Ep 157 - There’s a Fungus Among Us: Is it Acne or Something Else?

 

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0:01:42.5 S3: Hello, and welcome to ASCP's Esty Talk. I'm your co-host Maggie Staszcuk, an ASCP's Education Program Manager. 

 

0:01:50.8 S4: And I'm Ella Cressman, licensed aesthetician, certified organic formulator, ingredient junky and content contributor for Associated Skin Care Professionals. 

 

0:01:56.6 S3: Today we're talking all about acne, and this episode is inspired by Lauren Lollar-Goings from Beauty Call Make-up. She is a new aesthetician and reached out to us with a burning acne question, which we hope to address today. Hey Lauren. She asked, "I have a question that I'm dying to hear your input on, what is it about this new trend of using head and shoulders shampoo as your face wash to prevent breakouts? I'm seeing this pop up everywhere on social media." 

 

0:02:27.5 S4: And I think that this is everywhere on social media, everyone is saying, in fact, you'll see people often post a picture, "What do you guys think this is?" And like, "Oh, that's a fungal acne," but when you have to understand that, that's what they're referring to when they're talking about head and shoulders it's not like, "I have a break out," they're talking about using something like this for fungal acne, which is completely different than what we learn about in school, what is within our scope of practice, and that is an acne vulgaris, which is the medical name for common acne. We also have to acknowledge that there are several types of acne which require varying treatment approaches by different medical professionals, or professionals, period. [chuckle] 

 

0:03:03.7 S3: So let's start with the basics. A few stats and what is acne. Acne is the most common skin condition in the United States, affecting up to 50 million Americans alone. That's huge. Approximately 85% of people between the ages of 12 and 24 experience at least minor acne and acne occurring in adults is increasing, affecting up to 15% of women. Acne is also possible in newborns with roughly 20% of babies younger than six weeks developing neonatal acne. So there are many types of acne as well as acne-like conditions, but the most prevalent or acknowledged is acne vulgaris, and this is a condition that's caused when the hair follicle is blocked by dead skin cells, sebum and bacteria. So you guys know as estheticians, acne lesions are either inflammatory or non-inflammatory. Non-inflammatory are gonna be your open and closed comedones impacted with that dead skin and sebum. Inflammatory is when they become so filled with dead cells, sebum and nasty acne's bacteria that the follicle wall ruptures activating the immune system and causing blood to rush to the ruptured follicle, and it's bringing with it white blood cells to fight the acne bacteria. 

 

0:04:20.8 S3: You guys know this as a papule. Pustules then are developing as white blood cells battle the acne bacteria creating pus. There's also four grades of acne. Grade one and two are commonly treated with Keratolytic topical products to break up follicle impactions, this is gonna be things like salicylic acid, benzyl peroxide, your AHAs, sulfur, enzymes or combinations of the above. And grade three and four acne, this is extremely inflammatory, significant redness, deep nodules, cysts. This is always referred to the dermatologist and they may prescribe medications or recommend modalities like laser, LED, and injections. And by the way, if you are an ASCP member, you have access to ASCP Skin Pro, the must have app for aestheticians. It's designed to aid in skin analysis and gives you essential information for both skin conditions and ingredients like contraindications and treatment considerations and it's all for free, exclusive to ASCP members. 

 

0:05:20.8 S4: Something to... Great point. Something to think about, and this is what Maggie just said, that we have grade one and two, and three and four, and we know our lane where we sit. Then we enter fungal acne, or Pityrosporum folliculitis. This is different. This is different than the one that we learn about in school, this is the one that... Different than the one that we address in our treatment rooms. Fungal acne is actually a yeast infection of the hair and follicle. That doesn't sound pleasant, does it, Maggie?  

 

0:05:46.5 S3: Not at all, no. 

 

0:05:47.9 S4: Not at all. [chuckle] And it's a specific type of yeast that lives on 90% of human skin, which kind of creeps me out, but there's different conditions that will aggravate it. Usually they're lifestyle related, but that's on like a weakened immune system, taking antibiotics, exposure to heat and humidity, excessive sweating, all of those encourages yeast to grow out of control and triggers inflammation. And that inflammation looks like these tiny pink, red or purple bumps around hair follicles, and they're all usually the same size, they might itch. They're most commonly found on the hairline and upper forehead, shoulders, upper back. This is totally different. The difference between acne vulgaris and fungal acne, they look similar, and you can have both at the same time, but fungal acne break-ups look like a rash of little tiny pustules that are all the same size, and then, like we said before, they could be itchy. 

