Wednesday, April 3, 2019

Updated, Slightly Less Minimalist(ish) Skincare Routine

It's been ages since I last wrote about my skincare routine, and I thought it was high time for an update! All of my drugstore-priced, longtime favorite "holy grail" products are still in there, but the set of prescription products I use has changed slightly.

As I suspected, once I started my current job, I was no longer able to see my fancy dermatologist on my new insurance plan, but it's turned out not to be a big deal. My general practitioner has been happy to prescribe my acne-related medications, so it's all good. Insurance co-pays continue to be weird for my topical prescription medications, but that's not exactly new, as I'd already experienced paying anywhere from $40 (with manufacturer coupon) to as much as $80 per refill (a number I was previously shy about disclosing) on my old plan. Alas.

Please keep in mind that I'm not a medical professional, and can only speak to my personal experience with various skincare products and routines. To the extent that one has the misfortune of suffering from moderate to more severe acne (my sympathies!), the best first step for me has always been to start with the doctor or dermatologist, and what they prescribe.

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As background, I have long had bad skin. Its main problem, for at least 18 years now, is acne, primarily the big, icky, under-the-skin kind that could hang out for a month or more, even when I was on both Retin-A Micro 0.1% (the highest dose) and the contraceptive Yasmin or its generics. I get other, more typical breakouts with smaller blemishes too, but those heal so quickly in comparison, and are so easily covered up with makeup, that they've always been easy for me to ignore. Doctors sometimes refer to my acne as cystic, though anecdotally, there may be a distinction between what I  typically get (which eventually "comes to a head"; can pop, often by accident; and is then helped along by hydrocolloid bandages, in my case the CosRx Pimple Master Patches) and actual "cysts" which, on the thankfully rare occasions I've had them, tend to be smaller and and less inflamed most days, but also don't ever "come to a head" and start healing. Instead, they hang out for months on end before, sometimes, mysteriously disappearing.

Various combinations of additional products, including some over-the-counter ones, have helped reduce the frequency, size, and average healing time of my icky, under-the-skin blemishes. But even now that my skin has turned a bit of a corner, mainly thanks to prescription spironolactone, I still don't have perfect skin. I also don't think "perfect skin" is possible for me, it's just not a realistic goal, and I've long since accepted that.

Even if I never got another blemish again (unlikely!), the aftereffects of the years-long battle with acne will remain, mainly in the form of some oddly textured skin on my cheeks and chin. While those patches don't quite rise to the level of what's in photos of atrophic acne scarring, they're still noticeably bumpy if one gets really up close and personal, and the condition appears to be permanent. Nearly a decade of daily Retin-a Micro use hasn't been able to make that odd texture go away. Most days, I also have small dark spots left over from recently healed blemishes, but those, at least, tend to fade significantly over time, sometimes within as little as four to five weeks. (Though with my ongoing acne issues, by the time one dark spot has faded, another has popped up.) Whatever can be done about the oddly textured, slightly bumpy scarring, it's probably going to be expensive, and not covered by health insurance.

Some may remember the hullabaloo surrounding that silly The Outline article claiming that the entire skincare industry is one giant con. Many objected, including at Man Repeller, Racked, and Vox. Had I been paying attention then, I definitely would have objected too. From years of experience, including months-long periods where I stopped the Yasmin or dialed back the Retin-A Micro, only to find that I really couldn't do that if I valued the appearance of my skin, I've learned my lesson that, at least for me, there are times when extensive use of clinically-proven skincare ingredients (whether prescription or over the counter, and in my case, oftentimes both) is absolutely necessary, even if I just want to eke out a few weeks in an average month when I don't have one of those big under-the-skin blemishes hanging out.

In the meantime, however, I've also learned that "more" is not always better when it comes to those more clinically proven "active" ingredients. Indeed, though there was a time that my skin did very well with one of those Korean or East Asian skincare market-inspired 10-plus step skincare routines of legend (both morning and night), I may have been slightly in denial about how well it was actually working for me overall.

When that routine was working for me, as it did most of the time, it was fabulous! My skin got almost completely clear of those gross breakouts, for as little as two weeks to as long as a few months at a time (all of which is excellent results by my standards), and it often had an attractive "glow" that can't be replicated now that I've cut certain more expensive items from my routine. (In my experience the Missha First Treatment Essence, a SK-II dupe, is pretty unique in imparting a certain "glow" I don't get from any other product. Though your mileage may, of course, vary.) During the good times, my skin even got to the point where I honestly thought it looked better without makeup than with! Though I must admit, one factor there was that I don't have particularly excellent makeup skills.

