The question of whether what we eat directly impacts acne remains a hot topic, sparking a lively debate among dermatologists. While many patients and parents firmly believe in a connection, the scientific community is still grappling with definitive answers. A recent discussion at the European Academy of Dermatology and Venereology (EADV) Congress highlighted the divide, pitting strong biological theories against a call for more robust clinical evidence.
One side, championed by Dr. Brigitte Dréno, emphasizes the biological plausibility. She points to how high-sugar and high-lipid diets can trigger inflammation and affect molecular pathways that contribute to acne. From her perspective, it’s undeniable that diet plays a role, and she regularly counsels patients to avoid foods she links to breakouts. Dr. Dréno cites evidence, including meta-analyses, supporting the idea that high-glycemic diets can increase inflammation mediators like insulin growth factor 1, while fatty acids can upregulate inflammatory cytokines.
On the other hand, Dr. Clio Dessinioti argues that the clinical evidence to support a direct, causal link is largely theoretical and insufficient for making specific dietary recommendations. She references major guidelines from bodies like NICE and the AAD, which advocate for a balanced diet but refrain from endorsing specific diets for acne treatment due to a lack of high-quality randomized controlled trials (RCTs). Dr. Dessinioti cautions against unreliable internet information and emphasizes that “associations simply do not mean causation,” suggesting that other factors like genetics or body weight might better explain observed differences in acne rates, such as those in non-Western populations.
The core of the disagreement lies in the type and quality of evidence. While biological mechanisms offer compelling hypotheses, Dr. Dessinioti maintains that robust, placebo-controlled clinical trials are essential to confirm causation. She highlights the difficulty in controlling for variables like medication use and the unpredictable nature of acne flares in diet studies. Both sides agree on the urgent need for more definitive research, with Dr. Nichole Joanne Jouan, the debate moderator, echoing the sentiment that well-designed trials are needed to finally resolve this persistent question, especially given how often patients link their acne flares to specific foods.
