Does Stress *Actually* Age Your Skin? Is Cortisol Face Real? Dermatologist, and Psychiatrist Dr. Amy Wechsler Reveals All. Plus! A Walk-in Clinic for Acne Treatments

24:42Right. Is it lowering your stress level? I'm sure. Do patients who take antidepressants have better skin? Many of my patients are on antidepressants. Better skin in what way? Well, if stress is a big factor for your skin and you're taking antidepressants and it's an SSRI, like what, is that helping your skin? Have you? I don't know. Right. But I do think being less depressed is definitely good for your skin. So if taking the SSRI helps lower your depression and anxiety, like for sure, that's got to be good for you. And also you're probably sleeping better and that's good for your skin. So it's all connected.

25:21But there was a study, there were a study years ago on Botox here in the glabella, decreasing depression. So this is the 11s lines, everybody, between the forehead. And when people are depressed, they're often furrowing their brow. And lots of studies show that if you can't make a certain facial expression, you can't feel the emotion associated with it as strongly. So if you're smiling and laughing, very hard to feel sad. Right. And if you can't furrow your brow, it's been proven, you can't feel as irritable or sad or depressed. Now I said to everyone, like, don't go stop your antidepressants.

25:56Just get Botox. But it's an adjunct. And patients will often come in and say, I started to feel a little bit down before I noticed that my lines came back. And then I knew I needed to make an appointment. Yeah. I remember reading that. It's fascinating. So everybody can bookmark this episode and play it for their husbands because you now have a budget for facials and Botox. So that's amazing. Yeah. Okay. So we want to talk about the big news of the hour. So you recently opened first of its kind acne clinic in New York's Upper East Side called Spotless. Tell us what this is all about. OK, thanks for asking me.

26:33I can't wait to talk about it. So my daughter Zoe and I have a startup called Spotless and we conceived of it while I was in business school. I graduated last year. Congrats. Thank you. And it's an acne clinic. Spotless is an acne care company. So we're opening acne clinics for walk-ins and appointments. And we're also creating products. And we'll be selling curated products in the front of the spot called the Spot Shop. And all of the products are non-comedogenic. So we'll be totally safe for anyone with acne and fragrance-free. Wow. Okay, this is big news. Thank you. So you're launching a clinic, but also your own skincare line?

27:12Yes. Oh, wow. The skincare is going to come later. We've got our first product, which is a spot treatment in research and development right now. OK, so you have to tell us about this is like completely new. Is it a walk in clinic? Is it a by appointment only? How is this going to work? So it's both walk in and by appointment. OK. Staffed by nurse practitioners. I've written the curriculum. Everyone's training with me. I'm the chief medical officer and CEO. and what I, one of the main reasons I went to business school is because Zoe and I, we'd had a podcast in the beginning of the pandemic. It was our passion project.

27:47And the most fun thing about it was working together. So it was home doing college on the couch because of COVID. And I always had these kind of nebulous entrepreneurial ideas, but I thought unless I actually go to business school, I'd never taken a business class before and learned how to really do it on my own. I wouldn't actually try. So I always like to say like, I couldn't convince Zoe or Jade and my son to go to med school. So I went to business school. And in the middle of school, we conceived of spotless. So my business, which is a boutique practice on the Upper East Side, is not scalable.

28:22It really requires me. But one of the most important things I do is take care of acne because of all the psychological overlay, depression, anxiety, effects on self-esteem and confidence. And I've got drawers full of handwritten thank you notes over the years from patients whose skin I've cleared up because might sound a little cheesy, but it really does change people's lives. Like they feeling better about yourself and being confident, like makes people take healthy risks. They, they audition for a role. They, you know, interview for a new job. They go out on a date, they try out for a team, whatever it is, they stand up taller in the world, right?

28:58It just really doesn't. I remember how I felt when I had horrible acne as a teenager and how I felt when it cleared up. And so I thought, okay, I think I can scale the acne piece of the business. So I, and I thought of it together. And so that's what, that's what we're doing. So we're, we're all acne all the time. One of our taglines is breakout, pop by. Yeah. And we're going to be ground floor, you know, walk-in clinics. It's going to look very cool and inviting, but also exude expertise. Right. And we're training our nurse practitioners very rigorously. We're all about hospitality and patient care because I want to recreate what I've created in my office, which is that from the moment someone walks in the door of my office to the moment they leave, they're well cared for.

