Oxidative Stress in Different Clinical Severities of Acne

25 Feb

Acne affects more than 85% of adolescents and adults – making it the most common skin disease. Acne actually comes in several different forms, and the lesions are categorized as comedones, papules, postules, nodules or cysts. Acne can be caused by a long list of different factors, but researchers believe that acne develops through one of these four pathways: too much sebum production, abnormal keratinization of follicles, bacterial colonization, and inflammation of the follicle. Some of the more recent acne studies focus on the role of oxidative damage in the onset and progression of acne. Oxidative stress and inadequate defenses against it lead to inflammatory disease – and since acne is considered an inflammatory condition, it’s logical that antioxidant consumption may help to treat or even prevent acne. In the skin, immune cells called neutrophils roam the follicular wall, killing harmful pathogens. This process, however, results in oxygen free radicals, causing cellular damage within the follicle and inflammation. Oxidative species also impact sebum – which is an oily substance secreted by the skin to act as a lubricant and to waterproof the skin. The face and scalp contain the highest levels of sebum, but sebum production can often contribute to acne. Sebum composition is altered in those with acne, and when it contributes to the condition, irritation and destruction of the follicular wall causes an inflammatory reaction.

Researchers can study and measure the body’s ability to combat oxidative stress through several approaches. The body uses a molecule known as superoxide dismutase (SOD) to scavenge free radicals and reduce their toxicity within the body. When SOD converts harmful molecules to a less toxic form, it creates a byproduct called malondialdehyde (MDA). By measuring the levels of MDA, the researchers are able to get an idea as to how much oxidative stress the body undergoes. This measurement is important, as it indicates cellular damage caused by insufficient antioxidant consumption.

One study used 50 participants with acne to study the role of oxidative stress in different clinical severities of acne. First, the patients were assessed as to the onset, duration, and course of their lesions. Researchers then gave each patient a score that reflected the severity of their acne using the Global Acne Grading System (GAGS). The measurement was made by determining the site of the lesions and the number of lesions at each site. The grades were as follows: mild (1-18); moderate (19-30); severe (31-38); and very severe (>39). The researchers measured oxidative stress by MDA and SOD present in the patients’ blood. When the researchers compared SOD levels in the patient group, they learned that SOD levels widely vary according to the patient’s GAGS score. The same was observed in terms of MDA levels – showing significant differences according to GAGS scores. The conclusion was that SOD levels increase when the body reacts to oxidative stress occurring as a result of oxidant/antioxidant imbalance in the body.

When discussing their findings, the researchers explain that previous studies have had similar conclusions, yet the theories that underlie this phenomenon widely vary. One previous study suggested that high levels of MDA are due to high levels of lipid peroxidation due to exposure to oxidative stress. Another study suggested that ROS generated by acne inflammation is partially scavenged by the body’s antioxidant defense system, and that ROS might not cause lipid peroxidation. Most researchers, however, agree that SOD levels in patients with mild acne represent an appropriate response by the antioxidant defense system when coupled with normal MDA levels. In the group with mild acne, MDA levels stayed within normal range, so it’s likely that the patients’ antioxidant defense system is equipped to combat low levels of oxidative damage in this group. This is a likely theory, and in addition, is corroborated by the SOD and MDA levels seen in more severe acne cases. As the severity of acne increases, the body’s protective mechanisms become inadequate to combat the associated oxidative damage – and this is reflected in decreased SOD activities and increased MDA activities in the group of patients with moderate acne. In patients with severe acne, SOD levels were significantly decreased, while MDA levels were significantly increased, which represents the body’s inability to address high levels of oxidative damage. The study confirms the researchers’ hypothesis that the oxidant/antioxidant balance is affected depending on the severity of the acne.

Perhaps one of the most important questions is whether oxidative stress is a cause or consequence of acne. While we know that the antioxidant defense system is impaired in severe cases of acne, additional studies are necessary to explore oxidative damage as a cause or outcome of inflammation. Either way, the studies indicate that antioxidant supplementation may be helpful in treating acne and maintaining skin health. Researchers are currently putting together studies that examine different types of antioxidants and their effects in various forms of acne severity.

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