#113 How to treat oily skin, are Accutane and Benzoyl good for severe acne, and how to identify the root cause of cystic acne. With Dr. Keira Barr
Today’s guest is Dr. Keira Barr. She is a dermatologist at the Resilient Health Institute in Washington. She helps people who struggle feeling comfortable in their skin by what she calls the Resilient Rebel Roadmap. This is a one on one mentoring system that dives deep into figuring out a personalized step by step plan to help people achieve their goal. In this episode, Dr. Keira talks about her struggles with feeling comfortable in her skin and how she overcame them. Enjoy!
Audio Version: https://podcasts.apple.com/us/podcast/113-how-to-treat-oily-skin-are-accutane-benzoyl-good/id1318445077?i=1000451943483
Video Version: https://youtu.be/3pe8XdG9iw4
Dr. Keira’s website: https://www.chooseresilience.com/
Chantel Ray: Hey guys, welcome to this week of Waist Away. Today’s guest is Dr. Keira Barr. She’s a dermatologist at the Resilient Health Institute in Washington. She helps people who struggle to be comfortable in their skin. She is going to tell us a little bit about her own health journey, and tell you all about acne, your skin, and how you can feel more comfortable and confident. Welcome Dr. Keira.
Dr. Keira Barr: Thank you. Thank you for having me.
Chantel Ray: Tell us a little bit about your, I mean your skin looks amazing, so did you ever personally have any issues with acne?
Dr. Keira Barr: Just the occasional zit that was always at the most inopportune time, but I was fortunate that I didn’t deal with significant acne, but I had other skin issues that caused some challenges for me for sure.
Chantel Ray: What was the other skin issues that you had?
Dr. Keira Barr: I was born with two birth marks, one on each side of my face. As a kid I was bullied for their appearance. For me, I learned quickly that if I got tan, which I was never meant to tan, even though I have dark hair, my dad’s a red head so I burned, but I tried to mask them. As a dermatologist I learned how dangerous that actually was, and in fact had to diagnose myself with melanoma. So, not acne, but something a lot more life threatening.
Chantel Ray: Gotcha. We’ve been getting a lot of questions on acne and cystic acne lately. Can you talk a little bit about what are the best and worst foods for acne, and how does the food you eat directly affect your acne levels, and how your gut health directly affects it?
Dr. Keira Barr: Great questions. Great questions. My answer is going to be, it depends. There’s a lot of information out there, kind of broadspeaking generalities that may apply in terms of inflammatory or noninflammatory food, but I think in this day and age where there’s so much information readily available and being very dogmatic about things can add a lot of stress and overwhelm to people, as they’re already feeling stressed and overwhelmed with the appearance of their skin.
Dr. Keira Barr: I think in general dairy and sugar are probably the two biggest foods that have been shown to contribute to acne flares, dairy in particular, and skim milk rather than whole milk. That’s more because of the sugar content in the skim milk. What happens is that it turns on this insulin growth factor one receptor, which stimulates the oil glands, and oil is one of the big contributors to acne formation, so oil or your sebum, dead skin cells, and bacteria. By stimulating the oil and then contributing to the inflammatory cascade that ensues, and sugar can do the same thing, stimulates the same receptors. It’s a big kind of inflammatory load.
Chantel Ray: Now what about sheep’s milk? Does it do the same exact, that would still count like, or goat’s milk? Would that also count, or is it a little bit better?
Dr. Keira Barr: That’s another great question. There are a lot of people who don’t tolerate cow’s milk very well, but will tolerate sheep and goat’s milk. Looking at the whey and the casein and some of the proteins that are in the cow’s milk as well as the hormones, if you’re not drinking organic milk, and the hormones that that may or may not have impacted that the cows whose milk you’re drinking. That that very well can make a difference. As I shared, it’s very individual. Broadsweeping foods, dairy and sugar, but not everyone, those won’t necessarily be everyone’s triggers.
