- Oxidative Stress in Patients With Acne Vulgaris
- Why antioxidants could actually harm younger skin
- Study: Inflammation and Oxidative Stress Caused by Free Radicals in Adult Acne
- About acne
- Bowe offers tips for preventing and treating adult acne
- Do Antioxidants Hold The Key To Curing Acne?
- Acne patients under high oxidative stress
- How inflammation leads to acne
- Antioxidants as acne treatments
- Treatment strategies
- Conclusion: protect your skin
- Vitamin A for Acne: Scars, Benefits, Dosage, Topicals vs. Oral, More
Oxidative Stress in Patients With Acne Vulgaris
1. Bergfeld WF. The pathophysiology of acne vulgaris in children and adolescents, Part 1. Cutis. 2004;74(2):92–97. [PubMed] [Google Scholar]
2. Gollnick H. Current concepts of the pathogenesis of acne: implications for drug treatment. Drugs. 2003;63(15):1579–1596. [PubMed] [Google Scholar]
3. Burkhart CN. Clinical assessment of acne pathogenesis with treatment implications. Int Pediatr. 2003;18:14–19. [Google Scholar]
4. Briganti S, Picardo M. Antioxidant activity, lipid peroxidation and skin diseases. What's new? J Eur Acad Dermatol Venereol. 2003;17(6):663–669. [PubMed] [Google Scholar]
5. Webster GF. Inflammation in acne vulgaris. J Am Acad Dermatol. 1995;33(2 pt 1):247–253. [PubMed] [Google Scholar]
6. Basak PY, Gultekin F, Kilinc I. The role of the antioxidative defense system in papulopustular acne. J Dermatol. 2001;28(3):123–127. [PubMed] [Google Scholar]
7. Kurutas EB, Arican O, Sasmaz S. Superoxide dismutase and myeloperoxidase activities inpolymorphonuclear leukocytes in acne vulgaris. Acta Dermatovenerol Alp Panonica Adriat. 2005;14(2):39–42. [PubMed] [Google Scholar]
8. Yildirim M, Baysal V, Inaloz HS, Kesici D, Delibas N. The role of oxidants and antioxidants in generalized vitiligo. J Dermatol. 2003;30(2):104–108. [PubMed] [Google Scholar]
9. Oberemok SS, Shalita AR. Acne vulgaris, I: pathogenesis and diagnosis. Cutis. 2002;70(2):101–105. [PubMed] [Google Scholar]
10. Beutler E. Red Cell Metabolism. A Manual of Biochemical Methods. 2nd edition. New York: Grune & Stratton Co; 1975. pp. 261–265. [Google Scholar]
11. Fridovich I. Superoxide dismutases. Adv Enzymol Relat Areas Mol Biol. 1974;41:35–97. [PubMed] [Google Scholar]
12. Ohkawa H, Ohishi N, Yagi K. Assay for lipid peroxides in animal tissues by thiobarbituric acid reaction. Anal Biochem. 1979;95(2):351–358. [PubMed] [Google Scholar]
13. Oztas MO, Balk M, Ogus E, Bozkurt M, Ogus IH, Ozer N. The role of free oxygen radicals in the aetiopathogenesis of rosacea. Clin Exp Dermatol. 2003;28(2):188–192. [PubMed] [Google Scholar]
14. Akamatsu H, Horio T, Hattori K. Increased hydrogen peroxide generation by neutrophils frompatients with acne inflammation. Int J Dermatol. 2003;42(5):366–369. [PubMed] [Google Scholar]
15. Brown SK, Shalita AR. Acne vulgaris. Lancet. 1998;351(9119):1871–1876. [PubMed] [Google Scholar]
16. Nielsen PG. Topical metronidazole gel: use in acne vulgaris. Int J Dermatol. 1991;30:662–666. [PubMed] [Google Scholar]
17. Mates JM, Perez-Gomez C, Nunez de Castro I. Antioxidant enzymes and human diseases. Clin Biochem. 1999;32(8):595–603. [PubMed] [Google Scholar]
18. Pugliese PT. The skin's antioxidant systems. Dermatol Nurs. 1998;10(6):401–416. [PubMed] [Google Scholar]
19. Maccarrone M, Catani MV, Iraci S, Melino G, Agroet AF. A survey of reactive oxygen species and their role in dermatology. J Eur Acad Dermatol Venereol. 1997;8:185–202. [Google Scholar]
20. Pandey S, Parvez S, Sayeed I, Haque R, Bin-Hafeez B, Raisuddin S. Biomarkers of oxidative stress: a comparative study of riverYamuna fish Wallago attu (Bl. & Schn.) Sci Total Environ. 2003;309(1–3):105–115. [PubMed] [Google Scholar]
