Since early in the medical history the association of diet and acne has been controversial. There are numerous instances of advice to avoid eating certain foods to improve or avoid acne. Let us explore the evidence available to understand the relationship if any of milk and dairy products with acne.
As early as in 1885, Bulkley8 reported on 1500 patients with acne showing aggravation of acne with milk consumption. In the middle of last century there were a handful of studies, based on which the relationship between diet and acne was considered as a myth.1,2
However, both the studies have been criticised for not being blinded or randomised. The duration of the studies was far too short and the sample size was too small, and there were further criticisms’ about the methodology.
Robinson7 in 1949 showed in a sample size of 1925 patients, milk intake as the most common association with acne flares. His study was more based on his experience and there was no data or any statistical analysis.
So what is the evidence saying
The first big study was in In 2005, when Adebamowo et al3 studied the relationship between dairy and acne. They studied a group of 47,355 adult women who were asked to recall their high school diet and also if they were ever diagnosed as severe acne by a doctor.
They found that acne was positively associated with consumption of milk, particularly skimmed milk. Author’s hypothesis was that the concentration and/or absorption of factors responsible for aggravation of acne may be increased by skim milk processing. They also suggested that relationship between skimmed milk and Acne, as compared to whole milk maybe because skimmed milk contains less oestrogen, which is a hormone known to reduce acne. 3 They also hypothesised that as whole milk was less acnegenic, there was no association with milk fat in the aggravation of acne.
The limitations of the study are its retrospective design. It was based on the memory of adult subjects to remember their high school dietary intakes and the severity of the acne. Several variables were not considered such as heredity, nationality, and socioeconomic background. Also they did not consider the possibility of iodine in the milk also could be responsible for acne. 4
Adebamowo et al5 again in 2006 carried out a second study to follow up on the first and this time decided to not rely on memory of the subjects so did a prospective study and followed 6094 girls aged 9 to 15 years for up to 3 years. Again they observed an association between milk and acne flares and again no association between milk fat and acne. But there were again limitations of the study and most notably because the subjects self reported the severity of acne.
These guys were fairly persistent in their quest and followed up their results with a third study in 2008 6 Their study which had a sample size of 4237 boys and was a prospective study showed similar results. The study again demonstrated a relationship between skimmed milk and worsening of acne.
But all their studies have limitations and the association showed is weak at best.
A recently reported study in 2016 by LaRosa CL et al 9 also supported the link between skimmed milk and acne. This was a case control study of a sample size of 225 consisting of 14 – 19 year olds. The limitations were self reporting, and the case control design.
Another case control study from Malaysia by N H Ismail et al10 also positively showed a relationship between frequency of milk and ice cream intake and the presence of acne vulgaris. This finding has again been similar to one reported in a cross-sectional study in South Korea11 and they reported that milk and dairy products intake was associated with the development of acne vulgaris.
Another one from Italy this time suggesting a link between acne and milk and a stronger association with skimmed milk.12 And yet again, further studies from Norway13 and Nigeria14 suggesting the same link.
So despite the limitations seen in the studies there is repeated association of milk and specifically skimmed milk with acne prevalence and its aggravation. There may be other factors at play such as the genes and environment but it is difficult to ignore the association between milk and acne flare when it has been noticed in different parts of the world across all ethnicities. So whatever is the underlying factor, whether it is the hormones or the glycaemic load of dairy products, in my opinion it is difficult to now ignore the relationship between worsening of acne and milk intake, especially skimmed milk.
- Fulton JE Jr, Plewig G, Kligman AM. Effect of chocolate on acne vulgaris. JAMA 1969;210:2071-4
- Anderson PC. Foods as the cause of acne. Am Fam Physician, 1971;3:102-3.
- Adebamowo CA, Spiegelman D, Danby FW, Frazier AL, Willett WC, Holmes MD. High school dietary dairy intake and teenage acne. J Am Acad Dermatol 2005;52:207-14.
- Arbesman H. Dairy and acneethe iodine connection. J Am Acad Dermatol 2005;53:1102.
- Adebamowo CA, Spiegelman D, Berkey CS, Danby FW, Rockett HH, Colditz GA, et al. Milk consumption and acne in adolescent girls. Dermatol Online J 2006;12:1.
- Adebamowo CA, Spiegelman D, Berkey CS, Danby FW, Rockett HH, Colditz GA, et al. Milk consumption and acne in teenaged boys. J Am Acad Dermatol 2008;58:787-93.
- Theacne problem. SouthMed J 1949;42:1050-60.
- Bulkley LD. Acne, its Etiology, Pathology and Treatment. New York, NY: GP Putnam’s Sons;1885.
- LaRosa CL, Quach KA, Koons K, Kunselman AR, Zhu J, Thiboutot DM, Zaenglein A Consumption of dairy in teenagers with and without acne. J Am Acad Dermatol.2016 Aug;75(2):318-22
- Ismail NH, Manaf ZA, Azizan NZ. High glycemic load diet, milk and ice cream consumption are related to acne vulgaris in Malaysian young adults: a case control study. BMC Dermatol. 2012;12:13.
- Jung JY, Yoon MY, Hong JS, Choi YS, Suh DH. The influence of dietary patterns on acne vulgaris in Koreans. Eur J Dermatol. 2010;20(6): 1–5
- Di Landro A, Cazzaniga S, Parazzini F, et al. Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. J Am Acad Dermatol. 2012;67(6):1129–1135
- Ulvestad M, Bjertness E, Dalgard F, Halvorsen JA. Acne and dairy products in adolescence: results from a Norwegian longitudinal study. J Eur Acad Dermatol Venereol.2017 Mar;31(3):530-535.
- Okoro EO, Ogunbiyi AO, George AO, Subulade MO. Association of diet with acne vulgaris among adolescents in Ibadan, southwest Nigeria. Int J Dermatol.2016 Sep;55(9):982-8.