Exploring the roles of food on the pathogenesis of acne

1. Food & Acne:
Myth or Facts???
Peter Nugraha Soekmadji
Department of Dermatovenereology
Faculty of Medicine
Maranatha Christian University
Bandung

2. Conflict of Interest Statement
• NO support or commercial funding for this
presentation or for any products mentioned
here

3. Classification
Liao DC. Management of acne. J Fam Pract 2003;52:43–51
Management of Acne Volume 1: Evidence Report and Appendixes. Rockville, Md: Dept. of Health and Human Services (US),Public Health Service;
2001 Sep. Report No.: 01-E019.
Types Definition
Comedonal (noninflammatory) Dilated hair follicles filled with keratine,
sebum & bacteria
Papulopustular (inflammatory) Inflammatory lesion 2-5 mm in
diameter with/without visible core of
purulent material
Nodular (inflammatory) Solid, raised inflammatory lesions > 5
mm in diameter

4. Classification
Liao DC. Management of acne. J Fam Pract 2003;52:43–51
Management of Acne Volume 1: Evidence Report and Appendixes. Rockville, Md: Dept. of Health and Human Services (US),Public Health Service;
2001 Sep. Report No.: 01-E019.
Severity Comedone Inflammatory
lesions
Total lesions Pseudocyst
Mild <20 <15 <30
Moderate 20-100 15-50 30-125
Severe >100 >50 >125 >5

5. Southeast Asia
Treatment Guidelines
Goh CL et al. South-East Asia study alliance guidelines on the management of acne vulgaris in South-East Asian patients. Journal of
Dermatology 2015;42: 945–953

7. Pathogenesis of Acne
Bolognia, J., Jorizzo, J. and Schaffer, J. (2012). Dermatology. [Philadelphia]: Elsevier Saunders.

8. Updated Concepts of Acne
What's new in the physiopathology of acne? Suh DH, Kwon HH. Br J Dermatol. 2015 Jul;172 Suppl 1:13-9. doi:
10.1111/bjd.13634. Review.

9. Role of P. acnes
Update on etiopathogenesis and treatment of Acne. Bhat YJ, Latief I, Hassan I. Indian J Dermatol Venereol Leprol. 2017 May-
Jun;83(3):298-306. doi: 10.4103/0378-6323.199581. Review.

10. Biofilm Formations
Biofilm formation by Propionibacterium acnes is a characteristic of invasive isolates. Holmberg A, Lood R, Mörgelin M, Söderquist
B, Holst E, Collin M, Christensson B, Rasmussen M. Clin Microbiol Infect. 2009 Aug;15(8):787-95. doi: 10.1111/j.1469-
0691.2009.02747.x. Epub 2009 Apr 23.

11. Role of Sebum
Update on etiopathogenesis and treatment of Acne. Bhat YJ, Latief I, Hassan I. Indian J Dermatol Venereol Leprol. 2017 May-
Jun;83(3):298-306. doi: 10.4103/0378-6323.199581. Review.

12. Connection of Inflammation &
Comedone Formation
Update on etiopathogenesis and treatment of Acne. Bhat YJ, Latief I, Hassan I. Indian J Dermatol Venereol Leprol. 2017 May-
Jun;83(3):298-306. doi: 10.4103/0378-6323.199581. Review.

18. mTORC1-Related Conditions
Acne vulgaris: The metabolic syndrome of the pilosebaceous follicle. Melnik BC. Clin Dermatol. 2018 Jan - Feb;36(1):29-40. doi:
10.1016/j.clindermatol.2017.09.006. Epub 2017 Sep 8. Review.

19. Linking diet to acne metabolomics, inflammation, and comedogenesis: an update. Melnik BC. Clin Cosmet Investig Dermatol.
2015 Jul 15;8:371-88. doi: 10.2147/CCID.S69135. eCollection 2015. Review.

20. Laron Syndrome

21. Role of PPAR

22. Role of Adiponectin in Acne
Dietary glycemic factors, insulin resistance, and adiponectin levels in acne vulgaris. Çerman AA, Aktaş E, Altunay İK, Arıcı JE,
Tulunay A, Ozturk FY. J Am Acad Dermatol. 2016 Jul;75(1):155-62. doi: 10.1016/j.jaad.2016.02.1220. Epub 2016 Apr 6.

