Elsevier

Clinics in Dermatology

Volume 28, Issue 6, November–December 2010, Pages 598-604
Clinics in Dermatology

Nutrition and acne

https://doi.org/10.1016/j.clindermatol.2010.03.017Get rights and content

Abstract

There are significant data supporting the role of diet in acne. Our Western diet includes many dairy sources containing hormones.. The natural function of milk being to stimulate growth, it contains anabolic steroids as well as true growth hormones and other growth factors. The presence of 5α-pregnanedione, 5α-androstanedione, and other precursors of 5α-dihydrotestosterone add to the potency of milk as a stimulant of acne. In addition, foods with significant sugar content and other carbohydrates yielding high glycemic loads affect serum insulin and insulin-like growth factor-1 levels, both of which promote increased production of available androgens and the subsequent development of acne.

Introduction

Much has been written about hormonal influences in acne, most of the work directed at the effect of the traditional endogenous reproductive hormones. Gradually, however, we are learning to give due consideration to exogenous hormones and the effects they have on endogenous growth factors and androgen metabolism.

As background, all mammals rely on exogenous hormones from their first feeding. The entire milk complex evolved as it did to provide a precisely balanced synergistic stimulus to growth and maturation. Each species' milk provides the specific optimal mix of proteins, carbohydrates, fats, hormones, and growth factors needed by its babies. It is not generally appreciated that we actually start our lives with our first food laced with anabolic steroids. Little wonder that, in nature, this enriched material is withdrawn from the infant in due course. The growing youngster, whether human or bovine or whale, no longer needs such enriched food when it is capable of feeding itself, and the continued drain on the mother's fat and protein reserves must stop if she is to remain healthy to produce further robust offspring.

Section snippets

Background

Acne is well known to respond to hormones, both endogenous and exogenous. Androgenic progestins in birth control pills and now in intrauterine devices can cause significant acne in women,1 and the highly androgenic progestin, medroxyprogesterone acetate, is a known acnegen whether taken orally or as an intramuscular depot injection.

In men, we used to see acne caused by anabolic steroid use in weight lifters and body builders fairly regularly. Over time, the level of sophistication in this

The nonreproductive hormones

Although acne is regarded as androgen-dependent,10 its course during the teen years corresponds more closely to the serum levels of growth hormone (GH) than to androgen levels.11 The world of the nonreproductive hormones is even more complex than the steroids. A full explanation of the interactions of these hormones with the pilosebaceous units is beyond this contribution; indeed, it still awaits full clarification. What follows is a précis of the present concepts necessary for the appreciation

Conclusions

The complex interrelationships detailed in this contribution support to a high degree the case for dietary effects on acne (Figure 4). The typical Western diet, consisting of numerous dairy sources and foods with high glycemic indices, appears to have solidly-documented potentiating effects on serum insulin and IGF-1 levels, thereby promoting the androgens that are at the basis of the intraductal changes that lead to the development of acne vulgaris. More recent work, in progress, seems to

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