Damien Cuypersbestrong+well / YOUR HEALTHIEST SKINLET S TA L K
Karen Nern, M.D., is a dermatologist and dermatologic surgeon in Colorado.
Here, she discusses acne: why it’s on the rise, four crucial lifestyle habits that will
help, plus the two-minute antibreakout move you can do daily. By Isabel BurtonI
t seems as though more people are
struggling with acne. Is that true?
We’re under chronic pressure these days. Partly because
we’ve created an instant-feedback society with social
media, which makes us worry about getting likes and how
we look in photos. This intense climate means we’re constantly trig-
gering our stress hormones, like cortisol, which drives oil prod
uction and causes acne.
We see what acne can do to your skin,
but what about your psyche?
Acne occupies so much mental space. Once the acne is successfully
treated, that space becomes freed up to find more joy in life because
we don’t spend time worrying that people are scrutinizing our face.
Acne patients are some of my most rewarding. They’re dev-
astated by their skin, feeling so self-conscious that they
don’t make eye contact. When they’re clear, they
become incredibly happy and confident.
Break it down for us:
What’s the current thinking
about managing your skin?
Acne results when the pores get closed over
and the oil that’s backed up becomes infected.
We want to do three things: Open the pores by
exfoliating, kill the bacteria with a spot treat-
ment like benzoyl peroxide, and reduce inflam-
mation with antioxidants and vitamins in your
moisturizer, which will keep your skin’s barrier
intact and happy.
There’s a lot of buzz these days about
exfoliating. Your ideal program?
We know you need to exfoliate to open the pores. There are so many
new products with lactic, glycolic, or salicylic acid made for daily use
that are great for gentle exfoliation. Once a week go for something
stronger, like a glycolic peel pad. I love a monthly in-office treatment
like the new Diamond Glow Facial, which can resurface the skin and
get rid of some of the top dead layers but without downtime.
What’s the new frontier of acne control?
One ingredient we’re getting more information on is niacinamide,
or vitamin B3. That’s a really interesting vitamin. Here’s the science:
the mitochondria—essentially the engine—in cells need something
called NAD+ to make ATP, which is the fuel that your cells run on. You
need this ATP to do repair. Niacinamide supplies you with NAD+.
The results are impressive—an increase in ceramides, which form the
skin’s barrier; faster cell turnover; reduced oil production and inflam-
mation. Niacinamide is proving to be a hero topical drug. When your
cells are growing normally because they’re getting that fuel, they’re
not sticking together and blocking your pores.Probiotics: Can they help clear your skin?
These are an exciting emerging option for treating acne both topically
and orally. They work primarily by controlling inflammation, improv-
ing skin-barrier function and reducing acne-causing bacteria
[Propionibacterium acnes]. You can look for them on the ingredient list
on serums and moisturizers that you’d apply in the morning and night.
How are dermatologists battling
breakouts with prescriptions?
One drug we’re starting to use for female hormonal acne
is called spironolactone. It was originally designed as a blood pres-
sure medication, so it’s made for long-term use and has 30 years
of safety data. For acne, it impacts androgen [hormone] receptors
in the sebaceous gland, causing it to produce less oil and improving
acne symptoms.
What about life factors—how
do they play into preventing or
causing breakouts?
Exercise, sleep, diet, and stress—those are the
biggies. Working out increases blood flow,
so your tissues get more oxygen and nourish-
ment. Sleep is when your cells repair them-
selves, so that’s crucial. It also helps you de-
stress. And diet is huge. Studies show that
sugar and processed carbs drive insulin spikes,
which trigger oil production and inflammation.
Also, fat is your friend when it comes to your skin
barrier. You need healthy fat for the ceramides,
which protect you and keep your skin supple.
Any easy way to give your skin a boost?
I love anything that turns you upside down for a couple of
minutes. It gets blood flowing to the head, and you end up with
extra oxygenation of the tissues.
Even when the acne is under control,
there can be scars. What helps?
Retinoids are great for minimizing scars and those dark marks
from breakouts. There are all types of in-office laser treatments that
can reduce visible scarring. We use TCA Cross, a peel that treats
scars specifically. It’s a strong acid [trichloroacetic acid] that injures
the skin and lets scars fill in. We turn to the CO2 laser when we
want to conduct skin resurfacing.
The warmer months strike fear for many
sufferers who hate sunscreen. Advice?
Anyone on an acne treatment is sun sensitive, so sunscreen is
very important. One of five people gets a skin cancer by age 70.
These days, sunscreen is really skin care, packed with healthful
ingredients, so it does your skin a favor in addition to block-
ing rays. Opt for one that’s labeled noncomedogenic.SHA0520SWTLK_DG.indd 54 FINAL 3/18/20 12:57 PM