Ask Us Anything About… Acne

Description – The video begins inside a conference room at the Penn State Health Milton S. Hershey Medical Center. Two people are standing next to each other. Standing from left to right is Scott Gilbert and Dr. Diane Thiboutot.

Scott Gilbert – From Penn State Health, this is Ask Us Anything About Acne. I’m Scott Gilbert. In a way, it seems like a rite of passage for many of us in our teenage years. Acne affects about 85% of people between the ages of 12 and 24. In fact, it’s the most common skin condition in the U.S. There are both prescription and non-prescription treatment options, so we’re going to talk about those as well as the root causes of acne with Dr. Diane Thiboutot. She’s a dermatologist here at Penn State Health. Dr. Thiboutot, thanks a lot for your time today. Let’s start by talking a bit about what’s happening exactly under the skin or on the skin that leads to what we call an, a pimple or acne.

Dr. Diane Thiboutot – Well, usually, at the time of puberty or thereabouts, the hormones start to increase the production of oil on the skin, and that’s combined with the P. acnes bacteria that’s on the skin. And that produces inflammation that can lead to the formation of the whiteheads, blackheads, and the red pimples.

Scott Gilbert – You mentioned a few different terms there — whiteheads, blackheads. What are the differences between the different types of acne?

Dr. Diane Thiboutot – Well, the whiteheads and blackheads, those are called the non-inflammatory lesions of acne, meaning they’re not inflamed or they’re not red. And then, the more pimples type lesions are the red lesions. They can be tender, sore, raised. Those are the main differences.

Scott Gilbert – And what’s the difference in the cause there? Like, what will determine whether something on my skin might appear as a whitehead versus a blackhead?

Dr. Diane Thiboutot – Well, that’s one of the things we’re trying to figure out. There’s a lot that we don’t know about acne. We don’t know why inflammation occurs in some lesions and not in others. We don’t know why not every pore on the skin is involved with acne. So there’s a lot of questions that we’re still working towards finding an answer for.

Scott Gilbert – And acne most commonly appears on the face but not exclusively on the face.

Dr. Diane Thiboutot – Right, it can be on the face, chest, or back, for the most part.

Scott Gilbert – You’re watching Ask Us Anything About Acne from Penn State Health. This is Dr. Diane Thiboutot. She’s a dermatologist here. We welcome your questions. So, you know, again, this is an issue that affects everybody indirectly or even directly, and we welcome your questions in the comments section below this Facebook post. And if you like this interview, as we hope you do, we hope you’ll share it on your Facebook page as well. So what do we know about the causes? I know there’s a lot of speculation out there, and there is some evidence as well. And you’re a researcher as well, so I know you’re, you’ve looked into this as well. What are some of those most common causes of acne?

Dr. Diane Thiboutot – Well, there’s a lot of different factors, which is one of the challenges with acne. We’re learning more about the P. acnes bacteria. It actually got renamed, so now it’s called a C. acnes bacteria. And there are different types. Some of them are more associated with the acne condition, and others are more associated with healthy skin. So we’re learning more about the different types of bacteria. We’re trying to find ways to disrupt the effects of hormones on the skin such that it doesn’t cause acne. So there’s a lot going on. And all of these treatments are hopefully aimed at reducing the inflammation that can occur in the skin.

Scott Gilbert – And you mentioned that bacteria. Where does that come from? Where does it originate?

Dr. Diane Thiboutot – Well, we all have bacteria on our skin. It’s common. We have bacteria pretty much everywhere on our body. A lot of it is healthy bacteria that helps to keep disease-forming bacteria away. So it, basically, you’re born with it for some extent. You can get the bacteria from others, but what’s interesting about this C. acnes bacteria is that it plays a role not only in causing acne, which is a negative effect, but it also plays a protective role because it’s helping to protect against other bacteria that could cause infections.

Scott Gilbert – As with so many bacteria, there are upsides and downsides there. So we hear a lot of, in the news and elsewhere, about various causes of acne. I’m wondering about the validity of some of them. For example, dairy products and chocolate, things we eat. Are there things that we eat that can either cause or exacerbate it?

