January 13, 2016
International Journal of Dermatology
TAKE-HOME MESSAGE
- The authors of this small, prospective study evaluated the effect of a diet including daily consumption of 99% dark chocolate on acne severity in 25 males with acne-prone skin. Change in acne severity was assessed after 4 weeks of daily chocolate consumption. At that time, the Leeds revised score changed from a baseline of 2.04 to 2.48, comedone counts increased from a mean of 11.84 at baseline to 20.28, and the mean number of inflammatory papules rose from the baseline value of 6.60 to 13.70. The greatest increases occurred during the first 2 weeks of the study.
- Results indicate that chocolate consumption may exacerbate acne.
Written by Eliot N Mostow MD, MPH
This small study without a control group did find that acne appeared to get worse with daily dark chocolate consumption. Unfortunately, without a control group and with such small numbers, it’s impossible to tell if this was a real generalizable effect or simply chance. That being said, this article is exactly the kind of thing that gets the attention of the popular press! I think it’s okay, however, as we can always tell our patients that the “jury is still out” on this one. I like to reference the old joke where the patient says “Doc, it always hurts when I do this.” The doctor responds, “Then don’t do that!” I just consulted Dr. Google on this one, and I found an interesting Wikipedia article (https://en.wikipedia.org/wiki/Smith_%26_Dale) that some of you might enjoy. Until more evidence is available, I educate acne patients in the same manner as most dermatologists educate rosacea patients about their specific trigger factors. In the meantime, just like talking to rosacea patients about their specific trigger factors, I tell patients and parents that it’s difficult to pinpoint specific foods as exacerbating acne in all patients, but there is no question that some patients flare with specific foods. These patients should obviously avoid those foods or be aware that they need to adhere strictly to their treatment regimen when they eat those foods! Among the more interesting data in the last few years is the idea that a low glycemic diet might have a number of benefits, including improvement in acne. We discussed this in a PracticeUpdate article within the last few years.
So, while this study does not really answer the question once and for all, it is a nice point for discussion. I, for one, am going to have a dark chocolate-covered almond before I get back to seeing patients this afternoon. This has never caused a problem for me!
Abstract
The effects of chocolate on acne exacerbations have recently been reevaluated. For so many years, it was thought that it had no role in worsening acne. To investigate whether 99% dark chocolate, when consumed in regular daily amounts, would cause acne to worsen in acne-prone male subjects, twenty-five acne prone male subjects were asked to consume 25 g of 99% dark chocolate daily for 4 weeks. Assessments which included Leeds revised acne scores as well as lesion counts took place weekly. Food frequency questionnaire was used, and daily activities were recorded. Statistically significant changes of acne scores and numbers of comedones and inflammatory papules were detected as early as 2 weeks into the study. At 4 weeks, the changes remained statistically significant compared to baseline. Dark chocolate when consumed in normal amounts for 4 weeks can exacerbate acne in male subjects with acne-prone skin.