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Acne and dairy products in adolescence: Results from a Norwegian longitudinal study
Abstract
Background:
Acne is a very common skin condition, and it is of great interest to elucidate lifestyle factors that may contribute to its occurrence. In the last decade, the acne-diet connection has been brought back to credibility.
Objective:
To examine whether high intakes of dairy products in early adolescence is associated with moderate to severe acne in later adolescence.
Methods:
The study is a longitudinal, questionnaire-based population study of Norwegian adolescents. Students attending the 10th grade (15-16 years old) of compulsory schooling in Oslo in 2000-2001 and the 13th grade (18-19 years old) 3 years later, in 2004, were invited. Dairy product consumption was self-reported at age 15-16 and acne severity was self-assessed and reported at age 18-19.
Results:
The overall prevalence of moderate to severe acne was 13.9%. High intakes (≥2 glasses per day) of full-fat dairy products were associated with moderate to severe acne. In boys with exclusively high intakes of full-fat dairy products, the odds ratio for acne was 4.81 (1.59-14.56). A high total intake of dairy products was associated with acne in girls (OR 1.80, 1.02-3.16). No significant associations were found between acne and intake of semi-skimmed or skimmed dairy products, and not with moderate intakes of any fat variety of dairy products.
Conclusion:
This study shows association between high intakes of dairy products and acne in adolescence. Our findings support a hypothesis suggesting that dairy consumption may be a factor contributing to acne. The study is based on multiple hypothesis testing, and the methodological limitations must be considered when interpreting the results.
... There are numerous articles in the bibliography that address the effect of milk and dairy products on the pathogenesis of acne lesions [46,[52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70]. The authors collected and divided the studies according to the age of the research group. ...
... The study was conducted among 2489 Norwegian adolescents aged 15-16 years. The consumption of at least two glasses of full-fat-milk-based product daily was related with the presence of medium to extreme acne [55]. ...
... It is worth noting that there are conflicting data on which type of milk is involved in the pathogenesis of acne. In a study by Ulvestad M. et al., a high intake of full-fat dairy products was associated with acne, whereas an association between acne lesions and the consumption of skimmed or semi-skimmed dairy products was not found [55]. The opposite trend can be seen in scientific reports created by Juhl C.R et al. [54], Di Landro A et al. [57], LaRosa et al. [63], and Adebamowo C.A. et al. [58]., in which the consumption of lowfat/defat milk correlated more strongly with the appearance of acne lesions than full-fat milk. ...
Acne vulgaris is a widespread a chronic inflammatory dermatosis that affects millions of people around the world, which has a significant influence on patients’ standard of living. The progression of this dermatosis results in the appearance of inflammatory and non-inflammatory changes, and, in severe cases, disfiguring scars and hyperpigmentation. The aetiopathogenesis of acne is complex. It involves a complex interaction of many different factors, both endo- and exogenous in their effect on the hair and sebaceous unit. Genetic predisposition, hormones, the skin and gut microbiome, psychological stress, air pollutants, aggressive facial products, and certain medications are cited as factors influencing acne formation. The link between nutrition and acne is extensively debated for many years and is still relatively controversial. Diet is commonly recognised to have a direct relationship with certain biochemical markers and the transcription of genes related to sebaceous gland function, and the proliferation of bacteria and inflammation that encourage the progression of the disease. In this review, the authors take a closer look at the existing scientific reports on the involvement of nutrition in the development of acne vulgaris.
... 25 Igualmente, en un estudio longitudinal de adolescentes noruegos (n = 2,489), no se encontró correlación entre acné y la ingesta de leche, yogur y queso. 26 Los tres metaanálisis demostraron una asociación entre el consumo de leche y el acné como se muestra en la Tabla 17 En los tres estudios se demuestra una mayor asociación del acné con el consumo de leche descremada. Se han postulado dos hipótesis acerca de estos resultados: la leche entera contiene mayor cantidad de grasa, por lo que produce mayor saciedad con menor ingesta, mientras que la leche con menor porcentaje de grasa requiere de mayor ingesta para la saciedad, llevando a un mayor consumo de proteína de leche. ...
... 28 En el estudio de Ulvestad y colaboradores se encontró que la incidencia de acné era más alta en Tabla 1: Asociación del acné con el consumo de leche y sus diferentes tipos. 26 Di Landro y su equipo condujeron un estudio de casos-controles en Italia, incluyendo 205 pacientes de 10 a 24 años con acné moderado-severo y 358 controles sin acné o acné leve; reportaron un riesgo incrementado OR 1.78 (IC 95% 2.31-5.05) en los que consumían más de tres porciones de leche a la semana. ...
... En las tres revisiones sistemáticas existentes, los autores concuerdan en lo siguiente: la heterogeneidad de los estudios incluidos y el número limitado de investigaciones disponibles para cada análisis de subgrupo. Además, en algunos de los estudios incluidos, el diagnóstico de acné era reportado por el mismo paciente en cuestionarios [22][23][24]26,[31][32][33] y para valorar el consumo de lácteos utilizaron diferentes cuestionarios dietéticos. ...
... As a result, increased serum BCAA levels are linked through mTORC-1 to oxidative stress and inflammation [125]. Additionally, milk includes and stimulates IGF-1, which reduces FOXO1 and boosts mTORC-1 activity [126,127]. Despite having a low GI, milk consumption has been proven to produce an insulin response that is 3 to 6 times higher than its comparable GI, according to other research [126]. ...
... Additionally, milk includes and stimulates IGF-1, which reduces FOXO1 and boosts mTORC-1 activity [126,127]. Despite having a low GI, milk consumption has been proven to produce an insulin response that is 3 to 6 times higher than its comparable GI, according to other research [126]. Ulvestad (2016) study showed a direct correlation between high milk consumption and rosacea regardless of milk fat content, indicating that milk's pro-rosacea effects are more closely linked to its high concentration of hormones and bioactive chemicals than to fat content [127,128]. ...
Purpose of Review
"How do various nutrients influence the pathophysiology of rosacea, and what are the specific biochemical markers and genetic factors involved in the dietary modulation of this inflammatory skin condition?".
Explanation
The goal of this review is to examine the complex relationship between diet and rosacea, particularly focusing on how various nutrients may influence the pathophysiology of this common inflammatory skin condition. We seek to answer questions regarding the specific biochemical markers and genetic factors involved, as well as the potential pathways through which diet can exacerbate or mitigate rosacea symptoms.
Recent Findings
Recent research has highlighted the significance of genetic and environmental factors in the pathogenesis of rosacea, with a particular emphasis on neurovascular dysregulation, innate immune responses, and skin microbiota imbalances. Studies have identified the roles of various biochemical markers, such as IGFBPs, SHBG, mTORC-1, and FOXO1, and their interactions with dietary elements like glycemic load, glycemic index, and vitamin D. The activation of transient receptor potential (TRP) cation channels and their impact on neurogenic vasodilation has also been explored, providing new insights into potential pathogenic pathways.
Review Summary
This review concludes that the pathophysiology of rosacea is multifaceted, involving intricate interactions between diet, genetic predispositions, and environmental factors. Key findings include the identification of specific biochemical markers and genetic pathways that are influenced by dietary intake, which in turn affect the severity of rosacea symptoms. Understanding these connections opens avenues for future research focused on targeted dietary interventions as potential therapeutic strategies for managing rosacea. The major takeaway is the significant impact of diet on rosacea, which may guide future studies and clinical practices aimed at improving patient outcomes through nutritional modifications.
Graphical Abstract
... Acne has a complex pathophysiology which might be significantly influenced by factors such as genetics, environment, and hormones [188]. Excessive sebum production, Cutibacterium acnes hyperproliferation, hyperkeratinization of the pilosebaceous follicles, and inflammation are also important elements in the pathogenesis of acne. ...
... For instance, soy-based dairy products have been shown to decrease the incidence of acne. Studies suggest that isoflavones and phytoestrogens contained in soy and other PBDAs inhibit androgen-induced sebum production, which has been shown to improve the reduction of acne lesions [188][189][190]. ...
One significant food group that is part of our daily diet is the dairy group, and both research and industry are actively involved to meet the increasing requirement for plant-based dairy alternatives (PBDAs). The production tendency of PBDAs is growing with a predictable rate of over 18.5% in 2023 from 7.4% at the moment. A multitude of sources can be used for development such as cereals, pseudocereals, legumes, nuts, and seeds to obtain food products such as vegetal milk, cheese, cream, yogurt, butter, and different sweets, such as ice cream, which have nearly similar nutritional profiles to those of animal-origin products. Increased interest in PBDAs is manifested in groups with special dietary needs (e.g., lactose intolerant individuals, pregnant women, newborns, and the elderly) or with pathologies such as metabolic syndromes, dermatological diseases, and arthritis. In spite of the vast range of production perspectives, certain industrial challenges arise during development, such as processing and preservation technologies. This paper aims at providing an overview of the currently available PBDAs based on recent studies selected from the electronic databases PubMed, Web of Science Core Collection, and Scopus. We found 148 publications regarding PBDAs in correlation with their nutritional and technological aspects, together with the implications in terms of health. Therefore, this review focuses on the relationship between plant-based alternatives for dairy products and the human diet, from the raw material to the final products, including the industrial processes and health-related concerns.
... In a Norwegian study conducted among adolescents showed that high intake of dairy products is significantly associated with moderate to severe acne (20). Other factors such as diet rich in free fatty acids and sugar which contributed to aggravation of acne (16)(17)(18)(19)(20)(21). ...
... In a Norwegian study conducted among adolescents showed that high intake of dairy products is significantly associated with moderate to severe acne (20). Other factors such as diet rich in free fatty acids and sugar which contributed to aggravation of acne (16)(17)(18)(19)(20)(21). Fiber poor diet was consumed by the participants of our study. ...
Background:
Acne is a common skin disorder among younger age group. Dietary pattern are the key determinants among acne patients. The objective of this study is to determine the association of acne vulgaris with dietary habits among patients at tertiary care hospital in Karachi, Pakistan.
Methods:
it is a cross sectional study and participants were selected through simple random sampling from outpatient department of tertiary care hospital in Karachi, Pakistan. Patients presenting with acne irrespective of severity and treatment were included in the study. Bivariate analyses conducted at 95% CI and p=<0.05 considered statistically significant.
Results:
Females gender (62%) and family history (61%) was significantly associated with acne. Face region was most (92%) affected by acne. GI upset most common co-morbid illness with Acne (p=0.006). After adjustment of covariate, those consume oily food [Daily oily food; Twice a weekly oily food)]; sugar rich food [Daily consumed sugar; Twice a weekly consumed] and less glass of water [8-10 glass per day; 6-8 glass per day; less than 6 glass per] were significantly associated with acne.
Conclusion:
Study found that un-healthy diet is significantly associated with acne. Common dietary predictors for acne were frequent use of oily food, sugary food, and less amount of drink water.
... Milk also contains and induces IGF-1, thus decreasing FOX O1 and increasing mTORC-1 activity 31,33 . ...
... Depending on the level of fat, cow's milk is classified as whole milk (3.5%), low-fat milk (2%), and skim milk (fat-free), the latter being associated with higher plasma IGF-1 levels 13,31 . However, Ulvestad et al. demonstrated in 2016 a direct relationship between acne and high milk consumption regardless of milk fat content, which would reveal that the pro-acne effect of milk is associated more with its high content of hormones and bioactive molecules than with fat content 33,34 . ...
Acne is a chronic inflammatory disease of the pilosebaceous unit with multifactorial etiology. Abnormal proliferation of keratinocytes, altered sebum production, inflammation of the sebaceous follicle, and colonization by Cutibacterium acnes have been traditionally implicated. However, the diet has also been highlighted in the pathogenesis because of its direct relation with some biochemical markers and the transcription of specific genes associated with sebaceous gland activity, inflammation, and bacterial proliferation, which together promote the development of the disease, affect the severity of the condition, and modify its response to treatment.
... The Western diet consisted of more refined carbohydrates, oils, and dairy products than traditional cuisine, lacked fibre, and had a higher ratio of saturated fatty acids to unsaturated fatty acids (6). Some recent studies have shown that a high GL and consumption of milk are associated with acne (7)(8)(9)(10)(11). Although chocolate and oily or fatty foods have been frequently implicated, their influence remains inconclusive (3,4,(12)(13)(14)(15). ...
