Listed below will be a few supplements used for acne treatment.
Acne is a problem that many people go through leading into adulthood, and even continue to have as the years continue. The biggest issue I see today is a lot of acne comes from wearing makeup, which some wear frequently or not, but the most common response is that after wearing a product, a pimple always follows shortly after. There is a name for this specific type of acne, acne cosmetica. Even if you do not wear makeup daily, you can still develop this type of acne.
There are numerous factors to consider when dealing with a new blemish. The first thing to consider is how pimples form in the first place. According to New York Presbyterian, “Pimples form when dead skin cells mix with excess oil (sebum). This mixture plugs the pore, causing swelling. Bacteria can grow in the mix and lead to infection and pus.” If one were to see a diagram with a pimple forming, one can see the pimple grow across the layers of the skin. Another factor to consider, specifically with makeup, is where the product is being applied and for how long. If you notice that the acne is clustered around one specific area, it is easier to pinpoint what specific product is causing the breakout. However, there is the problem of time. Blemishes do not follow a specific clockwork and can vary based on how someone takes care of their skin or how prolonged a product is on the skin. This can cause breakouts to be delayed, making it harder to know which specific product is causing the issue. Additionally, there are different forms of acne cosmetica. Some may see tiny bumps on the face and whiteheads, while others may have full-blown infections on the skin. This makes it difficult to know when and how to treat each type.
Pharmacists can aid in the decision-making of patients by giving them tips to follow when choosing makeup. We can advise patients to journal the products they use and the times that they get breakouts to see if they can recognize a pattern between the two. After analyzing, they can pick their products accordingly. Additionally, they can choose products that are labeled non-comedogenic. These products are specifically made to not block the pores, which can help in the battle against acne. Furthermore, it should be emphasized that the patient should wash their face twice daily with a cleanser that doesn’t irritate the skin. If they also partake in activities that make them sweat like the gym, then they should wash their face after these activities as well. Largely with makeup, the rule of thumb is to always remove before going to bed, cleaning your makeup brushes every week, and trying not to share with other people. This helps reduce the potential of breakouts and even other diseases like pink eye. If the patient is asking for a recommendation on a product, benzoyl peroxide is usually the gold standard, as it is one of the few ingredients that fight the bacteria that causes acne. Other products like salicylic acid and adapalene can work in conjunction with benzyl peroxide to help unclog the pores.
“How Pimples Form: NYP.” NewYork-Presbyterian, www.nyp.org/healthlibrary/multimedia/how-pimples-form#:~:text=Pimples%20form%20when%20dead%20skin,lead%20to%20infection%20and%20pus
“I Have Acne! Is It Okay to Wear Makeup?” American Academy of Dermatology, www.aad.org/public/diseases/acne/causes/makeup
Acne is a very broad topic. There are different kinds of acne that can present on a person’s skin and there are different treatments to be provided for different kinds of acne. Acne is a very common skin disease which forms when follicles of the skin are clogged due to many reasons including dirt built-up. There are certain products that are overall great for the skin and are beneficial to be part of a skin care routine. Retinoids and Retinols, which are under the category of Vitamin A derivatives, provide numerous benefits for the skin. Retinoids and Retinols help increase the cell regeneration process which helps treat scars as well and it has shown to have benefits against aging. It helps decrease the occurrence of fine lines and wrinkles.
The major difference between retinoids and retinols is that for one of them, it is mostly required to have a prescription from a dermatologist while the other is easily accessible over-the-counter. Retinoids are more potent depending on the severity of one’s acne. Since retinoids are more potent and some can also have certain teratogenic (harmful effects on a newborn) effects therefore, they require a prescription and a follow-up with a dermatologist. Retinols are effective in the treatment of acne as well but the results are not as prominent in a short period of time as it would be for the use of retinoids.
Topical retinoids are great first-line treatment for acne. It is important to note that when using retinoids, the skin might worsen at first before becoming better. When this occurs then that means the medication is working. Many patients who notice that their skin is worsening, not due to allergic effects, believe that the medication is not working for them and quickly opt for another option aside from retinoid. Any skin condition might take at least 6-8 weeks to see drastic results. Know to be patient when being treated for any skin condition, including acne.
