“Stop picking your face” we say to ourselves, but as the day progresses, we find ourselves scratching, popping and aggravating pimples, bumps and anything that rises above the surface of the skin. Here, my patient and I share a real life journey of skin picking and solutions that have worked.

“I can go an entire weekend without touching my face, but as soon as I’m back at my computer trying to concentrate, I find my hands instinctively going to my face without even realizing it,” says Emily*, a patient who came to see me for her skin picking habit over a year ago.

Skin Picking at Desk

This is so much more common that people realize. I see many patients in my office who have strong urges to pick their skin, even though they know it creates scarring and infection. That’s why I’m sharing this blog with you. Here are some ways that I help patients in my office to combat this very real (and common) urge.

You Are NOT Alone: It’s Okay to Be Honest About Your Habit with Your Doctor

Fact: It’s estimated that 75 percent of people with a picking disorder are women.

When a patient comes into my office with this issue, she often doesn’t want to admit it initially. So, my goal is to make her feel comfortable and realize she’s not being judged. I’ll say something like, “It looks like you’ve been on the attack!” and then I’ll ask what’s been going on, and if there have been any recent stressors she wants to discuss.

The first objective is to let the patient know she’s part of a team and will have a partner to tackle the habit. It’s not about “curing” the patient or chastising her if she falls off the wagon and has a bad night.  It’s about coming up with a personalized strategy that helps that patient feel more in control.

“My skin has gone through ups and downs over the years,” Emily says. “My stress levels cause my picking to flare, but when I follow Dr. Bowe’s advice, my skin always improves.”

Retrain Your Brain to Be Mindful While Keeping Your Hands Busy

Often, this is an unconscious issue so we have to bring mindfulness to the behavior and help the patient realize when he or she is most likely to pick. Many of my patients pick most when they are sitting in front of a computer screen, trying to meet a deadline.  Others pick when they finally find time to unwind in the evening, relaxing in front of a TV screen.  I often suggest keeping a “Hands off!” sticky note on the computer screen or on the TV remote to call attention to the picking and remind the patient not to engage.

Sometimes just redirecting the patient’s attention to another “neutral” activity can retrain the brain to do something other than pick.

fidget spinner skin picking

“What makes it difficult for me to stop picking is the fact that I do it without thinking about it,” Emily says. “Dr. Bowe suggested I keep my hands busy with a fidget toy when I’m concentrating.” That habit has been successful in keeping Emily from picking at her skin. Some pickers may use a stress ball or spinner to keep their hands busy.

Use Tried and True Approaches to Skin Care that Minimize Breakouts

 I take a “field” approach with my patients. Rather than treat specific spots and chase the breakouts, I focus on keeping the skin healthy and clear. I encourage superficial in-office peels and a topical retinol alternating with an antioxidant.

Spot treating can’t hurt, but it won’t prevent pimples because you treat one pimple in one place, and another erupts in a completely different spot the next day. I’m all about staying one step ahead so no one has to resist the temptation to squeeze!

“Dr. Bowe mentioned that the best way to stop picking is to not have anything to pick,” Emily says. “Now I get monthly peels and use a topical retinol which has helped treat the breakouts.”

Meditate + Upgrade Your Diet

 Figuring out what triggers and aggravates the behavior is crucial. Stress is almost always a factor, so I encourage my patients to take out time to engage in calming, tension-relieving activities. Blocking out time to practice yoga, take a spin class or just spending time outdoors and experiencing nature can be incredibly therapeutic during high-stress periods. Patients who pick tend to be very successful, and many are perfectionists.  They often feel guilty taking time for themselves, but that’s one of the most critical steps on the road to recovery!

Yoga and skin health

Simply focusing on breathing can also help. Studies show that deep breathing triggers a relaxation response that relieves emotional stress. Just taking a few minutes to take deep breaths can lower cortisol levels and reduce stress all day long. I recommend trying a meditation app like Breethe / or guided meditation on Insight Timer or even the Oprah and Deepak Chopra 21-Day Meditation Challenge.

