Finalist Award in Clinical Case in Skin Enhancement and Integrative Acne Treatment: 6th Anti-aging and Beauty Trophy 2018-2019, Monaco Work Base on Food Intolerance Test: A Case Study

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Vipawan Annoppornchai, MD
Chawapon Kidhirunkul, MD
Atiya Rungjang, MD


Acne vulgaris is a skin condition that can occur in patients of any age. The outcome depends on genetic regulation in terms of hormone level control, sebum excretion, keratinization, and the level of immunological response. However, it is also possible that factors such as hygiene and diet can affect acne, while some recent studies have revealed links between certain specific food types and the onset or severity of acne. Therefore, this case study reports the effectiveness of the integrative approach in treating acne vulgaris in a young man who showed a rapid response to the combination of topical therapies and Intense Pulse Light (IPL) therapy with the removal of certain foods in line with the results of food intolerance testing. It was reported that the patient showed significant improvements following treatment for a three-month period, suggesting the strong potential of the integrative approach for acne treatment.

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How to Cite
Annoppornchai, MD V, Kidhirunkul, MD C, Rungjang, MD A. Finalist Award in Clinical Case in Skin Enhancement and Integrative Acne Treatment: 6th Anti-aging and Beauty Trophy 2018-2019, Monaco Work Base on Food Intolerance Test: A Case Study. BKK Med J [Internet]. 2021 Feb. 11 [cited 2024 Apr. 18];17(1):46-50. Available from:
Case Report


Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013. doi:10.1111/bjd.12149

Cunliffe WJ. Acne and unemployment. Br J Dermatol. 1986. doi:10.1111/j.1365-2133.1986.tb05757.x

Ramos-E-Silva M, Ramos-E-Silva S, Carneiro S. Acne in women. Br J Dermatol. 2015. doi:10.1111/bjd.13638

Shuster S, Fisher GH, Harris E, et al. The effect of skin disease on self image. Br J Dermatol. 1978. doi:10.1111/j.1365-2133.1978.tb15214.x

Williams HC, Dellavalle RP, Garner S. Acne vulgaris. In: The Lancet. ; 2012. doi:10.1016/S0140-6736(11)60321-8

Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016. doi:10.1016/j.jaad.2015.12.037

Bataille V, Snieder H, MacGregor AJ, Sasieni P, Spector TD. The influence of genetics and environmental factors in the pathogenesis of acne: A twin study of acne in women. J Invest Dermatol. 2002. doi:10.1046/j.1523-1747.2002.19621.x

Wei B, Pang Y, Zhu H, et al. The epidemiology of adolescent acne in North East China. J Eur Acad Dermatology Venereol. 2010. doi:10.1111/j.1468-3083.2010.03590.x

Ismail NH, Manaf ZA, Azizan NZ. High glycemic load diet, milk and ice cream consumption are related to acne vulgaris in Malaysian young adults: a case control study. BMC Dermatol. 2012. doi:10.1186/1471-5945-12-13

Kwon HH, Yoon JY, Hong JS, et al. Clinical and histological effect of a low glycaemic load diet in treatment of acne vulgaris in Korean patients: A randomized, controlled trial. Acta Derm Venereol. 2012. doi:10.2340/00015555-1346

Smith RN, Mann NJ, Braue A, et al. A low-glycemic-load diet improves symptoms in acne vulgaris patients: A randomized controlled trial. Am J Clin Nutr. 2007. doi:10.1093/ajcn/86.1.107

Smith RN, Mann NJ, Braue A, et al. The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: A randomized, investigator-masked, controlled trial. J Am Acad Dermatol. 2007. doi:10.1016/j.jaad.2007.01.046

Smith R, Mann N, Mäkeläinen H, Roper J, et al. A pilot study to determine the short-term effects of a low glycemic load diet on hormonal markers of acne: A nonrandomized, parallel, controlled feeding trial. Mol Nutr Food Res. 2008. doi:10.1002/mnfr.200700307

Grant JD, Anderson PC. Chocolate as a cause of acne: a dissenting view. Mo Med. 1965.

Magin P, Pond D, Smith W, et al. A systematic review of the evidence for “myths and misconceptions” in acne management: Diet, face-washing and sunlight. Fam Pract. 2005. doi:10.1093/fampra/cmh715

Adebamowo CA, Spiegelman D, Berkey CS, et al. Milk consumption and acne in adolescent girls. Dermatol Online J. 2006.

