Section Eleven: Vitamins B5, B6, E and
Chapter 42. Pantothenic Acid, Vitamin B5 for
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.
Left Image: The Mona Lisa with Acne, 1503
- 1505 by Leonardo da Vinci (1452–1519) , Medium Oil on poplar. Louvre Museum
Paris, courtesy of wikimedia commons.
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.
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.
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)
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
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.
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.
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
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.
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)
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
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.
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.
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.
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.
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.
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.
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.
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.
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
Vilante Home, and Video
Vilante B5 web site
The Vitamin B 5 Acne Theory Debunked
(4) http://deficiencydiseases.com/ Papers on B5 and Acne by
Lit-Hung Leung, M.D.
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.
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.
Coenzyme-ATM "Precursor The Master CoenzymeTM" by Nickolaos D.
Acne.Org message board…nuts and bolts advice on b5 .
acne b5 accutane message board
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.
(12) http://deficiencydiseases.com/ articles by Lit-Hung Leung on B5
ERYTHEMATOSUS: A Combined Deficiency Disease by Lit-Hung Leung, M.D. Formerly
Consultant Surgeon, Department of General Surgery, Hong Kong Central Hospital,
Med Hypotheses. 1995 Jun;44(6):490-2. Pantothenic acid deficiency as the
pathogenesis of acne vulgaris. Leung LH.
Using Pantothenic Acid (Vitamin B5) as an Acne Treatment By Ryan Bauer
Am J Clin Nutr. 1985 Mar;41(3):578-89. Effects of supplemental pantothenic acid
on wound healing: experimental study in rabbit. Aprahamian M, Dentinger A,
Stock-Damgé C, Kouassi JC, Grenier JF.
(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
Vestn Dermatol Venerol. 1963 Mar;37:16-20. [Combined treatment of lupus
erythematosus patients with resochin and calcium pantothenate.][Article in
Russian] TISHCHENKO LD.
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.
Volume 62, Issue 6, Pages 922-924 (June 2004) Systemic lupus erythematosus: a
combined deficiency disease. Lit-Hung Leung.
Welsh AL. Lupus erythematosus: Treatment
by combined use of massive amounts of pantothenic acid and vitamin E. Arch
Dermatol Syphilol 1954;70:181–98.
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
Jeffrey Dach MD
7450 Griffin Road Suite 190
Davie, Florida 33314
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