Dietary Modifications and Nutritional Supplements in Acne and Rosacea Management

Conclusions

• Lower-glycemic diets appear to reduce acne severity and can improve response to isotretinoin, especially in patients with higher insulin-related risk factors.
• Westernized diets high in dairy, red meat, and refined carbohydrates may promote acne through IGF-1, insulin, mTOR, and androgen-related pathways.
• Whey protein supplementation is repeatedly associated with worse acne and can make acne treatment less effective, while stopping whey may improve outcomes.
• Plant-based protein alternatives and lower–branched-chain amino acid sources may be preferable for acne-prone patients who need protein supplementation.
• Omega-3 fatty acids and gamma-linolenic acid may reduce inflammatory and noninflammatory acne lesions and may also lessen isotretinoin side effects.
• Vitamin B12 supplementation, especially in compounded weight-loss treatments, may worsen acne in some patients by altering C. acnes porphyrin production.
• Vitamin D deficiency is common in acne and supplementation seems most helpful for inflammatory acne rather than comedonal acne.
• Zinc supplementation can help inflammatory acne, but it should be used carefully because of gastrointestinal side effects and the risk of copper deficiency with long-term use.
• Some older tetracycline antibiotics have clinically relevant food and mineral interactions, while newer options like sarecycline are less affected.
• Practical dietary counseling for acne works best as realistic food swaps and gradual modifications rather than complete elimination of all trigger foods.
• Rosacea symptoms are often triggered by alcohol, spicy foods, heat, cinnamaldehyde-rich foods, and histamine-rich foods through neurovascular inflammatory pathways.
• Dietary pattern matters in rosacea as well, with higher plant-based diet scores linked to lower risk and higher sugar/carbohydrate intake linked to higher risk.