10.5826/dpc.1201a29
Introduction: As no centralized database of acne supplements is available, we aimed to provide an overview of these products, with a focus on safety.
Objectives: The objectives of this study were to document the number, formulation, contents, and marketing strategies utilized by acne supplements sold online.
Methods: An online search was conducted between March and May 2020. Products were included in the study if they used the terms: “whitehead”, “blackhead”, or “acne”. Data were extracted from the website, box, and Supplement Facts label.
Results: 49 products were identified, which contained 146 unique ingredients. These included vitamins, minerals, food extracts, botanical extracts, amino acids, animal products, and distinct microbial strains. Few (4.1%) products were tested by third parties.
Conclusions: This survey of acne supplements available online raised concerns regarding lack of warning labels, teratogenicity, exceedingly large levels of vitamins and minerals, and lack of third-party testing. Given the limited regulation and oversight of dietary supplements, it is imperative that physicians educate patients on the potential risks of these products.
text/xml
2160-9381
1751
en
Rajani Katta
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
safety
Acne Supplements Sold Online
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Original Article
2022-02-02
2021-04-06
2022-02-02
2022-02-09
e2022029
Dermatol Pract Concept
Introduction: As no centralized database of acne supplements is available, we aimed to provide an overview of these products, with a focus on safety.
Objectives: The objectives of this study were to document the number, formulation, contents, and marketing strategies utilized by acne supplements sold online.
Methods: An online search was conducted between March and May 2020. Products were included in the study if they used the terms: “whitehead”, “blackhead”, or “acne”. Data were extracted from the website, box, and Supplement Facts label.
Results: 49 products were identified, which contained 146 unique ingredients. These included vitamins, minerals, food extracts, botanical extracts, amino acids, animal products, and distinct microbial strains. Few (4.1%) products were tested by third parties.
Conclusions: This survey of acne supplements available online raised concerns regarding lack of warning labels, teratogenicity, exceedingly large levels of vitamins and minerals, and lack of third-party testing. Given the limited regulation and oversight of dietary supplements, it is imperative that physicians educate patients on the potential risks of these products.
Rajani Katta
2022/02/02
10.5826/dpc.1201a29
e2022029
Department of Dermatology, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, TX, USA
2160-9381
safety
en
e2022029
Zamil DH, Perez-Sanchez A, Katta R. Acne related to dietary supplements. Dermatol Online J. 2020; 26(8):13030/qt9rp7t2p2. PMID: 32941710.
Acne Supplements Sold Online
https://dpcj.org/index.php/dpc/article/download/1751/1495
                             Acne Supplements Sold Online
        Emily Burns1, Milbrey Parke1, Ariadna Perez-Sanchez2, Dina Zamil1, Rajani Katta3


1 Baylor College of Medicine, Houston, TX, USA
2 Department of Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
3 Department of Dermatology, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, TX, USA



Key words: acne supplement, dietary supplement, diet, nutrition, safety
Citation: Burns E, Parke M, Perez-Sanchez A, Zamil D, Rajani K. Acne supplements sold online.
Dermatol Pract Concept. 2022; 12(1): e2022029. DOI: https://doi.org/10.5826/dpc.1201a29
Accepted: August 2, 2021; Published: January 2022
Copyright: ©2022 Burns et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Rajani Katta, MD, Department of Dermatology, McGovern Medical School at University of Texas Health Science
Center at Houston, Houston, TX, USA. E-mail: info@kattamd.com




  ABSTRACT             Introduction: As no centralized database of acne supplements is available, we aimed to provide an
                       overview of these products, with a focus on safety.
                       Objectives: The objectives of this study were to document the number, formulation, contents, and
                       marketing strategies utilized by acne supplements sold online.
                       Methods: An online search was conducted between March and May 2020. Products were included in
                       the study if they used the terms: “whitehead”, “blackhead”, or “acne”. Data were extracted from the
                       website, box, and Supplement Facts label.
