Social Media Dermatology: Facts vs. Fiction

I'm Holly Wayment, and this is Pediatrics Now.

Here today with me in the podcast studio is Dr. Emily Becker. Shall we go over some myths versus facts about acne? Yes. Of course. Okay, so number one thing that we always see, and I still see parents talking about this, well, they eat so much greasy food and it's their diet that is the reason why the acne is so bad. If they just stopped eating all those french fries and pizza, do you think that's a myth or a fact?

Well, I thought that it was a fact, but then the way you're saying it makes me think that is a myth. It was kind of a trick question because it's kind of true yes and no. So a lot of the parents think that food is one of the main contributors, you know, second to hygiene. The only real food that we have had data showing it does contribute to worsening acne is actually milk and milk products. Really?

Yeah. And interestingly, you know, they did the studies and it's actually the skim milks are worse than, for example, the 2% than, for example, the whole milk. I wonder why. Well, you know, we're not sure if that hormonal aspect, right, of things plays a role in however it is the cows or, you know, milk is gotten. But in general, dairy and dairy-based products actually can take a stable kid's acne doing great and make it exacerbated or flare.

So that is one thing that you can kind of bug your kids about is, all right, chill on the milk. We don't need 10 glasses a day. Let's cut it down to two. So I did not say take out all yogurts and dairies and cheeses. Dr. Becker, you're the head of our pediatric dermatology program at University Health and UT Health San Antonio. That's a big job. So yes, and like born and raised Pexin met my husband here in medical school.

I think we always knew we were going to come back, but nonetheless, we traveled to the Northeast to do my pediatrics residency, and he did his internal medicine residency and got to hang out in the wonderful, amazing New York City. So taking a little Texas girl to New York was a culture shock. At Columbia, you were doing your... Yes, at Columbia. I did general pediatrics. And then... Did you like it there? Oh, I loved it. I love New York.

It's amazing, except that the culture shock was, you know, the first time I went to a grocery store and I bought all these wonderful things. And then I realized I don't even have a car to take them home. So I had to make four trips back and forth. Because you're walking everywhere. Yes. But nowadays, I guess you could Uber, you know, eats things and all kinds of delivery. But that didn't exist. I won't tell you how long ago. And then we got to travel to the wonderful West Coast.

Where I did some clinical dermatology research, specifically in psoriasis. We'll do that as another podcast someday. Yes. Sounds good. Put that on the books. I love San Francisco. And so my husband and I like to say, I love the East Coast. He loved the West Coast, but we couldn't compromise. I mean, we had to compromise. So we settled in the middle and ended up in Texas again. So we ended up back in Texas for my dermatology and pediatric dermatology fellowships

And of course, Texas is our heart. It's like where we knew we would be. And I'm super happy and proud to get to take care of all these wonderful children, adolescents, teens in our San Antonio and South Texas community. It's such an honor. That's great. And you see patients all throughout South Texas, even in Corpus.

And you do telemedicine, I understand. Yeah, so we do telemedicine. I see patients in South Texas. Again, pediatric dermatology is, it's a unique niche. There's not a ton of us. We're growing, we're growing, we're going to get there. But I always get made fun of for like, what do you actually do as a pediatric dermatologist in skincare and acne, right? But I don't know why I went into pediatric dermatology, just that I love skin and I love taking care of kids.

But the way I would describe my job as a pediatric dermatologist is sort of from diaper rashes to warts to teenage acne. Like, I've seen it all. And my job as a pediatric dermatologist is to make sure parents worry less. That's number one, right? Parents worry less because you parents are my patients too, right? And kids feel their best, one rash, one bump, one pimple at a time. And it's a huge job. But you love it. I love it.

I wouldn't rather be doing anything else. I mean, there's nothing else I can see that I enjoy doing. And we talked about in our Pediatrics Now for Parents episode, we just recorded that you get to take care of the largest organ in our bodies. It's challenging at times. You know, sometimes the skin gives you easy answers, and then other times it throws tough ones at us. And I think as pediatricians, and I am one myself, so been there, done that. You're triple board certified?

