The Role of Medical Nutrition Therapy in Dermatology and Skin Aesthetics: A Review

January 2020 | Volume 19 | Issue 1 | Original Article | 12 | Copyright © January 2020

Published online December 13, 2019

Martina M. Cartwright PhD RD,a Emmy M. Graber MD MBA,b Linda Stein Gold MDc

aDepartment of Nutritional Sciences, The University of Arizona, Tucson, AZ bDermatology Institute of Boston, Boston, MA; Affiliate Northeastern University, Boston, MAcHenry Ford Health System, Detroit, MI

Abstract
The field of nutritional sciences has advanced beyond research of the role of individual nutrients, supplements and diet in disease to the multi-disciplinary practice of adjuvant medical nutrition therapy (MNT). Nutrition research is often that of association rather than cause and effect, yet there are compellingly strong relationships between diet and disease severity and incidence of a number of dermatological conditions. MNT is a tailored, evidence-based, comprehensive nutrition intervention strategy delivered by a physician and registered dietitian to a subset of dermatology patients who may benefit from nutrition intervention. With shorter clinical interaction times and patients requesting nutrition information, a collaborative approach may spur clinically meaningful nutritional changes with advice beyond the often quoted “eat better, lose weight, and exercise.” This review provides a comprehensive overview of the latest Dermatology Medical Nutrition Therapy (D-MNT) recommendations and advocates an evidence-based, collaborative approach to dermatological patient care.

J Drugs Dermatol. 2020;19(1):12-18. doi:10.36849/JDD.2020.4745

INTRODUCTION

Medical Nutrition Therapy
Medical Nutrition Therapy (MNT) is recognized by the American Academy of Nutrition and Dietetics, the Centers for Disease Control and the National Institutes of Health (NIH) as essential to the prevention and treatment of certain diseases.1-3 MNT is an evidence-based approach to addressing specific health conditions through a tailored nutrition care plan implemented by a registered dietitian or nutrition professional who provides comprehensive diagnostic, therapy, and counseling services based on an individual’s nutritional intervention needs.4 MNT can be a beneficial adjuvant to some dermatology patients with chronic skin conditions, but questions remain as to the strength of the associations between diet or nutrients and skin health.5,6 Confounding interpretation of nutrition data is the lack of level one evidence involving placebo-controlled trials.7 Nevertheless, strong associations have been observed between dietary components and some skin diseases.5

MNT involves a comprehensive nutrition assessment, planning and implementation of evidence-based nutrition intervention with goal-directed diet counseling and post-implementation progress monitoring.1 Strong MNT protocols exist for diabetes, cardiovascular disease, oncology, weight management and food allergy,1-3 with dermatology MNT (D-MNT) an area of evolving interest.5,6

MNT in Dermatology
Dermatology MNT (D-MNT) recommendations exist for cutaneous manifestations of nutrient imbalance, acne, atopic dermatitis (AD), psoriasis and wound management. MNT is meant to complement, not replace, the normal use of therapies prescribed by physicians and other licensed healthcare providers and may be appropriate for subsets of dermatology patients, particularly those with inflammatory conditions5 (Figure 1).

Acne, AD, psoriasis and wounds are characterized by inflammation.9 Diet, excess nutrient intake and deficiencies and body composition influence inflammation; D-MNT focuses on modulation of nutrients affecting inflammatory pathways.5

Obesity is a condition of subclinical inflammation linked to the incidence and severity of AD, psoriasis, and poor wound healing.10 Central adipose tissue is metabolically active, releasing cytokines, growth factors and chemokines which regulate appetite, inflammation, and metabolism.11 Waist circumference rather than body mass index (BMI) is a better indicator of inflammatory disease risk and metabolic syndrome.10 Loss of adipose may improve some inflammatory skin conditions, but loss of lean body mass (LBM) contributes to skin barrier dysfunction.12

Sarcopenia is age-related loss of LBM. Nutrient poor diets and chronic inflammatory conditions accelerate sarcopenic onset and severity leading to compromised skin barrier function and wounds.12 Specific MNT protocols exist to combat sarcopenia