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Acne and rosacea have causes and effects that go well beyond the skin. A recent survey sponsored by Sun Pharma in collaboration with the American Acne and Rosacea Society (AARS) finds that 93 percent of parents worry that severe acne will leave their children scarred; 88 percent worry about the impact on their child’s social life and mental health.

A recent survey conducted by Galderma, in collaboration with Wakefield Research, finds that 62 percent of people with acne turn cameras off during video calls to avoid on-screen time. Half of students with acne say it has had a negative impact on their grades and academic achievement.

Attention to lifestyle factors is leading to practical recommendations for patients with these diseases, as addressed at this year’s AAD Virtual Meeting Experience 2021 (AADVMX 2021).

Acne and Diet

Associations of acne with carbohydrates date back to the 1930s, notes Julianna Kim Choi, MD, PhD. Although small studies in the 1960s and 1970s challenged dietary associations, “The overall trend favors that diet does play a role,” Dr. Choi says.

Evidence points to high glycemic load foods and certain dairy products as influencing acne. “It’s thought dairy and high glycemic load diets increase insulin and insulin-like growth factor 1 signaling. This leads to increased androgen hormones, increased cellular growth, proliferation of keratinocytes and seboctyes, leading to increased sebum production and leading to more acne,” Dr. Choi said during her lecture.

Hormonal mediators in dairy may also play a role. Skim and lowfat milk have the strongest correlation to acne, while yogurt and cheese do not seem to affect the disease.

Studying diet can be challenging, Dr. Choi acknowledges, and it may be difficult to arrive at definitive guidelines. Nonetheless, she says, “I consider dietary intervention to be an adjunctive treatment. I do not regularly recommend specific diet changes.” She advises interested patients to consider a low glycemic load diet and to avoid or minimizes milk consumption—cheese and yogurt are allowed—for up to three months. If patients see no benefit in that time, she recommends they simply follow a healthy diet with no specific food avoidance. Dr. Choi cautions patients about whey protein, “which is equivalent to several glasses of milk,” she says. Plant-based protein powders are an alternative.

Also speaking during the AADVMX 2021, Zoe Diana Draelos, MD noted a little-considered link between diet and acne. “Many people do not know that when they consume food, the vegetable oils and animal oils that are left behind on the face can indeed provide nutrition for C. acnes.” She advises all patients to wash their face immediately after eating.

In a similar vein, Dr. Draelos cautioned patients against topically applied botanical oils, which are increasingly touted for acne management, but may also contain nutrients for C. acnes. She noted that some factions of coconut oil have been shown to be non-comedogenic, if patients are intent to try it.

Also, Dr. Draelos reminded of the importance to remove facial cosmetics, which can trap and combine with sebum on the face. “Failure to remove cosmetics is also a failure to remove sebum from the face,” she says.

Rosacea and Diet

When it comes to rosacea, several dietary triggers—including alcohol, chocolate, and spicy foods—have been widely accepted. Speaking at the AAD VMX 2021, Vivian Shi, MD explained the triggering phenomenon: “Activating TRVP1 receptor on the skin to cause neurogenic release of substance P ultimately causes more dilation of the blood vessels and more edema, leading to facial flushing, burning, and inflammatory effects. Cold and formalin-forming foods affect TRPA1 on sensory neurons and activates substance P.”

More broadly, there is interest in identifying whether dietary factors influence the risk for or severity of rosacea, with “a tremendous rise in diet research,” Dr. Shi said. “That mirrors what our patients or consumers are searching on Google.” Research must continue, she said, especially given patient interest.

It’s too early to make generalized dietary recommendations, as controlled study of diet and rosacea have been limited. Dr. Shi pointed out one large, multicenter, controlled study from China suggesting that high frequency of intake of fatty foods correlated with erythrotelangiectatic type (ET) rosacea, while high rates of dairy correlated with decreased rates of ET rosacea. There is also evidence to suggest niacin-containing foods affect rosacea.

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