AW: Are there small nodules far beneath the surface of the skin? And does the affected area start under your ear and extend below your chin?
CA: Yes to both.
AW: What you're describing sounds like hormonal cystic acne—oil-filled pimples that lie deep below the surface. Abnormal hormone levels can also lead to irregular menstruation cycles, hair growth along the upper lip, and a thinning hairline. Do any of these ring true for you?
CA: My periods have been irregular since I went off the Pill, which is also when the acne started.
AW: Hormonal acne occurs when testosterone levels spike and start to bind to the skin's androgen receptors. Birth-control pills reduce testosterone levels.
CA: How can I prevent it without going back on the Pill?
AW: Cystic acne is best treated by a dermatologist. Possible remedies include oral antibiotics like doxycycline, topical medications like Tazorac, and laser treatments like Isolaz.
CA: I've also always had rosy cheeks, but they've gotten redder—sometimes looking like a rash. My sister has rosacea. Could I have it, too?
AW: Rosacea is very common—about 14 million Americans have it—and usually starts around age 30. We haven't found the exact cause but do know that it's a type of inflammation that dilates facial blood vessels, resulting in redness around the forehead, nose, cheeks, and chin. Do you notice the ruddiness worsening after exercise, hot showers, eating spicy foods, or drinking red wine?
CA: I've definitely been aware of it after hot showers and working out.
AW: Your case sounds mild, so the best thing you can do is avoid your triggers. Of course, you don't want to stop exercising, so try daily creams for redness relief—those with green tints tone down flushing.
CA: Should I be careful of other things I put on my skin, like antiaging products?
AW: At your age, the best thing you can do is avoid the sun, which signals the body to produce more blood vessels. Sunscreen is essential. If your rosacea gets worse, see a dermatologist.
CA: Thanks. I'll cover up with some new sunglasses as well!