This transcript is automatically generated.
00:00:05 Narrator
Welcome to Rumor Vs Truth. Your trusted source for facts. Where we dissect the evidence behind risky rumors and reveal clinical truths. Today we'll get face to face with claims about acne.
00:00:21 Steve Small
Well, hello, Don.
00:00:24 Don Weinberger
Hey Steve,
00:00:25 Steve Small
I got to ask you. My parents actually just dug up all my old yearbook photos, and it was a flashback and not necessarily a good one.
00:00:36 Don Weinberger
You know, I'm looking at your photo andā¦ how can I judge? Because I'm looking at mineā¦ so I can't really say anything about it.
00:00:42 Steve Small
I could say those were the good old days. But you know, I'm glad to be an adult.
00:00:46 Steve Small
And you know what's even better about being an adult is maybe less acne than those teenage years, and that's a perfect segue into our topic today. I'm Steve, the pharmacist.
00:00:55 Don Weinberger
And I'm Don the pharmacist.
00:00:57 Steve Small
In this episode, we're looking at acne vulgaris. The fear of teens everywhere.
00:01:04 Don Weinberger
Vulgaris. What a name. Sounds like a Harry Potter spell, but acne doesn't just affect teens.
00:01:09 Steve Small
True.
00:01:10 Don Weinberger
Adults can have it too, right? And about 50 million Americans suffer from acne each year, making it the most common skin condition in the US. And most patients, about 70% will self-treat first before seeing a dermatologist.
00:01:25 Don Weinberger
Butā¦ the question is, do these treatments have any evidence?
00:01:28 Steve Small
Absolutely Don, and some of their claims put the ācomplexā and complexion right? And stick around folks... we'll also answer a listenerās burning question about sunscreens from our last episode.
00:01:39 Don Weinberger
All right, Steve, you know, before we actually dive into that first acne claim, we do have a bit of a breakout moment for this show.
00:01:47 Steve Small
Break out moment. That's a good one, Don. Yeah, we're actually doing something a little bit different today and we think our listeners are going to love it.
00:01:55 Don Weinberger
Yeah. So we are thrilled to welcome a special guest to Rumor vs Truth, someone who's not only a fellow editor here at TRC Healthcare, but also brings that deep expertise in dermatology.
00:02:06 Steve Small
That's right. Please welcome Sara Klockars PharmD, BCPS. She's got an extensive background in dermatology, specialty practice and was genuinely excited when she heard we were tackling acne myths.
00:02:20 Sara Klockars
Yes, thank you for having me, Steve and Don. I'm super excited to be here. Acne topics are always bumping. It's one of those areas packed with misinformation. And I'm really just looking forward to help clear things up with both of you.
00:02:34 Steve Small
Excellent. And even better, she's pulling the mic and sticking around for the entire episode. Glad you're with us.
00:02:42 Don Weinberger
And listeners, don't worry, weāre still bringing in the same banter, puns and evidence based breakdowns you come to expect, just with a little extra expertise this time around.
00:02:52 Don Weinberger
And with that, let's go and dive into our first claim.
00:02:56 Don Weinberger
And that is certain foods can cause or worsen acne.
00:03:00 Don Weinberger
Because acne is caused by an increase of sebum which is an oily substance, people have long assumed that eating greasy foods will make your skin greasy, leading to an acne eruption.
00:03:12 Don Weinberger
Sara, any food for thought on this?
00:03:15 Sara Klockars
Yeah, so diet may play a role, but there's not a lot of good evidence.
00:03:19 Sara Klockars
There are some small studies that have shown, looking at low glycemic diet. So that's one with all the veggies, beans, oats instead of those high glycemic foods like white bread, potato chips, french fries, donuts all the things my teenagers eatā¦
00:03:38 Sara Klockars
That those low glycemic diets tend to decrease acne, but the thought is is they cause like that less of a spike in your blood sugar, and so this can limit the inflammation through your body, which also includes your skin.
00:03:52Sara Klockars
But there's also evidence that it may not help. And there's other studies where they've tried people on high glycemic food diets and they don't cause more acne.
00:04:03 Sara Klockars
So it's something someone can tryā¦ but we just don't know for sure.
