Unmasking Acne Myths: Separating Fact from Fiction for Clearer Skin

Trina Renea 00:07

Hey everyone, welcome to Facially Conscious. I'm Trina Renea, a medically trained master esthetician here in Los Angeles, and I'm sitting with my rockstar co-host, Dr. Vicki Rapaport, a board-certified dermatologist with practices in Beverly Hills and Culver City, Rebecca Gadberry, our resident skincare scientists and regulatory and marketing expert, and Julie Falls our educated consumer who is here to represent you. We are here to help you navigate the sometimes confusing and competitive world of skincare. Our mission is to provide you with insider knowledge on everything from product ingredients to medical procedures, lasers, fillers, and ever-changing trends. With our expert interviews with chemists, doctors, laser reps, and estheticians you'll be equipped to make informative decisions before investing in potentially expensive treatments. It's the Wild West out there, so let's make it easier for you one episode at a time. Are you ready to discover the latest and greatest skincare secrets? Tune in and let us be your go-to girls for all things Facially Conscious. Let's dive in.

Rebecca Gadberry 01:33

Good morning, everybody. Good morning.

Dr. Vicki Rapaport 01:36

Good morning.

Trina Renea 01:37

It is morning on a Saturday.

Rebecca Gadberry 01:40

This is Rebecca.

Trina Renea 01:41

This is Trina.

Dr. Vicki Rapaport 01:43

And this is Dr. Vicki Rapaport.

Rebecca Gadberry 01:46

Hi.

Dr. Vicki Rapaport 01:47

Hi there. Hi, everybody.

Trina Renea 01:49

So we have done a few episodes regarding acne. But there are some specific acne myths that we wanted to talk to you guys about today. That is going to just blow your mind. So we're just gonna jump right into this. Dr. Vicki, I want to ask.

Dr. Vicki Rapaport 02:11

Yes, ma’am.

Trina Renea 02:13

Do you get acne from not washing your face?

Dr. Vicki Rapaport 02:21

Oh, I wish it was that simple. No, that is wrong.

Trina Renea 02:23

So if I didn't wash my face for a week, I wouldn't break out.

Dr. Vicki Rapaport 02:29

If you have the tendency to be incredibly oily and breakout prone and have inflammation and have all the other components that create acne including overactive sebum, crazy hormones, then yes, you would.

Trina Renea 02:45

I know many men who don't wash your face and they don't have acne, FYI. But I also hear people come into my esthetician room all the time, sometimes a lot of times, and say “Oh my God, my skin is so dirty this week. I have so many blackheads.” Which is not the case at all. Blackheads and acne aren't dirt in your skin. It's not like your face is so dirty, right? It's oil and bacteria.

Dr. Vicki Rapaport 03:17

So yes, of course, some people need to wash their face more frequently than others. Obviously, people who have very, very dry skin aren’t prone to having the comedones can be a little lazier. And then of course the teenager with the crazy sebum and the crazy shiny nose by 9am in the morning probably should be a little careful about washing their face. But that is not the only reason why they're getting breakouts. I remember growing up in LA there was at the Brentwood Country Mart, there was this amazing place that actually still exists. It's chicken in a basket. And the woman, it was like and they would make this amazing chicken but also it was all about the french fries. And this woman would stand over that like fryer. And she had the most, she had the most impressive acne I'd ever seen. I thought oh she's the chick because I was a kid she needs to change her job I'm sure all that acnes from all the oil that she's absorbing from frying the French Fries.

Trina Renea 04:11

Yes, I would think the same thing.

Dr. Vicki Rapaport 04:14

Yeah, and then I became a dermatologist and then realized, she thought about her when I was in residency and you know, actually, it wasn't really the French fry oil. It was probably just her genetic predisposition. Her sebaceous skin and I thought Oh God, I'm such I was such a silly silly kid that I just assumed it was something so straightforward that she could just change your job but no, it's not. Acne does not come from not washing your face.

