Trish: Hey podcasters, well I’m here today with Dr. Doug Grose who is from DJG Cosmetic and we’re gonna have a chat about the age old problem of acne and what causes it, how we can fix it, and it doesn’t matter what time of your life, what age you are, acne can kind of happen almost at any time. So thank you so much for joining us today Dr Grose.
Dr Grose: Pleasure.
Trish: So tell us this is something that you like talking about.
Dr Grose: Very passionate about acne.
Trish: Yeah, so tell us about acne.
Dr Grose: Well the first comment to make is, acne is always considered to be a disease of teenagers, but in more recent years and by that I mean probably the last 15 to 20, It’s increasingly become a disease that we’re seeing in people in a higher age group, people who are experiencing a late onset who are in their 30s and 40s when the disease is coming on. Yet, although the demographics have changed a little bit, the fundamental nature of acne hasn’t changed. Just so we know what we’re talking about, acne is a disease of hair follicles, in which the hair follicle opening blocks up. Every hair follicle in your body has a little oil gland associated with it called the sebaceous gland and when that hair follicle blocks up, the sebaceous oil or sebum can’t get out on the skin and so the hair follicle swells. The hair follicle is a great place for bugs to grow and so bugs that are naturally in the hair follicle start to multiply which gives you the infection, which gives you the redness and all the other factors associated with acne. So that’s what acne is, a blocked hair follicle with infection.
So the question is what causes it? Probably the answer to some extent is that we don’t know, but what we do know is it’s probably in genetically susceptible individuals and unquestionably the new thing to understand is the importance of diet. The medical profession, to our shame, have denied the importance of diet just about as long as I have been a medical practitioner, which is what, 48 years. In recent years, the evidence now is starting to pile in very strongly and of course what we’ve done is gone back and had a look at some of the old research which denied diet to see how good it was, and it was terrible. I was particularly interested in looking at a paper that was published in 1969 showing that chocolate doesn’t cause acne. Many patients over many years have reported that if they eat chocolate their acne tends to flare.
Dr Grose: When you actually have a look at how the study was done, it was the inevitable test where some people had chocolate bars and some people had what they called a control bar. Of course the control bar was full of sugar, so it was actually slightly worse than the chocolate bar in terms of the amount of carbohydrates found in it. So guess what? There was no difference between the control bar and the chocolate bar. The reason there was no difference is they are both full of sugar, not because chocolate does not cause acne. Rubbish. Terrible study, but we’re learning. The big problem with diet and food and acne is carbohydrates generally. So what are carbohydrates? They are foods that come from grains typically; so your bread, pasta, cereals, biscuits, cake – all that sort of stuff is a major source. The second one is milk and milk products, but not plant based milks like Soy or Almond, but animal based milks like cow’s milk.
Trish: Okay. So basically if you’ve got acne you should stay away from your carbs and your milk?
Dr Grose: Absolutely, big time. The first paper was published on this quite a few years ago. It made the observation those populations that follow a very primitive diet, a Palaeolithic diet, a caveman diet, such as a close neighbour to our north, The Kativan Islanders, do have no acne. Their diet is still basically fish and vegetable and they have no acne.
Dr Grose: No acne. It’s true for just about every society that has a diet with very little grains in it, but as soon as you start cultivating food and herding animals for milk the problems start. If you think about it, man hasn’t been cultivating food for that long, man as a species.
Dr Grose: Probably 20,000 years. In biological terms, in terms of adaptation and evolution that’s a blink of an eye.
Dr Grose: So our bodies aren’t used to that high carbohydrate load that’s associated with grains resulting in bad outcomes including acne, diabetes and obesity.
Dr Grose: What high carbs does is stimulate production of a hormone called insulin growth factor 1, and also causes problems with testosterone levels in your bloodstream. The combination of the two stimulates the oil glands and also tends to make the skin thicken up causing blockage.
Trish: Yeah. All right. So say you get acne.
Dr Grose: Yep.
