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The routine that saved my skin
I suffered from Skin Picking disorder since I was 2... I used to pull my hair in my childhood, then acne in my teen years, then my toenails, then back to adult acne.
Last year there were many changes in my life and stress, anxiety and boredom woke up my compulsions uncontrollably. Since I am almost 40 and had scoriated acne / lesions / scars that would never heal, I wanted to put an end to this... I was so sick of it, and embarrassed.
What changed, was that I admitted to have a problem, opened up to ny husband about it and my trusted close family. So I read all there was to read about this, enrolled to this website/program/forum, wrote a diary and talked to a therapist for a couple of months... did some improvement, but always had fallbacks.
Funny how things indeed seem at the beginning of this journey to be impossible, but if you really reach the bottom, the chances things can get better are very good.
Below my manual. It worked for me, so I wanted to share. The first part is a summary of the opera for compulsive toc / picking. And then, what I did to physically help my skin, which was in itself, a big side of my problems.
Part I
Picking / psychotherapy:
"Urges" (from skinpick.com)
- Understand why you have them;
- ... Avoid triggers!
On the website, you can download the app, and monitor urges / note down sensations etc in a diary. Helps understand triggers, then try to avoid them.
Why / when:
I have urges mainly when my skin has some mild acne. I start picking when I am bored / anxious / stressed. One thing leads to another...
Understand your triggers:
Stress makes my skin oilier, the pimples tend to appear, and the cycle begins. But if I am left with a lot of time on my own - or simply anxious - I end up creating situations for "picking".
Mirrors or bathrooms with strong light show "defects" and should be AVOIDED (if possible, used in "company").
Ps: Today I go out early, I exercise, I focused my energies on various activities and hobbies ... I stay only a little time at home - and when I am, I focus my time/energy on other enriching activities... I play the piano, do some drawing, I even wash the dishes ... EVERYTHING other that entering a bathroom.
Hands off:
The "addiction" can be "focused" (when you do with the intention - ex.: in front of the mirror), or almost "unnoticed" (unconsciously), like touching the face to feel its "texture", etc.
This light touching contaminates the skin and again triggers the process ... so I now watch films with "anti-stress toys" on my hands. I had a new mania also of itching behind the neck and back (where I reach). My brain kind of created this as "competing response." The correct thing would be to stimulate nondestructive actions, but at the same time occupy hands and brain equally.
It can be ok though to negotiate with yourself "other areas", when you have an urge ... cuticles etc - everything to let the face / area to be rested ... but only as a "crutch" in the process.
Make-up:
Another good trick when the skin is kind of bad is getting a pretty good make up in the morning. Helps improve the self-esteem, and with it on the face, we avoid “touching” it. I have to be careful not to allow this routine to turn into another trigger (staying close to yourself/skin/mirror is never good). I walk into the toilet a half hour before I leave, just to give myself time to get things going.
Today I prefer to use the least possible daytime makeup so that my skin is not “clogged".
When the skin starts to look good, just a minimum of concealer and powder / blush - no foundation! Little makeup, made in a bathroom in low light. On a day-to-day basis, I do my make-up in the car - I think it's even better.
Part II
Skin care:
... Those with ocd will always aspire to have a "smooth" skin. So I decided to fight for it by testing various products.
Here is my routine - it cleared my adult acne:
1. Wash my face with soap with salicylic acid.
2. Use the P50 toner from the biologique recherche brand. It cleanses up to the soul, the scent is a bit like vinager ... it helps exfoliate, remove dead cells and debris from make up (which clogs pores). I had some internal pimples/cists on my neck, chest and jaw ... everything came out.
3. Use the vitamin C from skinceuticals - it leaves the skin moisturized but fresh. It is importante to moisturize the skin after cleaning it, it balances it back to normal (if left too dry, it will overproduce oils)
4. I use the egg mellow cream from too cool for school with some teatree oil drops and sunscreen for daytime
5. For the evening, I use instead an MSM cream
* On top of pimples I use only pure teatree oil or the blemish (salycilic acid) from skinceuticals. If the skin does not react, I try the next day salicylic acid gel from neutrogena. I think it's good to switch, it's more efficient ...
