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Aesthetics Journal
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Acne and Diet Dr Anjali Mahto discusses the relationship between acne and diet and explains how practitioners can consider diet when treating patients Acne is one of the commonest skin disorders and affects nearly 80% of the population at some point in their lives.1 It has substantial and well-recognised effects on quality of life including low self-esteem and confidence.2 As a result, finding new and effective treatments remains of paramount importance. Questions about diet and its role in acne are extremely frequent in consultations; it is therefore important that healthcare practitioners understand and are able to explain the current evidence in this area. Early history Through the years, the relationship between diet and acne has been highly controversial. In the late 1800s and early 1900s, dermatology textbooks frequently recommended dietary restriction as part of the treatment of skin disease.3,4 At this time, we did not fully understand the pathogenesis of acne and any advice given was based on observational and anecdotal evidence.
A Malaysian case control study in participants aged 18 to 30 years found that milk and icecream consumption was significantly higher in patients with acne compared to controls
Early research from 1931 reported that patients with acne had impaired glucose tolerance.5 Further studies demonstrated an improvement in acne severity following a restricted carbohydrate diet.6,7 In the 1940s6 and 1950s,7 observational and case studies reported an association between milk consumption and acne severity in addition to improvement in acne if a low-saturated fat diet was followed. Before the 1960s, dietary advice was therefore a standard part of acne therapy.8 Patients were discouraged from eating a wide range of foods including chocolate, fats, sweets and carbonated drinks. However, despite this advice, many researchers remained unconvinced of the association citing lack of evidence. Two pivotal research studies, often quoted in the literature, resulted in the potential diet-acne association being dispelled as myth for almost fifty years. This was a turning point in the long and often contentious history of the diet and acne relationship. Study by Fulton et al. The first of the two papers was published in 1969 by Fulton et al.9 It investigated the effect of chocolate on acne in a crossover singleblinded study. Participants (n=65) with mild to moderate acne were assigned to eat either a milk chocolate bar or placebo daily for four weeks. After a three-week rest period, subjects then consumed the alternate bar for four weeks. Acne improvement was scored as worsened or improved if the total number of lesions increased or decreased by 30%. From their results, the researchers determined that chocolate did not affect the clinical course of acne. Whilst on the surface the results were accepted, the study itself had important methodological flaws. Firstly, the duration of the study was too short. Most acne clinical trials should last a minimum of 12 weeks to allow for the natural history of blackhead/whitehead formation and evolution.10 The placebo bar was deemed to be an inappropriate control because it had similar total sugar and fat content as the chocolate bar. The control bar had a relatively high quantity of partially hydrogenated vegetable oil, which contains high levels of trans-fatty acids that contribute to inflammation.11,12 No consideration was made of the subjects’ baseline diet. Study by Anderson et al. In 1971, the diet-acne relationship was further challenged by Anderson et al.13 University students (n=27) with a self-reported history of dietary acne triggers were asked to consume chocolate,
Reproduced from Aesthetics | Volume 3/Issue 8 - July 2016
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