The Get Healthy Tampa Bay Podcast

E86: Acne Facts & Myths with Amanda Smay, PA-C and Dr. Reller

• Kerry Reller

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Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, I am joined by Amanda Smay, a dermatology physician assistant. In this episode, we dive deep into the world of acne, breaking down myths and sharing expert advice on treatment and prevention. Amanda offers insights into the causes of acne, effective skincare routines, and the impact of diet on skin health. We also discuss the benefits of professional treatments such as retinoids and light therapy. Tune in to gain practical tips for achieving clearer, healthier skin!

Amanda Smay is a board-certified physician assistant. She earned her Bachelor of Science from Clemson University and her Master of Physician Assistant Studies degree from Emory & Henry College, School of Health Sciences. During her academic career, she was an active member of Sigma Alpha Lambda National Leadership and Honors Society, the Alpha Epsilon Delta Medical & Pre-Health Honors Society, and the FIRST Organization for First Generation College Students.

Amanda has been working in the dermatology field since 2016 and is a proud member of the American Academy of Physician Assistants and the Florida Society of Dermatology Physician Assistants.

In her free time, Amanda enjoys many outdoor activities like running, kayaking, and playing tennis. She also loves spending time at the beach and cherishing moments with her dog Sadie.

0:40 - Introducing Amanda Smay: Dermatology PA
1:08 - Amanda's Journey into Dermatology
2:12 - What Triggers Acne?
3:50 - Understanding Cystic Acne
5:12 - Skincare Routines and Acne
6:45 - Debunking Common Acne Myths
9:05 - Dietary Influences on Acne
11:09 - Tools and Techniques for Cleansing
16:03 - Treating Severe Acne: From Topicals to Accutane
22:34 - Upcoming Open House Event Details


Connect with Dr. Kerry Reller
Podcast website: https://gethealthytbpodcast.buzzsprou... 
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Kerry:

All right. Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller. And today we have Amanda Smay. Welcome to the podcast, Amanda. How are you today?

Amanda:

Good. Thank you for having me.

Kerry:

All right. Why don't you tell us a little bit about who you are and what you do.

Amanda:

So, yeah, my name is Amanda Smay. I am a dermatology physician assistant. I work here in Clearwater, Florida. And I'm at Palm Harbor Dermatology off of Lakeview Road and we do a little medical and surgical dermatology and a little bit of cosmetic dermatology.

Kerry:

Okay. And you guys, so that's like Oldsmar, Palm Harbor area, right? Your location.

Amanda:

Yeah, close to, yeah, a little bit south of that and like Bel Air Clearwater area. Yeah,

Kerry:

Nice. Yeah. You guys have multiple locations, correct?

Amanda:

we do. Yep. Kind of throughout the Tampa Bay area for sure.

Kerry:

Awesome. Well, we're so excited to have you today. Can you tell us a little bit how you got into being a PA and how you got into dermatology in particular?

Amanda:

Yeah, so prior to PA school I was working on getting my patient care hours to apply for school and I started working as a medical assistant at a dermatology practice and truth be told, I didn't really have any interest in dermatology. I just wanted to get my patient care hours. And I was maybe more interested in surgery. And then when I started working in dermatology, I really started to kind of fall in love with how much variety there is in dermatology. So you're seeing everything from you know, doing skin checks to eczema, acne rosacea, but then you're also doing lasers, you can do surgical excisions lots of like procedure based appointments. I just liked all the variety. And not only that, the patients as well. Everything from little babies all the way up to geriatric patients. So lots of variety, which I think keeps my day from getting boring.

Kerry:

Yeah, absolutely. I think, the procedural aspect draws a lot of people to it. So that's a lot of fun. Cool. And today we were going to cover acne facts and myths. So I'm excited to hear all your expertise on that. Let's just start out with like the basics of acne. What is it? What causes it?

