Dr. Nicole Sundene, NMD
Holistic Dermatology & Hormones
Cystic Acne is a form of Hormonal Acne that tends to NOT follow the normal program when it comes to what is helpful for my typical acne patients.
Both the internal treatments from a Naturopathic standpoint, and the topical treatments vary quite differently in my mind and it is very important to get this skin condition under control with the proper treatments that work for cystic acne rather than lumping acne patients into a “one sized fits all” treatment plan that always fails the poor cystic acne patient.
The real Dermatological problem with cystic acne is it is occurring DEEP within the skin, and therefore most topical treatments are completely useless as they will not penetrate deep enough to be effective.
Cystic acne often does not rise to a head as normal acne, and attempting to pop cystic acne will cause scarring, as I have received from my own frustrating battle with cystic acne I share in "My Personal Acne Story."
Furthermore, so many of my cystic acne patients are in pain, frustrated, and desperate that they are constantly picking at their cystic acne and using mechanical scrubs.
If you do not learn anything from me today please learn that you should PLEASE THROW any mechanical scrubs into THE GARBAGE CAN if you have cystic acne and not use them. They will aggravate this condition and generally just dry out the top layers of the skin without addressing the problem at "The Root Cause."
Cystic acne is a very complicated chronic disease condition to treat in my experience, and is always multifactorial. Identifying all of the triggers from diet, hormone imbalance, and environmental causes must be addressed in order for cystic acne to permanently resolve.
As a female hormone specialist, I have seen many patients over the years with cystic acne, and there is always some form of hormone imbalance occurring between the female hormones, the pancreatic hormones, thyroid, and/or adrenals. Occasionally some women have imbalances in all of the aforementioned hormone systems.
The other issue with hormones and acne is that most of the MD's I worked for over eight years do not have the understanding of female hormones, and fine-tuning them that I have, and even if they know how to order your hormone panel (most do not) they don't know what numbers are optimal, and they lack the Naturopathic tools that I have to address the hormone imbalance.
The other issue with an MD treating your cystic acne, is they only know how to prescribe hormones, they don't know how to balance them. Generally, I do not prescribe hormones for cystic acne, which would be the only thing they would know how to do for you. Hormone excess is generally the issue at hand, herbs and natural supplements they don't know how to prescribe are then used to treat the hormone imbalance to clear up cystic ane.
A skilled women's health and hormone doctor is mandatory to diagnose the root cause of the cystic acne and order the correct lab panel that addresses all the hormones that can be potentially out of balance. My lab panel for this is generally 5-7 pages. Patients often tell me their MD just "Checked all their hormones," and all I see is a TSH, and or a testosterone level.
If we also do not address the diet and make dietary changes there is generally NO HOPE for me to improve your cystic acne. Just taking hormones is generally not enough, most hormone diseases I see occur because of digestive issues, as in Functional Medicine we call Digestion the “Mother of Hormone Imbalance,” so I never want someone to enroll in my practice and expect me to help their cystic acne, if they are not willing to make dietary changes.
It will simply be a waste of everyone's time and I only want patients to sign up to work with me that are willing to let go of whatever preconceived notions of diet they have and work to eat the diet their body is directing them to follow via signals from their skin.
Naturopathic Medicine will fail patients that cannot make diet changes, and it is important that patients know that up front so they can either work in conjunction with a counselor to assist me in enforcing gradual dietary changes needed by the body, or simply not sign up for Naturopathic services if you are reading this and thinking… “Nope, nope, nope…not gonna do it lady….”
Trust me, I feel your pain with diet changes and have struggled to cure my own cystic acne over the years. It was my 3rd year in Naturopathic school that I sat in on a lecture about cystic acne and realized I was doing everything wrong trying to apply things to my skin WAS USELESS as the professor described, and I needed to change my nutrition completely. It was only when I changed my nutrition, that my cystic acne cleared up. When I cheat on my nutrition too much around the holidays guess what happens?
It comes right back!
