Raja Sivamani, MD, FAAD, discusses highlights from his lecture on Gut Microbiome and How It Affects Acne and Rosacea at the 2021 Elevate-Derm Conference.
In this video
Dr. Sivamani revisits the old "party line" from his residency that diet didn't affect acne, noting that some 50-plus studies have since shown otherwise — dairy in all forms, high-sugar foods and sweetened drinks like colas and sweet teas, and fried fatty foods all impact acne. Rather than eliminating everything, he makes a point of having a nutrition conversation and steering patients toward foods that offer "some positive motivation."
He walks through the gut-to-skin connection, describing four or five routes food takes to the skin: direct absorption (about 20% of the fats eaten reach the skin and affect sebocytes), indirect hormonal pathways like insulin and IGF-1, and the gut microbiota, whose bacteria and fungi produce secondary byproducts that can influence acne for better or worse. He points to emerging randomized controlled evidence that probiotics, prebiotics, and herbal interventions can help in acne and rosacea, while stressing there's no one-size-fits-all — treatment must be tailored to the person.
- Diet does affect acne — dairy in all forms, high-sugar foods and sweetened drinks, and fried fatty foods are the main culprits, so worried parents aren't wrong.
- About 20% of dietary fat reaches the skin and directly impacts the sebocytes; food also acts indirectly through hormonal pathways (insulin, IGF-1) and the gut microbiota.
- Gut bacteria and fungi produce secondary byproducts that can influence acne in either a good or bad way.
- Prebiotics and probiotics show emerging, sometimes randomized-controlled, evidence in acne and rosacea — but interventions must be tailored to the individual, not one-size-fits-all.
- For the specific strains and interventions, Dr. Sivamani points viewers back to the full conference lecture.
