The ketogenic diet and dermatology: a primer on current literature.

The ketogenic diet has been therapeutically employed from antiquity and is still utilized today in many disease states. With the boom of the complementary and alternative health movement over the last 2 decades, the lay population has grown more interested in disease prevention and treatment via dietary and lifestyle changes and enhancing health and human performance. The ketogenic diet, whether exclusive or intermittent, has been purported by health care professionals and laypersons alike to meet these demands. In this review article, we look to the current literature for proven and possible mechanisms by which ketones and a ketogenic diet may be utilized in the field of dermatology and direct our readers to pursue further research for this promising potential treatment option.

The Role of Medical Nutrition Therapy in Dermatology and Skin Aesthetics: A Review

The field of nutritional sciences has advanced beyond research of the role of individual nutrients, supplements, and diet in disease to the multi-disciplinary practice of adjuvant medical nutrition therapy (MNT). Nutrition research is often that of association rather than cause and effect, yet there are compellingly strong relationships between diet and disease severity and incidence of a number of dermatological conditions. MNT is a tailored, evidence-based, comprehensive nutrition intervention strategy delivered by a physician and registered dietitian to a subset of dermatology patients who may benefit from nutrition intervention. With shorter clinical interaction times and patients requesting nutrition information, a collaborative approach may spur clinically meaningful nutritional changes with advice beyond the often quoted "eat better, lose weight, and exercise." This review provides a comprehensive overview of the latest Dermatology Medical Nutrition Therapy (D-MNT) recommendations and advocates an evidence-based, collaborative approach to dermatological patient care. J Drugs Dermatol. 2020;19(1):12-18. doi:10.36849/JDD.2020.4745

Dermoscopy in China: current status and future prospective.

OBJECTIVE: Dermoscopy is a useful technique for improving the diagnostic accuracy of various types of skin disorders. In China, dermoscopy has been widely accepted, and domestic researchers have made tremendous progress in the field of dermoscopy. The main purpose of this review is to summarize the current status of dermoscopy in China and identify its future directions. DATA SOURCES: Articles included in this review were obtained by searching the following databases: Wanfang, China National Knowledge Infrastructure, PubMed, and the Web of Science. We focused on research published before 2019 with keywords including dermoscopy, dermoscopic, dermoscope and trichoscopy. STUDY SELECTION: A total of 50 studies were selected. Of these studies, 20 studies were in Chinese and 30 in English, research samples of all the studies were collected from Chinese populations. RESULTS: Since 2000, more than 380 articles about dermoscopy have been published in domestic or foreign journals. Dermoscopy can improve the diagnostic accuracy of neoplastic diseases, evaluating the therapeutic effect of treatment, and determining the treatment endpoint, and it can also assist in the differential diagnosis of inflammatory diseases and in the assessment of the severity of the disease. In addition, researches about the applications of dermoscopy during surgical treatment have been published. Training courses aiming to improve the diagnostic ability of dermatologists, either face-to-face or online, have been offered. The Chinese Skin Image Database, launched in 2017 as a work platform for dermatologists, has promoted the development of dermoscopy in China. Computer-aided diagnostic systems based on the Chinese population are ready for use. In the future, cooperation, resource sharing, talent development, image management, and computer-aided diagnosis will be important directions for the development of dermoscopy in China. CONCLUSION: Dermoscopy has been widely used and developed in China, however, it still needs to address more challenges in the future.

The role of diet in preventing photoaging and treating common skin conditions.

As interest in complementary and alternative medicine has grown, the relationship between diet and skin health has become an active area of research. Various supplements, plant derivatives, and antioxidants have gained attention as possible tools to prevent signs of aging and improve skin conditions. As such, knowledge of clinical trial data is important to counsel patients appropriately on risks and benefits of these complementary treatments and lifestyle modifications. Herein, we review the role of diet and supplements in preventing photoaging and treating common skin conditions.

