Acne. Zits. Pimples. Blemishes. No matter what you call them, acne can be distressing and annoying. Dr. Michelle Parsons is happy to help you eliminate acne, whether you have adult onset acne, or had it since your teen years. Dr. Parsons also treats adolescents with stubborn acne. Treatment options include cleansing and anti-bacterial products, as well as oral and topical antibiotic medications as required. Dr. Parsons will perform a skin analysis, to include skin bacterial count, to determine which protocol is right for you.
CAUSES OF ACNE
Acne occurs when tiny holes on the surface of the skin, called pores, become clogged. Each pore is an opening to a canal called a follicle, which contains a hair and an oil gland. Normally, the oil glands help keep the skin lubricated and help remove old skin cells. When glands produce too much oil, the pores can become blocked, accumulating dirt, debris, and bacteria. The blockage is called a plug or comedone.
The top of the plug may be white (whitehead) or dark (blackhead). If it ruptures, the material inside, including oil and bacteria, can spread to the surrounding area and cause an inflammatory reaction. If the inflammation is deep in your skin, the pimples may enlarge to form firm, painful cysts.
Acne commonly appears on the face and shoulders, but may also occur on the trunk, arms, legs, and buttocks. Acne is most common in teenagers, but it can happen at any age, even as an infant. Three out of four teenagers have acne to some extent, probably caused by hormonal changes that stimulate oil production. However, people in their 30s and 40s may also have acne.
Recent studies show diet does in fact play a role in exacerbating acne. In particular, such foods with a high glycemic load; milk and dairy; chocolate; salty, oily, and fatty foods. A similar association was found with milk. Dairy products contain approximately 60 other growth factors and micronutrients that can influence acne.
With all this evidence, the conclusion seems very clear. In addition to prescribing medications, counseling about dietary modifications, such as elimination of dairy products and high glycemic foods must be part of treating acne patients in order for have optimal treatment outcomes.
THE 3 WORST FOODS
Wheat
Wheat is one of the worst things you could eat.
Wheat causes acne because it contains gluten. Gluten is a protein that binds things together. It’s the thing that makes dough so sticky.
Gluten is highly inflammatory for most people. Wheat hasn’t been a part of the human diet for that long (in evolutionary terms). So our digestive system isn’t used to it. The immune system treats gluten as an invader and this reaction causes inflammation. Too much inflammation can lead to acne for those who are prone to getting it.
The problem is that unless you have celiac disease, you won’t notice this reaction. These kinds of reactions are often called sensitivities. They are different from allergic reactions because they don’t create any immediate symptoms. Most likely you feel just fine after eating wheat, but it silently creates inflammation and damage in your body. Gluten is an integral part of wheat. So in this sense whole wheat products are NO better than those made out of white flour. Wheat is the most common source of gluten, but it’s also present in a few other grains. If you are highly sensitive to gluten, it’s a good idea to go totally gluten-free. Google gluten-free diet for more information
Dairy
Dairy products are among the few foods that have been scientifically linked to acne. The Achieves of Dermatology published a study on the link between dairy intake and teenage acne. The authors wrote: “CONCLUSION: We found a positive association with acne for intake of total milk and skim milk. We hypothesize that the association with milk may be because of the presence of hormones and bioactive molecules in milk.”
As the authors conclude, this is probably linked to hormones. Dairy is full of growth hormones. Think about it. The job of the milk is to make baby calves grow into massive cows. So it makes sense that milk is loaded with hormones.
Unfortunately these same hormones are linked to acne. One of these hormones is called IGF-1 (Insulin like growth factor-1). IGF-1 has been shown to increase sebum production and lead to clogged pores.
I highly recommend you minimize or stop the intake of all dairy products (milk, yogurt, cheese and so on). You can substitute milk with rice, almond or nut milks. Avoid soy milk, as soy products can be as bad as dairy products. Often cutting wheat and dairy is enough to bring severe acne down to mild/moderate acne. So I highly recommend you at least try this for a few weeks
Processed vegetable oils
Most processed vegetable oils are highly damaging to your health and skin. The extensive processing these oils undergo damages the delicate fats.
As a result these oils are highly inflammatory and can lead to acne. These fats are comparable to trans-fats. And that means, avoid at all costs. As a rule of thumb avoid all oils in supermarkets, with the exception of virgin and extra-virgin olive oils and coconut oil.