00:04:08 Sara Klockars
And choosing healthier food options is good for your overall health, so maybe it's good for your skin, too.
00:04:15 Don Weinberger
All right, so check on foods you being a buzzkill with all those delicious high glycemic that we eat all the time, right?
00:04:23 Don Weinberger
So, what about oils themselves like omega-3? Is that kind of stuff? What's your take on that?
00:04:28 Sara Klockars
Yeah. So I think it's also true when it comes to oils, it's the type of oils you're consuming may matter for your skin, just like your overall health.
00:04:38 Sara Klockars
So for example, there are a couple of small studies that show fish oils or those omega-3 fatty acids via supplements may decrease the number of pimples people had compared to their normal.
00:04:52 Sara Klockars
Compared to people who followed a normal diet, so there's just not solid evidence, though, to recommend using this supplement to treat acne.
00:04:59 Sara Klockars
But as with before, it's a good idea to eat more fish and get those dietary Omega threes for a whole slew of reasons other than acne. But it may help.
00:05:12 Steve Small
Yeah, really good point there. And then what about milk, though? I've heard that can be a major cause of breakouts. Don, what do you think?
00:05:19 Don Weinberger
Wellā¦
00:05:21 Don Weinberger
Don'tā¦ get ready to be āmoo-vedā on this one, but you know, some studies do suggest drinking cow's milkā¦ it is associated with acne, you know. But keep in mind most of these studies were surveys, subjects, connection with having that recall bias.
00:05:35 Don Weinberger
You know, they may prefer to remember things that suit their expected outcome.
00:05:40 Don Weinberger
You know, we don't have randomized clinical trials looking at the milk's effect on acne. So really can't say this link is proven
00:05:47 Steve Small
Good point.
00:05:48 Don Weinberger
And with that, let's go ahead and get back to that claim, which is certain foods can cause or worsen acne and the verdict is...
00:06:02 Don Weinberger
Rumor with conditions.
00:06:04 Don Weinberger
Diet may play a role in acne, but rather than focusing on just greasiness patients eating high glycemic foods could be at a higher risk. But the reality acne is multifactorial.
00:06:14 Don Weinberger
And it seems likely diet alone will make a major change, especially in severe cases.
00:06:19 Don Weinberger
While we know we need more research, if someone thinks a certain food is triggering their acne, it wouldn't hurt to hold off on that food for a month or so to see the impact and it could be combined with other approaches.
00:06:30 Steve Small
Great. So, what I'm getting from this is that greasy food doesn't cause acne, but it might cause regret.
00:06:35 Don Weinberger
Yeah, and it's full of regret, you know, through our college and our work life. So yeah, definitely.
00:06:42 Don Weinberger
But cut back for the sake of heart health wouldn't be a bad thing right?
00:06:46 Steve Small
True, very true. And now that we've wiped away that greasy myth, let's tackle another spotty assumption here. And it's that all oral tetracycline antibiotics are equally effective for acne. Now, Sara, can you help us out with this one?
00:07:01 Sara Klockars
Sure. And I think you're just referring to doxycycline, minocycline and sarecycline, we're not going to talk about tetracycline here today.
00:07:08 Sara Klockars
But Cutibacterium acnes or the C acnes, which is a new name for some people. Many of us know Propionibacterium acnes as the bacteria behind acne, but it's got a new nameā¦
00:07:22 Sara Klockars
But this is the bacteria that kind of triggers the inflammation and clogs pores. And so these antibiotics work against this bug. And then we also have sarecycline, which is a newer third generation option.
00:07:36 Steve Small
Oh.
00:07:37 Sara Klockars
They all may seem the same at face value, since they all kill bacteria by targeting the ribosomes. But there are a couple of nuances. Minocycline has that theoretical advantage of concentrating more in the oil glands in our skin...
00:07:54 Sara Klockars
So itās thought that it might hone in on those acne prone skin pores better than doxycycline, but it also has more side effects.
00:08:05 Steve Small
OK. What kind of side effects are we talking about here?
00:08:08 Sara Klockars
More severe ones. I've seen some cases of hepatitis. As well as
00:08:13 Steve Small
Ohh wow.
00:08:14 Sara Klockars
Skin discoloration where patients will actually turn a blue-gray skin color.
