Chapter 42. Pantothenic Acid, B5 for Acne

Chapter 42.  Pantothenic Acid, Vitamin B5 for Acne

Virtually everyone remembers the frustrating experience of acne with small inflamed dots called pimples or blackheads.  For the young woman concerned about self-image, skin complexion is important.  One or two strategically placed pimples can be intolerable.  For some, acne can progress, leading to scarring and disfigurement, with pitting and nodularity called Acne Vulgaris.  While some are spared this chronic ordeal, others endure many years of ineffective treatments by a succession of dermatologists.  Although some treatments such as Accutane™ may offer success, there is a price in terms of serious adverse side effects.

What Causes Acne?

Acne is caused by excess oil called sebum which originates in the sebaceous glands at the root of the hair follicles.  This oily build may occlude the duct in the skin causing blockage and infection.  "Popping the pimple” is a home remedy which forces the occluding plug to pop out of the pore, providing drainage and temporary relief.

Common Causes of Acne

Acne is a common adverse side effect of synthetic birth control pills which mimic testosterone.  Elevated testosterone levels in males and females are associated with increased oil production in the skin resulting in acne.  A common genetic mutation called atypical CAH (congenital adrenal hyperplasia) causes increased testosterone in females resulting in acne.  PCOS (polycystic ovary syndrome) syndrome is associated with increased testosterone production and acne is common.  Acne can also be associated with PMS symptoms in the cycling female.  When estrogen levels drop suddenly the last week of the cycle, serum binding protein also declines.  This liberates free testosterone which may cause PMS related acne for a week or so, until estrogen levels return to normal.  Young males may suffer from acne from abundant testosterone production.  Below, we make the case for vitamin B5 deficiency as a possible cause for acne. 

What are the Acne Treatments?

Traditionally, acne is treated by the dermatologist with various topical cleansers, antibiotics and drugs such as Accutane™.   Accutane's most commonly reported adverse side effect is depression which can lead to suicide.(25)

Vitamin B5 Treatment for Acne

In this article we will present to you information about Vitamin B5 (Pantothenic acid) as a treatment for acne.  We will explain the role of Vitamin B5 in the metabolism of fats and oils, and how increasing the metabolism of oils will reduce oil accumulation in the skin, and thereby reduce or eliminate acne.  Both Accutane™ and Vitamin B5 work by different mechanisms.  Accutane™ works by shrinking the sebaceous glands at the root of the hair follicles.  However, quite differently, Vitamin B5 works by reducing the oil production of the sebaceous glands.  This is done by increasing Coenzyme A (Co-A) which increases the metabolic breakdown of oils by normal activity of cell physiology.(26)

Co-Enzyme A and Pantothenic Acid for Acne - Lit-Hung Leung

I first became aware of the use of Vitamin B5 (also called Pantothenic Acid) as a treatment for acne from an article by Lit-Hung Leung (1997).(4,5,11,12)  In this article, Dr Leung explains that acne can be reduced or eliminated with the use of Vitamin B5, also called Pantothenic acid.  Pantothenic acid is a major component of Co-Enzyme A (CoA).(6)  CoA is used at the cellular level for fatty acid oxidation and in many other biochemical reactions in the cell.  Taking additional B5 increases the amount of Coenzyme A available for use in the cell.  The more Co-Enzyme A, the more fatty acids can be metabolized, which means they are oxidized or burned up as energy production.  CoEnzyme A is actually a Pantothenic Acid molecule attached to an ADP molecule.   ADP is widely available throughout cellular biochemistry as the currency of energy in the cell.

What is Pantethine?

Pantethine is made of two Vitamin B5 molecules linked together with two sulfurs (S-S) in the center.  It is well known that the Beta Oxidation of Fatty Acids depends on CoA.(26)   If there is a deficiency of Acetyl CoA in the body, oxidation of fatty acids will slow down, and the skin becomes oily resulting in acne.  Increasing availability of Acetyl CoA speeds up metabolic breakdown of fatty acids, then converted into cellular energy.  Taking vitamin B5, pantothenic acid,  is the easiest way to increase acetyl Co A and increase rate of fatty acid metabolism.

Dr Leung's Dosage is Rather Large

Dr. Leung gave his acne patients rather large doses of five to ten grams of Pantothenic Acid per day with considerable improvement in their acne.  He reported success with this regimen. 

