Fighting acne is like fighting war. There is collateral damage. Things get worse before they get better. Whole villages of innocent, noncombatant pores stand in the line of our chemical weapons. And like war, fighting acne can be "controversial." Last week our Sephora Spy, Jasmine made an offhand comment about how acne can render a person "homeless," and some of you commenters declared mutiny. This week Jasmine is back to defend herself and what she feels is a just war on her adult onset cystic acne. It is, after all, her own experience with adult-onset cystic acne that launched her into the never-ending quest for a cosmetic cure and the accompanying lame retail job she works at to fund her, um, research. Because when it comes to the skin on your face, cysts aren't a shallow concern: They're deep. Really, really deep. (Which is pretty much also why they suck so hard.)

So, how did you finally get rid of your cystic acne?

Cystic acne is the gift that keeps on giving. I have basically come to the conclusion that I will never be entirely rid of all of it. It's the hundred years war. It's the Mongols in Imperial China. You can stave it off, usually temporarily and by employing some really extreme measures, but it's not just going to go away forever and never bother you again, especially if it's the adult-onset hormonal variety.

But your face looks fine. I saw you in Sephora, under bright lights, and I would have thought you'd have some sort of miracle formula for dealing with this judging from how your skin looked.

Are you serious? Because you don't have to be nice to me about this. It's something I am realistic about. I'm breaking out right now and the cysts are so bad that I wake up in the middle of the night in pain because they rubbed on the pillow the wrong way. They're not gone or anything. If my skin looked even partially okay, it is because I have gotten good at doing makeup, which is necessary when you have acne. Actually, I think one of the best ways to help acne heal is to wear nothing except your skin care products — if you can hack it. Obviously, I can't. I am not Mother Teresa. I just want my skin to look good. But for anyone who can hack no makeup, that's probably the best way.

Meanwhile, this is how I feel about makeup. I want to look flawless, with light, gorgeous coverage... no Hollywood Post-Nine-PM drag, no crusty MAC tranny face situation, none of that. So with acne, to avoid getting crusty faced, you need something that gives heavy coverage without giving the appearance of being heavy-coverage makeup. So a smooth formula becomes all-important. Make Up Forever makes good full-coverage foundations that I use sometimes, with Clinique's All About Eyes concealer for spots. I don't love Clinique, but I like their concealer. It doesn't crack or get crusty as much as other concealers, maybe because it's meant to be for the under eye area. Lancome Photogenic Ultra Comfort foundation is a miracle. I think it must have some sort of dimethicone in it, because it goes on really smoothly. Napoleon China Doll foundation is like $50 a tube, but it's another miracle worker for me. These things are what is getting me through my Sephora shifts under those lights right now. I'm glad you think my skin looks good— I try really hard to get it to a state of general passability.

Okay, but for us mere mortals, weapons need to be deployed, attack strategies need to be perfected. What is the most radical thing you tried?

Well, the time I stole all those cortisone syringes from the dermatologist's office, which was the most risky thing I did from an ethical standpoint. But I think I know what you're getting at: cruel and unusual punishments, and I will tell you that nothing really compared to the 30% glycolic peel I had once. I went through maybe four weeks of intense, intense peeling. And when I say peeling, I looked like I was like... a burn victim who was never going to be better again. I had a prescription for silver sulfadiazine cream to use afterwards, which is literally the same thing that is prescribed for burn victims. The whole thing was pretty horrible. But when I got through to the other side, it looked like Jesus Christ came down and touched my face. My cheeks felt like the stomach of a six year-old child. I looked really good. The results lasted for maybe three months.

What did you try next?
At some point I started visiting an acupuncturist who got me into Chinese homeopathic face reading, which basically dictates that the area in which your acne appears corresponds to larger health problems. If you have acne from the nose down, like in the chin area, your lower cheeks, around your lips— it's hormonal. If it's in the temple area [-Ha! -Moe] it's toxicity... so you should worry about your liver and your kidneys, stock up on supplements to help those things out, maybe do a cleanse. On the forehead, it's usually an issue of sebum, hair that hasn't been washed enough, that kind of thing. There are a lot of websites that can offer rough guides. (Like here.) And this is if you believe in this stuff, which I do. The face reader I saw is pretty convinced that most adult onset acne is of the hormonal variety. Chinese homeopaths will give you teas, tinctures, things to balance your hormones, herbs, acupuncture, acupressure... did the acne come back? Yeah. But here's the thing: it always does.

If most acne is hormonal, does that mean I should just go on the pill already?
Well, that's what I did next. I went on Ortho Tri-Cyclen, the birth control pill. I took it for purely cosmetic reasons. If I hadn't had acne, I'd have just told guys to fuck me in the ear or the armpit or whatever, I don't give a fuck. But it cleared up my skin for awhile. It does, of course, lower your sex drive and it makes some people crazy, although acne made me way crazier, so it's a trade-off.

Is there anything too radical you've been too scared to use?
Part of me thinks using antiandrogens to treat hormonal acne is really where it's at. You want something that blocks testosterone from being received by your skin. I think that's what gives women acne. Also, a sex drive. These drugs are no joke, though. Antiandrogens are what they give male-to-female transsexuals. Spironolactone is one of the antiandrogens some doctors use to treat acne hormonally now. It's for high blood pressure and has supposedly "feminizing" side effects so men are only supposed to take it in extreme cases. Anyway, when women take it, their acne sometimes disappears. My gut feeling is that hormone therapy is probably the best bet for getting rid of the hormonal kind of acne, but I'm sketchy about using it. That's saying a lot because I'd harvest goat piss during a full moon and bathe in it while chanting hymns to Satan to get rid of my acne. But I do sort of feel that if I need hormone therapy this intense to get rid of my acne, maybe I'm just meant to have it and that's that.

