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Say it ain’t so: Dark chocolate exacerbates acne!

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By Warren R. Heymann, MD
May 5, 2016

Diet and acne has always been controversial. When I was a child I heard that pizza and chocolate could lead to break-outs; over time that was relegated to be a myth (thank goodness).

The latest foods that have may possibly lead to acne flares are those with a high glycemic content and dairy products, notably skim milk (1).

Vongraviopap and Asawanonda studied 25 acne-prone men who consumed 25 grams of 99% dark chocolate (Lindt) daily for 4 weeks. They were assessed by the Leeds revised acne scores and lesion counts on a weekly basis. Statistically significant worsening of comedones and inflammatory papules was observed, with the most dramatic increases during the first 2 weeks.

This was an open study with no placebo control. On the plus side, though, as you can imagine, compliance was outstanding!

The authors make some important points in their discussion: 1) milk was not a factor as only one brand of dark chocolate was utilized; 2) all of the patients already had acne — this study did not address if it would cause acne; 3) why dark chocolate, composed of anti-inflammatory flavonoids, would exacerbate acne is unknown. Perhaps it is because dark chocolate contains cocoa butter (with monounsaturated oleic acid and stearic acid, among other fats) (2).

If this study depresses you, perhaps your mood will be lifted by knowing that dark chocolate attenuates intracellular pro-inflammatory reactivity to acute psychosocial stress in men. Apparently flavanol-rich dark chocolate exerts its anti-inflammatory effects both by increasing mRNA expression of IL-10 and by blunting the stress reactivity of NF-ĸB (3). This mechanism may add to beneficial effects of dark chocolate on cardiovascular health (3).

So, until proven otherwise, here’s my advice: If you get stressed thinking about this, you might break out in a zit, as stress itself aggravates acne. Have a piece of dark chocolate — it will help your stress and your heart. If it causes a pimple, use your acne medication to clear it up.

Maybe I’m wrong. Perhaps the authors are correct and dark chocolate really does exacerbate acne. More study is needed, in a controlled fashion. I will be happy to participate in that trial — just don’t put me in the placebo group!

1. Zaenglein AL, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 2016; 74: 945-73.
2. Vongraviopap S, Asawanonda P. Dark chocolate exacerbates acne. Int J Dermatol 2016; 55: 587-91.
3. Kuebler U, et al. Dark chocolate attenuates intracellular pro-inflammatory reactivity to acute psychosocial stress in men: A randomized controlled trial. Brain Behav Immun 2016 Epub ahead of print April 28.
Kuklinski L, Kim J. Expression of PD-L1 in mastocytosis. J Am Acad Dermatol 2016; 74: 1010-2.

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