Ep 79: How Antioxidants Influence Acne Treatment
In this episode, Dr. Teo Wan Lin, board-certified dermatologist, shares about oxidative stress and acne, and the effects of antioxidant skincare.
We have all heard about damaging free radicals that generate in response to environmental stress, causing sun damaged, aging skin. Did you know that free radicals can also worsen acne? Acne-prone skin often associates with excessive oil production. A process known as lipid peroxidation generates free radicals, increasing oxidative stress and reducing the natural antioxidant protection of skin. This promotes comedone formation and inflammation in acne. Join in the discussion on the effects of antioxidant skincare in this episode brought to you by SkinCeuticals.
Potent antioxidants such as Silymarin CF, containing silybin, L-ascorbic acid, ferulic acid and salicylic acid prevent oil oxidation, reducing acne flares. Participants in a 12-week clinical study saw 16% reduction in skin oiliness within 1 week and also a 27% reduction in blemishes overall2.
Today’s podcast episode goes into the latest research on antioxidants for acne treatment, including effective active ingredients incorporated in SkinCeutical’s Silymarin CF serum that targets free radical stress, an increasingly important aspect of acne development recognised by dermatologists.
What causes acne?
Acne is due to a complex interplay of genetics, factors affecting the skin microenvironment – including the microbiome – all of which lead to increased inflammation that causes whiteheads and blackheads to form. Known medically as comedones, these eventually develop into inflamed acne bumps such as papules and cysts. Pore clogging is actually a result of dead skin cells accumulating around the follicles of acne-prone individuals. There is a slower rate of skin shedding which results in formation of whiteheads and blackheads. Larger acne bumps can get severe infection and lead to cyst formation. Rarely, it can even lead to abscesses which are collections of pus and debris. Oil production, triggered by hormonal influences, also increases the formation of comedones.
Traditional treatments for acne focus on a few aspects. Oil control, usually with astringent agents that dry out the pimple, anti-inflammatory treatments with oral antibiotics, are the first line for moderate acne in dermatology practices. Oral contraceptive pills with estrogen help for adult hormonal acne. Topical retinoids work by reducing follicular hyperkeratosis, which is a form of pore clogging. As a last resort, we prescribe isotretinoin for persistent or severe cystic acne, it works by stopping sebum production.
How does free radical stress affect acne?
When our skin has exposure to environmental damage – UV rays, airborne pollutants, and even psychological stress states, it is more susceptible to oxidative stress. This means that damaging free radicals are generated. Usually, healthy skin counteracts this damage by utilising its innate reserve of antioxidants. In older individuals, there is an impairment in this process. Typically this results in signs of skin aging, dullness, wrinkles, pigmentation and irregular skin texture. In acne-prone individuals, however, dermatologists have discovered that free radicals directly impact the course of acne.
Oxidative stress promotes comedone formation
Before a whitehead or blackhead appears on the surface of the skin, microcomedones, which are invisible blackheads and whiteheads, form under the surface. This process is aided by dead skin cells retained at the follicles, resulting in a phenomenon known as follicular hyperkeratosis. Research shows that when free radicals generate at the surface of acne prone skin, sebum undergoes a process known as lipid peroxidation1. This process actually promotes comedone formation. Molecules such as advanced glycation end products (AGEs) can enhance inflammation associated with acne.
Specifically, free radicals cause inflammation around pilosebaceous follicles.
These lipid peroxides, formed as a result of sebum and free radical interactions, can induce inflammation around the acne bumps and cysts. Eventually, this increases the risk of the wall rupturing and forming an abscess. This is a vicious cycle when the dead skin and pus release into the skin tissues as the body mounts an immune response to fight against it, resulting in even more redness and swelling.
Additionally, research shows that excess oil production and oxidative stress reduces natural antioxidant protection of skin. There is likely a direct link between oil oxidation and the formation of blemishes. When skin oils oxidize, free radical damage occurs. This then triggers a vicious cycle of inflammation and bacteria that links to blemish formation. Daily environmental aggressors like sun and pollution can generate free radicals that further oxidize skin oils.
With this background understanding of free radical damage and how it affects acne, the next part of our discussion will zoom in on antioxidant skincare, which are the solution to oxidative stress caused by free radical damage.
What are antioxidants?
Antioxidants are bioactive molecules, which can be synthetic or extracted from natural botanical sources. Vitamin C and its related compounds used in antioxidant skincare, such as L-ascorbic acid, sodium ascorbyl phosphate are examples of synthetic bioactive ingredients that have antioxidant properties. Naturally existing plant molecules also function as potent antioxidants. Essentially, these serve to quench the free radicals generated, reducing environmental damage to skin. Antioxidants are usually discussed in the context of skin aging. However, as we have discussed so far, they also play a key role in fighting acne.
How do antioxidants influence acne?
Primarily because research shows that the oil on acne prone skin undergoes oxidation when exposed to stress. Thus, antioxidants can play a part in reducing the harmful effects of this process. Applying an antioxidant skincare serum, for example, makes the local skin environment less hospitable for acne-causing bacteria such as Cutibacterium, previously known as P. Acnes. As we have discussed earlier, antioxidants in fact play a more critical role – reducing lipid peroxidation1 which directly impacts inflammation and comedone formation.
