RE-LAUNCH: Why Acne Isn't Just Skin Deep

We’re bringing back one of our most popular episodes—and for good reason.

Acne isn’t just a surface-level issue. It impacts confidence, mental health, and how you show up in your everyday life. In this re-aired conversation, Sam breaks down what’s really going on beneath the skin and why acne can feel so overwhelming and persistent.

From oil production and clogged pores to inflammation, bacteria, and genetics, this episode simplifies the science behind breakouts in a way that actually clicks. You’ll also hear why acne is rarely just a topical issue—and how internal factors like hormones, gut health, food sensitivities, supplements, and lifestyle habits can keep skin stuck in a cycle.

We also revisit key insights on the difference between oil and hydration, how congestion builds over time, and why inflammation plays a major role in scarring and pigmentation long after a breakout is gone.

If you missed it the first time—or need the reminder—this episode is packed with education, clarity, and a more compassionate approach to skin health.

Because sometimes, the episodes that resonate most are worth hearing again

Transcript

SPEAKER_00 0:07

Hey y'all, welcome to The Skin Trovert. I'm your host, Sam Bazeal. And today we are going to talk about a pesky little pimple problem. Yes, we are going to have an education topic, and we are talking about acne. Acne is a rough situation for all parties involved. It's rough for the provider, it's rough for the patient, but way more for the patient. So the thing with acne is it is something that can completely destroy your life. Speaking for someone who knows, it is not a fun time. Reason being, acne affects more than just your skin health. It also affects your mental health. You know, when I was younger and I had acne, and mind you, no one told me this. This is just the same brain working. Um, I used to think when my face was covered in acne that people were looking at me and saying, ew, she doesn't know how to bathe, or ew, she's got poor hygiene, or ew, she doesn't know how to clean herself. Like that's the tricks that your mind plays when you have acne. Okay. It just destroys you. And it also causes you to withdraw. I didn't want to go with my friends or go to the parties or do the things because I felt like people were going to look at me and say that. And then nobody was going to want to be my friend. Okay. So it's miserable. And it's just as yuck for as for adults. You know, you don't want to go for the job because you think like your skin health is effective of, you know, what kind of a job you can do, or that's what people think. It really does affect your overall mental. So being someone who suffered with acne, I would have loved to have a provider that was holding my hand and that would have guided me. And that's really and truly what led me to do what I'm doing is I wanted to help myself, but I also wanted to be a resource for people because I don't know, man, being an aesthetician and being a part of someone's skin health journey, uh, it's one of the most rewarding things you could ever do. Okay. So back to the acne topic. So you're stuck with all this mess on your face. Your skin health is compromised and your mental health is compromised. It just sucks all around. So you want to be able to offer your patient or yourself some knowledge. We want to know why this is happening. We want to know how to fix it, and we want to know where it's rooted. Because at the end of the day, just putting band-aids over it is not a fix. You got to really be able to dig in there and figure out what's going on to get to the problem. So let's first talk about what it is, where it comes from. Well, it sucks because acne goes from a little tiny, little, tiny little ball and it just snowballs into something massive. Okay. And why does it do that? Well, some of us are genetically predisposed to producing excessive amounts of oil. And that's where it starts, my friends. It starts with oil. And people will disagree because you know, if you were like me when I was younger, I was told, oh, you're going to age so gracefully with all that oil. That's what my grandmother used to tell me. She a laya, okay? You don't age gracefully with oil. And the reason why people think that, to be fair, is they relate oil to hydration. So they think, well, if you've got all this oil, you're going to be nice and hydrated, so your skin's going to age gracefully. No, hydration, oil, not the same, okay? Oil is something that is produced in the hair follicle, down in the dermis of the skin, and it lubricates the shaft so the hair can exfoliate. And those of us who are genetically predisposed to having excessive amounts of oil, it's like a faucet turn all the way on and it just pours, pours, pours. Hydration also produced down in the dermis, but it's produced in the glycosaminoglycans of your skin. Specifically, hyaluronic acid is what hydrates the skin. So they're not the same, right? We want lots of hyaluronic acid. We don't want lots of oil, okay? So remember, like I said, it's like the faucet turned all the way on and you're just kind of spewing oil, oil, oil. Well, this is why it's problematic. It's problematic for two reasons. Number one, excessive amounts of oil can be highly inflammatory to the skin. Second, oil is very thick, waxy, sticky, kind of like glue. If I were to walk up to someone and harvest the oil off of their skin and put it into a jar, it's gonna resemble honey. Well, why does it not look