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

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.

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.

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.

The role of nutrition in dermatologic diseases: facts and controversies.

Many dermatologic diseases are chronic with no definitive cure. For some diseases, the etiology is not completely understood, with treatment being difficult and associated with side effects. In such cases, patients may try alternative treatments to prevent onset, reduce symptom severity, or prevent reoccurrence of a disease. Dietary modification, through supplementation and exclusion, is an extremely popular treatment modality for patients with dermatologic conditions. It is, therefore, important for dermatologists to be aware of the growing body of literature pertaining to nutrition and skin disease to appropriately inform patients on benefits and harms of specific dietary interventions. We address the role of nutrition in psoriasis, atopic dermatitis, urticaria, and bullous diseases and specific dietary modifications as an adjunct or alternative to conventional therapy.

Alimentación y nutrición: repercusión en la salud y belleza de la piel / Diet and nutrition: effects on the skin beauty and health

Clásicamente, se ha postulado acerca de la posible relación entre la salud y la alimentación. A finales del siglo XX se comienza a considerar que la alimentación, además de un papel nutricional, podría tener un papel fundamental en la prevención de enfermedades crónicas y degenerativas, así como en el mantenimiento de la salud. Desde los trabajos de Kaimal, está bien establecido que el déficit de algunos nutrientes provoca enfermedades que afectan a la piel, como la pelagra en el dé- ficit de niacina. Sin embargo, en otras patologías dermatológicas existe una gran controversia acerca del papel que podría jugar la alimentación tanto en su prevención como en tratamiento coadyuvante. Nuestro objetivo ha sido revisar la evidencia científica existente hasta la actualidad buscando la relación entre la alimentación y las patologías dermatológicas, tanto en su prevención como en terapia coadyuvante al tratamiento tradicional. También se ha revisado el papel de la alimentación en el cuidado de la piel sana y su posible papel protector ante el fotoenvejecimento. La evidencia científica disponible hasta la actualidad, orienta a pensar, que además del papel relevante y claramente evidenciado de algunos nutrientes en patologías dermatológicas, modificaciones dietéticas podrían ayudar en el tratamiento y la prevención de recurrencias de algunas patologías cutáneas, como el acné y psoriasis, entre otras. Modificaciones dietéticas pueden ser fundamentales en aquellas dermatosis ligadas a la obesidad y en el envejecimiento cutáneo, aunque la mayoría de los estudios están realizados con muestras pequeñas y se recomiendan más estudios para afianzar la evidencia científica (AU)

Classically, the potential relationship between health and food has been proposed. In the late twentieth century the medical community begins to consider that food, added to a nutritional role, could be useful preventing chronic and degenerative diseases, as well as in the preservation of health. After Kaimal´s work it is well established that some nutrients’ deficiencies cause skin diseases, such as pellagra with a niacin deficiency. However, in other dermatological syndromes there is much more controversy about the role that nutrition could play both as prevention and as adjuvant treatment. Our purpose has been to review the current scientific evidence on the relationship between food and dermatological diseases, both as prevention and as an adjuvant therapy to conventional treatment. We have reviewed the role of food in healthy skin care and its possible protective role against sun damage. The up-to-date available scientific evidence makes us think, that besides the clearly evidenced role that some nutrients have in dermatological diseases, dietary modifications may be helpful in the treatment and prevention of recurrence of certain skin illnesses such as acne and psoriasis, among others. Dietary adjustments may be critical in those dermatologic diseases linked to obesity and aged skin, although most studies are conducted in small groups and further studies are recommended to strengthen the scientific evidence (AU)

Inflammatory disease processes and interactions with nutrition.

Inflammation is a stereotypical physiological response to infections and tissue injury; it initiates pathogen killing as well as tissue repair processes and helps to restore homeostasis at infected or damaged sites. Acute inflammatory reactions are usually self-limiting and resolve rapidly, due to the involvement of negative feedback mechanisms. Thus, regulated inflammatory responses are essential to remain healthy and maintain homeostasis. However, inflammatory responses that fail to regulate themselves can become chronic and contribute to the perpetuation and progression of disease. Characteristics typical of chronic inflammatory responses underlying the pathophysiology of several disorders include loss of barrier function, responsiveness to a normally benign stimulus, infiltration of inflammatory cells into compartments where they are not normally found in such high numbers, and overproduction of oxidants, cytokines, chemokines, eicosanoids and matrix metalloproteinases. The levels of these mediators amplify the inflammatory response, are destructive and contribute to the clinical symptoms. Various dietary components including long chain omega-3 fatty acids, antioxidant vitamins, plant flavonoids, prebiotics and probiotics have the potential to modulate predisposition to chronic inflammatory conditions and may have a role in their therapy. These components act through a variety of mechanisms including decreasing inflammatory mediator production through effects on cell signaling and gene expression (omega-3 fatty acids, vitamin E, plant flavonoids), reducing the production of damaging oxidants (vitamin E and other antioxidants), and promoting gut barrier function and anti-inflammatory responses (prebiotics and probiotics). However, in general really strong evidence of benefit to human health through anti-inflammatory actions is lacking for most of these dietary components. Thus, further studies addressing efficacy in humans linked to studies providing greater understanding of the mechanisms of action involved are required.

