Nutrition, Stress, Environment and Their Association With Acne

woman with acne on her chin
woman with acne on her chin
Nutrition, pollution, stress, and harsh skin care -- climate and sun exposure, too -- may be the most frequent contributing factors to acne, according to a large, international study.

Acne is associated with a variety of external and internal exposures, including nutritional, environmental, stress, and medicinal factors, according to study results published in the Journal of The European Academy of Dermatology and Venereology.

Many external and internal exposures that affect skin health and the skin microbiota have been suggested to play a role in exacerbation of acne. Researchers aimed to determine the association of these exposures, including nutrition, pollution, stress, climate, and tobacco use, with acne by using an international, real-life patient survey.

An anonymized survey was conducted via the Internet between December 2018 and January 2019 and collected responses from individuals 15 to 39 years of age in France, Germany, Italy, Brazil, Canada, and Russia. Responses from 6679 participants (42.3% with acne; 62.5% women) were used for further analysis. Demographics were similar in the 2 groups, except for body mass index, which was higher (P <.001) in the participants with acne.

Several nutritional factors were found to be associated with acne, including dairy consumption (odds ratio [OR], 1.21; 95% CI, 1.1-1.35; P <.001), nibbling (OR, 3.57; 95% CI, 3.0-4.25; P <.0001), consumption of whey proteins (OR, 3.94; 95% CI, 3.29-4.71; P <.0001), and consumption of probiotics (OR, 1.65; 95% CI, 1.44-1.89; P <.0001). Acne was also associated with consumption of sweets, chocolate, pastry, and soft drinks (P <.0001 for all). Stressful or harsh skin care routines consisting of essential or plant oils, scrubs, peels, or use of an electric brush were all associated with acne (P <.001 for all). Acne was also significantly more frequent in individuals who were regularly exposed to pollutants, who lived in hot or humid regions, and who received regular moderate to intensive sun exposure.

When asked to rate their stress level on a scale of 0 (none) to 10 (very high), participants with acne reported significantly higher stress levels (5.9±2.3) than those without acne (5.0±2.7; P <.001). The frequency of individuals experiencing extremely high levels of stress was also higher in those with acne (51.0%) than in acne-free individuals (29.0%; P <.001). Sleep disturbances were more commonly reported in individuals with acne than in those without (54.6% vs 47.6%; P <.001). Screen exposure prior to sleep was also higher in individuals with acne (91.3%) than in those without acne (85.2%; P <.001).

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Use of oral contraceptives was higher in individuals with acne (39.0%) than in acne-free individuals (30.5%; P <.001). However, in participants with acne, 42.7% reported that they believed the use of oral contraceptives reduced their acne, compared with only 20.8% who thought it increased their acne. An additional 26.5% of respondents thought it had no effect on their acne, compared with 79.5% of acne-free individuals who reported no effect on their skin.

Tobacco use and residence in temperate or cold regions were not significantly associated with acne prevalence. Legal restrictions on cannabis use in some regions resulted in a sample size of individuals that was insufficient to draw conclusions about the association between cannabis consumption and acne.

The authors acknowledge that the use of an anonymous Internet survey introduces several limitations to the study, including possible incorrect diagnosis of acne by participants.

“Our data confirm that among the questioned internal and external exposome factors, nutrition, pollution, stress, harsh skin care, temperature, humidity and sun exposure had a significant impact on acne,” the researchers concluded. To account for the influence of such a wide variety of internal and external factors, they also note, “[A] holistic approach is necessary for the efficient management of acne.”

Disclosure: This study was funded by Laboratoires Vichy, France.

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Dreno B, Shourick J, Kerob D, Bouloc A, Taïeb C. The role of exposome in acne: results from an international patient survey [published online November 30, 2019]. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.16119