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Scott Webb: Welcome to Aspirus Health Talk. I'm your host, Scott Webb. And most of us have had acne at some point in our lives. And there are many contributing factors, including hormones, hygiene, diet, and family history. And joining me today to help us all understand the causes and treatment options for acne is Dr. Tom Raisanen. He's a dermatologist with Aspirus, specializing in medical and surgical care of the skin, hair, and nails for people of all ages.

Doctor, thanks so much for your time today. We're talking about acne and I'm sure you get these questions a lot. So let's start upfront here with maybe the most basic one. What is acne?

Dr. Tom Raisanen: So acne is a very, very common, inflammatory condition that involves what we call the pilosebaceous unit. That's the hair follicle, the sweat gland that's attached to that hair follicle opening, as well as a little muscle that would pull down and cause goosebumps. It's very common and it's so common that up to 90% of patients as they go through their teenage years will experience at least some degree of acne.

It seems to be a multifactorial process, meaning there are a variety of factors that are leading to the acne that we see on all of our faces at some point. There's a mix of overactive oil glands. The pores getting a little bit plugged up with shed dead skin cells. Genetics plays a role. Hormones play a role. Different things like stress, medications and even diets seem to play a role as well.

Scott Webb: Yeah, it does seem so. And you struck a chord there with me because I have a couple of teenagers, so I'm very familiar with the acne years. I've got a 13 and an 18-year-old, so one's sort of aging out a little bit off that while my other one's heading in. And so for teenagers out there or parents of teenagers, what would be your advice generally? Is it just to make sure we wash our faces better? Can we avoid certain foods? Like what's the general advice for teens and parents of teens?

Dr. Tom Raisanen: Sometimes maybe certain lifestyle factors can be enough to help either prevent or control acne alone. And sometimes we need more than that. From lifestyle perspectives, things you can do would be just gentle cleansing of the face each day, especially after sweating or if you have more oily skin. You want to make sure you use a gentle cleanser each day.

Your question about diet is an interesting one because there's more and more data that's coming out. It's always felt that it was a little bit controversial or that the data was a little bit weak. It's still not strong data by any means, but we're starting to see a little bit more evidence that the high-glycemic load types of diets, so lots of simple sugars, carbohydrates, fatty foods, that those can drive some acne and lead to a worsening of acne. And the more healthy diets, fruits, veggies, healthy proteins, those seem to be perhaps a little better suited towards reducing the severity of acne. So there's a little bit of evidence there.

Dairy products are another thing that come up from time to time. And specifically, funny enough, it's skim milk that in at least one study was identified as, you know, being a culprit. So, typically that'd be someone if they drank tons of skim milk, more than the average person, that would be one thing. "Okay. Let's try cutting that out, see if that makes a difference," or at least reducing the intake, but certainly, having a healthy varied diet would be recommended on multiple health fronts and perhaps even to benefit the acne a bit.

Other things to look for would be when we use a lot of different products on our face, on our skin, moisturizers, sunscreens. So looking for products that say something like acne friendly, non-comedogenic, non-acnegenic maybe oil-free products. So those are sort of lifestyle decisions or choices that you can be thinking of, especially if you feel like you might be prone to developing acne and that can help maybe prevent some of it from flaring up.

Scott Webb: Yeah. I wanted to ask, you mentioned genetics, and is that just something that people deal with? I know when we talk about medicine in general, that genetics are such a factor, family history is such a factor. And is that such a thing? Do I have this right, that acne can kind of run in a family, if you will?

Dr. Tom Raisanen: That's absolutely correct. We can't change our parents, unfortunately. But we definitely see that. It's a good predictor sometimes. You know, like you say, if you have a 13-year-old and 18-year-old or, you know, different ages, if we know the older ones or maybe the parents had really severe acne when they were growing up, it can be a good predictor of what the next ones down the line will be experiencing. It's certainly not an absolute, but there does seem to be a strong genetic link in the studies and what we see every day in clinic as well. So we can use that to help guide treatments and think about future treatment options that we might be moving towards.

Scott Webb: Yeah. That sounds right. And let's talk about treatment. You know, my head sort of spins a little bit when I go to the grocery store to pick up something for one of my teenagers. Because I'm standing there as I'm sure many people do and there's just so many scrubs and wipes and, you know, acne treatments. What do you recommend when it comes to OTC and over-the-counter type stuff that parents and teens or anybody can use for acne?

