Radio Frequency (RF) Therapy

Radiofrequency (RF) Therapy for Acne Scars

Radio Frequency (RF) therapy uses beams of radio waves to heat sub-cutaneous tissue. RF Therapy is most widely used in treatments designed to improve skin laxity and diminish the appearance of cellulite. There are several different types of RF Therapy systems. High-power Radio Frequency platforms can also be used for ablative treatments. Certain types of RF Therapy are occasionally used for the treatment of active acne and acne scars.

How does Radio Frequency (RF) Therapy Work?

RF Therapy systems produce intense beams of high frequency radio waves (generally around 5 MHz). These beams of radio waves are absorbed by the target tissue, producing heat. Most RF therapy systems have a coolant system that sprays the surface of the treated area with cold gas. This prevents the surface from heating to the same degree of the internal tissue.

RF Therapy has many dermatological and cosmetic applications. The intensity of the radio beams and their specific frequency are optimized for specific types of treatments. Low-power RF Therapy is used for to tighten skin and reduce the appearance of cellulite. This application works by inducing small amounts of thermal damage that then stimulate the production of new collagen, elastin and other components of the Extra-Cellular Matrix (ECM) that supports the skin.

RF Therapy can also be used with high-power radio beams. High-power RF therapies are used for ablative treatments, such as resection of cancerous or damaged tissue.

RF Therapy for the Treatment of Active Acne and Acne Scars.

RF Therapy is generally used for the treatment of acne scars. It is primarily used for the treatment of mild acne scars, and it is frequently combined with complementary scar treatments. RF Therapy has also been tested as a treatment for active acne, but this is an uncommon application of RF technology.

RF Therapy is most effective for the treatment of mild to moderate to acne scars. RF Therapy can help improve the smoothness of the surface of the skin by inducing the growth and remodeling of the underlying tissue that supports the skin (eg. the Extra-Cellular Matrix “”ECM””). Dermatological applications of RF Therapy generally use low-power RF systems. These low-power RF systems are designed to cause small amounts of thermal damage and are considered non-ablative. Because effective treatment of moderate-to-severe acne scars often requires more aggressive skin resurfacing treatments (eg. ablative treatments), RF Therapy tends to be ineffective for the treatment of severe acne scars. For the treatment of moderate-to-severe acne scars, ablative laser treatments (eg. CO2, Er:YAG and Nd:YAG) are more frequently used.

RF Therapy has also been tested as a treatment for active acne. RF Therapy is rarely used for this application (and is not currently FDA-approved for this application at the time of this writing). However, some preliminary clinical research has indicated that RF therapy may be an effective treatment for active acne and some dermatologists are currently offering this treatment..

In the studies that have examined the efficacy of RF Therapy for the treatment of active acne, researchers have observed significant improvements in acne symptoms following treatment. However, it is important to note that relatively few clinical studies have been done on this topic, and many of those were funded by the manufacturer of the RF Therapy systems being tested. RF Therapy for acne is generally considered “”off-label”” and is not widely available. That may change if continued research supports the initial findings about the general efficacy of RF acne therapy.

In the treatment of active acne, RF Therapy may have two mechanisms of action that explain the observed benefits. First, the increased temperatures in the skin caused by RF Therapy may directly damage acne-causing bacteria (eg. P. acnes). The reduction in bacterial load following therapy could lead to a decrease in inflammation. Second, RF Therapy may decrease the size and activity of the sebaceous glands, causing a decrease in sebum production. Both of these effects could cause an improvement in acne symptoms.

How and Where is RF Therapy Administered?

RF Therapy is administered in many spas, dermatology offices, cosmetic surgery clinics and hospitals. RF Therapy is not widely available as an acne treatment.

The cost for RF Therapy can vary significantly depending on the application, area treated and system used. Generally speaking, RF Therapy tends to be fairly expensive. For example, treatments with Thermage (a popular RF therapy platform) generally cost over $2,000. Since RF therapy is not widely available as an acne treatment, there is little information available on the cost for that application.

RF Therapy should only be administered in a professional medical setting by trained professionals. Improper use of RF Therapy can permanently damage the tissue that supports the skin. This kind of damage can lead to permanent skin damage and scarring. Because RF Therapy targets the tissue underneath the skin, damage caused by improper use of this technology may not be immediately apparent after treatment.

