I've always considered myself lucky that, until about 16 months ago, I had seemed to inherit my grandmother's exceptional Eastern European skin. I struggled with pimples of varying severity throughout middle and high school, as we all (except Kaia Gerber) do, but my breakouts always seemed to pass. I was able to get by on my stable of drugstore products, like Neutrogena's three-step kit, which I used exclusively for no fewer than seven years. Things were just fine.
But then last spring, something changed. I started getting clusters of painful, under-the-skin hormonal cysts that looked as gruesome as they felt. They always seemed to cluster around the right side of my forehead and left unsightly dark spots that took months to disappear. I didn't know what to do, so I did what any well-meaning and desperate person would: I tried just about everything. I cut entire categories out of my diet and tried prescription topicals that dried me out like a reptile. The only thing I didn't try, in my own preference to avoid prescription pills, was spironolactone, by which several members of the Fashionista team swear.
This March, my dermatologist prescribed something new: Aczone, a topical gel that's approved to treat acne and works especially well on adult breakouts. I apply it to clean skin, once in the morning and once at night, under moisturizer. It saved my skin. That's no exaggeration: In literally one week, I experienced fewer new breakouts, and it had calmed the existing blemishes. Now, five months in, I don't know if my skin's ever looked better; in addition to being clear, it's smoother and more luminous than it had ever been before I started using the treatment. For me, it was a complexion miracle worker. Here's everything you need to know about it.
What It Is
While Aczone is approved to treat acne, it contains the active ingredient dapsone, which, interestingly, can also be used to treat both leprosy and dermatitis herpetiformis, a chronic skin rash. But just as spironolactone is technically a diuretic that's FDA-approved to treat high blood pressure, dapsone can also treat acne when applied topically, and with little to no side effects. And that's fairly rare.
I spoke to Dr. Joshua Zeichner, the Director of Cosmetic and Clinical Research in Dermatology at Mount Sinai Hospital, he explained that Aczone is unique in that it doesn't cause skin irritation and also doesn't bleach your fabrics should you wear it overnight. (To his point, I've experienced absolutely no redness or drying since I began using it, which has been, in a word, wonderful.) The thin, opaque gel-like lotion is available at 5 percent dosed twice daily or 7.5 percent once daily, a choice I discussed with my dermatologist.
How It Works
"While the mechanism of action is not completely understood, dapsone is known to have anti-inflammatory effects," says Dr. Zeichner. Dapsone itself is also antibacterial, and though it works to prevent breakouts in the future, that's why it can also help clear up preexisting acne, too. Its properties prevent blood cells from lingering in the affected area and thus, it calms inflammation (that's also why it can be used to treat leprosy, an infection that manifests itself in light, red-colored patches and lesions).
Aczone works best on pimples that are large and inflamed, like the cystic acne I was experiencing. And, true to my experience, it's known for getting to work quickly. According to Dr. Zeichner, results can begin as early as one month, but it starts to hit its peak effect at three. And in a 12-week trial, as reported by Glamour, 41 percent of patients treated had minimal or no acne at 12 weeks, compared with 33 percent in the control group. Not too shabby.
It's worth noting, though, that like most acne treatment, it's not exactly one-size-fits-all. While Aczone worked wonderfully for me, two Fashionista editors noted that they, too, had tried Aczone but didn't experience the same positive results I did. As I've found, it can take a while to find something that works for you and your skin, but be patient! The miracle is out there.
How to Use It
Aczone is often prescribed in conjunction with either an oral antibiotic, like spironolactone, a retinoid, like Differin, or both, though it can also be used on its own (along with a good at-home skin-care regimen). For hormonal acne, Dr. Zeichner commonly prescribes it alongside spironolactone to further block the effect of hormones on the oil glands to minimize oil production, which then lowers the amount of oil available to feed acne-causing bacteria on the skin. (For more information on spironolactone and its side effects, read our explainer.)
Aczone is incredibly easy to use: Just apply a pea-sized amount to skin — a little goes a long way — after cleansing, then follow with whatever else you typically put on your face. Dr. Zeichner, of course, recommends pairing it with a sunscreen for daytime.
Who Should Use It
All patients and acne types have been shown to benefit from the use of dapsone, though Dr. Zeichner notes that it's particularly useful in treating acne in adult women, especially for those "red, angry pimples." (While at that initial consultation back in March, my dermatologist mentioned that his staff — many of whom are women and appear to be roughly my age — always race to take home Aczone samples when they come in.) As for who should stay away from it? Anyone who is pregnant or planning on becoming pregnant, since Aczone can reportedly pass into breast milk and may cause harm to babies.
If, after reading this PSA, you think you'd like to try Aczone for yourself, reach out to your dermatologist for more information. You can read more about Fashionista editors' experiences with spironolactone, here, and Accutane, here.
Homepage photo: Imaxtree
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