like honey on my skin? Because of the temperature of my skin. It heats it up and then I just look like a greasy mess. But anyway you slice it, it's still thick, it's waxy, and it's sticky like glue. That's problematic because your skin should be naturally exfoliating cells. So, what do I mean by that? Well, all of us, our skin cells, it's our skin cycles through something called a keratinocyte maturation cycle. That is the time that the cells take to be born down in the basal layer when they're big and juicy like grapes. Well, then they go through a maturation process where they start to kind of dehydrate and flatten out and become grapes, I mean become raisins. Then they flatten out and dehydrate and die and become little pancakes, and then they flake off. Okay. That's a natural cell cycle and it also progresses more cells to be born. So while it's natural and healthy, those of us that have lots of oil, it's like glue. Instead of our cells naturally shedding off, they're just sticking and sticking and sticking and sticking. And then when that happens, it congests the hair follicle. When the hair follicle is congested, you start to notice things like blackheads, white heads, also known as open comadones, closed comadones. That congestion gives the perfect feeding ground for that acne bacteria. Acne bacteria thrives when it's all congested and dark, okay? So now you've just got this excess of bacteria. Well, then what happens? Well, our bodies were designed really neat by our creator, thank you, God. And our bodies are designed to detect invasion from bacteria and other harmful substances like allergens, okay? When your body detects an invader, it produces inflammation. That inflammation production is a way to ward off that invader, okay? And while the initial acute inflammation is good, it's healthy, it's how our body is designed to heal. If we never control the oil, if we never control the delay of cell cycling, if we never control having all that congestion in bacteria, what's going to happen? We're going to move from acute inflammation, which is good, to chronic inflammation, which is bad. Okay. So inflammation is happening, which is not good. And then when you're when you have this inflammation and injury, your body is going to respond. Those melanocytes are going to respond to injury with something called post-inflammatory hyperpigmentation, which is that brown pigment that's left over from injury, or it can be post-inflammatory erythema or PIE, which is the reds and purples that are left over from injury. So PIH or PIE both suck because they make all that those marks on the skin. Okay. And then the injury itself causes things like cystic or nodular acne, which then leads to scarring and textural abnormalities. So you see, it's just like this bad cause and effect. So if you're going to properly treat, it's important that you treat where you are in that journey. Okay, maybe you just have a little congestion. Well, maybe that's all you need is a little exfoliation. But if you're more advanced into that acne journey, you're going to need a little bit more. Okay. And a lot of people think, well, if I've got acne, I'm just going to throw this topical stuff, throw all these creams on it. And while creams are very helpful in treating, it's not the only thing that's going to make your acne go away. Trust me, we all want that magic wand. Acne, poof, be gone. And maybe one day in aesthetics we will get there. But right now, friends, we are not there and there is no magic wand for acne. Okay. So it's important that patients have realistic expectations. So they don't think, oh, well, if this one cream didn't work, my provider doesn't know what they're doing and this cream sucks. That's not it. Okay. A lot of times it's internal. And we're going to talk a little bit about that. Okay. So first let's talk about these amazing topical ingredients that can be very helpful for acne-prone skin. So my favorite is going to be a retinoid. Retinoids are derivatives of vitamin A that speed up cellular turnover. So we're increasing the skin's ability to exfoliate, which is great, remember, because our keratinocyte maturation cycle is slowing down from the oil. So when you're speeding it up, that's also helpful. Okay. Also, retinoids can be helpful with removing that superficial pigment, kind of cleans up all of that PIE and PIH. It's also really great for scarring because it can stimulate dermal renewal. So it's going to help with any deep dermal scarring. So retinoids to me are pretty much the gold standard. Okay. But there's other things that you can and should use. One thing that also helps with exfoliation is glycolic acid. Glycolic acid is considered an alpha hydroxy acid, okay? This particular alpha hydroxy acid promotes exfoliation by helping to encourage single cell exfoliation. So what do I mean by that? Well, our skin cells are bound together by little desmosomes, okay? They hold the skin cells together. And what glycolic acid does is it breaks apart the desmosomal bonds that holds the cell together so you can single cell exfoliate. Boom, boom, boom. So it's great for promoting exfoliation and usually very well tolerated by most skin types. Another acid that's helpful, it's a beta hydroxy acid, and that is salicylic acid. Salicylic acid is like a little pore vacuum. It just goes in and unclogs the pores. Okay. Tolerated well in most, but there are some skin types that are a little bit stubborn. So specifically, who is stubborn? Well, I've heard in the field, ooh, I