| Probiotics |
5 |
In vitro studies demonstrate probiotics inhibit the growth of C. acnes, inhibit skin inflammation, and accelerate skin barrier recovery. Clinical trials of probiotic supplementation demonstrate improvement in inflammatory lesion count12,13 Antibiotic treatment with adjuvant probiotic supplementation may offer synergistic anti-inflammatory effects and reduce potential gastrointestinal side effects14 Probiotic supplementation has also demonstrated significant reduction in IGF-1,15 and increased levels of anti-inflammatory marker IL-1016
|
None |
| Diindolylmethane (DIM) |
8 |
To date, there are no clinical studies that have evaluated DIM supplementation for the treatment of acne. A laboratory study demonstrated DIM inhibits the expressions of several biofilm-related genes in Cutibacterium acnes20 A case report demonstrated an improvement in menstrual cyclicity and hyperandrogenism following combination DIM and chasteberry supplementation, with acupuncture21
|
DIM supplementation has been associated with Drug rash with eosinophilia and systemic symptoms (DRESS),22 bilateral central serous chorioretinopathy,23 basilar artery stroke,24 deep vein thrombi and pulmonary embolism,25 and ischemic stroke.26 DIM is an inducer of the CYP3A4 enzyme and MDR1 gene, causing serious potential drug interactions.27
|
| Zinc |
19 |
Several clinical trials evaluating the effect of zinc supplementation on acne vulgaris demonstrate improvement in lesion count and acne severity31–36 Few clinical trials have found no significant differences in acne between placebo and zinc supplementation37–39 Zinc supplementation has also been evaluated in the setting of combination therapy, demonstrating significant improvement in acne40–42 Few studies compare oral zinc supplementation with oral tetracycline use for the treatment of acne; Two studies demonstrate antibiotic treatment is superior to oral zinc,43,45 while one study did not demonstrate a difference44
|
Gastrointestinal side effects are the most reported side effects associated with oral zinc supplementation.46,47 Rare side effects include pruritus48 and urticaria.49
|
| Vitamin A |
9 |
Reduces proliferation of sebaceous glands and anti-keratinization properties51,52 Supplements contain provitamin A carotenoids (beta-carotene) or preformed vitamin A (retinol, retinal, retinoic acid, and retinyl esters) Doses of 100,000 IU q daily for mean duration range of 7 weeks to 4 months showed successful acne clearance in 4 trials54 Isotretinoin (13-cis-retinoic acid) is a derivative of Vitamin A with slightly altered chemical structure
|
Side effects similar to isotretinoin: cheilitis, xerosis, triglyceridemia, transaminitis, teratogenicity54,55
Not all supplements explicitly state risk of teratogenicity. Doses greater than 10,000 IU have been found to be dangerous during first trimester58
May consider checking relevant labs in patients on supplements54
|
Vitamin B
Vitamin B3, Nicotinamide |
2 |
Water-soluble vitamin important for metabolism, DNA replication and repair, and potent anti-inflammatory59 Topical application of nicotinamide may improve acne due to anti-inflammatory action and reduction of sebum production60 Subjective improvement in acne noted by investigators and participants when combined with other supplements such as zinc, copper, folic acid61, Niren and Took
|
Only studied as combined treatment, effect of Nicotinamide alone unclear |
| Vitamin B7, Biotin |
2 |
Water-soluble vitamin, an essential cofactor for carboxylase enzymes involved in metabolic pathways62 Combination biotin and lactic ferment supplement improved Global Acne Grading (GAGs) scores at 60 day follow up64 An oral combination treatment with biotin, probiotics, Vitamin E, zinc, and nicotinamide with gender specific formulations had more improvement in GAGs at 12 weeks compared to topical treatment alone65 Water-soluble vitamin important in hematologic and nervous systems Excessive intake (>950pg/mL can cause acne and rosacea67 Both IM and PO Vitamin B 12 supplementation were associated with acneiform eruptions, that improved with discontinuation of VitB1268
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Effect of Biotin alone on acne unclear |
