The Science of Clear Skin: Debunking Acne Myths & Exploring Light Therapy

Dr. John Barbieri, a leading expert from Harvard Medical School, joins us to unravel the complexities of acne treatment with a focus on practical and preventive strategies. Ever wondered how something as simple as a hydrocolloid patch can help combat inflamed pimples and deter that irresistible urge to pick? Discover the benefits and limitations of these patches, along with critical insights into hormonal acne management for adult women. We promise you’ll gain a deeper understanding of why prevention is key, and how thoughtful skincare decisions can lead to clearer skin.

Topics Include

• Understanding effectiveness of hydrocolloid acne patches
• Role of hormones in triggering acne flare-ups
• Treatment options including birth control and spironolactone
• Risks associated with long-term antibiotic use
• Potential of light therapy as an adjunct to traditional treatments
• Common misconceptions about acne management
• Importance of a proactive approach to skincare

Tune in for a comprehensive guide on navigating the often overwhelming terrain of acne treatments, and equip yourself with strategies that could transform your skincare routine.

Transcript

Acne Treatments and Hormonal Acne

Speaker 1 0:00

Welcome to Dermot Trotter Don't Swear About Skin Care where host Dr Shannon C Trotter, a board-certified dermatologist, sits down with fellow dermatologists and skincare experts to separate fact from fiction and simplify skincare. Let's get started.

Speaker 2 0:19

Well, welcome everyone again to the Dermot Trotter Don't Swear About Skincare podcast. You know, today on our show we've got part two talking about acne with Dr John Barbieri. He's assistant professor at Harvard Medical School. He's also director of the Advanced Therapeutics Clinic at Brigham and Women's Hospital and he co-chairs the acne guidelines for the AAD. So welcome back, dr Barbieri. It's great to have you again on the show.

Speaker 3 0:45

It's a pleasure to be here.

Speaker 2 0:51

So last time, you know, we took a little dive into acne, talked about genetics like why do we get it, you know, talked a little bit about sort of the natural pseudocles and what's out there, what people are trying for acne. Today I wanted to shift gears a little bit, talk a little more about treatments that you're seeing that people are trying. It's on social media. You might be in again in that drugstore looking for it. One of the things I wanted to address is the use of acne patches, or the patches that are coming out, or on the spot treatments that you can put on, and really are they worth anything? You know, what do they contain and do you recommend them for your patients?

Speaker 3 1:21

And so these patches, kind of basic level of them, the principle they use this material called a hydrocolloid. We've actually used it in wound care and dermatology for a long time. These wounds had a lot of drainage to help kind of soak up all that gunk from the wounds and you imagine a pimple like a pussy pimple bump that you can use that same kind of approach to try and draw out all of that gunk from the pimple. And so I do think these hydrocolloid patches can be helpful as a spot treatment, particularly for pimples that are like a pus bump kind. They're not really good for like a whitehead or a blackhead, but that kind of bigger, like a little bit more inflamed or pus bump type of pimple. I do think they can help. They also kind of give us a signal not to pick at pimples. So having that there, it's like, hey, don't, don't mind, you know when you're just not thinking about like pick at that spot. So I do think it can help people sometimes pick at the pimples less but can help prevent scarring and I do think it helps pimples get better faster. In terms of like which one, they're all very similar. I think there's not huge differences across brands and there's certainly no real studies comparing them, so I think just something that's affordable and you like. They have different kind of shapes of them and they have different colors of them, so one that you like how it kind of feels and looks on your skin can be helpful.

Speaker 3 2:30

And there are these patches that now are medicated, so they put things in it like salicylic acid or other kind of acne active ingredients to try to help kind of have an even larger effect on these pimples, sometimes even using little dissolvable microneedles to try and deliver that active ingredient into the pimples. And these, I do think, have more risk of irritation. A lot of the active ingredients that they include are somewhat irritating for people on their own and then when you put them under something you really like are squishing it into the skin. That can make that even more of an issue. So you know, if you find those ones with active ingredients work even better, great, but I do think it's important to be careful about irritation with those. So I usually recommend people just use the basic hydrocolloid patches when using them.