00:08:20 Sara Klockars
Minocycline may also be associated with more vertigo, maybe drug induced lupus, so it just might be a little more riskier than doxycycline.
00:08:30 Don Weinberger
All right, so you did mention sarecycline. No relation, right?
00:08:35 Sara Klockars
Nope, didn't name that one.
00:08:38 Don Weinberger
No. What's up with this newest kid on the block?
00:08:41 Sara Klockars
So sarecycline attacks 2 sites on the bacterial ribosome, not just one like the minocycline and doxycycline. So mechanistically it's a little different and it's possible that this helps target a narrower spectrum of bacteria.
00:08:55 Sara Klockars
So the thought there is maybe we're going to have fewer stomach side effects than we have with doxycycline, which we know are not great. And then it may also limit antibiotic resistance if we're kind of honing in there on that mechanism.
00:09:10 Sara Klockars
And so the the big thing though is there are no head-to-head trials with these oral tetracyclines for acne. So any of them can work and one isn't proven to be more effective than the other at this time.
00:09:26 Steve Small
That's really good to know. Very interesting. So based on that, with our claim that all oral tetracycline antibiotics are equally effective for acne, the verdict isā¦
00:09:42 Steve Small
True, since there likely isn't a big difference in efficacy and any of them, work, it really comes down to risks or downsides when you're coming to picking one of these options and we'd lean more towards doxycycline in practice since minocycline, like Sara said, has some risks and it costs more.
00:09:59 Steve Small
And to kind of sort out all of these different products, we have a great online resource, pharmacotherapy of acne that can help you review all of these considerations for acne meds and more. So check it out.
00:10:11 Don Weinberger
And take a look at our show notes or description we've linked directly to that chart as well as the our antimicrobial stewardship toolbox to get you easy access to our clinical content.
00:10:21 Steve Small
Yeah. And if you aren't already a subscriber, don't miss out on these resources. Sign up today to stay ahead with trusted insights and tools.
00:10:29 Don Weinberger
So we sort out that tetracycline situation, Sara.
00:10:33 Don Weinberger
Now let's set off that beaten path and off label with this next one. So the claim is off-label meds like spironolactone and birth control are effective for acne treatment.
00:10:44 Don Weinberger
And Sara, I bet you've seen some creative approaches.
00:10:48 Sara Klockars
Yes, for sure. So both of these fall in that hormonal meds category, so.
00:10:56 Sara Klockars
Androgen hormones like testosterone can play a role in acne and these meds have those antiandrogen effects to reduce testosterone's effects on acne.
00:11:07 Sara Klockars
So we'll often see these used alot in female patients when other topical options have failed or they need something else.
00:11:16 Sara Klockars
They're super helpful and beneficial for those who have hormone hormonal acne, which is when it's like affecting the jawline or when it's associated with menses. So we often will have people track their acne and notice it's, you know, premenstrual flares. So these are good options for that too.
00:11:37 Sara Klockars
Or if patients have signs of too many androgens, such as, you know, excessive hair growth on the face might be another example.
00:11:45 Steve Small
But Sara, some oral contraceptives are FDA approved for treating acne, right?
00:11:50 Sara Klockars
Yes. So for instance, I think you know Ortho Tri-cyclen or norgesti-mate/ethinyl estradiol, one of the first ones approved and then Yaz is one that folks often think of and that's drospeerinone/ethinyl estradiol.
00:12:05 Sara Klockars
But the majority of oral contraceptives are not actually approved for acne, but some are. The good news is, is you can use any combination oral contraceptive for acne. There's not necessarily one that's best any can work.
00:12:21 Sara Klockars
But they do take time, just like when we're using them for other.
00:12:26 Sara Klockars
When we're using them for contraception or bleeding control, and they may need some tweaking, the main thing we don't want to use is those progestin only options, because those may actually worsen acne.
00:12:40 Steve Small
Good point, good point. And we mentioned spironolactone earlier. That's a diuretic. Are there any differences when using this one for acne?
00:12:47 Sara Klockars
Yes, we would get a lot of questions about this in practice. It isā¦
00:12:53 Sara Klockars
It's hard or it's you just have to explain to people you know, think about who's using it compared to who uses it for a diuretic.
