What can you do about your lifestyle and diet to heal your skin? The graph below in this private beta tries to answer this by presenting the summarized results of the studies about acne and 26 systemic factors there is evidence for influence the disease.

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bmi < 18.5 female 2/10 saw incidence Number of Studies: 2 Agreement: 50% Evidence Grade: D One study show 24% lower prevalence of acne in girls with low BMI, another showed no statistical correlation. 1 Halvorsen, J. A., Vleugels, R. A., Bjertness, E., & Lien, L. (2012). A population-based study of acne and body mass index in adolescents. Archives of dermatology, 148(1), 131-132. Method 20 to 19 year old participants were asked how severe acne they had had the last week and what their height and weight was when last measured, to be able to calculate BMI. Result No statistical assosication between low female BMI and acne. Absolute Risk (>1 implies higher risk) 1 Trial Design Cross Sectional Participants 3584 Median Age & Gender 18 to 19, 50 % male, 50 % female 2 Di Landro, A., Cazzaniga, S., Parazzini, F., Ingordo, V., Cusano, F., Atzori, L., ... & Naldi, L. (2012). Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. Journal of the American Academy of Dermatology, 67(6), 1129-1135. Method Cases with moderate to severe acne from dermatologic outpatient clinics in Italy was compared to control subjects coming from dermatologic consultations other than for acne. Result Moderate to severe acne was strongly associated with a family history. The risk was reduced in people with lower body mass index with a more pronounced effect in male compared with female individuals. Absolute Risk (>1 implies higher risk) 0.78 Trial Design Case Control Participants 563 Median Age & Gender 17.2 +- 3.1, 50 % male, 50 % female Notes No control for energy intake

bmi < 18.5 male 3/10 saw incidence Number of Studies: 2 Agreement: 50% Evidence Grade: D Males with low BMI has a 35% lower risk of having acne in one study, another study found no association. 1 Di Landro, A., Cazzaniga, S., Parazzini, F., Ingordo, V., Cusano, F., Atzori, L., ... & Naldi, L. (2012). Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. Journal of the American Academy of Dermatology, 67(6), 1129-1135. Method Cases with moderate to severe acne from dermatologic outpatient clinics in Italy was compared to control subjects coming from dermatologic consultations other than for acne. Result Acne risk was reduced in people with lower body mass index with a more pronounced effect in male compared with female individuals. Absolute Risk (>1 implies higher risk) 0.65 Trial Design Case Control Participants 563 Median Age & Gender 17.2 +- 3.1, 50 % male, 50 % female Notes No control for energy intake 2 Halvorsen, J. A., Vleugels, R. A., Bjertness, E., & Lien, L. (2012). A population-based study of acne and body mass index in adolescents. Archives of dermatology, 148(1), 131-132. Method 21 to 19 year old participants were asked how severe acne they had had the last week and what their height and weight was when last measured, to be able to calculate BMI. Only participants with a lot or very much acne were selected. Result No statistical assosication between male bmi and acne. Absolute Risk (>1 implies higher risk) 1 Trial Design Cross Sectional Participants 3584 Median Age & Gender 18 to 19, 50 % male, 50 % female