                       Results: 49 products were identified, which contained 146 unique ingredients. These included vita-
                       mins, minerals, food extracts, botanical extracts, amino acids, animal products, and distinct microbial
                       strains. Few (4.1%) products were tested by third parties.
                       Conclusions: This survey of acne supplements available online raised concerns regarding lack of
                       warning labels, teratogenicity, exceedingly large levels of vitamins and minerals, and lack of third-­
                       party testing. Given the limited regulation and oversight of dietary supplements, it is imperative that
                       physicians educate patients on the potential risks of these products.




Original Article | Dermatol Pract Concept. 2022; 12(1): e2022029                                                                   1
Introduction                                                      Objectives
Dietary Supplements in the US                                        The objective of this study was to document the number,
Dietary supplements are becoming increasingly popular in          formulation, contents, and marketing strategies utilized by
the U.S. Studies estimate that approximately 50% of the US        acne supplements sold online.
population consumes some form of dietary supplement [1].
The number of American people who consume acne supple-
                                                                  Methods
ments is unknown.
                                                                  We conducted a search of acne supplements sold online
The Role of Dietary Supplements in Acne                           between March 2020 and May 2020 using Google, Amazon,
Acne affects up to 50 million American residents each year,       Twitter, and Instagram. Acne supplements were defined as
and its prevalence has been reported to be as high as 85%         those featuring the words “whitehead”, “blackhead”, and/or
among people aged 12-24 years [2,3]. The role of diet and         “acne” (Figure 1). Data were extracted from the Supplement
dietary supplements in the development and treatment of           Facts label, manufacturer website, and/or third-party seller
acne is an evolving field of study. A recent systematic review    website for each product. Third-party sellers include Amazon
including 53 articles revealed that acne-promoting factors        and online supplement retailers.
include high glycemic index food, dairy, fatty food, and choc-
olate. Acne-protective factors include fruits and vegetables.
                                                                  Results
The possible varying degrees of acne-promotion of specific
subtypes of these foods (eg full-fat milk vs. low-fat milk) is    Ingredients
unknown [4].                                                      Forty-nine products were identified, which in total contained
    High doses of oral zinc have been shown to reduce severe      146 unique ingredients including vitamins, minerals, food
and inflammatory acne in double-blind randomized control          extracts, botanical extracts, amino acids, animal products,
trials (RCTs) [5,6]. Successful trials have used different dos-   and distinct microbial strains (Table 1). Products contained
ages and forms of zinc as well as zinc in combination with        an average of 3.18 vitamins, and the most common vitamins
other ingredients [7]. Therefore, future research is needed       included in descending order were vitamins A, E, B3, B5, and
to elucidate the best zinc dose and form associated with          B6 (Table 2). Products contained an average of 2.6 minerals,
improved acne outcomes.                                           and the most common minerals included were zinc and sele-
    Other vitamins and minerals have been studied, but            nium (Table 3). Many products contained supraphysiologic
double-blind RCTs are lacking [5,8]. Low selenium levels          doses of vitamins and minerals (Table 4), (Figure 2).
have been documented in patients with acne; however, the
clinical significance of low selenium and acne development
is unknown [5,9]. A cross-sectional study comparing blood
levels of vitamins A and E in 100 patients with acne and 100
patients without acne showed that subjects with acne had
significantly lower plasma concentrations of these vitamins
compared to the control subjects [5,10].
    Other naturally occurring compounds have been eval-
uated in animal and in vitro studies but human studies are
lacking. These compounds have exhibited antioxidant and
antibacterial properties, such as (--) epigallocatechin-3-gal-
late from green tea and nobiletin from Citrus depressa
(a green citrus fruit native from Taiwan and Japan) [5,11,12].
In hamsters, these compounds have been shown to reduce
sebum production and inhibit cell proliferation of sebaceous
glands respectively.
