Screen Shot 2014-08-25 at 10.30.57 AMI recently found out about a group of students at the University of Pittsburgh who wanted to work on acne bacteria in an attempt to get it to the point where we can experiment with genetic engineering on these bacteria that have a hand in acne.

When I first pledged money they were only about half way there. As of yesterday I found out they are fully funded! Fantastic guys. Rock it out!

Screen Shot 2014-09-18 at 9.09.42 AM

You can view more about this research here.

il-1The question, “Is acne an autoimmune disease?” has always lingered in the back of my mind. An article in Swiss Medical Weekly recently looked into how an over-active immune response could be the culprit in chronic skin inflammation. Since we know that acne is largely an inflammatory disease, could this play a part? The authors state, “The skin is our largest organ, which is exposed to and protects the body from microbes, pathogens and several irritants. However, the skin can…be a site of excessive immune responses resulting in chronic inflammation, autoimmunity or autoinflammation.”

Our skin, like other organs of our body, is pretty amazing. It provides defense against a multitude of pathogens. However, in the case of acne, might it be overreacting to perceived pathogens and creating an unjustified inflammatory response in the form of excess oil and/or hyper-proliferation of skin cells? The key may be in researching inflammasomes that detect pathogens and the cytokines that these inflammasomes activate, specifically interleukin 1 (IL-1).

I have not come across much research on acne and autoimmunity, but if any of you come across some good hard science on this topic, please send it my way.

Also, have any of you gone on immune suppressing medications (i.e. Humira) and seen your acne symptoms change? I’d be curious to hear from you.

I noticed there is also a thread on the forum discussing this as well. Feel free to add your comments there as well.

References:

  • Contassot E, Beer HD, French LE. “Interleukin-1, inflammasomes, autoinflammation and the skin.” Swiss Medical Weekly. 2012; 142:w13590.

Screen Shot 2014-09-05 at 10.57.35 AMWhen it comes to acne, cold beats hot.

Hot: The power of heat at this time is limited in acne care. Lasers and radio frequency devices use targeted heat to kill bacteria in the skin, which can improve acne, but only to a moderate degree and for a high cost. For these reasons, I don’t advocate for these methods, especially lasers. I am intrigued by radio frequency devices and will keep my eye on them as more research comes out, but so far I don’t see much good science when it comes to radio frequency and acne. Spot treatment devices which claim to use heat to stop a pimple from forming tend to disappoint in both their efficacy and cost as well.

Cold: Cold on the other hand, has a long standing history of helping to treat acne. According to a review article published in Cutaneous and Ocular Toxicology, “Cold is…a useful treatment modality. In dermatological care, cold is often used for angioedema (under the skin swelling)…” We can see the power of ice in spot treatment. If you feel a zit forming, put a piece of ice in a Ziploc bag and hold it very gently on the spot for 5 minutes. This simple treatment can work wonders, especially when combined with proper topical treatment and anti-inflammatory agents. While less convenient, ice can also be used all over the face. If you’d like to try it, simply fill up a styrofoam cup with water and freeze it. Then peel back the styrofoam and VERY GENTLY move the ice over your entire face. This can get messy but can be fun from time to time. Just be certain to remain ultra gentle to reduce any unwanted irritation.

Cold can help, but there is no substitute for properly treating your skin. First, get on The Regimen and get cleared up. Then, feel free to use ice on occasion when you need it for spot treatment or when you just feel like adding in something for a change of pace.

References:

  • Bayata S, Turel EA. “Thermotherapy in dermatology.” Cutaneous and Ocular Toxicology. 2012; 31(3): 235-40.

2.5% benzoyl peroxide Researchers at UCSF Medical School recently published a review article in the Journal of Dermatological Treatment which took a look at all available evidence on the dosing of benzoyl peroxide. They took a look at 8 studies in all. The authors concluded:

“There appears to be insufficient data…to document use of a higher concentration than 5% or even 2.5%.”

Regarding side effects, the authors note:

“There does appear a difference in the number of side effects according to the dose titration. The 2.5% formulations had a significant lower rate and lower severity of burning, erythema (redness) and peeling…”

They go on to further conclude:

“To increase compliance and thus the efficacy of the therapy, a lower titration of 2.5% should be preferred.”

Those of us who use benzoyl peroxide regularly have noticed this first hand. 2.5% works just as well or better than higher percentages because it does the same job as higher percentages without all the unnecessary irritation that can perpetuate acne cycle.

