Implications for the role of diet in acne

The effect of the ketogenic diet on Acne: Could it be a therapeutic tool?

Acne is a chronic inflammatory disease of the pilosebaceous unit resulting from androgen-induced increased sebum production, altered keratinization, inflammation, and bacterial colonization of the hair follicles of the face, neck, chest and back by Propionibacterium acnes. Overall, inflammation and immune responses are strongly implicated in the pathogenesis of acne. Although early colonization with Propionibacterium acnes and family history may play an important role in the disease, it remains unclear exactly what triggers acne and how treatment affects disease progression. The influence of diet on acne disease is a growing research topic, yet few studies have examined the effects of diet on the development and clinical severity of acne disease, and the results have often been contradictory. Interestingly, very low-calorie ketogenic diet (VLCKD) has been associated with both significant reductions in body weight and inflammatory status through the production of ketone bodies and thus it has been expected to reduce the exacerbation of clinical manifestations or even block the trigger of acne disease. Given the paucity of studies regarding the implementation of VLCKD in the management of acne, this review aims to provide evidence from the available scientific literature to support the speculative use of VLCKD in the treatment of acne.

Serum and salivary adipsin levels and its association with insulin resistance in acne vulgaris patients

BACKGROUND

There is scarcity in literature about the reliability of salivary markers in acne vulgaris.

AIMS

The aims were to evaluate the insulin resistance (IR) and adipsin levels in serum and saliva in a sample of acne vulgaris patients; and to correlate IR and adipsin levels with the disease severity.

METHODS

This prospective case-control study included 60 acne vulgaris patients (patients Group), in addition, 60 apparently healthy individuals (control group). The severity of acne vulgaris was determined according to Global Acne Grading system (GAGS). Serum and salivary adipsin, fasting glucose, and fasting insulin levels were measured using ELISA kits.

RESULTS

Fasting glucose, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) in patients group both in serum and saliva were elevated when compared with the control group. Serum and salivary levels of adipsin and Quantitative insulin sensitivity check index (QUIKI) in patients were decreased than the control group. Adipsin serum levels show significant negative correlations with all study variables except QUIKI with which the correlation was positive both in serum and saliva. There was a significant positive correlation between serum and salivary adipsin levels (r = 0.873, p < 0.00001) and serum and salivary fasting glucose (r = 1, p < 0.00001).

CONCLUSION

Adipsin could be considered as a promising biomarker for acne vulgaris and its associated insulin resistance. Moreover, the salivary measurements may be considered as useful biomarkers in acne vulgaris patients, but more studies are still required.

Association Between Diet and Acne Severity: A Cross-sectional Study in Thai Adolescents and Adults

The association between diet and acne is of growing concern. Every country has its own food culture; however, only a few studies have 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. Data were collected via a validated semi-quantitative food frequency questionnaire. In Thai adolescents and adults, the prevalence of mild acne was 52%, moderate acne 22%, and severe acne 8%. No acne was found in 18% of participants. The dietary factors associated with increased severity of acne were consumption of chocolate >100 g/week (adjusted odds ratio (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). Conversely, the factors associated with decreased severity of acne were consumption of sugar-free milk-free tea (aOR 0.61; 95% CI 0.43–0.87) and vegetables (aOR 0.74; 95% CI 0.62–0.89).

The Skin Microbiome: A New Actor in Inflammatory Acne

Our understanding of the role of Cutibacterium acnes in the pathophysiology of acne has recently undergone a paradigm shift: rather than C. acnes hyperproliferation, it is the loss of balance between the different C. acnes phylotypes, together with a dysbiosis of the skin microbiome, which results in acne development. The loss of diversity of C. acnes phylotypes acts as a trigger for innate immune system activation, leading to cutaneous inflammation. A predominance of C. acnes phylotype IA₁ has been observed, with a more virulent profile in acne than in normal skin. Other bacteria, mainly Staphylococcus epidermis, are also implicated in acne. S. epidermidis and C. acnes interact and are critical for the regulation of skin homeostasis. Recent studies also showed that the gut microbiome is involved in acne, through interactions with the skin microbiome. As commonly used topical and systemic antibiotics induce cutaneous dysbiosis, our new understanding of acne pathophysiology has prompted a change in direction for acne treatment. In the future, the development of individualized acne therapies will allow targeting of the pathogenic strains, leaving the commensal strains intact. Such alternative treatments, involving modifications of the microbiome, will form the next generation of ‘ecobiological’ anti-inflammatory treatments.

Hydrogel-Based Active Substance Release Systems for Cosmetology and Dermatology Application: A Review

Hydrogels are playing an increasingly important role in medicine and pharmacy. Due to their favorable physicochemical properties, biocompatibility, and designed interaction with living surroundings, they seem to be one of the most promising groups of biomaterials. Hydrogel formulations from natural, semi, or synthetic polymeric materials have gained great attention in recent years for treating various dermatology maladies and for cosmetology procedures. The purpose of this review is to present a brief review on the basic concept of hydrogels, synthesis methods, relevant mechanisms, and applications in dermatology or cosmetology. This review discusses transdermal therapies and the recent advances that have occurred in the field.