    The flavonoids kaempferon and quercetin from the
Inpatiens balsamina flower as well as resveratrol found in
several other plants have been shown to possess antibac-
terial properties against Propionibacterium acnes in vitro        Figure 1. Example of product image of an acne supplement sold
[5,13,14].                                                        ­online




2                                                                    Original Article | Dermatol Pract Concept. 2022; 12(1): e2022029
          Table 1. List of Selected Ingredients
 Methylsulfonylmethane (MSM)
 Coenzyme Q10 (CoQ10)
 Horsetail powder
 Pepper extract
 Grape seed extract
 Turmeric
 Diindolylmethane (DIM)
 Licorice root extract
 Bovine Adrenal Powder
 Bacteriophages
 Bovine Colostrum



Table 2. Vitamins Included in Acne Supplements
                  Sold Online
               Vitamin                       % of Products
 A                                                 53.1            Figure 2. Example of Supplement Facts label image from an acne
 B3 (niacin)                                       34.7            supplement sold online
 B5 (pantothenic acid)                             34.7
 B6 (pyridoxine)                                   34.7
                                                                    Table 4. High Doses of Vitamins and Minerals
 E (tocopherol)                                    34.7
                                                                           from Selected Acne Supplements
 No Vitamins                                       32.7
 C                                                 30.6                                                         % of Daily
 B7 (biotin)                                       24.5                   Nutrient         Labeled Dose          Values
 B2 (riboflavin)                                   16.3            Vitamin A              21,000 mcg RAE          2,333%
 B12 (cobalamin)                                   14.3            Vitamin B2                 25 mg               1,923%
 D                                                 14.3            (Riboflavin)
 B1 (thiamine)                                     12.2            Vitamin B3                 500 mg              2,500%
                                                                   (Niacin)
 B9 (folate)                                       10.2
 K                                                     4           Vitamin B5                 350 mg              3,500%
                                                                   (Pantothenic Acid)
                                                                   Vitamin B6                 50 mg               2,500%
                                                                   Vitamin B7               7500 mcg              2,500%
        Table 3. Mineral Content (%) of Acne
                                                                   (Biotin)
              Supplements Sold Online
                                                                   Vitamin B12               500 mcg             20,833%
            Mineral                       % of Products            Vitamin C                  280 mg               467%
 Zinc                                           65.3
                                                                   Chromium                  250 mcg               714%
 Selenium                                       40.8
                                                                   Zinc                       50 mg                333%
 Chromium                                       32.7
 Copper                                         28.6
 Magnesium                                      28.6                  Many products contained botanical and food extracts.
 No Minerals                                    26.5               The most common extracts included were methylsulfo-
 Calcium                                        14.3               nylmethane (MSM, 20%), coenzyme Q10 (CoQ10,13%),
 Manganese                                      12.2               horsetail powder (10%), pepper extract (10%), grape seed
 Sodium                                          8.2               extract (8%), turmeric (8%), diindolylmethane (DIM, 7%),
 Potassium                                       8.2               and licorice root extract (6%).
 Iron                                            6.1
 Sulfur                                          6.1               Formulation
 Iodine                                          4.1               Capsules were the most common formulation, followed by
 Phosphorus                                      4.1               tablets and gummies.




Original Article | Dermatol Pract Concept. 2022; 12(1): e2022029                                                               3
Dosing                                                           minerals, extracts, and other ingredients. They are sold on
47.9% of products did not provide clear labeling for total       manufacturer websites and third-party websites. This study
daily dose. For example, the Supplement Facts box included       raises concerns about lack of US Food and Drug Adminis-
the dose for one capsule, but the recommended dose is two        tration (FDA) oversight, lack of third-party testing, terato-
capsules.                                                        genicity potential, marketing practices, untested ingredient
                                                                 profile, supraphysiologic vitamin dosing, vulnerable patient
Pricing                                                          population, and consumer confusion.
                                                                     The US FDA regulates supplements as foods, not drugs
Pricing varied from $10-204 per month supply. The median
                                                                 [15]. There is no requirement to prove safety or efficacy
price per month was $31.
