Acne-Blog  ·  19. September 2018

Air pollution and Acne

WHAT EFFECT DOES AIR POLLUTION HAVE ON ACNE

 

 

 

Why air pollution?

 

Although this blog will largely explore the impact of nutrition on our skin, I start with another aspect of our lifestyle: the air that surrounds us. Unlike our food, we can barely control our ambient air, so it's even more important to know how to protect against potentially damaging effects.    
Air pollution is often suspected as a problem by acne patients and in forums, but usually without scientific basis. In this article, I give an overview of the state of research in this field and try to derive the best possible advice for acne patients. Since there are relatively few studies on the direct link between air pollution and acne, we need to rely in part on evidence from related research areas.

 

 

 

Background

 

Epidemiological studies show that acne occurs in modern societies among adolescents with a prevalence of about 79-95%. Even around half of people over the age of 25 still suffer from some acne. In some primeval living, non-modern societies, however, not a single case of acne is observed.1   
Since genetic causes can largely be ruled out as the cause of this observation (which I will explain in more detail in future blog post), scientists suspect differences in lifestyle as the reason.

 

Perhaps the most important lifestyle aspect which I will talk about in detail here on this blog is nutrition. Another aspect is the environmental pollution that we are exposed to in a modern society, but that is generally less present in the depths of the Amazon or on a remote island.   

 

Could this pollution be a cause that the entire modern world suffers from acne, whereas individual isolated populations with primal lifestyles do not?     
Probably the most impactful part of pollution is air pollution which I will cover in this article.

 

 

 

Health impact of air pollution

 

The World Health Organization classifies air pollution as the largest environmental risk factor for human health. The consequences are increased risk of respiratory diseases such as lung cancer, asthma and COPD, but surprisingly also heart disease and strokes.2.3

 

 

 

Air pollution and skin diseases

 

In addition to our lungs, of course, our skin is exposed constantly and on a large area to our ambient air. So it is no surprise that air pollution is also associated with accelerated aging of the skin.4 In particular, the formation of lentigos appears to be related to increased traffic-related air pollution.4,5 Lentigos are small, dark skin patches caused by increased melanocyte count or increased melanin formation.

 

Dark spots are one thing, but we're mainly interested in red spots that hurt and pus. What about with those?           
For a long time there was no research on acne and air pollution. However, it has been known for about ten years that other red spots on the skin are quite related to air pollution. Dermatitis and hives are much more prevalent in regions with increased traffic-related air pollution and increased ozone concentrations on the ground.6.7

 

 

 

Air pollution and acne

 

This year a study on acne and air pollution was finally published.8 Beijing scientists measured the number of patients who went to the doctor for acne. These data were then compared with the data of the local environmental authority on air pollution. It turned out that the higher the air pollution was, the more patients sought the doctor for acne. The correlation could be shown for nitrogen dioxide and particulate matter. However, to the surprise of the researchers, not for sulfur dioxide. Here, even a negative correlation was observed meaning the more sulfur dioxide was in the air, the fewer patients came to the doctor with acne symptoms.
However, one has to keep in mind that this first correlational study has a low level of evidence due to its design, meaning, we should not draw all to specific conclusions from it. Unfortunately, ozone, which is likely to play a role as well, was not considered in this analysis.

 

Other studies provide a possible explanation for the observed, negative effect.   
Simplified, air pollution appears to oxidize some components of the sebum, thus reducing the protective mechanism of the skin. This can make inflammation easier. In addition to that, some components of the sebum are highly acne-promoting after they have been oxidized by air pollution or other causes.

 

But now in more detail:        
Two studies in Mexico and China showed that people living in urban areas had altered skin sebum production compared to people in rural areas.9,10 Both studies noted a difference in sebum composition. One study also found overall increased sebum production in urban areas, which is a typical risk factor for the development of acne.

 

Also, the change in the composition of the sebum fits well with the assumption that urban air pollution favors the development of acne. The researchers measured lower levels of vitamin E and squalene in the sebum of city habitants. These antioxidants, which protect the skin from various irritants, may have been oxidized and "consumed" by air pollution-induced oxidative stress.9,11 This raises two problems that both promote acne:

 

 

 

1. Acne patients usually have increased squalene production.13,15  So, one could think that the air pollution’s effect of reducing the amount of squalene could even help against acne. However, since the reduction is probably due to the oxidation of squalene, we observe an acne-promoting effect. Because oxidized squalene is a very potent comedogenic substance. That is, it promotes the formation of pimples. On the one hand, this has been shown directly in animal experiments12, and on the other hand, various studies show that acne patients have significantly higher levels of oxidized squalene in the sebum than people without acne.13,14  Some scientists assume that the oxidation of lipids such as squalene in the sebum is even the trigger of acne.13  Researchers from Italy describe a possible process:    

