Acne is the most common skin disorder I see in private practice, and it can affect people in some form in almost all stages of life. Although not life threatening, it can have a negative impact on quality of life, especially during the critical adolescent stage, which happens to be when acne is also the most common.
Although treatment for all the acne subtypes may overlap to some degree, it will be different to manage acne in a newborn versus acne in a teenager. Therefore, it is critical as a dermatologist to spend time getting to know your patient. Due to the brevity of this article, I will focus on acne in teenagers.
My understanding of acne as normal during adolescence, which I had been taught during residency, was challenged after reading an article citing evidence that acne virtually does not exist in non-Westernized societies subsiding on minimally processed plant and animal foods. These societies do not eat any of the high glycemic load foods that are commonly consumed in this country. Further proof that acne and diet are related was that the researchers found when these Western foods were introduced to these individuals, they developed acne, which ruled out the potential for only genetic factors to be at play. After reading this article, it became clear to me that diet probably does play a role in acne, at least in some cases.
Previous studies that cited a role of dairy in acne have largely been debunked but the role of high glycemic foods although significant, may not be the only dietary factor affecting acne. Some studies have attributed a link to a higher ratio of omega 6 to omega 3 fatty acids, again, seen in Westernized diets, which contribute to acne. In general, further large scale randomized controlled trials are needed in order to assess the various effects of diet on acne.
Now, compared to 10 years ago, when I get asked whether or not diet plays a role in acne, my answer has changed from “No” to “Yes!”. However, treating acne with just recommendations for diet modification alone would make me largely unsuccessful in getting good results. If you have ever tried cutting “carbs” from your diet, you know how difficult it can be. Also, there are many other factors in addition to diet that contribute to acne. Otherwise, everyone who consumed high glycemic index foods would have acne, and this just isn’t the case. Therefore, the traditional acne treatments which involve skincare and topical as well as oral regimens for some patients are the major heavy lifters in what actually improves acne in most patients. Diet modification still appears to play only a minor role in most successfully treated cases of acne.
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In summary, although our understanding of the role of diet in acne is still not completely understood, there does seem to be an effect that the Westernized diet, with its abundance of high glycemic index foods and possibly other factors, such as increased ratio of omega 6 to omega 3 fatty acids, that appear to be implicated. For those patients who suffer from acne and want clearer skin, it might not be best to rely on medications alone, but also focus on eating healthily, increasing fruit and vegetable and whole grain food intake, avoiding processed foods and reducing high glycemic index foods in their diet. What I love about this is that patients that are able to eat healthier are actually getting healthier, even if they are just doing so because of their skin!
Apostolos P. The relationship of diet and acne. Dermatoendocrino 2009 Sep-Oct; 1(5): 262-267.
Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J. Acne vulgaris: a disease of western civilization. Arch Dermatol. 2002;138:1584–1590.