The findings also suggest the essential oil could help reduce the adverse effects resulting from treatment using the acne drug isotretinoin.
The retinoid pharmaceutical is used to treat all-cause acne, including moderate, severe, and recurrent acne, leading to improvements in skin integrity, but can provoke a number of unpleasant adverse effects.
However, the authors of a recent study observed substantial improvements in the prognosis of patients treated with 10 to 40 milligrams (mg) of isotretinoin per day (dosage was weight-dependent) and four 510mg capsules of evening primrose oil (Oenothera paradoxa) for nine months.
“Supplementation resulted in a significant increase in skin hydration in patients treated with isotretinoin, which significantly ameliorated the adverse effects of the drug such as dryness, lip cracking and peeling skin”, they write.
Acne vulgaris is a chronic inflammatory disease of the hair follicles and sebaceous glands, effecting 85% of young people aged 12-24. In addition, acne progresses to a severe form in around 20-25% of individuals; it can cause permanent scaring, social anxiety, and depression.
Isotretinoin aims to reduce sebum (oil) secretion - an important factor in the pathophysiology of acne vulgaris (responsible for the formation of comedonal and inflammatory acne lesions) - and is considered to be the most effective treatment currently on the market.
Despite proven remedial properties, the drug can lead to disturbing adverse effects, such as congenital abnormalities (when prescribed to pregnant women); liver dysfunction; and changes in lipid profile – such as increases in total cholesterol, LDL cholesterol, very low-density lipoprotein (VLDL), plasma triglycerides - and decreased HDL cholesterol.
Buccal mucositis (dry lips) is the most common adverse reaction of isotretinoin intake and affects approximately 90% of patients. More serious conditions associated with medication include Stevens–Johnson syndrome and toxic epidermal necrolysis. Weight gain has also been observed in patients.
Potential of primrose oil
The efficacy of evening primrose oil for improved skin integrity is well-documented; marked increases in hydration in both dry and normal skin after application with patches, were identified in two previous studies on patients with atopic dermatitis (AD), furthermore, improved skin moisture was observed in healthy adults taking orally administered Oenothera paradoxa (six capsules of 500 mg each).
Given the evidence, the essential oil is considered a safe dietary supplement, in spite of minor interactions with over 200 drugs that can lead to headaches and gastrointestinal discomfort.
The purpose of the present study was to evaluate the effect of treatment with isotretinoin, with or without supplementation, on skin hydration status (CORN), trans-epidermal water loss (TEWL), skin oiliness (sebum), and changes in body weight and BMI.
The researchers noted significant reductions in TEWL in both patient groups, “indicative with a strengthening of the skin barrier under the influence of isotretinoin treatment”, but no significant difference between groups.
Global decreases in sebum levels were also noted after nine months of treatment, with no statistical treatment-dependent distinctions.
“Therefore, it can be assumed that the reduction in sebum levels was a result of isotretinoin, and that evening primrose oil had no significant effect on the reduction in sebum levels in the intervention group (IOW),” they write.
One intriguing result was a reduction in body weight and BMI in both groups at the study end, although there was no apparent difference between groups - in terms of weight loss and BMI.
“This is interesting given that evening primrose oil, particularly the -linolenic acid (GLA) present in it, by stimulating brown adipose tissue and raising metabolic rate, may be an effective facilitator of weight loss processes; in addition, the resulting prostaglandins trigger fat burning in brown adipose tissue.”
The main strength of the study was the nine-month, randomised design, while the main limitation was the small group size (50), the authors say.
However, they maintain it is one of the first studies in humans to evaluate the efficacy of evening primrose oil on skin condition parameters, body weight and BMI during isotretinoin treatment.
Factors that could potentially influence the results, such as the use of ointments and creams, cosmetic and dermatological treatments, and physical activity, were not assessed, although participants were told to maintain their usual routine during the intervention.
Finally, no adjustment was made for multiple testing, “which could affect the significance of differences in results obtained during the intervention period”, they add.
Published online: doi.org/10.3390/nu14142980
‘Effect of Evening Primrose Oil Supplementation on Selected Parameters of Skin Condition in a Group of Patients Treated with Isotretinoin—A Randomized Double-Blind Trial’
Agnieszka Kazmierska et al.