Milk consumption and acne in teenaged boys

Impact of Diet and Nutrition in Patients with Acne Vulgaris

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.

Exploring Acne Treatments: From Pathophysiological Mechanisms to Emerging Therapies

Acne vulgaris is a common dermatological condition that can present across different ages but predominantly affects adolescents and young adults. Characterized by various lesion types, the pathogenesis of acne is complex, involving genetic, hormonal, microbial, and inflammatory factors. This review comprehensively addresses current and emerging acne management strategies, emphasizing both topical and systemic treatments, procedural therapies, and dietary modifications. Key topical agents include retinoids, benzoyl peroxide, antibiotics, and other specialized compounds. Systemic options like antibiotics, hormonal therapies, and retinoids offer significant therapeutic benefits, particularly for moderate to severe cases. Procedural treatments such as laser devices, photodynamic therapy, chemical peels, and intralesional injections present viable alternatives for reducing acne symptoms and scarring. Emerging therapies focus on novel biologics, bacteriophages, probiotics, and peptides, providing promising future options. This review underscores the importance of personalized approaches to treatment due to the multifaceted nature of acne, highlighting the potential of innovative therapies for improving patient outcomes.

The Effect of Whey Protein Supplements on Acne Vulgaris among Male Adolescents and Young Adults: A Case-Control Study from North of Jordan

Background

Young people and athletes willing to gain muscle mass and strength are likely to consume whey protein supplements. The effect of milk as a dietary source of whey protein on acne is still controversial. At the same time, a few studies have suggested an acnegenic impact of whey protein supplements.

Objectives

To examine the association of whey protein supplements on acne risk among male adolescents and young adults.

Materials and Methods

201 male teenagers and young adults attending fitness centers in Irbid/Jordan were involved in an observational case-control research; those with acne were deemed cases, and those without acne were considered controls. The primary outcome was a comparison of the proportion of participants in each group who consumed whey protein supplements within the previous three months.

Results

100 acne-afflicted participants were compared to 101 healthy controls with similar demographics, including age, body mass index, educational level, and smoking habits, as well as intake of vitamin B12, corticosteroids, and anabolic steroids. However, considerably more participants in the acne group (47%) were taking whey protein supplements than in the control group (27.7%) (p=0.0047). The significance of this difference was maintained after multivariate analysis.

Conclusion

This case-control study provides evidence of a positive association between whey protein consumption and acne risk.

Insulin and the sebaceous gland function

Insulin affects metabolic processes in different organs, including the skin. The sebaceous gland (SG) is an important appendage in the skin, which responds to insulin-mediated signals, either directly or through the insulin growth factor 1 (IGF-1) axis. Insulin cues are differently translated into the activation of metabolic processes depending on several factors, including glucose levels, receptor sensitivity, and sebocyte differentiation. The effects of diet on both the physiological function and pathological conditions of the SG have been linked to pathways activated by insulin and IGF-1. Experimental evidence and theoretical speculations support the association of insulin resistance with acne vulgaris, which is a major disorder of the SG. In this review, we examined the effects of insulin on the SG function and their implications in the pathogenesis of acne.

Recent advances in understanding inflammatory acne: Deciphering the relationship between Cutibacterium acnes and Th17 inflammatory pathway

Acne vulgaris is a common chronic inflammatory skin disease of the pilosebaceous units. Four factors contribute to acne: hyperseborrhea and dysseborrhea, follicular hyperkeratinisation, skin microbiome dysbiosis and local immuno-inflammation. Recent key studies have highlighted a better understanding of the important role of Cutibacterium acnes (C. acnes) in the development of acne. Three major findings in the last decade include: (1) the ability of C. acnes to self-organize in a biofilm associated with a more virulent activity, (2) the loss of the C. acnes phylotype diversity and (3) the central role of the Th17 pathway in acne inflammation. Indeed, there is a close link between C. acnes and the activation of the Th17 immuno-inflammatory pathway at the initiation of acne development. These mechanisms are directly linked to the loss of C. acnes phylotype diversity during acne, with a predominance of the pro-pathogenic phylotype IA1. This specifically contributes to the induction of the Th17-mediated immuno-inflammatory response involving skin cells, such as keratinocytes, monocytes and sebocytes. These advancements have led to new insights into the underlying mechanisms which can be harnessed to develop novel treatments and diagnostic biomarkers. A major disadvantage of traditional treatment with topical antibiotics is that they induce cutaneous dysbiosis and antimicrobial resistance. Thus, future treatments would no longer aim to 'kill' C. acnes, but to maintain the skin microbiota balance allowing for tissue homeostasis, specifically, the restoration of C. acnes phylotype diversity. Here, we provide an overview of some of the key processes involved in the pathogenesis of acne, with a focus on the prominent role of C. acnes and the Th17-inflammatory pathways involved.

