Rethinking the Approach, continued from page 4
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Diet & Acne “The role of diet in acne has been really controversial for decades,” said Stein Gold. In the 1960s, she continued, many clinicians and researchers believed diet definitely influenced sebum production. However, diet as a contributing factor fell out of favor in the ensuing decades. “Today, we’re coming back to understand diet probably does have an impact on acne,” she said. “We don’t have any really, really good evidence that proves diet directly influences acne, but a lot of small studies suggests that it does.” Most notably, several studies have pointed to a high glycemic diet – which includes foods like white bread, potatoes, sugar and white rice – as a potential trigger. Hyperglycemic diets increase insulinlike growth factor 1 (IGF-1) that has been shown to increase sebum production. Stein Gold pointed to an Australian study where two groups of participants consumed the same number of calories, but one group ate a high glycemic diet while the other consumed foods with a low glycemic load. “By eating a low glycemic diet … and changing nothing else … they actually had a significant decrease in their acne lesions,” she said of participants in the second group. “There have been some studies that suggest dairy products, especially skim milk, might also be associated with acne,” said Stein Gold, adding yogurt and cheese
do not seem to have the same associative relationship to excess sebum production. While the jury is still out on cause and effect of diet on acne, there is significant research touting the overall benefits of consuming foods with a lower glycemic load including whole grains and lentils. “You can never go wrong telling someone to eat more brown, whole grain foods,” Stein Gold pointed out.
When to Refer “Early acne can certainly be handled by a primary care provider,” said Stein Gold. “If you start to see scarring develop – and scarring can occur even in mild acne – it’s time to refer.” She added, “Also, take a pulse of the patient’s emotional state. The most important thing is to be empathetic with patients and listen for a few minutes.” However, Stein Gold noted primary care providers have to cover a lot of ground, and acne can tumble down the priority list when there are other pressing topics to address. If over-the-counter and first line prescription options don’t seem to work, or if a patient is exhibiting emotional distress over their acne, a dermatologist can explore other tailored therapies. “With today’s treatment armamentarium, there’s no reason we can’t get our patients clear or almost clear,” Stein Gold concluded.
2019 AAD Summer Meeting Linda Stein Gold, MD, is one of many presenters and panelists at the upcoming 2019 Summer Meeting for the American Academy of Dermatology. Set for July 25-28 in New York, the meeting’s agenda covers a range of clinical and practice management topics. For more information or to register, go online to aad.org/meetings.
Low Dose Naltrexone, continued from page 5 compounding pharmacy and I always prescribe a 90-day supply. It isn’t covered by insurance, but it is a low cost generic drug. Compounding costs vary widely, but most of my patients have found sources that charge between $35 and $45 for a 90-day supply. “Patients should take it every night about an hour before bedtime. It takes a while for such a small dose to turn around so much inflammation. They need to take LDN consistently for 90 days to get a clear sense of how well it will work for them. “You may find additional benefits. One of my patients was prescribed opioids by a pain clinic. A while after she started LDN, a doctor at the pain clinic called to ask how on earth I got her down from several opioid pills a day to using just 45 pills over 90 days. I told him about LDN, and now he is prescribing it. Dr. Younger is also studying other well-tolerated medications and readily available substances to find more alternatives that can pass through the blood brain barrier and calm inflamed microglia. “We may one day have drugs with the financial incentives to fund large studies, but discovery, development, clinical testing
and FDA approval could take years,” he said. “Meanwhile, people are suffering. We need more research to find options that are available now to relieve symptoms. “For the next few weeks, we will be continuing to recruit fibromyalgia patients for an ongoing pilot study using low dose dextromethorphan, the cough suppressant in cold medicines, which seems to have a similar effect on microglia inflammation, but doesn’t block opioid receptors. This would offer another alternative for people who need the pain relief of opioids for other conditions, or need the usual higher dose of naltrexone to fight addiction or alcoholism.” Toward the end of the year, Younger hopes to be evaluating preliminary findings on this study and another that evaluates the effectiveness of commonly available substances with anti-inflammatory properties such as curcumin and resveratrol. To refer fibromyalgia patients who may be candidates for the low dose dextromethorphan trial, contact UAB’s Neuroinflammation, Pain and Fatigue laboratory, email@example.com or call 205 9755907.
Birmingham Medical News June 2019