Some RF Therapy platforms are capable of delivering fractionated (pixelated) radio beams. Fractionated RF systems tend to have fewer side effects, but can require additional treatments to achieve the same end result as complete (unfractionated) RF treatments.

Common RF therapy Systems

3DEEP Fractional, Aluma, Duet RF, eLIGHT, Exilis, INFINI, Intensif, Pixel RF, SecretRF, Sublative RF, Syneron Matrix RF, Thermage, VelaShape, Venus Freeze.

References

Nonablative Radiofrequency for Active Acne Vulgaris: The use of Deep Dermal Heat in the Treatment of Moderate to Severe Active Acne Vulgaris (Thermotherapy): A Report of 22 Patients. Ruiz-Esparza, et al. 2003.
Nonablative Radiofrequency Treatment of Facial Laxity. Fisher, et al. 2005.
Laser Treatment of Acne Vulgaris. Jih, et al. 2007.
Procedural Treatments for Acne Vulgaris. Taub, et al. 2007.
Evaluation of pulsed light and radiofrequency combined for the treatment of acne vulgaris with histologic analysis of facial skin biopsies. Prieto, et al. 2005.
A novel fractional micro-plasma radio-frequency technology for the treatment of facial scars and rhytids: A pilot study. Halachmi, et al. 2010.
Novel technology in the treatment of acne scars: The matrix-tunable radiofrequency technology. Ramesh, et al. 2010.

Resorcinol

Resorcinol and Sulfur Cream

Resorcinol (Resorcin) is a keratolytic medication. It is a common ingredient in several Over-The-Counter (OTC) acne and skin tightening creams. Prescription formulations are available with higher concentrations of Resorcinol.

Resorcinol is used topically as antiseptic and keratolytic medication. In addition to the treatment of acne, topical ointments with Resorcinol are used in the treatment of other chronic skin conditions, such as psoriasis and eczema.

Keratolytic medications can improve acne symptoms by helping to prevent the formation of clogged pores and pimples. Keratolytics work by breaking down and exfoliating the outermost layer of the skin. Keratolytics can also be helpful for improving the appearance of mild acne scars, fine lines and small areas of uneven skin tone.

Red Light Phototherapy

Red Light Phototherapy

Red Light Phototherapy is a treatment that involves exposing the skin to high intensity red light in the red spectrum. The purpose of the treatment is to reduce skin inflammation and accelerate healing.

Red Light Phototherapy and Acne

Red Light Phototherapy is primarily used as a treatment for minor acne-scarring and to facilitate healing after an acne outbreak. It is also occasionally used for the treatment of active acne symptoms.

Red Light Phototherapy is most commonly used for the treatment of acne scars. It does not appear to be an effective scar treatment by itself, but it can be combined with other types of scar treatments (eg. Laser Resurfacing, Microdermabrasion) to accelerate the healing process.

Results from several clinical research studies indicate that Red Light Phototherapy can be partially effective as a treatment for active acne symptoms. However, the improvement in active acne symptoms in response to Red Light Phototherapy is likely to incomplete and temporary. For example, one study that evaluated Red Light Phototherapy found that treatment caused a small decrease in inflammation, but did not reduce the levels of acne-causing P. acnes bacteria or the production of sebum by sebaceous glands. This indicates that Red Light Phototherapy may be helpful by decreasing inflammation, but does not address some of the more fundamental causes of acne.

How Does Red Light Phototherapy Work?

Red Light Phototherapy is most commonly used for photo-rejuvenation procedures. Several research studies have reported that red light (600-900 nm) stimulates the growth of new skin tissue and the production of collagen. However, the underlying science of many of these studies is questionable.

High intensity Red Light Phototherapy also appears to assist in the resolution of inflammation, redness and other types of uneven skin tone. Scientists have some ideas about how red light might cause these changes in skin tissue, but the exact mechanism (or mechanisms) are not well understood. Nonetheless, the results from clinical research studies of Red Light Phototherapy have been generally positive. Although these study results may overstate the benefit of Red Light Phototherapy, the treatment is becoming more popular.

Researchers of Red Light Phototherapy have reported that the treatment induces the production and remodeling of collagen and elastin fibers. Collagen and elastin are protein based fibers that form an interconnected matrix (Extra-Cellular Matrix, ECM) that provides structural support and elasticity to the skin. A healthy ECM is one where the fibers form a three dimensional, interconnected structure that is capable of stretching and compressing in all directions. When skin is damaged or ages, the density and organization of the collagen and elastin matrix tends to deteriorate. Increasing the production of healthy collagen and elastin in the skin is one of the primary goals in skin rejuvenation procedures.