Dr. Diane Thiboutot – You know, that’s an area that’s, there’s a lot of research going on. In fact, we’ve done several studies here at Penn State to look at the association between dairy products and acne. Dr. Andrea Zaenglein has done that research. And basically, what we found is an association between the consumption of skim milk and the development of acne. It’s not a cause and effect. It’s just that if you take people with acne and people without acne and you look at what kind of dairy products they’re consuming, those that have acne are drinking more skim milk. We don’t know why that’s a difference or what that really means, but that’s what several studies have shown. We don’t know how much skim milk matters, but that’s where the association lies.

Scott Gilbert – And how about makeup? You know, we hear about makeup possibly clogging pores. Can that cause it?

Dr. Diane Thiboutot – No, that used to be a thought years and years ago back when the makeup had a lot of oil in it. Most makeups nowadays are water based, so they tend not to clog pores. And most of them all have been tested to show that they don’t cause acne.

Scott Gilbert – What about the role of hygiene? You know, making sure you wash your face at least once a day, if not twice a day. I mean, does that play a role?

Dr. Diane Thiboutot – Well, I think washing your face is a good idea [laughs] under any circumstance, so there hasn’t been any studies to show whether it actually changes the development of acne or not. That’s one of the things that parents like to say that, you know, if you wash your face more, you wouldn’t have so much acne. But there’s actually no evidence to suggest that washing makes a big difference.

Scott Gilbert – And that’s why we’re here today — to get some clear answers to these questions about acne with Dr. Diane Thiboutot, a dermatologist here at Penn State Health. We welcome your questions. Just put them in the comment field below this Facebook post. Even if you’re watching this video on playback, we’re happy to get you some answers and add those as comments below. And so your general advice, then, if you have somebody who comes in, presents with, you know, the, a very typical case of acne, are there any steps that you encourage them to take kind of in that moment, you know, regardless of what medication you may decide to put them on or other course of treatment? Are there certain kind of lifestyle changes or things you want to make sure they’re doing or not doing?

Dr. Diane Thiboutot – Yeah, I think the challenge comes is that we don’t have enough evidence to suggest that lifestyle modifications make a difference. There are things that people can try over the counter before seeing a doctor for their acne — things like benzoyl peroxide, which is available. It’s one of the most potent agents that kills the bacteria associated with acne. And there’s also other products that are now available over the counter that help to reduce the formation of the whiteheads and blackheads.

Scott Gilbert – How about the effects of sun exposure? Can that worsen acne?

Dr. Diane Thiboutot – I don’t know that there’s been reports of sun exposure worsening acne. Sometimes, people report that their acne gets better during the summer. But if you think about it, teenagers or kids, they’re off school during the summer. They have less stress. So it could be more of the lack of a stressful environment as opposed to the effects of the sun itself.

Scott Gilbert – And you touched on something there — stress. What do we know about — again, I know there’s a lot we don’t know about causes, but there is, stress has been implicated to some extent as a cause, right?

Dr. Diane Thiboutot – Yeah, stress causes release of hormones from the adrenal gland that can indirectly contribute to the development of acne.

Scott Gilbert – And we’re talking a lot about teens. I mean, we mentioned the fact that, at the top, about 85% of people between the ages of 12 and 24 are affected by acne. But it’s not exclusively that group. A lot of adults have acne, and some people don’t even have acne until they become adults.

Dr. Diane Thiboutot – Right. That’s right. And we actually see a lot of adults that have acne, in part because they don’t expect it to have acne. Most, acne’s mostly associated with teenagers. The more severe form of acne tends to occur in teenagers, but the more low-grade, persistent, and difficult to treat acne actually happens in the adult group.

Scott Gilbert – And do we know why, or is that another area under research?

Dr. Diane Thiboutot – That’s another area under research. No, we don’t know why. No.

Scott Gilbert – Interesting. There’s a lot we know, but a lot we don’t know about this, and I know you folks are doing your best to find out, right? You’re watching Ask Us Anything About Acne. We welcome your questions for Dr. Diane Thiboutot. We have 1 now from Janice. She says, “I had clear skin until I was in my late 20s. What is the best treatment for adult-onset acne?” So very related to what we were talking about. Are any — and we didn’t really get into treatments much yet, but to address her question, do the treatments for adult-onset acne differ from those for children?

Dr. Diane Thiboutot – They do sometimes. Usually, in the late 20s, that may be more of a hormonal type acne, but even though it’s hormonally related, you can still have whiteheads, and blackheads, and inflamed lesions that respond to the treatments that we would use to treat teenage acne. And some of those you can buy over the counter. But in terms of trying to interrupt the process of the hormones, that generally requires a prescription.

