It’s easy to fall for misinformation these days and while estheticians are well versed in acne, it’s your clients who may be falling for commons myths and home treatment methods. In this episode of the Rogue Pharmacist with Ben Fuchs, we discuss acne myths, medicine, and methods for treatment, and the real reason your clients have acne.
Associated Skin Care Professionals (ASCP) presents The Rogue Pharmacist with Benjamin Knight Fuchs, R.Ph. This podcast takes an enlightening approach to supporting licensed estheticians in their pursuit to achieve results-driven skin care treatments for their clients. You can always count on us to share professional skin care education, innovative techniques, and the latest in skin science.
About Ben Fuchs:
Benjamin Knight Fuchs is a registered pharmacist, nutritionist, and skin care chemist with 35 years of experience developing pharmacy-potent skin health products for estheticians, dermatologists, and plastic surgeons. Ben’s expert advice gives licensed estheticians the education and skin science to better support the skin care services performed in the treatment room while sharing insights to enhance clients’ at-home skin care routines.
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Ep 123 - The Rogue Pharmacist - Acne_FINAL
0:00:00.0 Speaker 1: This podcast is sponsored by Lamprobe. Lamprobe is a popular esthetic tool that enables skincare practitioners to rapidly treat a wide variety of common minor skin irregularities or MSI. Red MSI treated by Lamprobe include dilated capillaries and cherry angiomas. Yellow MSI: Cholesterol deposits and sebaceous hyperplasia. And brown MSI treated includes skin tags and more. Lamprobe MSI treatments are non-invasive and deliver immediate results. Lamprobe can empower your skin practice with these new and highly in-demand services. For more information, visit lamprobe.com. That's L-A-M-P-R-O-B-E.com. And follow Lamprobe on social media @lamprobe.
0:00:55.3 Tracy Donley: Welcome everybody to ASCP and The Rogue Pharmacist Benjamin Knight Fuchs. Hey, in each episode, we will explore ingredients, chemicals, and the environment, and how it can have a positive and negative effects on the skin. I am Tracy Donley, Executive Director of ASCP. And joining me today and co-hosting is Maggie Staszcuk, our very own Education Manager. Hi, Maggie.
0:01:20.6 Maggie Staszcuk: Hey, Tracy.
0:01:21.7 TD: Well, guys, today were gonna be discussing acne: Myth, medicine, and the method. I just kind of was wondering, Maggie. It sounds like you're still getting breakouts.
0:01:32.6 MS: I do get breakouts. Yeah, I get the occasional one like on my chest or my shoulders, so more body breakouts.
0:01:37.5 TD: Oh, see, I think that's a big reminder. You guys, it is not just on your face, right? It is anywhere on your body. Well, I think it's anywhere. Maybe Ben will tell us. Alright, Ben, we're just gonna turn it over to you.
0:01:48.4 Benjamin Knight Fuchs: You said it. Oh my god, you said so many things, I don't even know where to begin.
0:01:51.9 TD: I know. Acne.
0:01:52.8 BF: It's acne's such a huge subject.
0:01:54.7 TD: It is.
0:01:54.7 BF: First of all, what is acne? When I ask you this question... And I don't know. Do you mind me asking you this question?
0:02:00.7 TD: You can ask me.
0:02:01.0 BF: Am I putting you on the spot?
0:02:01.7 TD: You can put... Ask me.
0:02:02.1 BF: 'Cause if I put you on the spot, you'll see why we have such a problem treating acne and the biggest myth.
0:02:05.0 TD: Oh, yeah, you can make me look like a dummy. I'll admit it.
0:02:06.9 BF: So what is acne? Tell me what acne is.
0:02:08.7 TD: I think acne is like an infection.
0:02:10.7 MS: It is a disorder of the sebaceous glands.
0:02:13.1 BF: Ooh, Maggie.
0:02:13.7 TD: Well that's 'cause she's an esthetician and she has her certification.
0:02:15.4 BF: No, those are all things that are associated with acne, but that's not what acne is. I'll tell you what acne is. And when I tell you what it is, you'll understand why we don't treat acne effectively. And we really don't treat acne effectively, from a medical perspective anyway. This is the problem with treating acne: Acne is a word. That's all it is. A-C-N-E. It's a word, and you can't treat a word. And I'm not being facetious.