... The frequent consumption of milk, 2 glasses per week, was associated with more severe acne in univariate analysis; however, the relationship was not significant in terms of multivariate analysis. In contrast, previous studies showed an association between milk consumption, especially skimmed milk, and acne, while the association of consumption of other dairy products, such as yoghurt and cheese, with acne remained inconclusive (7,(9)(10)(11). In 2018, Dai et al. (8) studied the effects of milk consumption on acne; meta-analysis of observational studies found that the odds ratio was 1.41 for 1 glass of milk per day and 1.24 for 2-6 glasses of milk per week. In contrast to previous research, the amount of milk consumption among Thai adults was found to be relatively low; the median milk consumption in the current study was only 4 glasses per week, and the median consumption of low-fat or skimmed milk was less than 1 glass per week, and was not sufficient to influence the risk of acne. ...
The association between diet and acne has been growing in concern. Every country has its own food culture. A few studies surveyed the influence of Asian cuisine on acne. This study investigated the association between acne severity and diet/lifestyle factors in 2,467 Thai adolescents and adults. The data were collected from the validated semi-quantitative food frequency questionnaire. The prevalence of mild acne was 52%, moderate acne was 22%, and 8% severe acne in Thai adolescents and adults. No acne was found in 18% of participants. The dietary factors associated with increased acne severity were the consumption of chocolate >100 grams/weeks (aOR, 1.29; 95% CI, 1.07-1.56), oily and fried food >3 times/week (aOR, 1.84; 95% CI, 1.07-3.16) and white rice (aOR, 1.80; 95% CI, 1.24-2.63). On the contrary, the factors associated with decreased acne severity were the consumption of sugar-free tea (aOR, 0.61; 95% CI, 0.43-0.87), and vegetables (aOR, 0.74; 95% CI, 0.62-0.89).
... High plasma IGF-1 concentrations caused by milk consumption stimulate sebaceous cell proliferation, which leads to the development and progression of acne lesions [20]. A study by Ulvestad et al. [28] found that high consumption (≥2 glasses per day) of full-fat dairy products was associated with moderate to severe acne development. In boys consuming large amounts of full-fat dairy products, the odds ratio for developing acne was 4.81 (1.59-14.56). ...
... On the other hand, high total dairy consumption was associated with the development of acne lesions in girls (1.80, 1.02-3.16). In contrast, no significant associations were found between acne and consumption of semiskimmed or skimmed dairy products or with moderate consumption of any fatty dairy products [28]. ...
Acne is one of the most common dermatological conditions affecting millions of people worldwide. It is assumed that the main etiological factors acne are considered to be the excessive production of sebum and hormones, and the colonisation of P. acnes bacteria. The relationship between diet and acne lesions is still the subject of debate and scientific criticism.
On the one hand, studies suggest that an elimination diet is of no benefit in the treatment of acne, while other studies indicate that there is a close a close relationship between diet and the occurrence of acne lesions. Already in the 1970s, some scientists claimed that the course of acne could be modified by specific dietary components. Several studies have confirmed, among others, the role of a diet with a high glycemic index diet in acne exacerbation and suggested that a low glycemic index diet for several weeks may lead to a reduction in the number of acne lesions. The effect of milk consumption was also investigated in terms for its potential role in acne pathogenesis, including its ability to increase insulin levels. In the last decade, studies have also emerged to determine the effect of dark chocolate on the exacerbation of acne symptoms. To date, it has not been conclusively established which component of chocolate may have a potentially adverse effects on the course of acne. The article summaries the current knowledge on the relationship between diet and acne lesions, and discusses the results of recent studies on selected dietary components that may exacerbate acne.
... Milk intake might increase the risk and severity of acne in this review [59]. A Norwegian longitudinal study in 2489 adolescence found that high consumption of milk would increase the risk of acne in girls but not in boys [124]. The gender differences would be due to the different pattern of dairy intake, maturational stage and life styles [124]. ...
... A Norwegian longitudinal study in 2489 adolescence found that high consumption of milk would increase the risk of acne in girls but not in boys [124]. The gender differences would be due to the different pattern of dairy intake, maturational stage and life styles [124]. Another recent meta-analysis of observational studies in individuals aged 7-30 years also demonstrated milk consumption was related to a higher risk of acne, not only for whole milk but also low-fat or skimmed milk, and the effects were significantly related to the frequency of milk consumption [125]. ...
In order to recapitulate the best available evidence of milk consumption and multiple health-related outcomes, we performed an umbrella review of meta-analyses and systematic reviews in humans. Totally, 41 meta-analyses with 45 unique health outcomes were included. Milk consumption was more often related to benefits than harm to a sequence of health-related outcomes. Dose–response analyses indicated that an increment of 200 ml (approximately 1 cup) milk intake per day was associated with a lower risk of cardiovascular disease, stroke, hypertension, colorectal cancer, metabolic syndrome, obesity and osteoporosis. Beneficial associations were also found for type 2 diabetes mellitus and Alzheimer's disease. Conversely, milk intake might be associated with higher risk of prostate cancer, Parkinson’s disease, acne and Fe-deficiency anaemia in infancy. Potential allergy or lactose intolerance need for caution. Milk consumption does more good than harm for human health in this umbrella review. Our results support milk consumption as part of a healthy diet. More well-designed randomized controlled trials are warranted.
... Randomized trials could not investigate multiple food exposition within the same time period and might be limited by a small population sample. 22,33,34 Observational studies frequently focus on teenage acne 24,35 and are based on frequency questionnaires 17,24,35 for previous food exposure, which lead to both a lack of precision in food records and a recall bias without taking into account various potential confounding factors, such as depression, energy intake (kilocalories per joule), and smoking. 23,24,36 Thus, the objective of the present study was to assess the association between dietary behavior and current acne using a large cohort of French adults with accurate and timely dietary intake data. ...
... Randomized trials could not investigate multiple food exposition within the same time period and might be limited by a small population sample. 22,33,34 Observational studies frequently focus on teenage acne 24,35 and are based on frequency questionnaires 17,24,35 for previous food exposure, which lead to both a lack of precision in food records and a recall bias without taking into account various potential confounding factors, such as depression, energy intake (kilocalories per joule), and smoking. 23,24,36 Thus, the objective of the present study was to assess the association between dietary behavior and current acne using a large cohort of French adults with accurate and timely dietary intake data. ...
Importance
Acne is a chronic, multifactorial inflammatory disease. The association between consumption of dairy products and fatty and sugary foods and occurrence and progression of acne remains unclear.
Objective
To assess the association between dietary behavior and current acne in adults.
Design, Setting, and Participants
A cross-sectional study was performed as part of the NutriNet-Santé study, which is an ongoing observational, web-based cohort study that was launched in France in May 2009. The present study was conducted from November 14, 2018, to July 8, 2019. A total of 24 452 participants completed an online self-questionnaire to categorize their acne status: never acne, past acne, or current acne. Associations between dietary behavior (food intake, nutrient intake, and the dietary pattern derived from a principal component analysis) and current or past acne were studied in multinomial logistic regression models adjusted for potential confounding variables (age, sex, physical activity, smoking status, educational level, daily energy intake, number of dietary records completed, and depressive symptoms).
Results
The 24 452 participants (mean [SD] age, 57 [14] years; 18 327 women [75%]) completed at least 3 dietary records. Of these, 11 324 individuals (46%) reported past or current acne. After adjustment, there was a significant association between current acne and the consumption of fatty and sugary products (adjusted odds ratio [aOR], 1.54; 95% CI, 1.09-2.16), sugary beverages (aOR, 1.18; 95% CI, 1.01-1.38), and milk (aOR, 1.12; 95% CI, 1.00-1.25). An energy-dense dietary pattern (high consumption of fatty and sugary products) was associated with current acne (aOR, 1.13; 95% CI, 1.05-1.18).
Conclusions and Relevance
In this study, consumption of milk, sugary beverages, and fatty and sugary products appeared to be associated with current acne in adults. Further large-scale studies are warranted to investigate more closely the associations between diet and adult acne.
... 22 In a survey study on Norwegian adolescents, it was found that the incidence of acne was higher in males and females consuming two cups of whole milk or more daily. 23 In a study on the adult age group in Denmark, no correlation was found between acne and milk intake. 24 In the study by La Rossa et al 25 , it was reported that there was no statistically significant difference between the acne and control groups in terms of daily milk consumption. ...
... Another study on 2201 adolescents found no correlation between acne and milk, yogurt, and cheese consumption. 23 Moreover, a study from Malaysia reported no correlation between cheese consumption and acne. 22 ...
Background:
Acne vulgaris is one of the chronic skin diseases with bacterial and perifollicular inflammation in its etiology. In recent years, numerous studies have been conducted on hormones and food consumption, which are thought to affect this inflammation.
Aims:
In this study, how effective various possible factors such as food consumption habits and anthropometric measurement are in the etiology and severity of acne was investigated in patients with acne.
Materials and methods:
A case-control study was conducted including 53 acne vulgaris patients and 53 age-, gender-, and ethnicity-matched controls. Each patient's acne score was calculated by a dermatologist ranging from 0-44 points based on the Global Acne Grading System (GAGS) calculation. Dietary intake of milk and dairy products along with carbohydrate, fat, protein ratios and body mass index and body fat percentage were calculated. Statistical evaluation was carried out by calculating 95% confidence interval and prevalence rates between acne vulgaris and food categories.
Results:
Cheese consumption was higher in the acne vulgaris group than in the control group, and there was a statistically significant difference.(P < .05) There was a statistically positive correlation between acne score and carbohydrate consumption (P < .01) and a statistically negative correlation between acne score and fat consumption. (P < .01).
Conclusion:
In patients with acne vulgaris, it was observed that cheese consumption increased acne formation and carbohydrate consumption increased acne severity, while fat consumption did not increase acne severity.
... 8 In 2016 LaRosa et al 9 found that consumption of low-fat/skimmed milk was significantly higher in acne patients than those with no acne. 9 In 2017 Ulvestad et al 10 found that full fat dairy products were associated with moderate and severe acne, the odds ratio was 4.81 for boys and 1.8 for girls. 10 A recent meta-analysis of 14 studies found that whole milk, low fat milk, and any milk were positively associated with acne. ...
... 9 In 2017 Ulvestad et al 10 found that full fat dairy products were associated with moderate and severe acne, the odds ratio was 4.81 for boys and 1.8 for girls. 10 A recent meta-analysis of 14 studies found that whole milk, low fat milk, and any milk were positively associated with acne. 11 Whereas the same author could not find any association between milk and acne in a Mendelian randomization study in adults. ...
Background
Previous observational studies suggest that the development of acne may be triggered by dairy intake.
Objective
This study aimed to investigate the association of dairy intake and acne in Kabul citizens.
Methods
From February to September 2018, 279 acne patients and 279 controls aged 10–24 years were enrolled in a case control study at the dermatologic outpatient department of Maiwand Teaching Hospital in Kabul City, Afghanistan. The acne severity was determined by a dermatologist using the Global Acne Severity Scale.
Results
The consumption of whole milk 3 days or more per week was associated with moderate to severe acne (OR =2.36, 95% CI, 1.39–4.01). The association for low fat milk was less marked than for whole milk (OR 1.95 CI, 1.10–3.45). The risk was increased in those with a family history of acne in siblings (OR =4.13, 95% CI, 2.55–6.69). The risk was reduced in subjects doing physical exercise. No association with smoking emerged. A protective effect was associated with chicken consumption (OR =0.27, 95% CI, 0.15–0.49). Consumption of chocolate and chips was positively associated with acne.
Conclusion
This study showed an association between high intakes of dairy products and acne in adolescence suggesting that dairy intake may be a factor contributing to acne.
... 11 Specially milk was a determinant for acne in many types of research that identified an association between all types of milk such as skimmed milk and high-fat milk with acne development and suggested that hormones and bioactive molecules present in milk might be linked to this association. 12,13 It is proposed that high glycemic indexes lead to hyperinsulinemia and a resulting cascade of endocrine consequences, including increased androgens, increased IGF-1, and altered retinoid signaling pathways, that mediate acne. The severity of acne is correlated with facial sebum secretion and it has been hypothesized that foods high in fat or carbohydrates may exacerbate acne by production of more comedogenic sebum. ...