Scott Gilbert – So then, there’s a question — for teens and adults alike who are experiencing acne, what are some effective over-the-counter treatments? And if those don’t prove effective, perhaps then we come into the doctor’s office. But what are some of those things we can try first ourselves?

Dr. Diane Thiboutot – Yeah, I, any acne wash or acne product that contains benzoyl peroxide — that’s the ingredient that’s most potent at killing the bacteria associated with acne. And there’s also some over-the-counter topical retinoid medications. Adapalene is one. It’s also called a Differin gel. And that used to be prescription, and it works very well for the blackheads, whiteheads, and early inflammatory lesions. So those are probably the 2 best places to start in terms of over-the-counter treatments. That’s what we would recommend before seeking care from a doctor.

Scott Gilbert – So let’s say somebody tries those things. They aren’t really that effective, or maybe things are even getting worse. What are some of the treatments then you as a physician then try to work with them on?

Dr. Diane Thiboutot – You know, there are lots of treatments that are available. Mostly, we look at the severity of the acne — whether it’s mild, moderate, or severe. We look at the types of acne lesions that the patient might have. Do they mostly have blackheads and whiteheads? Do they have the more inflamed lesions? Does the acne involve the face, chest, and back? So there’s all these considerations that go into the treatment. So things we choose from would be a topical retinoid medication to help reduce the formation of acne. We sometimes use antibiotics, but research has shown that the overuse of antibiotics can be, you know, a problem, so we’ve cut back on our use of antibiotics and are using some more of the topical treatments to try to address acne. And there’s a whole variety of other treatments that are a little bit more intense that can be used when the first-line treatments don’t work.

Scott Gilbert – And here’s a big question I’m sure a lot of people have. I’m getting pimples on my face. I’m seeing the whiteheads. Should I pop them, or should I leave them be?

Dr. Diane Thiboutot – Oh my. [laughs] Popping them is never a good idea. It can lead to increased scarring. So even though you feel that you’re popping them on the surface, you’re also opening the pore underneath the skin, and that really intensifies the inflammation.

Scott Gilbert – You realize there’s a whole reality show based on that concept, though, right?

Dr. Diane Thiboutot – Oh, yes. I hear about it every day.

Scott Gilbert – We’ll talk about that some other time. But when we talk about scarring, you know, that is a potential long-term effect. Long after the acne goes, the scars can remain. What are some things people can do to try to reduce the chances of that?

Dr. Diane Thiboutot – Yeah. I think the best thing to do to reduce the chances of scarring is to get treatment early before scarring starts to happen. Once the scarring process happens and once scars develop, there’s really no magic eraser that will remove them. They’re very difficult to treat. The body heals them over time to some extent, but not completely. So the best advice we have is to get treatment for the acne to arrest the development of the acne and prevent the formation of scars.

Scott Gilbert – And how about gender differences? Do we see more cases of acne in women or men?

Dr. Diane Thiboutot – I think in the teenage years, it’s probably equally the same, both women and men. In the adults, we tend to see more acne in adult women.

Scott Gilbert – Interesting. We welcome your questions for Dr. Diane Thiboutot. She’s here with us on Ask Us Anything About Acne from Penn State Health. You can put your comments and your questions in the comment field below this Facebook post, and we’ll get you some answers. Also, like we mentioned, we encourage you to share this post on your Facebook page and, if you don’t already, make sure you follow this Facebook page so we can give you a heads up on future editions of Ask Us Anything About. So generally, then, when it’s time to see a doctor is when you’ve tried a few things and maybe it’s just not going away, right?

Dr. Diane Thiboutot – Yes, when you’ve tried some things and you’re not happy with the result or, in some cases, especially with teenagers, the presence of acne can be, it can take a toll on someone’s self-esteem. So if somebody’s really concerned about acne and they’re not getting better, then it would be advisable to seek the care of a physician.

Scott Gilbert – Sounds good. Anything else we didn’t touch on that you want to remind people about or that’s really important for them to know?

Dr. Diane Thiboutot – I think we’re good. Yeah.

Scott Gilbert – Good deal. Well, thank you again. Dr. Diane Thiboutot — she’s a dermatologist here at Penn State Health. We appreciate your time, and we appreciate you tuning in for Ask Us Anything About Acne from Penn State Health.