0:02:37.9 TD: Okay, 'cause it sounds like you are.
0:02:38.9 BF: I'm not being facetious. I'm being really serious because, you see, the biochemistry that is associated with acne varies. It's not just a pimple. Acne is a hyper-proliferative condition of the skin cells, and it usually occurs in the T-zone area. And so the very first thing we have to do when we come to treating what we call acne, or treating the word acne, or treating the diagnosis of acne, is we have to isolate the biochemistry that's associated with that specific type of pimple or that specific type of lesion. And the treatments that you use for treating acne on the cheek or treating breakouts. And, see, I'm calling it acne too.
0:03:22.2 TD: Hah, pimples.
0:03:22.8 BF: Treating lesions on the cheek are gonna be different from treating lesions on the T-zone, are gonna be different for treating lesions around the mouth, are gonna be different for treating lesions on the shoulder or on the decollete or in the back or in the butt area. Because the biochemistry associated with all these four different types of lesions, while they're all called acne, are different and mandate different treatments. And so the first thing you have to do is look at the lesion and where it's appearing on the body. And by where it appears on the face or on the body is going to determine what kind of protocol you're gonna use. And the biggest mistake even dermatologists make, and healthcare professionals make, let alone estheticians make, is they treat all zits, all lesions, all breakouts as acne and use a homogenous type of treatment, benzoyl peroxide, retinol, peels, etcetera, without making a distinction of the specific type of biochemistry that's associated with that specific type of lesion. Do you see what I'm saying?
0:04:20.6 TD: Wow.
0:04:20.8 MS: Yeah, I feel like you're gonna start telling us about like face mapping and stuff.
0:04:24.0 BF: Well, in a way because it's not too difficult. Face mapping is a little bit more complicated 'cause there's lots of parts of the face that are associated with face mapping, so it's similar. But with acne you basically have acne on the cheek, that's one type of acne. You have traditional acne. And again, I'm falling into calling it all acne too because that's just what we do.
0:04:41.8 TD: That's okay.
0:04:43.1 BF: But I wanna really make sure we understand that this is lesions or breakouts, that's what we call them. Don't call them acne. Typically, what we really call acne is a T-zone phenomena, and that has its own biochemistry, biochemical etiology. That's a fancy way of saying cause. So the biochemistry of the T-zone acne is going to be distinct from the biochemistry of the cheek lesions, which is gonna be distinct from the lesions around the mouth, which is gonna be distinct from the lesions that form on the jawline, or sometimes even on the chin.
0:05:13.8 TD: Okay, now I'm dying to know what is...
0:05:16.0 BF: Which is distinct from the lesions on the back and on the body. So let's talk about all these.
0:05:21.0 TD: Yes.
0:05:22.4 BF: The main distinction, the most problematic distinction of acne that I see as a therapist is the acne that appears on the cheek, and that some people come into a esthetician or a dermatologist practice and they'll get treated as if it were generic, real true acne, with retinoic acid or benzoyl peroxide or peels or ultraviolet light. And all they end up with is a big red mess. And you probably have seen this kind of condition. And they can't get anybody to treat it correctly because it's not acne, and it's being treated as if it's acne. It's an immune response. There's a lot of lymphatic vessels in the center of the face, in the cheek area of the face. This is where rosacea will appear, and it's the same idea. In the cheek, there's a large concentration of immunity, of immune functionality. And so when you breakout along the cheek area, you wanna think immunity. Immunity is defense, so you wanna think defense. Defense means offense, so you wanna think offense. What is the offending agent? And the beautiful thing, well, the horrible thing, as we said, about this kind of acne is you can't treat it like ordinary acne. It's an immune system condition.