Trina Renea 04:38

Okay. Thank you for that. I do tell people who have acne though, to wash your face twice a day because you know when they sleep they could some of the acne could erupt and then, you know, spread around.

Dr. Vicki Rapaport 04:53

And they shouldn't over-scrub, right? You and I know that over-scrubbing actually stimulates oil glands.

Trina Renea 05:00

Yes.

Rebecca Gadberry 05:01

And it spreads the bacteria.

Trina Renea 05:00

Yeah. Yeah, scrubbing is a whole another issue. Okay, so is acne only a teenage problem?

Dr. Vicki Rapaport 05:14

If I could swear I would say, H.E L.L.S. No.

Trina Renea 05:19

You could swear.

Dr. Vicki Rapaport 05:22

Hell, no.

Trina Renea 05:24

It's not just a teenage problem.

Dr. Vicki Rapaport 05:26

I think they're documented maybe 50 million people get acne, you know? Or every year and maybe half of those are adults. So yes, there is such thing as adult acne, which is typically a hormonal problems. And it's not just teenagers who get acne. Remember rosacea or acne rosacea is a 30 to 50 and above year old problem. So there are plenty of adults with breakouts. I have had a 90-year-old patient who had blackheads on his back, which was impressive.

Trina Renea 05:29

Wow.

Dr. Vicki Rapaport 06:00

So we get acne throughout our whole lives based on our predisposition.

Trina 06:03

Yeah.

Rebecca Gadberry 06:04

And does having a black head mean, you have acne and you need to go get it treated right away?

Dr. Vicki Rapaport 06:12

No, not at all. Right. Some people just have little clogged pores on their back because maybe they sweat during the night or they don't wash their sheets as often. And really, that's the only area where they have a couple of blackheads. No, it doesn't mean you have acne to get a back facial. But when I tell people, you know when they're looking at their back for moles, and they’re “I feel this thing is, what is that? Is that a mole?” And I tell them “No, it's a blackhead.” And they say “What?! Take that out for me right now.” And of course, I say “Yes, I won't let you leave my office with a blackhead on your back.” So sometimes they're very easy to get out.

Trina Renea 06:48

And those people who end up in the patient room going “I need a back facial” because they're horrified that they had a blackhead on their back. Or you get them in your ears.

Dr. Vicki Rapaport 07:00

In your ears, too. Yeah. But as we get older, we don't shed the skin as efficiently right? The turnover of the skin slows down. So that's partially, that's a big reason why adults will get blackheads because they're just not shedding all the sebum out of their pores efficiently.

Trina Renea 07:18

And are. So here's another myth. Are antibiotics terrible for you?

Dr. Vicki Rapaport 07:28

Terrible in what sense?

Trina Renea 07:30

Well, like when people get acne, they want to avoid antibiotics, because antibiotics are so bad for you. But that's what the first thing that doctors put you on is antibiotics. I mean, not the first thing. They start with topicals. But usually a lot of times, I should say, they go to antibiotics. That's the first kind of pill. Yes, so, are they bad for you?

Dr. Vicki Rapaport 07:54

When we evaluate a patient, and we evaluate them in a lot of ways, looking at the actual acne, but also we get a sense of what they want, right? We're not going to throw them on something that they're uncomfortable with. So if they're covered in papules, pustules and cysts and scars, topical medications will not cut it. So that is when we have the discussion about taking something oral. Typically, it's an oral antibiotic first. Sometimes we'll give them oral Spironolactone if they don't want to take an antibiotic. And of course, sometimes we'll give them Accutane. But oral antibiotics in and of themselves are not terrible. They're wonderful. They help people dramatically. If you had a raging infection in your leg and your eye and your body, you wouldn't even hesitate to take the antibiotic that was recommended. So absolutely. They're not terrible. They're life-saving literally, for acne. It's true. Dermatologists absolutely overprescribed, but not in a bad way, just that we have so many kids with so much acne that are miserable. So it's the right thing, and it's FDA-approved. So in the right patient, it's magic, it is not terrible.

