Issue of Acne
Acne (acne vulgaris) is a common chronic multifactorial disease of sebaceous hair follicles with a genetic predisposition. They are observed in 3.9%-9.4% of the population and occupy the 4th place in the structure of the overall incidence. Acne is especially significant for adolescents, in whom the frequency of registration reaches 72.3% -95% (Marzano et al., 2019, p. 64). Over the past decades, there has been an increase in the number of patients with late acne among women under 25 (12%-51.4%), as well as patients with moderate and severe acne (20%-35%) (Marzano et al., 2019, p. 79). The problem of acne treatment affects the interests of doctors of various specialties (dermatologists, pediatricians, gynecologists, cosmetologists), therefore it has interdisciplinary significance.
In this regard, a retrospective analysis of the frequency of registration of various forms of acne in the structure of dermatological pathology in a statistically significant sample of patients and an analysis of the effectiveness of previous therapy is relevant. It is significant that the number of relapses, the duration of the course of therapy, and the increase in the number of patients with moderate and severe forms of acne directly depend on the adherence of patients to therapy (Marzano et al., 2019). The maximum effect of treatment is achieved if the doctor is able to convince the patient of the need for therapy, and the patient fulfills all his appointments. In developed countries, only 50% of patients with chronic diseases adhere to the doctor’s recommendations (Marzano et al., 2019, p. 109). The formation of adherence to therapy in patients is one of the main conditions for successful treatment. Therefore, it is relevant to evaluate the effectiveness of therapy with the maximum compliance rate in patients with moderate and severe acne.
In accordance with the existing classification of acne, there are several clinical forms that have characteristic features of the course. However, most studies have only been performed on certain forms of acne. In this regard, a comparative multivariate analysis of the features of the course of vulgar papulo pustular and late acne of moderate and severe degrees, conglobate, and inverse acne on a statistically significant sample is relevant (Marzano et al., 2019). Environmental factors, psychological stress, smoking, hormonal dysfunctions, uncontrolled use of drugs and cosmetics, hereditary predisposition affect the severity of acne.
In the last decade, studies of the cellular and molecular genetic mechanisms of acne pathogenesis have shown that many genes that affect the severity of dermatosis are involved in the development of the disease. The most reliable genetic marker that determines the effectiveness of isotretinoin (IT) treatment is lipocalin-2 (LCN2) (Marzano et al., 2019). The action of LCN2 is associated with the “selection” of iron cations by siderophores, which are necessary for the vital activity of P. acne (Marzano et al., 2019). It has been established that IT activates the expression of the LCN2 gene, which is found in the area of the sebaceous glands only after taking the drug. This was a prerequisite for studying the relationship between the frequency of detection of the LCN2 gene allele mutation in the presence of a hereditary predisposition to acne according to the anamnesis, as well as for evaluating the effectiveness of therapy in patients with moderate and severe acne, taking into account these factors. IT currently remains the only effective drug in the treatment of moderate and severe forms of acne with clinical remission in 70-80% of patients (Marzano et al., 2019, p. 117). Recently, dermatologists around the world have been actively using low doses of IT.
However, the results of the effectiveness of treatment are controversial. A retrospective analysis of more than 17.3 thousand patients with acne over a 10-year period showed that after one course of therapy (the dose of treatment is not indicated), relapses were registered in 41% of cases (Marzano et al., 2019, p. 134). Particularly significant are the works in which the authors evaluate the effectiveness of IT therapy in certain clinical forms of acne.
The gender characteristics of patients and the incidence of clinical forms of acne were analyzed over 13 years (2003-2015). Annually, the ratio of patients by sex (men:women) was regular and amounted to 1:1.5-1.7 (Ojo, 2019, p. 77). In the structure of clinical forms, the proportion of acne vulgaris did not differ statistically over 12 years – 60.3% – 68.8% (p> 0.05), and late acne increased from year to year by 1.4 (2004) – 2, 5 (2014) times (p<0.05) compared to 2003 (Ojo, 2019, p. 77). The incidence of inverse acne was stable: 14.3% (2015) – 17.5% (2003, 2010) (Ojo, 2019, p. 93). On the basis of multivariate analysis, differences were established in the course of six clinical forms of the disease: vulgar papulopustular and late acne of moderate and severe degrees, conglobate, and inverse acne (Ojo, 2019). Differences in the occurrence of these forms by sex, onset, duration of the disease, previous systemic and topical therapy, the severity of skin pathology according to the dermatological acne index (DIA) were revealed.
