Research Review| Volume 113, ISSUE 3, P416-430, March 2013

Download started.


Acne: The Role of Medical Nutrition Therapy

Published:February 20, 2013DOI:


      Acne is a common disease in Westernized nations, particularly among adolescents and young adults. Acne has substantial effects on quality of life, making treatment essential. Medical nutrition therapy as a potential treatment for acne is not new, although the literature examining diet and acne during the past 100 years is mixed. During the late 1800s and early 1900s, diet was commonly used as an adjunct treatment for acne. During the 1960s, however, the diet–acne connection fell out of favor. In recent years, dermatologists and registered dietitians have revisited the idea and become increasingly interested in the role of medical nutrition therapy in acne treatment. This article reviews the history and existing literature examining the association between diet and acne. Although the total number of studies conducted within the past 40 years is relatively small, the growing body of epidemiologic and experimental evidence suggests a relationship between diet and acne. Compared with other dietary factors, more research examines dietary glycemic load. The evidence is more convincing for high glycemic load diets, compared with other dietary factors. To date there are no randomized controlled trials investigating the relationship between frequent dairy or milk consumption and acne. Similarly, the number of research studies examining the relationship between dietary fat and/or n-3 fatty acids is sparse and the evidence is less robust. Taken together, several methodologic limitations need to be addressed, and additional research, preferably randomized controlled trials, is warranted before comprehensive evidence-based guidelines can be established. While dermatologists and registered dietitians continue to debate and research the potential relationship between diet and acne, the best dietary approach is to address each acne patient individually, carefully considering the possibility of dietary counseling.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Spencer E.H.
        • Ferdowsian H.R.
        • Barnard N.D.
        Diet and acne: A review of the evidence.
        Int J Dermatol. 2009; 48: 339-347
        • McConnell R.C.
        • Fleischer Jr, A.B.
        • Williford P.M.
        • Feldman S.R.
        Most topical tretinoin treatment is for acne vulgaris through the age of 44 years: An analysis of the National Ambulatory Medical Care Survey, 1990-1994.
        J Am Acad Dermatol. 1998; 38: 221-226
        • Williams H.C.
        • Dellavalle R.P.
        • Garner S.
        Acne vulgaris.
        Lancet. 2010; 379: 361-372
        • Mallon E.
        • Newton J.N.
        • Klassen A.
        • Stewart-Brown S.L.
        • Ryan T.J.
        • Finlay A.Y.
        The quality of life in acne: A comparison with general medical conditions using generic questionnaires.
        Br J Dermatol. 1999; 140: 672-676
        • Dunn L.K.
        • O'Neil J.L.
        • Feldman S.R.
        Acne in adolescents: Quality of life, self-esteem, mood, and psychological disorders.
        Dermatol Online J. 2011; 17: 1
        • Koo J.
        The psychosocial impact of acne: Patient's perceptions.
        J Am Acad Dermatol. 1995; 32: S25-S30
        • Barkley L.D.
        Acne, its Etiology, Pathology and Treatment.
        GP Putnam's Sons, New York, NY1885
        • Stelwageon H.W.
        Treatise on Diseases of the Skin.
        in: 5th ed. WB Saunders, Philadelphia, PA1909: 981
        • Bowe W.P.
        • Joshi S.S.
        • Shalita A.R.
        Diet and acne.
        J Am Acad Dermatol. 2010; 63: 124-141
        • Fulton J.
        • Plewig G.
        • Kligman A.
        Effect of chocolate on acne vulgaris.
        JAMA. 1969; 210: 2071-2074
        • Anderson P.C.
        Foods as the cause of acne.
        Am Fam Physician. 1971; 3: 102-103
        • Sutton R.L.
        Diseases of the Skin.
        in: 4th ed. CV Mosby, St Louis, MO1921: 925
        • Campbell G.
        The relation of sugar intolerance to certain diseases of the skin.
        Br J Derm. 1931; 43: 297-304
        • Belisario J.C.
        Acne vulgaris: Its aetiology and treatment.
        Aust J Dermatol. 1951; 1: 85-111
        • Robinson H.M.
        The acne problem.
        South Med J. 1949; 42: 1050-1060
        • Hubler W.R.
        Unsaturated fatty acids in acne.
        AMA Arch Derm. 1959; 79: 644-646
        • Cornbleet T.
        • Gigli I.
        Should we limit sugar in acne?.
        Arch Dermatol. 1961; 83: 968-969
        • Grant J.D.
        • Anderson P.C.
        Chocolate as a cause of acne: A dissenting view.
        Missouri Med. 1965; 62: 459-460
        • Gaul J.E.
        Salt restriction in acne vulgaris.
        J Indiana State Med Assoc. 1965; 58: 839-842
        • Bett D.G.
        • Morland J.
        • Yudkin J.
        Sugar consumption in acne vulgaris and seborrheic dermatitis.
        BMJ. 1967; 3: 153-155
        • Rasmussen J.
        Diet and acne.
        Int J Dermatol. 1977; 16: 488-492
        • Thiboutot D.M.
        • Shalita A.R.
        • Yamauchi P.S.
        • Dawson C.
        • Arsonnaud S.