Researchers have also reported that specific wavelengths of light in the red spectrum appear to stimulate certain cellular functions. Some specific cellular components, mainly enzymes, have been shown to absorb light in the red spectrum. The most well studied of these red light absorbing enzymes is cytochrome c oxidase, an essential component of mitochondria, which are the power sources of a cell. The absorption of photons (light) by cytochrome c oxidase apparently increases the metabolic activity in a cell, which may explain the accelerated rate of healing observed after Red Light Phototherapy.

How is Red Light Phototherapy Administered?

Most Red Light Phototherapy procedures use large panels of LED lights to create a high intensity source of a specific color (wavelength) of red light. Depending on the treatment, the precise wavelength of the light used can range from 600 nm (orange/red) to 850 nm (infra-red). Achieving therapeutic benefits from Red Light Phototherapy appears to require a very high intensity light source.

Home use Red Light Phototherapy systems are available for purchase on the internet. Home-use phototherapy systems range between $20 and $700 dollars, with large variations in the size, intensity and quality of the various systems. Small and inexpensive home-use phototherapy systems are unlikely to be capable of generating the intensity of light that is required for the therapeutic benefits reported in the clinical research studies.

References

Influence of 5-Aminolevulinic Acid and Red Light on Collagen Metabolism of Human Dermal Fibroblasts. Karrer, et al. 2003.
cDNA MicroarrayAnalysis of Gene Expression Profiles in Human Fibroblast Cells Irradiated with Red Light. Zhang, et al. 2003.
Clinical Trial of a Novel Non-Thermal LED Array for Reversal of Photoaging: Clinical, Histologic, and Surface Profilometric Results. Weiss, et al. 2005.
Effect of NASA Light-Emitting Diode Irradiation on Wound Healing. Whelan, et al. 2001.
Single Low-dose Red Light is as Efficacious as Methylaminolevulinate Photodynamic Therapy for Treatment of Acne: Clinical Assessment and Fluorescence Monitoring. Horfelt, et al. 2009.
A prospective, randomized, placebo-controlled, double-blinded, and split-face clinical study on LED phototherapy for skin rejuvenation: Clinical, profilometric, histologic, ultrastructural, and biochemical evaluations and comparison of three different treatment settings. Lee, et al. 2007.
Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris. Papageorgiou, et al. 2000.
Non-invasive diagnostic evaluation of phototherapeutic effects of red light phototherapy of acne vulgaris. Zane, et al. 2008.
Red Light Phototherapy Alone Is Effective for Acne Vulgaris: Randomized, Single-Blinded Clinical Trial. Na, et al. 2007.

Red Light Phototherapy Images

Red Clover

Red Clover

Red Clover (Trifolium pratense) is a flowering plant that is native to Europe, Western Asia and Northwest Africa. It is now naturalized worldwide. Red Clover is a common agricultural cover crop because it fixes nitrogen in the soil and is a rich source of pollen and nectar for bees.

Red Clover is widely used in Naturopathic Medicine to treat a variety of ailments. In Naturopathic Medicine, dried Red Clover is occasionally used as an oral herbal supplement or mixed with topical formulations for the treatment of acne.

Red Clover and Acne

There are some people who have reported that both oral and topical Red Clover formulations were helpful treatments for their acne. The effect of Red Clover on acne may be related to the presence of Phyto-Estrogens. Estrogens can inhibit the activity of Androgens (male sex hormones). Elevated levels of Androgens are known to trigger acne symptoms in some individuals.

Unfortunately there are no rigorous scientific studies on the effectiveness of Red Clover for the treatment of acne. Nonetheless, Red Clover is one of the few herbal supplements that may actually be useful as an acne treatment, and this application deserves further investigation.

How Does Red Clover Work?

Red Clover is purported to have anti-inflammatory, expectorant and sedative properties. Red Clover is commonly used as a Naturopathic treatment for menopausal hot-flashes. Red Clover contains several isoflavone compounds which are similar in structure estrogen (a female sex hormone). These Estrogen-like compounds are called Phyto-Estrogens. Consumption of large amounts of Red Clover extract can trigger estrogen-dependent effects in the body.

