DNA science points to better treatment for acne

By Eryn Brown Ancient Egyptians were vexed by it, using sulphur to dry it out. Shakespeare wrote of its “bubukles, and whelks, and knobs, and flames o’ fire.”Today, acne plagues us still. Doctors can cure some cancers and transplant vital organs like hearts, but they still have trouble getting rid of the pimples and splotches that plague 85% of us at some time in our lives — usually, when we’re teenagers and particularly sensitive about they way we look.But new research hints that there’s hope for zapping zits in the future, thanks to advances in genetic research.Using state-of-the-art DNA sequencing techniques to evaluate the bacteria lurking in the pores of 101 study volunteers’ noses, scientists discovered a particular strain of Propionibacterium acnes bacteria that may be able to defend against other versions of P. acnes that pack a bigger breakout-causing punch.As best as dermatologists can tell, zits occur when bacteria that reside in human skin, including P. acnes, feed on oils in the pores and prompt an immune response that results in red, sometimes pus-filled bumps. But the study subjects who had the newly discovered bacterial strain weren’t suffering from whiteheads or blackheads, according to a report published recently in the Journal of Investigative Dermatology.Someday, the realisation that “not all P. acnes are created equal” might help dermatologists devise treatments that more precisely target bad strains while allowing beneficial ones to thrive, said Dr Noah Craft, a dermatologist at the Los Angeles Biomedical Research Institute who conducted the study with colleagues from the University of California, Los Angeles and Washington University in St Louis.Doctors might prescribe probiotic creams that deliver “good” P. acnes to the face the same way a daily serving of yogurt helps restore healthy bacteria in the digestive tract.“There are healthy strains that we need on our skin,” Craft said. “The idea that you’d use a nuclear bomb to kill everything — what we’re currently doing with antibiotics and other treatments — just doesn’t make sense.”The research is part of a broad effort backed by the National Institutes of Health to characterise the so-called human microbiome: the trillions of microbes that live in and on our bodies and evolve along with us, sometimes causing illness and often promoting good health.Most of the microbiome attention so far has gone to studying species in the gut, said study leader Huiying Li, an assistant professor of molecular and medical pharmacology at UCLA’s Geffen School of Medicine. But the NIH’s Human Microbiome Project, which funds her research, also looks at microbial communities in the nasal passages, the mouth, the urogenital tract and the skin.Li said she became interested in studying acne because the skin microbiome seemed particularly understudied.The research team recruited 101 patients in their teens and 20s from dermatology clinics in Southern California. Among them, 49 had acne and 52 had “normal skin” and were not experiencing breakouts but had come to the clinics for other problems.Doctors used adhesive pore strips to remove skin bacteria from patients’ noses. The researchers then collected the waxy plugs — a combination of bacteria, oils, dead skin cells and other stuff — and used DNA to figure out which bacteria were present.They found that the P. acnes species accounted for about 90% of the bacteria in pores, in both healthy patients and acne sufferers. Digging a little deeper into the DNA, they found that two particular strains appeared in about 20% of acne sufferers, while a third strain was found only in acne-free patients.“Dogs are dogs, but a Chihuahua isn’t a Great Dane,” Craft said. “People with acne had pit bulls on their skin. Healthy people had poodles.”The team then sequenced the complete genomes — about 2.6mn base pairs apiece — of 66 of the P. acnes specimens to explore in more depth how the good and bad strains differed.The two notable bad strains had genes, probably picked up from other bacteria or viruses, that are thought to change the shape of a microbe to make it more virulent. The researchers hypothesised that the foreign DNA, perhaps by sticking more effectively to human host tissues, may help trigger an inflammatory response in the skin: acne.The good strain, on the other hand, contained an element known to work like an immune system in bacteria, Li said. Perhaps it allows this P. acne to fight off intruders and prevent pimples from forming.Li said the researchers did not know why some people had the bad P. acnes strains and others did not, and whether genetics or environment played a bigger role.Dr Vincent Young, who conducts microbiome research at the University of Michigan Medical School but wasn’t involved in the acne project, said advances in sequencing technology and analysis made the new study possible. In the past, he said, scientists wouldn’t have tried to sequence dozens of genomes in a single species.