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Guidelines Of Care For The Management Of Acne Vulgaris
Acne vulgaris affects most people at some point in their lives. Due to unclear etiology, likely with multiple factors, targeted and low-risk treatments have yet to be developed. In this review, we explore the multiple causes of acne and how plant-based foods and supplements can control these. The proposed causative factors include insulin resistance, sex hormone imbalances, inflammation and microbial dysbiosis. There is an emerging body of work on the human gut microbiome and how it mediates feedback between the foods we eat and our bodies. The gut microbiome is also an important mediator of inflammation in the gut and systemically. A low-glycemic load diet, one rich in plant fibers and low in processed foods, has been linked to an improvement in acne, possibly through gut changes or attenuation of insulin levels. Though there is much interest in the human microbiome, there is much more unknown, especially along the gut-skin axis. Collectively, the evidence suggests that approaches such as plant-based foods and supplements may be a viable alternative to the current first line standard of care for moderate acne, which typically includes antibiotics. Though patient compliance with major dietary changes is likely much lower than with medications, it is a treatment avenue that warrants further study and development.
Acne affects between 40 and 50 million individuals in the United States [1], including mainly adolescents and adults. Factors influencing acne development include excessive sebum production, follicular hyperkeratinization of pilosebaceous ducts, and an increased release of inflammatory mediators. Additionally, some have hypothesized that androgens and microbial colonization with Propionibacterium acnes contribute to the pathogenesis of acne [2, 3]. The role of P. acnes is not clear, as this bacterium is ubiquitous. However, certain strains of acne may be more associated with acne and be pro-inflammatory [4, 5, 6]. Regardless of the ongoing debate regarding P. acnes, antibiotics used in the treatment of acne appear to have anti-inflammatory effects independent of their antimicrobial effects [7, 8, 9]. As a result, the first-line treatment of acne involves broad-spectrum oral and topical antibiotics, which require protracted treatments of a minimum of 3–6 months. Chronic antibiotics may have long-term side effects and detrimental effects on the host microbiome, including selection for multidrug resistant bacteria on the skin and in the gut [10]. For example, the use of clindamycin has been associated with pseudomembranous colitis [11], tetracycline has been shown to change skin color, and erythromycin can precipitate hepatic dysfunction [12]. Other medications used for acne such as isotretinoin, while effective, require close monitoring and have many side effects, including a risk of teratogenicity [13]. Therefore, there is a need for safe and effective alternatives to treat acne. Plant-based approaches have been practiced in multiple medical perspectives, including Chinese medicine and Ayurveda. Our understanding of medicinal plant efficacy and their mechanisms is growing as demand for natural, holistic approaches and fears over the ramifications of chronic antibiotic use increase. Here, we discuss the importance of the gut microbiome in acne pathogenesis and the potential for phytotherapeutic treatments (Table 1).
In January 2016, we searched Ovid MEDLINE databases for published clinical studies examining the use of oral plant-derived products for the treatment of acne vulgaris. Search terms such as “phytotherapy, ” “plant medicinal product, ” “herbal medicine, ” “herbaceous agent, ” “polyphenols, ” “microbiota, ” “gastrointestinal tract, ” “insulin, ” “diabetic” and “acne vulgaris” were used in the search strategy. Studies involving plant-derived compounds and acne vulgaris as an outcome measure were included. Bibliographies were searched for additional studies that met the inclusion criteria.
