Antibiotic therapy for acne. Cause for concern.

The more I learn about antibiotic therapy for acne, the more wary and less enthused I become. Due to overuse and misuse over the past twenty years, antibiotic resistance has become widespread throughout the skin of the world population. This is evidenced by the increasing ineffectiveness of both oral and topical antibiotics in clinical studies. Antibiotics never worked very well for acne, and now they work even less well.

According to a “Global Alliance to Improve Outcomes in Acne” published in the Journal of the American Academy of Dermatology, antibiotics should be avoided as the sole treatment of acne. Researchers agree strongly that if antibiotic therapy is used, it should be combined with other therapies. When you look at the superior effectiveness of these other therapies the question arises as to why someone would want to include antibiotics at all. For example, when one takes into consideration the fact that benzoyl peroxide kills 99.9% of acne bacteria on its own and does not create resistant colonies of bacteria, one has to wonder why so many prescriptions for antibiotic acne therapy–over 11 million per year–are still written. According to an article published in the journal Expert Opinion on Pharmacotherapy, “…evidence demonstrates that [topical antibiotics] are no more effective against inflamed lesions than [benzoyl peroxide], and are less effective against non-inflamed lesions…To date, [benzoyl peroxide], as both mono- and combination therapy, is the most evidence-based approach.” Other acne treatments exist, and while they may not be as effective as benzoyl peroxide, they easily outpace antibiotics.

The misuse of antibiotics can also cause antibiotic resistance in other skin bacteria, especially the bacteria known to lead to impetigo and folliculitis. If all of this weren’t enough, when we look at how gene mutations work in bacteria, we see that genes which allow for resistance to antibiotics are easily transferred from acne bacteria to other bacteria in the skin, thus further promoting unwanted antibiotic resistance in other skin bacteria.

If your doctor has you on antibiotic therapy for acne and nothing else, it may be time to have a talk with her/him. The authors of the expert opinion review also note that topical antibiotics should be used for no longer than 3 months and oral antibiotics for no longer than 6 months. So, if you have been on antibiotic therapy for a long time, it may also be time for an appointment with your dermatologist. Since poor compliance with antibiotic regimens are one of the main causes of antibiotic resistance, just make sure you do not stop antibiotic therapy on your own without consulting with your physician first.

Messageboard Upgrade Underway

Hey Everybody. Just a heads up to keep you all in the loop…we have been working on an upgrade to the messageboards for a few months now. It’s a huge job but we’re almost done. The new messageboard is now online and should be accessible for you, but keep in mind that it doesn’t have the look or feel that it ultimately will.  We will be working on sprucing everything up this week.  The new boards will have better navigation, search, members area…pretty much everything.  Plus it should be more integrated with social media and help everybody on here get to know each other better with upgraded tools.

Thanks for your patience, and please give me your feedback.  I know you will :)

Brand new augmentation (filler) scar treatment: Regenerative Cell Therapy by LaViv


What it is:  On June 21, 2011 the FDA approved a process by which a dermatologist or plastic surgeon numbs behind the ear, removes small pieces of skin, and sends these pieces of skin to a lab where the fibroblast cells in the skin samples are multiplied many times over and then frozen. These cells are then thawed when needed and injected into the skin under wrinkles or scars (boxcar or rolling) to help even out the appearance of the skin.

PROS: The body views these cultured cells as “own” and so the immune system does not respond. Working with your own cells eliminates allergic reactions, lumps, or abscesses which may come with other fillers. But probably the most compelling advantage is how long results last. Other fillers like bovine or synthetic collagen may last only a few months, and even more advanced fillers which combine polymer beads with collagen may only last a year or so. The LaViv treatment promises to last for years. As with many fillers, recovery is extremely minor and is evidenced by minor redness or bruising at the injection site. You can immediately return to work.

CONS: People don’t see results right away. The process requires 3 staggered injections and results aren’t seen until up to 3 months. It also costs a pretty penny–anywhere from $2000-$4000. However, other fillers which last less than a year can cost about $1000, so when you look at the long term, using your own cells may be more cost effective.

BOTTOM LINE: As always, the proof is in the pudding, and the pudding in this case is still cooking. This is such a new product and process that we literally haven’t had enough time to begin seeing “real” before and afters from everyday people posting online. There are 2 before and after pictures at this link which are provided by the company. Keep in mind as well that fillers are very often best used alongside other treatments, such as laser resurfacing.

