Science Vs - Acne

Episode Date: March 9, 2017

Trying to get rid of acne can feel like a science experiment with your face -- so we get to the bottom of what works and what doesn’t. We investigate the role of diet, stress and hygiene, and meet internet celebrity Dr Sandra Lee aka Dr Pimple Popper. We also speak to dermatologist Dr. Jonathan Weiss, MD and Prof. Huiying Li, PhD. Science Vs Live! Come see our live show on the science behind red wine, coffee and chocolate - could our favorite treats actually be good for us? Thursday 3/23 at The Bell House in Brooklyn, NYC. Get your tickets here.   Our Sponsors: Audible Channel's Sincerely X - Go to audible.com/sincerelyx to listen. Audible and Amazon Prime members can listen for free. Ebay's Open for Business - Season 2 returns March 16th. You can listen on iTunes, Google Play, or wherever you get your podcasts. Credits: This episode has been produced by Senior Producer Kaitlyn Sawrey and Wendy Zukerman, as well as Heather Rogers, and Shruti Ravindran. Production assistance from Ben Keubrick. We’re edited by Annie Rose Strasser. Fact Checking by Michelle Harris. Sound engineering, music production and original scoring by Bobby Lord. Thanks to Dr Robert Delavalle, Grand View Research and Stevie Lane, Pat Walters, Rose Reid, the Zukerman family, Joseph Lavelle Wilson. Selected References:2016 Guidelines of care for the management of acne vulgaris2013 study on ‘good’ vs. ‘bad’ strains of P. Acnes by Dr. Huiying LiDr. Pimple Popper’s ‘Blackheads for Dayzzzz’ videoCochrane Review on Light Therapy for Acne TreatmentA great summary of up to date research on acne and acne treatment. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Wendy Zuckerman and you're listening to Science Versus from Gimlet Media. Today, we're tackling acne. Are you excited to have your skin fixed? I'm just pretty sceptical at this point. It's just like, blah, blah, blah with your bulls**t. Caitlin Zorri has adult acne. It's not that bad, but it can really get her down. And she's been sold a lot of stuff in her time to get her skin clear.

Okay, started with creams, face washes, toners, masks, scrubs. I've cut out dairy, bread, been to clinics and spent a lot of money doing very strange things to my face. Even like home remedies. Turmeric is the funniest one because it makes your face bright yellow. It feels like a 10 year long experiment on my face. Why do you want to get rid of your pimples? As soon as I have a breakout, I immediately think that everyone is looking at it. I can't talk to anyone new without thinking that they definitely can't be attracted to me because what's on my face? Pimples are something that almost

everyone has had to deal with and it can drag on into adulthood. One survey found that 40% of adults still deal with their zits in their 30s. And this issue is more than skin deep. For some, it can be really stressful. Studies have found that people with acne have higher rates of anxiety, depression and social withdrawal. And even if you've got no skin in this game and you don't get acne, admit it. You've judged people who have it. You've looked at their scars and their pimply red face and you've thought to yourself,

wow, where did they go wrong? One small study found that almost 70% of those surveyed said that they would feel ashamed if they had acne. So between the judgments on one side and the self-loathing on the other, people with acne are the perfect targets for companies flogging cures. You know the worst thing about breakouts? Never knowing when the next one's going to pop up. Do you have acne and wake up wishing you could hide your face from the world?

Boost your confidence morning to night. After Caitlin complained to me about all the treatments she'd tried, I thought maybe a high-end skin store in Brooklyn might have a solution. Look, this could be it. This could be the day. Today's the day. There were dream catchers and everything was very white. It smelled great. Hello. I'm Jill.

Hey, Jill, how are you doing? Hey, I'm Katie. Jill is a buyer for the store. She was wearing a faux fur wrap and it felt like she floated out to us. Katie told her about her acne troubles. I'm trying to fix my skin and it's been a real drama for a long time. No one can see my face because of the pimple. Exactly.

I've just seen the pimple. The pimple is talking to them, saying, hi, my name's Caitlin. And Jill said she could definitely help. Did you say definitely you can help? Definitely. Jill says that acne can erupt for a whole lot of different reasons. Like a lot of people say when they move to New York, it's like an atmosphere thing and all the pollution in the air

really screws their skin up. Whenever the weather changes, whenever you have a baby and your hormones shift. Diet is another little piece of the puzzle. And of course, she sells solutions. There were creams, serums, and finally, Jill points to something that you might not associate with acne at all. Probiotics.

