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Acne Vulgaris: A Disease of Western Civilization (2002)

119 points| surlyadopter | 8 years ago |jamanetwork.com

164 comments

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[+] RobertRoberts|8 years ago|reply
1. When I was a kid, just getting a tan cleared up my acne.

2. Changing my diet helped clean up my acne (not eating junk food)

3. When I was a teenager, I got hurt really bad, and my father found me and had to take me to the hospital. I saw massive acne breakout on his face in less than 15 minutes.

4. When I got older and was less stressed about life, my acne went away. When I got a family/career/house and life stress was severe, acne would come back.

I think there a huge health and stress connection to acne.

[+] lj3|8 years ago|reply
When I was a teenager, I saw a dermatologist for my Psoriasis. I somehow wound up with a prescription for tetracycline for my acne. Not only did it not work, but I was constantly sick for a full year after I stopped the medication.

There is no moral to this story.

[+] King-Aaron|8 years ago|reply
> Changing my diet helped clean up my acne (not eating junk food)

This. Actually, for me, it wasn't really the diet in general, but making a switch to drinking water instead of pretty much any other drink (*especially soft drinks!). I went on a hike for a couple of weeks as a teenager, and I think that not having access to anything but water to drink was enough to change my habits.

[+] Clubber|8 years ago|reply
I had facial acne bad as a kid, and completely went away sometime when I was 18. I stress a lot (just my personality) but it hasn't come back. Anyway, just throwing out another data point.

PS: Acne as an already awkward and hormone supersaturated kid totally sucked.

[+] schuke|8 years ago|reply
Everytime I take a plane somewhere I would have huge acnes in the two , three hour duration of the flight. I always suspected it’s the stress of having to be on time and everthing that flying involves.
[+] autokad|8 years ago|reply
i think there is a connection in there, but not quite sure where.

I myself pretty much only ate junk food, although my diet was very low cal. i avoided the sun because i burned very easy, but I was outside a lot. i was always under a high amount of stress, but i never got acne or anything like that

edit: by junkfood, i mostly ate cereal and lots of cookies/candy bars

[+] patcheudor|8 years ago|reply
My daughter had severe acne. She changed her diet from vegetarian to full vegan and it cleared right up, in fact most of the past scaring is also now gone. She still consumes sugar (vegan sugar - yeah that's a thing: https://www.peta.org/living/food/is-sugar-vegan/) and doesn't take vitamin E or D supplements because she hasn't found any that are 'vegan certified.' Given some of the research we've looked at, our going theory is that dairy was the primary cause and there is some support for that: https://www.aad.org/media/news-releases/growing-evidence-sug...
[+] brucephillips|8 years ago|reply
I grew up with cystic acne that persisted into my early 20s, until two courses of Accutane cleared it up.

Anecdotally, I tried everything before going on accutane. I cut out sugar to the point of avoiding fruits with high glycemic indexes. I cut out dairy. I cut out meat. I tried every supplement you can imagine. If you're thinking about asking "but did you try X", don't bother, I did.

Only accutane worked.

Reading studies such as this, as well as the internet discussion regarding acne is a bit frustrating. Yes, there are anecdotes of this and that diet and lifestyle change reducing acne, but there's very little clinical evidence that non medical treatment improves cases of cystic acne, and yes, many diet studies have been performed.

Even this study grossly overstates their conclusions. Studying two primitive societies is not nearly enough data to support the conclusion in the title of this article.

[+] SOLAR_FIELDS|8 years ago|reply
Every acne thread has the inevitable comment about Accutane.

And every comment is essentially the same. It’s the only thing that worked for me.

I still love to read them. I’m still amazed by it. It’s literally the only drug I’ve ever encountered that could truly be called a “magic pill” in that it will permanently cure you of what you are taking it for.

The side effects are pretty crazy though. I had to wear sunglasses even when it was cloudy due to photosensitivy for the months I was taking it. Carried Aquaphor in my pocket for the perpetually dry lips and my whole face pretty much flaked off during the first few weeks.

100% worth it. I get a minor pimple every 6 months or so if I don’t wash my face. It used to be completely covered with acne.

[+] brandonmenc|8 years ago|reply
Can confirm, Accutane is magical.

A single round of it when I was 16 totally cleared me up. That was over 20 years ago.

Luckily for me, my mom remembered how my dad's acne in high school left his face scarred, so she got me into a dermatologist at the first signs of cystic acne.

The doctor tried everything on me, and Accutane was the last resort.

I implore:

If you have kids with acne, please, take them to a real skin doctor. Don't rely on unproven treatments like cutting carbs or dairy or meat. You have one chance to get it right, and if you don't, they'll have to live with facial scarring forever.

I see adults with acne or scarring and I am so thankful I was put on Accutane.

[+] jayess|8 years ago|reply
Totally anecdotal, but I started taking vitamin D supplements at the suggestion of my doctor because of my family history of colon cancer. I noticed that my acne declined significantly. I'm wondering if it has to do with the amount of time one spends outside in the sun.
[+] qwerty456127|8 years ago|reply
Here's the discussion and the paper on vitamin D: https://news.ycombinator.com/item?id=15867918 . TL;DR: make sure to always get at least 8000 IU of vitamin D per day (10 times the RDA) if you want to be healthy and have good bones, skin, mood, sleep, immunity and metabolism.

I have also heard a rumor that recent studies suggest solid vitamin D pills are better than oil capsules. Would be nice if somebody knowing what particular study says this could share a link.

[+] verbify|8 years ago|reply
Vitamin D deficiency is common in Saudi Arabia, especially among women - factors include traditional clothes, avoidance of sun, and inadequate dietary intake
[+] walshemj|8 years ago|reply
Vitamin D is prescribed for several skin conditions I am on 20k IU a week.

