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.
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Read moreAcne 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.
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.
Topical studies
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.
Antioxidant supplements
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 unlikely 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.
Treatment strategies
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.
Topical treatments
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 unlikely you’ll find anything with all (if you do, please let me know), so go with the one that has most of them.
- Use essential oils. 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
- Selenium
- Chromium
- Antioxidant vitamins (A, C and E)
- Vitamin B3
- Carotenoids
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.
Be patient
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 like 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 like 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.
Toggle references
- Acne vulgaris: the role of oxidative stress and the potential therapeutic value of local and systemic antioxidants.
- Tissue and blood superoxide dismutase activities and malondialdehyde levels in different clinical severities of acne vulgaris.
- Superoxide dismutase and myeloperoxidase activities in polymorphonuclear leukocytes in acne vulgaris.
- Oxidative stress in patients with acne vulgaris.
- Oxidative stress in acne vulgaris.
- The role of the antioxidative defense system in papulopustular acne.
- Oxidant/antioxidant status in obese adolescent females with acne vulgaris.
- Decrease in glutathione may be involved in pathogenesis of acne vulgaris.
- Erythrocyte glutathione peroxidase activity in acne vulgaris and the effect of selenium and vitamin E treatment.
- Blood glutathione-peroxidase levels in skin diseases: effect of selenium and vitamin E treatment.
- The possible role of reactive oxygen species generated by neutrophils in mediating acne inflammation.
- Effect of zinc gluconate on propionibacterium acnes resistance to erythromycin in patients with inflammatory acne: in vitro and in vivo study.
- An observational study of methionine-bound zinc with antioxidants for mild to moderate acne vulgaris.
- Topical nicotinamide compared with clindamycin gel in the treatment of inelammatory acne vulgaris. [sic]
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Hi Seppo,
I’d been reading your articles since last night (in fact I have 30 of your pages up in my chrome browser and yes, i did count the tabs to be exact ^_^), and I’m feeling so lucky! Let me give you a big “THANK YOU” in advance.
Here’s a warning: I’ll be babbling about my acne story.
I’d been battling with my acne two weeks after I left Manila (five months now). I am currently at the mercy of the scorching and sticky heat of Northern Mindanao (save for some rainy days when a storm passes by). Two weeks into my stay here, I ran out of my celeteque facial cleanser, so I resorted to using beauty bar soaps like Kojic soap, carrot soap and Perla. The latter is actually a laundry detergent bar that some people use on their faces with great results; but what was I thinking, really? I had this notion that my skin could get used to any kind of beauty soaps without inflicting damage to my skin. After all, a lot of people here, young and old, survive on these soaps without attracting any pimples. So why not me?
A few days into my beauty rebellion, the pimples started showing up. Since then, I tried every home remedy I could find online from natural mask treatments to oil cleansing method and facial sauna. I am also taking the Dong Quai capsules to stabilize my hormone, but this doesn’t seem to have an effect. The face masks did not work; so did the facial sauna, if anything it aggravated my acne; the oil cleansing method seemed to be working wonders on my face (in the first few days). At this point I stopped using any soap on my face. Then I noticed teeny-weeny plugs or pustules all over my face. I was alarmed but I chose to ignore them. I thought they might just be a reaction to the oil cleansing method (i combined castor and virgin coconut oil in a 1:3 ratio) and that they would eventually go away. Unfortunately, they did not. Then I started Oil Pulling again (I stopped doing it for a week when i started the Oil cleansing. This is a detox method I was using). This seemed to have worsened my acne. My pimples were very inflamed when I woke up the next day. I stopped doing both when my pimples got worse and worse. Well, lets suffice it to say I tried more regimens including moisturizing my face with honey, vitamin e, jojoba oil and cetaphil moisturizing lotion (by the way, i did not use these products all at once). Nothing better happened. I stopped using any type of moisturizer and just cleaned my face with cetaphil gentle cleanser, and once dry, I put baby powder on my face to close the pores. This at least stopped the propagation of my acne but they’re still there.
Here’s the worst part, (which eventually prompted me to doing some research). Over the holidays, it is a tradition here in the Philippines to prepare delectable cuisine loaded with refined carbohydrates, sugar, condensed milk and all-purpose cream. And mind you, in a period of two weeks, we celebrated Christmas, two birthdays, a wedding anniversary and the New Year. I admit I never ate so much carbohydrates and sugar in my life. It was the first time I was home to celebrate these events with my family.
A day later, my face was sprouting pimples as red as the spaghetti sauce we served, with an extra cream topping on top, if you know what I mean. I was just plain horrified. And just the other day, my pimples were itching so bad that I woke up in the middle of the night. My husband and I were dumbfounded as to what to do. I considered buying the benzoyl peroxide and not tell my husband about it (as it is, he’s very opposed to the idea since BP could cause premature aging). So I did my own research about the adverse effects of BP. I am so relieved I did not buy it.
And here I am now, reading your articles. From these, I gather it’s got to be my high refined carb diet. I never ate white rice when I was in Manila. I only ate brown rice, loads of green leafy goodies, fish and plenty of lentils. My diet changed drastically when I arrived here in Iligan. My body is not getting used to my new diet as much as I would like to, I guess. I think my sensitive hormones do not go well with my bad diet, don’t you think?
So, I will be watching what I eat and I will let you know of my progress in the coming weeks.