        • Kang S.
        Combination therapy with adapalene gel 0.1% and doxycycline for severe acne vulgaris in adults.
        Skinmed. 2005; 4: 138-146
        • Berger R.
        • Barba A.
        • Fleischer A.
        • et al.
        A double-blinded, randomized, vehicle-controlled, multicenter, parallel-group study to assess the safety and efficacy of tretinoin gel microsphere 0.04% in the treatment of acne vulgaris in adults.
        Cutis. 2007; 80: 152-157
        • Degitz K.
        • Placzek M.
        • Borelli C.
        • Plewig G.
        Pathophysiology of acne.
        J Dtsch Dermatol Ges. 2007; 5: 316-323
        • Eichenfield L.F.
        • Leyden J.J.
        Acne: Current concepts of pathogenesis and approach to rational treatment.
        Pediatrician. 1991; 18: 218-223
        • Danby F.W.
        Nutrition and acne.
        Clin Dermatol. 2010; 28: 598-604
        • Smith T.M.
        • Gilliland K.
        • Clawson G.A.
        • Thiboutot D.
        IGF-1 induces SREBP-1 expression and lipogenesis in SEB-1 sebocytes via activation of the phosphoinositide 3-kinase/Akt pathway.
        J Invest Dermatol. 2008; 128: 1286-1293
        • Ben-Amitai D.
        • Laron Z.
        Effect of insulin-like growth factor-1 deficiency or administration on the occurrence of acne.
        J Eur Acad Dermatol Venereol. 2011; 25: 950-954
        • Abedamowo C.A.
        • Spiegelman D.
        • Danby F.W.
        • Frazier A.L.
        • Willett W.C.
        • Holmes M.D.
        High school dietary dairy intake and teenage acne.
        J Am Acad Dermatol. 2005; 52: 207-214
        • Abedamowo C.A.
        • Spiegelman D.
        • Berkey C.S.
        • et al.
        Milk consumption and acne in adolescent girls.
        Dermatol Online J. 2006; 12: 1
        • Abedamowo C.A.
        • Spiegelman D.
        • Berkey C.S.
        • et al.
        Milk consumption and acne in teenaged boys.
        J Am Acad Dermatol. 2008; 58: 787-793
        • Di Landro A.
        • Cazzaniga S.
        • Parazzini F.
        • et al.
        Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults.
        J Am Acad Dermatol. 2012; 67: 1129-1135
        • Kim J.
        • Ko Y.
        • Park Y.
        • Kim N.
        • Ha W.
        • Cho Y.
        Dietary effect of lactoferrin-enriched fermented milk on skin surface lipid and clinical improvement of acne vulgaris.
        Nutrition. 2010; 26: 902-909
        • Yalcin A.S.
        Emerging therapeutic potential of whey proteins and peptides.
        Curr Pharm Des. 2006; 12: 1637-1643
        • Zimecki M.
        • Kruzel M.L.
        Milk-derived proteins and peptides of potential therapeutic and nutritive value.
        J Exp Ther Oncol. 2007; 6: 89-95
        • Ling J.M.L.
        • Schryvers A.B.
        Perspectives on interactions between lactoferrin and bacteria.
        Biochem Cell Biol. 2006; 84: 275-281
        • Verhagen A.R.
        • Koten J.W.
        • Chaddah V.K.
        • Patel R.I.
        Skin diseases in Kenya.
        Arch Dermatol. 1968; 98: 577-586
        • Ratnam A.V.
        • Jayaraju K.
        Skin diseases in Zambia.
        Br J Dermatol. 1970; 101: 449-453
        • Park R.G.
        The age distribution of common skin disorders in the Bantu of Pretoria, Transvaal.
        Br J Dermatol. 1968; 80: 758-761
        • Schaefer O.
        When the Eskimo comes to town.
        Nutrition Today. 1971; 6: 8-16
        • Steiner P.E.
        Necropsies on Okinawans: Anatomic and pathologic observations.
        Arch Pathol. 1946; 42: 359-380
        • Cunliffe W.J.
        • Cotterill J.A.
        The acnes: Clinical features, pathogenesis and treatment.
        in: Rook A. Major Problems in Dermatology. WB Saunders Co, Philadelphia, PA1975: 13-14
        • Cordain L.
        • Lindeberg S.
        • Hurtado M.
        • Hill K.
        • Eaton S.B.
        • Brand-Miller J.
        Acne vulgaris: A disease of Western civilization.
        Arch Dermatol. 2002; 138: 1584-1590
        • Jenkins D.J.
        • Wolever T.M.
        • Taylor R.H.
        • et al.
        Glycemic index of foods: A physiological basis for carbohydrate exchange.
        Am J Clin Nutr. 1981; 34: 362-366
        • Attia N.
        • Tamborlane W.V.
        • Heptulla R.
        • et al.
        The metabolic syndrome and insulin-like growth factor-1 regulation in adolescent obesity.
        J Clin Endocrin Metab. 1998; 83: 1467-1471
        • Galgani J.
        • Aguirre C.
        • Diaz E.
        Acute effect of meal glycemic index and glycemic load on blood glucose and insulin responses in humans.
        Nutr J. 2006; 5: 22
        • Kaymak Y.
        • Adisen E.
        • Ilter N.
        • Bideci A.
        • Gurler D.
        • Celik B.
        Dietary glycemic index and glucose, insulin, insulin-like growth factor-1, insulin-like growth factor binding protein-3, and leptin levels in patients with acne.
        J Am Acad Dermatol. 2007; 57: 819-823
        • Östman E.M.
        • Liljeberg Elmstahl H.G.M.
        • Björck I.M.E.
        Inconsistency between glycemic and insulinemic responses to regular and fermented milk products.
        Am J Clin Nutr. 2001; 74: 96-100
        • Treloar V.
        • Logan A.C.
