How To Zap Zits, Pummel Pimples And Keep Your Skin Clear

Summary

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.

Transcript

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[Dr. Kunal Malik]

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[Raj Panjabi Johnson]

That tabby's really moving. He's past second base.

[Dr. Kunal Malik]

And Coach Bakerfield's making a grab.

[Noah Michelson]

And.

[Dr. Kunal Malik]

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[Raj Panjabi Johnson]

Incredible. Someone give that cat a contract.

[Dr. Kunal Malik]

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[Raj Panjabi Johnson]

Hi, I'm Raj Panjabi Johnson, head of identity content at HuffPost.

[Noah Michelson]

And I'm Noah Michelson, head of HuffPost Personal.

[Raj Panjabi Johnson]

Welcome to Am I Doing It Wrong? The show that explores the all too human anxieties we have about trying to get our lives right. Okay. Noah?

[Noah Michelson]

Yeah?

[Raj Panjabi Johnson]

Are you doing acne wrong?

[Noah Michelson]

Ooh. So I have had acne for, I guess, 30 years now at this point, maybe more. I. I feel like I've tried everything. I was on Accutane three times, which I'm sure we'll talk about at some point in this, but I was on antibiotics. I've done everything over the counter. I feel like my skin is pretty good now.

[Raj Panjabi Johnson]

It's gorge.

[Noah Michelson]

Thank you. So I don't know that I'm doing it wrong, but I also don't know a lot. I'm like, can you pop a pimple? Should you not? So I'm curious, what about you? Are you doing it wrong?

[Raj Panjabi Johnson]

I mean, I definitely did it wrong in my puberty years. It was bad. Luckily, I only get a couple a year now. But I also wonder why they come around, you know, I'm also super curious.

[Noah Michelson]

I think most people deal with acne at some point. Yeah, even adults. And so I'm glad we're doing this show and I'm glad that we have Dr. Kunal Malik. He's a dermatologist at Spring Street Dermatology and the assistant clinical professor of dermatology at Mount Sinai School of Medicine.

[Raj Panjabi Johnson]

Yes. Get us right. Okay. Dr. Kunal, thank you so much for being here. We're so excited to have you.

[Dr. Kunal Malik]

Thanks so much for having me.

[Raj Panjabi Johnson]

Okay, let's start at the very, very beginning. What exactly is acne and why do we get it?

[Dr. Kunal Malik]

Basically, acne is. I mean, we all know what acne is, right? Like pimples. And you can get it like anywhere on the body, anywhere you have skin, really. But our understanding of acne has really evolved. So much. So like, even a couple years ago, if you asked me what acne was, right, I would tell you. Okay. It's like when your skin makes too much oil, the glands get clogged, there's inflammation. But now, not to bore you with the science behind that, we're learning so much more. Each of those steps is so much more nuanced and detailed than what we originally thought. So actually it's like there was a study referring to it now in 2023 that was published in Nature, which is like one of the highest tiers caliber.

[Raj Panjabi Johnson]

Oh, she's a hot girl.

[Dr. Kunal Malik]

We all love her. I mean, everything in that journal, like, is great, right? Very evidence based. And so we now know that there's this concept of like, bacterial microbiomes, ecosystems, right? Basically, it's not about having good or bad bacteria. It's the balance between them and the interaction between them. And I think that's where more and more of the data is, like, going now. Like, why do some people get acne? Of course, we don't really know 100% of everything. Like, it's still a work in progress. But we are learning more and more. It's this balance between the ecosystem. So it's not as simple as just like oil clogging glands causing inflammation. It's okay.

[Noah Michelson]

Can acne be genetic? Because I wonder about this. I mean, my mom and dad had bad skin. I had really bad skin. But, like, my little brother didn't have acne at all, really.

[Dr. Kunal Malik]

Right.

[Noah Michelson]

So if it is genetic, like, why would it skip him or. Talk to me about.

[Raj Panjabi Johnson]

Are you talking about specifically at the time most people get acne?

[Noah Michelson]

Yeah, like during puberty.

[Raj Panjabi Johnson]

Got it.

[Dr. Kunal Malik]

So that's also something that's been having more and more, like, light shed on it, for sure. I mean, you have great skin now. So I will say, you know, there. There were actually a couple of twin studies done, which I find so interesting, because if you're looking at identical twins. Right. Like, same genetic makeup.

[Noah Michelson]

Yeah.

[Dr. Kunal Malik]

And there was like 81% or something. Something crazy high. Like. Like heritable source. Right. So that there are genetic risk factors. We also know now that, like, parents having acne increases the likelihood of their offspring having it like, four times, which is pretty significant, if you ask me. So there's definite. And we've identified, like, at least 15 genetic markers right. At the genomics level of, like, why certain people get acne. So the evidence is pointing to the fact that, yes, there are genetic risk factors. To answer your question about why certain people get it and mothers don't, I think it's also something that a lot of work needs to be done on now. But basically, like, we know that it's not just having the gene. It's like having the gene plus other things. Right. Environmental factors, like, did you live a stressful life? Were you in, like, a. Like a major megacity? Right. Like New York, exposed to the elements? Like, so it's the environment, genetics, diet, lifestyle. Like, I think it's like, we're understanding. It's more holistic.

[Noah Michelson]

Yeah.

[Raj Panjabi Johnson]

Yeah, that makes sense.

[Noah Michelson]

So much of what we talk about in the show, like, the expert is always like, yeah, this is holistic.

[Dr. Kunal Malik]

Yeah.

[Noah Michelson]

It's not one thing which makes sense.

[Raj Panjabi Johnson]

And the fact that there's so many studies on this makes me. It just affirms that this really bothers us. Like, this is something that matters. Right. It's like we're talking mostly about acne on our face. It's like the first way we present ourselves.

[Noah Michelson]

So it's really stigmatizing, I think. I mean, I had really bad acne when I was a teen. I went on Accutane three times. And if people don't know what Accutane is, it's this incredibly strong drug when I was a kid. This is like 30 years ago. They prescribed it much more easily back then, but then they found out that some people are having mental health issues, could even cause suicidality, and we don't know exactly what it does to our bodies. Now, like, I'm. I'm convinced that I'm going to be, like, pickled when I'm in another five years because I've had so much of it. Sounds delicious, but I. You know, my skin was so bad that I didn't want to leave the house.

[Raj Panjabi Johnson]

No, I understand. I had really bad acne too. And it's just like, even though so many kids in middle school have it, it's still like, oh, yeah, like the cause of so much stress.

[Noah Michelson]

Will you take us through really quickly? Just sort of like the different kinds of acne. The classic pimple versus a blackhead versus whitehead.

[Dr. Kunal Malik]

Right. So I'm gonna put it in analogies in terms of a cake.

[Noah Michelson]

Oh.

