Investigating the relationship between the incidence of acne vulgaris
and lifestyle factors
Abstract
Lifestyle has several subsets, including: food choices, physical activities, sleep, work and education, use of smoke and alcohol, and values and beliefs. which can be effective in the incidence and severity of acne vulgaris. Acne vulgaris is a common inflammatory disorder in the pilosebaceous unit that has a chronic course. This complication usually appears with papules, pustules or nodules mainly on the face. In this research, the effect of some of the most important lifestyle indicators such as: diet, physical activity (exercise), sleep quality, and the use of cigarettes and alcohol on the occurrence and severity of acne vulgaris has been discussed; And we have come to the conclusion that
diet and alcohol consumption have a direct effect and physical activity (exercise), sleep quality and smoking have an indirect effect on the incidence and severity of acne.
Keywords: Acne, Acne Vulgaris, lifestyle.
Introduction
Acne is a very common inflammatory skin disease (Lee et al., 2019). The skin is the body’s largest organ (Grosbart, 2010), and damage to it hinders the functioning of the immune system. Acne vulgaris is one of the main causes of disability in the world. The skin plays an important role as a sensory organ in the socialization process of people
throughout the life cycle. This organ is the first organ seen in communication and responds to different types of emotional stimuli. In addition to the discomfort caused by the clinical symptoms of acne, patients may experience other negative effects. One study found significantly higher unemployment rates among acne cases than controls,
suggesting a link between acne and employment.Additionally, acne has been found to have a negative impact on people’s social life, self-esteem, and body image (Hing & Chiu, 2020). Therefore, acne, as one of the most
common skin diseases, has a close relationship with mental problems (Raza et al., 2012;Samuels et al., 2020 .)
Quality of life is a personal understanding of satisfaction in life, physical health, social and family health, hope, and the patient’s mental health (Neotaki et a;l2013).Quality of life is a vital field in skin care that is very important. and defines all aspects of Individuals well-being regarding the diseases they are fighting against (Chilika et al.,2017).
Because patient’s quality of life can severely acne affect the in many ways, several methods have been described to evaluate the quality of life of these patients.Although quality of life affects the acne in all individuals, changes in quality of life related to acne were greater among Asian groups than among whites and blacks.
Discussion
-What is acne vulgaris?
Acne vulgaris is a common cutaneous inflammatory disorder of the pilosebaceous unit,which runs a chronic course.
The condition commonly manifests with papules, pustules, or nodules primarily on the face, although it can also affect the upper arms, trunk, and back.
The pathogenesis of acne vulgaris involves the interaction of multiple factors that ultimately lead to the formation of its primary lesion, which is known as “comedo”.
Although acne vulgaris is commonly observed among adolescents, it is not restricted to this age group and can affect individuals of various ages.
The severity of this condition can vary, ranging from a mild presentation with only a few comedones to more severe forms characterized by disfiguring inflammatory manifestations, which can lead to hyperpigmentation, scarring, and adverse
psychological effects.
-What is lifestyle?
Life style is a set of habits, behaviors, choices and behavioral patterns of a person or
group throughout life, which shows their values, interests and identity. Lifestyle covers
a wide range of things, including:
Food choices: the type of food we eat, how we cook it, and when we eat it
Physical activities: type and amount of sports and recreational activities
Sleep: amount and quality of sleep
Social relations: how to interact with family, friends and society
Work and education: type of job, working hours and education level
Use of smoke and alcohol: The effects of cigarettes, drugs and alcohol are directly related to the quality of life
Environment: place of residence, type of housing and how to use natural resources
Values and beliefs: religious, political and moral beliefs
-Lifestyle in health:
Lifestyle plays a very important role in the overall health of people. Our choices about food, activity, sleep, stress, and other aspects of our lives can affect our physical and mental health.
By making healthy changes in your life, you can reduce the risk of chronic disease,improve your overall health, and generally live a longer, happier life.
– The relationship between diet and acne vulgaris:
Some foods may make acne worse, and conversely, some foods may help improve skin health.
Foods and drinks that increase blood sugar further increase the occurrence of acne.
These foods cause more insulin to be secreted and thus increase the occurrence of acne.
Therefore, you should avoid drinks sweetened with sugar, white bread, white rice, potatoes, pasta, popcorn, cakes and sweets.
A high-fiber diet may help control acne. However, more studies are needed in this area.
Therefore, consumption of legumes, fruits, vegetables and whole grains is recommended.
Western diets that are low in fiber and high in white grains can aggravate acne.
Omega-3 fatty acids may also improve the condition by reducing inflammation and decreasing the hormones that contribute to acne production. Fatty fish are one of the richest sources of omega-3.
Studies have shown a weak direct relationship between milk and dairy consumption and acne. Interestingly, fat-free or low-fat milk increases the incidence of acne more than whole milk.
