Acne
Acne vulgaris is a chronic inflammatory skin condition that affects up to 10% of the population worldwide. It is characterized by inflammatory skin lesions, such as comedones (whiteheads and blackheads) caused by excess sebum production, bacterial overgrowth, and hyper-keratinization. Certain dietary choices and supplements can help to treat these causes while improving skin health and perception.
Acne falls under theSkin, Hair, & Nailscategory.
Last Updated:February 27, 2023
Acne vulgaris is a chronic inflammatory skin condition that primarily affects teenagers, though adults are also affected. Acne vulgaris is characterized by inflamed skin lesions, such as papules, pustules, and comedones (whiteheads and blackheads), which occur when oil and dead skin cells clog hair follicles, which become inflamed.
The main signs and symptoms of acne vulgaris are inflamed and clogged hair follicles, especially on the face. They can appear in many forms and colors:
- Whiteheads (closed plugged pores)
- Blackheads (open plugged pores, which appear black due to oxidized melanin)
- Papules (tender red bumps)
- Pustules (containing pus)
- Nodules (cystic lesions appearing as painful lumps beneath the skin)
Diagnosing acne vulgaris can be difficult because it is often confused with other skin conditions like angiofibroma, folliculitis, and rosacea, due to their similar signs and symptoms.
There is no validated and universal way to diagnose acne vulgaris. Many definitions and grading scales exist, and most grading scales use photographs and the number of acne lesions to quantify the severity of acne vulgaris from mild to severe.[1]
- Mild acne: noninflammatory lesions, few inflammatory lesions, or both
- Moderate acne: more inflammatory lesions, occasional nodules that form as hard, painful lesions, and mild scarring
- Severe acne: extensive inflammatory lesions, nodules, and scarring, ongoing moderate acne that has not improved with treatment after 6 months, or any acne that causes serious psychological distress[2]
The diagnosis of acne vulgaris should be based on the clinical judgment of a medical professional.
The current treatments for acne vulgaris consists of three approaches:[3]
- Topicals treatments (e.g., antibiotics, benzoyl peroxide, dapsone, retinoids, or azelaic acid)
- Oral treatments (e.g., antibiotics, hormonal agents, and the current gold standard isotretinoin)
- Physical interventions (e.g., chemical peels, microneedling, and laser therapy)
The goal of treatment is to reduce the leading causes of acne vulgaris: excess sebum and keratin production, increased inflammation, and overgrowth of Cutibacterium acnes, the main bacterial species responsible for acne.
Supplementing with certain minerals, vitamins, and other compounds may improve acne. The most well-supported supplements include zinc, vitamin D, vitamin B5, fish oil, green tea extract, and probiotics. However, some supplements were shown to worsen acne symptoms or lead to breakouts, especially when taken at high doses. These include iodine, whey protein, vitamin B6, and vitamin B12.
Diet can have positive or negative effects on acne vulgaris. The most studied dietary factors that influence acne are:[3]
- Glycemic index: A low glycemic index diet can improve symptoms of acne vulgaris.
- Omega-3: Supplementation with omega-3 fatty acids can improve the symptoms of acne vulgaris.
- Probiotics: Supplementation with probiotics can improve the symptoms of acne vulgaris.
- Dairy: Consumption of dairy and whey protein powder, in particular, can worsen acne severity.
Many nonmedical treatments have been researched for acne vulgaris due to the prevalence of the condition, however, the evidence for most alternative treatments is either nonexistent or low in quality.[4]
For instance, there is some weak evidence that tea tree oil and bee venom may reduce total skin lesions in acne vulgaris.
In contrast, acupuncture, herbal medicine, and wet-cupping therapy were not found to be helpful to ease the symptoms of acne vulgaris.
Notably, alternative treatments may lead to adverse effects that can worsen acne vulgaris or lead to other health problems.
The exact causes of acne vulgaris are not yet clear. Genetics may be the main factor. Other possible causes include hormones, infections, diet, and stress. Studies investigating the effects of smoking, sunlight exposure, and general hygiene have been inconclusive.