Background: Acne vulgaris is one of the most commonly found skin problems affecting teenagers and adolescents. Dietary foods particularly dairy products consist of milk or any of its food made from milk are frequently regarded by patients and clinicians as a cause or aggravator of acne. As there are very limited studies found on this regard, this study was aimed to find the association of dairy foods in acne vulgaris. Methods: This wasa cross-sectional analytical study and was carried out in the Dermatology and Venereology department of Shaheed Suhrawardy Medical College Hospital. Total 260 patients were selected by appropriate inclusion criteria equally into two groups: Group A (diagnosed with acne vulgaris, n=130) and group B (patients not having acne vulgaris, n=130). A thorough history of every patient and face to face interview was taken by a predesigned questionnaire after getting the written informed consent of the patient. Data were collected in predetermined data collection form. Result were subjected to standard statistical evaluation and were analyzed by SPSS-24. Results: According to the age group, majority of the acne patients were between 10-20 years (75.4% in group A and 63.8% in group B, p<0.05), though mean age in both groups were statistically similar (18.53±5.78 and 17.29±4.59 years, respectively). Also, female respondents were predominant in both groups (80.8% and 72.3%). The risk was increased in those with a family history of acne in siblings (OR2.449, p=0.021;95% CI,1.145-5.238) and the risk was reduced in subjects doing physical exercise. Papules (35.4%) and comedones (27.7%) were most common lesion and mostly found in forehead (74.6%) and left (68.5%) and right (63.1%) cheeks. According to global acne severity grading, majority had mild form of acne (83.1%) and use of cosmetics (43.8% vs. 30%), topical steroid (34.6% vs. 16.9%), taking fastfood (24.6% vs. 14.6%) and less water intake (36.9% vs. 18.5%) also significantly higher among acne patients. Multivariate regression analysis showed, dairy products such as whole milk (OR 1.984, p=0.022), chocolate (2.490, p=0.004), chips (OR 3.207, p<0.001), Pizza (OR 2.388, p=0.021) and red meat (OR 3.055, p=0.009) were significant risk for developing acne vulgaris. Also, whole milk (3.050, p=0.01), chocolate (3.817, p=0.004) and pizza (3.822, p=0.005) were independent risk factors for moderate to severe acne. Conclusion: This study found an association between high dairy product consumption and acne in adolescents, indicating that dairy consumption may be a contributing factor for developing acne vulgaris. J Shaheed Suhrawardy Med Coll 2022; 14(2): 25-33
... У 81,8% пациентов основной группы семейный анамнез по акне был отягощен. При анализе результатов обнаружено, что употребление молока и мороженого более одного раза в неделю увеличивает проявления акне в 4 раза по сравнению с теми, кто употребляет эти продукты менее одного раза в неделю [43][44][45][46]. В ряде исследований отмечено, что частое употребление шоколада связано с высоким риском появления акне и утяжеления клинической картины заболевания, а сочетанное употребление молочных продуктов и шоколада оказывает комбинированное отрицательное влияние на дерматоз и способствует ухудшению клинической картины заболевания [47,48]. ...
... Moreover, a cross-sectional, observational, web-based cohort study (NutriNet-Santé study), reported an independent association between milk assumption and acne with participants with a more significant consumption of milk in patients with current acne consuming as compared with participants without acne (adjusted OR of 1.12 and P=0.04) [26]. Finally, other studies reported a positive correlation between acne and dairy assumption in some form, including ice cream [27][28][29][30][31]. ...
Acne is a common skin disease, affecting millions of subjects worldwide. Several processes and mechanisms have been identified in acne pathogenesis. Among these, it is known that acne or its worsening is also related to metabolic factors and nutritional influences. In this scenario, we carried out a review of the current literature in order to investigate the role of diet in acne disease, offering a wide perspective for possible clinical applications. A total of 55 manuscripts were considered. In particular, the role of the Western diet, glycemic index, glycemic load, dairy products, fats, fatty acids, Mediterranean diet, ketogenic diet, and dietary supplements in acne management has been investigated. On one hand, dairy products, foods with high glycemic load and glycemic index, fatty acids and fats seem to worsen the severity; on the other hand, Mediterranean and ketogenic diet, and oral supplements seem to improve the disease. Despite the conflicting results and conclusions in the scientific literature about the impact of nutrition in acne, mainly related to the severla limitations of the study design, several prospective, controlled, well-designed studies have recently demonstrated the role of some specific nutrition influenced mediators on acne severity.
... Of the lifestyle factors examined, smoking and an unhealthy diet rich in fatty/junk food were associated with worsened acne severity, concurring with earlier evidence [19,[31][32][33]. We also found physical inactivity and inadequate sleep as risk factors among Jordanians. ...
Introduction
Acne vulgaris is a common skin disease that affects a significant portion of the population, especially adolescents and young adults. While various factors contribute to the development of acne, lifestyle factors such as diet, sleep patterns, stress levels, and personal hygiene practices may play a significant role. This study aims to investigate the impact of lifestyle factors on the development and severity of acne vulgaris.
Methods
The survey team collected data on demographics and lifestyle from the individuals with acne vulgaris who attended dermatology clinics at tertiary hospital. Data on demographics, lifestyle factors, and acne severity were collected and analyzed data using descriptive and inferential statistics. A logistic regression analysis was done to identify predictors of acne severity.
Results
The study examined the factors affecting acne severity in 423 participants with a mean age of 20.2 years. The results showed that younger age (aOR = 1.41), female gender (aOR = 2.56), higher BMI (aOR = 0.63 and 0.85 for BMI < 18.5 and 18.5–23), smoking (aOR = 2.61), family history of acne (aOR = 2.67), low intake of fruits/vegetables (aOR = 0.82 and 0.61 for consumption a few times a week and nearly every day) and dairy products (aOR = 0.86 for consumption a few times a week), high intake of fast food/fatty food (aOR = 1.61) and sweets/chocolate (aOR = 1.43), low physical activity (aOR = 0.75 for exercise a few times a week), short sleep duration (aOR = 1.15), and significant stress (aOR = 1.52) were all associated with higher acne severity scores on the GEA scale.
Conclusion
More severe forms of acne are noted among females, younger individuals, those with familial history, higher BMI, unfavorable lifestyle habits, and stress. Specifically, unhealthy dietary patterns like higher fast food and lower vegetable/fruit intake, sedentary lifestyle, short sleep duration, and psychological stress appear to be linked to more severe acne. On the other hand, frequent consumption of dairy products has a protective effect.
... 1. Skin trauma: Repeated mechanical trauma to the skin due to scrubbing the affected skin with soaps, detergents etc. promote the development of inflammatory acne [8] . 2. Diet: Increased intake of milk and other dairy products has an association with the incidence of acne [9] . High glycemic load diets also have been shown to increase their incidence [10] . ...
... influence the development of seborrhea and acne, and recent investigations have shown an association between high intakes of dairy products,54 consumption of chocolate49,52 and acne.Hyperglycemic food and carbohydrates have also been associated with acne, while protective factors for acne include the consumption of fruit and vegetables, as exemplified by the Mediterranean diet (MD). A cross-sectional observational study found low adherence to MD in acne patients compared to individuals with healthy skin.55 ...
Background:
Acne pathophysiology includes a complex interaction among inflammatory mediators, hyperseborrhea, alteration of keratinization and follicular colonization by Propionibacterium acnes.
Aims:
To describe the impact of the exposome on acne and how photoprotection can improve outcomes.
Methods:
A narrative review of the literature was carried out; searches with Google Scholar and Pubmed from January 1992 to November 2022 were performed. The keywords used were "acne," "sunscreens," "photoprotection," "cosmetics," "cosmeceuticals," "pathogenesis," "etiology," "exposome," "sunlight," "stress," "lack of sleep," "diet," "postinflammatory hyperpigmentation," "pollution," "exposome," "ultraviolet radiation," and "visible light."
Results:
Environmental factors such as solar radiation, air pollution, tobacco consumption, psychological stress, diverse microorganisms, nutrition, among others, can trigger or worsen acne. Solar radiation can temporarily improve lesions. However, it can induce proinflammatory and profibrotic responses, and produce post-inflammatory hyperpigmentation and/or post-inflammatory erythema. While photoprotection is widely recommended to acne patients, only four relevant studies were found. Sunscreens can significantly improve symptomatology or enhance treatment and can prevent post-inflammatory hyperpigmentation. Furthermore, they can provide camouflage and improve quality of life. Based on acne pathogenesis, optimal sunscreens should have emollient, antioxidant and sebum controlling properties.
Conclusions:
The exposome and solar radiation can trigger or worsen acne. UV light can induce post-inflammatory hyperpigmentation/erythema, and can initiate flares. The use of specifically formulated sunscreens could enhance adherence to topical or systemic therapy, camouflage lesions (tinted sunscreens), decrease inflammation, and reduce the incidence of post-inflammatory hyperpigmentation/erythema.
... Other diverse randomized studies that do or do not confirm the effect of diet on acne severity are less reliable because they did not examine multiple food exposures during the same period and are limited by a small population sample. In addition, observational studies often focus on adolescent acne and rely on frequency questionnaires on previous food exposures, leading to both a lack of precision in food records and recall bias without considering various potential confounders like depression or smoking [37][38][39]. On this basis, this article assumes that diet can influence acne in selected populations. ...
The etiopathogenesis of acne is complex, as several endo- and exogenous factors that affect the sebaceous-hair unit are involved in the development of acne lesions. The main aim of the study was to evaluate selected metabolic parameters before treatment. Another goal of the study was to determine the correlation between selected metabolic and dietary parameters and the severity of acne before treatment. The third objective was to assess the severity of acne before and after treatment, considering the type of treatment used. The final objective was to assess the relationship between the difference in acne severity before and after treatment, considering the type of treatment used and factors of dairy or sweets intake. 168 women participated in the study. The patients belonged to two groups: the study group (99 patients with acne vulgaris) and the control group (69 patients without skin lesions). The study group was divided into subgroups according to the treatment used: contraceptive preparation, contraceptive preparation and cyproterone acetate, and contraceptive preparation and isotretinoin preparation. We found that LDL levels and consumption of sweets correlated with acne severity. The mainstay of acne treatment is contraceptive treatment (ethinylestradiol and drospirenone). The effectiveness of the three contraceptive-based treatments was confirmed by observing the severity of acne. There were no significant correlations between the difference in acne severity before and after treatment with the three treatments and factors of dairy or sweet consumption.
... Metformin: In a review of the literature, researchers found some evidence that patients with acne who took metformin with other topical or topical and oral antibiotics had a greater reduction in total lesion counts and inflammatory lesions from baseline compared to their control counterparts, with less adverse effects (e.g., diarrhea and flatulence) [66]. Dairy: A 2017 longitudinal research discovered correlations between high consumption of full-fat diet and acne, as well as high intake of total dairy [67]. ...
... Indeed, in a Norway study, 72% of the population consumed semiskimmed dairy products. 18 Finally, heredity is considered a predictive factor for acne risk and severity, 19 as confirmed in our study with a significant difference in family history between our acne patients and our control subjects (P = 0.0006). We showed that having at least one parent with a history of acne increased by 5.4 the risk of developing acne compared to nonacneic patients. ...
Acne is a common benign inflammatory disease, but it has a significant psychosocial impact. The role of the diet in the development of acne is controversial. Some daily foods such as milk and fast-release sugars tend to promote acne. The Mediterranean Diet (MD) is based on virgin olive oil and nuts that are rich in polyphenols with anti-inflammatory properties. The aim of this study was to assess an association between the adherence to the MD and the severity of facial acne in French women. A case-control observational study was conducted in Nantes Hospital (France). Based on a validated PREvención con DIeta MEDiterránean questionnaire, the adherence to the MD was assessed. The Global Evaluation Acne severity score was assessed by a trained dermatologist. Forty women with mild-to-severe acne and 40 control subjects were included. A global linear model identified a significant negative correlation between the severity of acne and the adherence to the MD in acne patients (regression coefficient = −0.17; P = 0.017). This was the first study conducted in France to investigate the relationship between the adherence to the MD and the severity of facial acne in women. This study confirmed the importance of using a holistic approach for acne management. Further studies are needed to confirm our findings.