References

Phytoestrogens derived from red clover: an alternative to estrogen replacement therapy? Beck, et al. 2005.
Therapeutic agents and herbs in topical application for acne treatment. Kanlayavattanakul, et al. 2011.
Estrogenic activity of two standardized red clover extracts (Menoflavon) intended for large scale use in hormone replacement therapy. Dornstauder, et al. 2001.
Clinical studies of red clover (Trifolium pratense) dietary supplements in menopause: a literature review. Booth, et al. 2006.
Isoflavones, phytohormones and phytosterols. Dweck. 2006.
Determination of isoflavones in red clover and related species by high-performance liquid chromatography combined with ultraviolet and mass spectrometric detection. Wu, et al. 2003.
Inhibition of angiogenesis and inflammation by an extract of red clover (Trifolium pratense L.). Krenn, et al. 2009.

Photodynamic Therapy (PDT)

Photodynamic Therapy (PDT) Acne Treatment

Photodynamic Therapy (PDT) is the generic name for a class of treatments that use specialized medications called photosensitizers to increase the effectiveness of a light-based treatment. PDT is used treat certain types of skin problems, including acne and some forms of cancer.

Photodynamic Therapy (PDT) for the Treatment of Acne

Numerous clinical research studies have reported that Photodynamic therapy (PDT) can decrease bacterial levels in the skin and help improve acne symptoms. PDT appears to be more effective for treating inflammatory acne lesions (Acne Types: 2-4) than non-inflammatory acne lesions (Acne Types: 1-2). PDT has also been reported to be more effective at improving acne symptoms than Blue Light Phototherapy or IPL alone.

However, PDT treatment alone rarely results in complete resolution of acne symptoms. It is important to keep in mind that PDT, like most light therapies, provides only temporary benefit and treatment must be repeated regularly to achieve and maintain significant improvements.

In addition to killing acne-causing bacteria, PDT has been shown to damage the sebaceous glands and temporarily decrease sebum production. Because of these effects, PDT can be a very useful treatment for patients with inflammatory acne that also have sebaceous hyperplasia or excessively oily skin. The effect of a PDT treatment regimen on sebaceous gland activity and sebum production appears to be semi-permanent.

How Does Photodynamic Therapy (PDT) Work?

Photodynamic Therapy (PDT) involves topical application of a photosensitizer followed by exposure to a specialized, high-intensity light source. The photosensitizer causes certain kinds of cells to produce large amounts of light-absorbing molecules called porphyrins. The photosensitizing agent helps target the treatment to the appropriate cells.

The acne-causing Propionibacterium acnes (P. acnes) bacterium produces a unique porphyrin molecule that absorbs light in the blue spectrum (~415 nm). When this porphyrin molecule absorbs blue light, it produces free radical molecules that can kill the bacteria.

Aminolevulinic Acid (ALA) is the most common photosensitizer for PDT-based acne treatments. But three other photosensitizers are also occasionally used: MAL (methyl aminolevulinate), LA (levulinic acid) and IAA (Indole-3-Acetic Acid). MAL is generally used with red light sources and is more commonly used against cancer than acne.

Summary

PDT popular technique for many dermatologists, but it has received mixed reviews from acne patients. Because PDT requires the careful application of a photosensitizer and controlled light exposure, effective PDT treatments for acne can become quite expensive and time consuming. There are also potential risks associated with the photosensitizers themselves, such as allergic reactions, hypersensitivity to sunlight, redness and inflammation. In summary, while PDT can be an effective acne treatment, many people prefer frequent Blue Light Phototherapy over PDT because of the decreased risk of side effects.