Trina Renea 09:01

And the one thing that sometimes I think happens is and why maybe mothers feel this way about their teenagers is that the dermatologists will put them on an antibiotic for a very long period of time. It's not like when you get sick, you take an antibiotic for a week or two. It's like a long, long term which can cause there, you know, the good bacteria too. I mean, it can just wreak havoc on their stomachs. So why the long long-term antibiotics?

Dr. Vicki Rapaport 09:43

Just because acne is very difficult to treat. So typically, we'll say one to three months on the antibiotic if people are doing great after a month we'll stop that if it takes a full three months. Absolutely they need it. If after three months, they're still not clear. It's very safe to continue, especially if they're improving really well. If they're not improving after 12 weeks, we'll switch the to a different class because you're right, we do really try and stop them after about three months if we can and not because it's dangerous or terrible, but because we don't want to give oral antibiotics if we don't need to. We want to keep it for when they quote-unquote, really need it for whatever God forbid infection they get in the future.

Trina Renea 10:27

And that leads me to Accutane. Is Accutane dangerous? Because there's a lot of people afraid of that drug but I often will recommend that drug over an antibiotic because I will say “You need to go see a dermatologist and ask about Accutane because I see that they're scarring.” And when I see the scarring, and it's not we're not being able to treat it like I'm working with a dermatologist and they're giving them topicals and they're doing antibiotics. And I'm helping them with extractions and they're using the right products and the acne just keeps coming and I see that their scarring. I'll often say just go do Accutane but people are so afraid of Accutane. Why?

Dr. Vicki Rapaport 11:17

In the right patient, Accutane really is a miracle. Period. So why are they afraid of Accutane? Great question. I think if they sit down with a dermatologist who really talks to them about the pros and cons of Accutane, they wouldn't be afraid of it anymore. It's just you know, the most negative stuff is online. I have seen some really positive journeys online. Thank God. Yay for that. And not just all the negative, you know, people who are you know, posting their typically it's a five to six-month course of Accutane and posting their whole journey, which is amazing. And you're right, if patient fails topicals if they fail oral antibiotics, if they are scarring, they're absolutely appropriate candidates for Accutane. And they just have to have a discussion. I mean, this is a complicated, a workup and evaluation. Not complicated, but it takes some time. Again, it's important for somebody who has empathy and sympathy for the patient to sit down and really explain to them what they're getting into with Accutane. But most of the time patients are like, yes, I want it, I need it. And it is actually a miracle. It starts working sometimes within a week.

Trina Renea 12:29

Yeah. Is it dangerous, though, that's the myth.

Dr. Vicki Rapaport 12:36

There are a whole host of potential side effects with Accutane that we go through from head to toe. We talked to the patient about what could happen. And I typically tell patients look, if any of the side effects happen, it's either totally tolerable. It's absolutely something you can get through by continuing to take the medication, it can just stop as your body gets used to the medication and as you see the skin get better, you'll want to continue or if the side effects are unbearable, stopping the medication is perfectly appropriate. And everything goes back to the way it was before. There are some very rare cases of Accutane unroofing depression, Accutane unroofing IBD, you know inflammatory bowel disease, unroofing remember not causing it in somebody who wasn't going to probably get it later. So we have to have those discussions. You know, it's but typically, like I said, all the side effects that happen if you decide to stop it or after your course it everything goes back to normal. The most important thing about Accutane is you just absolutely cannot get pregnant. So that is true that a fetus is basically unable to basically grow correct, appropriate bones. So they become they come out to form so you absolutely cannot get pregnant when you take Accutane.

Trina Renea 13:55

Alright. And the one thing I tell some people when they're afraid of the Accutane is listen, you can go off it if you start feeling something that you don't want to feel, go off it, like you don't have to stay on it.

