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Acne happens when hair follicles become blocked by oil and dead skin. It may be an isolated blemish, a small outbreak, or constant and severe acne that can lead to scarring. It is most common in teens, but can also occur in adults and children. Since it affects a person’s physical appearance, it can also lower self-esteem and result in social withdrawal.

Standard treatments include medications and procedures to control outbreaks. Some people look to alternative treatments when standard ones do not control acne or have bothersome side effects. Talk to a doctor about severe acne. If left untreated it can cause severe scarring.

Natural Therapies

Possibly Effective

  • Topical tea tree oil (Note: Tea tree oil can be poisonous if swallowed or taken by mouth. It may also irritate the skin.)A1-A2
  • Low glycemic load diet C2, C3
  • Topical nicotinamide B13, B19
  • Oral zinc (Note: High doses of zinc may result in side effects that range from nausea and vomiting to reduced immune function or reduced iron function.)B1-B12, B14-B20

Other factors that may help:

  • Chocolate avoidance C1
  • Sugar avoidance C1

Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.

Herbs and Supplements to Be Used With Caution

Talk to your doctor about all herbs or supplements you are taking. Some may interact with your treatment plan or health conditions. Some supplements discussed here have certain concerns such as:

  • Tea tree oil is known to be poisonous if swallowed or taken by mouth. It may also irritate the skin, especially in high concentrations.
  • Zinc in high doses may result in side effects that range from nausea and vomiting to reduced immune function or problems with iron.
 

References

Tea tree oil

A1. Enshaieh S, Jooya A, Siadat AH, et al. The efficacy of 5% topical tea tree oil gel in mild to moderate acne vulgaris: a randomized, double-blind placebo-controlled study. Indian J Dermatol Venereol Leprol. 2007;73:22-5.

A2. Malhi HK, Riley TV, et al. Tea tree oil gel for mild to moderate acne; a 12 week uncontrolled, open-label phase II pilot study. Australas J Dermatol. 2016 Mar 21.

Supplements

B1. Hillstrom L, Pettersson L, Hellbe L, et al. Comparison of oral treatment with zinc sulphate and placebo in acne vulgaris. Br J Dermatol. 1977;97:681-684.

B2. Michaelsson G, Juhlin L, Vahlquist A. Effects of oral zinc and vitamin A in acne. Arch Dermatol. 1977;113:31-36.

B3. Michaelsson G, Juhlin L, Ljunghall K. A double-blind study of the effect of zinc and oxytetracycline in acne vulgaris. Br J Dermatol. 1977;97:561-566.

B4. Weisman K, Wadskov S, Sondergaard J. Oral zinc sulphate therapy for acne vulgaris. Acta Derm Venereol. 1977;57:357-360.

B5. Goransson K, Liden S, Odsell L. Oral zinc in acne vulgaris: a clinical and methodological study. Acta Derm Venereol. 1978;58:443-448.

B6. Orris L, Shalita AR, Sibulkin D, et al. Oral zinc therapy of acne. Absorption and clinical effect. Arch Dermatol. 1978;114:1018-1020.

B7. Weimar VM, Puhl SC, Smith WH, et al. Zinc sulfate in acne vulgaris. Arch Dermatol. 1978;114:1776-1778.

B8. Cunliffe WJ, Burke B, Dodman B, et al. A double-blind trial of a zinc sulphate/citrate complex and tetracycline in the treatment of acne vulgaris. Br J Dermatol. 1979;101:321-325.

B9. Verma KC, Saini AS, Dhamija SK. Oral zinc sulfate therapy in acne vulgaris: a double-blind trial. Acta Derm Venereol. 1980;60:337-340.

B10. Amer M, Bahgat MR, Tosson Z, et al. Serum zinc in acne vulgaris. Int J Dermatol. 1982;21:481-484.

B11. Pohit J, Saha KC, Pal B. Zinc status of acne vulgaris patients. J Appl Nutr. 1985;37:18-25.

B12. Dreno B, Amblard P, Agache P, et al. Low doses of zinc gluconate for inflammatory acne. Acta Derm Venereol. 1989;69:541-543.

B13. Shalita AR, Smith JG, Parish LC, et al. Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris. Int J Dermatol. 1995;34:434-437.

B14. Meynadier J. Efficacy and safety study of two zinc gluconate regimens in the treatment of inflammatory acne. Eur J Dermatol. 2000;10:269 273.

B15. Porea TJ, Belmont JW, Mahoney DH Jr. Zinc-induced anemia and neutropenia in an adolescent. J Pediatr. 2000;136:688-690.

B16. Dreno B, Moyse D, Alirezai M, et al. Multicenter randomized comparative double-blind controlled clinical trial of the safety and efficacy of zinc gluconate versus minocycline hydrochloride in the treatment of inflammatory acne vulgaris. Dermatology. 2001;203:135-140.

B17. Igic PG, Lee E, Harper W, et al. Toxic effects associated with consumption of zinc. Mayo Clin Proc. 2002;77:713-716

B18. Brandt S. The clinical effects of zinc as a topical or oral agent on the clinical response and pathophysiologic mechanisms of acne: a systematic review of the literature. J Drugs Dermatol. 2013 May;12(5):542-545.

B19. Khodaeiani E, Fouladi RF, et al. Topical 4% nicotinamide vs. 1% clindamycin in moderate inflammatory acne vulgaris. Int J Dermatol. 2013 Aug;52(8):999-1004.

B20. Cao H, Yang G, et al. Complementary therapies for acne vulgaris. Cochrane Database Syst Rev. 2015;1:CD009436. Available at: http://www.cochrane.org/CD009436/SKIN_complementary-therapies-acne-vulgaris. Accessed August 15, 2017.

Dietary changes

C1. Magin P, Pond D, et al. A systematic review of the evidence for ‘myths and misconceptions’ in acne management: diet, face-washing and sunlight. Fam Pract. 2005 Feb;22(1):62-70.

C2. Smith RN, Mann NJ, Braue A, et al. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr. 2007;86:107-15.

C3. Cao H, Yang G, et al. Complementary therapies for acne vulgaris. Cochrane Database Syst Rev. 2015;1:CD009436. Available at: http://www.cochrane.org/CD009436/SKIN_complementary-therapies-acne-vulgaris. Accessed August 15, 2017.

Other therapies

D1. Shalita AR, Smith JG, Parish LC, et al. Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris. Int J Dermatol. 1995;34:434-437.

D2. Cao H, Yang G, et al. Complementary therapies for acne vulgaris. Cochrane Database Syst Rev. 2015;1:CD009436. Available at: http://www.cochrane.org/CD009436/SKIN_complementary-therapies-acne-vulgaris. Accessed August 15, 2017.

Last reviewed February 2019 by EBSCO NAT Review Board Richard Glickman-Simon, MD  Last Updated: 2/22/2019