Vitamins & Minerals: Their Role in Acne Treatment

Acne is a complicated disease in terms of treatment and symptoms. It produces everything from blackheads to painful pimples that can turn into cysts or nodules over time, with the possibility of long-term scarring.

Acne is caused by an alteration in the skin's pilosebaceous unit with clogging due to sebum and dead cells buildup, leading to infection and ultimately inflammation. Many factors are involved in its evolution, such as hormones (which is why it is common in teenagers), cleansing routine, genetics, and whether or not you use certain medications or products.

In general, acne is a multifactorial disease where many aspects play a role in its development, and therefore treatment is based on the control of each of them. Multiple medications are available to cope with it, such as benzoyl peroxide, retinoids, some acids and even medical procedures like chemical peels.

However, many products promise to improve acne under the premise that they ''cleanse from the first application'' today, including vitamins and minerals. But have you ever wondered if it's true?

Acne

Acne is a common skin condition known for the appearance of pimples, blackheads and, in severe cases, very painful nodules and cysts that can leave scars that are difficult to treat.¹

Four processes have a pivotal role in forming the lesions²:

Inflammatory mediators released into the skin
Alteration of the keratinisation process leading to comedones
Increased and altered sebum production under androgen control (or increased androgen receptor sensitivity)
Follicular colonisation by a bacterium called Cutibacterium acnes

In short, an ideal acne medication is the one that addresses these four steps or at least partially does so. But what leads to these processes? There are different situations from hormonal imbalance tending to androgens³, genetics⁴, inadequate facial hygiene⁵, certain medications such as steroids⁶ to even comedogenic oil-based facial products⁷.

Depending on whether inflammation is present or not, there are broadly two types of acne⁸:

Non-inflammatory acne: Includes non-inflamed lesions such as open or closed comedones and microcomedones (popularly known as blackheads).

Open comedones, or blackheads, show darkly coloured hyperkeratotic plugs within the follicular opening. This dark colouration is related to the oxidation of melanin and not dirt, as many mistakenly think. Closed comedones, or whiteheads, are white to flesh-toned in colour and seem not to have a central open pore.

Inflammatory acne: Inflammatory acne vulgaris lesions develop when comedones rupture and contents of the pilosebaceous unit spill into the surrounding dermis, causing inflammation. This kind of acne is the one that causes blemishes or scars after the lesions have disappeared.

Acne treatments

Acne treatments are international recommendations based on scientific evidence of products that actually address the four steps of its development, such as the European Academy of Dermatology and Venereology⁹ and the American Academy of Dermatology.¹⁰

Both academies agree that treatment depends on how severe the lesions are recommending medications like retinoids, benzoyl peroxide, antibiotics, and in some cases, azelaic acid.⁹,¹⁰

Among those not recommended or with low strength recommendation (with no scientific evidence to prove their efficacy) is oral zinc. This mineral is often thought to play a role in acne, but it has not been shown to provide any benefit to date.

Vitamins and acne

Vitamins are crucial chemicals for proper body functioning. They are naturally found in food, and their recommended daily intake ensures cell function, development, and growth.¹¹ While it has been claimed that some topical vitamin serums are beneficial for the skin, not all actually provide a notable benefit in acne.

Vitamins are not included in acne treatment in the first place, so using them would be more like using a cosmeceutical than a pharmaceutical. A cosmeceutical is a topical preparation sold as a cosmetic but with some performance features that suggest pharmaceutical action. It can affect the skin positively beyond the time of its application but are not always necessary.¹²

Vitamin B3, also known as niacinamide/nicotinamide, is an anti-inflammatory ingredient widely used in different medical conditions such as dermatitis, acne, and skin blemishes (hyperpigmentation). It is one of the most used cosmeceuticals today, and its benefits range from depigmenting, anti-inflammatory, face brightening, and sebum reduction in laboratory settings.