New therapeutic vision of nutrition in dermatology: Integrative nutrition.

Many skin disorders have been associated with nutritional deficiencies, as well as many skin disorders, have been associated to diet-related immune mechanisms. The food can be a source of beneficial substances for health that act in very precise ways on the body and the functioning of each individual cells, tissues, and organs.

The role of nutrition in inflammatory pilosebaceous disorders: Implication of the skin-gut axis.

Nutrition plays a critical role in the manifestation and management of inflammatory pilosebaceous disorders. There is rich potential for insight into the impact of dietary effects on the pathophysiology of inflammatory pilosebaceous disorders including acne vulgaris, hidradenitis suppurativa, rosacea, and the closely related seborrhoeic dermatitis. Acne vulgaris and hidradenitis suppurativa are thought to have similar diet-modulating pathogenic pathways. Western diet influences Acne vulgaris and hidradenitis suppurativa by increasing insulin and modulating FOX01/mTOR, resulting in over-expression of cytokeratins, hyperproliferation of keratinocytes, and hypercornification of the follicular wall. Key receptors in rosacea are alternatively activated by UV radiation, hot beverages, spicy foods, vanilla, cinnamon, caffeine, alcohol, cold temperatures, and niacin- and formalin-containing foods, to increase oedema and flushing, resulting in erythema, telangiectasia, and warmth, characteristic features of the condition. Seborrhoeic dermatitis, while not a follicular disorder, is closely related, and can be modulated by dietary influences, such as biotin and probiotics. This overview summarizes the role that nutrition plays on these disorders, and identifies dietary modifications as potential adjunctive therapies.

Diet and dermatology: Google search results for acne, psoriasis, and eczema.

It is difficult to regulate the abundance of medical information that is available to patients on the Internet. This systematic review evaluated content available online related to diet and 3 dermatologic conditions: acne, psoriasis, and eczema. Ultimately, our results indicated that most of the information that can be found online regarding diet and these dermatologic conditions is unfounded and/or misleading. Although current medical research may support some Internet findings, it is important to advise patients that many results of online searches for medical conditions are unconfirmed.

Skin and Diet: An Update on the Role of Dietary Change as a Treatment Strategy for Skin Disease.

An increasing body of research indicates that dietary change may serve as a component of therapy for certain skin conditions. This includes conditions such as acne, atopic dermatitis, aging skin, psoriasis, and rosacea. Certain nutrients, foods, or dietary patterns may act as disease "triggers", while others may prove beneficial. Avoidance or elimination diets may be helpful in some conditions, although testing may be recommended first. In terms of beneficial effects, an eating pattern that emphasizes the consumption of whole foods over highly processed foods may help in the treatment of certain skin conditions, and will certainly help in the prevention of associated co-morbidities.

The role of microbiota, and probiotics and prebiotics in skin health.

During the past decade, scientists have made great strides in understanding the microbiome's role in human health. Today, the microbiome has become key in scientific research, therapeutic development, medical treatment, and as a news feature in the media. Most studies have focused on the microbiome of our gut, but recently researchers have turned their attention to other microbiomes, including that of the skin. These studies of gut and skin microbiomes are yielding very informative results, new treatment strategies, and the development of new prebiotic and probiotic products for the treatment of many skin conditions.

An Effective Algorithm for Management of Noses with Thick Skin.

BACKGROUND: Thicker nasal skin blunts the definition of the underlying osseocartilaginous frame and the delicate topography of the nose posing additional challenges in producing desirable tip definition. Despite the recognized challenge in this patient population, there is a paucity of literature on how to overcome this problem. PURPOSE: The goal of this article is to provide a systematic algorithm to manage patients with thick nasal skin. METHOD: Approach to the thick nasal skin patient begins with an evaluation of the etiology of their skin thickness. Skin thickness secondary to sebaceous overactivity is diminished with the use of retinoic acid derivatives, lasers or isotretinoin (Accutane), commonly under the advice of the dermatologist. Rhinoplasty maneuvers include open technique, raising a healthy and reasonably thick skin flap overlying the tip, removing the remaining fat overlying and between the domes, creating a firm cartilaginous frame and eliminating dead space using the supratip suture reported by the senior author, and trimming redundant nasal skin envelope when indicated. CONCLUSION: This systematic approach has been greatly effective in achieving often predictable and aesthetically pleasing rhinoplasty results. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The promising potential role of ketones in inflammatory dermatologic disease: a new frontier in treatment research.

