Season 3 | Episode 1
>>Speaker 3:People don't see the real me, right? They just see my acne problem. People think that I eat too many chocolate bars. Or that I don't wash my face. Yeah, I tried many things. I tried everything but just nothing works. My brother says I'll probably grow out of it, but I don't think so. It's hard to believe now, that it will actually go away.
>>Joe McIntyre: Hello and welcome to another episode of the Merck Manuals Medical Myths Podcast. Thanks for joining us. I'm your host Joe McIntyre and today we're going to talk about a topic that impacts or has impacted nearly all of us at one point or another. You know whether it was as teenagers or for many of us as adults dealing with acne is an unfortunate part of our lives. We've heard the myths about how to avoid it, how to get rid of it, or how to cover it up. But where do the truths end and the myths begin? Well, on today's episode, we're fortunate to welcome an expert in this field, Doctor Jonette Keri. Doctor Keri is an associate professor of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine. She is also chief of dermatology service at Miami VA Hospital. Dr. Keri thanks for coming on the podcast.
>> Doctor Jonette Keri: Thank you, Joe. I'm very happy to be here today.
>> Joe McIntyre: Well, Dr. Keri let's jump right into it and start with a pretty basic level setting question. What is acne?
>>Doctor Jonette Keri: So, acne is a condition of a big medical term I'm going to call the Pilosebaceous unit. The Pilosebaceous unit is basically the pore. And what happens with the pore is it becomes clogged. You have inflammation and then you get what we call a pimple. So, if you think about the pore getting clogged, there are four basic steps that happen. The first step is that the skin makes more oil. The oil makes the cells and the pore get sticky. As they get sticky, bacteria which live on us normally, start to like that pore clog, and they basically think of it as food. The bacteria overgrow. And then the last step is the body sees this overgrowth of bacteria and the body comes with its white blood cells and its immune system to fight off the bacteria. So that leads us to the big pimple. So, we in dermatology we usually say there are four steps to a pimple turning into a pimple and that's the basics behind it.
>> Joe McIntyre: Now of course, there are plenty of myths about what causes pimples. What causes acne. Let's kind of go through them pretty quickly if we can. First one. Does eating chocolate cause acne?
>>Doctor Jonette Keri: You know, there's one study out there that shows that chocolate may exacerbate the acne. I'm on that study and I would tell you this. We don't feel that chocolate is so much the bad boy. It's more the sugar that we think is the bad boy. However, if chocolate sets you off, you can avoid it. But chocolate isn’t as bad as we used to think it was.
>> Joe McIntyre: That's good to hear for a lot of us. How about eating greasy foods? Does that cause acne?
>>Doctor Jonette Keri: Another, more of a myth. It's not so much that it's the grease in the food we're going to get back to the sugar or things that give you a high sugar level in your body. So, if you eat a lot of fried foods that will do that, yes, will be the sugar. But yes, I tell my patients they can have a couple French fries. They can have French fries occasionally, so greasy foods are not the reason.
>> Joe McIntyre: Even more good news. How about having poor hygiene? Is that a cause of acne too?
>>Doctor Jonette Keri: No if you have really bad hygiene. Yes, that will aggravate it, but I don't want parents and patients and people listening to think it's because people aren't clean. This is a condition that is rooted in the oil that is produced by the skin and then the clogging of a pore. Of course, we want people to have good hygiene but I don't want people to think that people get acne because they have poor hygiene. That is not true.
>> Joe McIntyre: Now, how about the pillows that we use? Or the bed sheets that we use? Are there certain types that may be more likely to cause acne or there are certain kinds of bed sheets that we can use to help us reduce our chance of getting acne?
>>Doctor Jonette Keri: As long as everybody washes their sheets. I'd say the standard once a week or even every other week if people don't have the ability to wash it every week. Maybe change your pillowcase once a week. You don't need to change your pillowcase every day. And as far as which type of pillowcase that's up to the person sleeping on that I'm not going to say one is better than another.
>> Joe McIntyre: Got it. Now, how about wearing makeup? Does adding makeup products to your face, is that a cause of acne too.
>>Doctor Jonette Keri: Actually, the makeup companies now, they don't want their makeup to clog your pores, and they're very good the makeup companies. And the makeups are generally very good. Occasionally, you'll have a patient who says that the makeup cause clogs their pores. Or causes a clog, is what I meant to say. But what you need to know is that makeup makes people feel better. There are very good studies showing that if we let our acne patients wear makeup that they feel better about themselves as they're going through treatment process. And the only boring comment I would make would be theatrical makeup. Theatrical makeup tends to be very thick. And that sometimes can be a little bit clogging to the pores.
>> Joe McIntyre: Now how about stress? I think we've all dealt with stress, especially in the past year. Are we more likely to have acne outbreaks if we're more stressed because of work or personal issues or whatever it may be?
>>Doctor Jonette Keri: So, stress is a really hard thing to define. But we have studied it in the acne world, not me particularly, but people have studied it and they've used defined stresses like exam stress, taking a test. And what we find with exam stress is that you do get more acne. There are patients who experience more acne when under stress, but to tell the listeners that stress is the cause of your acne would not be correct. You could say stress might aggravate the acne a little bit, but it wouldn't be the right answer to say stress causes acne.
>> Joe McIntyre: Now equally there are many, many myths about some home remedies or treatments for acne. Let's talk about a few of those real quick. Is using toothpaste on your acne an effective treatment?
>>Doctor Jonette Keri: People have done it for years, but my main concern is that it can give an allergic reaction or an irritant reaction called a contact dermatitis. I don't recommend it.
>> Joe McIntyre: Now, how about sun tanning or other forms of tanning? Is that an effective treatment for acne?