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.

Daily Intake of Soft Drinks and Moderate-to-Severe Acne Vulgaris in Chinese Adolescents

OBJECTIVES

To investigate the association of soft drink consumption and the intake of sugar from soft drinks with the prevalence of acne in adolescents.

STUDY DESIGN

This was a university-based epidemiologic investigation that included 8226 students who underwent health examinations and a questionnaire survey inquiring about the intake of soft drinks. Skin diseases were diagnosed by certificated dermatologists during the health examination. Two-level logistic and generalized additive models were used to estimate the associations, and aORs were presented as the effect size.

RESULTS

A total of 8197 student survey responses were analyzed. Frequent intake (≥7 times per week) of carbonated sodas (aOR 1.61, 95% CI 0.96-2.72), sweetened tea drinks (aOR 2.52, 95% CI 1.43-4.43), and fruit-flavored drinks (aOR 1.90, 95% CI 1.18-3.07) was associated with moderate-to-severe acne after adjustments for confounders. The occasional intake of fruit-flavored drinks (1-2 times per week) had a weak protective effect on acne (aOR 0.86, 95% CI 0.74-0.99). The intake of sugar from any soft drinks showed a nonlinear association with acne (P < .01), and sugar intake ≥100 g/d was significantly associated with moderate-to-severe acne (aOR 3.12, 95% CI 1.80-5.41).

CONCLUSIONS

Daily soft drink consumption significantly increases the risk of moderate-to-severe acne in adolescents, especially when the sugar intake from any type of soft drink exceeds 100 g per day.

Differences in Dietary Glycemic Load and Hormones in New York City Adults with No and Moderate/Severe Acne

BACKGROUND

Glycemic index (GI) and glycemic load (GL) may be implicated in acne pathogenesis.

OBJECTIVE

This cross-sectional study examined differences between GI/GL and biological factors associated with acne among adults with and without moderate/severe acne. Secondary objectives included examining differences between food-aggravated acne beliefs and acne-specific quality of life among adults with and without moderate/severe acne.

DESIGN

As part of a cross-sectional study, participants completed a 5-day food record; blood draw to measure biological factors associated with acne (ie, glucose, insulin, insulin-like growth factor-1, insulin-like growth factor binding protein-3, and sex hormone-binding globulin concentrations); body composition assessment; and questionnaire to evaluate food-aggravated acne beliefs and acne-specific quality of life. Food records were analyzed using Nutrition Data Services for Research.

PARTICIPANTS

Sixty-four participants (no acne, n=32; moderate/severe acne, n=32) from New York City, NY, were included in this study.

STATISTICAL ANALYSIS

Independent sample t tests and Mann-Whitney tests examined differences in anthropometric measurements, dietary intakes, biological factors associated with acne, insulin resistance, and acne-specific quality of life between acne groups. A χ² test for independence assessed differences in food-aggravated acne beliefs between acne groups.

RESULTS

Participants with moderate/severe acne consumed greater total carbohydrate (P=0.003), available carbohydrate (P<0.001), percent energy from carbohydrate (P<0.001), and GL (P<0.001) compared to participants without acne. Participants with moderate/severe acne had greater insulin (P=0.002) and insulin-like growth factor-1 (P=0.009) concentrations, greater insulin resistance (P=0.001), and lower sex hormone-binding globulin (P=0.015) concentrations compared to participants without acne. Although there were no differences between groups, 61% of participants reported food-influenced acne. Participants with moderate/severe acne reported a lower quality of life compared to participants without acne (P<0.001).

CONCLUSIONS

The results from this cross-sectional study suggest a relationship between dietary carbohydrate, including GL, and acne. Future research is necessary to determine the effect of medical nutrition therapy on biological factors associated with acne and acne severity.

The possible role of diet in the pathogenesis of adult female acne

Acne in adults is a chronic, increasingly common disease, especially among women. It differs in pathogenesis and clinical presentation from adolescent acne. Acne in adults is associated with Western diet, defined as high consumption of milk, high glycemic load and high calorie intake. Metabolic signals of this diet result in a significant increase in insulin/insulin growth factor 1 serum level and consequently in the molecular interplay of mammalian target of rapamycin complex 1 kinase (mTORC1)/forkhead box protein 1 (FoxO1) mediated nutrient signaling, leading to increased proliferation of keratinocytes, increased lipogenesis and sebum production and finally to aggravation of acne.

The blemishes of modern society? Acne prevalence in the Dogon of Mali

BACKGROUND AND OBJECTIVES

Non-communicable diseases may reflect an evolutionary mismatch between our human ancestry and modern environments. To explore the mismatch hypothesis for Acne vulgaris, we studied the prevalence and severity of acne in Dogon adolescents in Mali, West Africa.

METHODOLOGY

We graded the prevalence and severity of acne in 1182 Dogon adolescents aged 11-18 years from nine villages using facial photos taken as part of a prospective cohort study. Eighty-nine (89%) of the individuals in the cohort migrated to the city during adolescence, enabling us to assess the effect of urban migration. Using multivariable logistic regression, we estimated the effect of predictor variables on the presence of acne.