An example of a topical retinoid is Differin Gel 0.1% (Adapalene). Adapalene is different compared to other retinoids because it is the first topical retinoid to become available over-the-counter. Differin is a topical that is used once daily to the skin after it has been cleansed. The reason it was approved to be available over-the-counter is due to its safety use on a daily basis. Differin as well as other retinoids might cause the skin to be more prone to dryness therefore it is important to moisturize your skin daily when using this medication or medication class. It is also important to apply sunscreen daily since the sun can cause damage on the skin. Applying sunscreen using retinoids and retinols as well is crucial in order to gain the maximum benefit of the treatment.
If retinoid therapy is not shown to be effective on a patient, then the second-line treatment is to start oral antibiotic therapy. Each person’s skin is not the same. There are people who might see results right away while for others it might take time to find the best treatment that suites them. It is important to follow-up with a dermatologist.
Armitage, Author Hanae, et al. “Does Retinol Deserve the Hype? A Stanford Dermatologist Weighs In.” Scope, Logo Left ContentLogo Right Content 10,000+ Posts Scope Stanford University School of Medicine Blog, 6 Aug. 2020, scopeblog.stanford.edu/2020/08/06/does-retinol-deserve-the-hype-a-stanford-dermatologist-weighs-in/.
Feldman, Steven, et al. “Diagnosis and Treatment of Acne.” American Family Physician, 1 May 2004, www.aafp.org/afp/2004/0501/p2123.html.
Differin. Package Insert. Galderma Laboratories L.P.; 1996
Commissioner, Office of the. “FDA Approves Differin Gel 0.1% for over-the-Counter Use to Treat Acne.” U.S. Food and Drug Administration, FDA, www.fda.gov/news-events/press-announcements/fda-approves-differin-gel-01-over-counter-use-treat-acne.
That is a very important question Ms. Cesiro, after further researching into this it's actually a very big issue that should be addressed. Although westernized society has successfully found a way to handle most infectious diseases; we instead live in an environment where metabolic, cardiovascular and autoimmune diseases are common. The Western diet has high fat, high cholesterol, high sugar and excess salt intake as well as the overwhelming popularity of fast foods that have all been linked to the causes of all those diseases. High fat diets such as those in the western diet have been directly associated with obesity, and obesity has directly been associated with diseases such as diabetes, high cholesterol and high blood pressure.
As pharmacists it is our duty to educate patients on their diet and nutrition as well as their medications. Admittedly, diet changes are very difficult and involve much more factors such as cost issues and accessibility. But a good place to start is to first discuss with the patient, and allow the patient to disclose whatever they are comfortable with sharing. As pharmacists we must advocate for consumption of more fruits and vegetables as well as whole grains, low sodium, low sugar and low fat diets while expressing the benefits such as lower risk of diseases. A good place to start would be with taking one step at a time. Which could be to stop drinking beverages with lots of added sugar. Substitutions are important, instead of a candy bar you can go for a yogurt parfait or instead of a bag of chips you can go for a bag of pistachios. When preparing meals, cut down on the usage of fats and oils since they are calorie dense and full of fat. Try using oil cooking sprays as well as butter alternatives such as vegan butters.
Manzel A, Muller DN, Hafler DA, Erdman SE, Linker RA, Kleinewietfeld M. Role of "Western diet" in inflammatory autoimmune diseases. Curr Allergy Asthma Rep. 2014;14(1):404.
Do you feel the western diet creates a higher incidences of diseases not seen in many other countries. What do you feel is a Pharmacist's role in educating patients?
Genetics, diet and gender are all important factors in what causes acne. Before starting any skin treatments it is crucial to eliminate any potential causes of acne. Certain epidemiological studies have shown that the Western diet has a connection to acne. Whereas non-Western diets are preferable due to a lesser consumption of sugar, salt, oil, dairy and alcohol. Patients looking to treat their acne need to consider choosing foods with a lower glycemic index, since high glycemic index foods are a possible trigger for acne. At the start of puberty, the spike in androgenic hormones involving the conversion of testosterone to dihydrotestosterone will lead to an increase in size and activity of sebaceous glands. This will lead to an excess of sebum which will allow for the development of C. acnes as whiteheads and blackheads form.
