Maggie McKay (Host): Acne can be painful, not only physically, but emotionally as well, many times it's a condition reserved for teenagers, but a lot of adults suffer from it too. It can flare up with stress or hormonal changes and it can be so frustrating to deal with. But if you know how to treat it and possibly prevent it, acne can be managed. Today, I'm joined by Dr. Stacey brown, a rural health physician from Northern Inyo Healthcare District, as he dives into how he diagnoses acne and provides treatment to his patients. I'm Maggie McKay. Welcome to Mountain Medicine, the official podcast of Northern Inyo Healthcare District. Thank you so much for being here, Dr. Brown.

Dr Stacey Brown: Thanks, Maggie. It's great to be here.

Maggie McKay (Host): You know, when you're a teenager and you have acne, you feel like you're the only one in the world. But in fact, there are about 3 million cases in the US each year. So why is it so common?

Dr Stacey Brown: Well, acne has a lot of different causes and, unfortunately a lot of them are things that we can avoid, like adolescent. acne can be, from medications, it can be from, adolescent hormonal changes. It can be worsened by some other inflammation that's happening in your system. So lots of different causes kind of lead to the same end point.

Maggie McKay (Host): And what are the most common types of acne?

Dr Stacey Brown: Most of the time, what comes in through the office is going to be acne in your adolescents. And so the hormonal changes of what we call sebum production. It's a, the oils that are on your skin, that changes as you get through the hormonal kind of storm, that is adolescence. And that's usually when we see it the most often.

Maggie McKay (Host): Who is most likely to suffer from it? Is it teenagers?

Dr Stacey Brown: It can be teenagers. Although, I would see a lot of young adults too. you think that you're through the thick of it during high school and all of a sudden you're 25 and you're going and getting married or whatever, and now you've got to deal with it either again, or you just never quit dealing with it.

Maggie McKay (Host): Right. And is it preventable?

Dr Stacey Brown: To a certain extent, there is a lot of genetic factors. And so if you look at mom and dad, they may have had a difficult time with acne as a child an adolescent or young adulthood. So some of it's genetic and you can't really change your being. But, some of it is, preventable in the way that we end up, washing our faces or kind of decreasing the amount of oils that are on the skin. Decreasing the amount of inflammatory things that are happening to us. There's a lot of data out there on, pro-inflammatory things that we either eat or drink. And if we can reduce that, then the severity of the acne might get better, but maybe not be completely preventable.

Maggie McKay (Host): I remember when I was in college, Accutane came out and it was like, oh my goodness. So helpful to so many people suffering from acne. Is it still the go-to or is there something new?

Dr Stacey Brown: Accutane and the generic name isotretinoin is, been around for a long period. And I tell my patients, it's like the atom bomb of acne therapy. It really works, but it's almost like, you know, killing a cockroach with a sledgehammer. It can be a little heavy handed at times. So there's some things that we can do ahead of time, before we get to Accutane. But certainly Accutane is a great drug. A lot of the time, what we ended up using before we get to Accutane or topical agents, things that will decrease the oil production on the skin, your old clearacils, your benzoyl peroxide.

Some topical agents that decrease some of the inflammation that comes from little bacteria, that live on our skin normally and create inflammation from some of the excessive oils. So topical antibiotics, we ended up using some of the other things that is kind of pre Accutane or the same vitamin A analogues, these little molecules that are different from vitamin a, but really control the maturation of the skin and how the skin, builds up, before it sleffs off. And those, agents, like retinae or, some of the retinoids that we apply to the skin, lots of things that we end up doing either topically or orally before we hit that Adam bomb.

Maggie McKay (Host): Are there home remedies that keep pores clean? I read something recently that said add aloe Vera gel, rosewater, and tumeric. Do things like that really work?

Dr Stacey Brown: You know, I've been in this business long enough that I don't take, anything at gospel anymore. either good or bad. So if it looks like it works for some people, then, they should try it as long as it's not dangerous. And the interesting part about the ones that you just talked about is the tumeric is really, really potent anti-inflammatory so it may very well be something that, could be as simple as a tumeric containing compound could decrease, the flare of acne and the severity.

Maggie McKay (Host): I remember in high school, everybody used toothpaste overnight. Did you ever hear that to dry out your pimples?

Dr Stacey Brown: Yeah. And you know, the funny part is that I'm from a generation where I remember the old Clearasil commercial and the Clearasil commercial if I remember that benzoyl peroxide was, the prom queen had a zit on the end of her nose before, prom the next day. And then she grabbed the bottle of magic, sauce and smeared it on her nose and bingo, overnight it was cleared and that's, garbage. We know that acne takes about four to six weeks for it. at the beginning, at a molecular level, at the skin microscopic level to actually produce one of those white heads or blackheads.

We call them comedones Madison, and what you see today on your skin, I tell my patients was cooking for like four to six weeks before. So putting something on and expecting something that's going to be really good tomorrow. The only thing really that's going to do that is just some coverup.

Maggie McKay (Host): Right. Make-up. Just trying to extract acne on your own, really leave scars? That's what the facialist always say.