Consuming chocolate may also be effective in this regard. Therefore, you should avoid consuming it and consume more varieties that have less sugar. Regarding the consumption of fatty foods, contrary to popular belief, it seems that the consumption of fat does not have much effect on the occurrence of acne.
Other compounds such as antioxidants, zinc, and vitamin A may also be associated with acne, but their effects have not yet been proven.
In another research conducted by (Yesim Akpinar Kara, Deniz Ozdemir; 2020) they came to the conclusion that:In patients with acne vulgaris, it was observed that cheese consumption increased acne formation and carbohydrate consumption increased acne severity, while fat consumption did not increase acne severity.
– The relationship between Physical activities (sports activity) and acne vulgaris:
Exercise helps us control weight and increases blood circulation. Dermatologists believe that increasing blood circulation makes the skin healthy and fresh, while it also reduces stress and its negative effects on the skin. In more studies, it was proven that exercise itself has nothing to do with the occurrence of acne. In fact, science today shows that exercise and sweating are very beneficial for the skin. (dr.faghihi; 2022)
But what are the factors that cause acne in sports?
Wearing clothes that are tight and restrict your movements; Using some fabrics that are allergenic. Such as polyester and other fabrics with synthetic fibers that can trap bacteria and fat on your skin, and because of this, the
possibility of pimples increases. It is better to use fabrics such as linen or other fabrics that allow moisture to pass through. Remember that any clothing that causes itching on the skin will worsen the condition of pimples;
Exercising with face makeup can close skin pores and be effective in acne; Clean your face before and after exercise to prevent the skin from becoming bacterial, which can be an important factor in acne; Try to exercise in a cool environment.
– The Relationship between sleep quality and acne vulgaris:
Sleep has a strong regulatory role in general body function. Studies have shown that poor sleep quality is associated with an increased risk of physical and mental health problems(Zisapel N; 2007) It is characterised by short sleep
duration, insomnia and altered sleep latency. Very little research has been done on the association between sleep quality and skin function.(Oyetakin-White P;2015)
In a study aimed at investigating the relationship between facial sebum secretion and sleep quality in women with acne vulgaris, conducted by (Zlem Bilgi in2016). Zilgi and colleagues selected women with acne vulgaris who were
between 18 and 40 years of age.
They included subjects who (1) had not taken isotretinoin or other drugs that affect sebum secretion, (2) had not used a topical treatment for acne in the previous month, and (3) had normal menstrual cycles and were in the follicular phase. they chose Patients who, in addition to acne, had a history of physical or skin disease or significant cognitive problems, were excluded from the study.
They chose five places on the face: forehead, nose, right and left cheeks and chin.
These areas were classified as high sebum secretion area (T zone which includes forehead, nose and chin) and low sebum secretion area (U zone which includes both cheeks).
According to the Pittsburgh sleep quality index, 44 (51.8%) participants were good sleepers and 41 (48.2%) participants were poor sleepers. The mean sebum level over the T-zone and the entire face was significantly higher for the good sleepers than for the poor sleepers. However, no significant difference was found between the good sleepers and the poor sleepers for sebum levels in the U-zone
[Table – 1]
The results of this study provide preliminary evidence that good sleep quality is associated with elevated sebum levels over the T-zone in women with acne vulgaris. Although increased sebum production is one of the major pathogenic factors promoting acne vulgaris, it also has some protective effects over the body. Sebum creates a barrier against exogenous oxidative insults such as sunlight. (Youn SW; 2005)
Sebocytes are a part of the innate immune system and have antimicrobial components. Sleep performs protective and restorative functions for the skin.
Studies have suggested that acute sleep deprivation and poor sleep quality may impair the integrity of the skin. This may be associated with skin ageing and impaired response to exogenous stressors. (Zlem Bilgi in 2016) (Oyetakin-WhiteP; 2015).
Sleep also plays a strong regulatory role in hormonal rhythms.[1] Various studies report that good sleep quality increases the levels of plasma insulin-like growth factor-1 and dehydroepiandrosterone sulfate. (Makino S; Fujiwara; 2012) In short, it can be said: this study showed that good quality sleep patterns increase seborrhea in women with acne vulgaris.
– The relationship between smoke and acne vulgaris:
One of the risk factors of acne vulgaris is smoking. In relationship studies there are conflicting results between smoking and acne. And also a handful of articles are available in this field.
Smoking is a very important and reversible risk factor for disease and death. Tobacco is directly associated with cardiovascular disease, chronic bronchitis and many malignant diseases.
Tobacco has also many skin effects, most of which are harmful’. Cigarette smoking is associated with a variety of skin diseases like psoriasis, pustular palmoplantar psoriasis, suppurative hidradenitis, systemic and discoid lupus erythematosus, and cancers in some areas such as the lip, oral cavity and anogenital regions (just-Sarobe M; 2008).