References

A Comparative Study of Topical 5-Aminolevulinic Acid Incubation Times in Photodynamic Therapy with Intense Pulsed Light for the Treatment of Inflammatory Acne. Oh, et al. 2009.
A comparison of intense pulsed light, combination radiofrequency and intense pulsed light, and blue light in photodynamic therapy for acne vulgaris. Taub, et al. 2007.
The use of a novel intense pulsed light and heat source and ALA-PDT in the treatment of moderate to severe inflammatory acne vulgaris. Gold, et al. 2000.
Treatment of Inflammatory Facial Acne Vulgaris with Intense Pulsed Light and Short Contact of Topical 5-Aminolevulinic Acid: A Pilot Study. ROJANAMATIN, et al. 2006.
Effectiveness of Photodynamic Therapy with Topical 5-Aminolevulinic Acid and Intense Pulsed Light versus Intense Pulsed Light Alone in the Treatment of Acne Vulgaris: Comparative Study. Arianee, et al. 2005.
A comparative study of intense pulsed light alone and its combination with photodynamic therapy for the treatment of facial acne in Asian skin. Yeung, et al. 2007.
Photodynamic therapy of acne vulgaris with topical aminolaevulinic acid and incoherent light in Japanese patients. Itoh, et al. 2001.
Photodynamic therapy of acne vulgaris using 5-aminolevulinic acid versus methyl aminolevulinate. Wiegell, et al. 2006.
Photodynamic therapy for acne vulgaris with topical 5-aminolevulinic acid. Itoh, et al. 2000.
Photodynamic therapy of acne vulgaris using methyl aminolaevulinate: a blinded, randomized, controlled trial. Wiegell, et al. 2006.
Photodynamic Therapy of Acne. Sandberg, et al. 2001.
Topical ALA-photodynamic therapy for the treatment of acne vulgaris. Hongcharu, et al. 2001.
Photodynamic therapy for acne vulgaris: a pilot study of the dose-response and mechanism of action. Horfelt, et al. 2007.
Topical aminolaevulinic acid photodynamic therapy for the treatment of acne vulgaris: a study of clinical efficacy and mechanism of action. Pollock, et al. 2004.
In vivo porphyrin production by P. acnes in untreated acne patients and its modulation by acne treatment. Borelli, et al. 2006.

Photodynamic Therapy (PDT) Images

Pulsed Dye Lasers (PDL)

Pulsed Dye Laser Treatment and Acne

Pulsed Dye Lasers (PDL) are occasionally used for the treatment of both active acne symptoms and acne scars. Although they can be used for multiple applications, Pulsed Dye Lasers are not usually not the first-choice of treatment for either active acne or acne scars.

On average, Pulsed Dye Laser treatment of acne and acne scars is reviewed as poor to moderate by patients after treatment. It is likely that PDLs are popular because they are a relatively inexpensive, versatile and common platform – but not because they are an effective for active acne or acne scars.

Pulsed Dye Lasers and Active Acne

There are a handful of clinical research studies that found Pulsed Dye Lasers may be effective for treating active acne infections. There are also a few studies that found PDLs were not effective treatments for active acne. This disagreement is likely because there are several different kinds of PDLs, and the treatments being researched are not all the same for every study.

Research studies on the use of PDL systems for the treatment of active acne for acne found that optimum results required at least four treatments. In addition, PDL-based treatment of active acne usually only provides temporary relief, and acne symptoms eventually return.

Pulsed Dye Lasers can be used as part of Photodynamic Therapy (PDT), which is a treatment that targets sebaceous glands and acne-causing P. acnes bacteria. Photodynamic Therapy works better with adjustable PDLs that are capable of producing a laser with a wavelength near 415 nm (ultraviolet), instead of the more common 595 nm (green/yellow). However, PDLs are rarely used for PDT because there are easier-to-use (and less expensive) light sources available for this treatment.

Pulsed Dye Lasers can also be used to directly kill acne-causing bacteria. The acne-causing Propionibacterium acnes bacterium produces a special molecule called porphyrin. When porphyrin is exposed to high intensity light at a wavelength around 420 nm (ultraviolet/blue) it generates free radical molecules which can kill the bacterium. This process is called Blue Light Phototherapy. Pulsed Dye Lasers are available that can generate high intensity light in this spectrum. However, other high-intensity sources of blue light (eg. LEDs) are substantially less expensive than PDL and are generally used for this type of acne treatment.

PDLs are also being studied as a way to selectively ablate the sebaceous gland, which then inhibits sebum production and reduces acne symptoms. While the research indicates using PDLs is a a viable approach, there are alternative lasers (eg. Diode Lasers) with longer wavelengths that are better suited for this application.

Pulsed Dye Lasers and Active Scars

The most popular dermatology application for Pulsed Dye Lasers is for the removal of birthmarks and other hyper-pigmented marks on the skin. Low-power Pulsed Dye lasers are also used to improve the appearance of wrinkles by stimulating regrowth of the tissue immediately underneath the skin.

Pulsed Dye Lasers can be used for two ablative and non-ablative treatments. Ablative treatments (ablative means to be removed or vaporized at very high temperature) utilize longer laser pulses and/or high light intensity to thermally damage or destroy the target tissue. Certain molecules, like oxyhemoglobin (found in red blood cells), preferentially absorb energy from Pulsed Dye Lasers. This feature makes Pulsed Dye Lasers a viable treatment for spider veins, erythematous acne scars and other skin discolorations caused by damaged or dilated blood vessels.