Dr Stacey Brown: only if you're really aggressive at it. so those comedones, we talked about the white heads and the black heads. They're kind of the same ilk. the white heads are a little pocket of oil that gets produced in the skin and never really reaches the surface to kind of dry out and oxidize. It just kind of sits there and it attracts all these white cells to it. They create this red bump that can form pus pocket. And that's really what that whitehead is. The blackheads are open to the surface, open to the air. And so those little oil glands open up to the air and oxidizes contents of the oil and the, gland and the poor to a black. And those are much easier to extract. So with some gentle pressure, you can extract some of those blackheads, but the white heads, you're really just rupturing the little puss pocket that's there and creating a lot more inflammation.

Maggie McKay (Host): Does diet factor into the likelihood of getting acne?

Dr Stacey Brown: I get this question a lot, have patients that come in and like every time I eat pizza, I get acne every time I eat chocolate I get acne. And it's probably not the food's fault. It's just the way that your skin reacts to those foods. I give you an example. I had a patient who had a lot of sugary drinks, like sodas. And every time they went on a binge on drinking a lot of sodas that created more inflammation, not just in their skin, but kind of all over her body. And her acne got worse. She blamed the acne on the soda's not the soda's fault. It's just her skin's reaction to some of those factors.

Maggie McKay (Host): And is acne more common in men or women?

Dr Stacey Brown: I'd say it's probably equal. Although men generally don't come to the office as often. So we see more women, coming into the office with complaints about. I don't think that it's any less severe in either age group on my experience. I just think, see more women coming into the office.

Maggie McKay (Host): And when it comes to exposure to the sun, I've heard a lot. And I think it might be a myth that the sun is good for us. You know, if you bake out there, it will dry up your acne. Is that inaccurate?

Dr Stacey Brown: I don't see any good data on that. But, you can make a stretch, if you think about it, and what does sun do for our skin in a positive way other then giving us, skin cancer. It generates vitamin D and vitamin D is one of the more potent anti-inflammatories out there. So vitamin D I'm not suggesting this, that you go and suntan your acne away, but if your vitamin D level is low and you replace that with some judicious sun exposure, you might actually help your acne.

Maggie McKay (Host): And what do you tell patients who feel frustrated because say they've been going to the dermatologist for years and they still have acne. What do you say to them when they say, I don't think I've ever going to be rid of this?

Dr Stacey Brown: I start from the basics. building a house is like laying the foundation first and then building the wood structure on top of it. So you go back to the basics. Have you tried. this, have you tried the topical agents, the benzoyl peroxide? Work on those four pillars of how acne starts in the first place. Excessive amount of oil inflammation, decreasing a little bacteria that live on our skin, that create more inflammation. Go back to those, pillars that you have. The fourth one is the maturation of the skin, as it goes, from the basal level, all the way to the surface and then sleffs off.

So you go back to those four guiding principles, those four mechanisms, and you start from scratch. You may need hormonal therapy in some select cases, oral contraceptives help to decrease some of that extra androgen. The male hormones that goose the skin to produce more oils. You may need, some combinations of therapies. One thing may not do it, but a combination of two or three things might do it. And then of course, you might get to the point where you do need isotretinoin or the Accutane family of medicines to try to really be that, big push you need to get better.

Maggie McKay (Host): And some people have acne on other parts of their body. They're back or their chest. Do you treat that differently than you would acne on the face?

Dr Stacey Brown: You can, my experiences is you start with the basics and you put it on the front and the back, which are again, more of the common areas of getting, acne. And you start there and if it works great, but in my experience, sometimes takes that isotretinoin or Accutane therapy to really get the back and the chest under control. One other place that people are getting acne now with the pandemic as around places where, their facial masks rub. So sometimes we call it mask ne where the mask is irritated the skin caused inflammation, the oil doesn't get to the right places. And so people can get acne right around where their masks rub.

Maggie McKay (Host): Wow. Oh my goodness. Another consequence of the pandemic?

Dr Stacey Brown: Exactly. Another pandemic associated illness.

Maggie McKay (Host): So, Dr. Brown, how often do you suggest somebody go visit the dermatologist? If they are suffering from acne.

Dr Stacey Brown: I think if you're suffering from acne and none of the over-the-counter agents are working for you, then that's the time to seek a provider. And remember that most of the people in the United States with acne, don't see a dermatologist, they'll see their primary care provider, whether it's a family medicine provider or a nurse practitioner or physician's assistant to start therapy and they can offer a lot of things that can help. I think that during some of our well child visits and well adult visits, it's time to raise that question and ask, hey, is there anything I can do for my skin? And we can start a lot of things before we need to refer to the dermatologist. So once a year, I think is a good idea to touch base with your primary care physician and see if it looks like you need some help with your acne.

Maggie McKay (Host): Thank you so much, Dr. Brown for shedding, some light on this important topic that affects so many people. I think All this information you gave us is really helpful and we appreciate you. That's Dr. Stacey brown, a rural health position with Northern Inyo Healthcare District to find out more, please check out our website nih.org to book an appointment or to find out more about our positions. That's nih.org. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. Thank you for listening to Mountain Medicine, the official podcast of Northern Inyo Healthcare District. Hi, Maggie McKay. Be well.