The Origin Of Ray's Association Of Vitamin A (and Hormones) With Acne

[Amazoniac]

This thread is in celebration of Koveras' subscription to the horror show.
aguilaroja and burtlan, if you're reading this, acne is a type of lesion that appears on the skin of humans.

ROLE OF PARENTERAL MULTIVITAMIN THERAPY IN THE TREATMENT OF ACNE

"Many workers have reported on the beneficial effects of large doses of vitamin A in oil solution. Straumfjord3 reported that a supplement of 100,000 international units of vitamin A either cured or decidedly improved the condition of 79 of 100 patients suffering from acne, only, however, when the therapy was given over a period of six months. Other workers reported similar observations when vitamin A was used in large doses over prolonged periods. In a critical study of the effects of administering 100,000 units of vitamin A daily in oil, Lynch and Cook 4 reported satisfactory results obtained in 21 out of 45 unselected patients with acne."

"More recently, Combes and co-workers5 reported that 29 of 36 unselected patients with various types of acne showed pronounced improvement on a daily regimen comprised of the administration of 100,000 units of vitamin A in oil unassisted by other medicinal or special dietary measures."

"[Researches] found that in the presence of a vitamin A deficiency follicular hyperkeratosis occurred most frequently at the time of puberty and did not manifest itself as readily in the younger subjects. This relation between the utilization of vitamin A and the endocrine gland changes has been observed in experimental animals."

"[..]the liver is unable to inactivate estrogen in the presence of vitamin B deficiency was shown by Biskind and Biskind.14 A disturbance in the balance of the sex hormones could result in some liver dysfunction and then in poor utilization of vitamin A. Further, even though dietary intake of vitamins A and B may be adequate, the greater demands by the pilosebaceous apparatus during the adolescent period or at the period of the menstrual cycle may produce a relative inactivation or antagonism sufficient to produce the acne lesion. Hickman, Kaley and Harris 15 stated the conclusion that vitamin A is easily destroyed by the enzymes and oxidants of the intestinal tract and that vitamin E may function as an antioxidant when given by mouth or parenterally at the same time that vitamin A is given. It would seem, therefore, that the addition of vitamin E may be of value in this manner when treating acne vulgaris."

"Although the absorption of vitamin A from the gastrointestinal tract was not defective, the parenterally injected vitamin A which entered the peripheral circulation appeared to be more effective than that which first passed through the liver. A similar action may take place in patients with acne as well as in those with Darier's disease."*

"Further influences of other vitamins in acne were noted by Sutton and Sutton,16 who found that a diminished craving for fat had a beneficial effect in acne."

"[..]there is good evidence to show an interrelation among vitamins, sex hormones and liver function."

"Henricksen and Ivy ls found that viosterol [vit D2] in large doses, 20,000 to 100,000 units, was a useful adjunct."

"That vicious cycles may occur in the interactivity among gastrointestinal function, hormones and vitamins was pointed out by McGavack.19"

"[..]large doses of estrogen depress a factor concerned in the absorption and availability of certain vitamins in the body"

Foods aren't assimilated well, so even on a seemingly adequate diet there is "internal malnutrition."

*I suppose that's why they chose to inject the supplements.

"The effect of an aqueous multivitamin solution given intramuscularly to 25 patients with acne was studied. The clinical response was excellent. Many cases unresponsive to usual therapeutic procedures showed prompt and consistent progress.
The solution was well tolerated in over 500 injections. In contrast to the effects of oral therapy, there was no pronounced tendency to relapse after the parenteral aqueous therapy was discontinued."

Spoiler: Vitamin A solutions

"The developments in the dispersion of oil-soluble vitamin A in aqueous solutions by Freedman6 have resulted in the development of a new concept in the absorption and utilization of vitamin A. Increased rate of absorption, as shown by peak blood levels of vitamin A, higher liver storage and decreased excretion, have been reported by various investigators. The reports of Lewis and co-workers,7 Clifford and Weiler,8 Kramer and co-workers9 and Popper, Steigmann and Dyniewicz10 demonstrated that the rate of absorption and blood levels of vitamin A are many times higher when the vitamin is administered in the form of aqueous dispersions than when given in oil solutions. On the basis of increased absorption of aqueous vitamin A, Davidson and Sobel11 used the aqueous dispersion of vitamin A in a multivitamin mixture as a substitute for vitamin A in oil in the treatment of 30 patients with acne. Improvement was noted within two to four weeks, as contrasted with the four to six months necessary when a solution of vitamin A in oil was used. Determination of the serum vitamin A levels of venous blood showed a definitely better absorption of vitamin A with the aqueous form as measured by the vitamin A tolerance tests."
@haidut

Spoiler: Excellent references

--
PARENTERAL MULTIVITAMIN THERAPY OF RECALCITRANT ACNE VULGARIS

"The preparation employed [here] was the same as that used by Kline in his study [above]. Each 2 cc. of this preparation contains 10,000 U.S.P. units of vitamin A, 1,000 U.S.P. units of calciferol (vitamin D2), 10 mg. of thiamin hydrochloride, 1 mg. of riboflavin, 3 mg. of pyridoxine hydrochloride, 20 mg. of nicotinamide, 50 mg. of ascorbic acid, and 2 mg. of Diokine-tocopherol, in an aqueous solution containing 4% weight per volume of sorbitan monolaurate derivative with 0.5% chlorbutanol as a preservative."