Message Board Discuss Pantethine and B5 for Acne

After reading Dr. Leung's article, I then did an internet search for Acne and B5, and found a large amount of information on message boards posted by people suffering from acne trying various treatments, including pantothenic acid. (9,10)  I found that many, but not all, of these acne sufferers had success with vitamin B5 (Pantethine) which did work for many of them.  However, a common complaint was that the large amount of pantethine (10 grams) was hard to take, causing gastrointestinal gas and bloating, etc.

L-Carnitine Used as Booster

Obviously, the major difficulty with Dr Leung's Vitamin B5 protocol is the large amount of B5 required.  It would be advantageous to reduce the B5 dosage to a more reasonable level.  Considering the biochemical pathways involved, this would be possible with the addition of L-Carnitine, which transports fatty acids across the mitochondrial membrane where they can be oxidized.  (26-28)

Transport is Rate Limiting Step for Fatty Acid Oxidation

According to the biochemistry of fatty acid oxidation, transport is the RATE LIMITING STEP for oxidation of long chain fatty acids.  Carnitine transports long-chain acyl groups from fatty acids into the mitochondrial matrix, so that they can be broken down through β-oxidation to acetate to obtain usable energy via the citric acid cycle.(26-28)  

Reducing or Eliminating Acne with Pantethine and L Carnitine

Using the modified Leung B5 protocol with Pantethine 750 mg with 250 mg of L Carnitine three times a day, we have noted excellent success rates in reducing or eliminating acne.  An added advantage is a good cosmetic result with smaller pore size and smoother skin.  The vitamins are safe with no adverse side effects noted.

A College Student with Acne

A college student under my care was making preparations for her upcoming wedding when she noticed some new acne lesions on her face.  We immediately began the Pantethine and L-Carnitine.  Her acne cleared up immediately, and she was quite pleased.  By now, we have a number of satisfied patients who have used this program to clear up acne.  I myself have used the program and can report that it works quite well.  Since this anti-acne regimen is essentially a fat burning protocol, it is also useful for weight loss as noted in this article.  Unlike Accutane™ which may have serious adverse side effects, vitamin B5 has little or no adverse side effects.

Acetyl CoA Important for Cholesterol and Steroid Biosynthesis

Acetyl CoA is the first step in the body's synthesis of Cholesterol.  Cholesterol is then used to make all steroidal hormones.  Many of the steroidal hormones are made by the adrenal gland, so it is very logical that B5 deficiency can result in a syndrome called adrenal failure, or the inability to synthesis steroidal hormones such as Cortisol.  See my previous article on Adrenal Fatigue for more information about this syndrome.

Systemic Lupus and Acetyl CoA Deficiency

Systemic Lupus is an autoimmune disease with no known cause first described in 1851.  A blood test for anti-nuclear antibodies is diagnostic.   However, a number of features of Lupus suggest a link with steroid hormone synthesis.  For example, there is a well know tendency for Lupus to flare up under certain conditions in which there is a greater demand for steroidal hormone biosynthesis, such as puberty, and pregnancy.   Females are more affected than males by a ratio of ten to one.  Lupus preferentially affects females because they have greater demands for hormone production than do males.   These lupus flares seem to correlate with demand for higher levels of hormones.  Production of higher hormone levels could deplete the stores of precursor molecules for production of these hormones.  The first such precursor molecule is acetyl CoA, so a deficiency in acetyl CoA could be the culprit.

Low Hormone Levels in Lupus

Another feature of female Lupus patients is that when hormone levels are measured, they tend to run low.  Irregular menstrual cycles and absent menses is common among lupus patients. Giving hormones to raise levels seems to help.  For example, Quality of Life for Lupus patients seems to be ameliorated by DHEA administration, an adrenal hormone precursor.  DHEA administration can even reduce the number of Lupus Flares.  After menopause when hormone production declines dramatically, there is a reduction in Lupus flares and the disease becomes quiescent.  Acne tends to be a common issue for Lupus patients given DHEA, and this would be expected assuming there is an underlying B5/Acetyl CoA deficiency.  Administration of B5 along with the DHEA usually resolves the acne.  Cortisol production is also decreased in lupus patients, explaining why they do better when treated with steroids.

