Vitamin D for Acne: Research, Benefits and How to Use?

Introduction Popularly known as ‘the sunshine vitamin’, Vitamin D is an essential nutrient for the vitality and well-being of our body. Vitamin D plays a crucial role in our bodily functions including teeth and bone health, muscle activities, inflammation control, and immune responses. As more is known of its extensive effects on the body, vitamin D is increasingly regarded as a hormone or prohormone, and not just an ordinary vitamin (1). There is a growing interest in the use of vitamin D and its analogs as supplements or therapeutic agents for health conditions (2). The sunshine vitamin has been particularly considered in the treatment of many skin diseases like acne and atopic dermatitis. In this article, we summarize for you the current evidence, benefits, and the proper way of using vitamin D in the treatment of acne. Understanding Acne better Acne vulgaris, or acne for short, is a chronic inflammatory condition of the skin or skin pores. It manifests as unpleasant reddish inflamed bumps on the face, neck, and back, leading to scarring and hyperpigmentation (3). Understanding the nature of acne vulgaris is crucial for effective treatment and management. Acne affects about 85% of adolescents and young adults worldwide (4), although it may also affect older adults. Acne can be a source of cosmetic and psychological concern for patients, as many seek multiple information sources and therapeutic alternatives for their care. Acne may result from a number of factors. Current evidence identifies four main mechanisms by which acne lesions occur (3). These include: Recognizing these mechanisms can help in targeting treatments more effectively. Excessive secretion and clogging of hair follicles (skin pores) by sebum. Excessive sebum production can lead to clogged pores, which is a primary factor in acne development. Overproduction and deposition of keratin by keratinocytes thereby blocking and inflaming the hair follicle. The accumulation of keratin not only blocks follicles but can also exacerbate inflammation, contributing to acne severity. Infection of the hair follicle by the bacterium, Propionibacterium acne or Staphylococcus aureus, thereby triggering inflammation. Infections by bacteria like Propionibacterium acne can significantly worsen acne symptoms through inflammation. Inflammation and immune system flares. Any of these events can be triggered by either one or a combination of genetic, diet, and environmental factors (5). Accordingly, treatment approaches and medications for acne aim at altering this chain of events in the patient’s skin, especially the inflammatory processes (5). Can a lack of Vitamin D cause Acne? – what current science says. Vitamin D is a fat-soluble vitamin that is produced in the skin from cholesterol when it is exposed to UVB sun rays (6). It may be found in the body as cholecalciferol, 25-hydroxyvitamin D (25(OH)D) or calcifediol, and/or in its activated form, calcitriol, where it modulates calcium balance as well as inflammatory and immune responses among other functions. Vitamin D has been linked with a significant number of inflammatory skin conditions like psoriasis, acne, atopic dermatitis, vitiligo, and alopecia (7). In particular, the pathogenesis of acne is strongly connected with Vitamin D. Research indicates that Vitamin D's role in skin health is crucial, particularly in managing \1 like acne. For one, there is a large body of evidence that vitamin D insufficiency or deficiency is prevalent among people with acne (8). Some studies have shown that the severity of acne inflammation may even be correlated to the degree of vitamin D insufficiency in the patients (8). In a 2021 meta-analysis of studies comparing a total of 918 acne patients against 814 controls, the scientists found that the level of 25-hydroxyvitamin D [25(OH)D] in the serum of acne patients is significantly lower relative to that of the healthy controls (9). The vitamin D deficiency-acne hypothesis is also being proven progressively in clinical trials using vitamin D supplementation in acne treatment. Clinical trials are showing promising results regarding the \1 in treating acne, supporting the hypothesis of its deficiency contributing to the condition. In a 2016 randomized controlled trial (10), the serum 25(OH)D levels were significantly lower in the acne patient group compared to the placebo group. Following an 8-week supplementation with vitamin D (1000 IU/day), the investigators noted a 34.6% decrease in new lesions breakouts in the patient group compared to the placebo group. Serum