21. Kang HK, Kim DK, Lee BH, et al. Urinary N-acetyl-beta-D-glucosaminidase and malondialdehyde as amarker of renal damage in burned patients. J Korean Med Sci. 2001;16(5):598–602. [PMC free article] [PubMed] [Google Scholar]
22. Caglar Y, Kaya M, Belge E, Mete UO. Ultrastructural evaluation of the effect of endosulfan on mice kidney. Histol Histopathol. 2003;18(3):703–708. [PubMed] [Google Scholar]
23. Kletzien RF, Harris PK, Foellmi LA. Glucose-6-phosphate dehydrogenase: a “housekeeping” enzyme subject totissue-specific regulation by hormones, nutrients, and oxidant stress. FASEB J. 1994;8(2):174–181. [PubMed] [Google Scholar]
24. Bainy ACD, Saito E, Carvalho PSM, Junqueria VBC. Oxidative stress in gill, erythrocytes, liver and kidney of Niletilapia (Oreochromis niloticus) from a polluted site. Aquat Toxicol. 1996;34(1):151–162. [Google Scholar]
25. Wozniacka A, Sysa-Jedrzejowska A, Adamus J, Gebicki J. Topical application of NADH for the treatment of rosacea andcontact dermatitis. Clin Exp Dermatol. 2003;28(1):61–63. [PubMed] [Google Scholar]
Why antioxidants could actually harm younger skin
Expensive skin creams which are rich in antioxidants are championed by the beauty industry for their anti-ageing and wrinkle-reducing effects. But a new study suggests that they could actually be harmful to skin – at least for younger people.
When scientists in the US bred mice which produced excess free radicals to mirror the effects in humans, they expected to see accelerated ageing, but instead they found the animal's skin improved. Until the age of 50 in human years, it appears that free radicals are actually beneficial.
“This study shows that it's essential that we look across the entire lifespan when we examine mechanisms implicated in the aging process,” said Professor Judith Campisi at the Buck Institute for Research on Ageing, in California, US.
“In this case, we found unexpected effects, mechanisms that benefit us when we're young, cause problems as we age.”
Professor Campisi said eating or applying large amounts of antioxidants might have damaging effects to the skin in young people in their 20s because free radicals are necessary to keep skin regenerating effectively. Beta-carotene and vitamins C and E all have high levels of antioxidants.
Many people take supplements that are high in antioxidants believing they will slow ageing
“This is not a simple process,” added lead author Dr Michael Velarde. “It may be that nature used free radicals to optimize skin health, but because this process is not deleterious to the organism until later in life, past its reproductive age, there was no need to evolve ways to alter this mechanism.”
Free radicals are atoms which have missing electrons and so steal electrons from other healthy atoms, which causes cell damage in a process known as oxidation. Antioxidants essentially ‘donate’ their electrons to neutralise free radicals and stop them causing any more harm.
Free radicals are produced in the body as a by-product of normal metabolism and can also be introduced from an outside source, such as tobacco smoke, or other toxins pollution.
Health experts and beauticians have long recommended eating super foods blueberries and using specially formulated creams to boost antioxidants and battle free radicals
But it appears that it may only work in older age. As the mice in the study aged their skin cells became increasingly damaged by free radicals, eventually stopping dividing completely.
The study follows controversial claims by Dr James Watson, co-discoverer of the structure of DNA, that antioxidants may be harmful to people with late-stage cancer.
Writing in the journal Open Biology, he said free radicals help clear dysfunctional and dangerous cells from the body. Antioxidants may hinder cancer recovery by blocking their effect, he argued.
The research was published in the journal Proceedings of the National Academy of Sciences.