Adebamowo CA, Spiegelman D, Berkey CS, et al. Milk consumption and acne in teenaged boys. J Am Acad Dermatol. 2008. doi:10.1016/j.jaad.2007.08.049

Di Landro A, Cazzaniga S, Parazzini F, et al. Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. J Am Acad Dermatol. 2012. doi:10.1016/j.jaad.2012.02.018

Klaz I, Kochba I, Shohat T, et al. Severe acne vulgaris and tobacco smoking in young men. J Invest Dermatol. 2006. doi:10.1038/sj.jid.5700326

Schafer T, Nienhaus A, Vieluf D, et al. Epidemiology of acne in the general population: the risk of smoking. Br J Dermatol. 2001.

Plewig G, Fulton JE, Kligman AM. Pomade Acne. Arch Dermatol. 1970. doi:10.1001/archderm.1970.04000050084011

Tucker SB. Occupational tropical acne. Cutis. 1983.

Oprica C, Nord CE, Kalenic S, et al. European surveillance study on the antibiotic susceptibility of Propionibacterium acnes. Clin Microbiol Infect. 2005. doi:10.1111/j.1469-0691.2004.01055.x

Masters PA, O’Bryan TA, Zurlo J, Miller DQ, Joshi N. Trimethoprim-sulfamethoxazole revisited. Arch Intern Med. 2003. doi:10.1001/archinte.163.4.402

Gollnick H, Cunliffe W, Berson D, et al. Management of acne: A report from a global alliance to improve outcomes in acne. J Am Acad Dermatol. 2003. doi:10.1067/mjd.2003.618


Wolf R, Matz H, Orion E. Acne and diet. Clin Dermatol. 2004. doi:10.1016/j.clindermatol.2004.03.007

Smith RN, Braue A, Varigos GA, Mann NJ. The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides. J Dermatol Sci. 2008. doi:10.1016/j.jdermsci.2007.11.005

Adebamowo CA, Spiegelman D, Danby FW, et al. High school dietary dairy intake and teenage acne. J Am Acad Dermatol. 2005. doi:10.1016/j.jaad.2004.08.007

Fabbrocini G, Izzo R, Faggiano A, et al. Low glycaemic diet and metformin therapy: A new approach in male subjects with acne resistant to common treatments. Clin Exp Dermatol. 2016. doi:10.1111/ced.12673

Holmes MD, Pollak MN, Hankinson SE. Lifestyle correlates of plasma insulin-like growth factor I and insulin-like growth factor binding protein 3 concentrations. Cancer Epidemiol Biomarkers Prev. 2002.

Runchey SS, Pollak MN, Valsta LM, et al. Glycemic load effect on fasting and post-prandial serum glucose, insulin, IGF-1 and IGFBP-3 in a randomized, controlled feeding study. Eur J Clin Nutr. 2012. doi:10.1038/ejcn.2012.107

Aizawa H, Niimura M. Elevated serum insulin-like growth factor-1 (IGF-1) levels in women with postadolescent acne. J Dermatol. 1995. doi:10.1111/j.1346-8138.1995.tb03381.x

Vora S, Ovhal A, Jerajani H, Nair N, Chakrabortty A. Correlation of facial sebum to serum insulin-like growth factor-1 in patients with acne. Br J Dermatol. 2008. doi:10.1111/j.1365-2133.2008.08764.x

Mullin GE, Swift KM, Lipski L, et al. Testing for food reactions: The good, the bad, and the ugly. Nutr Clin Pract. 2010. doi:10.1177/0884533610362696

Atkinson W, Sheldon TA, Shaath N, et al. Food elimination based on IgG antibodies in irritable bowel syndrome: A randomised controlled trial. Gut. 2004. doi:10.1136/gut.2003.037697

Drisko J, Bischoff B, Hall M, et al. Treating Irritable Bowel Syndrome with a Food Elimination Diet Followed by Food Challenge and Probiotics. J Am Coll Nutr. 2006. doi:10.1080/07315724.2006.10719567

Karakula-Juchnowicz H, Gałęcka M, Rog J, et al. The food-specific serum IgG reactivity in major depressive disorder patients, irritable bowel syndrome patients and healthy controls. Nutrients. 2018. doi:10.3390/nu10050548

Mitchell N, Hewitt CE, Jayakody S, et al. Randomised controlled trial of food elimination diet based on IgG antibodies for the prevention of migraine like headaches. Nutr J. 2011. doi:10.1186/1475-2891-10-85

Alpay K, Erta M, Orhan EK, et al. Diet restriction in migraine, based on IgG against foods: A clinical double-blind, randomised, cross-over trial. Cephalalgia. 2010. doi:10.1177/0333102410361404

Aydinlar EI, Dikmen PY, Tiftikci A, et al. IgG-based elimination diet in migraine plus irritable bowel syndrome. Headache. 2013. doi:10.1111/j.1526-4610.2012.02296.x

Shakib F, Brown HM, Phelps A, et al. Study of IgG sub‐class antibodies in patients with milk intolerance. Clin Exp Allergy. 1986. doi:10.1111/j.1365-2222.1986.tb01980.x

Panush RS. Food induced ('allergic’) arthritis: Clinical and serologic studies. J Rheumatol. 1990.