23. Role of Diet in Acne
Update on etiopathogenesis and treatment of Acne. Bhat YJ, Latief I, Hassan I. Indian J Dermatol Venereol Leprol. 2017 May-
Jun;83(3):298-306. doi: 10.4103/0378-6323.199581. Review.

24. Metabolic & Nutrigenomic Effects of
Nutrients on Acne

26. Evidence of
Role of Diet in Acne
Acne and Nutrition: A Systematic Review. Fiedler F, Stangl GI, Fiedler E, Taube KM. Acta Derm Venereol. 2017 Jan 4;97(1):7-9. doi:
10.2340/00015555-2450. Review.

27. Recommendations
Guidelines of care for the management of acne vulgaris. Zaenglein AL, Pathy AL, Schlosser BJ et al. J Am Acad Dermatol. 2016 May;74(5):945-
73.e33. doi: 10.1016/j.jaad.2015.12.037. Epub 2016 Feb 17. Review.
Diet in dermatology: Part I. Atopic dermatitis, acne, and nonmelanoma skin cancer. Bronsnick T, Murzaku EC, Rao BK. J Am Acad Dermatol. 2014

29. Low vs. High GI Diet
The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters
associated with acne vulgaris: a randomized, investigator-masked, controlled trial. J Am Acad Dermatol. 2007 Aug;57(2):247–56.

30. Metformin +
Low Glycemic Diet
Low glycaemic diet and metformin therapy: a new approach in male subjects withacne resistant to common treatments.
Fabbrocini G, Izzo R, Faggiano A, Del Prete M, Donnarumma M, Marasca C, Marciello F, Savastano R, Monfrecola G, Colao A. Clin
Exp Dermatol. 2016 Jan;41(1):38-42. doi: 10.1111/ced.12673. Epub 2015 Jun 6.

31. Evidence of
Role of Diet in Acne
Acne and Nutrition: A Systematic Review. Fiedler F, Stangl GI, Fiedler E, Taube KM. Acta Derm Venereol. 2017 Jan 4;97(1):7-9. doi:
10.2340/00015555-2450. Review.

32. How Much is Too Much???
The constellation of dietary factors in adolescent acne: a semantic connectivity mapapproach. Grossi E, Cazzaniga S, Crotti S et
al.; GISED Acne Study Group. J Eur Acad Dermatol Venereol. 2016 Jan;30(1):96-100. doi: 10.1111/jdv.12878. Epub 2014 Dec 2.

33. How Much is Too Much???
The constellation of dietary factors in adolescent acne: a semantic connectivity mapapproach. Grossi E, Cazzaniga S, Crotti S et
al.; GISED Acne Study Group. J Eur Acad Dermatol Venereol. 2016 Jan;30(1):96-100. doi: 10.1111/jdv.12878. Epub 2014 Dec 2.

35. Salty and spicy food; are they involved in the pathogenesis of acne vulgaris? A casecontrolled study. El Darouti MA, Zeid OA,
Abdel Halim DM, Hegazy RA, Kadry D, Shehab DI, Abdelhaliem HS, Saleh MA. J Cosmet Dermatol. 2016 Jun;15(2):145-9. doi:
10.1111/jocd.12200. Epub 2015 Dec 9.

36. Linking diet to acne metabolomics, inflammation, and comedogenesis: an update. Melnik BC. Clin Cosmet Investig Dermatol.
2015 Jul 15;8:371-88. doi: 10.2147/CCID.S69135. eCollection 2015. Review.
Food Sources with
Protective Effects

37. Oral Probiotics
• Treg cells ↓ → inflammatory cytokines ↓
• Sebum production ↓
• Modulate side effects of antibiotics
Prospective, Randomized, open-label trial comparing the safety, efficacy and tolerability of an acne treatment regimen with and without a
probiotic supplement and minocycline in subjects with mild to moderate acne. J Cutan Med Surg. 2013 (March/April);17(2).

38. Acne:
Metabolomics & Treatments

39. • Fact: diet has a role in the pathogenesis of
acne
• High glycemic index diet and dairy products
may be associated with acne
• Further research needed for other food
sources
Conclusions