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70: Acne Treatment—No One Should Suffer from Acne

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70: Acne Treatment—No One Should Suffer from Acne

Feb 16, 2021

Producer Mitch shares his struggle with acne and its impact on his self-esteem. Dermatologist Dr. Luke Johnson talks about over the counter and prescription treatments. Troy explains why a man dies after eating too much black licorice. Scot and Troy do something together they haven't done since the pandemic started last March—and they both admitted it was weird.

Episode Transcript

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Do you have some sort of a tagline when you leave, like "Be skin healthy"? Anything like that?

Troy: Leave and just say, "I'm the balm."

Dr. Johnson: I don't, but maybe I should come up with one.

Scot: Yeah. Like a toast, like, "Here's to your skin."

Troy: "Here's to your skin."

Dr. Johnson: I hope that was skinteresting.

Troy: Skinteresting. Oh, I love it. That's it right there.

Scot: The podcast is called "Who Cares about Men's Health," giving you information and inspiration to better understand and engage in your health so you feel better today and in the future.

My name is Scot Singpiel. I am the manager of, and I care about men's health.

Troy: And I'm Dr. Troy Madsen. I'm an emergency physician at the University of Utah, and I care about men's health.

Dr. Johnson: I am Dr. Luke Johnson. I'm a dermatologist at the University of Utah, and I care about men's health.

Mitch: And I'm Mitch and I care about men's health.

Scot: All right. Today, we're back with dermatologist Dr. Johnson, because we wanted to talk about acne. I've heard a statement that if somebody has acne that there's no reason that they should suffer with that, and we're going to find that out today. So if you have acne, if somebody in your life has acne, maybe your son or your daughter . . . I think I said Acme, which of course is the Road Runner coyote thing. It's Acme.

Troy: Acme with an M. Acme.

Scot: What can be done and is that statement that no one should have to live with acne true? So, first, we want to hit with Mitch's story, because Mitch has had a battle throughout his life with acne. So tell us about your battle and how it impacted you and your health.

Mitch: Yeah. So, during high school, I had really bad acne as I went into like junior or senior year, and it was scarring acne. So every time that I'd have a really bad set of breakouts, all of a sudden I would have these little scabs, I'd have these little marks, and over time I was getting pockmarks all over my face.

And you don't see them these days, but that's because I went through a whole lot of work with the dermatologist. We tried everything from topical creams to everything we possibly could for a year or two before they decided to finally put me on Accutane, which I don't know if that's standard protocol anymore, the isotretinoin. But I was on that for about a year and a half just to try to get the acne to stop so my skin would stop scarring.

I was on that for about a year. It was a pretty miserable process. You're dry all the time. It's like your lips are falling off. And so, my first year of college, I was a bit of a pizza face or whatever. I had really, really bad acne.

And by the time it was all said and done, I was left with some scars and it really impacted my self-esteem, really made me kind of nervous to kind of talk to people. And so I had to go through a whole bunch of treatments. We ended up doing peels and even some sort of beetle poison that they put on my face to try to remove one thing or another.

And after all of that work, after years and years of working to fight against the acne and then eventually to minimize the scars, I now have the clear "broadcast-ready skin" that my dermatologist wanted me to get when I was originally going to go into television.

Scot: That's a great story. So it impacted your mental health because it undermined your self-confidence.

Mitch: Oh, most definitely. I was nervous. Even during treatment, I would not want to go to parties and stuff because my face was covered in scabs. I had all these little scars. I looked a little older than I wanted. Yeah, I didn't feel good about it.

Scot: Dr. Johnson, is Mitch's story common? Uncommon? Where would you categorize Mitch's journey?

Dr. Johnson: I would say it's fairly common, and I'm glad it has a happy ending. I think our current acne medicines that we have available are pretty good and we can give most people a happy ending.

Scot: And the amount of time that it took him to go through this process, is that pretty common or are things a little bit better now?

Dr. Johnson: Well, our treatments are actually fairly similar to when Mitch was going through this, but I would say that usually we can get people better a lot faster than that.