“They’d say, why waste the money?” he said. “Now you can do this in a couple of days.”Li and Craft — neither of whom suffered bad acne as teens — plan to keep up the work.More research is needed to come up with super-targeted anti-microbial therapies, or to develop a probiotic cream for acne sufferers.Craft continues collecting samples from patients’ pores. He hopes to study whether twins share the same microbial profiles, how acne severity is reflected in bacteria populations, and how things change in a single patient over the course of a treatment regimen.One of the study volunteers, 19-year-old University of California, Santa Cruz student Brandon Pritzker, said he would have loved to have treated his acne without affecting the rest of his body. When he took Accutane, he suffered back pain and mood shifts.Now off the drug, Pritzker said he is at peace with his pimples. “I still have breakouts, but I figure I’m 19, that’s the way it’s going to be,” he said.But, he added, “it hindered my confidence at the time. Kids with clear skin are probably a little happier.” — Los Angeles Times/MCTDeciphering the coughBy Dr Rakesh Kumar Kapoor A person having a distressing cough or breathlessness with inability to talk properly cannot go unnoticed anywhere.Have you ever thought of the reasons for such problems?It could be smokers cough of bronchitis/bronchial-asthma causes related to the heart (especially if it is associated with chest pain or swollen feet).Bronchial asthma is a condition of pipeline of air supply of lungs in which its calibre gets reduced, resulting in breathlessness. At times the patient or attendant may also hearing flute-like musical sounds (wheeze) emanating from the chest. Bronchial asthma patients have episodes of breathlessness interspersed by symptom-free periods.What is cough?It is the forceful effort of body, to expel out phlegm/foreign body from the respiratory tract. It is said to be ‘dry cough’ if nothing comes out. Do we need to take treatment in all cases of cough?Dry irritating cough has to be suppressed, whereas cough with phlegm with a bloody tinge is to be urgently investigated and needs prompt treatment. Simple cough with phlegm preceded by common cold without fever and not disturbing routine jobs can wait for treatment (only symptomatic treatment needed). Cough can be the only symptom of bronchial asthma. Does every dry cough means bronchial asthma?No, upper respiratory infections do give dry cough and it is also to be considered. What is severe bronchial asthma?In severe asthmatic attack, the patient is very breathless and during treatment it appears initially. In case of sudden onset of breathlessness with chest pain, we have to rule out pneumothorax and myocardial infarction and pulmonary embolism. Over a period there may be remission of asthma (symptom-free state) even without treatment. Unfortunately this is the time when patients often stops treatment and suffers severe attack later on.Do all the patients of wheezing have bronchial asthma?No. It has to be differentiated from chronic obstructive lung disease of smokers and acute asthmatic bronchitis. What are the factors inducing bronchial asthma?Infection, exertion, fumes & gases, perfumes and psychological disturbances, all can induce acute asthmatic attack. What should we do for wheezy chest with breathlessness?Proper evaluation and diagnostic confirmation and management is needed to keep it under control. Can bronchial asthma be cured?Majority of childhood asthma patients get rid of it at adulthood, some still continue to suffer. But adult asthma can be only be controlled, not cured.When we can say asthma is controlled?If the patient is well maintained on preventive medicine combination of inhaled medication (long acting broncho dilator+ corticosteroids) and does not require rescue medication of rapidly acting bronchodilator with short lived action or injectable steroids very often, then it is said to be controlled. What is required for the diagnosis of bronchial asthma?An X-ray of the chest, pulmonary function test, blood counts, electro-cardiogram (ECG) to rule out cardiac problem, allergy tests/ immunological evaluation etc may be needed in rare circumstances. Can a normal pulmonary function test rule out bronchial asthma?Not always, such as in cases of exercise induced asthma or cold wind induced asthma, this person with normal pulmonary function test may be subjected to exercise/cold wind and then a repeat pulmonary function test may indicate asthma which will disappear on re-testing after nebulisation with short and quick acting bronchodilators. How can we be sure it is simple cough/bronchial asthma?I will suggest the patient to consult a chest specialist (pulmonologist) for proper diagnosis and management. l