When that routine wasn't working, however, probably because the combination of all those active ingredients, mainly the BHA (whether from the Paula's Choice 2% BHA Liquid or the one-two combination of the CosRx BHA Skin Returning A-Sol and BHA Blackhead Power Liquid) was a bit "too much" for my skin, I'd get irritation-related breakouts, or my skin would get red and blotchy, or dry and flaky, and would need quite a few days of rest with a dialed-back "gentle, moisturizing products only" routine. I used that 10-plus step skincare routine, switching a few products in and out, for nearly three and a half years before the dermatologist asked me to take a step back, to let my prescription products better do their work. Since then, I've realized that, while my previous routine was great sometimes, those "good skin" months or weeks were always punctuated by semi-regular bouts of irritation-related breakouts. So maybe that super-extensive skincare routine wasn't the best idea after all.

Please follow the link below to read about my current routine!

These days, I've settled on a routine that's somewhere in between my previous 10-plus step skincare routine and the super-minimalist (by my standards) routine the dermatologist previously requested. That super-minimalist routine works fine for me in summer, but it isn't quite moisturizing enough in winter. Plus, with the super-minimalist routine, my post-acne dark spots don't fade fast enough for my tastes, so I was eager to get a Vitamin C serum back in.

Here's what my routine currently looks like, though it's still a work in progress. Products with no extra notation are used both morning and night, while certain other products are used in daytime or nighttime only:

  • Garnier Micellar Water - (evening only, after wearing makeup) - I don't wear makeup often, so this doesn't get much use. It's a dupe of the famous Bioderma Sensibio, which used to be difficult to obtain in the US. I've tried a few different micellar waters in my time, and found this to have about equal makeup cleansing power to the Bioderma and the fancy Koh Gen Do Cleansing Spa Water, and significantly better cleansing power than its drugstore competitor Simple Brand unscented micellar water. To use, soak a cotton pad with it and wipe all over the face to cleanse. I usually need three cotton pads if I was wearing a full face of makeup. One supposedly doesn't need to rinse with water after, but if I've worn makeup, I use both micellar water and then wash with my typical face cleanser. (And yes, I know I should buy reusable/washable cotton rounds instead, though I wear makeup so rarely that I still have quite a ways to go with an old package of disposable ones!)
  • Cerave Foaming Facial Cleanser - K and I have both used this for years. Not too much needs to be said, it's a no-frills and fairly gentle drugstore-priced face wash. Back in the day, some people on the skincare subreddits thought this was drying and preferred the Cerave Hydrating Facial Cleanser, but we've never had a problem with this one, even though we both use some fairly harsh topical prescriptions.
  • Benzaclin (clindamycin 1%, benzoyl peroxide 5%) - (prescription, morning only) - This is a fairly recent addition, and only time will tell if it works differently from the Acanya I was using last time (which the dermatologist discontinued because it didn't seem to do much). Back in the day, I remember that people online ( anyone?) were convinced that 2.5% (what's in Acanya) was a high enough concentration of benzoyl peroxide to be effective, so I wonder if 5% might be more irritating.
  • Retin-A Micro 0.1% - (prescription, evening only) - I've been using this product for a little over a decade now! Not too much to say, except that even though my skin is well and truly used to it, nightly use can still be drying and irritating, depending on the season and what other products I'm using. Although this is a very helpful and necessary part of my routine (I stopped for a few months once, and the breakouts got much worse), I usually need several other acne-fighting products to keep things under control. 
  • Hada Labo Gokujun Lotion - I've also been using this product on and off for a decade. Not too much to say about it either, except that I think it's an excellent "first step" if one is interested in trying out skincare products from the East Asian market. (It's also available at a lot of Japanese grocery stores, if one prefers not to shop from Amazon.) I've recommended this to tons of people over the years, including my sister, and I think it's generally well-tolerated by most people's skin. The texture is that of a moisturizing toner, and I apply a few drops directly to my face, no need for a cotton pad, both morning and evening. 
  • CosRx Triple C Lightning Liquid - (morning only) - It's only been a few weeks since I started using this. My instinct so far is that I'd prefer to go back to other Vitamin C serums I've used before (Paula's Choice C15 Super Booster is what I generally recommend, but it's expensive and starts oxidizing fairly quickly, within four months even when stored in the refrigerator; I've also had reasonably good luck with the more cost-effective Timeless Vitamin C plus E Ferulic Acid serum, a knockoff of the hyper-expensive Skinceuticals one, but I know a lot of people break out from the Timeless). This was one of the more cost-effective options available from a brand I knew reasonably well (I've never had breakouts from any CosRx product, though some work much better than others so they're not a "perfect" brand for me either), so as I ease back into using Vitamin C serum, I thought I'd start with it. 
  • The Ordinary Argan Oil - (evening only) - I used to be devoted to Josie Maran Light argan oil, and was absolutely convinced it was noticeably better than other drugstore-priced brands. But I've since changed my tune, in the interest of being a little more frugal about my skincare. I'm totally not picky about argan oil brands anymore, I might just switch to Trader Joe's, but The Ordinary one is similarly affordable. The only really noticeable difference between either of these and the Josie Maran is that they've processed the Josie Maran one to remove the scent. The scent is a little hard to describe, it's not too strong, but is a bit musty and nutty (though not as much as, say, neem oil). 
  • Cerave Daily Moisturizing Lotion - (morning only) - Another longtime favorite, which I've also been using for nearly a decade! This isn't heavy enough to be a nighttime moisturizer for me, but it's good for daytime use. 
  • Vanicream Moisturizing Skin Cream - (evening only) - Yet another longtime holy grail product, though I've only been using it for about a half-decade. This one is quite heavy and a bit slower to absorb, so it's mostly a nighttime-only moisturizer for me. 
  • Biore Sarasara Aqua Rich Watery Essence Suncreen - (morning only) - I used to prefer another Biore sunscreen (which are all drugstore-priced in Japan, Taiwan, Hong Kong, and China, among a few other markets), but their sunscreens are reformulated every other year or so, and this one is now the best for me. Like with the Hada Labo, I generally buy this from Amazon, and most of the best-priced sellers ship directly from Japan. Typical online prices are about $11 each for the sunscreen and closer to $14 each for the Hada Labo, but each of these products sells for around $6 or $7 each in Japan. 

