Omega-3 Fatty Acids and Acne

Omega-3s Might Help Reduce the Symptoms of Acne

The Essential Info

The typical modern diet is extraordinarily low in omega-3 fatty acids compared to the diet of our ancestors, and as a result, the fat intake of the average person’s diet these days is radically imbalanced. Increasing the intake of omega-3s might help get us back into balance and reduce the symptoms of acne, but evidence remains preliminary, and we can’t say for sure.

Omega-3s are most abundantly found in wild-caught fish. They exhibit several properties that may have a beneficial effect on acne. These properties include, but are not limited to:

• Anti-inflammatory Effects: Acne is at its core an inflammatory disease, so anything that reduces inflammation is welcome.
• Antibacterial Effects: Acne is in part a bacterial disease, so anything that fights bacteria could potentially help.
• Positive Effects on Wound Healing: Medically speaking, acne lesions are small wounds, so anything that helps heal wounds could help lesions heal more quickly and potentially reduce scarring.
   

So far, 3 preliminary studies reveal evidence that omega-3s might help reduce acne in some people. Additionally, when we look at research into the positive effects of omega-3s on other diseases, this further strengthens the argument that omega-3 might be a useful addition to acne treatment.

The Bottom Line: Since omega-3s are good for you, and people eating Western diets don’t typically get enough omega-3s in their diet, it makes sense to take a few fish oil pills each day. If you are vegetarian, you can try algae/algal oil supplements. I personally use cod liver oil as my omega-3 supplement because I don’t get a lot of sun exposure, and cod liver oil is a fish oil supplement that also comes with a good amount of vitamin D.

Special Note – Omega-3 Fatty Acids May Help Reduce Side Effects of Isotretinoin (Accutane^®): One study found that taking omega-3 supplements may help with dry skin and dryness of the nose and eyes, which are a common side effect of treatment with isotretinoin (Accutane^®).

The Science

• How Omega-3 Fatty Acids Might Help Treat Acne
• Effects on Inflammation
• Effects on Bacteria
• Effects on Wound Healing
• The Bottom Line

Omega-3 fatty acids are necessary for overall health, and we cannot thrive without them.¹ When it comes to acne, it is their anti-inflammatory activity that is likely the most helpful.

Omega-3s are called essential fatty acids, meaning the body cannot manufacture them and the only way to obtain them is through the diet.

There are three primary omega-3 fatty acids:

1. ALA (alpha-linoleic acid)
2. EPA (eicosapentaenoic acid)
3. DHA (docosahexaenoic acid)¹

When it comes to acne, EPA and DHA are most important.

EPA and DHA are present in certain species of wild-caught fish, particularly fish that live in cold, deep waters, such as salmon, tuna, swordfish, mackerel, herring, and sardines.^1-3 DHA is also present in algae.

How Omega-3 Fatty Acids Might Help Treat Acne

Omega-3s are a type of fatty acid called a polyunsaturated fatty acid, or PUFA for short.

There are two primary types of PUFAs:

• Omega-6
• Omega-3

Both are important for human health, but consuming them in the right ratio is also important. In modern diets, the ratio has become remarkably imbalanced. The ratio of omega-6 to omega-3 in our ancestors’ diets was around 2:1 or even 1:1. This is in stark contrast to the typical Western diet, which has a ratio of approximately 20:1. This leads scientists to wonder if acne could partly be the result of an imbalance of fatty acids in the diet.

Looking at the dietary habits of people with acne, 2 studies have found that people with acne tend to consume less fish compared to people without acne. Since fish is a source of omega-3 fatty acids, the researchers speculated that a lack of omega-3 fatty acids in the diet may contribute to acne development.^4,5

So far, 3 studies show us that omega-3 fatty acids might be beneficial for acne. In these studies, patients experienced a decrease in the number of acne lesions after taking supplements containing omega-3 fatty acids for 2 or more months.^6-8 However, 2 of the 3 studies were quite small, and in one of them, a handful of patients actually experienced a worsening of acne after taking omega-3 fatty acids, so we need more data before we can draw any firm conclusions.

Expand to read details of studies

A 2008 case-series report in the journal Lipids in Health and Disease followed 5 patients with mild to moderate acne who were taking an omega-3 supplement. This report found that after 2 months, 4 of the 5 patients experienced a reduction in the number of acne lesions, as well as a positive change in their mental states. As the authors explained, “The self-administration of an omega-3 fish oil-based nutrient combination for two months did appear to have some influence on the acne process, and perhaps more importantly, on mental outlook. Specifically, four of the individuals had a reduction in total lesion count, with a range of 11 to 41 less lesions after 2 months.”⁶ Unfortunately, while this study provides a bit of evidence, it is not particularly strong or reliable evidence: the study design was not robust; it was very small; and the omega-3 supplement used in the study also contained other ingredients that might have an effect on acne, such as antioxidants, zinc, selenium, and chromium.