 

0:06:37.4 S4: They're less likely to be those black heads or white heads, so it's open or closed comedones. And something else to consider with fungal acne is that it gets worse with antibiotics and traditional acne treatments. So we're looking at this, this is my, as a practitioner, red flag, and I'm not gonna address this because this is definitely outside of my scope of practice, that needs a doctor who can adjust this, who can identify, who can diagnose this. And from that, the treatments for fungal acne are often prescription anti-fungal shampoos, creams, topicals, and even sometimes lifestyle adjustments, all outside of my scope. [chuckle] So I think there's this plus that equals, and we have to understand where trends start, where they come from, but it's not to answer the question for Lauren, it's not, it should not be that you're taking fill in the blank tender shampoo and using it on break-outs on your skin. That is the wrong thing to do. 

 

0:07:38.8 S3: I totally agree. Just in general, we would never use a shampoo on our face, and while your shampoos for fungus may have some active ingredients to target a fungal acne, definitely defer to the dermatologist and make sure they're using the proper active medication to treat that condition. 

 

0:08:01.5 S4: Also, if there's 90% of skin... They're used to live on 90% of humans, right? You've gotta assume that that somehow food that's influencing your microbiome. So if you're doing that, you could be causing more problems, you can actually interfere with your microbiome and that could cause a whole other line of problems. [chuckle] I think there's also something to think about is that there's other types of acne. Like we said, we talk about mainly acne vulgaris, but if we look at the other types of acne, we have acne conglobata, which is the most... One of the most severe. Now, this one is intense. Have you ever seen a case like this, whether it's on the Internet or somebody's come in to you? This is where you have those inflamed nodules, like a bunch of pustules get together and then they connect. 

 

0:08:46.7 S3: Yeah. And you can see this often too on the body, like the back or the chest, this... And I don't know specifically if this is hormone-related, but often people who have hormonal issues can develop those deep nodules that then start to form as one big nodule. 

 

0:09:02.5 S4: They say this one is most prevalent on men and often... I mean, listen, we're not judging, but men who take steroids or even testosterone. And this is... A lot of people are taking testosterone more nowadays, both male and female, so being aware of it, but again, this, for me, red flag. This is referral, for sure. And we're all kind of familiar with the next one, even though we don't really know about is called acne mechanica. So this is heat... It's a reaction to heat, pressures against the skin. This happens often in sports, so they even call it sports-induced acne, but it happened to us when we started using masks, so there was this friction, this under underlying friction. Also, sometimes it happens with people who were bras and they have that under-wire friction you'll get it on the trunk of your body. 

 

0:09:50.5 S3: Yeah, the worst. Or even like the sweat band of your yoga pants. 

 

0:09:56.5 S4: If you're running. [laughter] I won't get that. There is no problem for me on that one. 

 

0:10:03.1 S3: It happens when I'm couch surfing. Yeah. [laughter] 

 

0:10:06.5 S4: Okay. Reaching for the remote, that's a lot of friction, to the left, to the red. So I think it's important to consider that not all acne is the same, you gotta think outside of the acne box and widen your perspective for relief potential, you also have to know that before you reach for perceivable fixes that you're sure that you have performed a complete and thorough consultation and analysis, and that way you will understand that this is something you can help it or whether or not you need to refer out. Most importantly, be open to adjust to your treatment program, it's great to call in some help every once in a while. 

 

0:10:43.9 S3: Now listeners, we wanna hear from you. Are you an acne specialist? Have you seen any of these acne conditions in your treatment room? Share with us your thoughts on trends on social media by commenting on Instagram or Facebook or by email and get connected at ascpskincare.com. Thank you for listening to ASCP Esty Talk and for more information on this episode or for ways to connect with Ella and myself or to learn more about ASCP, check out the show notes.