Pdf) Effective Intense Pulsed Light Protocol In The Treatment Of Moderate To Severe Acne Vulgaris Of The Chest And Back
The bacteria in our intestines function akin to an organ. Our gut bacteria perform multiple functions, including maintaining structural and functional integrity of the gut, immune system regulation, food breakdown, providing nutritional benefits to the host (biotin and vitamin K), and preventing the growth of harmful bacteria. In the 1930s, Stokes and Pillsbury used experimental evidence and anecdotes to identify an association between microbial flora and inflammation of the skin [30]. They found as many as 40% of those with acne had hypochlorhydria and hypothesized a lack of acid would induce a migration of bacteria from the colon to the small intestine and disrupt normal intestinal flora. In recent years, hypochlorhydria has been confirmed to be a significant risk factor for small intestinal bacterial overgrowth (SIBO), which can cause increased intestinal permeability (or “leaky gut”), leading to systemic inflammation [31, 32]. The excess bacteria can compete with the host for nutrients, produce toxic metabolites, and cause direct injury to enterocytes in the small intestine [33]. Studies as early as 1916 suggested intestinal permeability might be augmented in acne vulgaris [34]. In one such study of 57 acne patients, researchers used a blood serum complement fixation test to demonstrate enhanced reactivity to stool-isolated coliforms in 66% of the acne patients compared to none of the control patients [34]. Later in 1983, a study involving 80 acne patients showed the presence of lipopolysaccharide (LPS) endotoxins from Escherichia coli in the serum of acne patients [35]. These results suggest that gut microbes may enhance the presence of circulating endotoxins in the blood of acne vulgaris patients compared to healthy controls. Although the mechanisms for how the gut and skin communicate are poorly understood, acne appears to have a potential gut-skin connection that may be a manifestation of a systemic problem involving intestinal bacteria and increased permeability.
The human intestine is colonized by a complex microbial ecosystem that is hypothesized to be involved in the bioavailability of orally-administered drugs, as well as a number of disease states [36]. The intestinal microbiota is a complex and dynamic bacterial community that plays an important role in human health. Alterations in microbiota composition and function have been related to different intestinal and extra-intestinal diseases [37]. The first attempts to examine the intestinal bacterial flora in acne patients was conducted in 1955 by Loveman et al. [38]. The authors concluded there were no major differences in a small subset of pathogenic bacteria. However, Bacteroides species were more commonly isolated from the acne patients [38]. Only a few researchers have yet investigated the intestinal microbiome in acne patients. Russian investigators who studied 114 patients with acne vulgaris noted that 54% of acne patients have differences in their intestinal flora. Additionally, they found when acne patients with dysbiosis in their intestinal flora received probiotics, there was a reduction in the duration of treatment [39]. The potential dysbiosis in the enteric microbial profile of acne patients needs further investigation and remains a potential source for alternative treatments.
Differences in the gut microflora are not unique to patients with acne vulgaris. Investigators have identified lower counts of Bifidobacterium in fecal specimens from patients with atopic dermatitis compared to healthy controls [40]. Furthermore, the composition and diversity of the gut microbiota in young children who develop atopic dermatitis were found to be different from children who never develop the disease [41]. The mechanisms by which the gut microbiome exerts its effects and links between the gut flora and the pathogenesis of skin disease are not clear yet and remain an active area in research.
European S1 Guideline For The Treatment Of Hidradenitis Suppurativa/acne Inversa
Numerous studies have reported beneficial interactions between the human body and its microbiota. These relationships have suggested that modulation of the microbiota through prebiotics and probiotics may prevent or resolve various diseases such as pediatric infectious diseases [42], skin disease, gastrointestinal disorders [43], and allergic diseases [44]. Probiotics are live microorganisms that can alter gut homeostasis and immunity [45]. Here, we discuss current evidence supporting probiotics for the treatment of acne vulgaris.
Bifidobacteria and Lactobacilli are lactic acid-producing bacteria normally found in the gut that may assist in the treatment of inflammatory skin diseases, such as acne [46]. Physicians, as early as the 1930s, used orally-administered Lactobacillus acidophilus cultures as a probiotic to treat acne [47]. Despite various anecdotal reports, there was little research to determine efficacy at the time. The first formal case reports describing the use and benefits of Lactobacilli were not until 1961 [48]. The study
Numerous studies have reported beneficial interactions between the human body and its microbiota. These relationships have suggested that modulation of the microbiota through prebiotics and probiotics may prevent or resolve various diseases such as pediatric infectious diseases [42], skin disease, gastrointestinal disorders [43], and allergic diseases [44]. Probiotics are live microorganisms that can alter gut homeostasis and immunity [45]. Here, we discuss current evidence supporting probiotics for the treatment of acne vulgaris.
Bifidobacteria and Lactobacilli are lactic acid-producing bacteria normally found in the gut that may assist in the treatment of inflammatory skin diseases, such as acne [46]. Physicians, as early as the 1930s, used orally-administered Lactobacillus acidophilus cultures as a probiotic to treat acne [47]. Despite various anecdotal reports, there was little research to determine efficacy at the time. The first formal case reports describing the use and benefits of Lactobacilli were not until 1961 [48]. The study
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