Carbs and acne new study

WCD: Cut simple carbs to clear acne

By: AMY KARON, Dermatology News Digital Network |

VANCOUVER, B.C. – Mounting evidence suggests that consuming a low glycemic index diet can substantially improve acne, according to Dr. Hyuck Hoon Kwon. 

The approach has held up in several small-scale randomized clinical trials, earning it a grade of 1B last year from the American Academy of Dermatology, noted Dr. Kwon of Seoul National University in South Korea.

“Dermatologists can recommend dietary modification to patients, and can advise them to avoid foods that they believe worsen their acne,” Dr. Kwon said at the World Congress of Dermatology. He said he has seen clinically meaningful reductions in acne lesions as soon as 4 weeks after patients cut their intake of refined carbohydrates and other high glycemic index (GI) foods, although results can take up to 12 weeks, and more studies of time to effect are needed.

Scientists and clinicians have long debated the role of diet in the pathogenesis of acne, and until recently, there were no randomized, controlled trials or meta-analyses of the topic. But observational studies have repeatedly documented “astonishingly” low rates of acne in cultures with “traditional” diets that are lower in refined carbohydrates and fat than typical Western fare, said Dr. Kwon. 

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In one study of 1,285 individuals in Korea, those who did not have acne reported consuming significantly higher amounts of fish and yellow, leafy green, and cruciferous vegetables, while those with acne ate significantly more instant noodles, processed cheeses, and “junk” foods, he noted (Eur. J. Dermatol. 2010;20:768-72).

In another trial, Dr. Kwon and colleagues randomized 32 individuals with mild to moderate acne to either a low-GI diet that emphasized beans, barley, vegetables, fish, and whole-grain breads, or to a high-GI control diet (Acta Derm. Venereol. 2012;92:241-6). The low-GI group ate more protein to replace calories lost from cutting carbohydrates. At 10 weeks, the groups had similar mean calorie intakes and body mass indices, but the low-GI group had reduced its dietary glycemic load from baseline and had significantly fewer inflammatory and noninflammatory acne lesions compared with baseline and with the high-GI group, Dr. Kwon said. The low-GI group also had significant decreases in total average area of sebaceous glands, and decreased expression of sterol response element-binding protein-1 (SREBP-1), which stimulates lipogenesis in sebocytes.

Most recently, scientists have explored the molecular mechanisms linking diet to acne, Dr. Kwon noted. High GI diets trigger chronic hyperinsulinemia, which impairs the ability of FoxO1 transcription factor to mediate androgen receptor signaling, oxidative stress, lipogenesis, and sebaceous gland homeostasis. Importantly, FoxO1 inhibition also is associated with activation of mTORC1, which promotes lipid and protein synthesis, sebaceous gland hyperplasia, and sebaceous lipogenesis, he said.

Dr. Kwon reported having no relevant conflicts of interest. 

For Better Facial Rejuvenation: Combo Therapy

Combination treatment: better facelift results, less downtime

June 12, 2015

By Lisette Hilton

Nonsurgical procedures are the fastest growing area in aesthetics and can delay the need for invasive procedures, but they cannot treat all concerns, such as excess skin in the neck and upper eyelids and excess fat deposits, according to Palo Alto facial plastic surgeon Jill L. Hessler, M.D.

Dr. Hessler, an adjunct clinical assistant professor, otolaryngology, head and neck surgery at Stanford University School of Medicine, presented on the subject of combined treatments yesterday at the 11th annual Vegas Cosmetic Surgery and Aesthetic Dermatology multispecialty aesthetic symposium in Las Vegas.

Among the topics she tackled: surgical and non-surgical combination treatment for facelifting.

When assessing the aging face, first surgeons need to assess volume loss from skeletal changes, bone resorption and bony remodeling, as well as facial fat loss, which leads to a gaunt and hollow appearance, Dr. Hessler says.

“Secondly, there is laxity of the skin, as some of the elasticity and collagen weakens [thereby] creating the jowls, neck redundancy and dropping eyelid skin,” Dr. Hessler says. “Thirdly, there are intrinsic changes of the skin, which cause discolorations, fine and deep lines and lack of a uniform color and smooth texture. We need to address each of these areas separately.”

Nonsurgical treatments, such as laser resurfacing can address the third area, according to Dr. Hessler.

“In that past, it was suspected that combining laser resurfacing with facelift surgery would be too traumatic to the tissues and lead to a higher risk of complications,” she says. “Multiple experiences and studies have demonstrated that this is not the case, and laser resurfacing can safely be performed at the same time as facelift surgery — particularly, with new fractionated lasers….”

