Does consuming chocolate exacerbate acne?

Chocolate and Acne: The Evidence-Based Connection

Dark chocolate consumption can exacerbate acne, particularly in acne-prone individuals, as demonstrated by multiple controlled studies showing significant worsening of acne lesions after regular chocolate consumption. 1, 2

The Scientific Evidence on Chocolate and Acne

The relationship between chocolate and acne has been extensively studied, with recent research providing stronger evidence for this connection:

• A 2024 crossover study found that daily consumption of 50g of dark chocolate (85% cocoa) significantly intensified acne lesions in participants, even when following an anti-inflammatory diet. The severity of acne increased by approximately one point on the Investigator's Static Global Assessment scale in most participants 1.

• A 2016 study demonstrated that consuming 25g of 99% dark chocolate daily for 4 weeks caused statistically significant worsening of acne in acne-prone male subjects, with changes detectable as early as 2 weeks into the study 2.

• A 2018 study found that dark chocolate consumption affected facial skin by enhancing corneocyte desquamation and promoting bacterial colonization of the skin surface, particularly in young men 3.

Mechanisms Behind Chocolate's Effect on Acne

Several pathways may explain how chocolate consumption exacerbates acne:

• Inflammatory response: Components in chocolate may trigger inflammatory processes that contribute to acne development.

• Bacterial colonization: Dark chocolate consumption has been shown to promote bacterial colonization on facial skin 3.

• Skin cell turnover: Chocolate appears to enhance corneocyte desquamation (skin cell shedding), which can contribute to pore clogging 3.

Dietary Recommendations for Acne Management

The American Academy of Dermatology acknowledges the growing evidence for dietary interventions in acne management 4. Based on current guidelines:

1. Consider reducing or eliminating chocolate consumption, particularly dark chocolate, for acne-prone individuals 1, 2.

2. Adopt a low glycemic load diet, which has been shown in multiple randomized controlled trials to improve acne severity by:

   • Reducing sebum production
   • Decreasing inflammatory lesion counts
   • Reducing sebaceous gland size
   • Decreasing inflammatory cells and cytokines 4

3. Limit dairy consumption, especially skim milk, which shows the strongest association with acne development. A meta-analysis of 14 observational studies found a positive relationship between acne and milk intake 5, 4.

4. Be cautious with whey protein supplements, which have insulin-promoting properties that may trigger acne. These should be discontinued if acne occurs 5, 4.

Practical Implementation

For patients with acne concerned about dietary triggers:

• Keep a food diary to track potential associations between chocolate consumption and acne flares.

• Allow adequate time (10-12 weeks) to observe results from dietary modifications 4.

• Maintain conventional acne treatments while making dietary changes, as diet should complement, not replace, standard acne therapies 4.

• Consider incorporating foods with potential anti-acne benefits:

  • Foods high in antioxidants (colorful fruits and vegetables)
  • Foods rich in omega-3 fatty acids (may have protective effects)
  • Green tea (contains antioxidants that may help reduce inflammation) 4

Important Caveats

• Individual responses to chocolate may vary; not all acne patients will experience worsening with chocolate consumption.

• The specific components in chocolate responsible for acne exacerbation remain unclear 1.

• Dietary modifications should be considered as part of a comprehensive acne management plan that includes appropriate topical and/or systemic treatments based on acne severity.