There’s a nutrient for that

There may be something missing from your dermatology patients’ therapeutic regimen: proper nutrition. What people put into their bodies — or fail to — can have a considerable, lasting impact on overall health, including skin and hair.

“Any kind of nutritional deficiency can lead to dermatitis, lesions, and other undesirable dermatologic manifestations,” said Apostolos Pappas, PhD, R&I head executive consultant at Intercos. “A dermatologist should investigate whether the patient may be malnourished or have a nutritional deficiency due to a poor diet. After testing for any nutritional deficiencies, appropriate supplementation should be prescribed, including dietary changes and nutritional supplements where necessary. It is well established that, with proper supplementation, these undesirable manifestations typically regress or resolve.”

Wilma Fowler Bergfeld, MD, FAAD, director of the dermatopathology fellowship and professor of dermatology and pathology at Cleveland Clinic in Ohio, agreed that integrating nutrition into dermatology understanding and practice is critical to providing holistic treatment.

Today’s patients, especially younger populations, may seek alternatives to traditional pharmacologic drugs (such as supplements or fads they hear about online) or may want a more hands-on approach to preventing or treating dermatologic conditions, Dr. Bergfeld said. Whatever their reason, it’s important to discuss the role nutrition plays in skin and hair health and guide them in creating or improving a nutrient-forward approach.

Root cause

Wilma Fowler Bergfeld, MD, FAADInflammation plays a large role in many dermatologic conditions, and diet is one of the easier ways to regulate this via foods/drinks and dietary supplements, otherwise known as medical nutritional therapy, said Dr. Bergfeld.

“Oxidative stress on the scalp, skin, and hair follicles produces changes in follicle cycling and stem cells,” she said.

For example, patients who have alopecia may have a protein deficiency or lack sufficient amounts of iron, zinc, and/or biotin. One possible solution, she said, could be adding collagen to their diet.

“Human ex vivo studies demonstrate that collagen peptides promote elongation of hair follicles and induce new hair shaft formation. The evidence supports daily doses of 2.5-10 grams per day for eight to 24 weeks as effective for various dermatologic applications, including hair growth,” Dr. Bergfeld said.

Vitamins C and D are also essential nutrients for hair and skin health, she said. Vitamin C is critical to collagen production and iron absorption, both of which aid hair strength and decrease hair shedding.

Dr. Pappas shared a study in which participants increased their vitamin C intake simply by eating two whole kiwis (about 250 mg) every day for eight weeks. The experiment resulted in increased skin thickness (0.154 baseline to intervention 0.228; P<0.00001) and promoted greater epidermal renewal (Ki67 21.06 cs 27.42 intensity units; P<0.0091). Dr. Pappas cautioned that daily consumption is critical to maintain vitamin C levels, as the body does not store the nutrient long-term.

Apostolos Pappas, PhDNearly everyone living in the United States has some level of natural vitamin D deficiency. The recommended intake according to the National Institutes of Health (NIH) is 600-800 IU per day for adults, yet most Americans only get about 100 IU in their daily diet, Dr. Bergfeld said.

“In patients with alopecia areata and vitamin D deficiency, supplementation to reach optimal levels may reduce disease severity,” she said.

Fortunately, a lot of foods are fortified with vitamin D, and Drs. Pappas and Bergfeld join the AAD in its stance on nutritional supplementation: The AAD does not recommend sun exposure or indoor tanning as the primary source of obtaining vitamin D. Rather, it recommends “an adequate amount of vitamin D from a diet that includes foods naturally rich in vitamin D and/or foods/beverages fortified with vitamin D.”

Dr. Pappas recommends dermatologists familiarize themselves with the Dietary Guidelines for Americans, 2025-2030 and refer patients to Nutrition.gov to help sort fact from fiction.

Eat your five

While maintaining a healthy diet can be difficult, there are simple steps and solutions to put patients on the right path.

