Here's the tea: If an Internet headline is touting some singular quick fix for hormone-related acne, it’s probably clickbait. And furthermore, if some beauty editor is claiming that their case of acne was the worst, most extreme thing in the world, that’s probably hyperbole, too. Did the chin breakouts I dealt with this year as a result of my new IUD ruin my life? No. Certainly, research shows that chronic acne can cause major emotional distress, anxiety, and depression, but to say that my first-time adult acne experience caused any trauma, and that one teeny-tiny, straightforward product swap cured it for all eternity, would be a lie. “Acne… is a nuanced, complicated beast, influenced by... genetics, hormones, diet, and so many other seemingly random things,” wrote former Byrdie editor Victoria Hoff in a 2016 piece called “A (Very) Honest Discussion About Acne.” Everybody’s acne experience is totally different. Now, all that being said, here is mine.
IUDs and Your Skin
Before the spring of 2019, I had never had more than one pimple at a time, ever. But just before my 27th birthday, I had the Mirena IUD put in place (it was the most physically painful experience of my life, though that’s another story). Before my appointment, I had taken a cursory glance at the product’s potential side effects, so I knew that due to its use of the pregnancy-preventing hormone progestin, blemishes might result. "Hormonal IUDs may trigger acne for some women because they release progestin (an artificial form of the hormone progesterone) into the body," explains esthetician Renée Rouleau on her skincare blog. "When progesterone levels are increased, this can, in turn, increase the number of androgenic hormones (like testosterone) in a woman’s body. Androgens can cause acne by overstimulating oil glands, especially when you combine this with dead cells in the pore lining." Women who tend to break out before their period are more susceptible to acne after receiving a hormonal IUD like Mirena or Liletta. However, as someone who’d never really dealt with period breakouts before (and who also didn’t personally know of anyone who’d dealt had IUD acne), I figured I was in the clear.
Rest assured that soon after getting my IUD, when my chin exploded in cystic pimples, I was astonished. Whose skin is this? I thought to myself every morning when I looked in the mirror. I’d written about skincare for years, and still, I had no idea where to begin handling my acne. I’d thought the worst of my IUD experience was over after the excruciating insertion; but, just like doctors underreport the pain level of IUD placement (one study showed that on a scale of 0 to 100 women ranked the pain of insertion at about a 65 on average while doctors ranked it only about a 35), no one ever told me how bad post-IUD hormonal breakouts could be.
After about six weeks of doing not much at all to treat my acne (other than staring at it, hoping I was hallucinating), I decided to accept that this was my skin now and take action. A friend of mine had recommended I check out Beverly Hills-based esthetician Cynthia Franco. I had heard of her because the indie actress Mia Goth once told me in an interview that Franco gave her “the best facial [she’d] ever had”—a refreshingly “technical” experience in which “she did something very interesting with spoons.” Yes, great, spoons, I thought. Whatever it takes to get my face back on track.
Now, because its cause comes from within, even the best facialist on the planet can’t all-out cure hormonal acne, but they can at least get it under control.
And, if the esthetician is as experienced as Franco (who’d had two other clients come in with IUD-related acne issues just that month), you can walk away with some solid advice for how to maintain your results. I’m going to tell you right now: The acne-control facial I received from Franco was neither simple nor painless. It was a complex 90-minute ordeal, and not what I’d personally call relaxing (neither was the routine she gave me afterwards), but you know what? It really worked, and I haven’t had a bad breakout since.
“For hormonal acne breakouts I focus on deep cleansing and healing,” Franco says. My facial began with a double cleanse: first, an oil cleanser and facial massage to soften and coax out the debris and sebum (“I take my time doing this,” she notes). She followed up with a salicylic acid-based gel cleanser. Next, Franco applied an exfoliating enzyme mask over my whole face and spot treated the especially broken-out areas with a salicylic treatment mask. Then came a glycolic peel to clear the top layers of dead skin and gunk from my face.
Then, came a series of fancy devices: To treat my skin’s congestion, Franco administered a galvanic current and alkaline solution treatment. This process, called desincrustation, is basically a deep cleaning treatment, which involves gliding a little metal rod over the skin to administer an electrical current (it feels sort of like being low-key electrocuted, though it’s not actually super painful). This causes a chemical reaction, attracting toxins and debris out of the skin. Next: extractions. Franco does hers with a little vibrating spatula, which is able to unearth even the deepest, most stubbornly clogged pores. And after the extractions came a dose of high frequency (this is another electrical current treatment that kills bacteria and reduces inflammation).
Franco finished up with the healing portion of the treatment: a healing probiotic mud mask and a sulfur treatment to reduce any redness and swelling. Next she did a microcurrent infusion with a pure hyaluronic acid-and-aloe gel (“While microcurrent is sought after for lifting the face it is also highly beneficial for keeping breakouts away,” Franco says). Then, she applied AQ Solutions’s EGF moisturizing mask and let me chill under her blue LED light for a few minutes. “Blue LED can kill up to 97 percent of a certain type of bacteria that causes acne,” Franco says. Last, we did a hyperbaric oxygen infusion treatment (to help with cell repair) with vitamins, propolis (a healing product bees make naturally), and serum, followed by an adaptogenic soothing toner and probiotic moisturizer, both by Epicuren.
How I Maintain Clear Skin Now
Franco's no-joke facial was exactly the kick in the ass I needed to really start addressing my acne at home. According to her advice, I made a few key changes to my topical routine: switch from my favorite Japanese (chemical) sunscreen to a natural zinc oxide one (the zinc actually helps with breakouts), add retinol and sulphur to my routine, exfoliate a few times a week with salicylic acid to clear my pores and glycolic to heal any acne scarring, and continue using the tea tree spot treatment I already had. At Franco's urging, I also started eating way more probiotic-rich foods (so much tempeh) to help heal my gut biome.
After about three weeks of adjusting my routine, combined with just sort of letting my skin’s healing run its course, my face is basically acne-free. Do I still have congestion and breakouts here and there? Yes. Do I wish getting rid of hormonal acne was as simple as one product tweak? Certainly. But I’m doing what I can. Acne is a nuanced and complicated beast indeed.
Gorelick J, Daniels SR, Kawata AK, et al. Acne-Related Quality of Life Among Female Adults of Different Races/Ethnicities. J Dermatol Nurses Assoc. 2015;7(3):154-162. doi:10.1097/JDN.0000000000000129
Maguire K, Morrell K, Westhoff C, Davis A. Accuracy of providers' assessment of pain during intrauterine device insertion. Contraception. 2014;89(1):22-4. doi:10.1016/j.contraception.2013.09.008
Yin R, Dai T, Avci P, et al. Light based anti-infectives: ultraviolet C irradiation, photodynamic therapy, blue light, and beyond. Curr Opin Pharmacol. 2013;13(5):731-62. doi:10.1016/j.coph.2013.08.009