That's the good bacteria that you find in yoghurt. Like, you always want to get your gut settled too. That's why we sell ingestible beauty. How much does this guy? 70. Do we have evidence to show that if you make your belly healthier, your pimples go down? Like, when you say evidence, like, I'm not sure what you mean.

It's not that scientific here. It's like girlfriend vibes. Like, when you come in, it's like, oh, I've tried that. I really like it. Like, you should in, it's like, oh, I've tried that. I really like it. Like you should try it too. And the thing is, the acne industry is profiting quite a bit off all of these girlfriend vibes. Americans fork out $2.5 billion each year trying to treat acne. So today we're putting the skincare industry

and all the marketing hype under the microscope. Because when it comes to acne, there are lots of girlfriend vibes. But then there's science. Today, we get to the bottom of what works and what doesn't. Science vs Acne is coming up just after the break. After decades of shaky hands caused by debilitating tremors, Sunnybrook was the only hospital in Canada who could provide Andy with something special. Three neurosurgeons, two scientists, one movement disorders coordinator, 58 answered questions, two focused ultrasound procedures.

One specially developed helmet. Thousands of high-intensity focused ultrasound waves. Zero incisions. And that very same day, two steady hands. From innovation to action, Sunnybrook is special. Learn more at sunnybrook.ca slash special. So money is a thing, but it's not everything. I think you really look at the importance of what are you doing with your time? The conversations that we've had with our financial

advisor is very much about building what that framework looks like that helps support those important things. The places where you're investing your time and your resources, your family clearly, and those closest to you. Edward Jones. We do money differently. Visit edwardjones.ca slash different. It's season three of The Joy of Why, and I still have a lot of questions. Like, what is this thing we call time? Why does altruism exist? And where is Jan 11?

I'm here, astrophysicist and co-host, ready for anything. That's right. I'm bringing in the A-icist and co-host. Ready for anything. That's right. I'm bringing in the A-team. So brace yourselves. Get ready to learn. I'm Jan 11. I'm Steve Strogatz. And this is...

Quantum Magazine's podcast, The Joy of Why. New episodes drop every other Thursday, starting February 1st. Acne, it can range from one zit on your nose to a few pimples on your cheek to those painful swollen lumps that can be so large they connect together. It can be something that pops up once a month or that feels like it takes over your life and your face. To scientists, it's just all called acne, severe, moderate or mild. And to some observers, acne is like a billboard on someone's face advertising their behaviour. That is, the ones with zits are the ones to blame for their bad skin. So it's time to clear things up. The questions that Science Versus will face off against today are, one, why do people get acne? Two, can changing your diet do anything for your skin? Three, which treatments of acne actually work? And we'll walk you through the

medication that dermatologists are raving about and ask, what are the risks of taking it? Okay, before we get too deep into the claims of how to counteract the pus, let's do a little Pimple 101. To do that, it's time to meet our dermatologist, and he suffered from spots when he was a teen. My mother used to take me to the dermatologist. Sometimes you don't want to admit it, but your mother actually does know best.

This is Dr. Jonathan Weiss. He helped write the 2016 clinical guidelines for the treatment of acne for the American Dermatology Academy. He's also treated acne for decades and has been involved in dozens of trials for different acne medications. Basically, he's the perfect guy to ask, what is going on when you get a pimple? He told me to imagine that I was watching it all unfold from the inside. Okay, so you're sitting inside the hair follicle and you are totally normal. You see, it all starts inside a hair follicle. That's where the hair is coming out of. So you're sitting there inside the hair follicle and what

you'd see is the root of the hair. But if you looked up, you'd also normally see an opening. That's where the hair pops out of. But when a pimple is emerging, that opening starts getting clogged by dead skin cells that are hanging around on your skin, along with a protein that's made by skin cells called keratin. The first thing you see looking up is somebody plugging you up. Making matters worse, attached to your follicle are oil glands pumping out oil, and that oil is now getting trapped inside the hair follicle.

