Lactoferrin with vitamin E and zinc safe, effective for treatment of acne
Daily intake of lactoferrin with vitamin E and zinc appears to safely and effectively reduce acne lesions in individuals with mild-to-moderate acne vulgaris compared with placebo, according to a study.
“Current standard of care treatments for mild to moderate acne vulgaris exhibit well-known side effects, including local skin irritation, photosensitivity, teratogenicity and antibiotic resistance, which limit their use,” the authors said. “[The present] data support the potential use of lactoferrin as a safe and effective alternative or adjunct therapy to standard acne treatments.”
A total of 164 individuals aged 13 to 40 years were randomized to receive either a capsule formulation containing lactoferrin with vitamin E and zinc (LEZ group; n=82; mean age 19.3 years; 55 percent male) or placebo (n=82; mean age 19.4 years; 48 percent male) twice daily for 3 months. Respective total lesion and inflammatory lesion counts at baseline were 42.3 and 7.3 in the LEZ group and 35.9 and 6 in the placebo group. The primary outcome measure was a reduction in the number of acne lesions.
Compared with the placebo group, the LEZ group demonstrated a significant reduction in total lesions as early as week 2 (14.5 percent; p=0.0120). The maximum reduction occurred at week 10 (28.5 percent; p<0.0001). Similar results were observed for comedones (32.5 percent; p<0.0001) and inflammatory lesions (44 percent; p<0.0001) in the LEZ vs placebo group, with the maximum reduction observed at week 10. [Int J Dermatol 2017;doi:10.1111/ijd.13607]
A Mann-Whitney test revealed marked differences in the efficacy of LEZ between males and females. Specifically, a significant reduction in median total lesions was observed at week 2 in females (23 percent) and only at week 10 in males (19.6 percent). A similar pattern of response was seen for comedonal acne, with a significant reduction starting to take place at week 2 in females (21 percent) and only at week 12 in males (19 percent). No gender-specific difference was observed in LEZ response to inflammatory lesions.
Sebum levels also improved significantly, albeit slightly, by week 12. No adverse events were reported during the trial.
“Lactoferrin is an iron-binding milk-derived protein that has shown antibacterial and anti-inflammatory effects in vitro and in vivo,” the authors said. “Additionally, vitamin E and zinc have potent antioxidant and anti-inflammatory properties that are important for skin health.” [Biochem Cell Biol 2006;84:275–281; Nutrients 2010;2:903–928]
They pointed out that the potential mechanism by which lactoferrin can resolve acne involves a complex combination of antibacterial, anti-inflammatory and sebum-controlling effects. [Nutrition 2010;26:902–909; Arch Oral Biol 2011;56:869–876]
“Lactoferrin has both bacteriostatic and bacteriocidal effects due to its iron-sequestering and bacterial membrane-binding properties, respectively. A systemic antibacterial effect may lead to a dampened innate immune response involving TLR-2 and NLRP3 inflammasome. This, in turn, regulates the expression of downstream inflammatory cytokines such as IL-8, IL-12 and IL1b,” they explained. [Swiss Med Wkly 2012;doi:10.4414/smw.2012.13590]
The authors acknowledged that the study might be limited by their inability to individually assess the extent of contribution of each of the three substances in the formulation.
“Although several clinical studies have demonstrated the antiacne effects of zinc, these were at doses much higher than the dose used in this study. Also, no studies have been done to assess the effect of oral vitamin E against acne,” they noted.
“Because of these reasons, there is strong reason to believe that lactoferrin is the main component responsible for the reduction in acne lesions. Nevertheless, the potential synergistic effect of this combination cannot be discounted. The antioxidant effects of both vitamin E and zinc may also have contributed to a general improvement in overall skin health,” they said.
In an email to MIMS, Dr Hiok Hee Tan, senior consultant dermatologist at Thomson Specialist Skin Centre in Singapore, pointed out that larger studies are warranted before it can be concluded that lactoferrin with vitamin E and zinc can be used as a substitute to any of the pre-existing established medications.
“If you look at the results, the average number of [baseline] inflammatory lesions [in the group receiving the study drug] was very low (about 7 per patient). Therefore … any small change in the number of lesions would then result in a relatively large change in percentage terms, but might not be as meaningful clinically,” Dr Tan noted.
He also said he would not recommend routinely giving patients lactoferrin with vitamin E and zinc as a primary treatment for acne based on the results of the current study.
“The currently available treatment options for acne vulgaris are useful, but they must be used in the right clinical context. All medications can have possible drawbacks, but it does not mean they should not be used. Based on current established guidelines, they are effective and safe,” he said.
Clinicians should consider their patients’ wishes and circumstances when managing acne, he continued.
“The guidelines are useful, but they may still need to be tailored to each individual patient based on whether they have co-morbidities such as eczema (which might make them more likely to get irritation from some topicals), how much psychologically they are affected by acne and if they plans for pregnancy, among others,” he said.