bmi > 25 male <1/10 saw incidence Number of Studies: 3 Agreement: 66% Evidence Grade: C Two studies show no correlation between acne and high BMI, one shows a 16% higher incidence of acne compared to normal BMI 1 Halvorsen, J. A., Vleugels, R. A., Bjertness, E., & Lien, L. (2012). A population-based study of acne and body mass index in adolescents. Archives of dermatology, 148(1), 131-132. Method 19 to 19 year old participants were asked how severe acne they had had the last week and what their height and weight was when last measured, to be able to calculate BMI. Only participants with a lot or very much acne were selected. Result No statistical assosication Absolute Risk (>1 implies higher risk) 1 Trial Design Cross Sectional Participants 3584 Median Age & Gender 18 to 19, 50 % male, 50 % female 2 Bourne, S., & Jacobs, A. (1956). Observations on acne, seborrhoea, and obesity. British medical journal, 1(4978), 1268. Method Unselected soliders were surveyed for their acne history. Result No have any association between acne incidence and weight. Absolute Risk (>1 implies higher risk) 1 Trial Design Retrospective Cohort Participants 2720 Notes Possibly because serum levels of IGF-1 are highest during periods of the adolescent growth spurt and taper off in the 20s.In men over 20, BMI is correlated with acne incidence. Men with acne had a mean weight ot 10lb extra, wheares those without had a mean weight of 2.5lb under the mean. 3 Di Landro, A., Cazzaniga, S., Parazzini, F., Ingordo, V., Cusano, F., Atzori, L., ... & Naldi, L. (2012). Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. Journal of the American Academy of Dermatology, 67(6), 1129-1135. Method Cases with moderate to severe acne from dermatologic outpatient clinics in Italy was compared to control subjects coming from dermatologic consultations other than for acne. Result Moderate to severe acne was strongly associated with a family history. The risk was reduced in people with lower body mass index with a more pronounced effect in male compared with female individuals Absolute Risk (>1 implies higher risk) 1.16 Trial Design Case Control Participants 563 Median Age & Gender 17.2 +- 3.1, 50 % male, 50 % female Notes No control for energy intake

chocolate 2/10 saw lesion count Number of Studies: 3 Agreement: 66% Evidence Grade: B One study looking at 100% cocoa consumption, saw a 60% increase in non inflammatory lesion count, but two other studies found no association between chocolate consumption and acne. 1 Caperton, C., Block, S., Viera, M., Keri, J., & Berman, B. (2014). Double-blind, Placebo-controlled Study Assessing the Effect of Chocolate Consumption in Subjects with a History of Acne Vulgaris. The Journal of clinical and aesthetic dermatology, 7(5), 19. Method Participants consumed either capsules with unsweetened 100 percent coca, hydrolyzed geletain powder, or a combination of the two. Lesions were assessed through photographs. Result A statistically significant increase in acne lesions, but not controlled for calories consumed. Dosage 6 oz / day Effect Size 60 % Trial Design Randomized Controlled NP Trial Length 7 days Participants 13 2 Fulton, J. E., Plewig, G., & Kligman, A. M. (1969). Effect of chocolate on acne vulgaris. Jama, 210(11), 2071-2074. Method Half of participants ate a isocaloric candy bar with a high chocolate content, the other half ate a bar with no chocolate. Lesion count and sebum production was then measured. Result No difference between the two groups. On average eating either bar did not increase lesion count or sebum production. Dosage 4 oz / day Trial Design Randomized Controlled Trial Length 28 days Participants 65 Median Age & Gender Adolescents & young adults, 78 % male, 22 % female Notes 5 patients ate two bars a day, gaining weight in the process, but no discernable effect on sebum production was seen. Note that chocolate could aggrevate acne in people with sensitivity, which is not captured by averages. 3 Ismail, N. H., Manaf, Z. A., & Azizan, N. Z. (2012). High glycemic load diet, milk and ice cream consumption are related to acne vulgaris in Malaysian young adults: a case control study. BMC dermatology, 12(1), 13. Method Subjects were asked to record their food intake on two weekdays and one day on a weekend in a three day food diary. Body weight, height and body fat percentage were measured. Acne severity was assessed by a dermatologist according to the CASS scale. Result No difference between case and control groups Dosage na Absolute Risk (>1 implies higher risk) 1 Trial Design Case Control Trial Length 120 days Participants 88 Median Age & Gender 20 to 30, 50 % male, 50 % female Notes 5 days of food records over 4 months