Yeah, pediatrics, dermatology, PedsDerm, I've done it all. The joke is I could be like a neurosurgeon right now with all my years of training, but I wouldn't, again, rather be doing anything else. So as pediatricians, we're busy throughout the day. We know acne. You know skin care. You know the basics of those conditions, but how do we know when we need to reach out for support from our dermatology colleagues and when it's something we can handle within our own four clinic walls?

And so what are the top things that you would say this is something that can be treated in the clinic as opposed to being, or when is there a sign when something needs to be sent? If I could give my wish list of the perfect pediatrician referral, when to refer, all of our acne patients, the majority of them should be treated with something before sending to a dermatologist, whether it's an adult general dermatologist or a pediatric dermatologist.

So as pediatricians, let's go ahead and say, these are the things we want you to have done.

And if these things don't work, then we know we need referral to dermatology. So every kid that has acne or teenager needs to have at least done a benzoyl peroxide in some form or fashion. Remember, we have washes, we have lotions, we have gels, we have creams. So some type of benzoyl peroxide, some type of topical antibiotic, so aclindamycin and erythromycin, and then some type of retinoid.

And as you're familiar, I know the over-the-counter adapalene, many of our patients have tried, but we really do encourage trying the prescription versions as well. Well, my pediatricians love to prescribe the tretinoin. A lot of times we'll start out at the 0.025, and then if the patient tolerates it, we can work up to the 0.05 or the 0.1. Those are almost mandatory to have, please try those on your patients before saying, nope, their acne is horrible.

And then I challenge some of my other pediatricians that are comfortable, you guys write antibiotics all the time for me. Ear infections, skin infections, please feel comfortable writing things like doxycycline, minocycline for our acne patients who have failed the topicals that I just mentioned. You know, you don't have to do a forever course. Say, hey, I'm going to give you a three months of this doxycycline medication since our topical acne regimen may not have worked.

And in the meantime, I will send a referral to dermatology in case when I see you in three months, that acne is not better. So I feel like we should add the oral medications, doxycycline, minocycline, to some things that maybe I would love for my pediatricians to have tried before they send over some of the more complicated acne patients. And what about topical antibiotics? The topical antibiotics, the clindamycin and the erythromycin, those do great things.

So it's sort of like before you've done an oral antibiotic, I want you to have tried a topical because obviously topicals are less invasive, less problematic, less side effects. Now, in our female patients, it would be ideal if we could get some kind of hormonal treatment on board. If they've already failed our topicals, they may or may not have already tried an oral antibiotic.

We're still struggling. many of our female patients do great with hormonal options and many of my pediatrician colleagues are very familiar with birth control pills oral contraceptives easy to prescribe I understand there's some moral ethical concerns that many families may have but that's a short discussion and respecting their beliefs and desires understandably but at least as a pediatrician offering that to them as a great acne option.

Because let's be honest, the next step really is Accutane. Do you see anything that's often missed in the community pediatric setting that you'd want to mention?

Things that are missed in our pediatric world, I would say one thing we're really trying to encourage is atopic dermatitis or eczema, and we could have a whole separate talk, I still feel like many of my pediatric colleagues are using the systemic steroids and prednisone as a little bit of a crutch as a quick fix for some of these kids with severe eczema or atopic dermatitis.

I'm sure many are familiar with the fact that we have some great alternative non-steroidal systemic options that are non-immunosuppressive. Yes, many of them are in the injection form, but gone are the days of saying, oh, topicals aren't enough. Let's put you on a systemic steroid because the risk of the systemic steroids are so significant.

So I really, that would be maybe a miss that we're trying to work on when I educate and give talks to my pediatric colleagues is if topicals aren't enough for your atopic dermatitis, infants.

Children, teens, send them over to dermatology because we can have that discussion about maybe internal or systemic medicines that work from the inside out might be a good fit for this patient. What about spots for skin cancer. Is there anything you want to say there? Yeah, skin cancer spots in kids are, you know, pretty rare. I would say we do get a lot of referrals for mole checks.