I still struggle with some of the dietary choices but I am able to them 80-90% of the time so that my skin is now clear. So this is something I live every day myself. I know it works, I get amazing long lasting results with patients that astonish and wow their friends and family with their beautiful glowing skin!
I have had also a few failures treating cystic acne because parents enroll their teenager without asking them first if this is something they are willing to try to do. Have your teenagers read my blogs on acne and let them decide if they will be able to do it or not. Many are enthusiastic, and are really excited to learn about the option of Naturopathic Medicine!
With that being said, many of my teenagers are some of the most diligent compliant acne, eczema, dandruff, and psoriasis patients! Most of us adults tend to have more food hang ups and habits than teens, and many children are very intuitive with their body and are excited to have all the right information. Kids also think it makes perfect sense that the food they eat is making their skin bad and they are more open to making changes with proper instruction and follow-up. I can work with picky eaters, as I was that way too. If you can get your child to commit to 2-4 weeks of diet changes their cystic acne will clear up and they will see the benefits of the diet changes, that is when they will be the most motivated to follow it for the long run.
How to care for your cystic acne:
Use all mild products that are hypoallergenic and free of parabens, phthalates, and xenoestrogen agents as hormonal acne can be made worse by these fake hormone chemicals.
Use a mild peel on your skin at bedtime that is not a mechanical scrub. Never scrub acne prone areas! Scrubbing your acne just spreads the bacteria causing acne around your skin and makes it worse!
It is better to exfoliate daily with a gentle peel such as beta, alpha and glycolic acids. Aloe vera is also a natural exfoliator and perfect for my cystic acne patients to use as their “spot treatment” as I discuss in my blog, “Dr. Nicole’s #1 Acne Potion.”
Apply “Dr. Nicole’s Acne Potion” to your problem areas before moisturizing and 2-5 times daily to reduce inflammation to your acne lesions
Apply a very light moisturizer to your skin that is hypoallergenic and free of parabens and phthalates as I discussed also above. None of your products should have these hormone mimickers as it is the #1 thing messing up hormonal acne and cystic acne for some of my female patients!
Go to an esthetician for monthly facials and ensure they are following my instructions as above and guiding you to the right trusted paraben and phthalate free organic products that will be the best for your type of acne.
Keep in mind that with cystic acne, “Less is more.” I often think of the movie Tommy Boy, where he sets his sale on fire, and completely loses his sale because he is overly aggressive and stressed out.
This is how I was before I learned the best treatment for cystic acne. I had a lengthy ritual of bedtime treatments and morning treatments I would apply to the cysts, and in hindsight I was really aggravating my skin. Less is more!
I hear and see this happening often with my cystic acne patients, and as a hormone doctor that endured a long battle of cystic acne which I explain in my blog, “My Battle with Adult Acne,” I know how frustrating it is and how it can even impact your self esteem and cause low self esteem.
While I never judge anyone that has acne, I know it caused me to hide and avoid events that required me not to wear make-up like pool parties, hiking, and camping with friends. I was privately horrified with how my skin looked and always had a giant boil forming on my chin or jaw line as well as general acne breakouts.
As the first step for your cystic acne treatment, please stop using harsh peels, mechanical scrubs, and oily products on your face. All of these will make your skin much worse, and you need to get the right topical and internal treatments, and a diagnosis for your flavor of hormone imbalance, so that we can prevent you from having permanent scarring on your face.
Did you know I find many different types of hormone imbalance causing cystic acne? It is not a one sized fits all treatment process, and I am more of a "Dermatology Detective."
I used to work for a Dermatologist that would actually shoot steroids into my cystic acne, so I know how miserable it can be. But, what I have learned from that is that our skin is simply sending us messages in the form of a skin problem, once we listen to the message and address the physical imbalance…. The skin problem goes away. That is then how I work my way out of a job as your “Holistic Dermatologist.”
If you have cystic acne and want to prevent scarring to your skin, simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit. I would be happy to help!
Dr. Nicole Sundene
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology, Acne, Psoriasis, Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease.
She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!