The DERM Expert Podcast

The Truth About Acne: Causes, Treatments, and Myths

• Emily Brewer • Season 1 • Episode 1

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In our very first episode, Emily Brewer, DCNP, is joined by friend, colleague, and fellow dermatology nurse practitioner, Autumn Newman, Dermatology Nurse Practitioner in The DERM Center, to tackle one of the most common skin concerns: acne. From blackheads to cystic breakouts, they dive into what’s actually happening beneath the skin, how acne is graded, and what treatment options work best, from gentle over-the-counter routines to prescription care.

You’ll hear real talk about skin purging, retinoid reactions, hormonal acne, Accutane, and why personalized care makes all the difference. Emily and Autumn share their own experiences as both providers and patients, and explain how a minimal, conservative treatment plan can still lead to big results.

If you've ever felt overwhelmed by the skincare aisle or frustrated with breakouts that won’t budge, this episode is for you.

UNKNOWN:

Thank you.

SPEAKER_00:

I'm thrilled to welcome a special guest to our first episode. For over a decade, we've been colleagues, we've been neighbors, and we've been good friends. And as a board-certified dermatology nurse practitioner, she's undoubtedly made a huge impact in the lives of her patients as well as mine. I'm excited to welcome Autumn to our very first podcast, very first episode of season one. So welcome. Thank you. You're welcome. So today we're going to talk about a topic that is so incredibly common in the office. We're going to talk about acne. Just a few statistics. So acne affects 85% of the global population. So acne is definitely a problem that is so incredibly prevalent. The cost of acne in the United States exceeds$1 billion annually. I know, right? Studies also show that greater than 60% of acne patients suffer from low self-esteem, depression, and anxiety. So it doesn't just have a physical... you know, effect. It has a mental effect as well. So just kind of jumping right into acne. Autumn, talk to me a little bit about when acne is starting in the skin, what's actually happening under the surface?

SPEAKER_01:

So there are a couple of different things that are going on. One, there is typically excess sebum or oil production under the skin that can kind of trap dead skin cells. Naturally, your skin will cycle through dead skin cells will slough off for lack of better words but when you have that excess oil production it can trap those dead skin cells which creates inflammation bacteria will come bacteria can grow and then it just creates those little inflammatory acne bumps so it's just it's a cycle yeah but

SPEAKER_00:

For sure. So that increase in oil production, it really, that seems to be at such the root of acne. When we're looking at acne, we typically will grade it. So when we're assessing our patients right out of the gate, the first thing we're looking at is what kind of acne bumps are we dealing with here? Are we looking at the beginning acne, what I call sort of like beginner's acne, or are we looking at an acne that is a more progressive disease state? So let's kind of talk about a little bit When we're grading acne, what does that actually mean? What are we looking at?

SPEAKER_01:

So I look, I break it up into two different categories mainly. So you have non-inflammatory acne, blackheads, whiteheads, the little bumps or textured bumps that sit under the skin or blackheads. And then you have inflammatory acne bumps. So the big pink, red, painful pimples, what people think of when they think of a pimple. Yeah. Or like nodulocystic acne, bigger, painful, deeper cysts. So I'll start by dividing into which category out of the two.

SPEAKER_00:

Comodonal versus non-comodonal. Yep.

SPEAKER_01:

And then that will direct my treatment regimen.

SPEAKER_00:

Yeah. So, you know, I love to talk to my patients too about when we're talking about whiteheads. Because whiteheads, I think there is such a misconception with what a whitehead actually is. I think most people, when they think about a whitehead, they think about the pimple that comes to a head that they can pop.

SPEAKER_01:

Yep.

SPEAKER_00:

And in reality, whiteheads, that's not actually what they are. So whiteheads, you know, basically when that oil gets trapped underneath the surface of the skin, that inflammatory reaction hasn't really started yet. And you see that sort of textured skin colored bump under the surface. Those are actually very much grouped with blackheads. So treating that type of non-comedonal or that type of comedonal acne, whiteheads and blackheads really fall into that same group. And I think that's important to make note of because so many patients, I think, they think whitehead, pop it. And those are actually pustules, which is more inflammatory. That's right.