 "Products of O3-induced [O3  = ozone] lipid oxidation [squalene is a lipid] penetrate the outer skin barrier and cause effects on the deeper epidermis [outer skin layer] that can cause activation of transcription factors [genetic switches], such as κB, which regulates a variety of proinflammatory cytokines [signaling agents of the cell]."11
 

 

2. In addition, the skin's antioxidant protective barrier has been reduced, making it more sensitive to various external and internal oxidative stressors. Oxidative stress in turn promotes inflammatory processes22  that can manifest on the skin in the form of acne. In addition, the body’s ability to keep existing inflammatory processes in check has been degraded due to the reduced antioxidant protective barrier. Those oxidative stress factors mentioned above can be external or internal. Outside factors include UV light, bacteria or air pollution in the form of fine dust, nitrogen dioxide, ozone, cigarette smoke, etc. From the inside those stressors can be existing inflammatory processes, disease factors but also normal cell function, which inevitably produces low levels of oxidative stress, which is usually compensated by the body’s antioxidant protective mechanisms.

 

 

 

Contradictory findings

 

This blog is intended to give an unbiased presentation of the state of scientific research. That's why I also want to present a finding that, to my knowledge, does not fit into the current picture.

 

Unexpectedly, a lower concentration of interleukin-1α in the sebum of urban residents was found in one of the studies.9 Interleukin-1α is a signaling substance of the body that triggers inflammation and is usually found in an increased concentration in the skin of acne patients and in particular in the area of pimples.14

 

Despite this inconsistency, it seems obvious that air pollution, in addition to various other diseases, also promotes acne in its development and symptoms.

 

 

 

 

 

 

 

Practical tips   

 

So now the question is what can we do to protect our skin from these effects. Since it is quite impractical to change your place of residence, here are a few tips on how we can use diet and topical treatment to limit the damage.

 

 

 

Nutrition

 

Broccoli consumption leads to a significant improvement in our body's ability to detoxify various pollutants from cigarette smoke, diesel fumes and other airborne pollutants, thereby reducing inflammation.16-18  One of the reasons for this effect seems to be the substance sulforaphane in broccoli, which is also found in other cruciferous plants which include all types of cabbage, mustard plants such as arugula and radishes. In order for sulforaphane to form effectively, one should chop the plants several minutes before heating, since sulforaphane is produced at the cut surfaces by the enzyme myrosinase. This enzyme, however, is inactivated by heat.

 

Whether the anti-inflammatory mechanism has an effect on the skin as well has unfortunately not yet been investigated. However, in view of the many health problems caused by air pollution, it seems reasonable to regularly include these healthy foods in one’s diet.

 

Another study2  found evidence that the following substances may help against the effects of air pollution. Although this study focused less on skin health and more on respiratory health, its findings are still relevant for acne patients for two reasons:           
 1. All of the substances recommended in this study have already been found to have positive effects on acne in other studies except for choline.          
2. The researchers assume that the damage to the respiratory organs arises, among other things, due to air pollution-related oxidative stress. Therefore the mechanisms by which respiratory and skin health is damaged might be the same.

 

Substance

Best Source

Dosage

Comment

Carotenoids, i.e. provitamin A

orange, red and dark green vegetables: e.g.:

carrots, squash, sweet potatoes, tomatoes, spinach, kale

No evidence supporting one specific dose against acne.  

 

As a rule, the more vegetables, the better. 

Oxalate-rich vegetables such as spinach and chard should be consumed only in moderate amounts (100-200 g / day).

Diversity is important.

For absorption, the cells must be broken. This can be achieved by heating, pureeing or juicing. In addition, a source of fat should be consumed along with the vegetables (e.g. nuts, acne-friendly oil such as canola or flaxseed oil)

Vitamin C

Various fruits and vegetables: eg berries, kiwis, pineapple, cantaloupe, broccoli, kale, paprika (bell pepper)

No evidence supporting one specific dose against acne.

As a rule, the more fruit, the better, as long as other healthy foods such as whole grain cereals, legumes, vegetables and nuts are not neglected.
 However, fruit juices should be avoided.

You do not have to worry about sugar in whole fruit. The fiber and phytochemicals slow down its absorption and also have a positive effect on insulin sensitivity.

Berries tend to have the highest antioxidant capacity.

