Acne
How Obesity Increases Acne
Acne vulgaris can be categorized by areas of the skin with Seborrhea (scaly red skin), comedones (black- and whiteheads), papules (pinheads), pustules (pimples), nodules (large papules and scarring. (1) Acne is an almost universal disease affecting from 79% to 95% of the pubescent population in developed countries and while 40% to 50% of men and women older than 25 years have some degree of facial acne, the condition persists into middle age in 12% of women and 3% of men. (2) Between the ages of 12 and 18, acne is a common skin disorder affecting almost 80% of the population. (3)
Much debate exists amongst dermatologists as to the effects of obesity on acne. It is a widespread belief that acne is caused by issues such as stress, fatty foods, poor hygiene or sweating. These things can worsen acne if the condition is preexisting, for instance a diet that is high in sugar causes large amounts of sebum (oil) to be trapped in the skin’s follicles. None of these, however, prove to be significant as the sole cause of acne. Obesity can also change skin physiology so it may have an indirect affect on acne vulgaris. (4) (5) (6) (7) (8)
Teenage acne and BMI
During puberty the body undergoes major physical changes creating the perfect environment for acne.
The major pathogenic factors are: the rise in the level of puberty hormones cause a rise in sebum (oil) in the pores leading to acne. (9) Then that can lead to hyperkeratinization, a disorder of the cells lining the inside of the hair follicle. These cells normally detach from the skin lining in normal intervals and the dead cells depart through the follicle opening or pore. In hyperkeratinization the dead cells remain within the follicle, due to an excess of keratin, the natural hormone found in the skin. These dead cells bond together and clog the hair follicle or sebacouse (oil duct), leading to acne. (10) (11)
During puberty, obesity and a larger body mass index may aggravate acne. The body mass index (BMI) is defined as the ratio of body weight to height. A person is obese if their BMI is larger than 30. (12) In a study it was found that though the test group’s (persons with acne) BMI was within normal ranges, this group’s BMI was still significantly higher than the control group’s (non-acne persons) BMI ranges. Acne is not just a condition of the teens, thus it is appropriate to look for underlying factors which can cause both acne and obesity. (13)
According to an American study, adolescents are starting puberty earlier than has been previously shown. This early onset of puberty is correlative to a higher BMI in pre-pubescent girls, especially within the African-American population. Thus, if a higher BMI directly correlates to early puberty, it may also correlate to early acne development. As obesity causes changes in the hypothalamic-pituatary-gondal axis, changing the puberty hormone levels, this can in turn lead to an increase in sebum (oil) in the pores. (14) (15)
Glycemic carbohydrate foods’ effect on acne and obesity
The glycemic index (or GI) ranks carbohydrates according to their effect on the blood glucose level. The physical form of the food we eat also determines how quickly our digestive enzymes can react with and metabolize food. High GI foods cause the blood glucose levels to rise, while low GI foods do not raise the blood glucose level. A case can be argued for the indirect relationship between obesity and acne, if the obesity is due to a high carbohydrate diet, which may also inflame preexisting acne. (16)
In a clinical trial, 43 male patients ages 15-25 took part in a 12-week program. Their diet comprised of low-glycemic foods, where 25% of their energy intake came from protein while 45% came from low-glycemic-index carbohydrates. The control group consumed mostly carbohydrate-dense foods without reference to the glycemic index. Total lesion counts decreased more in the test group than the control group. Eating low-glycemic foods will not only help with weight loss, but may also not aggravate further a preexisting acne vulgaris. (17)
Sex hormone level with acne patients
The female menstrual cycle is divided into three phases: the follicular phase, ovulation, and the luteal phase. During the luteal phase progesterone is released causing body-core temperature elevation and may be a contributing factor in acne symptom aggravation. (18)
In a study conducted on female patients with acne, it was found that luteinizing hormone (LH), follicle-stimulating hormone (FSH) and estradiol 2 hormone (E2) puberty hormones were all lower than those of the control group (non-acne group - 33 cases). While the level of testosterone (T) was not significantly different, however, the level of progesterone in the female acne test group was significantly higher than that of the control group. The level of LH, FSH of male test group (acne group) were all lower than the control group, E2 and T hormone levels were not significantly different. (19)
This significant rise in progesterone in the female test group suggests that acne can be connected to progesterone levels in female acne patients, as post-pubescent females may experience acne during the last phase of the menstrual cycle. (20)
Acne and obesity
Obesity and a higher BMI has been shown to correlate with early puberty, thus leading to early acne development. Obesity may causes changes in the hypothalamic-pituatary-gondal axis, changing the puberty hormone levels, specifically progesterone levels, which may account for acne in not just obese teenagers but post pubescent females.
