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Research Findings
A scientific research study was conducted in Singapore on the
effects of Vitamin B5 on acne, and the results were astonishing. Of
the 100 patients in the study, all of them experienced a near 100%
remission of their acne! Although the actual methods of
administering B5 may vary today, the relationship
between vitamin B5 and clear skin is undeniable. Thanks to the
internet, thousands of users can now testify to the serious
results that this natural acne treatment brings. Below is a full
reprint of the original research article:
Pantothenic
Acid in the Treatment of Acne Vulgaris “A Medical Hypothesis”
by Lit-Hung Leung, M.D.
This article originally appeared in the scientifically
prestigious Journal of Orthromolecular Medicine Vol. 12 Number 2,
1997. The version below is from a reprint of the original article
and revisions were made in December 1998.
The Pathogenesis of Acne Vulgaris: A Medical Hypothesis
Over the years the pathogenesis of acne vulgaris has been
extensively studied including, the structure and function of the
pilosebaceous follicle, the physiology of sebum, microflora in acne
vulgaris, and abnormal follicular keratinization, considered to be
one of the earliest events in acne formation.
Despite the concerted effort of many scientists, internists,
pathologists and dermatologists, the pathogenesis of acne vulgaris
remains largely elusive.
In this paper, I would like to approach this problem from a
different perspective. My clinical observations suggest that acne
vulgaris may be closely related to the consumption of diets, which
are rich in fat content. This impression is by no means novel.
Textbooks do briefly mention this correlation though, more often
than not, it is dismissed as irrelevant. However, my observations
have led to quite the contrary conclusions. Not only is the fat
content of food closely related to acne vulgaris but it forms some
sort of linear relationship with the disease process. The more fat
the patient consumes, the more severe will be the acne process. This
observation is in line with the opinion of many dermatologists that
chocolate, which is composed mainly of the creamy part of milk, and
has a high degree of fat content, is bad for acne. Significantly, in
this group of patients, any deliberate attempt in trying to avoid a
fatty diet over a period of weeks, if not days, will often result in
important compound, cholesterol, which in turn is basically
synthesized from units of acetyl-CoA. In the synthetic process, the
body naturally is always trying not only to reach for a normal level
of androgens, but an optimal level, so as to allow the body to
function at its best. However, this is not always possible, and the
normal level reached may not represent the optimal level.
This is natures flexible way of dealing with shortage of essential
dietary elements in any form to achieve a level that is just enough
to manage the present situation, leaving a variable degree of
shortage from the optimal level. In the present instance, in the two
groups of boys, one group may have a normal level of androgens that
is falling short of the optimum. One possible explanation for this
is that there is a lack of basic building blocks, the acetyl-CoAs,
which deter the body from operating at peak efficiency. If this is a
viable possibility, it suggests that a plentiful supply or a
deficiency of acetyl-CoA in
the body may play a role in the acne process. this is certainly
possible. Aside from its role in the synthesis of the sex hormones,
acetyl-CoA, of which coenzyme-A is the important component, it is
also important in fatty acid metabolism as an acyl carrier in the
lengthening and degradation of long chain fatty acids by adding or
removing acyl groups in the metabolic process.
Acne vulgaris is related to lipid metabolism as well as the sex
hormones, both of which have a lot to do with Coenzyme-A. This
relationship provides a reasonable ground to link up the acne
process to Coenzyme-A and to investigate the pathogenesis of acne
vulgaris along this line.
The Importance of Coenzyme-A
In trying to link acne vulgaris to Coenzyme-A, it is important to
have a hypothesis supporting some basic facts. A closer look at
Coenzyme-A may provide the evidence.
A Sharing scenario; As a coenzyme active in both fatty acid
metabolism and sex hormone synthesis, Coenzyme-A is shared between
two different metabolic processes. This is not uncommon in
biochemical reactions in metabolism, where a coenzyme is often
shared among a number of reactions.
Coenzyme-A is arguably the most important coenzyme in the body, and
when a coenzyme is involved in the metabolic process to such an
extent as this, it becomes legitimate to ask if a shortage and
deficiency is possible. To answer this, a brief look at the
structure of Coenzyme-A is warranted.
Coenzyme-A is formed from adenosine triphosphate, cysteine, and
pantothenic acid. Of these pantothenic acid is the only component
that is a vitamin, and must be provided from our dietary intake.
Could there be an insufficient intake of pantothenic acid resulting
in a deficiency in Coenzyme-A, which would leave the body unable to
cope with all the reactions, that it has to perform with that
all-important coenzyme? Conventional wisdom does not think so. It is
suggested that pantothenic acid, being ubiquitous, can be had from
whatever kind of food that is taken in, and that there is no
question as to its deficiency in our body. However, a deficiency is
still possible. After all, when so many reactions are dependent on
the same agent, its demand must be tremendous. Shortage under such
circumstances is not entirely impossible.
