Mitchell Fleisher, MD, DHt, DABFM
While it is tempting to think of skin as being almost separate from the rest of us, skin is actually the largest organ of our bodies. It is divided into two parts: the epidermis and the dermis. The outermost portion of the skin, the epidermis continually renews itself. Keratinocytes (also called squamous cells) are formed in the innermost layer of the epidermis and produce a substance (keratin) that helps protect the skin. Gradually, these keratinocytes pass from the deepest layer to the surface and are shed—a process that takes from 45 to 75 days.
Our skin’s condition is integrally tied to our emotional health. Acne, rosacea, psoriasis, and wrinkles can take a heavy toll on self esteem. Skin cancer is an even more worrisome condition in that it can be a serious, life-threatening disease. Yet, even acne can be more than cosmetic—it is an indication that overall health is imbalanced.
In this article, I will review skin diseases and nutritional support for skin health.
Ultraviolet Protection and Skin Cancer
Sunburn increases the risk of developing more than just wrinkled skin—it can result in melanoma, the most fatal form of skin cancer, or the two most common nonmelanoma skin cancers (basal cell and squamous cell carcinomas).
Melanoma, which develops from pigment-producing cells called melanocytes, is far more likely to metastasize than the other forms of skin cancer. Because melanocytes produce melanin, melanoma tumors are often brown or black, although they can appear as lighter colors. Although melanoma is almost always curable in its early stages and occurs less frequently than basal cell and squamous cell carcinomas, its penchant for metastasizing means it is the most serious of all the skin cancers.
Nonmelanoma cancers are much more common than melanoma and are diagnosed in more than a million people every year in the United States. The two most common forms are basal cell carcinoma and squamous cell carcinoma. Basal cell carcinoma, a slow-growing cancer, originates in the lowest layer of the epidermis, called the basal cell layer. Roughly 3 out of 4 skin cancers are basal cell carcinomas, the lesions of which usually manifest on sun-exposed areas such as the head and neck. Basal cell carcinomas rarely metastasize, but if left untreated, they can spread and invade the bone or other subsurface tissues.
Squamous cell carcinoma originates in the upper part of the epidermis. Accounting for about 2 out of 10 skin cancers, it usually appears on the face, ear, neck, lips, and backs of the hands. Squamous cell carcinomas are more likely to invade fatty tissues just beneath the skin. Compared to basal cell carcinomas, they are slightly more likely to spread to lymph nodes or distant parts of the body.1
Several other, less common, types of skin cancers comprise less than 1 percent of nonmelanoma skin cancers.1 In fact, most skin tumors are not cancerous and rarely turn into cancers.
The standard advice is to always apply sunscreen before going out into the sun. However, as one group of researchers stated, "Sunscreens are useful, but their protection is not adequate to prevent the risk of UV-induced skin cancer. It may be because of inadequate use, incomplete spectral protection and toxicity. Therefore new chemopreventive methods are necessary to protect the skin from photodamaging effects of solar UV radiation."2
A limited amount of sun exposure can actually protect against skin cancer. This is because sunlight-exposed skin manufacturers vitamin D3, which inhibits the proliferation of melanoma cells. After six days of vitamin D3 exposure, the level of surface cell receptors on the melanoma cell surface was reduced by over 40 percent.3-4
Vitamin D3 supplementation can make up for what we do not receive from the sun. I advise patients to consume 1,000 IU per day if they are not receiving frequent sun exposure sans sunscreen. Furthermore, as we age, our ability to manufacture vitamin D3 is impaired, indicating that some supplementation is necessary even when we are exposed to sunlight.
A number of other nutritional supplements have been researched for their ability to safely protect the skin from ultraviolet light damage associated with skin cancer and/or from the initiation of cancer itself.