Determination of the levels of 17-β Estradiol and Progesterone in Cow milk and Baby Follow-on milk by ELISA

The current study was undertaken to determine the 17-β Estradiol (E2) and Progesterone (P4) levels in different milk products and some baby follow-on milk samples collected from retail markets in Türkiye. For this purpose, a total of 50 samples from 8 different product groups with different fat levels, production technologies, and production series were analyzed for natural P4 and E2 levels using a commercial ELISA kit. The highest E2 level was determined in UHT whole milk (3%) (39.20 ± 6.73 pmol·L-1) while the lowest level was found in buttermilk (26.50 ± 1.85 pmol·L-1) samples. For P4 levels, the highest concentration were found in baby follow-on milk (<1 year old) (45.83 ± 2.95 nmol·L-1) and the lowest values were found in pasteurized milk samples (23.00 ± 6.66 nmol·L-1). Also, in this study, differences among the product groups for E2 and P4 were not found statistically (P>0.05). In conclusion, the natural P4 and E2 were detected in all milk and baby follow-on milks at various levels and generally their levels associated with the product fat level.

The increasing importance of the gut microbiome in acne vulgaris

Acne is a frequently presented dermatological condition brought about by an interplay among inflammation, increased sebum production, hyperkeratinisation, and predominantly Propionibacterium acnes (renamed as Cutibacterium acnes) proliferation, leading to debilitating psychological scars. However, it has been shown that it is the loss of microbial diversity in the skin and the imbalance among C. acnes phylotypes that brings about acne rather than the C. acnes species as a whole. Interestingly, recent evidence suggests that other microorganisms may be implicated, such as the fungi Malassezia and the bacteria Cutibacterium granulosum. A plethora of scientific evidence suggests that the gut microbiome is implicated in the overall health and physiology of the host; studies show that the gut microbiome of acne patients is distinct and depicts less microbial diversity compared to individuals without acne. Herein, using the key terms: acne, C. acnes, IGF-1, sebum, and gut microbiome, we carried out a review of the literature, using Google Scholar and PubMed, and discussed the role of the gut and skin microbiome in relation to acne, as a narrative review. The role of hormones, diet, sebum, and stress in relation to the gut microbiome was also investigated. Therapeutic implications and the use of pre-/postbiotics are also deliberated upon. In this light, future research should investigate the relationship between the gut microbiome and the agreed upon factors of acne pathology, potentially leading to the discovery of novel acne treatments with milder side effects.

Non-conventional therapeutical approaches to acne vulgaris related to its association with metabolic disorders

The ever-increasing frequency of metabolic syndrome (MetS) is still a major challenge of the public health care system, worldwide. In recent years, researchers have been drawn to the uncommon (at first look) link between skin illnesses and MetS. Because of the pro-inflammatory mechanisms and insulin resistance (IR) that are upregulated in metabolic syndrome, many skin disorders are correlated to metabolic dysfunctions, including acne vulgaris. A comprehensive understanding of the link between MetS and acne vulgaris may contribute to the development of new treatment strategies. The current review focuses on dietary and therapeutic interventions and assesses the effect of various approaches such as improving diet by avoiding certain food products (i.e., milk and chocolate) or increasing the intake of others (i.e., food products rich in omega-3 fatty acids), metformin administration, therapy with plant extracts, plant essential oils, and probiotic supplementation on the improvement of certain acne vulgaris severity parameters. These therapeutic approaches, when combined with allopathic treatment, can improve the patients' quality of life.

The course of acne in healthcare workers during the COVID-19 pandemic and evaluation of possible risk factors

Background

There are a limited number of publications reporting an increase in acne in the COVID‐19 outbreak.

Objective

The study aimed to evaluate the course and the clinical features of acne and possible risk factors during the COVID‐19 pandemic in healthcare workers.

Method

A total of 172 physicians (female, n = 159, male; n = 13, mean age = 35.03 ± 5.27 years) who had acne in any period of their life were included in the study. A self‐administered online questionnaire was applied.

Results

During the COVID‐19 pandemic, 45.35% of the participants reported that their acne complaints increased, 27.33% reported relapses, and 7.56% reported occurrence for the first time. Newly formed acne was reported most frequently on the chin (78.26%). The number of female participants, smoking, increased stress, and the rate of surgical mask use were found to be higher in the group whose acne occurred for the first time, relapsed, or increased than in the group whose acne complaints were unchanged or decreased (p < 0.05). In the group whose acne relapsed or increased, adult‐onset acne, presence of scar, and use of systemic acne treatment before the COVID‐19 pandemic were more common than in the group whose acne complaints were unchanged or decreased (p < 0.05).

