Wondering what it’s like to have Dr. Pimple Popper treat your acne? If you’ve seen Sandra Lee, MD on TV diagnosing and treating a wide array of skin conditions, you might be curious to know how it happens irl. Here, America’s acne expert (and founder of SLMD Skincare), walks us through an acne consultation.

What's the first thing you do during an acne consultation?

DPP: Whenever I see a new patient — regardless of the condition — my first priority is to put them at ease. You just never know what a person’s mindset might be, or what kind of obstacles they’ve overcome just to be sitting in my office.

So I ask a few questions to begin with, then I sit back and listen, without judgment, and without interjecting my opinion right away. Getting to know someone a little better — hearing their story, understanding where they’re coming from — helps build trust and make patients feel more comfortable.

How do you evaluate a case of acne?

DPP: Acne vulgaris, which is the technical name for common acne, is typically quite straightforward to diagnose. But every case is unique, so it’s important for me to get key details from the patient. For an acne consultation, I’ll ask a new patient to tell me about their skin, asking questions like: 

• How does your skin typically behave? For example, is it oily, dry, sensitive? 
• When did you first notice signs of acne, and how severe is it generally?
• Do you tend to see more blackheads and whiteheads, more pustules or cysts, or a combination?
• Is your acne right now how it normally looks, or is this better/worse than usual?

How does a patient's medical history affect acne?

DPP: Even though we have decades of research, we still don’t have a cure for acne — nor have we pinpointed the exact causes. We do know that it seems to be a combination of abnormal skin cell shedding, excess sebum (oil in the skin), and in some cases, a heightened immune response to C. acnes bacteria.

These factors can all be affected by hormones, genetics, even other health conditions and medications. So I need to find out from acne patients information like:

• Do you have a history of any medical conditions?
• Do you take any medications?
• Have you had bloodwork done lately to check your hormone levels?
• Do any of your family members have acne or a history of acne?

Does a patient's lifestyle affect their skin?

DPP: Sometimes patients are surprised to learn that things like their job, their hobbies, or even their housekeeping habits might be contributing to their acne. So we go through all of that, because making small changes can have a substantial impact on their skin.

For example, a violinist might have a case of acne mechanica along their chin and lower jaw from their instrument — or oftentimes football players will get acne from their pads. We can treat the acne and the equipment, to reduce bacteria, if that’s the case. Another common culprit is not washing your sheets frequently enough, which is an easy fix. Not that these are always cures, but it can oftentimes make a noticeable difference.

Are there common mistakes patients make when treating their acne?

DPP: I always talk to new patients about what types of acne treatments they’ve tried in the past, and what (if any) skincare they’re using when they come to see me. Sometimes, I get patients who are fairly educated when it comes to what active ingredients are effective, but generally, people are in the dark about what works and what doesn’t. And with social media, there’s a mixed bag: some of it’s really educational and well-informed, but some of it is complete nonsense.

Something I see relatively frequently is that patients aren’t sticking with their acne products for long enough. So we go over that. Typically, it can take several months to really see results from acne treatment. I explain to patients that they need to use effective products, and they need to use them consistently.

How do you formulate a treatment plan?

DPP: Deciding how to treat a patient’s acne might seem straightforward, but there are a lot of factors that go into it. As a dermatologist, I have an array of options, from topical washes and lotions to oral medications, even chemical peels and lasers. Each case is unique and that’s why I take my time with patients.

Another important piece to all of this is what’s going to work best for the patient, which includes managing their expectations and making sure they understand their role in their own care plan. I can prescribe a whole regimen, but I can’t be there at your house to help you follow it. The good news is that we have a lot of highly effective treatments, and if we work together, we can make a difference.

What should acne patients do if they can’t see a dermatologist?

DPP: I know a lot of dermatologists have a wait time before you can get in for a consultation. And for some people, it’s cost prohibitive and they just can’t make it work. My suggestion in either of those situations is to do some research and find an over-the-counter acne treatment regimen.

This is why I started SLMD Skincare, to bring dermatologist-quality ingredients to people at an affordable price. My Acne System is a complete kit with everything you need to treat acne at home, and it’s available online and at Target.

Now if you try a store bought product and you’re not seeing results after a few months, it’s time to see a dermatologist. If for some reason you can’t, make an appointment with your general practitioner, especially if you’re worried about acne scarring. The sooner you treat severe acne, the better.