have a salicylic acid allergy. Okay, well, I have other thoughts on that. So what am I thinking about that? Well, I don't think it's necessarily an allergy, as it is a sensitivity. So let me explain. Salicylic acid is a little crystal, okay? And when skincare um companies add it to their formulas for whatever reason, they add alcohol to the solvent to dissolve the crystal so that way it can be put into the product. So sometimes the sensitivity isn't necessarily the salicylic acid, it's more the alcohol that's in the formula. So if you've ever used a salicylic acid and you want to give it another try, maybe you had some irritation from it or it was problematic, I would encourage you to look for a product that has a water-soluble salicylic acid. Okay. There's my little tip on that. All right. Another really helpful ingredient, and in my opinion, it goes underrated: sulfur. Sulfur is antimicrobial, it also helps with oil control and it's anti-inflammatory. Sulfur is amazing. Some people stay away from it because it's stinky, it's got a little fart smell, but that's a sulfur smell. Okay. There's lots of inflammation, there's lots of products out there that have figured out how to kind of calm down that smell so you can tolerate the sulfur. And I would try and keep a sulfur with a higher percentage if you're trying to treat acne. So somewhere around that 10% is a good effective dose of sulfur. Okay. All right, some other ingredients that are going to be helpful: niacinamide and azoleic acid. These are great for the redness, the inflammation. So the angry acne. It's also really good for the post-inflammatory erytheme or the PIE. Really great for those reds. Anytime you can bring in anti-inflammatories for your acne patient, the better. Inflammation, remember, is the root cause of all of this evil. So as much anti-inflammatory as we can put into their routine, the more successful that we're going to be in treating that acne. Okay. Now, what about the post-inflammatory hyperpigmentation, those browns that are left over? Well, my favorite is going to be the all-time favorite, the gold standard for treating browns, and that's going to be hydroquinone. Hydroquinone is a suppressor, but it also has a bleaching capability. So it kind of bleaches and evens out all of the skin tone. It is a prescription and it is not something that patients should use long-term or independently. So you should always have a provider follow you on your hydroquinone journey. But those are my favorites as far as topicals. Yes, there are so many more, and I'm sure people are gonna be like, why didn't you mention this or that? There's tons of other options. These are just my favorites and what I personally look for when I'm treating acne. Okay. Now, is that the do-all, end all, be all? No. Topical intervention should not be the only thing that you're bringing into your treatment. Why? Because it's rooted internally. Okay. So if something is internal that's causing all of this, but all you're doing is throwing topical creams, are you gonna see results? Maybe. If it's a great cream, if it's a really great treatment plan treatment plan with that cream, but it's not gonna be the only thing. You've got to bring in more. So for example, you as a provider may recommend other in-office procedures. Maybe you'll recommend chemical peels to help, you know, get your patient there. Maybe it's gonna be things like microneedling for the acne scarring. There's tons of options, but it's not only one option. I always like to tell the patients because everybody wants a one and done, right? They just want this quick fix, but that's just not reality yet. Okay. So I like to tell my patients so they don't think I'm just trying to like sell them all the things. I always compare a treatment plan for the skin to be like braces for the teeth, all right? You're genetically predisposed to what's going on here, all right? The oil, the textural things, all these things is in your DNA, right? So if I, let's say you have crooked teeth, right? That's also in your DNA. It's also in your genetic makeup, okay, but you don't like your crooked teeth. So I'm gonna put braces on those teeth. Well, the teeth are gonna get everything nice and straight, okay? But those braces are gonna come off and you're gonna have to wear a retainer. And what happens if you don't wear your retainer? Muscle memory, those teeth are gonna wanna go right back to where they were because that is genetically how your teeth are supposed to be. Your teeth don't care if you don't like them being crooked. They love it being crooked because that's genetically how they're supposed to be. So, muscle memory, your teeth are gonna go back. Your skin has more of a memory, okay? So you have to be able to, yes, do the braces, but also wear the damn retainer, okay? And your topical treatment, your at-home care, is your retainer. You could do all of those braces treatments, the lasers, the chemical peels, all the in-office procedures. But if you're not going home and wearing your retainer using your skincare, muscle memory, they're gonna want to go right back to where they are. So make sure you're taking a good comprehensive approach to treating your skin. Yes, it's an investment. I know sometimes it can be costly, but anything to do in healthcare, it's gonna be pricey. That's just what it is, okay? Anytime you're investing in your health, you're gonna have to invest. So there's that. All right, so we've got our in-office procedures, we've got our topicals, but