Conclusion

Almost half of the participants reported an increase in acne. More than a third of the participants reported that their acne relapsed or they had acne for the first time. In addition to the use of surgical masks, factors such as increased stress, smoking, adult‐onset acne, presence of scar, and previous systemic acne treatment were found to be responsible for acne development.

Prepubertal acne: A retrospective study

Background

Acne vulgaris is a common skin disorder, but studies on the epidemiologic features of prepubertal acne are limited.

Objectives

The aim of this study was to determine the prevalence and severity of prepubertal acne and to identify factors influencing acne severity and poor response to treatment.

Methods

A retrospective study was conducted on 683 patients with acne from our database who visited the dermatology department of Nantes University hospital between October 2014 and May 2018. Patients of prepubertal acne (7-12 years) were included in this study.

Results

Of the 683 patients with acne, 24 (3.5%) had prepubertal acne. Prepubertal acne was more common in female patients (75%). Acne severity assessment showed that severe acne (Groupe Expert Acné global acne severity scale 4) was the most common form (33%), and mild and moderate forms (Global Evaluation Acne Group, global acne severity scales 2 and 3) accounted for 25% each. There was a high predominance of phylotype IA₁ of Cutibacterium acnes (belonging to CC18 subgroup). The analysis of patients' lifestyle and acne features identified three factors associated with an increased risk of poor response or resistance to acne treatment. Initially severe acne grading (grade 4) was the most strongly associated parameter (p < .028), followed by regular milk consumption and taking other medications in addition to acne treatment (p < .049 for each).

Conclusion

This study reported on prepubertal acne features and identified three factors associated with a high risk of treatment failure or relapse. Adequate and prompt treatment is needed in this subgroup of patients to minimize disease burden and prevent subsequent disease worsening.

Cow's milk may be delivering potentially harmful undetected cargoes to humans. Is it time to reconsider dairy recommendations?

Mammalian evolution has shaped milk into a species-specific vehicle for post-natal development, continuing what began within the mother's womb. Increased consumption of the mother's breast milk is associated with the most adequate metabolic programming and lowers the incidence of the diseases of civilization during adulthood. An abundance of short sequences of RNA, known as microRNA, exists in mammalian breast milk, enclosed within robust small extracellular vesicles known as exosomes. These microRNAs can epigenetically regulate over 60% of human genes. When cow's milk is consumed by humans, the bovine exosomes are transported through the gastrointestinal tract, detected intact in the blood stream, and taken up by target cells, where they alter protein expression. The aim of this review was to highlight the role of dairy exosomes and microRNA, and of the type of dairy product consumed, in human diseases. Given that microRNAs are involved in a vast array of physiological processes and associated with several diseases, perhaps caution should be practiced with regard to human consumption of dairy, particularly for individuals within developmentally critical time frames, such as pregnant and lactating mothers, and young children.

Relationship Between Dairy Consumption and Abdominal Obesity

OBJECTIVE

This cross-sectional study aimed to demonstrate the relationship between dairy consumption and abdominal obesity in adolescents.

METHOD

In total, 700 adolescents participated in this cross-sectional study. Sociodemographic characteristics, consumption of dairy, body mass index (BMI), waist circumference (WC), and waist/height (W/H) ratio were evaluated. The participants were divided into two groups as to whether their dairy consumptions were below or above 3 portions/d, according to the Turkey Dietary Guideline recommendations.

RESULTS

The mean age of participants was 15.84 ± 1.23 years. The rate of girls (65.2%) who participated in this study was significantly higher than that of the boys (34.8%; p < 0.001). No statistically significant difference was found between the participants whose dairy consumption was below and above the specified limits in terms of BMI, WC, or W/H measurements. Energy intake (p < 0.05) and milk and cheese consumption (p < 0.001) were higher in boys than in girls. There was a significant negative correlation between dairy consumption and WC (r = -0.121), W/H ratio (r = -0.105), and BMI (r = -0.103) in girls (p < 0.05). It was found that a 1-unit increase in milk consumption can cause a 1.98-, 0.11-, and 0.552-fold decrease in WC, W/H ratio, and BMI in girls, respectively (p < 0.05; 95% confidence interval [-3.502, -0.471], [-0.020, -0.001], [-1.042, -0.062], respectively).

