I Tried A 30-Day Herbal Blood Cleanse To Treat My Cystic Acne

I am wearing a paper robe in an exam room in the office of a dermatologist I found on Zocdoc 20 minutes ago, fully nude except for a pair of sandals, which I am staring at as I face the wall. “Good, good,” the doctor says as he inspects my back for irregularities. The nurses behind him “mmhmm” in agreement. Apparently, this medical practice requires that all first-time patients, regardless of the reason for their visit, undergo a full-body skin exam — so yes, it is fair to say that I will do just about anything for a cortisone shot to quell a cyst, even if it involves getting naked.

As is the case for many people who wage the war against acne outside of the 12-to-20 age bracket, synthetic hormone injections are only one of the many questionable methods I’ve relied on to keep my face looking more like my face and less like the Lady in the Radiator from Eraserhead (google it). In the past five years, there have also been harsh topical treatments (accompanied by strongly worded warnings against use during pregnancy), three different types of birth control pills, and even an ill-advised yearlong stint on the antibiotic tetracycline — and always some combination of one or the other, because there’s never just one thing that makes a difference for my difficult-to-treat brand of hormonal acne. Sometimes, the stars align and my skin ends up clear for a precious moment, but chaos always awaits me just around the bend.

That is, of course, how I ended up there, naked, in the care of a dermatologist once again. After I was declared free of suspicious moles and authorised to put my clothes back on, the doctor took a closer look at my situation.

“Well, you definitely have acne,” he told me as he examined the three very red, very inflamed cysts lined up on my chin, the area of the face almost always reserved for breakouts of the hormonal sort. “I can give you a cortisone shot for those ones today, but what do you really want to do about it?”

I rattled off my existing plan of attack: a gentle cleanser followed by a topical antibiotic, a non-comedogenic moisturiser, and sunscreen in the morning. Then, another gentle makeup-removing cleanser, a non-comedogenic moisturiser, and a retinoid to top it all off at night. Plus, there’s the probiotic supplement my gynaecologist recommended that I take in the morning and the hormone blocker spironolactone, which I take 50 milligrams of twice a day. Oh, and I have a hormonal IUD.

“So, I don’t know what else can be done about it, let alone what I want to do,” I said, a little exasperated. After all, what I really wanted was for someone else to tell me the solution, not for me to have to figure out if there even is one.

The doctor paused. “Well, I’m also an Ayurvedic practitioner,” he said. “Rosie O’Donnell is one of my best clients. I think you could really benefit from a 30-day blood cleanse with neem.” He took out a pen and notecard, onto which he scrawled the words “neem tablets — 30 days — The Vitamin Shoppe.” He handed it to me. “Don’t forget: neem. To cleanse the blood,” he repeated before walking out. I left feeling perplexed. I had no idea what the hell neem was, and could not for the life of me understand how Rosie O’Donnell and blood cleanses had gotten involved in my routine dermatologist appointment.

Neem, as the internet informed me, is a tree. It's also the subject of a report titled Neem: A Tree for Solving Global Problems published by the National Academy of Sciences in 1992. Neem is native to India and South Asia, where its products have been used for their medicinal properties in the Ayurvedic tradition for thousands of years. According to those schools of thought, it’s an effective antifungal, antibacterial, and disinfectant. It's also believed to improve liver function, balance blood sugar, and treat skin diseases, particularly eczema and psoriasis, though thousands of all-caps Amazon reviews attest to supposedly transformative experiences after taking neem-leaf tablets to treat cystic acne. Convinced that a good blood cleanse would cure me of all my ills, I ordered a family-size bottle of capsules comprised of neem leaves, soft twigs, and flowers.

I’m no stranger to a variety of pills and supplements, but I still found the neem tablets to be a little more off-putting than I would have liked. For one thing, they’re sizeable — about the size of the average human thumbnail, I’d say — and the clear gelatine capsule means you get a clear view of what’s inside. And what's inside is crushed-up leaves. Then, there’s the taste, which is comparable to that of omega-3 fish-oil pills, which, coincidentally, is the reason I stopped taking fish-oil pills. Still, I soldiered on, holding my nose and trying not to choke. I took one of the tablets each day with food and water for 30 days as recommended, then consulted a physician.

“‘Blood cleanse’ is an old term given to herbs that are typically used to clear skin conditions,” explained Daniela Turley, a licensed medical herbalist. “Realistically, though, herbs that are given this term are likely to work through multiple means. Most ‘blood purifiers’ have anti-inflammatory properties, stimulate the liver and gallbladder, fight off bad bacteria and fungus in the gut, and increase digestive enzyme production.” Of neem in particular, Turley said that while she personally doesn’t use it to treat acne — in fact, she’s used the oil as a topical antiseptic and to treat her houseplants for funguses — it does have a traditional use in addressing skin conditions.

“Neem is such a rich source of bioactive compounds,” dermatologist Kenneth Howe, MD, told me. “It seems to have a lot of effects as an anti-inflammatory and antibiotic, which could potentially help acne a lot.”

But as for prescribing herbal treatments to his patients with skin disorders, Dr. Howe said, “I’m very interested in the use of Ayurvedic therapy for acne. If my patients are interested in it, I’ll refer them to an Ayurvedic practitioner. I don’t do it myself, because you can’t just take one herb and administer it in a Western way, say, as a single pill. They really need to be used in context.”

There’s also the question of what’s actually in those pills. “I’m just not sure how effective a lot of the neem extracts sold in the United States are,” Turley said. The potency of the terpenoids, which are the active plant antioxidants in neem, takes a hit from the drying process required to bottle them up into something that has a reasonable shelf life. In the U.S., Turley explained, “Manufacturers are only held accountable for making sure the plant is the correct species, with no onus on the manufacturer to make sure the product has any active ingredients.”

Sketchier still, she adds, “We find a lot of herbs from China and India that are contaminated and of dubious quality.”

Both Howe and Turley agree that it’s impossible to take a comprehensive Ayurvedic herbal treatment and boil it down into one tablet to be taken daily with food and water — there’s a much larger, more complex system to consider. “In papers I’ve read about Ayurvedic medicine, they talk about a synergy existing between all the different constituents within different plants,” Howe said.

And as an herbalist, Turley said, “I’ve had great success using herbs to treat cystic acne, but I typically use a formula containing five herbs — and each patient’s formula is different. I’ve never treated acne with just one herb.”

My particular case, Howe said, probably wouldn’t respond to any one herbal treatment, given that hormonal forces are at work, among other things. “There could be hormonal imbalance, digestive insufficiency, gut flora imbalance, immunity issue, elimination issue, stress involvement...the list goes on,” Turley said of the variables she looks for when putting together a treatment plan for her clients.

To exactly no one’s surprise, my brief and deeply uninformed affair with neem tablets was not the miraculous acne cure I — and the celebrity-beloved Ayurvedic practitioner who, to be fair, was at least kind enough to inject my face and examine me for skin cancer while giving me insufficient information — had arbitrarily hoped it would be. There was no appreciable difference to be found, and, trust me, I looked. Still, a thoughtful approach to Ayurvedic and herbal medicine could very well be worth exploring for all acne sufferers, myself included. The only downside is that you can’t buy that on Amazon for £15 with next-day delivery.