Sample Case Study - Acne
How is acne defined? Who commonly gets acne and when does it commonly start and stop?
Acne: A common skin disorder occurring in two forms. 1) Superficial – Acne Vulgaris—which effects the hair follicle and oil-secreting glands of the skin, which forms blackheads, whiteheads, and general inflammation. 2) Cystic – Acne Conglobata—the more severe form. Deep cysts form under the skin, often leaving scaring. Both forms of acne usually occur on the face, and occasionally on the back, chest, and shoulders, since these areas of the body contain more sebaceous glands1.
Acne is most common during puberty due to increased testosterone in both males and females1. The typical age range for acne to be present are 12-25, but acne can sometimes persist into adulthood3. The increased testosterone of adolescence causes the sebaceous glands on the face and body to enlarge and produce more sebum. At the same time, the skin cells in the pores produce more keratin, and the combination of these two substances increases chances of a blockage1. A pore blockage allows bacteria to overgrow, release enzymes that break down the sebum, and thereby promote inflammation1. If there is a passage way for the inflammation to escape, a whitehead or pimple forms. If there is no way out for the inflammation, the cystic form of acne is created1.
How is acne conventionally treated?
Oral Birth Control2: Anti-androgen impact on hormones that may help level out hormonal fluctuations in female clients5.
Isotretinoin Oral Medication2: Commonly known as Accutane, this medication is extremely effective in clearing up acne through a high does of Vitamin A, which reduces the skin’s natural oil production5.
Retinoid Topical2: These creams/gels work to unclog pores, allowing other medications to penetrate and teat better5.
Topical Antibiotic2: Kills bacteria on impacted areas of skin5.
Benzoyl Peroxide Topical2: Exfoliating agent that increases skin turnover and therefore, prevents proliferation of bacteria in the pores of the skin5.
What are some possible triggers causing your client’s acne to worsen and why?
Hormone Imbalance2: The low body temperature of individuals with hypothyroid may contribute to acne, and thyroid hormone supplementation may help alleviate acne in this population2. I would like to have her thyroid level tested.
Food Sensitivity/Inflammatory Diet2: Either a food sensitivity/allergy, or consumption of inflammatory foods may cause acne flairs/worsening of existing symptoms. It has been observed that populations who traditionally ate a diet low in processed grains, sugar, and dairy, and then switched to a more conventional SAD diet experienced acne flairs that were previously nonexistent2. She recently moved into the dorms and has experienced a significant dietary shift. I wonder if this is contributing for her given her GI symptoms.
Insulin/Blood Sugar Instability: High glycemic load diets cause swings in blood sugar and insulin production in the body. A high glycemic load diet has been associated with acne4. This client’s high-stress lifestyle, standard American diet, and reduced regenerative sleep time may be contributing to higher cortisol levels, and increased blood sugar swings4. I would like to have an A1c test run on her to see the average stability of her blood glucose levels.
Micronutrient Deficiency2: Zinc – Important for action of hormones, wound healing, immune response, and tissue regeneration1. B6 – Related to premenstrual acne flairs in females, supplementation may help. Vitamin A – Plasma levels of individuals with acne tend to be lower than those without acne, and less severe acne tends to have higher levels than more severe acne2. Her recent change in diet, stressful school/work load, and GI distress may be causing malabsorptive issues leading to nutrient deficiency2.
3 recipes that could help this client:
Recipe 1: Baked Sweet Potato with Black Beans, Avocado, Salsa, Lime Juice, and Nutritional Yeast.
Sweet Potato – High in vitamin A, which is often deficient in those with acne.2
Black Beans – High in fiber, which is good for detoxing the colon and digestive tract3, contain Mg and Zn which are beneficial for skin and gut health2.
Avocado – Contain vitamin E, which is a great antioxidant and strengthener for your skin2.
Salsa & Lime Juice – High in vitamin C, which is important for strength of tissues2.
Nutritional Yeast – Excellent vegan alternative to dairy cheese that is high in vitamin b12. B12 helps regulate skin pigmentation and prevents dark spots and promotes healing2.
Recipe 2: Overnight Oatmeal with Flax Seeds, Chia Seeds, Frozen Blueberries, Frozen Black Cherries, and Vanilla Almond Milk.
Oats – High fiber and protein compared to many other grains, which helps stabilize blood sugar and cleanse the digestive tract1.
Flax Seeds—Excellent source of omega-3, Mg, K, Mn1. This raw form of protein and fat in the diet will be beneficial for her acne3.
Chia Seeds—Another good source of omega-3 fat and protein3.
Frozen Blueberries & Cherries- These deeply-colored fruits contain high levels of antioxidants, making them excellent anti-inflammatory foods, as well as good sources of vitamins A and C1.
Almond Milk – A good non-dairy milk alternative that is often supplemented with vitamins and minerals. Won’t contain animal hormoes1.
Recipe 3: Kale Salad with Toasted Chickpeas, Cucumber, & Lemon Chia-Seed Dressing.
Kale- Extremely high in chlorophyll and carotenes, which are great at reducing inflammation and supplying the body with a dense source of nuitrients1.
Chickpeas- High in fiber, and also containing Zn, Fe, chickpeas are an excellent option to add some bulk, and staying power to turn a salad into a satisfying meal that will benefit whole-body health, including improving acne1.
Curry Spice Mix- This flavorful addition to chickpeas also packs a punch of anthocyanins. Many spices also aid in digestion. The benefits will vary based on which particular spices are used to the taste of the client1.
Cucumber- Hydration-promoting and high in vitamins C and A, which we know are good for skin1.
Dressing: Lemon, Chia, Extra Virgin Olive Oil: This light dressing is packed full with vitamin C and healthy fats to support her skin health1.
References
Murray MT, Pizzorno JE, Pizzorno L. The Encyclopedia of Healing Foods. Simon and Schuster; 2005.
Gaby A. Second Edition. Dermatology: Acne Vulgaris. In: Nutritional Medicine. 2017. Concord, NH: Fritz Perlberg Publishing: 707-710.
Dr. Golani. Lecture 3: Dermatology And The Aging Skin. 2019.
Katta, MD. Desai, MD. Diet and Dermatology. The Journal of Clinical and Aesthetic Dermatology. 2014 Jul; 7(7): 46–51. Accessed April 25, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106357/#__ffn_sectitle
Merck Manual Professional. Acne Vulgaris. Accessed April 24, 2019. https://www.merckmanuals.com/professional/dermatologic-disorders/acne-and-related-disorders/acne-vulgaris?query=acne