CONCLUSIONS

Inadequate milk consumption was related to increasing WC and WC may be one of the factors of abdominal obesity in girls. Therefore, it is of importance to raise awareness about milk and dairy consumption in adolescents.

Modifiable and non-modifiable epidemiological risk factors for acne, acne severity and acne scarring among Malaysian Chinese: a cross-sectional study

Background

Acne vulgaris, a highly prevalent multifactorial inflammatory skin disease, can be categorised into different severity and scarring grades based on the type, number, and severity of lesions. While many epidemiology studies have investigated the risk factors for acne presentation, fewer studies have specifically studied the risk factors for acne severity and scarring. Therefore, this study investigated the prevalence of acne, acne severity and scarring grades, and their associated non-modifiable and modifiable epidemiological risk factors among Malaysian Chinese.

Methods

A total of 1840 subjects (1117 cases/723 controls) completed an investigator-administered questionnaire as part of a cross-sectional study, which include socio-demographics, familial history, lifestyle factors, dietary habits, and acne history. Acne cases were further evaluated for their severity (n = 1051) and scarring (n = 1052) grades by a trained personnel.

Results

Majority of the acne cases (up to 69%) had mild acne or Grade 1/2 scarring, while 21.6% had moderate/severe acne and 5.5% had Grade 3/4 scarring. Males had significantly higher risk of presenting with higher grades of acne scarring. Those who had acne, regardless of severity and scarring grades, had strong positive familial history (either in parents and/or sibling). Frequent consumption (most or all days) of foods that are commonly consumed during breakfast (butter, probiotic drinks, cereals and milk) decreased the risk for acne presentation and higher acne scarring, while periodic consumption (once/twice per week) of nuts and burgers/fast food decreased the risk for higher acne severity. Alcohol drinking was significantly associated with increased risk for acne presentation, while paternal, parental and household smoking were associated with reduced risk of more severe acne.

Conclusions

In conclusion, positive familial history is a strong predisposing factor in influencing acne presentation, severity and scarring. Frequent consumption of foods that are commonly consumed during breakfast is protective against acne presentation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10681-4.

Relation of the C/T-13910 LCT Polymorphism with Body Composition Measures and Their Modulation by Dairy Products in a Caucasian Men

The C/T-13910 LCT is closely associated with lactase persistence and LCT has emerged as a new candidate gene for obesity, in particular in northern Europeans. The aim of this research is to investigate to what degree sex determines the association between the LCT variant and anthropometric traits in a cohort of healthy individuals. We recruited 1000 (500 males and 500 females aged 18-65 years) healthy blood donors. The C/T-13910 LCT polymorphism was genotyped using TaqMan assays. All individuals were phenotyped with respect to anthropometric characteristics. Prevalence of genotypes was 22.7% CC (lactase non-persistent, LNP), 58.6% CT, and 18.7% TT. LNP genotype was present less frequently among men p = .0005; OR 0.582 [0.425-0.794]. Therefore, in addition statistical calculations were performed separately for men and women. Additional analysis demonstrated an association between the CC genotypes and higher chest (p = .03), waist (p = .005), and forearm circumference (p = .0004) or more lean body mass (p = .04), than T-allele carriers in males. In females, they were not significantly different. Men consumed more milk (p = .003), while women ate more yoghurt (p = .001). Pearson's correlation analysis showed that the higher intake of milk and dairy products was associated with higher fat body mass among men with lactase persistence. In Caucasian men, the LNP genotype is associated with reduced milk intake and dairy products, but more fat-free mass and higher forearm circumference, which may be relevant to dietary management for lactose intolerant.

Association Between Adult Acne and Dietary Behaviors: Findings From the NutriNet-Santé Prospective Cohort Study

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.

Diet and acne: review of the evidence from 2009 to 2020

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.

Effects of Diet on Acne and Its Response to Treatment

Our understanding of the pathogenesis of acne vulgaris is still evolving. It is known that multiple factors impact acne pathophysiology, including genetic, hormonal, inflammatory, and environmental influences. Because of its implications in many of these factors, diet has been a part of the acne discussion for decades. Several studies have evaluated the significance of the glycemic index of various foods and glycemic load in patients with acne, demonstrating individuals with acne who consume diets with a low glycemic load have reduced acne lesions compared with individuals on high glycemic load diets. Dairy has also been a focus of study regarding dietary influences on acne; whey proteins responsible for the insulinotropic effects of milk may contribute more to acne development than the actual fat or dairy content. Other studies have examined the effects of omega-3 fatty acid and γ-linoleic acid consumption in individuals with acne, showing individuals with acne benefit from diets consisting of fish and healthy oils, thereby increasing omega-3 and omega-6 fatty acid intake. Recent research into the effects of probiotic administration in individuals with acne present promising results; further study of the effects of probiotics on acne is needed to support the findings of these early studies. In this review, we discuss the current evidence regarding the diets of US patients with acne and how they may impact acne and acne treatment.