THE 3 BEST FOODS
Greens
Leafy, green vegetables (greens for short) are the king of nutrition. They are the most nutritionally dense foods on the planet. Greens also help your digestive system. Because they are high in fiber they keep your bowels moving. Greens are considered ‘prebiotic’, meaning that they feed the beneficial bacteria in your gut. The only problem with greens is taste. Most people don’t exactly consider plain lettuce as a gourmet meal.
So here’s a simple way to get over it: make a green smoothie. Green smoothie is a fruit smoothie with some greens blended in. I know it sounds awful, but it tasted wonderful when it’s done correctly. Google green smoothie for recipes and more info.
Green smoothies are perfect for breakfast. They are quick to make, delicious and pack your morning with healthy nutrients. Need I say more?
Essential Fatty Acids (EFAs)
EFAs are another group of skin-friendly super foods.
These fatty acids are called essential because your body cannot make them. They have to come from diet. You probably know them as omega 3, 6 and 9.
Where processed fats are very bad for your health, unprocessed EFAs are very good. They are highly anti-inflammatory, so they can really help your skin.
The best sources for EFAs are:
Fish and seafood (but don’t eat too much because of mercury contamination)
Nuts and seeds
Fatty fruits, such as avocado, olives and coconut
Organic and grass-fed animal foods
Make sure you eat unprocessed EFAs liberally, but be careful with oils. Good quality oils are a great source of EFAs, but many oils go rancid during processing and storage. If you can find good quality oils, feel free to use them. If you need a recommendation, check your local health story for “Udo’s Choice” brand of oils.
Beans
Calorie per calorie beans pack more nutrients than fruits. They are loaded with healthy protein, and they help to keep your blood sugar levels stable.
Beans are also dirt cheap. So they are great for budget conscious healthy eaters.
The only problem with beans is that they are hard to digest for some people. But if you don’t experience gas or bloating after eating beans, make sure you eat them several times per week.
POLYCYSTIC OVARY SYNDROME
Acne is a characteristic feature in patients with polycystic ovary syndrome, who are also frequently hyperinsulinemic, insulin resistant, and hyperandrogenic. These patients typically maintain elevated serum concentrations of androgens and IGF-1 and lower concentrations of SHBG. Androgen levels can be lowered and disease symptoms alleviated by improving insulin sensitivity through weight loss or by use of pharmaceuticals such as metformin that improve insulin metabolism. Numerous studies have reported that tolbutamide, an antihyperglycemic drug similar to metformin, is therapeutically effective in treating acne.
MEDICATIONS USED TO TREAT ACNE
Retinoids
Prescription retinoid creams and gels are essential to help curb acne, even when they’re taken without oral antibiotics. Tretinoin is the acid form of vitamin A. Topical Tretinoin decreases cohesiveness of follicular epithelial cells with decreased microcomedo formation. Additionally, Tretinoin stimulates mitotic activity and increased turnover of follicular epithelial cells causing extrusion of the comedones.
Benzoyl Peroxide
Most benzoyl peroxides are formulated with insoluble macro-crystals that, when applied in the form of creams and lotions, remain largely on the surface of the skin, not deep within the hair follicles, or pores. Dr. Parsons recommends a new liquefied form of benzoyl peroxide that is 1/10,000 the size of any other benzoyl peroxide available, proven to penetrate more effectively than leading prescription benzoyl peroxide products. As a result, this powerful form of benzoyl peroxide instantly penetrates the pores and begins reducing acne below the skin’s surface, providing a clearer complexion as early as 2 weeks.
Salicylic Acid
Salicylic Acid gently dissolves dead skin cells and unclogs pores to reveal healthier skin.
Tetracycline
Tetracycline is the most widely prescribed antibiotic for acne. The usual starting dose is 500 mg twice a day continued until a significant decrease in acne lesions is seen. The dose can then be decreased to 250 mg twice a day or discontinued. The main drawback for this antibiotic is that it must be taken on an empty stomach to be the most effective. For a teenage boy who eats frequently, this can be very difficult. Tetracycline should not be given to pregnant women or children under 9 years of age.
Clindamycin topical
Topical antibiotics that are applied to the skin can kill some of the bacteria on the skin and reduce redness and inflammation. Examples of antibiotics include clindamycin and erythromycin.
