The web is full of rumors and hearsay about vitamin B5 (pantothenic acid) for acne, but there’s a gaping black hole when it comes to credible, evidence-based information. Let’s fix that now.
The point of this post is to take a critical look at the claims that you can treat acne with B5, and the paper by Dr. Leung that started it all. We’ll look at if there’s any good reason believe these vitamins can fix your skin.
So if you are tired of rumors and hype, you need to take a few minutes to read this post.
This post turned out a bit longer than I expected. So for those with short attention span here are the keypoints:
- The whole thing lays on a theory that vitamin B5 deficiency limits fat metabolism, and thus those excess fats are pushed through the skin as sebum.
- There is no credible scientific evidence to back this up. Dr. Leung never published his study he bases this on, so we have no way to know. Furthermore, prior to publishing his hypothesis paper he applied and received a US patent for B5 acne treatment. So he has a direct financial interest in promoting this theory.
- I could only find 1 ‘independent’ study on this. While the results were positive (50% reduction in acne) it was too small and poor quality to conclude anything, and it was sponsored by a company that sells B5 acne treatment.
- Several lines of credible evidence disagree with Dr. Leung’s theory. For example, he says that when you eat more fat you get more acne, both anecdotal evidence and studies show acne is more affected by carbohydrate consumption. And people who reduce carbs and eat more fat tend to improve.
- Furthermore, several studies show increased sebum production when skin cells are exposed to hormones (such as testosterone and insulin). This agrees with the hormonal nature of acne, but not with Dr. Leung’s theory. We also have the studies that show impressive reductions in sebum production with topical application of ‘androgen blockers’ (such as green tea and evening primrose oil).
- While Dr. Leung’s theory appears to be spectacularly wrong, lot of acne patients see improvements with megadoses of B5. Perhaps there’s another way B5 works. Hard to say since user reviews are very unreliable as evidence. And users at acne.org forums have abandoned the treatment, with common consensus saying it only works temporarily.
- All credible sources say supplementing with B5 is extremely safe. But there is anecdotal evidence of hair loss and even severe, very long lasting side-effects. Again, we can’t say for sure from anecdotes.
- It’s possible B5 helps your acne, but we just can’t say for sure. There is no good reason to believe Dr. Leung’s theory is correct, and there’s plenty of reasons to believe it’s incorrect.
The whole thing started in 1997 when Dr. Lit-Hung Leung published his theory of how deficiency in Coenzyme A (CoA), a derivate of pantothenic acid, is responsible for acne. I should note that his paper was not a medical study, it was a hypothesis paper published in Journal of Orthomolecular Medicine.
The journal’s scientific standards may be less than rigorous. Given that it was created because other, reputable journals refused to publish their papers. From Wikipedia:
The Journal of Orthomolecular Medicine, founded in 1967 as the Journal of Schizophrenia, is the main publication of those involved in orthomolecular medicine. It was founded, as Abram Hoffer wrote, because of the alleged conspiracy:
“We had to create our own journals because it was impossible to obtain entry into the official journals of psychiatry and medicine.”
Orthomolecular medicine is the discredited idea that you can use megadoses of vitamins to cure many diseases.
Of course this doesn’t mean the theory is wrong, just that it keeps scientifically bad company.
Briefly described the theory goes like this.
CoA is required in both fat metabolism, production of hormones and countless other processes in the body. And because it’s needed in so many places Dr. Leung says deficiencies are likely, something mainstream medical science disagrees with.
Given that it’s a limited resource the body prioritizes usage, giving higher priority to production of sex hormones (since they are important in reproduction). This leaves less CoA available for lipid (fat) metabolism.
Because the body cannot effectively process (metabolize being the more scientific term) fat, it accumulates in the body. In the case of acne it’s being pushed through the skin. And this explains high sebum production in acne patients.
The dear doctor says that acne is not linked to sex hormones but rather to deficiency in Coenzyme A. And since CoA is derived from vitamin B5, you can fix it with megadoses of pantothenic acid.
And so the vitamin B5 acne connection was born.
Possible conflict of interest
The hypothesis paper aside, is there any real evidence to back up this theory? In the same paper Dr. Leung talks about his own study with 100 acne patients. The problem is that this study was never published anywhere, as far as I can tell. And he describes it in most unscientific terms, it actually reads more like a testimonial than a scientific study. So we have no way to really know anything about this study. How good it was scientifically, or whether it even happened.
Another problem is that Dr. Leung applied and received a patent for his acne treatment prior to publishing his hypothesis papers. The patent was granted in 1996 and his paper was published in 1997, how convenient.
So he has a direct financial interest in promoting this theory. While there’s nothing illegal or wrong about this per se, this is not how real science works.