Ingesting certain plants called adaptogens can also help the body resist stress and lift energy levels. Many of my patients find that stimulants, like caffeine, can exacerbate their picking. I often recommend trying adaptogens like this one to support productivity and focus without relying on extra doses of caffeine (which lead to anxiety, which leads to picking).

Don’t Be Afraid to Ask For Help

When people are battling compulsive picking, getting medical help is essential. I advise my patients to schedule regular appointments for peels or in office light based treatments or to come in as soon as a cyst emerges for a cortisone injection. Often just knowing they’re coming in to see me makes a patient feel in control and accountable.

But there are some extreme instances when a mental health professional may be necessary. According to the International OCD Foundation, picking is a concern when it’s repeated, causes damage, interferes with daily activities and causes distress. In these instances, SSRI medications and cognitive behavioral therapy can work in tandem with a skin care regimen to reduce the urge to pick.

I’m honest with my patients and let them know it’s a journey, but one they will not have to endure alone.

“I’ve been seeing Dr. Bowe every three to four months for several years and my skin has dramatically improved,” Emily says. “My overall skin texture has improved and my acne is much less of a problem. But the biggest change is in my confidence level. I’m not distracted by my breakouts and I can talk to people without having anxiety about my skin.”

Dr. Whitney

*Name changed to protect patient’s privacy.

You are NOT alone in the primal urge to pick at your face- especially if you have a below the surface blemish or bothersome zit. BUT, here’s our real-world, skin-saving guide to allowing your skin to heal without making it worse!

Sometimes we’re our own worst enemies when it comes to our skin. If you’ve ever been obsessed with a blemish, you understand the self-sabotage. And maybe this sounds familiar: “When I consciously pick at my skin, I know deep down that it won’t help, but somehow I convince myself that this one time picking will suddenly make the breakout less apparent,” says Emily, a self-described chronic picker who has consulted Dr. Whitney Bowe, author of The Beauty of Dirty Skin, for help.

“I can’t tell you how many of my patients avoid eye contact, feeling some shame that they’ve “attacked’ a pimple and tell me how embarrassed they are—it happens all the time,” Dr. Bowe says. “If you’ve picked, the first thing I want you to realize is that you’re not alone. I probably have this conversation once a day in my office!”  

This two-part installment will reveal what drives this all-too-common behavior and how to treat it—and how one woman has overcome her picking compulsion.

Part 1: Picking—a Fight

There’s actually a good reason why it’s so difficult for us to leave our skin alone: “Popping a pimple or picking at your skin offers relief and gratification that rushes the brain with calming neurotransmitters like dopamine and serotonin,” says Natalie Gluck, MD,  a physician and board-certified psychiatrist in New York City. “In some cases people experience tension that can only be relieved by picking.”

The problem is that any time you pick, squeeze, pop or otherwise handle your skin, you risk infection and scarring. You’ll prolong the amount of time it takes a pimple to heal and spread oil, dirt and bacteria on your skin that can cause more breakouts—creating a vicious cycle. So a hands-off policy is one your dermatologist will always advise.

That being said, dermatologists are also human and understand that ignoring a blackhead or letting a whitehead run its course is not exactly realistic for anyone within arm’s reach of a magnifying mirror. There are, however, a few dermatologist-approved strategies that can be effective for anyone who wants to reform her picking habit.

5 Ways to Beat the Urge to Pick Your Zits for Healthy Skin

Get the red out.

If you reduce the inflammation, the blemish will be less glaring and less inviting to pick. Treat the area with a cold compress and hydrocortisone to calm the swelling and redness.  Spot treating with tea tree oil can also dial down the red, as tea tree oil acts as an anti-inflammatory. One of Dr Bowe’s new favorite spot treatments is this roller ball that coats just the right amount of salicylic acid and essential oils to dial down the red.

Make a note.

Before you get in a trance and spend too much quality time obsessing over your pores, put a reminder on a sticky note and put it on your mirror. Seeing the phrase “HANDS OFF” or “NO PICKING” may remind you to stop before you start.

Hit the spot.

