Dr. Raja Sivamani discusses highlights from her lecture on acne and rosacea at the 2021 Elevate-Derm Conference.
In this video
In this interview, Dr. Sivamani revisits the old "party line" from his residency days — that diet doesn't affect acne — and explains how some 50-plus studies have since overturned it. Turns out the parents are right: pizza and Coke, all forms of dairy, high-sugar foods and sweetened drinks, and fried fatty foods can all worsen acne. Rather than eliminating everything, he makes it a point to have a nutrition conversation and focus patients on foods that give them "positive motivation."
He also walks through the mechanistic side of the gut-to-skin connection, describing four or five ways food reaches the skin — direct absorption (about 20% of dietary fat gets to the skin and affects the sebaceous glands), indirect hormonal pathways like insulin and IGF-1, and secondary byproducts made by the gut microbiota. On treatment, he notes the prebiotic and probiotic evidence is now emerging in both acne and rosacea, including some randomized controlled studies, but stresses there's no one-size-fits-all — interventions have to be tailored to the person and to companies actually doing the research.
- Diet does impact acne — dairy in all forms, high-sugar foods and sweetened drinks, and fried fatty foods are among the biggest offenders.
- Don't ask patients to cut everything out; open a nutrition conversation and steer them toward foods that offer positive motivation.
- Food reaches the skin through several routes: direct absorption (roughly 20% of dietary fat reaches the skin and sebaceous glands), hormonal pathways like insulin and IGF-1, and byproducts from gut bacteria and fungi.
- Prebiotics and probiotics show promise in acne and rosacea, with some randomized controlled data, but there is no one-size-fits-all — tailor to the individual.
- Choose probiotics from companies backing specific strains with real studies rather than assuming all products are equivalent.