29:49And we understand that people walk in off the street like stressed out, right? Whether it's New York or any city. And maybe going to the dermatologist isn't the most stressful doctor to go to For some people it is, but our job is to lower their stress levels and make them feel heard and cared for. And so that's what Spotless is going to do. And to just have a destination that's just for that, I feel like is so smart. Yeah, it's like a blood dry bar for acne. Exactly. And we're going to be open nights and weekends and also some early mornings because there's so many barriers to entry for people to go to a dermatologist.

30:20Absolutely. And everybody has acne emergencies. Yes. So you can come in and get a pimple shot and the next day it'll be gone. Yeah, I need it for this. I was going to say you should have brought your cortisol or what is it called? Cortisone shot. Yeah. Next time. How's it called? If you want to come to the office tomorrow, just text me. Oh, no, I'll be performing surgery on this. No, no self-surgery. I can see you in the morning. I have to tell you. So we are Canadian. I remember that a dermatologist walk-in clinic opened in Toronto, not specifically for acne, just a dermatologist walk-in clinic.

30:59And at first it was great. It was awesome. It just became inundated because we have such a backlog with dermatologists. It takes months and months to get in. So it's just a place I can't even use it anymore. Like if my son has a rash and that's something not just aesthetic, I can't even go there. Is there just one location of that place? Yeah. So I wonder if this helps to solve a problem with how your system works with dermatologists or tell us about that. So we all we don't have that many dermatologists either. We're different. We don't have socialized medicine here, but there aren't that many dermatologists trained in the U.S.

31:39every year. And so it's really hard to see one. There's often a really long wait. If you go through insurance, you know, it can wait six months. If you're paying privately, it's expensive and you could still wait a while. And then dermatologists, probably the same in Canada, are mostly open nine to five. That's right. And that's when everyone's working in school, at rehearsal, at practice. And so that's another barrier to going. Right. We want to make it really easy, really efficient. Yeah. And so and we need to have multiple locations. I was just going to say, so will it be kind of like a studs or something like that?

32:13Yes. Like there will be multiple locations. Yes. OK, I love this. That's great. First one Upper East Side, 75th and Lex. Second one will be downtown. OK. And then we'll go around the year. Do you think the second one will be early next year? OK. Yeah. OK. Very cool. And in terms of like professional treatments that you would get on site, what are you what are you what's on the menu? So we have a few treatments on the menu. Pimple shots. Yeah. Which is dilute steroid right into the pimple. And then the next day it's so much better, often just gone. So that's great. Acne extractions, which are good for blackheads and whiteheads.

32:47So someone isn't doing it. at home. And acne chemical peels with 20 % salicylic acid. There's no downtime with that, but it just cleans out the sticky cells that clog the pores. And then I think like very important consultations and prescriptions. So we'll be prescribing topical medications and oral medications, and then we'll be doing follow-ups. Right. Right. And so you'll have that instant care if somebody has an acne emergency, but over time, that's when you'll have the take-home skincare as well. Yes. Sort of as an adjunct to get them on a routine. Exactly. And right away, we'll be selling products from a bunch of companies that we love.

33:24And we've chosen and curated, you know, one or two from each of these companies. Everything safe for someone with acne, everything fragrance free. So for everyone, we want boys and girls and men and women to be coming. Okay. Now I need to know which brands you have. Dr. Wexler has curated for the Spotless Clinic. So there are a bunch of brands and it's specific products within each brand. OK. So, for example, there's a cherry pick. We are professional cherry pickers. So go on. So there's, you know, two products from Clinique, from La Roche-Posay, from Sophie Pavitt. I was just going to say Sophie Pavitt must be in there.

34:01I can't tell you. Well, that was in our Hall of Fame and I use it a lot. The mineral sunscreen from Supergoop. And also because I'm a psychiatrist and we're fusing the psychology into Spotless and empathy and caring about all that stuff. There are these stress balls that are actually stress cubes from a company called Neato. And so we'll be selling those because kids and young adults really seem to like them. And squeezing something instead of picking at your cuticles or popping your pimples seems to be helpful. So you're going to need pimple patches. We may or may not carry pimple patches. I like some pimple patches because I think the one thing they do is they can stop someone from touching or picking.