Various trigger factors play an ambiguous role during exacerbation in patients with different forms of acne. Correlation analysis has been used to prove the relationship between hereditary predisposition to acne and the clinical form of the disease, its debut, duration, and topic of the process. In severe forms of acne, the value of hereditary predisposition was maximum (87% and 77.8%), in inverse acne, it was minimal (43.2%), and only in conglobate acne, it correlated with the sex of patients (Ojo, 2019, p. 94). In the presence of a hereditary predisposition, the number of anatomical zones involved in the process naturally increased from 57.4% (1 zone) to 93.3% (5 zones) (Ojo, 2019, p. 77). This led to an earlier onset of the disease and indicated a long-term (more than 5 years) persistence of the process in ¾ of the patients.
The occurrence of mutant alleles in the structure of the LCN2 gene was determined in the form of a stop codon substitution for the amino acid arginine. In IT-resistant patients, their incidence was significantly 6.6 times (44% vs. 6.7%) higher than in the control group and 4.2 times higher than in IT-sensitive patients (44% vs. %), which indicates the involvement of this mutation in the occurrence of relapses of the disease (Ojo, 2019, p. 77). Thus, the genetic element as the root cause of acne is indeed the place to be.
In the presence of a mutant allele in patients with acne, an average severity of the disease was recorded. In late acne, it was persistent, 80% had a hereditary predisposition, scars did not form, and in the presence of keloid scars, this mutation was absent (Ojo, 2019, p. 103). In acne, there is a deep imbalance of the cellular receptor apparatus at the level of TOLL receptors of various cell types involved in the formation of inflammation in moderate and severe acne, including late and inverse acne. The nature of the changes correlates with the clinical variety and severity of dermatosis.
The clinical and diagnostic significance of the identified disorders in the innate immune system in acne, which correlates with the data of genetic studies and largely determines the choice of treatment tactics and the prognosis of the disease. On a large sample of patients, the dependence of the effectiveness of acne therapy on the clinical form of the disease, the chosen therapy regimen (low or standard doses) and the hereditary burden has been proven (Plewig et al., 2019). The low efficacy of treatment of patients with vulgar papulo pustular and late acne of moderate degree in the presence of hereditary burden with low doses of isotretinoin has been proven. Comparison of the quality of life of acne patients using three indices showed their equal significance in various clinical forms of acne before and after treatment (Plewig et al., 2019). For the first time, the impact on the quality of life of patients was established by the formation of various types of scars.
Acne is the most common chronic multifactorial disease of sebaceous hair follicles with a genetic predisposition. It occurs in 72.3% -95% of adolescents, young people, and also over 25 years old and is often accompanied by a decrease in the quality of life in patients (Plewig et al., 2019, p. 64). The debut of clinical manifestations is observed at the age of 11-12 years in girls, boys a little later, but the peak incidence in most of them falls on 16 years (Plewig et al., 2019, p. 115). At the same time, 37% of patients have various clinical forms, of which 17% have moderate to moderate, and 20% of all cases of the disease account for the severe degree (Plewig et al., 2019, p. 134). A number of studies have shown that teenagers with acne are male-dominated, while adults are female-dominated.
According to the degree of severity, I degree is more common in women, II is moderately severe and III – severe in men. Localization of acne elements occurs on various anatomical regions (face, chest, back) more often in men, isolated location only on the face – in women (Plewig et al., 2019). According to clinical and epidemiological studies, there is a tendency towards an increase in the number of patients over 25 years old, mostly women, in whom 20-40% have adult acne of late onset, requiring an individual approach to prescribing therapy (Plewig et al., 2019, p. 137). The incidence of acne in women is 3-40%, the totality of the above data suggests that the gender characteristics of the human genetic code also affect the formation and course of the disease (Plewig et al., 2019, p. 55). This means that it makes sense to study genes associated with a person’s sex in order to identify pathological causes.