... Overall, 17.9% (5/28) of the observational studies exclusively assessed the association between GI/ glycemic load and acne (Table I). [19][20][21][22][23] Overall, 35.7% (10/28) exclusively commented on the association between dairy and acne (Table II), [24][25][26][27][28][29][30][31][32][33] and 46.4% (13/28) described the associations of dairy products and GI/glycemic load with acne (Table III). [34][35][36][37][38][39][40][41][42][43][44][45][46] All the interventional trials included examined the effect of GI/glycemic load on acne (Table IV). ...
Background
Acne vulgaris is a common cutaneous disorder. Diet and metabolism, specifically glycemic content and dairy, influence hormones such as insulin, insulin-like growth factor 1, and androgens, which affect acnegenesis.
Objective
To systematically review high-quality evidence regarding the association of dietary glycemic and dairy intake with acnegenesis.
Methods
A comprehensive literature search, without timeline restriction, of MEDLINE (completed between October and November 2021) for English-language papers that examined the association between diet and acne was conducted. The evidence quality was assessed using the Ottawa quality assessment scale.
Results
The literature search yielded 410 articles, of which 34 articles met the inclusion criteria. The literature on whether dairy product intake is associated with acnegenesis is mixed and may be dependent on sex, ethnicity, and cultural dietary habits. High glycemic index and increased daily glycemic load intake were positively associated with acnegenesis and acne severity, an observation supported by randomized controlled trials.
Conclusion
High glycemic index, increased glycemic load, and carbohydrate intake have a modest yet significant proacnegenic effect. Increased dairy consumption may have been proacnegenic in select populations, such as those in which a Western diet is prevalent. The impact of diet on acnegenesis is likely dependent on sex and ethnicity. Further randomized trials are necessary to fully characterize the potential associations.
... Previous extended research has provided inconclusive findings regarding the intake of chocolate on acne development, severity and exacerbation [22][23][24] . A doubleblind, placebo-controlled randomized, controlled trial was conducted to investigate the impact of milk chocolate intake in the majority of male participants with the diagnosed skin condition, which found eating chocolate led to progression in their acne severity [25,26] . In 2017, Ulvestad et al. evaluated that full fat dairy products were linked with moderate and severe acne whereas, one of the earliest study by Fulton et al, investigated acne and chocolate conducted on sixtyfive subjects diagnosed with acne consumed milk chocolate bars as compared to subjects given a chocolate-less placebo bar containing vegetable fat, with results indicating no significant difference between the two groups, suggesting chocolate had no effect on acne development [27] . ...
BACKGROUND & OBJECTIVE: The pathology of acne is vaguely understood to date, current epidemiologic evidence in Eastern populations indicates that consumption of chocolate, milk intake, fatty products, and glycemic load may be involved. Previously little research has been conducted highlighting the possible relationship between diet and acne among patients in Pakistan. The objective of this study was to identify the association of acne vulgaris and dietary intake patterns.
METHODOLOGY: An observational study enrolled 246 participants, both genders, 16 to 40 years of age, diagnosed with Acne Vulgaris recruited from a tertiary-care hospital out-patient clinic in Karachi. The structured questionnaire consisted of various methods for assessing nutritional parameters. Statistical analysis was carried out using SPSS, the association of Acne was tested with dietary habits using Pearson-Chi Square test. Food items with a p-value less than 0.05 in the Chi Square test were considered in Binary logistic regression for estimating the risk for Acne with a 95% confidence interval (C.I.).
RESULTS: Fifty-two percent of participants were found with mild acne, use of yogurt, ice cream butter, margarine, French fries, chocolate, bakery chips, white bread, vegetable, fruits, cake dates, and pickles give a significant association with severity of acne using Fisher's Exact test p
... Another source of PA might be circulating PA which is a major saturated fatty acid in plasma. PA level rises during consumption of high-fat diets and such diets contribute significantly to acne development [23][24][25] . Therefore, increased PA due to high-fat diets may have an endocrine effect on the sebaceous glands of acne patients. ...
Background:
Sebocytes are the main cells involved in the pathogenesis of acne by producing lipids and inflammatory cytokines. Although palmitic acid (PA) has been suggested to induce an inflammatory reaction, its effect on sebocytes remains to be elucidated.
Objective:
In the present study, we investigated whether PA promotes inflammasome-mediated inflammation of sebocytes both in vivo and in vitro.
Methods:
We intradermally injected PA into the mice ears. And, we treated cultured human sebocytes with PA. Inflammasome-mediated inflammation was verified by immunohistochemistry, Western blot and ELISA.
Results:
PA-treated mice developed an inflammatory response associated with increased interleukin (IL)-1β expression in the sebaceous glands. When PA was added to cultured human sebocytes, caspase-1 activation and IL-1β secretion were significantly enhanced. In addition, NLRP3 knockdown attenuated IL-1β production by sebocytes stimulated with PA. PA-mediated inflammasome activation required reactive oxygen species.
Conclusion:
These findings indicate that PA activates the NLRP3 inflammasome before induction of an inflammatory response in sebocytes. Thus, PA may play a role in the inflammation of acne.
... 43 Estudios relativamente recientes han encontrado resultados positivos en el consumo de leche descremada, 44 de leche entera 45 y alto consumo de productos lácteos. 46 Se ha demostrado polimorfismo genético de IL-1A 889, relacionado con acné, desencadenado o exacerbado por la dieta, 32 y mayor expresión del gen mTOR y de la Cinasa S6K1 en piel de pacientes con acné, formando el complejo mTORC1 (diana de células de mamífero del complejo de rapamicina 1), implicado también en varias enfermedades metabólicas como la obesidad, resistencia a la insulina, diabetes mellitus tipo 2, cáncer y enfermedades neurodegenerativas. 47 La dieta occidental con alto consumo de carbohidratos hiperglucémicos, leche y derivados, grasas saturadas y grasas trans, activan al mTORC1, el cual aumenta la secreción de andrógenos. ...
El acné vulgar es una enfermedad común, inflamatoria y multifactorial de la unidad pilosebácea que afecta, primariamente, a los adolescentes; sin embargo, puede encontrarse a cualquier edad. Cuando ocurre entre el nacimiento y los 12 años se denomina acné pediátrico, el que con base en la edad de inicio se ha categorizado en acné neonatal, infantil, de la mediana niñez y preadolescente. La importancia de esta categorización reside en los procesos etiopatogénicos implicados, curso, complicaciones y pronóstico.El acné neonatal que coexiste en las primeras 8 semanas de la vida tiene excelente pronóstico y no requiere tratamiento. El acné infantil ocurre de 8 semanas a 1 año; la mayoría cursa sin complicaciones y tiene la implicación de padecer acné severo en la adolescencia. El acné de la mediana niñez aparece entre 1 y 7 años, periodo en el que virtualmente no existen hormonas adrenales ni gonadales, por lo que debe investigarse una endocrinopatía subyacente. En cambio, el acné preadolescente, entre los 7 y 12 años, es muy frecuente y considerado normal. Sin embargo, en todo paciente con síntomas y signos de hiperandrogenismo deberá investigarse un trastorno endocrinológico.El conocimiento del acné pediátrico permitirá al médico tratante o al pediatra sospechar la existencia de una enfermedad subyacente. La influencia de la dieta occidental en la severidad del acné se ha demostrado y está adquiriendo mayor relevancia. El tratamiento pronto y efectivo del acné reduce la repercusión psicosocial del paciente. Sin embargo, se requieren investigaciones futuras para determinar ese efecto en el paciente pediátrico.
... A. Milk and dairy products: High intakes (≥2 glasses per day) of full-fat dairy products were associated with moderate to severe acne. No significant associations were found between acne and intake of semi-skimmed or skimmed dairy products, and not with moderate intakes of any fat variety of dairy products [151]. Also, no significant association between yogurt/cheese and acne development was observed by Aghasi et.al, 2018 [152]. ...
Acne, also known as acne vulgaris (AV), is a long-term skin disease that occurs when hair follicles are clogged with dead skin cells and oil from the skin. It is characterized by blackheads or whiteheads, pimples, oily skin, and possible scarring. An intact stratum corneum and barrier, normal natural moisturizing factor and hyaluronic acid levels, normal Aquaporin-3 (AQP3) expression (localized at the basal lateral membranes of collecting duct cells in the kidney), and balanced sebum secretion are qualities of the skin that fall in the middle of the oily–dry spectrum. Patients rarely, if ever, complain about reduced sebum production, but elevated sebum production, yielding oily skin that can be a precursor to acne, is a common complaint. Several factors are known to influence sebum production. AV is mostly triggered by Propionibacterium acnes in adolescence, under the influence of normal circulating dehydroepiandrosterone (DHEA). It is a very common skin disorder which can present with inflammatory and noninflammatory lesions chiefly on the face but can also occur on the upper arms, trunk, and back. Age, in particular, has a significant and well-known impact, as sebum levels are usually low in childhood, rise in the middle-to-late teen years, and remain stable into the seventh and eighth decades until endogenous androgen synthesis dwindles. Sebum, the oily secretion of the sebaceous glands containing wax esters, sterol esters, cholesterol, di- and triglycerides, and squalene, imparts an oily quality to the skin and is well known to play an important role in acne development. Acne can’t be prevented or cured, but it can be treated effectively. The pimples and bumps heal slowly, and when one begins to go away, others seem to crop up. Depending on its severity, acne can cause emotional distress and scar the skin. Acne may cause scarring of the skin, but generally causes no long-term health problems. In self-body image, some parts of the body including face play an important role. Existence of even a minor lesion in this part may be unpleasant for the patient and seems large. This image can cause mental disorders including depression and anxiety, low self-esteem, and decrease in social relationships. However, high levels of anxiety and depression in patients with facial acne are not related to oxidative stress, according to a study published online in the Journal of Cosmetic Dermatology
... Распространенность ВА в различных возрастных популяциях и регионах варьирует. Так, например, в Норвегии распространенность составила 13,9% в возрастной группе от 15 до 16 лет (2016 г.); в Германии -26,8% в популяции возрастом от 1 до 87 лет (2001 г.); во Франции -60,7% в группе возрастом от 15 до 24 лет (2014 г.) [6][7][8]. Тогда как в Бразилии (2014 г.) и Бельгии (2007 г.) данный показатель составил приблизительно 96% в группах от 10 до 17 и от 13 до 18 лет соответственно [9,10]. ...
В статье представлены современные данные о патогенезе вульгарных акне (ВА), особенностях клинической картины, диагностике и терапевтической тактике у детей и подростков. Приведены сведения о влиянии наиболее значимых внешних и внутренних факторов на патогенез и риск развития ВА. На основе анализа Европейских методических рекомендаций и рекомендаций Глобального альянса по лечению и диагностике ВА сформированы соответствующие диагностические и терапевтические алгоритмы ведения пациентов. Также продемонстрирована важная роль назначения эффективной терапии в виде фиксированной синергичной комбинации активных веществ, представленных топическим ретиноидом (адапален) и бензоила пероксидом.
... Süt ve süt ürünlerinin AV'de artışa neden olabileceği üzerine çalışmalar vardır. Önceleri yağı alınmış sütün etkisi üzerinde durulurken zaman içinde fazla miktarda tam yağlı süt ürünlerinin (süt, kefir ve yoğurt) tüketimi ile orta ve şiddetli akne oluşumu arasında ilişki olduğu bildirilmiştir [8][9][10] . Tam ve yarım yağlı sütün postprandiyal hiperinsülinemiye; pastörize günlük sütün IGF-1 artışına; yoğurt, dondurma, sporcuların kullandığı peynir altı suyu ve kazein gibi protein tozlarının rapamisin protein kompleksinin memeli hedefi-1 (mTORC1) aktivasyonuna neden olduğu savunulmaktadır 11 . ...
... Three studies also suggested that milk intake may increase the risk of more severe acne [40][41][42] , which is consistent with a meta-analysis that reported that high milk consumption was significantly associated with the presentation of moderate-severe acne 43 . Explanations for the association between milk intake and acne presentation may also explain the association observed for milk intake and acne severity. ...
