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Acne highly influenced by climate, pollutants, and unhealthy diet

Presented by
Dr Delphine Kerob, Vichy Laboratories, France
EADV 2019
In an online survey comparing more than 2,800 acne patients to participants without acne, climatic factors, air pollutants, milk products, and sweets as well as a harsh skin routine were identified as exposome factors that affect acne [1].

The exposome comprises all internal and external environmental factors that impact the onset, duration, and severity of a disease. To define the impact of the exposome on acne, an international study was performed in 6 countries (i.e. France, Germany, Italy, Brazil, Canada, and Russia). A total of 10,040 individuals were recruited and data from 6,679 participants was analysed (acne group n=2,826; control group n=3,853). Eligible for inclusion were acne patients who declared that their acne had been diagnosed by a physician or who had benefitted from an acne treatment prescribed by a physician. All participants filled out an online survey designed to evaluate 6 main exposome factors, climate, nutrition, and pollution.

With regard to climatic factors, acne patients lived significantly more often in a particularly hot climate (P<0.001 vs non-acne patients). A significant higher percentage of acne patients had an intense or moderate exposure to the sun in their work or daily activities. “Although sun exposure can improve acne, there are often flares after sun exposure,” explained Dr Delphine Kerob (Vichy Laboratories, France) who supported the study.

People with acne were also significantly more exposed to pollutants (i.e. tars, solvent vapours, oil vapours) than those without (P<0.001 for each comparison). Those affected by acne lived significantly more often near the airport or in an area with factories with chimneys (P<0.001 for each comparison).

Western diet aggravates acne vulgaris

Significant differences were also seen with regard to nutrition. Acne patients more often consumed cow´s milk on a daily basis (48% vs 39%, P<0.001), sodas, juices and syrups (35% vs 31%; P<0.001), baked goods, cakes, or pastries (40% vs 28%; P<0.001), chocolate (37% vs 28%; P<0.001), or sweets (23% vs 19%; P<0.001). In addition, they reported more frequently to snack on sugary foods between meals (62% vs 43% ; P<0.001). Whey proteins were consumed more often by acne patients than people without acne (11% vs 7.3%; P<0.001). This is in line with an earlier study that found a close link between acne and a western diet containing refined carbohydrates, milk and dairy products, and saturated fats. This led via multiple pathways to a Th17 activation resulting in inflammation and comedogenesis [2]. Another surprising finding was that 12% of acne patients had used an anabolic steroid or testosterone-based hormonal drug within the previous 12 months, compared with 3.2% of controls without acne.

Skincare routines can also influence acne: the use of facial scrubs, harsh cleansers, and dermarollers was significantly more common among acne patients. “A lot of patients used scrubs that can be responsible for mechanical acne,” commented Dr Kerob. Taken together, identifying and reducing the impact of the exposome is important for an adequate disease-management of acne.

    1. Kerob B, et al. Late-breaking abstract D3T01.1G, EADV 2019, 9-13 Oct, Madrid, Spain.
    2. Melnik MC. Clin Cosmet Investig Dermatol 2015;8:371-88.


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