Effects of fish oil supplementation on inflammatory acne
© Khayef et al.; licensee BioMed Central Ltd. 2012
Received: 1 November 2012
Accepted: 28 November 2012
Published: 3 December 2012
Given that acne is a rare condition in societies with higher consumption of omega-3 (n-3) relative to omega-6 (n-6) fatty acids, supplementation with n-3 may suppress inflammatory cytokine production and thereby reduce acne severity.
13 individuals with inflammatory acne were given three grams of fish oil containing 930 mg of EPA to their unchanged diet and existing acne remedies for 12 weeks. Acne was assessed using an overall severity grading scale, total inflammatory lesion counts, and colorimetry.
There was no significant change in acne grading and inflammatory counts at week 12 compared to baseline. However, there was a broad range of response to the intervention on an individual basis. The results showed that acne severity improved in 8 individuals, worsened in 4, and remained unchanged in 1. Interestingly, among the individuals who showed improvement, 7 were classified as having moderate to severe acne at baseline, while 3 of the 4 whose acne deteriorated were classified as having mild acne.
There is some evidence that fish oil supplementation is associated with an improvement in overall acne severity, especially for individuals with moderate to severe acne. Divergent responses to fish oil in our pilot study indicates that dietary and supplemental lipids are worthy of further investigation in acne.
Acne vulgaris is a common yet complex inflammatory skin disease in Westernized nations and the overall occurrence rate appears to be rising [1, 2]. Inflammatory mediators are predominantly released by activated leukocytes and result in inflammatory acne lesions characterized by pain, redness, and swelling . Given that acne is a rare condition in non-Westernized societies with higher ratios of n-3 to n-6 from dietary intake, it appears that the lower n-3 content of the western diet is an important dietary modulator of these inflammatory mediators [1, 4–6]. A case control study of Koreans found that individuals with acne consumed significantly less fish and more junk food than the control group . A similar study of an Italian population found that consumption of fish was associated with a protective effect against moderate to severe acne . This inverse association between fish consumption and acne severity is expected because fish contains high levels of n-3 fatty acid eicosapentaenoic acid (EPA) that acts as a competitive inhibitor of AA conversion to inflammatory mediators, PGE2 and LTB4, which leads to reduced inflammatory acne lesions . Some of these mediators include n-6 eicosanoids, prostaglandin E2 (PGE2), and leukotrine B4 (LTB4) that are derived from arachidonic acid (AA), an n-6 polyunsaturated fatty acid. Cytokines such as interleukin 1B (IL-1B) and tumor necrosis factor α (TNF-α) are also important inflammatory mediators . It has also been shown that n-3 fatty acid supplementation suppresses the production of TNF-α and IL-Iβ in healthy individuals [3, 10–12]. Despite the fact that the anti-inflammatory properties of EPA have been well-established in the literature, very few human studies have examined the clinical effects of this n-3 fatty acid on reducing inflammation in acne patients. A recent retrospective study examined the effect of a poly-nutrient supplementation containing EPA and antioxidants on 5 patients with mild to moderate acne who had consistently used the supplement for 2 months. Inflammatory acne lesion count was significantly reduced in all patients . Given that the various studies that supplementation with antioxidants may help reduce severity of acne, it would be interesting to investigate whether fish oil can exert the same effects [14–17]. The objective of this study was to detect the isolated effects of EPA in the form of fish oil on severity of inflammatory acne in young healthy males.
Changes in acne grade severity after 12 weeks of fish-oil supplementation
Acne Grade n (%)
A total of 16 healthy men were enrolled in this study and 13 completed the protocol. Two participants withdrew from the study and 1 participant was excluded from the data analysis due to self-reported compliance of less than 70%. The participants were young and had a BMI consistent with being normal in weight . Seven participants (54%) identified their ethnicity as Hispanic/Latino, 3 as Caucasian (23%), and 3 (23%) as Asian.
The research protocol was approved by the Human Subjects Committee of the Institutional Review Board at California State Polytechnic University, Pomona, protocol # 10-190.
In addition, it should be noted that in counting the inflammatory lesions, we did not differentiate between the types of inflammatory lesions for our data analysis. In other words, we did not distinguish between papules, pustules, and cysts in the lesion count, but rather categorized them all as inflammatory lesions. This may be why we did not achieve high correlation between a* and actual inflammatory lesion counts, 0.42, 0.62, and 0.44 at baseline, week 6, and week 12, respectively. Thus, given the fact that acne is a dynamic disease, any improvement in the type of inflammatory lesion might have not been accounted for in our study. For the same reasons, more accurate and reliable results could be obtained if a larger measuring head were used to obtain the redness and lightness measurements.
Although non-significant, there was a visible decrease in mean Δa* at week 6 (Figure 1) which suggest that fish oil supplementation for 6 weeks is sufficient to reduce inflammation, because a* is well-understood to be correlated with erythema (increased blood flow to the skin) [20, 21]. The non-significant linear increase in ΔL* from baseline to week 12 is also consistent with existing studies that found an inverse relationship between a* and L* in inflammatory skin diseases [22, 23]. However, there should be more investigation into whether L* correlates with subjective assessment of different stages of an acne lesion.
Although we cannot draw any firm conclusions from our study with a small sample size and no placebo group, there is some promising evidence that fish oil supplementation is associated with an improvement in ratings of overall acne severity, especially for individuals with moderate and severe acne. It is possible that increasing the dose of EPA from 930 mg to 3–6 grams daily, as recommended for arthritis patients, would reveal more significant results . In addition, effects of n-3 fatty acids should be examined in cohorts of subjects with the same acne severity grades or lesion counts in order to isolate the potential effect on different types of acne severity.
GK and BBW are registered dietitians in the state of California.
Cyvex Nutrition, Inc. donated the fish oil capsules. Dr. Azin Meshkinpour, MD and Dr. Robert A. Harper, Ph.D. conducted the clinical acne evaluation.
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