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Daily Dose

Acne Problems

Adolescents and acne….the two often go together. With so many options, both over the counter and prescription available, most teens who are interested in treating their acne can achieve clear skin.  The first step is typically making sure that the tween-teen is washing their face every morning and before bed…which proves to be difficult for some.


Interestingly, diet may also play a role in acne. While we were told years ago that french fries and greasy hamburgers may cause acne a new study suggests that milk may actually be the culprit and contribute to the development of acne. I can even remember the dermatologist many years ago asking my sons (who unfortunately all dealt with acne) if they were big milk drinkers.  


There have been earlier studies (2005 - 2008) which showed a correlation between milk intake and acne…and the risk seemed to be greater in those that drank non fat milk over whole milk.  The newest study published in 2016 looked at teens with acne compared to controls who did not have acne and found “positive associations with total dairy and non-fat dairy, but not with whole-fat or low -fat dairy. In other words it seemed that skim milk might be involved in the pathogenesis of acne??  There have been proposed mechanisms as to why this might occur, but much of it is speculative.


At the same time that teens are developing acne they are also growing and building healthy bones, which means more calcium is needed in their diets. Nutritional guidelines recommend 1,300 mg of calcium every day for adolescents. Much of the dietary calcium intake comes from dairy products including milk, yogurt, and cheese.  It is often very hard for adolescents to meet the daily calcium and vitamin D requirements and stopping dairy may put them at risk nutritionally.


But, with that being said….in cases of teenage acne that do not seem to be improving on a well prescribed skin care regimen, it may be prudent to do a dairy free trial to see if this makes a difference in their acne. During the trial you can easily offer a calcium supplement.   If the teen’s face does not seem to improve with a 2-4 week dairy free trial I would recommend to resume normal dairy intake - but maybe use whole-fat or low-fat dairy rather than non fat.


This would be a good topic for discussion with your own dermatologist.

Daily Dose

Selfies Cause Lice?

1.30 to read

Are teenagers spreading lice when they put their heads together to take a perfect selfie?  This is a hot topic trending lately.  I have had emails and texts from parents who are fighting head lice in their homes and are wondering if this is possible.  I was skeptical that this is how lice is being transmitted among the teen crowd but it is possible.  Laying on the same pillow or sharing hair brushes and headbands are more likely the culprit.

But what can you do if your teen has lice? Try an over-the-counter product which contains permethrin or pyrethrin and follow directions.

Using a hair conditioner before the use of the OTC product can diminish effectiveness, and many products recommend not washing the hair for several days after finishing the application. Re-apply carefully in order to treat hatching lice and lice not killed by the first application. In other words, you must read the package insert! 

Even with parents following the directions to a “T”, there are cases where the lice continue to thrive. This may be due to the fact that the lice have become resistant to the OTC products, and different geographic areas do seem to have different rates of resistant head lice. 

There are now four prescription products that have been approved by the FDA for use when OTC products have not worked. These products are Sklice, Natroba, Ovide and Ulesfia. Each of these products contains a different product that has proven to work against the human louse. These prescription products do differ by application time, FDA labeled age guidelines, precautions for use and cost. There is not one product that is the best one to use.

There has been a study that looked at oral Ivermectin as a therapy for head lice in children over the age of 2. The drug is not FDA labeled for this use. There are guidelines for its use when both OTC and prescription topical agents have failed to eradicate lice.  

There is no need to try all of the crazy stuff like applying mayonnaise on your teen’s head, or blow drying concentrated moisturizers into the hair shaft.  There are several areas of the country where there are businesses that will “nit pick” your child’s heads, but one of my patients spent $500 dollars on this (really), but continued to have problems with lice.

So, if the lice won’t go away, call your doctor before resorting to alternative, unproven therapies. And don't forget to smile in your next selfie.

Daily Dose

Ear Tubes and Your Child

How do you if your child needs ear tubes?I received another email via our iPhone App from a mom who had read the ear infection articles and asked about the placement of ear tubes. That is a great question as this topic comes up often in children who have frequent ear infections.

The placement of tympanostomy tubes (“tubes”) in the ear drums for recurrent otitis media (ear infections) has been studied a great deal over the last 10 years. Tympanostomy tube placement is a surgical procedure that places a small tube into the eardrum to ventilate the area behind the eardrum.  These tubes also equalize the pressure in the middle ear. There are around 2 million tympanostomy tubes place in children in the U.S. each year due to chronic and recurrent ear infections. The most common time for a child to have ear tubes placed is between 6 months and 2 years of age.   When a child has an ear infection it typically follows an upper respiratory infection and  fluid accumulates behind the ear drum and may become infected.  This infection is routinely treated with antibiotics.  In some cases a child’s ear infection does not clear despite the use of numerous antibiotics, or a child may develop recurrent ear infections with each cold they get. Lastly, it is very common for a young child to continue to have fluid behind the ear drum (serous otitis) which may last for weeks to months. Each of these scenarios may be a reason for your doctor to refer you to an ENT (ear, nose and throat) doctor for “tube” placement. Placing tympanostomy tubes helps prevent recurrent ear infections by allowing air into the middle ear.  The tube also drains the fluid that had accumulated behind the ear drum.   It had previously been the consensus that early tube placement would also prevent hearing loss that might occur due to persistent fluid resulting in possible language delays. In recent years two articles in the New England Journal of Medicine looked at whether early tube placement vs later tube placement resulted in differences in language and cognitive development in children.  In both of these studies, there was no difference in language or cognitive development at either 3 or 9 years of age between  the two groups. There is not one answer to the decision to place tubes.  Each case for tympanostomy tube placement should be looked at on an individual basis.  Not only should the number of ear infections be considered (often more than 5-6 in a season), but the age of the child may also be important,  as younger children are more prone to frequent infections. In my opinion it is also important to look at the time of year the infections are occurring,  as a group of children will often clear up frequent infections and  persistent fluid once spring and summer months are upon us.  Again, delaying tubes for several months while deciding the appropriate course for your child has not been shown to cause developmental or language delays. If your child is having recurrent ear infections discuss tympanostomy tube placement with both your pediatrician and a pediatric ENT. That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue now!

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