SPEAKER_01:

Yep. Different treatment.

SPEAKER_00:

Absolutely. So when we're staging acne, when we're grading it, you know, that really affects the treatment approach. Let's talk a little bit about when we're treating this comedonal acne. You know, for myself, I typically like to start with very mild products when we're talking about younger patients. Comedonal acne, we tend to see that in more young patients or in patients that are using products that are poor clogging. What is your typical go-to?

UNKNOWN:

Bye.

SPEAKER_01:

So it depends on the severity, the age, and honestly what I think their skin will tolerate. Usually I'll start with like a salicylic acid cleanser. Some of the leave on products I'll reserve for different options. So a good salicylic acid cleanser, work it on the skin, let it sit for a minute, wash it off. And that will help to increase skin cell turnover, release some of that buildup. So cleanser wise, I love that. Or I'll do a gentle cleanser and maybe start them on something like Differin Gel.

SPEAKER_00:

I love

SPEAKER_01:

Differin. I love Differin. And a lot of people think, I even had this conversation this morning, a lot of people think that just because it's over the counter, so there are two strengths. I know you know this. There's the 0.1%, which is over the counter, used to be a prescription. And then there is still 0.3%, which is a prescription. But the 0.1% is still so effective.

SPEAKER_00:

I love Differin. In fact, it's my go-to pretty much for every patient that I see when we're starting a over-the-counter topical retinoid. So tolerable, and it's effective, more importantly. So salicylic acid. Comparing salicylic acid with topical retinoids. Tell me how you advise your patients when they're over-the-counter at the pharmacy looking for products on the shelf. How do you direct your patients as to which they need to go for?

SPEAKER_01:

So I, again, it depends if they seem to have more sensitive skin, then I'll start slow. And I always tell them we want this to be, it's a slow process. We don't want it to be like a chemical peel. And if you're using too many things at once, it will feel like a chemical peel. Your skin's going to get irritated and you're not going to want to use anything. So typically, again, I'll have them start with the cleanser. And if we're doing the Differin as well, I may have them use the salicylic acid cleanser like on the weekends or two days a week or something just keep it simple on those other days just use a regular gentle like the C to fill gel cleanser I love that cleanser and then start slow so I'll always tell them even if it's over the counter it can still be irritating

SPEAKER_00:

for sure

SPEAKER_01:

so start every other day for a couple of weeks that gives your skin time to get used to the products and then at that point you should be able to increase to nightly and then give it a good three months I never want you to use it you're not going to see an improvement

SPEAKER_00:

and i almost would say even three to six three to six months

SPEAKER_01:

um so you have to give it time and i know i am in this position and when i struggle with breakouts i will also give it about two days and then i give up um so you have to power through but as long as you give it adequate time see what the products are going to do you should see results yeah at that point if you're not then that's when we're here i

SPEAKER_00:

think one of my favorite things when we're treating patients with topical retinoids I think one of my favorite things in such an educational moment to have in this moment when patients say well I stopped my topical retinoid because it made my face dry yeah and it's like we need to bump the brakes and we need to talk about some education for a minute because topical retinoids yes they will they absolutely that's exactly what they do in fact that's what makes them effective you want to see that exfoliative effect that's happening yeah otherwise it's not helping right so to that point you know I'll Yeah. Throw it in the garbage. It really is not helpful. And the same is true for patients with acne. If you're not having that exfoliative effect, you're not really helping yourself. But yeah, I think the patience and the persistence with treatment is so key. So when we're talking about this more inflammatory-driven acne, so the more red, inflamed, the pimple, the typical pimple, and the nodular-type acne, what is your go-to? What is your plan at that point with your patients?