Sam, is that all? Is that the do-all end all? Sadly, no. Okay, so let's talk about what's going on internal because if we don't end up addressing the root cause, yes, patients are probably gonna see it continue to return. So remember, it starts with oil. Oil is an internal condition. Okay, it's your genetics. So if I bring on, let's say, an oil-controlling toner, is that gonna stop the oil from coming? No, it's just gonna defat the skin long enough for those other products to penetrate deeper. So then what helps to turn that faucet off? If I've got my faucet turned, my oil faucet turned all the way on and it's spewing oil, what's gonna turn it off? Well, some doctors will prescribe medications, specifically oral isotretinoin, otherwise known as accutane. Accutane in high doses shuts the valve completely off, which is why some of those accutane patients go through the side effects of being really, really dry because we're just shutting that valve completely off. Okay. There's also other medications out there that are more on the hormonal side of it that address more of the hormones. And that can be medications called aldactone or spirinolactone. Okay. Those don't necessarily turn the valve all the way off. It's more of like a halfway where you just have that little steady stream kind of coming. And for most patients, that's enough just to get it under control. So, yes, there are oral systemic options to shutting the valve or slowing down the oil production. But hey, maybe as a patient, that's just not what you want to do. Maybe that's not in line with how you want to treat. That's why it's so important to find providers that you mesh well with, that you share that same treatment and messaging with. You need to find a provider that you trust and stick with them and stop doctor shopping. Okay. Just saying that. So find someone that's in line with you because that's helpful when you're trying to treat internal. Okay. So you can, yes, do that. You can use some supplementation, things like that will help turn off that valve, but really and truly it's finding the root. Um, another issue is gut health. You know, I didn't believe this. I thought this was all woo-woo. Okay. I wasn't, listen, there was a time when I thought anything holistic was woo-woo. Okay. And I was like, these woo-woo doctors, but there's something to the woo-woo. And I'm figuring that out right now as, you know, being in my 40s. These woo-woo people have things kind of figured out. So back in my 30s, I had gone through this horrible breakout. And I hadn't had a bad breakout like that since I was in my teens. So I was like, what is going on? And I was exceptionally confused because at the time I was trying to pay attention to what I was eating. I was dieting, I was doing the right things. Okay. So I talked to my friend who was a doctor of naturopaths, and I was like explaining, and she was wanting to do all these tests that were pricey. Okay. And I was like, no, girl, I ain't doing that. And she's like, well, at the very least, just do a food sensitivity test and let's see if you're eating any inflammatory foods. And I said, Well, I'm not. I'm doing the chicken and I'm doing the eggs. I'm doing all the right things. I'm getting lots of protein in. And she's like, okay, well, I would encourage you to still try because even something like lettuce can be a problem for you if it's specific to your sensitivity. So I did the test. And let me say, food sensitivity tests don't tell you if you're allergic to something, it tells you how sensitive your gut is to that food. So I do the test and it brings me, you know, all the results of everything they tested for. And it'll either say it's a mild, um, moderate, or a severe like sensitivity. And guess what came back as severe sensitivity? Eggs and chicken. And that's all your girl was eating. So I cut it out. I started getting my protein from another source, and acne started to clear up. Imagine that. So it definitely can be gut related. One thing I would encourage you if you are a patient or a provider that's doing all the right things, but yet you're still breaking out, do you drink energy drinks? And if so, what brand? Because there's some brands out there like Alani, Celsius, um, that have B12 and biotin. And guess what? That is a major pigment trigger for acne-prone skin. Why? Biotin specifically is a trigger because biotin causes your skin to produce more keratin, aka skin cells, okay, which is why people utilize it for hair growth. Because if you're producing more keratin, your hair is gonna start to grow more. Problem with acne prone is skin is we already produce too much keratin. We have too many skin cells and they're all congested. So if I give my body something that's gonna produce more keratin, I'm just throwing gasoline at the fire. So avoid biotin. Secondly, B12. Why is that problematic? B12 feeds the acne bacteria. So if you have the existing bacteria, it's just gonna give you more problems. So I would avoid the energy drinks. I would also talk with your practitioner that's treating you if you're doing B12 injections or you're doing the B12 IVs. Could be what's what's that little pesky trigger, you know, that's hanging in there. So I would encourage you to just what you put in will certainly reflect out. Okay. So have that conversation with your patient. You need to avoid inflammatory foods. So things like um gluten, things like dairy, things like um sugar, okay. I when I was younger, ice cream, that was a hard, hard thing. Still is, no, still