Acne vulgaris

Acne Vulgaris

Also indexed as: Pimples

Break free from acne breakouts. Put your best face forward with a few simple, yet effective, acne fighting actions. According to research or other evidence, the following self-care steps may be helpful:

Clean your skin
Washing with cleaning lotions and using oil-removing pads can help control acne

Use acne-fighting lotions
Lotions that contain niacinamide gel (4%) and tea tree oil (5%) can be helpful

Try zinc
60 to 90 mg a day of this mineral improves some people’s acne

Add copper
If taking extra zinc, your body will need 1 to 2 mg each day of copper to avoid deficiency of this mineral

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full acne vulgaris article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About acne vulgaris

Acne vulgaris, also known as common acne, is an inflammatory condition of the sebaceous glands of the skin. It consists of red, elevated areas on the skin that may develop into pustules and even further into cysts that can cause scarring.

Acne vulgaris occurs mostly on the face, neck, and back of most commonly teenagers and to a lesser extent of young adults. The condition results in part from excessive stimulation of the skin by androgens (male hormones). Bacterial infection of the skin also appears to play a role.

Product ratings for acne vulgaris

Science Ratings	Nutritional Supplements	Herbs
	Niacinamide (topical) Zinc	Tea tree oil (topical)
		Guggul
	Pantothenic acid Vitamin A Vitamin B6	Agnus castus (associated with menstrual cycle) Burdock
See also: Homoeopathic Remedies for Acne
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Acne is a skin condition characterised by pimples, which may be closed (sometimes called pustules or “whiteheads”) or open (blackheads), on the face, neck, chest, back, and shoulders. Most acne is mild, although some people experience inflammation with larger cysts, which may result in scarring.

Medical options

Over the counter products such as astringent lotions, oil-removing pads, and medicated bar soaps are used to keep the skin clean. Non-prescription topical agents containing salicylic acid (Clearasil Acne-Fighting Pads®, Stri-Dex Pads®) and benzoyl peroxide (Oxy 10 Maximum Strength Advanced Formula®, Fostex 10% Wash®, Clear By Design®) are often recommended to prevent the formation of pimples and to treat preexisting cysts.

Topical prescription medications include benzoyl peroxide (Benzac®, Desquam®, Triaz®); antibiotics such as erythromycin (Akne-mycin®, Erygel®), clindamycin (Cleocin T®), and azelaic acid (Azelex®); and tretinoin (Retin-A®). Oral antibiotics such as erythromycin (Ery-Tab®, E-Mycin®) or tetracycline (Sumycin®) are often prescribed. Women with severe acne are sometimes treated with birth control pills. People with the most severe acne are usually prescribed isotretinoin (Accutane®).

Dietary changes that may be helpful

Many people assume certain aspects of diet are linked to acne, but there is not much evidence to support this idea. Preliminary research found, for example, that chocolate was not implicated.¹ Similarly, though a diet high in iodine can create an acne-like rash in a few people, this is rarely the cause of acne. In a preliminary study, foods that patients believed triggered their acne failed to cause problems when tested in a clinical setting.² Some doctors of natural medicine have observed that food allergy plays a role in some cases of acne, particularly adult acne.³ However, that observation has not been supported by scientific studies.

Vitamins that may be helpful

In a double-blind trial, topical application of a 4% niacinamide gel twice daily for two months resulted in significant in improvement in people with acne.⁴ However, there is little reason to believe this vitamin would have similar actions if taken orally.

Several double-blind trials indicate that zinc supplements reduce the severity of acne.⁵ ⁶ ⁷ ⁸ In one double-blind trial,⁹ though not in another,¹⁰ zinc was found to be as effective as oral antibiotic therapy. Doctors sometimes suggest that people with acne take 30 mg of zinc two or three times per day for a few months, then 30 mg per day thereafter. It often takes 12 weeks before any improvement is seen. Long-term zinc supplementation requires 1–2 mg of copper per day to prevent copper deficiency.

Large quantities of vitamin A—such as 300,000 IU per day for females and 400,000–500,000 IU per day for males—have been used successfully to treat severe acne.¹¹ However, unlike the long-lasting benefits of the synthetic prescription version of vitamin A (isotretinoin as Accutane®), the acne typically returns several months after natural vitamin A is discontinued. In addition, the large amounts of vitamin A needed to control acne can be toxic and should be used only under careful medical supervision.

In a preliminary trial, people with acne were given 2.5 grams of pantothenic acid orally four times per day, for a total of 10 grams per day—a remarkably high amount.¹² A cream containing 20% pantothenic acid was also applied topically four to six times per day. With moderate acne, near-complete relief was seen within two months, while severe conditions took at least six months to respond. Eventually, the intake of pantothenic acid was reduced to 1 to 5 grams per day—still a very high amount.

A preliminary report suggested that vitamin B6 at 50 mg per day may alleviate premenstrual flare-ups of acne experienced by some women.¹³ While no controlled research has evaluated this possibility, an older controlled trial of resistant adolescent acne found that 50–250 mg per day decreased skin oiliness and improved acne in 75% of the participants.¹⁴ However, another preliminary report suggested that vitamin B6 supplements might exacerbate acne vulgaris.¹⁵

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

A clinical trial compared the topical use of 5% tea tree oil to 5% benzoyl peroxide for common acne. Although the tea tree oil was slower and less potent in its action, it had far fewer side effects and was thus considered more effective overall.¹⁶

One controlled trial found that guggul (Commiphora mukul) compared favourably to tetracycline in the treatment of cystic acne.¹⁷ The amount of guggul extract taken in the trial was 500 mg twice per day.

