Acne: dealing with nasty pimples

I’m taking a break from my usual blog entries to discuss a personal health issue, which is honestly a bit gross.

WARNING: Don’t read this while you’re eating, or maybe don’t read it at all. And DON’T SAY I DIDN’T WARN YOU.

Now that we have that out of the way… acne!
Most of us, especially men, get acne in their teenage years. Maybe a few zits here and there, maybe a whole face of pimples.

And for most folks that’s it; it’s gone by the time you’re in your early twenties.

But some of us aren’t so lucky.


I easily had the worst acne in my high school class. I had a pimple here or there at first, but then it slowly conquered my entire face.

My doctor prescribed some topical creams including bezoyl peroxide and Retin-A. She also gave me a large dose of antibiotics. According to modern medical theories, acne is caused by clogged pores, clogged with bacterial infections of the skin. The creams and antibiotics should take care of this.

These treatments didn’t work, my acne was getting worse. So she sent me to a dermatologist.


At this point (I was about 17) the acne had started forming what the dermatologist referred to as “cysts.” These were like monster pimples that would bleed and leak puss. She put me on a regime of an oral medication called Accutane and injected the cysts with cortisone.

Now this sort of worked, but the effect was temporary. The Accutane helped for a few months, but it’s not very good for your liver so there’s a limit as to how much you’re supposed to take. At the end of the Accutane cycle I was no better than before, except now my skin was incredibly dry.


At this point the cysts were at their worst; they would leak small amounts of puss, then skin would grow back over the puss. The nose pads on my glasses would be encased in skin and puss by the middle of he day, so that when I took my glasses off the cysts on my nose would start bleeding and leaking puss.

I tried all kinds of things; topical vinegar (it stings like crazy) egg white (is that even safe?) not to mention countless over the counter creams.

But the only thing that seemed to help were the cortisone injections, and the effect of those was short lived. I’d get an injection one week and a couple weeks later, the cyst was back.

Solution part 1: Topical ointment

Around the time I left for college, I discovered a website run by a guy in San Francisco called This site is run by a self-experimenter who found that washing his face carefully and using a 2% solution of benzoyl peroxide was effective in clearing his face. The novelty here was the 2% solution; normally benzoyl peroxide only comes in a “maximum strength” 10% solution. The advantage of this was that the 2% was less drying than the 10%, and it was significantly more effective.

Neutrogena was the only major brand selling a 2% solution at the time, and it was quite expensive at about $15 an ounce. But it did seem to be effective!

Eventually, created their own custom 2% benzoyl peroxide solution and sold it at a fraction of the cost of Neutrogena.

This worked for me far better than anything my doctors had ever prescribed. It was also cheaper, and there were no oral medications (taking antibiotics all the time makes your stomach hurt 24/7.)’s “regimen” improved my skin, not to mention my quality of life. If you haven’t experienced severe acne personally, I should tell you that having acne all over makes it painful to smile or talk.

Solution part 2: diet

Over the past 7 years I’ve experimented with diet for a number of reasons. I tend to be of the mindset that our species evolved to eat certain foods, but the foods that are common now are not what we evolved to eat. The obvious example is hydrogenated oil, aka “trans fat” which was developed in a lab a century ago. Our bodies responded to this new type of fat in an unpredictable way because we had not evolved to consume it.

So when I was given a book called The Acne Prescription: The Perricone Program for Clear and Healthy Skin at Every Age by Dr. Perricone, I was skeptical but not surprised by the finding that diet played a role in acne.

The book essentially advocates a very low-carb diet, completely free of refined sugars. No table sugar, white flour, etc. This means you’re not allowed to eat pasta, rice, corn, potatoes, bread, or anything made from dough.

It sounds rough, but keep in mind that the quantity of sugars we’re eating today are not what our ancestors ate. Most vegetables and all meats and fish have very few carbohydrates.

The other interesting thing about this book is that Dr. Perricone refutes the notion that acne is caused by bacteria. His hypothesis is that acne an inflammatory response caused by an immune system gone haywire from too much glucose in the blood. Hence the low-carb diet.

I’d also like to point out that I drank an absurd amount of soda all throughout high school, which if the blood glucose theory is correct, would explain why my acne got better; it wasn’t due to growing older so much as switching from soda to coffee.


For me, both the topical solution and the Perricone low-carb diet have worked… to an extent.

The topical regimen works wonders, but its effect is merely skin deep. Sure, the acne appears to be gone… but for me, it’s not. Instead of a couple zits on my face I get cysts that are under my skin. I can feel them; in fact it’s nearly impossible not to because large subdermal cysts are damn painful. And sometimes pimples show up inside my ear canals. It’s not easy to apply topical ointment in there. It’s also kind of strange to tell someone that it’s no big deal that I’m bleeding from my ear. It makes me feel like the James Bond villain in Casino Royale who bleeds from his eye.

So while the solution does work, for me it relocates the problem rather than solving it.

Dr. Perricone seems like he’s on to something. Right now I’m on a low-carb diet for the second time in my life, and my acne has been drastically reduced. But since I’m a pizza addict, I’m unable to do any low-carb diet without a weekly “cheat day.” For this reason, the topical solution is an invaluable accomplice to the diet.

In combination, the Perricone diet along with the 2% benzoyl peroxide regimen dials down the acne to a very manageable level.


Acne sucks. If not for aesthetic reasons then because it makes it physical hurt to smile, frown, or move your facial muscles at all.

Thanks to the internet and a love of self-experimentation I was able to get my acne down to a very mild level.

Look, acne isn’t going to kill you. If you have acne (and if you don’t why are you reading this repulsive entry?) then it’s worth taking a few months to do some self-experimentation. You don’t need to go to a doctor to treat your acne, and if you do there’s no guarantee that the side effects of your doctor’s prescription won’t be worse than an effective over-the-counter ointment. Maybe it’s time to try the topical regimen. Or why not consider a low-carb diet? Or both?