0:06:32.7 BF: And so, nothing that you do topically is really going to address this kind of acne but the good news is, is once you figure out the offending agent, it disappears, forever. Never to be seen again. As long as you don't introduce the offending agent. So bad news is, is you're not gonna be able to treat it like with benzoyl peroxide and topical preparations, retina and such or antibiotics, which is what they'll give. But the good news is, is that once you eliminate the offending agent, which is food, it will disappear. And let me tell you something, when you see a patient who has been going to dermatologist, after dermatologist and using strategy after strategy, and taking pills after pills and scrubbing and rubbing and nothing helps, and you say, well, maybe it's the gluten or maybe it's the dairy or maybe it's the eggs, or maybe it's the beans, and they figure it out and it goes away, the psychological lift that that patient has is, it's so dramatic.
0:07:25.2 TD: 'Cause they're in control of it finally.
0:07:26.5 BF: They're in control of it, it's not there, and they're not cursed. And it's an amazing thing, and I've seen this happen over and over and over again, where it completely disappears and even better, as if that's not great enough, you're now prevented or reduce the likelihood of autoimmune disease, of arthritis, of God forbid cancer, of other health challenges down the road that can cost further health misery and ultimately even shorten longevity. You've actually made a health difference in that patient in addition to clearing up their skin. Gluten is a culprit, but you know as we've talked about many times, plants make defensive molecules. Gluten is one of them, but there's many of them. And so a lot of times people will do their gluten-free beer and gluten-free bread and gluten-free donuts and gluten-free this and gluten-free that, and it's not helping. There are people who have reactions topically to gluten, and also you can have gluten intolerance to the brain.
0:08:17.3 TD: What?
0:08:17.8 BF: Yes. Gluten intolerance to the brain is associated with memory problems, brain fog, ultimately, it can even be associated with dementia, so yeah, you have leaky gut in the brain, leaky brain.
0:08:27.1 TD: Woah.
0:08:29.4 BF: You have blood vessels in the brain that when they're inflamed or when they're subjected to toxicity, open up and toxins can go right into your brain. So you can have leaky brain, because what we're really talking about is things getting into the blood through the intestine. So when we talked about reactions in the skin it's because things are getting into the blood into the lymphatic system. Along the same lines, you have a lot of lymph in your decollete area and you have lymph in the back area and kind of the top where your shoulders are, not quite your shoulders, but towards your shoulders, and then down the back and in the butt. Do you know why they say, Why do I have zits on my butt? Well, because you have a lot of lymph in that area, so that's a sign of lymphatic toxicity, and in fact, you may know this, you have teenage boys, right?
0:09:15.3 TD: Yeah, yeah.
0:09:16.0 BF: So one of the things that teenage boys, not so much anymore, but when I was growing up, one of the things teenage boys did was inject steroids, right?
0:09:21.5 TD: ____.
0:09:23.9 BF: Right? And anabolic steroids, to get big. And what the nurses would do, if they wanted to check to see if somebody was injecting anabolic steroids, is they check the back, because when you inject anabolic steroids, you're putting toxicity right into the bloodstream, you break out along the back.
0:09:37.4 TD: Okay.
0:09:38.2 BF: And so bacne can be caused by this whole toxicity issue, not necessarily just steroids, but any toxins that get into the bloodstream. So decollete, shoulders, back, butt all of that you want to think lymph along with the cheek area.
0:09:51.1 MS: So this is kind of going down a rabbit hole, but if somebody is very prone to ingrown hairs that are random, like say on the legs, for instance, where...
0:10:00.6 BF: Okay, so a couple of things, and that is a little bit...
0:10:01.9 TD: No, I'm dying to know that, because that actually happened to me ____.
0:10:03.5 BF: Okay. So that kind of leads us into the really true acne, which is androgenic acne. That means male hormone acne. So, how cells grow is tightly controlled. We Were talking about peptides before and making cells grow. Cells don't always want to grow. The growth of cells is tightly controlled, in fact, the default state of a cell is to grow. It's the breaking mechanism, that's what takes energy and that's what takes nutrition. Under conditions of inflammation or nutritional deficiencies, cells will hyper-grow. When a skin cell hyper-grows, it produces the stuff a skin cell produces, which is keratin, that's a keratinocytes, produces keratin. When a skin cell is hyper-proliferating and is producing lots of keratin, it can cause little plugs. This only happens to people who have curly hair or pubic hair area, the hair's curly, sometimes in combination with this hyper-proliferative state, this excess growth of keratinocytes or rapid division of keratinocytes and hyper secretion of keratin, in combination with a curly hair, the hair will curl back or on the sides, right in the bikini area, the hair will curl back and in combination with this hyper-proliferation, it will trap the hair, and that's what that ingrown hair is. So the good news is, is that because it's the hyper-proliferative state that is causing this plug is caused by certain issues, by correcting those issues, you can correct ingrown hairs and there's also some type of ____.
