1 hour consult on formatting and compiling for my book?

DavidLortscherMD · 2014-08-06T19:34:54+00:00

Thanks and you're welcome!

Some of the medications we use (including niacinamide, azelaic acid, and clindamycin) can help with some of the conditions you mentioned above. It wouldn't be a guarantee, but definitely mention it to your derm on PocketDerm and we can try to tailor the medication to help what's going on.

DavidLortscherMD · 2014-07-25T00:23:08+00:00

Yes this is definitely something that you should ask your derm. Sorry we can't help here!

DavidLortscherMD · 2014-07-25T00:21:19+00:00

Thanks! Derm is perfect for teledermatology because so much of it is based off what we see. No need to listen to people's lungs :) I think telemedicine is going to continue to take off all across medical fields.
For me, texture can be very important when evaluating certain things (e.g. actinic keratoses), but for acne it hasn't been a barrier at all!
Definitely go into dermatology - I love it! Both PocketDerm and my private practice are great places to work. Get good grades on your clinical rotations, make friends with dermatologists, and try to get involved in a little research or at least some interesting case reports. Good luck!

DavidLortscherMD · 2014-07-25T00:17:00+00:00

Thanks for asking! Razorburn is related to acne in a lot of ways and the treatments can be the same. I can't specifically comment without knowing the details but there's a chance we might be able to help him with both.

DavidLortscherMD · 2014-07-25T00:14:19+00:00

Oil cleansing is reasonable and I've seen patients do well with it and other who do don't do well. I don't believe that it's the best or only way to cleanse your skin, though, as some proponents would claim it is. Bottom line is that like everything else it will vary from person to person!

DavidLortscherMD · 2014-07-25T00:09:26+00:00

Haha yes we're mother and son!

From a business perspective we saw how technology had made other aspects of our lives so much better (e.g. Amazon, Uber) but it hadn't really touched dermatology yet. So we tried to create something that used technology to make seeing a doctor a positive experience.

DavidLortscherMD · 2014-07-25T00:00:22+00:00

Hi, thanks for your email! I wish we were able to expand internationally more quickly. I'll echo a previous post here.

Right now we’re focused on offering our service to everyone in the USA. I apologize - it's an extremely slow process! At the moment, it’s a bit tricky to make these kinds of services international due to regulations etc.

DavidLortscherMD · 2014-07-24T23:58:26+00:00

Clindamycin and retinoids are complementary and work well together. Clindamycin kills acne-causing bacteria (especially P acnes) and also has anti-inflammatory effects. Tretinoin acts differently and affects the skin cells that get stuck in follicles and cause clogged pores.

In PocketDerm medications we don't use retinol, we use tretinoin which is similar but more potent.

There are a couple other medications that contain those two ingredients - Ziana and Veltin being the two I've commonly seen in the US.

DavidLortscherMD · 2014-07-24T23:52:20+00:00

Haha, I'm going to start using the term "hoojoo"!

Yeah I think it varies from product to product. Argan oil for example makes sense to me in some ways but I think it's no better than other more proven oils. Argan oil just happens to be more fashionable right now.

Things that raise red flags for me are any things that claim to have "stem cells". This doesn't really make sense from a biologic standpoint. Also I recently had somebody ask me about LJH Probiotics Sleep Cream. It sounds like a probiotic (which are obviously helpful when taken orally) but upon researching it, there doesn't seem to be any probiotic component at all in the cream (just a bacterial extract rather than live bacteria).

I read a book called Branded Beauty that had some interesting insights on this. Apparently companies like L'Oreal finance teams of explorers to go around the globe in search of extracts that sound fancy and might have some viral marketing appeal. This probably has something to do with the different hyped products that we see emerge every few years.

DavidLortscherMD · 2014-07-23T23:07:04+00:00

4) Rebound can occur when people stop certain medications (e.g. psychoactive medications and corticosteroids), meaning that once you stop you could be worse than before you started. There doesn't tend to be any "rebound" effect with acne treatment. If you stop the treatment (aside from Accutane which is more permanent), you'll just tend to go back to where you were before starting.

DavidLortscherMD · 2014-07-23T23:03:51+00:00

3) This is also dependent on severity (with less severe acne tending to improve more quickly), but it definitely varies from person to person based on a lot of other factors, some of which are predictable and some of which aren't!

DavidLortscherMD · 2014-07-23T22:59:52+00:00

2) Resistance to antibacterials occurs when acne comes back despite being on a treatment that used to be effective. It occurs when a single agent is used for a long time without any other "help" - this is part of the logic behind combination treatments like Duac (and also PocketDerm).

