Vitamin D and Acne: Dermatologist’s Complete Guide

Vitamin D and acne, is there a link? In this series of Dermatology Lectures, Singapore dermatologist Dr. Teo Wan Lin goes through the scientific literature to help you understand skin science plainly. Follow her on her Instagram @drteowanlin and on Tik Tok where she regularly gives masterclasses on skin and hair health. 

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Point Summary:

The following is a discussion on the effects between vitamin D and acne. This is an emerging topic, what dermatologists know is still fairly limited. However, it is helpful to go through existing studies which offer some information on the subject.

Vitamin D and Acne: Korean authors published a study in the Annals of Dermatology 2016. They found that Vitamin D reduced oil production. Vitamin D also reduced acne inflammation. 

In the study [1], scientists determined the effects of vitamin D on the sebocytes which produce oil. Acne patients have increased oil production. Propionebacterium acnes, the bacteria in acne, stimulates sebum production. 

The study found Vitamin D blocked both inflammation and oil production. Specific markers known as interleukins as well. P. Acnes stimulates inflammatory acne. So the study concluded Vitamin D can block this inflammation and help acne. 

How does vitamin D affect sebum production? There are many other studies which link vitamin D and acne.  

Other studies also report Vitamin D’s ability to block the growth of sebocytes, responsible for oil gland activity in acne patients. Vitamin D decreases the production of inflammatory markers from these oil gland producing cells. This reduces inflammatory acne.  Many previous studies corroborate that vitamin D reduced activity of oil glands. The mechanism by which this occurs is confirmed by this study.  When sebocytes are incubated with vitamin D, vitamin D actually inhibits inflammation. This is important because inflammation is the main pathway in acne, which is mostly genetically determined. Vitamin D deficiency however looks like it affects the development of acne. On the basis of these findings, the authors recommend the use of vitamin D for inflammatory acne.

Why should we study the association of Vitamin D and acne? What do we know so far?

In vitro studies [2], conducted in the laboratory setting with cells, demonstrate vitamin D’s role in acne development. Vitamin D receptors are present in human oil glands known as sebocytes. Dermatologists also discovered that vitamin D affects oil and inflammation processes in skin.

However, our knowledge is not well established in terms of clinical studies. So this was considered the landmark paper that helped to correlate these two factors. 

Background about Vitamin D. What is Vitamin D and how does Vitamin D and acne link together? 

Vitamin D is an essential micronutrient for our immune system. It helps the immune function of  skin too. Vitamin D deficiency is implicated in skin diseases such as eczema (atopic dermatitis) as well as psoriasis. Acne is one of the commonest skin problems worldwide seen by dermatologists. 

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Micronutrients are essential to healthy organ functioning.

Acne is considered an inflammatory disease. So far, there are some associations of the levels of vitamin D and acne. Korean and American dermatologists published a study [2], a randomized control trial in 2016. They found that vitamin D deficiency was detected in up to 48.8% of patients with acne but only 22.5% of the healthy control group. 

A randomized control trial is considered the gold standard of study design. This is part of how we evaluate scientific hypothesis. 

Vitamin D and Acne: Does vitamin D reduce sebum production? Can vitamin D deficiency cause acne? Vitamin D deficiency associated with acne severity

Severity of acne is associated with vitamin D deficiency. This means, the higher the levels of vitamin D in the blood serum, the less severe the acne was. The 2016 study authors concluded that vitamin D deficiency was more frequent in patients who have acne. Also, serum vitamin D levels were inversely correlated with how severe the acne is. Particularly, in patients with more severe inflammatory cystic lesions. 

The background to this study is essentially the hypothesis that links vitamin D to our immune system. Dermatologists already know vitamin D mediates skin diseases such as eczema, psoriasis, autoimmune diseases, alopecia and vitiligo. 

More recently in 2021, authors Ming Wang published a systematic review [3] in the Journal of Cosmetic Dermatology.

Also known as a meta analysis, it is a complete study of the available scientific literature on how vitamin D status and vitamin D supplementation affects acne patients. The results showed that overall, in acne patients, there is a lower level of measurable serum vitamin D levels. Several other studies [3, 4, 5, 6] correlate the deficiency of vitamin D and acne severity.

Vitamin D and Acne: Does Vitamin D help hormonal acne?

This topic is not adequately researched. Vitamin D deficiency in the above study [7] is associated with adverse fertility outcomes including PCOS and hypogonadism. However, the evidence is insufficient to establish causality. High-quality RCTs are needed to further evaluate the effects of vitamin D supplementation in PCOS women as well as on androgen levels in men. It is a possible hypothesis that as Vitamin D does affect hormone regulation, it can also affect development of hormonal acne. 

Vitamin D and Acne: Can vitamin D help with acne? 

It is important to note that topically applied vitamin D is not expected to work. Vitamin D has a high molecular weight. This means it does not penetrate easily via topical agents. Oil gland cells known as sebocytes are involved in acne. Sebocytes are considered by scientists and dermatologists as vitamin D responsive cells. This is the main reason dermatologists consider if vitamin D supplements can be part of effective therapy for acne.

There is emerging evidence about a possibly therapeutic option of vitamin D supplementation for acne patients. Another important randomized control trials that we want to talk about was published in the Journal of Dermatological Treatments [4]. Author Amal stated that acne patients more commonly have vitamin D deficiency, compared to healthy individuals. This is a similar result found by the first study authors. Overall, these support the association of vitamin d and acne, that levels of vitamin D and acne severity are inversely correlated. 

Is sunlight really bad for your skin and health? The key is balance.

The role that Vitamin D plays in the development of skin disease is fairly well known to dermatologists. However, dermatologists are not entirely sure how vitamin D and acne link together. Acne is considered a rather complex condition primarily genetic. This means it occurs in genetically predisposed individuals. Other factors such as the immune system regulation also affects acne development. The immune system is different between individuals.

