Continuing medical education
Diet in dermatology: Part I. Atopic dermatitis, acne, and nonmelanoma skin cancer

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Patients commonly inquire about dietary modifications as a means to prevent or manage skin disease. Answering these questions is often challenging, given the vast and conflicting evidence that exists on this topic. This 2-part continuing medical education article summarizes the evidence to date to enable physicians to answer patients' questions in an evidence-based manner. Part I includes atopic dermatitis, acne, and nonmelanoma skin cancer. The role of dietary supplementation, dietary exclusion, food allergy, maternal diet, and breastfeeding in the development and/or prevention of atopic dermatitis is summarized. The dermatoendocrinologic mechanism for the effects of glycemic index/glycemic load and milk on acne is described, as well as related clinical evidence for dietary modifications. Finally, evidence and recommendations for restriction or supplementation of dietary factors in the prevention of nonmelanoma skin cancer, including fat, vitamins A, C, D, and E, and selenium, are reported.

Section snippets

Atopic dermatitis

Key points

  1. Prenatal followed by postnatal probiotic supplementation decreases the risk of atopic dermatitis

  2. Postnatal prebiotic supplementation decreases the risk of atopic dermatitis

  3. Elimination diets are only appropriate for patients who have a food allergy that has been proven by oral food challenge

  4. Maternal allergen avoidance diets do not prevent atopic dermatitis

  5. Exclusive breastfeeding and supplementation with hydrolyzed formula is protective against atopic dermatitis for high-risk infants

  6. For infants at

Acne

Key points

  1. Multiple randomized controlled trials with biochemical and histopathologic evidence support the benefit of a low glycemic index/load diet for acne patients

  2. While observational studies suggest that frequent milk consumption imparts a higher risk of acne, randomized controlled trials are necessary before dietary recommendations can be made

Many patients believe that diet contributes to acne.28, 29, 30, 31, 32, 33 The relationship between diet and acne has emerged as a hot topic, with >10 reviews

Nonmelanoma skin cancer

Key points

  1. A large randomized controlled trial found no significant effect of a low-fat diet on nonmelanoma skin cancer; therefore, a fat restricted diet should not be recommended for nonmelanoma skin cancer prevention

  2. Selenium supplementation may increase the risk of squamous cell carcinoma and total nonmelanoma skin cancer and should be avoided

  3. The effect of retinol and retinoid supplementation on nonmelanoma skin cancer varies based on risk factors, comorbidities, and cancer type

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      It has been suggested that the fat-reducing process could enhance the insulin and IGF-1-promoting elements of milk. Last, given that whey protein constitutes 20% of protein in cow's milk, its insulin-promoting component could help to explain the possible link between milk and acne.164,166,189 A case report of 5 men who developed acne in the setting of whey protein supplement consumption that improved upon discontinuation of the supplement supports this potential association.189

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    Funding sources: None.

    Conflicts of interest: None declared.

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