In contrast, the development of acne vulgaris on a cellular level is better understood. The pathogenesis of acne vulgaris revolves around four key factors:[3]
- Excess sebum production
- Overgrowth of Cutibacterium acnes, the main bacterial species infecting clogged hair follicles
- Hyperkeratinization, or excessive production of keratin, is one of the main structural proteins that stick skin cells together
- Inflammatory processes
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- ^Adityan B, Kumari R, Thappa DMScoring systems in acne vulgaris.Indian J Dermatol Venereol Leprol.(2009)
- ^Purdy S, de Berker DAcne vulgaris.BMJ Clin Evid.(2011-Jan-05)
- ^Baldwin H, Tan JEffects of Diet on Acne and Its Response to Treatment.Am J Clin Dermatol.(2021-Jan)
- ^Cao H, Yang G, Wang Y, Liu JP, Smith CA, Luo H, Liu YComplementary therapies for acne vulgaris.Cochrane Database Syst Rev.(2015-Jan-19)
- ^NHSAcne Causes(July 12, 2019)
- ^Chiu A, Chon SY, Kimball ABThe response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress.Arch Dermatol.(2003-Jul)
- ^Yosipovitch G, Tang M, Dawn AG, Chen M, Goh CL, Huak Y, Seng LFStudy of psychological stress, sebum production and acne vulgaris in adolescents.Acta Derm Venereol.(2007)
- ^Anna Hwee Sing Heng et alGene variants associated with acne vulgaris presentation and severity: a systematic review(April 13, 2021)
- ^Goulden V, McGeown CH, Cunliffe WJThe familial risk of adult acne: a comparison between first-degree relatives of affected and unaffected individuals.Br J Dermatol.(1999-Aug)
- ^American Academy of Dermatology10 skin care habits that can worsen acne
- ^Claudel JP, Auffret N, Leccia MT, Poli F, Dréno BAcne and nutrition: hypotheses, myths and facts.J Eur Acad Dermatol Venereol.(2018-Oct)
- ^ROBINSON HMThe acne problemSouth Med J.(1949 Dec)
- ^Melnik BCEvidence for acne-promoting effects of milk and other insulinotropic dairy productsNestle Nutr Workshop Ser Pediatr Program.(2011)
- ^Deplewski D, Rosenfield RLGrowth hormone and insulin-like growth factors have different effects on sebaceous cell growth and differentiationEndocrinology.(1999 Sep)
- ^Aizawa H, Niimura MElevated serum insulin-like growth factor-1 (IGF-1) levels in women with postadolescent acneJ Dermatol.(1995 Apr)
- ^Cappel M, Mauger D, Thiboutot DCorrelation between serum levels of insulin-like growth factor 1, dehydroepiandrosterone sulfate, and dihydrotestosterone and acne lesion counts in adult womenArch Dermatol.(2005 Mar)
- ^Hoppe C, Mølgaard C, Juul A, Michaelsen KFHigh intakes of skimmed milk, but not meat, increase serum IGF-I and IGFBP-3 in eight-year-old boysEur J Clin Nutr.(2004 Sep)
- ^Salehi A, Gunnerud U, Muhammed SJ, Ostman E, Holst JJ, Björck I, Rorsman PThe insulinogenic effect of whey protein is partially mediated by a direct effect of amino acids and GIP on β-cellsNutr Metab (Lond).(2012 May 30)
- ^Melnik BCFoxO1 - the key for the pathogenesis and therapy of acneJ Dtsch Dermatol Ges.(2010 Feb)
- ^Kim SJ, Winter K, Nian C, Tsuneoka M, Koda Y, McIntosh CHGlucose-dependent insulinotropic polypeptide (GIP) stimulation of pancreatic beta-cell survival is dependent upon phosphatidylinositol 3-kinase (PI3K)/protein kinase B (PKB) signalling, inactivation of the forkhead transcription factor Foxo1, and down-regulation of bax expressionJ Biol Chem.(2005 Jun 10)
- ^Melnik BCIs nuclear deficiency of FoxO1 due to increased growth factor/PI3K/Akt-signalling in acne vulgaris reversed by isotretinoin treatmentBr J Dermatol.(2010 Jun)
- ^Melnik BCThe role of transcription factor FoxO1 in the pathogenesis of acne vulgaris and the mode of isotretinoin actionG Ital Dermatol Venereol.(2010 Oct)
- ^Makrantonaki E, Zouboulis CCTestosterone metabolism to 5alpha-dihydrotestosterone and synthesis of sebaceous lipids is regulated by the peroxisome proliferator-activated receptor ligand linoleic acid in human sebocytesBr J Dermatol.(2007 Mar)