Isotretinoin (Accutane)
Accutane is a powerful, “last resort” medication for severe acne. Dr. Parsons does not recommend Accutane until topical treatment has been maximized. The side effects of Accutane can sometimes be severe. Most commonly, it causes dryness of the skin, eyes, mouth, lips, and nose. Other side effects include nosebleeds, achiness, diminished night vision, sun sensitivity, and changes in triglyceride levels and liver function. Since it can cause serious birth defects, women should use two different forms of birth control when taking Accutane. People using Accutane might need periodic blood tests. There are also possible psychological effects of Accutane. There have been a number of people using Accutane who suffered severe depression and attempted suicide. However, no one knows whether the medicine was really the cause. The fact is that depression is more common in people with acne, regardless of the treatment.
Clarisonic
Sonic technology first changed the way we clean our teeth–now it’s changing how we cleanse our skin! This cleansing method is so gentle and effective, it is used and recommended by leading dermatologists. This sonic micro-massage uses sound waves to deeply penetrates pores, loosening dirt, makeup and oil . It’s proven to remove six times more dirt, sebum, and makeup than traditional, superficial cleansing, allowing your serums and medications to absorb better. It’s so gentle, you can use it twice daily.
BLUE LIGHT THERAPY
Blue light therapy has been FDA approved to specifically target and kill the bacteria, P acnes, that causes acne. Mild to moderate inflammatory acne is most responsive to blue light therapy, while patients with only comedonal acne or a predominance of nodulocystic lesions are poor candidates. blue light therapy does not cause DNA damage or early photoaging as UV radiation does. Blue light therapy is a safe adjuvant treatment that can be incorporated into a therapeutic regimen for patients with inflammatory acne.
RED LIGHT THERAPY
Red light (Wavelength 640-750mm) has also been shown to be beneficial in treating acne. The longer wavelength of red light compared to blue light, penetrates deeper into the skin, and raches the sebaceous glands better. Red light is anti-inflammatory and directly inhibits macrophages.
ACNE AND DIET
Nutrition is one of those environmental factors that can and should be controlled in any acne treatment regimen. So what is the evidence for the role of nutrition in the pathogenesis of acne?
In one of the first papers to be published on the subject of the relationship of acne and diet, Cordain et al examined the prevalence of acne in two non-westernized societies: The Kitavan Islanders of Papua New Guinea and the Ache hunter-gatherers of Paraguay. No cases of acne were found among the 1200 Kitavan (including 300 15-25 year olds) or 115 Ache (15 15-25 year olds) examined. The authors observed that both the Ache and Kitavan diets were composed of minimally processed plant and animal foods, virtually devoid of typical Western-diet high glycemic loads that may acutely or chronically elevate insulin levels. Neither society had any evidence of insulin resistance. Kitavans were also not found to be overweight or hypertensive. Previous studies have demonstrated that diet-induced hyperinsulinemia elicits an endocrine response that promotes unregulated tissue growth and enhanced androgen synthesis. Based on that the authors concluded that dietary interventions with low glycemic loads may have a therapeutic benefit in acne treatment.
Interestingly, in the Eskimo and Zulu populations, acne was absent when they were living and eating in traditional manner, but became a problem when these populations moved from their villages to the cities
A 2006 prospective cohort study by Adebamowo et al. that examined 6094 girls aged 9-15 years showed that a greater consumption of milk was associated with a higher prevalence of acne. The results were not associated with the fat content of the milk. The authors postulated that the milk intake affected acne though the insulin-like growth factor-1 pathway and through the bioactive molecules milk contains, such as androgens, 5 alpha reduced steroids and other steroid hormones. The sebaceous gland has a full complement of enzymes that can produce testosterone from cholesterol or from its precursors found in milk. Similar results were shown when the Adebamowo team looked at dairy consumption and acne in teenage boys.
In 2007 Smith et al. compared the effect of an experimental low glycemic-load diet with a conventional high glycemic-load diet on clinical and endocrine aspects of acne vulgaris. In that study 43 male patients with acne completed a 12-week, parallel, dietary intervention study with investigator-masked dermatology assessments. Primary outcomes measures were changes in lesion counts, sex hormone binding globulin, free androgen index, insulin-like growth factor-I, and insulin-like growth factor binding proteins. The study found that at 12 weeks, total lesion counts had decreased more in the experimental group compared with the control group. The experimental diet also reduced weight, reduced the free androgen index, and increased insulin-like growth factor binding protein-1 (which reduced the bioavailability of IGF-1) when compared with a high glycemic-load diet. The study suggested that nutrition-related lifestyle factors play a role in acne pathogenesis.
With all this evidence, the conclusion seems very clear. In addition to prescribing medications, counselling about dietary modifications, such as elimination of dairy products and high glycemic foods must be part of treating acne patients in order for have optimal treatment outcomes.
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