00:13:00 Sara Klockars
So we're looking at a younger, female, who's probably still menstruating, able to get pregnant, having those hormonal bouts of acne. So in this population, it's a little different.
00:13:11 Sara Klockars
We may actually see side effects from the spironolactone like menstrual irregularities. We often will add oral contraceptives with spironolactone to help this.
00:13:22 Sara Klockars
But to also provide contraception, since spironolactone shouldn't be used in pregnancy.
00:13:28 Sara Klockars
And then another thing that we would often remind you know, pharmacies that you'll see higher doses for acne, you know 50 to 100 milligrams a day.
00:13:38 Sara Klockars
So the other, the other main difference here is there have been some studies where you don't necessarily need to monitor potassium unless patients are on interacting meds or have other comorbidities such as kidney problems or the diabetes.
00:13:56 Sara Klockars
So for general in general, otherwise healthy younger women, there's not really the same incidence of high potassium. So you might not see that being monitors as closely so.
00:14:07 Sara Klockars
Some differences.
00:14:10 Don Weinberger
Yeah, there's a lot of good stuff there, Sara. So circling back to that claim, then off-label meds like spironolactone, birth control are effective for acne treatment. The verdict isā¦
00:14:24 Don Weinberger
True, but with conditions.
00:14:26 Don Weinberger
So these options work, but they come with a lot of caveats. For example, they should really only be used in women, since their effects on testosterone wouldn't be good in men, plus we need to weigh their acne benefits with the risk of side effects such as breast tenderness, menstrual irregularities or headaches that we see with hormonal options.
00:14:45 Don Weinberger
And since we mentioned testosterone, stay tuned for our next podcast, where we actually dive into testosterone rumors and truths.
00:14:49 Steve Small
Yeah, that's going to be a great topic, Don. I'm looking forward to it.
00:14:52 Steve Small
And here's one other surprise I found out for acne problems. Your sink may not be the solution here. The claim here is washing your face more often can actually worsen acne.
00:15:05 Steve Small
In looking into this, skin, after all, is an organ very finicky, sensitive one at that. So we need to show it some love and over washing and scrubbing it can lead to irritation and inflammation that can cause acne, flare ups and having totally oil free dry skin is not the goal here.
00:15:24 Steve Small
Some oil is still needed to keep our skin healthy, right?
00:15:29 Don Weinberger
So then the question naturally is, how should patients clean their skin? Sara, back to you. What's the secret to beautiful skin? We're all listening.
00:15:40 Sara Klockars
Itās no secret, Don. There are some good recs out there, such as by the American Academy of Dermatology and the general recommendations are just to wash your face gently twice a day.
00:15:54 Sara Klockars
And then if you're exercising very sweaty after that if needed.
00:15:58 Sara Klockars
And using a non-comedogenic cleanser. So this means it won't clog those pores, with warm water, not hot water, and then rinse well and pot your face dry.
00:16:09 Sara Klockars
Sadly, you shouldn't scrub away or burn away with hot water your acne.
00:16:17 Sara Klockars
And then, of course, if the acne continues with this gentle cleansing regimen, we would start to talk about different washes and treatments out there.
00:16:28 Steve Small
Yeah, so simpler than I thought. Good beauty regimen there, Sara. So going back to our claim, washing your face more often can worsen acne. The verdict isā¦
00:16:44 Steve Small
True.
00:16:46 Don Weinberger
OK, well. I was at the store the other day.
00:16:49 Don Weinberger
And I saw this facial scrub brush, but it was electric. It had. I swore it plugged into the wall and it required like an adapter.
00:16:59 Don Weinberger
It looked like it I can use it for my face or my garden. So I'm guessing these miniature power tools, these electric facial scrub brushes, those are overkill too?
00:17:09 Steve Small
Yeah, fancy acne gadgets, Don. Those may be too aggressive as well. Also try to avoid marketed scrubs. Exfoliating might sound like a good idea to get smooth skinā¦
00:17:20 Steve Small
But you really are peeling off important protective skin layers instead of really nourishing it. And frankly Don, if your skin care routine requires safety goggles, maybe it's time to tone it down.
00:17:31 Don Weinberger
Yeah, good advice. Thank you, Steve.