- ^Smith TM, Gilliland K, Clawson GA, Thiboutot DIGF-1 induces SREBP-1 expression and lipogenesis in SEB-1 sebocytes via activation of the phosphoinositide 3-kinase/Akt pathwayJ Invest Dermatol.(2008 May)
- ^Fan W, Yanase T, Morinaga H, Okabe T, Nomura M, Daitoku H, Fukamizu A, Kato S, Takayanagi R, Nawata HInsulin-like growth factor 1/insulin signaling activates androgen signaling through direct interactions of Foxo1 with androgen receptorJ Biol Chem.(2007 Mar 9)
- ^Melnik B{Acne vulgaris. Role of diet}Hautarzt.(2010 Feb)
- ^Melnik BC, Schmitz GRole of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgarisExp Dermatol.(2009 Oct)
- ^Bhate K, Williams HCEpidemiology of acne vulgarisBr J Dermatol.(2012 Dec 4)
- ^Danby FWAcne and milk, the diet myth, and beyondJ Am Acad Dermatol.(2005 Feb)
- ^Adebamowo CA, Spiegelman D, Danby FW, Frazier AL, Willett WC, Holmes MDHigh school dietary dairy intake and teenage acneJ Am Acad Dermatol.(2005 Feb)
- ^Adebamowo CA, Spiegelman D, Berkey CS, Danby FW, Rockett HH, Colditz GA, Willett WC, Holmes MDMilk consumption and acne in teenaged boysJ Am Acad Dermatol.(2008 May)
- Acne Symptoms - Khodaeiani E, Fouladi RF, Amirnia M, Saeidi M, Karimi ERTopical 4% nicotinamide vs. 1% clindamycin in moderate inflammatory acne vulgarisInt J Dermatol.(2013 Aug)
- Acne Symptoms - Gebicki J, Sysa-Jedrzejowska A, Adamus J, Woźniacka A, Rybak M, Zielonka J1-Methylnicotinamide: a potent anti-inflammatory agent of vitamin originPol J Pharmacol.(2003 Jan-Feb)
- Acne Symptoms - Shalita AR, Smith JG, Parish LC, Sofman MS, Chalker DKTopical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgarisInt J Dermatol.(1995 Jun)
- Acne Symptoms - Dreno B, Amblard P, Agache P, Sirot S, Litoux PLow doses of zinc gluconate for inflammatory acneActa Derm Venereol.(1989)
- Acne Symptoms - Dreno B, Moyse D, Alirezai M, Amblard P, Auffret N, Beylot C, Bodokh I, Chivot M, Daniel F, Humbert P, Meynadier J, Poli F; Acne Research and Study GroupMulticenter randomized comparative double-blind controlled clinical trial of the safety and efficacy of zinc gluconate versus minocycline hydrochloride in the treatment of inflammatory acne vulgarisDermatology.(2001)
- Acne Symptoms - Göransson K, Lidén S, Odsell LOral zinc in acne vulgaris: a clinical and methodological studyActa Derm Venereol.(1978)
- Acne Symptoms - Brittany E Yee, Phillip Richards, Jennifer Y Sui, Amanda Fleming MarschSerum zinc levels and efficacy of zinc treatment in acne vulgaris: A systematic review and meta-analysisDermatol Ther.(2020 Aug 29)
- Acne Symptoms - Verma KC, Saini AS, Dhamija SKOral zinc sulphate therapy in acne vulgaris: a double-blind trialActa Derm Venereol.(1980)
- Acne Symptoms - Gabriella Fabbrocini, Stefania Staibano, Giuseppe De Rosa, Valeria Battimiello, Nunzio Fardella, Gennaro Ilardi, Maria Immacolata La Rotonda, Amelia Longobardi, Marialuisa Mazzella, Maria Siano, Francesco Pastore, Valerio De Vita, Maria Luisa Vecchione, Fabio AyalaResveratrol-containing gel for the treatment of acne vulgaris: a single-blind, vehicle-controlled, pilot studyAm J Clin Dermatol.(2011 Apr 1)
- Acne Symptoms - Caperton C, Block S, Viera M, Keri J, Berman BDouble-blind, Placebo-controlled Study Assessing the Effect of Chocolate Consumption in Subjects with a History of Acne VulgarisJ Clin Aesthet Dermatol.(2014 May)
- Acne Symptoms - Ahmed Salih Sahib, Haidar Hamid Al-Anbari, Mohammed Salih, and Fatima AbdullahEffects of Oral Antioxidants on Lesion Counts Associated with Oxidative Stress and Inflammation in Patients with Papulopustular AcneJournal of Clinical and Experimental Dermatology Research .()
- Blood Carnitine - S Georgala, K H Schulpis, C Georgala, T MichasL-carnitine supplementation in patients with cystic acne on isotretinoin therapyJ Eur Acad Dermatol Venereol.(1999 Nov)