Now, I don't need to see, I'd be crazy busy. I'd be busy with moles for my entire life as a pediatric dermatologist if we saw every child's moles. Moles are, you know, normal in kids. But the kids that you might want to send for skin checks would definitely be ones where there's family history of melanomas, family histories of dysplastic or atypical moles, family histories of basal cell, squamous cell, skin cancers. Because it's extremely, extremely rare, pediatric melanomas do exist.

But more importantly, we do have other types of atypical moles, spitz nevi, dysplastic nevi, that can show up in kids and may not present the same as what we see in our adult population. So the spot that may be, for example, a melanoma on you may look entirely different as a melanoma in a child.

So skin checks in those patients and kids that are high risk due to family history, genetic tendency, or those patients that are on immunosuppressive treatments or transplant cancer patients all need routine skin checks.

So once a year? Once a year, yeah. Is there anything new, Emily, in dermatology that's just kind of just blows your mind right now that you want pediatric community practitioners to know about? It blows my mind. I feel like the advances in medical treatment for many of our skin conditions that were previously seen as cosmetic, these advances medically have really changed the way we practice.

I mentioned earlier, I know atopic dermatitis is not cosmetic, but having these injection biologic medications has transformed how we treat these kids. It's not a curable disease, but it's a controllable disease, and it really affects their quality of life. Second would be a condition that many people do consider cosmetic is these advances we've had in the alopecia areata world. And, you know, I know my pediatrician colleagues, you guys are familiar with alopecia areata, varying forms.

Sometimes the kids will just have one bald spot on their scalp. Other times, 90%, 100% of their scalp has no hair. And in alopecia universalis, the severe form, they have no hair over all parts of their body, not a single hair on their body. We have some oral medication options now for those patients or parents that are willing to try a systemic medicine when topicals have not worked to regrow that hair. And I know it seems like it's just the hair, but it's so much more than that.

It's the kid's self-esteem. It's the kid's confidence. It's who they define themselves as. So definitely something to consider. Gone are the days of, eh, it's just hair loss. Wear a wig. Not that any of you would say that, but now we can say, you know, I know in dermatology they've had some. Treatment advances, why don't you go talk to your friendly neighborhood dermatologist, pediatric dermatologist, about if you want to consider some options.

And we've talked a lot about acne. And do you have any advice for it? Because a lot of community pediatricians have patients who, you know, where the advice is have a more nutritious diet with fruits and vegetables, but the family can't afford more fruits and vegetables.

Or what if the family can't afford to bring their child to a dermatologist and that child has acne. Right. So advice for, you know, maybe the patients in between where maybe they don't have access to a dermatologist, either financially, insurance-wise, or just time-wise, what can we do as pediatricians to help? You know, counsel the parents. I always like to say we don't want to draw too much attention to the acne. We don't want the kids to become more self-conscious because we're talking about

how horrible the acne scars are, how horrible the patient looks. No, you are beautiful. Your skin looks great. We just want to make it the best skin that it can be for you. I would encourage, you know, some education of patients and parents via reputable sources. So social media, TikTok, influencers are not the most reputable source for skincare, especially acne skincare. There's many myths. In fact, you can reference, right? They can all listen to our parent podcast.

Yes. Yes. So we recorded a podcast for parents on Pediatrics Now for Parents that's meant to be one less thing you have to say in the exam room. That's all about myth versus fact, social media, myths versus fact, hacks. Do they work or don't they? So Dr. Becker outlines directly what to say and even advice about sunscreen and products that might be doing more harm than good. So you can find that in Pediatrics Now for Parents.

Anywhere you get your podcasts. And you can tell your patients about that if you want. And I'll put a link in here. But I know for a lot of pediatricians, social media comes up in every visit, no matter what the child is coming in for. And it just seems like social media is not helping when it comes to our skin. Right. Social media is creating more of a hassle sometimes when it comes to the skin, and you'll hear me reference less is best.