34:44But they're not actually curing the acne. Right, right. I'd like to know your opinion on Accutane, where we're at with it now all these years later that it's been in the market. Are you using it as regularly? When do you prescribe it? Talk to me. I use Accutane frequently. I was lucky enough to learn from Dr. Alan Shalita, who was one of the three doctors who did all the original studies on Accutane and topical retin-A in the 1970s. He was chairman of my department. And people come from all over the world to see Dr. S. He was really psychologically minded. By the time people got to see him, he could be their 20th dermatologist and they'd be depressed and anxious.

35:24And he was looking to train a psychiatrist in dermatology. So we found each other and that was amazing. And so I had the most incredible education around Accutane. It's an unbelievable medicine and it's a form of vitamin A. And it gets such a bad rap and there's so many myths about it. So there's one study a couple of years ago that 55 % of the information on YouTube about Accutane was incorrect. Something recently, 75 % of the information on TikTok about Accutane is incorrect because they're non-medical content creators. Is there a myth you want to clear up here and now about Accutane? Yes. So one of the myths is that Accutane causes depression.

36:02And it's still in the consent forms in the U.S. I don't know about in Canada or if there is a consent form. But big studies have disproven that myth that Accutane causes depression. And there was a great study out of England a couple of years ago, studied hundreds, maybe thousands of teenagers. And there were three groups, teenagers with acne on Accutane, teenagers with acne not on Accutane, and teenagers without acne. The ones with the highest level of depression were the ones with acne, not an Accutane. The ones with the lowest were actually the teens with acne on Accutane. And the ones in the middle were the kids without any acne on nothing.

36:38Okay. And so the ones on Accutane, like they're just so hopeful they're getting better. Right. And during Accutane treatment, what we see is what was always seen anecdotally. Depression scores go down and self-esteem scores go up. Right. Now, the time of life when someone's on Accutane is also a time of life when depression is very common. So again, it's one of those true, true unrelated situations and people, it's just human nature to link things together. But that's just one study. There's some from Canada, from Europe, from the U.S., really good placebo controlled studies and big cohort studies to show that Accutane doesn't cause depression.

37:17Right. And it's still and I feel like the way in which germs are using it has they've innovated on that front, too, like with microdosing and things like that. Is that something you do? I do. I love using low doses of it. I even have some patients on it once or twice a week. Oh, really? Interesting. OK. For like a longer period of time. OK, exactly. But it's a really great medicine. And if you take a full course of it, which depends, it's different for each person, depends on the person's weight. It's about an 80 % chance of curing that person for life of acne. And that's amazing. That's life-changing.

37:51It really is.

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41:19We'll link to this URL in our show notes and on our website. Now back to the show.

41:29You mentioned some of your favorite brands for acne that you'll be carrying at Spotless. Yes. What are some popular products that people still use to treat their acne that you are not a fan of and that you will not be carrying at Spotless? I'm not a fan, a big fan of benzoyl peroxide for the face, for example. Benzoyl peroxide is really drying and irritating and can even cause allergies and redness. It doesn't really help that much. So we're not carrying benzoyl peroxide. We're not prescribing benzoyl peroxide. Benzoyl peroxide as a body wash for acne, where you leave it on for a few minutes in the shower and wash it off, can be helpful and non-irritating because body skin is just thicker and less sensitive.

42:11Okay, but not for the face. So no harsh acids. And you'd asked before about our skincare line, which will be called Dr. Amy Wexler. And when is that potentially going to come out? Early next year. Okay. Our whole goal is to create non-irritating products for acne. So, and the line is that we'll also have an extension. We'll do a moisturizer, toner, you know, face wash, body wash, sunscreen, all of those, but everything's safe for people with acne. People with acne are so scared still to use moisturizer because they're worried that the moisturizer is going to clog their pores. Some can, but the right ones, the non-comedogenic ones won't.

42:51And so a lot of what we'll be doing at Spotless is educating. And I'll be making TikTok videos to try to dispel the myths and just get the word out. You walk around and see people still with faces full of acne, but most people aren't walking around with severely crooked teeth anymore. They're getting braces or they're getting Invisalign. Acne is treatable. And so our whole goal at Spotless is to reach as many people as possible. Right. There's no shortage of myths, as you mentioned, on TikTok, even down some Reddit wormholes. What is one of those? What what's one of those myths that makes you just want to jump into the comments?