Keeping the skin clean is very important in treating acne, patients should wash their skin with a mild cleanser at most twice daily. Excessively cleaning the skin can actually worsen acne by stripping the skin of its oils and drying it out. Keeping the skin well hydrated is another priority, dehydration will lead to possible inflammation and alter the stratum corneum. Be sure to use cleansers that do not increase the skin pH as it can lead to further skin dehydration.
There is an abundance of oral and topical products available over the counter targeting acne and skin conditions.Tea tree oil is a popular skincare ingredient commonly used for its antibacterial, anti-inflammatory and antifungal properties. The active ingredient in tea tree oil is terpin-4-ol which is primarily responsible for its suppression of inflammatory mediators which will reduce inflammation. Tea tree oil is able to target Staphylococcus aureus since it is sensitive to the oil. While tea tree oil will effectively reduce skin lesions, there isn’t enough studies or scientific evidence to prove its benefits for acne.
Zinc by oral route is used as an alternative to tetracyclines such as minocycline, used for its bacteriostatic properties against C. acnes and targets severe acne. Zinc will also balance the hormonal levels in the body along with treating inflammation associated with acne. A dose of 30 mg zinc, particularly zinc gluconate has proven to be an appropriate option. Whereas topical zinc alone has not proven to be sufficient alone, topical zinc in combination with topical antibiotics is helpful. Adverse effects of zinc include nausea, vomiting and diarrhea which make it a less desirable option. Vitamin A is a retinol compound that is metabolized into other metabolites. One of its metabolites, retinoic acid is widely used in OTC products to eliminate fine lines and wrinkles. Oral vitamin A might benefit acne in women with a dose up to 300,000 (IU) daily, and in men a dose up to 500,000 IU daily. However few studies have shown its effectiveness against acne.
Nicotinamide is a water-soluble form of Vitamin B3, used to target acne. Nicotinamide is also known as the activated form of niacin, and reduces inflammation, improves skin texture of sun-burnt skin and reduces sebum production. Along with cleansing the skin, keeping the skin well hydrated and eliminating all other acne-triggering factors it is important to eliminate all other causes of acne. Certain drugs such as corticosteroids, anabolic-androgenic steroids and hormonal drugs have been known to trigger acne. Certain chemotherapies, immunosuppressant drugs, and autoimmune disease drugs also cause acne. High doses of vitamin B6 and B12 have been reported to cause acne outbreaks as well, especially the combination of those two vitamins together.
Jamie L. Woodyard and Chelsea M. Baker, (2020), "Chapter 38: Acne," Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 20th Edition. https://doi-org.jerome.stjohns.edu/10.21019/9781582123172.ch38
Zamil DH, Perez-Sanchez A, Katta R. Acne related to dietary supplements. Dermatol Online J. 2020 Aug 15;26(8):13030/qt9rp7t2p2. PMID: 32941710.
Zinc and Acne Overview. Acne.org. https://www.acne.org/zinc-and-acne-overview.html. Accessed 2021 June 10.
Vitamin A is another name for retinol but can also refer to the group of compounds called retinoids that are synthetic or natural derivatives of retinol. Vitamin A can be used for acne treatment and slowing down signs of aging on the skin. Retinoids work by binding to retinoid receptors in the skin, leading to decreased cohesiveness of follicular epithelial cells, decreased microcomedo formation, and increased turnover of follicular epithelial cells. Tazarotene is a topical retinoid that is used for the treatment of acne and psoriasis and studies have shown it to be effective in the treatment of photoaging as well. Adapalene is another topical retinoid used in the treatment of acne, but unlike tazarotene, adapalene is available over-the-counter as Differin. Differin contains the only FDA-approved prescription-strength retinoid that can be bought without a prescription. The main concern with retinoids is teratogenicity and oral retinoid use is contraindicated during pregnancy. It is highly recommended to avoid using topical retinoids during pregnancy due to possible systemic absorption that can cause major fetal malformations. Initiation of topical retinoids commonly causes a “retinoid reaction”, also known as “purging” or “retinization”. Patients may experience dose-related adverse effects like pruritus, erythema, dry skin, peeling skin, and a burning sensation at the sites of application. This may persist for the first few weeks of treatment which can lead to early discontinuation by the patient due to an apparent worsening of their acne. However, it is important for the patient to know that this is normal and can last a few weeks, but their skin will improve after that period. While using a retinoid, the patient must also be consistent with daily sunscreen application and moisturizer use to protect their skin from further damage and reduce skin sensitivity. Retinoids should be applied at night before or after a moisturizer. Applying the retinoid on top of a moisturizer can minimize skin irritation, but applying it before will maximize the skin benefits.
