Acne vulgaris is a common disease in developed nations, one that has increased in frequency in the last half century, particularly among adult women. The precise mechanisms of the acne process are characterized by sebum overproduction, follicular hyperkeratinization, oxidative stress and inflammation.
Since inflammation is one of the earliest events to occur in the acne process, the influence of inflammatory mediators and subsequent free radical generation has become a major focus of experimental and clinical research.
Speculation that dietary factors can influence acne has been a matter of debate for decades, and emerging research is certainly suggesting that diet may indeed be an important factor, particularly in mediating the inflammation and oxidative stress of the acne process.
Hints that omega-3 fatty acids might positively influence acne originate from studies which show that communities that maintain a traditional diet high in omega-3 fatty acids have low rates of acne.
One study in over 1000 teenagers from North Carolina found that each of the primary signs of acne comedones, papules, pustules, acne cysts and oily skin were significantly lower in those consuming the greatest amounts of fish and seafood.
A separate investigation showed that patients actually with acne are more likely to be infrequent consumers of dietary fish and seafood. More recently, investigators have outlined mechanisms whereby fish oil may be effective in reducing inflammatory acne.
The inflammatory chemical leukotriene B4 (LTB4) is now know to up-regulate sebum production, and synthetic inhibition of LTB4, in the form of the drug zileuton, leads to significant improvement in acne.
Eicosapentaenoic acid (EPA) from fish oil, and gamma-linolenic acid (GLA) from borage oil, have been reported to inhibit the conversion of arachidonic acid into LTB4 to the same degree as the LTB4-inhibiting acne drug candidate zileuton.
Sophisticated studies have recently demonstrated that each pilosebaceous unit has the machinery in place to manufacture inflammatory chemicals, including LTB4, with the raw materials supplied from the breakdown products of dietary fats.
Fish oil, and EPA in particular, has a wealth of research to support its ability to inhibit LTB4 production, yet to date, no investigators have reported on the clinical utility of fish oil for acne.
A number of emerging studies have also shown that acne patients may be under increased local and systemic oxidative stress, and the lowered blood levels of various antioxidant and anti-inflammatory nutrients might be a reflection of the increased demand in acne.
For example, lower levels of vitamins A and E among 200 age-matched acne patients vs. controls was recently found to be associated with the severity of acne. Furthermore, since the selenium-dependent glutathione peroxidase enzyme activity is low in acne patients, it has been theorized that selenium would be of value.
Indeed, low levels of blood selenium have been documented in acne patients, and one study examined the effect of selenium (400 mcg) and vitamin E (20 mg) daily for 12 weeks in acne.
The combination led to improvements, especially in those with low baseline glutathione peroxidase activity. The epigallocatechin-3-gallate (EGCG) polyphenol from green tea has also been suggested to be helpful in acne due to its well documented anti-inflammatory and antioxidant activity.
In addition, reports suggests EGCG may also influence hormonal aspects of acne since it is known to possess 5-alpha-reductase inhibiting properties when applied topically. Other botanical remedies which have antioxidant and anti-inflammatory activity, such as turmeric, have a long history of use in skin disorders such as acne.
Epidemiological studies suggest that traditional diets with a low glycemic load are protective against acne and one open label trial showed that 400 mcg of chromium improves acne. Clinical intervention studies show that a diet with an overall low glycemic load, more dietary fiber, more fish and seafood is helpful in acne. Results show an average 22 less acne lesions in those who adhere to such a diet.
On the one hand there are certainly hints that marine lipids, minerals and phytochemicals might have potential to reduce inflammatory acne lesions, and on the other, it is almost difficult not to notice that these are the very same nutrients that have been shown to influence mental outlook, depressive symptoms and anxiety.
Omega-3 fatty acids, zinc, selenium, chromium, and even phytochemicals such as those found in green tea, have been shown to improve mood and decrease anxiety in various clinical and experimental studies.
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