Study: Inflammation and Oxidative Stress Caused by Free Radicals in Adult Acne
When a woman in her 30s or 40s develops acne, she may reach for the same remedies she relied on decades ago to treat pimples as a teenager—over-the-counter acne cream and some cover-up to camouflage the blemishes.
But that's a mistake because adult acne is different from teen acne, according to Whitney Bowe, MD, a dermatologist with Advanced Dermatology in New York and a clinical assistant professor of dermatology at SUNY Downstate Medical Center.
While many factors contribute to adult onset acne, including hormones, diet and, yes, stress, research has also shown that oxidative stress, or inflammation, is one of the culprits.
In a 2012 study published in the Journal of Drugs in Dermatology, Bowe, the lead author, found that inflammation and oxidative stress—caused by free radicals—might play a role in causing acne, a theory that challenges the conventional wisdom that plugged follicles are the main instigator.
In an analysis of several studies, Bowe found that decreased antioxidant levels are commonly found in adults with acne.
(Blood levels of antioxidant vitamins such as A, C and E are actually lower in people suffering from acne as compared to people who have clear skin).
Studies have also found that people with acne have a higher burden of oxidative stress, as indicated by certain markers in the blood.
Bowe explains that antioxidants can be delivered directly onto the skin as a serum, cream or lotion, or they can be indirectly delivered to the skin after going through the mouth and undergoing digestion. In other words, clients can incorporate more antioxidant-rich foods or beverages in your diet.
For example, antioxidant-rich green tea can be found in a number of over-the-counter creams, but can also be sipped hot or cold. “Treating acne with antioxidants may address acne while at the same time reducing some of the signs of aging, such as fine lines and wrinkles,” she says.
“This makes antioxidants especially attractive for the woman who suffers from acne and also sees fine lines beginning to form.”
Acne is the most common skin condition in the United States, and research indicates that an increasing number of adults—particularly women—experience acne. A November 2012 study of nearly 3,000 women at Massachusetts General Hospital in Boston found that 45% of women 21-30 experienced acne; that number dropped to 26% among 31-40-year-olds and 12% in women 41-50.
Acne is characterized by chronic inflammation of the hair follicles and oil glands.
Adults with acne may have pimples as well as other blemishes, such as comedones (whiteheads and blackheads), nodules, cysts and solid round growths known as papules.
Acne is most common on the face but it can also appear elsewhere on body, including the back, chest, neck, shoulders, upper arms and buttocks, according to the American Academy of Dermatology.
Adult acne can be embarrassing and upsetting, leading to both depression and anxiety, says Bowe. “It can be perplexing and frustrating when the remedies you used to turn to aren't effective,” she says. “The good news is that after treatment many women feel more confident and it boosts self-esteem.”
Bowe offers tips for preventing and treating adult acne
“Almost all cases of acne in adults can be treated and, in some cases, it can even be prevented,” says Bowe. “It's crucial to address both periodic breakouts and chronic acne because, over time, acne can lead to scarring or dark spots.” Following are possible recommendations for clients struggling with adult acne.
- After cleansing your skin in the morning, apply an antioxidant serum under your sunscreen, or find a sunscreen that contains antioxidants along with broad-spectrum UVA and UVB-blocking ingredients. “Even though some people believe that the sun can help control acne, exposure to the sun's harmful rays can cause skin cancer and premature wrinkles. If you think your acne benefits from exposure to the sun, ask your dermatologist about light-based treatments that are just as effective for acne but safe,” says Bowe.
- Try to add antioxidants to your diet. “The more deep colors you see on your plate, the better. Look for deep greens such as kale or spinach, bright reds such as tomatoes and strawberries, and oranges such as salmon and squash.”
- Don't smoke, which can increase your exposure to free radicals and lead not only to accelerated signs of aging such as wrinkles, but also to cancer.
- Talk to an esthetician and/or dermatologist if you have chronic acne that isn't responding to over-the-counter therapies. Depending upon the type, location and severity of symptoms, additional treatments may include antibiotics, oral contraceptives and other medications, as well as laser and light therapy, treatments shown effective in clients with acne.
Do Antioxidants Hold The Key To Curing Acne?
Antioxidants have emerged as health silver bullets, at least if you pay attention to the popular media.
