We are often asked about the role that food or diet plays in skin conditions. While we don’t have all the answers, we know that diet affects both the skin and general health. The following are the latest evidence-based recommendations.

Diet and Acne
Sugar and processed carbohydrates are pro-inflammatory and can cause an exacerbation of acne. Following a low-glycemic load diet is generally beneficial for overall health and can give improvement of acne. We suggest limiting intake of high carb foods such as soda, fruit juice, energy drinks, smoothies, milk shakes, ice cream, candy, white bread, white pasta, white rice, ready to eat cereals, etc. In some people, consumption of dairy products can trigger acne. Several types of supplements have been linked to acne. Whey protein, typically taken by bodybuilders, has been linked to acne flares on the face and body. “Muscle building supplements” often have anabolic or androgenic steroids which can worsen acne. High doses of Vitamins B6 and B12 have been linked to acne. Excess iodine, found in kelp seaweed, can also worsen acne.

Diet and Rosacea
Known rosacea triggers include alcohol, hot beverages, and spicy foods which contain capsaicin. Other potential triggers include tomatoes, chocolate, cinnamon, and citrus. Rosacea has also been linked to various gastrointestinal conditions, including irritable bowel syndrome and small intestinal bacterial overgrowth. A gut-healthy diet, including an increased intake of fiber, may be beneficial. Patients should consider keeping a food diary and trying to eliminate suspected rosacea triggers from their diet.

Diet and Dermatitis
Patients with atopic dermatitis or eczema (sensitive, dry, itchy, inflamed skin) often have food allergies. In some patients, food allergies can actually trigger a flare of skin disease. Common triggers include milk, eggs, wheat, seafood, nuts, and soy. Reactions to food may occur soon after ingestion, or as late as 48 hours after exposure. Patients should keep a food diary if food allergies are suspected. Consumption of “healthy” fats rich in polyunsaturated fatty acids, such as flaxseed oil or fish oil, may be beneficial. We also recommend a diet high in fiber, including fruits, vegetables, and whole grains, to promote a healthy gut. Natural fiber is called a prebiotic because it encourages the growth of healthy gut bacteria. Foods with live active cultures such as yogurt (probiotics) may also be helpful.

Diet and Psoriasis
Patients with psoriasis have a higher risk for diabetes, high blood pressure, high cholesterol, obesity, and heart disease. Psoriasis patients should follow a heart-healthy diet such as the Mediterranean diet (high in fiber, whole grain, olive oil, nuts, seeds, with moderate intake of fish and decreased intake of red meat and processed carbohydrates). Reducing salt/sodium intake can help to reduce blood pressure. Psoriasis patients should be screened for diabetes. Overweight and obese patients who lose weight may notice an improvement in their psoriasis. It may be beneficial for psoriasis patients to see a nutritionist. Patients with psoriasis may have an increased risk of celiac disease and gluten sensitivity. Some patients may benefit from a gluten-free diet. It may be beneficial to test for gluten antibodies as 1 in 7 psoriasis patients will have gluten antibodies.

Diet and Aging
Dietary antioxidants have been found to reduce cellular damage from UV exposure. We recommend increased consumption of foods rich in antioxidants, including fruits, vegetables, whole grains, spices, and herbs. Specific antioxidants include lycopene (in tomatoes), ellagic acid (raspberries), genistein (soy), curcumin (turmeric), quercetin (onions), resveratrol (grapes), and polyphenols (green tea). A diet high in vitamins A and C has been correlated with fewer wrinkles. Intake of healthy fats, such as those found in olive oil and fish, can help to reduce inflammation. We also recommend reducing intake of processed carbohydrates or sugars by limiting intake of soda, fruit juice, candy, or other high carbohydrate foods. A high glycemic load diet leads to glycation, whereby glucose binds to proteins, and can accelerate collagen damage and reduce skin elasticity.

PLANT-BASED DIET
Most of the above diet recommendations are based on following a mostly plant-based diet. The foundation of the plant-based diet is vegetables, fruit, herbs, nuts, beans, and whole grains. Moderate amounts of meat, including fish, dairy, poultry, and eggs, are added on top of the plant-based foundation. Red meat is eaten only on occasion. Alcohol, which has been linked to cancer, is consumed only in moderation.

We are grateful for the information provided by Dr. Rajani Katta in Diet in Dermatology. The Dermatologist, 2018;26(11).

For further information see skinanddiet.com.