If it’s oozing or juicy, you might consider a a blemish treatment containing salicylic acid or benzoyl peroxide to start the healing process and dry it up. If you can, apply something that coats the pimple with a visible layer so you’re less apt to touch it.  Dr. Sandra Lee, a dermatologist at Skin Physicians & Surgeons in Upland, CA who is known as Dr. Pimple Popper, advises her patients to put a band-aid on the blemish if they can stay at home. The bandage acts as a literal barrier to picking and help them resist the urge to do more harm.

Know when to squeeze.

If you absolutely cannot keep your hands off, only touch a whitehead—the inflammation is at the surface and popping it is less likely to cause scarring or discoloration than handling a solid red cyst. Very gently apply pressure to release the pus, as soon as you see the white at the surface or if you see blood, stop immediately and apply a cold compress followed by a spot treatment.

Call your dermatologist.

“Often making an appointment to see me can help my patients stop from attacking a pimple because they know they’ll be seeing me soon,” Dr. Bowe says. “And a simple cortisone shot can make a deep cyst disappear in a few hours.”

Can’t stop?  Consult your dermatologist if this may be a true medical condition.

Determine if picking is causing you mental distress. “Sometimes picking is a form of obsessive compulsive disorder called excoriation disorder,” Dr. Gluck explains. “Picking becomes a clinical condition when it causes extreme distress or you spend significant time doing it.” A visit with a mental health specialist can determine if medication or cognitive behavioral therapy (CBT) will help with the underlying anxiety. But focusing on a single pimple isn’t a disorder—in most cases people stop once the blemish heals, Dr. Gluck explains.

Consider this unconventional but popular way to get your pimple fix:

As a testament to how alluring the satisfaction of picking can be, Dr. Pimple Popper  has a YouTube channel with more than 4 million subscribers!  Logging on and getting a vicarious thrill from watching a trained professional clear a blemish is much safer than doing self-harm and may reduce your urge to pick. “I think watching my videos is actually relaxing and decreases anxiety in those with skin picking disorder,” says Dr. Lee. “People tell me that watching these videos calms them.”

Dr. Bowe’s Bottom Line: If you can’t make it to a dermatologist, follow the advice above and take a proactive approach to your skin. Spot treatments aren’t a long-term solution. “You treat one spot and another erupts the next day in a different location,” Dr. Bowe says. Instead, she addresses the face as a “field” and uses ingredients like salicylic acid or retinol to the entire area. “This way you stay ahead of the game and you won’t find yourself struggling to resist the temptation to squeeze!”

Stay tuned for our next real woman’s story about finding solutions to picking. Plus, hear how Dr. Bowe’s expert support helped her cut down on aggravating her own beautiful skin.

 

You have probably heard that probiotics, the “good” live bacteria, helps keep your gut healthy. A considerable amount of research has also shown they can help support a healthy immune system, boost weight management and even improve your mental health. But one New York City dermatologist claims the “helpful” bacteria can even lead to clear, radiant skin.

“There’s ground breaking new science showing that the gut and the skin are intimately connected,” Dr. Whitney Bowe, a dermatologist and author of “The Beauty of Dirty Skin” told Fox News. “People don’t realize we have live bacteria covering our skin and swimming through our intestines and if we find a way to harness the power of these microscopic warriors we can do magnificent things with the skin. They can target things like acne, rosacea, eczema, premature aging, and skin cancer.”

In her book, Bowe describes how your gut’s microbial inhabitants, also referred to as your intestinal flora, are workhorses.

“They assist with digestion and the absorption of nutrients: you can’t nourish yourself effectively without them,” she said.

“Because gut bacteria can control certain immune cells and help manage the body’s inflammatory pathways, it is said that the gut (including its inhabitants) is akin to your immune system’s largest ‘organ.’ Gut bacteria may ultimately affect your risk of all manner of chronic afflictions…[including] dermatological issues,” she explained.

The global skin care products market is projected to reach $177 billion by 2024, according to a new report by Grand View Research, Inc. Bowe said her patients often think they have to spend a fortune on expensive creams and procedures to get gorgeous skin, but realistically those avenues are like putting a Band-Aid on.