And also Anecdotally I am also on imuno suppressants and touch wood haven't had a cold this winter - yay

[+] sanjeetsuhag|8 years ago|reply
I started Vitamin D supplements too, after reading several personal accounts of it being helpful. Still have not come across any good studies proving the effectiveness of taking Vitamin D supplements (TBH I also haven't tried finding any such information either).
[+] cal5k|8 years ago|reply
I'm always amused/horrified by Hacker News comments on anything health-related. Herein lie a group of incredibly smart individuals sharing anecdotal evidence and folk remedies without a lick of irony.
[+] _delirium|8 years ago|reply
The HN title should probably say "nonwesternized" (the term used in the abstract) rather than "non-Western" (although the paper subtitle does use "Western"). Still an ambiguous term, but "non-Western population" would usually be understood to include countries like Japan and China, who this study definitely doesn't mean to include.
[+] ajhurliman|8 years ago|reply
I was wondering about that; I was just in China and there were tons of people with acne there.
[+] dbcooper|8 years ago|reply
The title of the paper is "Acne Vulgaris - A Disease of Western Civilization."
[+] weeksie|8 years ago|reply
Why's everybody talking about vitamin D? (Same thing popped up in a Twitter thread I saw about this yesterday.)

As far as I can tell the paper only talks about high insulin loads and refined sugars for etiology? Then again I might have missed something? Seriously, I'm in no way competent to read these papers but all I could see were mentions of insulin spikes and such. Could someone ELI5 what I'm missing?

[+] DeusExMachina|8 years ago|reply
I noticed that on myself, high concentrations of sugar or high density carbs (pasta and bread) make it surge.

A couple of friends of mine also cured a candida infection by avoiding carbs. So our diet might play a role.

[+] explorigin|8 years ago|reply
Try cutting out dairy. That made a dramatic effect for the better in me. Milk chocolate is probably the worst for me.
[+] buckthundaz|8 years ago|reply
Yes. We as a culture do not move around enough to utilize the sugar we ask our body's to digest ( fast + dirty fuel )

The surplus sugar serves as a substrate to allow candida to thrive, not to mention a myriad of other maladies.

[+] t3rmi|8 years ago|reply
If you are in the Bay Area check out Acneology or the US Face reality clinics. They basically have the whole science of acne treatment down to almost perfection. Dermatology didn't help me at all but their treatments worked wonders. I'll give out more info if anyone is interested. Source - I've had acne for a decade :( more or less cleared up now.
[+] perardi|8 years ago|reply
"As in the Kitava sample, skin infections and intramuscular abscesses were common and responded well to treatment with antibiotics such as erythromycin and tetracycline."

I'll take the occasional zit and cover it up with concealer, thank you very much.

[+] sevensor|8 years ago|reply
It doesn't have to be a package deal -- their low glycemic load diet isn't causing the abscesses.
[+] intro-b|8 years ago|reply
taking a course of antidepressants and making some lifestyle changes during university for depression had the side effect of almost completely clearing up my acne that normal dermatological treatments were unable to deal with. given that there's some kind of biological link between chronic inflammation and depression, i wouldn't be surprised if some acne cases manifested the same way
[+] reillyse|8 years ago|reply
The double negatives here make this heading really hard to parse (I actually read the abstract thinking something totally different and had to come back to check), maybe something along the lines of

"Acne vulgaris exists predominately in Western populations" or "Acne vulgaris mostly exists in Western Populations" would make it clearer.

[+] JumpCrisscross|8 years ago|reply
TL; DR A 2002 study believes we should explore “dietary interventions using low–glycemic load carbohydrates may have therapeutic potential in the treatment of acne because of the beneficial endocrine effects of these diets.”
[+] ggm|8 years ago|reply
Given that all humans share a remarkably high % of genome, and race is a social construct, I'm struggling with the 'this is not genetic' part. Either its a truism, or its backed by strong evidence of no genetic linkage. Because this 'its not your race' thing, applies to almost anything. For instance the supposed Asian intolerance to unmodified milk proteins which has been changing as diet shifts. Is that also now not actually genetically determined?
[+] CryoLogic|8 years ago|reply
Human and pig genomics are also very similar. It's not the 98% that make or break these things. Lactose intolerance is inherited and as a result of LCT gene not expressing due to downregulation by another gene MCM6.
[+] janwh|8 years ago|reply
As per my personal anecdotal evidence: diet is always key to Acne. I have been suffering from Acne vulgaris, Acne conglobata, and—worst of all—Acne inversa for all my life (26yo), and whenever I fell into bad eating habits with lots of (saturated) fats and carbohydrates, my skin issues are worsening. Western food is just poor quality in general, being heavily processed and “enhanced” and all.
[+] wst_|8 years ago|reply
They decided to choose a closed, often tribal cultures for comparison. We can assume they behave as most of us do, mate within the group mostly. So the genes pool/variation differences must be huge between them and Western population (whatever Western means in this context - let's say United States.) On what premises they excluded genetic factor, then?
[+] snarfy|8 years ago|reply
I'v read a few studies about demodex mites causing chalazion[1]. Demodex mites are something humans picked up from having dogs and cats as pets. Do non-western countries have these animals as pets?

[1] ]https://www.ncbi.nlm.nih.gov/pubmed/26408604

[+] cmrdporcupine|8 years ago|reply
For my wife, it's lots of sugar that causes outbreaks. Or worse, cheap American chocolate (British chocolate doesn't trigger it as bad).

But all the dermatologists she saw as a teen and young adult... always ridiculed this and insisted it had nothing to do with diet.

[+] markhall|8 years ago|reply
I always love when obscure (but interesting) topics surface to the top of HN. Great community.