Adam Friedman, MD, FAAD, kicked off his session, “Diet and Acne,” at the 2022 AAD annual meeting by saying, “[A]cne is the number one inflammatory disease, so we can’t hide from it. We as dermatologists see it every day.”

Dr Friedman explained that because Western diets often have hormonal effects in cow’s milk products and are also high in caloric content, including carbohydrates, fats, and proteins, “the prevalence of acne is substantially lower in non-Westernized populations.”

Talking about dermatology patients Dr Friedman said, “If you have to ask about [a diet being bad for your skin], chances are it isn’t good for you!”

According to Dr Friedman, he stressed to the audience that a “pimple is not just a pimple. All acne is inflammatory!”

Additionally, he discussed the role hormones play in acne. He explained that hormonal effects on sebum production are “vital to the process.”

He then explained where diet fits in with acne. He said, “simply put, high glycemic load and high glycemic index foods, as well as dairy, increase risk factors for acne vulgaris.”

“Spoiler alert! Glycemic index and [glycemic load] levels have been shown in multiple studies to be significantly higher in patients with acne than in control participants,” Dr Friedman said as the audience chuckled.

Next, he talked about being “down with dairy.” He explained that many dairy products actually increases IGF-1 levels leading to acne. He noted skim milk as being the most acnegenic and is associated with the highest plasma IGF-1 levels. Additionally, skim milk has unclear etiology and may contain less estrogen, he said, although ultimately it is unknown. Finally, Dr Friedman said dairy may even interfere with treatments and absorption.

He then moved on and said, “What about my chocolate?” He explained. “The AAD suggests chocolate without accompanying sugar or milk is an unlikely factor in acne development.”

“No sugar, dark chocolate holds the lowest risk of acne,” he said.   

"So, what do we say to our patients," he said. Overall, he said simple diet “don’ts” include:

• dairy;
• whey protein supplements;
• high glycemic index/load;
• skim/reduced fat milk; and
• processed food.

He stressed to the audience that it is important patients understand dietary factors do not independently cause acne.

Dr Friedman said nutrition counseling can be suggested for patients as a first-line or adjunctive therapy. Finally, he stressed the importance of setting expectations with patients because changes in acne due to any pharmaceutical treatment or dietary change can take up to 10-12 weeks.

Reference:

Friedman A. Diet and Acne. Presented at: AAD Annual Meeting; March 25-28, 2022; Boston, MA.