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Zinc Levels in Patients with Acne Vulgaris

Yeim KAYMAK,1* Esra ADIEN,2 Murat ERHAN,3 Blent ELK,4 Mehmet Ali GRER5
1Dermatology Specialist, Health Center, Gazi University; 2Dermatology Specialist, Department of Dermatology,

Faculty of Medicine, Gazi University; 3Clinic Microbiology Specialist, Health Center, Gazi University; 4PhD, Biosta-
tistics Specialist, Vocational Education Faculty, Gazi University; 5Professor, Department of Dermatology, Faculty
of Medicine, Gazi University, Ankara, Turkey.
*Corresponding author: Yeim Kaymak, MD Hodere Cad. air Baki sok. 2/5 Y. Ayranc, Ankara 06540 Turkey

J Turk Acad Dermatol 2007;1 (3): 71302a
This article is available from:
Key Words: acne treatment, inflammatory acne, serum zinc level, zinc deficiency


Objectives: Zinc is a trace element required for the growing and developing organism and is found
in quite high levels in the epidermis of the skin. Zinc deficiency is one of the most common mineral
deficiencies encountered in our country where 70-80% of the daily calorie requirement is obtained
from grains and grain products.
The aim of our study was to determine the effect of zinc deficiency on the development of acne in
students who were unable to follow an adequate and stable diet at the university through measur-
ing the serum zinc levels in students presenting with a complaint of acne.
Methods: The study included 47 patients with acne vulgaris and 40 healthy control subjects. The zinc
levels were measured in the serum obtained from the acne patients and control subjects.
Results: The acne patients had low zinc levels at a rate of 54.1% while only four cases (10.0%) in the
control group had low zinc levels. When serum zinc levels of the acne patients and the control
group were compared, the zinc level was statistically significantly lower in the acne group. Correla-
tion studies showed no relation between the zinc level and the degree of acne or disease duration.
Conclusion: We believe that determining serum zinc levels in acne patients is necessary and an
easy method, and that prescribing zinc supplement treatments for patients with low serum zinc lev-
els may help increasing the success rate of acne treatment.

Introduction such as growth hormone, insulin, sex hor-

mones and thymulin and influences the ac-
Zinc is a trace element found in the struc- tivity of these hormones [2, 3].
ture of many metalloenzymes that play a Meat and fish products are the best sources
role in important functions such as protein of nutrition for zinc content and bioavail-
synthesis, DNA and RNA replication and ability. The zinc in food of animal origin is
cell division. Zinc is therefore required for absorbed better than zinc in food of grain
growth and development [1]. It plays a role origin [4]. The phytates present in grains
in delayed type hypersensitivity reactions, bind zinc and decrease its absorption. Zinc
regulation of inflammation, normal kerato- deficiency is a common mineral deficiency
genesis, cell membrane stabilization and in our country where 70-80% of the daily
many enzymatic reactions. Zinc is also a calorie requirement is derived from grains
structural component of many hormones and grain products [3].

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J Turk Acad Dermatol 2007; 1 (3): 71302a.

Zinc deficiency can be due to genetic or ac- cording to the International Consensus Confer-
quired causes. Genetic zinc deficiency leads ence on Acne Classification system [10] with the
to acrodermatitis enteropathica, charac- following categories: mild; few to several comedo-
terized by red, patchy and scaly dermatitis nes, papules, and pustules, no nodules, moder-
ate; several comedones, papules, pustules, few
involving the face, periorificial and anogeni- to several nodules, and severe; numerous come-
tal regions, papulopustular, psoriasiform or dones, papules, and pustules, many nodules.
vesiculobullous eruptions of the acral re- The face, chest, neck, and back of all acne pa-
gions, and alopecia. Acquired zinc defi- tients were examined at a close distance under
ciency can be associated with alcoholism, bright lighting. After grading, fasting venous
chronic diseases, malabsorbtion due to je- blood samples were obtained from a forearm vein
junoileal bypass and consumption of food with needle technique for zinc. Serum zinc levels
with a high phytate content such as some were determined by colorimetric test using a Co-
bas-Mira (Wartenberg, Germany) autoanalyzer
high-fiber vegetable and grains [5].
with Randox kits. The normal value of zinc in
The acne-like papulopustular lesions in zinc adults was accepted as 46-150 mg/dl. The zinc
deficiency and their rapid improvement with levels of acne and control groups were compared
zinc supplementation have led some investi- statistically with the Student t test and p<0.05
was accepted as significant.
gators to assess the relationship between
serum zinc levels and acne. These studies
are few in number but have shown that pa- Results
tients with acne have low serum zinc levels
although these levels do not correlate with The patient group with acne consisted of 31
the severity of disease [6]. Some authors females (66.0%) and 16 males (34.0%) with
have therefore combined zinc to inflamma- ages between 16 and 25 (mean 20.36) and a
tory acne treatment, and it is still used with disease duration of one months to 10 years
varying rates of success [7, 8, 9]. (mean 46.6 months). The control group con-
sisted of 20 females (50.0%) and 20 males
The aim of the study was to determine the (50.0%) with ages between 17 and 25 (mean
serum zinc levels in university students 21.13).
with acne.
The severity of acne was mild in 12 patients
Materials and Methods (25.5%) and moderate in 35 (74.5%). The
zinc level was low in 54.1% of acne patients
A total of 47 patients presenting to our outpa- while only four control group subjects
tient department with acne vulgaris and 40 vol- (10.0%) had zinc levels lower than normal.
unteers with no acne or abnormal dermatological Statistical comparison of acne and control
or systemic findings were included the study.
groups revealed that patients with acne had
The acne and control groups were matched for
mean age and gender. None of the women in pa- significantly lower serum zinc levels
tient and control groups was using oral contra- (p<0.05) There was no significant difference
ceptives, and none was pregnant. The age, gen- between the serum zinc levels of two
der and disease duration were noted for patients groups, according to sex, acne grade and
with acne and acne grading was assessed ac- disease duration (Table 1).