00:17:34 Don Weinberger
Before we get into our next claim, a quick reminder if you're enjoying this episode and want access to even more clinical insights, check out a Pharmacistās Letter, Pharmacy Technicianās letter and Prescriber Insights. As a listener you can get 10% off a new subscription with the code āpodcasts1025ā at checkout.
00:17:52 Don Weinberger
OK, so after clearing up that claim, let's polish off another interesting one, and the claim is household items like toothpaste can clear acne.
00:18:03 Don Weinberger
Well, toothpaste is creative, but it's abrasive. I remember being a kid and my parents telling me to put some spot toothpaste on pimples.
00:18:12 Don Weinberger
Growing of the next day the pimple was still there, but I was minty fresh. It was kind of interesting, but folks feel it helps dry out pimples like my parents and some toothpaste have antibacterial ingredients like stannous flouride.
00:18:23 Don Weinberger
But similar to what we talked about with excessive washing, toothpaste can irritate the skin and cause more problems than they fix. They're meant to scrub junk off your hard teeth enamel and not your soft face. And now we don't have placebo-controlled randomized trials looking at toothpaste for acne, at least not yet.
00:18:41 Steve Small
Yeah. Interesting study idea, Don. But what about honey? I've heard people talking about that online. What's the data there?
00:18:48 Don Weinberger
Yeah, well, be careful with that one, Steve. Right. It might be a sweet little treatment options. You know, we've seen honey like and it's, you know, there's that muddy honey out there that actually is for wound care.
00:19:04 Don Weinberger
So it's known to it might kill bacteria and fungus. It's like, but it's still likely ineffective for acne and also quite messy. Save that honey for your toast.
00:19:13 Sara Klockars
In terms of other things around the house, have you guys heard about slugging?
00:19:19 Don Weinberger
Ehā¦You know, based on that name, Sara, you know, not really sure I want to know what that is, but I do. So go ahead.
00:19:29 Sara Klockars
Yeah, it's not hitting a baseball really hard. Think of it as slathering your face with an occlusive ointment like petrolatum or petroleum Jelly.
00:19:41 Sara Klockars
I actually thought about doing it before this podcast to see what you guys would think when I was all shiny.
00:19:48 Steve Small
Well, I'm just glad it has nothing to do with real slugs Sara.
00:19:51 Steve Small
But this sounds counterintuitive. Like you're clogging pores. What'sā¦ what's the basis for this? What's the evidence?
00:19:56 Sara Klockars
Yeah. So I actually had to look into this because this was happening in my house. There isn't much evidence, not that anyone would believe me.
00:20:06 Sara Klockars
It's conflicting as to whether it worsens acne or treats acne.
00:20:10 Sara Klockars
But petrolatum is a good moisturizer for dry skin and sometimes we recommend it on the face, especially if you're on isotretinoin or something drying.
00:20:19 Sara Klockars
So perhaps if someone is extremely dry it's OK, but in general, locking in moisture, to already oily, acne prone skin could potentially worsen flare ups for some.
00:20:37 Don Weinberger
OK, so don't immediately rush for those jars of petrolatum to slather on your face for acne got it. OK.
00:20:47 Don Weinberger
So, let's go back to the claim household items like toothpaste can clear acne. The verdict is...
00:21:00 Don Weinberger
Rumor.
00:21:01 Steve Small
Yeah, totally agreed, Don. But I'm intrigued with this toothpaste idea and I think we should do a study because maybe it could work, but as a distraction technique because even though your acne might not get better, no one's going to notice they're going to be focusing on why do you smell like mint?
00:21:18 Don Weinberger
Well, Steve Minty fresh idea, but medically questionable.
00:21:23 Steve Small
Very true. And so, Sara, with that, what's the bottom line truth we should share with our listeners here?
00:21:29 Sara Klockars
Yes, there are a lot of products out there and there's a lot of advice and different treatments or practices claiming to treat acne. So we can just help patients sort through those options and the misinformation there.
00:21:46 Don Weinberger
All right, So what are, what are some? That's some specific take home advice that we can give?
00:21:51 Sara Klockars
Yeah, I think we can help patients find, you know, effective OTCs like benzoyl peroxide and adapalene and help them get a gentle cleanser and get them set up with the routine to help keep their acne at bay.