So please encourage patients and parents to get their knowledge from reputable sources and. More is not always better, and less is sometimes best. Anything else you want to say about social media? And I'll put in some of what we talked about so they can hear, you know, what we talked about. You said a lot of good stuff. Yeah, and just be cautious.

Just be discerning. I know all of us in today's day and age, we're sort of, you know, tracking what sites our kids are visiting, you know, what sites our things are popular, not popular. So start asking your patients where they're getting their information. And it takes a five-second comment of, well, actually, I have a better source of information for you to learn about acne.

Why don't you try this? It's just redirecting them and showing them the example of how to, you know, be a responsible learner and take care of yourself in a, you know, I guess, proven way, a scientifically proven way, as opposed to the influencer way. Mm-hmm. Well, and I know when you saw my daughter... She said to me, because you'd mentioned how beautiful her eyes are, she said, Dr. Becker said I had beautiful eyes and beautiful skin.

And to your point, like the power that when you're a doctor in that exam room for that self-confidence for a patient, that there's so much to cover in the exam room. But those few seconds that you said that, I feel like it made a huge difference. Well, and one of my good, esteemed, amazing pediatric dermatology colleagues, Dr. Alana But Brie has a program for children with skin conditions. And so I can't take credit. I'll give her all the credit.

But she says really empower the child, the adolescent, even the infant to love the skin they're in. Love the skin that you were given. Whatever the best form of that skin may be, love the skin you're in. And so I think as pediatricians, going back to the basics, sometimes it doesn't matter exactly what acne cream we give them, exactly what topical steroid lotion we prescribe for that eczema patient.

What matters is maybe the words we say and how we choose to say them and if you can get that patient who comes to you for a skin condition to love the skin they're in then i really truly feel we've done our job i think that's so beautiful do you have anything specific example wise you would want to say because with our a lot of our listeners they're seeing so much and flu, their vaccines, you're talking about measles now and bird flu and everything.

I think this is not a particular example. It happens all the time. I've kind of made it a thing to empower especially some of my younger kid patients. So they come in maybe with a birthmark or a mole on their face that, you know, they may not like or other friends or kids are teasing them about, I like to say, well, that special spot that you were given, you know it provides you with superpowers. Well, what do you mean superpowers? Yeah, superhero powers.

What kind of superhero are you going to be? Because you have that special birthmark, you know, that special, you know, hemangioma, that special skin lesion. What kind of superpowers do you have? and just leave it open-ended question. And it's such a fun thing, because even the quiet, more reserved children will just come out of their shell. And it may not be that visit, but that next visit you see them again, they'll be like, I have invincibility.

Like, what? And I'll forget I even talked about it. Oh, because your birthmark mole gave you invincibility. Yeah, look. Or I have invisibility power. You're right, I can't see you right now. And just normalizing the fact that. They're unique and special in their own way, but also acknowledging that that very birthmark spot, that very, you know, hemangioma, port wine stain, whatever it may be, rash, eczema, makes them special and unique in their own way. I think that's really beautiful.

Emily, for the busy pediatrician, is there anything that you want to say? So this is sort of like, you know, is this the bonus segment? I switch from pediatric dermatologist to just dermatologist slash doctor mama with mature skin that wants to keep my skin looking as young as possible. Yeah. OK. This is all the bonus stuff. Every one of us that enters our more mature ages, you know, we're no longer teenagers anymore or even college kids.

All of us should be for sure using sunscreen. That's going to prevent some of our photo aging, some of our melasma, some of our dark spots or our sunspots. So that's a must. We also like to incorporate vitamin C in some form or fashion as antioxidant. There's different serums, things. That's something that's very easy to find over the counter in various formulations. And then we should also all moisturize our skin. I'm not talking about the slugging. We can reference the slugging in the parent

podcast. If you do not know what that is, my fellow pediatricians, go learn all about it. But we need to moisturize to really keep our skin as fresh and youthful as it can be. And then lastly, I really do feel that as long as you're not actively trying to conceive or pregnant, most of us would benefit from a topical retinoid. Remember that vitamin A topical retinoid with its exfoliative, anti-wrinkle, anti-aging properties, even if it's only two or three times a week, is very beneficial.