Dr. Tom Raisanen: Yeah. So there are a few products that we commonly would recommend patients use. The over-the-counter ones include benzoyl peroxide. That's typically in a wash form. There's salycilic acid, another common wash that's in the acne Isles. And then lastly, there's a topical retinoid that's available over-the-counter now. It's called adapalene. These are commonly part of the regimens that we have patients on. Maybe it's a part of the regimen. Maybe there's other things involved.

Now, these are readily available over-the-counter, like I said, but there are some nuances to using them. They can cause irritation. We have to think about pregnancy in certain populations. So I would always suggest at least visiting with your primary care provider or your dermatologist about these, just to review some of those intricacies of using these medications and maybe talking about, "Okay, what things would we want to avoid?" Or "How can we best use these products?"

In the clinic setting, our treatment sort of toolboxes is much more expanded than that. But you're right, that these are readily available and sometimes it can be of great benefits to people.

Scott Webb: Yeah, I'm sure they can. And I want to talk about, as you say, in the clinical setting, so let's say somebody is working with their primary and they suggest or the doctors suggest that maybe "Let's step this up a little bit and see a dermatologist." So when do you think that's indicated? And then, you know, once we're seeing the dermatologist or where we're within a more of a clinical setting, what treatment options are available?

Dr. Tom Raisanen: The timing of when to visit a dermatologist is really up to the patient. I'm happy to see patients at any stage of the acne severity spectrum. Maybe they just have a couple pimples or just starting to get things, you know, that'd be a great time to come in. And we can talk about acne, what treatments are available, what would be most useful at that time, what might be down the road, things to be thinking about. If you have maybe moderate or especially really severe acne, that's also a great time to come in and we can help patients get a handle on their acne and, again, reviewing the different treatments that are out there, the different risks, potential side effects, benefits with these treatments as well.

Within the clinic setting, we use a lot of topicals, you know, creams, ointments, washes, oral medications, oral antibiotics are still commonly used. Sometimes we'll use medications to target the hormonal aspect of acne. We use a lot of what are called retinoids both as topicals and then orally, that would be the classic medications called Accutane or the generic term is isotretinoin, that's a medication that's right at the top of the treatment ladder and it's the most effective one that we have. But it comes with a lot of discussion, potential side effects, things to talk about.

So it's always fun seeing these patients in clinic and really trying to find out, "Okay, where can we meet the patient with their goals, their attitudes, their concerns? And where on this treatment ladder, this treatment spectrum can we best help them out at?"

Scott Webb: Yeah. And you mentioned the concerns there, and I'm just thinking about teenagers or even adults, you know, really anyone with acne, I'm sure there's mental component to this, right? A psychological component to this, because, you know, the faces are what we see, maybe not during COVID, but now that people are starting to take off their masks, do the vaccines, we're seeing more and more of people's faces and that can be difficult. It can be difficult on teens, which are tough years to begin with, or maybe on adults when maybe adults wouldn't be expected to have acne. So what advice do you have for anybody in the spectrum, as you said, who has acne, who's trying to deal with it and maybe feels, you know, some embarrassment over it?

Dr. Tom Raisanen: Yeah. Well, it's certainly not something to be embarrassed about because like I said, we all go through this, almost all of us will go through acne to some degree. You know, sometimes we can feel a bit bummed out if we have an acne flare or we can't get rid of it. We feel like we have all these pimples over our face and we feel like people are really honing in on those, when we know that's not the case. But the treatments, they can be very effective. Even in acne, it's not a dangerous condition, but by treating it, we can have improved self-esteem or mood symptoms can improve. And those naturally go hand in hand where we kind of clear up our face or other areas that are affected by acne and our self-esteem can naturally follow that. We just feel more confident.

Scott Webb: We've all been there, especially in our teen years. You look in the mirror and you feel like you're looking good and it kind of boosts your confidence when you walk out the door. One thing I did as a teenager, and I'm sure it just was because it dried my face out, but I found sunlight to be really effective. I found swimming in pools with chlorine also to be really effective during flare ups. So I don't know that you advise those things. But I am wondering, does sunlight the heal acne?

