Acne

Acne is a chronic inflammatory skin disease that shows up on the skin as red pimples, pustules, and deeper bumps (known as nodules and cysts). If left untreated, acne typically leads to scarring that can show as a changes in the skin contour and changes in the skin color.

It is a common disorder affecting approximately 80% of young adolescents. However, acne can typically persist into adulthood as well, especially in women and is known as adult female acne.

Acne presents are three types of lesions: whiteheads, blackheads, and deeper red bumps known as nodules.

What causes acne?

The exact cause of acne is dependent on many factors such as genetics, environment, more These lesions are the result of an overproduction of sebum, which are oily secretions of the skin’s oil glands (known as sebaceous glands). Although acne is not an infection, bacteria on the skin may have a significant contribution to the development of acne lesions. Acne typically occurs on the face, neck, chest, and back. The severity of acne is assessed by carefully observing the location, type, and number of lesions.

Treating acne

The treatment of acne requires a holistic approach. This means that we will discuss medications, nutrition, and lifestyle approaches. The goal is to provide control and to reduce both the psychological and physical burden of the acne and acne scarring.

Special note on diet: Although diet does not cause acne, some dietary foods may worsen acne. For example, dairy (examples are milk and cheese) and high-glycemic foods (sweets, sodas, sweetened teas) are associated with worsened acne.

Acne references
Haider A, Shaw JC. Treatment of acne vulgaris. JAMA.2004;292(6):726-735; PMID: 15304471

Kraft J, Freiman A. Management of acne. CMAJ.2011;183(7):E430-435; PMID: 21398228

Williams HC, Dellavalle RP, Garner S. Acne vulgaris. Lancet.2012;379(9813):361-372; PMID: 21880356
Juhl CR, Bergholdt HKM, Miller IM, Jemec GBE, Kanters JK, Ellervik C. Dairy Intake and Acne Vulgaris: A Systematic Review and Meta-Analysis of 78,529 Children, Adolescents, and Young Adults. Nutrients. 2018;10(8). pii: E1049. PMID: 30096883

Atopic dermatitis (eczema)

Atopic dermatitis, also commonly called eczema, is a chronic condition that leads to inflammation, itching, and dry and irritated skin. Although typically seen in younger children, atopic dermatitis can persist into the teenage years and can affect sleep, lead to stress, and affect a person’s ability to concentrate.

What causes atopic dermatitis?

There are many different factors involved the development of atopic dermatitis that include:

  • Genetics: those with parents or siblings with atopic dermatitis have a higher risk for atopic dermatitis
  • Environment: Dry and weather extremes (cold or hot) can aggravate atopic dermatitis
  • Clothing: Wool is known to aggravate atopic dermatitis
  • Allergies: When allergies flare, this can flare the atopic dermatitis. Also, many topical products may have fragrances or preservatives that can flare atopic dermatitis

Treating atopic dermatitis

Atopic dermatitis is a chronic condition that requires a holistic approach and constant attention with a shift in lifestyle to manage it well. Whether the treatment is approached from the Western perspective or from a perspective that merges alternative medicine and Western medicine, lifestyle and regular management are key. Treatments may include topical steroids, alternatives to topical steroids, and oral and injected medications in the case of severe disease.
It is very important to use a moisturizer daily when you have atopic dermatitis. The moisturizer should be selected carefully to avoid the presence of irritating ingredients and to pick ingredients that can help match your skin tendencies and improve the skin’s hydration.

Atopic dermatitis references
Lee JH, Son SW, Cho SH. A Comprehensive Review of the Treatment of Atopic Eczema. Allergy Asthma Immunol Res. 2016 8(3):181-90. PMID: 26922927.

Alopecia areata

Alopecia areata characteristically causes hair loss in circular shapes. In 48% of patients diagnosed with alopecia areata, people start losing hair during their adolescent years, making this condition common among adolescents. Hair regrowth can occur in up to 50% to 80% of patients diagnosed, but it is possible for additional hair loss to occur, which may lead to total scalp hair loss known as alopecia totalis. In rare cases, all of the body’s hair may be lost and this is known as alopecia universalis. The cause of alopecia areata is unknown, and the resolution of the disorder is unpredictable.

What causes alopecia areata?