In 2012, the same journal published another study looking at omega-3 fatty acid supplementation and acne. In this study, the researchers gave 3 grams of fish oil containing 930 mg of EPA and 270 mg of DHA to 13 acne patients for 12 weeks. After the 12 weeks, acne severity improved in 8 patients, worsened in 4, and remained unchanged in 1 patient. Because some people’s acne got worse and some got better, when looking at all the data together, there was no significant change in acne after taking the omega-3 supplements. However, because 8 people did experience an improvement in their acne, and most of them had moderate-to-severe acne at the start, the researchers speculated that omega-3 supplements might be somewhat helpful for people with moderate-to-severe acne.⁷

A more robust 2014 study in Acta Dermato-Venereologica looked at 45 patients with mild-to-moderate acne. This study divided patients into 3 groups: one group received omega-3 fatty acids; a second group received an omega-6 fatty acid; and a third group received a placebo (inactive substance). After 10 weeks, the patients in both the omega-3 fatty acid and the omega-6 fatty acid group experienced a significant reduction in acne lesions. The authors stated, “After 10 weeks of omega-3 fatty acid or [omega-6 fatty acid] supplementation, inflammatory and non-inflammatory acne lesions decreased significantly.”⁸

Since we only have these 3 studies that look specifically at the effect omega-3s have on acne, for a clearer picture we can look at studies showing the positive effect of omega-3s on:

1. Inflammation: Acne is a chronic inflammatory disease.
2. Bacteria: Acne is in part a bacterial disease.
3. Wound healing: Acne lesions are essentially small wounds.

Let’s dive into each of these a bit more deeply.

Effects on Inflammation

Acne is at its core an inflammatory disease. While there is no research to date looking at whether omega-3 fatty acids reduce inflammation in acne, many studies have evaluated the anti-inflammatory effects of omega-3 fatty acids in other inflammatory diseases, such as inflammatory bowel disease and rheumatoid arthritis. These studies have shown that omega-3 fatty acids appear to have a significant anti-inflammatory effect.

For example, in one study, fish oil taken by patients with inflammatory bowel disease decreased bowel inflammation.⁹

In another study, patients with Crohn’s disease (a type of inflammatory bowel disease) who took fish oil capsules experienced significantly less relapse of their disease than patients taking a placebo.⁹

In yet another study, higher levels of omega-3 fatty acids in the blood correlated with higher levels of anti-inflammatory markers and lower levels of pro-inflammatory markers, indicating that omega-3 fatty acids influence inflammation levels in the blood.⁹

These results suggest that omega-3 fatty acids might be able to reduce the inflammation that is present in acne.

Effects on Bacteria

One recent study found that omega-3 fatty acids can inhibit the growth of bacteria in the lab, including the type of bacteria that play a role in acne.¹⁰

Expand to read details of study

A 2013 in vitro (in the lab) study in the journal Marine Drugs investigated the potential antimicrobial (anti-bacterial) effects of 6 different PUFAs, including EPA and DHA, on C. acnes and S. aureus, which are 2 strains of bacteria that are associated with acne. This study found that all 6 PUFAs inhibited the growth of both strains of bacteria. Of the omega-3s tested, DHA was more effective than EPA against C. acnes; DHA and EPA were equally effective against S. aureus. The authors concluded, “[PUFAs] warrant further evaluation as possible new agents to treat skin infections caused by C. acnes and S. aureus, especially in synergistic combinations with antimicrobial agents already used clinically.”¹⁰

Effects on Wound Healing

Acne lesions are “wounds.” Some research has also shown that omega-3 fatty acids might promote wound healing.

For example, one study found that supplementation with omega-3 fatty acids increased certain molecules necessary for wound healing.

Two other studies found that, in patients who had undergone major abdominal surgery, those who took fish oil supplements had shorter hospital stays and lower rates of severe infection than those who took a placebo.¹¹

While these studies did not investigate wound healing in acne, the process of wound healing in acne lesions is similar to that in other wounds, so it is reasonable to infer that omega-3 fatty acids might be beneficial in healing acne lesions as well.

Omega-3 Fatty Acids Might Relieve Some Side Effects of Isotretinoin, a Medication Some People Take for Severe Acne

Taking enough omega-3s may also be beneficial for people who take isotretinoin.

Doctors typically only prescribe isotretinoin for the most severe cases of acne because it comes with a variety of side effects. These side effects sometimes result in patients not sticking to the treatment plan or stopping treatment altogether.

