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Omega-3 fish oil and skin health

The physiological changes and various characteristics of essential fatty acid (EFA) deficit with respect to our skin are numerous. Deficits have been shown to lead to dysfunctions in the skin barrier, inflammatory responding, and cellular signaling. Several clinical disorders such as atopic dermatitis, psoriasis and acne have also been linked to EFA deficits (Wright, 1989). Furthermore, new and exciting research suggests that increasing dietary EFAs rejuvenates the look of our skin and can prevent both chronological and sun-damage induced signs of aging.

Fish oil and wrinkle prevention
Research suggests that the youthfulness of skin can be maintained with fish oil, specifically eicosapentaenoic acid (EPA). Fish oil has been found to be effective in reducing photoageing (especially elastosis), wrinkle formation and is also beneficial in preventing chronological ageing, such as thinning of the skin (Kim et al., 2005).
Aging of the skin is attributed to both intrinsic aging (chronological) and extrinsic aging (sundamage). Naturally aged skin is pale, smooth and has fine wrinkles, where as photoaged skin is coarsely wrinkled and is associated with yellowing of the skin, laxity, and a leathery dry appearance (Gilchrest, 1989). Studies have suggested that collagen alteration is the major cause of extrinsic aging (Fisher et al., 1997).

Protection from the sun’s ultraviotlet radiation (UV)is very important for preventing premature aging. Ultraviolet radiation damages skin by activating proteins in the skin which generate reactive oxygen species leading to collagen degradation. Once photo aging has occurred, skin appears coarse with deep wrinkles. Luckily, EPA diminishes the UV induced damage to our skin which helps maintain a youthful appearance (Sies & Stahl, 2004).

Work has been done to determine the mechanism by which EPA prevents photodamage. The research suggests that omega-3 fatty acids protects against oxidative stress which underlies photoaging. Rhodes et al., (2003) examined the effect of EPA supplementation on ultraviolet radiation induced DNA damage in humans and assessed basal and post-ultraviolet oxidative levels. Forty two healthy subjects took purified omega-3 EPA, or monounsaturated oleic acid (OA) daily for three months. Sunburn sensitivity was reduced in the group supplemented with EPA. Subjects who received the EPA showed a significantly lower level of skin p53 expression 24 hrs after exposure to the UV radiation. This reduction in sunburn, and UV radiation induced p53 suggested that dietary EPA protects against acute UV radiation induced genotoxicity. It was inferred that long-term supplementation would reduce sun exposure induced forms of skin cancer in humans. (Rhodes et al., 2003)

To determine whether a reduction in sunburn is mediated by a reduction in UV-B proinflammatory mediators, tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1 beta, IL-6, IL-8, or prostaglandin E2 (PGE2) was subsequently assessed by Shahbakhti et al. (2004). For three months, twenty eight subjects received 4 g daily of EPA form or oleic acid. Skin biopsies and suction blister fluids were taken from UV-B exposed and unexposed skin and were examined immunohistochemically for mediator expression and were quantified with an immunoassay. Irradiation with UV-B resulted in a significant increase in blister fluid, TNF-alpha, IL-6, IL-8 and prostaglandin E2 in subjects who were not given the omega-3 EPA supplement. However, when 4g of EPA was supplied daily, increases in UV-B mediators were abolished in UV-B exposed skin (Shahbakhti et al., 2004).

A study conducted by Kim et al (2006) discovered that EPA not only prevents UV induced skin aging but that EPA also rejuvenates the skin. They discovered that EPA administration to sun exposed skin caused an increase in the expression of extracellular matrix proteins, such as procollagen, tropoelastin, and fibrillin-1 by increasing transformin growth factor-b (TGF-b). An increase in such proteins rebuilds the skin and improves its appearance.

Omega-3 deficiency and inflammatory skin disease
A dietary deficit in essential fatty acid consumption can lead to several negative characteristics and conditions in our skin. Deficits have been shown to lead to dysfunctions in inflammatory responding, cellular signaling and have led to several clinical disorders such as atopic dermatitis, psoriasis and even acne (Wright, 1989).

Fish oil and acne    
The notion that acne is influenced by dietary factors is not a new idea, nor is the involvement of essential fatty acids. Acne is characterized by hyperkeratosis of the follicular epithelium, leading to impactions which lie dormant as open or closed comedones and cause inflammation of the follicle (Downing, Stewart, Wertz, & Strauss, 1986).