SPEAKER_01:

Over-the-counter or prescription? let's

SPEAKER_00:

say over the counter first and then we'll go to prescription yeah so over the counter

SPEAKER_01:

over the counter i love um a benzoyl peroxide wash i feel like that does not get the credit it deserves um but again you have to give it time it's one of those things that you're not really going to use it one time and everything looks pristine yeah so give it adequate time um but i love a bpo cleanser a lot of the uh leave-on benzoyl peroxides can be irritating Some of the newer prescriptions aren't as irritating. They've really tried to alter that molecule to prevent that skin irritation, which is so good. But I love the cleanser for that. And inflammatory chest acne, back acne, shoulders, the back knee. I

SPEAKER_00:

totally agree. I think benzoyl peroxide, so underrated over the counter. It is irritating and it does bleach. So as a mom, I'm like, you know, hey, if we're using benzoyl peroxide, know that it's going to take the color out of clothes, sheets, towels. So it does bleach.

SPEAKER_01:

Use white towels. Use white towels, white sheets. That's right. You're welcome. Right?

SPEAKER_00:

But I definitely, I think that benzoyl peroxide, it's not even just with the cleansers, but the topical gel, benzoyl peroxide gel. Yeah. I love that, especially for spot treatment.

SPEAKER_01:

Yep.

SPEAKER_00:

So yeah, over the counter. Any other thoughts?

SPEAKER_01:

lot um

SPEAKER_00:

pimple patches are so great especially for patients that pick

SPEAKER_01:

yes

SPEAKER_00:

you know i mean if you're likely to just go after a spot it is such a great way to keep your fingers off of it and it's actually helpful at helping to clear the bump so yeah love that what about prescription

SPEAKER_01:

prescription wise um again a benzoyl peroxide and typically depending on allergies of course um i like a clindamycin benzoyl peroxide the two make each other work better together And then you also have that the benzoyl peroxide prevents that antibiotic resistance that you can get with the clindamycin. So I love that. I love Cabtrio.

SPEAKER_00:

Yeah, that's sort of a new one. Let's talk about Cabtrio because that actually is one of my favorites too right now. It's such a nice one-stop shop, especially for young patients, teenagers that struggle with compliance. So

SPEAKER_01:

benzoyl

SPEAKER_00:

peroxide, adapalene and clindamycin yep all in one

SPEAKER_01:

yep

SPEAKER_00:

so love that

SPEAKER_01:

sounds like it would be irritating especially with the products that we're previously used to it sounds like something that could be irritating to the skin but they nailed it

SPEAKER_00:

it's effective yeah i mean i have really seen it work especially in patients that you know at first glance i might have a thought of okay we need a systemic treatment but maybe you know parents or or whatever aren't on board yeah and it's such a good starting point because they do see results i'm not fully clear the patient but certainly going to see a positive a positive response for sure

SPEAKER_01:

on both types of acne yeah so the clindamycin benzoyl peroxide for inflammatory acne and the adapalene for blackheads whiteheads skin texture yeah it's

SPEAKER_00:

which i love because most patients especially young patients with acne usually we're looking at that combination you're looking at some blackheads some whiteheads some you know inflammatory bumps so it really is a nice all-encompassing once a day use it before bed simple treatment that is effective so yes i agree cap trio is a winner for me for sure. What about systemic treatments? When do you feel like the time is right to start oral antibiotics or other systemic options?

SPEAKER_01:

So if it is inflammatory, if they have tried topicals and failed, or if it's pretty significant, then I will suggest a systemic treatment. One of my go-tos is a medicine called, say, Sarah, Saracyclin. It's the only FDA-approved antibiotic for acne. So I love the that. It doesn't cause sun sensitivity like things like doxycycline or some of the older tetracycline antibiotics would. You really don't get that stomach irritation. And this one too, you usually see an improvement. I'm always cautious to say this, but you tend to see it a little bit quicker. In

SPEAKER_00:

fact, they market it, I believe, at like two weeks. You should see improvement.