Geographic features and differences in the prevalence of dermatosis are noted. Thus, about 90% of adolescents in Belgium, China, and Australia, 78.9% in Korea, 50-58% in the Philippines, and 50% in the UK and Peru suffer from acne (Plewig et al., 2019, p. 66). Moderate to severe prevalence varies across countries from 14% in Iran to 48% in Singapore (Plewig et al., 2019, p. 66). In Japanese and Koreans, acne is less common and occurs in a milder form compared to Europeans (1:3), northern Tanzanian acne occurs in 0.1%, in Germany 3.9% of the population aged 16-70 years (Plewig et al., 2019, p. 66). The prevalence of acne in China is found in 8.1-85.1%. In the United States, more than 45 million people have various clinical types of acne, of which 3-4% have acne inversion (hidradenitis suppurativa) (Plewig et al., 2019, p. 66). Appeal to dermatologists of patients with acne who require treatment is about 20% (Plewig et al., 2019, p. 67). Among patients with inverse acne, according to Vaidya T. et al (2017), Caucasians predominate in 18% of cases and 1.3% are found in African Americans (Plewig et al., 2019, p. 74). There are populations in which acne does not occur. These are the inhabitants of the island of Okinawa, Bantu in South Africa, the Eskimos, isolated South American Indians. In other words, there are populations (Pacific Islanders and Paraguayans) that do not suffer from acne. This is due to existing genetic defects, leading to a lack of sensitivity of receptors to growth hormones.
Etiopathogenesis of Acne
An analysis of current literature data allows us to conclude that despite the progress made, the pathogenesis of acne has not been sufficiently studied to date. In turn, this limits the development and application of effective therapies. In the development of the disease, the following main pathogenetic factors are distinguished: genetic predisposition, hypercolonization of the main class of bacteria essential for this pathology (Propionibacterium acnes), hormonal dysfunction, defect in inflammatory immunological mechanisms.
However, to date, the exact sequence of pathogenetic processes is not clear. It was previously believed that the main pathophysiological factor is hereditary hyperandrogenism in the form of an increase in the number of androgens and increased sensitivity to them of receptors in the cells of the sebaceous glands, which ultimately leads to hypersecretion of sebum (Marzano et al., 2018). However, there is evidence that acne inflammation precedes follicular hyperkeratosis.
The Role of Genetic Predisposition in the Occurrence and Development of Acne
Studies of hereditary predisposition in acne have a history of more than 100 years, although specific genetic markers have not yet been found. Only polymorphisms of genes that regulate the innate immune system of the skin and the metabolism of steroid hormones have been identified (Marzano et al., 2018). Obviously, many genes are involved in the development of acne. Some of them are responsible for the development of hyperandrogenism and a pathological reaction to the normal content of androgens.
Severe acne is caused by a mutation in a gene that is one of the key enzymes in androgen biosynthesis. Polymorphism of the IGF-1 gene, consisting of variable repeats of cytosine and adenosine, affects the expression of IGF-1 and the severity of dermatosis (Marzano et al., 2018). An increase in male sex hormones is genetically determined, which leads to hypertrophy of the sebaceous glands, a change in the type of secretion, and an increase in the functional activity of the sebaceous glands.
It is known that genetically determined skin type, features of immunity, androgen metabolism, and increased sensitivity of androgen receptors to testosterone and its active metabolites, which is realized in an autosomal dominant manner. In monozygotic twins, the rate of sebum secretion is the same, while the severity of acne may be different. In heterozygous twins, both are different. Cases of neonatal acne described in the literature are associated with familial hyperandrogenism (Marzano et al., 2018). It is assumed that the predisposition to acne depends not on one, but on many genes, among which, perhaps, the steroid-21-hydroxylase gene, polymorphism of genes that affect the production of androgens in the adrenal glands, and genes encoding enzymes of fatty acid metabolism.
Mutations of the AR gene can lead to the formation of such forms of the receptor that are activated by normally inactive androgen precursors, estradiol, progesterone, cortisol, and antiandrogens. There are also mutations in the AR gene, leading to both a complete loss of androgen sensitivity and increasing sensitivity to androgens (Marzano et al., 2018). In this case, the increased activity of the androgenic system exists with an unchanged level of testosterone in the blood (relative hyperandrogenism) (Thomas et al., 2018). The cause of relative hyperandrogenism may also be an increased production of any coactivator proteins or a decrease in the production of AR corepressor proteins.
Recent studies have shown an association of severe acne with gene loci polymorphisms. These gene loci are involved in androgen metabolism, inflammation, scar formation, and are associated with the TGF-β signaling pathway (Marzano et al., 2018). Increased expression of TGF-β leads to the formation of hypertrophic and keloid scars. TNF-α is encoded by a gene that exhibits a high level of genetic polymorphisms (Marzano et al., 2018). It is known that single-nuclear polymorphisms (SNP) of the TNF-α gene are associated with an increased risk of developing chronic inflammatory diseases, including acne. A direct correlation was found between the severity of inflammatory elements and the frequency of polymorphism of certain genes.