Acne treatments
Many treatments have been shown to have an effect on acne. The best results can be reached by consulting a dermatologist to suit each individual’s specific needs, as most acne responds to a combination of treatments. Amongst these are: topical retinoids (in the case of mild inflammation of comedones), oral antibiotics (in severe inflammation cases), hormone therapy, dermatological and cosmetic creams and tonics, and losing weight to relive the strain on the endocrine system. It should also be noted that topical retinoids can reduce outbreaks and inflammation by 40-70% and long-term anti-biotical treatment should be avoided as bacterial resistance may occur. (21) (22)
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(1) Definition of Body mass index, April 27, 2011. Retrieved July 8th, 2011, http://www.medterms.com/script/main/art.asp?articlekey=16125
(2) CORDAIN Loren ; LINDEBERG Staffan ; HURTADO Magdalena; Acne vulgaris: A disease of western civilization PMID : 12472346 ISSN : 0003-987X CODEN : ARDEAC Archives of dermatology (1960) Y. 2002, vol. 138, No. 12, pages 1584-1590. Retrieved July 8th, 2011, www.ncbi.nlm.nih.gov/pubmed/12472346
(3) Min-Chien Tsai, Wen Chieh Chen, Yu-Wen Cheng, Cheng-Yu Wang, Guan-Yu Chen, Tzung-Jen Hsu. Higher body mass index is a significant risk factor for acne formation is schoolchildren. European Journal of Dermatology. Volume 16, Number 3, 251-3, May-June 2006. Retrieved July 8, 2011, www.ncbi.nlm.nih.gov/pubmed/16709487
(4) Clement A. Adebamowo, Donna Spiegelman, F. William Danby, A. Lindsay Frazier, Walter C. Willett, Michelle D. Holmes High school dietary dairy intake and teenage acne Journal of the American Academy of Dermatology - February 2005 (Vol. 52, Issue 2, Pages 207-214, DOI: 10.1016/j.jaad.2004.08.007). Retrieved July 8th, 2011, www.ncbi.nlm.nih.gov/pubmed/15692464
(5) Gil Yosipovitch, Amy DeVore, Aerlyn Dawn. Obesity and the skin: Skin physiology and skin manifestations of obesity. Journal of the American Academy of Dermatology - June 2007. Retrieved July 8th, 2011, www.ncbi.nlm.nih.gov/pubmed/17504714
(6) Ines Brajac, Lidija Bilić-Zulle, Mladenka Tkalčić, Karmen Lončarek, Franjo Gruber. Acne vulgaris: myths and misconceptions among patients and family physicians. Patient Education and Counseling - July 2004. Retrieved July 8th, 2011, www.ncbi.nlm.nih.gov/pubmed/15210256
(7) Toyoda, Masahiko, Morohashi, M. Pathogenesis of acne. Medical Electron Microscopy. 2001. Springer Japan. Pg. 29-40. Volume: 34 Issue 1. Retrieved July 8th, 2011, www.ncbi.nlm.nih.gov/pubmed/11479771
(8) Definition of Body mass index, April 27, 2011. Retrieved July 8th, 2011, http://www.medterms.com/script/main/art.asp?articlekey=16125
(9) Diane Thiboutot MD. Hormones and acne: Pathophysiology, clinical evaluation, and therapies. Seminars in Cutaneous Medicine and Surgery, 2001 - Elsevier. Retrieved July 8th, 2011, www.ncbi.nlm.nih.gov/pubmed/11594669
(10) Eugene J. Van Scott, Ruey J. Yu, Hyperkeratinization, corneocyte cohesion, and alpha hydroxy acids, Journal of the American Academy of Dermatology, Volume 11, Issue 5, Part 1, November 1984, Pages 867-879, ISSN 0190-9622. Retrieved July 8th, 2011, www.ncbi.nlm.nih.gov/pubmed/6096420
(11) Definition of Body mass index, April 27, 2011. Retrieved July 8th, 2011, http://www.medterms.com/script/main/art.asp?articlekey=16125
(12) Obesity, Wikipedia. Retrieved July 8th, 2011, http://en.wikipedia.org/wiki/Obesity
(13) Min-Chien Tsai, Wen Chieh Chen, Yu-Wen Cheng, Cheng-Yu Wang, Guan-Yu Chen, Tzung-Jen Hsu. Higher body mass index is a significant risk factor for acne formation is schoolchildren. European Journal of Dermatology. Volume 16, Number 3, 251-3, May-June 2006. Retrieved July 8, 2011, www.ncbi.nlm.nih.gov/pubmed/16709487
(14) Paul B. Kaplowitz, Eric J. Slora, Richard C. Wasserman, Steven E. Pedlow, and Marcia E. Herman-Giddens Earlier Onset of Puberty in Girls: Relation to Increased Body Mass Index and Race Pediatrics 2001; 108:2 347-353. Retrieved July 8th, 2011, www.ncbi.nlm.nih.gov/pubmed/11483799
(15) George A. Bray. Obesity and reproduction. Hum. Reprod. (1997) 12(suppl 1): 26-32 doi:10.1093/humrep/12.suppl_1.26. Retrieved July 8th, 2011, humrep.oxfordjournals.org/content/12/suppl_1/26.full.pdf
(16) Glycemic index, Wikipedia. Retrieved July 8th, 2011, http://en.wikipedia.org/wiki/Glycemic_index
(17) A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Robyn N Smith, Neil J Mann, Anna Braue, Henna Mäkeläinen and George A. Varigos. American Journal of Clinical Nutrition, Vol. 86, No. 1, 107-115, July 2007. Retrieved July 8th, 2011, http://www.ajcn.org/content/86/1/107.short
(18) Menstrual cycle, Wikipedia. Retrieved July 8th, 2011, http://en.wikipedia.org/wiki/Menstrual_cycle
(19) Shi Weiming; Chen Deli; Piao Yinlan; Zou Soughai. Study on serum sex hormones level with acne patients (Department of Dermatology, Gan Quan Hospital, Medical College of Shanghai Tiedao University. Retrieved July 8th, 2011, www.ncbi.nlm.nih.gov/pubmed/2426899
(20) Menstrual cycle, Wikipedia. Retrieved July 8th, 2011, http://en.wikipedia.org/wiki/Menstrual_cycle
(21) Aamir Haider, James C. Shaw Treatment of Acne Vulgaris JAMA. 2004;292(6):726-735.doi:10.1001/jama.292.6.726. Retrieved July 8th, 2011, jama.ama-assn.org/content/292/6/726.full
(22) Acne vulgaris, Wikipedia. Retrieved July 8th, 2011, http://en.wikipedia.org/wiki/Acne_vulgaris