Aside from Dr. Leung’s research, I could find just one study looking at the effect of B5 on acne. I’m assuming it was sponsored by the company that produces Panthothen, a B5 supplemented marketed as an acne treatment. The study didn’t contain normal ethics statement, so I can’t say for sure. But it was done by Neutraceuticals Medical Research, a company that conducts outsources medical research for natural health companies. And it specifically mentions the brand Panthothen in the paper, so I’m assuming the company sponsored it.
The study showed 50% reduction in acne after 8 weeks. But it only had 10 participants and had no control group. This makes it scientifically more or less worthless – but great for marketing purposes.
So in summary, there’s no good scientific evidence to say that vitamin B5 helps acne. And the original theory itself is very shaky (I’ll talk about it more below).
Absence of evidence doesn’t mean evidence of absence
In the name of intellectual honesty I have to point out that lack of scientific evidence doesn’t mean B5 is useless for acne. It just means we can’t say either way.
Lack of scientific evidence hasn’t deterred acne patients from experimenting with megadoses of pantothenic acid. User reviews are generally very positive. At the acne.org review section it’s rated as 3.7 (out of 5).
Unfortunately user reviews are just about the most unreliable form of evidence there is. No controls, no way to know what caused the effect, no way to know whether the effect was real (or just part of the cyclical nature of the condition). No way to know whether it was just a temporary effect, etc. This is why medical science is not based on anecdotes and user reviews.
Sidebar. Here’s a good article on why we need science to evaluate medical claims and why anecdotal reports can be very misleading: Why We Need Science: “I saw it with my own eyes” Is Not Enough.
There’s also the possibility that at least some of these reviews are written by companies that sell B5 acne treatments. This happens unfortunately often.
Vitamin B5 seems to be very safe. So even if it doesn’t help your acne, it’s unlikely to harm you either.
This is from the risk assessment of The Food Standards Agency in The UK.
Case reports and some much earlier non-controlled studies describe a lack of acute or chronic toxic effects of pantothenic acid compounds (calcium or sodium pantothenate, panthenol) at very high doses (approximately 10,000 mg/day in some cases for a number of years), although such levels have been associated with diarrhoea and gastrointestinal disturbances.
Risk Assessment Pantothenic acid (PDF)
Other regulatory agencies pretty much say the same thing. No evidence of toxicity.
Anecdotal evidence of harm
Though there’s no scientific evidence of harm, there are anecdotal reports of severe side-effects after vitamin B5 megadoses. Such as this one: Pantothenic Acid megadose – permanent side effects. Several people have also experienced hair loss from megadoses of B5: Vitamin B5 Hair Loss (acne.org forums). With more searching I could probably find evidence of other side-effects.
Of course these are anecdotal reports, and as such not very reliable.
Vitamins are bioactive compounds and in recent years rigorous studies have shown harm from regular use of some vitamins and supplements. Vitamin B5 shares pathways with other B vitamins. So megadosing on B5 may inhibit and lead to deficiencies in other B vitamins. Please don’t assume vitamins are automatically safe.
Closer look at Dr. Leung’s paper
At superficial level Dr. Leung’s theory makes sense, but starts to look shaky when you look at it closely. So let’s look at some problems with the theory.
Here’s a PDF of the full text study. Feel free to check it out and make sure I don’t take anything out of context.
This is from the beginning of the paper.
However, my observations have led to quite the contrary conclusions. Not only is the fat content of food closely related to acne vulgaris, but it forms some sort of linear relationship with the disease process. The more fat the patient consumes, the more severe will be the acne process.
This seems utterly ridiculous to me, and none of the diet acne studies support this. Anecdotal evidence from acne and diet forums suggests opposite. Acne often improves when people limit carbohydrates, either by going on a low-carb or paleo style diets.
Significantly, in this group of patients, any deliberate attempt in trying to avoid a fatty diet over a period of weeks, if not days, will often result in an improvement of the clinical condition. This observation forms the basis of my hypothesis that the disease process may be connected with fat metabolism– or a deficiency of it.
I don’t know where he pulls the observation that limiting fat improves acne. It’s true that limiting some fats improves acne, but that’s because trans-fats and other bad fats are highly inflammatory. But more often than not it’s the limiting of carbohydrates and/or reducing glycemic index of carbohydrates that improves acne, a fact that’s supported by both available diet studies and understanding of how hormones affect the skin. Regardless, it’s a ridiculously shaky ground to build a scientific hypothesis on.
Little bit later comes this gem.
When lipids are deposited in the sebaceous glands and excreted as sebum secretion, it does suggest some abnormality is going on and hint that some form of fat metabolism may be at fault. These fatty materials, after all, are energy rich compounds. Under normal circumstances, they should be stored away in fat depots. To have them excreted with a concomitant wastage of energy is not nature’s way of handling excess energy.