Involvement of Hormones in the Pathogenesis of Acne
Increased androgenic activity leads to hypertrophy of the sebaceous glands, hyperproduction of sebum, and changes in its lipid composition when the balance of polar and neutral fatty acids is disturbed. The level of linoleic acid decreases, the level of squalene and sphingosine increases, the ratio of saturated/monounsaturated fatty acids increases (Seli & Garcia-Velasco, 2020). In turn, an increase in the quality and quality of sebum can affect the composition of the skin microflora, including P. acnes, which stimulates the production of pro-inflammatory cytokines.
The secretion of sebum is also influenced by testosterone of testicular or ovarian origin, dehydroepiandrosterone, and ∆4-androstenedione synthesized in the adrenal glands. The production of androgens in the adrenal glands increases with a violation of the biosynthesis of glucocorticoids in case of insufficiency of one of the hydroxylases (androgenital syndrome) (Seli & Garcia-Velasco, 2020). It has been proven that DHT is involved not only in the production of sebum, but also in the production of pro-inflammatory cytokines. Liver globulins have the ability to bind sex hormones, so a decrease in the level of globulins may be the cause of an increase in testosterone levels (Seli & Garcia-Velasco, 2020). The sebaceous glands have an increased sensitivity to testosterone, which is due to the presence of enzymes in the cells of the sebaceous gland.
Skin Genes
In the human body, there are a great many genes, each of which has its own area of responsibility. By “skin genes” we mean genes that predetermine the characteristics and properties of the epidermis of a particular person. For example, the genes TNFa, IL4, IL6, IL13 are responsible for the development of inflammatory processes in the skin (Dayan, 2020). The presence of polymorphisms in these genes indicates a high tendency to various inflammatory skin diseases, including acne and acne.
The FLG, TNFa, and IL6R genes predetermine the tendency to atopic dermatitis. It is a chronic inflammatory skin disease that is closely associated with acne. Dermatitis has a significant impact on the immunity of the skin, so its occurrence often leads to an exacerbation of all other skin problems (Dayan, 2020). The SOD1, SOD2, SOD3, CAT genes are responsible for oxidative stress. This is the process of action of reactive oxygen species on cells, as a result of which there is a pathological accumulation of free radicals. They, in turn, trigger inflammatory processes in the skin cells and lead to the development of hypersensitivity. Individuals with a genetic predisposition to oxidative stress are more likely to develop acne and other skin inflammations.
The metabolism of vitamins has a great influence on the health and beauty of the skin. If there is a chronic deficiency of important substances, the skin is unprotected and unable to withstand negative environmental factors (Dayan, 2020). Few people know, but the functions of assimilation of various vitamins are also laid down at the genetic level. For example, vitamin A is an antioxidant, regulates sebum production and has a great influence on local skin immunity. The BCMO1 gene is responsible for the metabolism of vitamin A (Dayan, 2020). With certain modifications of this gene, a person has a tendency to reduce the metabolism of vitamin A in the blood. As a result, he will have an increased genetic propensity for acne, inflammation, and thinning of the skin.
Vitamin C provides skin regeneration processes and its protective functions. It is involved in the synthesis of interferon, steroid hormones, collagen. The SLC23A1 gene is responsible for the absorption of this vitamin (Dayan, 2020). “Breakdowns” in this gene lead to dry skin, thinning of the walls of blood vessels, reduced protection against skin infections, and slower regeneration processes. That is the likelihood of acne increases. In addition, the effectiveness of treatment decreases, as the healing and restoration of the skin is slow.
The B vitamins are very important for the skin. Their deficiency often leads to the development of skin diseases, skin peeling, acne, and redness. The ALPL and NBPF3 genes are responsible for vitamin B6, the FUT2, TCN1, MTHFR genes are responsible for vitamin B12, and the MTHFR gene is responsible for vitamin B9 (Dayan, 2020). Skin regeneration processes are also determined by genes. If the skin has a good restorative function, then acne treatment will be much more effective and faster (Dayan, 2020). The genes AQP3, FUT2, MTHFR, BCMO1 are responsible for skin regeneration. In the presence of polymorphisms in the genes: COL1A1, ELN, MMP1, MMP3, TIMP1, FUT2, MTHFR, their owner will face a high probability of scarring in the process of acne healing.
