Calming Acne, Not Burning It
Shanna Miranti, PA-C, opens the episode where she always seems to want to start — acne. Her core message is that the cosmetic aisle is sensory overload for patients, and clinicians can cut through it by keeping recommendations simple and anti-inflammatory. Rather than reinforcing the social-media instinct to 'dry this up and burn this stuff off,' she reframes acne as an inflammatory condition and tells patients the goal is to 'calm your very mad skin down.'
On benzoyl peroxide, Miranti revisits last year's benzene scare that Buchi Neita, PA-C, remembers as 'scary times.' She explains that benzene is a natural breakdown byproduct of BPO under heat, but notes it takes roughly 114–120°F for seven to 14 days to begin releasing — a real concern mainly for patients who leave products baking in hot cars in Southern climates. Her workaround is to recommend BPO in a solid form, specifically the 111 MedCo 10% BPO bar soap available on Amazon.
She rounds out an acne kit with a gentle, non-salicylic cleanser (favoring a glycolic option that won't sting), a non-comedogenic moisturizer to restore the skin barrier, and several barrier-friendly lines: the RoC/Proceris (Lipikar) line certified by the National Eczema Association, the Cetaphil purple acne line, Vanicream for sensitive or medication-dried skin, and Avène thermal-water products. Both hosts agree skin barrier repair is foundational — Neita calls it the basis of treating most chronic inflammatory facial disease, especially rosacea and acne.
Body Odor and the Case for Vinegar
Neita transitions to body odor, a common but under-mentioned complaint in the humid climates of Naples and Atlanta. Her top pick is hypochlorous acid — well tolerated, non-irritating, and it doesn't drive resistance — available as sprays and cleansers, with CLN as a favorite brand. Miranti adds that the 111 MedCo CLN Sport Wash hypochlorous acid spray is easy for athletes and 'the boys who don't want to reach their back.'
Benzoyl peroxide works well for body odor too, but the hosts stress it must be lathered and left on for a couple of minutes before rinsing, and warn about bleaching towels. Miranti flags the viral glycolic acid toner trend (The Ordinary) as popular but capable of causing irritant contact dermatitis. Chlorhexidine wash is described as the most powerful odor agent, but she urges antibiotic and antimicrobial stewardship — reserve it for limited use, not daily. Neita adds a safety note: keep chlorhexidine away from ears and eyes, where it can be toxic to the eardrum and eye.
Neita's most memorable tip is plain white vinegar. She explains that apocrine glands secrete odorless fluid that only becomes odorous once skin microorganisms act on it, so white vinegar soaks — two washcloths tucked under the arms for about five minutes before showering — help rebalance the microbiome. Patients may 'smell like a stinky Greek salad' briefly, but it's a natural option for the more granola crowd.
White Vinegar Beyond Odor, Plus Razor Bumps
Drawing on her podiatry family background, Miranti extends white vinegar to nail and fungal conditions. She recommends vinegar soaks for green nail syndrome (typically Pseudomonas), and calls it a 'poor man's cure' for tinea pedis and chronic paronychia — usually a half-and-half vinegar-and-water soak for about 10–15 minutes, adjusted for the thickness of skin and area involved, aiming to lower the pH to a level fungus dislikes.
Neita then tackles pseudofolliculitis — ingrown hairs and razor bumps — reminding listeners it isn't only a facial, male-shaving problem. It can occur anywhere terminal hairs are shaved, including the axillae and bikini/groin area, and it isn't always benign: it can be itchy, painful, and cause hyperpigmentation or keloidal scarring, especially in darker-complexioned patients. Her all-star is Tend Skin, an old-school concentrated salicylic acid solution (also in a roll-on). She warns it contains isopropyl alcohol, so it should never be used on freshly shaved, washed, or lasered skin — she jokes she tested that theory herself. Typical use is once daily, up to twice for severe cases, tapering to two to three times weekly for maintenance.
For a gentler option, Neita likes pre-moistened glycolic/salicylic pads — Replenix (10%/2% and 5%/2%) and First Aid Beauty — which are less irritating and easier to use than Tend Skin. Miranti notes these same pads and washes are excellent for keratosis pilaris, along with 'rough and bumpy' formulations from CeraVe and Cetaphil, KP Erase, and the more concentrated Gladskin/Glytone KP kit. The key is choosing a tolerable concentration that won't set tender skin — often on kids' and teens' arms, cheeks, thighs, and buttocks — on fire.
Two Standouts: Diclofenac Gel and a Better Seb Derm Shampoo
Neita shares a favorite she has presented on at conferences: over-the-counter diclofenac 1% gel (branded Voltaren) for acne keloidalis nuchae and dissecting cellulitis, both of which disproportionately affect Black men. Citing a podium lecture by Dr. Matt Zirwas, she cites a published case series showing significant improvement with twice-daily use. She was impressed enough to try it on her younger brother's AKN — with the German version — and reports it cleared completely after one week of twice-daily use. Miranti was struck by the before-and-after photos. Consider it as monotherapy or an adjunct.
For seborrheic dermatitis, Miranti recommends zinc pyrithione bar soaps — again citing the 111 MedCo zinc pyrithione bar — as an easy fit for older male patients who prefer bar soaps and present with chest 'snow.' Neita adds salicylic acid 5% shampoo (Neutrogena T/Sal) for dense scalp psoriasis and scaly seb derm, lathered and left on several minutes before rinsing.
Her current favorite, though, is the Vichy Dercos selenium sulfide shampoo. She notes it was compared to ketoconazole shampoo with similar efficacy but better patient-reported hair quality—an important advantage since ketoconazole can be drying and cause breakage in textured hair. The selenium sulfide product was studied in curly and textured hair without increased dryness or breakage, matching what she's seen in practice, at a reasonable OTC price. Both hosts note — unsolicited and unsponsored — how helpful the generous samples from OTC companies are for letting patients try before they buy.