Mukherjee S, Date A, Patravale V, Korting HC, Roeder A, Weindl G. Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety. Clin Interv Aging. 2006;1(4):327-348. doi:10.2147/ciia.2006.1.4.327
Noble S, Wagstaff AJ. Tretinoin. A review of its pharmacological properties and clinical efficacy in the topical treatment of photodamaged skin. Drugs Aging. 1995;6(6):479-496. doi:10.2165/00002512-199506060-00008
Acne Grades and Treatment
Acne vulgaris occurs in the teens as well as throughout adult life. It can affect our quality of life as our self-esteem and psychosocial development is impacted.2 With proper daily skincare along with over-the-counter- and prescription treatments, it is easy to get overwhelmed with establishing a regimen that works.
To effectively treat acne, we must be able to identify the different Grades as well as the different variants that exist. (Source 2):
Grade I, often referred to as mild in severity, presents as open and closed comedones with few inflammatory papules and pustules.
Grade II is referred to as moderate in severity and presents as papules and pustules, mainly on the face.
Grade III is referred to as moderately severe in severity and presents as numerous papules and pustules, and occasional inflamed nodules often occurring on the chest and back.
Grade IV is severe and presents as many large, painful modules and pustules.
As the many skin condition treatments, the treatment for acne vulgaris aims to reduce the severity and frequency of skin lesions. Successful treatment is deemed satisfactory based on patient preference. There may be underlying causes such as diet and lifestyle but oftentimes, it is hereditary. Topical therapy is the standard of care as treating local irritation with antimicrobials, gels, and pledges can be beneficial. Topical examples include benzoyl peroxide, clindamycin, and erythromycin while oral antibiotics commonly used are tetracycline, erthyromycine, and trimethoprim-sulfamethaxole.
1. Diagnosis and Treatment of Acne, https://www.aafp.org/afp/2012/1015/p734.html
2. Management of Acne, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080563/
Nicomide is a formulated vitamin and mineral oral supplement created by Avion Pharmaceuticals. It is indicated for the use of nutritional deficiencies for patients that have irritation and inflammation of the skin. Nicomide contains folic acid, niacinamide, copper, and zinc which allows better function of the cell process on the skin to target the inflammatory pathway. It promotes clearer and healthier skin and is considered well-tolerated.
Folic acid (Vitamin B-9)
This vitamin is an essential co-factor in the enzymatic pathway of (Hcy)methyltransferase. Lack of this vitamin can lead to hyperhomocysteinaemia which leads to blood clots, damage to the blood vessels, and increase a patient’s risk for CAD. However, reports have shown that although this vitamin is essential for cardiovascular, neurological, and psychological functions, it may exacerbate acne vulgaris as well. Patients who are takin isotretinoin might see a decrease in their vitamin B12 and folic acid levels. This is because isotretinoin may affect the metabolism of folic acid, vitamin B12, and Hcy, however, this may be dependent on the duration or concentration of isotretinoin treatment.
Niacinamide (Vitamin B-3)
This vitamin can be found in many medicines and cosmetic products used for the skin. It treats disorders relating to hyperpigmentation by blocking the migration of melanosome and suppresses skin pigmentation. Niacinamide can also provide antimicrobial effects, photo-protection, anti-pruritus, and repair DNA from damage caused by ultra-violet radiation. Improvement can be seen in the skin’s barrier function and can decrease sebum secretion which contributes to acne vulgaris. Studies have found that patients who take niacinamide can often prevent damage to the DNA and have lipid peroxidation protection.
Copper is one of the minerals that considered essential for humans due to the different roles it plays in the functioning of the human tissues. 15% of copper within the human body can be found in the skin. Copper can produce dermal fibroblast proliferation, upregulate collagen and elastin fibers, acts as a cofactor of superoxide dismutase (used as protection against free radicals), skin regeneration, etc. It is found in many different household items such as pillowcases and socks to help patients with skin disorders. Pillowcases that contain copper have been found to decrease wrinkles while copper-containing socks have been shown to increase elasticity of the skin. Copper-containing wound dressings have also been found to stimulate wound healing. The use of copper is for the overall improvement of skin whether it is for skin aging products or rejuvenation.