Amanda:

yeah, so I'm definitely glad we're talking about acne. I feel like this is something that is actually the number one skin problem in the United States. And we tend to see it. acne among adolescents, you know, any from like 35 to 90 percent of adolescent suffer with acne. So it's definitely something I treat very, very often in clinic. With that being said, kind of what causes acne is, you know, within our skin we have lots of hair follicles, right. And then within that each hair follicle, we have something called the pilosebaceous unit and this kind of helps create sebum or oil that occurs on our skin. Now, that's a good thing. We want sebum and oil on our skin to keep our skin soft and supple, to help make a good skin barrier, prevent infections, as well as kind of protect it from mechanical trauma. So When all is going well, it's kind of producing the right amount of oil and our skin is nice and healthy. Sometimes when this process is upregulating, we have more oil on the skin or potentially more dirt or bacteria like sea acne or dead skin cells. These Pores get clogged and there's kind of a disruption in that pilosebaceous unit. And when that for is more open, it oxidizes it creates a blackhead. When it's closed, it creates a whitehead. So that's kind of the long and short of why we see acne and what causes it.

Kerry:

What about the cystic type acne? How is that different?

Amanda:

Yeah, so cystic acne is basically just a whitehead, but just bigger. And we tend to see more of a hormonal component to the cystic acne. So adult females certainly can have more cystic acne. Or just more inflammatory acne that has gone kind of uncontrolled can turn more cystic as well.

Kerry:

Okay. You already kind of alluded to this, but you mentioned like some common triggers or factors that exacerbate acne and the one being hormones. What else would you say? And can you explain the hormone part a little bit more?

Amanda:

Yeah. So definitely, you know, acne is, there's not really one thing that causes acne. It definitely is multifactorial. So hereditary components play a role. So if one or both of your parents suffered with acne when they were a child, then you're going to be, you know, one to three full times more likely to suffer with acne as yourself, or also hormonal Factors play a role. So patients with PCOS can potentially have more exacerbation of acne just because of basically dramatic changes in androgens like progesterone, things like that. As well as in our hormone years, we're going through our puberty years, we're going through a lot of hormonal changes. So again, that is also a reason why we tend to see more acne in adolescents.

Kerry:

Is there any like role where their personal skincare routine takes effect to make things worse or better?

Amanda:

Yeah, absolutely. So I tend to find maybe like one of that, like acne myths too, is that people either are not washing their face enough or they're washing too much. So especially, you know, the kids that they are wanting to just really like scrub their face with very abrasive like exfoliants or the ultrasonic brushes or like loofahs, things like that. Sometimes they can maybe overdo that. And with a lot of that abrasion and exfoliation that can kind of perpetuate that inflammatory process of acne. Typically for the normal patient will recommend like once a week is kind of that sweet spot for how often you should be exfoliating. Other things too, sometimes patients aren't washing their face enough. So If you aren't washing your face routinely, I normally would recommend twice a day, once in the morning, once in the evening with a good gentle cleanser. Again, that can lead to accumulation of dirt and bacteria, dead skin cells and things that kind of, you know environmental things that get onto our skin every day. And again, can kind of clog those pores and can contribute to acne. And maybe even sometimes I recommend a third time, if you're active, if you're sweating you know, immediately try to go home after practice or go into the gym and wash off. So that sweat doesn't sit on the skin and clog the pores.

Kerry:

Yeah, so you've seen like people who just wash their face like a million times a day and then it causes it to be worse.

Amanda:

Yeah. Yeah. I mean, I like grew up in the generation of the St. Ives apricot scrub, and I can't believe I used that every day. It's just, you know, just kind of. Basically tearing your skin down, you know, kind of

Kerry:

I remember something like myself. Yeah.

Amanda:

so,

Kerry:

any other common myths about acne that you hear a lot?