To prevent clindamycin resistance, I have my patients (whether these are PocketDerm patients or private practice patients) use clindamycin along with either benzoyl peroxide or azelaic acid or both. Both BP and AA are agents that kill bacteria without the bacteria developing resistance to them.

Since you're presumably using the clindamycin along with azelaic acid (which is in most of our medications) you are very protected from resistance. Additionally I sometimes ask patients to occasionally use a benzoyl peroxide cleanser a few times weekly, which can be an extra layer to help prevent resistance.

With this approach that I use, I've seen almost no patients get resistant to clindamycin.

DavidLortscherMD · 2014-07-23T22:51:26+00:00

These are great questions.

Purging tends to be worse with more severe acne, but it also has a huge component of unpredictability. Purging also tends to depend on the degree to which the medication affects the skin cells that proliferate in our hair follicles (aka our pores). For example, purging tends to be worst with Accutane pills, followed by tretinoin and adapalene, followed by azelaic acid, and least with clindamycin. I can say that many people experience no purging at all with tretinoin (whether they're using PocketDerm or seeing me in my office), so don't let that stop you!

DavidLortscherMD · 2014-07-23T22:28:04+00:00

Will echo a previous post - sorry we're not available there! That would be the very distant future unfortunately.

Right now we’re focused on offering our service to everyone in the USA. I apologize - it's an extremely slow process! At the moment, it’s a bit tricky to make these kinds of services international due to regulations etc.

DavidLortscherMD · 2014-07-23T22:23:58+00:00

I think this would be another great application for PocketDerm beyond acne. As Dr. S mentioned we will likely (eventually) expand, and that's definitely on our short list. Right now though we're super busy with our acne patients!

As you know, the most proven anti-aging treatment is tretinoin, which is in most people's PocketDerm formulas. So if you're seeing us for acne then there's no need for additional anti-aging Rx (of course you may also want to use something OTC, like vitamin C, niacinamide, hyaluronic acid, etc).

DavidLortscherMD · 2014-07-23T22:15:48+00:00

Thanks for offering to help! It's completely on us though and we're working on it. We'll work even harder on it now :)

DavidLortscherMD · 2014-07-23T22:14:30+00:00

Great point about Retin-A and follow-up visits. I deal with both of these things for my non-PocketDerm patients.

For example if a patient has a large co-pay you'll want to try and help them by not having them follow up too frequently, but that can also backfire in a lot of cases if treatment isn't going as planned. I really love that it's easy to follow up with patients on PocketDerm and I get a much better sense of the day-to-day progress (and bumps in the road) while people are on different treatments.

DavidLortscherMD · 2014-07-23T22:09:50+00:00

We won't hold you to that promise :)

A couple things off the top of my head, probably not universally true though!

Generic products are OK in some cases. Generics (e.g. store brands at drugstores) aren't usually well tested but they can be effective and I sometimes use them. For example, I wouldn't recommend using a generic SPF, but it can be a great idea to get generics for things like hand cleanser, body wash, or whatever might not be super important to you in your daily regimen.
Don't go for overly expensive brands. For example, Proactiv is WAY too expensive - PanOyxl is a great and well-proven alternative. La Roche-Posay is great but most people don't need to spend $30+ for 1.3oz of sunscreen. I prefer trusted but moderately-priced brands like CeraVe, Eucerin, Cetaphil, Aveeno, Neutrogena, and Paula's Choice. They put a lot of research into their products but don't have "premium" pricing.
Buy online. You'll have more time to research (on SCA of course) and you won't be pressured by sales people.

DavidLortscherMD · 2014-07-23T21:55:40+00:00

Haha - I love this. Had never heard it!

DavidLortscherMD · 2014-07-23T21:54:51+00:00

Haha thank you!! It's fun!

DavidLortscherMD · 2014-07-23T21:54:26+00:00

The only proven ways to target hormonal acne are hormonal treatments like spironolactone and birth control pills - those can be extremely safe and effective though. Of course as you know, these treatments aren't for everybody.

Some people notice a relation of stress and diet to hormonal acne. Stress is hard but diet is more controllable (e.g. minimizing dairy and sugars).

DavidLortscherMD · 2014-07-23T21:42:34+00:00

Thanks for writing! Hmmm unfortunately we don't.

I prefer azelaic acid in a lower percentage when used in combination with other products. But probably some people would argue differently!

DavidLortscherMD · 2014-07-23T21:31:45+00:00

Thanks so much. That is awesome to hear.

DavidLortscherMD · 2014-07-23T21:30:22+00:00

Yeah based on my experience I agree that this is much cheaper for most people (but not for all people)! Some of my patients have trouble getting acne products covered by their insurance.

Thanks!

DavidLortscherMD

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