Dr. Vicki Rapaport 14:10

Absolutely.

Trina Renea 14:11

Right? You know, it's not like it's a permanent situation. But anyways, I'm not a hater of Accutane. But okay, so changing your diet can help acne. Is it true? Is it true?

Dr. Vicki Rapaport 14:29

Is it true? Changing your diet can help acne? Maybe. The answer is maybe. You know, patients need guidance and want guidance about their diet when they have acne. It's a very hip thing. Oh, it must be from milk it must be from this, it must be from that, and the only real truth that we know is very high glycemic index foods can exacerbate acne. So high glycemic index foods like the white sugar and the white flour. So we like people who are curious about their diet to go on a very low glycemic index diet. And when I say diet, it's not that it's just changing their lifestyle. So, you know, clean fruits, clean vegetables and protein, and no, nothing. Boxed. No pastries.

Trina Renea 15:15

Do you know all your acne patients this or is that they should change your diet or just people who ask?

Dr. Vicki Rapaport 15:23

I should. I don't. Again, we're not really trained in the nutritional aspects of it but you know if patients asked, I'm interested in helping them but you're right, I don't. And I think it's good again just for overall healthy lifestyle because the other thing is with less blood sugar spikes, with high glycemic index foods, you have high blood pressure, blood sugar spikes, and with less blood sugar spikes, you get less inflammation and less sebum. So it probably is actually a really good thing for overall health and for acne. But it's not like the again, it's not the one thing you need to do to change your diet.

Trina Renea 15:57

If you eat a bag of potato chips or a pint of ice cream. You're not going to break out the next day in acne?

Dr. Vicki Rapaport 16:05

Some people, maybe if they're craving it, because they're about to ovulate are about to get their period. Yes, but in the end, it's really just because they got their period. It's not because they ate that, you know, pint of Haagen Dazs. So I think I tell the story once before Trina I was at the I don't know, Rite Aid or CVS, one of these pharmacies where you can pretty much buy everything. And this woman behind me had tampons, and a bag of Hershey's Kisses. And I was ding ding, ding, ding, ding moment, I thought, oh, it's not the chocolate that's making people break out, you know, around their period. It's the act, but they're having their period, right? Because they're craving chocolate. They're craving all these things. So people are so cute. They're like, Oh, definitely chocolate breaks me out. Oh, definitely. And then you when you really, if they could keep a diary, it probably in the end would be because they are actually ovulating or menstruating. It is what causes those those cravings to eat the stuff and then you know all those spikes, and all the all the hormonal spikes and the glycemic spikes cause some increase of sebum and increase of inflammation. So again, it's just multifactorial, if not one thing.

Trina Renea 17:16

Yes. Okay. All right. And here's the next one. Scrubbing your skin can help acne.

Dr. Vicki Rapaport 17:27

Okay, so that's false. And I would say scrubbing your skin can make acne worse.

Trina Renea 17:33

That's correct.

Dr. Vicki Rapaport 17:37

Right? It spreads the bacteria, it aggravates the follicle, it makes people it makes the sebaceous glands feel like they need to produce more sebum. So it's literally the opposite. Again, you can do a very mild exfoliating.

Trina Renea 17:51

People think they could scrub that acne or scrub those blackheads. Or just scrub it, it's gonna like get it off, you know, it just feels good. And it feels like it's doing something. But at the end of the day, it's not really doing anything at all. Except for scratching at the surface.

Dr. Vicki Rapaport 18:09

You got it exactly, literally is scratching the skin.

Trina Renea 18:13

What I like to tell people is like, think of look at a brick wall. That's like your cells, right, and the mortar, the glue-like substance is in between the cells. If you put a scrub on the top of the brick wall, is it doing anything to help get rid of the skin cells that are down below or clean out those pores? That is the mortar? No, the scrub is just scrubbing at the very surface of your skin. So it feels good. And it feels you know it feels nice, but it's not actually helping with any acne at all. Correct?