RESULTS

The prevalence of acne in the cohort was 28%, with 90% of cases being mild or very mild. Thus, the prevalence and severity of acne was much lower than for adolescents in high-income countries. Controlling for age, puberty, and body mass index (BMI), the odds of boys developing acne was 85% lower in the city than in the villages (P = 0.002).

CONCLUSION AND IMPLICATIONS

Acne is similar to the 'diseases of civilization' in being promoted by the pro-inflammatory properties of modern diets. The low prevalence and severity of acne in the Dogon supports the mismatch hypothesis and suggests that acne should join the list of diseases of modern lifestyles. However, we also observed an unexpected decrease in acne in urban boys. Future research is needed for a deeper mechanistic understanding of the interplay between diet, inflammation, immune function and other environmental exposures that differ between urban and rural environments.

Acne scars in 18-year-old male adolescents: a population-based study of prevalence and associated factors

BACKGROUND

Acne vulgaris is a pilosebaceous follicle disorder affecting over 85% of adolescents to some degree. It frequently causes psychological distress that may persist into adulthood due to scarring. Little information about post-acne scarring epidemiology is available.

OBJECTIVES

To describe prevalence, distribution patterns and associated factors of acne scarring in young males, drawing on a representative population sample from a southern Brazilian city.

METHODS

A cross-sectional study was undertaken during presentation for military service, which is compulsory for all 18-year-old males. A questionnaire was applied, covering topics like diet, smoking habits, ethnicity, family structure, socio-economic level, as well as specific questions about active acne and resulting scars. Dermatologists conducted the clinical examination.

RESULTS

A total of 2,201 male adolescents were interviewed and examined. The overall prevalence of acne scarring was 22%. The malar region was the most frequently involved, present in 80% of affected individuals, followed by the frontal region (31.5%), back (17%), anterior chest (8.2%) and mentonian region (6.4%). Correlation between the intensity of clinical acne and the presence of scars was found, but no association was observed with educational level, smoking, ethnicity, obesity or socio-economic status.

CONCLUSIONS

There is a high prevalence of acne scars among this population. This is the first study to ascertain a correlation between acne scarring and factors such as socio-economic status and educational level. The direct relation between acne severity and scarring indicates that prompt and effective treatment is the best way to reduce scarring.

Dietary glycemic factors, insulin resistance, and adiponectin levels in acne vulgaris

BACKGROUND

There is increasing evidence to support the relationship between acne vulgaris and diet.

OBJECTIVE

The aim of this study was to investigate possible associations among dietary glycemic index, glycemic load, milk consumption, insulin resistance, and adiponectin levels in the pathogenesis of acne vulgaris.

METHODS

The dietary glycemic index, glycemic load, milk consumption, fasting glucose, insulin, insulin-like growth factor)-1, insulin-like growth factor binding protein-3, adiponectin, and homeostasis model assessment of insulin resistance values of 50 patients with acne vulgaris and 36 healthy control subjects were measured.

RESULTS

Glycemic index and glycemic load levels were significantly higher (P = .022 and P = .001, respectively) and serum adiponectin levels were significantly lower (P = .015) in patients with acne than in the control subjects. There was an inverse correlation between serum adiponectin concentration and glycemic index (P = .049, r = -0.212).

LIMITATIONS

This study used a cross-sectional design and the study population was limited to young, nonobese adults.

CONCLUSION

A high-glycemic-index/-load diet was positively associated with acne vulgaris. Adiponectin may be a pathogenetic cofactor contributing to the development of the disease. Further research on adiponectin levels in patients with acne in terms of development of insulin resistance might be important in this possible relationship.

The constellation of dietary factors in adolescent acne: a semantic connectivity map approach

BACKGROUND

Different lifestyle and dietetic factors have been linked with the onset and severity of acne.

OBJECTIVE

To assess the complex interconnection between dietetic variables and acne.

METHODS

This was a reanalysis of data from a case-control study by using a semantic connectivity map approach. 563 subjects, aged 10-24 years, involved in a case-control study of acne between March 2009 and February 2010, were considered in this study. The analysis evaluated the link between a moderate to severe acne and anthropometric variables, family history and dietetic factors. Analyses were conducted by relying on an artificial adaptive system, the Auto Semantic Connectivity Map (AutoCM).

RESULTS

The AutoCM map showed that moderate-severe acne was closely associated with family history of acne in first degree relatives, obesity (BMI ≥ 30), and high consumption of milk, in particular skim milk, cheese/yogurt, sweets/cakes, chocolate, and a low consumption of fish, and limited intake of fruits/vegetables.

CONCLUSION

Our analyses confirm the link between several dietetic items and acne. When providing care, dermatologists should also be aware of the complex interconnection between dietetic factors and acne.