Drug Induced Lupus

Another interesting feature of Lupus is that the disease can be caused by 70 various drugs.  The three most common are procainamide, hydralazine and isoniazid.  These drugs have nothing in common except they are metabolized by the acetylation pathway, a connection to Acetyl CoA.

Combined Nutritional Deficiency Disease

The first manifestations of a nutritional deficiency state appear in the skin, joint and connective tissue with various lesions. The vital organs are only involved much later on. For example, deficiency states such as Beri Beri and Scurvy initially spare the vital organs, and first involve the skin and musculoskeletal system.  Lupus follows this pattern as well.

In his article, Dr. Leung noted a connection between Systemic Lupus (SLE) and Acetyl CoA deficiency, however he was not the first to suggest giving Pantethine (Vitamin B5) to Lupus patients.  There were a number of reports on this in the 1950's.  However, early studies seemed to discredit the whole idea of B5 deficiency or acetyl CoA deficiency or a genetic acetylation defect in Lupus.  Nonetheless, Leung reported improvement in his lupus patients who supplemented with pantothenic acid.  Late stages of Lupus are characterized by specific anti nuclear antibodies (ANA test) which obviously will not be affected by giving pantothenic acid.  However, much can be done to improve quality of life of the lupus patient.  Perhaps a combined approach supplementing with bioidentical hormones such as estradiol, progesterone, DHEA, Cortef, testosterone  as well as vitamin mineral supplementation with pantethine, and others would be the most logical way to help lupus patients get back their health.

Facial Rash of Lupus, Pregnancy and Addison's

Another interesting connection is the appearance of a skin rash on the face in Lupus flares with pregnancy.  There can be increased facial skin pigmentation in pregnancy itself (without lupus) called Melasma, also known as chloasma or the mask of pregnancy.  Another syndrome is Addison’s Disease (adrenal failure) which frequently causes hyper-pigmentation in the face and elsewhere.  Characteristic sites are skin creases in the hands, and the inside of the cheek (buccal mucosa). Old scars may darken. All three, Lupus, Pregnancy and Addison’s, share the need to stimulate more adrenal steroidal hormones with ACTH (ACTH = adreno cortico stimulating hormone).  ACTH is secreted by the pituitary to stimulate more adrenal hormone synthesis.  Increased ACTH causes an increase in melanocyte-stimulating hormone (MSH).  The MSH induces melanocytes to cause the pigmentation.

A Lupus Patient Tells Her Story

A 45 year old Lupus patient came to see me in the office.  She had seen many rheumatologists and specialists over the years with a confirmed diagnosis of Lupus.  She appeared under weight and chronically ill, and had absent menses for the last 7 years.  Her main complaint was severe chronic fatigue and inability to gain weight.  In the past she had been on many of the usual drug treatments for lupus with many adverse effects and no real improvement in quality of life.

Initial testing showed low salivary cortisol,  and low serum levels for the other hormones, DHEA, estradiol, progesterone and testosterone.  She also had low B12 and Vitamin D levels.  She was started on bio-identical hormones, Pantethine (B5), B12 and Vitamin D.   About three months after starting treatment, she calls me and states she is feeling much better with improved energy levels, and she just had a normal menstrual period, the first one after seven years of absent menses.

For references and links, see my web site: www.bioidenticalhormones101.com

Articles with Related Interest

Use of B5, Pantethenic Acid in Adrenal Fatigue


References for Chapter 42. Pantothenic Acid, B5 for Acne and Lupus

(1) http://www.vilantae.com/index.php Vilante Home, and Video

(2) http://www.b5acnetreatment.com/2007_03_01_archive.html
Vilante B5 web site

(3) http://www.acnetohealth.com/vitamin-b-5-acne.html
The Vitamin B 5 Acne Theory Debunked

(4) http://deficiencydiseases.com/ Papers on B5 and Acne by Lit-Hung Leung, M.D.

(5) http://www.coenzyme-a.com/acne_vulgaris.html
Pantothenic Acid in the Treatment of Acne Vulgaris "A Medical Hypothesis"  by Lit-Hung Leung, M.D. The Effect of Pantothenic Acid on Acne Vulgaris

(6) http://www.coenzyme-a.com/research.html Research Articles on Coenzyme A, Pantethine: A Review of their Biochemistry and Therapeutic Applications first published in Alternative Medicine Review, Volume 2, Number 5.

