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Acne in adolescence: a role for nutrition?

Article Excerpt
KEY POINTS

* Acne prevalence varies substantially between populations and is low in non-Westernised societies consuming traditional diets.

* A unifying feature of traditional diets is low glycaemic load.

* High-glycaemic-load diets have recently been implicated in acne aetiology due to their ability to affect insulin demand, androgen bioavailability and insulin-like growth factor-I activity.

* The beneficial results of a low-glycaemic-load diet on acne observed in a recent trial require confirmation in larger studies.

During the past century, much controversy has surrounded the subject of diet in acne management. In the 1930s, major dermatology textbooks advocated dietary restrictions for acne patients based upon 'clinical experience ... that [suggests] a diet high in carbohydrates and sweets seems to make some acne cases worse'. (1) However, apart from the individual impressions of physicians, there was little evidence to support dietary practices for the control of acne. Forty years later, dietary advice was removed from standard texts, and the consensus has since been that 'diet plays no role in acne treatment in most patients'. (2) Nonetheless, many acne patients continue to believe that acne is exacerbated by diet, (3,4) and a recent survey found that 41% of final-year medical students at Melbourne University regarded diet as an aggravating factor. (5)

Few studies have examined the diet and acne connection, and those that have, show major design faults. Fulton et al. in a crossover single-blind study found no effect of chocolate on acne when compared with a placebo bar. (6) However, a later examination of the ingredients in the placebo bar revealed that the fatty acid composition and sugar contents were virtually identical to that found in the experimental treatment. (7) Anderson examined the effect of the daily consumption of chocolate, milk or nuts and found no effect on acne. (8) However,...

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