Over the last ten years, some of the most promising research has been conducted on silymarin (Milk Thistle or silybum marianum). In mice, silymarin protects against ultraviolet B (UVB) damage in skin. In animals it also prevents the development of UVB-induced biomarkers that signal the probable future development of non-melanoma skin cancer. The mechanism of action thought to be responsible for these effects is silymarin’s ability to prevent DNA damage, enhance DNA repair, inhibit UVB-caused cell death and stop sunburn cell formation.5-6
According to one group of researchers, "Overall, the protective efficacy of silibinin [silybum] against skin cancer is supported by sound mechanistic rationale in animal and cell culture studies, and suggests its potential use for humans."
Curcumin, derived from the spice turmeric, is another botanical extensively studied for its effects on skin cancer and its ability to prevent sun damage. In one rodent study, curcumin-treated melanoma cells formed eight-fold fewer lung metastases. In addition, curcumin-treated melanoma cells exhibited a dose-dependent reduction in their ability to bind to tissues by over 50 percent in 24 hours, and by 100 percent after 48 hours of curcumin treatment. This effect persisted even after 15 days of cultivating cells in a curcumin-free medium. Curcumin also enhanced the expression of antimetastatic proteins.7
In another study, curcumin caused cell death in eight melanoma cell lines in both a dose- and time-dependent manner.8 The type of melanoma cells used in the study are strongly resistant to conventional chemotherapy, leading the researchers to state “curcumin may overcome the chemoresistance of these cells and provide potential new avenues for treatment.”
Eicosapentaenoic acid (EPA), the fatty acid found in fish oils, is another nutrient useful in protecting the skin from ultraviolet damage. One group of researchers examined the effect of EPA supplementation on a range of indicators of ultraviolet radiation-induced DNA damage in humans in a double-blind randomized study. Forty-two healthy subjects took 4 grams per day of purified omega-3 EPA or monounsaturated, oleic acid for 3 months. At the end of the study, the EPA skin content showed an 8-fold rise from baseline. Sunburn sensitivity was reduced in subjects taking EPA. In addition, the time it took for the skin to redden after exposure to ultraviolet light increased after EPA supplementation, and peripheral blood lymphocytes (PBL) showed a reduced susceptibility to ultraviolet radiation and reduced strand breaks. No significant changes were seen in any of the above parameters following oleic acid supplementation.9
The researchers concluded that this reduction of early skin damage markers indicates "longer-term supplementation might reduce skin cancer in humans."
Docosahexaenoic acid, the other fatty acid found in fish oil, has caused cell cycle arrest and apoptosis (cell death) in melanoma cells.10
Wrinkles and Liver Spots
As we age, we develop additional skin-related concerns. DMAE (dimethylaminoethanol) taken orally or applied topically can reduce wrinkles and eliminate liver spots.11
A powerful anti-inflammatory, DMAE is a precursor of the neurotransmitter acetylcholine. Although acetylcholine is usually associated with brain health, the skin is an active site of acetylcholine synthesis, storage, secretion, metabolism, and receptivity. Acetylcholine receptors have been localized in keratinocytes, melanocytes and dermal fibroblasts.
In clinical practice, I have found that high-dose DMAE is especially effective at reducing the lipofuscin that accumulates over time, resulting in the brown liver spots that appear on the skin as we age. I have also created a recipe for a topical—and very affordable—homemade DMAE cream. Empty contents of 1 capsule of DMAE 250 mg, 2 capsules of R-Lipoic acid 50 mg into 1 tablespoon of organic coconut oil in a small bowl. Place bottom of small bowl into larger bowl filled with very warm water to melt the mixture. Blend thoroughly and allow to firm. Try a test dose on a small patch of skin on the thigh or abdomen. Wait 48 hours. to test for any oversensitivity, then apply to facial or body skin twice daily. The skin’s improvement after applying this mixture is enhanced by simultaneously taking DMAE 100 Plus and R-Lipoic acid orally.
