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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The development and progression of acne are conditioned by genetic&#44; hormonal&#44; and environmental factors&#46; Hormonally&#44; elevated androgen and growth hormone levels has been associated with acne exacerbations&#46; Environmentally&#44; it has been postulated that diets associated with a high glycemic index &#40;GI&#41;&#44; and the consumption of milk and chocolate&#44; can exacerbate this condition<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">GI represents a score from 1 to 100 that expresses how quickly a carbohydrate is digested&#44; absorbed&#44; and metabolized<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a>&#46; Diets with a high GI have scores &#62; 55&#46; The Western diet is characterized by the consumption of dairy and high-glycemic foods&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Meixiong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> conducted a systematic review evaluating the association of a high-GI diet and&#47;or dairy intake with acne pathogenesis&#46; They included a total of 34 articles &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>120&#44;398&#41;&#58; 28 were observational studies &#40;42&#46;9&#37;&#44; case-control studies&#59; 14&#46;3&#37;&#44; longitudinal cohort studies&#59; and 42&#46;9&#37;&#44; cross-sectional studies&#41; and 6 were controlled clinical trials &#40;5 were randomized and 1 non-randomized&#41;&#46; A total of 77&#37; of the 18 observational studies performed showed an association between high-GI diets and acne severity&#46; Smith et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> randomized a total of 43 acne patients treated with facial cleanser to receive a low-GI diet &#40;GI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#41; or a control diet &#40;GI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>56&#41; for 12 weeks&#46; The low-GI diet group experienced better results than the control group&#58; a decrease in the number of lesions -16 in the low-GI group vs &#8211;8&#46;5 in the control group &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Conforti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> conducted a review on foods that may be involved in acne pathogenesis and the pathophysiological explanation of the molecules involved &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; High-GI diets are associated with hyperinsulinism&#44; which leads to an increase in androgens&#44; insulin-like growth factor 1 &#40;IGF-1&#41;&#44; and IGF-3&#44; contributing to the development and worsening of acne1&#46; Carbohydrate-rich diets are associated with hyperglycemia&#44; reactive hyperinsulinemia&#44; and elevated levels of IGF-1&#46; However&#44; a Mediterranean diet &#40;MD&#41;&#44; characterized by low-glycemic-load foods&#44; minimal dairy intake&#44; and an abundance of nutrients with antioxidant and anti-inflammatory properties such as fruits and vegetables&#44; may decrease the signaling produced by IGF-1 and&#44; consequently&#44; acne<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a>&#46; These foods contain hydroxytyrosol&#44; tyrosol&#44; oleocanthal&#44; and resveratrol&#44; phenolic compounds with anti-inflammatory properties&#46; Recently&#44; Ah-Thiane et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> published a case-control study<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>80&#41; to determine the relationship between acne severity in French women and adherence to the MD&#46; In acne patients&#44; a significant negative correlation was found between acne severity determined by the Global Evaluation Acne &#40;GEA&#41; scale and adherence to the MD&#44; with a Spearman correlation coefficient of r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>-0&#46;47&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Morales-S&#225;nchez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> recently conducted a clinical trial &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41; with male patients aged 18 to 25 with moderate acne using the same treatment &#40;topical adapalene 0&#46;1&#37; and systemic doxycycline 100<span class="elsevierStyleHsp" style=""></span>mg daily&#41;&#46; Patients were randomized into 2 groups based on whether they would receive a low-glycemic diet or a control diet&#44; observing a statistically significant reduction in acne lesions in patients on the low-carbohydrate diet at 12 weeks&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Although more clinical trials are needed to establish whether there is a clear relation between high-glycemic foods&#44; current studies anticipate a protective role of the MD in acne&#46; Regarding dairy&#44; to date&#44; only 1 positive association between increased intake of these foods and worsening acne in Western populations has been reported&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We recommend a diet based on the consumption of fruits&#44; vegetables&#44; whole grains&#44; nuts&#44; extra virgin olive oil&#44; fish&#44; white meats&#44; and a restricted intake of red meats&#44; dairy&#44; and sugary products&#46;</p></span>"