However, one recent study found that taking omega-3 supplements might relieve some common side effects of isotretinoin, such as dry skin and dryness of the nose and eyes. The researchers wrote, “Since oral omega-3 reduces…side effects of isotretinoin, it is recommended in patients with acne…who are receiving this drug.”¹²

Expand to read details of study

The study was published in the journal Dermatology Research and Practice in 2018. The researchers looked at 118 acne patients who were randomly divided into 2 groups. The patients in the first group were taking isotretinoin only, while the patients in the second group were taking isotretinoin as well as 1 g of oral omega-3 fatty acids (equivalent to 2 capsules or soft gels) per day. After 16 weeks of treatment, the scientists found that the patients in the second group had experienced significantly fewer side effects like skin dryness and dryness of the nose and eyes. The researchers concluded that taking daily omega-3 supplements may reduce the side effects of isotretinoin.¹²

The Bottom Line

Our modern diet tends to provide a serious lack of omega-3 fats. Omega-3s are important for overall health, and may help regulate inflammation in our bodies. Since acne is an inflammatory disease, while still unproven, it makes sense that taking in more omega-3s might help reduce acne. A quick and easy way to get more omega-3s is by taking a few fish oil pills per day (up to 6). If you don’t get regular sun exposure, cod liver oil may be the best choice since it also contains vitamin D.

References

1. Wall, R, Ross, R. P., Fitzgerald, G. F. & Stanton, C. Fatty acids from fish: the anti-inflammatory potential of long-chain omega-3 fatty acids. Nutr. Rev. 68, 280-289 (2010). https://www.ncbi.nlm.nih.gov/pubmed/20500789
2. Marangoni, F. & Poli, A. Ω-3 fatty acids: functional differences between food intake, oral supplementation and drug treatments. Int. J. Cardiol. 170, S12-S15 (2013). https://www.ncbi.nlm.nih.gov/pubmed/24045226
3. Arterburn, L. M., Hall, E. B. & Oken, H. Distribution, interconversion, and dose response of Ω-3 fatty acids in humans. Am. J. Clin. Nutr. 83, 1467S-1476S (2006). https://www.ncbi.nlm.nih.gov/pubmed/16841856
4. Jung, J. Y., Yoon, M. Y., Min, S. U., Hong, J. S., Choi, Y. S., Suh, D. H. The influence of dietary patterns on acne vulgaris in Koreans. Eur. J. Dermatol. 20, 768-772 (2010). https://pubmed.ncbi.nlm.nih.gov/20822969/
5. Balić, A., Vlašić, D., Žužul, K., Marinović, B. & Bukvić Mokos, Z. Omega-3 versus omega-6 polyunsaturated fatty acids in the prevention and treatment of inflammatory skin diseases. Int. J. Mol. Sci. 21, 741-767 (2020). https://pubmed.ncbi.nlm.nih.gov/31979308/
6. Rubin, M. G., Kim, K. & Logan, A. C. Acne vulgaris, mental health and omega-3 fatty acids: A report of cases. Lipids Health Dis. 7, 36 (2008). https://www.ncbi.nlm.nih.gov/pubmed/18851733
7. Khayef, G., Young, J., Burns-Whitmore, B. & Spalding, T. Effects of fish oil supplementation on inflammatory acne. Lipids Health Dis. 11, 165-169 (2012). https://pubmed.ncbi.nlm.nih.gov/23206895/
8. Jung, J. Y. et al. Effect of dietary supplementation with omega-3 fatty acid and gamma-linolenic acid on acne vulgaris: a randomised, double-blind, controlled trial. Acta Derm. Venereol. 94, 521-525 (2014). https://www.ncbi.nlm.nih.gov/pubmed/24553997
9. Simopoulos, A. P. Omega-3 fatty acids in health and disease and in growth and development. Am. J. Clin. Nutr. 54, 438-463 (1991). https://www.ncbi.nlm.nih.gov/pubmed/1908631
10. Desbois, A. P. & Lawlor, K. C. Antibacterial activity of long-chain polyunsaturated fatty acids against Propionibacterium acnes and Staphylococcus aureus. Mar. Drugs. 11, 4544-4557 (2013). https://www.ncbi.nlm.nih.gov/pubmed/24232668
11. Kiecolt-Glaser, J. K., Glaser, R. & Christian, L. M. Omega-3 fatty acids and stress-induced immune dysregulation: implications for wound healing. Mil. Med. 179, 129-133 (2014). https://www.ncbi.nlm.nih.gov/pubmed/25373096
12. Mirnezami, M. & Rahimi, H. Is oral omega-3 effective in reducing mucocutaneous side effects of isotretinoin in patients with acne vulgaris? Dermatol. Res. Pract. May 29, 6974045 (2018). https://www.ncbi.nlm.nih.gov/pubmed/30002675

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