A systematic review was conducted on epidemiology studies on acne obtained from a Web of Science search to study risk factors associated with acne presentation and severity. A strong association was observed between several risk factors – family history, age, BMI and skin type – and acne presentation or severity in multiple studies. The pooled odds ratio of 2.36 (95% CI 1.97–2.83) for overweight/obese BMI with reference to normal/underweight BMI and the pooled odds ratio of 2.91 (95% CI 2.58–3.28) for family history in parents with reference to no family history in parents demonstrate this strong association. In addition, a pooled odds ratio of 1.07 (95% CI 0.42–2.71) was obtained for sex (males with reference to females). However, the association between other factors, such as dietary factors and smoking, and acne presentation or severity was less clear, with inconsistent results between studies. Thus, further research is required to understand how these factors may influence the development and severity of acne. This study summarizes the potential factors that may affect the risk of acne presentation or severe acne and can help researchers and clinicians to understand the epidemiology of acne and severe acne. Furthermore, the findings can direct future acne research, with the hope of gaining insight into the pathophysiology of acne so as to develop effective acne treatments.
... Milk and dairy products: High intakes (≥ 2 glasses per day) of full-fat dairy products were associated with moderate to severe acne. No significant associations were found between acne and intake of semi-skimmed or skimmed dairy products, and not with moderate intakes of any fat variety of dairy products [146]. Also, no significant association between yogurt/cheese and acne development was observed by Aghasi et al, [147]. ...
... Facial appearance has an important role in self-perception, as well as in the interaction with others; face lesions cause a significant impact in women's quality of life [143]. The psychological impact of acne is generally significant and largely underestimated; stress during professional and private life, anxiety and sleep quality, in particular, have a reciprocal relationship with disease susceptibility and severity [144]. Suicidal ideation was found in 6-7% of acne patients. ...
Acne, also known as acne vulgaris (AV), is a long-term skin disease that occurs when hair follicles are clogged with dead skin cells and oil from the skin. It is characterized by blackheads or whiteheads, pimples, oily skin, and possible scarring. An intact stratum corneum and barrier, normal natural moisturizing factor and hyaluronic acid levels, normal Aquaporin-3 (AQP3) expression (localized at the basal lateral membranes of collecting duct cells in the kidney), and balanced sebum secretion are qualities of the skin that fall in the middle of the oily-dry spectrum. Patients rarely, if ever, complain about reduced sebum production, but elevated sebum production, yielding oily skin that can be a precursor to acne, is a common complaint. Several factors are known to influence sebum production. AV is mostly triggered by Propionibacterium acnes in adolescence, under the influence of normal circulating dehydroepiandrosterone (DHEA). It is a very common skin disorder which can present with inflammatory and non-inflammatory lesions chiefly on the face but can also occur on the upper arms, trunk, and back. Age, in particular, has a significant and well-known impact, as sebum levels are usually low in childhood, rise in the middle-to-late teen years, and remain stable into the seventh and eighth decades until endogenous androgen synthesis dwindles. Sebum, the oily secretion of the sebaceous glands containing wax esters, sterol esters, cholesterol, di-and triglycerides, and squalene, imparts an oily quality to the skin and is well known to play an important role in acne development. Acne can't be prevented or cured, but it can be treated effectively. The pimples and bumps heal slowly, and when one begins to go away, others seem to crop up. Depending on its severity, acne can cause emotional distress and scar the skin. Acne may cause scarring of the skin, but generally causes no long-term health problems. In self-body image, some parts of the body including face play an important role. Existence of even a minor lesion in this part may be unpleasant for the patient and seems large. This image can cause mental disorders including depression and anxiety, low self-esteem, and decrease in social relationships. However, high levels of anxiety and depression in patients with facial acne are not related to oxidative stress, according to a study published online in the Journal of Cosmetic Dermatology.
... A Norwegian study of 2467 students aged 18-19 years found that approximately 14% had moderate-to-severe acne. 18 In a Chinese study that included 389 young adults, 23% of subjects had a diagnosis of moderate, severe, or very severe acne. 19 The obesity rates in our study (5.1% in males and 4.3% in females) also concur with the global prevalence of obesity in late adolescence in developed countries. ...
Dairy consumption has been implicated in acne development through mechanisms involving insulin and insulin-like growth factor-1 (IGF-I). Dairy whey elevates insulin, while casein increases IGF-I, both of which enhance access to androgen receptors, contributing to follicular blockage. Epidemiological studies, including large cohorts from the U.S. and Norway, show a positive correlation between milk, especially skim milk, and acne. Milk consumption triggers postprandial insulin and IGF-I surges, promoting sebaceous lipogenesis and inflammation, key factors in acne pathogenesis. The milk-entero-pituitary axis, through GIP stimulation, also boosts growth hormone (GH) and IGF-I levels. Furthermore, dairy-derived hormones and bioactive compounds can affect endocrine pathways involved in acne, with both gender and dietary differences influencing outcomes. While low-fat dairy has often been associated with acne, recent findings suggest a stronger link with full-fat dairy. Studies from various countries also indicate other dietary factors, like chocolate and chips, are linked to acne. The exact bioactive components in dairy responsible for these effects remain unclear, highlighting the need for more research.
Acne and rosacea are common inflammatory skin conditions that are associated with systemic inflammation and metabolic abnormalities. Here, we review the evidence for a connection between diabetes, acne, and rosacea. Acne has been linked to type 2 diabetes and insulin resistance. The pathophysiologic basis of this connection involves hyperandrogenism and activation of the mTORC1/FoxO1 pathway. However, rosacea has a less clear link to insulin resistance. While available evidence is insufficient to recommend routine screening of all acne and rosacea patients for diabetes, management of glucose intolerance shows promise in improving the severity of skin disease. Nevertheless, future studies involving larger cohorts and randomized controlled trials need to be conducted to clarify the role of diabetes in acne and rosacea.
Objective: To investigate the association of vitamin D level and moderate to severe acne as a primary outcome, and its association with BMI, dairy products, and chocolate consumption. Subjects and Methods: A case-control study was conducted in a dermatology outpatient clinic. Patients, diagnosed with moderate to severe acne vulgaris that warrant treatment with oral antibiotics, and had global acne grading system (GAGS) score of >=19 were eligible to be selected as cases. Aged matched, with no or mild cases of acne were eligible to be selected as controls. The participant height, weight, BMI, and serum circulating 25-hydroxyvitamin D level were measured. A modified food frequency questionnaire was used for dietary history. Results: Comparing Cases (N = 101) and Control (N = 134), the mean of vitamin D level in cases were lower than that in the controls, however no statistically significant difference is observed. There were statistically insignificant differences between the studied groups regarding milk (whole, low fat, skimmed and any type of milk), cheese, yogurt, other dairy products, and chocolate consumption. However, a statistically significant disparity in weight is noted, but not in BMI. Conclusion: The results did not reveal any statistically significant associations between vitamin D level, BMI, dairy and chocolate consumption, and moderate to severe acne. However, it is important to note that this does not definitively rule out the possibility of any potential relationships or effects.
Acne vulgaris is one of the most widespread and distressing chronic skin diseases worldwide. It affects about 9.4% of the world’s population during a specific period of their life. Several underlying risk factors like poor dietary habits, family history and poor hygiene are known for acne development. Objective: To assess the dietary habits of undergraduate students with acne. Methods: It was a cross-sectional study including 173 undergraduate students from 3 colleges of Akhtar Saeed Group located at Canal Campus, Lahore. A self-designed questionnaire was used to assess dietary habits of acne participants after getting their written consent. The collected was analyzed by SPSS. Results: The results of this study showed that 54% of selected respondents had acne, with the majority having oily skin and females. The consumption of high glycemic index fruits, junk foods, oily foods, sugary foods, especially dark chocolates, sweetened beverages and milk was found to very high among the acne respondents. They consumed vegetables and whole grains very occasionally. Conclusions: This study concluded that diet has a very high impact in causing acne. Further studies are needed to be done in order to find a more comprehensive link between acne and diet.
Plant-based diets and veganism are receiving increased attention for many reasons. Leading international nutrition organizations have determined that a well-planned and balanced plant-based diet is protective against such chronic diseases as obesity, diabetes, and cardiovascular diseases. Many physicians may be unaware of its potential advantages especially in the field of dermatology, and for this reason, the vegan diet is often discouraged. Although the literature about diet in dermatology is limited, the introduction of foods of plant origin, vitamin B12 supplements, and elimination of animal products may have a protective role in skin diseases. There may be many benefits of a vegan diet for patients with acne, psoriasis, and atopic dermatitis.
RESUMO: A acne vulgaris é classificada como a 8ª patologia mais comum em todo o mundo, com uma prevalência estimada de 9,4% globalmente. Ela afeta indivíduos da maioria das idades, no entanto, a prevalência mostra um pico significativo na adolescência. É considerada uma doença inflamatória crônica da unidade pilossebácea multifatorial, envolvendo fatores genéticos, desequilíbrio hormonal, aumento da produção de sebo, queratinização anormal e proliferação bacteriana. E, embora os fatores dietéticos tenham sido considerados sem importância, evidências apoiam o papel da nutrição como um fator predisponente na manifestação da acne. O presente estudo tem como objetivo realizar uma revisão integrativa explorando a associação entre a acne, a ingestão de laticínios (leite, iogurte, queijo), subgrupos de laticínios (gordura total, baixo teor de gordura, desnatado) e o uso de whey protein como suplementação proteica. Optou-se a realização de uma revisão integrativa de literatura que contemplasse a seguinte questão de pesquisa: “Qual a influência dos laticínios e da suplementação proteica em pacientes com diagnóstico de acne?”. A busca na literatura foi realizada na Medical Publisher (PUBMED), Science Direct e na Scientific Eletronic Library (SCIELO). Verificou-se que há evidências que demonstram a correlação do leite, seus derivados e das proteínas do leite “whey protein” na ocorrência da acne vulgar, sendo maior em indivíduos do gênero masculino. Os achados apontam para uma significativa correlação entre a influência dos laticínios e da suplementação proteica na manifestação da acne, mostrando uma maior incidência em indivíduos que fazem o uso de Whey Protein, consumo este popularizado na atualidade e disseminado na população mais jovem, que busca o ganho de massa corporal, desconhecendo os contras do uso desse tipo de susbstância.
Acne vulgaris and hidradenitis suppurativa are chronic inflammatory, multifactorial skin disorders that often develop in adolescence and young adulthood. Both acne vulgaris and hidradenitis suppurativa can cause significant morbidity and psychologic distress, with a negative impact on the quality of life. The relationship between diet, acne, and hidradenitis suppurativa remains somewhat controversial; however, there is increasing evidence that high-glycemic diets, and consumption of milk and dairy products promote acne. Studies suggest that weight loss through dietary interventions or bariatric surgery and Brewer's yeast exclusion diets have the potential to ameliorate the signs of hidradenitis suppurativa. We review h the role of diet in the pathogenesis, prevention, and treatment of hidradenitis suppurativa and acne vulgaris.
Acne vulgaris is a disorder of the pilosebaceous unit that primarily affects adolescents. Its effect on adults above 25 years is often under-recognized but nevertheless can cause significant psychosocial impact. Adult acne is more common in females and can be severe. Autoinflammatory syndromes, disorders of endocrine metabolism as well as dietary factors are reported to be important aetiologic factors to consider when managing adults with acne vulgaris. Therapeutic options besides the standard topical retinoids, benzoyl peroxide, oral antibiotics and isotretinoin for adult acne include metformin and light/photodynamic therapies and, in females, combined oral contraceptive pills and spironolactone. Acne during pregnancy and lactation poses special challenges, as they add additional constraints on the already limited armamentarium against acne management.
Objectives: To assess the prevalence, level of knowledge and lifestyle association of acne vulgaris among undergraduate medical students of a public sector institute of Pakistan and to evaluate the level of knowledge and different lifestyle factors with gender and all the years of study. We aim to find most common factor associated with acne in our young generation, their understanding and misconception so that the clinical perception of future health professionals and therefore of the community regarding acne vulagris can be improved. Methodology In this cross-sectional study carried out among undergraduate medical students, the data was collected using stratified random sampling technique. A paper-based self-made English questionnaire was distributed to the participants by the researchers. Chi square test was used to compare differences of different categorical variables across gender and academic years. Results: A total of 170 medical students were recruited for the study according to the calculated sample size. More than half of the students (n:110; 64.7%) had acne vulgaris out of which 75 (68%) were females. Years of study were significantly related to knowledge. Gender was significantly related to lifestyle where females had acne lesions appearing more at the time of stress. However, females had less disturbed sleep as compared to males. Conclusions: Acne is a prevalent problem in the medical community with females being most affected. Help seeking attitude was lacking and knowledge was adequate with some misconceptions. Hormones and stress were the most perceived causal factors. However, stress was the only significantly associated lifestyle factor.