SPEAKER_01:

Yeah, which I'm cautious with that because setting expectations is, you know. For

SPEAKER_00:

sure.

SPEAKER_01:

Yeah. But you do tend to see that anti-inflammatory effect pretty quick.

SPEAKER_00:

Yeah, I totally agree. I love

SPEAKER_01:

Say Sarah. Thank you so much. Or like I said, sometimes I'll go straight to that if there is scarring involved.

SPEAKER_00:

Accutane is such an interesting area of acne treatment because I think, you know, at least clinically what I see with patients, I have some patients that come in or parents that will come in with their teenager and they are in hot pursuit to want Accutane. They want it. They don't want to waste time on topicals or other antibiotics or whatever. And then you have, it's almost like the polar opposite. You've got patients that come in and they're like, I don't even want to hear the word Accutane. You know what? I mean? So it's, you know, usually again, a good educational moment to sort of explore what the hesitations are with Accutane. So let's talk a little bit about what Accutane actually is. So Accutane,

SPEAKER_01:

go ahead. Vitamin A derivative. It helps, I mean, basically when you start it, it will essentially decrease or stop that oil production. So one of the biggest side effects that we talk about with patients is dry skin, chapped lips, but it's everywhere because it is a systemic treatment or something that cycles throughout the body, you're not just going to have a dry face. So dry cuticles, dry hair, dry nose, nosebleeds, all the things. So like you mentioned, the side effect conversation is certainly necessary.

SPEAKER_00:

The biggest thing, the pregnancy. So Accutane, you know, one of the biggest things with it is, you know, it causes such severe birth defects if you get pregnant while you're taking it. So I really think that's a large part of the concern around Accutane for a lot of patients. But then again, you know, I think a lot of patients too, they look to social media, they go to TikTok and they hear, oh my gosh, TikTok.

UNKNOWN:

Yes.

SPEAKER_00:

It's fun, but at the same time, when it comes to skin care, I know. So I think they go to TikTok or other outlets to get their information about Accutane. And it really, you know, it can seem very scary, I think, when you do hear, oh, it causes birth defects or, you know, all of these other potential dangerous side effects. Suicidal thought and behavior was associated with Accutane for a while, which I think now pretty much has gone away. You don't really see that listed.

SPEAKER_01:

Accutane itself has been discontinued. Now we have the newer drug. drugs, generics.

SPEAKER_00:

But, you know, I think that for the right patient, it's great. I took it.

SPEAKER_01:

I took

SPEAKER_00:

it. I know. So, I mean, I know for both of us, I think it was life

SPEAKER_01:

changing.

SPEAKER_00:

It really was. And I know for myself, you know, scarring, while my acne was never bad, it was just, it was kind of persistent and, you know, different things that I would try for it. And I was in the medical field at this point and knew what I needed to use. And it just, I couldn't get it completely clear yeah and man Accutane took care of it for me so it's not for everyone right definitely not for everyone but it is

SPEAKER_01:

definitely involves a conversation

SPEAKER_00:

with for sure yeah I totally agree so I think it has to for sure be like a a group approach has to be right for the patient right for the parents if it's a minor but definitely has a good place for me I think yeah I love it so in terms of the causes of acne so when patients come into the office and they'll say well what is causing my acne that's a really tricky question because that question comes from teenagers and it comes from adults. So when you're talking about a diagnosis that applies to such a wide age range. How do you go about answering that for your patients?

SPEAKER_01:

So it depends on the patient and what they're doing. If it's, say, a high school boy who plays football all day and wears a chin strap and his acne is right here, he's growing hair, beard hair, sweat, oh gosh. Yes, practice outside, all the things. Then that will direct my treatment depending on, and the conversation, like when you're done exercising or workouts or whatever, practice, take everything off. I love hypochlorous acid. Yeah. I don't know if you... I

SPEAKER_00:

actually don't utilize that very often. Oh my gosh. Sometimes I forget about it, but it really is great. I love

SPEAKER_01:

it.

