If you think selfies are just for social media posts, think again. Curology, a service offering customized acne and anti-aging prescriptions, uses your selfies to help you shoot even better selfies by evaluating your skin care problems based on them and issuing treatments designed to address those problems. Formerly called PocketDerm, Curology is at the forefront of telehealth, a wave of advancements in medical care that’s linking patients with doctors through computers, iPads and smartphones. Curology’s technology allows dermatologist David Lortscher, its cofounder and chief executive officer, to be a modern-day version of the old school family doctor, who made house calls and knew his or her patients personally. Lortscher cares for patients across the country without putting miles on his car. He took time out of his packed schedule of seeing them to talk to us about Curology and the benefits of virtual dermatology. While we had an acne expert on the phone, we seized upon the opportunity to lob a few questions at Lortscher about adult acne, and he gamely supplied informative answers.
BBTA: Why did you start Curology?
DL: I was practicing for a year as a dermatologist in New Mexico. The moment I opened my practice, I was booked out two months end to end. I realized how impossible it is for a lot of people across the country to access a dermatologist. My initial inspiration was that we needed technology to solve this problem. There are 9,000 dermatologists active in the United States, and there are nowhere near enough. Acne is so easy to treat, and people get left behind. I created PocketDerm to help treat people with acne without having them have to wait two months and drive two hours, which is what my patients were doing in New Mexico.
BBTA: What has happened since you launched Curology as PocketDerm in March of last year?
DL: People who didn’t have acne were using it because they wanted to get Retin-A for wrinkles. Where it started as a way to connect people with a dermatologist, it became a brand that stood for much more than that. They thought, “This is amazing. I have a dermatologist that listens to me. I can ping them at any time and have a medication custom made for me.” We evolved to be way more than a software program that connects people with a dermatologist. Today, we have six dermatology professionals, and we have patients around the country. We are a medical practice and also a cosmetics brand.
BBTA: Have you discovered that people who are in cities or towns without many dermatologists are indeed using Curology?
DL: Yes, but a lot of are patients from cities where they do have dermatologists near them like New York or L.A. or San Francisco. These patients can message back and forth with me. They are people that say, “I never really thought about going to a dermatologist to make my skin pretty. I thought that was for stuck-up people, but this is only $20, so I signed up.” I think people have this assumption that a dermatologist is for rich, stuck-up people.
BBTA: How does Curology work?
DL: Our philosophy from the beginning was to make it as simple as possible. For people that sign up, you log onto your account, you are introduced to your doctor, and you upload high-resolution photos. We don’t allow doctors to communicate via email. You have to interact through the secure site. Within 12 hours, your derm will get back to you to give you an assessment. Dermatology is really unique because a high-resolution photo can be as good as your eye. It’s really amazing how well it works. The big difference is the ease of communication, meaning my patients don’t have to wait two months to see me and ask for a question. They can ping me, and I answer the next day. Our patients feel like this is better than coming into an office.
BBTA: Are there limits to what can be done with dermatology telehealth?
DL: We only treat acne and anti-aging. I would not feel comfortable trying to diagnose skin cancer this way.
BBTA: What is the most common concern of Curology patients?
DL: The most common is acne lesions. The second most common is hyperpigmentation left behind from acne or from the sun. The third would be wrinkles. Our patient’s average age is 24. We have a lot of people in their teens and Twenties, but then we have people in their Thirties, Forties and Fifties as well.
BBTA: What do you think is the biggest misconception about adult acne?
DL: I’m always surprised that doctors don’t tell their patients how a method of birth control can affect acne. Every patient we see, we find out what type of birth control they are on, and we find out how that is affecting their acne. A Mirena IUD can make their acne worse. A copper IUD generally wouldn’t affect it. There are so many different types of birth control pills with different types of hormones. Some can be helpful [for acne] and some are not. Regardless of what doctor prescribes the birth control, they have much more important concerns than how it affects their skin, so they don’t discuss it with the patient.
BBTA: How do you deal with a patient whose acne might be affected by their birth control choice?
DL: We don’t prescribe birth control. What I will sometimes do is that, if I see somebody who has acne in a hormonal pattern, I will ask them about their preexisting hormonal issues. Then, I will tell them that, in my experience, this is a birth control that will make acne worse, if they are on one that does, and these are birth control options that could help with acne. A lot of times people will tell me it makes a huge difference. Ortho Tri-Cyclen is associated with improving acne. Another example would be YAZ.
BBTA: Besides birth control, what is another common factor in adult acne?
DL: Diet is really important. Then, we ask patients about their [skin care] regimen. A lot of people have super complex regimens. Especially for teenagers, over-scrubbing and irritating is an issue. People tend to grow out of that. Overall, we have a population that has been sold by cosmetics companies on the benefits of scrubbing, cleaning and exfoliating, and that tends to cause inflammation that makes things worse.
BBTA: How do you suggest adult acne sufferers change their diet to alleviate acne?
DL: If people stop drinking milk, their acne can improve 50 percent. Milk has hormones that are similar to the hormones that cause acne. Also, they should consider shifting to a lower glycemic index diet. Avoiding simple sugars can help a lot.
BBTA: Beyond birth control switches and diet modifications, what do you recommend to tackle acne?
DL: Topical prescription creams work well for acne, and they are so safe. They’ve been around for 40 years. Ingredients like tretinoin are still really expensive, though, when you buy them from a pharmacy. In the United States, they are prescription only, and the fact that our patients get a prescription cream sent to them makes a big difference.
BBTA: What do you think of Proactiv?
DL: Consumer Reports looked at it from an objective point of view and found that it helped 30 to 35 percent of people. Proactiv didn’t work that well for people that come to us. There is a good one-third of the population that it works very well for. It’s not a question of severity. At any given severity, it may work for some people and not for others.
BBTA: Do the prescription creams work for a wide swath of people?
DL: They work for a ton of people. It’s really amazing. With a prescription treatment, we can get almost anyone’s skin beautiful. When you are using Proactiv, it’s benzoyl peroxide, one ingredient that basically kills anything that touches it. That’s it’s job. We have the ability to select from 10 different ingredients that all have slightly different actions. Our prescriptions come in little bottles each with three different ingredients. You apply just a few pumps that you rub all over your face. It works while you’re sleeping. It is very simple. It doesn’t require these weird regimens that have evolved. It works pretty darn fast. We have a lot of patients that will see improvement in the first week.
BBTA: What do you think of treating acne with antibiotics?
DL: All dermatologists are trying to move away from prescribing antibiotics. We try to get people clear on just topical treatments. It is important to use a combination of topical treatments. When you are using Retin-A, you might need something else as well. In the past, they might have prescribed Retin-A with an antibiotic. Now, they will prescribe a couple of different creams. We do prescribe antibiotics, but under 10 percent of our patients are on pills. If they need them, we get them on the lowest dose possible.
BBTA: Is there a pimple spot treatment that you prefer?
DL: I recommend something called a hydrocolloid bandage. It covers it up and sucks it up. Most people wear it overnight, though you can wear it in the daytime. We found they work really well for spot treatments.
BBTA: What is the future of Curology and of telehealth more generally?
DL: Not many people in the large scheme of things have really heard of us. The main goal [for Curology] is scaling. It’s inevitable that almost all medicine is going to be much more connected and online. I think about how easy it was for people to switch from travel agents to Expedia. It’s just better.