A holistic approach to acne treatment
Acne, being a very common skin condition, should never be overlooked. It could be a skin condition that is highly distressing, impacting one’s quality of life. The issue with traditional over the counter skincare formulated for acne is that it does not address the underlying process of inflammation. Now that the latest research shows us the key features influencing inflammation in acne formation, we have a better approach to skincare for acne sufferers.
Benefits of antioxidant skincare for acne scars
Acne marks and scars are also a key concern for those who suffer from acne. The initial redness known as post inflammatory erythema becomes post inflammatory hyperpigmentation.This eventually either resolves or persists as a form of acne scarring. Deeper inflammation caused by acne papules and cysts can lead to indented scars. These are what we know as ice pick or box car type scars. Often by the time these form, only ablative resurfacing procedures such as fractional CO2 lasers can help. The key is to create the optimal wound healing environment while the acne bump is healing. In order to minimise the chance of permanent scars. This is where antioxidant skincare plays a critical role. Antioxidants engulf free radicals which otherwise overwhelm the skin’s ability to repair damage. This means that cells can also remove pigmentation more efficiently, and repair the area of damage faster and better.
Why Silymarin CF is ideally formulated for acne treatment
Silymarin CF is a breakthrough vitamin C serum by SkinCeuticals developed for oily and blemish-prone skin. It comprises 0.5% silymarin (milk thistle extract), 15% L-ascorbic acid, 0.5% ferulic acid and 0.5% salicylic acid. These synergize to help prevent oil oxidation. Silymarin is a powerful antioxidant derived from the milk thistle plant. It contains a high concentration of silybin, the active compound within the extract which prevents oil oxidation that contributes to breakouts. This is why Silymarin CF reduces breakouts and also visible signs of skin aging for adult acne sufferers. Its high antioxidant capacity also means it can reduce acne marks and scars.
How does Silymarin CF work?
In a study conducted by L’Oréal, participants who used Silymarin CF saw a 16% reduction in skin oiliness within 1 week and also a 27% reduction in blemishes overall in a 12-week period2. It is an oil-free formula that is also comfortable on skin in humid climates such as Singapore. In fact, it has been clinically demonstrated to reduce oil oxidation by up to 76%, as well as reduce oiliness, refine skin texture, and visibly improve skin clarity and fine lines.
Another key characteristic of this combination antioxidant skincare serum is that it is formulated under the Duke Antioxidant patent. This means it is designed to be optimally absorbed by skin, especially in the context of Vitamin C or L-ascorbic acid. The Duke Antioxidant patent outlines the formulation parameters required for effective delivery of vitamin C to skin: 1) pure L-ascorbic acid (vitamin C); 2) an acidic pH within the 2.0-3.5 pH range and; 3) a concentration between 10%-20%. SkinCeuticals is the only brand to formulate antioxidants according to these parameters.
The ideal antioxidant acne serum
The ideal acne serum is one that targets inflammation and oxidation. Silymarin CF improves acne, oiliness and skin clarity.
While traditional acne skincare seems focused on antibacterial face washes, astringent toners and pimple creams, the latest research we discussed today provides the scientific grounds for incorporating effective antioxidant skincare serums for the treatment of acne. Silymarin CF specifically, provides advanced antioxidant protection from environmental aggressors. Overall, this helps prevent oil oxidation that can lead to breakouts. The clinical studies also show that it reduces oiliness, a common complaint of acne sufferers. More than that, Silymarin CF was able to minimize pore appearance and other parameters of cosmetic concern. These include a more refined skin texture, improved skin clarity, radiance, and uneven skin tone. For those concerned with skin aging, it also was associated with improved appearance of fine lines.
To recap, what we have learnt today is that free radical damage isn’t just relevant for skin aging. It is also an important concept in acne formation, because sebum, when oxidised can generate more inflammation and worsen the vicious cycle of acne. Free radicals do not just damage the skin, but they can also trigger off inflammation and harmful bacteria linked to acne formation. Living in an urban environment, many of us are also exposed to daily environmental aggressors like the sun and pollution which directly generate free radicals that further oxidise skin oils. Hence, it is important for us to appreciate that potent plant-based antioxidant serums such as Silymarin CF, can not just provide antioxidant protection against free radicals and prevent skin aging, but also prevent oil oxidation which worsens acne flare ups.
As always, thank you for allowing me to be part of your skincare journey. You can follow me on Instagram @drteowanlin and also do remember to check out our podcast transcript on www.ScienceOfBeauty.Net for more on this week’s episode.
1. Bowe WP, Logan AC. Clinical implications of lipid peroxidation in acne vulgaris: old wine in new bottles. Lipids Health Dis. 2010 Dec 9;9:141. doi: 10.1186/1476-511X-9-141. PMID: 21143923; PMCID: PMC3012032. (PubMed)
2. Lynch S, Patel K, Lee B, Choudhary H. A Topical Antioxidant Serum Containing Silymarin Reduces Sebum Peroxidation and Improves Facial Acne. Poster presented at: 2022 American Academy of Dermatology Annual Meeting; 2022 Mar 25-29; Boston, MA.
This podcast episode is sponsored by SkinCeuticals as a joint collaboration to create scientific educational content relevant to skincare and dermatology. Images produced as part of editorial collaboration consistent with site policy.