The ketogenic diet has been shown to be beneficial for numerous diseases across different organ systems, but a dearth of information exists regarding these benefits for skin disease. Here, we searched the literature for known mechanisms behind inflammation in dermatologic disease and correlated that with suggested mechanisms of anti-inflammatory activity of ketones and a ketogenic state in the human body to observe how ketones and ketosis might aid in the treatment of inflammatory skin diseases based on these mechanisms. Specifically, we found that ketones modulate the NRPL3 inflammasome, augment anti-oxidation against reactive oxygen species through various direct and indirect means, and may influence mTOR activity, which are all involved in inflammatory dermatologic diseases to an extent. This evidence shows that ketones and the ketogenic diet may have a promising role in the dermatologist's disease treatment repertoire. Our goal is to provide a novel direction for research in the role of a ketogenic diet and even exogenous ketone therapy in the treatment of inflammatory dermatologic disease.

Skin steroidogenesis in health and disease.

The skin is an important extra-gonadal steroidogenic organ, capable of metabolizing various hormones from their precursors, as well as of synthesizing de novo a broad palette of sex steroids and glucocorticoids from cholesterol. In this manuscript, we review the major steroidogenic properties of human skin and we suggest steroidogenesis' impairment as a cardinal factor for various pathological conditions such as acne, rosacea, atopic dermatitis, and androgenic alopecia.

Nutrition and skin.

Nutrition has long been associated with skin health, including all of its possible aspects from beauty to its integrity and even the aging process. Multiple pathways within skin biology are associated with the onset and clinical course of various common skin diseases, such as acne, atopic dermatitis, aging, or even photoprotection. These conditions have been shown to be critically affected by nutritional patterns and dietary interventions where well-documented studies have demonstrated beneficial effects of essential nutrients on impaired skin structural and functional integrity and have restored skin appearance and health. Although the subject could be vast, the intention of this review is to provide the most relevant and the most well-documented information on the role of nutrition in common skin conditions and its impact on skin biology.

Intestinal-borne dermatoses significantly improved by oral application of Escherichia coli Nissle 1917.

AIM: To evaluate the effect of oral Escherichia coli (E. coli) Nissle application on the outcome of intestinal-borne dermatoses. METHODS: In a randomized, controlled, non-blinded prospective clinical trial 82 patients with intestinal-borne facial dermatoses characterized by an erythematous papular-pustular rash were screened. At the initiation visit 37 patients entered the experimental arm and 20 patients constituted the control arm. All 57 patients were treated with a vegetarian diet and conventional topical therapy of the dermatoses with ointments containing tetracycline, steroids and retinoids. In the experimental arm patients received a one month therapy with oral E. coli Nissle at a maintenance dose of 2 capsules daily. The experimental group was compared to a non-treatment group only receiving the diet and topical therapy. The primary outcome parameter was improvement of the dermatoses, secondary parameters included life quality and adverse events. In addition the immunological reaction profile (IgA, interleucin-8 and interferon-α) was determined. Furthermore the changes of stool consistency and the microbiota composition over the time of intervention were recorded. RESULTS: Eighty-nine percent of the patients with acne, papular-pustular rosacea and seborrhoic dermatitis responded to E. coli Nissle therapy with significant amelioration or complete recovery in contrast to 56% in the control arm (P < 0.01). Accordingly, in the E. coli Nissle treated patients life quality improved significantly (P < 0.01), and adverse events were not recorded. The clinical improvement was associated with a significant increase of IgA levels to normal values in serum as well as suppression of the proinflammatory cytokine IL-8 (P < 0.01 for both parameters). In the E. coli Nissle treated group a shift towards a protective microbiota with predominance of bifidobacteria and lactobacteria (> 10(7) CFU/g stool) was observed in 79% and 63% of the patients, respectively (P < 0.01), compared to no change in the control group without E. coli Nissle. Moreover, the detection rate of a pathogenic flora dropped from 73% to 14 % of the patients in the experimental arm (P < 0.01) with no significant change in the control arm (accounting 80% before and 70% after the observation period, P > 0.05). Accordingly, stool consistency, color and smell normalized in the E. coli Nissle treated patients. CONCLUSION: E. coli Nissle protects the mucus barrier by overgrowth of a favorable gut microbiota with less immunoreactive potential which finally leads to clinical improvement of intestinal borne dermatoses.

