Abstract
Acne vulgaris affects most people at some point in their lives. Due to unclear etiology, likely with multiple factors, targeted and low-risk treatments have yet to be developed. In this review, we explore the multiple causes of acne and how plant-based foods and supplements can control these. The proposed causative factors include insulin resistance, sex hormone imbalances, inflammation and microbial dysbiosis. There is an emerging body of work on the human gut microbiome and how it mediates feedback between the foods we eat and our bodies. The gut microbiome is also an important mediator of inflammation in the gut and systemically. A low-glycemic load diet, one rich in plant fibers and low in processed foods, has been linked to an improvement in acne, possibly through gut changes or attenuation of insulin levels. Though there is much interest in the human microbiome, there is much more unknown, especially along the gut-skin axis. Collectively, the evidence suggests that approaches such as plant-based foods and supplements may be a viable alternative to the current first line standard of care for moderate acne, which typically includes antibiotics. Though patient compliance with major dietary changes is likely much lower than with medications, it is a treatment avenue that warrants further study and development.
Highlights
Acne affects between 40 and 50 million individuals in the United States [1], including mainly adolescents and adults
These results suggest that gut microbes may enhance the presence of circulating endotoxins in the blood of acne vulgaris patients compared to healthy controls
These studies suggest that the gut microbiome may play an important role in acne pathogenesis and that we can modulate it for clinical improvements, but further investigation into the mechanisms and effects of oral probiotics in acne vulgaris is needed
Summary
Acne affects between 40 and 50 million individuals in the United States [1], including mainly adolescents and adults. Regardless of the ongoing debate regarding P. acnes, antibiotics used in the treatment of acne appear to have anti-inflammatory effects independent of their antimicrobial effects [7,8,9]. Chronic antibiotics may have long-term side effects and detrimental effects on the host microbiome, including selection for multidrug resistant bacteria on the skin and in the gut [10]. Epigallocatechin-3-gallate (EGCG), the major polyphenol in green tea, has potent anticarcinogenic, anti-inflammatory and antimicrobial activities; EGCG can modulate several key pathological factors of acne, including hyperseborrhea, lipogenesis, inflammation and P. acnes overgrowth. Decreased acne lesions in postpubescent females with a trending decrease in fasting blood sugar Both produced a progressive reduction in the lesions; with tetracycline, the percentage reduction in the inflammatory lesions was 65.2% as compared to 68% with gugulipid (p > 0.05). Used in traditional Chinese medicine for menopausal symptoms, but their role as estrogen analogues makes them promising for attenuation of acne
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