Speaker 2 3:14

That's, you know. I think one of the things that people talk about with the patches is, you know, keeping the hands off is really important that you mentioned, because when we are addressing that mountain Vesuvius about ready to erupt on our chin, I mean, I think that that temptation is just to chase it and go after it, which can cause a lot more inflammation and problems down the line, potential for scarring, and so I think that's a really good point that you mentioned that the patches really can be like hey, hands off. Plus, they're pretty cool. Now they have them in stars and different colors and shapes. So I think that people are having fun with this as much as it's helping with their acne. It's not like a little accessory that you can do as well, yeah, you can try and make it your own style.

Speaker 2 3:48

Now the one thing with pimple patches.

Speaker 3 3:50

They're really like a reactive treatment so they're great for, you know, potentially helping a breakout get better faster. But you know, in my mind always the goal of acne care is prevention. The goal is to not have the breakouts in the first place and pimple patches are never going to be able to do that. So they can be part of an approach to treat acne.

Speaker 3 4:07

But if they're only thing you're doing for acne, that's really not a great strategy. We want to try and think about what can we incorporate in terms of preventative strategies to keep those breakouts from happening in the first place?

Speaker 2 4:18

And now that you've talked about that prevention piece, it's kind of a good segue. You know, for myself, like you know, even you know struggling with acne into adulthood it's one of the things that you know, I think, in particular for women we struggle with this hormonal component for acne that can present, obviously, in adolescence. But even beyond those years maybe we never even had acne as a teenager and now into our thirties, our forties and fifties and beyond, we all of a sudden are dealing with acne. What type of approach do you recommend for somebody struggling with hormonal acne that might include preventative measures?

Speaker 3 4:49

When it comes to treating acne. Really all acne is hormonal. So even when I had acne as a teenager, my acne was hormonal right Puberty androgens like testosterone those turn on our oil on the skin. So hormones play a role in all acne. But there are some people where hormones may play a larger role People who may have higher androgen levels, people who might have a condition like polycystic ovarian syndrome or just for whatever reason. Their oil glands in the skin are more sensitive to this. And women sometimes signs of that can be having acne that flares like a little bit before the menstrual period, having hair on the chin or chest, called hirsutism, or sometimes getting this darkness on the neck or on the armpits, called acanthosis nigricans. Those can all be signs that hormones and androgens are playing a bigger role in acne.

Speaker 3 5:33

And when it comes to treating those who kind of have acne or hormones are playing a big role, we have a few medicines that directly target that which can be great.

Speaker 3 5:41

Birth control pill is one example of them that reduces the production of androgens and increases this thing called sex hormone binding globulins, like a sponge that kind of sops them up. And then we also have a medicine called spironolactone which in several recent trials has been shown to be very effective for adult women with acne and this blocks the action of androgens at the oil gland itself. And we also have a topical medicine called clascotone that goes by the brand named Winlevy, which is a really nice topical product that you can use actually in men and women to address that fundamental component of hormones that contributes to all acne. So there's some direct strategies that can address hormones and of course really any other just general acne strategy can still be helpful, even if the main driver of acne might be hormones in one. Individual Treatments like topical retinoids, topical antibiotics, benzoyl peroxide, oral, other oral medications for acne, these can all still be helpful.

Speaker 2 6:35

I think it's a really good point. You know that you highlight for men the hormonal components. I feel like you know guys are kind of left out a little bit of that. They're sort of neglected in that group. So I think it's excellent to point out the role that hormones play for men as well as women, you know, to contribute to the formation of acne. You mentioned spironolactone, One of the things you know. I've had patients come in and say and say, oh, I can't go on that medicine. I've got a family history of breast cancer. I heard it causes breast cancer. How do you talk with patients really about what the data shows between the use of spironolactone and breast cancer?

Speaker 3 7:07

It's a really important question. So spironolactone, because it has some effects on hormones, there's questions about whether it could increase someone's risk of certain kinds of cancers that might be sensitive to hormones, like breast cancer or ovarian cancer. And in animal studies there were some concerns that spironolactone might be associated with various kinds of benign tumors, not really like breast cancer, but certain kinds of benign tumors, and so that raised us to ask you know, can that happen in people? And in general, all the data we have so far suggests that in the way that we use it to treat acne or other conditions in humans, it doesn't seem to be an issue.

