Is Your Birth Control Breaking You Out?

Are you breaking out and have no clue as to why? It could be your birth control...

Come in for an acne consult and find out if your monthly oral contraception is causing your acne.

The Puzzling Relationship Between Diet and Acne

The relationship between acne and diet has been an ongoing debate. There are no meta-analyses, randomized controlled clinical studies, or well-designed scientific trials that follow evidence-based guidelines to elucidate a cause-effect relationship. However, for decades anecdotal evidence has shown that acne and insulin resistance, such as that seen in patients with polycystic ovarian syndrome (PCOS), are highly linked. Now the literature points to the growing relationship between nutrition and the prevalence of acne, especially to glycemic index and the consumption of dairy.

Glycemic index is a ranking system based on the quality and quantity of consumed carbohydrates and its ability to raise blood sugar levels. Foods with high glycemic indices such as potatoes, bread, chips, and pasta, require more insulin to maintain blood glucose levels within the normal range. High-glycemic diets that are prevalent in the United States not only lead to insulin resistance, diabetes, obesity, and heart disease but also to acne.

Several studies have looked at the glycemic load, insulin sensitivity, and hormonal mediators correlating to acne (Am. J. Clin. Nutr. 2007; 86:107-15; J. Dermatol. Sci. 2008;50:41-52). Foods with a high-glycemic index may contribute to acne by elevating serum insulin concentrations (which can stimulate sebocyte proliferation and sebum production), suppress sex hormone-binding globulin (SHBG) concentrations, and raise androgen concentrations. On the contrary, low-glycemic-index foods increase SHBG and reduce androgen levels; this is of great importance because higher SHBG levels are associated with lower acne severity. Consumption of fat and carbohydrates increases sebum production and affects sebum composition, ultimately encouraging acne production (Br. J. Dermatol. 1967;79:119-21).

A new study by Anna Di Landro et al. published in the December 2012 found a link between acne and the consumption of milk, particularly in those drinking skim milk and more than three servings of milk per week (J. Am. Acad. Dermatol. 2012;67:1129-35).

Dr. Di Landro et al. also found that the consumption of fish had a protective effect on acne. This interesting finding points to the larger issue of acne developing in ethnic populations that immigrate to the United States. Population studies have shown that non-Western diets have a reduced incidence of acne. Western diets are deficient in long-chain omega-3 fatty acids. The ratio of omega-6 to omega-3 fatty acids in our Western diet is 10:1 to 20:1, vs. 3:1 to 2:1 in a non-Western diet. Omega-6 fatty acids in increased concentrations induce proinflammatory mediators and have been associated with the development of inflammatory acne. Western diets with high consumption of seafood have high levels of omega-3 fatty acids and have shown to decrease inflammatory mediators in the skin (Arch. Dermatol. 2003;139:941-2).

In my clinic, the ethnic populations that immigrate to the United States often develop acne to a greater extent than they had in their native countries. Although factors including stress, hormonal differences in foods, and pollution can be confounding factors, we must not ignore the Western diet that these populations adapt to is higher in refined sugars and carbohydrates and lower in vegetables and lean protein. Every acne patient in my clinic is asked to complete a nutritional questionnaire discussing the intake of fast food, carbohydrates, juice, sodas, and processed sugar. We have noticed that acne improves clinically and is more responsive to traditional acne medications when patients reduce their consumption of processed sugars and dairy and increase their intake of lean protein. Similarly, our PCOS patients who are treated with medications such as metformin, which improves the body’s ability to regulate blood glucose levels, have improvements in their acne. So, is acne a marker for early insulin resistance?

The underlying etiology of acne is multifactorial, although now we can appreciate diet as one of the causative factors. Although there is no direct correlation between obesity or insulin resistance and the prevalence of acne, a low glycemic index diet in combination with topical and systemic acne medications can be a powerful method of treating acne. Nutritional counseling is an adjunct educational service we should provide to our patients in addition to skin care advice and medical treatments for acne.

No single food directly causes acne, but a balanced diet can alter its severity. Encouraging our patients to eat a variety of fruits and vegetables, lean protein, and healthy fats can prevent the inflammation seen with acne and also can protect against cardiovascular disease, type II diabetes, and even obesity.

It is unfortunate that the medical education system in the United States has no formal nutrition education. Nearly every field of medicine including internal medicine, cardiology, endocrinology, allergy, pediatrics, obstetrics and gynecology, surgery, and not the least, dermatology, is influenced in some realm by nutrition. As the population diversifies, so will the importance of dietary guidance. We need to educate ourselves and our residents-in-training to better appreciate the symbiotic relationship between diet and skin health and to provide this guidance to our patients.

By: LILY TALAKOUB, M.D., Skin & Allergy News Digital Network

You may have acne, but do you know which TYPE?

Whether you suffer from troublesome blackheads or embarrassing pimples, we all know the uncomfortable feeling acne can cause.

At McLean Dermatology, we are dedicated to both teaching you about the possible causes of your acne and how to treat it.

What most people don’t know is that there are several different types of acne, meaning not all products are “one size fits all.”

Comedonal Acne - the typical blackheads underneath the skin’s surface. These are essentially small non-inflamed, clogged pores.

