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In order to examine the association between diet and acne, the authors surveyed 2476 Thai adults (681 males; 1795 females) at mean age of 26 years. Significantly more patients with acne believed that diet could aggravate acne, reporting that fried food, chocolate, and dairy products exacerbated their acne. Participants with more severe acne were younger (18–25 years) and more often had a family history of acne. Factors associated with an increased risk of patient-reported severe acne included consumption of >100 g of chocolate per week, oily and fried food at least three times per week, white rice, and sleeping <6 hours per day. Protective factors included consumption of at least three portions of vegetables a week and drinking tea without sugar and milk.