We should all have a sunscreen, moisturizer, vitamin C, and if possible, remember, not during pregnancy, not during active conceiving, retinoid. And then put it all over the face? Yeah, you want to do like the retinoid pea-sized amount all over the face nightly because remember it can cause sun sensitivity and some dryness and irritation. And then we like to put the moisturizer on over. After about 10 minutes, wait 10 minutes? No, you don't need to wait.

Just put it on. Who has time for that with kids and work and life? And if we put more than a pea-sized portion, is that really bad? It's not really bad. But if you wake up in the morning, like literally elephant dry lizard skin cracking, you know you put too much. Okay. Oh, and what about a quote? We forgot to say the quote. Do you have a quote you want to share with our listeners? Is less is best and more is not better. Let's do that. More is not necessarily better.

So when it comes to the skin, less is best and oftentimes more is not better.

And a lot of times that more is what is the messages people are getting on social media and other places. Right. We don't need to overdo things. Take it easy. Relax.

The skin being the largest organ in the whole body, it truly is very complicated but when you cut right through it it's very simple very nice okay and real fast what do you like to do in your spare times because we like to promote having a life outside of medicine do you do it like you have four kids what do you like to do in your spare time are you reading anything that you love watching anything you love and then we'll wrap.

Going on a trip anytime soon fun just got back from somewhere fun yeah going to the beach and wearing a large hat. Oh, yeah. Well, in my spare time, I enjoy being outdoors with family. We just celebrated my mom's 70th birthday. I have four younger brothers, four kids of my own. So you can imagine it's a big extended family. I can't be the doctor that I am today without the help and support of my family, my mom, and all those that, you know, keep us going through this crazy time we call life.

That's beautiful. Dr. Emily Becker, the head of our pediatric dermatology program at University Health and UT Health San Antonio, thank you so much for being here today on Pediatrics Now. Thank you for having me. Here's a clip from Pediatrics Now for Parents and other social media myths. So one pediatrician I was talking to, she said no matter what a child comes in for, they end up talking at some point about social media.

Let's talk about some viral acne hacks. So some of these hacks can do more harm than good. So most of these viral hacks go with, you know, our thought of sometimes less is best, right? Sometimes we're actually doing more harm by putting more and more on our face. And then remember, secondly, just because something is expensive doesn't mean it's necessarily better. So let's take the probably least expensive viral hack is, have you heard of the toothpaste on pimples?

Did your mom tell you to do that? No, but I can imagine it. I have not heard that. Yeah, so basically toothpaste has all kinds of ingredients that are meant to be in our mouths, not over our epidermis, on our skin, and it can aggravate, irritate the skin, and actually make breakouts worse. So that's one where instead of doing toothpaste to kind of cover up the pimples, a lot of patients I recommend options like some spot treatment.

And remember going back to benzoyl peroxide, there's very strong strengths of benzoyl peroxide in some of those spot treatments. And those are great to help, quote unquote, dry up the acne pimple and do it in a safe, non-irritating way. So have your teens look for those spot treatment options. Don't put toothpaste on. Don't put toothpaste. The other thing is if you have the urge to put something on. These hydrocolloid bandages, oh my gosh, I wish I would have come up with these.

Are those those little, like sometimes they're a little heart shape? Oh my gosh, they have stars, they have hearts, they have translucent clear ones, and they're just little circles or various shapes about the size of an acne pimple that have a hydrocolloid center that basically protects the acne pimples, but also helps in some of the healing process.

One of our most favorite things to recommend now that you're not going to waste money on it's a good use of money is actually to get those little acne spot treatment patches to cover up any of the active acne pimples but there's no concern there that it could be doing yes and no i love them so much because for my purposes it keeps the kids from picking the pimples and remember let the body heal it up on its own, the body will do a better job than we will.

So some of my very patients that like to touch the budding dermatologists, they want to be Dr. Pimple Poppers. I like to recommend the little patches because it keeps their hands away. But some of my patients that follow rules too much, we are seeing some kids keep the patches on for too long. And what do we think is going to be percolating under those patches if we've now left it on for three, five, seven days? Acne, a pimple. Acne, pimple, and nasty bacteria.