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                  \t\t\t\t">The association between elevated levels of IGF-1 and increased acne severity has been demonstrated&#46;IGF-1 has a dual mechanism in worsening acne&#58; it stimulates the transcriptional activity of the androgen receptor &#40;AR&#41; and inhibits the AR co-regulator called forkhead box O1 &#40;FoxO1&#41;&#44; enhancing androgen activity in the sebaceous glands and increasing the comedogenic component&#46;IGF-1 amplifies androgen activity by increasing 5-alpha reductase and reducing levels of Fox-1 &#40;a transcription factor that inhibits the action of the androgen receptor&#41;&#46; A deficiency in FoxO1 can be seen during puberty growth hormone signaling and with increased insulin&#47;IGF-1 signaling due to the consumption of insulinotropic milk&#47;dairy products&#44; and hyperglycemic carbohydrates from the Western diet&#46; This deficiency worsens acne through the proliferation of pilosebaceous keratinocytes&#44; sebaceous lipogenesis&#44; and the expression of perifollicular inflammatory cytokines&#46;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">SREBP-1 is a regulator of the production of sapienic acid&#44; a natural antimicrobial&#46; A decrease in the size of the sebaceous gland and SREBP-1 levels in the molecule have been associated with low-carbohydrate diets in acne patients&#46; Additionally&#44; low levels of SREBP-1 reduce the total production of sebum&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">mTORC1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Elevated levels associated with worsening acne&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">It is a regulator of anabolism that targets the progression of the nutrient-dependent cell cycle&#44; and the activation of lipogenesis&#46; High caloric intake&#44; high glycemic load&#44; high consumption of fats and meat&#44; and an increased intake of dairy proteins contribute to elevating mTORC1 through high levels of IGF-1&#46; This increase in mTORC1 signaling contributes to the worsening of acne&#46; FoxO1 acts as a negative regulator of mTORC1&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Associated with new lesion formation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">This effect could be explained by a high glycemic index after food consumption&#44; leading to an increase in pro-inflammatory cytokines&#46;Block et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> discuss a relationship between the amount of chocolate consumed and the number of new acne lesions&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Milk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Increased dairy consumption has been associated with worsening acne&#44; although so far&#44; this has only been confirmed in Western populations&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Milk can stimulate the production of IGF-1 in the liver&#44; increasing the levels of this growth factor in the bloodstream&#46; Additionally&#44; milk protein contains high levels of the amino acid glutamine&#44; which plays an important role in the activation of mTORC1&#44; in sebaceous lipogenesis&#44; and in sebocyte proliferation&#46; Scientific evidence on the direct association between dairy products and acne is scarce&#59; however&#44; an association has been confirmed between the worsening of acne and increased dairy intake in Western populations&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Omega-3 polyunsaturated fatty acids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elevated levels of foods containing these molecules have been associated with an improvement in acne&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">They exhibit anti-inflammatory properties&#46; They lead to a decrease in IGF-1&#44; which in turn reduces the expression of pro-inflammatory cytokines &#91;IL-1B&#44; IL-6&#44; IL-8&#44; TNF-alpha&#44; and matrix metalloproteinases &#40;MMP&#41;&#93; in sebum-producing cells&#46;They also reduce inflammation by decreasing the dimerization of Toll-like receptors 1 &#40;TLR-1&#41; and &#40;TLR-2&#41;&#46; The expression of these receptors increases in keratinocytes and macrophages due to the presence of Cutibacterium acnes&#44; leading to inflammation and keratinocyte proliferation&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">High glycemic index carbohydrates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elevated levels associated with worsened acne&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Increase in IGF-1 levels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Fish&#44; resveratrol&#44; curcumin&#44; genistein&#44; and silymarin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elevated levels associated with improved acne&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Suppression of inflammatory cytokines&#59; decrease in IGF-1 levels&#59; inhibition of TLR-1 and TLR-2 dimerization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Foro de Residentes
RF-The role of diet in the management of acne
FR-El papel de la dieta en el acné
M. Luque-Luna, M. Sidro-Sarto
Corresponding author
sidro@clinic.cat

Corresponding author.
Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Cl&#237;nic de Barcelona&#44; Universitat de Barcelona&#44; Barcelona&#44; Spain"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The development and progression of acne are conditioned by genetic&#44; hormonal&#44; and environmental factors&#46; Hormonally&#44; elevated androgen and growth hormone levels has been associated with acne exacerbations&#46; Environmentally&#44; it has been postulated that diets associated with a high glycemic index &#40;GI&#41;&#44; and the consumption of milk and chocolate&#44; can exacerbate this condition<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">GI represents a score from 1 to 100 that expresses how quickly a carbohydrate is digested&#44; absorbed&#44; and metabolized<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a>&#46; Diets with a high GI have scores &#62; 55&#46; The Western diet is characterized by the consumption of dairy and high-glycemic foods&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Meixiong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> conducted a systematic review evaluating the association of a high-GI diet and&#47;or dairy intake with acne pathogenesis&#46; They included a total of 34 articles &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>120&#44;398&#41;&#58; 28 were observational studies &#40;42&#46;9&#37;&#44; case-control studies&#59; 14&#46;3&#37;&#44; longitudinal cohort studies&#59; and 42&#46;9&#37;&#44; cross-sectional studies&#41; and 6 were controlled clinical trials &#40;5 were randomized and 1 non-randomized&#41;&#46; A total of 77&#37; of the 18 observational studies performed showed an association between high-GI diets and acne severity&#46; Smith et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> randomized a total of 43 acne patients treated with facial cleanser to receive a low-GI diet &#40;GI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#41; or a control diet &#40;GI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>56&#41; for 12 weeks&#46; The low-GI diet group experienced better results than the control group&#58; a decrease in the number of lesions -16 in the low-GI group vs &#8211;8&#46;5 in the control group &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Conforti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> conducted a review on foods that may be involved in acne pathogenesis and the pathophysiological explanation of the molecules involved &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; High-GI diets are associated with hyperinsulinism&#44; which leads to an increase in androgens&#44; insulin-like growth factor 1 &#40;IGF-1&#41;&#44; and IGF-3&#44; contributing to the development and worsening of acne1&#46; Carbohydrate-rich diets are associated with hyperglycemia&#44; reactive hyperinsulinemia&#44; and elevated levels of IGF-1&#46; However&#44; a Mediterranean diet &#40;MD&#41;&#44; characterized by low-glycemic-load foods&#44; minimal dairy intake&#44; and an abundance of nutrients with antioxidant and anti-inflammatory properties such as fruits and vegetables&#44; may decrease the signaling produced by IGF-1 and&#44; consequently&#44; acne<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a>&#46; These foods contain hydroxytyrosol&#44; tyrosol&#44; oleocanthal&#44; and resveratrol&#44; phenolic compounds with anti-inflammatory properties&#46; Recently&#44; Ah-Thiane et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> published a case-control study<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>80&#41; to determine the relationship between acne severity in French women and adherence to the MD&#46; In acne patients&#44; a significant negative correlation was found between acne severity determined by the Global Evaluation Acne &#40;GEA&#41; scale and adherence to the MD&#44; with a Spearman correlation coefficient of r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>-0&#46;47&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Morales-S&#225;nchez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> recently conducted a clinical trial &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41; with male patients aged 18 to 25 with moderate acne using the same treatment &#40;topical adapalene 0&#46;1&#37; and systemic doxycycline 100<span class="elsevierStyleHsp" style=""></span>mg daily&#41;&#46; Patients were randomized into 2 groups based on whether they would receive a low-glycemic diet or a control diet&#44; observing a statistically significant reduction in acne lesions in patients on the low-carbohydrate diet at 12 weeks&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Although more clinical trials are needed to establish whether there is a clear relation between high-glycemic foods&#44; current studies anticipate a protective role of the MD in acne&#46; Regarding dairy&#44; to date&#44; only 1 positive association between increased intake of these foods and worsening acne in Western populations has been reported&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We recommend a diet based on the consumption of fruits&#44; vegetables&#44; whole grains&#44; nuts&#44; extra virgin olive oil&#44; fish&#44; white meats&#44; and a restricted intake of red meats&#44; dairy&#44; and sugary products&#46;</p></span>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">IGF-1&#44; insulin-like growth factor 1&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Adapted from Conforti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Molecule type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Effect on