Both ablative and non-ablative PDL treatments are available for treating acne scars. Pulsed Dye Lasers are generally only used for the treatment of mild acne scars. Improvements in acne scars following PDL treatment are usually modest and superficial. The Pulsed Dye Laser platform is not well suited to correct severe acne scarring. This is because most PDL systems do not penetrate deeply enough into the skin tissue to correct significant acne scar damage.

How Do Pulsed Dye Lasers Work

Dye Lasers get their name from the fact that they use a specialized liquid dye suspension, instead of a crystal, as the source of the laser beam. Pulsed Dye Lasers (PDLs) are designed to deliver short bursts of light that last only a fraction of a second. Many Pulsed Dye Lasers can be adjusted (tuned) to create lasers of several different wavelengths (colors). For dermatology purposes, Pulsed Dye Lasers that produce laser beams at ~495 nm (green/yellow) are the most common.

Popular Pulsed dye laser (PDL) Systems

C-Beam, Cobra, Cynergy, Navigator, N-Lite, PhotoGenica, Regenlite, Vbeam.

References

Laser Treatment of Acne Vulgaris. Jih, et al. 2007.
Investigation of the Mechanism of Action of Nonablative Pulsed Dye Laser Therapy in Photorejuvenation and Inflammatory Acne Vulgaris. Seaton, et al. 2006.
Treatment of Acne Vulgaris With a Pulsed Dye Laser: A Randomized Controlled Trial. Orringer, et al. 2004.
Improvement of Facial Acne Scars by the 585 nm Flashlamp-Pumped Pulsed Dye Laser. Alster, et al. 1996.
Comparison of a 585-nm pulsed dye laser and a 1064-nm Nd:YAG laser for the treatment of acne scars: A randomized split-face clinical study. Lee, et al. 2008.

Papaya

Papaya and Acne

Papaya (Carica papaya) is a fruiting tree that is native to Central America. The Papaya fruit is an important food source and is cultivated commercially in tropical regions around the world. In addition to its culinary applications, the Papaya fruit is widely used in Naturopathic and traditional medicine.

Preparations from fresh Papaya fruits are occasionally used as a topical Naturopathic treatment for acne. Also, Papaya extracts are commonly added to commercial anti-acne skin care products.

Papaya fruits contain several enzymes and phytochemicals that may be useful for the treatment of acne. Papaya is a rich source of a proteolytic (digestive) enzyme called Papain. Papain can break down proteins and it is used in topical Naturopathic treatments as an enzymatic exfoliant. For some people with acne, masks and face washes containing unprocessed Papaya may help even skin tone, exfoliate rough patches and possibly even reduce the frequency of minor acne lesions. Papaya fruits also contain many phytochemicals, including, benzyl isothiocyanates, carotenoids and polyphenols.

Although some people have reported that topical treatments containing fresh Papaya or Papaya extracts helped to improve their acne symptoms, there has been no rigorous scientific research on the efficacy of Papaya as an acne treatment. Overall, topical preparations containing Papaya may help improve skin tone, but are unlikely to dramatically improve acne symptoms for most individuals. More research is needed to determine whether topical Papaya formulations are a useful addition to a holistic Naturopathic acne treatment regimen.

References

Phytochemical studies on Carica papaya leaf juice. Akhila, et al. 2015.
Topical herbal therapies an alternative and complementary choice to combat acne. Kapoor, et al. 2011.
Antimicrobial activity of some tropical fruit wastes (guava, starfruit, banana, papaya, passionfruit, langsat, duku, rambutan and rambai). Mohamed, et al. 1994.
Papaya: A gifted nutraceutical plant-a critical review of recent human health research. Kaliyaperumal, et al. 2014.
A review on medicinal properties of Carica papaya Linn. Vij, et al. 2015.
Medicinal Plants used as Anti-Acne Agents by Tribal and Non-Tribal People of Tripura, India. Dey, et al. 2014.
Treatment of mild to moderate acne with a fixed combination of hydroxypinacolone retinoate, retinol glycospheres and papain glycospheres. Veraldi, et al. 2015.