This Just In: Good old pumps are back

A while back we switched to new pumps–pictured below on the right. You guys let me know they were kinda annoying and I agreed, so I switched back to the old pumps–pictured below on the left. From now on, if you order any Acne.org product with a pump, you will get the old, good pumps.

Diet and Acne: Wrapping it up

The last few days I have spent going through all clinical studies/trials regarding acne and Omega-3 fats, iodine, antioxidants, chocolate, calorie intake, fatty/oily food, digestion, and zinc. Adding to this what I have learned regarding dairy and glycemic load, I’m sorry to say that nothing stands out for me as a smoking gun when it comes to diet and acne. We simply don’t have enough research yet, and nothing feels super compelling to me at this point. However, at least researchers are looking into how diet may affect acne, so hopefully by the next time I review the literature, the evidence available to the scientific community will start taking shape. In the meantime, based on digesting everything the research community has to offer regarding diet and acne, here is what I am personally going to do as far as diet goes:

1.  Keep taking fish oil and eating wild delicious sushi :)  I take 4 fish oil pills per day to make up for my Western-style diet, which like almost everyone living in modern society, is overly rich in Omega-6 fats from vegetable oils, grains, etc. There is enough evidence to persuade me of the overall health benefits of Omega-3s and I feel good taking fish oil regardless of whether or not it may be helping with my skin. Also, when I go out to eat, I specifically ask whether the fish or sushi on the menu is wild. Farm raised seafood is far inferior in Omega-3s and other nutrition than wild seafood.

2.  Keep taking a zinc supplement. Having dived deeper into the role of zinc, I am still convinced that it is likely an important nutrient when it comes to combating inflammation and keeping bacteria in check. I’ll keep taking my 30mg per day.

3.  Not worry about iodine, chocolate, fatty/oily food. I’ll keep eating seaweed salad and seafood (contain iodine).  There exists no evidence showing that the amounts of iodine consumed in these foods is in any way detrimental for acne. Based on the available evidence, I’ll also continue eating a little dark chocolate every day without worrying about how my skin will react. I will also keep eating the occasional naughty greasy meal without fear.

4.  Try to be generally healthy. Antioxidants are important calming agents in the body, and eating antioxidant-rich colorful fruits and vegetables is fun and tasty anyway. When it comes to glycemic load, whether or not scientists know if it will help with acne yet, I’ll try to keep my meals balanced with carbs, fat, and protein to keep my energy and mood level and avoid crashes.

A full update to the diet and acne page of acne.org is on its way with much more information on each of the above mentioned topics. In the meantime, when you look at the evidence at hand, eating healthy and in moderation will suffice as a general wrap up for what we know regarding diet and acne at this point. Not exactly a Eureka moment.

Latest Greatest Research: Glycemic Load and Acne

If you eat a high glycemic diet with foods like white bread, sugary soda, white potatoes, and white rice, you will experience insulin spikes. This we know. What we don’t know (sorry Josh) is whether this sort of diet will directly affect acne.

Scientists hypothesize that a high glycemic diet and its resulting insulin reaction will result in higher levels of hormones (IGF-1 and androgens) which may contribute to clogged pores and increased skin oil production.

When it comes to high glycemic diets in particular, scientists also postulate that eating this way may lower the amount of beneficial proteins (IGFBP-3) and natural retinoids, which help keep skin cell growth in check and pores from becoming clogged.

However, as is becoming customary in my research on diet and acne, we do not have enough research to make any strong correlations. The only 2 studies which have been done on glycemic load and acne have been performed by the same group of Australian researchers, led by Robin Smith, and while acne lesion counts appear to reduce on low glycemic diets, results are inconclusive. What stands out most sharply is the lingering question of whether glycemic load leads to decreased acne symptoms or whether it is the weight loss that tends to go hand in hand with this sort of diet that causes the reduction in acne. To answer this question, we need data on whether a reduction in acne symptoms is sustained after weight loss has leveled off. Until then, I’m happy that the scientific community is at least starting to investigate.

Latest Greatest Research: Dairy and Acne

After a thorough review of the literature up until today…

This is what scientists know:

Hormones: Milk contains hormones such as IGF-1 (insulin-like growth factor) and androgen (male hormone) precursors.

