Recently membership has been gaining momentum. We just leapfrogged over the 400,000 mark! Thanks for participating everybody. It’s such a helpful, supportive group of people here and I appreciate it!

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unnamed-1I’ve noticed over the years that anything I read about acne in magazines is usually replete with errors and terrible misinformation. I’m at my dad’s house for a few days right now and my step mother gets Fitness magazine. The cover claims “Clear Skin Breakthroughs That Really Work.” I had to crack it open and read it. Their advice boils down to using salicylic acid and perhaps staying away from milk. Wow. Such bad advice. First of all, anyone who researches acne to any degree knows that salicylic acid is very weak at controlling breakouts. The legal limit for salicylic acid products is 2% and at this concentration it does very little if anything to help clear the skin. And milk has been associated with breakouts in only very limited, confusing studies based on people recalling what they ate many years previously. This evidence is so flimsy that the authors in The Journal of Clinics in Dermatology concluded, “Our conclusion, on the basis of existing evidence, is that the association between dietary dairy intake and the development of acne is slim.”

unnamed-2I could go on and on here picking apart the deep horrendousness of this one supposed “Clear Skin Ahead” article as it is titled inside the magazine, but suffice it to say that this article will do nothing for anyone other than cause them frustration and confusion. This is true of upwards of 90% of other articles I have read in major magazines over the years. Can you tell I’m mad? Well, I am. Ok, I just have to quote one more thing from this article. Haha. Keep in mind that almost every journalist who has ever interviewed me has misquoted me, so I’m not dogging the doctor here. But they quote a doctor saying, “sweat and bacteria left on the skin after a workout can be a breeding ground for breakouts…” The reality is that bacteria on the surface of the skin has zero to do with acne. Zero. It is bacteria deep within the skin which causes acne. Far from clearing things up for the readers of Fitness magazine, this quote just reinforces yet another myth about acne.

Bottom line: Don’t believe pretty much anything you read in magazines about acne. And to extrapolate, don’t believe pretty much anything you read in magazines period.

8577792156_aaa5d79a90_zI live in San Francisco where the weather is almost always temperate–cool with low humidity. However, I am in Pennsylvania right now visiting family. I forget how unforgiving hot, sticky summer weather can be to acne-prone skin until I am enveloped in it. I’ve had to be super strict with The Regimen since I’ve been here to stay clear. This is par for the course in hot, humid weather, however. Researchers have found that people in hot and humid climates have more incidence of acne and more severe cases of acne than those in temperate climates. This is not to say that you can’t still stay clear during summer. It just takes stricter adherence to The Regimen.

Tips to stay clear in hot/humid climates:

1. If you end up sweating, try to be gentle when you dry off. Dab your skin gently with a towel or napkin and do not rub the sweat off. Constantly wiping off sweat can be irritating to the skin and cause a breakout. More tips on how to avoid irritation here.

2. Be super strict with The Regimen. Do it twice a day, every day, use plenty of benzoyl peroxide, and moisturize even if you don’t feel that you need to. In the summer it is even more important to follow The Regimen to a T.

3. Try adding 10% glycolic acid (AHA) to The Regimen to bump up the effectiveness even more. Just be sure to adequately protect your skin from the sun if you decide to add in glycolic acid.

4. Since body acne can be aggravated by irritation, and sweat + irritation can make this worse, you may need to treat your body in the summer as well.

Now go out and have some fun! :)

Screen Shot 2014-07-08 at 10.12.39 AMI’ve been working on the personalized advice page in order to make it more fun for people to fill out and easier for people to digest the information.

I have not launched this page yet. Instead, I’d like to get some people to test it and give me any feedback on issues they found. If you get a chance, please take the quiz and reply here with any issues you came across or comments you might have.

I coach people through The Regimen regularly. Something I’ve always noticed is that it’s much harder to get them cleared up when they are on alternative products. When I get them on Acne.org products they clear up nicely. Sure, sometimes I need to get them to be more gentle, avoid getting sunburnt, etc. but oftentimes it’s as simple as just getting them off of other products and on to Acne.org products.

Recently, I asked a bunch of people to look at The Regimen pages and tell me what products I thought they should use. Almost unanimously, they said the impression they got was that they could just as easily use alternative products on The Regimen and get clear. This is not the truth. What I’ve always tried to communicate is that you can theoretically use alternative products on The Regimen, but you need to choose them carefully and they may not work as quickly or as well.

Therefore, I have removed alternative products from The Regimen page. I feel it is a disservice to send people on a wild goose chase from the start. I’m getting way too many people telling me that they think The Regimen is not working when they are using alternative products and ultimately getting cleared up quickly when I get them switched over to Acne.org products. If you are currently on The Regimen using alternative products and having problems, this may be the cause.

I still mention that you can use alternative products on the FAQ and of course people are welcome to discuss alternatives on the forums and around the Internet. I just wanted to keep you guys in the loop as always.