Lifestyle affecting Vitamin D levels in the skin is an established concept. Our lifestyles of advocating sun avoidance as the primary means of photoprotection can have an impact on our immune system and our health.

All vertebrates need vitamin D to maintain and develop a healthy skeleton. The skin actually manufactures vitamin D. The skin is able to make the biologically active vitamin D metabolite. This is very important to regulate growth and differentiation. of cells. Phototherapy with UVB is used for the treatment of inflammatory skin conditions such as psoriasis. In psoriasis, skin cells proliferate excessively. This is how UVB suppresses inflammation. 

We should tread a very, tread the line very carefully when talking about sun exposure and vitamin D levels. For skin cancer prevention, dermatologists will always recommend sun avoidance, together with adequate sun protection. Sun protection can be in the form of sunscreen and photo protective clothing. This reduces skin cancer risk.

Vitamin D and Skin Health

In a study published in 2007 by a dermatologist from Germany in Experimental Dermatology, the author suggests vitamin D analogues as skin therapy.

The biological effects of vitamin D analogues can prevent cancer and also treat inflammatory skin diseases. He suggested for the dermatological recommendations on sun protection campaigns for skin cancer prevention to be re-evaluated. 

This is to prevent widespread population vitamin D deficiency. 

Perhaps the key is to consider Vitamin D supplementation.

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Mushrooms are a source of Vitamin D in diet. Especially if they are exposed to sunlight when growing.

The overactive oil gland is the underlying cause of excess oil production in acne patients. This information about vitamin D and acne means that it is potentially a target for biologically active vitamin D analogues. Pharmacological analogues, also known as supplements, can be helpful if true. The studies show that vitamin D can directly affect the oil glands and also the immune system, hence establishing the clear link between vitamin D and acne.

How is vitamin D made in our skin?

Vitamin D analogues, offered as supplements, help to protect against ultraviolet radiation. UV rays cause apoptosis, a type of cell death. Failure of cell death of cancerous cells cause skin cancer formation.

Vitamin D supplements can protect against infection. Skin infections, particularly by regulating the local skin immune system. The problem with vitamin D deficiency is actually greater than what we know it to be. The skin is very relevant because it is the main organ  where vitamin D is made. Excessive sun protection does increase the risk of vitamin D deficiency. Older scientific papers in 2007 evaluated transplant patients who were required to avoid UV exposure in an extreme sense for skin cancer prevention. They all had  serious vitamin D deficiency. 

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Learn about how diet can affect your skin in this series of Edible Beauty Masterclasses by Dr. Teo Wan Lin.

How much vitamin D is necessary to protect against cancer and other diseases?

The overall consensus is that 1000 units needed to have a protective effect. Dermatologists will not have to worry excessively in a patient with adequate vitamin D supplementation. However, one needs to be aware that strict sun avoidance measures can lead to a serious health risk of vitamin D deficiency. Vitamin D supplementation will increasingly feature in scientific publications about dermatological conditions. Before that, we should have an adequate understanding of how vitamin D works in our and throughout the whole body.

Disclaimer: This series on Dermatology Lectures offers the author’s personal perspective on scientific literature and should not be regarded as medical advice. 

References:

1. Lee WJ, Kim MJ, Ryu HS, et al. Effect of Vitamin D on the Expression of Inflammatory Biomarkers in Cultured Sebocytes Treated with Propionibacterium acnes or Ultraviolet B Irradiation. Ann Dermatol. 2016;28(5):665-669. doi:10.5021/ad.2016.28.5.665
2. Lim SK, Ha JM, Lee YH, Lee Y, Seo YJ, Kim CD, Lee JH, Im M. Comparison of Vitamin D Levels in Patients with and without Acne: A Case-Control Study Combined with a Randomized Controlled Trial. PLoS One. 2016 Aug 25;11(8):e0161162. doi: 10.1371/journal.pone.0161162. PMID: 27560161; PMCID: PMC4999291.
3. 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 Dec;20(12):3802-3807. doi: 10.1111/jocd.14057. Epub 2021 Apr 15. PMID: 33690970.
4. Ahmed Mohamed A, Salah Ahmed EM, Abdel-Aziz RTA, Eldeeb Abdallah HH, El-Hanafi H, Hussein G, Abbassi MM, El Borolossy R. The impact of active vitamin D administration on the clinical outcomes of acne vulgaris. J Dermatolog Treat. 2021 Nov;32(7):756-761. doi: 10.1080/09546634.2019.1708852. Epub 2020 Jan 3. Erratum in: J Dermatolog Treat. 2020 Jan 21;:1. PMID: 31868550.
5. Alhetheli G, Elneam AIA, Alsenaid A, Al-Dhubaibi M. Vitamin D Levels in Patients with and without Acne and Its Relation to Acne Severity: A Case-Control Study. Clin Cosmet Investig Dermatol. 2020 Oct 7;13:759-765. doi: 10.2147/CCID.S271500. Erratum in: Clin Cosmet Investig Dermatol. 2020 Nov 02;13:815. PMID: 33116739; PMCID: PMC7549021.
6. Kemeriz F, Tuncer SÇ, Acar EM, Tuğrul B. Evaluation of 25-hydroxy vitamin D levels and disease severity in patients with acne vulgaris. Dermatol Ther. 2020 May;33(3):e13393. doi: 10.1111/dth.13393. Epub 2020 May 6. PMID: 32268447.
7. Trummer C, Pilz S, Schwetz V, Obermayer-Pietsch B, Lerchbaum E. Vitamin D, PCOS and androgens in men: a systematic review. Endocr Connect. 2018;7(3):R95-R113. doi:10.1530/EC-18-0009.