A retrospective analysis of electronic health records found that patients with acne face more than twice the odds of developing eating disorders compared to those without acne. The association remained significant even after accounting for other psychiatric conditions like anxiety, depression, and body dysmorphic disorder.
Study Design and Findings
Researchers leveraging data from the National Institutes of Health’s All of Us research program analyzed more than 7,000 individuals with acne and over 200,000 individuals without acne. Using multivariable logistic regression adjusted for demographic factors, the study identified greater than 2-fold increased odds of eating disorders among patients with acne. After further controlling for comorbid anxiety, depression, and body dysmorphic disorder, the independent association persisted with an adjusted odds ratio of 1.65 (95% confidence interval, 1.41-1.92; P <0.001). The findings were published in the Journal of the European Academy of Dermatology and Venerology.
Clinical Implications
The research highlights that eating disorder vulnerability appears to track acne-related quality-of-life impairment more than clinician-assessed severity. This means patients with mild-to-moderate acne as assessed by dermatologists may experience significant emotional and psychological effects warranting escalated treatment to achieve skin clearance.
For psychiatrists, referral to dermatology is recommended for patients with acne concerns regardless of severity. Dermatologists are uniquely positioned to recognize warning signs of eating disorders, including patients expressing intense fear of weight gain, substantial changes in eating habits, or physical indicators like worn tooth enamel, swelling of salivary glands, or Russell’s sign. The American Academy of Dermatology’s 2024 Acne Guidelines did not provide dietary recommendations for acne management due to limited and conflicting evidence regarding factors like dairy and chocolate. Until more data emerge, dermatologists should recommend well-balanced, healthy diets, particularly given that up to approximately 90% of acne patients attempt dietary changes to manage their condition.
Research Limitations and Future Directions
The authors acknowledge the study’s retrospective design prevents assessment of underlying mechanisms. They hypothesize acne may trigger heightened body appearance concerns among individuals with psychological risk factors, driving cognitive biases and maladaptive eating behaviors. Prospective studies are needed to evaluate this hypothesis. Additional research is necessary examining adolescents under 18 years old and males specifically, as the majority of study participants were females with acne.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.psychiatrictimes.com/view/acne-might-increase-eating-disorder-risk-what-to-know