dairy low fat milk boys 2/10 saw incidence Number of Studies: 2 Agreement: 100% Evidence Grade: C Consumption of low fat milk in boys is correlated with moderately increased acne lesion count 1 Tsoy, N. O. (2013). Effect of Milk and Dairy Products upon Severity of Acne for Young People. World Applied Sciences Journal, 24(3). Method Participants responded to a food questionnaire, and split in two groups, one with acne cases and one without. Result Found a positive association between intake of milk and acne. Dosage Daily Absolute Risk (>1 implies higher risk) 1.13 Trial Design Case Control Participants 182 Median Age & Gender Teenagers, 50 % male, 50 % female 2 Adebamowo, C. A., Spiegelman, D., Berkey, C. S., Danby, F. W., Rockett, H. H., Colditz, G. A., ... & Holmes, M. D. (2008). Milk consumption and acne in teenaged boys. Journal of the American Academy of Dermatology, 58(5), 787-793. Method Participants reported dietary intake on up to 3 food frequency questionnaires. Prevalence ratios for acne comparing highest with lowest intake categories were computed. Result Found a positive association between low fat milk and acne. Dosage >= 2 cup/day Absolute Risk (>1 implies higher risk) 1.17 Trial Design Prospective Cohort Trial Length 1095 days Participants 4 Notes Results were controlled for height and energy intake, comparing higest intake with lowest. BMI did not influence the result. Noticed small 1.08 positive correlation with Vitamin D intake.

dairy skim milk boys 3/10 saw incidence Number of Studies: 2 Agreement: 100% Evidence Grade: C Consumption of skim milk in boys is correlated with significantly increased acne lesion count, more so than low fat or whole milk. 1 Di Landro, A., Cazzaniga, S., Parazzini, F., Ingordo, V., Cusano, F., Atzori, L., ... & Naldi, L. (2012). Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. Journal of the American Academy of Dermatology, 67(6), 1129-1135. Method Cases with moderate to severe acne from dermatologic outpatient clinics in Italy was compared to control subjects coming from dermatologic consultations other than for acne. Result Increased risk with skim milk consumption. Trial Design Case Control Participants 563 Median Age & Gender 17.2 +- 3.1, 50 % male, 50 % female Notes No control for energy intake 2 Ismail, N. H., Manaf, Z. A., & Azizan, N. Z. (2012). High glycemic load diet, milk and ice cream consumption are related to acne vulgaris in Malaysian young adults: a case control study. BMC dermatology, 12(1), 13. Method Subjects were asked to record their food intake on two weekdays and one day on a weekend in a three day food diary. Body weight, height and body fat percentage were measured. Acne severity was assessed by a dermatologist according to the CASS scale. Result Acneic case group had higher glycemic load, milk and ice cream consumption. BMI and body fat was the same. Dosage >= 1 cup / week Absolute Risk (>1 implies higher risk) 1.25 Trial Design Case Control Trial Length 120 days Participants 88 Median Age & Gender 18 to 30, 34 % male, 66 % female Notes Boys and girls mixed. 3 days of food records sampled.

dairy whole milk boys 1/10 saw incidence Number of Studies: 2 Agreement: 100% Evidence Grade: C Consumption of whole milk in boys is correlated with slightly increased acne lesion count, but less so than low fat and skim milk. 1 Di Landro, A., Cazzaniga, S., Parazzini, F., Ingordo, V., Cusano, F., Atzori, L., ... & Naldi, L. (2012). Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. Journal of the American Academy of Dermatology, 67(6), 1129-1135. Method Cases with moderate to severe acne from dermatologic outpatient clinics in Italy was compared to control subjects coming from dermatologic consultations other than for acne. Result Increased risk with whole milk consumption, less than with skim milk. Dosage > 3 cups/day Absolute Risk (>1 implies higher risk) 1.1 Trial Design Case Control Participants 563 Median Age & Gender 17.2 +- 3.1, 50 % male, 50 % female Notes No control for energy intake 2 Adebamowo, C. A., Spiegelman, D., Berkey, C. S., Danby, F. W., Rockett, H. H., Colditz, G. A., ... & Holmes, M. D. (2008). Milk consumption and acne in teenaged boys. Journal of the American Academy of Dermatology, 58(5), 787-793. Method Participants reported dietary intake on up to 3 food frequency questionnaires. Prevalence ratios for acne comparing highest with lowest intake categories were computed. Result Found a positive association between intake of whole milk and acne. Dosage >= 2 cup/day Absolute Risk (>1 implies higher risk) 1.1 Trial Design Prospective Cohort Trial Length 1095 days Participants 4 Notes Results were controlled for height and energy intake, comparing higest intake with lowest. BMI did not influence the result. Noticed small 1.08 positive correlation with Vitamin D intake.