“They’re not getting to the root of the issue, if you want to get to the source of the problem you really have to think about what you’re eating, what your putting into your body and the health of your gut. An inflamed gut shows up as inflammation of the skin,” she said.

To start introducing probiotics into your life, begin adding certain foods and beverages, a daily probiotic supplement and then skin care products if you want to target a specific skin issue, Bowe said.

“When it comes to your diet you want to start incorporating foods like yogurt, kimchi, sauerkraut, sipping on some kombucha, that’s a fermented tea,” Bowe said. “If you’re somebody who likes to use say protein powder in your shake or smoothie, you want to look for the words ‘fermented’ on the label.”

For a daily supplement, Bowe warns that starting with a high dosage could lead to uncomfortable gas if you introduce too many probiotics at once. Aim for 10 to 15 billion CFU each daily, Bowe recommended.

Since your gut contains trillions of bacteria, there are different bacteria strains that can address specific health issues. You can look for supplements that contain certain bacterial strains that are good for acne or other conditions like eczema, but Bowe’s believes diversity is key.

“We know that the more strains we incurporate in both our diet and in our skin care, the better,” she said.

Skin products are also finding their way into the probiotic industry. While research on topical probiotics is still in its infancy stage, Bowe has been testing and vetting such products to find out which ones really work.

“Using a probiotic topical not only provides a protective shield, preventing harmful bugs in your environment from taking hold and causing infection, but also triggers the production of natural moisturizers in the skin, keeping the skin barrier healthy,” she said.

Why are more and more adult women experiencing acne than ever before and what can we do about it? I’m answering these important questions on Megyn Kelly Today!

Dr. Whitney Bowe shares her expertise on acne – how to treat it, how to prevent it, and whether popular social media posts offer a one size fits all solution.

As a dermatologist, I see the emotional and physical scars of acne in my office every day. This skin disease can be devastating in terms of self-esteem and confidence – its impact is very real. I have focused on acne for this very reason for many years in my practice and during my residency. Actually, as a dermatology resident, I studied the relationships between acne and emotions and published several papers on the topic.

Meanwhile, despite the fact that acne is the most common skin condition in the United States, its mental and emotional toll continues to be underappreciated.

However, there is now hope for recognition of this reality and a change due to a new study in the British Journal of Dermatology. Researchers from Canada used a very large United Kingdom database which tracked visits to primary care doctors. Remarkably, the sample size of acne patients involved 134,427 men and women (compared to 1.7 million controls without an acne diagnosis)! After an initial diagnosis of acne, the researchers looked for a subsequent diagnosis of major depressive disorder over the next 15 years. There was an increased risk of major depressive disorder within the first 5 years after an acne diagnosis, especially in the first year – 63% higher in patients with acne. The key word here is disorder; that is, levels of depression serious enough to interfere with daily functioning. Major depressive disorder is its own bona fide risk factor for many other diseases and is, of course, potentially life-threatening.

This study joins several other recent studies which have looked at acne patients over time — in 2016, researchers from New Zealand found that acne patients (in a study spanning 23 years) had a 45% increase in anxiety disorder risk. My acne patients are also much more likely to struggle with either anxiety or depression, as demonstrated in these studies.

Clearly, skin disorders are NOT just skin deep. In fact, the skin and the brain are intimately connected, and as dermatologists, we need to evaluate each patient in an integrative, comprehensive way if we truly want to determine the best course of treatment. I have been taking a comprehensive approach to my patients for years, asking about their stress levels, sleep patterns and coping mechanisms in addition to examining their skin, and this study only provides even more evidence supporting this approach. I want to bring this discussion to the forefront. It’s a reality that many people live with every single day and cannot and should not be ignored.

Antioxidants are absolutely essential when it comes to radiant, healthy skin. Let’s start with what antioxidants do: antioxidants pack a powerful punch to fight free radicals. Free radicals are like bullets or missiles, and they destroy everything in their path. They are highly reactive forms of oxygen whose effects can damage cell membranes and other structures in the body, including DNA and collagen. Free radicals come from both normal metabolic processes such as exercise and respiration, but they also come from external sources such as pollution and the sun. When you are exposed to a lot of free radicals, it means you are suffering from oxidative stress, and too much oxidative stress can lead to premature aging, skin cancer, and chronic skin conditions like acne. The take home message here: we do not like free radicals.