Vitamin E

Nuts and seeds, especially almonds, peanuts, hazelnuts, NO sunflower seeds

Vegetable oils esp. Canola oil, wheat germ oil (in small quantities)

Green vegetables esp. Broccoli, spinach, kale, chard

No evidence supporting one specific dose against acne.   

If those food groups are incorporated daily, a sufficient vitamin E supply can easily be achieved.  

Sunflower seeds should be avoided despite their high vitamin E content because they are suspected to exacerbate acne.26

Sunflower oil should be avoided because of the high omega-6 fatty acid content.

Vitamin D

Body's synthesis

Dietary supplement

1000 IU D3 / day led to about 30% reduction of inflammatory pimples over placebo over 8 weeks.24

My recommendation:

Depending on latitude and skin tone 15-30 min midday sun from spring to autumn or 1000-2000 IU vitamin D3 per day.

In winter 1000-2000 IU of vitamin D3 per day.

 

Curcumin (yellow molecule in spice turmeric)

Turmeric

No evidence supporting one specific dose against acne.  

 

 

Use in combination with pepper, since the piperine contained in pepper inhibits the degradation of curcumin and thus enhances its effect.

Choline In-house

Your body’s own synthesis (or rather that of your gut microbiota)

No evidence supporting one specific dose against acne.  

Can be sufficiently formed by the body with sufficient protein and folic acid supply. High additional intake through food or supplement is suspected to be harmful due to the formation of TMAO.

Omega-3 fatty acids

α-linolenic acid (ALA):
flaxseed, hemp seeds and chia seeds, walnuts and their oils as well as canola oil

EPA, DHA:
algae oil, fish oil

ALA:
No evidence supporting one specific dose against acne.  

Foods should be included daily.

EPA, DHA:
In a controlled trial, 2000 mg / day for 10 weeks reduced inflammatory pimples by about 40%.25

CAUTION!:
In the long term only 250 mg per day are recommended!

Algae oil is preferable to fish oil because it is less likely to be contaminated with heavy metals and environmental toxins, and it can be produced more ecologically and ethically.

 

 

 

 

 

Topical

 

In the case of the skin, we can also combat the harmful oxidation of sebum lipids topically. Here are three examples:

 

 

 

Vitamin B3    
The application of the antioxidant vitamin B3 together with linoleic acid (a fatty acid that occurs in the sebum of acne patients in lower concentrations) and phosphatidylcholine (component of cell membranes, which is supposed to reduce the cornification of the skin and congestion of the pores) led to a reduction of the acne symptoms by about 80% over 12 weeks. The improvement was even slightly stronger than with an antibiotic used in a control group.19 This was a so-called randomized, double-blind, placebo-controlled study with 118 participants. There were two control groups: one with placebo, one with antibiotic. Thus, the significance of the study and its power of evidence is very strong.

 

But how do we know that the antioxidant vitamin B3 has actually contributed to the improvement? Because there was a similar study over 20 years ago. In that study, however, only vitamin B3 was used and no other ingredients.23 The effect was compared to a controll group using that same antibiotic. Both studies used a lotion with 4% vitamin B3. Here the cream was applied twice daily, though, instead of once daily, as in the above study. It was a double-blind, randomized, controlled trial of 76 participants, but only ran eight instead of twelve weeks. Again, vitamin B3 showed a stronger effect than the antibiotic reducing the number of pimples by 60%, the antibiotic only by 43%.         
The researchers in these studies also highlighted the importance of lipid oxidation in the development of acne and that reducing this oxidation with antioxidants is a potential mechanism for combating acne.

 

 

 

Vitamin C

 

The antioxidant vitamin C also showed strong effects against acne in a randomized, controlled study.20 It was compared to benzoyl peroxide, a popular acne medication, and resulted in "excellent" symptom relief in 77% of subjects, while benzoyl peroxide only did so in 61% of subjects. In addition, the oxidation of squalene was greatly reduced, which these researchers also saw as a possible cause for the improvement of the symptoms.

 

 

 

Green tea

 

Green tea, which has strong antioxidant phenolic compounds, reduced acne symptoms by about 60% within six weeks.21 However, this study has a much lower power of evidence due to its design.

 

 

 

It should be noted that all of these substances have multiple mechanisms of action and the effect is not only based on improving the skin's antioxidant protective barrier. Other mechanisms of action include reducing the growth of the potentially acne-promoting bacterium Cutibacterium acnes (formerly Propionibacterium acnes), reducing sebum production and lowering the pH of the tallow. In the case of green tea, even an effect on the hormone metabolism of the skin is conceivable.