[Dr. Kunal Malik]

So I hope this will not turn you off to the idea of a cake. Yeah. So basically, like the classic sort of pimple, like with the round sort of. We call it a papule, like a raised bump. The round, raised red bump with a central sort of white discoloration in it. Right. And that's basically your classic pimple. And then that's the superficial frosting of it. Right. And then the deeper you get, the more cystic you get. Right. Like there's. And we'll touch upon, like, why certain cystic pimples are more painful and what's going on that differentiates them from your classic pimple. But basically, these other terms like whiteheads and blackheads are in this category called comedones. I don't know if you've guys have heard of that. Yeah. So we call them comedones, but basically it's just a medical term that describes blackheads or whiteheads. A white head is a closed comedone. So for lack of a better term, it's like the. The gunk inside of a pimple is underneath the skin. Right.

[Noah Michelson]

Okay.

[Dr. Kunal Malik]

And a blackhead is that. But there's no covering. So the. The open gunk, so to speak, is oxidized. Right. That's why it gets discolored and black.

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Okay.

[Dr. Kunal Malik]

So that's. They're essentially the same.

[Raj Panjabi Johnson]

Okay.

[Dr. Kunal Malik]

One is closed, one is open. Right. And then you have your cystic pimples, which are referring back to that cake analogy, are in the deeper layers. They're no longer the frosting, they're going down.

[Raj Panjabi Johnson]

Those things are monsters.

[Dr. Kunal Malik]

Exactly. And that's why they hurt so much. They're like trigger. They're pressing on nerves. There's a huge inflammatory response. And those nerves that they're pressing on, we associate with pain receptors in our brain. So it's not as simple as just like a zit. There's a lot of different sort of flavors and. Sorry. Sorry for the food analogies. I hope this doesn't turn you off to.

[Noah Michelson]

What about adult acne versus teenage acne? So, you know, the acne that you get when you're a kid, you're hormonal, all that's happening. But I still get zits now, and I feel like I will forever. What is the difference between those two kinds of acne?

[Raj Panjabi Johnson]

Yes, I'm just. Sorry. I just say I get two on schedule a year.

[Noah Michelson]

They just take off.

[Raj Panjabi Johnson]

It's always two. And I'm always like. They look my. Like, you know, yearly pimples here. Yeah. And I'm like, oh, it's cute. And he's like, it's not like. But that's because I'm lucky. I only get a couple of years right now.

[Noah Michelson]

Way to think about it.

[Raj Panjabi Johnson]

I think just, you know, showing up to show me I'm still youthful. Sorry, yeah. Does it mean I'm still youthful if I.

[Noah Michelson]

Of course, yeah.

[Dr. Kunal Malik]

You're very youthful. Yeah. You have radiant skin. So in general, I feel like adult versus teenage acne also goes down to, like, the differences between adult versus teenage skin.

[Noah Michelson]

Right, that makes sense.

[Dr. Kunal Malik]

Yeah. Like. Like, teenage acne, in my experience, like, clinically at least, from seeing patients, usually focuses on the T zone. Right. Like, that's not to say, obviously, like, teenage acne can't happen anywhere on the face. Like, any acne can happen anywhere on the face. But classically, you see more of those comedones, which is the term I alluded to earlier. You see a lot more sort of blackheads and whiteheads in the T zone. And a lot of that is influenced also by the puberty hormones, which, you know, hopefully by adulthood and, you know, a quote unquote, normal adult, like those. That hormonal response is kind of tapered off a little bit. But in puberty, the effect of those hormones really shows in terms of, like, how that acne presents itself. So blackheads, whiteheads on the T zone. Teenage skin just tends to be a lot more resilient than adult skin also. And also less scarring, maybe, as long as the acne is treated early on. Right. Like any acne, like, the longer it kind of lingers, the higher the risk for scarring. So all of the data is now pointing at, like, earlier treatment. Be a little bit more Aggressive. Go at the, go to your dermatologist at the earliest signs of acne before you kind of get to that accutane stage. Right. That's when the scarring can be really challenging to reverse. Not impossible, certainly, but challenging. But we know like, you know, in terms of treating adult versus teenage acne, the differences also sort of carry over into how they're treated a little bit differently too. Yeah, And I think a lot of that has to do with teenage skin just being more resilient. You can be a little bit more aggressive with it. Yeah, that makes sense. Adult skin, like you have to be a little bit more mindful of the skin barrier, which I know is a very hot term these days, but for a reason. I mean, adult skin just tends to be, you know, doesn't heal as quick. The turnover of the skin cells is slower. In women, especially in adult acne, you see a lot more of a hormonal influence as well.

[Raj Panjabi Johnson]

Yeah, for sure, that makes sense.

I just have to throw in this question. I feel like pimples are a little less stigmatized. I think the kids are nicer and cooler now than they were when I was a kid. Pimple patches, like me and my friends use them sometimes. Cause we see the Gen Zs doing it and it's like you go into the world with this like star sticker.

[Noah Michelson]

On your face, just by your face.

[Raj Panjabi Johnson]

It's so co. Crazy. I could never in sixth or seventh grade. But do those work?

[Dr. Kunal Malik]

They absolutely do work. And I, I'm so happy that they're becoming more and more normalized in our culture and our society because I agree with you. Like even a couple years ago, like people were like embarrassed to walk out with a pimple patch. And I think with like the current generation, they have all of these fun colors and shapes and it's like people are just more accepting of it and like open about it, which I think is incredibly destigmatizing. But from like a, A, like a scientific perspective, they absolutely do work. Most pimple patches, at least the ones that work, are hydrocolloid based. Basically what they're doing is they're draw. They're kind of sucking up the debris in that pimple. Right. And they're shielding it from the environment. They're protect. They're offering a physical barrier for you to against, for people from picking at.

[Raj Panjabi Johnson]

It or touching it.

[Dr. Kunal Malik]

So that helps with.

[Raj Panjabi Johnson]

It's so tempting to touch.

[Dr. Kunal Malik]

So tempting. It's so tempting. I know, that's human psychology response, I think. Yeah, it's just squeezes It, Right?

[Raj Panjabi Johnson]

Yeah.

[Dr. Kunal Malik]

But terrible. Right. I know. I live in the real world. I know people will do it despite me telling people not to do it all day long. But pimple patches are a great sort of way to protect the pimple. You're not. Even if you do touch it, there's a physical barrier there. You're protecting against bacteria which our fingers are written with. Right. Like, yeah, just our hands really just go through it day in, day out. And so you. The last thing you want to do is sort of bring all of that onto your face. Yeah.

[Noah Michelson]

And then they're delivering targeted medicine to them.

[Dr. Kunal Malik]

Yes. They have some of those salicylic acid and tea tree oil patches these days, which I'm all for, you know, as long as people are not overdoing it with actives, which I'm sure we'll talk about as well. Because sometimes, you know, I think like in our society with like the over consumption of products and like there's so much to choose from, it can actually get overwhelming even for a dermatologist. We're getting so many things to test as PR and all of this. But sometimes like, less is more. And that's what I always preach to my patients. Like, you really want to sort of fine tune and be intentional with your skin care and not overdo it because there is this phenomenon of causing too much inflammation with aggressive treatments. Right. And then once that happens, you know, you're kind of being counterproductive.