And bacteria on the skin may start multiplying as they make a picnic on that oil is now getting trapped inside the hair follicle and bacteria on the skin may start multiplying as they make a picnic on that oil. This now is starting to attract white blood cells. You look outside and all of a sudden you see these white blood cells coming at you and white blood cells are what cause inflammation. So it's like you're sitting in the hair follicle and you're being attacked a little bit from above and below. And lo and behold, you're starting to scream that,

oh my gosh, I'm going to become a pimple. While Jonathan told us a simple story of a pimple starting, the curious thing is that science is still figuring out exactly who starts this pimple party. Was it really the pore that got clogged first? Was it the bacteria attracting the white blood cells? Or would the white blood cells have crashed that party anyway? Why are the white blood cells suddenly coming into my hair follicle?

That is the million-dollar question right now. And it could be that different types of pimples start in different ways. Because there's a whole family of pimples out there. There's blackheads, those little black dots. They actually have nothing to do with the skin being dirty, but rather when dead skin cells and oil in the hair follicle aren't covered by a layer of skin, they react with the oxygen in the air to turn black, becoming blackheads.

Whiteheads are basically the same thing, with a little layer of skin on top of the dead skin cells and the oil, meaning they're never exposed to oxygen, and so they don't turn black and instead look white. Then there's those 3D pimples that are easy to pop. They're called pustules and they happen when the white blood cells come to the pimple party. In fact, it's those cells mixed in with oil and a bit of dead skin that you're popping and they form what we would normally call lovingly pus. And so that becomes a pustule, and that's what you're popping.

And if you're really good, you can hit the mirror with it from about two feet away. Hit the mirror? Anyway, then there's the bumps on the skin. They're the ones that you want to squeeze, but you can't get anything out of them. They're called papules. And finally, the Dante's Peak pimple.

That happens when the hair follicle has been filling up with so much oil, bacteria and white blood cells that it can actually implode the hair follicle. These guys can look like red mountains and they're called cystic acne. So, those are the main types of pimples out there. Next question, how do you get rid of them? Will laying off the chocolate and the pizza clean up your pizza face? Diet has been a question in acne since I was a kid and went to my dermatologist. And he could say, you ate a potato chip, didn't you?

And even before Jonathan was a kid, back in the 1940s and 50s, many dermatologists believed that acne was linked to eating chocolate, sweets and fried foods. In fact, a paper written in 1941 suggested that acne is worse in summer, partly because of a, quote, gross increase in oil intake on account of the popularity of ice cream, end quote. But then in the late 60s, something changed. A paper was published in 1969, which tested whether diet was connected to acne. And the authors wrote that when it came to acne, quote, the list of forbidden foods has one remarkable feature.

All of the blacklisted items are delicious and delectable to the adolescent taste, end quote. And they picked out one particular food that always seemed to be suspected of causing acne, writing, quote, none is more universally condemned than chocolate, end quote. And so the researchers wanted to give chocolate a fair trial. My chocolate, my beautiful chocolate. To do that, they got 65 people, gave half of them a chocolate bar to eat each day and gave the other half a so-called placebo bar. That was a sweet bar that had no chocolate in it. Several weeks later, there was no difference in the acne of either group.

Another paper, published soon after, found that acne wasn't linked to consuming milk, peanuts, Coke or chocolate. After that, many dermatologists stopped thinking that diet was linked to acne. By the early 1970s, it was already being written that special diets to avoid spots were unnecessary and may even lead to the disruption of family eating habits. But the thing is, those papers were hardly conclusive. Take that chocolate paper with the placebo bar. For one, that so-called placebo bar

had about the same amount of fat and sugar in it as the chocolate bar did. So that doesn't tell us anything about whether fat and sugar can give you acne, only that maybe cocoa isn't the culprit. Second problem, there were only 65 people in that study. And third problem, word on the research street, is that Hershey's funded the paper. That's amazing that one Hershey-sponsored study was able to drive the industry for quite a while. Absolutely. But it's pretty typical of what went on back then. Fast forward to today,

and we still don't have that many studies on diet. There has been some research, particularly focusing on sugar and acne, but the studies are usually really small. One recent review paper found that there's no clear evidence that you're more likely to get acne whether you chow down on sugar or not. The truth is, we don't fully understand how your diet might give you plukes. Plukes. That's how you say acne in Scotland. Anyway, some work does suggest that high sugar diets might affect oil production on your face. But we don't really know. Curiously, there have been studies into a potential link with milk. Several studies have found that the more milk teens drank, the higher their risk of acne. But it's unclear why. Possibly because of the sugars in the milk, or maybe because the milk is influencing hormones