Sex Hormone Genes
Often, the occurrence of acne in adolescence is explained by the restructuring of the hormonal system. These statements have a real basis. Indeed, the state of sex hormones affects the appearance of the skin. And the hormonal system, in turn, is also predetermined by genes (Dayan, 2020). The genes 17-alpha hydroxylase and Aromatase are responsible for the formation of the sex hormones estrogens and androgens (female and male hormones).
The “AA” polymorphism in these genes leads to an increase in the synthesis of sex hormones, that is, to hyperandrogenism and hyperestrogenism. Hyperandrogenism is an excess of male hormones, hyperestrogenism is an excessive amount of female hormones (Dayan, 2020). One of the main symptoms of hyperandrogenism is the occurrence of acne, since as a result of an increase in testosterone levels, sebum production is significantly increased and pores are clogged. Also, acne often worries women with elevated testosterone levels against the background of polycystic ovary syndrome (Dayan, 2020). The presence of small rashes can be noticed during the period of ovulation, even with the correct level of hormones, since it is during this period that the testosterone level rises.
The Role of Poor Nutrition in Acne
There is no evidence that diet plays a role in acne in adolescence or adulthood. Indeed, if you turn to the world’s leading dermatological associations with the issue of acne treatment, treatment with nutrition or a special diet will not be mentioned anywhere as one of the first and necessary ways to control the course of the disease. Like eczema, acne has both hereditary and unpredictable etymologies, developing under the influence of genetic and environmental factors, aggravated by contact with triggers specific to an individual organism.
The body is a single structure, and an imbalance in any of the systems leads to disruption in the other. It is difficult to imagine a clinical study that describes the relationship of all external manifestations of a malfunction of one single system: immune, nervous, digestive, and any other. However, if we take the systems separately, we know that a violation of the intestinal microflora can be associated both with a decrease in the immune status and with neuropsychiatric diseases, which, in turn, can also suffer from a lack of micro- and macroelements important for the body, which are not received with food.
There are not many studies that directly consider the relationship of certain aspects of the diet with the appearance and development of acne. As is known, meta-studies conducted on a large number of people from different countries and cultures and investigating various factors of people’s health associated with nutrition have errors, and it is impossible to determine the course of the disease with their help. A more targeted study of the mechanism of the appearance of acne and the lifestyle of the person in whom it develops revealed a dependence on certain factors directly related to human nutrition at the biochemical level.
Insulin
Major research on the relationship between diet and acne has been fueled by increased scientific interest in the growing number of adolescents and adults developing type 2 diabetes. Findings from a number of studies have focused on glycemic load, insulin sensitivity, hormonal mediators, and acne. The researchers reported that foods with a high glycemic index (60-90 units) may contribute to the spread of acne by increasing serum insulin concentrations, suppressing sex hormone-binding globulin (SHBG) concentrations, and increasing androgen concentrations (Suh, 2021). Foods with a low glycemic index (30-60 units), on the contrary, increase SHBG and decrease androgen levels. And, as you know, higher levels of SHBG are associated with a lower degree of acne.
These studies included control groups and looked at the effect of a diet based on low glycemic load foods (25% calories from protein and 45% from low glycemic carbohydrates) on acne, as well as insulin sensitivity. Randomly selected study participants (n=43, men 15-25 years old) were included in the study, which lasted 12 weeks, and were divided into three groups (Suh, 2021, p. 15). Dermatologists assessed the number of acne lesions every four weeks in the control group and in groups eating predominantly low and high glycemic foods. Participants who changed their diet to lower the rate of glucose uptake experienced a significant reduction in total acne and inflammatory lesions compared to the control group. In addition to improved skin condition, volunteers on a low glycemic diet showed improved insulin sensitivity and significant changes in androgen levels (Suh, 2021). A positive correlation was observed between the change in the total number of lesions and the change in insulin sensitivity. SHBG globulin levels were also negatively correlated with change in the number of lesions.
Today, the typical Western diet is associated not only with a high calorie intake, but also with a high content of foods with a high glycemic index. It is this diet that often causes insulin resistance, disrupts the sebum production mechanism and, therefore, provokes inflammation and acne (Tyerman et al., 2020). Of course, acne and its dependence on nutrition needs to be further studied in order to say with certainty about the direct effect of insulin production on skin condition (Suh, 2021). After all, of course, not all people with pancreatic dysfunction have acne. However, as mentioned above, the problem is most often complex and acne is most likely a combination of disorders in the operation of several systems at the same time, and not one of them.