[Noah Michelson]

Yes.

[Dr. Kunal Malik]

And not really treating the acne, but causing more damage.

[Noah Michelson]

I would guess too that if you are screwing with that skin microbiome, that's also not going to be good for your skin.

[Dr. Kunal Malik]

Right.

[Noah Michelson]

So too many things drying it out and then adding lotions and stuff on top of it. Your body's just like, what are you doing exactly.

[Raj Panjabi Johnson]

Too much intervention.

Let's take a quick break and we'll be right back.

[Noah Michelson]

This episode is brought to you by Olive and June Noah.

[Raj Panjabi Johnson]

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[Noah Michelson]

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[Raj Panjabi Johnson]

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[Noah Michelson]

Wow, that sounds way more convenient than scheduling and traveling for an appointment to take care of your nails.

[Raj Panjabi Johnson]

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[Noah Michelson]

And I have to say I've been noticing your nails recently, Raj, and they're looking good.

[Raj Panjabi Johnson]

I love that for me.

Thank you.

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[Noah Michelson]

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[Raj Panjabi Johnson]

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[Raj Panjabi Johnson]

Welcome back to Am I Doing It Wrong?

[Noah Michelson]

We have so many questions from listeners and from folks who work with us, so let's just get in some of those. There's some of the fun ones. I think you just sort of talked about this, but we had someone ask, what is the deal with popping pimples? Can we ever do it? Should we never do it? Is there one kind like a tiny whitehead that we can do I will say this is not scientific, but I feel like when I pop a pimple, it does heal quicker. Or it seems like it starts to heal immediately. Right. But.

[Raj Panjabi Johnson]

And it looks better.

[Noah Michelson]

Yeah, but I've just heard. Yeah. No one wants, like, a big pussy. But tell us what your professional opinion is.

[Dr. Kunal Malik]

Right. So this is such a popular question also in my practice. Like, you won't believe how many people are like, do I pop it? Do I not pop it?

[Noah Michelson]

Yeah.

[Dr. Kunal Malik]

By the book, the answer is no.

[Raj Panjabi Johnson]

Yeah.

[Dr. Kunal Malik]

But again, like, we all live in the real world. Like, the human sort of tendency to want to just squeeze it is so high and so satisfying. Right. Like, yeah. There's. On even social media, you'll see all of these, like, pimple videos and, like, it's hard to scroll past them. They're just tempting.

[Noah Michelson]

Yeah.

[Raj Panjabi Johnson]

So what's the harm reduction version?

[Dr. Kunal Malik]

Yeah, yeah. So basically you want to do it. And I mean, we do extractions in clinic as well. There are certain pimples that can be popped. Okay. I'm not advocating for this. Like, my fellow dermatologist colleagues will kill me. But basically you want to do it in a very. As sterile technique as possible. Right. You don't want to do it with the wrong amount of pressure, with, you know, ungloved. That's like a pet peeve also because again, you're bringing so much bacteria onto your face, potentially even sort of causing more inflammation and bacteria to go deeper into this.

[Noah Michelson]

Directly into it.

[Dr. Kunal Malik]

Yeah. And then you're pushing that sort of ball of pus deeper into your skin, and that causes more like cystic acne. So if you're going to do it, it's important to realize, like, what is an okay pimple to pop and what you do not want to pop. Right. Just going back quickly about the pimple patches. I always am a fan of pimple patches over popping, if that's something that you're debating between. Because now most of the research that we have also shows that pimple patches will increase the healing time, decrease scarring by as much as 50%.

[Raj Panjabi Johnson]

Wow.

[Dr. Kunal Malik]

Which is like a high, really high number.

[Noah Michelson]

Yeah.

[Dr. Kunal Malik]

And sometimes, you know, patients will go after pimples that are kind of inappropriate to pop. Like the deep sea ones.

[Raj Panjabi Johnson]

Yeah.

[Dr. Kunal Malik]

You never want to pop.

[Raj Panjabi Johnson]

I don't. That looks like. Don't come near me.

[Noah Michelson]

Yeah. Say more, though, about why you don't want to pop those.

[Dr. Kunal Malik]

You're. You're basically causing, like, inflammation to become super inflammation. You're. You're pushing back to that cake layer. Yeah, yeah. Like if something was in that superficial frosting layer of your cake, now it's like at the depths. Right. And now you've kind of even spread it. Right. Like that mother pimple has given its offspring. Yeah, that's what I'm saying. Like you don't want to do it. And like definitely it can cause once you have that deep inflammation.

[Noah Michelson]

Yeah.

[Dr. Kunal Malik]

Especially in skin of color, which we know scars easier than like non melanated skin.

[Raj Panjabi Johnson]

Yeah.

[Dr. Kunal Malik]

Now you're causing increased risk for scarring, which becomes very sort of challenging to treat, but also emotionally challenging for people to deal with. Yeah. Yeah.

[Noah Michelson]

I have two more questions related to this one. I've heard, like, instead of popping, put a hot compress and let the heat sort of empty the pus out. Is that good or is that bad?

[Dr. Kunal Malik]

I am kind of not in favor of that. I like to use cold compresses.

[Noah Michelson]

Interesting.

[Dr. Kunal Malik]

Yeah. So usually I tell patients like a cold metal spoon or something put on a pimple that's like throbbing and painful or just very inflamed.

[Noah Michelson]

Yeah.

[Dr. Kunal Malik]

Right. We know that the cold will actually decrease it inflammation. The idea behind a warm compress, like scientifically is to increase blood flow to the area, but you can also increase potential with blood flow, increase more inflammation as well. So that's where the current, to my understanding. Yeah, that's where the current sort of evidence is. Lies around that. Right. Like just. I usually just tell people, just go to the dermatologist. Like we have so many options in our toolbox. But if you're in a jiffy and you have like a pimple, like, we can definitely, like right before a big event, we can do a cortisone shot. Like I've done that. Yeah. Aren't they magical?

[Raj Panjabi Johnson]

Like unbelievably amazing.

[Dr. Kunal Malik]

They're great.

[Raj Panjabi Johnson]

I have to say, like, we've heard every kind of like how to fix your pimple, you know, without asking for help. Just go to the fucking dermatologist.

[Noah Michelson]

Right.

[Raj Panjabi Johnson]

But diluted tea tree oil, does that calm inflammation at all?

[Dr. Kunal Malik]

I think there is some evidence that it has.

[Raj Panjabi Johnson]

I've seen like some flimsy studies.

[Dr. Kunal Malik]

Yeah, yeah, yeah, yeah. It's definitely not like gold standard. Like, I definitely recommend like a patient coming into my office, like, you have to get tea tree oil.

[Raj Panjabi Johnson]

Yeah.