Troy: I was going to say it sounds like . . . I mean, for Mitch, it sounds like things were pretty advanced, Mitch, when you got to a point when you saw the dermatologist. At what point, Mitch, in that process did you see a dermatologist? Then, Dr. Johnson, is this something where if he maybe had an opportunity to see someone like you earlier, could it have prevented a lot of the peels and the interventions he needed down the road?

Mitch: Well, at the time, I went to a dermatologist relatively early when we started seeing the scarring and the over the counter stuff was not quite cutting it. And at the time, the dermatologist said that they would not escalate to Accutane until other things were tried and necessary.

I don't know if that was an insurance thing, I don't know if that was a best practice thing, but we had to try some other treatments for a month or two at a time before we went nuclear, essentially, with the Accutane.

Dr. Johnson: Well, I think probably that dermatologists are a lot more comfortable with Accutane now. There's been a lot of research that's come out showing that it's a pretty safe drug. And also there's been a lot more interest in the last 10 or 20 years in what we call antibiotic stewardship, which means limiting the number of antibiotics we prescribe to people in general in order to reduce the resistant bacteria that exists in the world.

So I have a pretty low threshold to go ahead and start Accutane on people these days.

Mitch: I got my treatment back in 2008/2009, so the last 10 years. I mean, it was a controlled substance. I had to get tested, I had to do a psych evals, everything, every month or two that they would give me my refills.

Dr. Johnson: We're getting a little farther afield here with the Accutane discussion, but what I would like to say about Accutane is that it's a great medicine. I also took it. And it sounds like you had a fairly significant reaction to it since you described yourself as being fairly miserable for a year or a year and a half on it, but that's an extreme reaction. I would say most people definitely get dry, but they don't find it too bad. And then six to seven months later, their acne is better. So it's a great medicine, it's pretty safe, it works well, and dermatologists use it plenty.

Scot: This is a part of the show where Scot goes, "But, Doctor, if Mitch would have just changed his diet, that would have taken care of the problem, right?"

Dr. Johnson: Oh, yeah. You were probably getting too many vegetables.

Troy: Yeah, chocolate. Mitch, were you eating just tons of chocolate? What's your deal?

Mitch: Oh, I did. That's all I ate. Then I'd smear it on my face.

Troy: Take Hershey bars and smear it around . . . you probably never bathed either.

Mitch: Nope.

Dr. Johnson: These are myths, so thanks for bringing them up. There has been a fair amount of research into diet and acne. And lately, there's actually been a couple positive spikes where it looks like if you drink skim milk, not other types of milk, but skim milk specifically, or your diet has what we call a high-glycemic load, which means it's got a lot of simple sugars in it, it might make your acne a little bit worse. So instead of having five pimples a month, you might have six pimples a month or something, but it doesn't make a big deal.

And also cleaning and hygiene doesn't seem to have a lot to do with it either. However, there are particular medicated cleansers that people can use that can really help out their acne.

Troy: I was going to say there's a certain brand that you see advertised all the time on TV. Does that make a difference? Is that something that people should be trying?

Dr. Johnson: So here's one of the heartbreaking things that I see in my practice. Somebody has significant acne and they have spent hundreds of dollars on over-the-counter products to try to make it better.

Scot: Advertised by celebrities, right? Is that what we're talking about?

Dr. Johnson: Many of them.

Troy: Perhaps Kristen Bell.

Mitch: That's what I used.

Dr. Johnson: I won't name any names, but she's awesome in "The Good Place."

Troy: She's awesome in "The Good Place."

Dr. Johnson: So people spend a bunch of money on products that maybe help a little bit, but if they had just come to a dermatologist's clinic, we could get them better a lot faster and a lot better and a lot cheaper.

So there are over-the-counter products that are pretty good for acne, and some of these expensive, fancy products that you see advertised contain some of those ingredients, so that part is good, but you can get them a lot cheaper in sort of generic forms.