Chantel Ray: What about gluten? Do you see that gluten is also a trigger, or not as much as dairy and sugar?
Dr. Keira Barr: Again, it depends. There are some people who are gluten sensitive, gluten intolerant. Because of the overall inflammation that it may cause in someone’s body, acne may be one of the manifestations of that. We always talk about the big five that are commonly talked about. Corn, soy, dairy, gluten, and sugar are kind of the big ones that if you’re doing just kind of a broadsweeping elimination, those are usually the first recommended foods or food groups to eliminate. But again, not everyone will respond. For some people, something that seems as healthy as strawberries or something like that. If you have some sort of sensitivity, that might be your trigger.
Dr. Keira Barr: Again, it’s kind of hard to be very dogmatic about things. A lot of it is try, do an elimination, but if you’re not getting the results, then that’s where a food sensitivity testing to really kind of pin down what your individual sensitivities might be.
Chantel Ray: Would you say honey and fruit would count in your sugar, or would you say honey and fruit, natural fruit are okay?
Dr. Keira Barr: I think that fruit would would be more okay than honey. Some people don’t tolerate honey very well. I think, again, it’s a matter of kind of tuning into what your body needs, seeing how you respond to certain foods. We had mentioned, you had mentioned gut health. It’s not just, you aren’t just what you eat. It’s what your body can absorb, assimilate, process, what your microbiome can absorb, assimilate, and process, and how it deals with the food that you’re taking in. When there is an imbalance, foods that you might’ve been able to tolerate previously, or would be kind of the party line of what’s considered healthy, you may not be able to tolerate that. As a result, it manifests as breakouts, or skin inflammation, or rashes, or bloating, or a whole host of symptoms.
Chantel Ray: How can somebody identify the root cause of their cystic acne? Does sunlight benefit cystic acne?
Dr. Keira Barr: That’s a great question. As with most things, there usually isn’t just one contributing factor. When we look at cystic acne, certainly there are individuals, if there’s a strong family history of cystic acne, there may be a genetic predisposition. Looking at diet, just as we talked about. Are there things in your diet that could be contributing? Looking at taking out as much of the processed foods as we can, eating a nutrient dense whole foods diet, making sure that you’re hydrating enough. Are there products that you’re using on your skin or in your household that then are on your hands that could be disrupting your skin microbiome and contributing to acne flares? Are there certain medications or supplements?
Dr. Keira Barr: There’s a really interesting study looking at B12 supplementation having a correlation with acne flare. Things that we think may be doing us some good could actually in some individuals be contributing to flares. Makeup that you’re using, hormone imbalances, and then stress. That’s a lot of things that I’m sharing, but it’s usually not one thing. You kind of go layer by layer and look at your entire environment and the soil in which your skin essentially is growing within, and look to see if there’s any contributing factors.
Chantel Ray: Do you think that it’s good for your skin to get extractions often, and what’s the best way to extract pimples? Can extracting pimples cause more breakouts?
Dr. Keira Barr: Extractions can be quite helpful, certainly when we talk about open comedones and closed comedones. Acne in general is formed in a hair follicle. When there’s dead skin cells and oil production and bacteria, and that kind of dilates the hair follicle and it can get obstructed, so you may need a little extra help to clean those pores out. It’s a matter of how it’s being done. I always suggest, we always talk about don’t pick your pimples or pop your pimples yourself because you can cause a lot of additional inflammation. Going to a skilled professional like an aesthetician, or dermatologist do extractions. It’s not something that needs to be done all the time. It depends on the severity of the acne. Some people do go for a period of time, once a week, once every other week, maybe getting facials and doing some gentle exfoliation with peels and such.
Dr. Keira Barr: But just squeezing yourself or using tools that you can buy at Sephora or something have the potential to cause more damage and inflammation, and actually potentially secondary infection and making things worse rather than better. I would definitely seek out the help of a skilled professional.
