Skin Therapeuticals

“Nutrition has nothing to do with skin health” Click to read the full email

Did you know how gut health influences your skin? Did hear about postbiotics? Those are Short-Chain Fatty acids such as butyrate, acetate, and propionate. Your gut microbes produce them, and the benefits reach far beyond your gut.

https://news.nutrilink.co.uk/2022/06/23/scfas-and-skin-health/

image credit: gut, skin Kaitlin Walsh

Why do adult women start to produce more testosterone and develop adult acne?

Adult acne is more common in women than men, and the reason behind is insulin.

When men get chronic insulin surges, they produce more oestrogens (overweight men start to have more female traits).

When women get chronic insulin surges, they may start to produce more testosterone and have male traits (facial hair, hair thinning, abdominal fat, more oily skin etc).

Chronic insulin surges stimulate testosterone production in women with PCOS and this is the initial driver which should be addressed first.

Testosterone is known to stimulate oil glands to produce more sebum.
It induces abnormal skin cell growth and consequently leads to the blocking of the sebum and cells in the follicular gland.
This can be an acne culprit.

One of the most prescribed treatments for women's acne is Birth Control Pill. It delivers oestrogens, which mask the androgens when taken. Often when stopped acne comes back.
Chronically elevated blood sugar levels lead to elevated insulin and this needs to be addressed primarily.

Have you heard that diet and lifestyle do not cause acne?
What is the main cause of insulin spikes rather than your lifestyle choices?

Skin symptoms can be signs of hormonal imbalances such as Polycystic Ovarian Syndrome

The incidence of women in primary care with Polycystic Ovarian Syndrome PCOS is lower than in the actual numbers indicating that PCOS is an under-recognised condition.

Dermatological appearances, for example adult acne, are crucial for early detection of PCOS as it aids in preventing the condition from advancing to its long-term sequelae.

Adult acne is easier to diagnose as it is visible and maybe one of the signs of elevated insulin and androgens in adult women.

The most common condition related to an above-average level of androgens is seen in PCOS

Common symptoms of PCOS: irregular or absent menstrual cycles, ovarian polycystic changes, infertility, tendency to storing fat around belly rather around the hips (female patterns). On the blood test elevated androgens and increased glucose, insulin levels and many times lipids.

Symptoms of elevated insulin and androgens can be seen on the skin as:

- skin oiliness (face and scalp), open pores and acne (inflammatory and non-inflammatory);
- hair loss and hair thinning (the most common reason of hair thinning in woman is insulin surges, not thyroid);
- tendency to post inflammatory pigmentation, especially in darker skin types (after a small injury to the skin or after a acne breakout, the pigmentation caused on the skin stays for weeks or months);
- thicker hair on the face as well as throughout the body (around the ni***es, chest, the inside thighs and abdomen);
- tendency to darken the skin (behind your neck, under arms and around the v***a);
- the skin does not heal quickly and may have tendency to skin candidiasis, dandruff;
- skin tags.

Some skin conditions often co-occur with PCOS and insulin resistance:
- Hidradenitis suppurativa;
- Seborrheic dermatitis;
- Acanthosis Nigricans;
- Psoriasis;
- Female Androgenetic Alopecia;
- Vitiligo.

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Image credit Kaitlin Walsh

Why do women get acne?

Adult acne is more common in women than men, even the main acne trigger are androgens, male hormones (which women also have in smaller amounts).

A study from 1997 shows that 76% of acne patients were women with a mean age of 35.5 years.

Why?
Women are more prone to hormonal fluctuations throughout life.

What?
Excess calorie consumption, a Western-style diet (high in carbohydrates, high in fats low in nutrients and plant fibre) high stress, and unbalance in circadian rhythms, all this cause insulin surges, which in women shift hormones to produce more testosterone and may lead to acne.
Insulin surges in women cause hormonal shifts toward testosterone, whereas in men toward oestrogen paths. As an example, we see more female traits in men with higher BMI scores, and in women, androgens related symptoms, such as acne and PCOS (Polycystic O***y Syndrome).


PMID: 9039297

Do we remove skin microbes with cleansing practices, even antibacterial and exfoliating treatments?
The answer is no. The skin has the power to repair quickly, and microbes will regrow in 24-48 hours.
Microbes are attached to the skin as well as colonising the skin below the surface and inside of the follicles.

By using cleansers, we temporarily change the skin’s environment, and it can alter the skin function and microbes’ populations if we do it too often or use too harsh products or treatments.
Hopefully, we see trends toward more gentle cleansing ingredients and less over-exfoliating treatments.

If you have acne or rosacea (or both) and your skin is oily, and you cleanse and exfoliate your skin often to reduce oil and bacteria, it can have negative effects on your skin. While you cannot wash off bacteria (only the superficial ones and they will repopulate) and you cannot regulate oil gland production by cleansing, you can cause a negative effect on your skin barrier function.
Over-cleansing and over-exfoliating can damage the hydro lipophilic film, which your skin naturally produces as protection.
The skin has several protection mechanisms against pathogens and creates physical and chemical barriers to maintain its integrity and hydration.
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Choose gentle cleansing ingredients and avoid common soaps.

Choose to wash your face with a cleanser once a day, preferably in the evening.
The sebaceous gland is very closely dependent on circadian rhythms and how our hormones activity.
Our body rests in the night, therefore, there is no need to cleanse your skin with a cleanser in the morning, as the hormones have not been active during the night, so there is not much sebum.
Water on its own removes about 50% of oil and dirt from the skin.

Acne has many underlying triggers, and as an effect, we see increased sebum production, abnormal skin keratinisation which leads to oil gland blockage and perturbed microbial composition.

The mainstream approach in the last 3 decades focuses to eradicate bacteria, which is not a root cause of acne, only one of the symptoms. Bacteria alternations (aka dysbiosis) is one of the consequences of the skin changes leading to developing acne.
Acne is not a skin infection and c. acne bacteria are not a pathogenic invader.
C. acne is a major residential microbe with a beneficial role in maintaining skin barrier function (it helps to produce free fatty acids from sebum and maintain acidic pH of the skin which both are antimicrobial and protects us from infections).
On the other hand, there is no case of acne without c. acne.

Extremely exciting is recent microbiome research which slowly helps us to understand more about those microbes and their unique functions and involvement in health and disease.
Many studies have shown that microbe-related human diseases are often caused by certain strains of a species, rather than the entire species being ‘bad’.

Recent studies on c. acne have shown that there are subgroups -> strains, and certain strains are more likely to be involved in acne.

The idea that acne is caused by increased sebum production which promotes the overgrowth of bacteria is outdated.
The loss of balance between the different C. acnes strains together with general dysbiosis may result in acne development.
more to read:
O'Neill and Gallo, 2018, Dreno et al. 2020, Brüggemann H, Salar-Vidal L, Gollnick HPM and Lood R (2021)
Infographic credit: Lucy Reading-IkkandaWe