or maybe it has nothing to do with milk and this is actually just a correlation. The thing is, when it comes to the link between acne and diet, we just don't have enough evidence either way. And Jonathan has an idea as to why that might be. Quite honestly, most studies today are sponsored by pharmaceutical companies or by people who have a commercial interest in the condition. So without conclusive research, when pimpled up teens come into Jonathan's office, he doesn't tell them not to eat dairy or chocolate. But he does say to his patients that since eating less sugar is probably good for you generally and it might help you with your acne, why not give a healthier diet a go? The evidence is definitely not definitive, but I think it's good enough and it's a generally healthy diet that it's worth not standard medical practice right now to say, you know, restrict sugars because it makes your acne worse.

Conclusion. The evidence isn't there to show that what you eat will appear on your face. Enough studies just haven't been done. Okay, so what's at the drugstore? Will any of those products clear up your acne? Let's go shopping. I went to the store with Caitlin Sori, who you heard from at the beginning of the show.

She's still struggling with acne and girlfriend vibes. And Caitlin, she's actually our senior producer here at Science Versus. So we really wanted to help her out. This is why these stores are so big. I can't find anything. I always find myself at the lolly section and I'm like, how did I even get here? Over here. Right.

There might seem like a lot of products on the market, but when Caitlin and I got down to it, there were really only a couple. Let's go from the right to the left. Benzoyl peroxide formula, salicylic acid. Benzoyl go from the right to the left. Benzoyl peroxide formula, salicylic acid. Benzoyl peroxide. Salicylic acid. Benzoyl peroxide. Salicylic acid. Benzoyl peroxide.

Benzoyl peroxide. Ooh, this is my favourite. Deep action. Here it is. The light therapy acne mask. The power of light therapy to treat breakouts. Do you want to try this? I kind of do.

Now, time for Caitlin to try out her new acne treatment. Let's do this. You've got to open it. You've got to open this packet. It's an all-white plastic mask that looks like a hockey mask with little blue and red LED lights on the inside so that when you turn it on, you glow a pinky purple colour. All right.

It's going on my face. It's now on your face. I've got to leave it on for 10 minutes. 10 minutes. Okay. Here we go. Do I have to hold it down? Oh, there we go.

Whoa. All right. Forget the sceptics. Forget the naysayers. Forget the little voice inside of me that says this is bullshit. It's not a little voice. It's me right here. I'm going to give it a go.

I'm going to give it the benefit of the doubt and see what happens, okay? Ten minutes on the clock starts now. Now. Okay, we'll explain the science of this mask soon, but while we wait for the mask to do its magic, let's leave Caitlin looking like an honorary member of Daft Punk, rewind and look at those other two products at the drugstore. Benzoyl peroxide formula.

Salicylic acid. Benzoyl peroxide. Salicylic acid. Benzoyl peroxide formula. Salicylic acid. Benzoyl peroxide. Salicylic acid. Benzoyl peroxide. Salicylic acid. Let's start with salicylic acid. What does it do? Well, remember how a pimple can start forming

when the opening to the hair follicle gets plugged up with dead skin and protein? And if that plug turns black, then you get a blackhead. Well, salicylic acid is an exfoliant, so the idea here is that you can pop that potential pimples door right open. Here's Jonathan, our dermatologist. So it can help by unplugging hair follicles a little bit. And it's pretty popular. Last year more than $130 million was spent on acne products

with salicylic acid in it around the world. The problem is that salicylic acid has not been studied that well. The American Academy of Dermatology Guidelines, which Jonathan helped write, called clinical trials into salicylic acid... ..limited. And another paper published in Nature Reviews noted that we don't have sufficient medical literature to say that salicylic acid is effective for acne.

Jonathan says it might be helpful for some people with mild acne, but... Salicylic acid has not absolutely been tested. It's relatively weak and we don't see it in any, to my knowledge, products that I certainly use for the treatment of acne. So what about that other product that we saw on the shelves at the local chemist, benzoyl peroxide? If you've ever used it, you know you end up with bleach stains all over your clothes, towel, and sheets. And that's because benzoyl peroxide is a bleach. Fun fact, it has been used for over 50 years to bleach flour and milk to make Italian cheeses. So it'll bleach your sheets, but will it fix your acne? Well, remember how we told you

about that bacteria that might be picnicking on the oil on your skin to get the pimple party started? Well, benzoyl peroxide works by killing bacteria on your skin. Benzoyl peroxide just kind of gets inside the bacteria and explodes it, if you will. We like to think of it as dropping a little bomb on them. And that bomb is trying to target a particular bacteria called Propionibacterium acnes, or P. acnes, as we'll call it. And when it comes to acne, this organism has been on researchers' radar since the turn of the century.