Honestly, reading this paper starts giving me headache. I seriously wonder what was going on his head as he wrote that sebum secretion is wasting precious energy resources. Has he never heard of the skin barrier function? That sebum in the skin prevents excess water loss, without which your water-rich internal organs would wither and die. That sebum forms a protective layer on the skin that protects you from inflammation and elements.
Yes, acne patients produce more sebum, but I would hardly say this is a waste of precious resources. And the fact that acne-prone skin produces more sebum is already explained with genetic sensitivity to androgen hormones.
Then he talks about how Coenzyme A is needed for both hormone production and fat metabolism and proposes the following.
The author’s proposed hypothesis for the pathogenesis of acne vulgaris is that the disease process is not caused by androgens, or any other sex hormones. But rather, the disease process results from a defects in lipid metabolism that is secondary to a deficiency in pantothenic acid, hence Coenzyme A.
Except that again facts don’t agree with him. Acne is a common side-effect of testosterone medications, and abuse of anabolic steroids by bodybuilders often also causes acne. Or the inconvenient fact that sex hormone levels are often elevated in acne patients.
Regardless of the cause, overproduction of either T or T precursors leads to exaggerated T action in target tissues such as skin. In skin, T is converted to DHT by the enzyme 5a-R, which acts directly on hair follicles and the sebaceous glands. The most frequent dermatologic manifestations of androgen excess are hirsutism, acne, and androgenic alopecia.
Then he talks how the body prioritizes hormone production over fat metabolism.
Facing with the dilemma of a shortage of Coenzyme A, the body will tend to make a choice that is to the best advantage of the individual. The body does by largely maintaining the functionally more important reaction, while at the same time slowing down the lesser important one. The choice here is a relatively simple one. Nature will seek to take care of the synthesis of hormones first, because continuation of the species depends on the development of the sex organs.
If that’s the case, then why sex hormones levels are elevated in acne patients? He already established that CoA is the limiting factor here. Why would the body waste this precious resource producing excess sex hormones? Why not produce just what’s needed and save some CoA for fat metabolism?
Finally, he makes the statement that the difference between people with acne and clear skin is vitamin B5 status. Those with sufficient reserves remain clear.
The mechanism proposed above may be the reason why two groups of adolescent boys–both with a normal blood level of androgen–may exhibit differences in the incidence of acne. The group with acne is the one that has not enough of pantothenic acid in the body, whereas in the other group, pantothenic acid levels are not deficient.
This sounds like a claim that’s easy to test. So far it’s been shown that acne patients have higher levels of certain androgen hormones, insulin, insulin like growth factors and inflammatory chemicals and lower levels of antioxidants. But nobody has shown a difference in B5 levels. I wonder why Dr. Leung hasn’t bothered to test this, as it seems like a very easy way to support his theory.
Here are some other problematic points I noticed in the paper:
- It doesn’t make evolutionary sense that we would need such high doses of vitamin B5, doses you can never get from diet. It’s not likely that such a trait would have evolved through natural selection as it doesn’t seem to offer any reproductive advantage. Of course a lot of weird things happen in evolution, so this doesn’t prove anything.
- This theory doesn’t jive with the fact that birth control pills usually help with acne?
- What about the diet studies that show improvements in acne with low glycemic index and high-protein diets? We can explain this through the effect insulin has on the skin, but not though CoA.
- If excess sebum production is a result of deficient fat metabolism and not hormones, then why do green tea and other 5-alpha reductase inhibitors (substances that reduce the effect testosterone has on the skin) reduce sebum production? See studies here, here and here.
- This theory also doesn’t agree with petri dish studies that show skin cells produce more sebum when you increase the amount of androgen hormones they are exposed to.
Suffice to say that there are a lot of problems with B5-acne theory. In all fairness most of these things were not known when Dr. Leung published his paper. So perhaps his theory made somewhat more sense given the what we knew when the paper was published.
The theory of treating acne with megadoses of vitamin B5 supplements is based on a rather sketchy hypothesis paper published by a Chinese researcher Dr. Lit-Hung Leung. The theory makes superficial sense, but doesn’t agree with lot of the research published in the past 15 years, such as reduction in sebum production with low glycemic index diets or green tea creams.
There is no credible research to show pantothenic acid megadosing is helpful in acne. Lack of studies doesn’t mean anything itself, and there are anecdotal reports that B5 helps with acne – though many say it works for some months and then acne comes back.
Most credible sources say vitamin B5 is safe even in high doses, though again we have anecdotal reports of hair loss and even severe side-effects.
In the end I have to consider Dr. Leung’s theory thoroughly debunked. Of course this doesn’t mean that B5 wouldn’t work for acne. It’s possible it works through some other mechanism.