The Crucial Question and the New Theory
If the question of deficiency of Coenzyme-A does come up, how does
it affect acne, knowing its importance in fatty acid metabolism and
sex hormone synthesis? This is the crucial question. This is where
the new hypothesis on the pathogenesis of acne vulgaris is based,
and this is where it diverges from conventional medical ideas. The
author’s proposed hypothesis for the pathogenesis of acne vulgaris
is that the disease process is not caused by androgens, or any other
sex hormones, but rather, the disease process results from a defect
in lipid metabolism that is secondary to a deficiency in pantothenic
acid, hence Coenzyme-A. Coenzyme-A, in carrying out its function
efficiently both as an agent in fatty acid metabolism and an agent
in androgen and sex hormone synthesis, has to be present in
sufficient amounts, and anything less than sufficient will result in
some compromise.
Mother Nature’s Choice
Faced with the dilemma of a shortage of Coenzyme-A the body will
tend to make a choice that is to the best advantage of the
individual. The body does so by largely maintaining the functionally
more important reaction, while at the same time slowing down the
lesser important one. The choice here is a relatively simple one.
Nature will seek to take care of the synthesis of hormones first,
because continuation of the species depends on the development of
the sex organs. Fatty acid metabolism is, for the time being, at
least in part halted. Lipids start to accumulate in the sebaceous
glands, sebum excretion is increased, and acne begins to appear.
When there is enough Coenzyme-A in the body, however, both reactions
will be well taken care of. There are enough sex hormones for the
sex organs to develop. The lipids in the sebaceous glands are
completely metabolized by sufficient Coenzyme-A, and there will be
no unwanted lipid in the glands and little sebum will be excreted to
cause acne vulgaris.
The Mystery Revealed
The mechanism proposed above may be the reason why two groups of
adolescent boys both with a normal blood level of androgen may
exhibit differences in the incidence of acne. The group with acne is
the one that has not enough pantothenic acid in the body, whereas in
the other group, pantothenic acid levels are not deficient.
This new theory seems to work well here, and can be tested in other
metabolic situations. In the case in which endogenous androgen
stimulates acne, whereas exogenous does not, the reasoning for the
observation is the same. Any endogenous androgen synthesis will
require the participation of extra amount of pantothenic acid. This
will channel off some of those that are doing the work of fatty acid
metabolism. Consequently, fatty acid metabolism becomes less
efficient and the individual is more prone to have acne.
Today, the percentage of adult women that have acne is increasing.
Some of these women may not have had acne as teenagers, and are
surprised to find that they have to deal with this unpleasant
problem during their adult years. Acne can have profound
psychological and social effects on adults, just as it does in
teenagers.
Many women in their 30s and 40s experience high levels of life
stress because they shoulder the multiple burdens of career, child
rearing, and housework, and often the responsibility of caring for
their own aging parents. Perhaps this increasing level of stress has
contributed to the rising incidence of acne in adult women.
Microcomedo
Acne vulgaris of adulthood is similar to teenage acne. The
pilosebaceous units of the face, chest, and back can be involved.
The primary lesion of acne is the “microcomedo.” A microscopic plug
develops due to the presence of thickened and impacted keratin (dead
cells) and excess oil production (sebum). More and more of the
keratin and sebum back up behind this plug and form a distended
follicular pore. This results in either an open comedo (blackhead)
or a closed comedo (whitehead). The enlarged pilosebaceous structure
allows Propionibacterium acne’s, an anaerobic diphtheroid, to
proliferate. Propionibacterium acne’s contributes to the breakdown
of lipids to free fatty acids, which are highly inflammatory. The
distended follicle can rupture, causing further inflammation and the
development of papules, pustules and nodules.
Acne Rosacea
Another skin disease that simulates and can coexist with acne
vulgaris is acne rosacea. This skin problem is common in women, most
often between the ages of 30 and 50. The face, especially the middle
third, is erythematous and flushed. Multiple telangiectasias are
frequently present. Small papules and pustules, which may look
similar to those seen in acne vulgaris, are common, but the
microcomedo component of acne vulgaris is absent in blepharitis.
Rosacea keratitis is less common, but potentially
vision-threatening. Rosacea is another skin disorder that is
frequently stress related.
What about premenstrual flare?