Insulin resistance in severe acne vulgaris

Introduction

Acne vulgaris is a pilosebaceous gland disease that usually affects people from puberty to young adulthood. It is seen especially on the face, neck, trunk and arms. Its severity differs from patient to patient and its pathogenesis is multifactorial. The main pathogenic factors of acne are high sebaceous gland secretion, follicular hyperproliferation, high androgen effects, propionibacterium acnes colonization and inflammation. Diet is always thought a probable reason for acne and many studies are done about acne and diet.

Aim

To determine the effect of insulin resistance in severe acne vulgaris.

Material and methods

Two hundred and forty-three acne vulgaris patients and 156 healthy controls were enrolled into the study. The blood levels of insulin and glucose were measured. Homeostasis Model Assessment (HOMA) Index was calculated. The values were compared with the control group.

Results

All of the patients were in the severe acne group according to their scores on the global acne scoring scale. While fasting blood glucose levels were not different between the groups (p > 0.05, 82.91 ±9.76 vs. 80.26 ±8.33), the fasting insulin levels were significantly higher in the patient group than in the control group (p < 0.001, 14.01 ±11.94 vs. 9.12 ±3.53). Additionally, there was a highly significant difference between the patient and control groups in terms of HOMA values (p < 0.001, 2.87 ±2.56 vs. 1.63 ±0.65).

Conclusions

These results suggest that insulin resistance may have a role in the pathogenesis of acne.

Linking diet to acne metabolomics, inflammation, and comedogenesis: an update

Acne vulgaris, an epidemic inflammatory skin disease of adolescence, is closely related to Western diet. Three major food classes that promote acne are: 1) hyperglycemic carbohydrates, 2) milk and dairy products, 3) saturated fats including trans-fats and deficient ω-3 polyunsaturated fatty acids (PUFAs). Diet-induced insulin/insulin-like growth factor (IGF-1)-signaling is superimposed on elevated IGF-1 levels during puberty, thereby unmasking the impact of aberrant nutrigenomics on sebaceous gland homeostasis. Western diet provides abundant branched-chain amino acids (BCAAs), glutamine, and palmitic acid. Insulin and IGF-1 suppress the activity of the metabolic transcription factor forkhead box O1 (FoxO1). Insulin, IGF-1, BCAAs, glutamine, and palmitate activate the nutrient-sensitive kinase mechanistic target of rapamycin complex 1 (mTORC1), the key regulator of anabolism and lipogenesis. FoxO1 is a negative coregulator of androgen receptor, peroxisome proliferator-activated receptor-γ (PPARγ), liver X receptor-α, and sterol response element binding protein-1c (SREBP-1c), crucial transcription factors of sebaceous lipogenesis. mTORC1 stimulates the expression of PPARγ and SREBP-1c, promoting sebum production. SREBP-1c upregulates stearoyl-CoA- and Δ6-desaturase, enhancing the proportion of monounsaturated fatty acids in sebum triglycerides. Diet-mediated aberrations in sebum quantity (hyperseborrhea) and composition (dysseborrhea) promote Propionibacterium acnes overgrowth and biofilm formation with overexpression of the virulence factor triglyceride lipase increasing follicular levels of free palmitate and oleate. Free palmitate functions as a "danger signal," stimulating toll-like receptor-2-mediated inflammasome activation with interleukin-1β release, Th17 differentiation, and interleukin-17-mediated keratinocyte proliferation. Oleate stimulates P. acnes adhesion, keratinocyte proliferation, and comedogenesis via interleukin-1α release. Thus, diet-induced metabolomic alterations promote the visible sebofollicular inflammasomopathy acne vulgaris. Nutrition therapy of acne has to increase FoxO1 and to attenuate mTORC1/SREBP-1c signaling. Patients should balance total calorie uptake and restrict refined carbohydrates, milk, dairy protein supplements, saturated fats, and trans-fats. A paleolithic-like diet enriched in vegetables and fish is recommended. Plant-derived mTORC1 inhibitors and ω-3-PUFAs are promising dietary supplements supporting nutrition therapy of acne vulgaris.

Adherence to acne treatment guidelines in the military environment - a descriptive, serial cross-sectional study

BACKGROUND

Acne vulgaris, a common skin disease, affects up to 80 % of the population. Moderate to severe acne requires treatment with a combination of topical and oral drugs such as antibiotics, hormones and retinoids. Retinoids have many contraindications and adverse effects requiring close monitoring. The study's objectives were to describe prescribing trends in acne medication over time in a military setting, and assess physician adherence to guidelines for acne treatment, including drug precautions, clinical monitoring, and treatment progression.

METHODS

We conducted a descriptive, serial cross-sectional study of acne drugs prescribed in the Israel Defense Forces (IDF) in the years 2002-2007, analyzing the classes of drugs prescribed and patient characteristics. In addition, the clinical quality of the medical encounter was assessed by examining physician adherence to IDF guidelines.

RESULTS

Between 2002 and 2007, 64,281 patients were treated for acne. Treatment courses generally persisted for 1-2 months. Over 70 % of female patients receiving oral retinoids were not concomitantly receiving oral contraceptives.