[Dr. Kunal Malik]

Definitely not the case.

[Noah Michelson]

Yeah.

[Dr. Kunal Malik]

A lot of other things come before tea tree oil in my experience, but you know, it's one of those things that can't hurt.

[Raj Panjabi Johnson]

Yeah.

[Dr. Kunal Malik]

A lot of these essential oils, I do tell people to be very.

[Raj Panjabi Johnson]

It can burn you.

[Dr. Kunal Malik]

We've learned this burns and allergic contact dermatitis, like a lot of essential oils will do it. So that's a whole nother conversation about like natural being good or not.

[Raj Panjabi Johnson]

Right.

[Dr. Kunal Malik]

But just, just be careful with what you're on your face.

[Raj Panjabi Johnson]

Yeah.

[Noah Michelson]

I mean, I think the reality is though too, like, like we said go see a dermatologist. But number one, if you just have a couple, you're probably not going to go in. And two, if you don't have insurance, you're not going to go in. And three, it takes a long time to get in to see a dermatologist. Like I just made my annual appointment for my skin check. His first opening was February 28th. Let's talk about some of the things that actually do work. If you're at home, you have a zit, what are sort of going to be in your toolkit that you're going to tell us to put in our toolkit?

[Dr. Kunal Malik]

Right. So I think we kind of address some of them. Pimple patches. Definitely. Huge fan. Especially the ones that, you know, have hydrocolloid, which is very well studied in terms of like wound healing and all of that. So it definitely, that definitely helps. Cold will help, right? Like the cold metal spoons will help decrease inflammation. I always caution against putting like ice directly on the skin. Can cause more issues like burns. Right. Like cold burns. So you don't want to do that. There are some great over the counter products these days, right? Yeah, but yeah, so I usually like benzoyl peroxide for those really sort of inflamed, juicy zits.

[Raj Panjabi Johnson]

Right.

[Dr. Kunal Malik]

I think there's a lot of data showing now that there's anti inflammatory, antibacterial function. And in fact like now we even know that the lower concentrations work equally as good as like the stronger.

[Noah Michelson]

I've heard that those things are great.

[Raj Panjabi Johnson]

They'll dry you right up.

[Dr. Kunal Malik]

They will dry you.

[Noah Michelson]

I love benzoyl peroxide. I don't think I've not had a tube in my medicine cabinet over the last 30 years. Yeah, it works so well. And I have heard that, that you could use like 5%, two and a half percent instead of 10.

[Dr. Kunal Malik]

Yes.

[Noah Michelson]

And it would probably be just as effective.

[Dr. Kunal Malik]

Yeah.

[Raj Panjabi Johnson]

And you can just put it on once, truly like overnight it makes a difference.

[Dr. Kunal Malik]

Right. And now there's actually like so many brands out there that are catching on that, you know, this can be potentially an irritating ingredient. And now with the movement being towards like skin barrier friendly products, I think companies are also formulating products that are very skin barrier friendly. Right. So you have the benzoyl peroxide, but you have the ceramides. You have the hydrating ingredients also not. This is not a sponsored Recommendation but like CeraVe is like a great brand also.

[Raj Panjabi Johnson]

So many dermatologists say that they have.

[Dr. Kunal Malik]

Like a really good acne foaming cleanser that has like they have a 5% and a 10%.

[Noah Michelson]

I have it in my shower. Yeah.

[Dr. Kunal Malik]

And it's not irritating at all. And I promise I'm not getting paid to say that, but like it's, it's great.

[Raj Panjabi Johnson]

Send us stuff though.

[Noah Michelson]

Sarah V. No, I think that's great. What about like salicylic acid?

[Dr. Kunal Malik]

Yeah, so salicylic acid is also good as well. I think it's works better for other specific types of acne. So it works really well for. Remember those comedones we were talking about like those blackheads and those whiteheads. So salicylic acid is a beta hydroxy acid and what that means is it's oil soluble, oil loving. So it actually gets deep into the pores. Right. Because we may have learned in like middle school chemistry class, like, like, like oil loves oil. Right. Like it's hydrophobic. It's, it's basically going to go deep into the oils producing glands and sort of dissolve all of the gunk and prevent it from building up, prevent that clog up from happening.

[Raj Panjabi Johnson]

Okay.

[Dr. Kunal Malik]

And so it's really good for blackheads and whiteheads.

[Noah Michelson]

Okay.

[Dr. Kunal Malik]

And so got to be careful with combining too many things together because that's definitely a recipe for irritation.

[Raj Panjabi Johnson]

This is not a chemistry lab exactly.

[Dr. Kunal Malik]

Like I don't, I'm not a huge fan of combining like benzoyl peroxide with salicylic acid together.

[Noah Michelson]

Yeah.

[Dr. Kunal Malik]

Have been there, have done it personally. Can cause a lot irritation. So different types of acne I think can benefit from different sort of angles of treatment. We have so much in our toolboxes.

[Raj Panjabi Johnson]

Let's take a quick break and we'll be right back.

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[Raj Panjabi Johnson]

Welcome back to Am I Doing It Wrong? I feel like everyone's parents were like, don't eat chocolate and junk food. That's gonna give you acne. Which, like, sounds like horseshit.

[Dr. Kunal Malik]

Right.

[Raj Panjabi Johnson]

Like, I eat a lot of chocolate.

[Noah Michelson]

Yeah. When it comes to diet, let's just start with that.

[Raj Panjabi Johnson]

Yeah. Like what? Tell us the truth.

[Noah Michelson]

Does chocolate cause acne?

[Dr. Kunal Malik]

So it's such an interesting question because I feel like there's so much research going on these days over, like, the last couple of years into diet and acne. And I have a lot of patients and asking similar questions.

[Raj Panjabi Johnson]

But that's because of the microbiome, not because of, like, junk food. Right.

[Dr. Kunal Malik]

So. So we are learning that there is a connection between the gut skin axis. Right.

[Raj Panjabi Johnson]

Okay, makes sense.

[Dr. Kunal Malik]

Yes. And a lot of that has to do with the microbiome, to your point. And so we're learning also that, you know, cortisol and insulin spikes can cause excess oil production and can affect, at least on the molecular and biological level, increased acne predisposition. So it's definitely not completely.

[Raj Panjabi Johnson]

I hate when my mom is right and she's right A lot.

[Dr. Kunal Malik]

But you know, when it comes to like specific food groups, I think like it's, it's. The evidence is not quite out yet to say X food group is going to cause acne to demonize.

[Raj Panjabi Johnson]

Like one, it's more like balance.

[Dr. Kunal Malik]

Exactly, right, exactly. We know, for example, like dairy. Right. Like that's a big one. And I think that more and more research is showing that specific types of dairy, like skim milk in particular, you know, will sort of cause some sort of interplay between hormones and affect the skin.