acne&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mechanisms of effect on acne&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IGF-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elevated levels associated with worsening acne&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">The association between elevated levels of IGF-1 and increased acne severity has been demonstrated&#46;IGF-1 has a dual mechanism in worsening acne&#58; it stimulates the transcriptional activity of the androgen receptor &#40;AR&#41; and inhibits the AR co-regulator called forkhead box O1 &#40;FoxO1&#41;&#44; enhancing androgen activity in the sebaceous glands and increasing the comedogenic component&#46;IGF-1 amplifies androgen activity by increasing 5-alpha reductase and reducing levels of Fox-1 &#40;a transcription factor that inhibits the action of the androgen receptor&#41;&#46; A deficiency in FoxO1 can be seen during puberty growth hormone signaling and with increased insulin&#47;IGF-1 signaling due to the consumption of insulinotropic milk&#47;dairy products&#44; and hyperglycemic carbohydrates from the Western diet&#46; This deficiency worsens acne through the proliferation of pilosebaceous keratinocytes&#44; sebaceous lipogenesis&#44; and the expression of perifollicular inflammatory cytokines&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SREBP-1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Elevated molecular levels associated with worsening acne&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">SREBP-1 is a regulator of the production of sapienic acid&#44; a natural antimicrobial&#46; A decrease in the size of the sebaceous gland and SREBP-1 levels in the molecule have been associated with low-carbohydrate diets in acne patients&#46; Additionally&#44; low levels of SREBP-1 reduce the total production of sebum&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">mTORC1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elevated levels associated with worsening acne&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">It is a regulator of anabolism that targets the progression of the nutrient-dependent cell cycle&#44; and the activation of lipogenesis&#46; High caloric intake&#44; high glycemic load&#44; high consumption of fats and meat&#44; and an increased intake of dairy proteins contribute to elevating mTORC1 through high levels of IGF-1&#46; This increase in mTORC1 signaling contributes to the worsening of acne&#46; FoxO1 acts as a negative regulator of mTORC1&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Chocolate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Associated with new lesion formation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">This effect could be explained by a high glycemic index after food consumption&#44; leading to an increase in pro-inflammatory cytokines&#46;Block et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> discuss a relationship between the amount of chocolate consumed and the number of new acne lesions&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Milk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Increased dairy consumption has been associated with worsening acne&#44; although so far&#44; this has only been confirmed in Western populations&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Milk can stimulate the production of IGF-1 in the liver&#44; increasing the levels of this growth factor in the bloodstream&#46; Additionally&#44; milk protein contains high levels of the amino acid glutamine&#44; which plays an important role in the activation of mTORC1&#44; in sebaceous lipogenesis&#44; and in sebocyte proliferation&#46; Scientific evidence on the direct association between dairy products and acne is scarce&#59; however&#44; an association has been confirmed between the worsening of acne and increased dairy intake in Western populations&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Omega-3 polyunsaturated fatty acids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Elevated levels of foods containing these molecules have been associated with an improvement in acne&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">They exhibit anti-inflammatory properties&#46; They lead to a decrease in IGF-1&#44; which in turn reduces the expression of pro-inflammatory cytokines &#91;IL-1B&#44; IL-6&#44; IL-8&#44; TNF-alpha&#44; and matrix metalloproteinases &#40;MMP&#41;&#93; in sebum-producing cells&#46;They also reduce inflammation by decreasing the dimerization of Toll-like receptors 1 &#40;TLR-1&#41; and &#40;TLR-2&#41;&#46; The expression of these receptors increases in keratinocytes and macrophages due to the presence of Cutibacterium acnes&#44; leading to inflammation and keratinocyte proliferation&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">High glycemic index carbohydrates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elevated levels associated with worsened acne&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Increase in IGF-1 levels&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fish&#44; resveratrol&#44; curcumin&#44; genistein&#44; and silymarin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Elevated levels associated with improved acne&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Suppression of inflammatory cytokines&#59; decrease in IGF-1 levels&#59; inhibition of TLR-1 and TLR-2 dimerization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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ISSN: 00017310
Original language: English
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