        • Danby F.W.
        • Cordain L.
        • Mann N.J.
        Comment on acne and glycemic index.
        J Am Acad Dermatol. 2008; 58: 175-177
        • Smith R.N.
        • Mann N.J.
        • Braue A.
        • Makelainen H.
        • Varigos G.A.
        A low-glycemic-load diet improves symptoms in acne vulgaris patients: A randomized controlled trial.
        Am J Clin Nutr. 2007; 86: 107-115
        • Smith R.N.
        • Mann N.J.
        • Braue A.
        • Makelainen H.
        • Varigos G.A.
        A 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; 57: 247-256
        • Smith R.N.
        • Mann N.
        • Mäkeläinen H.
        • Roper J.
        • Braue A.
        • Varigos G.
        A pilot study to determine the short-term effects of a low glycemic load diet on hormonal markers of acne: A nonrandomized, parallel, controlled feeding trial.
        Mol Nutr Food Res. 2008; 52: 718-726
        • Smith R.N.
        • Braue A.
        • Varigos G.
        • Mann N.J.
        The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides.
        J Dermatol Sci. 2008; 50: 41-52
        • Halvorsen J.
        • Dalgard F.
        • Thoresen M.
        • Bjertness E.
        • Lien L.
        Is the association between acne and mental distress influenced by diet?.
        BMC Pub Health. 2009; 9: 340
        • Law M.
        • Chuh A.
        • Molinari N.
        • Lee A.
        An investigation of the association between diet and occurrence of acne: A rational approach from a traditional Chinese medicine perspective.
        Clin Exper Dermatol. 2009; 35: 31-35
        • Rouhani P.
        Acne improves with a popular, low glycemic diet from South Beach.
        J Am Acad Dermatol. 2009; 60: P706
        • Ghodsi S.Z.
        • Orawa H.
        • Zouboulis C.C.
        Prevalence, severity and severity risk factors of acne in high school pupils: A community-based study.
        J Invest Dermatol. 2009; 129: 2136-2141
        • Jung J.Y.
        • Yoon M.Y.
        • Min S.
        • Hong J.S.
        • Choi Y.S.
        • Suh D.H.
        The influence of dietary patterns on acne vulgaris in Koreans.
        Eur J Dermatol. 2010; 20: 768-772
        • Reynolds R.C.
        • Lee S.
        • Choi J.Y.
        • et al.
        Effect of the glycemic index of carbohydrates on acne vulgaris.
        Nutrients. 2010; 2: 1060-1072
        • Kwon H.H.
        • Yoon J.Y.
        • Hong J.S.
        • Jung J.Y.
        • Park M.S.
        • Suh D.H.
        Clinical and histological effect of a low glycaemic load diet in treatment of acne vulgaris in Korean patients: A randomized, controlled trial.
        Acta Derm Venereol. 2012; 92: 241-246
        • Simopoulos A.P.
        Evolutionary aspects of diet and essential fatty acids.
        World Rev Nutr Diet. 2001; 88: 18-27
        • Logan A.C.
        Omega-3 fatty acids and acne.
        Arch Dermatol. 2003; 139: 941-943
        • Rubin M.
        • Kim K.
        • Logan A.
        Acne vulgaris, mental health and omega-3 fatty acids: A report of cases.
        Lipids Health Dis. 2008; 36: 1-5
        • Wu T.Q.
        • Mei S.Q.
        • Zhang J.X.
        • et al.
        Prevalence and risk factors of facial acne vulgaris among Chinese adolescents.
        Int J Adolesc Med Health. 2007; 19: 407-412
        • Wei B.
        • Pang Y.
        • Zhu H.
        • et al.
        The epidemiology of adolescent acne in North East China.
        J Eur Acad Dermatol Venereol. 2010; 24: 953-957
        • Brismar K.
        • Fernqvist-Forbes E.
        • Wahren J.
        • Hall K.
        Effect of insulin on the hepatic production of insulin-like growth factor binding protein-1 (IFGBP-1), IGFBP-3 and IGF-1 in insulin-dependent diabetes.
        J Clin Endocrinol Metab. 1994; 79: 872-878
        • Zouboulis C.C.
        Acne and sebaceous gland function.
        Clin Dermatol. 2004; 22: 360-366
        • Vora S.
        • Ovhal A.
        • Jerajani H.
        • Nair N.
        • Chakrabortty A.
        Correlation of facial sebum to serum insulin-like growth factor-1 in patients with acne.
        Br J Dermatol. 2008; 159: 990-991
        • Shaw J.
        Acne: The effect of hormones on pathogenesis and management.
        Am J Clin. Dermatol. 2002; 3: 571-578
        • Melnik B.C.
        • Schmitz G.
        Role of insulin, insulin-like growth factor-1, hyperglycemic food and milk consumption in the pathogenesis of acne vulgaris.
        Exp Dermatol. 2009; 18: 833-841
        • Crave J.C.
        • Lejeune H.
        • Brebant C.
        • Baret C.
        • Pugeat M.
        Differential effects of insulin and insulin-like growth factor-1 on the production of plasma steroid-binding globulins by human hepatoblastoma-derived (Hep G2) cells.
        J Clin Endocrinol Metab. 1995; 8: 1283-1289
        • Ben-Amitiai D.
        • Laron Z.
        Effect of insulin-like growth factor-1 deficiency or administration on the occurrence of acne.
        J Eur Acad Dermatol Venereol. 2011; 25: 950-954
      1. Tasli L, Turgut S, Kacar N, et al. Insulin-like growth factor-1 gene polymorphism in acne vulgaris [published online ahead of print October 10, 2011]. J Eur Acad Dermatol Venerol. doi:10.1111/j.1468-3083.2011.04299.x.