                                                                 prior to sale, and there is no limit on dosages of vitamins or
                                                                 minerals, even for those with defined tolerable upper limits.
Third-Party Seals of Approval
                                                                 There is also no requirement to test or document interactions
Approximately 4% of products displayed seals of approval
                                                                 between ingredients and/or other medications [16].
from third-party testing centers recognized by the US Office
                                                                     Although the US FDA requires that supplements sold in
of Dietary Supplements.
                                                                 stores display the Supplement Facts label, this requirement
                                                                 does not apply to supplements sold online. On some websites,
Marketing and Claims
                                                                 including Amazon and other third-party sellers, this label was
The most common marketing claims included gluten free
                                                                 not visible.
(67%), vegan or vegetarian (45%), made in the USA (43%),
                                                                     The FDA has issued Good Manufacturing Practices
natural (43%), hormonal balance or regulates hormones
                                                                 (GMPs), which are a set of guidelines for safe manufacturing
(43%), detoxify (41%), inflammation (39%), antioxidant
                                                                 of dietary supplements. The FDA expects manufacturers to
(37%), proprietary blend (26%), and cruelty free (20%).
                                                                 comply with GMPs but does not regularly investigate for
Most (55.1%) products used the terms “research” or “clinical
                                                                 compliance with these rules [15].
study” in the marketing materials. Some (8.2%) products
                                                                     In terms of quality testing, only 4.1% of products in our
cited a clinical study. Most (55.0%) of products had an
                                                                 sample were tested by third-party companies recognized by
auto-delivery or subscription option available upon check-
                                                                 the Office of Dietary Supplements, including the US Pharma-
out. Most (55.1%) of products had a coupon available upon
                                                                 copeia, National Sanitation Foundation, and Consumer Lab.
checkout. Other marketing techniques included before-and-
                                                                 Without US FDA testing or third-party testing, consumers
after photographs (51.1%) and video testimonials (12.2%).
                                                                 must rely only on the companies themselves to ensure the
Most (83.7%) supplements were reviewed on Amazon.
                                                                 safety, purity, and lack of contamination of these products.
                                                                     To date, there is little data about the quality and safety
Labeling                                                         of acne supplements sold online. Ayurvedic medicines sold
Some (20.8%) products had different information provided         online have been documented to contain heavy metals includ-
by multiple sources. In these instances, labels provided by      ing lead, mercury, and arsenic [17]. In 2015, the New York
Amazon sellers conflicted with third party sellers and/or        State attorney general’s office accused four national retailers
manufacturers. For the purposes of the data collection of        of selling dietary supplements containing unadvertised, poten-
this study, the label from the manufacturer website was used.    tially allergenic ingredients. Many products did not contain
Supplement manufacturers are required by law to include the      the advertised herbal ingredients, and some contained aller-
phrase “This statement has not been evaluated by the FDA.        genic components, such as wheat, while advertising that the
This product is not intended to diagnose, treat, cure, or pre-   product was “gluten-free” [18].
vent any disease” on the bottle if a structure/function claim        With regards to teratogenicity, prescription medications
is made. 12.2% of products did not have this phrase clearly      require a package insert with pregnancy warning categories,
visible online. A 53.1% of products did not list a phrase        which indicate risk to the developing fetus. No such notifi-
containing or similar to “Consult your doctor or health care     cation is required for supplements, even for compounds that
practitioner before use” and 30.6% of products failed to         pose a known teratogenic risk. Consumers of child-bearing
include any type of pregnancy warning.                           potential should exercise caution when consuming acne sup-
                                                                 plements, as some of these products may pose a risk to the
Conclusions                                                      developing fetus.
                                                                     High dietary doses of preformed vitamin A (> 10,000 IU)
Acne supplement manufacturers use a wide variety of ingre-       during early pregnancy are associated with neural crest
dients and health claims. There is little consensus among        defects such as cleft lip, ventricular septal defect, transposition
these products regarding the number or dosing of vitamins,       of the great vessels, hydrocephalus, and craniosynostosis [19].



