Acne vulgaris is the most common disease of the skin. Obesity is arguably the commonest of a clinical entities in the affluent society. The pathogenesis of these disorders is far from clear cut and they appear to have little in common. In the present paper it is hypothesized that the pathogenesis of both acne vulgaris and obesity is largely due to a relative deficiency of the same agent, pantothenic acid, a vitamin that is hitherto quite unknown to cause any deficiency syndromes in man. Furthermore, the evidence suggests that surprisingly large doses of pantothenic acid are required to overcome deficiency states as illustrated in the treatment of acne vulgaris and weight reduction.
In reviewing the numerous studies that deal with the pathogenesis of acne vulgaris, and one gets the impression of reading a detective story. There is the victim. The facts are all there. There are all the clues, as well as the suspects. But the culprit cannot be identified. The identification is made the more difficult because the clues seem all tangled up. At times, they fit in with the suspects very well, other times however, the same clues are contradictory, and appear to lead to a hopeless situation. In the same way, it is quite a mystery that an over-weight person, with an abundance of energy deposited as fat depot, cannot efficiently use this stored fat in times of need as during dieting when food intake does not meet the energy demand. Not only is this precious stored unavailable,I n some cases it is actually squandered.
In two previous articles1,2 the author reported that both of these two conditions are related largely to a deficiency in dietary pantothenic acid. It is the aim of this present article to expand and to describe in greater detail the reason and logic behind the hypothesis.
Over the years, the pathogenesis of acne vulgaris has been extensively studied3,4,5 including, the structure and function of the pilosebaceous follicle,6 the physiology of sebum secretion7,8,9 the com- position of sebum10-13 microflora in acne vulgaris,14 and abnormal follicular keratinization15,16 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, however, is by no means novel. Textbooks do briefly mention this correlation17,18,19 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, and is bad for acne.20-23 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 an improvement of the clinical condition. This observation forms the basis of my hypothesis that the disease process may be connected with fat metabolism–or a deficiency of it.
Other arguments also support this hypothesis. There is the composition of the sebum secretion which consists mainly of lipid material.10,11,13 When lipids are deposited in the sebaceous glands and excreted as sebum secretion, it does suggest some abnormality is going on and hint that some form of fat metabolism may be at fault. These fatty materials, after all, are energy- rich compounds. Under normal circum- stances, they should be stored away in fat depots. To have them excreted with a concomitant wastage of energy is not nature’s way of handling excess energy. One possibility the body behaves in such a manner is that it is simply unable to cope effectively with all the fat that is being absorbed, re- sulting in some being dumped through some unusual venue. This perhaps helps to explain the observation that an increase in fat content of food appears to worsen acne.
Back to Skin Care Research