Table of Contents

• Introduction
• Background
• What is Pantothenic Acid?
• How Does Pantothenic Acid Work For Acne?
• Studies & Anecdotal Reports
• But if Pantothenic Acid is so Great Why Isn’t It Used More in Acne Therapy by Doctors?
• Safety
• Side Effects
• My Experience
• But Why Can’t I Just Get More Pantothenic Acid From My Diet?
• Tips & Where to Buy
• Top Recommended Brands
• Summary & Key Takeaways

Why is this important? Because when we focus on treating effects, we’ll never get to the root cause. Acne isn’t just a skin problem, it’s a health problem. And focusing on and prioritizing our physical and mental health is the sustainable key to clear skin. 

Yes, skincare is still an important piece of the puzzle (if it wasn’t I wouldn’t have created Authentic Ego), but with skincare alone, we’ll NEVER be able to get to the root cause of why we’re getting acne in the first place.

Sure you can help treat and improve the general appearance of your skin but with persistent acne, the problem is far deeper and the chain of events that allows acne to occur, happen through a complex and still not fully understood process (Source). By the time your pores become ‘clogged’ and active breakouts kick in, a dozen other events have already happened in your body that led to acne occurring in the first place (Source).

So while I don’t believe in singular miracle cures, there’s some compelling research and A LOT of anecdotal reports showing that Pantothenic acid can make a significant difference for acne sufferers. This is because it targets one of the root causes of acne formation and has a positive overall health impact at the same time (Source). 

Aside from medical studies which I’ll summarize shortly, while completing research for this blog post I also read hundreds of comments and watched dozens of videos from people’s experiences with pantothenic acid and the results were all overwhelmingly positive. While individual experiences aren’t medical studies, it's of paramount importance that when thousands of people are saying something worked for them, that we listen, and listen carefully.

Ignoring individual's experiences is one of the key ongoing failures of the medical community.

Background

In the late 90’s a physician named Dr. Lit-Hung Leung published an article hypothesizing what he believed to be the root cause of acne. That root cause was vitamin B5 deficiency (Source). At the time (and still to this day) the chain of events that leads to acne formation is still not fully understood. 

Instead of viewing acne as an isolated problem within the pilosebaceous unit (aka pores) Leung’s hypothesis is centered around a deficiency surrounding fat metabolism in the body (Source). This defective metabolism becomes more apparent with increasing levels of fat consumption in the diet. The body has no effective way to deal with it, and acne is a critical effect of this defective metabolism process. To clarify, this is not to say that we’re consuming too much fat or need to decrease our fat intake- it’s simply an evolutionary glitch in our bodies. 

What is Pantothenic Acid?

Pantothenic acid is a water-soluble vitamin also known as vitamin B5 (Source). It can be found in several plant and animal-based foods including peanut butter, liver, almonds, cheese, and lobster (Source). It’s also artificially added to fortified foods (Source). The levels found in foods in comparison are a tiny fraction (about 10,000 times lower) than what was studied when used it as acne therapy (Source). 

B5 can also go by the name panthenol or dexpanthenol when used topically, and oral versions include pantothenic acid, calcium pantothenate, and pantethine amongst others (Source). This blog post will focus strictly on pantothenic acid as an oral supplement as that’s what has been used in acne studies. Topical B5 aka Panthenol is also an amazing ingredient worth exploring but that’s a topic for another day!

How Does Pantothenic Acid Work For Acne?

It all starts with Coenzyme A which is arguably the most important coenzyme in the body as it's involved in more than 100 different reactions (Source). Two key processes involving Coenzyme A are fatty acid metabolism and sex hormone synthesis (Source). 

All is well and good in the world of coenzyme A in childhood as there is no great demand to produce sex hormones. Once puberty hits though, the body’s demand for Coenzyme A goes through the roof as it needs to start making sex hormones so we can reproduce (Source). 

In cases where there is a deficiency in the availability of coenzyme A, acne develops. Therefore, the hypothesis is that acne starts to develop during puberty not because of the increase in sex hormones, but because there is an inadequate amount of Coenzyme A to facilitate fatty acid metabolism in the body; and when faced with a choice, the body will always choose to make sex hormones over metabolizing fatty acids. In evolutionary terms, the body does what works, not what’s good for us (yeah, evolution can be a jerk). In this case, survival through passing our genes on is more important than having clear skin (Source). 

This is interesting particularly from the perspective of the traditional androgen hypothesis as a cause of acne because it totally goes against what we’ve come to accept as the main contributing factor in acne development. Even more interesting is when scientists have looked at the levels of androgens (male hormones) circulating in men and women with and without acne, they don’t always find statistically significant differences in the levels of androgens in those with or without acne (Source, Source). Essentially, people with acne may more or less have the same amount of androgens in their bodies as those who don’t. This is something that still can’t be explained.