Oh my, this has ended up being a bit of a mini-dissertation about my routine! Clearly, I have a lot of opinions about skincare products, even though just about everything I use is on the more "basic" side, mostly things available from the drugstore and pharmacy, whether here or abroad, and whether by prescription or over the counter.

And this routine is still a work in progress, too. Among other things, I would still like to phase in one of those serums from The Ordinary that I bought last August. I haven't had the chance to try any but the niacinamide and zinc serum, which broke me out and probably isn't going to work. My skin could also benefit from another moisturizing and soothing product or two, particularly after adding in the Benzaclin. My additional products of choice are, first, the CosRx Advanced Snail 96 Mucin Power Essence, and after that, if still needed, the CosRx Advanced Snail 92 All in One Cream (which is more of a gel than a cream, and not at all heavy enough to be an "all in one" moisturizer for my skin). I've used several units of both before, they're nice, soothing moisturizing products that are easy to add to whatever my routine is at the moment. There are also times when I'd like to add a sulfur mask to my routine (I prefer the DDF Sulfur Therapeutic Mask, though I've also tried the Peter Thomas Roth one and found it pretty similar), for the occasional days when I'm having more problems with breakouts. But I never need a sulfur mask often enough to use a significant amount before it starts drying out in the container, so I rarely ever end up buying one.

Overall, given how long I've been needing so many skincare products (and some prescription pills besides), I think some people would be inclined to recommending that I consider other solutions, particularly diet or other lifestyle changes. One of the main things that many people recommend for intractable acne is cutting out or seriously limiting intake of dairy products. I've heard of a lot of anecdotes where people reported that cutting out dairy products has serious anti-acne benefits, and I've even experienced some of those for myself. A few years back, I limited my dairy intake for a few weeks, and was definitely seeing reduced (but not completely eliminated) acne breakouts. Though I really like ice cream, cheese, and lattes, so I haven't been inspired to go back to that experiment.

How often do you change up your skincare routine? Do you favor a simpler routine, or one with more steps? Anyone else have the relative misfortune of needing to rely on prescription topicals or other acne-related prescriptions as much as I do? And, if so, have you experienced some really absurd fluctuating co-pays for some of your medications? In my case, I think Valeant Pharmaceuticals's drug-pricing practices have played a role. 

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