And that's because back in the lab when they cultured a lesion, it came through that it was this organism. And since benzoyl peroxide bombs this little bacteria, it actually can reduce the number of pimples on your face. It's quite clear that benzoyl peroxide has been scientifically proven. But if you are going to give it a go, there's no clear evidence that higher strength options like 10% work better than 2.5 or 5%. So it's recommended that you go for the lower strength because it can cause irritation. Still, according to Jonathan, it definitely won't clear up everyone's skin. And the reason that benzoyl peroxide isn't an amazing cure-all is because, well, acne can come about from a range of things besides bacteria. We talked about oil and dead

skin cells, but there's other stuff like genetics. One study of more than a thousand teens found that having someone else in your family with spots doubled the risk of you getting severe to moderate acne. Caitlin, our senior producer, points the finger at her dad. Thanks, Dad. Hormones can also play a role in how oily your skin is, which is why teenagers whose hormones are changing are more likely to get pimples and why women with acne can be put on birth control pills

that contain estrogen to tweak their hormones. Finally, stress could be a factor. While there's not a lot of research here, a recent paper which reviewed a whole bunch of studies on acne described stress as a, quote, potential risk factor, end quote. This was partly hinged on a link found between stress and a protein that's involved in oil production, called Substance P. Yes, we know, it sounds like something that created the Powerpuff Girls. Substance P. But seriously, that's what it's called.

And all these factors are why washing your face will not rid you of pimples. A Lancet paper found that there is, quote, no good evidence that acne is caused quote, So to take this idea back to the daft punk slash light therapy mask on Caitlin's face right now. We're powered down. Oh, we're powered down. Okay, I'm done. The idea of the light therapy mask is that it uses two types of light.

Blue light is supposed to zap P. acnes bacteria on your face and red light is supposed to decrease inflammation. And oh my God, the pimple's gone. Is it? No. You look exactly the same. I thought so. To be fair, you are supposed to use the mask over several weeks

and just so you know, it says it's only useful for mild to moderate acne. Plus, this is a sample size of one and not a study. We know. But anyway, if Caitlin went on daft punk patrol for a month, what's the chances her pimples would go away? A Cochrane review, which is a systematic review of the major research on a particular topic, looked at the use of shining coloured light on your face to get rid of pimples.

And it found two small studies of around 30 people that suggested blue-red light therapies might be better than placebos. But overall, the Cochrane review, which was published in 2016, noted that, quote, high quality evidence on the use of light therapies for people with acne is lacking, end quote. And it's why Jonathan remains unconvinced. I think it's another gimmick in my mind right now. A lot of treatments begin in one form and move on to another. So my mind's open that there might be some light system in the future that might work.

Conclusion. Light masks are definitely a great Halloween outfit. But there's no conclusive evidence that they'll help you with your acne. Other things at the drugstore, like benzoyl peroxide, could be helpful, but it won't necessarily clear your skin entirely. As for salicylic acid, the evidence for that isn't good. Now, while researching this episode, we came across some pretty interesting information

about little old pea acnes. Cue the music. So, for decades, scientists suspected that pea acnes could be the bacteria that led to acne. It's named after it, for goodness sakes. Did you get that? Pea acnes, acne? Anyway, but remember what Jonathan said? Every time they cultured a lesion, it came through that it was this organism.

We'll get this. It turns out that pee, acnes is found on healthy skin too. Our skin and body is teeming with bacteria and pee, acnes is the most common bacteria on our faces, on clear faces, pimpled faces, freckled faces, moon faces. In one study, it made up 90% of the bugs hanging out on people's faces. So what is going on here? How can P. acnes cause acne but be found on healthy people's faces too?