Coucke F. Food intolerance in patients with manifest autoimmunity. Observational study. Autoimmun Rev. 2018. doi:10.1016/j.autrev.2018.05.011

Bentz S, Hausmann M, Piberger H, et al. Clinical relevance of IgG antibodies against food antigens in Crohn’s disease: A double-blind cross-over diet intervention study. Digestion. 2010. doi:10.1159/000264649

Wilders-Truschnig M, Mangge H, et al. IgG antibodies against food antigens are correlated with inflammation and intima media thickness in obese juveniles. Exp Clin Endocrinol Diabetes. 2008. doi:10.1055/s-2007-993165

Purohit V, Bode JC, Bode C, et al. Alcohol, intestinal bacterial growth, intestinal permeability to endotoxin, and medical consequences: Summary of a symposium. Alcohol. 2008. doi:10.1016/j.alcohol.2008.03.131

Vanuytsel T, Van Wanrooy S, Vanheel H, et al. Psychological stress and corticotropin-releasing hormone increase intestinal permeability in humans by a mast cell-dependent mechanism. Gut. 2014. doi:10.1136/gutjnl-2013-305690

Söderholm JD, Perdue MH. Stress and the gastrointestinal tract II. Stress and intestinal barrier function. Am J Physiol - Gastrointest Liver Physiol. 2001. doi:10.1152/ajpgi.2001.280.1.g7

Bjarnason I, Takeuchi K. Intestinal permeability in the pathogenesis of NSAID-induced enteropathy. J Gastroenterol. 2009. doi:10.1007/s00535-008-2266-6

Bibbò S, Ianiro G, Giorgio V, et al. The role of diet on gut microbiota composition. Eur Rev Med Pharmacol Sci. 2016.

Playford R, Davison G, Marchbank T, et al. OC-023 Randomised Trial: The Nutriceutical Zinc Carnosine Works with Bovine Colostrum in Truncating Heavy Exercise Induced Increase in Gut Permeability through Actions on Tight Junctions, Apoptosis and Heat Shock Protein 70 Production. Gut. 2016. doi:10.1136/gutjnl-2016-312388.23

Lamprecht M, Bogner S, Schippinger G, et al. Probiotic supplementation affects markers of intestinal barrier, oxidation, and inflammation in trained men; a randomized, double-blinded, placebo-controlled trial. J Int Soc Sports Nutr. 2012. doi:10.1186/1550-2783-9-45

Pires W, Veneroso CE, Wanner SP, et al. Association Between Exercise-Induced Hyperthermia and Intestinal Permeability: A Systematic Review. Sport Med. 2017. doi:10.1007/s40279-016-0654-2

Kawashima M, Hashimoto H, Alio Sáenz AB, et al. Is benzoyl peroxide 3% topical gel effective and safe in the treatment of acne vulgaris in Japanese patients? A multicenter, randomized, double-blind, vehicle-controlled, parallel-group study. J Dermatol. 2014. doi:10.1111/1346-8138.12580

Kawashima M, Sato S, Furukawa F, et al. Twelve-week, multicenter, placebo-controlled, randomized, double-blind, parallel-group, comparative phase II/III study of benzoyl peroxide gel in patients with acne vulgaris: A secondary publication. J Dermatol. 2017. doi:10.1111/1346-8138.13798

Hayashi N, Kurokawa I, Siakpere O, et al. Clindamycin phosphate 1.2%/benzoyl peroxide 3% fixed-dose combination gel versus topical combination therapy of adapalene 0.1% gel and clindamycin phosphate 1.2% gel in the treatment of acne vulgaris in Japanese patients: A multicenter, randomized, invest. J Dermatol. 2018. doi:10.1111/1346-8138.14497

Yeung CK, Shek SY, Bjerring P, et al. A comparative study of intense pulsed light alone and its combination with photodynamic therapy for the treatment of facial acne in Asian skin. Lasers Surg Med. 2007. doi:10.1002/lsm.20469

Kaymak Y, Adisen E, Ilter N, et al. Dietary glycemic index and glucose, insulin, insulin-like growth factor-I, insulin-like growth factor binding protein 3, and leptin levels in patients with acne. J Am Acad Dermatol. 2007. doi:10.1016/j.jaad.2007.06.028