Acne*

Acne is a disorder of the glands which lubricate the skin, called sebaceous glands. When these glands become blocked, bacteria overgrow and causes skin lesions. It is one of the most prevalent skin conditions, primarily affecting teenagers.

Acne is characterized by pimples, scaly red skin, blackheads, whiteheads, pinheads and large papules. The most nocuous form of acne is called cystic acne, which develops internally beneath the skin; whereas most other forms of acne are more topical.

Traditional treatment of cystic acne requires both a topical and internal approach. This is why many have chosen to go on oral antibiotics, or in more severe cases, Accutane. Both of these treatments come with risks. For instance, antibiotics that are effective in killing bacteria also increase the risk of causing bacterial resistance. Accutane can occasionally have serious side effects, including dry and scaly skin, headaches and an inability to properly digest triglycerides. In addition, Accutane may cause liver damage; therefore, blood work is necessary per month as a precautionary measure. This is where vitamin D may have great value.

Vitamin D and Acne

Acne is often seasonal, with the winter months sometimes seeing the most severe disease and summer (when vitamin D levels are higher), a significant improvement.

Founder and Medical Director of the Vitamin D Council, Dr. John Cannell, wrote,

“When I was a teen, my acne almost disappeared in the summer. I thought it was the salty water I swam in, but not so. It improved in the summer regardless of any salt water exposure.”

Furthermore, there is evidence that vitamin D supplements, if given in physiological doses, has a remarkable treatment effect on acne. The first (and highest quality) study published on this was in 1938 by Dr. Maynard; you can access the entire paper here:

Maynard MT. Vitamin D in Acne: A Comparison with X-Ray Treatment. Cal West Med. 1938 Aug;49(2):127-32

Dr. Maynard wrote:

“There is probably no skin disease of greater importance to the human race than acne. It is undoubtedly our commonest skin disease, and it is rare that any individual reaches maturity without having had it in one of its phases. It is a disease of considerable economic importance, as the disfiguring scars of a severe case are never completely obliterated. It is also a disease of youth. It attains its most noxious form at the time the individual first has to earn his own living. It is undoubtedly responsible for many failures in getting business positions. It is also the basis for inferiority complexes and discouragement in young people.”

Dr. Maynard treated hundreds of patients with 8,000 to 14,000 IU/day. After several months, he reported:

“I believe I may say that at no time in my dermatological experience have I felt such complete satisfaction with a treatment as I have with the cases of this series. I know that vitamin D is an imperfect weapon to slay this disfiguring disease, but it undoubtedly gives one a feeling of being well defended. From the patient’s viewpoint, it has left little to be desired, as they find themselves improving, both in appearance and in general well-being. Many have expressed the sentiment, ‘Never felt better.’”

Moving forward, a randomized controlled trial (RCT) published in 2016 found that low doses of vitamin D (1,000 IU/day; 25 mcg) has a treatment effect on acne.

Seul-Ki Lim et. Al. Comparison of Vitamin D Levels in Patients with and without Acne: A Case-Control Study Combined with a Randomized Controlled Trial. PLoS One, 2016.

These researchers evaluated the vitamin D levels in 80 patients with acne and 80 healthy controls. The participants had their vitamin D levels measured at baseline and after treatment. Here is what the researchers found:

  • A total of 48.8% of patients with acne were vitamin D deficient; whereas, only 22.5% of healthy controls were deficient (P = 0.019).
  • Serum 25(OH)D levels were inversely associated with the severity of acne (P = 0.002).
  • Vitamin D status was negatively associated with the presence of inflammatory lesions (P < 0.001).

After the initial observation, the 39 vitamin D deficient patients with acne entered a subsequent blinded controlled trial in which the patients were randomly assigned to receive a low dose of vitamin D3, 1,000 IU (25 mcg) drop per day (n = 20) or a daily placebo drop (n = 19) for a period of two months. The patients were assessed by three independent, blinded dermatologists at baseline, and after weeks two, four and eight.  The acne severity was determined according to the global acne grading system (GAGS).

Here is what the researchers discovered:

  • Vitamin D supplementation significantly increased 25(OH)D (P < 0.001) and was associated with an improvement in clinical severity compared to the placebo group.
  • Those who supplemented with vitamin D experienced a decreased presence of inflammatory lesions compared to the control group (P < 0.05).
  • After 8 weeks of treatment, inflammatory lesions in the vitamin D group decreased by 34.6% compared to only 5.8% in the control group.

It is amazing that such a low dose had an effect on acne. Dr. Maynard, 60 years ago, had a much better understanding of how to dose vitamin D (8,000 to 14,000 IU/day). In the Korean study, the low dose of 1,000 IU/day (25 mcg) only increased 25(OH)D from 12 to 16 ng/ml. Also, it appears from this study that otherwise normal Korean teenagers have an average vitamin D level of 12 ng/ml!

Recommendations

If you are a teenager or adult with acne, the Vitamin D Council recommends supplementing with 5,000 IU (125 mcg) to 10,000 IU (250 mcg)/day of vitamin D, depending on your weight (higher weight individuals may require more vitamin D). In 2 months, have your vitamin D levels tested. If your levels are below 60 ng/ml, increase your vitamin D intake by small increments until your vitamin D blood level is around 70 ng/ml. It may take about  2-3 months to begin to experience an improvement. However, maximum improvement may not occur for 5-6 months.

If have supplemented with vitamin D to help manage your acne, we would love to hear your story. Please email info@vitamindcouncil.org to share your experience.

Citation

John Cannell, MD. Health condition: Acne. The Vitamin D Council Blog & Newsletter, November 13, 2017.