SPEAKER_00:

Yes. So

SPEAKER_01:

I will tell athletes and... If you go to the gym, if you, I had somebody the other day that trains. So she can't take a shower after each training session. She's there all day. So hypochlorous acid spray, it's anti-inflammatory, antibacterial, antifungal.

SPEAKER_00:

It's over the counter at the pharmacy. Over

SPEAKER_01:

the counter. But that will help to clean surfaces, but you can also spritz it on you, put it on your practice mat, put it on your yoga mat. That's a good point.

SPEAKER_00:

Disinfects the equipment too.

SPEAKER_01:

Yep.

SPEAKER_00:

Love that. So let's talk about other causes of acne. So the sweat is an issue. Let's talk about one that comes up so frequently in the office. Hormones. Yes. Yeah. So obviously for teenagers, the hormones, that's a thing. And that's, I think, easy to say, oh, that's the cause of the acne and people accept that. And that's the end of it.

SPEAKER_01:

Yeah. You'll grow out of it.

SPEAKER_00:

You'll grow out of it. Yeah. So then fast forward ahead, especially for females. Yep. Now we see this also, too, with a lot of males with the whole testosterone treatments.

UNKNOWN:

Yeah.

SPEAKER_00:

Speak to that issue. So when we see an adult female, when we see these adult males that come in that are taking these testosterone supplements, talk about what's happening in regards to acne for these patients.

SPEAKER_01:

Okay. So, I mean, hormone treatments just in general with peri-postmenopausal women with progesterone or hormone replacement. I mean, we'll also see more acne with that. So, again, it depends on the cause for a male taking testosterone.

UNKNOWN:

Okay.

SPEAKER_01:

benzoyl peroxide cleanser but if you have to utilize that testosterone I mean maybe a topical option but really that

SPEAKER_00:

is a hard hard conversation because now there are so many places where men in particular are going but I mean I see this too with women that take hormone replacement with testosterone so many patients that are looking at using hormone replacement especially aging population and And while it can be very effective and help with a lot of different things that maybe they're struggling with that have ultimately led them to taking the hormones. The acne, man, it is a problem. And, you know, I think one thing when I'm talking to my patients about testosterone in particular, because that comes up a lot, is, you know, it's not necessarily an indicator of having too much testosterone in your body or by taking too high of a dose. What I tend to see as the issue with testosterone is it's just a side effect. I mean, if you're taking a fraction of a milligram, you can still have acne as a side effect to that. So that's a really tough one because because obviously testosterone makes patients feel better

SPEAKER_01:

yeah

SPEAKER_00:

they want it and it may be

SPEAKER_01:

necessary

SPEAKER_00:

and it may be necessary yeah but you know it's one of those conversations sometimes where it's like you know we can try these topicals we can try these other potential systemic options but at the end of the day so long as the testosterone is still on board it still may be an issue so that's that's usually a tough conversation it is um but yes testosterone for sure that that's something that i discuss a lot with like i said men and women um

SPEAKER_01:

with females sprenolactone

SPEAKER_00:

love that is my number one

SPEAKER_01:

oh my gosh love so beneficial

SPEAKER_00:

yes

SPEAKER_01:

um so i absolutely love it with and that's another indicator or something that we look at as providers like teenage acne very different adult acne different hormonal acne i mean it has such its own distribution for sure so we see it jaw chin line acne cystic painful snoring, um, and spironolactone if tolerated. can be life-changing.

