Dr. Amy Nett: Absolutely, gluten is a place you have to look. The two primary triggers I see contributing to acne are gluten and dairy. That’s another strong trigger. If the acne is bothering her enough, that might be enough of a driver for her to go completely gluten and dairy free, preferably for about three months, to see if that’s contributing. Otherwise, when I read these symptoms and the description of the acne and the dry skin, I do think about what the androgen levels look like. Twenty months postpartum I would consider doing a hormone profile. It might be of somewhat limited utility if she’s still nursing, but you would at least get some idea as to what the hormone levels look like. In particular, I’m wondering if her androgens are particularly high. It might be that something during pregnancy that occurred that caused a hormonal imbalance, and she’s leaning towards a higher androgen level.
You might also think about whether or not she’s getting adequate vitamin A and D. You could consider starting something like cod liver oil that has both vitamins A and D, and if she’s still nursing, it’s completely safe to take. Just maybe recommend about one to two teaspoons. Two teaspoons would probably be more of a therapeutic dose, and one teaspoon would be more of a maintenance dose. Hopefully that’s helpful, and of course, if the Cyrex Array 3 results show that they’re out of range, that’s an easy indication to take out gluten, but I would say even if those are normal and there’s not evidence of an immune response, it could still be worth seeing that’s contributing to her acne, so I would discuss with her that gluten and dairy can contribute to acne, regardless of the Cyrex Array 3 results. Hopefully that helps.