Acne Vulgaris

Also indexed as: Pimples

Common acne, known medically as acne vulgaris, occurs most commonly in teenagers and to a lesser extent in 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.

Checklist for Acne Vulgaris

Rating Nutritional Supplements Herbs
3Stars Niacinamide (topical)
Zinc		 Tea tree oil (topical)
2Stars   Guggul
1Star Pantothenic acid
Vitamin A
Vitamin B6		 Burdock
Vitex (associated with menstrual cycle)
See also:  Homeopathic Remedies for Acne
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of acne? Acne is a skin condition characterized 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.

How is it treated? Astringent lotions, oil-removing pads, and acne soap are used to keep the skin clean. Topical creams containing salicylic acid, benzoyl peroxide, or tretinoin (Retin-A®) are often recommended to prevent the formation of pimples and to treat preexisting cysts. For more severe cases, oral antibiotics such as erythromycin or tetracycline are often prescribed. Women with severe acne are sometimes treated with birth control pills. People with the most severe acne are treated with 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.

Nutritional supplements 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 favorably 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 vitex 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.

Other integrative 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:

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.