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Holiday Stress and Your Skin

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With all the food, socializing, and stress, the holidays can be hard on your skin. Every year from Thanksgiving to New Year's Day, I see an increase in patients that are distressed by acne flares. They can't understand why they have good skin year round, but now, suddenly, cysts and bumps are ruining their holiday spirit. Recent studies on the pathogenesis of acne, however, may offer an explanation for these seasonal break outs and possibly ways to combat them.

Dermatologists have long debated the role of diet in acne and hoped that a simple dietary change could help with a disease that is often difficult to control. Many studies have shown that acne is mostly a problem of Western society and is rare in Non-Westerized societies. In particular, Dr. Cordain and colleagues showed that while 79-95% of Western adolescents experience acne vulgaris, it is almost nonexistent in the Kitavan Islanders of Papua New Guinea and the Ache hunter-gatherers of Paraguay. Although this suggests that a Westernized diet may contribute to the high rate of acne in our society, their research did not control for genetic factors that play a strong role in acne development.

In another study, Dr. Varigos and his Australian colleagues controlled for these genetic factors while evaluating the effect of high glycemic diets on acne flares. Over their 12 week study, the researchers randomly assigned 54 male participants with mild to moderate acne to a low glycemic diet or to a conventional high glycemic diet and rated their acne severity and insulin sensitivity. According to the study, participants in the low glycemic group

"were educated on how to substitute high glycemic index foods with foods higher in protein (eg, lean meat, poultry, or fish) and lower in glycemic index (eg, whole grain bread, pasta, and fruits)... The recommended low glycemic index diet consisted of 25% energy from protein, 45% from low glycemic index carbohydrates and 30% energy from fats. In contrast, the control group received carbohydrate-dense staples and were instructed to eat these or similar foods daily."

Study participants who followed the low glycemic diet had significant improvement in their acne and insulin sensitivity. The researchers hypothesize that improved sensitivity to insulin may reduce circulating testosterone levels, which subsequently reduces oil production in the sebaceous glands and proliferation of acne causing bacteria. This study suggests that diet does play a role in acne development.

Other researchers are focusing on stress as a cause for acne flares. Dr Kimball and colleagues followed college students during examination periods to determine whether their perceived level of stress correlated with an exacerbation of acne. After controlling for changes in sleep hours, sleep quality, diet quality, and number of meals per day, they found that increased acne severity was significantly associated with increased stress levels. Hormones released in times of stress, such as corticotropin releasing hormone, may stimulate inflammation and hormonal cascades, which produce acne flares. Biopsies of acne involved skin show far greater localization of corticotropin releasing hormone in oil glands than non acne skin, giving more support to this theory.

Regardless of the cause, people who suffer from holiday acne are eager to get rid of it prior to spending time with friends and loved ones. If improving your diet and lowering your stress are not enough, there are several over the counter treatments that can be useful in resolving acne as quickly as possible. For people who suffer from clogged pores, washes and lotions that contain 2% salicylic acid can help dissolve the keratin plug and open the pore. It is important to remove these blockages because sebum inside the blocked pores promotes the growth of P. acnes, bacteria that leads to red bumps and pustules. Should these develop, I recommend products containing benzoyl peroxide, one of the strongest P. acnes killers and is available in a variety of over the counter products ranging from 2.5% to 10%. Because benzoyl peroxide can be irritating, try the lower strength products first, twice a day to the problem areas. Finally, cysts anywhere on the face can be painful and distressing. Squeezing the cyst may remove the contents temporarily but this can lead to scarring and infection. The best treatment option is to see a dermatologist for corticosteroid injection that flattens the cyst in about 24 hours.

Enjoy the holiday season, but if lifestyle modification and over the counter treatments fail to treat your acne, seek professional help here and start 2010 with great skin!