{"id":8688,"date":"2013-03-06T14:15:30","date_gmt":"2013-03-06T14:15:30","guid":{"rendered":"https:\/\/acneeinstein.com\/?p=940"},"modified":"2018-11-03T11:56:20","modified_gmt":"2018-11-03T11:56:20","slug":"studies-reveal-almost-irrefutable-evidence-for-the-root-cause-of-acne","status":"publish","type":"post","link":"https:\/\/acneeinstein.com\/studies-reveal-almost-irrefutable-evidence-for-the-root-cause-of-acne\/","title":{"rendered":"Studies Reveal (Almost) Irrefutable Evidence For The Root Cause Of Acne"},"content":{"rendered":"

Not too long ago a person at acne.org forums was complaining that despite \u2018doing all the right things\u2019 her acne just wouldn’t go away. She then went on to complain how acne is maddeningly confusing and how nothing seems to work. Needless to say, acne, and trying to get over it, had made her utterly confused.<\/p>\n

I believe this confusion as to what acne is how to treat is the biggest obstacle between you and clear skin. It leads you to merry-go-round where you try one thing after another. Desperation starts creeping in when you don\u2019t see the results you expect, and that makes you vulnerable to quacks promoting unscientific and dubious methods.<\/p>\n

Today I\u2019m going to share with you a couple of studies that provide antidote to the confusion. We are going to talk about 3 new studies that provide even more evidence that inflammatory damage at the skin is the<\/b> root cause of acne.<\/p>\n

Acne severity correlates with inflammation level<\/h2>\n

A study<\/a> published in January 2013 provides quite damning evidence. In the study Saudi Arabian researchers compared measures of inflammatory damage between acne patients and people with clear skin. They further divided the patients to three groups: mild, moderate and severe, according to acne severity.<\/p>\n

This graph shows measures of inflammatory damage. For copyright reasons I can\u2019t use their graphs, but I reproduced them from the data.<\/p>\n

\"Chart<\/a><\/p>\n

Source: Biochemical Markers of Oxidative and Nitrosative Stress in Acne Vulgaris: Correlation With Disease Activity<\/a>.<\/p>\n

As you can see, there\u2019s a clear correlation between acne severity and inflammatory damage. The graph shows measures for both protein oxidation (the blue bars) and lipid peroxidation (damage to fats, the red bars). But the details don\u2019t really matter to us. What matters is the overall trend showing higher levels of inflammatory damage as acne goes from mild to moderate to severe.<\/p>\n

On the flip side, they also looked into antioxidant activity. Here are the results for antioxidant enzymes. This chart shows measures for two very important antioxidant enzymes glutathione<\/i> and superoxide dismutase<\/i>. Much like vitamins C and E, these enzymes neutralize free radicals and other inflammatory molecules.<\/p>\n

\"Chart<\/a><\/p>\n

Source: Biochemical Markers of Oxidative and Nitrosative Stress in Acne Vulgaris: Correlation With Disease Activity<\/a>.<\/p>\n

Again we see a similar pattern. People with clear skin show higher levels of these antioxidants and that the levels drop as acne gets worse.<\/p>\n

Of course correlation doesn\u2019t equal causation. These data don\u2019t prove that inflammation causes acne. And if these were the only data, I would be careful not to jump to unwarranted conclusions. But these are not the only data, not even close. In the earlier posts I have covered more data on inflammatio<\/a>n and the potential role of topical antioxidants<\/a>.<\/p>\n

Acne lesions show inflammatory damage<\/strong><\/p>\n

Another study<\/a> published in Novermber 2012 provides more evidence. The earlier study measured markers of inflammatory damage and antioxidant enzymes in the blood. This study measured similar things in actual pimples. For the study the researchers took skin samples from people with varied severities of acne, again divided into mild, moderate and severe categories. They also took control samples from people with clear skin.<\/p>\n

Results show that people with severe acne showed 2 to 4 fold higher levels of inflammatory damage<\/strong> than people with mild or moderate acne. Similarly, antioxidant enzyme readings were significantly lower in people with severe acne than the other participants. For the most part, there was not much difference between people with mild acne and those with clear skin.<\/p>\n