Once again, thank you so much for your wonderful articles. You writing style is very genuine and easy to read and understand. I am learning a lot from you ^_^
Sorry for taking up so much of the comments page. I hope you don’t mind as I am the first commentator
More power to you!
Thanks for your comments Jo-Ann. I’m always happy to hear from readers.
I’ll just comment on some of the things you mentioned.
I assume that the Dong Quai capsules you mentioned are some Chinese herbal remedy? I wouldn’t think that any herbal remedies have significant effect on hormones. At least anything you could ingest safely.
About the oil cleansing method. I’m not sure I would use it every day. Some people say it can irritate the skin if you use it too often. Also, coconut oil can be comedogenic. I would use jojoba and evening primrose oils or jojoba and castor oils.
Oil pulling is probably just another form of detox quackery. Probably harmless, but not also very nice to do (I tried it during my alt-med days).
From the moisturizers you’ve mentioned, vitamin E can help the skin. Same with vitamin B3. There’s actually decent research to support topical use of vitamin B3 in skin conditions. So I would keep using either of those. Living in tropics means you need to protect your skin against UV radiation, and especially so if you live in a polluted city. The combination of UV rays and air pollution can be quite harmful to the skin.
Finally, about benzoyl peroxide. I wouldn’t say it’s too bad for your skin. It can be if you use too much of it, but used moderately and in combination with antioxidant moisturizers it can be good for your skin. Just keep in mind that inflammation from acne can also prematurely age the skin (or so I presume). So BP can actually be the lesser of two evils and reduce inflammation in your skin.
Anyway, I’m happy to hear I’ve managed to help you a bit. Do let me know if you have some questions.
Hey Seppo, about the skin care with antioxidants in it, there is a company called Raw Gaia that sells skin care products that are raw and organic and some of them does contain a lot of antioxidants.
And looks to be a fair bit over-priced also
Thanks for the suggestion. Those products wouldn’t be my personal choices, but I can understand that the whole raw and organic message appears to some people.
Well you can get some trial sizes.
Hi Seppo, thanks for the informative article, I appreciate the insight into antioxidants: supplements & topicals alike. You mentioned that you aren’t aware of specific brands but I’m quite lost as to where I can find a decent antioxidant supplement containing the vitamins you mentioned. I’m assuming you don’t use these kind of supplements yourself, or you would probably already know of the best brands to get?
Do you recommend getting trying to find a supplement containing Zinc, Selenium, Chromium, Vitamin B3, Carotenoids, if that even exists? I’m scouring over amazon right now, and there’s so many different options, but it’s hard to pick out a supplement that contains all or just a few of the vitamins together.
Since writing this post I found a good supplement that contains most of the antioxidants and minerals found helpful in acne. It’s called Michael’s Naturopathic, Teen & Adult Skin Factors. It contains most of the nutrients for which there is some evidence they might be helpful in acne. Aside from vitamin D, this is the only supplement I’m taking. The price is ok, not cheap but not too expensive also, about $10 per month.
Hi Seppo,
I did not know you replied to my comment until now. THANK YOU so much!
Since I last commented here, there’s been an improvement to my acne. I did switch to castor oil + jojoba for my oil cleansing. I still do the cleansing every night but I reduced the time to 2-4 minutes instead of doing it for 10 minutes everyday. I totally stopped using any type of cleansers on my face. I only wash my face with warm water then rub a concoction of lemon and cinnamon powder onto my face. (Good thing i am not allergic to cinnamon). Then I use a cinnamon + honey mask twice a week (I will be switching to once a week as my acne eruptions are no longer crazy). And of course, I eat loads of anti-oxidant rich food as much as I can. Right now I am battling with my ACNE SCARS. I tried using vit E oil to lighten the scars but the thing with using vit E oil on my face is, it tends to trigger new spots. Is there any particular reason for this? Can you please give me a recommendation how to fight lighten the acne scars? Also, I stopped using commercial moisturizers and sunblock as these tends to worsen my acne. And besides, these products are almost always loaded with harmful chemicals. Doing some research on which ones are lesser evils got me nowhere. Right now I use a bit of jojoba oil as moisturizer and I tried to avoid sun exposure when I can. Do you recommend any good moisturizer and sunblock creams that are not loaded with parabens, perhaps?
Thank you so much in advance for your reply. You are such an AHHMAZING blogger!
Cheers!
Glad to hear your skin is doing better!
I’ve never heard of vitamin E being helpful with acne scars or hyper-pigmentation. High potency vitamin C creams can lighten the skin and fade away red marks and discoloration.
Why vitamin E oil would give you more pimples? Hard to say. Maybe the oil itself is not good for your skin. I find it hard to believe that vitamin E itself would harm the skin.
I wouldn’t worry too much about chemicals in moisturizers and personal care products. Most of the chemical-free scaremongering is just propaganda by ignorant people. Parabens, for example, have been tested thoroughly and they are among the least irritating preservatives in skin care products. Some natural preservatives are far worse for your skin than parabens.
As to product recommendations. I ordered these products recently from iHerb. Maybe you can try them out. iHerb.com also has a nice selection of natural products you might like. They are also very good with international shipping. Living in Thailand it’s cheaper for me to order from iHerb than to buy products locally here. I presume it’s the same for you.
I think you should add glutathione, the most potent antioxidant, to this list. To increase glutathione levels take n-acetylcysteine, glutathione’s precursor.
Thanks for the tip and information, Mark. I just published a new post that talks about glutathione and n-acetylcysteine in more detail. Really encouraging results!