My favorite over-the-counter acne treatment is called benzoyl peroxide. It's not hydrogen peroxide. It's benzoyl peroxide. It comes in a lot of different forms. It comes as washes, it comes as creams, it comes as spot treatment pads. I like it best as a cleanser or a wash because I figure most people who care about acne are going to be washing their face anyway, so you might as well put some medicine in there to avoid having something else to do.

This will bleach towels, however, so all of my towels are white or bleached.

Scot: The red ones are now pink.

Dr. Johnson: Yeah. My wife says I owe her a set of teal towels sometime when I stop using this medicine, but I don't think I'm ever going to stop using it.

Troy: And that's interesting that you point that out. This isn't just about maybe someone in their teens or early 20s when a lot of us have dealt with acne, but you're talking as an adult, maybe into your 30s, 40s, this is still stuff that people are using and you're recommending.

Dr. Johnson: I'm 16.

Troy: Oh, I'm sorry. My mistake.

Scot: Were you born on a leap year? What's going on?

Dr. Johnson: I just turned 40. Still get some acne.

Troy: We talked about this in the previous episode, but I think a lot of us are dealing with acne outbreaks right now just for mask use, the whole maskne thing where you have that moisture there and that seems to be leading to some more acne. Is that something you're seeing more of as well?

Dr. Johnson: Yes, and I think maskne is a real thing. Medicines like this benzoyl peroxide can help. So let me offer a couple of specific pointers for your listeners. If your skin is not particularly sensitive, then you can use whatever benzoyl peroxide is cheapest. I just buy the Walmart brand 10% benzoyl peroxide stuff. But if you have more sensitive skin that gets irritated by the benzoyl peroxide, then you want to use something with a lower strength.

So my favorite gentle version is called AcneFree. It's a 2.5% containing benzoyl peroxide cleanser, extremely gentle. And the brand CeraVe also makes a good one called Foaming Acne Facial Cleanser, or something like that. Both very gentle. So if you try the normal stuff and it's too irritating, try one of those instead.

There's another product that I think I mentioned in the last episode called Differin. The medicine is adapalene, which is in there. Also good for acne, good for scars, also good for wrinkles, etc.

So what I normally recommend is you do the benzoyl peroxide cleanser in the morning, you put on something like Differin at night, and that's all you need to do for your acne. Don't use astringents. Don't use apricot scrubs. Don't use random creams from Mexico. Just those two things are the best things you can do that are over the counter.

And if they're not working . . . and give them a few months. It takes four to six months really, so be patient. But if you try it for that length of time and you don't get where you want to be, then see a dermatologist and we can help.

Troy: I love it. And it's such a simple regimen. Like you said, it just gets to the basics. Forget all the expensive products. Forget the mail order stuff. Simple stuff. Like you say, you can buy the cheap stuff at Walmart. It sounds like this is a regimen that in your experience sounds like works for the large majority of people with acne.

Dr. Johnson: If it's mild, then this works pretty well. If it's not mild, then it probably needs prescription medicines, but we have some pretty good ones.

Scot: All right. Well, I guess it is true that you shouldn't have to live with acne. You shouldn't have to go through what Mitch went through. And just to be clear, you could try those two over-the-counter products that you've talked about. You would recommend a patient does that first, and if after how many months they're not seeing success, that's when you'd want to come to dermatologist? Or would you recommend a trip to the dermatologist before you try any of those products?

Dr. Johnson: I would say if you're in doubt, see a dermatologist because we can tell you if all you need is that stuff or if you need something stronger. You can start using that stuff while you wait for your appointment to come up.

Scot: All right. Perfect. Do you have a final kind of thought when it comes to the topic of acne and men and our health?

Dr. Johnson: I 100% agree that nobody should have to suffer with it. We have really good treatments, so come see us.

Scot: All right. Dr. Johnson, thanks for being on the show, and thank you for caring about men's health.

Dr. Johnson: Happy to.

Troy: Scot, a common question I get asked when people find out what I do is "What is the craziest thing you have ever seen?" People love to ask that question. You've probably asked me that question at some point. I think you might have. But you've got to figure if you're going to see crazy things, it's in the ER.

