Acne, the most common skin condition, impacts millions of Americans annually, and because of that impact, thousands of estheticians choose to specialize in it. However, many skin conditions that look like acne could require a different treatment. In this episode of The Rogue Pharmacist, Ben Fuchs talks about reasons for acne and conditions that may look like acne but aren’t.
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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About Our Sponsors:
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0:00:00.1 Benjamin Knight Fuchs: Calling all forward-thinking Estheticians, it's time to redefine the art of skincare and embrace a revolutionary approach that begins with your client's skin cell health. I'm Pharmacist Benjamin Knight Fuchs welcoming you to Truth Treatment Systems. Where beauty begins at the cell. We believe you're not just a beauty professional, you are a healthcare professional. You wanna make a positive difference, and you wanna make a good living. And we will help you do both. We're here to support your outta the box thinking and empower you to question traditional products, outdated formulations, and old school ingredients. Imagine a world where solutions to the skin's, enigmatic conditions, lie just beyond the horizon. At Truth, we're not just a skincare brand, we're a movement that encourages you to explore better solutions and find that Aha moment that changes the game. You are an artist and a healer of the skin, and we're here to provide the canvas and the tools for you to create tailored protocols leaving generic ones in the past. Sign up now @truthtreatmentspro.com and receive two complimentary mineral-rich electrolyte sheet masks. That's truthtreatmentspro.com, where healthy skin is Beautiful Skin.
0:01:09.3 S2: This podcast is sponsored by LAMPROBE. LAMPROBE is a popular aesthetic 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-evasive 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.
0:02:04.3 Maggie Staszcuk: Hello and welcome to ASCP and the Rogue Pharmacist with Benjamin Knight Fuchs. In each episode, we will explore how internal and external factors can impact the skin. I'm Maggie Staszcuk ASCP's Education Program manager, and joining me is Ben Fuchs skincare, formulator and pharmacist. Hey Ben.
0:02:21.3 BF: Hey Maggie. Good to see You.
0:02:22.7 MS: Good to see you. Acne is such a buzzword and a lot of estheticians choose to specialize in this condition, but there are a lot of skin conditions out there that look like acne but aren't.
0:02:32.7 BF: That's great.
0:02:33.8 MS: Let's talk about it.
0:02:34.0 BF: Yeah, that's a really, really great point. And acne's more than a buzzword, oh my God. It's, it could be psychologically debilitating. It could affect people for their entire lives. And you raise such a good point because we tend to think that every time you have zits or blemishes, boom, it's acne. And I suppose technically you could call it acne, but not distinguishing different areas of the face and different biochemical causes of the breakouts really keeps us from being able to treat these conditions effectively. So the two major kinds of acne, or acne like lesions, let's say, or androgenic acne, those are the acne lesions that appear in the T-zone. And then what I like to call immune-related acne. And that's acne, that's on the cheeks where you have a lot of lymphatic vessels and a lot of immunity.
0:03:23.4 BF: And those are the kind, that's the kind of acne that is related to foods and digestion. And the problem with not distinguishing these two different types of acne is when people, sometimes healthcare professionals, doctors, dermatologists, aestheticians, see lesions on the face. They tend to treat them all the same. So these immune condition, immune related, blemishes or immune related rashes, which tend to be rashy, papular, macular versus papular kind of dispersed. There's pimples usually in there, but mostly it's kind of inflammation and rashyness that tends to get treated the same way as androgenic acne, which is to say, or, things that dry up the skin. Benzoyl peroxide, retinoic acid, alcohol based toners. What ends up happening is you end up with a big red mess because it's not really condition caused by androgens, that is male hormones. Women make male hormones as well.
0:04:17.7 BF: Androgenic acne along the T-zone area is a confluence of three factors. Number one, hyper sebaceous secretions, lots of sebum. Number two, hyperkeratosis, lots of keratin division, keratinocyte division, and lots of keratin protein. And number three bacteria. Those are the three factors that make up androgenic acne. First, the bacteria, the skin cells proliferate. Keratin is deposited in the follicles causing blockages. Sebum is secreted in excess, causing blemishes or causing pimples. And then bacteria come and eat the sebum, and then you end up with a classic zit. That doesn't happen with the kind of acne that appears on the cheeks, the kind of acne that appears on the cheeks and sometimes on the chin and the jaw, jawline is related to foods and digestion. Until you control the food and digestive issues, specifically SIBO, Small Intestinal Bacterial Overgrowths, leaky gut food allergies, and food intolerances, they all kind of combine together.
