Effects of nutritive and non-nutritive sweeteners on acne vulgaris: A systematic review

Acne vulgaris is a prevalent inflammatory skin disorder influenced by sebaceous gland activity, hormonal regulation, and microbial proliferation. Dietary factors, including sweetening agents, may modulate acne pathophysiology, affecting sebum production, inflammatory responses, and the skin microbiome. This systematic review summarizes the effects of nutritive and non-nutritive sweeteners on acne-related markers, with a focus on Cutibacterium acnes activity and associated inflammatory pathways. Non-nutritive sweeteners such as mannitol and xylitol show potential in regulating acne pathogenesis and exhibiting antibacterial activity against C. acnes. Strategic combinations of sweeteners with bioactive compounds, such as mannitol with bakuchiol or Ginkgo biloba extract, and xylitol with propanediol and caprylic acid, further enhance anti-inflammatory and antimicrobial effects, offering a multifaceted approach to acne management. For nutritive sweeteners, experimental evidence suggests that glucose may enhance C. acnes biofilm susceptibility when combined with certain antibiotics. These findings emphasize the importance of careful selection and formulation of sweetening agents in dermatological interventions. Incorporating sweeteners, alone or in combination with bioactive compounds, could complement conventional acne therapies, reduce microbial proliferation, modulate inflammatory pathways, and support overall skin health. This review provides a scientific basis for dietary recommendations and the development of adjunctive acne treatments, highlighting sweetening agents as emerging functional modulators of acne pathogenesis.