dairy whole milk girls 2/10 saw incidence Number of Studies: 2 Agreement: 100% Evidence Grade: C Consumption of whole milk in girls is correlated with slightly increased acne lesion count, but less so than skim milk. 1 Di Landro, A., Cazzaniga, S., Parazzini, F., Ingordo, V., Cusano, F., Atzori, L., ... & Naldi, L. (2012). Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. Journal of the American Academy of Dermatology, 67(6), 1129-1135. Method Cases with moderate to severe acne from dermatologic outpatient clinics in Italy was compared to control subjects coming from dermatologic consultations other than for acne. Result Increased risk with whole milk consumption, less than with skim milk. Dosage > 3 cups/day Absolute Risk (>1 implies higher risk) 1.1 Trial Design Case Control Participants 563 Median Age & Gender 17.2 +- 3.1, 50 % male, 50 % female Notes No control for energy intake 2 Adebamowo, C. A., Spiegelman, D., Berkey, C. S., Danby, F. W., Rockett, H. H., Colditz, G. A., ... & Holmes, M. D. (2006). Milk consumption and acne in adolescent girls. Dermatology online journal, 12(4). Method Participants reported dietary intake on up to 3 food frequency questionnaires. Prevalence ratios for acne comparing highest with lowest intake categories were computed. Result Found a positive association between intake of milk and acne. Dosage >= 2 cup/day Absolute Risk (>1 implies higher risk) 1.19 Trial Design Prospective Cohort Trial Length 730 days Participants 6 Notes The group drinking less than one glass of milk a day on average consumed 1736 vs 2217 calories in the 2 or more a day group. This 21% difference could indicate that the study did not adequately factor in energy intake, even though BMI was not different between groups.

food allergies <1/10 saw na Number of Studies: 2 Agreement: 50% Evidence Grade: D One study found no effect of improvement upon eliminating food that triggered an allergen response in 9 acneic subjects, another claims that 20% of acneic subjects saw a large positive effect from an elimination diet. 1 Wüthrich, B., & Much, T. (1977). [Acne vulgaris: results of food allergen tests and a controlled elimination diet (author's transl)]. Dermatologica, 157(5), 294-295.* Method n=9 with food allergies underwent resitriction diet. Result Intervention diet made no difference. Trial Design Open Uncontrolled Trial Length 90 days Participants 120 Notes Only abstract available. =0.3*0.2 2 Cormia, F. E. (1940). Food sensitivity as a factor in the etiology of acne vulgaris. Journal of Allergy, 12(1), 34-41. Method Elimination diet of patients with suspected food sensitivities, then counting the lesions Result 20% of the patients with acne in the practice of the author showed clinical evidence of food sensitivity ; 70 per cent of this group were greatly improved or cured by food eliminations. Effect Size 50 % Trial Design Open Uncontrolled Trial Length ? days Participants 32 Median Age & Gender ?, 31 % male, 69 % female Notes Required at least five papular or papulopustular extra lesions to say a food caused aggrevation of acne. Two strong reactions to mil, generation eight and ten extra lesion, the rest saw improvement on a strict milk diet (saturated fatty acid good?).

gamma linolenic acid 6/10 saw inflammatory lesion count Number of Studies: 1 Agreement: 100% Evidence Grade: B Supplementation with 400 mg Gamma Linolenic Acid / day for 10 weeks led to a 32% reduction in inflammatory acne lesions and 15% in non inflammatory lesions. 1 JuNG, J. Y., KWON, H. H., HONG, J. S., YOON, J. Y., PARK, M. S., JANG, M. Y., & SUH, D. H. (2014). Effect of Dietary Supplementation with Omega-3 Fatty Acid and gamma-linolenic Acid on Acne Vulgaris: A Randomised, Double-blind, Controlled Trial. Method Participants were given either 1000 mg EPA + 1000 mg DHA per day, or 200 mg GLA. Acne severity, ultrasonographic data on polycystic ovaries and hormonal parameters were measured in participants Result All lesions types decreased significantly with both EPA and GLA. Dosage 400 mg GLA / day Effect Size -32 % Trial Design Randomized Controlled Trial Length 70 days Participants 45 Median Age & Gender 17 to 33, 80 % male, 20 % female Notes Participants had mild to moderate acne. Looking at inflammatory lesion count, less improvement for non inflammatory lesions. No significant diff between Omega 3 and GLA supplementation. Start seeing significant resutls afte 1 month.