Speaker 3 7:46

We have a meta-analysis we did a few years ago looking at all of the studies of cancer with spironolactone. We found that there was no evidence of increased risk of really any cancer. In fact, prostate cancer was the last which might make sense based on how the medicine works. There's no increased risk of breast cancer. There's no increased risk of ovarian cancer, though it's important to note that because ovarian cancer is rare, there's a lot of imprecision. We call with that estimate so you know it doesn't look like there's an increased risk, but we can't exclude that there might be some increased risk that we just can't detect because we don't have a big enough study yet.

Speaker 3 8:11

So I do think it's an important discussion. I think if people are concerned about it, it's a reason to think about other options if it makes you feel more comfortable. But, reassuringly, all the data we have in humans, at least, both in the use for acne and in other settings, doesn't really support any increased risk of cancer, and there's even some studies using it in those who've had a history of breast cancer without any increased evidence of recurrence or future breast cancer down the road. So I do think it's something that can be used in those who may be at higher risk for cancer, but it is something where we should have an open discussion to decide whether it's right for that person.

Speaker 2 8:46

And if somebody didn't do something like spironolactone, you know, I think, which has offered great benefits for patients. You know, I've seen it myself clinically and tolerability as well. A lot of people just traditionally think, oh, if I need a pill for acne, you know I'm going to go to an antibiotic. You know the pluses and minuses of antibiotic use, especially the patient that comes in that says this only works for me. I've been on it, you know, nine months. I'm not going to do anything else. How do you address? You know the role of antibiotics for patients and also kind of caution patients about long-term antibiotic use and what it might actually do to your health.

Speaker 3 9:23

Yeah, so yeah, unfortunately oral antibiotics, although they are a great treatment for acne, they do come with some important risk, and actually oral antibiotics are associated with an increased risk of breast cancer and colon cancer. So you know that's something to think about. It's certainly not a huge increased risk, but you know it does matter kind of on a if you treat 10,000 people kind of level. And oral antibiotics, of course, can cause other side effects like stomach upset. We probably don't fully understand the effects they have on our microbiome and things like that. Now, when it comes to being on oral antibiotic, for me they're not a disease modifying treatment. The only acne treatment we really have is a pill that changes the course of acne is isotretinoin and Accutane. So every other treatment, if you stop it, acne kind of goes back to whatever is going to be otherwise. So oral antibiotics they work fast, they work well. But I really, if I'm going to prescribe some oral antibiotic, it's either a bridge to something else, like we need to get better quickly because there's a lot of dark marks, or something we really want to get fast control. But our long term plan is to use spironolactone or a really good topical regimen or something else, or really as a long term treatment.

Speaker 3 10:26

I do think it's a very reasonable treatment to use, kind of in a more long-term way. When we look at the changes to the microbiome, for instance, they happen within weeks and then they stabilize. So I know there have been some guidelines in the past or recommendations to try to limit the use of oral antibiotics to three to four months or three to six months, but to me these don't really make a lot of sense from an evidence-based perspective. Certainly, I think you know if we can try to limit the overall use of antibiotics, that's better, right. They do have risks and the more you're exposed then the worse those risks might be.

Speaker 3 10:55

But the idea to be on an antibiotic or not is far more important to me than how long. So if we think an antibiotic is the right treatment and maybe there is no other treatment that makes more sense. Maybe this is someone who's a male patient. They have really severe acne. They get mood changes when they're on isotretinoin, so we can't use that. Maybe they've tried other things that haven't worked and you know the antibiotic actually works for them. Well, you know what, if our choice is not controlling acne or being on the antibiotic and we understand the risks and benefits of that. You know being on that long-term antibiotic might be the best approach for that person. There might be someone else where we have a lot of other options and instead of using an antibiotic at all, we go straight to those other options because we know the antibiotics going to kind of make us just stuck on if we pick that route. So I think the main thing is to be thoughtful about whether to use it at all, more than that kind of how long question.

Speaker 2 11:45

Very good point and I think too it gets confusing too I mean not only for patients but even for us as dermatologists is you know what are the differences between the antibiotics you see, you know, kind of out there, you'll see that they're extended release or delayed release or they said, no, this is low dose, it's not going to affect the bacteria. People will argue or debate. Can you sort of provide some clarity on that, to kind of explain the difference between the antibiotic options that are out there for patients?

