Poor diet may increase risk for acne in adolescent girls

MedWire News: Results from a Norwegian study indicate that adolescent girls who rarely eat raw, fresh vegetables may be at increased risk for acne.


The researchers also found a consistent association between presence of acne and mental distress – anxiety and depression – in both adolescent boys and girls.

There have been few previous studies examining a possible link between acne and dietary factors, although more recently two studies showed that milk consumption can increase and a low-glycemic-load diet decrease the prevalence of acne, as reported by MedWire News.

A link between mental health problems and diet has also been suggested and in the latest research, Jon Halvorsen (University of Oslo) and colleagues evaluated links among acne, diet, and mental distress in a group of 3775 Norwegian adolescents aged 18–19 years.

The presence of acne was self-reported by the participants. The researchers used the Hopkins Symptom Checklist 10 to measure mental distress, while diet and lifestyle factors were recorded using a questionnaire.

Reporting in the journal BMC Public Health, the investigators write that 14.4% of boys and 12.8% of girls had acne.

The results from the initial analysis showed that boys with acne consumed 40% and 54% more chocolate/sweets and potato chips, respectively, than boys without the condition. They were also 63% more likely to suffer from mental distress.

Girls with acne consumed 41% less raw, fresh vegetables than those without acne. They were also 1.77, 2.14, and 2.16 times more likely to have a non-Western background, be from a low-income family, and suffer from mental distress, respectively, than other girls.

Following adjustment for potential confounding factors, boys and girls with acne were still significantly more likely to suffer from mental distress than those without the condition.

In addition, the association between acne in adolescent girls and low consumption of raw, fresh vegetables was still valid.

Halvorsen commented: “Our study shows a possible link between diet and acne. However, when we introduced symptoms of depression and anxiety in our statistical model, the role of diet became less clear.”

He concluded: “It is too early to give evidence-based diet advice to teenagers with acne.

“I hope that this study will encourage doctors to help adolescents to treat their acne and researchers to find preventive factors. Young people deserve better!”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

what is new ?

MedWire News: Acne vulgaris patients are unable to suppress early inflammatory changes due to defective immunosurveillance resulting from low levels of the anti-inflammatory interleukin (IL)-10, say researchers.
“Acne vulgaris is a very common dermatosis characterised by an inflammatory reaction in the pilosebaceous follicles of the face and trunk,” explain Adrian Mountford (University of York, UK) and co-workers.
One trigger for acne is thought to be dysregulation of the inflammatory response to the bacterium Propionibacterium acnes. In normal skin this is prevented by the action of factors such as IL-10, which is a “strong inhibitor of IL-12 production in the skin and likely acts to contain excessive dermal inflammation.”
The team investigated the response of peripheral blood mononuclear cells (PBMCs) cultured from 47 acne patients and 40 age- and gender-matched controls to stimulation with P. acnes.
As reported in the British Journal of Dermatology, Mountford and colleagues found that pro-inflammatory factors such as IL-8 and tumor necrosis factor (TNF)-α were higher in PBMCs taken from acne patients compared with those from controls.
However, cells taken from acne patients secreted significantly lower amounts of IL-10 compared with those from controls.
The impaired IL-10 production was isolated to CD14+ cells thought to be monocytes. The researchers found that CD14 cells from acne patients were unable to destroy P. acnes, but function appeared to be restored on addition of IL-10.
Mountford and team conclude that “acne therapeutics might profitably target IL-10 both as a regulator of pro-inflammatory cytokines and in augmenting the CD14+ cell phagocytic response.”
They add: “Future studies should seek to characterize the cellular sources of IL-10 in evolving and healing acne lesions and compare the skin distribution of IL-10 in subjects with acne and subjects who acne has spontaneously resolved.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

What is new ?

As far as acne goes, if we analyze what is new in recent years, we have the integration of groups with a
special focus in acne, teams concerned about providing the best options and recommendations to the
whole dermatological community about this worldwide condition, about this disease affecting the
totality of young people between 13 and 22 years old. A condition which, over the years, we have seen
spreading to older population. And which represents a true problem in the daily life of these people.
These teams are interested in all aspects, starting with the research stage, since one of the problems we
are observing is, for example, the resistance to antibiotics which is what we use the most to treat acne.
If this continues to grow, then new people exposing to these resistant bacteria would have less
possibilities of obtaining an effective answer to treatment. That, on the one hand, and on the other, the
new acquisitions we have for the treatment of this condition would be the combination of medications
which are manufactured by well-reputed commercial laboratories who follow all standards pertaining
to the pharmacological industry so that they are more effective against this condition. Currently, we
live in a time when people want quick solutions. They don’t want this problem to progress. We, the
physicians, also want to provide treatment and, as much as possible, we want treatment to be timely.
Early treatments that prevent scarring, which, unfortunately, affects patients and which we, the
dermatologists consider not only as skin scars, but scars of the soul. When questionnaires about the
quality of life are applied to patients, we can see that they are much more severely affected if we
compare it with other diseases such as hypertension, diabetes, psoriaris. It makes young people alter
their daily lives, their working activities, their interrelation activities. That is why it is so important to
treat acne. We could then summarize that, as far is what new is, it would be the creation of expert
groups who are interested in providing to dermatologists with treatment algorithms, favoring, for
example, research activities, which update us on where we are standing in the world, what the status on
resistance is, how we are standing as far as adherence, and generate also communication and generate
strategies to decrease this situation. From the point of view of other developments, well, that is always
growing. We have, from the therapeutic point of view, besides all the pharmacological developments,
other breakthroughs in the field of lasers, in the field of lights. Because there will be patients, for
example, pregnant women, who can not have access to systemic medications, because of their
pregnancy and so they will have to use these other tools.

