Acne is the most common skin condition in the US, affecting between 40-50 million people, both adults and teens. Recent research is focused on some new approaches that may not require medication.
It is well know that a bacteria that lives on the skin, Propionibacterium acnes, causes acne. Other culprits are increased oil production, blocked pores and hormonal irregularities. The standard treatments include: topical antibiotics to decrease bacterial colonization, topical vitamin A or tretinoin to exfoliate and prevent blocked pores, oral antibiotics to kill bacteria and reduces inflammation, and Isotretinoin, an oral vitamin A lmedication which reduces oil production. For women, dermatologists often recommend oral contraceptives to block female testosterone and reduce oil production. Spironolactone, another type of testosterone blocker, can be used with oral contraceptives, to increase the acne clearing effect.
Some patients do not completely improve with the above treatments or do not want to take oral medication. Light in the blue color range ( longer wavelength than UV light) has been shown to reduce or kill p.acnes bacteria on the skin. The light treatments are an excellent supplement to topical medication and can reduce the need for oral medication. For more severe acne, the light can be used with a light-activated topical medication AKA, photodynamic therapy. This treatment is FDA approved for other skin conditations, not yet for acne. It can be used as an adjunctive treatment for diffiuclt to treat acne. At the time of this writing, photodynamic therapy for acne was not yet covered by insurance.
What about diet and acne? Does chocolate or greasy food flare up acne? It was thought that there was no causative effect of sweets or fast food on acne. However, recent research has demonstrated a link between acne and high glycemic diets. Foods that are high in carbohydrates ( high glycemic index) raise the blood sugar and insulin levels in the blood, which stimulates increased oil production in the skin. Low glycemic foods, such as vegetables and lean meats, reduce androgen levels and oil production. Another recent study has shown a link between acne and high milk intake. Eating fish was found to reduce acne. Acne will respond better to acne medications when patients reduce their intake of sugar, bread and milk and eat more fish. and lean meat.
Probiotic therapy for acne is still in the early research stages. Scientists have identified a more virulent strain of Pacnes that colonizes pores of acne sufferers. In a recent study,DNA sequencing was done on the bacteria from tthe pores of acne sufferers and acne free patients. The P acnes bacteria on the skin of acne sufferers had foreign DNA which resulted in cause more inflammation on the skin. The P acnes of the clear skinned patients contained a gene that helped it to fight off other, more virulent bacteria, a protective immune response.
Perhaps sometime in the future, specific treatment can target the more virulent bacteria. Or, the good bacteria can be used to replace the other acne causing strains.