COMMENTARY

Does Dairy Cause Acne?

Graeme M. Lipper, MD

Disclosures

September 02, 2016

Consumption of Dairy in Teenagers With and Without Acne

LaRosa CL, Quach KA, Koons K, et al
J Am Acad Dermatol. 2016;75:318-322

The role of dietary triggers in acne vulgaris remains controversial but is one of the most frequent inquiries made by acne patients and their parents. Acne is caused by a myriad of genetic, hormonal, and mechanical factors. In 2002, Cordain and colleagues[1] reinvigorated the "acne-genic" food debate with the observation that Pacific Islanders developed acne only after adopting Westernized diets. Subsequent nutritional studies showed links between acne, high–glycemic index diets,[2] and high dairy intake, especially low-fat and skim milk.[3]

To further explore this potential dairy-acne connection, LaRosa and coworkers conducted a case-control study to investigate the diets of 120 teenagers aged 14-19 with moderate acne vulgaris compared with those of 105 acne-free controls. Acne and control groups were comparable in regard to age, gender, ethnicity, and body mass index. Participant diets were characterized via phone interviews using the Nutrition Data System for Research. Statistical analysis of acne versus control groups revealed the following associations:

  • Total dairy consumption was slightly higher in the acne group.

  • Low-fat/skim milk consumption correlated with having acne (0.61 servings of low-fat/skim milk per day in the acne group versus 0.41 servings of low-fat/skim milk per day in the control group; P =.01).

  • In contrast, whole milk consumption did not correlate with having acne.

  • Investigators found no link between acne and the mean dietary glycemic index; total daily calorie intake; intake of saturated or trans-fat; total carbohydrates; total protein; total fat; or percentage of calories from fat, protein, or carbohydrates.

Viewpoint

This large case-control study echoes prior reports linking low-fat and skim milk intake to a higher prevalence of acne vulgaris in teenagers. This effect may be due, at least in part, to stimulation of sebaceous glands via transient milk-induced elevations in insulin and insulin-like growth factor-1.[4]

As LaRosa and colleagues note, this modest association between low-fat dairy intake and acne does not establish causality. Furthermore, dairy-restriction diets have yet to show any clinically measurable benefit in reducing acne. Because milk contains a complex mixture of fatty acids, proteins such as casein, and the fat-soluble vitamins A and D, it remains unclear which, if any, of these components has a pro-acne effect. This is especially important because whole milk appears to show no pro-acne effects. In contrast, low-fat/skim milk elimination may benefit some teenagers with refractory acne, but clinical trials are needed to quantify this effect and to tease out which specific components of milk are responsible.

Abstract

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