CONCLUSION

This study provides a unique perspective of acne treatment in a military setting, overall displaying good adherence to general guidelines. The common prescription of oral retinoids to young females without concomitant contraception is alarming.

Diet in dermatology: Part I. Atopic dermatitis, acne, and nonmelanoma skin cancer

Patients commonly inquire about dietary modifications as a means to prevent or manage skin disease. Answering these questions is often challenging, given the vast and conflicting evidence that exists on this topic. This 2-part continuing medical education article summarizes the evidence to date to enable physicians to answer patients' questions in an evidence-based manner. Part I includes atopic dermatitis, acne, and nonmelanoma skin cancer. The role of dietary supplementation, dietary exclusion, food allergy, maternal diet, and breastfeeding in the development and/or prevention of atopic dermatitis is summarized. The dermatoendocrinologic mechanism for the effects of glycemic index/glycemic load and milk on acne is described, as well as related clinical evidence for dietary modifications. Finally, evidence and recommendations for restriction or supplementation of dietary factors in the prevention of nonmelanoma skin cancer, including fat, vitamins A, C, D, and E, and selenium, are reported.

Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets

Very-low-carbohydrate diets or ketogenic diets have been in use since the 1920s as a therapy for epilepsy and can, in some cases, completely remove the need for medication. From the 1960s onwards they have become widely known as one of the most common methods for obesity treatment. Recent work over the last decade or so has provided evidence of the therapeutic potential of ketogenic diets in many pathological conditions, such as diabetes, polycystic ovary syndrome, acne, neurological diseases, cancer and the amelioration of respiratory and cardiovascular disease risk factors. The possibility that modifying food intake can be useful for reducing or eliminating pharmaceutical methods of treatment, which are often lifelong with significant side effects, calls for serious investigation. This review revisits the meaning of physiological ketosis in the light of this evidence and considers possible mechanisms for the therapeutic actions of the ketogenic diet on different diseases. The present review also questions whether there are still some preconceived ideas about ketogenic diets, which may be presenting unnecessary barriers to their use as therapeutic tools in the physician's hand.

Acne: Diet and acnegenesis

Acne is a manifestation of hormonal overstimulation of the pilosebaceous units of genetically susceptible individuals. Endogenous reproductive and growth hormones, exogenous reproductive hormones, insulin and endogenous insulin-like growth hormone-1, sourced from and stimulated by dairy and high glycemic load foods, all appear to contribute to this overstimulation. A postulated molecular mechanism linking food and acne is reported and integrated into the clinical picture.

Dietary intervention in acne: Attenuation of increased mTORC1 signaling promoted by Western diet

The purpose of this paper is to highlight the endocrine signaling of Western diet, a fundamental environmental factor involved in the pathogenesis of epidemic acne. Western nutrition is characterized by high calorie uptake, high glycemic load, high fat and meat intake, as well as increased consumption of insulin- and IGF-1-level elevating dairy proteins. Metabolic signals of Western diet are sensed by the nutrient-sensitive kinase, mammalian target of rapamycin complex 1 (mTORC1), which integrates signals of cellular energy, growth factors (insulin, IGF-1) and protein-derived signals, predominantly leucine, provided in high amounts by milk proteins and meat. mTORC1 activates SREBP, the master transcription factor of lipogenesis. Leucine stimulates mTORC1-SREBP signaling and leucine is directly converted by sebocytes into fatty acids and sterols for sebaceous lipid synthesis. Over-activated mTORC1 increases androgen hormone secretion and most likely amplifies androgen-driven mTORC1 signaling of sebaceous follicles. Testosterone directly activates mTORC1. Future research should investigate the effects of isotretinoin on sebocyte mTORC1 activity. It is conceivable that isotretinoin may downregulate mTORC1 in sebocytes by upregulation of nuclear levels of FoxO1. The role of Western diet in acne can only be fully appreciated when all stimulatory inputs for maximal mTORC1 activation, i.e., glucose, insulin, IGF-1 and leucine, are adequately considered. Epidemic acne has to be recognized as an mTORC1-driven disease of civilization like obesity, type 2 diabetes, cancer and neurodegenerative diseases. These new insights into Western diet-mediated mTORC1-hyperactivity provide a rational basis for dietary intervention in acne by attenuating mTORC1 signaling by reducing (1) total energy intake, (2) hyperglycemic carbohydrates, (3) insulinotropic dairy proteins and (4) leucine-rich meat and dairy proteins. The necessary dietary changes are opposed to the evolution of industrialized food and fast food distribution of Westernized countries. An attenuation of mTORC1 signaling is only possible by increasing the consumption of vegetables and fruit, the major components of vegan or Paleolithic diets. The dermatologist bears a tremendous responsibility for his young acne patients who should be advised to modify their dietary habits in order to reduce activating stimuli of mTORC1, not only to improve acne but to prevent the harmful and expensive march to other mTORC1-related chronic diseases later in life.

High glycemic load diet, milk and ice cream consumption are related to acne vulgaris in Malaysian young adults: a case control study

BACKGROUND

The role of dietary factors in the pathophysiology of acne vulgaris is highly controversial. Hence, the aim of this study was to determine the association between dietary factors and acne vulgaris among Malaysian young adults.