And sometimes I think I've seen just about everything, but then I'll read different case reports about things people have seen in other ERs, and then it's such a unique thing. Then they write about it and publish it in a journal and I think, "Wow, I have not seen that and that's fascinating."

Scot: Have you ever run across one of these crazy cases in the . . . is it a medical journal?

Troy: Yes.

Scot: Have you ever run across one of those cases that then eventually you see and you're like, "Oh, I know how to handle that now"?

Troy: Yeah, I have. And sometimes you will see things and you think, "Wow, this is crazy. I've never seen it. I need some more insight into it." So you'll search for an article and you'll find a case report. That's the beauty of these case reports. You're like, "Oh, wow, someone else saw this and this is what I need to do, and this is their insight into it."

And I've published case reports too of things I've seen, like crazy cases that others haven't seen. So it's a cool thing. It's a process. You publish what you see and then you read what others have published as well. And these are in obviously reputable medical journals.

Here's a crazy case report, Scot. First question for you. Do you like black licorice?

Scot: Not really. No.

Troy: Some people love it and some people hate it. I really like black licorice. I really like it.

Scot: I'm more on the hate side. You can have all my black licorice.

Troy: That's so funny, because oftentimes if I ever get candy, I'll buy Good & Plenty. It's this black licorice coated in candy, and Laura's like, "I think you bought the one that's been on the shelf since 1950 because no one else eats that stuff."

Well, here's a case of a person who . . . this was reported in "The New England Journal of Medicine," one of the top medical journals. A 54-year-old man who came into the emergency department after experiencing a life-threatening heart rhythm.

So he was in a life-threatening heart rhythm. He was unconscious. And as they tried to resuscitate this patient, it sounds like they were able to get a blood pressure back and he improved somewhat, but they're trying to figure out why in the world this happened.

And so they talked to his family and this is what they found. They said this individual did not have a very good diet. His diet seemed to consist only of black licorice. In the past couple of weeks, he had been eating one to two large packages of black licorice every day.

I mean, that was his diet, essentially. His entire source of nutrition was nothing more, it sounds like, than black licorice over the past couple of weeks prior to this.

You might think from a health standpoint that doesn't sound particularly healthy. You're basically just consuming a lot of sugar and that's what's keeping you going. You're missing out on a lot of other nutrition, but besides being unhealthy, what's the risk?

Well, this is something I did not know. Apparently, black licorice contains a compound called glycyrrhizin. I have never heard of this compound before. It's derived from the licorice root, which is what gives black licorice its flavor. And if you consume too much of this, it actually drops the body's potassium levels.

Now, this being said, I have seen people come in the ER with life-threatening low potassium levels, and it does bad things to the heart. If your potassium is low, it affects the heart's activity and it can kill you.

So this person was consuming so much black licorice and so much of this substance, this glycyrrhizin, that it actually lowered their potassium level to a dangerously low level and caused their heart to go into some crazy heart rhythm. They lost their pulse.

The sad ending of this story is this individual went to the intensive care unit and actually passed away 32 hours later. So he did not survive.

But the point of this is there are certain hidden risks in some of these foods and kind of the whole thing of "all things in moderation." You eat too much of one thing, especially black licorice, it can have some kind of crazy, very severe detrimental effects.

Scot: That's exactly what I was thinking. I was just thinking that we think . . . well, first of all, black licorice is natural, so how could that damage somebody? But over-consumption of anything, natural or not, could possibly lead to bad outcomes or something going wrong.

And it just really reinforces when you're doing stuff, taking medications, or whatever, and you're like, "Oh, I'll just take a couple extras," if black licorice can do that, medications can have a quite a larger impact I'd imagine.

Troy: Yeah. The good news of this is at least half of our population is not at risk of this because they absolutely hate black licorice. I think it's like cilantro. There's something about cilantro that it's so polarizing, and black licorice is the same. People just think it's disgusting, and other people love it.

I'm on that side that loves it, but after reading this, I thought, "Well, once in a while I might eat an entire package of Good & Plenty in one sitting," but I thought, "Maybe I should be a little more cautious about that." I'm just kidding. Obviously, it's a huge amount that would take to do this.