Public Interest in Acne on the Internet: Comparison of Search Information From Google Trends and Naver

Background

Acne vulgaris is a common skin disease primarily affecting young adults. Given that the internet has become a major source of health information, especially among the young, the internet is a powerful tool of communication and has a significant influence on patients.

Objective

This study aimed to clarify the features of patients’ interest in and evaluate the quality of information about acne vulgaris on the internet.

Methods

We compared the search volumes on acne vulgaris with those of other dermatological diseases using Google Trends from January 2004 to August 2019. We also determined the search volumes for relevant keywords of acne vulgaris on Google and Naver and evaluated the quality of answers to the queries in KnowledgeiN.

Results

The regression analysis of Google Trends data demonstrated that the patients’ interest in acne vulgaris was higher than that for other dermatological diseases, such as atopic dermatitis (β=−20.33, 95% CI –22.27 to –18.39, P<.001) and urticaria (β=−27.09, 95% CI –29.03 to –25.15, P<.001) and has increased yearly (β=2.38, 95% CI 2.05 to 2.71, P<.001). The search volume for acne vulgaris was significantly higher in the summer than in the spring (β=–5.04, 95% CI –9.21 to –0.88, P=.018) and on weekends than on weekdays (β=–6.68, 95% CI –13.18 to –0.18, P=.044). The most frequently searched relevant keywords with “acne vulgaris” and “cause” were “stress,” “food,” and “cosmetics.” Among food, the 2 highest acne vulgaris–related keywords were milk and wheat in Naver and coffee and ramen in Google. The queries in Naver KnowledgeiN were mostly answered by a Korean traditional medicine doctor (53.4%) or the public (33.6%), but only 12.0% by dermatologists.

Conclusions

Physicians should be aware of patients’ interest in and beliefs about acne vulgaris to provide the best patient education and care, both online and in the clinic.

Enhancement of lipid content and inflammatory cytokine secretion in SZ95 sebocytes by palmitic acid suggests a potential link between free fatty acids and acne aggravation

A relationship between acne and free fatty acids (FFAs) has been suggested recently. However, the effects of FFAs on sebaceous glands are still largely unknown. At the same time, the role of FFAs during chronic inflammation is well established. Considering that FFAs are also a major component of sebum, it is likely that changes in FFA affect both the synthesis of sebum and the inflammatory response in sebaceous glands. In this study, we examined a hypothesis that FFAs increase the production of sebum and induce inflammation in the sebaceous glands. We found that treatment of SZ95 sebocytes with exogenously applied palmitic acid (PA), a major saturated FFA, induced a significant increase in intracellular lipid levels. Moreover, PA treatment also increased the expression and secretion of the proinflammatory cytokines in SZ95 sebocytes. We also found that Toll-like receptors were required for the inflammatory response triggered by PA. The results of our study strengthen the notion about the link between acne and FFAs and suggest the mechanism underlying this relationship. Our results serve as a foundation for future work that will explore the association between FFA and acne and pave way to the development of novel treatment options for acne.

Holistic dermatology: An evidence-based review of modifiable lifestyle factor associations with dermatologic disorders

BACKGROUND

Holistic dermatology focuses on treating the human body as a whole and implementing lifestyle changes to enhance the treatment and prognosis of skin disease. Understanding the interplay between modifiable lifestyle factors and patients' dermatologic health will help physicians better inform patients on self-care methods to mitigate the burden of their skin disease(s).

OBJECTIVE

To review the current scientific literature on the relationship between modifiable lifestyle factors and the dermatologic outcome of skin disorders.

METHODS

A systematic literature search on PubMed, Cochrane, and Web of Science was conducted to identify research articles examining the relationship between dermatology and 6 major categories of modifiable lifestyle factors: diet, sleep, exercise, stress, alcohol, and smoking.

RESULTS

A substantial amount of evidence supports the relationship between modifiable lifestyle factors and dermatologic outcomes. There were the most studies on diet, stress, alcohol, and smoking, but all lifestyle factors were supported by some degree of scientific evidence.

CONCLUSION

All modifiable lifestyle factors explored in this review play a critical role in modulating the onset and progression of skin disease. We anticipate more research studies in the future and an increasing integration of holistic dermatology into patient care.

Systematic review of the epidemiology of acne vulgaris

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.