00:22:05 Sara Klockars
And then know when to recommend seeing a doctor or a dermatologist if they're still having symptoms, you know, and if patients are having severe scarring or acne is causing a lot of distress, which again with teenagers, you may want to refer to a dermatologist sooner rather than later.
00:22:23 Sara Klockars
And then the other thing that I think to reinforce is your skin doesn't get better overnight. It can take about 4 to 8 weeks, sometimes longer to see improvement and patients might actually see their acne worsen before it gets better.
00:22:42 Sara Klockars
So, a big dose of patience, which is really hard, patience and consistency are super important.
00:22:52 Steve Small
Excellent point, Sara, and thank you for joining us today and sharing your dermatology expertise. I learned a lot.
00:22:59 Don Weinberger
Yeah. Thanks for helping us pop some of those myths and smooth out the facts.
00:23:02 Steve Small
Gross, Don.
00:23:04 Sara Klockars
Thanks for having me. And you shouldn't pop your zits. This was āspot-tacular,ā and I'm always happy to talk, acne. Anytime.
00:23:11 Don Weinberger
Ah.
00:23:13 Steve Small
Whoops, there's cracking out the puns with us. I love it. We'll definitely take you up on that, Sara. And all right, with Sara heading out, Don and I will stick around and answer listener question for our last episode hereā¦
00:23:24 Steve Small
Keeping with the skin theme of the question from our last episode about sunscreen is, are spray on sunscreens less effective than lotions and creams?
00:23:34 Steve Small
Now I can see where this is coming from. Spray on versions have the benefit of being quick and easy to apply, and they're also easier to make it to cover your back since we all know that's awkward to try to do on your own with with lotions.
00:23:47 Steve Small
But folks commonly have told me that they feel these spray on versions didn't improve their sunburns in the past.
00:23:54 Steve Small
And actually they burned in a weird splotchy pattern.
00:24:00 Don Weinberger
Well, then the question is, Steve, are they using it correctly?
00:24:03 Steve Small
Exactly. Don. I'm thinking the same thing. A lot of patients simply spray the skin and that's it. And then they get that weird splotch effect from inconsistent coverage. But the American Academy of Dermatology here is really good advice.
00:24:16 Steve Small
Emphasize rubbing in the sunscreen, after spraying to really ensure you get that even protective coat. So really either sunscreen version is effective. We need to ensure patients are using them properly since application clearly is slightly different.
00:24:32 Steve Small
A great question there, and if you'd like to have yours answered about this episode next month, please send us a message we want to answer all your questions.
00:24:42 Don Weinberger
That's right. So you know, we also use suggestions to plan our episodes. So send us your ideas for rumors and truths to analyze at trchealthcare.com/contact-us, use the ācontact usā link at the bottom of your TRC healthcare home page, or send us a text right from the podcast show notes.
00:25:01 Steve Small
Lots of good options there Don, and we know folks that you've got some great ideas for us to demystify and we've got a couple more things here for you.
00:25:09 Don Weinberger
Alright. And if you like what we heard on this episode, be sure to follow rate and review Rumor vs Truth wherever you get your podcasts.
00:25:15 Don Weinberger
Of course. Check us out at trchealthcare.com. You can also help grow our show by telling a friend about the awesome things you've learned about and where you found us.
00:25:25 Steve Small
And like Don said before, a quick reminder for our special 10% discount.
00:25:29 Steve Small
Just use the code āpodcast1025ā when you check out and if you're a student, even better, you can get free access to our Pharmacistās Letter versions. We've got links in the show notes that take you directly to the right places to take advantage of all of these awesome deals, so go check them out.
00:25:47 Don Weinberger
Alright, and join us next time where Steve and I will man up and wrestle with claims about testosterone, but don't worry, we'll keep our shirts on.
00:25:54 Steve Small
Let's hope and thanks for joining us on Rumor vs Truth, your trusted source for facts, where we dissect the evidence behind risky rumors and reveal clinical truths. See you next time.
00:26:17 Narrator
Want to put faces to these voices? Catch the video version on YouTube. Just search TRC healthcare or click the link in our show notes.
00:26:26 Narrator
While you're there, check out our other TRC podcasts like Medication Talk and Clinical Capsules.
