In recent years there has been more and more research published which tries to elucidate the role that genetics, lifestyle and external factors like diet play in the pathogenesis, severity, and response to treatment of acne. One such study written by Amanda Suggs, MD and colleagues appears in the April 2018 issue of the Journal of Drugs in Dermatology. To gather data for this unique project, the investigators went to the yearly Twins Day Festival held in Twinsburg, Ohio to study the differences in acne concordance between identical and fraternal twins. Their findings both confirm and expand upon what we know about genetics and lifestyle factors in patients with acne. I spoke with co-author, Amanda Suggs, MD to get her takeaways from the study.
Angelo Landriscina: Thanks so much for agreeing to speak with us. I found your group’spaper very interesting. How did the idea come about?
Amanda Suggs: Thank you for having us! Being in Northeast Ohio, our department has a research booth at the Twins Day Festival each year. Over the years, we have studied various dermatologic conditions such as rosacea and skin cancer. We noticed that a lot of the twins who were willing to participate in survey-based research studies were young females. We felt that acne was a perfect condition to study given that many young females (including myself!) suffer from this condition. The link between acne, lifestyle and diet was of interest to me as my undergraduate studies were in food science and human nutrition.
AL: What is it like being at the Twins Day Festival?
AS: The Twins Day Festival is a unique experience! I was actually pregnant at the time we ran this study. Many of our twin participants assumed that I was having multiples given that I was at Twins Day! I received more questions that weekend regarding if I was having twins than I got total throughout the rest of my pregnancy. Disclaimer: I had a singleton pregnancy!
AL: While your study was fairly simple, it confirmed some associations we already know about, but also uncovered some new ones. Tell me about that.
AS: In agreement with other studies, we found acne to be associated with PCOS and anxiety. Interestingly, we also found acne to be associated with asthma. A study by Silverberg et alfound a similar association. We need more research to confirm if this is a true association or not. Some theories for an association between acne and asthma could be a possible link with toll-like receptor 2 or, perhaps, as was suggested by Silverberg et al, P acnes may play a role in the pathogenesis of sinopulmonary disease.
AL: Based on your findings, what do you think should be the next steps in examining the genetics of acne?
AS: Other studies have shown that acne is largely attributable to genetics. Our study supported this as the proportion of concordant pairs (i.e. both twins having acne) was higher in identical versus fraternal twins. I think our next step research-wise is to study how we can modify environmental factors (such as diet) to decrease acne severity. Per the current acne management guidelines, there are no specific dietary recommendations for acne patients. The guidelines do comment that data suggests an association between high glycemic index diets and acne. Our data also suggested this. More research is needed in this area to confirm this association and if applicable, add this to the guidelines. Per the guidelines, there is some evidence that dairy, especially skim milk, may contribute to acne. Our twin study did not find an association between dairy and acne, however, our survey did not subdivide dairy into skim milk, whole milk, whey, yogurt, cheese, etc. I wish we had! It could have been meaningful data if we could have showed that certain dairy products may have more of an effect on acne severity thanothers. We’ll leave this for, perhaps, a future research study!
AL: How do you think we can use your findings in clinical practice?
AS: The findings from this study suggest that lifestyle factors may play a role in acne severity. In our study, identical twins with acne had a higher BMI and exercised less than those without. We can counsel our acne patients that maintaining a healthy body weight and exercising regularly may help prevent acne breakouts. Like other studies, our twin-to-twin analysis also found that intake of sugar and refined carbohydrates may worsen acne. We can counsel our patients that reducing intake of high glycemic foods may decrease their acne severity.