0:11:32.8 TD: What are those issues?
0:11:33.7 BF: Hang on, hang on.
0:11:34.3 TD: I get so excited.
0:11:35.5 BF: There's also a topical strategy you could do, so that was kind of a digression, but not really because that leads us into talking about androgenic acne. Because this hyper-proliferative state is stage number one for the development of male hormone. It's called male hormone acne but women get it too. So you have androgens, which are male hormones, but I don't want people to think that that's just hormone guys, women make male hormones, men make female hormones. So androgens, elevated androgens are step number one for the formation of so-called androgenic acne, and that's the hyper-proliferation of skin cells and the hyper-secretion of their protein, keratin. So quick digression, on your skin, you have these holes, right? I think we've talked about this before. They're called pores, and the pore has a rabbit hole, I call it a rabbit hole.
0:12:21.5 TD: Okay. [chuckle]
0:12:21.7 BF: It's like the opening of a rabbit hole, and then you got a pore, the pore is the opening of the rabbit hole, then you have a follicle and the follicle is a rabbit hole. And the follicle is just like a rabbit hole, except it's lined with skin cells, it's like your skin is here and then it curls back and forms of follicle and the same skin cells that are on the surface line the follicle. Does that make sense?
0:12:42.2 TD: Yep.
0:12:42.5 BF: Okay, and then, Alright, sometimes they'll be hair coming out of the follicle, then it's called hair follicle, sometimes they'll be a little sebaceous gland, oil gland, and that's very important. And then technically, they call that whole thing, the pilosebaceous unit, and then the hair, and then the sebaceous gland. So the lining of that follicle, like the old skin, contains skin cells, if skin cells are hyper-dividing and hyper-secreting keratin in that follicle, now you've got a plug.
0:13:12.5 TD: Oh!
0:13:13.1 BF: Okay, that's the plug. Now, that's not acne yet, that's the plug, and I'll tell you what you can do about this and what its caused by in a second. Okay, so you got a plug, now, on the surface of the skin, you have bacteria. Bacteria on the surface of the skin are controlled by oxygen and they're controlled by light, but if these bacteria are now inside the follicle and they're plugged up with keratin, now there's no light and there's no oxygen, they can start to proliferate, then the sebaceous gland is cranking out oil, and under certain conditions, sometimes that oil is really thick and viscous, so now you have a plug, you got bacteria and you've got oil. These bacteria love, like all living things, love protein, keratin, they love fat, sebum. So now you got these bacteria trapped inside a plug, and essentially they're at Las Vegas, all-you-can-eat buffet.
0:14:12.5 TD: Oh my Gosh, totally. [laughter]
0:14:14.5 BF: They're just munching down on the fats and they're munching down on the protein, this initiates bacterial proliferation, the immune system becomes involved. Boom, you got your pimple. So the pimple is made up of the zit of acne. The traditional acne zit is made up of a combination of factors, and that's the take-home message. These combination of factors represents your power points, your leverage points as a therapist for controlling the pimple, you work on the hyper-proliferative state of the keratinocytes. So you slow down keratin production, you work on the thickness of the sebum and the hyper-secretion of the sebum, and you work on the bacteria and by approaching your acne blemishes at all three areas, now you have control over the formation of zits.
0:14:58.9 MS: The people that are prone to this hyperkeratinization, are they also prone to potentially getting things like psoriasis or seborrheic dermatitis or things like that?
