Factors contributing to acne development have long been debated. The link between diet and acne, specifically, is a popular topic. Our objective was to describe the evolution of thought regarding diet and acne. When descriptions of acne were first published in the 1800s, diet was presumed to play a role. Recommendations ranged from avoiding vegetables, stimulants, and alcohol to consuming a simple diet of milk, starchy foods, and red meat. Works from between 1900 and 1940 also suggested avoiding alcohol, in addition to sugary and fried foods, eggs, and gravy. Starchy foods were debated: while some claimed carbohydrate metabolism is not affected in acne, others advised against starch. Certain foods were purported to improve acne, including liver, fruit, oatmeal, green vegetables, and boiled meat. In the mid-1900s, chocolate and dairy were scrutinized. However, skepticism regarding the role of diet in acne grew in the 1960s and 1970s. Two studies found acne was not affected by large amounts of chocolate, and another study found no difference in sugar consumption between acne patients and controls. Diet was implicated in acne again in the 2000s. 21st century researchers critiqued the methodology of the well-cited 1969 chocolate and acne study. Observations from 1974, 2002, and 2012 suggest the role of Western diet in acne pathogenesis, corroborated by randomized controlled trials. More recently, reports suggest connections between acne and milk as well as whey protein supplements. As controlled trials become more common, researchers continue to gain greater understandings of diet and acne.
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