Enter antioxidants! Antioxidants help squelch and neutralize free radicals so they stop them from damaging your skin. Studies show that antioxidants not only slow down the development of wrinkles and age spots, but they also fight against skin cancer and even keep inflammatory skin conditions under control—conditions like acne, eczema, rosacea, and psoriasis. The take home message here: we love antioxidants!

When it comes to addressing skin conditions, antioxidants are key! For example, because antioxidants help control inflammation, if you’re prone to any skin issue rooted in inflammation- which can mean eczema, rosacea, or psoriasis – they will help relieve those stubborn conditions.

Antioxidants are also proving to be helpful in combating acne. New evidence suggests that free radicals and oxidative stress play a role in the initiation of acne. It is now documented that people with acne tend to have lower levels of cellular antioxidants and higher levels of markers of oxidative damage. We are learning that inflammation is actually one of the very first steps in the acne process. One theory is that free radical damage to skin’s natural oil, or sebum, appears to be a match that lights the inflammatory process. The process is called “lipid peroxidation,” or “sebum oxidation.” If we can stop this process from happening, could we possibly prevent acne from spinning out of control? Based on this exciting new knowledge, I recommend my acne-prone patients in particular make sure they are getting plenty of antioxidants.

And last but not least, numerous studies have demonstrated that antioxidants can slow down or even reverse signs of aging including fine lines, wrinkles, and brown spots. They do so primarily by protecting the skin from the ravages of sunburn, inflammation, and DNA damage.

So, it’s clear that antioxidants are important for your skin’s health. But, the question I get all the time in my office is – what’s the best way to get them? Should you use antioxidants topically through skincare products or orally through what you eat?

The answer is: BOTH.

Antioxidants are unstable, and they get used up very quickly, especially if you produce or are exposed to lots of free radicals. So it’s critical to replenish your antioxidant stores both internally and externally morning and night, and even more frequently if you engage in intense exercise, live in an urban center with lots of pollution in the air, or expose your skin to the sun.

For specific product recommendations, keep your eye on my Dr. Whitney’s Picks page and sign up for my VIP newsletter because I will be sharing much more on this topic with my VIPs!

QUESTION 1: What helps with acne scarring?
ANSWER: When it comes to acne scarring, there are many options that can smooth out those scars, but they usually work best when used as part of a personalized treatment plan. Topical retinoids are key to use at home, as they help to rebuild the collagen especially in atrophic scars (ones that appear depressed or have a shadow). If scars are raised (so called hypertrophic scars), then cortisone shots can make a huge difference. For ice pick scars, and many types of rolling scars, I usually combine lasers with microneedling and fillers. I use lasers like the Fraxel laser to resurface the skin. Microneedling is amazing for acne scars as well. I can combine microneedling with your own plasma (the so-called Vampire Facial), or I can combine microneedling with radiofrequency energy (the Endymed Intensif). Last, chemical peels can also help to slowly even out the tone and textural changes associated with acne sequelae. (more…)

Question 1: How do I get rid of cystic acne?

ANSWER: Cystic acne is usually a result of hormones, stress and diet. The cysts are deep, and often tender or even painful, and they tend to stick around for what feels like FOREVER! If you try to pop them, nothing comes out because they’re not connected to the surface. You usually end up making things worse. When the cysts resolve, they leave marks that can sometimes last for weeks or even months.