Table 1. Descriptive Characteristics of the Study Groups

Acne Group (n=47) Control Group (n=40)

Age (Years) Mean (SD) 20.36 (1.98) 21.13 (2.13)

Range 16 - 25 17 25

Gender Female 66.0 % (31) 50.0 % (20)

Male 34.0 % (16) 50.0 % (20)

Acne grade Mild 25.5 % (12)

Moderate 74.5 % (35)

Acne duration (Months) Mean (SD) 46.62 (33.18)

Range 1 - 120

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Discussion [9]. However, how zinc deficiency in the epi-

Zinc is a trace element that is necessary for dermis causes acne or its importance in the
epithelial differentiation and normal puber- course of inflammatory acne is not known.
tal growth. It exists in high amounts within The probable association between zinc and
the skin and especially the epidermis [5]. Its acne may be due to the anti-inflammatory
importance for human metabolism has action of zinc together with its effects on an-
been noted by the dramatic improvement of drogen metabolism and vitamin A metabo-
acrodermatitis enteropathica following zinc lism [12].
supplementation. A case of acrodermatitis
The effect of zinc on inflammatory cells and
enteropathica was reported, where severe especially on granulocytes is the most im-
acne also completely resolved with zinc portant mechanism relevant to acne [7].
treatment [9]. Zinc plays a regulatory role in the control of
There are few studies regarding the rela- bactericidal activity and phagocytosis, sta-
tionship between zinc deficiency and acne. bilizes macromolecules and lysosomes, in-
Michaelson et al. studied zinc levels in the creases the speed of neutrophil chemotaxis
serum, epidermis and dermis of 73 patients and complement activation and has an anti
with inflammatory acne, aged 15-28, with -inflammatory effect [12, 13]. Studies with
an acne degree of 3-4 and disease duration laboratory animals have shown that zinc in-
of 1-10 years. The dermal and epidermal hibits histamine secretion from mast cells
zinc levels of male patients were signifi- and prevents inflammatory phenomena
cantly lower than the control group, while [14].
the serum zinc levels were similar. There Another mechanism binding zinc deficiency
was also no association between the serum and acne development involves the retinol
levels and epidermal and dermal zinc levels binding protein (RBP). RBP enables the
[8]. Amer et al. have compared the serum transport of vitamin A to the tissues and its
zinc levels in 50 patients with acne vulgaris serum level reflects the levels of vitamin A
(31 males, 19 females) and 38 control sub- in target organs. Zinc is essential for RBP
jects (20 males, 18 females) and found sta- synthesis and secretion in the liver [15].
tistically significantly lower zinc levels in
Zinc is thought to influence vitamin A
grade III and IV acne patients compared to transport and utilization directly or indi-
the control group. The zinc levels of grade I rectly through some enzymes and prevent
and II female acne patients were also lower keratinization and follicular obstruction
than control females and the levels in the [16]. Michaelson et al. have found signifi-
affected males were lower than the control cantly lower RBP levels in patients with se-
males [11]. The present study involved acne vere acne, in their study of 173 acne pa-
patients who had inflammatory mild and tients (97 males, 76 females) aged 15 or
moderate acne. Supporting the previous
over [9].
studies, our study revealed statistically sig-
nificantly lower serum zinc levels in pa- Damage to the zinc-dependent enzyme sys-
tients with acne, as compared with the con- tems in androgen synthesis is thought to be
trol group. We believe that the zinc defi- another mechanism explaining zinc defi-
ciency among the university students par- ciency and development of acne vulgaris. It
ticipating in this study may be related to in- has been shown that testosterone converts
adequate and unbalanced nutrition. Since mostly into DHT with the reductase enzyme
patients with severe acne is not included in and that zinc inhibits the reductase enzyme
the study, the power of our results to docu- [17].
ment the relationship between the serum
Zinc tablets are used with various success
zinc levels and the severity of acne is lim-
rates in the treatment of patients with in-
flammatory acne [7, 11, 12]. Reports rec-
The zinc deficiency in acne patients has ommend 400-600 mg zinc sulphate/citrate
been associated with nutritional deficiency, effervescent tablets or the zinc sulphate
dieting patients, decreased absorption, and tablet form for acne treatment [18]. Topical
increased excretion with sweat or feces. The formulations have also been developed and
inflammatory reaction in acne patients is their efficacy was evaluated in patients with
another factor decreasing serum zinc levels acne [19, 20].

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J Turk Acad Dermatol 2007; 1 (3): 71302a.

There are only a few studies on the serum 10. Pochi PE, Shalita AR, Strauss JS, Webster SB,
Cunliffe WJ, Katz HI, Kligman AM, Leyden JJ,
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Lookingbill DP, Plewig G. Report of the Consensus
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acne and that zinc supplementation in pa- associated with consumption of zinc. Mayo Clin
tients with low serum zinc levels will in- Proc 2002; 77: 713-716. PMID: 12108610
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vulgaris. Drugs 2004; 64: 2389-2397. PMID:
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