Acne vulgaris is the most common skin disease treated by dermatologists, with an estimated 85% of the population suffering from it at some stage in their life. While adolescent onset acne is the most common form and it is thought to be a response to hormonal changes, adult-onset acne is becoming more prevalent, and unlike adolescent acne, not only has a strong tendency to be more inflammatory, but it is often characterized by the presence of papules, pustules, nodules and cysts.
It is a fact that most adolescent acne is caused by a rise of androgen hormone levels that cause the oil glands sitting directly under the skin to enlarge and produce increased levels of sebum. When the skin pores become overfilled with sebum, it can cause the cell walls to rupture, creating a breeding ground for bacteria. Another likely factor in the prevalence of acne is genetics, with acne often seeming to run in families.
Two other factors that are less studied that seem to either cause or aggravate acne, especially adult onset acne, are inflammation and stress. The two could be interconnected as inflammation anywhere in the organism does put the individual cells under increased levels of physiological stress, which in turn can cause psychological stress.
Modern, conventional treatments for acne involve benzoyl peroxide, salicylic acid, retinoids, oral antibiotics, hormonal treatments and chemical peels, often for prolonged periods of time with often unsatisfactory results and possible severe side effects, posing the question: is there another way, if not to replace a conventional treatment, at least to give it enough of a boost to ensure it becomes more effective?
As mentioned before, it seems that cystic acne is at least in part inflammatory in nature, with the results of inflammation manifesting in a visible way on the skin. The link between inflammation and diet has been thoroughly researched and taking into consideration the fact that acne has an inflammatory cause and it has been established that diet can cause inflammation, it is hard not to at least consider a link between diet and acne.
Studies have shown that a high glycemic index diet, low in fibre and rich in saturated fats, while it does not directly cause acne, it does have a role in worsening the condition. By the same token, a diet rich in Omega 3, fresh fruit and vegetables, low in sugars and refined carbohydrates, has a role in alleviating the severity of acne breakouts, as does maintaining optimal hydration.
Recent studies looking into the connection between vitamin and mineral deficiency and acne have concluded that a deficiency in Omega-3, Vitamin A, Vitamin D and Zinc can be linked with the severity of acne, while supplementation with these vitamins and minerals can help reduce the gravity of the disease.
Animal experiments and clinical intervention studies indicate that omega-3 fatty acids have anti-inflammatory and immunomodulatory properties and, therefore, might be useful in managing the inflammatory disease. While all Omega 3 fish oils are highly beneficial for the body, in the treatment of acne and inflammation, a high level of EPAs is preferable over DHA, which is found in most fish oil supplements.
Essential fatty acids can be found in a variety of foods, such as salmon, mackerel, tuna, sardines, walnuts, chia and hemp seeds, flaxseeds, olive oil, almonds and egg yolks among many others.
Vitamin A is a powerful antioxidant essential to the normal shedding of dead skin, preventing the build-up of dead cells inside the pores and due to its anti-inflammatory properties helps calm red, swollen acne breakouts. Further, low levels of vitamin A have been associated with increased severity of acne breakouts. While high levels of Vitamin A in the form of Accutane or other strong retinoids are often used in the dermatological treatment, the latest studies seem to suggest that supplementing at lower levels might actually be more beneficial.
Vitamin A is a fat-soluble vitamin and needs to be consumed with fats in order to have optimal absorption. It can be found in high quantities in foods such as sweet potatoes, carrots, kale, squash, cantaloupe melon, dried apricots, sweet red peppers, tuna and mango.
Another vitamin often linked with the incidence of acne is Vitamin D, which has a role in reducing inflammation, and while it does not seem to have a direct impact in the treatment of acne, indirectly, due to the impact it may have on sebocytes (cells that excrete oil) by producing proteins with antibacterial properties, and due to the actions on hormone production and regulation, it seems to help with acne control, something evidenced by higher levels of acne in winter, when exposure to sun is minimal.
Foods containing vitamin D are cod liver oil, sardines, salmon, mackerel, tuna, eggs and mushrooms, but the most important source of Vitamin D is sunlight as it promotes the synthesis of the vitamin from cholesterol in the skin.
Extremely important not only for skin health but for the general wellbeing of the organism is Zinc which is an essential cofactor in most chemical reactions in the body. Zinc can help in the treatment of acne by assisting in the metabolism of Omega 3 fatty acids. Not only that Zinc has antioxidant and anti-inflammatory actions that are important in combating acne, but it can also break down the nerve chemical that promotes sebum production when the body is under stress, and it helps transport Vitamin A from the liver.
Zinc can be found in spinach, beef, kidney beans, shrimps, oysters, flax and pumpkin seeds, peanuts, cocoa powder, cashews, kefir and yoghurt.
Selenium is a mineral that is crucial due to the antioxidant role as part of the enzyme glutathione peroxidase, which is responsible for protecting the organism from the oxidative stress that leads to inflammation.
Selenium can be found in grains, nuts (especially Brazil nuts), salmon and halibut.
While it is impossible to think of an effective acne treatment that does not address the mineral and vitamin deficiencies and imbalances in the body, it is equally as important not to forget the role of topical treatments.
Contrary to the common misconception that the severity of acne increases with the use of moisturizers or oils, that is not always the case. The main factor to consider is the comedogenic (ability to clog pores) rating of the oils used in skin care designed for oily and acne-prone skin. The right moisturisers not only that will not clog the pores, but will help balance the skin sebum production and maintain a healthy skin.