It’s clear that media hype far outruns scientific evidence when it comes to antioxidants and in some cases antioxidants may even be harmful. But acne is one area where reality slowly catches up with the hype.
Emerging research implicates inflammation (oxidative stress) as one of the causes of acne, and trials with antioxidants show promising results.
In this post I’m going to take an in-depth look at the role of inflammation in causing acne and how you can use antioxidants to treat acne.
Before we get started I want to thank Dr. Whitney Bowe. She kindly gave me material and guidance as I was researching this post.
Acne patients under high oxidative stress
Several studies now show that acne patients are under higher levels of inflammation (oxidative stress in medical speak). As this review study concludes:
These studies provide indirect, yet very obvious indicators of a mismatch between an oxidative stress burden and a diminished antioxidant defense system capacity in acne…
It appears as though these antioxidant enzymes might be depleted at a faster rate in those who suffer from the chronic inflammation that characterizes acne.
Acne vulgaris: the role of oxidative stress and the potential therapeutic value of local and systemic antioxidants.
And we are talking about significant differences here. For example one study found 43% higher hydrogen peroxide (inflammatory chemical) production in acne patients when compared to healthy controls.
One study showed also significant differences in inflammation markers and anti-inflammatory substances between those with mild and severe acne. People with severe acne had much more inflammation and fewer antioxidants than those with mild acne.
In the name of intellectual honestly I have to note that results vary from study to study.
Some find no correlation between acne severity and inflammation status, and other studies find only minor differences between acne patients and healthy controls. This is normal as science is messy.
But when you look at the evidence as whole it shows that acne patients suffer from higher levels of inflammation and have fewer antioxidants to protect them.
This inflammation can come from many sources, such as gut problems, eating foods you are sensitive, stress and sleep deprivation.
How inflammation leads to acne
OK, fine. So we have a bit more inflammation coursing through the body. But what does it have to do it acne? Good question (especially since I asked it, lol).
Science hasn’t answered this definitively yet, but the answer is probably just a simple depletion of antioxidants in the skin (at least one study showed that acne-prone skin has fewer antioxidants than healthy skin). The skin is constantly exposed to the elements, many of which cause inflammation (such as UV rays from the sun).
Without adequate antioxidant protection sebum gets damaged (oxidized). Sebum composition is somewhat different in acne patients. Our sebum has more squalene (a fatty acid), perhaps because squalene is quite resistant to oxidation (i.e. it can take more abuse than many other fatty acids).
The problem is that when squalene gets damaged (oxidized) it’s highly comedogenic, that is, it causes acne. The damaged form of squalene is called squalene peroxide. Squalene peroxide in the skin starts an inflammatory cascade that further depletes the protective antioxidants from the skin.
Vitamin E is one of the most important antioxidants in the skin. It protects sebum from inflammatory damage. But of course vitamin E levels in acne-prone skin have been measured and found wanting.
Inflammation as the trigger for acne
Researchers now speculate that this initial inflammation is the trigger that starts the acne formation process. As researchers study the progression of a pimple they find inflammation in the earliest stage of the pimple.
In the review paper she co-authored Dr. Bowe says that this initial inflammation helps the P. Acnes bacteria to colonize the skin pore. I didn’t really understand the mechanism of how it happens, but people smarter than me have spoken about altered oxygen tension and how it creates an ideal environment for the acne causing bacteria.
Under these ideal conditions the bacteria rapidly multiplies. Exposure of skin cells to the bacteria triggers further inflammation and turns a harmless blocked pore into an angry, red pimple.
Antioxidants as acne treatments
If inflammation causes acne can we treat it with antioxidants? We don’t have enough studies to say for sure, but initial results suggest we can. Studies with treating acne with both topical and internal antibiotics have provided good results.
For example studies using sodium ascorbyl phosphate (SAP), a vitamin C precursor, topically show that SAP is more effective than benzoyl peroxide and clindamycin creams. Similarly, studies on topical use of zinc show promising results.
Vitamin B3 is another possible treatment. In one study 4% vitamin B3 cream was a bit more effective than antibiotic cream. 82% of the patients treated with the B3 cream showed improvements as compared to 68% treated with the antibiotic cream.
The effect of antioxidant supplements on acne has also been studied. For example in one study 30mg of zinc gluconate reduced inflammatory acne by 57% after 2 months.