Martina Cartwright, PhD, MS“When addressing nutrition, dermatologists should advise patients to eat at least five servings of fresh or frozen fruits and veggies every day. Eating produce rich in nutrients helps quell inflammation and feeds the skin with antioxidants and powerful phytonutrients that may reduce signs of aging and reduce the inflammatory response,” said Martina Cartwright, PhD, MS, director of continuing professional education at the University of Arizona School of Nutritional Sciences and Wellness in Tucson.

Dr. Cartwright is a registered dietician and scientist who has dedicated her career to improving dietary health by employing evidence-based nutritional strategies. She has a toolbox of tips she shares with physicians and patients alike.

“You want to leverage bioavailability, which is the rate and extent a nutrient is absorbed and used by the body or the quantity of a nutrient consumed in food,” she said. “You need to mindfully combine food and drinks to maximize nutrient absorption.”

Individuals can do this in several ways:

• Drink more water. Urine should be the color of pale lemon juice, she said. Using a clear vessel with a straw can increase water intake.
• Avoid the four “S” in beverages: sugar, salt, spirits (alcohol), and stimulants. Currently, the most popular dietary supplement among American teens and young adults is energy drinks, said Dr. Cartwright, and sugary substances as well as caffeine are closely linked to acne.
• Reach for the rainbow. There are so many natural nutrients, antioxidants, and carotenoids that humans could be consuming but aren’t, she said. “Phytochemicals perform important functions in the human body. Diets rich in phytochemicals help reduce the risk of certain types of heart disease, infection, and other disorders.”
• Incorporate healthy fats or fat-soluble vitamins into daily diet to improve skin and hair health. These include vitamins A, C, D, E, and K as well as minerals such as zinc, iron, and calcium.

Dr. Cartwright suggested the paper, “Nutritional Dermatology: Optimizing Dietary Choices for Skin Health,” published in Nutrients. And when in doubt, eat real food, she said, quoting Dr. William F. McCaughey: “If your body doesn’t recognize it, you probably shouldn’t eat it.”

How do I look?

Lawrence J. Green, MD, FAADAccording to Lawrence J. Green, MD, FAAD, skin aging is a popular patient topic, particularly how to minimize the appearance of aging. Dr. Green is a clinical professor of dermatology at George Washington University School of Medicine in Washington, D.C.

While there are many external factors to skin aging, including nutrition, pollution, smoking, and trauma, Dr. Green said sun exposure remains the primary influence on aging skin. Other elements include cellular and vascular changes, pigmentary alterations, collagen and elastin loss, DNA damage, inflammation, wrinkles, and slower wound healing — all of which occur naturally.

However, patients can control other factors (e.g., diet) that contribute to the skin aging process, said Dr. Green, referencing another paper published in Nutrients, “Diet and Skin Aging — From the Perspective of Food Nutrition.”

“I recommend proper nutrition, such as a Mediterranean-style diet or one free of high sugar/carb content and ultra-processed foods, to help curb an aging skin appearance. But that said, nutrition is just one of several factors that can affect how skin ages,” he said. “Smart sun avoidance or using sunscreen when you are in the sun, not smoking, avoiding areas with high pollution, and getting adequate rest are examples of factors besides nutrition that affect how the skin ages. The better someone does with all these factors determines how their skin will age.”

Ultra-processed foods, which can prematurely shorten telomeres, can make up 25-50% of average daily caloric intake in the United States, said Dr. Green. When our bodies break down high-sugar, ultra-processed foods, they form Advanced Glycation End (AGE) products that can contribute to wrinkles. Dr. Green suggested substituting sugary, processed products for fresh fruits and vegetables, whole grains, and foods rich in omega-3 and omega-6 as well as varying cooking methods by not frying and grilling as much, which can also cause sugars to form AGEs. Instead, opt to boil, steam, or poach proteins or marinate them in an acidic base like citrus or vinegar prior to cooking.

“In patients with visible signs of aging, poor diet can worsen the effects, but improved diet with optimized nutritional intake can help,” Dr. Green said.