(A period that my skin was very inflamed, I used sometimes the led mask from Neutrogena. It was good with cists ... idem the led pen ... I thought that helped to decrease inflammation)
* In open pimples I also use bandaids (hydrocolloid), which help to absorb water / inflammation. Leave it on the skin for 8 hours, and the bumps disappear and healing accelerates
* when I have to remove makeup from the eyes and I have used foundation, I use an oil based makeup remover and the foreo or the sonic brush to clean WELL the skin
What I'm doing aside from this - that helped MUCH:
TCA peelings
- 1x every 15 days, a session. I was using 15% at home, but my skin became resistant to the percentage. After 4-5 times, I did it then at the dermatologist with 25-30%. It was great, it rejuvenates, improves texture and also helps dry blackheads and pimples.
* the skin peels already in the 2-3 day (nothing horrible ... with moisturizer it is not so visible!), For max. 5-7 days.
Micro-needling
- Alternate with TCA the "dermaroller" (1 week tca, 1 week the roll): I put vitamin C ferulic after the session
- Dermaroller also helps to improve some blemishes and scars (acne cannot be active with this)
I bought 2: 1 of 1mm and another of 1.5mm, the deepest one for the worst scars
- I got some mild improvement from dermarollers, and then upgraded to Vivace (microneeding with radio frequency) - I am now on my 4th month. The theory is the same, but the needles are precise and change from 5mm to 2.5-3mm on each different area of the face. Great too, I found it almost painless, 0 downtime. It lightens blemishes, renews skin, creates new collagen, etc.
Medications - I do not know if they influence:
- I started taking NAC, 1200g x day, 4 months ago. It helps contain "urges" in the brain. It might have helped a bit ...
I never slept again with makeup, and I follow this routine every day, morning and night. My skin still has blackheads and mini pimples, of course, but I avoid looking. I agreed with myself to look at a distance of at least 30cm from the mirror. No one comes so close to our skin to check it ... At night, when the risk of "analyzing" is greater, I enter the bathroom when my husband is still awake (on purpose) ... and he keeps "monitoring me" .
Sometimes I squeeze 1-2 pimples, but the next day I regret it. Every single time. But I think I'm finally able to "reason", even because my skin has improved a lot, and then I can convince myself that it is not worth it! This whole process was long (7 months)... but having good skin is the best incentive not to ruin it. Focus your energy in things that make you feel good about yourself, and slowly, your time will be used for better, you will feel powerful again... and skin picking may become something that “”you used to do”...:)
Very informative post. Thank you for sharing all of your experience so far!
I'm very curious about your TCA treatments. Have you noticed that your scars improve from the chemical peels or do you feel you need to do more of them to see results? Also, how long did you leave the 15 percent TCA solution on your skin? How many layers did you do each time?
BTW...the vivace treatment looks very interesting. I read about it in Allure magazine this past week. Will have to find the article again. Do you notice that the microneedling and the simultaneous radio frequencies break up scar tissue and trigger the formation of healthy tissue in between or does it shrink the diameter of the scar? I can imagine the scar possibly tightening it's edges as it keeps on being damaged and having to compensate by producing more collagen for healing. I wonder if scar tissue can be fragmented into smaller chunks where it's less obvious. Particularly the flat white scar tissue which lies like flat platelets in between skin layers.
Hi Serene! I loved those peelings, they gave my skin that initial boost of healthy skin that I needed. And for some reason, recovering from peelings unwires my brain too... I manage to let my skin heal and keep my hands completely off for the first 4 days, which was the pause my skin needed and the peace for my mind that helped me snap out from the compulsion. Sometimes those 4 days only really do the magic my skin needs! I say 4 because I do tend to peel off some deade skin and exfoliate mildly as to accelerate the post phase. I know we shouldn’t, but it is difficult for me not to. Anyway, I only do it so carefully that it has not been a problem ever. It helped a LOT the pigmentation and texture overall. Shallow scars also improved. I think though for the deeper scars, there are other treatments that help more the collagen inducing, which is why I started the dermarolling at home and eventually upgraded to vivace - which I loved. It is a very slow process, but I am getting more and more compliments for my skin...