Acne Vulgaris: A Patient and Physician's Experience

In this article, the first coauthor, a young woman with acne vulgaris, shares her experience with the condition; she not only describes the clinical presentation and the eventual successful treatment of her acne, but also the emotional consequences that this skin disorder caused. The second coauthor, the patient's dermatologist, reviews some of the features of acne vulgaris: morphologic manifestations, pathogenesis, and treatment options. He also summarizes the patient's response to isotretinoin therapy. In addition, he reveals his subsequent enlightenment regarding the acne-related non-dermatologic effects that the patient experienced and the significant improvement of her self-image that occurred following the successful treatment of her acne.

Potential Role of the Microbiome in Acne: A Comprehensive Review

Acne is a highly prevalent inflammatory skin condition involving sebaceous sties. Although it clearly develops from an interplay of multiple factors, the exact cause of acne remains elusive. It is increasingly believed that the interaction between skin microbes and host immunity plays an important role in this disease, with perturbed microbial composition and activity found in acne patients. Cutibacterium acnes (C. acnes; formerly called Propionibacterium acnes) is commonly found in sebum-rich areas and its over-proliferation has long been thought to contribute to the disease. However, information provided by advanced metagenomic sequencing has indicated that the cutaneous microbiota in acne patients and acne-free individuals differ at the virulent-specific lineage level. Acne also has close connections with the gastrointestinal tract, and many argue that the gut microbiota could be involved in the pathogenic process of acne. The emotions of stress (e.g., depression and anxiety), for instance, have been hypothesized to aggravate acne by altering the gut microbiota and increasing intestinal permeability, potentially contributing to skin inflammation. Over the years, an expanding body of research has highlighted the presence of a gut–brain–skin axis that connects gut microbes, oral probiotics, and diet, currently an area of intense scrutiny, to acne severity. This review concentrates on the skin and gut microbes in acne, the role that the gut–brain–skin axis plays in the immunobiology of acne, and newly emerging microbiome-based therapies that can be applied to treat acne.

Dairy consumption and acne: a case control study in Kabul, Afghanistan

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.

Acne Management Guidelines by the Dermatological Society of Singapore

Due to the multiethnic patient population with varying skin types in Singapore, clinicians often find the management of acne in their patients to be challenging. The authors developed these guidelines to provide comprehensive advice on individualized acne treatment and to provide a reference guide for all doctors who treat patients of Asian descent. Unique features of acne in Singapore are highlighted. We address concerns such as diet, special population needs, and the benefits, side effects, risks, and cost-effectiveness of currently available acne treatments. These treatment guidelines outline recommendations for the diagnosis, grading, and treatment of children, adolescents, and adults with acne of varying severity, and include advice pertaining to the use of cosmeceuticals and management of scars.

Diet and men's fertility: does diet affect sperm quality?

Male contribution to a couple's fecundity is important, and identifying the dietary factors that can influence male fertility potential is of high importance. Despite this importance, there are currently no clear clinical guidelines for male patients seeking fertility treatment. In this review, we present the most up-to-date evidence about diet and male fertility in humans. We focus on the dietary factors necessary for production of healthy functioning sperm with high fertility potential. Based on this review, men may be encouraged to use antioxidant supplements and to follow dietary patterns favoring the consumption of seafood, poultry, nuts, whole grains, fruits, and vegetables. Evidence is strongest for recommending the use of antioxidant supplements to men in couples undergoing infertility treatment-although the specific antioxidants and doses remain unclear-and increasing consumption of omega-3 fatty acids from fish and nuts.

Approaches to limit systemic antibiotic use in acne: Systemic alternatives, emerging topical therapies, dietary modification, and laser and light-based treatments

Acne is one of the most common diseases worldwide and affects ∼50 million individuals in the United States. Oral antibiotics are the most common systemic agent prescribed for the treatment of acne. However, their use might be associated with a variety of adverse outcomes including bacterial resistance and disruption of the microbiome. As a result, multiple treatment guidelines call for limiting the use of oral antibiotics in the treatment of acne, although actual prescribing often does not follow these guidelines. In this review, the rationale for concerns regarding the use of oral antibiotics for the management of acne is reviewed. In addition, we will discuss our approach to complying with the intent of the guidelines, with a focus on novel topical agents, dietary modification, laser and light-based modalities, and systemic medications, such as spironolactone, combined oral contraceptives, and oral isotretinoin.

