This article discusses the prevalence and factors influencing acne development, contrasting the condition's commonality in Western societies with its rarity in nonwesternized populations. In the United States, acne affects between 40 million and 50 million people, with a significant presence not only in adolescents but also in adults over 25. However, studies in nonwesternized societies, including the Inuit as they transitioned to a modern lifestyle, pre-WWII Okinawans, rural Brazilians, Peruvian adolescents, and Bantu adolescents in South Africa, show a markedly lower incidence of acne. The article further examines the absence of acne in the Kitavan Islanders of Papua New Guinea and the Aché hunter-gatherers of Paraguay, attributing their lack of acne to environmental factors and diet rather than genetic predisposition. The Kitavans and Aché maintain diets low in processed foods and high in minimally processed plant and animal foods, contributing to low levels of hyperinsulinemia, which is implicated in acne development through its effects on insulin resistance, hyperandrogenism, and inflammation. The findings suggest that Western diets high in refined sugars and carbohydrates may contribute to the higher prevalence of acne through diet-induced hyperinsulinemia, suggesting potential therapeutic roles for low–glycemic load diets in acne treatment.
https://jamanetwork.com/journals/jamadermatology/fullarticle/479093
