PracticeUpdate Dermatology February 2019

EXPERT OPINION 21

– – Oat oil contains avenanthramides, which upregulate cer- amides, whereas borage seed oil contains linoleic acid—both of which can be beneficial for barrier repair. – – Olive oil, which contains high levels of oleic acid, can be irritating, and thus is not recommended for barrier repair. • Skin bacterial transplant studies : Topical application of mucosa lysate from healthy volunteers significantly decreased AD severity, topical steroid requirement, and S. aureus burden. Topical B. longum application in women with reactive skin led to decreased skin sensitivity, increased skin resistance to physical and chemical trauma, and decreased skin dryness. • Cannabinoids : When combined withmid-potency topical steroids, topical application of cannabinoids led to greater improvement in AD. Topical cannabinoids have been shown to have anti-inflam- matory efficacy comparable to that with hydrocortisone 1% cream and have been shown to improve sleep in AD patients. • Beneficial ingredients in moisturizers : Look for products containing linoleic acids, ceramides, monolaurin, and anti- inflammatory ingredients such as nicotinamide, glycyrrhetinic acid, palmitoylethanolamine, and telmesteine. There is currently no evidence to support the superiority of prescription-only moisturizers to over-the-counter moisturizers. Integrative trends in acne and hidradenitis suppurativa – Ali Alikhan MD • Regarding diet and acne, evidence supports recommendation of a low-dairy (especially non-fat milk) and low glycemic-load diet. • Data on the effects of zinc or nicotinamide consumption are currently mixed. • Hormonal therapies that have shown efficacy for hidradenitis suppurativa include oral contraceptives, spironolactone, met- formin, and finasteride. www.practiceupdate.com/c/78617

• Antioxidants that may have activities against photoaging include lycopene (tomatoes), ellagic acid (raspberries), genistein (soy), curcumin (turmeric), quercetin (onions), resveratrol (grapes), and polyphenols (green tea). Foods and nutrients that have shown anti-inflammatory potential include turmeric, green/black tea, ginger, garlic, onion, saffron, pepper, thyme/oregano, fiber, mag- nesium, omega-3 fatty acids, zinc, niacin, selenium, folic acid, beta carotene, flavonoids, anthocyanidins, and vitamins A, B6, C, D, and E. Glycation can be modulated by reducing sugar spikes. Acupuncture in dermatology – Joseph Alban MS; licensed acupuncturist • In traditional Chinese medicine, a person is considered a unique blend of five elements of qi, or life force energy – wood, fire, earth, metal, and water. Acupuncture focuses on bringing these elements into balance. • Acupuncture points for acne, perioral dermatitis, melasma, eczema, and urticaria were discussed. Further research is needed to bring quality evidence to this ancient therapy, which has shown to be beneficial for thousands of years. Topical recommendations for dry skin – Vivian Shi MD • Natural oils : The ratio of essential fatty acids determines barrier repair benefits of natural oils. Oils with a higher linoleic acid to oleic acid ratio have better barrier repair potential, whereas higher amounts of oleic acid may be irritating. Cold pressing is the preferred method of oil extraction, which limits irritating byproducts. – – Coconut oil, rich in monolaurin, has antimicrobial properties against aureus, yeasts, and viruses. – – Sunflower seed oil is high in polysaturated linoleic acid and decreases inflammation via the PPAR-α pathway.

VOL. 3 • NO. 1 • 2019