In the luteal phase of the menstrual cycle, progesterone in is
secreted abundantly by the corpus lutcum. This naturally will take
up a lot of pantothenic acid from the body’s pantothenic pool
leading to a re-distribution of the vitamin and putting enormous
pressure on fatty acid metabolism. When this metabolic process is
not performing satisfactorily, lipid begins to accumulate in the
sebaccous glands, an increase in sebum is excreted, and acne
follows. That is why even though progesterone has no effect on
sebaceous gland activity, an increasing level of progesterone in the
late stage of the luteal phase leaves the acne patient with a
prominent flare.
Similarly, this may explain why eunuchs rarely exhibit acne. Since
so few sex hormones are secreted, the pantothenic acid pool can
deploy a more significant portion of its reserve to metabolize fatty
acids. When this is efficiently done, little sebum is excreted, and
no acne is formed.
This theory also explains the paradoxical problem of equal sex
hormones that counts. Both males and females need sex hormones for
the development of sex organs and the secondary sexual
characteristics. The only difference is that in the male, the female
sex hormones predominate. Apparently the synthesis of sex hormones
uses a large portion of the pantothenic acid pool, leaving a
relative shortage of it to efficiently metabolize fatty acids. The
result is that acne starts to erupt, at the same time the sex organs
begin to develop at puberty.
The reason acne first erupts at puberty is not, therefore,
endocrinological, but rather secondary to the deployment of a
substantial amount of pantothenic acid for the purposes of synthesis
of sex hormones, leaving a relative deficiency for fatty acid
metabolism. The size of this pantothenic acid pool and the ability
with which the individual can deploy reserves from the pool varies
and is likely to be influenced by genetic and dietary factors.
In conditions in which there is an increase in secretion of any
hormone whose synthesis requires the participation of pantothenic
acid, acne may erupt.
This is frequently seen with those hormone secreting tumours of the
ovary, testis and the adrenals. The rapid decline in incidence of
acne after adolescence can also be explained. After the sex organs
are fully developed, less sex hormones are required, leaving an
adequate supply of pantothenic acid to serve the function of fatty
acid metabolism. When this function is efficiently accomplished,
sebum secretion dries up, and acne starts to fade.
Deficiency in Lipid Metabolism
In linking the pathogenesis of acne vulgaris to a deficiency in
lipid metabolism and pantothenic acid, it is worthwhile to remember
that fatty acid metabolism is not the sole domain of pantothenic
acid. There are some other essential dietary factors that are also
of importance in the same process.
Together they form a system that will make the whole metabolic
process as efficient as possible. Preliminary studies by the author
suggest that, together with pantothenic acid, biotin as well as
nicotinamide help to further improve the therapeutic results. By
themselves alone, they are far less effective in helping acne
patients than with pantothenic acid, and this serves to support the
suggestion that pantothenic acid plays a central role in lipid
metabolism.
Lipid metabolism is a complicated process, and is often intertwined
with other metabolic processes, sharing with them common coenzymes
in widely different reactions. When there is an increase in level of
some of these coenzymes, there may be a shift in the directions of
some ongoing reactions, and may affect lipid metabolism as a result.
This can manifest clinically as acne vulgaris. To illustrate this,
there are reports showing that acne may be induced by administration
of large doses of vitamin B12 alone or in combination with B6.
Cessation of the administration of these vitamins will bring a halt
to the acne eruptions. If the body is in a relative deficiency state
in B6 and B12, administration of the vitamins will enhance the
reactions that involve the participation of these vitamins. This
will set up a chain of events, some of which entail the
participation of pantothenic acid. With the total pantothenic acid
pool fixed relative to an increase in other vitamins, emphasis of
any reaction involving pantothenic acid will automatically mean a
cutting back on other reactions that require it as a coenzyme. This
will often include those involving lipid metabolism, resulting in a
certain degree of deficiency in that metabolic process, hence the
increased incidence of acne vulgaris in these studies.
Stress Related Acne
It is perhaps relevant here to consider stress as another common
factor that is known to affect acne adversely. Stress in many forms
poses as an aggravating factor in acne lesions. Lack of sleep at
night, pre-examination tension, any psychological problem that may
worry the patient will bring on new acne lesions. To understand
this, one should recall that in combating stress, the body will
secrete glucocorticoids from the adrenal glands as a means to adapt
to stress, what is commonly known as the fight-or-flight reaction.
The glucocorticoids, like the sex hormones, are derivatives of
cholesterol, and increased demand for this hormone will draw on the
pantothenic acid pool. Lipid metabolism may therefore be
compromised, rendering the body more prone to acne.
If pantothenic acid deficiency is indeed the main causative agent in
the pathogenesis of acne vulgaris, it is logical to ask how much
pantothecic acid patients are lacking in absolute amounts.
