Influences

Journal of Drugs in Dermatology,  July-August, 2004  

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Dr. Brand: I think so as well.

Dr. Shalita: Yes, in certain subsets of the population.

Dr. Brand: Of all the myths and popular beliefs about acne that I've encountered in the clinical setting, the cleanliness myth and the link to diet are the two most persistent ones.

Dr. Shalita: That's very important. Dr. James Leyden at the University of Pennsylvania has clearly demonstrated that excessive washing and scrubbing can actually exacerbate acne.

Dr. Shupack: Is the reverse true as well? Can under-washing exacerbate acne? By leaving more sebum and allowing P. acnes to proliferate and multiply, can it produce an immune inflammatory response?

Dr. Shalita: No.

Dr. Shupack: What you want is the happy mean. You should wash enough but not too much.

Dr. Shalita: The point is that acne is not a disease of dirt. You just look dirty because you have a lot of blackheads on your face.

Dr. Brand: Nor is it a disease of diet, although some individuals may have a food sensitivity that aggravates acne.

Dr. Shalita: My sister insists she breaks out from chocolate, so I tell her not to eat it.

Dr. Berson: There's a whole philosophy now about inflammation and carbohydrates. One of our colleagues has publicized a regimen involving diet, medications, vitamins, and anti-inflammatory agents. He first talked about it with respect to photodamage, and now he's written a book about it as a therapy for acne. His philosophy is that acne is induced by inflammation, not by all the other factors that are traditionally considered to be influential. Patients who have read the book believe in it, and they're convinced that if they eat a low-carbohydrate diet, their acne will improve.

Dr. Shalita: They may be right.

Dr. Berson: When you talk about inflammation and how it relates to carbohydrates and carbohydrate metabolism, the question is, will an Atkins type of diet improve someone's acne? A layperson asked me this at a conference, and she swore that when she eliminated carbohydrates from her diet, her acne improved. My feeling is that perhaps she lost weight and looked better and thus had less stress. There are a lot of factors involved, but we really don't know the answer.

Dr. Shupack: There's another component involved as well. If you believe something long enough and strong enough, it happens.

Dr. Shalita: The power of positive thinking.

Dr. Brand: The mind is always an important part of healing. Patients receive multiple benefits from meditation and other stress-reduction activities. A healthy diet is also a good recommendation for everyone.

Dr. Shalita: On average, we get 35 percent improvement with acne patients using this vehicle alone. Every time we do an acne study, the control group's improvement rate is so high that the treatment group has to have better than 35-40 percent improvement to be considered successful.

Dr. Shupack: For one thing, just being part of a study removes a lot of stress. They feel that the responsibility for their condition is out of their hands.