## Lower fiber intake observed in acne patients
> Patients with acne had a significantly higher family history of acne compared to controls (P=0.006). Serum level of **malondialdehyde was significantly higher in cases (P=0.01)**, while high-density lipoprotein cholesterol was significantly lower (P=0.02). Moreover, significantly **lower fiber intake was observed in cases **compared with controls (P=0.007).

*Moazen, M., Mazloom, Z., Jowkar, F., Nasimi, N., & Moein, Z. (2019). Vitamin D, Adiponectin, Oxidative Stress, Lipid Profile, and Nutrient Intakes in the Females with Acne Vulgaris: A Case-Control Study. Galen medical journal, 8, e1515. https://doi.org/10.31661/gmj.v8i0.1515*

## Psyllium husk (soluble fiber)
> Conclusion: Patients in both subgroups who received psyllium in addition to antibiotics and systemic retinoids treatment showed better results after treatment in terms of **skin condition**, overall health and quality of life.

*Ledentsova, S., Gulyaev, N., Sitkin, S., & Seliverstov, P. (2021). Acne as a common extraintestinal manifestation of celiac disease. Treatment approaches. Meditsinskiy sovet = Medical Council. https://doi.org/10.21518/2079-701x-2020-21-126-135.*

> Conclusion: Patients in both subgroups, who in addition to antibiotic and systemic retinoid treatment, received psyllium, showed better results of skin health, **intestinal microbiome**, general well-being, and quality of life.

*Ledentsova, S., Gulyaev, N., Oreshko, L., & Seliverstov, P. (2023). Microbiome changes in acne patients with celiac disease under different treatments. Experimental and Clinical Gastroenterology. https://doi.org/10.31146/1682-8658-ecg-207-11-70-79.*

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## FOS and GOS (soluble fibers)
> Conclusion: In adult female acne, supplementation with prebiotic FOS and GOS was associated with positive effects on glycemic and lipid metabolic parameters.

*Dall'Oglio, F., Milani, M., & Micali, G. (2018). Effects of oral supplementation with FOS and GOS prebiotics in women with adult acne: the "S.O. Sweet" study: a proof-of-concept pilot trial. Clinical, cosmetic and investigational dermatology, 11, 445449. https://doi.org/10.2147/CCID.S179627*

> Conclusion: A cream containing retinoid molecules and Iris Florentina root extract is effective and well tolerated in the management of AFA. The treatment combination with a prebiotic and anti-inflammatory food supplement offers an additional clinical benefit mainly in reducing inflammatory lesions and improving the severity acne score.

- Limitations: Food supplement containing a mixture of prebiotic molecules (FOS&GOS) zinc, lactoferrin, and niacinamide, not just one ingredient
*Kazandjieva J, Dimitrova J, Sankeva M, Yankov D, Bocheva V, Kircheva K, Gincheva V, Gospodinova K, Andasorova R, Milanova M, Jeleva D, Zlateva P, Vasileva I, Yankova R, Gotseva S, Dakova T, Zografova E, Marina S, Kateva M, Broshtilova V, Todeva V, Tsankov N, Mitova Z, Boyanova N, Milani M. Efficacy of a retinoid complex plus anti-inflammatory component cream alone or in combination with prebiotic food supplement in adult acne: A randomized, assessor-blinded, parallel-group, multicenter trial on 184 women. J Cosmet Dermatol. 2022 Nov;21(11):5716-5722. doi: 10.1111/jocd.15074. Epub 2022 May 23. PMID: 35545875.*

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## Topical Glucomannan hydrolysates (GMH)
> The results showed that there was a significant (P< 0.001) improvement of the skin health at the second (20 days) and third clinical evaluation (40 days) for established (e.g. antibiotics) and GMH treatments.

Bateni, Ellie, et al. "The use of konjac glucomannan hydrolysates (GMH) to improve the health of the skin and reduce acne vulgaris." American Journal of Dermatology and Venereology 2.2 (2013): 10-14.

Potential fiber side effects:
- Can cause gas, bloating, and digestive discomfort, especially when started at high doses (depending on the prebiotic fiber type)
- May interfere with absorption of certain medications and nutrients.