4                                                                   Original Article | Dermatol Pract Concept. 2022; 12(1): e2022029
In our sample, 6.1% of acne supplements sold online included       including children, can order acne supplements online. Par-
potentially teratogenic levels of vitamin A. The teratogenic       ents and pediatricians should be wary of these products, as
potential of another 8% of products containing vitamin A           they are readily available online.
could not be determined because the products did not specify          Finally, of significant concern is that approximately 1 in 5
the form of vitamin A [20].                                        (20.8%) supplements sold in multiple outlets (manufacturer,
    In terms of marketing strategies, most products (55.1%)        third-party, Amazon) displayed varying doses of ingredients.
included the terms “research” or “clinical study” on the           It is unclear which label consumers should use to evaluate the
labeling, and some products cited the research used to             dose and ingredients included in the supplement.
support the claim. Two studies cited by a product were
evaluating magnesium, B6, and a plant extract (Vitex agnes         Limitations
cactus) for use in premenstrual syndrome [21,22]. These               As our study was designed only to investigate products
studies did not evaluate use of these components for acne.         sold online, this represents a limited sample of acne supple-
One website referenced three articles that were not found          ments. Further research should evaluate products sold in
online and could not be substantiated. During the editing          stores. In addition, the authors could not find any PubMed
process, these articles were removed from the product’s            indexed studies evaluating the components of these products
website. Another article did not appear in a PubMed-in-            using laboratory testing.
dexed journal [23].                                                   Dietary supplements marketed for acne include sup-
    Our survey documented a wide variety of ingredients            raphysiologic levels of vitamins and minerals as well as
contained in these products, including many ingredients            food extracts, botanical extracts, amino acids, animal prod-
that have not been tested in human acne studies. The most          ucts, and microbes. These products do not require US FDA
included ingredients outside of vitamins and minerals were         approval and thus do not undergo the same rigorous safety
MSM, CoQ10, horsetail powder, pepper extract, grape seed           and efficacy testing as pharmaceuticals; however, most prod-
extract, turmeric, DIM, and licorice root extract. The topical     ucts include the term “research” or “clinical study” on their
application of grape seed extract is associated with decreased     label. Few products undergo testing by third parties, although
sebum content in human skin [24]; however, we were unable          they can be pharmacologically active and can be linked to
to locate research on oral grapeseed extract intake or the         adverse effects. Many of the ingredients included in acne
other listed compounds in acne.                                    supplements have not undergone RCTs to evaluate their
    Interestingly, the few plant compounds (kaempferon,            efficacy, and high doses of vitamin A may be associated with
querceptin, green tea extract and nobiletin) that have been        birth defects in pregnant patients.
studied in hamsters and in vitro were not the most commonly           As the US FDA does not routinely monitor supplements
used extracts. Some unique and unexpected ingredients              sold in stores or online, consumers and physicians reporting
included bovine adrenal powder, a proprietary enzyme blend         is vital for monitoring adverse events. The US FDA has an
including digestive enzymes, bacteriophages intended to affect     online Safety Reporting portal, which streamlines the process
gut bacteria, and bovine colostrum, intended to improve            of reporting product safety issues. The portal may be found
natural defenses.                                                  here: https://www.safetyreporting.hhs.gov/SRP2/en/Home.
    High-dose vitamins and minerals were used in multiple          aspx?sid=0506bbbe-42e5-40f9-a58b-742b04d74295
products and represent another area of concern. Vitamins A,
B2, B3, B5, B6, B7, B12, C as well as chromium and zinc were
                                                                   References
included in very high doses. As zinc has been shown to reduce
acne, it was unsurprising that zinc was the most commonly           1. Chen F, Du M, Blumberg JB, et al. Association Between Dietary
used mineral (65%) [6].                                                Supplement Use, Nutrient Intake, and Mortality Among US
                                                                       Adults: A Cohort Study. Ann Intern Med. 2019;170(9):604-
    Supraphysiologic doses of vitamins and minerals included
                                                                       613. DOI: 10.7326/M18-2478. PMID: 30959527; PMCID:
in dietary supplements have been linked to multiple side
                                                                       PMC6736694.
