Acne and diet: Why some of my worst affected patients have the cleanest diets

Photo by Brooke Lark on Unsplash

“I keep telling him it’s because of all the chocolates he’s eating, but he won’t listen to me. Could you please tell him too, he might listen to you?”

If I had a pound for every time the parent of a teenage acne patient uttered a version of that statement in my office… you get my point. Chocolate and sugar in general have traditionally been blamed for acne breakouts. Of course, nowadays it is not just teenagers with acne that get to experience this guilt over food, or even food shaming — however unintentional. I have listened to grown women tell me their friends and family will point out that perhaps they should not be eating that dessert because of their skin.

Quite often, adult acne patients will tell me how they have tried all sorts of dietary manipulations over the years, in an attempt to cure their acne. And it is not just about avoiding chocolate. Going vegan, adopting a raw food diet for a whole year, cutting out all sugar, dairy and/or all processed food. These are some of the dietary patterns that my patients have reported.

When “clean” eating goes too far

Worryingly, guilt and self-blame over consumption of seemingly acne-inducing food, can result in an unhealthy preoccupation with eating the “right” things. Somewhere along the line, all the well-intentioned comments by friends and even strangers, combined with readily available information online, have led people to try some fairly restrictive diets. A new trend for “clean” eating is often adopted by long term acne sufferers, and can vary from making simple adjustments resulting in a healthier diet, to excluding multiple food groups with a very rigid diet indeed.

Moreover, “clean” eating can imply to some that their current diet is somehow “unclean”; and by extension they, too, must be unclean. There is already a misconception that patients are somehow causing their acne by not washing their skin often enough, and in some ways the clean eating trend in acne is probably adding to that feeling of being made to feel “dirty”.

So, what is the basis behind these dietary recommendations? Is chocolate your enemy when it comes to your skin? Should you be cutting out sugar and processed foods altogether?

It’s complicated

Interestingly, there is not much data to support that chocolate in particular should be avoided. Studies on this are few and many decades old, with very small patient numbers and have given conflicting reports ¹ ². Similarly, studies on the relationship between acne and diet have been largely observational or relied on self-reported patient data, and not adequately powered to reach statistically significant conclusions.

The role of dairy in acne is another contentious issue, with some studies suggestive of acne worsening due to dairy and others refuting it. A large study of 47,000 women, found an association between low fat cow’s milk intake and teenage acne, but relied on patients filling out questionnaires on past dietary intake dating back many years!³

There is some emerging data that a high glycaemic diet, rich in sugar and refined carbohydrates, can impact on acne⁴ ⁵. The theory behind this is that sugar and refined carbohydrates can result in more keratin build up and increased oil production, via a rise in testosterone and other hormones. Previous studies have been quite small and therefore difficult to draw conclusions from.

A recent article in a prestigious dermatology journal reported on a cross-sectional study of 24,000 people, which concluded that a “Western” diet, high in sugar, refined carbohydrates and fat, could result in a greater incidence of acne⁶. This appears to be one of the largest studies to date on the association between diet and acne. The limitations of the study include its observational nature, its reliance on patient self-reporting, including self-diagnosis of acne, with an absence of data regarding pre-existing hormonal profile/hormonal treatments used, as well as lack of detailed information on the use of topical treatments for acne.

Everything in moderation

In conclusion, there is currently not enough data for dermatologists to suggest a particular type of diet in acne. Am I saying that people should binge on sugar, fat or processed foods? Of course not. I always tell my patients that, as long as they have a generally healthy diet, and leading a healthy lifestyle, that is all I require of them. If they have noticed a particular dietary trigger for their breakouts, they may want to moderate that. Excluding whole food groups, however, tends to be unnecessary and can create more stress than it is worth. Remember, acne is a medical condition and it is not likely to be fully controlled through dietary measures alone.

All you can do is be healthy, and not blame yourself over something that is not your fault.

So, in answer to that initial question, no, I will not be telling your child they are not allowed to eat that chocolate or sweet after — or even before — dinner. That battle is all yours!

I am a consultant dermatologist and founder of Dr Pratsou Dermatology, a private medical practice focusing on all things skin. In my 10 years as a dermatologist, I have treated over 25,000 patients. I am passionate about promoting skin confidence without filters. Visit my website for more information on acne and specific treatment options.

Consultant dermatologist and founder of Dr Pratsou Dermatology Ltd, a medical practice specialising in all things skin. Over 25,000 skin patients treated.