Trish: So whether it’s as a teenager or menopausal or during midlife, whenever, how can you actually treat it? I know there’s different modalities out there, but what’s the process to go through different treatment modalities?
Dr Grose: Okay. First…-
Trish: Or if it was you what … Yeah.
Dr Grose: Well it depends on the severity. For me as a doctor, treating people with acne, it depends on how severe it is. So let’s talk about somebody who’s just got a few early stage pimples, the young person, the teenager perhaps who’s just starting to show signs. First thing, change your diet. Okay? Get rid of the carbs, which is not easy. If you’re a teenager, getting carbs out of your diet is not easy. Not easy for mums and dads sending their kids to school to get food that the kid can take to school to eat. Basically, that’s the first thing though; get the carbs right down low. The second thing is to cleanse the skin gently, preferably exfoliating it as well. So use a mild scrub as a gentle exfoliator, but cleansing or exfoliating only twice a day. Not four times a day, not once a day. Twice a day. Okay.
Dr Grose: Four times a day is too much and will cause problems. Once a day is too little.
Trish: So morning and night.
Dr Grose: Morning and night.
Trish: Touch your skin.
Dr Grose: I usually recommend that people cleanse in the morning and a scrub at night.
Dr Grose: In the morning it depends on how severe their problems are, but in the morning generally speaking, if they’re going be out in the sun they have to use sunscreen. That’s the other trick – avoid cream based sunscreens and tend to go for the sports gel or spray type products, because they don’t aggravate acne.
Dr Grose: Then at night time, it just depends. Benzoyl peroxide, which is a very common product available over the counter, is very useful at helping control bacterial over infection in the skin. A little bit of Benzoyl peroxide will help on the skin at night. After that, some of the cosmeceutical companies make products that have got a mixture of salicylic acid and glycolic which is a fruit acid. They’re also very good to put on the skin in the morning or at night. So anything that unclogs the pores, that’s what you are trying to do. So I say to people, once your pores are draining, you’re never going to get acne. As long as the oils are getting out on your skin there will be no acne.
Dr Grose: Okay. So what you have to do is stop the pores from blocking up. That’s the whole key to acne.
Trish: Yeah, and it’s true ’cause you can’t even get a teenage boy to use anything on his skin, so as long as you can get them to cleans at night and morning, you’re one step in the right direction.
Dr Grose: Yeah. Boys are difficult, they’re actually probably the reason I’m so passionate about acne actually, because girls can put makeup all over to hide it but not boys.
Dr Grose: You can tell girls have got acne, but it doesn’t look too bad, whereas boys don’t have that luxury. I think boys suffer much more with their acne and in fact they’re quite receptive to advice if they trust you. And that’s always the thing. I find when I have boys for patients, teenage boys, my first thing is I have to get this boy to trust me……
Dr Grose: …that what I’m telling them is correct, and get him to do the treatment, ’cause if he doesn’t do it, it won’t work.
Trish: Yeah. So what about the old age old question, to squeeze or not to squeeze?
Dr Grose: Generally speaking I would say you should go to a professional if you want to squeeze your pimples.
Trish: I’m gonna regret it.
Dr Grose: I’m going to say you need a professional pimple picker if you want to get your pimples picked.
Dr Grose: The thing is that if you have trouble … All you’re doing is dislodging a little plug that’s in the hair follicle.
Dr Grose: That’s what you’re basically trying to do and as long as it’s done correctly and not too aggressively then it’s fine, but what happens if the lesion is large enough and if it’s hard to dislodge the plug? Typically the skins grown over the top of it, so if you squeeze all you do is rupture the hair follicle, which releases all this infected sebum into your skin, into your dermis, which creates a much more severe inflammatory reaction, which potentially can lead to scaring.
Dr Grose: So that’s the reason why we don’t want people to do it. Okay?
Trish: Okay. Okay, so if you’re gonna do it, get it done professional?
Dr Grose: Yeah, exactly. Get a professional licensed pimple picker.