 

 

 

 

 

 

 

 

 

 

 

 

 

Summary:

 

  •  Air pollution presumably promotes acne by causing the oxidation of sebum lipids which are comedogenic (pimple-promoting). In addition, the antioxidant capacity of the sebum and the skin is reduced, which further promotes the development of inflammatory processes.
  •  Dietary measures:
     The following nutritional strategies can be recommended with varying degrees of evidence.

 

·         

 

    •  Cruciferous plants (e.g. broccoli), dark green, orange and red vegetables in large quantities
    •  Vitamin C-rich fruit and especially berries in large quantities
    •  Vitamin E-rich foods daily (examples see table above)
    •  15-30 minutes of sun exposure daily or 1000-2000 IU Vitamin D3 as a dietary supplement, in winter  1000-2000 IU Vitamin D3 as a dietary supplement.
    •  cook regularly with turmeric or curry
    •  250 mg EPA / DHA  (ideally as algae oil) daily, for short durations also higher doses
  •  Topical treatment:  
    The      following substances have shown strong effect against acne by protecting the skin and the sebum from oxidative damage:

 

 

 

·         Vitamin B3 = niacin / nicotinic acid: in creams e.g. as niacin or nicotinamide

 

·         Vitamin C = Ascorbic acid: In creams e.g. as sodium ascorbyl phosphate

 

·         Green tea (limited evidence): In creams usually as an extract

 

 

 

 

 

 

 

 

 

Disclaimer:
 I am not a doctor and do not replace such. The information has been researched with the utmost care, but I accept no liability for errors or incompleteness. Following the advice given here is at your own risk.

 

 

 

 

 

 

 

 

 

______________________________________________________________________________________________________________________________________________________________________________________

 

 

 

 

 

Bibliography:

 

 

 

[1] Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand Miller J. Acne vulgaris: a disease of Western civilization. Arch Dermatol. 2002; 138 (12): 1584-90. https://www.ncbi.nlm.nih.gov/pubmed/12472346

 

 

 

[2] Whyand T, Hurst JR, Beckle M, Caplin ME. Pollution and respiratory disease: can diet or supplements help? A review. Respir Res. 2018; 19 (1): 79. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5930792/

 

 

 

[3] World Health Organization. Ambient air pollution: health impacts. Accessed Sept. 02, 2018. http://www.who.int/airpollution/ambient/health-impacts/en/

 

 

 

[4] Vierkötter A, Schikowski T, Ranft U, et al. Airborne particle exposure and extrinsic skin aging. J Invest Dermatol. 2010; 130 (12): 2719-26. https://www.ncbi.nlm.nih.gov/pubmed/20664556

 

 

 

[5] Hüls A, Vierkötter A, Gao W, et al. Traffic-Related Air Pollution Contributes to the Development of Facial Lentigines: Further Epidemiological Evidence from Caucasians and Asians. J Invest Dermatol. 2016; 136 (5): 1053-6. https://www.jidonline.org/article/S0022-202X(16)00453-X/fulltext

 

 

 

[6] Kramer U, Sugiri D, Ranft U, et al. Eczema, respiratory allergies, and traffic-related air pollution in birth cohorts from small-town areas. J Dermatol Sci. 2009; 56 (2): 99-105. https://www.ncbi.nlm.nih.gov/pubmed/19713084

 

 

 

[7] Xu F, Yan S, Wu M, et al. Ambient ozone pollution as a risk factor for skin disorders. Br J Dermatol. 2011; 165 (1): 224-5. https://www.ncbi.nlm.nih.gov/pubmed/21457212

 

 

 

[8th] Liu W, Pan X, Vierkötter A, et al. A Time-Series Study of the Effect of Air Pollution on Outpatient Visits for Acne Vulgaris in Beijing. Skin Pharmacol Physiol. 2018; 31 (2): 107-113. https://www.ncbi.nlm.nih.gov/pubmed/29408821

 

 

 

[9] Lefebvre MA, Pham DM, Boussouira B, Bernard D, Camus C, Nguyen QL. Evaluation of the impact of urban pollution on the quality of skin: a multicentre study in Mexico. Int J Cosmet Sci. 2015; 37 (3): 329-38. https://www.ncbi.nlm.nih.gov/pubmed/25655908

 

 

 

[10] Lefebvre MA, Pham DM, Boussouira B, et al. Consequences of urban pollution upon skin status. A controlled study in Shanghai area. Int J Cosmet Sci. 2016; 38 (3): 217-23. https://www.ncbi.nlm.nih.gov/pubmed/26291783

 