0:15:08.9 BF: Absolutely. Absolutely, these are all hyper-proliferative states, absolutely, including cancer, which is the classic hyper-proliferative state. So any time you have hyper-proliferation, you're prone towards all kinds of health challenges. Now, typically androgenic acne only occurs in kids, so they're not deteriorated badly enough to where they're gonna get cancer but this is on the road, this is on the way. So then the question becomes, how do we control all this? Well, first of all, the most important substance in the body for controlling, I will say one of the most important, it may be the most important, but at least one of the most important substances for controlling hyper-proliferation is Vitamin A.
0:15:44.7 TD: Oh, my God, Vitamin A.
0:15:46.0 BF: Vitamin A's role... It has quite a few roles to play, but one of its main roles is to control proliferation, and in the business, we say Vitamin A is a normalizing vitamin. Vitamin A will stimulate things or will slow things down, which is why the treatment of choice, pretty much the only treatment that you could get at the doctor's office for treating acne effectively is what?
0:16:06.6 TD: Retin-A.
0:16:06.8 MS: Retin-A.
0:16:07.4 BF: Retin-A. That's how Retin-A works. Retin-A is a cream that contains, and there's generics now, but originally Retin-A, the brand, was a cream that contained active vitamin A, which is retinoic acid, and its mechanism of action was to stabilize hyperkeratinization, stabilize hyper-proliferation of the keratinocyte, and in fact, vitamin A's anti-proliferative effect is actually used to treat cancer. Retinoic acid is used to treat lung cancer. Vitamin A is a must-have nutrient, it's an essential vitamin that's not even a vitamin, it's a hormone, meaning it doesn't just assist, it doesn't just provide the environment that's appropriate for chemistry, it makes it happen. And not only is it a hormone that makes it happen, but it's one of those hormones that goes into the cell, and it doesn't just go into the cell, it goes into the nucleus of the cell, it goes into the genetics of the cell. It is a genetic modifying vitamin or substance that we call a vitamin because it's essential, it's a hormone that we can't make, that we have to get from food, and by the way, it's only found in animal foods, it's not found in plant foods, there are substances in plants, in fact, there are substances throughout nature that have Vitamin A activity, and they're not vitamin A, but they have vitamin A like activity, and one of them, for example, is beta-keratin.
0:17:31.0 TD: I know you always say, get it from your food, get it from your food, but if you can't get enough from...
0:17:34.4 BF: Supplement.
0:17:34.7 TD: Yeah, can you supplement?
0:17:35.7 BF: Heck yes. Heck yes.
0:17:36.6 TD: I mean, do you have to look for anything special on the bottle?
0:17:39.2 BF: Vitamin A.
0:17:39.9 TD: It just says vitamin A?
0:17:40.9 BF: Yes, it'll say retinol. It usually says retinol. Sometimes it'll say retinyl palmitate. Vitamin A should be balanced with Vitamin D. And Vitamin A and vitamin D kinda work synergistically, they each help each other work, and that is another really powerful tool for treating acne, that's the sun or even a sun lamp. The sun is wonderful for help stimulating the production of cells, but it also is important as an antibacterial, which is the second mechanism, I don't wanna say the second mechanism, but the next mechanism, in addition to stabilizing hyperkeratosis, you also wanna control bacteria. Now, the bacteria are at the end, so that's not the primary strategy, and that's why antibiotics, topical antibiotics or internal antibiotics, that's not the best way to treat acne. Although you can have some temporary effects, bacteria tend to come back. So to me, if you're gonna work with bacteria, I love salicylic acid, because salicylic acid also has an anti-keratin effect, that's keratinolytic, so it will actually dissolve keratin plugs, and it will kill bacteria as well. And then the third phase or the third compartment of the acne, the formation of acne pimple is the sebum, the oil, and this is very interesting because androgenic acne is called androgenic acne because the male hormones, testosterone.