analysis also revealed an improved level of serum 25(OH)D in the treatment group. Similarly, in a 2020 study, patients in the treatment group who received an active Vitamin D analog, alfacalcidol (0.25ug daily), showed increased serum levels of 25(OH)D, decreased inflammatory cytokine levels, and overall better clinical outcomes compared to their baseline. The control group did not show significant changes in baseline parameters. This was thought to be because they had no prior vitamin D deficiency, and hence, it was believed that vitamin D supplementation would improve acne only in patients that are deficient in the vitamin. (11) Nevertheless, more large-scale controlled trials are required to substantiate these findings and further establish the benefits of vitamin D in acne treatment. While initial findings are encouraging, \1 to confirm the full impact of Vitamin D on acne treatment and its long-term benefits. Benefits of Vitamin D in the Treatment of Acne If you are considering adding vitamin D to your skincare shelf for anti-acne, you may want to know more about some of its properties that are responsible for its anti-acne effect. Here are some of them: Understanding the specific \1 can help you make informed decisions about its use in your skincare routine for acne management. 1. Antiinflammatory action The immunomodulatory effect of Vitamin D may help stem the tide of inflammatory mediators in the skin and acne lesions. This \1 is vital in reducing redness and swelling associated with acne lesions, potentially leading to clearer skin. In past studies, researchers have established that sebum-producing cells in the skin (sebocytes) express vitamin D receptors (VDRs) through which vitamin D may modulate sebum production and overall sebocyte functions (12). Studies have also suggested that the activation of the VDRs may play a role in offsetting the inflammatory and immune responses triggered by P. acne in infected sebaceous follicles (7, 12). Related reading The 5 Best Vitamins For Your Skin: How to Supplement, and How Often? IPL for Acne: Does IPL Get Rid of Pimples? Top 7 Foods That Cause Acne & Why (+ What to Eat Instead) 2. Antibacterial properties Vitamin D has also been found to exhibit strong systemic antimicrobial activity against some common pathogens involved in acne like P. acne and S. aureus (13). This clears the sebaceous glands of their infections and prevents the inflammation of the hair follicle and acne occurrence. 3. Anti-comedogenic effect Vitamin D has shown a significant impact in modulating the growth and functions of keratinocytes in hair follicles. By this, it inhibits the excessive deposition of keratin that may lead to the clogging of skin pores and comedo (blackheads) formation (7). 4. Antioxidant effect Oxidative damage to skin structures following acne inflammation causes scar formation and hyperpigmentation in the affected parts. Free radicals may also be generated by stress, infections, or poor diet signals in the body. Oxidative damage can significantly affect the appearance and health of your skin, leading to conditions like scarring and discoloration. Vitamin D has been shown to possess significant antioxidant activity. In a 2019 meta-analysis, vitamin D supplementation was shown to improve the total systemic antioxidant capacity. The levels of intrinsic antioxidant molecules like glutathione and nitric oxide were significantly increased while the levels of oxidative stress markers, like malondialdehyde, were significantly reduced (14). How to Use Vitamin D in Acne Care Here are the best ways to get the full benefits from vitamin D in treating acne and improving your skin health. To maximize the benefits of vitamin D, it's essential to incorporate it into your daily routine effectively. 1. Consume vitamin D-rich foods Even though this vitamin can be synthesized in our skin when exposed to sunlight, foods rich in vitamin D remain the best bet to getting the recommended daily amount of this nutrient to avoid deficiency. The growing sedentary lifestyle, being of darker skin tone, and living in Northern latitude areas with insufficient sunlight in the winter are good reasons to ensure adequate dietary intake of vitamin D. According to the NIH, the Recommended Dietary Allowance (RDA) of vitamin D for adults 19 years and older is 600 IU (15 mcg) daily, and for elderly people >70 years, it is 800 IU (20 mcg) daily (15). Meeting the Recommended Dietary Allowance of vitamin D is crucial for maintaining overall health and supporting skin function. Food sources offer two forms of vitamin D — Vitamin D2 (ergocalciferol