Iodine: Milk often contains iodine, largely due to farmers dipping the teats of cows in an iodine solution before milking in order to sterilize. At large doses, iodine can cause what are called acneiform eruptions. Acneiform eruptions look similar to run-of-the-mill acne vulgaris but are different in important ways.

This is what scientists postulate, but don’t know:

Hormones: IGF-1 and androgen precursors in milk could theoretically lead to increased skin cell production, causing pores to become clogged. IGF-1 and androgen precursors could also theoretically lead to increased skin oil production. Since we know that acne does not flourish in low oil environments, perhaps the hormones in milk might help provide an oily fertile ground for acne.

Iodine: The link between iodine and acne is even more theoretical than with dairy. However, some select scientists put out the possibility that if iodine does in fact aggravate acne, since milk contains iodine, milk could lead to more acne.

The bottom line:

What stands out strongly now that I have read all of the evidence is that the design limitations in dairy and acne studies thus far leave us without any concrete answers. After performing a thorough review of existing evidence, authors in the Journal of Clinics in Dermatology agree: “Our conclusion, on the basis of the existing evidence, is that the association between dietary dairy intake and the pathogenesis of acne is slim.”

My common sense takeaway:

Northern Europeans were the first to domesticate animals and drink milk past childhood. In fact, the last genetic adaptation we see in humans is the gene which allows people of Northern European ancestry to digest lactose. If you can drink milk and eat dairy products without stomach aches, excess gas, or discomfort, perhaps ingesting dairy is part of a healthy lifestyle for you. However, for the rest of us, me included, if you do not have the gene, and dairy gives you issues, that’s a pretty clear sign that your body isn’t crazy about dairy. It might be a good idea to steer clear of it for overall health. As far as acne in particular is concerned, we just don’t know yet. I personally love pizza more than breathing ;) and I’m not going to give up dairy completely until I see more concrete evidence linking it directly with acne or other serious negative health consequences.

Latest Greatest Research: Diet and Acne

Thanks for voting for what you guys wanted me to concentrate my acne research on. The last I looked at the poll results diet and acne was winning. Now I see that scars have a few more votes. Well, scars will be next. But first, let’s delve into diet and acne. In fact, let’s get deep and dirty and nitty gritty with it shall we? Yes? Great, then we shall :) I’ve read every published trial and review of literature since 2008 regarding diet and acne there is good news and bad news.

Good news: Scientists are all over it! No longer is diet and acne relegated to a back seat. According to the Journal of the American Academy of Dermatology (2010), “…it is evident that dermatologists can no longer dismiss the association between diet and acne…In light of the last decade of research investigating the relationship between diet and acne, it is no longer dermatologic dogma to state that any association between diet and acne is mere myth.” In other words, researchers are conducting studies and we’re getting interesting data.

Bad news: The data is still spotty and almost all of the recent studies come with serious “design limitations” as they call them. An example of a design limitation is researchers relying on subjects’ personal recollection of their diet habits instead of actually watching what they eat. Another example of a design limitation is trusting subjects to define for themselves whether they have “acne” instead of employing a professional to count lesions across a study cohort. In other words, we can’t trust the data that’s coming out yet. We need more trials, and better trials, before we make conclusions.

Um, a little more bad news: Because pharmaceutical companies do not make money from educating the public on diet, funding for diet and acne studies is sparse. But hey, even without the pharmaceutical companies, we’re seeing a resurgence of interest in the topic of diet and acne.

My gut feeling on the subject: Regardless of whether some hunter/gatherer tribes do not have acne, it is literally impossible for us to go back to a hunter/gatherer way of living, and for real concrete answers to acne, we’ll have to include diet as only one piece of a much larger puzzle. As much as I would love for it to happen, I don’t think we’re going to find a magic bullet. I don’t think we’ll find a super bad food or food group which we’re all eating which is causing acne. I also don’t think educating people to “eat right” and “low glycemic” will clear people up to the degree any of us want.

I’ll keep updating the blog with specifics regarding some diet and acne subtopics like dairy, glycemic load, iodine, etc. for the next few updates. Hopefully with all of us wading deep into the muck of the latest research we can pool our minds and get food working for us as much as possible.

The Latest Greatest Research

I’m diving headfirst into acne trials and medical journal articles, starting with Accutane. What do you want me to research after that?

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