Paleo Diet

Paleo Diet

The Paleo (Paleolithic) Diet is designed around the types of food that were most likely consumed by ancient hunter gatherer peoples. The core concept of the Paleo Diet is that for the bulk of human evolution, our diet consisted of meats, fish, fruits, vegetables, tubers and unprocessed grains. Therefore, our bodies and metabolic systems have evolved to work best when we consume these foods. The Paleo Diet restricts all processed foods, especially sugar, and it is very low in simple carbohydrates.

Many individuals have found that switching to a Paleo Diet (and other diets that minimize consumption of processed foods) helped to improve their acne symptoms. There are several possible reasons why this may be true. First, high intake of sugar and simple carbohydrates may alter the balance of hormones (eg. Insulin Growth Factor 1, IGF-1) that have an impact on acne symptoms. Second, some people may have food-specific allergies that contribute to acne symptoms, and these foods are often excluded in restrictive diet. Third, a well-balanced and healthy diet can improve overall immune function, which can help control acne symptoms.

There has been little clinical research into whether switching to a Paleo Diet is an effective treatment for acne. However, any dietary changes that reduce the consumption of processed foods and sugar, while increasing consumption of vegetables, lean meats and fruits, are likely to have a positive effect on overall health. For many acne sufferers, improving dietary choices is likely to be at least somewhat beneficial.

References

Acne vulgaris: a disease of Western civilization. Cordain, et al. 2002.
The role of diet in acne and rosacea. Keri, et al. 2008.
Linking diet to acne metabolomics, inflammation, and comedogenesis: an update. Melnik, et al. 2015.
Origins and evolution of the Western diet: health implications for the 21st century. Cordain, et al. 2005.

Oregon Grape

Oregon Grape (Mahonia aquifolium) Berries

Oregon Grape (Mahonia aquifolium) is an evergreen shrub that is native to western North America. The Oregon Grape is the official plant of the state of Oregon (USA). The bush has spiny leaves and blooms of yellow flowers that develop into dark blue berries.

The berries of Oregon Grape are edible, but they are quite tart. Oregon Grape was an important element of the traditional medicine of the Native Americans who inhabited the region. Oregon Grape is occasionally used in Naturopathic treatments for acne.

Extracts from the roots of Oregon Grape are available commercially and are commonly used in Naturopathic Medicine. Oregon Grape root extract has been reported to have anti-inflammatory and antibacterial properties. Some Naturopaths prescribe Oregon Grape root extract as an oral supplement to treat inflammatory skin conditions, such as psoriasis and acne. Some people have reported that oral supplements of Oregon Grape root extract helped improve their acne symptoms. However, no rigorous clinical studies have been conducted to determine if Oregon Grape extracts are actually an effective treatment for acne.

Oregon Grape root extract contains signficant concentrations of a biologically-active molecule called Berberine. Berberine is an alkaloid that has been shown to have anti-bacterial properties. Berberine may be responsible for many of the reported medicinal properties of Oregon Grape root extract. Berberine is found in many other plants (eg. Goldenseal), and many cultures utilize those plants for medicinal purposes.

References

From medical herbalism to phytotherapy in dermatology: back to the future. Dattner. 2003.
Herbal medicine for acne vulgaris. Yarnell, et al. 2006.
Different approaches of alternative medicines in acne vulgaris treatment. Ghosh, et al. 2011.
A review on herbal drugs acting against Acne Vulgaris. Patel, et al. 2015.
Botanicals in dermatology. Reuter, et al. 2010.
Topical herbal therapies an alternative and complementary choice to combat acne. Kapoor, et al. 2011.
Method validation for determination of alkaloid content in goldenseal root powder. Weber, et al. 2003.

Olive Oil

Fresh Picked Olives

Olive Oil is an oil that is extracted from the fruit of the olive tree (Olea europaea). Olives are an important part of Mediterranean cultures and have been an farmed in the region for thousands of years.

Olive Oil is widely used for cooking, but it is also used in Naturopathic medicine, pharmaceuticals, cosmetics and as a fuel source. Olive Oil is a Carrier Oil, not an Essential Oil. Some topical Naturopathic acne treatments use Olive Oil as a base for formulations of essential oils and other ingredients.

Olive Oil is infrequently used in Naturopathic acne treatments. Other carrier oils (eg. Jojoba Oil) are considered to be better suited for use in acne treatments because they are more similar to natural sebum than Olive Oil.

There has been very little research about how topical application of Olive Oil affects acne symptoms. Laboratory testing indicates that Olive Oil is not likely to be strongly comedogenic. Allergic reactions to topical use of Olive Oil are rare. Olive Oil is a central component of the Mediterranean Diet, and some people have reported that this diet helped to improve their acne symptoms.