METHODS

A case-control study was conducted among 44 acne vulgaris patients and 44 controls aged 18 to 30 years from October 2010 to January 2011. Comprehensive acne severity scale (CASS) was used to determine acne severity. A questionnaire comprising items enquiring into the respondent's family history and dietary patterns was distributed. Subjects were asked to record their food intake on two weekdays and one day on a weekend in a three day food diary. Anthropometric measurements including body weight, height and body fat percentage were taken. Acne severity was assessed by a dermatologist.

RESULTS

Cases had a significantly higher dietary glycemic load (175 ± 35) compared to controls (122 ± 28) (p < 0.001). The frequency of milk (p < 0.01) and ice-cream (p < 0.01) consumptions was significantly higher in cases compared to controls. Females in the case group had a higher daily energy intake compared to their counterparts in the control group, 1812 ± 331 and 1590 ± 148 kcal respectively (p < 0.05). No significant difference was found in other nutrient intakes, Body Mass Index, and body fat percentage between case and control groups (p > 0.05).

CONCLUSIONS

Glycemic load diet and frequencies of milk and ice cream intake were positively associated with acne vulgaris.

Nutrition and acne: therapeutic potential of ketogenic diets

The influence of nutrition on skin health is a growing research area but the findings of various studies on the effect of diet on the development of acne have often been contradictory. The general opinion among researchers has oscillated between two different, opposing positions: that diet either is or is not a key factor for acne development. This review examines the evidence supporting an influence of various dietary components on the development of acne particularly focusing on the role played by carbohydrates. The physiological and biochemical effects of the ketogenic diet are examined from this perspective and mechanisms will be proposed via which this type of diet could have a role in the treatment of acne.

Acne: prevalence and relationship with dietary habits in Eskisehir, Turkey

BACKGROUND

Acne vulgaris is a common disease affecting adolescents. There is not comprehensive data on acne prevalence in the Central Anatolia Region in particular. Etiology of acne is not clarified yet. Acne might be related to environmental factors. There is increasing evidence supporting acne and diet relationship.

OBJECTIVES

The aim of the study was to determine the acne prevalence in adolescents in the city of Eskisehir, located in the Central Anatolia, Turkey in addition to evaluate factors affecting acne and its relationship with dietary habits.

METHODS

A cross-sectional study was conducted on 2300 participants aged 13-18 years. The participants were asked to complete a questionnaire form consisting information about acne and a questionnaire form consisting information about dietary habits (The Adolescent Food Habits Checklist). In addition an objective evaluation of acne was determined.

RESULTS

The mean age of students with acne was 15.10±1.53. The current acne prevalence was 60.7%. Although 21% of the participants had severe acne (grade 3-4) and 25% developed sequelaes, only 11.5% of all participants consulted a doctor. The participants without acne had healthier dietary habits than participants with acne (P<0.05). Frequent fat intake (OR=1.39, 95% CI: 1.06-1.82), frequent sugar intake (OR=1.30, 95% CI: 1.05-1.60), frequent eating sausages, burgers (OR=1.24, 95% CI: 1.03-1.48), frequent eating pastries, cakes (OR=1.20, 95% CI: 1.01-1.43) were associated with increased risk for acne.

CONCLUSIONS

Acne prevalence is high among adolescents in Eskisehir but the rate of consulting doctor is low. Increasing public awareness is critical for convincing adolescents to seek medical help earlier. Acne was related with dietary habits. Fat, sugar and fast food consumption is found to be positively correlated with acne prevalence.

Acne vulgaris treatment : the current scenario

Acne Vulgaris is one of the most common skin disorders which dermatologists have to treat. It mainly affect adolescent, though may present at any age. In recent years, due to better understanding of the pathogenesis of acne, new therapeutic modalities and various permutation and combinations have been designed. In topical agents; benzoyl peroxide, antibiotics, retinoids, etc are the mainstay of treatment; can be given in combinations. While systemic therapy includes oral antibiotics, hormonal therapy, and isotretinoin, depending upon the need of patients it has to be selected. Physical treatment in the form of lesion removal, photo-therapy is also helpful in few of them. Since various old and new topical and systemic agents are available to treat acne, it sometime confuse treating dermatologist. To overcome this, panel of physicians and researchers worked together as a global alliance and task force to improve outcomes in acne treatment. They have tried to give consensus recommendation for the treatment of acne. Successful management of acne needs careful selection of anti-acne agents according to clinical presentation and individual patient needs.

Clinical implications of lipid peroxidation in acne vulgaris: old wine in new bottles

Acne vulgaris is a common dermatological disorder, one that is frequently associated with depression, anxiety and other psychological sequelae. In recent years there has been an increasing focus on the extent to which oxidative stress is involved in the pathophysiology of acne. Emerging studies have shown that patients with acne are under increased cutaneous and systemic oxidative stress. Indeed, there are indications that lipid peroxidation itself is a match that lights an inflammatory cascade in acne. The notion that lipid peroxidation is a 'starter gun' in acne is not a new one; here we review the nearly 50-year-old lipid peroxidation theory and provide a historical perspective to the contemporary investigations and clinical implications.