For best results, stick with 2.5%, and use it within The Regimen.

References:

  • Brandstetter AJ, Maibach HI. “Topical dose justification: benzoyl peroxide concentrations.” Journal of Dermatologic Treatment. 2013; 24(4): 275-7.

fusion proglide

I try every razor that comes out in the futile attempt to find something that comes close to the Gillette Trac II, which is by far the least irritating razor on the market and the best for people who are acne-prone.

The commercials are so compelling. A FlexBall! It hugs the contours of the face! Well, not really. This razor is much like any other 3, 4, or 5 blade razor. It is much more irritating than the Trac II and doesn’t provide as good of a shave. For 3 days each, I tried both the manual version of this razor and the “power” version which vibrates when you press the button, and neither version seems to hug my face at all. To be honest, the FlexBall for me was just a gimmick and did nothing special. The same goes for the power vibrating version. It feels no different from the manual version and seems completely unnecessary.

Take it from me…save our money and go with the Trac II.

All the info you need for shaving: Acne.org’s complete guide to shaving

400px-H.pyloriAcne rosacea is a different disease from acne vulgaris (run-of-the-mill acne). However, since symptoms often overlap, I like to keep on top of rosacea research as well. A few years ago I read a truly fascinating study which found that the guts of people with rosacea had a much higher incidence of bacteria colonization with a type of bacteria called H. pylori (helicobacter pylori), the same bacteria that is responsible for the majority of stomach ulcers. Of the people who had this bacteria, 20 of 28 of them appeared to be cured by using a powerful antibiotic to specifically kill the helicobacter pylori bacteria. I got so jazzed from the possibility that perhaps H. pylori could also affect acne vulgaris that I went to the doctor and had him order an H. pylori test for me. The test took hours and involved me blowing into a detector every few minutes. My results: Negative. I didn’t have any H. pylori in my gut.

Another study has since been conducted in Nepal. The researchers found that 17 out of 26 rosacea patients they studied had colonies of H. pylori in their gut.

This evidence is so compelling that rosacea researchers are starting to look at the possibility that rosacea is simply a skin manifestation of an internal disease of the gut.

Might another existing or still undiscovered gut bacteria cause or aggravate acne vulgaris? I would so love to know.

References:

  • Parodi A, et al. “Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication.” Clinical Gastroenterology and Hepatology. 2008; 6(7): 759-64.
  • Ghattarai S, et al. “The study of prevalence of helicobacter pylori in patients with acne rosacea.” Kathmandu University Medical Journal. 2012; 10(40): 49-52.

bottle-kit-3.4oz_2We just started selling new Travel Sized products in 3.4 oz. bottles. Airport security (TSA) in the United States sets the limit for carry on products at 3.4 ounces, so we went right up to that legal limit. These Travel Sized products should last you for about 12-13 days which should be plenty even for a longer trip.

Enjoy!

Screen Shot 2014-08-11 at 12.06.49 PMScientists recently took a look at 55,825 outpatient dermatologist visits from 1995-2009 and found that “In comparison to other dermatologic disorders, acne was over two times more likely to be associated with ADHD.” They controlled for age, sex, ADHD medications, and other mental disorders. A second look at 5240 patient visits showed similar results: “Our results…reveal a significantly high prevalence of ADHD in acne patients…”

These are retrospective studies, and even the authors themselves call their findings preliminary and say, “These findings need to be confirmed in clinical samples of acne patients.” However, if it turns out to be true, why might this be the case? Might both acne and ADHD be worsened by similar dietary factors? Perhaps it is the fidgeting of people with ADHD that causes increased irritation of the skin and thus acne.

Side note: Interestingly, eczema has also been associated with ADHD before.

References:

  • Gupta MA, Gupta AK and Vujcic B. “Increased frequency of Attention Deficit Hyperactivity Disorder(ADHD) in acne versus dermatologic controls: analysis of an epidemiological database from the US.” Journal of Dermatological Treatment. 2014; 25: 115-118.
  • Gupta MA, Gupta AK and Vujcic B. “Cormirbidity of acne with attention deficit hyperactivity disorder: Results from a nationally representative sample of 5240 patient visits for acne from 1995 to 2008.” Journal of the American Academy of Dermatology. 2012; 66(4): AB86.

photo-80Medical science is still not close to deciphering what causes acne, but it’s not for lack of trying. Here I will summarize 9 recent studies that I have read which attempt to get to the bottom of it. Keep in mind that we have no definitive conclusions, just ongoing research. Warning: Big words!