Papular/Pustular Acne - develops as red bumps and pus-filled whiteheads. These bumps have a tiny opening to the skin’s surface.  So tiny, in fact, that it makes air hard to reach the follicle causing the white bubble.

Nodular/Cystic Acne - the most severe type of acne. These are hard (nodules) or fluid-filled (cystic) painful bumps. Cystic acne is known to take much longer to heal and often results in scarring and discoloration of the skin.

Hormonal Acne - the result of fluctuating hormones in the body. This type of acne can occur into late adulthood. Easily recognized by the bumps located on the chin and jaw, hormonal acne can also advance to the neck and posterior scalp. These develop into hard, painful bumps that can take weeks to heal.

Treatment options are available for each of these particular types of acne and can be addressed with various oral and/or topical agents. However, not all medications are a right fit.  If you suffer from acne and have yet to find relief, please call today to schedule an appointment.

Top Acne Fighting Foods You Should Eat this Thanksgiving

Ever hear the saying “You are what you eat?”  Many foods can contribute to acne flare-ups.  Aside from hormones and poor skincare routine many of the ingredients in your foods can surprisingly produce breakouts.

Here are four acne-fighting foods that can give you clearer skin this holiday season:

- Greens – foods that are rich in the antioxidant, Vitamin E, help skin to heal from acne damage and scarring.  Try making a spinach salad topped with almonds and eggs, drizzled with olive oil.

     - Carrots – foods that are rich in beta-carotene convert to Vitamin A in the body and enhance the benefit of selenium to the skin.  Vitamin A is the derivative used in many anti-aging Retinol creams.

3   - Whole wheat – Skip the white stuff!  White bread, mashed potatoes, white rice, anything made from sugar should be off limits this holiday.  Try substituting it for buckwheat, which is known to help balance the acne inducing hormones.

4   - Sweet potatoes – another great side dish containing beta-carotene.  Aim to consume at least a half-cup of yellow or red fruits and veggies to your daily diet.  Trade out those starchy mashed potatoes for sweet potatoes, and skip the marshmallows.

Stick to these healthier alternatives during your Thanksgiving feast to keep your skin vibrant and healthy.

Hormonal Acne

Spironolactone & Treating Women’s Hormonal Acne

Acne is a very common issue, however there is a huge increase in adult acne recently. Adult acne looks, behaves, and is treated differently than teenage acne. Women will get hormonal breakouts after the age of 25. These breakouts are on the lower half of their face, usually starting on the cheeks and going down to the chin and along the jaw line. They are large, deep, painful cysts that often do not break the surface. They often happen a week before or after the period and seem to NEVER go away completely.

Almost all women with adult acne have some level of hormonal impact on their acne. Most have normal levels of circulating androgens (the “male” hormone such as testosterone or progesterone), which increases around the period. Androgen receptors are present in the sebaceous glands. Spironolactone is effective in treating acne because it effectively blocks this androgen receptor.

The oral medication, Spironolactone is a receptor-blocker and is very effective in treating women’s hormonal breakouts.

If you suffer from hormonal acne, talk to Dr. Lily about Spironolactone for therapy. Clinical studies done with this drug have shown outstanding results for women experiencing hormonal acne. However, it is contraindicated if you are pregnant, nursing or planning on becoming pregnant. 

Spironolactone is often combined with topical regimens. An anti-acne skin cleanser, moisturizer and topical medicines can be used for stellar results!

Treating Hormonal Acne

Hormonal acne is not anything like the acne that you got back when you were in high school. The next question is, how do you determine if it is hormonal? There are 2 key differences, hormonal acne breakouts are around the chin and jaw line also they are felt underneath the skin's surface before they are visible, and almost always sore to the touch. Never ever attempt to "pop" these, it will make it worse than it was to start with. This type of acne is not caused by dirt or bacteria on the skin's surface.  It is caused by a fluctuation of hormones approximately a week before menses dues to an increased level of testosterone or progesterone.

The main obstacle that women with hormonal acne face is that the traditional acne treatments will not work. Hormonal acne needs to be treated by oral medications prescribed by your Dermatologist. 

For skincare however, a common rule to follow in any skincare regiment, especially when dealing with hormonal acne is do not over wash your face! Make a habit out of washing at bedtime with a gentle cleanser (Purpose Gentle Cleansing Wash or Cetaphil Gentle Skin Cleanser).

In the morning before applying any product, rinse face with just water and pat dry. Many of us have a facial moisturizer, sunscreen and foundation... however many products on the cosmetics market now are becoming more hybrid and fusing all three.... into one daily use product (Laura Mercier Oil-Free Tinted Moisturizer SPF 20). Using a product like Laura Mercier's Tinted Moisturizer will suffice as a moisturizer, an SPF and also will give you light coverage all in one application. If you still feel like you need additional moisture or your skin feels dry you can apply moisturizer at bedtime after cleansing try a night moisturizer that is oil free. (VICHY Nutrilogie 2 night cream).

Hormonal acne is tough to treat. Oral medications are the best way to clear it so see your Dermatologist for a program best fit for you. Remember that skincare is also important for your overall complexion, under-doing it is better than over-doing it. Stay simple!