Dr. Vicki Rapaport 18:45

Exactly. Exactly.

Trina Renea 18:47

And unless hold up, I haven't unless there's an enzyme in there. Like a papaya enzyme or you know some kind of enzyme that's eating through the skin like eating up the dead skin cells. With a little bit of scrub that helps a little bit if it does have something like that in it, I can see how maybe it would help a little tiny bit.

Dr. Vicki Rapaport 19:09

Great. So it’s not so when you talk about scrubbing, you and I are talking about physical exfoliation that what you're saying is beneficial and I totally agree is the chemical exfoliation is great. So if people want to apply glycolic or salicylic or lactic or whatever on a from a pad onto the skin, that's a that is a chemical scrub that is absolutely appropriate and some are fine. Some products are fine to do every single day. But if they want to do like an actual bead, or you know a physical scrub, that has to be super, super mild and maximum three times a week, don't you agree?

Trina Renea 19:42

Yes. And I just, I try and steer people away from the scrubs, especially with acne because again, if you break a pustule, then you're just spreading that bacteria around your face anyway with the scrub. Okay, last question. Then we have to hit the road. Acne medication works right away. Is that true?

Dr. Vicki Rapaport 20:05

Well, if it’s Accutane, it works right away. So, so it's like a true and a false. So if you're talking about acne medication being Accutane, it can work within a week. If you're talking about topical medication, it's false, it takes six to 12 weeks to work. And the studies go three months before they're FDA approved. So I always tell patients when I give them something because I want them to be consistent and not give up. Because we have no, we have absolutely no patience these days, right? We want something to work within a day, it's obnoxious, like what is wrong with us? I tell them look at studies that got this medication FDA approved, went for 12 whole weeks. So before we would switch any medication on you, we're gonna give it a full three months to work.

Trina Renea 20:48

And you have to keep taking it, please. That's the other thing is when I see dermatologists, putting people on their medications, and especially their topicals, I find that they stop using them because it dried out their skin or they have a moment you know that it's dry, and then they'll just stop, instead of like just cutting back a little bit and like working into it. And so I always have to, like get them back on. But in order to for anything to work, you have to give it the time. And it's it's I think some dermatologists like you tell the patients that but a lot of them don't. They're just going to they get them in, they get them out, they say “Use this medication, Do this, do that.” And then they don't really tell them what you said about it takes a whole 12 weeks.

Dr. Vicki Rapaport 21:32

You're absolutely right. And also, I would say that, you know, we really do try and give somebody something that will work sort of quickly enough, something really strong, and then we'll give themselves something kind of mild that they can use on the days where they are a little bit dry. So because you know, we know that people have no patients like you're going to want to see some improvement to have the desire to continue for the 12 weeks. So we kind of magically figure out, you know, what we think is the best regimen based on what the person needs. But I do want to say one of the thing about myths, and we didn't really talk about it would be the myth, the myth that milk, cow's milk and dairy causes acne. Yes. And I would say cow's milk can cause acne, but it's not well understood. So it's, there's possibly some kind of possible link to maybe the hormones that are in the milk. But you know, there's no evidence that either milk or excuse me, yogurt or cheese could cause it. So it's really just the actual milk, glass of milk. It's not all products, but you know, if people want to get off dairy, and they're just using it as an excuse, because they think it's breaking out, that's fine. But you know, I just hate for people to, to, you know, believe these falsies that really haven't been proven. So if you can drink organic without the hormones, it's probably a little bit better. And again, it's not for everybody, but it's it's something that we shouldn't touch on because that is that's a big acne method that people have. It's like it's possible, maybe never really been truly studied. It's possible there's a hormonal link, so either stop drinking, but eat yogurt and cheese or go organic.

Trina Renea 23:12

Okay, well, thank you for that. And let's say goodbye and thanks for listening. You guys will do more acne acne myths in the future. Thanks for hanging by everyone.

Trina Renea 23:30

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