A controversial relationship between smoking and melanoma, cutaneous squamous cell carcinoma, basal cell carcinoma and acne vulgaris has been also proposed (Sele BA;2002).
In contrast, smoking seems to have a protective effect against rosacea, labial herpes simplex, pemphigus vulgaris and dermatitis herpetiformis (just-Sarobe M; 2008)
(Simantov E;2000). Smoking is directly responsible for certain dermatoses such as nicotine stomatitis, black hairy tongue, periodontal diseases and some types of urticaria and contact dermatitis (just-Sarobe M; 2008).
Tobacco smoke is a complex mixture of gaseous and particulate compounds, many of which have the potential of causing physiological and pharmacological effects (Thomsen SF, Sorensen LT; 2010).
The skin is an organ in contact with cigarette smoke both directly through contact with environmental smoke and indirectly as the toxic substances entering into the blood stream by smoke inhalation (just-Sarobe M; 2008).
In studies about the effect of smoking on acne, conflicting results have been achieved so far.
A positive relationship between the incidence of acne and smoking has been shown by some researchers (Schafer T, Nienhous A; 2001).
while in other studies, a protective effect for smoking has been suggested (Rombouts S, Nijsten T; 2007).
According to the studies (Yalda Nahidi, Zari Javadi; 2012) that reached this conclusion on the relationship between
acne vulgaris and smoking in young men in Iran:
Patients with acne were more likely to smoke than patients without acne. Therefore, smoking may be an effective factor in the occurrence of acne.
– The relationship between Alcohol and acne vulgaris:
The oral consumption of alcohol (ethanol) has a long tradition in humans and is an integral part of many cultures. The causal relationship between ethanol consumption and numerous diseases is well known. In addition to the well-
described harmful effects on the liver and pancreas, there is also evidence that ethanol abuse triggers pathological skin conditions, including acne (Johannes kleemann et al;2024).
Alcohol abuse has been linked to the exacerbation of several cutaneous disorders. Studies have shown a correlation between alcoholism and dermatoses such as seborrheic dermatitis, rosacea, and acne vulgaris. These skin conditions
can be further aggravated by excessive alcohol consumption.
Understanding how alcohol affects acne is key to comprehending the relationship between the two. Several factors come into play when considering
the impact of alcohol on acne, including its effect on hormones and sebum production, inflammation and acne symptoms, as well as its potential to weaken the immune system.
Alcohol consumption appears to be a risk factor for acne. Many cross-sectional studies conducted among European and Asian populations have found that individuals consuming alcohol exhibit a significantly higher risk for developing acne compared with abstainers. (Say YH, et al; 2021)(Dreno B, Shourick J; 2020)
The effects of alcohol consumption on adolescent acne, a common acne subtype, have been inconsistent in the literature. A large-scale community-based study conducted in six cities in China revealed that alcohol consumption was associated with adolescent acne, where 41% of drinkers suffered from acne. (Shen Y,Wang T ,et al; 2012)
However, another study involving 1277 schoolchildren in Lithuania reported an absence of associations between acne and alcohol consumption.(Karciauskiene J 2024)
As for adult acne, Shen et al study provided the prevalence in adults (over 25 years old). (Shen Y,Wang T ,et al;2012)
They found the prevalence of acne was 5.5% in heavy drinkers, 5.8% in mild to moderate drinkers, and 5.5% in non-drinkers, suggesting that alcohol consumption does not appear to be a risk factor for adult acne. Nevertheless, a
cross-sectional study involving 3888 subjects, whose age range is 17–71, found that alcohol consumption was associated with acne severity, particularly mild acne.(Heng AHS, Say YH; 2022)
It reported that alcohol consumption is a risk factor for mild acne compared to more severe acne with the odds ratio of 1.484. These inconsistent results suggest that the role of alcohol consumption in adult acne should be studied in age stratification and whether it is persistent or late-onset acne.
The mechanisms by which alcohol elevates the risk of acne remain unclear but may involve its effect on epidermal microorganisms. Akçınar UG, Ünal E,Doğruman Al F; 2018)
Certain acne-related microorganisms possess alcohol dehydrogenase, which converts excess alcohol into toxic acetaldehyde, which in turn may play a role in the pathophysiology of acne.
Conclusion
Findings related to whether lifestyle can affect the incidence of acne vulgaris?
It should be said that lifestyle has an effect on the occurrence of acne, but it should be noted that some cases have a direct effect and some cases have an indirect effect on this issue. According to the findings and research collected in this article, it can be said: Food and alcohol consumption have a direct effect and sleep quality, sports activities and
smoking have an indirect effect on the incidence of acne vulgaris or acne severity.
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collected by Shirin Safikhani