Chantel Ray: This is a question I like to ask all my guests is just walk us through a day in the life of yourself. What did you eat yesterday? When did you eat it? Are there certain foods that you are off limits or that you avoid?
Dr. Keira Barr: Yeah, that’s a great question. I have had to over the last several years [inaudible 00:10:52] my way of eating significantly because what I thought was healthy and all the things that I talked about of things that would be healthy for somebody else were actually making me quite ill. I’ve had to do food sensitivity testing. In general, I practice a form of intermittent fasting. I will have my black coffee, oftentimes with a little cinnamon, like yesterday morning. Then I usually am eating after I work out, probably at 11 or noon. Yesterday was wild caught Alaskan salmon, because I’m very fortunate my husband goes on a fishing trip and he stocks our freezer with salmon to get those healthy Omega-3s.
Chantel Ray: I don’t like salmon.
Dr. Keira Barr: Oh you don’t?
Chantel Ray: I love raw tuna, but that’s … I wish I liked salmon, it’s so good for you, but I just don’t like it.
Dr. Keira Barr: Yeah. Well that’s okay.
Chantel Ray: Yeah.
Dr. Keira Barr: There’s other ways to get Omega-3s. And a green salad, that’s what I had. Then for dinner we did roasted chicken with butternut squash.
Chantel Ray: Awesome. Well let’s jump right into the listener questions. This is from Taylor in Austin. “I’ve always had oily skin for as long as I can remember. I’ve literally tried every product out there and no matter what I do I can’t control it. I heard the reason for this is actually because I have dry skin and my skin is overcompensating because of the oiliness. Is that true? Do you have any product recommendations and is there anything I can do to help my oily skin?” Taylor in Austin.
Dr. Keira Barr: All right. Well, Taylor in Austin, great question. First and foremost, there’s a lot of great products out there, but before you go and spend your money on products, taking a step back and looking at what are your daily skincare habits. The question would be how often are you washing your face. A lot of people think that when they have oily skin they need to wash and overwash. What can happen is that you actually can make the skin a little bit more dry and irritated. Then your skin does kind of overcompensate and produce some more oil. For those individuals with oily skin, using a gentle foaming cleanser twice a day, maybe three times a day if you’re working out, but not more than that.
Dr. Keira Barr: Also, moisturizing your skin. I think that people who have oily skin think that they can’t moisturize because they’re going to be making their skin more oily, when in fact that isn’t true. Choosing an oil free noncomodogenic moisturizer would be the product type that you’d be going for, but your skin actually, just because it’s more oily, you still need to maintain the skin barrier and the integrity of that, so using a moisturizer is important, and not scrubbing hard too. When you’re washing your face a lot of people think they need to scrub the oil away, but that actually can cause more irritation and actually stimulate more oil production.
Chantel Ray: We had a girl on our podcast that’s recommended that if you have oily skin that you should actually put oil on your skin, that putting an organic oil on your skin will actually reduce the amount of oil. Do you agree with that?
Dr. Keira Barr: You know, I personally, I have dry skin so I actually like oil cleansers. I think it really depends on the individual and the type of oil that’s being used. Some people with oily skin, especially if they have been kind of overwashing and scrubbing and things like that, or using toner. For the oily skin folks, toning down how much you use the toner because that actually can, it’s an astringent that can strip the skin of natural oils and make skin feel tight and dry. In those cases, an oil cleanser, or using oil on the skin could be helpful.
Dr. Keira Barr: I think again, there’s a lot of experimentation. I don’t like to be very dogmatic. A lot of it is trial and error and seeing how you respond, and looking at what you’ve been doing for your skin up until that point because it could be helpful. But it also, yeah.
Chantel Ray: All right. This is Caroline in Grand Rapids. “When I was younger I used to have really bad acne. As I got older, I finally gained control of it and now it’s nowhere as bad as it used to be, but now I have really bad scars. It’s so embarrassing and I always feel like I will hate my skin. What’s the best way to treat these scars?”