Amanda:

yeah, well, we touched on one earlier. I don't love, people asking about those ultrasonic brushes a lot you know, to use to like, cleanse the face. And I'm not a big fan of those in the loofahs. I tend to find that these devices aren't washed often enough and can harbor bacteria, which again is one of the kind of things that leads to acne on the skin. So I normally just recommend a good gentle cleanser fingertips, kind of gently massaging with some warm water, just so you get kind of a nice lather. Other things as well with acne is that diet can certainly play a role as well. For patients who are presupposed to acne, I tend to find that diet choices can be contributory. So one myth, you know, is like chocolate is a big one that can trigger it. We haven't actually seen a ton of, you know, data. One is still kind of controversial is how contributory chocolate can be to acne. But more so we have seen a link between acne exacerbation with patients who drink a lot of dairy milk, cow's milk products. Again, maybe touching on like the hormonal aspect of that. There's a lot of hormones in cow's milk type products. So I always recommend switching to a dairy alternative such as almond milk or coconut milk. Also patients who do a lot of protein supplements and powders on specifically whey protein which has been shown to potentially exacerbate And again, not causal, but maybe contributory. And then patients who have diets that are high in a lot of like simple sugars and carbohydrates. So these types of foods will really increase your glycemic index, very quickly. And it's more of those peaks in glycemic index that can again, kind of trigger an upregulation and oil production of the skin, which contributes to acne. So I always as a general guideline recommend avoiding very processed, very sugary foods in lieu of more whole food diet like vegetables, fruits and again, skipping more sugary beverages like sodas in lieu for something like water.

Kerry:

Yeah, I definitely preach on the whole sugar aspect related to many things. And as far as skin care, I think that's a big 1, too you know, I think eliminating those processed foods and the high sugar foods is usually helpful. You mentioned some other ones that I hadn't thought of before. What about like a creatine supplement? Have you, do you have any comment on that?

Amanda:

You know, I'm not 100 percent sure on that one. With any contributions to acne, I think with the protein factor with the whey protein, it's more of just that whey component. And I always recommend switching if you are in a whey protein to like a pea protein is a good alternative for that. But I don't have any data on

Kerry:

creatine yeah, I'll have to look that up. I don't know. It's just, I feel like more people with the, with the going along with the protein supplements and stuff are starting to, like once again, use creatine. I was just wondering if it would affect anything, but we'll look it up, see if there's any studies, but like you said, it's probably just associative and definitely not causal. So how about tanning beds? Do they help cure acne? Not that I'm ever promoting, or you should ever promote that either being in dermatology.

Amanda:

Right. Yeah. Yeah. No, I don't. I don't recommend you know, a ton of sun exposure or tainting bed exposure for a treatment for acne. Especially when weighing that against the risk of skin cancers and UV damage that you can get. There's a whole different kind of range of products and things that we can do to treat acne. Potentially I've seen some like new emerging therapies with red light and blue light devices being helpful. So if you were looking at maybe a tanning bed, I would maybe opt for one of those kinds of devices, which sometimes can be offered in a dermatology office, or they even have a lot of these devices available over the counter. So That might be a new emerging treatment option, but definitely would not recommend the tanning bed for an acne treatment.

Kerry:

Glad to hear that. I was going to say, so I thought the ultra, I thought you were, when you were talking about the ultrasonic thing, I actually don't know what that is, but when I was at a conference recently, they did have like a sample red light therapy. And I thought it was cool. I was mostly thinking about melasma for my case, not for acne, but I didn't know it would also help with acne and those are definitely becoming more prevalent. And there's also like, like you said, over the counter grades, and then there's also provider grades. Like they could use them in the office and they're a lot more expensive, but those are good. But what's the difference. Do you have any idea between this ultrasonic brush? Cause I don't know what that is versus like red light therapy.