Zinc is an important trace element that helps with growth and development, the immune system, reproductive health, neurobehavioral development, and sensory function. Zinc may also have importance in the development in keratinocytes because it is involved with the changes in normal epithelial cells. Patients who have reduced zinc levels may see changes in sebaceous gland function as a result from an increase in androgen production. In some studies, male patients who suffered from severe acne had lower levels of zinc compared to patients with mild or no acne. The reduction in zinc levels for patients with severe acne vulgaris may hint towards the importance of zinc during the local inflammation process. Thus, resulted in the hypothesis that oral and topical zinc formulations may help with acne treatment. However, the data is inconsistent across studies.
Nicomide. (2021). Avion Pharmaceuticals, Atlanta, GA. Retrieved from: Nicomide® Dietary Supplement
Gökalp, H., Bulur, I., & Gürer, M. (2014). Decreased vitamin B12 and folic Acid concentrations in acne patients after isotretinoin therapy: a controlled study. Indian journal of dermatology, 59(6), 630. https://doi.org/10.4103/0019-5154.143533
Kamal, M., Polat, M. (2015). Effect of different doses of isotretinoin treatment on the levels of serum homocysteine, vitamin B 12 and folic acid in patients with acne vulgaris: A prospective controlled study. J Pak Med Assoc, 65(9), 950-53.
Zhen, A. X., Piao, M. J., Kang, K. A., Fernando, P., Kang, H. K., Koh, Y. S., Yi, J. M., & Hyun, J. W. (2019). Niacinamide Protects Skin Cells from Oxidative Stress Induced by Particulate Matter. Biomolecules & therapeutics, 27(6), 562–569. Advance online publication. https://doi.org/10.4062/biomolther.2019.061
Borkow G. (2014). Using Copper to Improve the Well-Being of the Skin. Current chemical biology, 8(2), 89–102. https://doi.org/10.2174/2212796809666150227223857
Majid Rostami Mogaddam, Nastaran Safavi Ardabili, Nasrollah Maleki, Maedeh Soflaee, "Correlation between the Severity and Type of Acne Lesions with Serum Zinc Levels in Patients with Acne Vulgaris", BioMed Research International, vol. 2014, Article ID 474108, 6 pages, 2014. https://doi.org/10.1155/2014/474108
Many Americans struggle with acne. While sometimes it is due to hormonal changes, acne can occur at any age and to any gender. On average, it affects 50 million people in the US every year. Glands on the surface of the skin produce more oil than normal which clogs the pores and allows bacteria to collect and a pimple to form. There are many different types of pimples, including blackheads, whiteheads, cysts, and nodules.
While harsh, topical, and oral medications are often recommended and prescribed by doctors, some people suffering from acne seek to use more natural and herbal treatments for their acne.
Topical use of Vitamin A has been shown to improve acne in patients according to clinicians at the University of Michigan. Vitamin A taken orally will not give the same effects on patients and can possibly cause harm due to high toxic levels. Many topical medications chemically alter the vitamin into a retinoid which regenerates and health the skin rapidly. Using appropriate sunscreen with the use of topical vitamin A is very important. Because it leaves them with a fresh layer, it weakens the skin’s natural UV protection. Using a sunscreen with SPF 30 daily is critical
Zinc can also be used to improve acne. This can either be taken orally by the patient or applied topically. A study done back in 2003 found that topical zinc can decrease oral production and protect against bacterial infection and inflammation. This mineral reduces three components that contribute to acne on the skin. A daily dose of 30mg of zinc can help treat acne. Zinc can also help prevent sickness so it can be used as dual therapy, especially during the pandemic. A study showed that the combination of erythromycin and zinc therapy helped patients obtain clearer skin in 12 weeks.
There is some evidence out there that barberry extract can also be used to prevent acne. Barberry has anti-inflammatory and antibacterial effects that help contribute to its prevention of acne. It is also found that barberry’s antilipogenic effects help to prevent acne. In a study done in 2012, adolescents between the ages of 12 and 17 were given a gelatin capsule wither filled with aqueous extract of dried barberry or placebo. After 4 weeks, the mean number of noninflamed, inflamed, and total lesions decline by a median of 42%. After the study, it was shown that dried barberry extract is safe, and well tolerated in patients and effective treatment in teens with moderate to severe acne.