Another substance that can produce dramatic changes in the skin’s appearance is ribonucleic acid (RNA). Dr. Frank, the noted RNA researcher, reported that in human studies, subjects taking RNA experienced significant improvements in their skin including a healthier, rosier looking tone, an apparent smoothening of the skin of the face, and diminished lines, wrinkles and liver spots. Dr. Frank also observed increases in skin tightness, along with increased hydration. He estimated that the improved skin appearance resulted in an apparent decreased age by ten years or more in older patients (those over 70).12
The aging of connective tissues also involves modifications of collagen. Collagen is the protein that forms connective fibers in tissues such as skin, ligaments, cartilage, bones and teeth, acting as a kind of intracellular glue. Therefore, strengthening collagen is an important aspect of improving skin health. One of the most effective supplements in this regard is vitamin C, which helps prevent collagen breakdown.13
Rosacea
One of the most common conditions dermatologists treat, rosacea is a chronic disease of the skin of the face that usually begins between the ages of 30 and 50 and affects an estimated 13 million Americans. It is characterized by papular and pustular acne, redness of the face, and, especially in men, of nodular swelling of the nose called rhinophyma.
A large body of evidence is beginning to strongly suggest a link between the ulcer causing bacterium helicobacter pylori and the development of rosacea. A number of studies have investigated h. pylori incidence in rosacea patients and have concluded that there is a greater incidence of this gastric bacterium in people who have this skin condition.14
In one study, researchers assessed the potential association between rosacea severity and evidence of h. pylori infection in 49 rosacea patients. The proportion of patients with inflammatory rosacea who tested positive for h. pylori infection was significantly higher than in patients with non-inflammatory rosacea.15 According to the study authors, "This pilot study provides sufficient evidence suggestive of a positive association between the severity of rosacea and the presence of h. pylori to warrant further research."
Other reports not only have suggested an increased prevalence of helicobacter pylori infection in patients with rosacea, but also have provided evidence that there is dermatological improvement in rosacea patients treated with antibiotics for this infection.16
The large number of studies implicating h. pylori in the development of rosacea indicates that mastic gum, shown to eradicate h. pylori from the gut, may help support the skin health of rosacea patients. In vitro tests have revealed that mastic gum was effective in killing 99.9 percent of h. pylori when tested against seven different strains—NCTC 11637 (a standard reference strain) and six clinical isolates, including three resistant to metronidazole. Mastic was equally effective against the drug resistant strains of h. pylori, even at very low concentrations.17
Beyond supplementation, eating a healthy diet filled with plenty of fruits, vegetables, wild seafood and organic meats and avoiding refined carbohydrates and sugar can help support digestive tract health, making it more difficult for h. pylori to reside there.
Due to its antibacterial actions, clinicians also have used mild silver protein in rosacea patients with some degree of success. In addition, large doses of MSM have, in some clinical settings, resulted in improvement in rosacea. Furthermore, Dr. John Lee observed many cases in which topical progesterone cream (applied to the site of the rosacea) resulted in significant improvement in female patients.18
Acne
One of the most frustrating conditions to plague some adults is acne. In westernized societies, acne vulgaris afflicts 79 to 95 percent of the adolescent population. In men and women older than 25 years, 40 to 54 percent have some degree of facial acne, and clinical facial acne persists into middle age in 12 percent of women and 3 percent of men. Epidemiological evidence suggests that acne incidence rates are considerably lower in nonwesternized societies.
