What Vitamins Help With Acne

AUTHOR - DR. DAVID JACK

Acne is the most common inflammatory skin condition, affecting more than 95% of people in the UK aged 11-30, and around 3% of people aged 35 in the UK. Whilst the treatment of acne with topical skincare is well established, the role of supplements in acne is less well understood.

What Causes Hormonal Acne, And How To Treat it?

Hormonal acne results from increased sebum (oil) production in the hair follicles of the skin due to changes in hormone levels, particularly sex hormones such as testosterone and oestrogen, and other ‘steroid’ hormones including cortisol

The onset of puberty is most commonly the time in life when acne first appears, due to elevated levels of sex hormones, but stress, early pregnancy and hormone therapy can also predispose to this

Most cases of acne will have an underlying genetic predisposition, and there will be some exacerbating factors that cause breakouts, such as sugary foods, dairy and gluten. Other lifestyle factors such as smoking can also contribute to the appearance of acne.

When sebum levels rise, bacteria including P. Acne colonise the pores, causing inflammation and the typical comedones and redness that are seen in those with acne. Hormonal acne most commonly affects areas of the skin that are ‘hormone sensitive’, particularly the beard area/forehead.

What is the best treatment for hormonal acne?

The approach to treating hormonal acne will always be multi-pronged, given the multi-pronged factors underlying the condition. The approach is as follows:

  • Reduce bacterial levels:
    • Skincare - topical skincare products can help reduce hormonal acne by reducing the amount of P. acne bacteria in the skin - products such as Benzoyl Peroxide. This can dry the skin out slightly so some people prefer to introduce it gradually, but it should be used once to twice per day as a cleanser and usually takes a few weeks’ to work. 5% benzoyl peroxide is the usual strength available over the counter in the UK. Our favourite is Acnecide which is available from most good pharmacies without a prescription.
    • Topical antibiotics: for cases that are resistant to benzoyl peroxide, topical antibiotics such as erythromycin and clindamycin may be an option to help reduce the severity of acne. These are available on prescription so require a consultation from your doctor or dermatologist.
  • Reduce sebum production
    • Skincare - topical preparations to balance sebum production can help reduce the occurrence of breakouts. Skincare ingredients to consider include:
    • RETINOIDS - retinoids are derivatives of vitamin A. These help to balance sebum production and are powerful antioxidants. They can help reduce inflammation in the skin also and may help reduce the risk of acne scar development.
    • AHAs (Alpha-Hydroxy Acids) - AHAs including glycolic, lactic and mandelic acid can help to balance sebum production in the skin and treat acne.
    • BHA (Beta-Hydroxy acid) - also known as Salicylic acid helps to exfoliate the skin and reduce sebum production.
  • Reduce inflammation in the skin
    • Inflammation is a key cause of longer term acne scarring, so managing this in the short term is important to prevent this relatively common side effect of hormonal acne. Topical skincare ingredients such as Azelaic acid and Vitamin B5 (panthenol) can significantly reduce inflammation in the skin, so are good to use as part of an overall approach to acne. My Good Night cream contains both a topical retinoid and also azelaic acid and vitamin B5 to help reduce acne and inflammation.
  • Balance gut inflammation: the gut microbiome in acne
    • There is increasing evidence to support the role of the gut microbiome in inflammatory skin conditions, including hormonal acne via an interaction known as the gut-brain-skin axis. Looking after the health of your gut microbiome may help those who are undergoing treatment of hormonal acne and may actually help reduce the severity of cases. Diet would usually be considered the first line for this, with low -glycemic index foods, plant-based diet and probiotics being thought to be beneficial.
  • Balancing hormones in acne
    • Whilst it is difficult to control hormone levels, certain supplements may actually help to balance their effects - and reduce inflammation in the skin. Antioxidants and ingredients with low-glycemic and anti-inflammatory properties may again be helpful with this.

What Helps Acne Scars?

Acne scars are created due to chronic inflammation in the skin related to acne. When acne is left untreated for long periods of time, or if the condition is particularly severe, the risk of acne scarring is higher. Inflammation results in activation of scar tissue formation, which over time forms the various types of acne scars. These broadly fall under the following categories:

  • Atrophic scars: these are depressed, indented type scars that sit below the surrounding skin. These can have the following characteristic appearances:
    • Boxcar scars - boxcar scars have sharp edges and are generally wider and ‘U’ shaped. They vary in depth from shallow to deep and more shallow scars tend to respond better to treatments such as laser resurfacing.
    • Icepick scars - these are smaller point like scars that have a ‘V’ shaped conformation that extend deep into the skin. They are usually round or oval and appear like little holes. They are more difficult to treat than the other types of scar due to their depth.
    • Rolling Scars - rolling acne scars are similar to boxcar scars except they have a more rolling (rather than sharp) edge. They tend to be wide depressions and have an irregular appearance.
  • Hypertrophic scars: these are raised scars that project out of the surrounding skin, due to excessive collagen production and appear like bumps on the surface of the skin. They mostly occur in acne on the chest and back and tend to be red/purplish and then turn white over time.