Diseases of Civilization - Cancer, Diabetes, Obesity and Acne - the Implication of Milk, IGF-1 and mTORC1

Nutrition and food are one of the most complex aspects of human lives, being influenced by biochemical, psychological, social and cultural factors. The Western diet is the prototype of modern dietary pattern and is mainly characterized by the intake of large amounts of red meat, dairy products, refined grains and sugar. Large amounts of scientific evidence positively correlate Western diet to acne, obesity, diabetes, heart disease and cancer, the so-called "diseases of civilization". The pathophysiological common ground of all these pathologies is the IGF-1 and mTORC pathways, which will be disscussed further in this paper.

The role of nutrition in inflammatory pilosebaceous disorders: Implication of the skin-gut axis

Nutrition plays a critical role in the manifestation and management of inflammatory pilosebaceous disorders. There is rich potential for insight into the impact of dietary effects on the pathophysiology of inflammatory pilosebaceous disorders including acne vulgaris, hidradenitis suppurativa, rosacea, and the closely related seborrhoeic dermatitis. Acne vulgaris and hidradenitis suppurativa are thought to have similar diet-modulating pathogenic pathways. Western diet influences Acne vulgaris and hidradenitis suppurativa by increasing insulin and modulating FOX01/mTOR, resulting in over-expression of cytokeratins, hyperproliferation of keratinocytes, and hypercornification of the follicular wall. Key receptors in rosacea are alternatively activated by UV radiation, hot beverages, spicy foods, vanilla, cinnamon, caffeine, alcohol, cold temperatures, and niacin- and formalin-containing foods, to increase oedema and flushing, resulting in erythema, telangiectasia, and warmth, characteristic features of the condition. Seborrhoeic dermatitis, while not a follicular disorder, is closely related, and can be modulated by dietary influences, such as biotin and probiotics. This overview summarizes the role that nutrition plays on these disorders, and identifies dietary modifications as potential adjunctive therapies.

Dairy Intake and Acne Vulgaris: A Systematic Review and Meta-Analysis of 78,529 Children, Adolescents, and Young Adults

A meta-analysis can help inform the debate about the epidemiological evidence on dairy intake and development of acne. A systematic literature search of PubMed from inception to 11 December 2017 was performed to estimate the association of dairy intake and acne in children, adolescents, and young adults in observational studies. We estimated the pooled random effects odds ratio (OR) (95% CI), heterogeneity (I²-statistics, Q-statistics), and publication bias. We included 14 studies (n = 78,529; 23,046 acne-cases/55,483 controls) aged 7⁻30 years. ORs for acne were 1.25 (95% CI: 1.15⁻1.36; p = 6.13 × 10^-8) for any dairy, 1.22 (1.08⁻1.38; p = 1.62 × 10^-3) for full-fat dairy, 1.28 (1.13⁻1.44; p = 8.23 × 10^-5) for any milk, 1.22 (1.06⁻1.41; p = 6.66 × 10^-3) for whole milk, 1.32 (1.16⁻1.52; p = 4.33 × 10^-5) for low-fat/skim milk, 1.22 (1.00⁻1.50; p = 5.21 × 10^-2) for cheese, and 1.36 (1.05⁻1.77; p = 2.21 × 10^-2) for yogurt compared to no intake. ORs per frequency of any milk intake were 1.24 (0.95⁻1.62) by 2⁻6 glasses per week, 1.41 (1.05⁻1.90) by 1 glass per day, and 1.43 (1.09⁻1.88) by ≥2 glasses per day compared to intake less than weekly. Adjusted results were attenuated and compared unadjusted. There was publication bias (p = 4.71 × 10^-3), and heterogeneity in the meta-analyses were explained by dairy and study characteristics. In conclusion, any dairy, such as milk, yogurt, and cheese, was associated with an increased OR for acne in individuals aged 7⁻30 years. However, results should be interpreted with caution due to heterogeneity and bias across studies.

Lactase Persistence, Milk Intake, and Adult Acne: A Mendelian Randomization Study of 20,416 Danish Adults

Whether there is a causal relationship between milk intake and acne is unknown. We tested the hypothesis that genetically determined milk intake is associated with acne in adults using a Mendelian randomization design. LCT-13910 C/T (rs4988235) is associated with lactase persistence (TT/TC) in Northern Europeans. We investigated the association between milk intake, LCT-13910 C/T (rs4988235), and acne in 20,416 adults (age-range: 20⁻96) from The Danish General Suburban Population Study (GESUS). The adjusted observational odds ratio for acne in any milk intake vs. no milk intake was 0.93(95% confidence interval: 0.48⁻1.78) in females and 0.49(0.22⁻1.08) in males aged 20⁻39 years, and 1.15(95% confidence interval: 0.66⁻1.99) in females and 1.02(0.61⁻1.72) in males above 40 years. The unadjusted odds ratio for acne in TT+TC vs. CC was 0.84(0.43⁻1.62) in the age group 20⁻39 years, and 0.99(0.52⁻1.88) above 40 years. We did not find any observational or genetic association between milk intake and acne in our population of adults.