The author is a pulmonologistat Apollo Clinic, Qatar.Small good habits can give huge benefits over timeBy Alva Carpenter Just a few tiny lifestyle changes can make you happier and healthier. Now is a good time to start in preparation for the summer.Many people delay getting into a healthy routine such as eating a healthy diet or getting fit because they imagine it will take huge changes in their lifestyle and they think, “Oh no, not now, I don’t have time.” But we do not have to wait until our holiday or we have time off work we can start making a few positive changes each and every day. Why take exercise when you could be relaxing on the sofa?Let’s run though a few quick reasons to improve our health.m Exercise stimulates the release of feel-good endorphins that not only make you feel better but also raise your energy levels. A healthy lifestyle helps stave off hypertension (high blood pressure), promotes healthy cholesterol levels, reduces the risk of diabetes, and keeps your heart in shape.m A little exercise every day puts you in touch with your body and gives you empowerment and confidence: when you exercise you feel good about your body and that feeling carries over and translates into the way you present yourself and how you are perceived by others. m Taking daily exercise improves your circulation and also improves the appearance of your skin, teeth and nails and gives you that certain glow that makes you look great.Adults should take at least 30 minutes of exercise per day. And it has been found that it can help an estimated 60% of patients overcome their depression without using anti-depressant medications. In addition, exercise can give you the time you need to relax.Many people are put off exercise as they connect it to hour-long sessions sweating in the gym. But you can exercise anywhere and even just ten minutes every day in the gym will have a powerful effect on your health. I have always believed it is more natural to exercise in the morning at the start of your day.Try to do something every morning, perhaps a 10-minute walk or my own 10-minute mini morning workout free from minigt@ardenhealth.com or 10 minutes of yoga or your own programme of stretches. Research shows that people who exercise in the morning are much more consistent exercisers long-term. Once the day gets under way, it is easier to get distracted. Or make excuses.So for getting healthy before the summer plan 30 minutes of daily exercise; for example, 10 minutes in the morning, use the stairs and finish your day with a swim or a walk. Gradually introduce small healthy eating habits. * Eat three meals a day: 1 main meal and 2 light meals. * Never eat more at a meal than you can hold in your 2 cupped hands. * Always say no thank you to second helpings. * Always eat a healthy breakfast. Breakfast is the best meal of the day* Eat fruit and vegetables and salad every day.* Gradually limit snacks per day: start with 4, that is, 2 healthy snacks and two small treats. Gradually move on to 3 snacks per day: ideally 2 healthy snacks and one treat.* Simple food is best. A colourful plate of food is a healthy plate of food.  * Cut down on fat by not frying food; instead opt for grilling or baking. * Start your day with a glass of hot water and lemon juice.* Make water your main drink of the day. Drink 8–12 glasses of water daily. * Limit tea and coffee. Decide on a number: my number is 3. When you know you drink less you naturally take more time to enjoy them.* Gradually cut out sugar from tea and coffee. (1 heaped teaspoon equals 25 calories)* See sodas and fizzy drinks and colas as occasional treats not an everyday habit. Cut down or avoid them. (No matter what the advertising says, they are not cool, they give you gas).* Take a good quality multivitamin daily: It is an insurance policy that your body has everything it needs to heal and protect.* Save cakes for celebrations and then really enjoy them.* Chose low fat options: low fat yoghurt; semi-skimmed milk; low fat ice cream etc. * Limit fast food and takeaways to once per week. Then look forward to it and really enjoy it.* Gradually reduce your salt and sodium intake — don’t sprinkle salt on your food.Ask AlvaCan you repeat how to send off for your exercise sheets?  I am 120 kilos and want to start exercise at home until I lose some weight and could you also recommend a vitamin to take as my doctor has put me on a diet. — AnaI have exercise sheets for everyone to mail in for: l Bed exercise from bedgt@ardenhealth.coml Chair exercise from charigt@ardenhealth.coml The 10 minute mini-morning workout from minigt@ardenhealth.coml Office exercises from officegt@ardenhealth.comYou must also eat a balanced healthy diet even if you are losing weight you must be healthy.And if you would like to receive my motivational newsletter that is available in English and Arabic, e-mail me at newsgt@ardenhealth.com.