Adolescence and zits seem to go hand in hand. So do teenagers and junk food. Coincidence? Maybe not!

After decades of denying any connection, some mainstream dermatologists are recognizing that diet may indeed play a role in teen acne. You may remember hearing that eating chocolate or greasy foods brings on pimples, or you may have heard that that is an old wives’ tale! After all, a website run by the American Academy of Dermatology still proclaims that it is a “myth” that acne is caused by diet.

However, recent studies have shown that young patients eating foods we all think of as “healthier” have significantly fewer acne lesions. So now, in some doctors’ offices, what kids eat and drink is at least part of the discussion. “Even five years ago, we did not raise the issue of diet,” says Robin Hornung, M.D., the chief of pediatric dermatology at Seattle Children’s Hospital. “More and more evidence suggests that food is a complicating factor, and that it may be worth trying diets such as low-carbohydrate ones.”

An Australian study published last year in the Journal of the American Academy of Dermatology even found that, on a “low-glycemic load” diet – which in common terms means lean meats, whole grain breads, certain fruits and veggies – adolescent boys saw improvement in their acne even beyond what the topical acne solutions provided. “The findings could explain why acne, the scourge of adolescents in industrialized nations, is uncommon in the developing world,” writes study author Neil Mann, Ph.D.

The science goes as follows: When blood sugar spikes, insulin is released, which in turn releases various hormones that increase the amount of sweat and sebum in the body. Zits begin to form when sebum mixes with excess dry skin cells causing a blockage. The blocked channel becomes infected with bacteria, thus inflaming the follicle. Acne can show up in a variety of forms, from blackheads or whiteheads to cysts.

In his book The Acne Prescription, Nicholas Perricone, M.D., characterizes acne as an inflammatory disease caused by high-carb, usually highly processed foods that fuel the body’s own destructive power. “All [acne] lesions are inflammatory, regardless of whether the inflammation is visible under the dermatologist’s microscope or not,” Perricone says. So while it is not accurate to say that chocolate and grease cause zits, some dermatologists are emphatic that the wrong foods jump-start destructive processes in the body that ultimately show up as plain old, ugly acne.

Other causes
Besides notoriously bad food choices, most teens are going through puberty. Male-type hormones stimulate the oil glands to produce more sebum, which contributes to the development of acne. A dermatologist might recommend that a girl with severe acne undergo hormone therapy, such as taking a birth control pill.

Hornung adds that heredity plays a big role in not just the onset, but the pattern and type of acne. For instance, teens are predisposed to severe acne, if their parents struggled with bad acne.

As many parents can attest, many teens are also under a tremendous amount of stress. And while this, too, is a controversial link, some, such as Terry Dubrow, M.D., author of The Acne Cure, see a connection. Dubrow’s theory is that stress releases chemicals in the body that in turn increase the production of sebum.

Treatment
Go to any drugstore and you’ll see shelves lined with over-the-counter acne treatments with names such as Stridex and Zapzyt. Ingredients may include salicylic acid, glycolic acid and benzoyl peroxide, a drug that has been used as an ointment for skin and acne problems since the 1930s. Severe acne cases may be treated with hormones, the antibiotic tetracycline or even Accutane.

But now, proponents of the acne-diet connection want to educate young people about their own food choices. Perricone has a long list of inflammation-inducing foods to avoid. There are the obvious ones: candy, cookies, hot dogs, soda and the like. But teens not familiar with low-carb diets may be surprised to know that other seemingly healthy favorites are also no-no’s: bagels, cream cheese, pasta, tacos and pizza.

Hornung recommends that mild acne sufferers give the low-carb diet a try for a couple of months. If that doesn’t work, she urges young people struggling with acne, to seek professional help. “I hate to see kids coming in with late-stage acne, with scars, when it could have been treated,” says Hornung. “There can be depression, self-esteem issues. When they do talk about it, it’s devastating.”

Hilary Benson is a Mercer Island freelance writer and mother of three.

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