Feb 13, 2020
At the 2020 ODAC Dermatology, Aesthetic & Surgical
Conference in Orlando, Angelo Landriscina, MD, revealed how
dermatologists can help their LGBTQ+ patients. Dr. Landriscina, and
MDedge reporter Jeff Craven join producer Nick Andrews to discuss
how dermatologists are
uniquely suited to treat sexual- and gender-minority
As patients are becoming more involved in their own care,
physicians must stay up to date on trends such as the ketogenic
(keto) diet to encourage better health and steer patients away from
dangerous online advice. Dr. Vincent DeLeo spoke with Dr. Daren
benefits of the ketogenic diet for dermatologic conditions such
as acne, diabetic skin diseases, and cutaneous malignancies. Dr.
Fomin also provided tips for safely and effectively implementing
this diet. “Coming alongside [patients] as more than just a
diagnoser and treater of disease but [as a] promoter of health, I
think that’s very valuable, and honestly I think that’s where
medicine is moving,” Dr. Fomin said.
Things you will learn in this episode:
- Ketosis is the state of producing ketones, which is necessary
to maintain proper organ function in the absence of sufficient
- Ketosis can be achieved through fasting; prolonged aerobic
activity; certain physiologic states (e.g., pregnancy or the
neonatal period); and processes such as the ketogenic diet, which
tricks the body into a low glucose state that results in metabolic
and cellular benefits without famine or fasting.
- Some dermatologic conditions might theoretically respond to a
ketogenic diet. “From our reading of the literature, we think
potential candidates would be acne, hidradenitis suppurativa,
autoinflammatory syndromes, definitely diabetic skin diseases,
melanoma, and perhaps other skin cancers, psoriasis, morphea, and
... obesity-related skin disease,” Dr. Fomin explained.
- Ketogenesis may provide a multiangle approach to acne
treatment. Beta-hydroxybutyrate, the main ketone produced during
ketogenesis, can potentially decrease or inhibit the inflammatory
response in acne vulgaris. Ketogenesis also helps prevent the
hyperproliferation of keratinocytes seen in acne and optimizes
androgens to reduce sebum production.
- Low-carbohydrate regimens such as the ketogenic diet have been
associated with risk reduction of such diabetic skin diseases as
diabetic peripheral neuropathy, ulcers, acanthosis nigricans,
microangiopathy, and cutaneous infections: “This is due to several
known mechanisms,” Dr. Fomin noted. “Less glucose entering the body
and less fat deposition as a product of that, less end-product
glycation, less free radical production, enhanced fat loss and
metabolic efficiency, increased insulin sensitivity, and then
decreased inflammation, as well.”
- Because cancer cells from melanoma and other malignancies
survive only in the presence of glycogen, there is serious
potential that cancer could be “starved out” by feeding normal
tissues with ketones. “Honestly, it’s my hope and kind of my
optimistic thought that in 10-20 years, maybe we’ll see an increase
in the number of patients being put on some sort of either
endogenous or exogenous ketone therapy as an adjunct to their
cancer treatments,” Dr. Fomin said. “I’d be curious to see if we
can start adding this on to adjunctive melanoma therapy and see if
there’s an improved outcome in our patients.”
- The ketogenic diet generally is well tolerated, but potential
transient adverse effects include dehydration, acidosis, lethargy,
hypoglycemia, dyslipidemia, prurigo pigmentosa, and
gastrointestinal distress. Chronic side effects include
nephrolithiasis and unintended weight loss.
- The ketogenic diet approach to managing skin disease takes a
lot of self-motivation and work from patients. It is important to
make sure patients know to expect a few days to weeks of
potentially noticeable physiologic effects (e.g., hyperglycemia,
lethargy) before they become adapted to the diet.
- When working with patients to initiate the ketogenic diet,
dermatologists are encouraged to involve educated nutritionists if
they have access to them.
Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent
A. DeLeo, MD (Keck School of Medicine of the University of Southern
California, Los Angeles)
Angelo Landriscina, MD (George Washington University,
Washington); Daren A.
Fomin, DO (Walter Reed National Military Medical Center,
Show notes by: Alicia Sonners, Melissa Sears,
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