In addition, we present a novel hypothesis in which lipid peroxidation may be priming an increased susceptibility to co-morbid depression and anxiety in those with acne. The emerging research on the systemic burden of oxidative stress in acne sheds further light on the brain-skin axis. The recent findings also suggest potential avenues of approach for the treatment of acne via specific nutrients, dietary modifications, oral and topical interventions.

Effect of the glycemic index of carbohydrates on Acne vulgaris

Acne vulgaris may be improved by dietary factors that increase insulin sensitivity. We hypothesized that a low-glycemic index diet would improve facial acne severity and insulin sensitivity. Fifty-eight adolescent males (mean age ± standard deviation 16.5 ± 1.0 y and body mass index 23.1 ± 3.5 kg/m²) were alternately allocated to high or low glycemic index diets. Severity of inflammatory lesions on the face, insulin sensitivity (homeostasis modeling assessment of insulin resistance), androgens and insulin-like growth factor-1 and its binding proteins were assessed at baseline and at eight weeks, a period corresponding to the school term. Forty-three subjects (n = 23 low glycemic index and n = 20 high glycemic index) completed the study. Diets differed significantly in glycemic index (mean ± standard error of the mean, low glycemic index 51 ± 1 vs. high glycemic index 61 ± 2, p = 0.0002), but not in macronutrient distribution or fiber content. Facial acne improved on both diets (low glycemic index −26 ± 6%, p = 0.0004 and high glycemic index −16 ± 7%, p = 0.01), but differences between diets did not reach significance. Change in insulin sensitivity was not different between diets (low glycemic index 0.2 ± 0.1 and high glycemic index 0.1 ± 0.1, p = 0.60) and did not correlate with change in acne severity (Pearson correlation r = −0.196, p = 0.244). Longer time frames, greater reductions in glycemic load or/and weight loss may be necessary to detect improvements in acne among adolescent boys.

Acne e dieta: verdade ou mito?

Nos últimos 50 anos, foram publicados inúmeros estudos com a finalidade de comprovar se a dieta está relacionada à etiologia da acne. Embora existam estudos antigos, que são bem difundidos entre os dermatologistas e negam a associação entre acne e dieta, seu delineamento científico é pobre. Recentemente, novos artigos demonstraram evidências contrárias às publicações anteriores. Sendo assim, os autores realizaram esta revisão bibliográfica com o intuito de averiguar se a dieta influencia direta ou indiretamente um ou mais dos quatro pilares etiopatogênicos fundamentais da acne: (1) hiperproliferação dos queratinócitos basais, (2) aumento da produção sebácea, (3) colonização pelo Propionibacterium acnes e (4) inflamação.

Diet and acne

Historically, the relationship between diet and acne has been highly controversial. Before the 1960s, certain foods were thought to exacerbate acne. However, subsequent studies dispelled these alleged associations as myth for almost half a century. Several studies during the last decade have prompted dermatologists to revisit the potential link between diet and acne. This article critically reviews the literature and discusses how dermatologists might address diet when counseling patients with acne. Dermatologists can no longer dismiss the association between diet and acne. Compelling evidence exists that high glycemic load diets may exacerbate acne. Dairy ingestion appears to be weakly associated with acne, and the roles of omega-3 fatty acids, antioxidants, zinc, vitamin A, and dietary fiber remain to be elucidated. This study was limited by the lack of randomized controlled trials in the literature. We hope that this review will encourage others to explore the effects of diet on acne.

Prevalence of skin disorders in school children in southwest Nigeria

Physiological and structural changes of the pilosebaceous unit occur typically in adolescence leading to increase in sebaceous and apocrine secretions. Common disorders in this age group usually include acne vulgaris and infections with yeast organisms especially in a tropical climate.

OBJECTIVE

It has been suggested that some disorders are more prevalent in adolescents in the western world when compared to the developing ones.

METHOD

We looked at the prevalence of skin disorders in secondary school children in Ibadan, Southwest Nigeria. After obtaining relevant bio-data, students were examined for the presence of skin disorders. A total of 1,415 students were interviewed and examined.

RESULTS

There age range was 10-20 years. There were 725 (51.2%) males. Skin disorders seen were acne vulgaris 502 (35.5%), pityriasis versicolor 321 (22%) and papular urticaria 120 (8.5%) and seborreheic dermatitis 3.5%. Thirty six of the students (2.5%) which were mainly female students had developed side effects from the use of skin lightening agents. Peri-ocular hyper pigmentation and palmoplantar hyper pigmentation were found in 21 (1.5%) and 2 (0.1%) of the students respectively. Pyoderma, ringworm infection and scabies accounted for 0.6%. 1.0% and 1.1% of diseases respectively.

CONCLUSION

We concluded that acne vulgaris and pityriasis versicolor were the commonest skin disorders in adolescents in our environment. Complications from the use of skin lightening agents were seen in a few students.