This may also explain why women suffering from hormonal acne tend to experience a worsening of symptoms in the roughly two weeks preceding their period; the synthesis of progesterone increases greatly, leaving little coenzyme A leftover to deal with lipid metabolism (Source). 

So where does pantothenic acid come into play? Pantothenic acid is the key precursor needed for the body to make enough coenzyme A and supplementing with high doses gives the body the ability to make enough coenzyme A– enough for both sex hormone synthesis and fatty acid metabolism (Source). 

Following this premise, we then assume that supplementing with high doses of pantothenic acid may lead to a significant improvement in acne. 

To sum it up:

“The author’s proposed hypothesis for the pathogenesis of acne vulgaris is that the disease process is not caused by androgens or any other sex hormones. But rather, the disease process results from defects in lipid metabolism that is secondary to a deficiency in pantothenic acid, hence Coenzyme A.” (Source). 

Studies & Anecdotal Reports

Below, I’ll summarize the studies done on Pantothenic acid supplementation as it relates to acne, the results, study drawbacks, and limitations or conflicts of interest. The goal of this is to summarize things for you so you don’t have to read all the articles yourself. 

Study 1

This study is the only randomized double blind placebo controlled trial done on pantothenic acid to date. This type of study is considered the gold standard in medical research as neither the subjects nor the people conducting the study know if the subject is taking the active or the placebo (Source). 

Side note. The advantage of these types of studies is two-fold. First, they contain a lot of subjects. This is important because studies that have too few subjects risk providing false positive or false negative results that aren’t accurate. In other words, if I did a study testing out Pantothenic acid as an acne treatment on 5 people and none of them saw an improvement, I can’t reliably say that Panthoeneic acid doesn’t work for acne. The sample size is just too small to draw these conclusions. This would be a possible false negative. But if I test out Pantothenic acid on 500 people and no one saw an improvement vs. placebo I could be a lot more confident that it doesn’t work. This is an overly simplistic explanation but it helps to demonstrate the importance of ‘evidence-based’ claims we’re starting to see pop up everywhere. Not all studies are created equal. 

Two, when subjects and people conducting the study don’t know whether they’re giving or taking the active or the placebo this helps to remove bias from the study. 

51 subjects with more than 50 non-inflammatory and up to 50 inflammatory acne lesions were enrolled in this study. Before it began they had to stop using all topical and oral acne treatments and be off of them for at least three months. The average age of the study subjects was 29. 

Half of the subjects were assigned either a placebo pill or the active treatment called Pantothen which is a brand name supplement. For the record, this supplement contains other ‘active’ ingredients which in my opinion, royally messes things up. 

The dose given was 2200mg of Pantothenic acid daily which was taken for 12 weeks and divided into a twice daily dose. 

The results were positive and subjects assigned the active saw a 68.21% reduction in total acne lesions. These before and after photos of two different subjects are pretty remarkable:

Drawbacks of this study

While the results from this study were overall very promising, there are a few issues I’d like to highlight in the interests of transparency. 

Not enough men were included.

Of those enrolled to receive the active in the study, 20 out of the 23 completed it. But only 3 of these were men. This is definitely not enough for results to be statistically significant for men. We also don't know whether the 3 who dropped out were men or not. 

Not diverse enough. 

Of those assigned the active, 10 were White, 6 were Black, 2 were Asian, and 3 were of Latin descent. So while the study was diverse, for it to be truly representative, the total number of subjects should have been higher in each group. Designing diverse studies is important because customers are diverse and studies need to reflect who will be using the product so results are statistically significant for all groups. 

There also might be a specific ethnic group that may have responded better, worse, or not at all. But at these low numbers, we can’t determine this. This happens with drug studies all the time and it’s related to genetics and the differences in how our bodies process molecules (Source). 

Length

At three months in length the results were positive but this is a relatively short time frame to be studying an acne intervention. In all likelihood, the study time was short to save on costs. These trials are extraordinarily expensive to run. 

Conflict of Interest

This study was obviously funded by the company that makes the supplement Pantothen so it was designed with the goal in mind to prove that this supplement is a good treatment for acne. This doesn’t discount the results but needs to be mentioned. 

Other Ingredients in Supplement

Because the supplement Pantothen was used, this actually wasn’t technically a study on Pantothenic acid and whether or not it improved acne, but whether all the ingredients in the supplement improved acne. This isn’t great because there are 5 other B vitamins, folate, and l-carnitine in the supplement. Did these compounds impact the subjects' acne positively or negatively? There’s no way to know. 