 
[11] Valacchi G, Sticozzi C, Pecorelli A, Cervellati F, Cervellati C, Maioli E. Cutaneous responses to environmental stressors. Ann NY Acad Sci. 2012; 1271: 75-81. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495295/

 

 
[12] Chiba K, Yoshizawa K, Makino I, Kawakami K, Onoue M. Comedogenicity of squalene monohydroperoxides in the skin after topical application. J Toxicol Sci. 2000; 25 (2): 77-83. https://www.ncbi.nlm.nih.gov/pubmed/10845185

 


[13] Bowe WP, Logan AC. Clinical implications of lipid peroxidation in acne vulgaris: old wine in new bottles. Lipids Health Dis. 2010; 9: 141st https://www.ncbi.nlm.nih.gov/pubmed/21143923

 

 

 

[14] Capitanio B, Lora V, Ludovici M, et al. Modulation of sebum oxidation and interleukin-1α levels associates with clinical improvement of mild comedonal acne. J Eur Acad Dermatol Venereol. 2014; 28 (12): 1792-7. https://www.ncbi.nlm.nih.gov/pubmed/24628899

 

 
[15] Pappas A, Johnsen S, Liu JC, Eisinger M. Sebum analysis of individuals with and without acne. Dermatoendocrinol. 2009; 1 (3): 157-61. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835908/

 

 
 [16] Riso P, Vendrame S, Delbo 'C, et al. Effect of 10-day broccoli consumption on inflammatory status of young healthy smokers. Int J Food Sci Nutr. 2014; 65 (1): 106-11. https://www.ncbi.nlm.nih.gov/pubmed/23992556

 

 
[17] Heber D, Li Z, Garcia-lloret M, et al. Sulforaphane-rich broccoli sprout extract attenuates nasal allergic response to diesel exhaust particles. Food Funct. 2014; 5 (1): 35-41. https://www.ncbi.nlm.nih.gov/pubmed/24287881

 

 

 

[18] Egner PA, Chen JG, Zarth AT, et al. Rapid and sustainable detoxication of airborne pollutants by broccoli sprout beverage: results of a randomized clinical trial in China. Cancer Prev Res (Phila). 2014; 7 (8): 813-823. https://www.ncbi.nlm.nih.gov/pubmed/24913818

 

 
[19] Morganti P, Berardesca E, Guarneri B, et al. Topical clindamycin 1% vs. linoleic acid-rich phosphatidylcholine and nicotinamide 4% in the treatment of acne: a multicentre-randomized trial. Int J Cosmet Sci. 2011; 33 (5): 467-76. https://www.ncbi.nlm.nih.gov/pubmed/?term=21668835

 


[20] Klock J, Ikeno H, Ohmori K, Nishikawa T, Vollhardt J, Schehlmann V. Sodium ascorbyl phosphate shows in vitro and in vivo efficacy in the prevention and treatment of acne vulgaris. Int J Cosmet Sci. 2005; 27 (3): 171-6. https://www.ncbi.nlm.nih.gov/pubmed/?term=18492184

 

 
[21] Elsaie ML, Abdelhamid MF, Elsaaiee LT, Emam HM. The efficacy of topical 2% green tea lotion in mild-to-moderate acne vulgaris. J Drugs Dermatol. 358-64: 8 (4), in 2009. https://www.ncbi.nlm.nih.gov/pubmed/?term=19363854

 

 

 

[22] Lugrin J, Rosenblatt velin N, Parapanov R, Liaudet L. The role of oxidative stress during inflammatory processes. Biol Chem. 2014; 395 (2): 203-30.
 https://www.ncbi.nlm.nih.gov/pubmed/24127541

 

 

 

[23] Shalita AR, Smith JG, Parish LC, Sofman MS, Chalker DK. Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris. Int J Dermatol. 1995; 34 (6): 434-7. https://www.ncbi.nlm.nih.gov/pubmed/7657446

 

 

 

[24] 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. E0161162: 11 (8); 2016th https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4999291/

 

 

 

[25] Jung JY, Kwon HH, Hong JS, et al. Effect of dietary supplementation with omega-3 fatty acid and gamma linolenic acid on acne vulgaris: a randomized, double-blind, controlled trial. Acta Derm Venereol. 2014; 94 (5): 521-5. https://www.ncbi.nlm.nih.gov/pubmed/24553997

 

 

 

[26] Mohebbipour A, Sadeghi-bazargani H, Mansouri M. Sunflower Seed and Acne Vulgaris. Iran Red Crescent Med J. 2015; 17 (9): e16544. https://www.ncbi.nlm.nih.gov/pubmed/26473070