[Raj Panjabi Johnson]

Is it for everyone? Because I have two girlfriends in particular who dairy like makes their skin just, just fucks it up. But it's not me. So I'm like, is it certain demographics? Is it, you know.

[Dr. Kunal Malik]

Exactly.

[Raj Panjabi Johnson]

Or hormonal makeup?

[Dr. Kunal Malik]

Yeah. So I think it kind of goes to like that first point we were talking about. Like it's not just one risk factor. It's like the right genetics and the right patient like doing like some like the right diet or the wrong diet, what kind of environment they're growing up in, what kind of products. Like it's so multifaceted and multifactorial that I think a lot of the research while we're finding out all of these cool studies about like diet and environment and genes and genetics, like there's a lot of teasing out to still be done about like the interplay and relationship between all of these different things. So it's like, I think we love to like oversimplify things, but it's really just not that simple.

[Raj Panjabi Johnson]

Yes.

[Noah Michelson]

Right.

[Raj Panjabi Johnson]

Sounds like it.

[Noah Michelson]

One simple thing that we've heard though is like wash your face. But talk to us about that because I feel like you can probably wash it too much.

[Raj Panjabi Johnson]

I've definitely done that.

[Noah Michelson]

Yeah. If you have acne especially, you're like, I just need to keep this clean. But then I think you can be doing damage too. Right?

[Dr. Kunal Malik]

Yeah, you're absolutely right. At bare minimum, I do think people should be washing their face morning and evening.

[Noah Michelson]

Right.

[Dr. Kunal Malik]

And anything more than that. I mean also like kind of to my earlier points, depends on the environment you're in. Like if you're in some like smog ridden city. Right. Like in the, like maybe like, I don't know, like what kind of environment you're in, like what kind of work you're doing, what kind of things your face is coming into contact with. But at bare minimum, I think twice a day is a good option for most people especially. And you know, more and more people are realizing, you know, you can also just wash Your face with plain water in the morning, for example, Your skin hasn't really been through the elements throughout the night. Right. Like, and we can talk about sleep hygiene as well, but at the end of the day, definitely, I recommend using a cleanser just to take. Take the day off. Right. Like, you're throughout most people's regular nine to fives. Like, you've been through it. Like, you know, you're. You're going outside, you're going on the subway, you're coming into contact with things. You're cooking meals. Yeah. Like, things are getting on your face. Like you want to. Also, before bed, make sure you're doing a really good job at taking makeup and sunscreen off. Right. Like, those are definitely acne triggers. Like, when people go to sleep with those kind of things on. Like, that's poor clogging. That's like, in inflammation inducing.

[Raj Panjabi Johnson]

Yeah, that makes total sense to the sleep hygiene point. My two pimples usually happen after I haven't changed my pillowcase for too long. Like, if I. It goes like two weeks and whatever, and I'm like, oh, shit. I try to change it quickly, but that's when my pimples come. When the pillowcase is like, yeah, been there for a while.

[Dr. Kunal Malik]

I have such an interesting fact here that is kind of gonna blow your mind, because when I read it, I was like, no way. But. But can you guess how much bacteria increases on our pillowcases, like, over, like, a night?

[Raj Panjabi Johnson]

I'm so scared.

[Noah Michelson]

I'm scared too.

[Dr. Kunal Malik]

Oh, my God. It's like 17,000%. When I saw that, I didn't know.

[Raj Panjabi Johnson]

That I could be having no pimples a year.

[Dr. Kunal Malik]

After one week, 17,000% increase in bacteria.

[Noah Michelson]

That makes me want to, like, hang upside down from the ceiling and never use a pillow again. Yeah. Like, that is terrifying.

[Raj Panjabi Johnson]

Wait, that's. That's incredible. Like, it's such an easy thing to do to change your pillowcase. You don't even have to change the rest of your shoes.

[Noah Michelson]

Right.

[Raj Panjabi Johnson]

That's so gross. And I really just be making love to my pillowcase at night. Like, I'm rubbing my face on it. I sleep. I sleep good.

[Dr. Kunal Malik]

Yeah.

[Raj Panjabi Johnson]

Oh, my.

[Noah Michelson]

Are there particular kinds of pillowcases that are better? Like, I always hear about, like, satin versus cotton versus polyester.

[Dr. Kunal Malik]

Yeah. So I like silk pillowcases. I know it sounds so fancy, but honestly, like, silk has some level of antimicrobial properties. I'm not saying I thought this was.

[Raj Panjabi Johnson]

Also BS like, but I. I read that this is true.

[Dr. Kunal Malik]

It's True.

[Raj Panjabi Johnson]

Even for your hair, right?

[Dr. Kunal Malik]

Yeah, even for your hair. And that might have to do with like friction and. Right. Like, it's just like a little bit smoother sliding. Right. In terms of like, the substance. But when it comes to like pillowcases and bacterial buildup and skin dead skin cell buildup, having silk pillowcases is not like a replacement. Like, I'm not saying if you have a silk pillowcase, you don't have to wash your pillows for like, imagine for like month. Like, you still should wash them.

[Noah Michelson]

Right?

[Raj Panjabi Johnson]

Yeah.

[Dr. Kunal Malik]

But if you have the option between like a cotton pillowcase versus a silk pillowcase.

[Noah Michelson]

Yeah.

[Dr. Kunal Malik]

And you're looking to just optimize everything. I think a silk pillowcase is a better investment. Okay.

[Noah Michelson]

I just cannot imagine myself being a person with silk pillowcases. It sounds crazy hard for me to imagine that.

[Raj Panjabi Johnson]

I want that for you.

[Noah Michelson]

Okay.

[Dr. Kunal Malik]

Maybe 2025 will be the year.

[Raj Panjabi Johnson]

I'm gonna save up and get it for your next birthday. But just one.

[Noah Michelson]

That's how I think it's gonna happen. If someone gives this me as a gift, maybe I'll try it. But I can't imagine hitting buy on those.

[Raj Panjabi Johnson]

It's just our own values.

[Noah Michelson]

But I mean, if the science is there, like, that makes sense. I get it. I understand why that would be. But let's talk a little bit about old wives remedies.

[Dr. Kunal Malik]

Yes.

[Noah Michelson]

And let's just go through them. Does toothpaste do anything to.

[Raj Panjabi Johnson]

Oh, I used to do that.

[Dr. Kunal Malik]

Oh my God. Toothpaste is one of the worst things you can put on your face.

[Raj Panjabi Johnson]

But it dries out your. It dries it out, but it does not make it go away.

[Dr. Kunal Malik]

It does not make it go away. It may have a temporary drying effect, but there's so many potential harmful things that come with putting toothpaste on your face. So. Ph. Right. Like. Like toothpaste is very, like alkaline. It's very. It can cause chemical burns. And I've seen that. And also it's 2025. We have so many better things to put on your face. Toothpaste.

[Raj Panjabi Johnson]

I did it in 1998. So you get.

[Dr. Kunal Malik]

Yeah, maybe. Maybe the. The science wasn't grade.

