Zinc in the Pathophysiology and Treatment of Acne Vulgaris: Clinical Efficacy, Molecular Mechanisms, Safety Profile, and Future Therapeutic Perspectives – A Comprehensive Literature Review
DOI:
https://doi.org/10.12775/QS.2026.79.76733Keywords
acne, acne vulgaris, zinc supplementation, zinc, zinc deficiency, topical treatment, retinoids, sebum production, Acne scars managementAbstract
Background: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit involving sebum overproduction, follicular hyperkeratinization, Cutibacterium acnes colonization, and immune dysregulation. Zinc may reduce sebum, exert antibacterial and anti-inflammatory effects, and support wound healing.
Aim of the study: This review summarizes evidence on zinc in acne vulgaris, including its mechanisms, clinical effectiveness, safety, biomarker potential, effects on antibiotic resistance, scar healing and sebum production, and treatment costs.
Methods: PubMed was searched up to 2026. Clinical trials, meta-analyses, and mechanistic studies evaluating oral and topical zinc in acne were reviewed, with emphasis on serum zinc levels, efficacy versus standard therapies, safety, antibiotic resistance, scarring, sebum and androgen modulation, zinc transporter genetics, and costs.
Results: Patients with acne often have lower serum zinc levels than healthy controls, particularly in severe disease, suggesting potential as a biomarker. Oral zinc modestly reduces inflammatory lesions but is less effective than tetracyclines and isotretinoin; topical zinc mainly provides adjunctive benefit. Both forms have favorable safety profiles. Zinc does not induce C. acnes antibiotic resistance and may reduce antibiotic use. It may support scar healing and decrease sebum partly through 5α-reductase inhibition. Evidence on zinc transporter genetics remains limited. Zinc is generally inexpensive, but robust cost-effectiveness data are lacking.
Conclusions: Zinc is a safe, accessible adjunctive option for acne vulgaris, particularly inflammatory lesions, but is less effective than established first-line therapies. Further standardized trials are needed to define optimal dosing, formulations, and patient selection.
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