As for tca 15%, I arrived at 15 minutes max., with 3 layers +-. In some areas I went for an extra layer. My skin felt stronger and less reactive to it after 2 months (when I did 4-5 peelings on my own), so I did my last 2 (20-30%) at the dermatologist a month or so ago, since it was still cold and there was not much sun out. With the higher percentage, 5 minutes and one layer was enough to achieve the same level of peeling I was doing at home, yet I noticed I flaked a bit in sheets on some areas as well then. I bought the 20% ad will use it again next winter... my doctor here keeps telling me that I still have some acne left and tca is not the best (she insists on glycolic and other stuff)... but I tell her that nowadays I mind less the acne, but get more bothered on the texture (scars), because I can hide everything else with some make up when needed. Scars are a bummer.
But yes, improvements are gradual, but the key is consistency - I included in my routine the vivace now (ok to do during summertime), and it is addicting. I even enjoy the mild pain (lol)... becaise it feels like an investment!! :)
To answer the questions: “Do you notice that the microneedling and the simultaneous radio frequencies break up scar tissue and trigger the formation of healthy tissue in between or does it shrink the diameter of the scar?” - yes, it does. It creates controlled damage, with 0 downtime, and your skin after only a couple of days glows and feels tight/plumped. The actual longterm effects can be seen after 1-2 months. I feel like it helps to even out the surface slowly, but effectively. I used some filler on the deeper ones I had and my doctor with the needle did some mild subcision on those, which were good too... from some distance and pictures, the overall picture is aready much better... so I will continue doing this and check again results in a year or so. I became also more patient and less hudging of myself... with time. So I can wait, and having improvements help me also during the process. “I wonder if scar tissue can be fragmented into smaller chunks where it's less obvious. Particularly the flat white scar tissue which lies like flat platelets in between skin layers.” Not sure I understood this, can you explain it better? What I did notice is that the led lights vivace has also KILL bacteria... so to me, it is even better than laser...! All in one procedure :):). I have also done this past 6 months one mild laser deep co2 (not sure on the specs of this) and one session of fotona 4d (good for skin tightening and overall texture).
Everything helps, but the real difference had been achieved with tca/vivace.
*judging
So I found the info on microneedling with radio frequency. It says that these treatments poke tiny holes in the skin to promote healing, which will help you shed the abnormal scars. At the same time, a radio frequency laser heats underneath the skin to build up regular collagen and tighten the scars. There is no risk of triggering hyperpigmentation. They also use these treatments for stretch mark removal. Interesting, because the white scars I mentioned look similar to stretch marks in that they lack normal pigment. For stretch marks they use Intracel and Intensif and 2 to 4 treatments can produce improvement of 60 percent. In the next post I include a link with an example of the white type of acne scars I'm talking about. On this lady they are very apparent because she has tanned her skin. Just scroll down to the last photo on the link.
http://www.regionalderm.com/Regional_Derm/files/acne_scars.html
I purchased a glycolic peel..30 percent which is a mild starting dose. I have not tried it yet. Also got a lactic peel.... have not tried that one either. Lactic acid is the best for pigmentation issues. Which TCA brand did u purchase the 20%? Also the VI peel is really good. I got it done at a dermatologist and it was very effective.
Are you using retinol in between treatments or does your dermatologist not advise it due to possible skin sensitivity?
This is a great post. It is exactly how I feel... it was a long ride, and the more I focused on new things/activities and the more I took good care of my skin (both things simultaneously), the less I felt the need to pick and the better my skin became... fot both the skincare products and less destructing picking (I managed somehow to invert the cycle). The routine is really important as I need a smooth skin that will not make my brain crazy to pick it... and providing little time for countless hours in the bathroom, I gave it enough time to start healing.