Prevalence, severity, and severity risk factors of acne in high school pupils: a community-based study

A cross-sectional, community-based study was performed to determine the prevalence and severity of acne vulgaris in adolescents and of factors influencing the acne severity risk. The presence of acne was clinically determined and the secondary outcome measures of family acne history and the relation of acne to nutrition habits, emotional stress, menstruation, and smoking were recorded in a questionnaire. A representative sample of 1,002 pupils aged 16+/-0.9 years was enrolled. The overall acne prevalence was 93.3, 94.4% for boys and 92.0% for girls. Moderate to severe acne was observed in 14%. The prevalence of moderate to severe acne was 19.9% in pupils with and 9.8% in those without a family history of acne (P<0.0005; OR: 2.3). Acne severity risk increased with the number of family members with acne history. A mother with acne history influenced the severity of acne the most. Increasing pubertal age, seborrhea, the premenstrual phase, mental stress, and sweet and oily foods were recognized as risk factors for moderate to severe acne. In contrast, gender, spicy foods, and smoking were not associated with acne severity. In conclusion, acne is a common disorder in Iranian adolescents, with a low rate of moderate to severe acne. A genetic background is suggested, with mother's acne history being the most important prognostic factor. Skin quality and certain nutrition habits may affect acne severity.

Acne vulgaris, mental health and omega-3 fatty acids: a report of cases

Acne vulgaris is a common skin condition, one that is associated with significant psychological disability. The psychological impairments in acne include higher rates of depression, anxiety, anger and suicidal thoughts. Despite a paucity of clinical research, patients with skin conditions and/or mental health disorders are frequent consumers of dietary supplements. An overlap may exist between nutrients that potentially have both anti-acne and mood regulating properties; examples include omega-3 fatty acids from fish oil, chromium, zinc and selenium. Here we report on five cases of acne treated with eicosapentaenoic acid and antioxidant nutrients. Self-administration of these nutrients may have improved inflammatory acne lesions and global aspects of well-being; the observations suggest a need for controlled trials.

Fatores etiopatogênicos da acne vulgar

A acne vulgar é uma das dermatoses mais freqüentes na população em geral. Encontra-se na literatura grande número de trabalhos científicos referentes sobretudo a sua etiopatogenia. No entanto, dado o grande número de informações geradas a respeito, dificilmente consegue-se reuni-las em entendimento comum. Esta revisão literária foi proposta a fim de abordar os mecanismos etiopatogênicos clássicos da acne vulgar (produção sebácea, hiperqueratinização folicular, colonização bacteriana folicular e inflamação glandular) e o mecanismo coadjuvante principal, a influência hormonal.

Acne through the ages: case-based observations through childhood and adolescence

Acne vulgaris is a common disorder that affects more than 17 million individuals in the United States. Knowledge of the disease is an important part of clinical practice, particularly for the pediatric practitioner. Contrary to common belief, acne is not a disease limited to adolescents and young adults but can occur at any stage of life. This article is a case-based review of acne during childhood and adolescence. Workup is based on age and concurrent physical findings, whereas therapy depends on the type of skin lesions along with patient characteristics and preferences.

New insights into adolescent acne

PURPOSE OF REVIEW

Acne vulgaris remains one of the most common conditions affecting adolescents. The pediatric practitioner is the first to evaluate adolescent acne, making familiarity with the condition and its management essential. This review covers some of the recent literature regarding acne to help practitioners stay current on the issues regarding this topic.

RECENT FINDINGS

The pathogenesis of acne is multifactorial and complex, but recent advances in molecular genetics have provided additional information on the actions of Proprionibacterium acnes. Nutritional studies have reevaluated a possible role for diet and lifestyle factors in acne development. Many therapies are available to control acne and to limit associated scarring. Their appropriate use requires an understanding of not only the benefits but also the possible risks and adverse effects involved. Recent concerns regarding the use of antibiotics and isotretinoin will be addressed.

SUMMARY

This study reviews the recent literature regarding teenage acne, focusing on pathogenesis, associations, and controversies and considerations in therapy.

Practical considerations in acne treatment and the clinical impact of topical combination therapy

Acne vulgaris is a highly prevalent, multifactorial disease process affecting the pilosebaceous units of the dermis. The effects of acne are profound both physically and psychosocially across all age groups and ethnicities; therefore, prompt recognition and appropriate treatment are critical. Pharmacotherapeutic approaches range from simple monotherapy to multimodal treatments with a variety of topical and systemic agents. Optimal patient outcomes in acne management, however, are based both on treatment efficacy as well as overall patient satisfaction. In an effort to comprehensively address these key clinical considerations in acne management, we examine the diverse nature of acne patients, the factors in optimizing treatment outcomes, and the clinical impact of current medications, particularly topical combination therapy.

Milk consumption and acne in teenaged boys

OBJECTIVE

We sought to examine the association between dietary dairy intake and teenaged acne among boys.

METHODS

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.

RESULTS

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.

LIMITATIONS

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.

CONCLUSION

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.