Dr. Keira Barr: That is a great question. Thankfully, in this day of technology, we have a lot of lasers that can help, so going to see a board certified dermatologist who has an interest in scars, chemical peels. Oftentimes it’s not just one thing, it is this synergy of different modalities put together. Oftentimes you may use a topical retinoid combined with a series of chemical peels with light therapy with resurfacing laser procedures. Again, everyone’s an individual. Depending on the severity of the acne scarring, some [inaudible 00:16:35] sometimes. If it’s just like an ice pick scar or something that’s a little bit deeper and causes an indentation, we can go in and kind of break up the scar tissue, sometimes filler can be used.
Dr. Keira Barr: The good news is, I know that’s a very long winded answer and I feel like I’ve been very long winded this whole time, but skin is very complex. It’s your largest organ. It’s an amazing organ. Everyone is going to be individual. The good news is that there are so many things that can be done. It breaks my heart that she’s had such a bad experience and feels badly, but the great news is there’s a lot of things that can be done to help.
Chantel Ray: Okay. This next one says, “Recently I’ve been getting severe acne and I’ve tried every product and facewash I can find, but nothing is working. I’ve done a little research about Accutane and benzoyl. Are these good products that I should be looking into? Do you have any recommendations for severe acne?” Rebecca in Lexington.
Dr. Keira Barr: Okay Rebecca, that’s another phenomenal question. I’m sure there’s a lot of other people that have similar questions. Before diving into, when I was practicing traditional derm I’d be like 100%, we need this medication, this medication. Instead of just laming and taming it with drugs, really looking at when you say you’ve done all the things, what are those things, and had diet and lifestyle factors played, how much of diet and lifestyle factors played a role in your acne management because that would be one of the first places that I’d want to look.
Dr. Keira Barr: The good news is there’s probably a lot of room to to insert some changes that could be incredibly beneficial. The downside is it’s not a quick fix. Accutane is an amazing medication, I think, when all other choices truly are exhausted. It’s a five month course. It does require blood work and close monitoring. A lot of people tolerate it well. Some people experience a lot of side effects. Before diving into something requiring that much of a commitment, I’d really want to explore diet, sleep, stress, what products you’re using, is there any supplementation that that could help boost liver support to help clear the toxins, clear the hormones and things like that. That would be my … Those are good medications, but that wouldn’t necessarily at this point be my first go to.
Chantel Ray: Okay. Have you seen people that have had bad side effects from those?
Dr. Keira Barr: Benzoyl peroxide is in general really well tolerated. I mean, you can get it over the counter. The thing to know is that it can be drying. Some people experience dryness and irritation. The other thing it has a bleaching effect, so only use the towels that you could care less about or white towels. Don’t use your favorite black towels because it will bleach them. That’s really the only downside with benzoyl peroxide. But Accutane, I have seen … Accutane got a bad rap for being associated with depression and suicidal ideation. My personal experience is that the individuals who were dealing with serious acne, they already were depressed, their self esteem and their self image was already so low that when they were starting to see improvement with Accutane, their mood improved.
Dr. Keira Barr: The side effects really were skin dryness, irritation, dry lips, sometimes night vision because it’s a vitamin A derivative. You need vitamin A for skin cell turnover, but too much of a good thing is not always a good thing. Joint aches and things like that, but I never saw any significant mood changes except for the better.
Chantel Ray: Okay. This next one is from Dawn in Orlando. “I’ve never been one to use sunscreen until about a year ago when I realized there was a little spot on my nose that looks a little scary. It’s a pretty dark spot and it peels pretty often and it gets darker and drier if I’m outside all day. Every time I go out in the sun I use an SPF of 50 on that spot. I reapply sunscreen if I’m out all day. I haven’t been diagnosed with any kind of skin cancer thankfully, but I wouldn’t be too surprised if I eventually do. Is there anything I should be doing to prevent skin cancer, and should I be using a higher SPF to help with any damage already done to my skin?” Dawn in Orlando.
