Podcast Summary: "Am I Doing It Wrong?" — Episode: How To Zap Zits, Pummel Pimples And Keep Your Skin Clear

Release Date: January 30, 2025
Host/Authors: Raj Punjabi-Johnson & Noah Michelson
Guest: Dr. Kunal Malik, Dermatologist at Spring Street Dermatology and Assistant Clinical Professor of Dermatology at Mount Sinai School of Medicine

Introduction

In this enlightening episode of "Am I Doing It Wrong?", hosts Raj Punjabi-Johnson and Noah Michelson delve into the pervasive issue of acne—a topic that resonates with millions grappling with skin concerns. Joined by Dr. Kunal Malik, a seasoned dermatologist, the trio explores the complexities of acne, debunking myths, and offering actionable strategies to achieve clear skin.

Understanding Acne: Causes and Genetics

Dr. Kunal Malik begins by redefining acne beyond the simplistic notion of excess oil and clogged glands. He emphasizes the "balance between bacterial microbiomes and ecosystems" in understanding why some individuals are more prone to acne than others (03:33). Highlighting recent studies from prestigious journals like Nature, Dr. Malik explains that "there are at least 15 genetic markers that influence acne susceptibility".

Noah Michelson raises a pertinent question about the genetic aspect:
"Can acne be genetic? My parents had bad skin, but my little brother didn't have acne at all." (04:54)

Dr. Malik responds by acknowledging genetic risk factors while also pointing out the role of environmental influences such as stress, diet, and lifestyle:
"It's not just having the gene; it's having the gene plus other factors like environment, diet, and lifestyle." (05:09)

Types of Acne: Pimples, Blackheads, Whiteheads, and Cystic Acne

Using a relatable analogy, Dr. Malik categorizes different acne types:

• Papules (Classic Pimples): "A raised red bump with a central white discoloration." (07:42)
• Comedones (Blackheads and Whiteheads):
  "A whitehead is a closed comedone with debris beneath the skin, while a blackhead is an open comedone where the debris oxidizes and turns black." (08:50)
• Cystic Acne:
  "Deeper, more painful pimples that press on nerves, causing significant inflammation." (09:03)

Raj humorously remarks, "Those things are monsters." in reference to cystic pimples (09:02), highlighting their severity and emotional impact.

Pimple Patches: Efficacy and Benefits

Noah Michelson mentions pimple patches popularized by Gen Z:
"Pimple patches really work and can protect your skin as it heals. And they're cute." (12:51)

Dr. Malik confirms their effectiveness:
"Most pimple patches are hydrocolloid-based, which help draw out debris and shield the pimple from environmental bacteria." (13:12)

He adds that pimple patches not only aid in healing but also significantly "decrease scarring by as much as 50%" (19:53).

Treatments: Over-the-Counter Options

Dr. Malik discusses various over-the-counter treatments:

• Benzoyl Peroxide:
  "It has anti-inflammatory and antibacterial properties. Lower concentrations (2.5%) are as effective as higher ones (10%) with less irritation." (23:48)
• Salicylic Acid:
  "A beta hydroxy acid that penetrates deep into pores to dissolve debris, effective for blackheads and whiteheads." (25:06)
• Oil-Free Moisturizers:
  "Maintain a healthy skin barrier without clogging pores. Products like La Roche-Posay’s Matte Moisturizer and Cerave’s oil-absorbing moisturizers are recommended." (45:28)

Raj Punjabi-Johnson emphasizes the importance of selecting "non-comedogenic" products to avoid pore-clogging ingredients (46:33).

Myths and Remedies: Debunking Common Misconceptions

The hosts explore popular but ineffective or harmful home remedies:

• Toothpaste:
  "It's very alkaline and can cause chemical burns and allergic contact dermatitis. It does not effectively treat acne." (34:46)
• Baking Soda:
  "Similar to toothpaste, it can disrupt the skin microbiome and cause chemical burns." (35:53)
• Aspirin Paste:
  "Not recommended as it can lead to long-term skin barrier disruption and irritation." (36:24)

Conversely, Dr. Malik acknowledges a few natural remedies with some efficacy:

• Manuka Honey:
  "Has antibacterial and antimicrobial properties when used in its pure form." (38:44)
• Green Tea:
  "Contains anti-inflammatory compounds beneficial for acne." (38:52)

He advises caution with essential oils to prevent "burns and allergic reactions" (22:29).