Acne and nutrition: hypotheses, myths and facts

Acne is an inflammatory and multifactorial skin disease. Different external and internal factors, including air pollution, aggressive skincare products, medication, mechanical, hormonal and familial factors and, more recently, lifestyle and stress, have been suggested as having an impact on acne. Moreover, for many years nutrition was believed to cause or worsen acne. Over the last decades, however, it has become a dermatological doctrine that there is no direct association between diet and acne. Even if recent research has allowed to identify certain nutritional elements and behaviour that may impact on acne, including the excessive intake of dairy products and hyperglycaemic food, modern lifestyle nutrition, obesity and eating disorders, knowledge about the role of nutrition in the physiopathology of acne still remains sparse and hypotheses and myths continue to dominate the debate. Thus, further clinical and translational research is necessary to investigate and confirm the association between nutrition and acne.

Is vegetarianism healthy for children?

According to the Academy of Nutrition and Dietetics' influential position statement on vegetarianism, meat and seafood can be replaced with milk, soy/legumes, and eggs without any negative effects in children. The United States Department of Agriculture endorses a similar view. The present paper argues that the Academy of Nutrition and Dietetics ignores or gives short shrift to direct and indirect evidence that vegetarianism may be associated with serious risks for brain and body development in fetuses and children. Regular supplementation with iron, zinc, and B12 will not mitigate all of these risks. Consequently, we cannot say decisively that vegetarianism or veganism is safe for children.

Hormonal and dietary factors in acne vulgaris versus controls

Background: Acne vulgaris is an inflammatory skin disorder with not as yet fully understood pathogenesis. In this controlled study, we assessed acne vulgaris patients for several possible pathogenic factors such as vitamin D deficiency, vegan diet, increased body mass index (BMI) and positive anti-transglutaminase antibody. Methods: We screened 10 years of records at a family medicine clinic for patients diagnosed with acne vulgaris. In eligible subjects, we collected data regarding 25-hydroxylvitamin D levels, BMI, dietary preference and serum IgA tissue transglutaminase levels. Controls were age- (+/− 12 months) and sex-matched patients seen during the study period without a diagnosis of acne vulgaris. Results: 453 patients were given a diagnosis of acne vulgaris during the study period. Compared with controls, we found significant associations between vitamin D deficiency (<50nmol/L), and/or positive transglutaminase antibody level (>4.0U/mL) and a diagnosis of acne vulgaris. Conclusions: Our study adds important information to the current body of literature in pursuit of elucidating the pathogenesis of this complex multifactorial disease.

The influence of exposome on acne

BACKGROUND

Acne vulgaris is one of the main reasons for dermatological consultations. Severity and response to treatment may be impacted by various external factors or exposome.

AIM

To assess the impact of environmental factors on acne and to provide a comprehensive overview of the acne exposome.

METHODS

Two consensus meetings of five European dermatologists and a comprehensive literature search on exposome factors triggering acne served as a basis for this review.

RESULTS

Acne exposome was defined as the sum of all environmental factors influencing the occurrence, duration and severity of acne. Exposome factors impact on the response and the frequency of relapse to treatments by interacting with the skin barrier, sebaceous gland, innate immunity and cutaneous microbiota. They may be classified into the following six main categories: nutrition, psychological and lifestyle factors, occupational factors including cosmetics, as well as pollutants, medication and climatic factors. Moreover, practical considerations for the dermatologist's clinical practice are proposed.

CONCLUSION

Exposome factors including nutrition, medication, occupational factors, pollutants, climatic factors, and psychosocial and lifestyle factors may impact on the course and severity of acne and on treatment efficacy. Identifying and reducing the impact of exposome is important for an adequate acne disease management.

A review of diagnosis and treatment of acne in adult female patients

This review focuses on the treatment options for adult female patients with acne. Acne in adult female patients may start during adolescence and persist or have an onset in adulthood. Acne has various psychosocial effects that impact patients’ quality of life. Treatment of acne in adult women specifically has its challenges due to the considerations of patient preferences, pregnancy, and lactation. Treatments vary widely and treatment should be tailored specifically for each individual woman. We review conventional therapies with high levels of evidence, additional treatments with support from cohort studies and case reports, complementary and/or alternative therapies, and new agents under development for the treatment of patients with acne.