        • Kolodziejczyk B.
        • Duleba A.
        • Spaczynski R.
        • Pawelczyk L.
        Metformin therapy decreases hyperandrogenism and hyperinsulinemia in women with polycystic ovary syndrome.
        Fertil Steril. 2000; 73: 1149-1154
        • Evans T.R.J.
        • Kaye S.B.
        Retinoids: Present role and future potential.
        Br J Cancer. 1999; 80: 1-8
        • Berra B.
        • Rizzo A.M.
        Glycemic index, glycemic load: New evidence for a link with acne.
        J Am Coll Nutr. 2009; 28: S450-S454
        • Liu B.
        • Lee H.Y.
        • Weinzimer S.A.
        • et al.
        Direct functional interaction between insulin-like growth factor-binding protein-3 and retinoid X receptor-alpha regulate transcriptional signaling and apoptosis.
        J Biol Chem. 2000; 275: 33607-33613
        • Hoyt G.
        • Hickey M.S.
        • Cordain L.
        Dissociation of the glycaemic and insulinaemic responses to whole and skimmed milk.
        Br J Nutr. 2005; 93: 175-177
        • Ostman E.M.
        • Liljeerg Elmstahl H.G.
        • Bjorck I.M.
        Inconsistency between glycemic and insulinemic responses to regular and fermented milk products.
        Am J Clin Nutr. 2001; 74: 96-100
        • Melnik B.
        Milk consumption: Aggravating factor of acne and promoter of chronic diseases of Western societies.
        J Ger Soc Dermatol. 2009; 7: 364-370
        • Blum J.W.
        • Baumrucker C.R.
        Insulin-like growth factors (IGFs), IGF binding proteins, and other endocrine factors in milk: Role in the newborn.
        Exp Med Biol. 2008; 606: 397-422
        • Hoppe C.
        • Molgaard C.
        • Michaelsen K.F.
        Cow's milk and linear growth in industrialized and developing countries.
        Annu Rev Nutr. 2006; 26: 131-173
        • Melnik B.C.
        Evidence for acne-promoting effects of milk and other insulinotrophic dairy products.
        Nestle Nutr Workshop Ser Pediatr Program. 2011; 67: 131-145
        • Melnik B.C.
        Dietary intervention in acne: Attenuation of increased mTORC1 signaling promoted by Western diet.
        Dermatoendocrinol. 2012; 1: 20-32
        • Silverberg N.B.
        Whey protein precipitating moderate to severe acne flares in 5 teenaged athletes.
        Cutis. 2012; 90: 70-72
      2. Cordain L. Implications for the role of diet in acne. Semin Cutan Med Surg. 205;24(2):84-91.