Background
Dietary habits may play a non‐negligible role in the development, duration, and severity of acne, as shown in past critical review articles on such association.
Methods
The aim of this systematic review is to supplement data available on scientific literature spanning the last 10 years by inserting the keywords “acne” or “acne vulgaris” and “diet”, “nutrition”, “food”, “chocolate”, “dairy”, “whey protein”, “fatty acid”, or “drink” in the timeframe “January 2009‐April 2020” within the PubMed database.
Results
Fifty‐three reviewed articles met eligibility criteria. They included 11 interventional clinical trials (seven randomized controlled trials and four uncontrolled open label studies) and 42 observational studies (17 case‐control and 22 cross‐sectional studies, and three descriptive studies).
Conclusions
This review reinforces the notion of a rapidly growing exponential trend of interest in this subject by the scientific community. Acne‐promoting factors include high GI/GL food, dairy products, fat food, and chocolate, whereas acne‐protective factors include fatty acids, fruit, and vegetable intake. The role played by specific dietary components pertaining to different foods, as done for milk (full‐fat/whole, reduced‐fat, low‐fat/skim milk), dairy products (milk cream, ice cream, yogurt, cheese, etc.), or chocolate (cocoa, dark/milk chocolate), remains an unsolved issue and objective of future research.
ABSTRACT
Acne being one of the skin condition that is not deadly but is affecting emotionally and psychologically. Many factors contribute in causing acne and leading
it towards severity. Diet is considered as one of the important factor in making acne severe. Foods that are high in glycemic index are thought to aggregate
acne severity. Fried items, sugary beverages, pastries etc are considered as food items that may cause acne. Where as many non-diet related factors such as
family history, self-hygiene, environmental factors are also held responsible for causing acne. Where unhealthy eating habits promotes acne, healthy diet
such as low glycemic index foods, fish consumption, omega 3 fatty acids etc. helps to reduce acne severity and also diet rich in anti-inflammatory foods
helps to reduce redness and inflamed pimples.
Background: Milk is one of the dietary products containing hormones which stimulate the production of insulin-like growth factor 1 that affects the skin and leading to acne development. The objective of this study was to explore the relationship between acne vulgaris and the intake of dairy milk (full fat, low fat, skim). Methods: This study conducted on patients complaining from acne from Al-Karama teaching hospitals during the period between 1 st May till the end of June 2019. The selected age group was from 10-45 years old. Data were collected using a semi-structured questionnaire adopted by a dermatologist and public health specialist for that purpose and analyzed by SPSS version 21using frequency and percentages. Results: The result of this study was obtained by the analysis of 40 patients. Females represented 72.5% and those patients with age groups (21-35) years were represented 52.5% followed by 37.5% for those with within the age group (16-20) years old. About 60% of patients have acne in their faces. All of them mentioned milk-drinking especially skimmed type in 60% of them and 37.5% drank milk daily and at least one cup in (90%). 57.5% noticed an improvement in acne when leaving milk drinking for a while. Conclusion: Milk products was associated with increased acne in individuals especially in young age females.
The aim of this paper is to expand application scope of pea protein isolate by improving its emulsification. Pea protein isolate was ground for different time, and changes in its structure and emulsification properties were studied, and then revealed the influence mechanism of grinding on emulsification. It was found that the β-sheet of protein decreased from 39.92% to 31.47% after grinding for 20 min, and the pea protein was converted from a solid ball to a hollow ball. So the emulsion flocculation index decreased from 1.01% to 0.29% and the amount of protein adsorbed increased by 4.5%, which showed that the emulsion stability of the pea protein was significantly improved. Within a short grinding time (2.5–5 min), the viscosity of the emulsion was increased. Studies had shown that proper grinding treatment made pea protein isolate possess greater potential for an excellent emulsifier.
El acné es una patología dérmica relativamente común que afecta la unidad pilosebácea. Principalmente, afecta a la población adolescente y adultos jóvenes, sin embargo, el cuadro clínico puede afectar también a otros grupos etarios. La etiología del acné es multifactorial y, se han identificado cuatro mecanismos involucrados en el desarrollo de la enfermedad. A pesar de que hoy en día se han estudiado y documentado avances importantes en materia del tratamiento de esta patología, uno de los pilares continúa siendo los retinoides, al que se le pueden adicionar otros medicamentos como el peróxido de benzoilo y los antibióticos.
Daniel Turner (1667–1741) of London was the first to emphasize dietary restrictions for acne therapy. Joseph Jakob Plenck (1735–1807) of Vienna related the frequency of acne in young people to a rich diet. Since then acne and diet has been a continuing debating issue. Over the last five decades, diet has been declined to play a role in acne pathogenesis. In 1969, the study of Fulton and coworkers, which was not controlled by glycemic index, showed that high amounts of chocolate did not affect the course of acne vulgaris or the output or composition of sebum. Though much more critical work is required, present knowledge suggests that the sebaceous gland has a high degree of autonomy. In 2002, Cordain and coworkers observed completely acne-free adolescents of Kitava islanders living under Paleolithic nutritional conditions excluding hyperglycemic carbohydrates, milk and dairy products. Further observations of low acne prevalence rates in less developed Paleolithic populations such as the Arche hunters in Paraguay, natives in rural Brazil, Eskimos, Okinawa islanders, and Chinese consuming traditional Chinese food suggested that acne is a disease of Western civilization.
Acne vulgaris ist die häufigste entzündliche Hauterkrankung in industrialisierten Ländern mit einer Prävalenz von 85 % während der Adoleszenz. Das epidemische Auftreten spricht gegen den vorherrschenden Einfluss genetischer Faktoren. Stattdessen steht die westliche Ernährungsweise mit überhöhter glykämischer Last und erhöhtem Konsum von Milch und Milchprodukten im Fokus aktueller Pathogenesekonzepte.
Skin disease is one of the top 15 groups of medical conditions for which prevalence and health care spending increased the most between 1987 and 2000, with approximately 1 of 3 people in the United States with a skin disease at any given time. Even so, a national data profile on skin disease has not been conducted since the late 1970s. This study closes the gap by estimating the prevalence, economic burden, and impact on quality of life for 22 leading categories of skin disease. The estimated annual cost of skin disease in 2004 was 29.1 billion in direct medical costs (costs of health services and products) and 56.2 billion. Including the economic burden on quality of life, the total economic burden of skin disease to the US public in 2004 was approximately $96 billion.
Background: Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither effort quantified uncertainty in prevalence or years lived with disability (YLDs).
Methods: Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis.
Findings: Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350 000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coefficient -0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa.
Conclusions: Rates of YLDs per 100 000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantification of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Effective and affordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world.
Funding: Bill & Melinda Gates Foundation.
Acne vulgaris, the most common skin disease of western civilization, has evolved to an epidemic affecting more than 85% of adolescents. Acne can be regarded as an indicator disease of exaggerated insulinotropic western nutrition. Especially milk and whey protein-based products contribute to elevations of postprandial insulin and basal insulin-like growth factor-I (IGF-I) plasma levels. It is the evolutional principle of mammalian milk to promote growth and support anabolic conditions for the neonate during the nursing period. Whey proteins are most potent inducers of glucose-dependent insulinotropic polypeptide secreted by enteroendocrine K cells which in concert with hydrolyzed whey protein-derived essential amino acids stimulate insulin secretion of pancreatic β-cells. Increased insulin/IGF-I signaling activates the phosphoinositide-3 kinase/Akt pathway, thereby reducing the nuclear content of the transcription factor FoxO1, the key nutrigenomic regulator of acne target genes. Nuclear FoxO1 deficiency has been linked to all major factors of acne pathogenesis, i.e. androgen receptor transactivation, comedogenesis, increased sebaceous lipogenesis, and follicular inflammation. The elimination of the whey protein-based insulinotropic mechanisms of milk will be the most important future challenge for nutrition research. Both, restriction of milk consumption or generation of less insulinotropic milk will have an enormous impact on the prevention of epidemic western diseases like obesity, diabetes mellitus, cancer, neurodegenerative diseases and acne.
Selection bias is a threat to the internal validity of epidemiological studies. In light of a growing number of studies which aim to provide DNA, as well as a considerable number of invitees who declined to participate, we discuss response rates, predictors of lost to follow-up and failure to provide DNA, and the presence of possible selection bias, based on five samples of adolescents.
We included nearly 7,000 adolescents from two longitudinal studies of 18/19 year olds with two corresponding cross-sectional baseline studies at age 15/16 (10th graders), and one cross-sectional study of 13th graders (18/19 years old). DNA was sampled from the cheek mucosa of 18/19 year olds. Predictors of lost to follow-up and failure to provide DNA were studied by Poisson regression. Selection bias in the follow-up at age 18/19 was estimated through investigation of prevalence ratios (PRs) between selected exposures (physical activity, smoking) and outcome variables (general health, mental distress, externalizing problems) measured at baseline.
Out of 5,750 who participated at age 15/16, we lost 42% at follow-up at age 18/19. The percentage of participants who gave their consent to DNA provision was as high as the percentage that consented to a linkage of data with other health registers and surveys, approximately 90%. Significant predictors of lost to follow-up and failure to provide DNA samples in the present genetic epidemiological study were: male gender; non-western ethnicity; postal survey compared with school-based; low educational plans; low education and income of father; low perceived family economy; unmarried parents; poor self-reported health; externalized symptoms and smoking, with some differences in subgroups of ethnicity and gender. The association measures (PRs) were quite similar among participants and all invitees, with some minor discrepancies in subgroups of non-western boys and girls.
Lost to follow-up had marginal impact on the estimated prevalence ratios. It is not likely that the invitation to provide DNA influenced the response rates of 18/19 year olds. Non-western ethnicity, male gender and characteristics related to a low social class and general and mental health problems measured at baseline are associated with lost to follow-up and failure to provide DNA.
We performed a cross-sectional, questionnaire-based study to explore the relationship of suicidal ideation, mental health problems, and social functioning to acne severity among adolescents aged 18-19 years. A total of 4,744 youth were invited and 3,775 (80%) participated. In all, 14% reported having substantial acne (a lot and very much). Among those with very much acne, as compared those with no/little acne, suicidal ideation was twice as frequently reported among girls (25.5 vs. 11.9%) and three times more frequently reported among boys (22.6 vs. 6.3%). Suicidal ideation remained significantly associated with substantial acne (odds ratio 1.80, 95% confidence interval 1.30-2.50) in a multivariate model including adjustments of symptoms of depression, ethnicity, and family income. Mental health problems, as assessed by the Strengths and Difficulties Questionnaire (2.25, 1.69-3.00), low attachment to friends (1.52, 1.21-1.91), not thriving at school (1.41, 1.12-1.78), never having had a romantic relationship (1.35, 1.05-1.70), and never having had sexual intercourse (1.51, 1.21-1.89) were all associated with substantial acne in a multivariate model. Acne is frequently found in late adolescence and is associated with social and psychological problems. Adverse events including suicidal ideation and depression that have been associated with therapies for acne may reflect the burden of substantial acne rather than the effects of medication.
Several studies with conflicting findings have investigated the association between acne and mental health problems. Acne usually starts in adolescents, as does an increase in the prevalence of depression and anxiety. Recently, there has been more focus on the link between diet and acne and diet and mental health problems. The objective of this study is to investigate the association between acne and mental distress and to explore a possible influence of dietary factors on the relation.
A population-based cross-sectional study in Oslo of 18 or 19 year old adolescents. The participation rate was 80%. Acne was self-reported. To measure mental distress, the Hopkins Symptom Checklist 10 was used. Diet and lifestyle variables were also collected by questionnaire and socio-demographic variables were obtained from Statistics Norway.