43:35Oh, there's so many. Well, fun one. Chocolate causes acne. It does not. Poor chocolate gets a bad rap. And I think dark chocolate's good for you because of all the antioxidants. Yeah. I feel like there's a lot of a lot of homemade treatments that are going around. Like beef tallow and more than just toothpaste. People used to put toothpaste on their pimples. Just stuff you can find at home. And it's like some of these drugstore products are pretty inexpensive. Like I don't know why you need to use something that costs the same amount of money out of the pantry. And what is the difference? What is why is it better?

44:12I don't really understand. I just I guess it's just all these, you know, non-medical content creators. or someone else to call them, but people who really don't know what they're talking about, but now they have an audience. Right, right, right, right. Yeah. And the more like extreme your home remedy is, the more views it's going to get. Right. That's true. Exactly. And there are some home remedies that can be really soothing for your face. So for example, like whole milk or whole milk yogurt, the fats in the whole milk are really anti-inflammatory. So if someone has eczema, I will tell them sometimes to do a whole milk compress and I'll I'll be like, I know this is going to sound really weird, but because I used it when I was a kid and it really works.

44:49OK. And so if you really want a DIY home mask, get some whole milk yogurt and some honey, mix them together, heat it up a little bit in the microwave, stir it together. And that's really soothing. Honey is antibacterial and soothing. And the fats in the yogurt are also soothing. But so many other things, the beef tallow thing is really bad. Yeah. And that one just keeps going and going. Now we talked a lot about teens and acne. What about adult acne? Are you expecting to see a lot of those types of patients? I'm sure that comes through your door every day. It does. Women in their 40s or whatnot.

45:21Definitely. So I have a whole group of patients, often women 35 to 55, who are breaking out and have wrinkles and they feel too old for their pimples and too young for their wrinkles. Good news is a topical retinoid often can treat both, but there's things to do for both. And sometimes there's a hormonal component to the acne. And then there's a medicine like spironolactone, for example, to treat that acne. And yes, we'll be doing that at Spotless. For anyone listening, please open a perimenopause clinic as well. We will take one of those in every city. Absolutely. Can I ask something that I keep seeing on TikTok?

45:57Of course. The PSA to not pop a pimple in the triangle of death. Oh, God. What's that? Explain. I mean, That is total BS. Really? OK. Talk to me. Years ago, there was a TV show that will be unnamed that I. Oh, I know. Went on a couple of times that called me one day and said, hey, Dr. Amy, we want you to come back on to talk about the triangle of death on the face. And I was like, what are you guys talking about? They're like, you know that if you like pop a pimple by your nose, the bacteria will go to your brain and kill you. Yeah. I said, that's total BS. That is not science. No, I'm not coming on to talk about that.

46:32So and I just it just popped up in my feed. Yes. Last week. It's back. Everything comes back. Vitamin C is back. Triangle of death. Yes. It's just meant to scare people. That is not a real thing. OK. No. Even though you shouldn't pop pimples that you're not going to die because you can make the pimple worse. Even if you if you pop that pimple, you've pushed so hard, you've created inflammation right next door. You'll get a pimple next to it. People don't stop. If a pimple is poppable. My trip, my home trick is to take Q-tips instead of your fingers because people do not stop. And there's a thing about like wrapping your fingers in a tissue somehow that that's safer.

47:08No, because fingernails are sharp and hard and no one stops until they get something, which is often blood. But a lot of pimples are not poppable. A cyst is not poppable. A pustule that's white and looks like it's ready to be popped. Okay. After you wash your face or take a shower, you can take two Q-tips and apply gentle, even pressure. And a Q-tip will break if you push too hard. It's soft. It's round. If it doesn't work. put them aside and like realize that it's not possible. I heard that there was going to be an acne vaccine in the works. Have you heard of this? I read that article also. Okay.

47:45It's so early on basic science. You think? It is. Yeah. Okay. But it's an interesting concept. Well, thank you so much, Dr. Wexler. I think we've covered it all. I think so too. In our hour long consult. Amazing. Thank you for having me. Thank you so much. It was great to meet you. And I believe your daughter's here today. Zoe's here. Yes. Zoe, you can you don't have a mic over there, but really excited for you guys for what you're building. And we can't wait to see your clinic pop up and we will pop in. Yes. All the puns. Thanks so much. Yes. Pop by. Exactly. Thank you, Dr. Wexler. Thank you so much for having me.

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