This small study without a control group did find that acne appeared to get worse with daily dark chocolate consumption. Unfortunately, without a control group and with such small numbers, it's impossible to tell if this was a real generalizable effect or simply chance. That being said, this article is exactly the kind of thing that gets the attention of the popular press! I think it's okay, however, as we can always tell our patients that the "jury is still out" on this one. I like to reference the old joke where the patient says "Doc, it always hurts when I do this." The doctor responds, "Then don't do that!" I just consulted Dr. Google on this one, and I found an interesting Wikipedia article (https://en.wikipedia.org/wiki/Smith_%26_Dale) that some of you might enjoy. Until more evidence is available, I educate acne patients in the same manner as most dermatologists educate rosacea patients about their specific trigger factors. In the meantime, just like talking to rosacea patients about their specific trigger factors, I tell patients and parents that it's difficult to pinpoint specific foods as exacerbating acne in all patients, but there is no question that some patients flare with specific foods. These patients should obviously avoid those foods or be aware that they need to adhere strictly to their treatment regimen when they eat those foods! Among the more interesting data in the last few years is the idea that a low glycemic diet might have a number of benefits, including improvement in acne. We discussed this in a PracticeUpdate article within the last few years.
So, while this study does not really answer the question once and for all, it is a nice point for discussion. I, for one, am going to have a dark chocolate-covered almond before I get back to seeing patients this afternoon. This has never caused a problem for me!
Written by Eliot N Mostow MD, MPH