Alopecia areata is a type of hair loss caused when the immune system attacks the hair follicles. This disorder causes inflammation that affects normal hair growth cycling by shifting the follicles from a hair growth phase (anagen phase) to a resting phase (telogen phase).

Treating alopecia areata

Although there is no cure for alopecia areata, there are various treatments that can improve alopecia areata in patients.

There are two overall goals for treatment:

  • Reduce the inflammation around the hair follicle
  • Promote the hair to go back into a growth phase

If the alopecia areata is only affecting a few areas, the treatments may include topical or locally injected steroids. In more severe cases of alopecia areata, oral or other systemic medications may be used.

Alopecia areata references
Luggen P, Hunziker T. High-dose intravenous corticosteroid pulse therapy in alopecia areata: own experience compared with the literature. J Dtsch Dermatol Ges.2008;6(5):375-378; PMID: 18205838

Spano F, Donovan JC. Alopecia areata: Part 2: treatment. Can Fam Physician.2015;61(9):757-761; PMID: 26371098

Spano F, Donovan JC. Alopecia areata: Part 1: pathogenesis, diagnosis, and prognosis. Can Fam Physician.2015;61(9):751-755; PMID: 26371097

Price VH. Double-blind, placebo-controlled evaluation of topical minoxidil in extensive alopecia areata. J Am Acad Dermatol.1987;16(3 Pt 2):730-736; PMID: 3549809

Freckles and moles

Freckles are pale brown spots on the surface of the skin that are usually a direct result of prolonged sun exposure. Freckles can also appear as a result of genetics. Moles are distinctively darker than freckles, are long-lasting, and are also related to both genetics and sun exposure.

Both freckles and moles are exceedingly common and are more easily identified in individuals with light skin. On average, a typical adult has 10-40 moles. Most moles begin growing by the age of 10 and continue until mid-adulthood. In adolescents, moles will grow as the child grows.

What causes moles to form?

These spots are made up of clusters of specialized skin cells called melanocytes which produce melanin. The pigment of each spot is determined by the number of cells clustered and the amount of melanin produced. While most moles are the result of genetics, sun exposure and sunburns can lead to the formation of more moles.

Most moles and freckles are considered harmless. However, atypical moles occur in around 10% of the population and some of these can be more serious. It is important to note if your mole changes shape, has irregular edges, grows, or bleeds. Atypical moles should be reviewed by a trained professional, such as a dermatologist, and a biopsy may be taken to check the mole.

Moles and freckles references
“Freckles, Moles and Melanomas | Cambridge University Hospitals” NHS Foundation Trust. Accessed July 15, 2019.

Levy R, Lara-Corrales I. Melanocytic Nevi in Children: A Review. Pediatr Ann.2016;45(8):e293-298; PMID: 27517357

Vitiligo

Vitiligo is a disorder of where the natural color and pigment in the skin is lost. Vitiligo affects nearly 1% of the population worldwide. This shows up on the skin as white patches. The hairs in the affected areas may turn white.

What causes vitiligo?

Vitiligo appears to have a genetic basis to it. There are several reasons that scientists believe are the cause for vitiligo:

1) Autoimmune cause: The body’s immune system is believed to attack it’s own pigment producing cells in the skin and hair follicles.
2) Oxidative stress: Another theory is that the body has enhanced oxidative stress that leads to loss of

Stress, such as sunburn, trauma, or chemical exposure, can cause a response or and inhibit pigment-producing melanocytes, causing depigmentation. Vitiligo can occur in any individual regardless of race or age, but most cases develop in young children and adolescents. Patients with vitiligo have a loss of natural sun protection in their skin due to the lack of melanin.

Treating vitiligo

Although there is no cure for vitiligo, some treatments and medications have improved the disorder. Medications that reduce inflammation (such as topical steroids) applied to the affected skin areas have been reported to encourage skin pigmentation after 4 to 6 months. Additionally, light treatment has been shown to improve pigmentation in vitiligo such as narrowband ultraviolet B phototherapy with a laser (excimer laser) or with booth phototherapy.

Vitiligo references
Gawkrodger DJ, Ormerod AD, Shaw L, et al. Guideline for the diagnosis and management of vitiligo. Br J Dermatol.2008;159(5):1051-1076; PMID: 19036036

Manga P, Elbuluk N, Orlow SJ. Recent advances in understanding vitiligo. F1000Res.2016;
PMID: 27635239 “