Dr. Tom Raisanen: I feel like I had the same personal experience myself, when I was treating acne as a teenager, I told my dermatologist like, "Oh, I'm doing way better, but that's because I've been out in the sun a little bit more." But now, when I'm in the dermatology setting and get to see sort of the other end of the spectrum, the more elderly population, we see the damages that a lot of sun can have on patients. That sort of cautions me in how we would approach that. And we always want to, first of all, make sure that we're having safe sun exposure. And there's ongoing studies still into finding, "Okay. What is it about sunlight or is there a specific wavelength of sunlight or UV light? More specifically, is there a specific wavelength or a range that can be really helpful for acne?" Maybe down the line, we'll see more UV-related treatments come out.

There's been some recently, some of them pulled off the market. It's certainly one where the safety would be really under close consideration and making sure that patients are not exposing themselves to more long-term risks for a short-term gain. So we would always want to be cautious about sun exposure and we're not routinely advocating for, you know, sun as a treatment for their acne.

Scott Webb: Yeah. There can be a lot of positive benefits obviously to being in the sun. I think we all just feel a little bit better when we get a little bit of sun. But as you say, the short term benefits do not outweigh the long-term risks of spending too much time in the sun. So a great advice. And it's been a great conversation today. Any takeaways you have for folks about acne, how to treat it and just generally how optimistic they should be that these flare ups are within their control?

Dr. Tom Raisanen: With acne being so common, we have lots of treatment options that are available. It's not a dangerous condition, again extremely common. And most often, we can work with patients and find effective regimen that'll help control their acne. One thing that we didn't mention that I just want to mention before we wrap up, is that even though most patients will grow out of their acne some will last through adulthood, but the majority of patients as they kind of go through teenage years, get to the, you know, early 20s, they'll start growing out of it and not have to deal with it.

However, acne can cause permanent scarring. So certain types of acne result in more inflammation. When you have more of the inflammation, we can see scarring and scarring can show up in different ways. It can be texture changes on the face, little pits or indentations. Sometimes when it's on, say, the chest, shoulders or back, it can be raised scars or thick pink spots, pink scars that don't go away even after the acne goes away.

So sometimes even though if acne runs its course and goes away, we can be left with a permanent reminder of what was there and still be left with these skin changes. So one of our primary goals as a dermatologist when seeing patients is to do our absolute best at preventing scarring from happening, because if we can do that, we feel like we're successful and the acne, if we get it to go away, that's great, but we've prevented scarring, which is even more important sometimes.

Scott Webb: Yeah. Yeah, I think you're so right. And along those lines, while we're still talking this through, what do you recommend? Is it really just sort of wash our faces? Not kind of squeeze and pick at things. I don't mean to be too graphic, but I am curious, you know. Is there a way that we can prevent scarring?

Dr. Tom Raisanen: Certainly you mentioned like the picking or trying to pop pimples. By avoiding that, we can sometimes limit inflammation and scarring. The best thing would be to control the acne and keep it to a minimum as the best way to prevent scarring. Once scarring has happened, that scarring has happened, it's there. There are other cosmetic treatments down the line that could be then attempted on those scars to improve them. But really the best thing is to treat the acne with the things that we talked about, you know, gentle cleansing of the face, and then either with a combination of over-the-counter things, prescription medications. Or if you're lucky enough where you don't have severe acne, is just keeping things under control.

Sometimes we'll see, "Oh, we can start seeing early scarring," with appropriate discussions with the patients, but start talking about, "Okay, maybe we need to start escalating therapies a little bit here to get things under better control, so we don't have even more scarring happening."

Scott Webb: Yeah, that sounds good. Well, doctor, thank you so much for your time today. This has been a really educational and helpful. And I'm sure for parents and teens and everybody else, even adults who have occasional flare ups, this is great advice. So thanks so much and you stay well.

Dr. Tom Raisanen: Awesome. Thank you for having me. I enjoyed it very much.

Scott Webb: And thank you for listening to Aspirus Health Talk. For more information, visit Aspirus.org. And please remember to subscribe, rate and review this podcast and all the other Aspirus podcasts. For more health tips and updates, follow us on your social channels. I'm Scott Webb. Stay well.