Speaker 3 12:14

And so the first thing is just the antibiotic itself. So, for instance, some of the most common antibiotics used for acne are this tetracycline group like doxycycline, minocycline, now saracycline, and particularly saracycline, is designed to be what we call narrow spectrum.

Speaker 3 12:25

It's like if you took an antibiotic made it really good at the acne stuff and tried to intentionally make it really bad at everything else, and so the idea here is that we're going to have something that might have less impact on our gut microbiome, that might have less impact on our other good bacteria but still have those beneficial effects for acne, and it certainly works really well for acne. It also has less stomach upset and other side effects and other oral antibiotics, which is great. Theoretically it should have less impact on the microbiome. They really don't have a lot of data, like in people, to show whether or not that's the case, but I think you know if you were just going to pick one or the other.

Speaker 3 12:58

It certainly has a lot of great advantages. Now the challenge of it is access and cost, so right now it's something that can be difficult for people to be able to be on and use. But if you imagine a scenario where it costs as much as doxycycline, I think we'd prescribe that every time. We never prescribe doxycycline anymore. So I think we do have these narrow spectrum antibiotics that can help us in those situations where that is the best option for the patient.

Speaker 3 13:21

We don't have other choices that we can do and we know we're going to be on a long-term antibiotic. So that's the first thing is just which antibiotic? And we do have this narrow spectrum one that's probably a little better. And then there's this other thing about like the dose and the formulation in general, these kind of more like extended release or modified release versions of them can sometimes improve convenience because they're usually once a day instead of twice a day. They often are a little bit easier on the stomach in terms of side effects, like nausea or diarrhea or those kinds of issues.

Speaker 3 13:49

When it comes comes to antibiotic resistance, if you ask someone like Alexander Fleming, who invented penicillin, what was one of his biggest fears, it was someone might underdose themselves with penicillin and then create antibiotic resistance. Like if you're in a lab and you want to create antibiotic resistance, if you actually expose bacteria to kind of like sublethal concentrations of antibiotic, that's actually speeds the development of resistance. So this idea that, like low dose antibiotics are good and they don't impact the microbiome and they're not going to cause problems, really theoretically doesn't make a lot of sense.

Speaker 3 14:20

And then, just practically, when you look at the data low dose regimens still disrupt the microbiome you can see that in studies, they still lead to the development of antibiotic resistance. You can see it in studies. So they do have less side effects. They do work, so that's great. So someone who's having stomach upset or problems like that, low dose regimen awesome. But the idea that using low dose antibiotics, we don't have to worry about the microbiome resistance it's really just not supported by the data.

Speaker 2 14:45

I think that's a really good point to highlight because I think there's a little bit of a misconception that it's going to be fine. There's this sort of assumption they are much safer all around. But I think emphasizing really the tolerability factor is important for our patients, especially because antibiotics have been the mainstay of acne treatment for so long. Newer treatments are coming out and I think a lot of patients are getting excited about things that they see that go beyond just using topicals or pills. I think what I get a lot of patients are getting excited about things that they see, you know, that go beyond just using topicals or pills. I think what I get a lot of questions about are going after light devices now, both in and outside red and blue light. What are your thoughts on kind of the pluses and minuses, or is this something you even recommend to patients to do?

Speaker 3 15:25

I think these light devices can be potentially a valuable kind of part of a treatment regimen. So the nice thing about them is, you know, as you point out, they're not a medicine, they're not a pill, they're not a topical thing. They really don't have a lot of side effects in terms of causing irritation or like hurting your stomach or something like that. So they're, in general, pretty safe. You definitely don't want to overexpose your eye stem. I think the original Neutrogena mass ended up in some issues because of that. So we have to be thoughtful about that kind of risk of just bright light around the eyes, but in general they're quite safe and well tolerated, which is a nice thing about them.

Speaker 3 15:57

In the clinical trials of them at least the ones that are available they do seem to work relatively well for both kind of inflammatory acne and also a bit for kind of whitehead and blackhead comodontal acne. And both blue and red light seem to be helpful, and there's maybe a little bit of evidence that combined them together works better than just either alone. So kind of similar to topicals like the multimodal concept. Multi wavelengths of light seem to be helpful here, and so I do think that red and blue light can be useful in treatment of acne Mechanistically. The way people think this might work is one actually the acne bacteria. It has in it this molecule called porphyrins, and red and blue light can kind of activate that molecule which causes damage to the bacteria, can kind of have an antimicrobial, antibacterial effect, and then there may be some anti-inflammatory effects of these light wavelengths as well. So there's kind of two ways that they may work mechanistically. In the trials that seem to work they're relatively low risk, I think, to do, and so for people who are interested in them I think they're a nice option.

