When Lisa, who works as a nurse at a nearby hospital, entered my office, her big, relaxed smile was the first thing I noticed. But her easy manner quickly fell apart when she started talking about what had overwhelmed her for the last five years: cystic acne that wouldn’t budge, no matter what she did. Her skin had been beautiful — perfect — all through puberty, high school and college; she’d never had to think twice about it. Until she turned 24 and great big, painful pimples started to turn up, starting on her jaw but soon spreading all over her face. She’d tried a number of approaches: a vegan diet, chemical peels, herbal supplements, and medications prescribed by her dermatologist. Nothing helped, and she was becoming increasingly desperate.