Resources

  1. Maynard MT. Vitamin D in Acne: A Comparison with X-Ray Treatment. Cal West Med. 1938 Aug;49(2):127-32
  2. Seul-Ki Lim et. Al. Comparison of Vitamin D Levels in Patients with and without Acne: A Case-Control Study Combined with a Randomized Controlled Trial. PLoS One, 2016.
  3. Adityan, B. Thappa, D. M. Profile of acne vulgaris–a hospital-based study from South India. Indian journal of dermatology, venereology and leprology. 2009 May-Jun; 75 (3): 272-8.
  4. Al-Ameer, A. M. Al-Akloby, O. M. Demographic features and seasonal variations in patients with acne vulgaris in Saudi Arabia: a hospital-based study. International journal of dermatology. 2002 Dec; 41 (12): 870-1.
  5. Ammad, S. Gonzales, M. Edwards, C. Finlay, A. Y. Mills, C. An assessment of the efficacy of blue light phototherapy in the treatment of acne vulgaris. Journal of cosmetic dermatology. 2008 Sep; 7 (3): 180-8.
  6. Ayer, J. Burrows, N. Acne: more than skin deep. Postgraduate medical journal. 2006 Aug; 82 (970): 500-6.
  7. Berg, M. Epidemiological studies of the influence of sunlight on the skin. Photo-dermatology. 1989 Apr; 6 (2): 80-4.
  8. Elman, M. Slatkine, M. Harth, Y. The effective treatment of acne vulgaris by a high-intensity, narrow band 405-420 nm light source. Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology. 2003 Jun; 5 (2): 111-7.
  9. Fluhr, J. W. Gloor, M. The antimicrobial effect of narrow-band UVB (313 nm) and UVA1 (345-440 nm) radiation in vitro. Photodermatology, photoimmunology & photomedicine. 1997 Oct-Dec; 13 (5-6): 197-201.
  10. Gfesser, M. Worret, W. I. Seasonal variations in the severity of acne vulgaris. International journal of dermatology. 1996 Feb; 35 (2): 116-7.
  11. Harrison, W. J. Bull, J. J. Seltmann, H. Zouboulis, C. C. Philpott, M. P. Expression of lipogenic factors galectin-12, resistin, SREBP-1, and SCD in human sebaceous glands and cultured sebocytes. The Journal of investigative dermatology. 2007 Jun; 127 (6): 1309-17.
  12. Jha, A. K. Gurung, D. Seasonal variation of skin diseases in Nepal: a hospital based annual study of out-patient visits. Nepal Medical College journal : NMCJ. 2006 Dec; 8 (4): 266-8.
  13. Jung, J. Y. Yoon, M. Y. Min, S. U. Hong, J. S. Choi, Y. S. Suh, D. H. The influence of dietary patterns on acne vulgaris in Koreans. European journal of dermatology : EJD. 2010 Nov-Dec; 20 (6): 768-72.
  14. Koreck, A. Pivarcsi, A. Dobozy, A. Kemeny, L. The role of innate immunity in the pathogenesis of acne. Dermatology. 2003; 206 (2): 96-105.
  15. Kramer, C. Seltmann, H. Seifert, M. Tilgen, W. Zouboulis, C. C. Reichrath, J. Characterization of the vitamin D endocrine system in human sebocytes in vitro. The Journal of steroid biochemistry and molecular biology. 2009 Jan; 113 (1-2): 9-16.
  16. Lee, D. Y. Huang, C. M. Nakatsuji, T. Thiboutot, D. Kang, S. A. Monestier, M. Gallo, R. L. Histone H4 is a major component of the antimicrobial action of human sebocytes. The Journal of investigative dermatology. 2009 Oct; 129 (10): 2489-96.
  17. Melnik, B. [Acne vulgaris. Role of diet]. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete. 2010 Feb; 61 (2): 115-25.
  18. Melnik, B. C. Evidence for acne-promoting effects of milk and other insulinotropic dairy products. Nestle Nutrition workshop series. Paediatric programme. 2011; 67131-45.
  19. Nakatsuji, T. Kao, M. C. Zhang, L. Zouboulis, C. C. Gallo, R. L. Huang, C. M. Sebum free fatty acids enhance the innate immune defense of human sebocytes by upregulating beta-defensin-2 expression. The Journal of investigative dermatology. 2010 Apr; 130 (4): 985-94.
  20. Nouri, K. Villafradez-Diaz, L. M. Light/laser therapy in the treatment of acne vulgaris. Journal of cosmetic dermatology. 2005 Dec; 4 (4): 318-20.
  21. Reichrath, J. Vitamin D and the skin: an ancient friend, revisited. Exp Dermatol. 2007 Jul; 16 (7): 618-25.
  22. Sardana, K. Sharma, R. C. Sarkar, R. Seasonal variation in acne vulgaris–myth or reality. The Journal of dermatology. 2002 Aug; 29 (8): 484-8.
  23. Schwalfenberg, G. K. A review of the critical role of vitamin D in the functioning of the immune system and the clinical implications of vitamin D deficiency. Molecular nutrition & food research. 2011 Jan; 55 (1): 96-108.
  24. Tamer, E. Ilhan, M. N. Polat, M. Lenk, N. Alli, N. Prevalence of skin diseases among pediatric patients in Turkey. The Journal of dermatology. 2008 Jul; 35 (7): 413-8.
  25. White, J. H. Vitamin D as an inducer of cathelicidin antimicrobial peptide expression: past, present and future. J Steroid Biochem Mol Biol. 2010 Jul; 121 (1-2): 234-8.
  26. Zouboulis, C. C. [Acne vulgaris. The role of hormones]. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete. 2010 Feb; 61 (2): 107-8, 110-4.

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