effects [25]. For example, vitamins B6 and B12 have been            2. Bickers DR, Lim HW, Margolis D, et al. The burden of skin
associated with a worsening of acne in some reports [26].              diseases: 2004. J Am Acad Dermatol. 2006;55:490–500. DOI:
Surprisingly, products in our sample included both of these            10.1016/j.jaad.2006.05.048. PMID: 16908356.
ingredients at high doses: vitamin B6 at 2,500% of Rec-             3. White GM. Recent findings in the epidemiologic evidence, clas-
                                                                       sification, and subtypes of acne vulgaris. J Am Acad Dermatol.
ommended Dietary Allowance (RDA) and vitamin B12 at
                                                                       1998;39:S34–37. DOI: 10.1016/S0190-9622(98)70442-6. PMID:
20,833% of RDA.
                                                                       9703121.
    As this analysis focused on products sold online, it high-      4. Dall’Oglio F, Nasca MR, Fiorentini F, Micali G. Diet and acne:
lights dangers posed to a vulnerable pediatric population.             review of the evidence from 2009 to 2020. Int J Dermatol.
Many patients suffering from acne are minors. Anyone,                  2021;60(6):672-685. DOI: 10.1111/ijd.15390. PMID: 33462816.



Original Article | Dermatol Pract Concept. 2022; 12(1): e2022029                                                                   5
 5. Bowe WP, Joshi SS, Shalita AR. Diet and acne. J Am Acad Der-                  ber 3, 2020. Available from: https://ods.od.nih.gov/factsheets/
    matol. 2010; 63(1):124-141. DOI: 10.1016/j.jaad.2009.07.043.                  WYNTK-Consumer/. Accessed April 6, 2021.
    PMID: 20338665.                                                         17.   Saper RB, Phillips RS, Sehgal A, et al. Lead, mercury, and arse-
 6. Dreno B, Moyse D, Alirezai M, et al. Multicenter randomized                   nic in US- and Indian-manufactured Ayurvedic medicines sold
    comparative double-blind controlled clinical trial of the safety              via the Internet. JAMA. 2008;300:915–923 DOI: 10.1001/
    and efficacy of zinc gluconate versus minocycline hydrochloride               jama.300.8.915. PMID: 18728265; PMCID: PMC2755247.
    in the treatment of inflammatory acne vulgaris. Dermatol Basel          18.   O’Connor A. New York Attorney General Targets Supplements
    Switz. 2001;203:135–140. DOI: 10.1159/000051728. PMID:                        at Major Retailers. N Y Times. 2015. Available from: https://well.
    11586012.                                                                     blogs.nytimes.com/2015/02/03/new-york-attorney-general-tar-
 7. Katta R, Kramer MJ. Skin and Diet: An Update on the Role of                   gets-supplements-at-major-retailers/.
    Dietary Change as a Treatment Strategy for Skin Disease. Skin           19.   Rothman KJ, Moore LL, Singer MR, Nguyen US, Manni-
    Ther Lett. 2018;23:1–5. PMID: 29357214.                                       no S, Milunsky A. Teratogenicity of high vitamin A intake.
 8. Michaëlsson G, Edqvist LE. Erythrocyte glutathione peroxidase                 N Engl J Med. 1995;333(21):1369-7133. DOI: 10.1056/
    activity in acne vulgaris and the effect of selenium and vitamin              NEJM199511233332101. PMID: 7477116.
    E treatment. Acta Derm Venereol. 1984;64:9–14. PMID: 6203294.           20.   Zamil D, Burns E, Perez-Sanchez A, Parke M, Katta R. Risk of
 9. Michaëlsson G. Decreased concentration of selenium in whole                   Birth Defects From Vitamin A “Acne Supplements” Sold Online.
    blood and plasma in acne vulgaris. Acta Derm Venereol.                        Dermatol Pract Concept. 2021;11(3):e2021075. DOI: 10.5826/
    1990;70:92. PMID: 1967890.                                                    dpc.1103a75. PMID: 34123566; PMCID: PMC8172008.