Amanda:

Yeah, it's like this little like brush device. It's kind of handheld and it has little bristles on the end and basically kind of use it to, I guess, cleanse the face instead of doing the like regular kind of fingertips kind of thing. So I don't know there for a time people were like, I feel like really gung ho about these. And I think of late, I think dermatologists in general are kind of moving away from those devices just because of the harboring bacteria kind of component of them. So

Kerry:

Okay. So they're not like electric device.

Amanda:

I don't, yeah, I don't think so. Yeah.

Kerry:

Well, you're saying don't use those, but maybe red light therapy. So that's helpful. Anyway. Okay. Yeah. So any other fun myths? I do remember the toothpaste to dry it out kind of thing. Is that a thing or what?

Amanda:

Yeah. I, again, I don't know about the toothpaste thing. I know that's like the old school. Yeah. Kind of myth there. It's so funny because like, there's everybody wants to have this perfect skin. And one thing I will say is that we are pretty good now with the treatment options that we have available in terms of topical antibiotics, topical antiseptics retinoids hormonal therapy. So I wouldn't go raiding your kitchen sink or your bathroom sink looking for some like products just come in if you've exhausted a lot of the typical over the counter options for treating acne. I would probably skip the toothpaste and come in and see a dermatology provider. And I think we can get you on something a little bit better. Yeah. So

Kerry:

when would someone need to kind of come in to get help with their acne treatment?

Amanda:

I mean, I would say typically if you are a patient who has tried a lot of the over the counter stuff and you aren't seeing good clearance of your acne lesions. Specifically if you have a lot of cystic lesions that can be a big thing. A big reason to want to come in because a lot of those cystic lesions that we can't treat early can potentially lead to acne scarring, which is going to be the most devastating kind of consequence of uncontrolled untreated acne. And again, somebody who has a strong family history of acne potentially like Accutane use or families for Accutane use, again, would point me towards somebody who may benefit from being on a prescription strength acne regimen as well as somebody with an underlying hormonal condition that again, predisposes into acting like PCOS or something like

Kerry:

Do you mind going through, like you already kind of mentioned, like the topical things of like antibiotics and all that stuff. What are the main, ways of treating it in the office?

Amanda:

So, you know, typically I always recommend, as a base, starting with a good gentle cleanser. Personal favorite brands like CeraVe or Cetaphil, something, you know, very kind of stripped down and bland that doesn't have a lot of chemicals or additives that could irritate your skin. And they have a whole kind of range of products anywhere from, if you're more oily, they have more ones that are for oily prone skin they're more for oil control. And then they have ones, if you're more dry, they're like more hydrating. So kind of work to getting some like moisture back in the skin, but still clean. Cleansing the skin thoroughly. And then beyond that, I'll normally kind of build depending on what type of acne that you have. I tend to find for patients with more inflammatory pustules, papules respond better to topical antibiotics such as clindamycin potentially benzoyl peroxide. I normally like to prescribe those together to prevent antibiotic resistance with the clindamycin. And The benzoyl peroxide is a kind of a tried and true ingredient we've had for treating acne for a long, long time. It's good topical antiseptic and again, kind of helps combat some of that bacteria and that oil that sits on the skin and can contribute to acne. For patients with more like textural changes or more blackheads you know, I tend to go more a retinoid kind of route. There's a whole range of products everywhere from Adapalene or Differin, which used to be available only via prescription is now available over the counter. So that can certainly be a great place to start. And these medications basically in the retinoid family are a catalytic, right? So they are working at speeding up skin cell turnover. So again, it's helping getting rid of some of those dead skin cells that can sit on the pores and kind of clog those pores and contribute to acne. So I like retinols a lot for my more blackhead type of acne patients. And again, Tretinoin, retinoids, these can check a lot of boxes too. I like these a lot for acne scarring as well as post inflammatory hyperpigmentation. When we have an old inflammatory lesion of acne that leaves behind a dark mark on the skin retinoids are really helpful at going in and kind of helping with that new skin coming in to be more even in tone and texture.

