:48 PM on September 17, 2019 [1 favorite]

so when i dove into the skin care reddits, i did find good information about things to do with my face. HOWEVER, it also led me to start super focusing on all my flaws and feeling even worse about them and just being hyperaware. you and i both need to step away from the reddits. in the vacuum of people with really nice skin and before and afters, it's hard to forget that most people don't have perfect skin. the longer you stay away, the more your anxiety will slip into the background.

i would suggest stopping with all products and stuff for at least a few days. just a water wash in the am and pm and maybe a liiiiiiiight moisturizer with no active ingredients if you feel really dry. let your skin chill out and calm down, and then slowly add back in products you are interested in (aha/bha/vitamin c).

and don't do any crazy miracle treatments right before your wedding, that's what photo retouching is for.
posted by misanthropicsarah at 2:02 PM on September 17, 2019