Dr. Julie Harper is a Clinical Associate Professor of Dermatology at the University of Alabama-Birmingham. She is founding director of the American Acne and Rosacea Society, a task force member of American Academy of Dermatology Telemedicine committee, and a former Women's Dermatologic Society Board of Directors Young Physician Representative. In addition to running a private practice, Dr. Harper has written and spoken on the subject of acne and rosacea extensively. Ahead she discusses the state of care in acne, as well as pearls for listening to and communicating with patients.
How much do broader perceptions of acne impact how patients live with it, and what affect do these notions have on treatment/adherence?
“There are still so many misperceptions regarding both the causes of acne and the treatment of acne,” says Dr. Harper. “Some of the ‘old' misperceptions continue to resurface. For example, eating greasy foods causes acne, drinking more water would improve acne, washing your face more frequently and aggressively will improve acne,” Dr. Harper notes. “Individuals with acne are inundated with the notion that they have done something to cause the acne and that if they would simply alter their behavior, the acne would go away. Clearly this is the wrong message and leaves acne-sufferers feeling guilt on top of embarrassment.” Also, she observes that in this age of instant everything, patients often expect acne treatments to work overnight, which is not practical. “One of the most important components of a successful acne visit is setting the expectation for when an acne treatment is going to work, and that is not overnight,” she notes. Moreover, in this era of Photoshop, many people are satisfied only with perfect. “While we can make acne much better, we cannot achieve perfection. Flawless, poreless skin does not exist.”
With so much research and discussion about the etiological factors of acne in recent years, how would you assess the progress in how scientists and clinicians understand and think about acne?
Current research has shed light on a central role of inflammation in acne, notes Dr. Harper. “Inflammation appears to play a primary role in the pathogenesis of acne, not just a secondary role. In years past, we have thought of inflammation as being only a secondary response to P. acnes or free fatty acids. We have now learned that it is so much more than that, present very early in the disease, before P. acnes and before the comedone. This information should shift our target,” Dr. Harper says.
What is one thing that you've learned about the skin and/or the practice of medicine in your years counseling and treating patients with acne and other skin disorders?
“The most important thing that I have learned in my years in practice is to be a good listener and to be compassionate. It is easy to blame all treatment failures on lack of adherence to the treatment plan. But sometimes I am wrong. Maybe I was too quick to make a diagnosis without really listening to the history. Maybe I didn't understand financial restrictions or time restrictions that limited treatment,” Dr. Harper observes. “Taking extra time to sit down and listen to my patients and to really care for them improves my patients' outcomes. I frequently remind my staff, and myself, to treat our patients better than they deserve.”