SPEAKER_00:

I love spironolactone. It's not for every patient, but for sure, especially for these females that come in with that very classic chin, jawline, neck, chest, upper back even. Spironolactone, it's so effective. It blocks that testosterone surge that happens just naturally in the body, which when that testosterone level goes up, we know that it tells the oil gland, make more oil, and that increase in oil production results in the acne. And spironolactone works right at the beginning of that chain. So as that testosterone goes up, it blocks Right. Yeah. Yeah. It's not for everyone either. And, you know, it's nice to have an option that we can go to. In fact, I usually choose spironolactone over birth control for most of my female patients. I love it. Very few side effects. I mean, it is a diuretic. So, I mean, it can help with water retention and other issues that patients may face. But low blood pressure. Yeah. I talk to patients about that one because it can definitely cause some low blood pressure. Yeah. High levels of potassium. So we talk about those side effects. But outside of that, pretty benign drug and extremely effective. I will say this, though, about spironolactone. And I have seen this to be true for myself, even taking spironolactone. It takes a full 12 weeks.

SPEAKER_01:

Yes.

SPEAKER_00:

So it is one of those things that I tell my female patients, give it some time because you'll get there. It'll work. Right. But give it 12 weeks. And I mean like clockwork. I'll have patients call the office at like week 10 and they'll say, you know, I'm still breaking out. Like, what can we do? And it's like, nope, just give it two more weeks. I promise.

SPEAKER_01:

Stay the course.

SPEAKER_00:

And like clockwork. Yeah. Two weeks later, they follow up for that three month appointment and they're like, wow, that actually really, yeah, made a difference.

SPEAKER_01:

Yeah.

SPEAKER_00:

So when you're treating your patients, Do you typically have a more conservative approach with your patients or do you like to start aggressive? How do you like to approach your acne treatments with your patients?

SPEAKER_01:

So I like to make it very specific person to person and I want them to feel involved as well. I don't. Like going somewhere where someone, I have a problem with people telling me what to do. So I never want, shocker, never want anyone doing that to me. So I will give an option and I will tell them we can go a conservative route. Here's what we could do. We can start topically or, um, I mean, some people have had acne for years and it doesn't faze them. And so they just want a conservative treatment. Like I'll use a cream, I guess it's fine. And then some people have had acne for six months and it is completely where they have one nodule oh my gosh yeah and they're like I want to do every single thing I can possibly do so it's really just patient to patient yeah I make it specific and I try to make their I try to make them a part of the conversation and the decision and just see what they will be consistent with too I

SPEAKER_00:

think that's so important because if the patient is involved in the treatment plan they are so much more likely to actually execute the plan itself well you feel empowered you feel like you're a part of it absolutely you do yep so I love that I will say sometimes with acne I typically will have a little bit of a more aggressive approach just because I while there are some that do come in that are sort of you know they don't they're not really bothered by their acne most of them you know that I see they they are yeah that's right they're there and obviously they're there because they're bothered so you know I like to sometimes you know have a more aggressive approach with patients because I like to get results quickly yeah so I like to be kind of aggressive and then I I start pulling back on treatment so that I think for me has been a good approach with patients but you know to your point you know if they're not on board with the treatment aggressive or conservative

SPEAKER_01:

it

SPEAKER_00:

doesn't matter they're not going to do it which brings me to compliance Compliance and acne treatment is, it's a tough one too, because, you know, it is, it's a marathon.

SPEAKER_01:

Very much so.

SPEAKER_00:

It's not a sprint. You are in it for the long haul and it's so frustrating. Oh

SPEAKER_01:

my gosh.

SPEAKER_00:

Yeah. Because you're using these products every single day and you're not seeing immediate results. And it's so hard. It's like exercise. It's like trying to, you know what I mean?

SPEAKER_01:

So it's, it's a process. Instant gratification. Totally. Yes.

SPEAKER_00:

So in moving forward with your patients that are non-compliant, how do you approach that?