Patients often are concerned with fine lines and deep lines around the face. The laser, alone, can treat superficial fine lines, but, can’t adequately address the deeper lines and folds without some form of additional skin tightening, according to Dr. Hessler.

Volume loss in the face is yet another missing piece in this picture for many patients. While facelifts reposition tissue and remove the deeper lines and folds and lasers remove fine lines and discoloration, adding volume for more youthful contours creates a synergistic enhancement with these other procedures.

“Combining these procedures allows the surgeon to obtain enhanced results, while being slightly less aggressive with each treatment, which allows faster recovery and a lower chance of side effects,” she says. “Combining surgical procedures with the less invasive procedures allows surgeons and patients to obtain the best from both worlds: optimizing treatment results with more limited recovery and downtime.”

Dr. Hessler reports no relevant disclusures. 

Lid Lift with latisse! This is a very good thing!

Bimatoprost for ‘chemical’ blepharoplasty?

June 12, 2015

By Lisette Hilton

Topical bimatoprost (Latisse, Allergan) is approved for the treatment of hypotrichosis, but using it off-label might help patients achieve a chemical blepharoplasty, according to a presentation given yesterday at the 11th annual Vegas Cosmetic Surgery and Aesthetic Dermatology multispecialty aesthetic symposium in Las Vegas.

Deborah S. Sarnoff, M.D., clinical professor of dermatology at New York University School of Medicine, presented her experience and new study, published May 2015 in the Journal of Drugs and Dermatology, on the use of bimatoprost beyond eyelashes.

In the study, Dr. Sarnoff and plastic surgeon Robert H. Gotkin, M.D., report significant changes in the appearance of the periorbital area after applying topical bimatoprost ophthalmic solution, 0.03% to the upper eyelid margins. The authors write that while published reports in the literature suggest side effects and potential complications from the drug, including prostaglandin-associated periorbitopathy, or PAP, theirs is the first report in the dermatology and plastic surgery literature looking at the rejuvenating effect of topical bimatoprost on the periorbital area. 

“While periorbitopathy implies pathology or a state of disease, we report changes that can be perceived as an improvement in the overall appearance of the periorbital area. We, therefore, propose a name change from PAP to PAPS — prostaglandin — associated periorbital syndrome. This better describes the beneficial, as well as the possible negative effects of topical bimatoprost,” according to the study authors.

Dr. Sarnoff says she treated herself with bimatoprost for eyelash enhancement and used her case report for the study. She applied the topical to the base of the upper eyelid cilia daily for three months; then, reduced application to two to three times a week. By 3 months, her eyelashes were noticeably fuller. Dr. Sarnoff also notes deepening of the upper eyelid sulcus, improvement in the hooding of the upper eyelids, involution of the dermatochalasis in the upper and lower lids, decrease in lower eyelid fat bulging and lower lid skin tightening, according to the study.

"Although there is a risk for periorbital changes that could lead to disfigurement in some patients, in properly selected candidates, when used bilaterally and the dose titrated appropriately, bimatoprost can have a rejuvenating effect beyond eyelash enhancement. It can improve hooding and dermatochalasis of the upper eyelid, diminish lower eyelid fat pads and tighten periorbital skin,” Dr. Sarnoff says. “The striking improvement in the periorbital appearance of some individuals using bimatoprost (Latisse), warrants further research into its potential use to achieve a 'chemical blepharoplasty.'"

Dr. Sarnoff reports no relevant disclosures.

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Lack of sleep may speed up skin aging

Publish date: SEP 24, 2013

 

 

By: Sarah Thuerk

 

Sleep deprivation can increase the signs of aging in the skin and decrease the skin’s ability to recover after sun exposure, a recent clinical trial indicates.

Researchers at University Hospitals Case Medical Center, Cleveland, examined 60 premenopausal women between the ages of 30 and 49, with half of the participants categorized as having poor sleep quality, according to a news release. This classification was made based on average duration of sleep and the Pittsburgh Sleep Quality Index.

Participants were given a visual skin evaluation and noninvasive skin tests such as UV light exposure and skin barrier disruption. Participants also completed sleep logs for one week to quantify sleep duration.

Poor quality sleepers demonstrated increased signs of intrinsic skin aging such as fine lines, uneven pigmentation and reduced elasticity. Good quality sleepers recovered more efficiently from skin stressors. Sunburn recovery was slower in those who got poor quality sleep, with erythema remaining higher over 72 hours.

Using a transepidermal water loss test at various points, good quality sleepers had recovery 30 percent higher than poor quality sleepers.

“Sleep deprived women show signs of premature skin aging and a decrease in their skin’s ability to recovery after sun exposure,” Elma Baron, M.D., the study’s primary investigator, said in the news release.

The study was commissioned by Estée Lauder.