>>Doctor Jonette Keri: So, what we know about sun tanning is that when we get sun on our skin, it turns down, actually, the immune system a little bit in our skin and that makes that immune response. That redness that comes with the pimple die down some. Sun tanning can also help the skin look a little bit more even if the skin is uneven. That being said, I don't agree with tanning as a way to make the skin look better, I would prefer that we take care of the acne and not try to mask it some with the use of the sun. That doesn't mean I don't want people to be out in the sun having fun, but I do think that using the sun as a treatment for acne is not the way to go.
>> Joe McIntyre: The Merck Manuals website offers a variety of video, audio, and interactive content. With so many choices, it's easy to access information is the best first place to go for free, understandable medical content.
>> Joe McIntyre: Now this next question may be a myth on both sides. Does exfoliating work to treat acne or does it make it worse? Does it make it better? Kind of what is exfoliating's role in acting treatment?
>>Doctor Jonette Keri: Sure. So, when you exfoliate, you can do it a couple ways. Remember, you can use a chemical exfoliator. That would be something like an acid; salicylic acid glycolic acid. And you can manually exfoliate. Those would be the little beads or harsh washcloth, so exfoliation is not bad, but it must be done very gently. I don't recommend any products that are harsh and I don't recommend any severe scrubbing of the skin. So gentle exfoliation, and I really mean gentle, can help with acne. But you gotta be very careful that you don't irritate the skin.
>> Joe McIntyre: Now I know acne is often associated with puberty and teenagers. But as many of us, I'm sure who are listening to this, and even I'm sure some of us on this podcast recording, know that's not always the case. Why is it that only young people seem to be associated with acne? And as we get older, does acne really always go away?
>>Doctor Jonette Keri: Very good question. I think the reason we associated with young people and puberty and adolescence teenagers is because that's when most people get acne so 80, 90% of kids will have some acne during that time. But what you need to know is about 40%, give or take a little, of women into their 4th decade or their 40s will have acne. With men it’s much less, but men will still have acne. You know, three, four, five even a little bit higher percent of men will have acne into the 40’s. Now, why is that? A lot of that has to do with the role of the hormones. With cycling hormones in women, you can have that continued impetus to drive the acne, but in general it's not a disease, just of teenagers. And that's a common myth that I have to debunk when patients come to see me.
>> Joe McIntyre: Now there are some who say you should never "pop” acne. Yet there are some TV shows dedicated to this very topic, however disgusting they may be to me and some others. So, what's the truth here? Should you pop acne? Should you let it go? What's the deal?
>>Doctor Jonette Keri: So, in general, we tell our patients not to touch their skin. We use the word manipulate. We don't want you to play with your skin. However, if a patient is going to pop it and most people are. We tell them how to do it. This is what I tell them.
I tell them after a shower, when you come out, when your hands are clean when your face is clean, you can gently wipe the skin with alcohol. And if it is to use my language is a big whitehead, you can pop it out gently. One that's almost all ready to go. And when I say pop it out, I mean one that you could pretty much remove with a washcloth. You don't want to be putting a lot of pressure. It’s one that you can almost wash away with a washcloth. That's the one you want to go after. Now, in the experienced hands of, let's say a dermatologist or an esthetician, we do it for patients but we know what we're doing and we have sterile instruments to do it.
>> Joe McIntyre: Now we've talked about a few myths over the past 10 minutes or so. Now let's get to the truth a little bit. What is the best way to treat acne?
>>Doctor Jonette Keri: So, the best way to treat acne in my mind is to see a dermatologist if you haven't been able to take care of it with your over-the-counter products. Everyone can start with benzoyl peroxide, which is over the counter. We have some topical retinoids which are over the counter. Now we have retinal and adapalene so everyone can start with over-the-counter products. I would tell people to wash your face twice a day. Not to scrub too aggressively. To use things like benzoyl peroxide, salicylic acid, glycolic acid. And as I talked, some of the over the counter, retinoids can all help with acne. There are other ingredients that also help, but it's a pretty long list, so I hit the big ones for you there. Now, if you're not getting better, or if your acne is getting worse and you're starting to see scarring indented spots on your face that are maybe a darker color, then you want to make sure that you get to a dermatologist because you want to prevent scarring. The best way to prevent scarring is to see somebody who can stop that process. And patients will often say well, I'll get it lasered later out later in life. But it's better to prevent the scar than to treat the scar. So, my idea is to get patients to a dermatologist when they need it. And once you see us, we have a couple different things we can use or more than a couple. We can use oral antibiotics. We can use oral hormonal medicines for women, Spironolactone and oral contraceptive pill. We also have this very strong medicine called isotretinoin. Which is a very good medicine along with some lasers and lights and other in office procedures. But again, those often aren't covered by insurance.
>> Joe McIntyre: So, Dr. Keri as we wrap up this podcast here, where should people go for information about acne? How to treat it? How to prevent it? How to get rid of it? Where should folks go for information?
>>Doctor Jonette Keri: Sure. They should see their doctor. Their dermatologists. The Merck Manual site. And we have an editorial coming out with some more specifics on acne care.
>> Joe McIntyre: Ok Dr. Keri. Thank you so much for joining us for this very enlightening topic about acne. Would you be able to stay on for a little bit longer to talk about a couple other topics related to dermatology?
>>Doctor Jonette Keri: Sure, let's do it, Joe.
>> Joe McIntyre: Perfect, perfect. As a sign off, I'll leave our listeners with this. As we always say at the Merck manuals.
>>Doctor Jonette Keri: Medical knowledge is power. Pass it on.
>> Joe McIntyre: Thank you so much.