makeup use <1/10 saw incidence Number of Studies: 2 Agreement: 100% Evidence Grade: C Makeup users have 3% higher incidence of acne in one study, another study supports there is a correlation 1 Wu, T. Q., Mei, S. Q., Zhang, J. X., Gong, L. F., Wu, F. J., Wu, W. H., ... & Diao, J. X. (2007). Prevalence and risk factors of facial acne vulgaris among Chinese adolescents. International journal of adolescent medicine and health, 19(4), 407-412.* Method Chinese adolescents received questionnaires and physician examinations. The prevalence of acne vulgaris was calculated from the collected data. . Result Lack of sleep and cosmetic make-up use was associated with significantly higher risk of acne. Trial Design Cross Sectional Participants 3163 Median Age & Gender 19 to 20, ? % male, ? % female Notes Potential risk factors including age, gender, diet, skin type, sleeping habits, and facial make-up use were analyzed using stepwise logistic regression 2 Poli, F., Dreno, B., & Verschoore, M. (2001). An epidemiological study of acne in female adults: results of a survey conducted in France. Journal of the European Academy of Dermatology and Venereology, 15(6), 541-545. Method Participants received a questionnaire, validated by three dermatologists. Result Make up users have 3% higher incidence of acne Absolute Risk (>1 implies higher risk) 1.03 Trial Design Cross Sectional Participants 3305 Notes Also saw a small negative effect of makeup and benzodiazepine use.

omega-3 regular acne 5/10 saw lesion count Number of Studies: 4 Agreement: 75% Evidence Grade: B Omega-3 supplementation with 1000 mg EPA and 1000 mg DHA daily is likely to moderately reduce number of non inflammatory acne lesions in most people. 1 Di Landro, A., Cazzaniga, S., Parazzini, F., Ingordo, V., Cusano, F., Atzori, L., ... & Naldi, L. (2012). Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. Journal of the American Academy of Dermatology, 67(6), 1129-1135. Method Cases with moderate to severe acne from dermatologic outpatient clinics in Italy was compared to control subjects coming from dermatologic consultations other than for acne. Result Fish consumption correlated with less acne. Dosage >= 1 serving / day Absolute Risk (>1 implies higher risk) 0.86 Trial Design Case Control Participants 563 Median Age & Gender 17.2 +- 3.1, 50 % male, 50 % female Notes No control for energy intake 2 Rubin MG, Kim K, Logan AC: Acne vulgaris, mental health and omega-3 fatty acids: a report of cases. Lipids Health Dis 2008, 7:36. Method 5 subjects with acne were 250 mg of EPA, 3.75 mg of zinc gluconate, 50 mcg of selenium, 50 mcg of chromium and 50 mg of EGCG from green tea extract per day for at least two months. Did objective and subjective measure of acne lesions. Result Four of the subjects had reduced total lesion count, mostly effective against inflammatory lesions. Dosage 250 mg EPA / day Effect Size -26.67 % Trial Design Open Uncontrolled Trial Length 60 days Participants 5 Median Age & Gender 18 to 23, 60 % male, 40 % female Notes Participants also received 3.75 mg of zinc gluconate, 50 mcg of selenium, 50 mcg of chromium and 50 mg of EGCG from green tea extract daily. 3 Khayef, G., Young, J., Burns-Whitmore, B., & Spalding, T. (2012). Effects of fish oil supplementation on inflammatory acne. Lipids in health and disease, 11(1), 165. Method Subjects were given 3g of fish oil to their diet, then acne was assessed using overall severity grading, total inflammatory lesion count and colorimetry. Result Acne severity improved in 8 subjects, worsened in 4 and remained unchanged in 1. Not enough participants to reach significannce. 7 of in the improvement group had moderate to severe acne, whereas 3 og the worsened group had mild acne. Dosage 930 mg EPA + 720 mg DHA / day Trial Design Open Uncontrolled Trial Length 84 days Participants 13 Notes 3 g Omega 3 / day contained 930 mg EPA, unknown what other fatty acids the supplement contained. Seems lik