Well, one group of scientists now believe that there are different strains of the bacteria, some strains that make it more likely that your skin will get pimples. Dr. Huying Li and her colleagues at the University of California, Los Angeles, uncovered this unexpected P. acnes surprise a few years ago. What I learned from my research is not all bacteria are bad. Some are good, some are bad. They're not really equal.

She found several strains of P. acnes that were more likely to be found deep inside the follicles of people with acne. But she found other strains that, as you heard her say, were good strains that might actually be protecting the skin from the bad bacteria. And those good strains of P. acnes, well, they might help you to avoid acne because they take the space and the food of the bad strains. You can think of them as double agents on your skin. It's a good time to appreciate what these tiny, tiny creatures do for us. Thanks, tiny creatures.

After the break, can popping your pimples help? We meet the internet celebrity known as Dr. Pimple Popper to find out. This is science, man. You see, we don't mess around. So we've looked at some of the big treatments on the market with mixed results. But one of the most tempting things to do when you have acne is to pop your pimples. But should you? Is it bad for you? And could it help your acne? We've got just the person to answer these questions and we went to sunny LA to meet her.

Welcome to LA, baby. Dr. Pimple Popper, a.k.a. Dr. Sandra Lee, is a dermatologist with over 2 million subscribers on her YouTube channel, which shows her popping her patients' pimples and cysts. Good ones. Sometimes you're kind of impressed by how much comes out of one little pore there. Hello. Hello.

Hi. Sandra, nice to meet you. I love your scrubs oh really thank you i like pajamas we watched one of her videos together a patient had come to see her with a back full of blackheads so this is um blackheads for days do you do the titles uh yeah usually i do do the title i like the title oh thank you the titles. I like the titles. Oh, thank you. She used a little metal tool to squeeze out those blackheads. As she did, all these little snakes of dead skin cells, keratin and oil popped out. So this is the part that people like to watch. This is more like a...

Oh, goodness. I saved it. I'm going to be fine. Okay. Science. Okay. Science. Yep. Over two million subscribers. That means millions of people around the world are watching her pop pimples.

It's an online community that calls themselves popaholics. And Sandra now self-identifies as one. I am a born-again popaholic. A few years ago, Sandra had no idea about popaholics or this corner of the internet until she posted a video online from her dermatology practice. And it went nuts. What were it? It just started to flip and I couldn't even get on my phone. She thought, wow, I'm onto something here. Some people love watching pimples get popped. I'm like their queen.

I could be their queen. So I'm like, let me just put some more up there. And so that's what happened. It was just two years ago. Why do you think they really love it? They're relaxing. There's a cleansing feeling like you're getting rid of something that is not supposed to be there. I had to ask the queen of the popaholics,

should you pop your pimples? And despite her reputation and her name, she says that sometimes you really shouldn't be a poppin'. You know, if it's deeper under the skin, you can't, the more you squeeze it, the more it'll just get more swollen and inflamed and potentially bigger. For example, I have a pimple right now on my chin that I've been feeling. Where is this?

You can feel it. You can feel it, but you can't see because it's coming out. The reason you shouldn't go hacking into these pimples is because it can lead to scarring. Now, there's not a lot of studies that have looked into how many people who pop their pimples actually get scars. One study of less than 200 people who ended up in a dermatologist's office to treat acne found that 95% of them had some acne scars. But that's probably at the extreme end. Another survey of more than 2,000 people from the general population

found that only 1% had acne scarring. Sandra says that once you start opening wounds, you can also increase your risk of getting an infection, which could mean more white blood cells and more inflammation and nastier pimples. We couldn't find any studies on how often this happens, though. It's based on the experience of dermatologists, and it's why many dermatologists,

including Jonathan Weiss, who you heard from, have a standard line and they say you should never pop your pimples. But Dr. Sandra Lee reckons there is a time when you probably can. You know, I think there's a perfect time to pop your pimples and it's really when it comes to a head. You have to wait for it to come to the surface. So these are the pimples that are really easy to squeeze and pop. And Sandra says if you are going in, be sure to use a clean workspace. And if the pimple is not popping, give up because forcing it can make your skin worse. The key here is this. Know when to pop and know when to stop. Once you pop, you can't stop. Even the guidelines from the American Academy of Dermatology say that while there's not a lot of research on pimple popping, getting a professional to remove blackheads might be helpful. But will it stop you getting more pimples? Me extracting blackheads and whiteheads, that's not going to

prevent them from getting new blackheads or whiteheads, that's not going to prevent them from getting new blackheads or whiteheads. And it's just trying to help with the bumps that they have now. I'm not really treating their acne per se. I'm just trying to help make the appearance look better. Conclusion. While you can probably pop some of those surface pimples with little harm and a little bit of satisfaction, there's so much we don't know here. You can end up permanently scarring your face or making your pimples worse. So pop at your own peril. Now to our last treatment for acne that we're looking at today. And Dr. Pimple Popper says it blows everything else out of the water.