Ok, enough doom and gloom. What can we do to treat or prevent cystic acne? Although the typical acne creams with retinoids and benzoyl peroxide can’t hurt, they don’t do much in cases of cystic acne. To treat cystic acne, it’s best to use a multimodal approach. First, diet and stress are key factors in this kind of acne. More on how to make some dietary and lifestyle changes that will help prevent cystic acne below. Second, many of my patients with cystic acne benefit from prescription hormonal medications such as birth control pills or a medication called spironolactone. If you’re going the birth control route, you should make sure your pill contains BOTH estrogen and progesterone. Progesterone only forms of contraception (the “mini-pill,” implantable devices and even some IUDs can make cystic acne MUCH worse). Spironolactone has literally been a game changer in my practice. It’s a pill you take every day that blocks the effects of male hormones on the skin, and can dramatically clear up adult female acne. But I like to keep the doses low and to do that, I need to make sure my patients are following the right diet and reducing their stress levels as much as possible. That’s one of the reasons I wrote The Beauty of Dirty Skin (link below). It’s easy to write a prescription, but diet and stress management is complicated! You can write chapters on those topics… so I did! Last, I like to tackle cystic acne using minimally invasive procedures in my office like cortisone injections, chemical peels and light-based therapies.

Question 2: Is there anything other than Retin A, cortisone injections to treat cystic acne? What preventative steps can be taken in terms of diet and lifestyle?

ANSWER: Cortisone injections can be amazing if you can get in to see a derm, but that’s easier said than done for most people! When it comes to diet, it’s essential to avoid skim milk, as this has been shown in a number of studies to trigger acne. But also beware of milk proteins that might sneak their way into your diet: whey and casein can play a major role in acne for some people, and they are commonly found in protein powders and “healthy” bars that are high in protein. High cortisol levels can also make cystic acne lesions explode all over your chin. It’s essential to start making lifestyle changes that drop those cortisol levels and keep them in a healthy range. One tip for doing that is incorporate regular exercise. Regular exercise reduces stress levels very effectively and helps you sleep better (which in turn further reduces your stress hormone levels in your blood).

Question 3: Are regular treatments like peels or lasers something that should be considered to minimize future cystic acne breakouts and/or reduce residual scarring?

ANSWER: Absolutely! My patients who can afford to get regular peels and light-based therapies see a huge difference in their skin FAST. Salicylic acid chemical peels combined with Theraclear (also called Acleara) light treatments are incredibly effective and work FAST. In my practice, I use a number of lasers and devices to improve acne scarring and minimize pore size, including Fraxel, Endymed Intensif and Microneedling. However, these treatments can be costly and those costs can add up.  Even without these therapies, if you use the right skincare products and make certain lifestyle changes (detailed in my book – The Beauty of Dirty Skin), you can achieve beautiful, radiant skin on any budget!

xoxo,

Dr. Whitney

I wanted to share more insight into the food swaps for beautiful, clear skin that I discussed on GMA!

Skim Milk

As I discussed on Good Morning America, a number of studies are now showing that if you drink dairy milk, you will be more likely to struggle with breakouts and acne. We believe this issue arises from a combination of hormones that are found in the milk as well as milk proteins like casein and whey. Skim milk has actually been found to show the STRONGEST link to acne flares.

SIMPLE SWAP #1:

Instead of SKIM MILK, choose ALMOND MILK OR COCONUT MILK. Both are low in calories and are delicious!

Whey Protein Dietary Supplemnents:

As I also mentioned on GMA, the vast majority of protein powders and nutritional bars are made with whey protein, which has also been shown to contribute to inflammation and acne in the skin. Many of my friends and even my family members drink shakes containing whey protein daily as part of their meal plan! However, many athletes who use whey powder in their shakes or eat protein bars made with whey are finding that they are breaking out on their faces, chests and back.

SIMPLE SWAP #2:

Instead of WHEY PROTEIN SUPPLEMENTS, opt for VEGAN OPTIONS. Many of the companies that make these dietary supplements now offer vegan alternatives which do not contain whey. Look for pea protein or rice protein!

Refined Carbs:

If you are breaking out, you want to make sure to avoid refined carbohydrates like white bread, cornflakes, chips and pretzels.

SIMPLE SWAP #3:

Instead of REFINED CARBS, choose QUINOA, BARLEY or SWEET POTATOES. These choices are great for your skin and for your waistline!

@DrWhitneyBowe

RT @DrOz: Could you be buying fake beauty products online and not know it? @DrWhitneyBowe reveals what could be in these counterfeit items.…

@DrWhitneyBowe

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