found in plant sources) and Vitamin D3 (cholecalciferol, found in animals). Natural rich food sources of vitamin D include (15): Understanding the two forms of vitamin D is important, as they come from different sources and can impact your health differently. Fatty fishes e.g. Herring, Salmon, Tuna Fish, Sardines Fatty fish are an excellent source of vitamin D, providing essential nutrients that may help improve your skin's appearance. Eggs Meat Liver Mushroom Soy milk Oat Ready-to-eat cereals and other vitamin-D-fortified foods Note: Milk and Cheese are also rich sources of vitamin D. However, eat them with caution as some research suggests that dairy products may likely worsen acne as they might increase sebum production. While milk and cheese are good sources of vitamin D, it is important to consider that they may also have effects on skin health. Some studies suggest that dairy could potentially increase sebum production, which might exacerbate acne. 2. Get a healthy amount of sunshine Are you aware that if you get sunlight only in a sunny office or while driving, you are still unlikely to get vitamin D synthesized in your skin? Regular exposure to sunlight is essential for adequate vitamin D synthesis, which may not occur with limited sunlight exposure. This is because window glasses completely block out UVB radiation needed to produce vitamin D in our skin. Understanding UVB radiation is crucial, as it is the specific type of sunlight required for vitamin D production in the skin. This means that sometimes, you have got to go out wearing partly-covering clothes to get adequate sunshine. Getting adequate sunshine will not treat your acne directly, but it will improve your vitamin D levels and the outcomes of treatment. However, on other days, put on sunscreen with adequate SPF when going outdoors to prevent sunburn and other skin damage. Related reading Raw Milk on Face: Uses, Benefits, And Side Effects How Your Diet and Gym Habits Are Causing Acne? 3. Take Vitamin D supplements The larger majority of people worldwide consume less than the recommended daily intake of vitamin D (16). Taking vitamin D supplements may go a long way in correcting this deficiency. Supplementation can be crucial for those who may not get enough vitamin D from sunlight or diet alone. Commercially available vitamin D supplements feature ergocalciferol or cholecalciferol in capsule forms for oral use. Some experts suggest that cholecalciferol may be superior to ergocalciferol in raising the 25(OH) D levels. Ergocalciferol is sometimes preferred by people following vegan diets. But any of the two will get the job done. 4. Topical vitamin D Some evidence indicates that vitamin D can be safely and effectively delivered through the skin (17). It is hypothesized that its anti-inflammatory and antimicrobial activities will be beneficial in the topical treatment of acne. Topical applications of vitamin D may serve as a complementary approach to traditional acne treatments. Precautions The upper limit recommended for vitamin D supplementation is 4000 IU (100 mcg) daily (16). Although toxicity from vitamin D is rare, taking more than the RDA for a long time can result in hypercalcemia which can be life-threatening. Monitoring vitamin D intake is important to avoid potential health risks associated with excessive supplementation. Bottom Line Evidence suggests that vitamin D deficiency may be connected with acne development and severity. Obtaining vitamin D through a proper diet, adequate sunshine, supplements, and topical agents may be beneficial in the treatment of acne. Addressing vitamin D deficiency could be a key factor in managing acne, highlighting the importance of a holistic approach to skin health. Frequently asked questions Is vitamin D good for acne? Vitamin D is often discussed in relation to skin health, particularly for conditions like acne, which can affect many individuals. There is good evidence that a lack of vitamin D may cause or worsen acne. Taking VitD supplementation in such cases may be beneficial for acne treatment. Adequate levels of vitamin D are crucial because they may help regulate skin function and inflammation, which are key factors in acne development. Can taking vitamin D clear my skin? While vitamin D can support skin health, it is important to remember that results can vary based on individual health conditions and skincare routines. Yes, in cases of vitamin D deficiency. However, it may be better to opt for products containing vitamins A, D, E, and Zinc, all of which are good for the skin. Incorporating multiple vitamins and minerals, including