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Zinc for Acne

4/9/2019 11:57:39 AM
zincAcne involves a variety of pathophysiologic processes, including stimulation of sebaceous glands by androgens, hyperkeratinization, obstruction of sebaceous follicles, proliferation of Propionibacterium acnes, recruitment of inflammatory cells, and metabolism of triglycerides into fatty acids in the sebum. Treatments include topical formulations (e.g., antibiotics, retinoids, and comedolytics) and systemic treatments (e.g., oral isotretinoin, oral antibiotics, spironolactone, and oral contraceptives). In addition, zinc is recognized for its therapeutic potential in treating acne vulgaris.

Zinc reviewed for acne treatment potential

A 2017 review evaluated 32 studies of topical or oral zinc for the treatment of acne. Zinc was evaluated as a single agent in 12 studies, in combination products in 6 studies, and compared with other treatments in 14 studies. Study durations ranged from 7 days to one year.
Eight of the 12 single-agent studies concluded that zinc was effective at treating acne. Oral zinc gluconate (60 mg to 200 mg per day) and oral zinc sulfate (400 mg to 600 mg per day) were the most common single-agent products. Single-agent products tended to be less tolerable than combination products, producing nausea as the most common side effect.

Zinc formulas found effective for acne treatment

All 6 of the combination-product studies concluded that zinc was effective in treating acne. These products included zinc with topical erythromycin, zinc pyrrolidone plus L. digitata-derived oligosaccharide (topical cream), NicAzel® oral supplement (nicotinamide 600mg, azelaic acid 5mg, Zn oxide 10mg, pyridoxine 5mg, copper 1.5mg, folic acid 500mcg), and APC complexTM oral supplement (methionine-bound zinc complex providing 15mg zinc, ascorbic acid 60mg, Dunaliella salina extract, D-alpha tocopheryl acetate 11.53mg, chromium picolinate 1.04mg).
The studies that compared zinc to other agents produced mixed results. Ten studies compared zinc to antibiotics. Zinc was equally or less effective than tetracycline, equally or more effective than erythromycin and clindamycin, and less effective than oral minocycline. Oral zinc was found to be superior to oral vitamin A, but topical zinc sulfate was inferior to tea lotion.  

Physiology supporting zinc's role in acne treatment

Multiple mechanisms have been proposed to explain zinc’s therapeutic role in acne. Zinc is a cofactor for 300 metalloenzymes and 2000 transcription factors, regulating protein, lipid, and nucleic acid metabolism. Zinc regulates gene transcription and assists in cell replication, wound repair, and immune activity. Zinc stimulates natural killer cell and complement activity and inhibits inflammation by regulating the production of tumor necrosis factor and interleukin-6. Zinc has been shown to inhibit proliferation of P. acnes and inhibit 5-alpha reductase, blocking the conversion of testosterone to DHT.
Not all studies demonstrate a beneficial effect of zinc for the treatment of acne, and zinc appears to be less effective than antibiotic treatments. Particularly in combination products, however, zinc may offer a safe and affordable option for the treatment of acne vulgaris.     
Cervantes J, Eber AE, Perper M, Nascimento VM, Nouri K, Keri JE. The role of zinc in the treatment of acne: A review of the literature. Dermatol Ther. 2018; 31.

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