Omega-3 fatty acids (o-3 FA), such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are essential fatty acids with anti-inflammatory effects. A recent study published in The Journal of Cosmetic Dermatology examines the efficacy of ω-3 FAs in acne.
Study: Investigating the Potential of Omega-3 Fatty Acids in Patients with Acne: A Prospective Intervention Study. Image credit: BLACKDAY / Shutterstock.com
How does diet affect acne?
Highly processed foods rich in refined sugars, dairy products and saturated fats can cause overproduction of sebum and excessive build-up of keratin in hair follicles in the dermis. The resulting inflammation and bacterial colonization of the follicles can cause or worsen acne.
Dietary interventions to modulate the incidence and severity of acne have not been fully explored. However, the anti-inflammatory activity of ω-3 FAs makes them promising dietary components to study their anti-acne therapeutic potential.
Alpha-linolenic acid (ALA) is an essential fatty acid that cannot be produced endogenously in humans despite its importance in food digestion. EPA and DHA are synthesized in small amounts from ALA. Therefore, ALA, EPA and DHA must be consumed in adequate amounts to maintain healthy levels.
Modern Western diets often promote inflammation, containing up to 20 times more pro-inflammatory ω-6 FA than anti-inflammatory ω-3 FA. Restoring this balance is essential to reducing inflammation.
As a result, many enzymes are affected by ω-3 FA and are involved in different pathways affecting acne. With ω-3 FA supplementation, reduced sebum synthesis, inflammatory cytokine levels, and follicular acne-causing bacteria Corynebacterium acnesas well as improved skin integrity and increased antioxidant function, can be achieved.
About the study
The current study was motivated by the need to provide more direct evidence that ω-3 FA can moderate acne. To this end, 60 patients with an average age of 26 years who were not taking any prescription acne medication were included in the study.
Thirty-seven study participants had acne papulopapular (AP), while 23 had acne vulgaris (AC). About 64% of the study cohort were dissatisfied with their improvement after previous treatment or its side effects.
All study participants were advised to consume a Mediterranean diet, including ω-3 FA supplementation from algae. Each patient received oral supplements containing 600 mg DHA/300 mg EPA for the first eight weeks of the intervention, followed by 800 mg DHA/400 mg EPA for the next eight weeks.
Study participants attended four visits to monitor blood levels of EPA, DHA and ALA, as well as to calculate the HS-omega-3 index. The HS omega-3 index reflects the percentage of EPA/DHA within red blood cells (RBCs).
The target indicator value was between eight and 11%, with values below 8% and 4% indicative of a deficit and a severe deficit, respectively. These values were compared with responses to standardized questionnaires and clinical findings.
What did the study show?
At baseline, over 98% of patients were EPA/DHA deficient, 40 and 18 of whom were severely deficient and deficient, respectively.
At the initial visit (V1), the mean HS-omega 3 index was 5%. By the fourth visit (V4), it had improved significantly to 8%. However, one in 18 participants remained in severe deficit and deficit, respectively.
Both inflammatory and non-inflammatory lesions decreased throughout the study period. By the end of the study, 42 patients had AC and 11 had AP, compared with 23 and 37 in V1, respectively.
At baseline, 32 patients had intermediate severe acne and 29 had mild acne. By V4, 45 had mild acne and eight had intermediate severity, with two patients showing no non-inflammatory lesions in V4. In addition, 42 subjects reported fewer than ten non-inflammatory lesions compared with eight patients at baseline.
One patient reported 26-50 lesions from V4 compared to 20 patients at baseline. Between V1 and V4, 27 and eight patients reported 10–25 lesions in V1, respectively.
Complete clearance of inflammatory acne was seen in 13 patients at V4, while 33 had fewer than ten lesions compared with 23 at V1. A significant reduction was observed from 28 subjects in V1 reporting 10–20 lesions to seven subjects in V4. No patient had more than 20 lesions by the end of the study compared with nine at baseline.
While nearly 80% of the study cohort reported improved acne, 8% of patients felt it had worsened. Overall, patients reported better quality of life despite acne persistence, with these improvements particularly evident in the AP group, which showed the most significant change in HS-omega 3 index values.
Perceived food triggers had a greater impact on acne onset and flare-ups than foods such as nuts, fruits, vegetables and whole grains that were considered healthy. Certain foods such as milk, French fries and crisps were consumed more frequently in the AP group than those with AC. During the study period, most patients reduced their consumption of dairy products.
conclusions
Although the current prospective study did not use a control group, most acne patients were deficient in ω-3 FA. These findings are similar to previous reports in which HS-omega 3 index values were below 5.5% and 8% in German and European studies, respectively.
These deficits can be corrected by eating a Mediterranean diet combined with ω-3 FAs derived from algae. By restoring the ω-3 FA deficit through supplementation and dietary intervention, most patients in the current study experienced significant improvement in their acne severity. The improvement in safety, acceptability, and quality of life with this treatment approach supports its potential role as an intervention alone or in combination with prescription medications.