[Raj Panjabi Johnson]

Yeah.

[Dr. Kunal Malik]

Yeah. No, you're not the only one. I hear so many people like that currently even put toothpaste on their face. And it's just like so many better things are out there now.

[Raj Panjabi Johnson]

Remember when, back in the day when the burn was supposed to be a good thing, like stuff you put on your face was supposed to kind of tingle a little that's not, that's not good.

[Dr. Kunal Malik]

That's usually a sign that your skin barrier is being damaged. You're getting a burn.

[Raj Panjabi Johnson]

Yeah.

[Noah Michelson]

So I'm going to guess though, if you said that toothpaste is alkaline, then we shouldn't put baking soda on our faces.

[Dr. Kunal Malik]

Baking soda is a no go. Similar to toothpaste. It can cause a lot of chemical burns. It can disrupt your microbiome. Microbiome.

[Noah Michelson]

Right.

[Dr. Kunal Malik]

Which can over the long run. If you're doing that like on a weekly basis, let's say you're going to end up with more acne over the long run because now you're like, you're kind of have caused this imbalance.

[Raj Panjabi Johnson]

Yeah.

[Dr. Kunal Malik]

Of your microbiome and cause burns and destruction of your skin barrier.

[Noah Michelson]

What about, I've heard people say too, they will crush up an aspirin, make a paste out of that and use that. Same idea.

[Dr. Kunal Malik]

I don't recommend it.

[Noah Michelson]

Yeah.

[Dr. Kunal Malik]

I mean, all of these things in the short run might feel like they're doing something, but trust me, over the long run, you don't want to deal with like a baking soda or toothpaste induced chemical burn which can now take months to sort of heal.

[Raj Panjabi Johnson]

Yeah.

[Dr. Kunal Malik]

You don't want to be left with chronic like skin barrier disruption, which can also take weeks to months to sort of fix. Right. Like, so just, just stay away from it.

[Noah Michelson]

Okay. I have a scenario for you.

[Raj Panjabi Johnson]

Experimentation. Yeah.

[Noah Michelson]

It's a Friday night and I'm on vacation and I all of a sudden have a big juicy pimple. And I'm looking in the mirror and I look on the sink and I have a tube of toothpaste. I have some baking soda. I have some aspirin and I just have cleanser. What are you telling me to do for that big juicy pimple? Just wash it and leave it alone. Use anything.

[Dr. Kunal Malik]

Do you have a fridge?

[Noah Michelson]

I have a fridge.

[Dr. Kunal Malik]

So if you have a fridge, I would go and I would definitely use your cleanser.

[Noah Michelson]

Yeah.

[Dr. Kunal Malik]

Pat your face dry. Right. Like this is like the emergency protocol. Put like a cold spoon on it or put some sort of. Of cold on it. Right. To decrease that inflammation.

[Noah Michelson]

Got it.

[Dr. Kunal Malik]

I don't know if you have access to a pimple patch, but also like, if you're on vacation, you can probably go to the drugstore at some point. Go to cvs, go to Walgreens, get a pimple patch and put a pimple patch on it.

[Noah Michelson]

Right.

[Dr. Kunal Malik]

Don't pop things on vacation, especially if you can't see a dermatologist or don't have access to like good medical care.

[Noah Michelson]

Right.

[Dr. Kunal Malik]

Like what if you caused now like a deep sort of cystic inflammatory pimple? Right? Yeah. Like you just need a cortisone shot, you need antibiotics. Like we have things that we can do in office. And to your point, I know not everyone can get access to a dermatologist or a physician asap, but you know, there are certain like emergency situations. And I know it sounds funny to say that, you know, a pimple would be an emergency situation, but they can be. Especially if it's like a deep sort of cystic pimple and you're concerned for like a deeper infection going on.

[Noah Michelson]

Right.

[Raj Panjabi Johnson]

Is this, is this like an urban legend or can you possibly contract like staff from like popping a pimple?

[Dr. Kunal Malik]

You absolutely can.

[Raj Panjabi Johnson]

Okay. Yeah, yeah.

[Dr. Kunal Malik]

That's not fun.

[Raj Panjabi Johnson]

Yeah.

[Noah Michelson]

Navarage and me at the emergency room every time we have a sit now.

[Raj Panjabi Johnson]

No, because our twice a year we're going to use the pimple patch.

[Noah Michelson]

There you go.

[Raj Panjabi Johnson]

So cute.

[Noah Michelson]

Are there old wives remedies though? We talked a little bit about tea tree oil. Are there things that you're like, actually this does work or this is beneficial.

[Dr. Kunal Malik]

Right. So when I was going through some of them, honey, which I feel like a lot of people have talked about, like manuka honey.

[Noah Michelson]

Okay.

[Dr. Kunal Malik]

There is actually, actually evidence that there's antibacterial, antimicrobial properties honey has. I mean it has to be like unadulterated honey, right? Like, yeah, it has to be like pure honey. But and also like there are things before honey that I would recommend. Right. Like we talked about some of them, but honey is one of them that I do think works. Interesting. So that's an interesting one. Green tea is another one. Right. Like whether, like there is some data out there that it has anti inflammatory compounds in it and that's like whether you're sipping it or putting it on. Right. Like there is evidence that, yeah, like a tea bag, like it can decrease inflammation as well. Again, similar to that medical grade honey. Like there are other things that I would recommend before, you know, green tea, tea tree oil or honey. But I'm just saying, like there are things that we're learning more and more.

[Raj Panjabi Johnson]

About that tea bagging. How new tea bagging.

[Noah Michelson]

I will bring it back.

[Raj Panjabi Johnson]

Great for your skin.

[Noah Michelson]

I love that.

[Raj Panjabi Johnson]

Say it's the pimple's not there yet, but you can feel it. There's like a fetus of a pimple and it's like you can see it happening. There's this Hilarious episode of Sex and the City where Carrie's about to see big and she's like, I can feel it. What should you do?

[Noah Michelson]

Yeah.

[Dr. Kunal Malik]

I would do the same thing with cold that compresses that I was talking about to decrease any inflammation before it comes up and put a pimple patch on it.

[Raj Panjabi Johnson]

Right.

[Dr. Kunal Malik]

Ooh, good idea.

[Raj Panjabi Johnson]

Yeah.

[Dr. Kunal Malik]

Don't try to pop a pop. Pop things that especially don't have a head.

[Raj Panjabi Johnson]

Yeah.

[Dr. Kunal Malik]

Because those deeper sort of pimples or pimples that haven't come to a head, usually they come to a head in three to four days is my experience, but sometimes can take a little bit longer. But if it's not. If it's that fetus of a pimple that you were saying, like, and you kind of pop it now, you've sort of pushed that inflammation into that sort of cake analogy, deeper into the layers of the cake.

[Raj Panjabi Johnson]

Yeah.

[Dr. Kunal Malik]

And caused more trouble and scarring and inflammation. And so it's not going to end up well. All right.

