Why some people are plagued by pimples and others remain spot-free is still not fully understood by conventional medicine, but several factors are suspected to play a role, including family history, hormonal changes and stress. Still, the doctor's answer to the problem is usually the same: a topical cream or gel containing retinoids, antibiotics, benzoyl peroxide or azelaic acid, or for more severe cases, oral antibiotics or retinoids. For women, oral contraceptives are also commonly prescribed.
Aside from often being ineffective, these drugs come with a host of nasty side-effects, from minor skin changes such as redness, burning and peeling (seen with the topical treatments) to psychological and systemic effects, including depression and liver damage (associated with the medications taken orally).
So, it's no surprise that many acne sufferers-as well as skin scientists-are looking for better ways to manage this distressing condition. Fortunately, a number of drug-free treatments are proving to be useful weapons in the fight against acne.
- Thyme. The latest acne research suggests that the herb thyme may be better at fighting spots than the standard prescription preparations. Researchers from Leeds Metropolitan University have recently tested the effects of thyme, marigold and myrrh tinctures on the acne-causing bacteria Propionibacterium acnes in the lab. They found that, while all three herbal preparations were able to kill these bacteria after five minutes of exposure, the thyme tincture was the most effective. What's more, thyme's anti-bacterial effect was more potent than that of the standard concentrations of benzoyl peroxide-the active ingredient in many acne creams and gels. The tincture was not tested on human skin, however, and the results have yet to be published. But these initial findings, recently presented at the Society for General Micro-biology's Spring Conference in Dublin, suggest that thyme may have an important role to play in the development of future acne treatments. If you're keen to try thyme tincture for yourself, be sure to consult a qualified herbalist.
- Tea tree oil. Derived from the Australian myrtle tree Melaleuca alternifolia, tea tree oil is another natural antibacterial that may help to beat acne. It proved to be just as effective as benzoyl peroxide in one trial. Both a 5-per-cent tea tree oil gel and a 5-per-cent benzoyl peroxide lotion significantly improved mild-to-moderate acne in a group of 124 sufferers. Tea tree oil, however, had fewer side-effects (Med J Aust, 1990; 153: 455-8). More recently, a study of 60 acne sufferers showed that tea tree oil gel was significantly more effective than a placebo at reducing spot numbers and severity (Indian J Dermatol Venereol Leprol, 2007; 73: 22-5).
- Ayurvedic herbs. An Indian trial of the Ayurvedic herb guggul (Commiph-ora mukul) against the antibiotic tetracycline in 20 people with cystic acne found that, after three months of twice-daily treat-ment, both treatment groups saw a similar, significant reduction in spots. However, guggul outperformed tetra-cycline in those who had particularly oily faces (J Dermatol, 1994; 21: 729-31). In another Indian study that used both topical and oral Ayurvedic herbal extracts of Aloe barbadensis (Aloe vera), Azardirachta indica (neem), Curcuma longa (turmeric), Hemidesmus indicus (Indian sarsparilla), Terminalia chebu-la (yellow myrobalan) and Withania somnifera (ashwa-ganda), all were found to work against acne (J Ethnopharmacol, 2001; 78: 99-102).
- Green tea extract. This has been getting some attention as a potential acne treatment. Green tea contains potent anti-oxidant and anti-inflammatory compounds called 'catechins', such as epigallo-catechin-3-gallate (EGCG), which may be beneficial to the skin. In a study by University of Miami researchers, 20 acne patients were given a 2-per-cent green-tea lotion to apply to their skin twice-daily for six weeks. The number of acne lesions decreased by more than half over the course of the study. Acne severity was also improved (J Drugs Dermatol, 2009; 8: 358-64).
Nutrition as medicine
- Diet. Although the orthodox view is that diet has nothing to do with acne, growing evidence suggests that foods with ahigh glycaemic load, such as processed snacks, refined sugar and baked products, may promote or exacerbate acne (Cutis, 2011; 88: 84-91). In one study, acne sufferers following a low glycaemic diet for three months saw a significant improvement in symptoms compared with the controls (Am J Clin Nutr, 2007; 86: 107-15). Other evidence suggests that dairy, particularly cow's milk, is associated with acne (Skin Therapy Lett, 2010; 15: 1-2, 5). An elimination diet may be useful to determine whether these or any other foods are causing or aggravating the problem.
- Supplements. Several studies suggest that oral zinc supple-ments may improve acne (Acta Derm Venereol, 1980; 60: 337-40). However, the high doses used (up to 600 mg/day) 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). In a small study of just five patients, a fish-oil-based supplement containing 250 mg of eicosapentaenoic acid (EPA, an omega-3 fatty acid), 3.75 mg of zinc gluconate, 50 mcg of selenium, 50 mcg of chromium and 50 mg of EGCG from green tea extract, taken four times a day, appeared to improve acne after two months (Lipids Health Dis, 2008; 7: 36).
- Topically applied vitamins. Some nutrients may be useful when applied to the skin. Nicotinamide, for example, has anti-inflammatory actions that may help inflammatory skin conditions such as acne. In a study of 76 acne sufferers, topically applied 4-per-cent nicotinamide gel was more effective than the topical anti-biotic clindamycin-and its use came without the risk of bac-terial resistance (Int J Dermatol, 1995; 34: 434-7). Nicotinamide is available over the counter as Freederm gel. Vitamins A, C and E may also be helpful when used topically, although clinical studies are lacking (J Drugs Dermatol, 2008; 7 [7 suppl]: s2-6). In fact, vitamin A has many of the same properties as the retinoid drugs for acne.
- Blue light therapy. Exposing the skin to a low-intensity blue light source is believed to destroy acne-causing P. acnes bacteria. In a study of 60 volunteers, blue light treat-ment was just as effective as benzoyl peroxide at improving acne severity, and had fewer side-effects (An Bras Dermatol, 2009; 84: 463-8). Other evidence suggests that a combination of blue and red light may be more effective than blue light alone (Br J Dermatol, 2000; 142: 973-8). As light therapy can be an expensive option, requiring regular sessions to be effective, there are a number of home-use devices available, such as Lumie Clear (www.lumie.com), making light therapy more affordable.
- Biofeedback and cognitive imagery. These mind-body techniques, used to combat stress, were tested on 30 patients with acne. Compared with a placebo or no treatment, those using biofeedback and cognitive imagery 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 (J Psychosom Res, 1983; 27: 185-91).
- Hypnotherapy. Hypnosis-used since ancient times to treat a variety of skin conditions-may have a role to play in easing acne (Arch Dermatol, 2000; 136: 393-9). It may be particularly useful for acne excori'ee, a form of acne in which spots or blackheads are compulsively squeezed or picked, resulting in scabbing and scars (Am J Clin Hypn, 2004; 46: 239-45). Acne excori'ee is thought to be associated with underlying depression, anxiety or other emotional problems.
- Acupuncture. Various forms of acupuncture have been found to help acne (Dermatol Ther, 2003; 16: 87-92). In one study, a technique called earlobe-bleeding combined with body acupuncture was effective in 96 per cent of cases (J Tradit Chin Med, 2008; 28: 18-20).
Factfile: Why women get acne
According to WDDTY columnist Dr Harald Gaier, a registered naturopath, homeopath and herbalist, the most common reason for women to develop acne is the presence of ovarian cysts. Usually linked to polycystic ovarian syndrome (PCOS), enlarged cystic ovaries can occur without the more typical symptoms of hirsutism (abnormal hairiness), infertility and scanty periods. Indeed, they can be found in women who have conceived and are not hairy, in infertile women who have regular periods and in those whose ovaries 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.