You might know it as the brand name Accutane, which is no longer available in America. Other companies make a similar drug. The generic name is isotretinoin. But for this show, we'll keep calling it Accutane because that's what most people know it as. Accutane is a fantastic medication. It will do things that no other medication does.

Dr. Sandra Lee, aka Dr. Pimple Popper, says there's nothing that comes close to the effectiveness of Accutane, particularly for bad or difficult to treat acne. That's the type that can be painful to touch where the skin is covered in bumps and craters. This is where Accutane really comes into its own. In other words, all these other medications, oh, they might help your acne, they might not. There's nothing in between. Accutane can clear up most people's acne. Accutane hit the US market in 1982

and it's been used by more than 13 million patients. It can cure around 85% of people's acne. That is, the pimples don't come back. So how does it do this magic? It's a mega dose of vitamin A. Jonathan Weiss again. And well, he says Accutane isn't exactly vitamin A. It's an analog, which means it's a really, really similar chemical. And he says that megadose blocks the major processes in the body known to lead to acne. It can tweak how your genes express themselves and so shrink your oil glands and even change the way you make skin cells. It changes the way the hair follicle grows. It changes the way the sebum or the oils are produced, and it gets some of the most severe acne under control.

So it sounds like the miracle acne cure that sufferers have been waiting for. The only problem, there's some major side effects. It can massively dry out your skin, leaving it red and raw for the first month or so. And another much worse side effect is what can happen if a woman gets pregnant on Accutane, because ultimately this drug changes the way that cells divide and form. And a fetus is just a ball of differentiating tissue. Differentiation is what means that a hair cell becomes a hair cell and a skin cell becomes

a skin cell and a heart cell becomes a heart cell. If you're messing with that process in a fetus, you're going to have a fetus that comes out malformed in some way. So that's why drugs like Accutane are highly regulated in the United States. Before it's prescribed, a woman has to promise to use two different types of contraceptives, although almost a third of women admit they don't do this. The shadow that has hung over Accutane, though, doesn't have anything to do with malformed babies. The story that many people know is the link between Accutane and depression and suicide. And by the way, if you're someone who has or is experiencing depression,

heads up, we will be talking about it a little bit. So if you're not feeling great, you can call the US National Suicide Prevention Lifeline on 1800 273 8255. OK, so in 1999, the 17-year-old son of Democratic Congressman Bart Stupak was prescribed Accutane for his acne. Several months later, he killed himself. Stupak went on national television and blamed his son's death on the prescription of Accutane. He successfully pushed to get a congressional hearing to investigate the safety of the drug.

Here's Bart Stupak interrogating Accutane's maker, president and CEO of Hoffman LaRoche, George Abercrombie. Does there appear to be a problem with Accutane, depression, suicide ideation, psychosis and suicide? Sir, there are no scientific data. No, I didn't ask you that. I asked you, does there appear to be a problem, an association? I didn't ask for studies. An association between Accutane use, depression, suicide ideation, psychosis and some suicide. Again, sir, we base our conclusions on sound scientific principles and studies and data.

Around the same time, 15-year-old Charlie Bishop, who was taking Accutane, stole a plane and crashed it into a Bank of America building in Tampa, Florida. His mother blamed the drug and filed a lawsuit, which was later dropped. Other families started suing Hoffman LaRoche, alleging that Accutane was associated with their children's depression and suicide. After being the leader in acne treatment for almost 20 years, by the late 2000s, Accutane had lost more than 95% of the US market share to generics, and Hoffman LaRoche soon stopped selling Accutane in the US.