0:05:12.9 BF: You're not gonna get, have any success. And if you try to treat it this condition with benzoyl peroxide and retinoic acid and alcohol toners, you end up with a big red mess and you don't treat the condition. The good news is, is that once you start to straighten out the digestive system, most especially by eliminating problem foods, although you can also do things like apple cider vinegar with your meals, digestive enzymes, probiotics and various, hyperimmune egg, which can kill excess bacteria inside the intestine. These various strategies, the condition disappears because it's an immune reaction. It's much easier to deal with this kind of condition. Than androgenic acne, androgenic acne, you have to start to work with the hormone system, which is always tricky, this kind of acne on the cheeks, the immune-based acne, the lesions that will disappear as soon as you correct the digestive issues.
0:06:01.2 BF: And that's what makes it number one so tragic, the fact that it's misdiagnosed and we try to treat it with the androgenic strategies. And number two, it's so easy to treat if you do it correctly, that I consider that to be the most tragic of all skin conditions. And I see people all the time with this kind of carpet like lesion all over their face. And I just wanna tell them, look, all you gotta do is start working on your digestive system and eliminate problem foods. Oftentimes it's things like dairy or eggs or grains, just by eliminating specific foods. Now, you do have to do other things for the digestive system, but sometimes just by eliminating specific foods, you can have the condition disappear. To further compound the bad news is if somebody has this kind of condition, they're on the road to a lot of worse things, including autoimmune diseases, cancer, neurodegenerative diseases, all of these are also associated with the small intestinal bacterial overgrowth, placebo or leaky gut condition that is associated with the blemishes. So the blemishes are also kind of a, they give you a barometer for how you're doing in terms of your overall health. And they, by controlling the blemishes and working at the level of the digestive system, you can prevent further problems down the road that are much worse than just cosmetic.
0:07:13.5 MS: And is it possible too that, somebody could actually be dealing with Rosacea, let's say.
0:07:20.0 BF: Rosacea is related? Absolutely. Rosacea is oftentimes it's definitely related. Rosacea is also a food condition, and people have Rosacea Know that there's certain foods that trigger their Rosacea and they'll tell you to stay away from chocolate or spicy foods or alcohol and such. That alone just tells you that you're dealing with a digestive problem. Just the fact that foods will trigger it seems pretty obvious, right? If foods trigger a condition, obviously it has to do with food and digestion, but Rosacea also involves a bacteria called H. Pylori. Have you heard of this?
0:07:47.2 MS: I have, yeah.
0:07:48.0 BF: Yeah. So H. Pylori infections are very common in people who have Rosacea. H. Pylori is a bacteria that lives in the stomach when stomach acid is suppressed, and this condition of low stomach acid, achlorhydria or hypochlorhydria also leads to SIBO bacteria. Stomach acid is very antibacterial. So stomach acid's role, one of stomach acid's role is to help break down, breakdown, kill bacteria, but it also stomach acids also involve in activating digestive enzymes. So if you don't make enough stomach acid, not only are you going to make, you may have bacterial overgrowth because you're depriving yourself of a very powerful antimicrobial strategy, but also you're not gonna be processing your food completely. And incompletely processed food can also lead to SIBO. So using things like apple cider vinegar with your meals or, betaine HCL with your meals, things that digestive bitters, things that stimulate acid secretion can help with, preventing H. Pylori. These days, they give you an antibiotic to kill H. Pylori, but if you don't take care of the stomach acid situation, you may end up with the H. Pylori coming back. They used to tell you that stomach ulcers, for example, were caused by too much stomach acid.
0:08:58.4 BF: I don't know if you heard that. And Antacids are like the second or third bestselling over the counter drugs. Ironically, achlorhydria or hypochlorhydria, low stomach acid is a much more common problem than too much stomach acid. And by the way, heartburn or GERD, gastroesophageal reflux disease, reflux that comes back up, a lot of people will think, oh, that's too much stomach acid. And so they'll take Antacids. Ironically, SIBO, Small Intestinal Bacterial Overgrowth, which is caused by low stomach acid, is one of the main reasons why people get this reflux issue. So it's actually low stomach acid, not too much stomach acid that can be responsible for reflux. And ironically, people will treat it by using antacids, making the problem worse.
0:09:40.2 MS: You often hear, "adult acne"
0:09:44.4 BF: Yes. Yes.
0:09:47.2 MS: And, what is your take on that?