SPEAKER_01:

So, um, I try to find out what they would possibly be compliant with. So if, and I've had a lot of people who, um, don't like the texture of things. So if they don't like the way a lotion feels or there's a lot of aversions out there for people. So I also take that into consideration. Um, they make, instead of like a topical clindamycin benzoyl peroxide together, I would possibly use a benzoyl peroxide wash and then have have them use clindamycin wipes because hopefully they're washing their face in the shower yeah um so if they're not at least they have something they can go over yeah um so you're already taking a shower that's easy and then they get out use a wipe throw it away yeah you're not having to take time put something on you know yeah so i try to i try to find ways in different products that might be most beneficial for them

SPEAKER_00:

i think one of my favorite mottos is you know the best treatment is the treatment that the patient will do yep you know what i mean It may not be the absolute best combination of things or the things that we would default to first for a treatment option. But quite frankly, if it's a treatment regimen that they aren't going to do, waste time. It wastes the patient's time. It wastes money. So I'm a big, big supporter of if a patient comes back and they've not been compliant on their treatment, really getting to the root of what's the problem. Is it a texture issue? Is it just a... having to incorporate it into a routine issue or is it just you know you're dealing with you know a teenage boy for example and they just don't care right you know what I mean so it's usually a conversation with the parent which you know the parent comes in and they

SPEAKER_01:

have thought they've been here that's right for the last three and

SPEAKER_00:

that is that's

SPEAKER_01:

actually

SPEAKER_00:

a common conversation parents come back they're so mad yeah kids still have acne and then you get down to it and you're like well you know I'm looking at your skin it's not dry it's not red full of acne like how

SPEAKER_01:

many refills have you picked up

SPEAKER_00:

right oh You're still in your original.

SPEAKER_01:

Yeah.

SPEAKER_00:

So, you know, always comes out. And then the parents are like, hmm, why have you not been doing your treatment? But yes, common conversation to have for sure.

SPEAKER_01:

Absolutely.

SPEAKER_00:

What are your thoughts on diet and acne?

SPEAKER_01:

So, gosh, I think we are still at the tip of the iceberg. Yeah. There's a lot. And rightfully so. I'm very excited about this huge emphasis on gut health and microbiome, all the things. Probiotics. I think we're just at the tip of it. So basically, I mean, I'll ask, do you drink gallons of skim milk or do you drink a ton of skim milk? That one seemed to be priority or the highest cause of the inflammation there. High glycemic diet, you know, just checking in. If you're eating a well-balanced diet, then, I mean, one, I say this just because I love Sour Patch Kids, one salad Who's eating one?

SPEAKER_00:

I don't

SPEAKER_01:

know.

SPEAKER_00:

Are you eating just

SPEAKER_01:

one? One box. One bag. Family size bag. My girls, my dogs, my family. So just it's. I don't think we have enough evidence and research on what exactly to recommend aside from just a nice balanced diet. Now, things like whey protein, that has been proven to be a cause for breakouts. Biotin products also. So trying to see, I mean, we try to investigate, you know, when we're talking to patients. So trying to see if there's something that they're doing that could be contributing. But aside from that...

SPEAKER_00:

A big one, too, when it comes to food, I think, is interactions with the medications that we have them on. So to your point, you know, with dairy. So if we have patients on doxycycline, for example, and they're consuming a ton of dairy, especially when they're taking their medication. Right. that can certainly interact with the medication, keep it from working. So I'm usually very diligent too with patients to talk about, okay, you're on this medication, these are the foods that you need to avoid or incorporate, for example. Probiotics, I love incorporating that, especially when we're on a medication like an antibiotic that they're gonna be on for extended periods, which brings me to another point, this extended period of antibiotic. That seems to be an area, especially with parents, that they don't love. It's really very common in dermatology for us to prescribe antibiotics for extended durations. You know, I don't love it, quite frankly. I don't really love having antibiotics, you know, on board for long periods of time, especially in regards to acne, when I think that there are potentially other things that we can explore as treatments. But, you know, probiotics, is that something that you really advocate for your patients to incorporate when they're on antibiotic treatment?