Effects of niacinamide in the skin

Niacinamide has several effects on the skin, ranging from regulation of keratinocyte differentiation markers, epidermal ceramide synthesis, hyperpigmentation reduction, helps prevent UV-induced molecular and immunological events, and regulation of sebaceous lipid production.¹³ However, we will focus only on their role in sebum production as it is the one most involved in acne.

Scientifically and in laboratory tests, niacinamide has been shown to reduce the total amount of skin lipids, especially triglycerides and fatty acids, compared to the control product.¹³

Triglycerides represent by far the largest proportion of sebaceous gland lipid (50- 60%).¹³ C. acnes inhabits the pilosebaceous unit using lipid-rich sebum as a nutrient source, so the more lipids, the more bacteria there are and, therefore, more inflamed lesions.² Despite this, only a few studies on human facial skin prove benefits in acne.

For example, an ancient study with 4% niacinamide gel proves to be clinically effective in decreasing acne outbreaks (papules/pustules) when applied to the face daily, even comparable to over-the-counter drugs such as 1% clindamycin, probably because of its anti-inflammatory effects. After 8 weeks of treatment, both compounds produced similar results in terms of pimple reduction.¹⁴

Another study shows that 2% niacinamide reduces facial sebum excretion by up to 21% after four weeks of treatment compared to a placebo product, measured using a particular luminous device.¹⁵ A similar study using the same niacinamide concentration found no difference in sebum excretion at week 6 of treatment than a placebo.

A study comparable to Alan et al.¹⁴ assessed whether 5% niacinamide could provide similar benefits to 2% clindamycin. The results suggest that both niacinamide and clindamycin decrease acne severity, but the second showed superiority.

So whereas several studies show that niacinamide decreases sebum production and inflammation, others suggest the opposite and that its benefits do not extend beyond acne recommended medications.

According to experts, acne treatment should be a combination of different active ingredients, and niacinamide seems supplementary to the primary medications. Indeed, there is nothing wrong with using it, but it does not cure acne on its own.

Furthermore, reducing facial sebum production with a topical formulation is not addressing the problem but its consequences. In acne, the principal issue of oily skin is hormonal imbalance, where all the focus should be on treatment.

The remaining trials studied niacinamide combined with other actives or other purposes beyond our scope.

Minerals

Minerals, like vitamins, are essential for proper body functioning. Zinc appears to be the most related to acne, perhaps because of its antimicrobial and anti‐inflammatory actions and regulatory and inhibitory effects on many metabolic steps.¹⁶

Some studies have shown low blood levels of zinc in patients with acne than those without, but this finding has not been attributed to causation.¹⁷ Despite this, no scientific evidence proves the mechanism by which zinc acts on acne to date.

Topical zinc has also not been found to be beneficial in acne. In fact, a single-blind randomised clinical trial using two formulations (5% zinc sulphate and 2% tea lotion) showed that tea lotion was more beneficial in decreasing the number of inflammatory lesions than zinc.¹⁸

Other formulations include zinc, such as zinc+erythromycin (an antibiotic prescribed for acne), because it was thought to increase the skin absorption of the antibiotic. Yet, it was shown to make no difference¹⁹, and absorption may even be less than when benzoyl peroxide and clindamycin are combined (two recommended pharmaceuticals in acne)²⁰, so there is no point in using it.

Conclusion

It is well known that acne is a problematic dermatological condition, both for the physician and the patient. First, lesions can be drug-resistant, especially to antibiotics, and it can negatively affect the patient's mental health because treatment takes time, and lesions do not improve overnight.

With this in mind, patients may take alternative paths on their way to speeding up recovery, opting for serums, multivitamins or other products that promise to ''clear acne'' but end up being a waste of money.

A dermatologist must evaluate you first to determine your acne and what medication you need accordingly. Vitamins and minerals are essential, of course, but most of them are in food, and eating well meets biological needs, so their supplementation use is rarely considered in acne.

The treatment approach must go to the root of the problem, whether hormonal, drug-related, comedogenic products or any other cause. Vitamins topical applications may help in some ways, but they are unnecessary and may also be a waste of money when considered a priority instead of a bonus.