Another thing I've noticed is that no one thing works for me forever, but short-term, a lot of things work. Maybe the answer lies in just rotating treatments, mixing it up so that your skin doesn't have a chance to figure out a way to thwart your treatment. I'm planning on seeing an endocrinologist next. I'll report back on what they say about it.

What are some of the more moderate treatments sold in stores — say, Sephora — that you've seen work for other people?
DERMAdoctor is a really good line. Don't let the queer-ass names stop you from buying this shit, this is a company that is not afraid to use chemicals, which I like. Ain't Misbehavin' is their acne serum. Supposedly, it contains two ingredients that specifically fight hormonal breakouts, so if you believe the packaging you're applying some sort of hormonal inhibitor to your skin. Picture Porefect is another serum in the line that helps with what people like to call "enlarged pores." Basically, you can't shrink the actual size of your pores. But if you're aging and losing collagen and sagging, the shape of the pores will kind of stretch out. This stuff will help with that, and you'll temporarily look better. Blockhead—specifically for a patch of blackheads. It comes in a container that looks like an eyedropper. It's a really intense exfoliating serum that just goes on one patch of skin. It'll make you dry, but it'll work on the blackheads. Expect a dry, red patch for a week. In order to get rid of this stuff, a few layers of skin are going to come off and you're going to look like shit for awhile.

Kinerase's acne line is a gentler approach to healing acne... more about healing than exfoliating, which is good especially for older clients who don't feel like abrading the fuck out of their face. They all contain this topical antioxidant that's very soothing and good for people who are dry, sensitive, and flaky, but still breaking out. Clear Skin Moisture Light is nice and gentle. Clear Skin Treatment Serum smells like sphincter, but if that's what it takes to nurse your skin back to health, I know I'd walk around with the whole sphincter in my pocket.

What about acne scarring? Is there anything I can do to minimize this?
Two different concerns here. The first one being that people with darker complexions are going to deal with hyper-pigmentation, or dark spots where their zits used to be. Hydroquinone, which has recently been linked to liver cancer, is something that helps with that. You can get a 2% solution over the counter and a dermatologist will prescribe a 4%. A lot of companies are coming up with hydroquinone free products that lighten up dark spots a bit... kojic acid, licorice, naturally occurring melanin inhibitors from plants. Do they work as well? Ehhh.

Then we have our lovely pits. Microdermabrasion or a chemical peel will help with those. I think microdermabrasion will be a course of six treatments, which will run you about a thousand bucks. Peels are about $250, and that's just one. Cosmetic fillers that you'd get from a plastic surgeon. Oh, side note: I would never recommend microdermabrasion or a peel on a live crusty zit situation. It's abrading the skin, tearing it. When you do that, the tears become channels that the bacteria can swim up and infect other parts of your face. You're making an open wound situation on your skin. I don't believe in doing microderm until you're finished with your acne treatment, kind of like icing on the cake.

At what point do you just embrace your sad, homeless-looking face and say "Fuck it, I'm done?"
This is, believe it or not, something I've done a lot of thinking about. I know I'm out of control. Nice, clear skin is my obsession the way some people are into shoes, clothes, hair, sports cars, big screen TVs, whatever else they're obsessed with. I don't give a shit about any of that. I'll leave my house in a nipple ring and a diaper, but when you see me walking down the street you'll be like, "Oh! Your face looks radiant!" That's my goal. I will spend all of pennies and go into debt looking for the answer to this. When I bought my house, one of the things I liked best about it was the third floor bathroom. It's gigantic. I have a whole skin care station set up in it, with basically theater lights to make sure that I am not missing anything. I do firmly believe that all of the things I have done to stay on top of my skin situation have improved my face. It looks better than it would if I were not doing anything.

Which brings me to the homeless. You ever see a kid who's probably from Darien, Connecticut with rich parents sitting on the street with their dog and their dreadlocks and their heroin addiction and a little sign and a face full of pimples? That's what I'm talking about. They have made a choice to not take care of their skin: hence, they are pimply. The choice they made was to jump from boxcar to boxcar and re-name themselves Avocado and become a crust-punk junkie or whatever else it is that they believe in. I'm not knocking their lifestyle. I just do not personally want to look like a member of it when I am not. We all have our priorities, including the homeless, but I think it's somewhat dishonest to pretend that they are the same ones in a column about what is basically a gigantic beauty product franchise.

Anyway, getting intensely into skincare basically comes down to a lifestyle choice, too. A lot of the things you can do to yourself to help with your acne are the kinds of thing a sane person would not willfully elect to do to themselves if they were not in a desperate situation. When you fuck with this stuff, you are almost always going to look hideously fug before you look better. Once you kind of stabilize, your skin will look better. But if you have cystic acne, this is like a quest. I think a person really needs to evaluate how much their acne bothers them and make a decision, because none of the treatments are fun or anything. I mean, how bad is your acne? If you have one zit and go on Accutane, I guess that's your choice, but... even I think that's insane. But it's all about what it's worth to you. And if you can honestly evaluate whether all the peeling and flaking and burning and not wanting to leave your house is worth it to eradicate that one zit from existence, then there is no shortage of things for you to try that will more or less, temporarily, accomplish that goal.

Earlier: I Work Here To Feed My Sick Fancy Product Addiction The Least I Can Do Is Help You
Meet Jasmine, Our New Sephora Undercover Agent