Epidemiological studies show that communities which maintain a diet high in omega-3 fatty acids have lower rates of acne (Schaffer et al. 1989). In another study by Hitch and Greenberg (1961), it was discovered that the lowest rates of acne were among adolescents consuming the greatest amounts of fish and seafood. In fact, each of the primary signs of acne, including: oily skin, comedones, papules, pustules, and acne cysts were significantly lower among the teenagers who were consuming a diet higher in oily fish.

Studies have begun to show that dietary omega-3 supplementation can prevent skin inflammation and help to reduce the signs of acne (Logan, 2007). Recently, investigators have reported that inhibition of an arachidonic acid product; leukotriene B4 (LTB4) reduces sebum production and improves inflammatory acne. Proinflammatory LTB4 has been found to be highly involved in acne (Logan, 2003). Furthermore, administration of a LTB4 blocker reduced inflammatory acne lesions by 70% (Zouboulis, 2001). Supplementation with omega-3 fatty acids inhibits LTB4 and provides anti inflammatory effects such as preventing hyperkeratinization of sebaceous follicles. This suggests that supplementation with fish oil as a source of omega-3 fatty acids could improve and prevent acne (Zouboulis, 2001).

Fish oil for Psoriasis
The possibility that an increase in arachidonic acid plays a role in cutaneous and scaly disorders was first described in 1975 by a study which discovered that there is a build-up of arachidonic acid, and its lipoxygenase products within the lesions seen on the skin of patients with psoriasis (Hammarstrom et al., 1975). Subsequently, experiments were conducted to investigate the effect of adding lipoxygenase mediators to normal skin. Intracutaneous injections of arachidonic acid metabolites; LTB4, LTC4 and LTD4 into normal skin elicited inflammation combined with neutrophil infiltration, wheal formation and erythema (Soter et al., 1983). Thus, an increase in arachidonic acid derived eicosanoids is involved in scaly inflammation and psoriasis.

These findings lead to investigations which assessed the effect of omega-3 fatty acids on omega-6 derived inflammatory mediators. The notion that omega-3 fatty acids may play a role in psoriasis was first examined when it was discovered that Eskimos (diets consisting of large amounts of oily fish and omega-3 fatty acids) exhibit a lower incidence of psoriasis (Kromann and Green, 1980). Ziboh et al. (1991) assessed if supplementation with omega-3 fatty acids prevents the over production of omega-6 derived arachidonic eicosanoids in patients with psoriasis. A fish oil supplement, containing EPA and DHA was administered for eight weeks in psoriatic patients which resulted in mild to moderate improvements in psoriatic lesions.

Fish oil and Eczema
In 1984 Manku et al. conducted a study which assessed the relationship between omega-3 fatty acids and eczema. They measured the essential fatty acids found in the plasma phospholipids of adults with atopic eczema and compared them to the results of healthy controls. Alpha-linolenic acid, a short chain omega-3 polyunsaturated fatty acid was slightly elevated, while eicosapentaenoic acid and docosahexaenoic acid, the longer chain omega-3 metabolites were significantly reduced. These results suggested that atopic eczema involves abnormal metabolism of omega-3 fatty acids via the enzyme delta-6-desaturase (Manku et al., 1984). Such a hypothesis is strengthened by the fact that our skin lacks the ability to desaturate the shorter chain fatty acids, such as the conversion of linoleic acid into gamma linoleic acid. The epidermis does however have an elevated level of enzymes involved in the elongation of omega-3 and omega-6 fatty acids (Ziboh, 1994). This suggests that dietary supplementation with EPA and DHA from fish oil could improve symptomology in patients with eczema because they do not rely on the enzyme delta-6-desaturase.

Fish oil for skin disease in the elderly and malnourished
Essential fatty acid supplementation has also been linked to improvements in skin disease among the elderly and malnourished. A study conducted by Cederholm et al. (1994) found that essential fatty acid deficiency is involved in cutaneous anergy. The fatty acid profiles and cutaneous hypersensitivities of 20 malnourished elderly non-cancer patients were measured and compared to 20 age matched controls. Subsequently, both groups were given an omega-3 supplement. Supplementation with omega-3 turned negative skin tests positive in the malnourished group and enlarged their median skin indurations threefold. The researchers thus concluded that a deficiency in omega 3 fatty acids is one of the contributing factors to the development of cutaneous anergy in elderly malnourished patients (Cederholm et al., 1994).

References

Cederholm TE, Berg AB, Johansson EK, Hellstrom KH, Palmblad JE (1994) Low levels of essential fatty acids are related to impaired delayed skin hypersensitivity in malnourished chronically ill elderly people. Eur J Clin Invest 24:615-620.
Fisher, G. J., Z. Q. Wang, S. C. Datta, J. Varani, S. Kang, and J. J. Voorhees. 1997. Pathophysiology of premature skin aging induced by ultraviolet light. N. Engl. J. Med. 337: 1419–1428.