What are the best treatments for acne scars?

Acne scars are often difficult to treat, and treatments depend on the type of scar (atrophic or hypertrophic). Depending on the type of acne scar, treatments include:

  • Skin peels - these work by resurfacing the skin in the area of the acne scar, which in turn improves the surface texture and, depending on the ingredients in the peel, can improve areas of hyperpigmentation. Examples of ingredients that are used for acne scar peels include:
  • Daily sunscreen use - as with any skin issue, daily sunscreen can decrease inflammation in the skin, improve collagen levels and reduce the risk of hyperpigmentation over time. With acne scarred skin, sunscreen is essential to reduce the risk of deepening of hypertrophic scars and to reduce post inflammatory hyperpigmentation (PIH) associated with acne scars.
  • Fractional skin resurfacing - fractional resurfacing involves creation of tiny injuries on the surface of the skin to promote the maturation and softening of scar tissue in acne scars and improvement in the surface texture of the skin. Example treatments include microneedling, Morpheus8 and carbon dioxide laser.
  • Subcision and filler - subcision is a process where the blade of a needle is inserted into the scar used to cut through deep scar tissue in atrophic acne scars, causing it to release from the underlying tissues it is adherent to. This then creates a space where dermal filler can be injected underneath the scar to make the scar more shallow.
  • Steroid injections - hypertrophic acne scars are characterised by excessive scar collagen production. Steroid injections can help to soften these scars and reduce the appearance of hypertrophic acne scars.

What Supplements Are Good For Acne?

Bioclear

The place for supplements in treating acne has been contentious and debated. There are some supplements that are gaining significant evidence for their use as an adjunct to treatment of acne, alongside the lifestyle measures I discussed above. The best supplements for acne may include:

  • Antioxidants and anti-inflammatory ingredients: these help to neutralise free radical activity in the skin and reduce inflammation. Synthetic and natural sources of vitamins would be included in this list, including:
    • Vitamin A - not only does topical retinol (a form of vitamin A) form the mainstay of treatment for acne, oral retinoids may also help those who have moderate acne - you may have heard of the use of retinoic acid (isotretinoin) in acne as a prescription treatment, given orally, but other forms of vitamin A, such as retinyl palmitate can be found in over the counter forms.
    • Vitamins D and E - both vitamins D&E are fat soluble, antioxidant vitamins. Vitamin E has potent anti-inflammatory properties, and vitamin D is essential in supporting the immune system.
    • ‘Natural’ sources of antioxidants include ingredients such as astaxanthin and grapeseed extract (resveratrol).
    • ‘Natural’ anti-inflammatory supplements, such as cinnamon, ginger, carob and kale may also benefit those with acne and other inflammatory skin condition.
  • Probiotics for acne - probiotics are the ‘good’ gut bacteria, which help to optimise the immune function of your gut and help to reduce gut-related inflammation. There is some evidence that taking probiotics may help in those suffering from acne and other inflammatory skin conditions.
  • Prebiotics for acne - prebiotics are the foods that the ‘good’ gut bacteria like to eat, and include things like chicory, inulin and jerusalem artichokes. These in turn are thought to be useful in supplements for acne.
  • Hormone balancing adaptogens in acne: the use of adaptogens is a field of interest for many. These are plant based ingredients (often with roots in ayurvedic medicine) that are thought to help balance hormone levels and in turn may be of benefit to those suffering from hormonal acne. These include ingredients such as ashwagandha, rhodiola rosea and astragalus.

My Bioclear supplement has been designed with hormonal acne in mind - it includes a blend of antioxidants, anti-inflammatory ingredients, adaptogens and prebiotics and probiotics for acne sufferers. It is designed as a once-daily drink to take, alongside lifestyle measures and topical acne treatments to help treat acne from the inside-out.

Useful Resources

https://www.nhs.uk/conditions/acne
https://www.webmd.com/drugs/2/drug-1344/benzoyl-peroxide-topical/details
https://www.boots.com/acnecide-face-wash-5-percent-w-w-gel-50g-10289479?storeId=11352&catalogId=28501
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678709
https://pubmed.ncbi.nlm.nih.gov/23886975
https://pubmed.ncbi.nlm.nih.gov/28513546
https://pubmed.ncbi.nlm.nih.gov/34207527
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574737
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418745

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