In another study zinc supplementation was compared to oral antibiotics. Antibiotics produced better results, but zinc was judged as clinically effective in 31% of the patients.
Clinical effectiveness means more than 2/3 reduction in inflammatory acne.
And in yet another study 79% of the people taking an antioxidant supplement had 80-100% improvement after 12 weeks. The daily total from the supplement contained zinc, vitamin C, mixed carotenoids, vitamin E and a chromium. There are some problems with how this study was done, so it’s highly unly that you will get such good results in real life.
Then there’s also the fact that many antibiotics are also anti-inflammatory. Take Metronidazole as an example. It has no real effect on P. Acnes bacteria, but effectively treats acne.
There are also other studies, but I don’t want to turn this into a medical review. The point I want to make is that antioxidants, both topical and supplements, can help with acne.
So how can you use this information to make a difference on your skin? It’s hard to turn preliminary data into real treatment strategies, but here’s something you could try.
Shift your topical treatment strategy from slaying scores of bacteria to supporting the health of your skin.
- Avoid the use of harsh chemicals, especially benzoyl peroxide. BP can be used effectively, but you have to be careful with it. BP can deplete vitamin E from the skin and make it more vulnerable to inflammation. Use carefully and judge how your skin reacts to it.
- Use moisturizer. Moisturizers can repair the skin barrier function and that way reduce inflammation from the skin. Choose a moisturizer that’s formulated for facial skin, and try to find something containing the following: vitamins C, E, and B3, zinc, and green tea. It’s unly you’ll find anything with all (if you do, please let me know), so go with the one that has most of them.
- Use oils with good fatty acids. Acne-prone skin has been shown to be low in linoleic acid (LA). LA is a fatty-acid that can reduce inflammation in the skin. Evening primrose oil is a good source, and many skin patients (psoriasis, eczema and acne) say topical application of evening primrose oil helps.
You’ll probably get better results when you combine topical treatment with antioxidant supplements. Here are some that you could try:
- Zinc, most studies used 30mg dose
- Antioxidant vitamins (A, C and E)
- Vitamin B3
I don’t know enough to recommend specific brands, so please don’t ask. The evidence is still quite flimsy to make specific recommendations. But if I were to try this I would probably get a dedicated zinc supplement and then try to find a multivitamin/mineral supplement that covers the others.
Also, more is not necessary better. There’s no good reason to believe that mega-dosing vitamins gets better results. Also, vitamins are bioactive compounds, and taking too much can cause real harm.
One thing I noticed from these studies is that it takes time to get results. Some studies made a specific mention that real improvements started happening only after 6 to 8 weeks of treatments. So please don’t expect quick miracles.
Conclusion: protect your skin
All this underscores the need to protect the skin from inflammation. Because of excessive sebum production acne-prone skin needs more antioxidants, and becomes sensitive if it doesn’t get them (a bit my girlfriend becomes moody with the lack of attention).
Jokes aside, there’s a good reason to believe both internal and external inflammation play a role in acne.
Internal (also known as systemic) inflammation can come from things diet, stress and lack of sleep, whereas UV rays from the sun, pollution and chemical exposure can cause external inflammation on the skin.
Inflammation damages sebum, and many researchers now believe that this initial inflammatory damage to sebum is what really triggers acne. Bacteria come to play later and aggravate the problem further.
Supporting this theory is the fact that treatment with antioxidants produces good results. Both oral and topical antibiotics have shown promising results in preliminary studies.
But before you get too excited you should keep in mind that these are still preliminary results. Science needs to grind its wheels still many years before we have enough data to reach scientifically valid conclusions. That said, I think this is worth a shot. The costs are minimal and there is no real risk in trying this.
Vitamin A for Acne: Scars, Benefits, Dosage, Topicals vs. Oral, More
If you buy something through a link on this page, we may earn a small commission. How this works.
Vitamin A is an essential nutrient found in orange and yellow fruits and vegetables as well as other nutrient-dense food sources, leafy greens.
As an antioxidant, vitamin A can help promote better skin and overall health by fighting free radicals.
Vitamin A may also help ward off inflammation, an underlying factor in acne vulgaris.