The prevalence of acne was 14.4% among the males and 12.8% among the females. The mean score of mental distress increased when the severity of acne increased. In the crude analyses, the significant associations with acne among the males were: mental distress OR = 1.63, frequent consumption of chocolate/sweets OR = 1.40, frequent consumption of potato chips OR = 1.54. The significant crude associations with acne among the females were: mental distress OR = 2.16, infrequent consumption of raw vegetables OR = 1.41, non-Western background OR = 1.77 and low family income OR = 2.14. No crude associations with acne were identified in either gender for the consumption of sugary soft drinks, fatty fish, cigarette smoking or alcohol. In adjusted models which included diet and socio-demographic variables, the association between acne and mental distress was unchanged for both males (OR = 1.68) and females (OR = 2.04), and between acne and infrequent consumption of raw vegetables among the females (OR = 1.38).
Among late adolescents in Oslo, self-reported acne is significantly associated with mental distress and, among girls, with infrequent consumption of raw vegetables. Our finding does not support the hypothesis that dietary factors alter the relationship between acne and mental distress.
Adolescents' skin problems can be studied at the population level. The aim of this study was to validate five questions on skin complaints for use in population surveys among adolescents. Of the 260 adolescents aged 18-20 years invited to participate, 217 were included in the study. The prevalence of the adolescents' self-reported complaints were higher than those found during clinical examination by a dermatologist. The overall agreement between the adolescents' answers and recorded clinical signs was: 74% (pimples/signs of acne), 40% (dry skin/xerosis), 81% (rash/signs of dermatitis) and 83% (other skin complaints/other skin findings). No corresponding objective skin sign was recorded for "itch". Repeatability of the adolescents' answers and inter-agreement between the investigators had an overall agreement of 77-97% and a kappa of 0.29-0.93. When using the dermatologist's findings as gold standard, the sensitivity and specificity were best for "signs of acne", 93% and 43%, respectively.
There has been a remarkable paucity of evidence for an association between diet and acne. Our previous studies suggest that there is an association between milk intake and teenage acne. This is a prospective cohort study to evaluate that relationship. We studied 6,094 girls, aged 9-15 years in 1996, who reported dietary intake on up to three food frequency questionnaires from 1996 to 1998. Presence and severity of acne was assessed by questionnaire in 1999. We computed multivariate prevalence ratios (PR) and 95 percent confidence intervals for acne. After accounting for age at baseline, height and energy intake, the multivariate PRs (95 % CI; p-value for test of trend) for acne comparing highest (2 or more servings per day) to lowest (<1 per week) intake categories in 1996, were 1.20 (1.09, 1.31; <0.001) for total milk, 1.19 (1.06, 1.32; <0.001) for whole milk, 1.17 (1.04, 1.31; 0.002) for low fat milk and 1.19 (1.08, 1.31; <0.001) for skim milk. This result did not change appreciably when we excluded girls who reported use of contraceptives and when we restricted our analysis to those younger than 11 years of age at baseline. We found a positive association between intake of milk and acne. This finding supports earlier studies and suggests that the metabolic effects of milk are sufficient to elicit biological responses in consumers.
Acne is a multifactorial inflammatory disease affecting pilosebaceous follicles. The initial event in the development of an acne lesion is abnormal desquamation of the keratinocytes that line the sebaceous follicle, which creates a microplug or microcomedo, An increase in circulating androgens at the onset of puberty stimulates the production of sebum in to the pilosebaceous unit. These events combine to create an environment within the pilosebaceous unit that is favorable for the colonization of the commensal bacteria, Propionibacterium acnes. With proliferation, P acnes secretes various inflammatory molecules and chemotactic factors that initiate and perpetuate the local inflammatory response and possibly induce keratinocyte hyperproliferation as well.
Health professionals must enquire about issues such as low self-esteem when reviewing patients with acne.
Recent observational and experimental evidence suggests that diet may contribute to acne prevalence.
To examine the differences in select dietary factors (glycemic index [GI], total sugar, added sugar, fruit/fruit juice, fruit/vegetables, vegetables, saturated fat, trans fat, and number of milk and fish servings perday) between groups of self-reported acne severity. Secondary objectives were to investigate the differences in food-aggravated acne beliefs and acne-specific quality-of-life between groups of self-reported acne severity.
This study utilized a cross-sectional design.
A total of 248 (115 male, 133 female) participants, age 18 to 25 years, completed questionnaires designed to measure self-reported acne severity, select dietary factors, food-aggravated acne beliefs, acne-specific quality-of-life, and anthropometric and demographic characteristics. The Block fat/sugar/fruit/vegetable food frequency questionnaire assessed usual dietary intake. Data were collected in New York City between January and May 2012.
One-way between groups analysis of variance examined differences in dietary factors, anthropometric characteristics, and acne-specific quality-of-life between groups of self-reported acne. χ² tests compared food-aggravated acne beliefs and demographic characteristics between groups of self-reported acne.
Compared with participants with no or mild acne, participants with moderate to severe acne reported greater dietary GI (P<0.001), added sugar (P<0.001), total sugar (P<0.001), number of milk servings per day (P<0.001), saturated fat (P<0.001), and trans-fatty acids (P<0.001), and fewer servings of fish per day (P=0.002). Among all participants, 58.1% perceived diet to aggravate or influence acne.
This study suggests that diet, particularly dietary GI, saturated fat, trans fat, milk, and fish may influence or aggravate acne development. Future research is necessary to elucidate the proposed mechanisms linking diet and acne and determine the impact of medical nutrition therapy on acne development.
Background: Previous studies suggest possible associations between Western diet and acne. We examined data from the Nurses Health Study II to retrospectively evaluate whether intakes of dairy foods during high school were associated with physician-diagnosed severe teenage acne.
Acne is a common disease in Westernized nations, particularly among adolescents and young adults. Acne has substantial effects on quality of life, making treatment essential. Medical nutrition therapy as a potential treatment for acne is not new, although the literature examining diet and acne during the past 100 years is mixed. During the late 1800s and early 1900s, diet was commonly used as an adjunct treatment for acne. During the 1960s, however, the diet-acne connection fell out of favor. In recent years, dermatologists and registered dietitians have revisited the idea and become increasingly interested in the role of medical nutrition therapy in acne treatment. This article reviews the history and existing literature examining the association between diet and acne. Although the total number of studies conducted within the past 40 years is relatively small, the growing body of epidemiologic and experimental evidence suggests a relationship between diet and acne. Compared with other dietary factors, more research examines dietary glycemic load. The evidence is more convincing for high glycemic load diets, compared with other dietary factors. To date there are no randomized controlled trials investigating the relationship between frequent dairy or milk consumption and acne. Similarly, the number of research studies examining the relationship between dietary fat and/or n-3 fatty acids is sparse and the evidence is less robust. Taken together, several methodologic limitations need to be addressed, and additional research, preferably randomized controlled trials, is warranted before comprehensive evidence-based guidelines can be established. While dermatologists and registered dietitians continue to debate and research the potential relationship between diet and acne, the best dietary approach is to address each acne patient individually, carefully considering the possibility of dietary counseling.
Despite acne being an almost universal condition in younger people, relatively little is known about its epidemiology. We sought to review what is known about the distribution and causes of acne by conducting a systematic review of relevant epidemiological studies. We searched Medline and Embase to the end of November 2011. The role of P. acnes in pathogenesis is unclear: antibiotics have a direct antimicrobial as well as an anti-inflammatory effect Moderate to severe acne affects around 20% of young people and severity correlates with pubertal maturity. Acne may be presenting at a younger age because of earlier puberty. It is unclear if ethnicity is truly associated with acne. Black individuals are more prone to post-inflammatory hyper-pigmentation and specific subtypes such as 'pomade acne'. Acne persists into the 20s and 30s in around 64% and 43% of individuals respectively. The heritability of acne is almost 80% in first degree relatives. Acne occurs earlier and is more severe in those with a positive family history. Suicidal ideation is more common in those with severe compared to mild acne. In the United States, the cost of acne is over three billion dollars per year in terms of treatment and loss of productivity. A systematic review in 2005 found no clear evidence of dietary components increasing acne risk. One small randomised-controlled-trial showed low glycaemic-index diets to lower acne severity. A possible association between dairy food intake and acne requires closer scrutiny. Natural sunlight or poor hygiene are not associated. The association between smoking and acne is probably due to confounding. Validated core outcomes in future studies will provide help to combining future evidence.
Background:
Genetic and environmental components may contribute to acne causation.
Objective:
We sought to assess the impact of family history, personal habits, dietary factors, and menstrual history on a new diagnosis of moderate to severe acne.
Methods:
We conducted a case-control study in dermatologic outpatient clinics in Italy. Cases (205) were consecutive those receiving a new diagnosis of moderate to severe acne. Control subjects (358) were people with no or mild acne, coming for a dermatologic consultation other than for acne.
Results:
Moderate to severe acne was strongly associated with a family history of acne in first-degree relatives (odds ratio 3.41, 95% confidence interval 2.31-5.05). The risk was reduced in people with lower body mass index with a more pronounced effect in male compared with female individuals. No association with smoking emerged. The risk increased with increased milk consumption (odds ratio 1.78, 95% confidence interval 1.22-2.59) in those consuming more than 3 portions per week. The association was more marked for skim than for whole milk. Consumption of fish was associated with a protective effect (odds ratio 0.68, 95% confidence interval 0.47-0.99). No association emerged between menstrual variables and acne risk.
Limitations:
Some degree of overmatching may arise from choosing dermatologic control subjects and from inclusion of mild acne in the control group.
Conclusions:
Family history, body mass index, and diet may influence the risk of moderate to severe acne. The influence of environmental and dietetic factors in acne should be further explored.
Acne is a chronic inflammatory disease of the pilosebaceous unit resulting from androgen-induced increased sebum production, altered keratinisation, inflammation, and bacterial colonisation of hair follicles on the face, neck, chest, and back by Propionibacterium acnes. Although early colonisation with P acnes and family history might have important roles in the disease, exactly what triggers acne and how treatment affects the course of the disease remain unclear. Other factors such as diet have been implicated, but not proven. Facial scarring due to acne affects up to 20% of teenagers. Acne can persist into adulthood, with detrimental effects on self-esteem. There is no ideal treatment for acne, although a suitable regimen for reducing lesions can be found for most patients. Good quality evidence on comparative effectiveness of common topical and systemic acne therapies is scarce. Topical therapies including benzoyl peroxide, retinoids, and antibiotics when used in combination usually improve control of mild to moderate acne. Treatment with combined oral contraceptives can help women with acne. Patients with more severe inflammatory acne usually need oral antibiotics combined with topical benzoyl peroxide to decrease antibiotic-resistant organisms. Oral isotretinoin is the most effective therapy and is used early in severe disease, although its use is limited by teratogenicity and other side-effects. Availability, adverse effects, and cost, limit the use of photodynamic therapy. New research is needed into the therapeutic comparative effectiveness and safety of the many products available, and to better understand the natural history, subtypes, and triggers of acne.
The association of acne and self-evaluation is barely explored among late adolescents in the general population.
We sought to explore self-esteem, body satisfaction, and acne among 18-year-old young adults at a community level.
We conducted a questionnaire-based survey among 3775 late adolescents.
Our response rate was 80%. The prevalence of acne was 13.5%. Girls and boys with acne had significantly more depressive symptoms, lower self-attitude, more feelings of uselessness, fewer feelings of pride, lower self-worth, and lower body satisfaction than those without acne. In a regression model adjusting for body mass index and depressive symptoms, acne explained significantly poor self-attitude for boys only (odds ratio 2.07 [confidence interval 1.10; 3.88]) and poor self-worth for girls only (odds ratio 1.88 [confidence interval 1.23; 2.88]).
Not all items of the self-esteem instrument were included.
At age 18 years, acne is related to self-evaluation independent of body mass index and depressive symptoms.
Acne is a common skin condition. No universally accepted standardized classification system for acne vulgaris exists, although there is a strong need for it. Thus, the clinical definition of acne has been unclear in many studies. The reported prevalence of acne varies from 35 to over 90% of adolescents at some stage. In some studies the prevalence of comedones approaches 100% in both sexes during adolescence. The prevalence of acne varies between sexes and age groups, appearing earlier in females than in males, possibly reflecting the earlier onset of puberty. There is a greater severity of acne in males than in females in the late teens, which is compatible with androgens being a potent stimulus to sebum secretion. The prevalence of acne at a given age has been shown to be highly dependent on the degree of sexual maturity. Acne commonly shows a premenstrual increase in women. Some studies have detected seasonal variability in acne vulgaris, with the colder months associated with exacerbation and the warmer months showing improvement. Other studies have not confirmed these findings. Several studies that have investigated the psychosocial impact of acne have had conflicting results. The prevalence of severe acne has decreased over the past 20 years due to improved treatment. The general prevalence figure for acne may be confounded by treatment and this factor needs to be accounted for when collecting data.