Ashpari Z. The Best Minerals and Vitamins for Acne. Health Line. https://www.healthline.com/health/minerals-vitamins-for-acne. Published July 31, 2020. Accessed January 28, 2021.
Brandt S. The clinical effects of zinc as a topical or oral agent on the clinical response and pathophysiologic mechanisms of acne: a systematic review of the literature. J Drugs Dermatol. 2013;12(5):542-545.
Fouladi RF. Aqueous extract of dried fruit of Berberis vulgaris L. in acne vulgaris, a clinical trial. J Diet Suppl. 2012;9(4):253-261. doi:10.3109/19390211.2012.726702
Kandola A. Vitamins and minerals for acne: Treatment and prevention. Medical News Today. https://www.medicalnewstoday.com/articles/324396#other-natural-remedies. Published February 8, 2019. Accessed January 28, 2021.
Schachner L, Eaglstein W, Kittles C, Mertz P. Topical erythromycin and zinc therapy for acne. J Am Acad Dermatol. 1990;22(2 Pt 1):253-260. doi:10.1016/0190-9622(90)70034-f
Acne is a chronic inflammatory skin condition that consists of four major factors: increased sebum secretion, keratinization, Propionibacterium acnes bacteria colonizing the skin, and inflammation. There are a wide variety of options when it comes to treating acne. Some of the drugs used to treat acne include, but are not limited to, benzoyl peroxide formulations, retinoic acid, antimicrobials and other miscellaneous agents. Antimicrobials are effective in treating patients with acne, but continued widespread use of these drugs results in the emergence of pathogens that are resistant to these antimicrobials. This raises the need for alternative non-antimicrobial agents for the treatment of acne. Nicotinamide gel is one of these alternatives and it provides antiinflammatory activity without the risk of inducing bacterial resistance. In the first study, a double-blind investigation was conducted and the safety and efficacy of topically applied 4% nicotinamide gel was compared to 1% clindamycin gel for the treatment of moderate inflammatory acne. Seventy-six patients were randomly assigned to apply either 4% nicotinamide gel (n = 38) or 1% clindamycin gel (n = 38) twice daily for 8 weeks. Efficacy was evaluated at 4 and 8 weeks using an overall evaluation, amount of acne lesions on the skin, and an acne severity rating. After 8 weeks, both treatments produced comparable beneficial results in the overall evaluation of inflammatory acne; 82% of the patients treated with nicotinamide gel and 68% treated with clindamycin gel showed improvement in symptoms. Both treatments produced statistically similar reductions in acne lesions (papules/pustules; -60%, nicotinamide vs. -43%, clindamycin, P = 0.168), and acne severity (-52% nicotinamide group vs. -38% clindamycin group, P = 0.161). The results from this study show that nicotinamide gel is at least non-inferior to 1% clindamycin gel. This is a promising study because now physicians will hopefully start prescribing more nicotinamide gel in lieu of 1% clindamycin gel which will then decrease antimicrobial resistance.
Shalita AR, Smith JG, Parish LC, Sofman MS, Chalker DK. Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris. Int J Dermatol. 1995;34(6):434-7.
Levin J, Momin SB. How much do we really know about our favorite cosmeceutical ingredients?. J Clin Aesthet Dermatol. 2010;3(2):22-41.
