“…Four key pathogenic processes lead to the formation of acne lesions: alteration of follicular keratinization that leads to comedones; increased and altered sebum production under androgen control; follicular colonization by Propionibacterium acnes ; and complex inflammatory mechanisms that involve both innate and acquired immunity ( Williams et al, 2012 , Zaenglein et al, 2016 ). Genetics (twin studies Bataille et al, 2002 , family history of severe acne Wei et al, 2010 ), diet (glycemic index Ismail et al, 2012 , Kwon et al, 2012 , Smith et al, 2007a , Smith et al, 2007b , Smith et al, 2008 ), including chocolate ( Grant and Anderson, 1965 , Magin et al, 2005 ) and dairy consumption ( Adebamowo et al, 2006 , Adebamowo et al, 2008 , Di Landro et al, 2012 ); and environmental factors (smoking Klaz et al, 2006 , Schafer et al, 2001 , occlusive cosmetics Plewig et al, 1970 , occupational exposures Tucker, 1983 ) also contribute to the pathogenesis of acne.…”