Speaker 3 16:57

The challenge is really again cost for some of these things. They often are a few hundred dollars to buy these. Although it's sort of a tip, they last a long time usually, so it's the kind of thing where maybe actually investing in that may cost less than other things that someone's doing for their acne. We actually did a study recently where people were spending on average of $500 at a time of year on their overall acne care regimen, and you know, a $300 mask that works for you might actually be a good investment compared to that. So I do think that they can be a useful treatment option. I think they're very safe.

Speaker 3 17:33

There's a little bit of some uncertainty around how well they work, and a real challenge is that there's a lot of different ones on the market and like which one do you pick? And most of the current ones on the market don't really have a strong evidence base in terms of trials around them. So my main recommendation is get something that does both blue and red light, because it seems like both wavelengths can help and together they might do more than either alone. And I think, like a lot of things, you don't want to buy the cheapest one and you probably don't want to buy the most expensive one and you just look for, you know, a reputable brand somewhere in the middle, and that's probably the best we can do right now with the data we have Great advice.

Speaker 2 18:01

Plus, they just look cool. You know like to put that on like. I don't know like, especially the mask. You know that one of my patients like it just looks great and futuristic and I said, well, it definitely can be a fun way to treat and, as you said, it does get around some of the other challenges with our traditional therapies. And the last couple of minutes we have, I wanted to just kind of pick your brain on maybe a couple of your favorite sort of acne, like myth busters that you just like to pull out, that like you might hear in clinic, or something that a patient asks you like. Oh my gosh, if I hear this again, it's going to make me scream. Do you have a couple that you'd like to share with our audience on what you'd really like to tell people? This isn't necessarily true.

Speaker 3 18:38

Yeah, so you know, first one might be more. I might call it like a mistake or an issue that I think leads to not as good improvement as we'd hope. It happens in clinic all the time, which is using acne treatments as spot treatments instead of what they're best at, which is prevention treatments. I see a lot of people who are like I got a breakout, I put Trenon on it and Trenon 1 is not a good spot treatment to begin with. But again, you know my goal is to prevent the future breakouts and so really almost all acne treatments once you think about using them on the whole areas that you tend to get acne and thinking about them like preventing your future acne rather than treating your current breakout.

Speaker 3 19:16

It's much better to be proactive than reactive and in general with acne consistency, doing something all the time beats intensity like reacting something in a really strong way. So that's, I think, maybe a kind of mistake or myth or issue that comes up a lot where I think you know in the community, if we do a better job of using our acne treatments as prevention, they're going to work better than using them in a reactive way.

Speaker 2 19:40

And Dr Barbary. For our audience out there, can you let us know sort of where they can find you if they want to hear more on your information on acne and tips and some of the recent studies that you've done? Can you fill them in on where they can find you on online or social media?

Speaker 3 19:55

Yeah, so I have the social media. I handle Dr John Barbieri and I have that one on YouTube and Instagram and also on on X, formerly known as Twitter, and then also, you know, if you like reading the literature, you can go check things out on PubMed or on our lab website as well.

Speaker 2 20:13

Thank you so much, dr Barbieri. It's always a pleasure to have you on. I learned so much. You know, I think for our audience you know where acne is the most common skin condition we treat. We see all of us to a degree personally relate For those that can't. We kind of hate those people, but most of us that can relate to this. You give us valuable information. So thank you so much for coming on the show again today.

Speaker 3 20:35

We really appreciate your time and all your great advice, and it was a pleasure to be here. Thank you for having me.

Speaker 2 20:38

Of course We'll welcome you back anytime and stay tuned. We may have Dr Barbarian again for more tips on acne on the Dermot Trotter. Don't swear about skincare podcast tips on acne on the Dermot Trotter. Don't.

Speaker 1 20:50

Swear About Skincare podcast. Thanks for listening to Dermot Trotter. For more about skincare, visit DermotTrottercom. Don't forget to subscribe, leave a review and share this podcast with anyone who needs a little skincare sanity. Until next time, stay skin smart.