0:09:47.9 BF: A 100% digestive and SIBO related. Now, it could also be related to hormones, specifically testosterone and estrogen, but as it turns out, hormones are also processed in the digestive system. So sometimes people who have, an adult acne, androgenic acne, will be dealing with imbalances in estrogen and imbalances in testosterone. In fact, that's usually what the cause is. So you can deal with that sometimes by doing your androgenic acne strategies. But I would be working with small intestinal bacterial overgrowth. In fact, I don't think there's a single chronic health challenge, skin related or otherwise that's not related to this dysbiosis or messed up gut bacteria SIBO condition. And more, more we're finding that out. Five years ago, people didn't even know what SIBO was. Now if you go online and look up the research between SIBO and any chronic health challenge, you can name, you'll see a connection.
0:10:38.6 MS: And is that something that someone themselves can balance by, like probiotics and diet? Or is this going to the doctor and getting medicine?
0:10:50.0 BF: No. Well, if you go to the doctor, they'll give you an antibiotic, kill the bacteria. The problem with that is antibiotics are kind of, they're not specific. They'll kill all bacteria. So you'll kill your good bacteria and you'll kill your bad bacteria. So that's not a great strategy, although it may work in the short run, much better is to stop feeding the bacteria. And the most important foods that feed the bacteria are fermentable sugars. FOD, you've probably heard of FODMAPs, right?
0:11:15.2 MS: Yeah, yeah.
0:11:16.4 BF: The FODMAPs sugars, those are, FODMAPs foods. Those are the ones that feed, the bacteria. Celiac disease, gluten intolerance, those kinds of things can exacerbate the problem. But a lot of times people will go gluten-free, and they'll wonder why they're not getting better. And that's because these fermentable sugars feed the bacteria. So the best thing to do is do a food diary, and that's where you see which foods make your problems worse.
0:11:43.4 BF: The interesting thing about bacteria in terms of SIBO is they will grow quickly. So you'll feel your... If you eat the wrong food, you'll know it pretty quickly. In fact, the test for SIBO is a breath test where they give you sugar to drink a sugar solution, and then they measure the gases that come outta your mouth. They measure, the gases that you emit. So it really doesn't take very long for the bacteria to start proliferating once food gets into the intestine. So you'll know it pretty quickly. And that's why food diary is really, it's really the best way to go real quickly, androgenic acne male, we call it androgenic because it's related to male hormones, but I really wanna be clear, women get male hormone acne too. Vitamin A and zinc are your two go-to nutrients. In fact, many cases of male hormone acne can be resolved just with vitamin A and zinc.
0:12:31.4 MS: Internally or topically.
0:12:34.5 BF: Internally and topically can help, but internally really 'cause you want to Zinc is involved in hormone balancing, and Vitamin A is involved in how cells divide the number. The initiating factor in male hormone acne is rapid cell division. The keratinocytes, the skin cells are, like all cells, they divide. And as they're dividing, they're maturing and growing in a process called differentiation. So as they're rising from the bottom to the top, from the basal layer to the stratum corneum, they're taking on different shapes. And each shape that they take on is very important in the sense that they'll feed back to the bottom and say, "Hey, stop growing. We already have enough cells here." When you have acne, that signal is missed. And so the cells keep proliferating. And that's the initiating factor in male hormone acne is rapid division overgrowth of keratinocytes and over secretion of keratin causing the plugs. And that's the first thing that happens.
0:13:28.6 BF: The second thing that happens is sebaceous secretions, excess sebaceous secretions, and then causing an oil plug and then bacteria. But the first factor is differentiation of the keratinocytes and rapid secretion and excess secretion of keratin. So vitamin A controls that, and that's the first thing to do. Now, vitamin A and Zinc is also involved in testosterone in metabolism. And excess testosterone is one of the stimulus for keratinocyte division. So controlling testosterone and controlling, stabilizing differentiation, the growth of cells, those are your two main strategies. But sebaceous secretions can also be increased by sugar and insulin, and insulin will upregulate sebum. So keeping your sugars down is also important for your acne androgenic acne patient. And in fact, a lot of times, back in the old days when I was in pharmacy school, we used to call acne skin diabetes, and we would use anti-diabetic medicine for treating acne. In fact, until probably in the 19 until the middle of 1960s, early 1970s, that was the main treatment for acne was, diabetic medicine, anti-diabetic medicine. So keeping your sugar down and also using supplements like chromium, vanadium, vitamin B1, vitamin B3. These are selenium, these are nutrients that help stabilize sugar, and those can also be helpful for male hormonal acne. And they're just good supplements to use anyway.
0:14:52.3 MS: That concludes our show for today. We thank you for listening, but if you just can't get enough of Ben Fuchs, the ASCP's Rogue Pharmacist, you can find him @truthtreatments.com. For more information on this episode or for ways to connect with Ben Fuchs, or to learn more about ASCP, check out the show notes.