Before, I would not engaged in anything since my mood was hopes were so low that I did not feel like going out. My days were long and all I thought about was how bad my skin looked... so the beginning is the hardest, I forced myself to be out, to think and try new habits/hobbies that would fulfill my mind and make myself feel worthy again.
All the peelings and procedures also make you think of it as an “investment” (time and money) not worth ruining. TCA and microneedling (vivace) are not so expensive, and can be alternate every 15 days. This was also crucial as, like I said, it really helps clearing the skin and gives you a push towards that peace of mind.
Now I look at my skin and the thought is “it looks so blemish free, I will NOT ruin it” as opposed to “it looks so awful, I might as well just pick it and relieve this urge”.
I feel more confident, people tell me my skin look better. It was very slow and gradual, I still don’t feel 100% cured but it is ok.
It took me these many months to post again on this website. I also learned so much from it, that I wanted to share my experience, hoping it can help people - it is possible to slowly train yourself to be different. It is not easy, but it can and will work if you are consistent and determined.
I did as said create new mecanisms (competing responses) that are not healthy either (picking my toenails, chest and back). But these areas don’t provide the same level of pleasure my face did anyway (not sure why...), so I just did/do it when trying to take the focus away from my face. So now my chest looks a bit ugly (some scars and pigmentation, but nothing too serious)... I will take my time to help it heal as well... it seems anyway less complicated.
I believe that creating a meticulous routine is key... for people with ocd, even better :). We love “steps”. I forbade myself to use any bathrooms with strong lighting and keep a safe distance - always - from the mirror.
When a big painful zit comes to the surface... there is still a 50% chance I won’t be able to ignore it. But... they are now occasional.
Within a month of my routine I was already noticing the difference - that toner p50 really accelerated the process (I am now using it on my back and chest and they are both better as well).
Another good point you mentioned is our perception. I guess checking out people’s “digitally enhanced” picture on social media can make us think that good skin has no pores, no blemishes, no wrinkles... and feel insecure. I started to watch some people whose skin looked so great more closely... and noticed this was an illusion. We tend to check on our skin on such a detailed level that we miss the whole point... and anyway we’re not our skin! Skin is just skin. Difficult to see things like this when my skin looked really really bad. But now that it looks better (not flawless, but better), I am starting not to care so much and not to focus too much on its flaws. With make-up, when I need it, I can I create the illusion of even better skin... I use the porefessional balm from Benefit to make my pores look small (it really works), use some nice foundation to even out the tone... and really, everything is just perception. I focus instead gon exercising, being fit, and my new/old hobbies and activities that I started to do on a regular basis (as to create a new healthy routine), with a full time schedule OUTSIDE my apartment, hence no time to check on my skin. But religiously, I clean it... never skipping one single day... with all those products I mentioned and also, avoid foundation/heavy make-up on a daily basis.
You were already a step ahead, you’re younger, and have already your sucess story with the nail biting, so your skin - if not yet - is next on your list :).
I am on a good phase, have had many (millions...) setbacks on the way, but everytime I picked, I forgave myself, and started back again, and again. It is really a learning process and an addiction, and by the time you realize it is so destructive, so much harm has been done, and the guilt is hard to cope with. But this community made me feel normal, and all these notes and feedback - yours specially - made me connect and keep it up. My husband and family played an important part, no more jokes and judging are allowed anymore. Everyone finally gets it - me in the first place.
My sister opened up and told me she actually had the exact problem for years (so genetic...) - so close, so far... I thought she did not have it!! She also said she managed to beat it only after her first daughter was born, as she had a “new focus” and very little time for herself. Sometimes all we need are very big “distractions” to point you in the right direction.
Anyway... happy to hear from you!
Happy you think this post helped.
Hi again! Now I see what you mean about white scars... I have some close to the jawline, but with some make up they are easy to hide, so they do not bother me much.
I am not using retinols - at all - since I am now trying to get pregnant... bummer. Many things I should not use :-(.
The tca 20% I bought (have not used it yet) is from PerfectImage. Now there is already too much sun, so I am afraid I might have hypergimentation... just relying on vivace lately...!