Complementary, Holistic, and Integrative Medicine: Acne

Anju Sawni; Amritpal Singh

doi:10.1542/pir.34-2-91

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Anju Sawni, MD*
Amritpal Singh, MD^†

^*Pediatric Education, Hurley Children’s Hospital/Hurley Medical Center, Flint, MI.
^†Department of Dravyaguna (Medicinal Plants), Sri Dhanwantry Ayurvedic College, Chandigarh, India.

Author Disclosure
Drs Sawni and Singh have disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

EFAs:: essential fatty acid
LTB4:: leukotriene B4

Introduction

Acne vulgaris is a common skin disorder that affects ∼70% to 87% of adolescents and young adults. (1) The pathogenesis of acne is multifactorial and complex, and is thought to be due to androgen-stimulated sebum production. This production leads to follicular occlusion and hyperkeratinization, with comedo formation, as well as microbial colonization of pilosebaceous follicles by Propionibacterium acnes, leading to inflammatory papules and pustules. Conventional treatments for acne include salicylic acid, benzoyl peroxide, retinoids, and antibiotics (topical and systemic). However, symptoms may not always improve, and patients may have adverse reactions to conventional treatments and thus seek alternative treatments. Antibiotic resistance in P acnes also has been rising, thus promoting the need to look at alternative therapies. (2)

Dietary and Lifestyle Factors

The influence of diet on acne has been debated for decades. One review of the literature looking at the evidence for diet, face washing, and sunlight exposure in acne management concluded that the evidence is incomplete at best. (3) Another review did not support any link between acne and foods such as dairy products, chocolate, and fatty foods. (4) However, with more recent focus on diet and nutritional supplements, emerging research suggests that diet may be a factor, particularly in mediating the inflammation and oxidative stress of the acne process. (5)(6)(7)

Western diets, with characteristically high glycemic indices, can elevate insulin and insulin-like growth factor 1 levels acutely and chronically. (5) These hormones stimulate adrenal and gonadal androgen production, leading to increased sebum production and acne. Frequent consumption of high-glycemic-index carbohydrates may repeatedly expose adolescents to acute hyperinsulinemia. Therefore, a low-glycemic-load diet may have a beneficial effect on acne. (6)

A review …