A systematic review of the evidence for 'myths and misconceptions' in acne management: diet, face-washing and sunlight.

BACKGROUND Lay perceptions that diet, hygiene and sunlight exposure are strongly associated with acne causation and exacerbation are common but at variance with the consensus of current dermatological opinion. OBJECTIVES The objective of this study was to carry out a review of the literature to assess the evidence for diet, face-washing and sunlight exposure in acne management. METHODS Original studies were identified by searches of the Medline, EMBASE, AMED (Allied and Complementary Medicine), CINAHL, Cochrane, and DARE databases. Methodological information was extracted from identified articles but, given the paucity of high quality studies found, no studies were excluded from the review on methodological grounds. RESULTS Given the prevalence of lay perceptions, and the confidence of dermatological opinion in rebutting these perceptions as myths and misconceptions, surprisingly little evidence exists for the efficacy or lack of efficacy of dietary factors, face-washing and sunlight exposure in the management of acne. Much of the available evidence has methodological limitations. CONCLUSIONS Based on the present state of evidence, clinicians cannot be didactic in their recommendations regarding diet, hygiene and face-washing, and sunlight to patients with acne. Advice should be individualized, and both clinician and patient cognizant of its limitations.