Trish: Not a mum who’s really good at it.
Dr Grose: No, no, no, not mum with long fingernails. “Sit there, I’m not trying to hurt you. Sit there, just keep still.” No don’t you do it. The other thing to do is to get what’s known as a comedone extractor. They’re east to get, you buy them from chemist shops.
Trish: How do you spell that?
Dr Grose: Comedone is C-O-M-E-D-O-N-E. Comedone. A Comedone extractor. It’s just like a little tiny curette with a hole in it. You just gently push it down onto the lesions. That’s much less traumatic than mother’s fingernails.
Trish: Yeah. They hurt too. I’ve got one of them at home. Yeah. All right, great. We’re not gonna squeeze our pimples unless we go to someone professional. We’re gonna cleanse in the morning, exfoliate at night, and we’re going to use a non cream …
Dr Grose: Sunscreen.
Trish: … sunscreen in the morning and still moisturiser at night time?
Dr Grose: You can, but you’ve got to be very careful about moisturisers, because generally speaking people who have acne have extremely oily skin anyway and so moisturising is not going to be any benefit to them.
Dr Grose: They already have got very oily skin anyway. I mean what is a moisturiser? It’s oil and water mixed together. So you’ve already got plenty of oil on your skin, why add to it? And some oils are what is called comedogenic which means they tend to create Comedones which are the lesions that you get in acne. So generally speaking, I’m not a big fan of moisturising skin in acne patients. I prefer to use something that’s got some salicylic acid in it, glycolic acid, or some benzoyl peroxide. That type of thing; or prescription products.
Trish: A bit astringent?
Dr Grose: Yes, I don’t mind. Astringents are basically alcohol and I would put that on the skin at night. I’d prefer something that tends to actually dissolve the plugs in the hair follicles more.
Dr Grose: So that’s where the glycolic or particularly salicylic acid comes in
Dr Grose: … which is probably the most effective agent for that.
Dr Grose: salicylic acid is oil soluble so it tends to get down into the hair follicles very well.
Trish: All right. Awesome. If all else fails you can always go and see a practitioner who specialises in acne.
Dr Grose: Come and talk to me. Love to have you. Love talking to people with acne. It’s something I’m very passionate about. I just see so many people whose lives are damaged by acne. My particular story of life, if I’ve got a second just to tell you …
Dr Grose: A story of a young lady who is a patient of mine and she’s a little bit special. She’s got some mental issues and what have you, but she has horrendous acne or had horrendous acne from an early age but we got it completely better I’m pleased to say. I sort of said to her one day, “Has your life changed?” And she said, “When I looked like I used to look, people would not talk to me and if they did they would not look at me when they spoke.”
Dr Grose: She said, “Now they both look at me and talk to me. It’s made such a difference in my life.” That sounds such a simple thing doesn’t it? But to her it was massive. That was the biggest change in her life is that people would now look at her and talk to her. So acne is a disease that I am very passionate about as you can probably gather.
Dr Grose: It is life changing.
Trish: Well my nephews got it and I just every time I see him now I can’t stop but stare you know. I just wanna get in there and squeeze ’em but they’re like, “No, no, leave ’em alone. Don’t do anything about…” I know it’s a real …it’s different for so many people.
Dr Grose: I was going to say, it’s difficult for doctors like me where I want to deal with their acne. I often see kids working in checkouts at supermarkets with bad acne and I want to say to them, “Here’s my card, come and see me.”
Trish: Yeah don’t…
Dr Grose: I know how you feel about your nephew.
Trish: Yeah. Well thank you so much for taking the time to talk to us today.
Dr Grose: It’s a pleasure.
Trish: So ladies, gentlemen, men, women, boys anyone. If you’ve got an acne problem and you wanna see Dr. Grose? You can contact him at Rejuven8 Cosmetix or you can drop us an email to firstname.lastname@example.org. Thank you so much.
Dr Grose: That’s a pleasure. Thanks for having me.