Scot: An accumulation over time.

Troy: Yeah, it's an accumulation over time.

Scot: It built up, built up, and built up, and he just wasn't able to get rid of it fast enough I'd imagine.

Troy: Yeah. I think it was that part of it and then also the part of probably not eating the other good stuff, things that would provide potassium. So you've got something that's lowering your body's potassium and then probably just not consuming other things.

There are lots of things that can do this in diets. We see this a lot with alcohol, chronic alcoholics who their only source of nutrition is alcohol and they just drink tons and tons of alcohol. And then that affects their thiamine levels, thiamine and folate, and they can come in with severe nutritional deficits that cause some really severe neurologic issues. So it's not limited to licorice. There are lots of things out there that can do that.

Scot: Time for "Just Going To Leave This Here." It might have something to do with health. It might not. Could be totally random. Just something that might not have someplace else to live on the show.

Troy: Scot, I'm going to go first here. I'm just going to leave this here. I had an experience recently, and you were part of this experience. I have been speaking to you now for, I don't know, 10-plus months. I have not actually seen your beautiful face until just a week ago.

Scot: That's so sweet. Big old sweetheart you are.

Troy: Yeah, it is. It's crazy. It was a kind of a surreal experience to feel like I've been talking to you this long. And it's so funny, because at work that day, I had a little downtime between patients, so I was listening back just to a couple of our recent episodes. It was so funny having listened to you and it just felt like I'd been talking to you all morning, and then to actually see your face, I was like, "Whoa, there's Scot. I haven't seen this guy since March 10th," or whenever it was. So I'm just going to leave this here. It was good to see you. It's been a while.

Scot: Thanks. I appreciate it. I want to clarify. We record on a platform that does not have visuals, so we literally have not seen each other for that long. And it was a little weird for me, I'm going to have to admit. I think I'm a little awkward socially anyway unless it's behind a microphone because I feel comfortable there. So I'm standing there. You're looking at me, I'm looking at you, and I'm like, "Well, I guess that's . . . I don't know. What should we talk . . ." I could talk all day like this, but . . .

Troy: Exactly. We needed to turn away from each other so we couldn't see each other and then we could speak to each other.

So first impression. Any first impression, Scot, after not seeing me for 10 months?

Scot: Your hair is redder than I thought it was, because usually I think you keep your hair shorter. It's a little bit longer. I think there's some red in there that I never noticed before, but you look good. I mean, you had your mask on.

Troy: Yeah, you look good too. First impression, you look healthy. It's like, "You look healthy. You look good."

Scot: Thanks.

Troy: You've been staying healthy. I'm glad to see that.

Scot: Just going to leave this here. I love this little saying that I stumbled across the other day. I'm always trying to think of a new way to look at something to motivate myself or that might motivate somebody else, kind of a new paradigm, because sometimes just even a new paradigm can make a huge difference.

The saying is "You do not design your future. You design your habits, and your habits design your future." I love that, because what that speaks to is instead of thinking about what you ultimately want to accomplish, think about the things you need to do to accomplish it. Make those your habits, and then eventually that's going to become part of your future. Does that make sense to anybody other than the guy talking right now?

Troy: It makes sense. That sounds like something that Nick said recently. And he also kind of said that too. He talked about not just going for the end goal, but being more process-oriented. I mean, it's more enjoying the process and developing that process and then you take whatever comes as a result of that. Hopefully, it's a good thing. So it makes sense.

Scot: All right. Time to say the things that you say at the end of podcasts because we are at the end of ours. First of all, if you want to get in touch with us, you can do it a lot of different ways. The way that would be kind of cool is if you called 601-55SCOPE. That's 601-55SCOPE, and leave us a voicemail with your message, your question, your feedback, whatever. But there are other methods as well.

Troy: You can contact us, We're on Facebook, Our website is Also, subscribe anywhere you get your podcasts. We're on Apple, Google Play, Spotify, Stitcher, Pocket Casts, whatever works for you.

Scot: Thank you for listening. Thank you for caring about men's health.