So I do not want overuse, trapping in that bacteria for too long. And now we're dealing with a separate situation, not just the acne, but other gunky germs and infection. Again, more harm than good. Right. So we do want to just make sure we're changing them. If you see that that same bright star has been on for three days, that's too long. Take it off. So one day probably. Yeah. I think it says like everyone's different, but like 12 hour time frame.

A lot of times we'll have them do it at night, take it off in the morning so it does its work at night. And then if they want to use some of the translucent ones for the daytime, first thing when they wake up and take it off before they go to bed. What about lemon juice as a spot treatment? I know. Highly acidic, can burn, irritate. Also. Bad idea. Bad idea. I used to use lemons to place in my hair and go out of the sun to bleach it.

We did do that, yes. So what do you think the lemons are going to do to your skin? Probably take something off of it that shouldn't be taken off. Some of the patients can actually get hyperpigmentation, meaning darker spots where the lemon has touched the face.

So last thing your team wants is let's trade polka dot dark spots for acne pimples um no okay don't don't don't know let me use the spot treatment do it yourself scrubs with sugar and coffee grounds yeah do it yourself anything is a no-no just say no to do it yourself. Hydrocoilic coiloid bandages 24 7 right so those are the ones that we talked about please don't overuse those little acne pimple patches. Those need to just be used on a limited basis.

Okay, so we covered that. So they're also called hydrocoiline patches, but the little stars, they look so cute. They look so cute. Heart stars, everything. Okay, so what about raw egg masks? Oh my gosh. Raw eggs. I love this trend toward very natural type products, but I hate the trends. The answer is no, but yes, eggs are very natural.

They are not meant to be covered all over our face. If you recall, when you were little, your mom would say, don't eat the raw egg yolk because of the risk of salmonella. And bird flu now too, but still salmonella is the main risk. It's the main one, and I know it's probably rare, but just a little bit of that raw egg slips into your mouth and you just don't know. So there is no data on raw eggs applying it to your face to help with acne.

What about, do you think that trendy skincare ingredients are being overused? We talked about slugging. We talked about excessive chemical exfoliation, right? What about do-it-yourself apple cider vinegar toner? Right. So do-it-yourself anything. It's a no. Everyone's skin is different. We don't want to overstrip the good things from our skin. And basically, to convince your teenager, just tell them you're actually weakening your skin by using some of these products instead of strengthening.

More is not always best. And so stay away from apple cider vinegar toner. Is that a product or some kids just putting that on their face? I can't keep up with all of the creations that the kids have. In fact, my patients teach me so many things every day. I'm like, oh, I got to add that one to the list. Oh, what is the snail mucin is one of the ones that is being talked about a lot right now. It's literally like sludge from the snail.

You know the little goop they leave behind? Yeah, there's formulated versions of that that people are putting on their face. Not necessarily for acne, more for just facial rejuvenation. But again, the concept is, as long as we're moisturizing. I'm okay, but we don't need to take it to the extent of some of these very pricey, expensive things when we have wonderful moisturization options out there in forms that we know work and will not cause problems.

And that's good. You hear so many things about apple cider vinegar being so great for so much, but don't put it on your face. Exactly. And so keep in mind that it's important for our pediatric practitioner listeners and for parents to know that they already know this, but social media is not a dermatologist. But our kids may not know that. And a lot of people may not know that. Right. And, you know, social media is not Dr. Google.

And we have gone as dermatologists through lots of years of training. In fact, you as the parent, after listening to this podcast, may actually be more qualified to help with your child's acne than social media is. so you can have them reference. Have your kids listen to our podcast. How about that? What do you think? I love it.

We hope you've enjoyed this episode of Pediatrics Now. Click on the link for free credit if you're a practitioner. You can also email us with questions or episode ideas. That address is pediatricsnow at uthscsa.edu. We release a new episode every Friday. I'm Holly Wayment. I hope you can join us for our next episode.