Kerry:

Yeah, those are definitely good things. I would kind of answer my question regarding, you know, what happens with the scarring. What can you do? So that's really helpful. And obviously, I'm a little older and more thinking about the longevity benefits of using those retinoids. So that's pretty cool.

Amanda:

I love, yeah, retinoids are great because, you know, like I said, checks a lot of boxes for not just acne, acne scarring, but fine lines, wrinkles, and you know, it's just a, it's a good overall, you know, kind of product to incorporate into a skincare regimen.

Kerry:

And as far as like really more severe cases is when you might think of doing like the Accutane, right?

Amanda:

Yeah, absolutely. So, you know, kind of beyond topicals, if we aren't you know, kind of getting where we need to be you know, that next kind of step may be considering like an oral antibiotic. I normally like the tetracycline family, like, and like doxycycline But we really are using the oral antibiotics less for antimicrobial purposes and more for anti inflammatory purposes. So normally we'll have them on a lower dose than we typically would to treat like an infection. And they may be on that for, you know, a couple months maybe three months, maybe six months more. So to kind of calm down some of those cystic lesions, those inflammatory lesions with my goal that eventually I could wean them off of that and we could just maintain with topical medications. So I really like the the oral antibiotics for that. There's also, you know, kind of somewhere in between topicals and Accutane a great medication called Spironolactone. That is a anti androgen diuretic. So this medication is really great for my adult female patients who suffer with more of that hormonal acne. So this medication is working to kind of control that those testosterone levels, those androgen levels that again can be kind of increasing sebum production in acne with those medications again, now we're starting to kind of get into like blood work monitoring and things like that, but very effective for sure. And then, if we kind of tried some more of these conservative therapies, you know, next time would potentially be accutane.

Kerry:

Yeah, which has its own risk factors and you have to do blood work and urine pregnancy testing too, right?

Amanda:

Yeah, absolutely. So accutane I think it has a, a big stigma around it. People are kind of scared of accutane and because it's associated with so many side effects. And I think that, you know, Yeah, absolutely. I agree that, it needs to be used with caution. But I definitely think that there's a time and a place for Accutane in my patients who have severe recalcitrant acne that's not responding traditional therapies. Then sometimes, Accutane is required. You know, like you kind of touched on Accutane is linked to potential birth defects, which is why it's very important that patients who are on this medication are not going to get pregnant. So we will typically bring patients in monthly to do in office pregnancy tests as well as every couple of months we'll do blood work just to monitor and make sure things are going well, in terms of, you know, cholesterol levels liver and kidney function, things like that. So, it is a scary medication, but I definitely think that it has its, it's time in place and it can be a very effective tool for treating acne for sure.

Kerry:

Yeah, I definitely, I agree. I think also that's like the time where also you want to take into that role of like what's going on with the nutrition and maybe, I don't know, what do you think about stress management related to acne?

Amanda:

Yeah, absolutely. So, we kind of talked about how hormones play a role. Cortisol definitely being one of them that's been associated with acne. I always say stress makes everything worse. So no matter whether it's Acne, psoriasis, you name it always has negative implications for our health. It's a terrible cycle too, because if you have acne, you're going to be stressed about it. And then, you know, the cycle continues, but just know there's lots of things we can do to treat the acne. So.

Kerry:

do you have any practical tips on preventing acne breakouts?

Amanda:

I would probably say washing your face twice a day is a good kind of baseline, using sunscreen every day is good for your skin health. And then potentially, like I said, trying some of the over the counter products, if we don't have good results with the over the counter products, then maybe seeing your local dermatology provider to see if we can kind of get you started on some prescription strength treatments.

Kerry:

Your favorite over the counter cleansers were CeraVe and Cetaphil. Were there any other over the counter things that you find helpful?

