Applied nutritional investigationDietary effect of lactoferrin-enriched fermented milk on skin surface lipid and clinical improvement of acne vulgaris
Introduction
Acne vulgaris is a widely prevalent skin condition that affects nearly 80% of adolescents and most of the population at some point in their lives [1], [2]. The earliest non-inflammatory acne lesions may be no more than a minor annoyance, but in persons with more harsh inflammatory acne lesions, embarrassment, social withdrawal, and physical and psychological scarring can be life-changing [3], [4].
The earliest non-inflammatory lesions in acne vulgaris are microcomedones, which are formed as a result of follicular plugging and sebaceous gland hyperplasia with increased sebum production [1], [5], [6]. As the lesions increase in size, they become non-inflamed closed or open comedones (whiteheads or blackheads, respectively) [1], [5], [6]. In time the comedones may fill with Propionibacterium acnes bacteria, which secrete chemotactic and proinflammatory byproducts, inflammatory cells surround the follicle, disperse through the follicular wall, and lead to larger and inflammatory lesions, such as papules, pustules, and nodular cystic lesions [1], [5], [6].
A better understanding of the pathogenesis of acne vulgaris, coupled with an adverse effect and the lack of therapeutic benefit of pharmaceutical agents, is developing new insights into the relation among food intake, dietary supplements, and skin health [7]. Low–glycemic-load diets have been reported to improve symptoms of acne vulgaris in adolescent patients [8]. Experimental evidence has suggested that increased ingestion of ω-3 polyunsaturated fatty acid can decrease inflammatory acne lesions by inhibiting the synthesis of proinflammatory eicosanoids [9]. In addition, daily ingestion of Lactobacillus bulgaricus and acidophilus has been shown to relieve acne symptoms by inhibiting the production of proinflammatory cytokines [10]. Lactoferrin has also been shown to decrease skin inflammation due to its broad antibacterial and anti-inflammatory activities [11].
Lactoferrin is a whey milk protein after removing precipitated casein [12], [13]. Although it is not the major whey protein, lactoferrin is known to have prominent activities against inflammation and microbial infection in vitro [11], [12], [13]. As an iron-binding protein, it sequesters iron that is essential for microbial growth, and it can also bind directly to the bacterial membrane and increase bacterial membrane permeability for bacteriocidal activity [11], [12], [13]. It also modulates the immune system by inhibiting the production of proinflammatory cytokines [14], [15], [16]. However, most anti-inflammatory activities of lactoferrin have been observed in in vitro studies [11], [12], [13], [14], [15], [16] and little information is available on the systemic effects of lactoferrin as a dietary supplement. Therefore, in this study, we investigated the dietary effects of lactoferrin-enriched fermented milk on patients with mild to moderate acne vulgaris, a prevalent inflammatory skin condition.
Section snippets
Subjects
The study protocol was approved by the Kyung Hee University/Kyung Hee Medical Center human investigation review committee (Seoul, Korea). Patients signed informed-consent forms before inclusion. Clinical investigations were conducted according to Declaration of Helsinki principles. Healthy male and female patients with mild to moderate acne vulgaris of the face, with at least 15 inflammatory and/or non-inflammatory lesions but no more than three nodulocystic lesions and an acne grade of ≥2.0 to
Clinical assessment
The baseline characteristics of the subjects are listed in Table 1. There were no differences between male and female subjects for any of the baseline characteristics; therefore, the data for male and female subjects were combined. There was no difference in body weight and body mass index between groups. The clinical severity of acne vulgaris at baseline matched well to dermatologic assessment as inflammatory lesion count (ILC), total lesion count (TLC), and acne grade, which were not
Discussion
New insights into the beneficial effects of food intake and dietary supplements on health improvement have developed [22], [23]. Specifically, human intervention studies with a low–glycemic-load diet, ω-3 polyunsaturated fatty acid, and Lactobacillus GG [8], [9], [10] have been reported to exert beneficial effects on skin health. In vitro studies [11], [12], [13], [14], [15], [16] and results from orally administered studies in animals [24] have provided evidence that lactoferrin has
Conclusions
This clinical study demonstrated a novel observation that daily ingestion of lactoferrin-enriched fermented milk decreases acne vulgaris with a selective decrease in TGs in skin surface lipids. Lactoferrin-enriched fermented milk may be a potential alternative therapy or may serve as an adjunct to conventional therapies for the treatment of acne vulgaris.
Acknowledgments
The lactoferrin used in this study was in the form of lactoferrin-enriched whey protein concentrate (80% lactoferrin) under the trade name of Praventin and was supplied by DMV International, Veghel, The Netherlands. Preparations of lactoferrin-enriched fermented milk were provided by Pasteur Milk Co., Ltd. (Gangwon-do, Korea).
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This study was supported by a research grant from Pasteur Milk Co., Ltd., and Whanee Corp.