        • Lewis R.A.
        • Austen K.F.
        • Soberman R.J.
        Leukotrienes and other products of the 5-lipoxygenase pathway.
        N Engl J Med. 1990; 323: 645-655
        • Zouboulis C.H.C.
        • Saborowski A.
        • Boschnakow A.
        Zileuton, an oral 5-lipoxygenase inhibitor, directly reduces sebum production.
        Dermatology. 2005; 210: 36-38
        • Gannon M.C.
        • Nuttall F.Q.
        • Westphal S.A.
        • Seaquist E.R.
        The effect of fat and carbohydrate on plasma glucose, insulin, C-peptide and triglycerides in normal male subjects.
        J Am Coll Nutr. 1993; 12: 36-41
        • Bhathena S.J.
        • Berlin E.
        • Judd J.T.
        • et al.
        Effects of omega 3 fatty acids and vitamin E on hormones involved in carbohydrate and lipid metabolism in men.
        Dermatology. 1991; 54: 684-688
        • Li Y.
        • Seifert M.F.
        • Ney D.M.
        • et al.
        Dietary conjugated linolenic acids alter serum IGF-1 and IGF binding protein concentrations and reduce bone formation in rats fed (n-6) or (n-3) fatty acids.
        J Bone Miner Res. 1999; 14: 1153-1162
        • Jenkins D.
        • Kendall C.
        • Augustin L.
        • et al.
        Glycemic Index: Overview of implications in health and disease.
        Am J Clin Nutr. 2002; 76: S266-S273
        • Venn B.J.
        • Green T.J.
        Glycemic index and glycemic load: Measurement issues and their effect on diet-disease relationships.
        Eur J Clin Nutr. 2007; 61: S122-S131
        • Riediger N.D.
        • Othman R.A.
        • Suh Miyoung
        • Moghadasian M.H.
        A systemic review of the roles of n-3 fatty acids in health and disease.
        J Am Diet Assoc. 2009; 109: 668-679
        • Brand-Miller J.
        • Ludwig D.S.
        Glycemic index and glycemic load, part A, overview.
        in: Nonas C.A. Foster G.D. Managing Obesity: A Clinical Guide. 2nd ed. American Dietetic Association, Chicago, IL2009: 38-41
        • Lehmann H.P.
        • Robinson K.A.
        • Andrews J.S.
        • et al.
        Acne therapy: A methodologic review.
        J Am Acad Dermatol. 2002; 47: 231-240


      J. Burris is a PhD candidate, Department of Nutrition, Food Studies, and Public Health, Steinhardt School of Culture, Education, and Human Development, New York University, New York.


      K. Woolf is an assistant professor of Nutrition, Department of Nutrition, Food Studies, and Public Health, Steinhardt School of Culture, Education, and Human Development, New York University, New York.


      W. Rietkerk is an associate professor of Dermatology, Department of Dermatology, New York Medical College, New York.