[Noah Michelson]

I think one of the things that's going to haunt me the most from this conversation is the idea that popping the pimple pushes inflammation further.

[Raj Panjabi Johnson]

It's not what. You would.

[Noah Michelson]

Never really heard about that before in your mind. You think it's pushing it out. You're getting rid of it.

[Dr. Kunal Malik]

Right. Not always. Remember, like, we all also do extractions in the office, but it's like, you have to know, like, what is poppable and what is.

[Shopify Advertiser]

Yes.

[Dr. Kunal Malik]

And what you're doing and how you're popping it.

[Raj Panjabi Johnson]

Yeah, the strategy.

[Dr. Kunal Malik]

Exactly.

[Raj Panjabi Johnson]

Yeah.

[Dr. Kunal Malik]

Yeah.

[Noah Michelson]

And watching Dr. Pimple Popper on YouTube is not the same as having a medical degree.

[Raj Panjabi Johnson]

No.

[Noah Michelson]

As much fun as it may be, I met her once. She is a doll.

[Dr. Kunal Malik]

I know.

[Noah Michelson]

She's so sweet.

[Dr. Kunal Malik]

She's so sweet.

[Noah Michelson]

I loved her. Like, I was like, you can't be as nice as you are on TV. And, I mean, I only met her for 10 minutes, but she.

[Raj Panjabi Johnson]

I love when people are. That's the nicest.

[Noah Michelson]

Completely. She did not ruin it for me.

[Raj Panjabi Johnson]

I heard that stress can cause or is, you know, somehow related to acne. Is this true?

[Dr. Kunal Malik]

True. Absolutely. Okay, so we know, going back to that sort of cortisol, Right. Like, when we wake up in the morning, our cortisol levels are the highest. That's our body trying to, like, wake us up. And to an extent, cortisol is normal. Like, we need it for normal life. But when those levels get higher than what they should, they can definitely. At the level of those oil glands right. In the Skin can cause more sebum production, can cause more oil production, which leads to the cascade, the complicated cascade of acne developing. And so that also ties into, like, why certain food groups which we were talking about earlier lead to acne. And it has to do with that insulin spike and that cortisol as well.

[Noah Michelson]

Okay, interesting.

[Raj Panjabi Johnson]

Makes sense.

[Dr. Kunal Malik]

Yeah. Yeah, it's pretty interesting.

[Noah Michelson]

What is the telltale sign that we should go see a doctor for acne? When. When do we know that we should give you a call?

[Dr. Kunal Malik]

Right. So as a dermatologist, I will say there's no right or wrong answer to this. Like, usually, like, when people are even debating it, that's a sign. Just come in.

[Noah Michelson]

Okay.

[Dr. Kunal Malik]

If it starts affecting your emotional sort of health. Right. Like, our face we talked about is, like, kind of how you present yourself to the world. Now, if you're getting emotionally distressed by having acne, I think that's a sign to come to the dermatologist. People don't realize that, you know, we have so many new and emerging tools in our toolbox. Like, there's so many. Over the last decade, there have been so many new medications. Right. That have been FDA cleared for acne. And, like, not everything is, like, not everyone is a good candidate for everything, but, like, we have so many things we can do for acne that we didn't have back even a couple years ago.

[Noah Michelson]

Yeah.

[Dr. Kunal Malik]

And so earlier treatment is better. And all of the research is now showing this. Right. Like scars, for example. Even when you treat acne, scars earlier, when you treat acne earlier, people are finding more and more success with earlier interventions with combined interventions. So rather than just doing your pimple patches, like, like, do pimple patches plus benzoyl peroxide plus retinoids, plus, like, oral, like. Right. Like, not everything is like a cookie cutter sort of solution for everyone. But I often will combine a lot of different things for different people. And the earlier you start to do that, the better the results are.

[Noah Michelson]

Yeah, yeah.

[Raj Panjabi Johnson]

So it is like, a very personalized cocktail kind of thing.

[Dr. Kunal Malik]

Yeah.

[Raj Panjabi Johnson]

Okay.

[Noah Michelson]

It's interesting, too, because I was talking to a friend about this episode, and we were just saying if you've never had bad acne and you see someone with acne, like, a lot of people just think, like, they don't wash their face or they're not taking care of themselves, but, like, that's not enough for a lot of people, and you need a doctor who can say, this is what we're gonna try.

[Raj Panjabi Johnson]

Yeah.

[Noah Michelson]

And it's really awful, right, to be going through that and then to have people judging you for it.

[Raj Panjabi Johnson]

That's true. It is associated with bad hygiene. And you're like, that's not at all what's happening here.

[Dr. Kunal Malik]

Yeah. That's such misinformation though. Like acne is a medical condition and it's not a reflection of like self worth or hygiene.

[Raj Panjabi Johnson]

Yeah.

[Dr. Kunal Malik]

You know, and I think people are hopefully more people start to realize.

[Raj Panjabi Johnson]

I think, I think it's changing for sure. I had a moisturizer question because when you're like shiny and, and like pimply, the last thing you want to do is like put an emollient on your face. But you should still be moisturizing when you're like treating acne, right?

[Dr. Kunal Malik]

Absolutely. And I think it's kind of counter like intuitive. Like you were like, okay, if I'm oily, why would I put more moisturizer on? I get it. Like as of a couple of years ago, I think a lot of dermatologists used to think the same, but I think now we know better. Right. Like even acne prone, oily skin still needs a moist. Like you still need a healthy skin barrier. Right. Like that oil and sebum that your skin is making might be a paradoxical response to having dry skin.

[Raj Panjabi Johnson]

Yeah, totally.

[Dr. Kunal Malik]

And so now there's actually, you know, like brands also are realizing, realizing that acne is prone and oilier skin needs a moisturizer. And there's so many really good like oil free moisturizers and they have like, there's so many moisturizers with things like silica in it which will absorb oil throughout the day so you don't have to look really.

[Raj Panjabi Johnson]

Okay, so what? And again, not sponsored, but like what are some of your name, a couple of moisturizers that you like for people that struggle.

[Dr. Kunal Malik]

So I personally have oilier skin as well and I really like the La Roche posay. It's in the blue bottle. It's the Matte double repair Matte moisturizer. It's perfect. Again, this is totally non sponsored. I personally use it every single day.

[Raj Panjabi Johnson]

I love that.

[Dr. Kunal Malik]

So that's a great option. It has what I was talking about earlier, the silica, which will over throughout the course of the day will sort of normalize oil control and make sure that you're not making too much. It has niacinamide in it, which is also a buzzy ingredient. But there's good research that it sort of balances oil production. I mentioned a brand earlier, Cerave, that's also a great brand. Right. That has a really Nice oil absorbing moisturizer.

[Noah Michelson]

And it's affordable. Yeah, yeah, that's, that's great for people.