Blue light therapy for acne

Blue light phototherapy significantly reduces inflammatory lesions in patients with mild-to-moderate acne, study findings suggest, despite having no effect on Propionibacterium acnes colony counts.
Alternative acne treatments, such as lasers and light therapy, are becoming important due to the emergence of antibiotic-resistant P. acnes, the side-effects of antibiotics, and intolerance or resistance to oral retinoids.
High-intensity, narrow-band blue light therapy is one such promising treatment for acne. It was thought that blue light, by killing or altering the function of P. acnes, could reduce the severity of the condition, especially inflammatory lesions, explain Sadia Ammad (Cardiff University, UK) and colleagues.
However, they say that their finding "raises the possibility that blue light may in fact be improving acne lesions by as yet unknown mechanisms in addition to the accepted mechanism of action by endogenous porphyrin sensitization."
They evaluated the effects of intense blue light within the spectral range of 415-425 nm in the treatment of 21 patients with mild-to-moderate facial acne. All patients received 14-minute treatment sessions twice weekly for 4 weeks.
Acne severity was significantly reduced with blue light phototherapy. Using the Leeds technique, the mean score of acne grading reduced from 1.64 at baseline to 1.35 at week 4.
The mean inflammatory lesion count was also significantly reduced, from 46.71 to 35.33, whereas a trend toward significance was demonstrated for the reduction in noninflammatory lesions, from 23.86 to 19.43.
P. acnes colony counts failed to show a significant reduction at the end of treatment. The mean value for the P. acnes cultures was 4.94 at baseline and 4.80 at week 4.
"The findings demonstrate that inflammatory lesions show the greatest improvement, while evidence exists for reduced colonization in these lesion types by P. acnes in comparison with the highly colonized noninflammatory lesions," Ammad and team comment in the Journal of Cosmetic Dermatology.
They conclude: "Treatment options involving blue light and another topical or systemic agent may prove to be helpful by targeting different factors involved in the pathogenesis of acne."

WHAT IS NEW ?

Pulsed dye laser (PDL) and 1064-nm long-pulsed neodymium: yttrium-aluminum-garnet (Nd:YAG) laser treatments are similarly effective for treating facial acne scars, a randomized, split-face study suggests.
Nonablative remodeling lasers such as the 585-nm PDL or 1064-nm Nd:YAG can reduce acne scarring with minimal downtime and a low risk for adverse events, say Dae Hun Suh (Seoul National University College of Medicine, Korea) and co-workers.
Noting that studies have not compared a 585-nm PDL and a 1064-nm Nd:YAG laser in the same patient, they used both lasers on 18 individuals affected by acne scars.
Patients received four sessions of PDL or Nd:YAG laser treatment at 2-week intervals in a randomized split-face manner, and were followed up at 4-week intervals for 8 weeks after the final session.
The treatments resulted in similar, mild, atrophic acne scar improvements at 8 weeks after treatment that were statistically significant.
Clinical scores for acne scarring using the Echelle d’évaluation Clinique des Cicatrices d’Acne (ECCA) improved by a mean of 18.3% with PDL and 18.7% with Nd:YAG, a nonsignificant difference. Histologic improvements concurred with clinical efficacy.
Both modalities were particularly effective at treating superficial rolling and boxcar scars, with more than 25% improvements at 8 weeks after treatment.
Ice-pick scars tended to respond better to PDL, while deep boxcar scars tended to benefit more with the Nd:YAG lasers, although these differences were not significant.
Nonetheless, the researchers say: “This observation, which has not been previously mentioned in the literature, might be valuable for choosing the type of laser better suited for the treatment of certain scar types.”
Reporting in the Journal of the American Academy of Dermatology, they further note that “greater improvement by test shots with Nd:YAG laser than by those with PDL strongly favors the use of Nd:YAG laser in the subsequent sessions.”

WHAT IS NEW ?