Drugs and other product choices.

Dermatologists have at their disposal a wide range of products to recommend or prescribe to their patients, all of which are regulated in some way by the Food and Drug Administration (FDA). However, the degree to which FDA has confirmed the safety and efficacy of a dermatological product can vary widely. Most prescription and some over-the-counter drugs and medical devices are approved by the FDA based on scientific data. Most over-the-counter drugs are marketed in compliance with FDA regulations based on expert medical review. The FDA clears most medical devices based on their substantial equivalence to other legally marketed devices. Cosmetics, medical foods, and dietary supplements are subject only to general postmarket prohibitions against adulterated and misbranded products, although the FDA may review ingredient safety and specific claims for dietary supplements. Some product information is available on FDA's Web site, but the prudent physician should supplement that information by reviewing available scientific literature.

Zinc supplementation for the treatment or prevention of disease: current status and future perspectives.

Zinc is a nutritionally essential trace element, and thus zinc deficiency may severely affect human health. Many studies were published in which the effect of nutritional zinc supplementation on the incidence or severity of a certain disease was investigated. This review summarizes the main observations and aims to evaluate the use of nutritional zinc supplementation for prevention and treatment of human disease.

Transient symptomatic zinc deficiency in a breast-fed preterm infant.

Transient, symptomatic zinc deficiency in breast-fed, low-birthweight infants is a rare, but probably underrecognized disorder hallmarked by periorificial and acral dermatitis. Unlike in acrodermatitis enteropathica, symptoms disappear when nursing ends. We report a breast-fed, preterm infant with demarcated, erythematous, and exudative patches with overlying crusts on the perioral, perianal, and acral areas. Laboratory investigations revealed lowered zinc levels in the infant's serum, but normal levels in his mother's milk. Oral zinc supplementation resulted in total clearing of skin lesions within 4 weeks. Our patient's presentation illustrates the importance of zinc in rapidly growing preterm infants and aims to stimulate awareness for this disorder. Symptomatic zinc deficiency can be easily diagnosed by careful examination and effectively treated with oral zinc substitution.

Metabolism of polyunsaturated fatty acids by skin epidermal enzymes: generation of antiinflammatory and antiproliferative metabolites.

In the skin epidermis, the metabolism of polyunsaturated fatty acids (PUFAs) is highly active. Dietary deficiency of linoleic acid (LA), the major 18-carbon n-6 PUFA in normal epidermis, results in a characteristic scaly skin disorder and excessive epidermal water loss. Because of the inability of normal skin epidermis to desaturate LA to gamma-linolenic acid, it is transformed by epidermal 15-lipoxygenase to mainly 13-hydroxyoctadecadienoic acid, which functionally exerts antiproliferative properties in the tissue. In contrast, compared with LA, arachidonic acid (AA) is a relatively minor 20-carbon n-6 PUFA in the skin and is metabolized via the cyclooxygenase pathway, predominantly to the prostaglandins E(2), F(2)(alpha), and D(2). AA is also metabolized via the 15-lipoxygenase pathway, predominantly to 15-hydroxyeicosatetraenoic acid. At low concentrations, the prostaglandins function to modulate normal skin physiologic processes, whereas at high concentrations they induce inflammatory processes. PUFAs derived from other dietary oils are also transformed mainly into monohydroxy fatty acids. For instance, epidermal 15-lipoxygenase transforms dihomo-gamma-linolenic acid (20:3n-6) to 15-hydroxyeicosatrienoic acid, eicosapentaenoic acid (20:5n-3) to 15-hydroxyeicosapentaenoic acid, and docosahexaenoic acid (22:6n-3) to 17-hydroxydocosahexaenoic acid, respectively. These monohydroxy acids exhibit antiinflammatory properties in vitro. Thus, supplementation of diets with appropriate purified vegetable oils, fish oil, or both may generate local cutaneous antiinflammatory and antiproliferative metabolites which could serve as less toxic in vivo monotherapies or as adjuncts to standard therapeutic regimens for the management of inflammatory skin disorders.

Diet and dermatology. The role of dietary manipulation in the prevention and treatment of cutaneous disorders.

The role of dietary manipulation and vitamins in the prevention and treatment of certain skin diseases is reviewed. Manipulation of nutrition by either diet restriction or supplementation can effect cutaneous disorders such as skin cancer, wound healing, atopic dermatitis, psoriasis, and dermatitis herpetiformis.

Nutritional considerations in small animal dermatology.

Aside from food hypersensitivities, nutritional skin diseases in pets fed commercial foods appear to be very uncommon. Nutritional deficiencies all cause seborrheic skin signs and most of the clinical presentations are not pathognomonic for a specific nutrient deficiency. Careful consideration of the history and the results of skin biopsies usually suggest which nutrient is deficient. Because nutritional supplements can unbalance an animal's diet, they should not be used indiscriminately but only when indicated. Balanced nutrition should minimize the need for supplements.