0:18:55.8 BF: Well, there's a hormone in the body that overlaps with testosterone, and the reason, by the way, I should say that testosterone is associated with acne is because testosterone is a growth substance, that's why teenage boys and the teenage girls get it 'cause they're in a growth spurt, so the body will secrete lots of testosterone, in fact, sometimes that testosterone will get converted into super testosterone, which is called DHT, which you may have heard of and is associated with male pattern baldness. And so, there's another hormone that overlaps with testosterone in terms of its building and growth properties, and that's insulin, and so elevated insulin levels can compound the problem of elevated testosterone and in addition to elevated insulin causing hyper-proliferation of skin cells, it can also cause along with testosterone, hyper-secretion of sebum, also stress hormone will cause hyper-secretion of sebum. So working at the hormonal level with testosterone, with cortisol and with insulin can have an anti-proliferative effect and it can have an anti-sebaceous effect.
0:19:58.7 BF: And as a bonus, if you work with cortisol, you'll also get a reduction in hyper-pigmentation, especially post-inflammatory hyper-pigmentation that can sometimes occur and it's your acne patient who's secreting lots of cortisol, making lots of sebum, who is going to have a tendency towards PIH, post-inflammatory hyper-pigmentation, and you can kind of see this, and by the way, you could see this, the body types will tell you a lot. I can diagnose, I don't wanna say diagnosed, but I can assess what kind of acne somebody's dealing with by asking questions on the telephone, asking about hair, asking about leanness of the body, asking about body fat, asking about muscle tone.
0:20:34.7 TD: Wow.
0:20:35.2 BF: All of these will tell you whether you're dealing with an androgenic acne condition. So, for hyperkeratosis, Vitamin A. For hyperkeratosis also salicylic acid, for getting rid of keratin plugs, salicylic acid, for bacteria, antibacterial strategies. Salicylic acid is a great one. Benzoyl peroxide, which I'm not crazy about for a couple of reasons, but that also has antibacterial properties and then slowing down sebum production by controlling testosterone, eating less sugar and keeping your insulin down, and then stabilizing cortisol, and there's lots of ways you could do that.
0:21:09.5 TD: Look at your sleep.
0:21:10.5 BF: Get your sleep, but you could also use things like Vitamin A, Vitamin E, Pregnenolone, even Melatonin, all the kids typically don't have a problem with that, but that can have a cortisol stabilizing effect, lowering blood sugar by changing the way you eat, you know, Indigenous cultures don't get acne. Acne is a disease of Western civilization. Now, these days, there's not a lot of indigenous cultures, but a guy named Dr. Weston Price in the 1930s, I think, he went to New Guinea and he saw Indigenous cultures and he studied them, he was actually studying it for their teeth, he was a dentist, but he noticed they didn't have acne. And so, acne is a disease of Western civilization and really, the most prominent distinguishing feature of Western civilization over Indigenous cultures, is the foods we eat. So sugar plays a major, major role, reducing sugar intake, of course, with kids, that's not always easier said than done. A real good sugar hack, if you find yourself eating a lot of sugar is eat more protein, because protein gets turned into sugar gradually, so eating more protein and also using an amino acid called glutamine can help with sugar.
0:22:09.7 BF: If you look at my supplements for dealing with acne, I use sugar control nutrients, Chromium, Vanadium, the B Vitamins, as you mentioned, and then there's one B Vitamin that is super spectacular for slowing down sebum production, and that's Vitamin B5 or Pantothenic acid, although you do have to take high doses of Pantothenic acid, by high doses, I mean like 500 milligrams to 1000 milligrams a day. It's water soluble, so you don't have to really worry about toxicity. But with all of this, shows you is that by understanding the distinction between the breakouts and not labelling everything acne, which is a word, you have control over the process, and that control mostly involves lifestyle issues that don't mandate or require participation with drugs, or participation with the medical model, you can supplement, you can change your diet, you can relax, you can use exfoliation techniques, get rid of the Keratin. There's so much we can do at home to deal with acne without having to, number one, deal with a medical model, or number two, have to just live with the condition.
0:23:08.2 TD: This is awesome. I think we could totally do another episode one of these days on acne, so great, but I'm gonna wrap our show, and as always, if you're not an ASCP member, joined us today at ascpskincare.com/join, and if you like this episode, please, please, please join and subscribe. So you never miss it. Okay, and if you love Ben and who doesn't, you can definitely check out his blog, pharmacistben.com, I invite you guys to check it out, it's awesome. And that's it for us today. Have a great day.