Oxidative stress. Scientists published an article in the Journal of Drugs in Dermatology considering the role of oxidation as something that “may be an early event that helps to drive the acne process.” Could it be skin oil (sebum) oxidizing that causes acne? Could antioxidants help?

Growth hormone and IGF-1 (Insulin-like growth factor 1). A study in Iran attempted to evaluate the power of growth hormone and IGF-1 to affect male hormones and thus increase the severity of acne. “The mean serum levels of GH and IGF-1 of severe acne patients were significantly increased when compared with mild-, moderate acne patients, and healthy controls.” A second Turkish study further evaluated the link between IGF-1 and acne. Again a significant link was found between IGF-1 levels and acne severity.

Staphylococcus aureus (S. aureus). You may have heard of this in regards to “staph infections.” In the journal North American Journal of Medical Sciences, researchers looked at the Staphylococcus aureus levels in acne patients vs. healthy controls. Results were inconclusive. “S. aureus was detected in 21.7% of the subjects in acne, and in 26.6% of control groups.”

Altitude. An article in the European Journal of Pediatrics looked at 6,200 boys. Interestingly, they found that “the acne frequency decreased with the increasing of the altitude where the boys lived.” Why this might be the case we don’t know.

Inflammation. Three articles looked at inflammation more closely. The first in the Journal of Drugs in Dermatology further elucidates the particular sequence of inflammation that leads to acne lesion formation. “An important facet of the new paradigm is that a specific follicular pattern of innate inflammation occurs before and during follicular hyperkeratinization. Moreover, this inflammation persists during the resolution of the macular phase after inflammatory lesions flatten toward the end of their life cycle.” A second article in the Journal of Drugs in Dermatology further states this point, “Newer research has shown that inflammation may precede comedo formation. Gene array analysis of acne lesions has elucidated newer inflammatory mediators…” A third study, again published in the Journal of Drugs in Dermatology drives home the point, “Recent evidence suggests that subclinical inflammation is the primary event in lesion development and that inflammation persists throughout the lesion life-cycle. Therefore, all types of acne should be considered ‘inflammatory’ acne.”

Genetics and Lifestyle. An study performed in Italy and published in the Journal of the American Academy of Dermatology looked at family history, personal habits, diet, and menstrual history. Their conclusion: “Family history, body mass index, and diet may influence the risk of moderate to severe acne. The influence of environmental and dietetic factors in acne should be further explored.”

Thanks scientists for all your work! Hopefully we will keep getting closer to figuring out what causes acne so we can get to the root of it and wipe it out for good!

References:

  • Bowe WP, Patel N, Logan AC. “Acne vulgaris: the role of oxidative stress and the potential therapeutic value of local and systemic antioxidants.” Journal of Drugs in Dermatology. 2012; 11(6): 742-6.
  • Saleh BO. “Role of growth hormone and insulin-like growth factor-1 in hyperandrogenism and the severity of acne vulgarism in young males.” Saudi Medical Journal. 2012; 33(11): 1196-200.
  • Tasli L, et al. “Insulin-like growth factor-1 gene polymorphism in acne vulgaris.” Journal of the European Academy of Dermatology and Venereology. 2013; 27(2): 254-7.
  • Khorvash F, et al. “Staphylococcus aureus in Acne Pathogenesis: A Case-Control Study.” North American Journal of Medical Science. 2012; 4(11): 573-6.
  • Robeva R, et al. “Acne vulgaris is associated with intensive pubertal development and altitude of residence–across-sectional population-based study on 6,200 boys.” European Journal of Pediatrics. 2013; 172(4): 465-71.
  • No authors listed. “Decoding Acne: Genetic Markers, Molecules, and Propionibacterium Acnes.” Journal of Drugs in Dermatology. 2013; 12(6): s61-2.
  • Weiss JS. “Messages from molecules: deciphering the code.” Journal of Drugs in Dermatology. 2013; 12(6): s70-2.
  • Stein Gold LF. “What’s New in Acne and Inflammation?” Journal of Drugs in Dermatology. 2013; 12(6); s67-9.
  • Di Landro A, et al. “Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults.” Journal of the American Academy of Dermatology. 2012 67(6):1129-35.