Acne

Question 1

Acne Vulgaris

Answer 1

Inflammatory skin condition characterised by
excess sebum
follicular hyperkeratinisation of sebaceous ducts
C. acnes
Inflammation.

• Commonly affects adolescents with incidence tending to decrease with age.
• More common in males than females due to hyper- responsiveness to androgen hormones.
• Microbial colonisation with Cutibacterium acnes implicated but not the causative factor

Question 2

Acne: Clinical presentation

Answer 2

• Comedones (pimples) mainly affect face, shoulders, upper chest, back.
• Dilated pores with dark plugs of keratin (a protein found in skin) and sebum (secretion of sebaceous glands).
• Open (blackheads), closed (white heads)
• Dome shaped papules formed through sebum and keratin accumulations deeper in the ducts.
• Bacterial infection causes inflammatory cysts (granulomas) beneath the skin, which result in
• Low self esteem: Link to anxiety and depression.

Question 3

Acne: Cause and risk factors

Answer 3

Hormones
IR/Hyperinsulinemia
IGF-1/mTorc1
Stress
Depression/anxiety
Corticosteroids
Diet: Dairy, High GI Foods, Meat
Vitamin D
High Bacteriodes

Question 4

Acne: Causes and Risk Factors - Hormones

Answer 4

Hormones:
Increased
Free Testosterone
5-alpha-reductase
DHT
DHEA

Low SHBG

Flucutations hormones: puberty, pregancy, PCOS

Question 5

Acne: Causes and Risk Factors - Stress

Answer 5

Psychological stress via HPA axis, release of CRH, promotes lipogenesis and induces cytokines
(IL6 + IL11) in keratinocytes → inflammation.

Question 6

Acne: Causes and Risk Factors - IR

Answer 6

Insulin resistance: Diet, obesity, inactivity.
* Hyperinsulinemia upregulates IGF 1, -> downregulates FoxO1 -> activation of mTORC1
* mTORC1 mediates sebaceous gland hyperproliferation , lipid synthesis, and hyperplasia of keratinocytes.

Net effect = androgen production and direct impact on keratinocyte hyperplasia and apoptosis.

Question 7

Acne: Causes and Risk Factors - Diet

Answer 7

• Dairy and high GI / GL foods increase IGF 1 and circulating levels of insulin
• Dairy and meat activate mTORC1.

Question 8

Acne: Causes and Risk Factors - Vitamin D

Answer 8

• Regulating proliferation and differentiation of keratinocytes and sebocytes
• Anti-comedogenic properties.

Question 9

Acne Nutrition: Avoid

Answer 9

• Dairy
• Transfats
• Saturated fat
• Red meat (↑ BCAAs)
• Sugar
• Refined foods
• High GI / GL foods
• Excess omega-6 fatty acids
• Alcohol
• Spicy foods.

Question 10

Acne Nutrition: Include

Answer 10

Consume low GI / GL foods: Balance blood sugar
Increase fibre
Omega 3 decrease IGF 1. EPA inhibits mTORC1 activation.
Low GI fruit and vegetables
Green tea, turmeric, berries: polyphenols decrease mTORC1.
Cinnamon -> glycaemic control.
Hydration

Question 11

Acne: Supplements

Answer 11

Vitamin A
Vitamin B3
Vitamin D
Chromium
Zinc

Question 12

Acne: Vitamin A

Answer 12

Dose: 5,000 iu/day

• Collagen synthesis and skin barrier integrity.
• Reduces sebum and hyperkeratosis
• Inhibits C. acnes

Question 13

Acne: Vitamin B3 (niacinimide)

Answer 13

Dose: 20-50mg in B complex

• Insulin regulation.
• Anti inflammatory and reduces histamine release.
• Inhibits C. acnes induced IL-8 production in keratinocytes
• Antibiotic qualities

Question 14

Acne: Vitamin D

Answer 14

• Regulates metabolism of keratinocytes and sebocytes
• Supports insulin sensitivity

Question 15

Acne: Chromium

Answer 15

Dose: 200 -1000 mcg/day

Insulin sensitivity

Question 16

Acne: Zinc

Answer 16

Dose: 15-30mg/day

• Inhibits 5 α reductase, DHT.
• Antimicrobial activity against C. acnes.

Question 17

Acne: Herbs

Answer 17

Saw Palmetto - 5 α reductase
Cleavers - lymphatic function
Milk Thistle - liver detoxification
Passionflower - anxiety/depression