Fish oil and acne: omega-3 doses and evidence

Fish oil has a small controlled trial showing fewer acne spots, and the NIH describes its side effects as usually mild. The evidence is still limited: the three studies of omega-3 for acne itself had 13 to 60 people each. This guide covers what the omega-3 trials found, the doses they used, what happens when fish oil is combined with isotretinoin, and the safety advice from the US National Institutes of Health (NIH). It is part of Skinli's acne diet guide. A shorter summary sits in supplements for hormonal acne.

Skinli gives general education and is not a doctor or dietitian. Ask a doctor or pharmacist before you start fish oil, especially if you take a blood thinner or any prescription medicine.

What is in fish oil

The NIH Office of Dietary Supplements (ODS) explains that the omega-3s in fish oil are mainly EPA and DHA. A typical 1,000 milligram fish oil capsule contains 180 milligrams of EPA and 120 milligrams of DHA, though amounts vary widely between products. The same omega-3s are sold as krill oil, cod liver oil and algae oil, which is made from algae and suits people who do not eat fish.

When you compare products, look at the amount of EPA plus DHA on the label, the measure the acne trials use for their doses.

Why omega-3 might help

The researchers behind these studies give two reasons to test omega-3. The German group writes that omega-3s reduce inflammation, including substances the body releases during inflammation, and lower IGF-1, a growth hormone linked to acne. The 2012 pilot study starts from the observation that acne is rare in societies that eat more omega-3 fats compared with omega-6 fats. In the 2014 trial, skin samples after omega-3 showed less of interleukin-8, one of the signals the body uses to drive inflammation.

These ideas explain why omega-3 is worth testing. The trials below test these ideas in people.

What the trials found

Study	Who	What they took	Result
Acta Dermato-Venereologica, 2014	45 people with mild to moderate acne	2,000 mg EPA and DHA daily, borage oil, or nothing extra, for 10 weeks	Fewer inflamed and non-inflamed spots with both oils; no severe side effects
Lipids in Health and Disease, 2012	13 people with inflamed acne	3 grams of fish oil with 930 mg EPA daily, for 12 weeks	No clear change overall; 8 improved, 4 worsened, 1 unchanged
Journal of Cosmetic Dermatology, 2024	60 people with acne	Mediterranean diet plus 900 to 1,200 mg of algae omega-3 daily, for 16 weeks	Fewer spots and better quality of life; no side effects reported

The 2014 trial

This was a randomized, double-blind trial published in Acta Dermato-Venereologica. People took either omega-3, borage oil (a plant oil rich in another fatty acid) or no supplement. After 10 weeks, both oil groups had fewer spots, and skin samples showed less inflammation. The authors concluded that omega-3 could be used as an add-on to standard acne treatment.

The 2012 pilot study

Thirteen people added fish oil to their usual diet and acne treatment for 12 weeks. As a group, their acne did not change clearly. Individually, the results split: 8 improved, 4 worsened and 1 stayed the same. Seven of the 8 who improved had moderate to severe acne at the start, and 3 of the 4 who worsened had mild acne. The authors called for more research on how fats in the diet affect acne.

The 2024 German study

This study combined two changes: a Mediterranean diet and algae omega-3 capsules. Almost all participants, 98.3 percent, had low omega-3 levels at the start, and the average level rose from 4.9 to 8.3 percent over 16 weeks. Acne improved. Because diet and supplement changed together and there was no comparison group, the study cannot say how much of the benefit came from the omega-3.

Early case reports

A 2008 report in Lipids in Health and Disease described 5 people with acne who took EPA with antioxidant nutrients. Their inflamed spots and their general sense of well-being seemed to improve. The authors wrote that the observations point to a need for controlled trials, which came later.

Omega-3 levels in people with acne

A 2024 study from the same German group measured omega-3 in the red blood cells of 100 people with acne. In 96 of them, the level was outside the recommended range of 8 to 11 percent, with an average of 5.15 percent. Higher levels went with eating legumes regularly, taking omega-3 supplements and avoiding sunflower oil. The level did not differ with acne severity. There was no group without acne for comparison, so the study cannot show that low omega-3 is more common in acne.

Fish oil with isotretinoin

Two trials looked at fish oil taken with isotretinoin (Accutane), the strongest acne medicine:

• 2018, Dermatology Research and Practice. 118 people with moderate or severe acne took isotretinoin for 16 weeks, half with 1 gram of omega-3 a day. The omega-3 group had dry lips, dry skin, a dry nose and, early on, dry eyes less often.
• 2026, Journal of the American Academy of Dermatology. 80 people aged 18 to 25 took 10 milligrams of isotretinoin a day for 3 months, half with 1 gram of fish oil and half with a dummy capsule. Acne cleared as well in both groups. The fish oil group kept more moisture in the skin and had smaller rises in blood fats called triglycerides.

A third trial, published in 2026 in Lipids in Health and Disease, gave 46 people with acne isotretinoin for 6 months, with or without omega-3. It measured fats in the blood. The blood fat profile of the combination group moved closer to that of 20 healthy volunteers, and the authors concluded that omega-3 improved the response to treatment.

These results suggest fish oil does not weaken isotretinoin and may ease some of its dryness. Cod liver oil is different, because it contains vitamin A, and the isotretinoin label says to avoid vitamin A supplements. See vitamin A and acne and Accutane side effects.

What the guidelines say

The 2024 acne guideline from the American Academy of Dermatology (AAD) reviewed omega-3 and found the evidence insufficient to make a recommendation. The trials above are small. Of the studies on acne itself, only the 2014 trial compared omega-3 with no supplement in a blinded way.

Safety

The ODS says:

• Side effects are usually mild: unpleasant taste, bad breath, heartburn, nausea, stomach discomfort, diarrhea, headache and smelly sweat.
• The FDA has concluded that supplements providing no more than 5 grams of EPA and DHA a day are safe when used as recommended.
• High doses may slow blood clotting. People taking warfarin or similar blood thinners should talk to their doctor first.
• Cod liver oil supplies vitamin A and vitamin D as well as omega-3.

Omega-6 fats and the balance

Omega-6 fats, found in oils such as sunflower and corn oil, come up in the same research. In the 2024 German blood study, people who avoided sunflower oil had higher omega-3 levels. A 2024 Polish survey linked oils rich in omega-6 to worse acne, as people rated it. The authors of a 2024 chocolate trial limited these oils in the anti-inflammatory diet they used. No trial has tested cutting omega-6 oils on its own for acne.

Oily fish in your diet

Food is another way to raise omega-3. A 2023 German study of 120 people with acne listed oily fish, along with vegetables, legumes, olive oil and nuts, among foods that appear helpful for acne. A 2025 review found that closer adherence to the Mediterranean diet, which includes seafood, was linked to less severe acne, though the quality of that evidence was low. For how other fats compare, see greasy food and acne.

A practical approach

1. Keep your acne treatment going. Omega-3 was tested as an add-on. The acne skincare routine covers the treatment steps, and analyze your skin builds a free plan from a photo.
2. Check the EPA and DHA per serving, and stay within 5 grams a day of the two combined.
3. Give it 10 to 16 weeks, the length of the trials.
4. Ask first if you take a blood thinner, isotretinoin, or any medicine that affects bleeding.
5. Tell your pharmacist about cod liver oil or multivitamins you already take, so the vitamin A and vitamin D in them can be counted.