(7) http://www.coenzyme-a.com/research.html
Pantothenic Acid in the Treatment of Obesity. "A Medical Hypothesis" by Lit-Hung Leung, M.D.
Journal of Orthromolecular Medicine Vol. 12 Number 2, 1997.

(8) http://www.coenzyme-a.com/research.html
Coenzyme-ATM "Precursor The Master CoenzymeTM" by Nickolaos D. Skouras, Ph.D.

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Acne.Org message board…nuts and bolts advice on b5 .

(10)  http://www.ironmagazineforums.com/history/topic/23051-1.html
acne b5 accutane message board

(11) http://orthomolecular.org/library/jom/1997/articles/1997-v12n02-p099.shtml
The Journal of Orthomolecular Medicine Vol. 12, 2nd Quarter 1997.  A Stone that Kills two Birds: How Pantothenic Acid Unveils the Mysteries of Acne Vulgaris and Obesity  Lit-Hung Leung. M.D.

(12) http://deficiencydiseases.com/ articles by Lit-Hung Leung on B5 and Acne

(13) http://deficiencydiseases.com/SLE_full_text.pdf
LUPUS ERYTHEMATOSUS: A Combined Deficiency Disease by Lit-Hung Leung, M.D. Formerly Consultant Surgeon, Department of General Surgery, Hong Kong Central Hospital, Hong Kong.

(14) http://www.ncbi.nlm.nih.gov/pubmed/7476595
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(15) http://ezinearticles.com/?Using-Pantothenic-Acid-(Vitamin-B5)-as-an-Acne-Treatment&id=48855
Using Pantothenic Acid (Vitamin B5) as an Acne Treatment By Ryan Bauer

(16) http://www.ncbi.nlm.nih.gov/pubmed/3976557
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(17) http://lpi.oregonstate.edu/infocenter/vitamins/pa/ Pantothenic Acid, Linus Pauling Inst. Oregon State.

(18) http://www.bastyrcenter.org/content/view/439/ Nutritional Supplements In The Treatment Of Acne
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(19) http://www.ncbi.nlm.nih.gov/pubmed/13985157
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(20) http://www.ncbi.nlm.nih.gov/pubmed/13423891
AMA Arch Derm. 1957 Jun;75(6):845-50.The diagnosis of lupus erythematosus; probable significance of pantothenate blood levels. SLEPYAN AH, FROST DV, OVERBY LR, FREDRICKSON RL, OSTERBERG AE.

(21) Cochrane, T., Leslie, G. (1952). The treatment of lupus erythematosus with calcium pantothenate and panthenol. J. Invest. Dermat., 18, 365-367.

(22) http://www.journals.elsevierhealth.com/periodicals/ymehy/article/PIIS0306987704000945/abstract
Volume 62, Issue 6, Pages 922-924 (June 2004) Systemic lupus erythematosus: a combined deficiency disease. Lit-Hung Leung.

(23) http://www.mitamins.com/library/Concern/Lupus.html
 Welsh AL. Lupus erythematosus: Treatment by combined use of massive amounts of pantothenic acid and vitamin E. Arch Dermatol Syphilol 1954;70:181–98.

(24) http://archive.food.gov.uk/committees/evm/papers/evm0101.pdf
Cochrane T, Leslie G. The treatment of lupus erythematosus with calcium pantothenate and panthenol. J Invest Dermatol 1952;18:365–7.

(25) http://www.accutaneaction.com/adr/index.html most frequently reported adverse event for Accutane/Roaccutane

(26) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1217938/?tool=pubmed Biochem J. 1996 December 1; 320(Pt 2): 345–357.  Mammalian mitochondrial beta-oxidation.S Eaton, K Bartlett, and M Pourfarzam

(27) http://www.sciencedirect.com/science/article/pii/S0006291X85722322 Fatty Acid β-Oxidation in Peroxisomes and Mitochondria: The First, Unequivocal Evidence for the Involvement of Carnitine in Shuttling Propionyl-CoA from Peroxisomes to Mitochondria. Jakobs B. S. and Wanders R. J. A.

(28) http://oregonstate.edu/dept/biochem/hhmi/hhmiclasses/biochem/lectnoteskga/2kjan14lecturenotes.html Fatty Acid Oxidation-Oregon State University dept of biochemistry.

Author: Jeffrey Dach MD