In a report published in the Archives of Dermatology, one group of researchers reported on acne prevalence in 2 nonwesternized populations: the Kitavan Islanders of Papua New Guinea and the Achι hunter-gatherers of Paraguay. Of 1,200 Kitavan subjects examined (including 300 aged 15-25 years), no case of acne was observed. Of 115 Achι subjects examined (including 15 aged 15-25 years) over 843 days, no case of active acne was observed. The researchers believed that these astonishing differences in acne rates could not be attributed to genetic factors and make a convincing case for the involvement of diet-induced high insulin levels in the pathogenesis of acne vulgaris. They noted that the populations studied do not consume sugar or refined carbohydrates.19
In response to the above study, another group of researchers suggested that the low intake of omega-3 fatty acids in the typical western diet and the high intake of proinflammatory omega-6 and trans fatty acids may be the factor accounting for the high acne prevalence. They point out that the involvement of proinflammatory leukotriene B4 (LTB4) in the pathogenesis of acne has recently been described and that administration of an LTB4 blocker led to a 70 percent reduction in inflammatory acne lesions. Omega-3 fatty acids are known to act as natural inhibitors of LTB4.20
Given the poor quality of the average American diet, it is not surprising that other nutrient deficiencies have been linked to acne. Consequently, a multivitamin/mineral supplement containing selenium, vitamins A and E, pantothenic acid (vitamin B5), and zinc (all of which have been found to dramatically improve skin health in acne patients)21-23 should be considered.
Zinc is especially important to skin health. Zinc inhibits Propionibacterium acnes, a bacteria located on the skin that may be responsible for acne. Zinc (30 mg per day) has resulted in a reduction of acne lesions and in vitro addition of zinc in the culture media of Propionibacterium acnes reduced resistance of this bacteria to the antibiotic erythromycin.24
Psoriasis
Psoriasis is a chronic skin disease that manifests as red papules that join to form plaques with distinct borders. It can range from a minimal cosmetic problem to a life-threatening condition. Many of the skin changes occur due to the rapid turnover of the epidermis in psoriasis patients (35,000 new cells daily for each square centimeter compared to only 1,250 cells per day for normal skin).
For more than 30 years, Germany and the Netherlands have used fumaric acid as a psoriasis treatment. Fumaric acid is important in the citric acid cycle, which plays a pivotal role in cellular energy production. Normally, fumaric acid is formed in the skin after sunlight exposure. In psoriasis patients, however, this process is defective and prolonged exposure to ultraviolet light is necessary in order to produce fumaric acid.
Extensive research has confirmed fumaric acid’s role in psoriasis support. In one multicenter, prospective study of 70 psoriasis patients, fumaric acid-supplemented patients showed an overall 80 percent decrease in the amount and severity of psoriasis after four months.25
Proinflammatory leukotriene B4 (LTB4) is elevated in psoriasis lesions. LTB4 is a metabolite of the highly inflammatory arachidonic acid. Eicosapentaenoic acid, a major polyunsaturated fatty acid in fish oil, and gamma-linolenic acid (GLA), stop arachidonic acid from being converted into LTB4 and cause it to be metabolized into a less inflammatory compound. This may offer an explanation as to why both fish oil and GLA have helped improve skin health in psoriasis patients.26
Finally, in What Your Doctor May Not Tell You About Menopause, Dr. Lee reported that many psoriasis patients experienced a remission after using topical natural progesterone cream.18
Eczema and Dermatitis
Eczema is an acute or chronic cutaneous inflammation of the skin with erythema (redness), papules, pustules, scales, crusts, or scabs. Dermatitis is a similar inflammatory skin condition marked by itching, redness, and skin lesions.
For both of these conditions, skin irritants such as harsh laundry detergents should be avoided as should temperature extremes and emotional stress. Nutritional support can include supplementation with probiotics (especially Lactobacillus GG), which has improved dermatitis in infants.27
Research also indicates that mothers of infants with atopic dermatitis have significantly decreased proportions of long chain polyunsaturated derivatives (such as gamma linolenic acid-GLA) in their breast milk compared to controls. When treated with GLA-rich evening primrose oil, children and adults with atopic eczema dramatically improved their condition in as little as four weeks.28-29
Conclusion
Nourishing our skin’s health is important to both physical and emotional well-being. Undertaking a supplement program to support skin health can help protect against sun damage and various skin conditions, ensuring that our outer layer is as healthy and glowing as our innermost selves.
References
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