Diet Basics
A diet based on foods with a high glycemic load may be associated with the spread of acne. Nutrition with a low glycemic load does not harm the patient, is complete and can be recommended as a preventive measure or as part of a complex therapy in the fight against acne (Suh, 2021). Fruits contain mainly fructose and a moderate amount of glucose, which does not cause a sharp increase in insulin, a large number of microelements important for the body and fiber, which improves the intestinal microflora and stimulates the immune system.
Vegetables, the basis of any diet, are not only sources of essential fiber, vitamins and minerals, but also antioxidants that can inhibit inflammation in the body and participate in the elimination of toxins. The World Health Organization recommends eating at least 5 servings of fruits and vegetables a day to reduce the risk of cardiovascular disease, obesity, and type II diabetes, which are correlated with the development of skin conditions such as acne (Stoff et al., 2021). Grains, a source of slow carbohydrates, are part of any healthy diet. It is thanks to grain products that the body has the opportunity to obtain glucose, which is important for the functioning of the brain and all metabolic processes, in moderate amounts without causing sharp spikes in insulin. Other studies that are considered in the development of the Mediterranean Diet have been aimed at studying the work of the brain and the digestibility of various types of fatty acids in our body. Dairy products are a source of a large number of important nutrients, such as calcium, vitamins B2 and B12 (Stoff et al., 2021). At the same time, such a controversial element as saturated fatty acids, a certain amount of hormones and milk sugars. Several studies have shown an association between consumption of whole cow’s milk and the number of acne lesions in small study groups, while products such as yogurt and cheese (or dairy products in general) did not show this association. The study, published in Jama Dermatology on June 10, 2020, included more than 11,000 people who had or still had acne filled out a 24-hour food diary (one of the gold standards for collecting dietary data on a large sample of people) (Stoff et al., 2021, p. 56). Skin problems in adulthood were significantly associated with consumption of sweet-fat foods, sugar-sweetened beverages, and milk.
Features of Nutrition During Puberty
The main periods associated with the development of acne fall on the periods of puberty in adolescents. Hormonal and emotional overload are often associated with eating disorders. Needless to say, that adolescents at the age of 11-19 have a diet that is poor in nutritional value (Stoff et al., 2021). Given the opportunity to make independent choices, a teenager tends to choose foods that are forbidden in his home or those that will help him identify himself as an independent, advanced member of society. Unfortunately, modern marketing realities are such that “fashionable” products have a minimum of nutritional value (Stoff et al., 2021). A prolonged deficiency of the main elements leads to protracted infectious diseases, a drop in immunity, increased stress, and a tendency to depression.
The problem with acne takes a heavy toll on the self-esteem of both a teenager and a young mother, and people with metabolic disorders, obesity and diabetes – constant stress and self-doubt, among other things, can again and again lead to overeating of low-quality products, excessive consumption of sugar and reduced consumption important products for the body (Tyerman et al., 2020). Dermatologists should not ignore nutritional research and rely only on new technical developments in the field of external treatment of skin diseases (Stoff et al., 2021). Perhaps, in a number of situations with the development of acne, a nutritionist can be involved to analyze the balance of the diet and possibly correct the violation of sebum secretion.
Also, a psychologist – to help a person in a difficult life situation, to regulate self-esteem and improve eating habits. As a result of the work of a dermatologist, it is worth considering the possibility of improving the quality of a person’s life as a whole, and not just his appearance. In the UK and America, reference books for dermatologists are regularly published with updates on research in the field of skin diseases and their possible relationship with nutrition, the endocrine and immune systems, lifestyle, ecology and psychology. An integrated approach to the problem and cooperation between specialists is important, as well as further research into possible mechanisms that affect the appearance of acne.
Conclusion
When analyzing the factors that negatively affect the appearance and development of acne in adolescents, it is impossible to draw an unambiguous conclusion. On the one hand, nutrition is not the root cause of acne in individuals, on the other hand, it contributes to the aggravation of the disease. In addition, a number of authoritative studies prove the relationship between inflammation and the genetics of a particular person, which indicates a genetic predisposition. However, the two factors should be considered together and all areas should be controlled at once in order to cope with the disease as effectively as possible.
References
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Ojo. O. (Ed.). (2019). Nutrition and chronic conditions. MDPI AG.
Plewig, G., Melnik, B. and Chen, W. (2019). Plewig and Kligman’s acne and rosacea. Springer International Publishing.
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