J Invest Dermatol 2009; Advance online publication
MedWire News: The risk for acne may be linked with the X chromosome, say researchers after finding that mothers are more influential than fathers in determining its severity in teenagers.
The team studied risk factors for acne vulgaris among 1002 Iranian pupils in Tehran, of whom 499 were boys and 503 were girls. The mean age of participants in the cross-sectional study was 16 years.
The overall prevalence of acne was 93.3%, and was 94.4% for boys and 92.0% for girls.
Moderate-to-severe acne was observed in 14% of the group and was more common in those with than without a family history of the condition, at 19.9% versus 9.8%, respectively, and an odds ratio (OR) of 2.3.
The risk for suffering moderate-to-severe acne increased with the number of affected immediate members of the family, with a family history of acne carrying an OR of 1.7 in multivariate logistic regression.
Interestingly, the mother’s acne history was more important in determining its severity than the father’s, at corresponding ORs of 2.8 and 1.9. Both were more influential in determining acne severity than brothers or sisters.
Being aged at least 17 years was associated with an OR of 2.2 for moderate-to-severe acne compared with a younger age. Being a female smoker was also associated with an OR of 6.7 for this outcome.
In multiple logistic regression, having self-assessed oily or normal skin or physician-assessed seborrhea was associated with moderate-to-severe acne, at ORs of 2.6 and 2.8, respectively.
Moderate-to-severe acne was also associated with the premenstrual phase, mental stress, and eating sweet and oily foods, but not with gender, spicy foods, or smoking overall.
Reporting in the Journal of Investigative Dermatology, Christos Zouboulis (Dessau Medical Center, Germany) and colleagues say: “These findings clearly indicate a vertical transmission of a genetic risk factor that may be X-chromosome-linked.”

WHAT IS NEW ?

Risk factors for severe acne flare on isotretinoin identified.
MedWire News: Male gender, severe acne, macrocomedones, presence of truncal comedones, a higher number of facial comedones, and the presence of more than two facial nodules are risk factors for severe acne flare during isotretinoin treatment, say researchers in Turkey.
"Flare of acne is an expected event at the beginning of isotretinoin treatment," explain Sadiye Kus (Acibadem Hospital, Istanbul) and colleagues.
"However, severe flare, which necessitates treatment with systemic steroids or discontinuation of the drug, is rare."
Multiple comedones, male gender, and young age have previously been reported as promoting factors for severe acne flare during isotretinoin treatment; however, detailed information is currently limited.
Therefore, Kus and team conducted a prospective study to investigate the incidence, types and course of acne flare and the predictive factors for its occurrence during isotretinoin treatment in patients with moderate to very severe acne. Patients received an initial dose of 0.5 mg/kg, which was increased to 1 mg/kg at the end of the first month.
Of 244 patients enrolled, 161 completed the study. Of these, 79 patients (32%) experienced a facial and/or truncal flare which was classified as mild (18%), moderate (10%), or severe (4.5%).
The predictive factors for severe flare were male gender, severe acne, a global acne grading system cutoff score of >28, the presence of more than 44 facial comedones or two facial nodules, and the presence of truncal nodules.
"Recognizing these predictive factors for severe flare may help us to take early precautions such as the mechanical extraction of comedones before starting isotretinoin, pretreatment or concomitant treatment with oral antibiotics or steroids and introduction of isotretinoin in low doses," write Kus and team in the European Journal of Dermatology.
"These measures would not only increase our treatment success but also improve patient satisfaction in those suffering from acne."

WHAT IS NEW ?

The FDA has approved a new prescription acne gel called Epiduo for use in patients 12 and older.
Epiduo, which is used once daily, combines two long-time acne treatments: benzoyl peroxide 2.5% and adapalene 0.1%. Adapalene is a retinoid sold generically and by the brand name Differin.
Galderma, the company that makes Epiduo, states in a news release that Epiduo is the "first and only" combination acne gel of its kind. Epiduo will be available in the first quarter of 2009, according to a Galderma news release

WHAT IS NEW ?

St. Louis University School of Medicine is to research the effects of non-ablative lasers on acne scars, specifically in those with darker skin tones.
Treating acne scars in people with dark skin has always been a tricky situation. Certain scar treatments, such as dermabrasion and laser treatments, often leave an unwanted side effect: skin discoloration. While hyperpigmentation (darkening of the skin) and hypopigmentation (loss of skin color) can occur in people of any skin tone, it is much more common in those with darker complexions, especially African-Americans and people of Hispanic descent.
The researchers at St. Louis University will study the effects of non-ablative lasers on acne scars in those with dark complexions. Non-ablative lasers work deeper in the skin's layers without causing damage to the epidermis, so there is less chance of developing pigmentation problems. The hope is that non-ablative lasers will smooth acne scars without causing unwanted changes in the skin's natural color.
The findings may someday help those with brown skin treat their acne scars more effectively.

WHAT IS NEW ?

Severe acne vulgaris is associated with significantly more oxidative stress than mild or moderate forms of the disease, study findings suggest.
To deal with the harmful effects of reactive oxygen species, the skin is equipped with antioxidant defense mechanisms. Superoxide dismutase (SOD) constitutes an important fraction of the antioxidant capacity of living cells to prevent oxidative injury and maintain skin homeostasis.
Prior studies have proposed the role of oxidative stress in the etiopathogenesis of acne. To investigate further, Abdel Fattah and colleagues from Ain Shams University in Cairo, Egypt, conducted a case-control study to assess the role of oxidative stress in different grades of acne severity.