A decision they said was partly based on the cost of defending personal injury lawsuits. And the thing is that many doctors think that Accutane and all the drugs with isotretinoin really can cause depression. It's something that Jonathan takes seriously. When you've seen somebody get profoundly depressed after taking a medication, it's impressive and it's something that you never forget and you never stop thinking about or discussing with patients. Jonathan can remember the first time this happened. It was in the late 1980s,

and he'd prescribed a very similar sister drug to Accutane. And the poor kid got terribly depressed. Jonathan didn't know what was going on with this kid, and so he sent him to a psychiatrist to figure it out. I said, look, you're clearly depressed. I want you to seek some help. I sent him to a colleague of mine, and the colleague in psychiatry said, look, you're clearly depressed. I want you to seek some help. I send them to a colleague of mine. And the colleague in psychiatry said, oh, no, this can be a rare side effects of small group of vulnerable people who respond really, really badly to the drug.

I've treated thousands of patients with isotretinoin and its sister drugs, and I've had this happen less than five times over 30 years. In fact, this group of people is so small that when you look at large studies with lots of people on the drug, statistically, researchers can't even pick up that isotretinoin leads to depression in anyone. And that's because when the number of people affected by something is very small, that signal can get lost when you start to look at averages. And if your acne isn't that severe, there's drugs similar to Accutane called topical retinoids. And they come in a cream or gel and work in a similar way to

Accutane or isotretinoin. But they have vastly different potencies. And because they're being applied directly to your skin rather than in pill form, which is absorbed through your gut and then gets into your blood, they have much milder side effects. Now, while there's not too many trials into topical retinoids and how effective they are at getting rid of acne, the ones that are around show that these creams can help reduce your spots. And actually, after researching this episode and conducting the experiment with her face while she was at it, senior producer Caitlin Sori found that using topical retinoids at night did reduce some of her pimples. Thanks, science. But just because it worked for Caitlin, it doesn't mean it'll work for you. We asked Jonathan about this. With the current knowledge, do we have the data to be able to say things like

there is an 85% chance that your acne will go down if I give you this treatment? The only treatment that I think we can say that about is isotretinoin right now. That people, that a vast majority will get significantly better on isotretinoin than they were when they started. But unfortunately, we can't say that about absolutely every treatment. So we don't have that good a data, that good a studies on the other stuff? No, we really don't. So when it comes to science versus acne, what works and what's to blame? Did that pizza give you pizza face? Well, there's no slam dunk evidence that diet is related to acne, but there are some small studies that link sugar and milk to getting pimples. Does stress make you break out?

Well, there's no good evidence showing that it does, but there are some theoretical links. Substance pee, my friends, substance pee. There are good studies, though, linking acne to your genetics. Not that you can do anything about that. When it comes to treatment, what works? Light therapy masks look cool, but the evidence that they do anything for your acne is very slim. Benzoyl peroxide has some evidence that it works. Salicylic acid is not well researched. The only thing known to work really well on a lot of people is isotretinoin,

aka Accutane, and it's mainly for severe acne. But will it make you depressed? Well, it's possible, but the chances of you getting depressed are actually very low. Still, if you're worried about it and you're feeling odd and you're on the drugs, please talk to your doctor. And even if you don't have depression, acne can really mess with your head. It can make you feel really bad and vulnerable. And there's a lot of people and companies exploiting your vulnerability and promising solutions. Problem is say definitely you can help? Definitely. The problem is there's a lot less science out there. And if you don't know your facts, you can waste a lot of money and fall for just about anything.

And, oh, my God, the pimple's gone. Is it? No. You look exactly the same. That's science versus acne. This episode has been produced by senior producer Caitlin Sori and me, as well as Heather Rogers and Shruti Ravindran. Production assistance by Ben Kebrick.

We're edited by Annie Rose Strasser. Fact-checking by Michelle Harris. Sound engineering, musical production and original scoring by Bobby Lord. Thanks to Dr Robert Delivale, Grandview Research, as well as Stevie Lane, Pat Walters, Rose Reid, The Zuckerman Family and Joseph Lavelle-Wilson. Next Thursday at 3pm EST in the US,

which is Friday at 7am EST in Australia, we're dropping climate change. Is there really an apocalypse coming? Oh, you're going to really nail me on it, aren't you? And finally, if you're in New York, Science Versus is going to be performing a live show at the Vell House on March 23rd. We're tackling coffee, wine and chocolate.

Are they really that good for you? Are they really that bad for you? Are they really that bad for you? Come meet us, say hello, learn science. It'll be great. March 23rd at the Bell House. All right, back to you next time.