vitamins A, D, E, and Zinc, may enhance overall skin health and potentially improve acne more effectively. How Long Does It Take for Vitamin D to Work? The time it takes for vitamin D to show effects can vary, but consistent supplementation is generally recommended for noticeable improvements. This may depend on your initial levels of vitamin D. However, with 1-2 months of consistent vitamin D supplementation, you should notice the remission of symptoms of vitamin D deficiency. Monitoring your vitamin D levels is important, as individuals with lower initial levels may experience more significant results from supplementation. References Ellison DL, Moran HR. Vitamin D: Vitamin or Hormone? Nurs Clin North Am. 2021;56(1):47-57. https://doi.org/10.1016/j.cnur.2020.10.004 Alaraj M, Alenazi FS, Hassan D, Hossain A. Vitamin D as a drug: new therapeutic approaches. Pharmacia. 2022. 69(3): 765-770. https://doi.org/10.3897/pharmacia.69.e85057 Bhat YJ, Latief I, Hassan I. Update on etiopathogenesis and treatment of Acne. Indian J Dermatol Venereol Leprol 2017;83:298-306. https://doi.org/10.4103/0378-6323.199581 Ruba M. Jaber, Basma M. Alnshash, Suzan N. Mousa, et al. Epidemiology of Acne Vulgaris among Adolescents and Young Adults in Jordan University Hospital. Open J of Nursing, 2020: Vol.10 No.4. https://doi.org/10.4236/ojn.2020.104024 Cong TX, Hao D Wen X, et al. From pathogenesis of acne vulgaris to antiacne agents. Clin Aesthet Dermatol. 2013;6(9):2735. https://doi.org/10.1007/s00403-019-01908-x Harvard School of Public Health. Vitamin D. The Nutrition Source. [online]. Available: https://www.hsph.harvard.edu/nutritionsource/vitamin-d/ . Accessed: 11 Mar 23 This source from the Harvard School of Public Health provides essential information about Vitamin D, including its dietary recommendations and health benefits. Yildizgören MT, Togral AK. Preliminary evidence for vitamin D deficiency in nodulocystic acne. Dermatoendocrinol. 2015;6(1):e983687. https://doi.org/10.4161%2Fderm.29799 Alhetheli, G., Elneam, A. I. A., Alsenaid, A., & Al-Dhubaibi, M. (2020). Vitamin D Levels in Patients with and without Acne and Its Relation to Acne Severity: A Case-Control Study. Clinical, cosmetic and investigational dermatology, 13, 759–765. https://doi.org/10.2147/CCID.S271500 . Wang M, Zhou Y, Yan Y. Vitamin D status and efficacy of vitamin D supplementation in acne patients: A systematic review and meta-analysis. J Cosmet Dermatol. 2021;20(12):3802-3807. https://doi.org/10.1111/jocd.14057 This systematic review and meta-analysis highlights the relationship between Vitamin D status and the effectiveness of supplementation in treating acne. Lim SK, Ha JM, Lee YH, et al. Comparison of vitamin D levels in patients with and without acne: a case-control study combined with a randomized controlled trial. PLoS One. 2016;11(8):e0161162. https://doi.org/10.1371/journal.pone.0161162 Ahmed Mohamed A, Salah Ahmed EM, Abde-Aziz RTA, et al. The impact of active vitamin D administration on the clinical outcomes of acne vulgaris. J Dermatolog Treat. 2020;1-6. https://pubmed.ncbi.nlm.nih.gov/31868550/ Reichrath J, Zouboulis CC, Vogt T, Holick MF. Targeting the vitamin D endocrine system (VDES) for the management of inflammatory and malignant skin diseases: An historical view and outlook. Rev Endocr Metab Disord. 2016;17(3):405-417. https://doi.org/10.1007/s11154-016-9353-4 Youssef DA, Miller CW, El-Abbassi AM, et al. Antimicrobial implications of vitamin D. Dermatoendocrinol. 2011;3(4):220-229. doi:10.4161/derm.3.4.15027. https://doi.org/10.4161/derm.3.4.15027 Mahdi Sepidarkish, Farnaz Farsi, Maryam Akbari-Fakhrabadi, et al. The effect of vitamin D supplementation on oxidative stress parameters: A systematic review and meta-analysis of clinical trials. Pharmacological Research. 2019: 139; 141-145. https://doi.org/10.1016/j.phrs.2018.11.011 NIH ODS. Vitamin D. Factsheet for Professionals. Available. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ IOM (Institute of Medicine). Dietary Reference Intakes for Calcium and Vitamin D. Washington DC: The National Academies Press; 2011 https://nap.nationalacademies.org/catalog/13050/dietary-reference-intakes-for-calcium-and-vitamin-d Sadat-Ali M, Bubshait DA, Al-Turki HA, Al-Dakheel DA, Al-Olayani WS. Topical delivery of vitamin d3: a randomized controlled pilot study. Int J Biomed Sci. 2014;10(1):21-24. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3976443/ This study explores the \1 of vitamin D3, suggesting it may have \1 for skin health in acne treatment. Ulike Welcome to Ulike! We hope our expertise can bring value to you.