Historically, tonic herbs, such as burdock, have been used in the treatment of skin conditions. These herbs are believed to have a cleansing action when taken internally.¹⁸ Burdock root tincture may be taken in the amount of 2 to 4 ml per day. Dried root preparations in a capsule or tablet can be used at 1 to 2 grams three times per day. Many herbal preparations combine burdock root with other alterative herbs, such as yellow dock, red clover, or cleavers. In the treatment of acne, none of these herbs has been studied in scientific research.

Some older, preliminary German research suggests that agnus castus might contribute to clearing of premenstrual acne, possibly by regulating hormonal influences on acne.¹⁹ Women in these studies used 40 drops of a concentrated liquid product once daily.²⁰

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Integrated approaches that may be helpful

Acupuncture may be helpful in the treatment of acne. Several preliminary studies have reported that a series of acupuncture treatments (8 to 15) is markedly effective or curative in 90 to 98% of patients.²¹ ²² ²³ Besides traditional Chinese acupuncture using needles alone, a technique called “cupping” is frequently used in the treatment of acne. Cupping refers to the use of cup-shaped instruments to apply suction to the area being needled. Two preliminary trials of cupping treatment for acne reported marked improvement in 91 to 96% of the study participants.²⁴ ²⁵ Controlled trials are necessary to determine the true efficacy of acupuncture and other traditional Chinese therapies in the treatment of acne.

Some hypnotherapists believe that hypnosis might help prevent facial scarring associated with acne. In one case study, a patient was instructed to say the word “scar” in place of picking her face, and the scratch marks resolved. The underlying acne was unaffected.²⁶

References
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1. Fulton JE Jr, Plewig G, Kligman AM. Effect of chocolate on acne vulgaris. JAMA 1969;210:2071–4.

2. Anderson PC. Foods as the cause of acne. Am Family Phys 1971;3:102–3.

3. Gaby A. Commentary. Nutr Healing 1997;Feb:1,10–1.

4. Shality AR, Smith JR, Parish LC, et al. Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris. Internat J Dermatol 1995;34:434–7.

5. Hillström, L Pettersson L, Hellbe L, et al. Comparison of oral treatment with zinc sulfate and placebo in acne vulgaris. Br J Dermatol 1977;97:681–4.

6. Verma KC, Saini AS, Dhamija SK. Oral zinc sulphate therapy in acne vulgaris: a double-blind trial. Acta Dermatovener (Stockholm) 1980;60:337–40.

7. Dreno B, Amblard P, Agache P, et al. Low doses of zinc gluconate for inflammatory acne. Acta Dermatovener (Stockholm) 1989;69:541–3.

8. Michaelsson G. Oral zinc in acne. Acta Dermatovener (Stockholm) 1980;Suppl 89:87–93 [review].

9. Michaelsson G, Juhlin L, Ljunghall K. A double blind study of the effect of zinc and oxytetracycline in acne vulgaris. Br J Dermatol 1977;97:561–6.

10. Cunliffe WJ, Burke B, Dodman B, Gould DJ. A double-blind trial of a zinc sulphate/citrate complex and tetracycline in the treatment of acne vulgaris. Br J Dermatol 1979;101:321–5.

11. Kligman AM, Mills OH Jr, Leyden JJ, et al. Oral vitamin A in acne vulgaris. Preliminary report. Int J Dermatol 1981;20:278–85.

12. Leung LH. Pantothenic acid deficiency as the pathogenesis of acne vulgaris. Med Hypotheses 1995;44:490–2.

13. Snider B, Dietman DF. Pyridoxine therapy for premenstrual acne flare. Arch Dermatol 1974;110:130–1 [letter].

14. Joliffe N, Rosenblum LA, Sawhill J. Effects of pyridoxine (vit B6) on resistant adolescent acne. J Invest Dermatol 1942;5:143–8.

15. Braun-Falco O, Lincke H. The problem of vitamin B6/B12 acne. A contribution on acne medicamentosa. MMW Munch Med Wochenschr 1976;118(6):155–60 [in German].

16. Bassett IB, Pannowitz DL, Barnetson RS. A comparative study of tea-tree oil versus benzoyl peroxide in the treatment of acne. Med J Austral 1990;53:455–8.

17. Thappa DM, Dogra J. Nodulocystic acne: oral gugulipid versus tetracycline. J Dermatol 1994;21:729–31.

18. Hoffman D. The Herbal Handbook: A User’s Guide to Medical Herbalism. Rochester, VT: Healing Arts Press, 1988, 23–4.

19. Amann W. Improvement of acne vulgaris with Agnus castus (Agnolyt ™). Ther Gegenw 1967;106:124–6 [in German].

20. Amann W. Acne vulgaris and Agnus castus (Agnolyt ™).Z Allgemeinmed 1975;51:1645–58 [in German].

21. Xu Y. Treatment of facial skin diseases with acupuncture—a report of 129 cases. J Tradit Chin Med 1990;10:22–5.

22. Xu YH. Treatment of acne with ear acupuncture—a clinical observation of 80 cases. J Tradit Chin Med 1989;9:238–9.

23. Liu J. Treatment of adolescent acne with acupuncture. J Tradit Chin Med 1993;13:187–8.

24. Chen D, Jiang N, Cong X. 47 cases of acne treated by prick-bloodletting plus cupping. J Tradit Chin Med 1993;13:185–6.

25. Ding LN. 50 cases of acne treated by puncturing acupoint dazhui in combination with cupping. J Tradit Chin Med 1985;5:128.

26. Shenefelt PD. Hypnosis in dermatology. Arch Dermatol 2000;136:393–9.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.