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PARIS — There is strong biological evidence to support an argument that diets high in sugar, lipids, or both are contributing factors in the risk for acne, according to one expert arguing for the need to counsel patients about diet. But her opponent arguing for the opposite position relied on what was labeled as weak clinical evidence to support her stance.

Based on the biology, “you cannot say that there is no link between diet and acne,” asserted Brigitte Dréno, MD, PhD, chief of the Dermatology Unit, University Hospital Center, Nantes, France.

She regularly advises patients who have acne or are at risk for acne to avoid the foods that she links to acne based on triggers of inflammation and molecular pathways that she believes underlie the disease.

During the debate that took place on September 18 at the European Academy of Dermatology and Venereology (EADV) 2025 Congress, Clio Dessinioti, MD, PhD, dermatologist and researcher affiliated with the Andreas Syggros Hospital of the National and Kapodistrian University of Athens, Athens, Greece, considered Dréno’s argument to be largely theoretical.

Parents Are Among Those Hoping Diet Matters

“Parents are hoping that I will tell their adolescents not to eat so much sugar, but the truth is that there is very limited clinical evidence that it makes a difference in regard to acne,” Dessinioti said.

This is not just her opinion, she said, citing several major guidelines, such as the UK’s National Institute for Health and Care Excellence (NICE), which advocated for a balanced diet but concluded that there “is not enough evidence to support specific diets for treating acne.”

The 2024 guidelines from the American Academy of Dermatology (AAD) are similar. Although these cite three small randomized controlled trials (RCTs) that associated low-glycemic load diets with improvement in acne, it cited a fourth RCT that includes almost twice as many patients as any of the others, which was unable to show improved acne control. Ultimately, no specific dietary recommendations to reduce the risk for acne were made.

Yet in her review of published studies, Dréno said that diets with a high-glycemic load result in higher levels of insulin growth factor 1, a mediator of inflammation, while diets high in lipids can be linked to proliferation of sebaceous glands. Diets high in fatty acids, which are building blocks for oils, lipids, and other forms of fat, upregulate inflammatory cytokines in the skin and elsewhere, she noted.

She also challenged the idea that there is limited supportive clinical evidence for a link between diet and the risk for acne. As one example, she cited a 2022 meta-analysis of data from 34 published studies. While only six of these studies were RCTs and the authors concluded that the acnegenic effect of high-glycemic diets was “modest.” Dréno said, this and other evidence support the biologic plausibility described in experimental work.

From her perspective, Dessinioti kept returning to the relative lack of high-quality clinical trials on which to provide any evidence-based recommendations.

Hypotheses on Diet Are Not Resolved With Evidence

“There are lots of hypotheses about how diet might relate to risk of acne, but none have been confirmed,” she said.

According to Dessinioti, many sources of information, particularly those found on the internet, are unreliable, often suggesting that the risk for acne can be modified with diet but with little to no support. This type of language is not helpful, she said, emphasizing that “associations simply do not mean causation.”

A Google search supports her contention. One such search produced a patient-oriented webpage maintained by the AAD. Although no specific dietary recommendations are made, it does state that scientists believe that a low-glycemic diet “may reduce acne.” The webpage goes on to encourage those with acne to look for associations between the food they eat and their flares.

The high risk for acne on a Western diet has been a common basis on which to make the association, but Dréno and Dessinioti drew different conclusions. For Dréno, who cited multiple studies associating a Western diet with acne, a 2002 study that found no cases of acne in two non-westernized populations — island inhabitants near Papua New Guinea and hunter-gatherers in Paraguay — provided compelling evidence of the link.

For Dessinioti, the difference in the rate of acne is not relevant without considering other potential explanations such as genetic susceptibility and body weight. She acknowledged that healthy nutrition may be protective against many health risks but argued that acne cannot be attributed to diet alone without controlling for a long list of other variables.

“The Western diet is a source of obesity, and weight control might be a better explanation for the low relative risk of acne we see in non-Western populations,” she said. She maintained that there has never been an adequate controlled trial to prove that the Western diet by itself is or is not an acne risk factor.

In addition to the lack of high-quality evidence of a causal relationship between dietary choices and increased risk for acne, Dessinioti noticed weaknesses and inconsistences across the available studies. She believes many have failed to control for presence or absence of anti-acne medications or the unpredictability of acne flares.

“It is really essential to perform placebo-controlled trials when testing diet because acne remits and flares on its own,” she said.

In clinical consultations, Dessinioti acknowledged that she often discusses diet with adolescents but only because the topic is almost always raised by the patient or a parent. On the basis of guideline-derived evidence, she explains that she cannot provide any advice based on objective evidence.

The debate moderator, Nichole Joanne Jouan, MD, dermatologist practicing in Brest, France, remained neutral, but she agreed that most recent guidelines, including those from the AAD, have declined to provide dietary recommendations.

Given how often that patient link their acne flares to specific foods, Jouan suggested that this topic “urgently needs the type of trials that would resolve the question.”

Dréno, Dessinioti, and Jouan reported having no financial relationships relevant to this topic.