Cutaneous Manifestations of Non-Celiac Gluten Sensitivity: Clinical Histological and Immunopathological Features.

BACKGROUND: The dermatological manifestations associated with intestinal diseases are becoming more frequent, especially now when new clinical entities, such as Non-Celiac Gluten Sensitivity (NCGS), are identified. The existence of this new entity is still debated. However, many patients with diagnosed NCGS that present intestinal manifestations have skin lesions that need appropriate characterization. METHODS: We involved 17 patients affected by NCGS with non-specific cutaneous manifestations who got much better after a gluten free diet. For a histopathological and immunopathological evaluation, two skin samples from each patient and their clinical data were collected. RESULTS: The median age of the 17 enrolled patients affected by NCGS was 36 years and 76% of them were females. On the extensor surfaces of upper and lower limbs in particular, they all presented very itchy dermatological manifestations morphologically similar to eczema, psoriasis or dermatitis herpetiformis. This similarity was also confirmed histologically, but the immunopathological analysis showed the prevalence of deposits of C3 along the dermo-epidermal junction with a microgranular/granular pattern (82%). CONCLUSIONS: The exact characterization of new clinical entities such as Cutaneous Gluten Sensitivity and NCGS is an important objective both for diagnostic and therapeutic purposes, since these are patients who actually benefit from a GFD (Gluten Free Diet) and who do not adopt it only for fashion.

Future perspective of probiotics in dermatology: an old wine in new bottle.

Probiotics are live microbial food supplements that are beneficial to the host health when administered in adequate amounts. Probiotics do have an exciting concept in digestive functions, but these live microbes have wider applicability as evidenced by gut-brain-skin axis theory given 80years back. However, the details regarding use of probiotics for dermatological indications ranging from atopic dermatitis to acne and sexually transmitted infections is dispersed in the literature, herein we have tried to focus all under one heading. Overall, probiotics seem to be promising and safe therapeutic modality, but the evidence as of now, from the available published data is low. This review will stimulate readers to carry out well designed, larger population based trials, so as to validate its use in dermatology practice.

Dermatosis in children with oedematous malnutrition (Kwashiorkor): a review of the literature.

Children with oedematous malnutrition, known as kwashiorkor, may develop a characteristic skin lesion, named 'Dermatosis of Kwashiorkor' (DoK). Only a few studies have been concerned with this condition, and the reason for the development of DoK remains unexplained. This study review the existing studies concerning DoK, including its clinical manifestations, histopathology, suggested pathophysiology, current treatment and prognosis for children of the age of 6 months to 5 years. Standardized clinical studies are needed to further understand the implications of DoK. Such studies would suffer from the lack of consistency concerning the terminology and scoring of the lesions in DoK. We therefore stress the need for a standardized scoring of the degree of DoK. This would facilitate valid and comparable studies and the development of better treatment for this vulnerable group of patients.