Screen Shot 2014-06-18 at 11.07.42 AMPrevalence: Acne is prevalent in Asians. According to an article in Pediatric Dermatology, “Acne remains one of the most common dermatologic diagnoses in children of all races.” The authors of this article found that the most common reason that Caucasians visit the dermatologist is acne, while the most common reason that Asians visit the dermatologist is dermatitis (inflammation of the skin), with acne not far behind. Another study in the journal Acta Dermato-Venereologica looked at people of all ages in six cities around China and found not suprisingly that younger people experience more acne, and that males had more acne than females. However, they also found that prevalence of acne was lower in Asians than in Caucasians and far lower in Asian adults than Caucasian adults (1% vs. 13%).

Hyperpigmentation: The literature echoes what I have always said, which is that prevention is key when it comes to the dark/red spots that acne leaves behind. According to authors of an article in the Journal of the European Academy of Dermatology and Venereology, “The primary treatment of PIH (post-inflammatory hyperpigmentation) is prevention and treatment of the underlying inflammatory condition.” The Regimen is the best way to topically prevent acne and it works remarkably well in people of Asian heritage. The authors go on to note, “In addition to prevention, there are a variety of medication and procedures used to treat PIH. Although topical skin-depigmenting agents remain the treatment of choice for PIH, lasers and light sources may be an affective adjunctive therapy or alternative for treatment failures. When treating PIH, any treatment options selected should be optimized and utilized carefully because the treatments itself may worsen the PIH.”

Accutane: A 4-year retrospective study in The Journal of Dermatologic Treatment looked at how well Accutane (isotretinoin) worked for Asian skin. They concluded: “This study reaffirms the overall safety and efficacy of oral isotretinoin in Asian patients with acne vulgaris.” “Safety” is a relative term here since we know that Accutane can and will cause severe birth defects if taken when pregnant. If you are Asian and considering Accutane, do it only in close contact with a trusted physician.

References:

  • Eimpunth S, Waniphadeedecha R and Manuskiatti W. “A focused review on acne-induced and aesthetic procedure-related post inflammatory hyperpigmentation in Asians.” Journal of the European Academy of Dermatology and Venereology. 2013; 27(1): 7-18.
  • Henderson MD, et al. “Skin-of-color epidemiology: a report of the most common skin conditions by race.” Pediatric Dermatology. 2012; 29(5): 584-9.
  • Gan EY, et al. “Isotretinoin is safe and efficacious in Asians with acne vulgaris.” Journal of Dermatologic Treatment. 2012; 24(5): 387-91.
  • Kundu RV and Patterson S. “Dermatologic conditions in skin of color: part 1. Special considerations for common skin disorders.” American Family Physician. 2013; 87(12): 850-6.
  • Shen Y, et al. “Prevalence of Acne Vulgaris in Chinese Adolescents and Adults: a Community-based Study of 17.345 Subjects in Six Cities.” Acta Dermato-Venereologica. 2011; 92(1): 40-4.

EPSON DSC pictureResearchers published a very interesting study recently in The American Journal of Clinical Dermatology to gauge how accurate data from crowdsourcing is when it comes to the efficacy of acne treatments. The researchers asked 662 online acne patients to tell them how well their treatments were working and then compared this to results from clinical studies. I found a few interesting things.

Responses from the crowd seemed to vary quite widely with clinical studies. For instance, only 46% of respondents from the crowd reported any improvement from tretinoin (Retin-A) compared with 80% of subjects in clinical trials. 64% of the crowd reported improvement from Accutane (isotretinoin) compared with upwards of 90% of subjects in clinical trials. 41% of the crowd reported improvement from tetracycline oral antibiotic therapy compared with 57% of subjects in a clinical trial. 38% reported improvement from doxycycline oral antibiotic compared with 50% of subjects in a clinical trial.

You may be noticing a trend here. As the authors of this particular study note, “For most…treatments, medication with high efficacy in clinical trials did not produce high effectiveness ratings based on the crowdsourced online data.” Why might this be? Could it be due to the inaccuracy in respondent responses outside the parameters of a clinical setting? Or could it be because the people funding the vast majority of clinical trials are the companies who make the products? Lest I get too high on my high horse, I do not think it is always the case that data is skewed in favor of corporations and profits. For instance, over the past 20 years, hundreds of thousands of pieces of input from people here at Acne.org show Accutane (isotretinoin) producing improvement for way more than 64% of people.

Something I very often find disturbing from results of acne medications, whether the data comes from the crowd or clinical trials, is the poor efficacy of the medications themselves. Who wants to use a medication which only helps 50% of people improve, and only improve somewhat? This is why I want the world to know about The Regimen here at Acne.org. It reliably gets almost everyone completely clear. That’s the kind of results people want.

So where do we go from here? I firmly believe that the future of pretty much everything is in crowdsourcing, and medicine is no exception. We know from Wikipedia that when enough people get together to share their knowledge, crowdsourcing can be incredibly accurate and valuable. I think the same can be true for medical information as long as we achieve a critical mass of people inputting their data. That’s one of the big goals of Acne.org and I hope we see more of this in the future across the medical spectrum. Join Acne.org if you haven’t already and add your voice!

References:

  • Armstrong A, et al. “Harnessing the power of crowds: crowdsourcing as a novel research method for evaluation of acne treatments.” The American Journal of Clinical Dermatology. 2012; 13(6): 405-16.