Deficiency Syndromes
Nutritional requirements can rarely be met through a well balanced
diet, and dietary supplements, including vitamins, are often
required. It is the generally held belief of the medical profession
that vitamins, though essential to life and not synthesized in the
body, are not required in great amounts.
This view was challenged, notably by Linus Pauling. In his book, How
to Live Longer and Feel Better, Pauling provided vigorous proof,
through comparative studies in animals and from an evolutionary
point of view, that vitamin C supplements are needed if an optimal
state of health is to be achieved. Not only is supplementation
necessary, gut the amount required is far greater than most people
believe, as with the case of vitamin C where the optimal dose may be
10 or more grams a day. This issue was a point of heated debate in
the 1970s and 1980s.
Though Pauling has quite a large following, by and large, the issue
was dismissed by the mainstream medical profession, because of a
lack of theoretical support and a general bias against nutritional
and vitamin therapy. But, in view of the new evidence suggested in
these and many other papers, it seems appropriate that the issue be
considered.
How Much Pantothenic Acid?
In trying to determine the amount of pantothenic acid necessary to
relieve acne patients of their symptoms, Pauling’s experience with
vitamin C provides a good guideline. Pauling had for a long time
recommended vitamin C in high dosages to achieve optimal health.
Radically different from what is recommended by the Food and
Nutrition Board of the National Research Council (who recommended 60
mg daily). Pauling’s recommended daily intake of vitamin C amounts
to several grams a day. The recommendation was stepped up to 15-20
grams a day in his later years. Using these recommendations as a
background, it becomes somewhat easier to arrive at a proper dosage
for pantothentic acid in the treatment of acne vulgaris.
Pantothenic acid, which acquires its name from the Greek word
meaning ubiquitous, is present in all tissues. Its universal
presence is an indication of its importance. This is further
reflected by the many reactions that it catalyzes. It should not
come as a surprise then, that the amount of pantothenic acid
required for optimal health, is of the same order of that of vitamin
C. Based on this argument, the dose of pantothenic acid administered
to the acne patients was up to 10 grams a day, and the result of
these studies were first reported in Medical Hypotheses.
The Effect of Pantothenic Acid on Acne Vulgaris
One hundred patients of Chinese descent were included in the study,
45 males and 55 females. The age ranged from 10 to 30, and with
about 80% between 13 and 23. The severity of the disease process
varied. They were given 10 grams of pantothenic acid a day in four
divided doses. To enhance the effect, the patients were also asked
to apply a cream consisting of 20% by weight of pantothenic acid to
the affected area, four to six tines a day.
With this treatment regimen, the response is as prompt as it is
impressive. There is a noticeable decrease in sebum secretion on the
face usually 2-3 days after initiation of therapy. The face becomes
less oily. After two weeks, existing lesions start to regress while
the rate of eruption of new acne lesions begins to slow down. In
cases with moderate severity, the condition is normally in complete
control in about eight weeks, with most of the lesions gone and new
lesions only to erupt occasionally. In those patients with severe
acne lesions, complete control may take months, sometimes up to six
months or longer. In some of these cases, in order to get a more
immediate response, it may even be necessary to step up the dose to
15-20 grams a day. In any event, the improvement is normally a
gradual and steady process, with perhaps minor interruptions by
premenstrual flare or excessive intakes of oily food. With this form
of treatment, another striking feature is the size of the facial
skin pore.
The pore size becomes noticeably smaller within one to two weeks,
very often much sooner. Like sebum excretion, the pores will
continue to shrink until the skin becomes much finer, giving the
patient a much more beautiful skin.
This decrease in skin pore size is presumably related to sebum
excretion. When an acne lesion is formed, there is in the epithelial
cell of the hair follicle an accumulation of lipids, leaving the
epithelial cells bulky and the lumen of the gland narrowed. When
there is a concomitant increase in sebum flow, the follicle has no
choice but to hypertrophy to accommodate the changes, resulting in
an enlarged skin pore and coarse skin. With the administration of
pantothenic acid, the whole process is reversed. Lipid metabolism
becomes normal and efficient. The epithelium is no longer laden with
fat droplets, there is a decrease in sebum excretion, the
hypertrophy process is not required. The skin pores revert to a much
smaller size and the skin becomes smooth and fine.
As acne lesions tend to subside spontaneously after puberty, some
patients do not need a maintenance dose. But, if a patient is in his
mid-teens, when the sexual characteristics have yet to fully
develop, it may be necessary for replacement therapy to be
implemented. This maintenance dose, can be lowered, or increased
with the clinical symptoms. A maintenance dose will not only act as
a preventive measure against sporadic eruption, but the extra
pantothenic acid will help to ease the relative deficiency state,
and likely improve the general health of the patient.
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