10. El-Akawi Z, Abdel-Latif N, Abdul-Razzak K. Does the plasma              21.   Fathizadeh N, Ebrahimi E, Valiani M, Tavakoli N, Yar MH.
    level of vitamins A and E affect acne condition? Clin Exp Derma-              Evaluating the effect of magnesium and magnesium plus vitamin
    tol. 2006;31:430–434. DOI: 10.1111/j.1365-2230.2006.02106.x.                  B6 supplement on the severity of premenstrual syndrome. Iran
    PMID: 16681594.                                                               J Nurs Midwifery Res. 2010;15:401–405. PMID: 22069417.
11. Liao S. The medicinal action of androgens and green tea epigal-               PMCID: PMC3208934.
      locatechin gallate. Hong Kong Med J Xianggang Yi Xue Za Zhi.          22.   Schellenberg R, Zimmermann C, Drewe J, Hoexter G, Zahner C.
      2001;7:369–374. PMID: 11773671.                                             Dose-dependent efficacy of the Vitex agnus castus extract Ze 440
12.   Sato T, Takahashi A, Kojima M, Akimoto N, Yano M, Ito A.                    in patients suffering from premenstrual syndrome. Phytomedicine.
      A citrus polymethoxy flavonoid, nobiletin inhibits sebum produc-            2012;19:1325–31. DOI: 10.1016/j.phymed.2012.08.006. PMID:
      tion and sebocyte proliferation, and augments sebum excretion               23022391.
      in hamsters. J Invest Dermatol. 2007;127(12):2740-8. DOI:             23.   Leung LH. A Stone that Kills two Birds: How Pantothenic Acid
      10.1038/sj.jid.5700927. PMID: 17597820.                                     Unveils the Mysteries of Acne Vulgaris and Obesity. Journal of Or-
13.   Docherty JJ, McEwen HA, Sweet TJ, Bailey E, Booth TD. Res-                thomolecular Medicine. 1997; 12(2). Accessed July 2021. http://
      veratrol inhibition of Propionibacterium acnes. J Antimicrob              orthomolecular.org/library/jom/1997/articles/1997-v12n02-p099.
      Chemother. 2007;59:1182–1184. DOI: 10.1093/jac/dkm099.                    shtml
      [PMID: 17449884.                                                      24. Sharif A, Akhtar N, Khan MS, et al. Formulation and evaluation
14.   Lim Y-H, Kim I-H, Seo J-J. In vitro activity of kaempferol isolated       on human skin of a water-in-oil emulsion containing Muscat ham-
      from the Impatiens balsamina alone and in combination with                burg black grape seed extract. Int J Cosmet Sci. 2015;37:253–258.
      erythromycin or clindamycin against Propionibacterium acnes.              DOI: 10.1111/ics.12184. PMID: 25402429.
      J Microbiol Seoul Korea. 2007;45:473–477. PMID: 17978809.             25. Burns EK, Perez-Sanchez A, Katta R. Risks of Skin, Hair, and
15.   Frequently Asked Questions. National Institutes of Health: Office         Nail Supplements. Dermatol Pract Concept. 2020;10:e2020089.
      of Dietary Supplements. Updated February 5, 2021. Available               DOI: 10.5826/dpc.1004a89. PMID: 33150030. PMCID:
      from: https://ods.od.nih.gov/HealthInformation/ODS_Frequent-              PMC7588165.
      ly_Asked_Questions.aspx. Accessed April 6, 2021.                      26. Zamil DH, Perez-Sanchez A, Katta R. Acne related to dietary
16.   Dietary Supplements: What You Need to Know. National Insti-               supplements. Dermatol Online J. 2020; 26(8):13030/qt9rp7t2p2.
      tutes of Health: Office of Dietary Supplements. Updated Septem-           PMID: 32941710.




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