Dr. Keira Barr: Oh my goodness. Dawn in Orlando, have you really gotten that spot checked out? Please, please, please, please, please do because what that sounds like, a spot that that peels off, it sounds like a precursor to skin cancer called an actinic keratosis, which really just tells you that you’ve had a significant amount of sun exposure over your lifetime. The issue is you can see that spot, but it’s all that we don’t see. Most of the time there’s a whole field of that. The one spot on your nose didn’t just get the sun exposure, your whole face did. I am concerned about longterm risk of skin cancer and wanting to minimize that.
Dr. Keira Barr: People always talk about SPF being your BFF. I’m a big proponent that it should be part of your inner circle, but you need some more friends. Wearing sunscreen on a daily basis is important. Just like you brush your teeth, using moisturizer that has sunscreen in it. Fifty is fine. You really aren’t going to get more bang for your buck above 50. In fact, the FDA is changing the guidelines. The difference between the protection you can get at 50 of like 97%, 98%, versus 100%, 98%, 99%. it’s a matter of being consistent about putting it on every single day and how much you put on to actually get that full SPF protection.
Dr. Keira Barr: Wearing a hat, a broad brim hat with a three inch brim that will actually give some shade over your face is key. Wearing sunglasses to protect your eyes and the sides of your face is also important. Before you even go outdoors, really filling your plate, building your resilience from the inside out. That’s where eating a whole foods nutrient dense diet, filling that plate with the rainbow of fruits, veggies, getting your Omega-3s, your vitamin C, your vitamin E, all of that because that’ll help fend off the oxidative stress that you’re getting by being exposed to the sun.
Dr. Keira Barr: First things first, get checked out. Don’t guess. Get a board certified dermatologist to examine you. Then all the other things, hat, sunglasses.
Chantel Ray: Gotcha. We had a girl on our podcast that talked about homeopathic sulfur and boyrun to help with psoriasis. Have you had any experience with any homeopathic treatments for psoriasis, or any other things that help with psoriasis?
Dr. Keira Barr: I am not an expert in homeopathy whatsoever, so I’m not necessarily familiar with that protocol. We do use sulfur in a lot of treatments for acne. There are sulfa based medicines that are used, so that is not unfamiliar. I think what we’re finding now, the gut-skin connection, especially with regards to psoriasis, is becoming more and more highlighted. The things that you can do is the same for psoriasis, for exzema, or acne is really looking at diet and lifestyle.
Dr. Keira Barr: With psoriasis in particular, potentially an elimination diet of sorts for really tuning into foods that that may cause flares. Being really mindful of okay is it gluten, is it dairy, is it sugar, is it corn, processed foods, eating a nutrient dense whole foods diet. We know that psoriasis is significantly impacted by stress, so really tuning into okay what’s happening in your life right now. There’s no way to get rid of stress, but there are always opportunities to reframe it and to help manage it, mindfulness meditation, some exercise, really connecting.
Dr. Keira Barr: I think psoriasis can be a very isolating skin condition at times because people don’t necessarily understand it. They may think it’s infectious or the individual who has it doesn’t feel like they want to be close to somebody else, but really that community and connection is really important and powerful. Sleep is another huge factor that most people don’t prioritize, but we know that it helps the body heal, rest and repair and may help with stress modification. Those would be some things, not necessary homeopathy, but a little bit more of a holistic approach to psoriasis.
Chantel Ray: Awesome. Well, thank you so much for joining us today. Where can our listeners go to follow you and your work?
Dr. Keira Barr: Yeah. They can follow me on my website, which is drkeirabarr.com, and on Instagram, same thing, @drkeirabarr.
Chantel Ray: Awesome. Well, and if you have a question that you want answered, go to questions@chantelrayway.com. We’ll see you next time. Bye. Bye.
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