is. I hate to admit it, but ice cream, it's a bazile thing. You know, you should talk to my dad. We all have like ice cream addictions. It's terrible. But ice cream is a double whammy. It's dairy and sugar, okay? So always be conscious of inflammatory foods. What you're putting in can always be problematic of what's going on on the out. Okay. Another issue that I wouldn't encourage you to talk to your patients about, talk to them about what their lifestyles are like, okay, what they're doing. Because let me tell you, um, what you are doing to your skin as an acne patient matters. Specifically, I would encourage acne patients not to cleanse in the shower. I know that's like a taboo top subject, but when we take showers, you are taking piping hot showers. Okay. If you don't and you take a cold shower, you are a freak psychopath. And I'm not talking about you, I'm talking about the rest of society. Okay, when you're in that hot shower, if you are putting hot water on your face, you're keeping the heat and the inflammation in. And as acne patients, we want to just avoid inflammation at all costs. Okay. Also, if you're having PIH, you definitely don't want heat there either because heat is a pigment trigger. So it's going to produce more inflammation, more pigments. So I would get in the shower, wash your body, wash your hair, put your towel on, get out, and wash your face at the sink with cool water. I would also encourage you to only use disposable towels on your skin. Why? Even the hand rags that you have, if you wash them after every use, they harbor bacteria. So you're constantly keeping the bacteria present in the skin. Use disposable towels, okay? That's the best way to make sure you are not reintroducing bacteria to the skin. Okay. So there's lots of little tips and tricks that you can talk about with your patient. But point is lifestyle has to change, okay? Diet has to change. You have to walk this journey with a provider that is smart, understands your skin, and is willing to guide you. Those are the things that I didn't have. When I was on my acne journey, I was given a prescription. Here you go. Hopefully that works. And if it doesn't, we'll follow up. It was just medications throwing at me. It was not Sam, this is what you need. This is what we have to do. And I hope and I encourage if you're a provider watching this, be the better provider. Okay. Be the provider that is going that extra mile, that is going to educate the patient and talk to the patient about what is happening in the skin. Why is this happening? This is how we need to treat. And guess what? I'm going to be right here to hold your hand. I'm going to help you on this journey. And look, if this doesn't work, we're going to pivot. Because guess what? I, as a provider, can make recommendations for your skin based on face value. Okay. What I see, what you tell me, I'm going to build this plan. Your skin may go home and go, no, girl, that ain't working for me. We need to pivot. Okay. Because what works for you is not going to work for every single patient. Okay. You have to be, you have to be flexible as a provider to pivot. And as a patient, you need to give your provider grace. Okay. Even the smartest, most competent provider is not going to be able to say exactly what is for you. We have to, it's a trial and error and it's a journey. And the sad thing is it's a skin health journey that never ends. Okay. We are in an aging world. Okay. Everything is just going to keep, there's no stopping the clock. Okay. So the journey is ongoing. It's forever going. And you need to be patient and able to walk that journey with the patient. Okay. Hopefully you guys got some really great information, just some basic acne education. I can't wait because soon, soon, soon, I'm going to have a functional medicine doctor, a practitioner, let me correct myself, practitioner, that's going to join me and be a guest on this podcast and share all of the things that are important to help your acne patient heal truly from the inside out. What I gave you today was nothing on what this provider is going to be able to share with you. We'll talk about certain testing that can be done, why that testing is recommended. And that way you can be empowered as a patient and a provider to really take your acne treatments to the next level. So I hope you enjoyed this information. And like I always say, do you agree? Do you disagree? I want to hear from you. Please let me know your feedback on today's episode if there's something that you don't agree with that maybe I could, you know, learn more, you know, expand my knowledge. I'm always down for that. Or if you'd like to be a guest on my podcast, or if you have a specific topic that you think we should cover, I want to hear from you. You can reach out to me on all social media platforms as the skintrovert, or you can email me directly at theskintrovertsam at gmail.com. And please, if you enjoyed today's episode, I would love it if you would follow me on all podcast platforms. Leave me a five-star review if you feel inclined, and subscribe. Until next time, thanks, guys. Y'all have a wonderful day. Take care. Think of the skintrovert as your aesthetics roundtable, not a training manual. This podcast is for professional education and discussion. It's not medical advice. Your scope of practice matters, regulations vary, and your license always leads. To continue the conversation, follow the Skintrovert on Apple, Spotify, or any platform that you listen to your podcast.