Niacinamide, also known as niacin, nicotinic acid or vitamin B3 is a popular ingredient used in skin regimen. Nicotinic acid and niacinamide can be converted to each other in the body. Nicotinic acid may interact with nicotinic acid receptors on the skin having a drug related mediated effect. This can cause vasodilation and skin flushing whereas niacinamide doesn’t. Niacinamide doesn’t cause a change in blood pressure, body temperature or pulse which is why some patients prefer this. Niacinamide is a precursor of cofactors such as niacinamide adenosine dinucleotide and its phosphate derivative. They are reduction-oxidation coenzymes in at least 40 biochemical reactions so it has multiple effects on the skin. Niacinamide has functions including act as an antioxidant, improve skin barrier function, reduce wrinkles and hyperpigmentation, decrease redness in skin and also improve skin elasticity. Niacinamide can help build cells in the skin and speed up the differentiation of keratinocytes. In a study done with eighteen Japanese women, one side of the face was treated with 5% niacinamide while the other was treated with vehicle. After eight weeks, the result showed that there was significant lightening of the hyperpigmentation the side treated with the niacinamide compared with the other side. Niacinamide also has anti-inflammatory properties and can help with acne. A randomized, controlled trial with 60 patients was done to evaluate the efficacy of 5% nicotinamide gel versus 2% clindamycin gel to treat acne. Overall, the trial showed that nicotinamide gel was at least as effective as clindamycin gel for treatment and that the patients had no side effects with the treatment. The acne severity index mean decreased in both groups and was statistically significant. They had similar reduction and nicotinamide had similar efficacy as clindamycin gel.
Shahmoradi Z, Iraji F, Siadat AH, Ghorbaini A. Comparison of topical 5% nicotinamid gel versus 2% clindamycin gel in the treatment of the mild-moderate acne vulgaris: A double-blinded randomized clinical trial. J Res Med Sci. 2013;18(2):115-117.
Dapsone is another effective treatment for acne vulgaris. Oral dapsone has been used due to its anti-inflammatory and antimicrobial properties, although the mechanism through which dapsone gel treats acne is unclear. Dapsone benefits inflammatory and noninflammatory acne lesions, with more benefit for inflammatory ones. In two phase 3 randomized trials of dapsone 5% gel with a total of 3010 patients, the percent reduction of inflammatory lesions after 12 weeks of treatment was significantly greater in patients treated with topical dapsone than in those treated with placebo, 48% compared to 42%. An open-label long-term study of patients treated with the same regimen for up to 12 months found a reduction in inflammatory lesions of 58%. In addition, dapsone is a sulfone, and is not contraindicated in sulfa allergic patients. One notable side effect is a discoloration of hair or skin tone to yellow to orange with concomitant use of topical benzoyl peroxide. If used together these drugs should be applied at separate times of the day, with washing of the skin it is applied to. Methemoglobinemia is a known complication of systemic dapsone, but is a rare side effect of topical use.
Biotin also known as vitamin H, vitamin B7 or vitamin B8 is normally taken for skin and hair health. Biotin works as a coenzyme that is involved in carboxylation, transcarboxylation, and decarboxylation reactions of gluconeogenesis, lipogenesis, fatty acid synthesis, propionate metabolism, and the catabolism of leucine. Many skin disorders are associated with biotin deficiency and are used for their treatment. Treatment with biotin could also be used in acne associated with high rate of seborrhea, and may be specifically helpful for patients skin when they treat their acne with topical retinoids, The biotin works by controlling of flaking and irritation associated with the topical retinoids. Biotin has an excellent tolerability with no risk hypervitaminosis even in high doses. There is currently no indicated dose to treat acne so patients should consult their dermatologist on how much to take.
Zinc is another mineral that is helpful with acne. Unlike Vitamin A, both the oral supplement and topical supplement are helpful. A recent study compared the effects of zinc to minocycline, a popular oral acne medication. This multi center randomized double-blind trial included 332 patients who either received 30 mg of elemental zinc or 100 mg of minocycline over 3 months. The clinical success rate was 31.2% for zinc and 63.4% for minocycline. Another 12 week double blind study looked at the safety and efficacy of erythromycin plus zinc acetate and showed such as much improvement as patients original medications.
Vitamin A, if given the right way, can be one of the best treatments for acne. University of Michigan clinicians have done research showing that oral supplements do not work the same as topical supplements of this vitamin. Topical forms chemically alter the vitamin into a retinoid, which can be applied to the skin. Some popular retinoid brands include Tazorac (tazarotene) and Adapalene (Differin), which are available to people with a prescription. They act my primarily unblocking pore and preventing blackheads and whiteheads from forming onto the skin. It is important to note that self treating acne with large amount of oral supplements is not recommended since it does not have the same effect as the topical vitamin A. Serious side effects such as liver damage could occur if taken too much and the wrong way. An important note is that retinoids decrease the skin’s natural UV protection, so it is important to make sure to wear sunscreen daily and avoid excessive sunlight.