Relationship Between Diet, Hydration, and Acne

Noah Michelson probes the link between diet and acne:
"Does chocolate cause acne?" (28:43)

Dr. Malik responds by explaining the gut-skin axis and how diet affects insulin and cortisol levels, which in turn influence sebum production:
"Specific food groups like dairy can interact with hormones and affect the skin, but it's a multifaceted relationship involving genetics and environmental factors." (28:56)

Regarding hydration, Dr. Malik debunks the myth that excessive water intake can cure acne:
"There's no research that shows drinking water will cure acne. Treat your acne appropriately while maintaining overall hydration." (48:39)

Skincare Tips: Washing, Moisturizing, and Pillowcases

Washing Face:
Dr. Malik recommends washing the face twice daily with a gentle cleanser to remove impurities without over-stripping the skin:
"Use a cleanser to take the day's grime off and ensure you remove makeup and sunscreen before bed." (31:02)

Moisturizing:
Contrary to popular belief, moisturizing is essential even for oily, acne-prone skin. Dr. Malik suggests:
"Use oil-free, non-comedogenic moisturizers like La Roche-Posay’s Matte Moisturizer or Cerave’s oil-absorbing options." (44:21)

Pillowcases:
Highlighting the importance of hygiene, Dr. Malik shares a startling statistic:
"Bacteria on pillowcases can increase by up to 17,000% in a week." (32:44)
He recommends frequently changing pillowcases and considering silk pillowcases for their antimicrobial properties:
"Silk pillowcases are a better investment for reducing bacterial buildup and minimizing skin irritation." (33:26)

Emotional Impact and Stigmatization of Acne

The conversation emphasizes that acne is not a reflection of hygiene or self-worth. Dr. Malik highlights the emotional toll it can take:
"If your acne is affecting your emotional health, it's a sign to consult a dermatologist." (43:04)
Both hosts acknowledge the stigma associated with acne and advocate for "emotional support and professional treatment" rather than judgment.

Expert’s Final Advice and Takeaways

Dr. Malik urges individuals to seek professional help early to prevent scarring and emotional distress:
"Earlier intervention with combined treatments yields better results and minimizes scarring." (43:41)

Better in Five: Top Five Takeaways

1. Acne is Multifactorial:
   "Acne is caused by a combination of genetics, environment, and diet."

2. Avoid Popping Pimples:
   "Popping pimples might feel good, but it can exacerbate acne and lead to scarring."

3. Efficacy of Pimple Patches:
   "Pimple patches work effectively to heal acne and are now stylish and widely accepted."

4. Pillowcase Hygiene:
   "Frequently changing pillowcases can drastically reduce bacterial buildup that contributes to acne."

5. Moderate Cleansing:
   "Over-cleansing can damage the skin barrier. Washing twice daily with an oil-free cleanser is ideal."

Conclusion

The episode wraps up with the hosts reflecting on their personal experiences with acne and appreciating the evolving understanding and treatments available. They encourage listeners to "treat acne appropriately and seek professional advice", fostering a supportive environment for those struggling with skin issues.

Noah Michelson concludes with a heartfelt message:
"None of us are alone with this. Most of us are dealing with it at some point or another, and it's better to have informed strategies rather than relying on misinformation."

Notable Quotes:

• Dr. Kunal Malik [03:33]:
  "It's the balance between bacterial microbiomes and ecosystems that determines why some people get acne."

• Noah Michelson [04:54]:
  "Can acne be genetic? My parents had bad skin, but my little brother didn't have acne at all."

• Dr. Kunal Malik [25:06]:
  "Salicylic acid penetrates deep into pores to dissolve debris, making it effective for blackheads and whiteheads."

• Raj Punjabi-Johnson [32:44]:
  "A 17,000% increase in bacteria on pillowcases in just one week? That's horrifying!"

• Dr. Kunal Malik [43:04]:
  "If your acne is affecting your emotional health, it's a sign to consult a dermatologist."

For those seeking clear skin guidance, this episode offers a comprehensive exploration of acne, blending expert insights with relatable anecdotes. Whether you're battling teenage breakouts or adult acne, the strategies discussed here are geared to empower you with knowledge and effective solutions.