When it comes to treating acne with vitamin A, topical formulas show the most promise. These products are also called retinols or retinoids.
Don’t take vitamin A supplements to treat acne without checking with your doctor first, though. They can make sure the supplements won’t interfere with any other medications or supplements you may already be taking.
Vitamin A is an antioxidant. Antioxidants are known for preventing free radicals that can lead to cell damage. This may help decrease skin aging.
Vitamin A may also help treat acne, but it all depends on the source and how you use it. Eating vitamin A-rich foods can promote better skin health from the inside out, while topical formulas may target acne directly.
According to the American Academy of Dermatology (AAD), retinol (retinoid), a topical form of vitamin A, can help treat and prevent inflammatory acne lesions.
In fact, the organization recommends using topical retinoids to treat several types of acne.
Retinol may help improve acne by:
- decreasing inflammation
- increasing skin cell growth to heal lesions and scars
- possibly decreasing sebum (oil) production
- smoothing skin
- evening skin tone
- protecting against environmental damage
Retinoids may also work well with antibiotics as needed for clearing up severe acne breakouts.
There’s a lot of research backing up the use of topical vitamin A for acne. But research on oral vitamin A for acne has been mixed.
Older research couldn’t support oral vitamin A as an effective acne treatment, but researchers did say it could possibly prevent acne vulgaris from getting worse.
More recent research concluded oral vitamin A is effective at treating acne, but the study was small and of low quality.
Overall, vitamin A as an acne treatment is most promising as a topical treatment only.
While it’s important to get enough vitamin A in your diet, this isn’t the best acne treatment solution. Taking too much can harm your health.
Vitamin A content on foods and supplements is listed in international units (IU). The U.S. Food and Drug Administration (FDA) states the daily value of vitamin A for people ages 4 and up is 5,000 IU.
You shouldn’t take more vitamin A just for the sake of treating acne. This could lead to severe health consequences, liver damage.
Vitamin A is an antioxidant, which may help fight inflammation and free radicals in your skin — all which may contribute to acne.
Most people can get enough vitamin A through diet alone. The following foods are rich in vitamin A:
- orange and yellow vegetables, such as carrots and sweet potatoes
- green leafy vegetables
- beef liver
Overall, though, the AAD says there’s no specific diet proven to treat acne. The only exceptions are to avoid sugar and dairy, which could possibly aggravate breakouts in people who are already prone to acne.
Getting enough vitamin A in your diet can help promote overall skin health, but it’s not ly to treat acne alone. Instead, focus on a balanced diet with lots of fruits and vegetables for healthier skin.
Vitamin A supplements may help improve your overall immune system and your skin health. However, consider taking supplements only if you don’t already get enough vitamin A through diet alone, or if you don’t already take a multivitamin.
Too much vitamin A can lead to adverse health effects, including liver damage. Birth defects are also possible if you take excessive amounts of vitamin A while pregnant.
Side effects from too much vitamin A in supplement form can include:
It’s important to note that these side effects are linked to supplemental forms of vitamin A only. Excessive amounts of beta carotene found in vitamin A-rich fruits and vegetables won’t cause life-threatening side effects.
Also keep in mind that the FDA doesn’t monitor the purity or quality of supplements. It’s important to talk with your doctor before you begin taking any to weigh the benefits and risks for you.
Despite the potential antioxidant benefits of vitamin A, topical formulas show the most promise for acne treatment. These can come in the form of creams and serums.
A 2012 review found concentrations as low as 0.25 percent may provide benefits without side effects. If your dermatologist thinks you’d benefit from a higher concentration, they might order a prescription-strength cream.
When you first start using topical vitamin A, it’s important to begin gradually so your skin gets used to the product. This could mean using it every other day at first before you eventually use it every single day.
Beginning gradually can also reduce the risk of side effects, such as redness and peeling.
Retinoids can also increase your skin’s sensitivity to the sun. Be sure to wear sunscreen every single day to prevent sun damage.
Vitamin A is just one potential treatment for acne. Your dermatologist can help you decide what treatment measures are best depending on the severity and history of your skin health.
Good skin care practices can also go a long way for acne-prone skin. In addition to eating a nutritious diet and using topical products, getting enough sleep, water, and exercise can also promote better skin health.