Dose

Subjects took 2200mg of pantothenic acid a day divided into 2 doses. Was that enough to be truly effective for everyone? What about higher or lower doses? It’s hard to tell. I personally took 5000 mg a day for six months before lowering my dose and have seen reports of people taking up to 20,000 mg a day. 

Study 2

This study was done on 100 subjects (45 male, 55 female) of Chinese descent. The average age was a bit younger with 80% being between 13 and 23. This was a series of case reports and a non-randomized study meaning subjects would have known they were taking the active substance. There was no mention of whether they were using, or had recently used other topical or oral acne medications.

The physician doing the study was using Pantothenic acid on patients in his clinical practice which is totally fine, it’s just not as controlled an environment as the previous study. The fact that this physician is truly interested in looking at treating acne in a different manner than the traditional antibiotics and Accutane route is commendable. Dr. Leung, I salute you for not caving into big pharma. 

The results of this study were reported in a qualitative way- meaning there was no one assessing total lesion count using photographs. The physician reported that patients began to notice a decrease in sebum production within 1-2 days, a decrease in new acne lesions within 1-2 weeks, and complete resolution within 8 weeks. He noted that some more severe cases took 6 months or longer to see full effects. 

The overall results of this study are also promising, however, there are no before and after photos, and results weren’t independently assessed. 

What can we gather from this? This physician was obviously seeing results using pantothenic acid as an acne treatment in his clinical practice so he decided to share his findings formally. 

Study 3

This wasn’t technically a study but it’s a case report co-written by a physician detailing a patient's first-hand experience with Pantothenic acid. And bonus, it’s from a male so it lends a bit more weight to how it might work on men. 

He details his experience with acne since the age of 17. He goes on to write how it remained problematic and consistent well into his 40s and how he also struggled with excessive oiliness of the skin.

Prior to starting Pantothenic acid, he used various traditional and non-traditional acne remedies- mentioning retinoids, salicylic acid, Tetracycline (oral antibiotic), meditation to reduce stress, and restrictive diets. After these treatments failed he began to take Accutane which he remained on for the next 18 years.

Concerned about the long-term side effects of Accutane he sought alternative treatment. While the Accutane had brought his acne under control he still suffered from excessive sebum production and sebum plugs, which despite his increasing age were unrelenting. 

He began taking 10,000 mg of Pantothenic acid daily while he weaned himself off the Accutane over 3 weeks. After the 3rd week, he reported a decrease in sebum plugs and general oiliness. He also began to notice that his sebum was less solid or sticky and started to have a thinner consistency. For the record, I noticed the same thing about a month after starting pantothenic acid. 

Over the next 3 months, his breakouts and oiliness continued to decrease at a steady rate and he continued to take a high dose for the next 4 years. At the end of the 4 years, he mentioned that his skin was smooth and clear and his pores appeared much smaller in size. 

I love this case report because as an engineer he developed a deep understanding of the issue and states that “practitioners still seem constrained to treating the symptoms of acne rather than the elusive cause.”

Disappointed in the medical community he then goes on to write about why pantothenic acid isn’t used more in clinical practice which leads me to my next topic…

But if Pantothenic Acid is so Great Why Isn’t It Used More in Acne Therapy by Doctors?

There are a few reasons but the short answer is money & research. 

Because there’s no big fortune to be made from a vitamin that can’t be patented and marketed for insane amounts of money, researchers are highly unlikely to get any funding to conduct expensive clinical trials to continue and expand upon existing research. With the way the system is built, there’s simply no financial incentive. 

This is one of the reasons why the studies completed to date on pantothenic acid as an acne treatment have been so few and far between- there’s just no money in it. Drug and Pharma companies focus their R&D on novel patentable molecules to treat diseases even when the answer already exists in nature- because nature can’t be patented.

It’s the same reason why doctors don’t prescribe us magnesium over prescription stool softeners, weight-bearing exercise instead of calcium injections for osteoporosis, or diet changes instead of cholesterol-lowering medication to prevent heart disease. There's no money in being healthy. 

Physicians are paid millions upon millions of dollars a year by Pharma companies when they write prescriptions, (Source) and I can guarantee you that it’s not always in the best interests of the patient. 

And then it becomes a vicious cycle - lack of funding leads to lack of research, which leads to lack of evidence which leads to lack of confidence, and lack of use in clinical practice. 