SPEAKER_01:

Gosh, I love a probiotic for everybody.

SPEAKER_00:

Yeah, me

SPEAKER_01:

too. Honestly, just in general, acne treatment or not. Antibiotic or not. Yeah. So yeah, absolutely. I do recommend it just because antibiotics are so beneficial. They wipe out the bad bacteria, but they also do take some of the good bacteria too. So trying to replace that as much as we can. I mean, you know, we do what we do. So certain treatments are necessary to get the desired outcome. But anything we can do to try and avoid some of those side effects.

SPEAKER_00:

Skin health, GI health, it's just good for you, honestly. So regarding metabolic issues with women so when we see these adult females that come in that have this cystic jawline top acne and then you start the conversation with them and then you realize okay we're looking at some other things too we're looking at some increase increase hair growth on the chin we're looking at you know central obesity irregular periods difficulty getting pregnant How do you approach that when you're suspecting some kind of metabolic imbalance?

SPEAKER_01:

So if it's a child, or I say child, if it's a younger adult, and I ask everybody of childbearing age, are you trying to conceive? If they aren't, then that's where I think starting them on spironolactone and then sending a referral for GYN just to have... both, I mean, both medical specialties prioritize their care. Yeah.

SPEAKER_00:

So I... That's true. Maybe it could be a piece of that puzzle. Oh, absolutely. Yeah.

SPEAKER_01:

Absolutely. But earlier when we were talking about spironolactone for that acne, it also helps with unwanted hair growth. Yeah. So that can be really beneficial while we're working towards a solution. Yeah. But yeah, having a collaborative care effect is a priority in those women.

SPEAKER_00:

I'm usually checking a lot of labs on these patients too. I like to, you know, run thyroid panels and really, I don't dive too, too deep into it because then we start kind of getting a little bit into, yeah, into endocrinology maybe. But, you know, I do like to, you know, really evaluate those patients carefully because while, you know, they're just at the derm office with acne, there can certainly be a much, much bigger, you know, piece to that puzzle for sure. So it's

SPEAKER_01:

all

SPEAKER_00:

related. Absolutely. Well, Autumn, do you have any final thoughts about acne?

SPEAKER_01:

Gosh.

UNKNOWN:

Okay.

SPEAKER_01:

I mean, no, I love to treat it. I love to talk about it. I love to educate people, patients, family members on it.

SPEAKER_00:

As an acne sufferer myself, you know, it's something, yeah. I mean, even to this day, having had Accutane in the past and various treatments, still get acne from time to time. And it is just, it's frustrating. And it's so irritating to even be, you know, in a position to have all the answers at our... disposal and be able to have all these treatments and still struggle sometimes. It

SPEAKER_01:

still affects

SPEAKER_00:

us. Yeah, it really does in a big way.

SPEAKER_01:

I took Accutane as an adult. I think you did as well. So it's not a teenage problem.

SPEAKER_00:

It's really not.

SPEAKER_01:

I think that's one of the biggest misconceptions.

SPEAKER_00:

I agree. Seems like a forever problem sometimes. There are solutions. Yes, there are definitely solutions, things we can do to help. I think a big take-home message that I have for patients that may be listening and struggling is you know it's not something that you have to go to a pharmacy and go to a shelf and try to navigate by yourself oh

SPEAKER_01:

my gosh

SPEAKER_00:

acne is such a like i said it's it's a marathon it is and it's such a customized skincare routine right that goes by you know the patient and by how they present and their issues and the type of acne like we talked about and it's something that we truly can be along for the journey for these patients and give them that

SPEAKER_01:

specialized care

SPEAKER_00:

absolutely customized approach that's everything

SPEAKER_01:

Yeah, I agree.

SPEAKER_00:

Well, thank you so much for being on today. Yeah, thank you for having me. I appreciate it. You can find Autumn at the Derm Center. She's a board-certified dermatology nurse practitioner and so happy to have you today. Thank you.