"In no case were we able to observe a "cure." However, only 3 of the 20 patients failed to note at least subjective improvement. Definite objective improvement was noticed in six patients and moderate objective improvement in four patients."

 

[aguilaroja]

ROLE OF PARENTERAL MULTIVITAMIN THERAPY IN THE TREATMENT OF ACNE
"More recently, Combes and co-workers5 reported that 29 of 36 unselected patients with various types of acne showed pronounced improvement on a daily regimen comprised of the administration of 100,000 units of vitamin A in oil unassisted by other medicinal or special dietary measures."
..."Henricksen and Ivy ls found that viosterol [vit D2] in large doses, 20,000 to 100,000 units, was a useful adjunct."....
--
PARENTERAL MULTIVITAMIN THERAPY OF RECALCITRANT ACNE VULGARIS
"The preparation employed [here] was the same as that used by Kline in his study [above]. Each 2 cc. of this preparation contains 10,000 U.S.P. units of vitamin A, 1,000 U.S.P. units of calciferol (vitamin D2), 10 mg. of thiamin hydrochloride, 1 mg. of riboflavin, 3 mg. of pyridoxine hydrochloride, 20 mg. of nicotinamide, 50 mg. of ascorbic acid, and 2 mg. of Diokine-tocopherol, in an aqueous solution containing 4% weight per volume of sorbitan monolaurate derivative with 0.5% chlorbutanol as a preservative."
....Definite objective improvement was noticed in six patients and moderate objective improvement in four patients."

With sixty plus more years of research, some factors and proportions in the formula would be adjusted, if this kind of research could find support. For instance, the D2 (ergocalciferol) would be replaced with D3 (cholecalciferol).

It’s Time to Say “Goodbye” to Vitamin D2 (ergocalciferol) - ClinCalc.com

As the thread indicates, Dr. Peat has mentioned the work of G.R. Biskind in multiple contexts over the years.

As the Lewis 1952 article reminds us, standard treatment for pronounced acne vulgaris in 1950 was X-radiation. It is a good reminder of history of “risks” from a medical view.
“Only those patients who had not responded satisfactorily to ordinary therapeutic measures, including x-ray therapy, were included in this….”
PARENTERAL MULTIVITAMIN THERAPY OF RECALCITRANT ACNE VULGARIS

 

[Dan W]

Thank you for this, I'd always been fuzzy on *why* vitamin A seems to help acne, and was always a little concerned that we were just blindly damaging sebaceous glands or something.

"The developments in the dispersion of oil-soluble vitamin A in aqueous solutions by Freedman6 have resulted in the development of a new concept in the absorption and utilization of vitamin A. Increased rate of absorption, as shown by peak blood levels of vitamin A, higher liver storage and decreased excretion, have been reported by various investigators..."

On the flip side, I wonder if this makes for increased toxicity risk:
Water-miscible, emulsified, and solid forms of retinol supplements are more toxic than oil-based preparations

 

[GorillaHead]

Interesting they mention perifollicular hyperkertosis a pathogenesis of mpb.


Yet oral use of isotretinoin or other retinol derivates cause hairloss but i wonder if that hairloss is diffuse and is due to the fact that high retinol lowers vitamin d or vdr expression. I rememebr reading that they balance each other.

 

[DrJ]

Further influences of other vitamins in acne were noted by Sutton and Sutton,16 who found that a diminished craving for fat had a beneficial effect in acne.

This is very interesting. Do you take this to mean that a fat craving might be a proxy to a craving for vitamin A or fat soluble vitamins? So the craving went away when they presumably had enough vitamin A to fix their acne?

 

[Amazoniac]

This is very interesting. Do you take this to mean that a fat craving might be a proxy to a craving for vitamin A or fat soluble vitamins? So the craving went away when they presumably had enough vitamin A to fix their acne?

"Further influences of other vitamins in acne were noted by Sutton and Sutton,[16] who found that a diminished craving for fat had a beneficial effect in acne. Richter[17] also produced this experimentally in rats. Henricksen and Ivy[18] found that viosterol in large doses, 20,000 to 100,000 units, was a useful adjunct. Sulzberger and Wolf[1] advocated the use of 150 to 250 mg. of ascorbic acid and the administration of large doses of vitamin D in some cases. Thus, there is good evidence to show an interrelation among vitamins, sex hormones and liver function. That vicious cycles may occur in the interactivity among gastrointestinal function, hormones and vitamins was pointed out by McGavack.[19]"​

Could be that they found fat less appealing when their nutritional and hormonal state allowed them to process more carbs for being in a better condition (and improvement in acne as a reflect).