Physicians are taught to practice evidence-based medicine, so it’s not surprising, nor can they be blamed for recommending treatments that have the highest level of evidence available, even if they only treat surface symptoms. Doctors do not want to be liable for recommending treatments that haven't been studied and given the green light by the FDA.

The second reason which is outlined by the physician who wrote about his own experience with pantothenic acid is that there are a lot of traditional and outdated views on vitamin supplementation (probably because of the lack of studies… hmm 🧐). The official recommendation is 10 mg of pantothenic acid per day and most physicians will be hesitant to recommend mega-doses of any vitamin- even water-soluble ones that are easily excreted in urine because they simply haven’t been studied extensively (Source). 

The last reason he mentions is one of my favorites as it’s something I’ve encountered countless times in life. We have an innate bias as humans to assume that complex problems always require equally complex solutions. Acne, despite all the research out there, is still poorly understood and full of discrepancies and contradictions. What if the answer to all of our unanswered questions is actually quite simple? (Source)

Safety

The good news is since Pantothenic acid is a water-soluble vitamin, excess amounts are excreted by the body via urine. 🚽 No known cases of B5 or pantothenic acid toxicity have ever been reported which means that no upper limits have been established in terms of dosing (Source).

I’ve read a few anecdotal reports on Reddit that individuals who started mega-dosing with Pantothenic acid started to experience hair loss. This type of hair loss would be called Telogen Effluvium and involves temporary and reversible diffuse shedding of hair. 

It’s quite possible there is something about mega-dosing with pantothenic acid that disrupts the growth cycle of hair but there is currently no published research explaining this phenomenon so it would be hard to speculate on it further. 

But It should also be noted that large doses of pantothenic acid can compete with biotin synthesis and absorption in the gut (Source, Source). This could theoretically explain why some people have experienced hair loss because low levels of biotin in the body can cause hair shedding and breakage (Source). If you’re concerned about hair loss you can proactively take a biotin supplement but you’d need to take it several hours before or after taking pantothenic acid as they compete with each other for absorption. 

On a personal note, I take 300 mcg of biotin a day and have yet to experience hair loss, thinning, or brittleness since starting to take pantothenic acid. I’d recommend a low-dose biotin supplement as a lot on the market have mega-doses and there’s no known benefit to taking so much (Source). 

This is one of the key reasons why so many people breakout when they take a biotin supplement. The biotin in and of itself isn't causing the acne- the fact that's it's impairing absorption of what little B5 you get from your diet is actually why it makes you breakout.

Side Effects

The most common anecdotal side effects reported are diarrhea, gas, bloating, and loose stools (Source, Source). When I started taking pantothenic acid I experienced bloating for about 6 weeks but it slowly subsided. 

My Experience

While doing ingredient research on panthenol (the topical version of B5) for one of our products in development I discovered the research on oral pantothenic acid supplementation as an acne treatment. The safety profile of B5 made it a no-brainer to try. 

While my skin wasn’t breaking out too badly when I started taking pantothenic acid, I was struggling with generalized redness, irritation, and an increasing number of hormonal breakouts on the lower half of my face along with ever-persistent fungal acne that I’ve struggled to keep under control for years. 

While there is no singular miracle cure for acne (yet), I’ve been taking high-dose pantothenic acid as the icing on my healthy diet and lifestyle cake and the results have been significant. 

I can confidently say for the first time since I was a teenager that my skin has been 99% clear over the last 2 years. 

**Long term update:

Months 1-6: 5000 mg twice a day

Months 6-12: 2500 mg a day

Months 12 to current day I take 500 mg twice a day as a maintenance dose

I did go down to 500 mg once a day at one point but I noticed some brekaouts started to return. 

What didn’t improve? I’m still extremely clog-prone and while this got rid of my baseline acne I still break out if I try to use a moisturizer or products with lipids, most plants oils, or esters. 

And in terms of diet, I can finally tolerate high fat foods, like nuts and coconut oil without breaking out. I've also for the first time been able to take an omega-3 supplement without beaking out in cysts for the first time in my life. 

Because there’s still more about acne that we don’t know than what we know, there could be other variables or reasons out there that will determine whether or not pantothenic acid will work for you or be a dud. 

But given its safety profile, relative affordability, and low risk of side effects I still think it’s worth a try. 

But Why Can’t I Just Get More Pantothenic Acid From My Diet?

This is an excellent question and one worth exploring because generally speaking, I’ve always been of the mindset that getting as many vitamins and minerals as possible from our diets versus supplements is better. 

However, this isn’t always the case and it would appear that from an acne standpoint the amount of pantothenic acid required to treat acne would be impossible to achieve through dietary pantothenic acid sources alone. 10,000 eggs a day anyone?