The ordinary Western diet is now under severe attack from critics who are willing to accept primarily epidemiologic evidence for a causative role of diet in the occurrence of a wide variety of diseases.1 Among the disease states attributed either wholly or substantially to dietary factors are atherosclerosis and coronary heart disease,2,3 diabetes,4 hypertension,5 dental caries,6 diverticulosis and hemorrhoids,7 and cancer of the bowel.8 Recent evidence also suggests that cancer of the breast, endometrium, and prostate are more likely to occur on high-fat diets.9
This growing (although by no means universally accepted) consensus makes it increasingly difficult for practicing dermatologists to shrug off the query "What about diet?" that is asked, if not by most of their acne patients, at least by some of these patients' parents who remember the stringent dietary restrictions of a previous generation of dermatologists.
As far as acne