Rice bran oil not only has a comedogenic rating of 0 (does not cause breakouts), but it contains ferulic acid and gamma-oryzanol, two essential acids with antioxidant activity more powerful then Vitamin E. Further, due to the presence of phytosterols, Rice Bran oil can improve the appearance of scar tissue and reduce inflammation, while the Coenzyme Q10 gives this oil anti-aging properties, making it an ideal all-rounder not only for acne prone skin, but for all skin types.
Sweet almond oil has a rating of 2, meaning it may cause breakouts, however, due to the oil properties, it helps emulsify sebum making it easier to clean pores while also improving cell regeneration, which is important in the treatment of acne.
Other carrier oils useful for acne conditions are argan oil, blackberry seed oil, goji seed oil, hemp seed oil, poppy seed oil and sunflower oil.
In terms of essential oils beneficial in the treatment of acne and oily prone skin, it is hard to miss the multi-facet properties of Lavender, due to its antibacterial action against S. epidermidis and P. acnes., the two bacteria strands responsible for causing acne. Other then its antibacterial action, Lavender essential oil is also anti-inflammatory, analgesic, antimicrobial and detoxifying, making it an ideal adjuvant treatment in many skin conditions.
Another well-researched essential oil in terms of antibacterial properties in acne is Clove oil, which is also a powerful antioxidant that helps lessen the effects of ageing and combats wrinkle formation by stimulating the skin circulation.
Eucalyptus oil helps kill bacteria, dry out blemishes and heal skin irritation, while Rosemary essential oil reduces excess oiliness in the skin, is anti-inflammatory and reduces redness and has astringent properties, helping reduce pore size.
Cedarwood essential oil has antiseptic properties, reduces inflammation and helps tighten facial pores.
A combination of these oils can be a useful adjuvant to any conventional acne treatment, while the inclusion of vitamins, minerals and essential fatty acids can help balance the skin from the inside by maintaining cell integrity and ensuring proper cell nutrition, suggesting that natural treatments could be a valuable tool in combating acne.
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Braun, L. & Cohen, M. (2010). Herbs and Natural Supplements An Evidence-Based Guide. 3rd Edition. Elsevier.
Merck Manual. Acne Vulgaris. Keri, J. E., Retrieved from: http://www.merckmanuals.com/professional/dermatologic-disorders/acne-and-related-disorders/acne-vulgaris (July 2017)
Orchard, A., & van Vuuren, S. (2017). Commercial Essential Oils as Potential Antimicrobials to Treat Skin Diseases. Evidence-Based Complementary and Alternative Medicine : eCAM, 2017, 4517971. http://doi.org/10.1155/2017/4517971
Sinha, P., Srivastava, S., Mishra, N., & Yadav, N. P. (2014). New Perspectives on Antiacne Plant Drugs: Contribution to Modern Therapeutics. BioMed Research International, 2014, 301304. http://doi.org/10.1155/2014/301304
Chiu A, Chon SY, Kimball AB. The Response of Skin Disease to Stress Changes in the Severity of Acne Vulgaris as Affected by Examination Stress. Arch Dermatol. 2003;139(7):897–900. doi:10.1001/archderm.139.7.897
Pappas, A. (2009). The relationship of diet and acne: A review. Dermato-Endocrinology, 1(5), 262–267.
Romańska-Gocka, K., Woźniak, M., Kaczmarek-Skamira, E., & Zegarska, B. (2016). The possible role of diet in the pathogenesis of adult female acne. Advances in Dermatology and Allergology/Postȩpy Dermatologii I Alergologii, 33(6), 416–420. http://doi.org/10.5114/ada.2016.63880
Agak, G. W., Qin, M., Nobe, J., Kim, M.-H., Krutzik, S. R., Tristan, G. R., … Kim, J. (2014). Propionibacterium acnes induces an interleukin-17 response in acne vulgaris that is regulated by vitamin A and vitamin D. The Journal of Investigative Dermatology, 134(2), 366–373. http://doi.org/10.1038/jid.2013.334
Rubin, M. G., Kim, K., & Logan, A. C. (2008). Acne vulgaris, mental health and omega-3 fatty acids: a report of cases. Lipids in Health and Disease, 7, 36. http://doi.org/10.1186/1476-511X-7-36
Lim, S.-K., Ha, J.-M., Lee, Y.-H., Lee, Y., Seo, Y.-J., Kim, C.-D., … Im, M. (2016). Comparison of Vitamin D Levels in Patients with and without Acne: A Case-Control Study Combined with a Randomized Controlled Trial. PLoS ONE, 11(8), e0161162. http://doi.org/10.1371/journal.pone.0161162
Gabriella Fabbrocini, M. C. Annunziata, V. D'Arco, et al., “Acne Scars: Pathogenesis, Classification and Treatment,” Dermatology Research and Practice, vol. 2010, Article ID 893080, 13 pages, 2010. doi:10.1155/2010/893080
Khunger N, Kumar C. A clinico-epidemiological study of adult acne: Is it different from adolescent acne? Indian J Dermatol Venerol Leprol 2012;78:335-41
Ma Y, Hébert JR, Li W, . Association between dietary fiber and markers of systemic inflammation in the Women’s Health Initiative Observational Study. Nutrition. 2008;24:941-949. Crossref, Medline
Mozaffarian D, Pischon T, Hankinson SE, . Dietary intake of trans fatty acids and systemic inflammation in women. Am J Clin Nutr. 2004;79:606-612. Medline