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Everything I Used to Fend Off Post-Pill Acne

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Sixish years ago, my best friend went off birth control. She wasn’t planning on having children anytime soon, but a doctor had prescribed her the pill as a solution for painful cramps when she was 14, and she’d long been curious what her body (mostly her mood and intensity of menstrual cycles) would feel like without the birth control in her system. For a while, she noticed little to no symptoms at all. But about six months after quitting, she began growing clusters of painful, under-the-skin breakouts around her chin and cheeks — stubborn cysts sprouting up in groups of threes and fours weekly. As long as we’d been friends, acne had never been a concern of hers; as a matter of fact, I remember seething with jealousy at her smooth, scar-free complexion during a time when I was covered in picked scabs and pimple patches. But this breakout, she said, was relentless, and her trusty Aztec clay mask (remember, it’s 2016) wasn’t helping in the slightest.

My best friend chose not to go back on the pill, and after about eight months, with the help of a dermatologist, she was able to calm down her acne flare-ups significantly. But her story became a cautionary tale among our friend group, a kind of scary story she would sometimes dramatically tell alongside before-and-after pictures. As a result, we all obediently continued to take the birth control we were prescribed as middle-schoolers late into our 20s, even during times when pregnancy was of absolutely no concern.

But in 2022, after a string of hormone-related medical issues, my doctor urged me to consider coming off the pill myself. When I told my best friend this, she initially winced, then quickly assured me that my experience would be different. After all, there is such great skin care available these days, and if anyone would be equipped with the right products, it would be me — right? But she might have forgotten that I started the pill at 15 as a result of fairly severe cystic acne, and I’d chosen birth control as an alternative to Accutane. While I still had breakouts when I was on the pill, albeit far less intense, I was convinced that my skin was a ticking time bomb, that tons of dormant acne was bound to erupt the moment birth control was out of my system.

In light of my doctor’s recommendation, I began furiously researching acne in relation to birth-control cessation, reaching out to a friend and board-certified dermatologist, Dr. Ranella Hirsch, for clarity on the science. When I asked her to pinpoint what exactly is happening in the body and skin when a woman goes off birth control, she warned me that a number of variables (including types of birth control, specific hormone count, and timing) make it a fairly nuanced and complicated topic. However, to simplify it as much as possible, Dr. Hirsch explained that birth-control pills regulate our hormones, and when we stop taking them, our bodies spend time readjusting to its natural hormone fluctuations, and this imbalance can create an environment for breakouts.

When I asked about preventing post-birth-control breakouts, Dr. Hirsch says the most proactive thing that can be done is involve a dermatologist before you’ve gone off the pill. That way, you can work together to create a plan — carefully timing when you are going off the pill in relation to your menstrual cycle and life events (for example, a wedding) — and get your skin adjusted to any new products. With patients who have a history of acne, Dr. Hirsch says starting antibiotics before going off the pill is also an option, as they can help target acne-causing bacteria, helping to make the transition period a bit smoother.

If you’re up for a splurge, the AviClear laser is another effective, pre-cessation option (fees vary by office, but one session will likely run you several hundred dollars). The laser shrinks sebaceous glands, reducing oil production and breakouts. And it’s energy isn’t absorbed by melanin, so it’s safe for all skin colors. Board-certified dermatologist Dr. Dendy Engelman of Shafer Clinic in New York City recommends at least one treatment four weeks before stopping the pill, particularly for people who had been using it to control hormonal acne.

If you’ve already stopped taking the pill and are experiencing breakouts, Dr. Hirsch explains that while this will make things slightly more challenging, hope is far from lost. As always, avoiding picking is essential when it comes to reducing breakouts — do everything you can to keep your fingers away from your face (here are some tips) so that you don’t make your active acne and post-acne scarring any worse. Dr. Hirsch also emphasizes the importance of patience; while it may take several months, your hormones will adjust to being off the pill and begin to stabilize, and this alone can sometimes do some heavy lifting to resolve some of your acne flare-ups. She also recommends talking to a dermatologist and an aesthetician, as in the interim they can work with you to create a consistent skin-care routine consisting of topical treatments such as retinoids, benzoyl peroxide, and salicylic acid, which can help unclog pores and reduce inflammation.

Most important, if you are looking for a new birth control or have a child who is considering starting the pill (for pregnancy prevention, acne management, or other health reasons), Dr. Hirsch recommends speaking with your dermatologist and OB/GYN in advance about all of the birth-control options — and there are tons of options with various levels of hormones and insertions. Learning more about how a specific kind of birth control functions in your body can help you pick one that’s best for your personal health and hormones and that will ultimately be easy to come off of if you chose to down the line.

And as for myself, I was able to work with a dermatologist to find a tretinoin that was right for my skin type (I use a specific brand called Altreno, which uses a slightly more hydrating formula) so that when I eventually went off the pill, my skin was fully adjusted to potent treatment and I was able to reap the full benefits of a prescription-strength retinoid. It’s now been a year since I have been off the pill. While I have admittedly experienced a slight increase in breakouts (especially during my time of the month), it was nowhere near as terrifying as I had anticipated, and my consistent routine of prescription-strength retinoids and over-the-counter benzoyl-peroxide face-washes has allowed me to have the tools necessary to manage flare-ups so that they quickly come and go.

Below, a list of products recommended by me and Dr. Hirsch to consider for your skin-care arsenal when coming off the pill.

If you are going off the pill in order to conceive, Dr. Hirsch says you should not be applying retinoids, as you’ll need to stop using them once you get pregnant. However, if you are not stopping the pill for this purpose, and don’t have access to a dermatologist to discuss prescriptions, Dr. Hirsch recommends Differin, which is one of the stronger over-the-counter retinoids available. It was specifically formulated to treat acne and works by reducing inflammation and preventing the formation of breakouts. As it’s on the more potent side, Dr. Hirsch recommends integrating it slowly into your routine — initially using it once a week and increasing usage conservatively — in order to avoid irritation and tenderness.

You might be coming off the pill in the hopes of getting pregnant, and if that’s the case, Dr. Hirsch recommends the PanOxyl 4% Acne Creamy Wash — one of my personal favorites — which uses benzoyl peroxide to kill acne-causing bacteria and calm down any redness or swelling from zits. If your skin is sensitive, opting for a benzoyl peroxide face-wash like this one instead of a serum allows for the strong ingredient to penetrate without having to be left on your skin all night, which helps reduce the possibility of flakiness or irritation. But as always, Dr. Hirsch says that before you buy the product, you should check with your doctor to ensure that it’s okay to use.

If you’re already off the pill and have been trying to get your active acne under control for a bit now, Dr. Hirsch often suggests La Roche-Posay’s Effaclar Duo, an overnight gel treament that’s easy to find (you can pick it up at a CVS or Target) and, like the PanOxyl face-wash, uses benzoyl peroxide to fight acne. While Dr. Hirsch clarifies that everyone’s tolerance is different, she said many of her patients have had success using a benzoyl peroxide such as this one or PanOxyl in the morning and a retinoid like Differin in the evening to treat breakouts.

While I allow my tretinoin to do a lot of the heavy lifting in my skin-care routine, on nights I don’t use a retinoid, I like to apply this serum from Naturium for an extra kick. It uses azelaic acid to kill bacteria, break up the dead-cell plugs that cause pimples, and help reduce redness. The formula also uses niacinamide for smoothing as well as oat and squalane to simultaneously moisturize and soothe the skin.

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Everything I Used to Fend Off Post-Pill Acne