probiotics supplementation unknown/10 saw lesion count Number of Studies: 2 Agreement: 100% Evidence Grade: D One open uncontrolled study reported a positive effect, which could be due to placebo. More studies are needed. 1 Jung, G. W., Tse, J. E., Guiha, I., & Rao, J. (2012). Prospective, Randomized, Open-Label Trial Comparing the Safety, Efficacy, and Tolerability of an Acne Treatment Regimen with and without A Probiotic Supplement and Minocycline in Subjects with Mild to Moderate Acne. Journal of cutaneous medicine and surgery, 17(2), 114-122. Method Participants with acne were randomly assigned to one of thee groups. Group A received probiotic supplementation, group B received only minocycline. Group C was treated with both. Clinical and subjective assessments were completed at baseline and during follow-up visits. Result Minocycline and probiotics are effective at reducing acne, the combintation most effective, then minocylcine then probiotics alone. Trial Design Open Uncontrolled Trial Length 84 days Participants 45 Notes Poster, study not available 2 Volkova LA, Khalif IL, Kabanova IN: Impact of the impaired intestinal microflora on the course of acne vulgaris. Klin Med (Mosk) 2001, 79:39-41, Russian. Method Intestinal microflora in 114 patients with acne vulgaris (94 and 20 with its papulopustular and nodulocystic forms). Sixty-one (54%) patients have either the first (21%) or second (78.7%) impaired bacterial microflora. no great differences in the content of the intestinal microflora in different forms of acne. Result Adding intestinal microflora-correcting agents to combined therapy in patients with papulopustular acne vulgaris and verified dysbacteriosis reduces the duration of treatment by over twice and makes its duration the same as that in patients without dysbacteriosis Trial Design Open Uncontrolled Trial Length ? days Participants 114 Notes Combined theraphy, need paper to judge results of probiotics

sleep quality (poor) <1/10 saw incidence Number of Studies: 2 Agreement: 100% Evidence Grade: C 3% higher risk to have acne if you're in a high risk group 1 Poli, F., Dreno, B., & Verschoore, M. (2001). An epidemiological study of acne in female adults: results of a survey conducted in France. Journal of the European Academy of Dermatology and Venereology, 15(6), 541-545. Method Participants received a questionnaire, validated by three dermatologists. Result A small difference in quality of sleep was recorded betwen the acne and non acne group. Absolute Risk (>1 implies higher risk) 1.03 Trial Design Cross Sectional Participants 3305 Notes Also saw a small negative effect of makeup and benzodiazepine use. 2 Wu, T. Q., Mei, S. Q., Zhang, J. X., Gong, L. F., Wu, F. J., Wu, W. H., ... & Diao, J. X. (2007). Prevalence and risk factors of facial acne vulgaris among Chinese adolescents. International journal of adolescent medicine and health, 19(4), 407-412.* Method Chinese adolescents received questionnaires and physician examinations. The prevalence of acne vulgaris was calculated from the collected data. Potential risk factors including age, gender, diet, skin type, sleeping habits, and facial make-up use were analyzed using stepwise logistic regression. Result Lack of sleep and cosmetic make-up use was associated with significantly higher risk of acne. Trial Design Cross Sectional Participants 3163 Median Age & Gender 18 to 20, 50 % male, 50 % female

soy consumption 0/10 saw incidence Number of Studies: 1 Agreement: 100% Evidence Grade: D One study did not see any correlation between soy consumption and acne incidence. 1 Law, M. P. M., Chuh, A. A. T., Molinari, N., & Lee, A. (2010). An investigation of the association between diet and occurrence of acne: a rational approach from a traditional Chinese medicine perspective. Clinical and experimental dermatology, 35(1), 31-35.* Method Chinese participants were examined for acne severity and yin and yang scores. Diet and acne relationship was investigated. Result Statistically significant relationship between soy and dairy consumption and protection against acne. Dosage >=1 cup / day Trial Design Cross Sectional Participants 322 Median Age & Gender 19, 53 % male, 47 % female Notes Separated participants into yin and yang groups, saw statistically significant improvement of acne in yang group with milk and soy consumption.