Guest: Dr. Hilary Baldwin
Presenter: Neal Howard
Guest Bio: Dr. Baldwin, the Medical Director of the ATRC, is a board certified dermatologist with nearly 25 years of experience. Her area of expertise and interest are acne, rosacea and keloid scars. Dr. Baldwin received her BA and MA in biology from Boston University. She became a research assistant at Harvard University before attending Boston University School of Medicine.
Segment overview: Dr. Hilary Baldwin, Medical Director of the Atlantic Health System’s Acne Treatment and Research Center in Morristown, NJ, and Galderma Laboratories consultant, discusses new data on how inflammation impacts scarring and how to prevent and treat acne scars.
Health Professional Radio – Prevention and Treatment of Acne Scarring
Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard. Thank you for joining us on the program today. Our guest is Dr. Hilary Baldwin, she’s the Medical Director of the Atlantic Health Systems Acne Treatment and Research Center in Moorestown, New Jersey. She’s here to talk with us about some new data on how inflammation impacts acne scarring and how to prevent and possibly treat these scars if and when they do appear. Welcome to the program Doctor.
Dr. Hilary Baldwin: Thank you very much for having me.
N: Thank you. You’re a board certified Dermatologist. You’ve got a lot of experience, your area of expertise and interest are acne, rosacea and keloid scars. Does all acne cause scarring of some type or are some of us able to get through it, never know that we had it unless we tell somebody?
B: Right. Well honestly, I think nobody emerges unscathed from the acne process. If you have significant acne, if you have acne that is visible to the outside world, I believe that everybody ends up with psychological scarring as a result of having gone through the process. Also, everybody ends up with physical scarring to some extent, it just may not be visible to the naked eyes. So what we really talking about here obviously is scars that leave long lasting imprints on the skin and that is less common than acne itself but there are some studies that suggest that 85-95% of patients have some scarring of some sort. Now it maybe on the chest, the back, the arms or the face, so it does leave a mark on most everybody. Those who are going to scar, unfortunately are not necessarily predictable, it is definitely true that the more severe your acne, the more likely you are to scar. But in two studies, we saw that the moderate patients scarred in about 40-45% of cases and mild acne that barely met the radar screen form scars in 20-25% of patients. So acne severity does not necessarily predict whether or not you’re going to scar and how bad the scars are. In fact, I see patients coming into my office all the time who don’t even notice that they’re scarring, I have to sort of point it out to them, “Now you’ll notice here in your temples especially, very common area and you do have some scarring and I’m afraid that if we don’t get this condition under control immediately that this is going to be lifelong.” We’re treating acne when patients walk in and we’re treating them for their acne that day so that they look better and feel better about themselves but also we sort of have to force them to make sure they adequately treat themselves so that they don’t regret it when they’re 30 and 40 and 50 and have acne scars until they’re permanent.
N: So, not only can you get the acne, the acne can run its course but you can be scarred for life. If these scars aren’t treated, adding to the psychosocial aspect of acne. There are treatments that involve topical solutions, oral solutions and laser solutions that we talked about in other segments. Are some of these solutions effective when it comes to the scarring of acne and not simply the treatment of acne?
B: Right. Well there are but in overall, it’s a heck of a lot easier to prevent the formation of scars than it is to treat them after the fact. There are some excellent methods for treating scars like you just mentioned there’s some topicals, there’s some orals, laser and light for sure doing a nice job and excisions, surgery to remove it and resurfacing techniques. So there are ways to deal with the scars after the fact but they’re quite expensive, they’re lengthy treatments, often you look a heck of a lot worse before you look better and you go through a period of time when, I mean if you’re really doing a thorough job at treating acne scars, you’re going to have to disappear from your social life for a good couple of weeks maybe even a month. So it’s way easier to prevent them than it is to treat them after the fact. And there are several studies now that demonstrate that the earlier you seek treatment for your acne, the less likely you are to scar. Two studies showing that if you sought treatment before 3 years into your acne, you were 3 times less likely to scar than if you waited. So I think the take home message is “Don’t wait to treat your acne. Whether or not you can appreciate the fact that you’re scarring, you ought to be treated early and perhaps aggressively.“
N: Are there any factors other than the severity or how long the patient has been dealing with acne that contribute to the effectiveness of one treatment or another? Say an age group or maybe a gender, other factors than just the acne itself that lend themselves to better treat the scars.
B: Well there are factors that lend themselves to more scarring. For whatever reason men are more likely to scar in some studies, in other studies the women kept up with the men. You have to wonder if that’s because more women present to the Health Care Professional with scars because they’re more bothered by them or do they actually have them more frequently so that sort of a mixed page. And next is probably the overwhelming determinants as to whether or not you’re going to scar. Darker skin, although not more likely to scar can certainly scar with more hypopigmentation which looks more noticeable but very pale skin tends to heal up with post inflammatory erythema with these red dots which last forever. So there’s all sorts of aspects to this condition, so I think overall no, you can’t predict who is going to scar in any fashion expect those that waited too long and perhaps more severe patients, but predicting whose going to respond to therapy, not really.
N: Do you often find yourself having to dissuade the patient from one treatment or another because for some reason they find themselves convinced that this or that will work and they’re looking for you to co-sign that you have to say be “Based on what I know of your history I suggest this, that or the other?”
B: Yes, I agree and I love the word co-sign because that was exactly they’re asking me to do. They’re asking me to give them permission to not treat or sometimes permission to treat with something that I feel is overly aggressive. So both sometimes occurs, sometimes it’s from the patient and sometimes it’s from the parent. Occasionally the patient drives the parent in kicking and screaming and sometimes the parent brings the patient in kicking and screaming, so there is a dynamic within the family that sometimes needs to be dealt with as well. But yes, I try not to co-sign on something obviously that I think is not going to work or is inappropriate. But often I find that I have to start at the first visit entertaining the viewpoint of the patient in order to gain trust and to have it be via communication, this is after all their treatment. And then once it’s not working as well as they had hoped, we move on to a more appropriate treatment.
N: When someone is experiencing scarring, is there pain? Is that something that they have to deal with when the scarring has occurred?
B: Sometimes. Yes, well hypertrophic scars and keloids are certainly painful. Now there are several types of scars, quickly there are in-is and out-is. In-is don’t often hurt, they’re usually just physically unattractive to the patient. But out-is, the hypertrophic scars and the keloids are often itchy or quiet painful to touch and of course much harder to treat.
N: Which should the patients just abandon the over the counter medications and come to you for serious help?
B: Well, I would say if the over the counter hasn’t worked in 2 to 4 weeks, if you have a psychological overlay which is to say that withdrawal from social situations and decrease in scholastic performance, depression, certainly suicidal thoughts, or in some cases because of bullying and humiliation actually homicidal thoughts, any of those things occurring then you need help in multiple ways. But your acne needs to be dealt with to alleviate the psychological overlay. And then certainly if you see any physical scarring whatsoever. But the psychological is often more difficult to tell because the teenagers are not often very forthcoming with the emotional toll that is taking on them. I may sound self-serving since I‘m a Dermatologist, but I feel that anybody with acne significant enough to warrant walking into a Pharmacy, ought to be going to Dermatologists.
N: Some great information. Thank you so much for talking with us today Dr. Baldwin.
B: Pleasure, thank you very much for having me.
N: Thank you. You’ve been listening to Health Professional Radio with Dr. Hilary Baldwin, Medical Director of the Atlantic Health Systems Acne Treatment and Research Center. I’m your host Neal Howard here on Health Professional Radio. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.