Adult acne

Q) Can you recommend any natural treatments for acne? I’ve suffered with the condition since my early teens (I’m now 27) and, while it has improved, I still get frequent breakouts. I’ve tried a number of over-the-counter and prescription medications, but I’ve yet to go down the alternative route. What do you suggest?—L.M., via e-mail

 

A) In the West, acne is estimated to affect up to 95 per cent of adolescents and around half of those over age 25 (Am J Clin Nutr, 2007; 86: 107–15). Why some people are plagued by pimples and others remain spot-free is not fully understood, but several factors are generally thought to be involved, including family history, hormonal changes and stress.

Conventional acne treatments include topical retinoids, benzoyl peroxide, azelaic acid, and topical and oral antibiotics. However, many of these are linked with nasty side-effects—from skin peeling and burning (Clin Ther, 2007; 29: 1086–97) to liver disease (BMJ, 1996; 312: 138) and depression (Expert Opin Drug Saf, 2004; 3: 119–29).

Fortunately, alternative medicine has plenty to offer.  For the best results, an integrated therapeutic approach is usually recommended.

 

Alternative treatments

-           Diet. Although the accepted wisdom is that diet has nothing to do with acne, a recent placebo-controlled study found that a low-glycaemic diet—one that is low in refined carbohydrates—can significantly improve symptoms (Am J Clin Nutr, 2007; 86: 107–15). Other studies have reported an increased risk of acne among adolescent girls who drink milk—whether full-fat, low-fat or skimmed (J Am Acad Dermatol, 2005; 52: 207–14; Dermatol Online J, 2006; 12: 1). It may be worth consulting a qualified nutritionist to determine whether certain foods in your diet might be causing or aggravating your acne.

-            Supplements. Several studies suggest that oral zinc supplementation can improve acne (Acta Derm Venereol, 1980; 60: 337–40; Acta Derm Venereol, 1989; 69: 541–3). However, the high doses required have the potential to cause toxicity (J Pediatr Hematol Oncol, 2002; 24: 582–4), so take zinc only under strict medical supervision. Other supplements that may help are folic acid, selenium, chromium and omega-3 fatty acids (Med Hypotheses, 2007; 69: 1080–4).

-           Tea tree oil. Derived from the Australian tree Melaleuca alternifolia, tea tree oil has long been regarded as a useful topical antiseptic as it contains a variety of natural antimicrobial agents. When its effectiveness against acne was tested, it proved to be just as effective as benzoyl peroxide (5 per cent tea tree oil gel vs 5 per cent benzoyl peroxide lotion), but with fewer side-effects (Med J Aust, 1990; 153: 455–8). More recently, a trial of 60 mild-to-moderate acne sufferers showed that tea tree oil gel was significantly more effective than placebo at reducing the severity of acne lesions (Indian J Dermatol Venereol Leprol, 2007; 73: 22–5).

-            Ayurvedic medicine. The Ayurvedic remedy Sunder Vati was effective against acne when given orally for six weeks (J Ethnopharmacol, 1995; 49: 127–32). In another study, using both topical and oral Ayurvedic herbal extracts containing Aloe barbadensis, Azardirachta indica, Curcuma longa, Hemidesmus indicus, Terminalia chebula and Withania somnifera was more effective than oral preparations alone (J Ethnopharmacol, 2001; 78: 99–102). The Ayurvedic herb guggul (Commiphora mukul) has also shown promise in treating acne, especially in those with oily faces (J Dermatol, 1994; 21: 729–31).

-            Nicotinamide. This form of vitamin B3 has anti-inflammatory actions which may benefit people with inflammatory skin conditions such as acne. In one study, topically applied 4-per-cent nicotinamide gel was more effective than the topical antibiotic clindamycin—and it comes without the risk of encouraging bacterial resistance (Int J Dermatol, 1995; 34: 434–7). Nicotinamide is available over the counter as Freederm gel.

-            Acupuncture. Various forms of acupuncture have been found to help acne (Dermatol Ther, 2003; 16: 87–92). In one study, earlobe-bleeding combined with body acupuncture was effective in 96 per cent of cases (J Tradit Chin Med, 2008; 28: 18–20).

-            Biofeedback and cognitive imagery. These two techniques, used to combat stress, were tested on 30 patients with acne. Compared with a placebo or no treatment, those receiving biofeedback and cognitive imagery therapy reported significant reductions in acne lesions after 12 sessions. Those who continued to practise at home after the trial ended maintained their improvement, while any benefits were lost in those who stopped the practice (J Psychosom Res, 1983; 27: 185–91).

-            Photodynamic therapy (PDT). Initially used to treat skin cancer, PDT—which uses laser or light energy—is also promising as an acne treatment (Semin Cutan Med Surg, 2008; 27: 52–62).

 

Why women get acne

According to WDDTY columnist Dr Harald Gaier, the most common reason for women to develop acne is the presence of ovarian cysts. Enlarged cystic ovaries can occur without the more typical symptoms of hirsutism (abnormal hairiness), infertility and scant periods: they can be found in women who have conceived and are not hairy, in infertile women with regular periods and in those with ovaries that are small or normal-sized.

In the absence of other suspicious symptoms, acne associated with ovarian cysts can be diagnosed by ultrasound and blood tests. The herb Vitex agnus castus may be useful for treating this type of acne.