Amanda:

I would say I really like Those products, they also have in the Cetaphil line, there's a purple top line, it's called the Dermacontrol line, and especially with a lot of the medications that we use to treat acne can be photosensitizing, so make you burn a little bit easier in the sun, like doxycycline, retinoids so with those medications we want you on sunscreen so you're protecting your skin, but at the same time you know, a lot of patients find, oh, you know, These sunscreen products clog my pores, right? And make my acne worse. So they're reluctant to get on it. So I like this one by Cetaphil called the Dermacontrol line. And it is a kind of a three in one product. So it's a facial moisturizer, but it has SPF 15 built into it and it's non comedogenic, so it doesn't clog your pores. So that's like my favorite kind of AM three in one product for kind of my acne patients.

Kerry:

That's pretty cool. I love how all these new products have come out I feel like since I was, you know, going through puberty and dealing with some of these things and doing some of these myths myself, so it's nice to see that medicine and just the, I guess, drug aspect of the world has improved since then. That's really good. Is there anything else you'd like to share or add or recommend to patients?

Amanda:

You know, I mean, the good news is that like I said, acne is very common, so I think patients are very distressed when they come in and they have acne and it can certainly affect their quality of life. But just know that you're not alone. Like I said, it's the number one skin conditioner skin problem in the United States. So you know, and there's lots of great things that we have available now to treat it. So yeah, so I would say you're not alone. And like I said, there's other things too. I mean, we have everything chemical peels can be helpful. You know, medications, there's a light therapy now. So all kinds of stuff that we can use for acne and acne scarring.

Kerry:

Do you guys do the light therapy in your office?

Amanda:

We do have a light that we use for acne treatment. And then we also have a lot of lasers that we can use for acne scarring. So especially with patients who have more just than post inflammatory hyperpigmentation dark spots to have more like ice pick scarring or kind of divot scarring in the skin where it kind of affects the texture. We can do different procedures that kind of resurface in kind of our microneedling to kind of get that skin texture improved.

Kerry:

now Are those kind of things covered by insurance or is those mostly going to be on the aesthetic side?

Amanda:

unfortunately, when we're kind of on the side of treating acne scarring, a lot of these treatments are not going to be covered by patients insurance. But I have seen occasionally that the chemical peels for treating acne may be covered by some people's insurance.

Kerry:

Okay. We're hopeful, right?

Amanda:

That's right. Always a battle.

Kerry:

Oh, yes, it is. I know. All right. Well, anything else you'd like to add? I think we've gotten a great summary here. And I've This has been fun, but anything else to add?

Amanda:

I don't think so. I feel like they covered a lot of bases with acne. So

Kerry:

Yeah. Well, tell me about this open house you guys have coming up.

Amanda:

yeah, so we are doing an open house event. And our office here in Clearwater, this will be a Thursday September 12th and it's going to be from 5 to 7. And we're having a couple of different vendors coming in from the local community so you can kind of meet myself and my staff and then, also maybe doing some specials as well on some products maybe some Botox specials. So it'll be a great event for, you know, kind of coming in, see the office meeting us as well as a couple of other community members. So, yeah.

Kerry:

Awesome. Sounds like a lot of fun. All right. We'll put that in the show notes and everything like that. And if people want to work with you or where, how can they find you other than call in the office?

Amanda:

Yeah. Yeah. So yep, you can call our office. And then we also have a website available. It uh, ph dermatology. com. And the good news is that if, you know, you're almost anywhere in the Tampa Bay area, you can probably find an office pretty close to you and on our website, it will also let you schedule online and you can see when the next available appointment is for each office. So that always helps. You can see if you're going to be a month out, a week out, a couple months out. So yeah, a nice little handy tool we have.

Kerry:

Perfect. Thank you so much for joining me on the podcast today and everybody stay tuned next week. And if you need a primary care an obesity, medicine doctor, allergy, and asthma at Clearwater family medicine and allergy, you can call us at 7274461097, And yeah, thank you so much, Amanda.

Amanda:

Yeah. Thank you for having me. This was so much fun.

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