Fisher, G. J., S. C. Datta, H. S. Talwar, Z. Q. Wang, J. Varani, S. Kang, and J. J. Voorhees. 1996. Molecular basis of sun-induced premature skin ageing and retinoid antagonism. Nature. 379: 335–339.

Galus R, Zandecki L, Antiszko M, Borowska K, Zabielski S (2007) [Photoaging of a skin]. Pol Merkur Lekarski 22:580-584.
Gilchrest, B. A. 1989. Skin aging and photoaging: an overview. J. Am. Acad. Dermatol. 21: 610–613.


Hammarström S, Hamberg M, Samuelsson B, Duell EA, Stawiski M, Voorhees JJ (1975).  Increased concentrations of nonesterified arachidonic acid, 12L-hydroxy-5,8,10,14-eicosatetraenoic acid, prostaglandin E2, and prostaglandin F2alpha in epidermis of psoriasis. Proc Natl Acad Sci 72:5130-4.

Hitch, J.M., and Greenburg, B.G. (1961). Adolescent acne and detary iodine. Arch Dermatol. 84: 898-911.

Horrobin DF (2000) Essential fatty acid metabolism and its modification in atopic eczema. Am J Clin Nutr 71:367S-372S.

Kim HH, Shin CM, Park CH, Kim KH, Cho KH, Eun HC, Chung JH. (2005). Eicosapentaenoic acid inhibits UV-induced MMP-1 expression in human dermal fibroblasts. J Lipid Res 46:1712-20

Kromann N, Green A (1980) Epidemiological studies in the Upernavik district, Greenland. Incidence of some chronic diseases 1950-1974. Acta Med Scand 208:401-406.

Logan, A.C. (2007). Dietary fat, fiber, and acne vulgaris. Journal of the American Academy of Dermatology 57:1092-1093

 Manku MS, Horrobin DF, Morse NL, Wright S, Burton JL (1984) Essential fatty acids in the plasma phospholipids of patients with atopic eczema. Br J Dermatol 110:643-648.

Miller CC, Tang W, Ziboh VA, Fletcher MP (1991) Dietary supplementation with ethyl ester concentrates of fish oil (n-3) and borage oil (n-6) polyunsaturated fatty acids induces epidermal generation of local putative anti-inflammatory metabolites. J Invest Dermatol 96:98-103.

Rhodes LE, Shahbakhti H, Azurdia RM, Moison RM, Steenwinkel MJ, Homburg MI, Dean MP, McArdle F, Beijersbergen van Henegouwen GM, Epe B, Vink AA (2003) Effect of eicosapentaenoic acid, an omega-3 polyunsaturated fatty acid, on UVR-related cancer risk in humans. An assessment of early genotoxic markers. Carcinogenesis 24:919-925.

Robinson DR, Prickett JD, Polisson R, Steinberg AD, Levine L (1985) The protective effect of dietary fish oil on murine lupus. Prostaglandins 30:51-75.

Rona C, Vailati F, Berardesca E (2004) The cosmetic treatment of wrinkles. J Cosmet Dermatol 3:26-34.

Schaffer, H.K. (1989). Essential fatty acids and eicosanoids in cutaneous inflammation. Int J Dermatol. 28: 281-290.

Shahbakhti H, Watson RE, Azurdia RM, Ferreira CZ, Garmyn M, Rhodes LE (2004) Influence of eicosapentaenoic acid, an omega-3 fatty acid, on ultraviolet-B generation of prostaglandin-E2 and proinflammatory cytokines interleukin-1 beta, tumor necrosis factor-alpha, interleukin-6 and interleukin-8 in human skin in vivo. Photochem Photobiol 80:231-235.
Sies, H., and Stahl, W (2004). Nutritional protection against skin damage from sunlight. Annu Rev Nutr, 24: 173-200.
Soter NA, Lewis RA, Corey EJ, Austen KF. (1983). Local effects of synthetic leukotrienes (LTC4, LTD4, LTE4, and LTB4) in human skin. J Invest Dermatol. 80:115-9.

Wright S (1989) Essential fatty acids and the skin. Prostaglandins Leukot Essent Fatty Acids 38:229-236.
Ziboh VA (1994) Essential fatty acids/eicosanoid biosynthesis in the skin: biological significance. Proc Soc Exp Biol Med 205:1-11.

Zouboulis CC. (2000). Human skin: an independent peripheral endocrine organ. Horm Res. 54: 230-42.

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