Study: Antioxidant supplements reduce acne by 50%<\/h2>\n

Late 2012 Iraqi researched published a study that shows antioxidant supplementation can reduce acne<\/a> by 50%. A few such studies have been published earlier, but those were quite low quality and as such we can\u2019t draw strong conclusions from them. This study was placebo-controlled, which makes this much better.<\/p>\n

Placebo control is important because, though it doesn\u2019t seem like that, the placebo effect is very strong in acne. For example, it\u2019s been pointed out that the placebo effect may account for about 50% of all the positive effects seen in studies using oral and topical antibiotics. Without placebo-control we can never know how much of the observed effect was due to the treatment and how much due to various placebo effects. The internet is full of stories of people getting better after ridiculous and implausible \u2018therapies\u2019 \u2013 most such stories can probably be explained with placebo, and that\u2019s another reason why you shouldn\u2019t put too much faith into those stories. What \u2018works\u2019 for them may not work for you.<\/p>\n

Back to the study. At the beginning of the study they measured the levels of glutathione (GSH), malondialdehyde (MDA) and interleukine -8 (IL-8). Glutathione is an antioxidant enzyme and malondialdehyde and interleukine -8 are measures of inflammation.<\/p>\n\n\n\n\n\n\n
 <\/td>\n\n

Acne<\/p>\n<\/td>\n

\n

Clear skin<\/p>\n<\/td>\n

\n

Difference<\/p>\n<\/td>\n<\/tr>\n

GSH<\/td>\n\n

0.65<\/p>\n<\/td>\n

\n

1.61<\/p>\n<\/td>\n

\n

60% lower<\/p>\n<\/td>\n<\/tr>\n

MDA<\/td>\n\n

8.68<\/p>\n<\/td>\n

\n

5.46<\/p>\n<\/td>\n

\n

59% higher<\/p>\n<\/td>\n<\/tr>\n

IL-8<\/td>\n\n

61.17<\/p>\n<\/td>\n

\n

36.65<\/p>\n<\/td>\n

\n

66% higher<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Again the same pattern emerges. Acne patients show much higher level of systemic inflammation (they are under higher oxidative stress in medical speak).<\/p>\n

Here\u2019s a graph from the study that again shows a correlation between glutathione (antioxidant) level and acne severity. As antioxidant level drops the number of pimples goes up.<\/p>\n

\"Chart<\/a><\/p>\n

The study also showed similar graphs for other measures of inflammation. I\u2019m not going to post them here, but the study is open-access so you can check them out for yourself.<\/p>\n

In the study 56 acne patients were divided into 4 groups. 3 of the groups received one of the 3 studied antioxidant supplements while the 4th<\/sup> group received a placebo pill. The antioxidants were silymarin (milk thistle) (210 mg\/day), N-Acetylcystein (NAC) (1200 mg\/day) or selenium (200 mcg\/day). NAC is a precursor to glutathione and can increase glutathione level in the body. Similarly selenium acts as a coenzyme in glutathione antioxidant reactions. The authors write that silymarin is believed to act as a potent antioxidant in human tissue.<\/p>\n

Here are the results.<\/p>\n

\"Chart<\/a><\/p>\n

As you can see, the reduction in pimple count is practically linear for both N-Acetylcystein and silymarin supplements. After 8 weeks both supplements reduced acne lesions by about 50%. Selenium supplementation also showed a nice reduction, if not quite as quick as with the other 2 supplements. In contrast, there was no real change in the placebo group. I should note that this study was single-blinded, so the participants didn\u2019t know which supplement they received.<\/p>\n

This reduction in acne lesions was mirrored in increase in glutathione levels and reduction in measures of systemic inflammation. In other words, acne and systemic inflammation went down hand in hand.<\/p>\n

Pretty encouraging results – especially considering what we discussed above.<\/p>\n

There\u2019s also older data<\/a> that show low levels of glutathione in people with skin problems, and that combined supplementation with selenium and vitamin E increases glutathione levels and improves skin condition.<\/p>\n

NAC supplementation may cause adverse effects<\/b><\/h2>\n

In the comment section Bob alerted me to the possibility of side-effects from NAC supplementation. He mentioned that NAC may increase histamine level and thus cause hives or rash.<\/p>\n

Unfortunately I couldn\u2019t find any studies on adverse effects of NAC supplementation at doses used for acne. NAC is used as antidote for paracetamol poisoning and in that context we do have safety data.<\/p>\n

Adverse effects include:<\/p>\n