Acne affects between 40 to 50 million individuals in the United States. Recent findings regarding the multifactorial pathogenesis of acne have facilitated a reexamination of the classification of acne and acne-related disorders. Disorders without a microcomedo as the initial pathologic condition are no longer classified as "acne." Research has also identified that the clinical characteristics of acne vary with age, pubertal status, gender, and race. These findings may have implications for the clinical management of acne and acne-related disorders.
We examined the prevalence of depression (measured by the Carroll Rating Scale for Depression, CRSD), wishes to be dead and acute suicidal ideation among 480 patients with dermatological disorders that may be cosmetically disfiguring, i.e. non-cystic facial acne (n = 72; 5.6% suicidal ideation), alopecia areata (n = 45; 0% suicidal ideation), atopic dermatitis (n = 146; 2.1% suicidal ideation) and psoriasis (79 outpatients, 2.5% suicidal ideation and 138 inpatients, 7.2% suicidal ideation). Analysis of variance revealed that the severely affected psoriasis inpatients (mean +/- SD total body surface area affected: 52 +/- 23.4%) had the highest (P < 0.05) CRSD score, followed by the patients with mild to moderate acne; both scores were in the range for clinical depression (CRSD score > 10). The 5.6-7.2% prevalence of active suicidal ideation among the psoriasis and acne patients was higher than the 2.4-3.3% prevalence reported among general medical patients. Our findings highlight the importance of recognizing psychiatric comorbidity, especially depression, among dermatology patients and indicate that in some instances even clinically mild to moderate disease such as non-cystic facial acne can be associated with significant depression and suicidal ideation.
The prevalence, severity and disability related to facial acne (comprising acne on the head and neck) was assessed in a randomized sample of 2491 students (aged 4-18 years) from schools throughout the State of Victoria in Australia. Students were diagnosed clinically by a dermatologist or dermatology registrar. The overall prevalence (including 4-7 year olds) was 36.1% (95% confidence intervals, CI 24.7-47.5), ranging from 27.7% (95% CI 20.6-34.8) in 10-12 year olds to 93.3% (95% CI 89.6-96.9) in 16-18 year olds. It was less prevalent among boys aged 10-12 years than girls of the same age; however, between the ages of 16 and 18 years, boys were more likely than girls to have acne. Moderate to severe acne was present in 17% of students (24% boys, 11% girls). Comedones, papules and pustules were the most common manifestations of acne, with one in four students aged 16-18 years having acne scars. Twelve per cent of students reported a high Acne Disability Index score. This tended to correlate with clinical severity, although there was some individual variation in perception of disability. Seventy per cent of those found to have acne on examination had indicated in the questionnaire that they had acne. Of those, 65% had sought treatment, a substantial proportion of which (varying with who gave the advice) was classified as being likely to have no beneficial effect. This is the first population-based prevalence study on clinically confirmed acne published from Australia. The results show that acne is a common problem. They suggest the need for education programmes in schools to ensure that adolescents understand their disease, and know what treatments are available and from whom they should seek advice.
Skin diseases such as acne are sometimes thought of as unimportant, even trivial, when compared with diseases of other organ systems. To address this point directly, validated generic questionnaires were used to assess morbidity in acne patients and compare it with morbidity in patients with other chronic diseases. For 111 acne patients referred to a dermatologist, quality of life was measured using the Dermatology Life Quality Index, Rosenberg's measure of self-esteem, a version of the General Health Questionnaire (GHQ-28) and the Short Form 36 (SF-36). Clinical severity was measured using the Leeds Acne Grade. Population quality of life data for the SF-36 instrument were available from a random sample of adult local residents (n = 9334) some of whom reported a variety of long-standing disabling diseases. All quality of life instruments showed substantial deficits for acne patients that correlated with each other but not with clinically assessed acne severity. The acne patients (a relatively severely affected group) reported levels of social, psychological and emotional problems that were as great as those reported by patients with chronic disabling asthma, epilepsy, diabetes, back pain or arthritis. Acne is not a trivial disease in comparison with other chronic conditions. This should be recognized in the allocation of health care resources.
Acne is a common skin disorder, but epidemiological data from the general population obtained by examination are scarce. Clinical experience suggests an association between smoking and acne, although confirmatory evidence from appropriate studies is lacking.
To determine the prevalence and demographic factors of acne in a general population sample and to investigate the association of smoking and acne on a qualitative and quantitative level.
In a cross-sectional study, 896 citizens (aged 1--87 years, median 42) of the City of Hamburg were dermatologically examined. The prevalence and severity of acne were recorded and further information on demographic variables, medical history, and alcohol and cigarette consumption were obtained by a standardized interview.
According to the clinical examination, acne was present in 26.8% overall, and was more prevalent in men (29.9%) than women (23.7%) (odds ratio, OR 1.37, 95% confidence interval, CI 1.01--1.87). Prevalence followed a significant linear trend over age with peak prevalence between 14 and 29 years (P < 0.001). The reported age at onset was significantly lower in women than men (P = 0.015). According to multiple logistic regression analyses acne prevalence was significantly higher in active smokers (40.8%, OR 2.04, 95% CI 1.40--2.99) as compared with non-smokers (25.2%). A significant linear relationship between acne prevalence and number of cigarettes smoked daily was obtained (trend test: P < 0.0001). In addition, a significant dose-dependent relationship between acne severity and daily cigarette consumption was shown by linear regression analysis (P = 0.001).
Smoking is a clinically important contributory factor to acne prevalence and severity.
Acne vulgaris is a distressing condition that affects the majority of adolescents, but its impact on mental health in this age group is poorly understood.
To determine the prevalence of acne, knowledge about acne and rates of help-seeking behaviour in English teenagers. It was hypothesized that presence of acne would be associated with higher rates of emotional and behavioural difficulties.
Three hundred and seventeen pupils (80% response rate) aged 14-16 years participated from a comprehensive school in Nottingham. An age-appropriate, validated measure of emotional well-being, the Strengths and Difficulties Questionnaire (SDQ), and an Acne Management Questionnaire were used to assess participants' psychological health, level of acne knowledge and help-seeking behaviour. Acne severity was by graded by visual facial examination using an adaptation of the Leeds Acne Grading Technique.
There was a prevalence of acne in 50% of the study sample, with 11% of participants having moderate to severe acne (> 20 inflammatory lesions). Participants with definite acne (12+ lesions) (P < 0.01) and girls (P < 0.05) had higher levels of emotional and behavioural difficulties. Participants with acne were nearly twice as likely as those without acne to score in the abnormal/borderline range of the SDQ (32% vs. 20%; odds ratio 1.86, 95% confidence interval 1.03-3.34). Knowledge about the causes of acne was low (mean 45%), and was unrelated to acne status. Fewer than a third of participants with definite acne had sought help from a doctor.
Acne is a common disorder in English adolescents and appears to have a considerable impact on emotional health in this age group. Low levels of acne knowledge and poor acne management are concerns that could be amenable to a school-based education programme.
In westernized societies, acne vulgaris is a nearly universal skin disease afflicting 79% to 95% of the adolescent population. In men and women older than 25 years, 40% to 54% have some degree of facial acne, and clinical facial acne persists into middle age in 12% of women and 3% of men. Epidemiological evidence suggests that acne incidence rates are considerably lower in nonwesternized societies. Herein we report the prevalence of acne in 2 nonwesternized populations: the Kitavan Islanders of Papua New Guinea and the Aché hunter-gatherers of Paraguay. Additionally, we analyze how elements in nonwesternized environments may influence the development of acne.
Of 1200 Kitavan subjects examined (including 300 aged 15-25 years), no case of acne (grade 1 with multiple comedones or grades 2-4) was observed. Of 115 Aché subjects examined (including 15 aged 15-25 years) over 843 days, no case of active acne (grades 1-4) was observed.
The astonishing difference in acne incidence rates between nonwesternized and fully modernized societies cannot be solely attributed to genetic differences among populations but likely results from differing environmental factors. Identification of these factors may be useful in the treatment of acne in Western populations.
Previous studies suggest possible associations between Western diet and acne. We examined data from the Nurses Health Study II to retrospectively evaluate whether intakes of dairy foods during high school were associated with physician-diagnosed severe teenage acne.
We studied 47,355 women who completed questionnaires on high school diet in 1998 and physician-diagnosed severe teenage acne in 1989. We estimated the prevalence ratios and 95% confidence intervals of acne history across categories of intakes.
After accounting for age, age at menarche, body mass index, and energy intake, the multivariate prevalence ratio (95% confidence intervals; P value for test of trend) of acne, comparing extreme categories of intake, were: 1.22 (1.03, 1.44; .002) for total milk; 1.12 (1.00, 1.25; .56) for whole milk; 1.16 (1.01, 1.34; .25) for low-fat milk; and 1.44 (1.21, 1.72; .003) for skim milk. Instant breakfast drink, sherbet, cottage cheese, and cream cheese were also positively associated with acne.
We found a positive association with acne for intake of total milk and skim milk. We hypothesize that the association with milk may be because of the presence of hormones and bioactive molecules in milk.
Acne is a multifactorial inflammatory disease affecting pilosebaceous follicles. The initial event in the development of an acne lesion is abnormal desquamation of the keratinocytes that line the sebaceous follicle, which creates a microplug or microcomedo. An increase in circulating androgens at the onset of puberty stimulates the production of sebum into the pilosebaceous unit. These events combine to create an environment within the pilosebaceous unit that is favorable for the colonization of the commensal bacteria, Propionibacterium acnes. With proliferation, P acnes secretes various inflammatory molecules and chemotactic factors that initiate and perpetuate the local inflammatory response and possibly induce keratinocyte hyperproliferation as well.
Skin disease is one of the top 15 groups of medical conditions for which prevalence and health care spending increased the most between 1987 and 2000, with approximately 1 of 3 people in the United States with a skin disease at any given time. Even so, a national data profile on skin disease has not been conducted since the late 1970s. This study closes the gap by estimating the prevalence, economic burden, and impact on quality of life for 22 leading categories of skin disease. The estimated annual cost of skin disease in 2004 was 39.3 billion dollars, including 29.1 billion dollars in direct medical costs (costs of health services and products) and 10.2 billion dollars in lost productivity costs (defined as costs related to consumption of medical care, costs associated with impaired ability to work, and lost future earning potential because of premature death). Based on a methodology of willingness to pay for symptom relief, the additional economic burden of skin disease on quality of life amounted to an estimated 56.2 billion dollars. Including the economic burden on quality of life, the total economic burden of skin disease to the US public in 2004 was approximately 96 billion dollars.
We sought to examine the association between dietary dairy intake and teenaged acne among boys.
This was a prospective cohort study. We studied 4273 boys, members of a prospective cohort study of youths and of lifestyle factors, who reported dietary intake on up to 3 food frequency questionnaires from 1996 to 1998 and teenaged acne in 1999. We computed multivariate prevalence ratios and 95% confidence intervals for acne.
After adjusting for age at baseline, height, and energy intake, the multivariate prevalence ratios (95% confidence interval; P value for test of trend) for acne comparing highest (>2 servings/d) with lowest (<1/wk) intake categories in 1996 were 1.16 (1.01, 1.34; 0.77) for total milk, 1.10 (0.94, 1.28; 0.83) for whole/2% milk, 1.17 (0.99, 1.39; 0.08) for low-fat (1%) milk, and 1.19 (1.01, 1.40; 0.02) for skim milk.
Not all members of the cohort responded to the questionnaire. Acne assessment was by self-report and boys whose symptoms might have been part of an underlying disorder were not excluded. We did not adjust for steroid use and other lifestyle factors that may affect occurrence of acne.
We found a positive association between intake of skim milk and acne. This finding suggests that skim milk contains hormonal constituents, or factors that influence endogenous hormones, in sufficient quantities to have biological effects in consumers.
Acne vulgaris: a disease of Western civilization
- Cordain