Dermatology: Practical and Conceptual Research | Dermatol Pract Concept 2015;6(2):5 21 DERMATOLOGY PRACTICAL & CONCEPTUAL www.derm101.com Introduction Research on the link between diet and acne goes back decades. In the 1960s, several research groups studied this subject, and one of the largest studies involved 65 patients. Over a four- week period, subjects were administered either a chocolate bar or a placebo bar, and no difference in acne severity was seen [1]. Based on such studies, patients were counseled Diet and acne: an exploratory survey study of patient beliefs Quynh-Giao Nguyen1, Ramsey Markus1, Rajani Katta1 1 Department of Dermatology, Baylor College of Medicine, Houston, TX, USA Key words: acne, diet, Internet, dermatologist, foods Citation: Nguyen QG, Markus R, Katta R. Diet and acne: an exploratory survey study of patient beliefs. Dermatol Pract Concept 2016;6(2):5. doi: 10.5826/dpc.0602a05 Received: November 6, 2015; Accepted: January 10, 2016; Published: April 30, 2016 Copyright: ©2016 Nguyen et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: None. Competing interests: The authors have no conflicts of interest to disclose. All authors have contributed significantly to this publication. Corresponding author: Rajani Katta, MD, Professor of Dermatology, Baylor College of Medicine, 1977 Butler Blvd, 6th Floor, Suite E6.200, Houston, TX 77030, USA. Email: info@kattamd.com Background: In the past, medical literature reflected that diet was not a proven cause of acne. How- ever, studies in recent years have substantiated a link between certain dietary factors and acne. It is unclear whether patients are aware of recent research findings. Objectives: Acne patients were surveyed to explore beliefs regarding the link between diet and acne, to determine whether these beliefs translated into behavior change and to identify health information sources. Patients/Methods:  Upon Institutional Review Board (IRB) approval, surveys were administered to 50 acne patients at an academic dermatology clinic in 2014, with 49 completed in full and included in this analysis. Results: Ninety-two percent of respondents believed that diet could affect acne. Seventy-one percent attempted to change their diet to improve acne. Seventy-one percent believed acne to be caused by fried or greasy foods, although chocolate (53%), dairy (47%), and soda drinks (35%) were highly implicated. Patients obtained information from Google searches (49%), dermatologists (43%), family members and TV (41% each), and medical websites (31%). Conclusions: In this exploratory study, patients reported utilizing a diversity of information sources, a majority from the Internet. In those surveyed, there was a persistence of long-held belief that fried/ greasy foods and chocolate may serve as acne triggers, and less belief in trigger foods supported by re- cent research, including refined carbohydrates and sugar. Given the multiplicity of beliefs and utilized sources among acne patients in our survey, there is a need to establish up-to-date and reliable methods to educate patients on diet and acne. ABSTRACT 22 Research | Dermatol Pract Concept 2016;6(2):5 This study was designed to be an initial, exploratory survey study of current patient perceptions about the link between diet and acne. The aim was to identify common beliefs, misconceptions, and current information sources regarding the connection between diet and acne. As in other exploratory survey studies [13], these findings would help indicate directions for future research and would be of benefit to clinicians when counseling patients. Materials and methods This protocol was approved by the Baylor College of Medi- cine Institutional Review Board. Patients presenting to an academic dermatology clinic for the treatment of acne or acne scarring were asked if they wished to participate in a survey study about the link between diet and acne. If so, they completed a self-administered questionnaire prior to the physician visit. Subjects were asked to classify their acne from mild to severe, based on their personal perception of the disease’s impact. Demographic data, such as age, gender, weight, height, and education level, was included in the questionnaire. Surveys were administered from March to November of 2014. Results Of the 50 questionnaires administered, 49 were completed in full and were included in the analysis. The mean age of that diet did not impact acne. This belief was reflected in textbooks, patient information brochures, and the medical literature [2]. However, later researchers noted methodological flaws in the original study, including the fact that the placebo bar contained a similar total sugar and fat content as the choco- late bar [3]. Further studies have now correlated a number of dietary factors and acne. The strongest studies to date indicate that dietary glycemic load may contribute to acne. A randomized controlled trial of Australian males [4] dem- onstrated significant improvement of acne severity after 12 weeks of adherence to a low-glycemic-load diet, compared to the high-glycemic-load diet control group. Follow-up studies [5,6] have noted that switching to a low glycemic diet led to better insulin sensitivity, lower androgen bioavailability, and altered skin sebum production. It is not known, however, what role individual differences, duration of dietary changes, and other factors play in this association. Therefore, studies such as Di Landro et al.’s [7] have documented the opposing view that weekly consumption of cakes, sweets, and choco- late—foods high in glycemic load—was not associated with a higher risk of acne. In addition, researchers examining the link between dairy consumption and acne have noted some association. Stud- ies [8,9,10] have demonstrated this link in three separate populations, though in each instance the correlation results were considered relatively weak. Closer evaluation of this link revealed that only skim milk showed a statistically sig- nificant correlation with acne, perhaps due to its increased processing and/or decreased estrogen content in comparison to whole milk [8]. A number of other dietary factors have been studied for their potential role in improving acne. For example, an inverse relationship has been found between acne severity and con- sumption of omega-3-rich fish [11,7] with the mechanism of action postulated as omega-3-mediated reduction of inflam- matory acne [12]. While some promising results have been noted from in vitro or animal studies, studies in humans are limited, and each of these dietary factors requires further investigation before recommendations may be made to patients. These include foods or supplements containing vita- min A, omega-3 fatty acids, zinc, antioxidants, and fiber. [12]. Given that the scientific literature on this topic is rapidly evolving, it would be expected that patients might receive conflicting advice. Patients have long held certain beliefs about diet and acne, including the common perception that fried, greasy foods would lead to oily skin and acne. However, it is not known whether patients are aware of the research findings that support a link between specific dietary factors and acne. Patients seek out and receive medical information from multiple sources, and current patient beliefs about diet and acne are not known. TABLE IA. Sample characteristics, N (%). [Copyright: ©2016 Nguyen et al.] Gender Male 11 (22.4) Female 38 (77.6) Age 16-19 5 (10.2) 20-29 24 (48.9) 30-39 17 (34.7) 40-45 3 (6.1) BMI <18.5 3 (6.1) 18.5-24.9 31 (63.3) 25-29.9 13 (26.5) 30+ 2 (4.1) Education