[Dr. Kunal Malik]

People think that, like, drugstore brands are not great. I, I'm a huge fan of drugstore brands. I think, like, you know, as long as the science is there and these companies, like some of the bigger ones, have invested a lot of research and time into making sure that the products they're putting out are scientifically sound and they partner with a lot of dermatologists to make their products.

[Noah Michelson]

Do we always want a product to be non clogging? I forget the exact term and I can't pronounce.

[Dr. Kunal Malik]

Non comedogenetic.

[Noah Michelson]

There you go. Is that what we want to be looking for?

[Dr. Kunal Malik]

Absol. And so non comedogenic basically just means what you said, like it's non pore clogging. And so, you know, I always tell people in my clinic, just if you're ever concerned about a product, just flip over the back. Right. And look at the ingredient list. It should say non comedogenic. Non pore clogging. You want to look for makeup. That's not.

[Raj Panjabi Johnson]

This is why I know this word, because it's makeup. Like, I used to use a certain brand that I won't mention that was like Dr. Parik told me, he's like, don't. That clogs your pores. But now I look in. It's like a different world.

[Dr. Kunal Malik]

Yeah, yeah, that moisturizers. Right. Like things that you're putting on your face. Now, I think people are becoming more and more well versed about what that means. Yeah, it's always good to just read what you're putting on your face.

[Noah Michelson]

For sure. With shows like this, hopefully it'll be even more. We've been starting to do this thing at the very end where we ask our expert, you know, like, what is one thing you wouldn't do if you had a pimple? What would that be for you don't wait.

[Dr. Kunal Malik]

I think a lot of people wait until they have. They're like, okay, like, maybe I can do this, maybe I can do this. And yeah, I'm not completely dismissing, like, you know, self treatment and self empowerment to do things from like the drugstore even. There's great things out there. But if you're doing things and honestly, if you feel that your acne is not getting better, you know, just summarizing all of the sort of studies we were talking about in the research, like, more and more data is now showing that the earlier intervention is better. And I know, you know, not everyone has access to a dermatologist, but, you know, make that appointment. Just come in sooner. Like, there's so many things, honestly, that we can do to help your skin. And I also would add in, like, don't feel that acne is a reflection of your self worth or your sort of hygiene. Right. Like, it's really not. It's. It's a medical condition that you may have no control over.

[Shopify Advertiser]

Yeah.

[Dr. Kunal Malik]

And so there are things to do to help it.

[Raj Panjabi Johnson]

Yeah.

[Noah Michelson]

Yeah, I love that. My very last question I have, and we didn't get to this, but I think there's this idea that if you're drinking gallons of water a day, your skin, what is the relationship between hydration and acne?

[Dr. Kunal Malik]

Oh, my God. That's such a pet peeve of mine. Because on social media, I feel like. I feel all of these people are like, just drink water. Right? And I'm like, that's not the answer. Like, this is a medical condition. Like, yeah, of course you should be drinking water, like, for your overall health, but drinking water. There's no research that says drinking water will cure you of your acne. Right. Like, that's just not.

[Raj Panjabi Johnson]

Yeah.

[Dr. Kunal Malik]

There's more to it than just being dehydrated or not drinking enough water.

[Noah Michelson]

That's good that we, that we said that because I think you're right. So many people, influencers, like, have their big Stanley cups or whatever, and they're like, oh, you're not getting enough water. And I'm like, we did a whole episode on hydration and we busted a lot of those men myths there too. But I think especially with acne, drink.

[Dr. Kunal Malik]

Your water, but treat your acne appropriately.

[Noah Michelson]

Love that. I feel so much better. Yeah, I learned a lot.

[Raj Panjabi Johnson]

I might not have my two pimples next year.

[Noah Michelson]

This year maybe just one.

[Raj Panjabi Johnson]

Just one.

[Noah Michelson]

Yeah.

[Dr. Kunal Malik]

Damn. The pillowcase thing isn't that crazy? Change your pillowcases, or at least like, flip them throughout the night.

[Raj Panjabi Johnson]

Flip them.

[Dr. Kunal Malik]

So many. If you like the cold side better. Yeah, I do.

[Raj Panjabi Johnson]

Yes. Thank you so much.

[Noah Michelson]

Of course.

[Dr. Kunal Malik]

Thanks for having me. Great.

[Noah Michelson]

Yeah.

[Raj Panjabi Johnson]

So good.

[Noah Michelson]

It's time for Better in Five. These are your top five takeaways from this episode.

[Raj Panjabi Johnson]

Number one, acne is caused by a combination of factors which can include genetics, environment, and diet.

[Noah Michelson]

Number two, popping pimples might feel good, but it shouldn't be your first line of offense. It can actually make things much worse.

[Raj Panjabi Johnson]

Number three, Gen Z is correct. Pimple patches really work and can protect your skin as it heals. And they're cute.

[Noah Michelson]

Number Four, you're gonna wanna change your pillowcases frequently. They can harbor insane amounts of bacteria. And if you're fancy, maybe try a silk pillowcase.

[Raj Panjabi Johnson]

You are fancy.

And number five, the tendency is to over cleanse your face when you have acne. Don't do it twice a day is perfect. And use an oil free moisturizer.

[Noah Michelson]

Okay, rise. Have you been doing acne wrong?

[Raj Panjabi Johnson]

I mean, I was right when we started. I was doing it wrong like everything I tried under the table as like a swarthy, oily, 13 year old, swarthy, terrible. I was a little pimply pirate. Luckily I grew out of that phase. But it's humbling to know that even dermatologists didn't have all the answers when I was growing up. So it's like I wasn't alone in my chaos. And it was nice to learn about how the research is evolving.

[Noah Michelson]

I mean, yeah, my dermatologist put me on Accutane three times.

[Dr. Kunal Malik]

Yeah, exactly.

[Noah Michelson]

Is insane. So, yeah, I agree. I learned a lot. I don't think I'm gonna pop another pimple. That's still my.

[Raj Panjabi Johnson]

But. But only, you know, a very tiny one.

[Dr. Kunal Malik]

Not.

[Noah Michelson]

And not the deep one.

[Raj Panjabi Johnson]

No, definitely not.

[Noah Michelson]

But yeah, I also like that it's evolving. We're learning more about it. None of us are alone with this. You know, most of us are dealing with it at some point or another. And I feel better when I have more information.

[Raj Panjabi Johnson]

Yeah.

[Noah Michelson]

And it's not coming directly from TikTok.

[Raj Panjabi Johnson]

Totally. Except I do want those patches.

[Noah Michelson]

Yeah, except for the patches. But don't put the toothpaste on your face anymore.

[Raj Panjabi Johnson]

No.

[Noah Michelson]

Anyway, until next time, as long as there are things to get wrong, we're going to be right here to help you do them better.

[Raj Panjabi Johnson]

Love you guys.

[Noah Michelson]

Do you have something you think you're doing wrong? Email us at amidoing it wrong huffpost.com and let us know.

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