Olive Oil is a blend of fatty acids of varying length. The specific composition of Olive Oil varies depending on the source and the type of oil. There are several classes of Olive Oil, including Extra-Virgin, Virgin, Refined and Pomace Olive Oil.

References

Cornicabra virgin olive oil: a study of five crop seasons. Composition, quality and oxidative stability. Salvador, et al. 2001.
Olive oil volatile compounds, flavour development and quality: A critical review. Kalua, et al. 2007.
Topical application of natural honey, beeswax and olive oil mixture for atopic dermatitis or psoriasis: partially controlled, single-blinded study. Al-Waili, et al. 2003.
Virgin olive oil as a fundamental nutritional component and skin protector. Viola, et al. 2009.
Efficacy of Aloe vera/olive oil cream versus betamethasone cream for chronic skin lesions following sulfur mustard exposure: a randomized double-blind clinical trial. Panahi, et al. 2012.
Acne vulgaris: studies in pathogenesis: triglyceride hydrolysis by Corynebacterium acnes in vitro. Kellum, et al. 1970.

Norgestrel and Ethinyl Estradiol

Norgestrel and Ethinyl Estradiol (Ovral G)

Norgestrel and Ethinyl Estradiol is a Hormonal Contraceptive (birth control) medication. Norgestrel and Ethinyl Estradiol are analogues of the female hormones Progesterone and Estrogen, respectively. Levonorgestrel is the biologically active form (enantiomer) of Norgestrel.

Hormonal contraceptives are not frequently used as a primary treatment for acne, but many women report substantial changes in their acne symptoms after starting use of Hormonal Contraceptives.

There are many different types of Hormonal Contraceptives. All Hormonal Contraceptives include versions of the female sex hormones estrogen and/or progesterone. The specific composition of these hormones varies between different types of Hormonal Contraceptives.

Hormones have a major impact on acne symptoms. Female sex hormones (eg. Estrogen, Progesterone) and male sex hormones (eg. Testosterone) control many important functions within the body. Use of Hormonal Contraceptives has been shown to improve acne in some women and worsen it in others, with comparable frequency. Hormonal Contraceptives may improve acne symptoms in some women by blocking the effect of androgen (male) hormones. Androgen hormones can increase the activity of the sebaceous glands and sebum production, which can contribute to the development of acne.

Norgestrel and Ethinyl Estradiol Medications

Cryselle, Lo-Ovral, Loovral, Low-Ogestrel, Ogestrel, Ovral.

Norgestimate and Ethinyl Estradiol

Norgestimate and Ethinyl Estradiol (Ortho Tri-Cyclen)

Norgestimate and Ethinyl Estradiol is a Hormonal Contraceptive (birth control) medication. Norgestimate and Ethinyl Estradiol are analogues of the female hormones Progesterone and Estrogen, respectively.

Hormonal contraceptives are not frequently used as a primary treatment for acne, but many women report substantial changes in their acne symptoms after starting use of Hormonal Contraceptives.

There are many different types of Hormonal Contraceptives. All Hormonal Contraceptives include versions of the female sex hormones estrogen and/or progesterone. The specific composition of these hormones varies between different types of Hormonal Contraceptives.

Hormones have a major impact on acne symptoms. Female sex hormones (eg. Estrogen, Progesterone) and male sex hormones (eg. Testosterone) control many important functions within the body. Use of Hormonal Contraceptives has been shown to improve acne in some women and worsen it in others, with comparable frequency. Hormonal Contraceptives may improve acne symptoms in some women by blocking the effect of androgen (male) hormones. Androgen hormones can increase the activity of the sebaceous glands and sebum production, which can contribute to the development of acne.

Norgestimate and Ethinyl Estradiol Medications

Mononessa, Ortho-Cyclen, Ortho Tri-Cyclen, Tri-Lo Sprintec, Trinessa.

Norethindrone and Ethinyl Estradiol

Norethindrone and Ethinyl Estradiol (Lomedia 24-Fe)

Norethindrone and Ethinyl Estradiol is a Hormonal Contraceptive (birth control) medication. Norethindrone and Ethinyl Estradiol are analogues of the female hormones Progesterone and Estrogen, respectively. This medication is widely used and is marketed under many different names.

Hormonal contraceptives are not frequently used as a primary treatment for acne, but many women report substantial changes in their acne symptoms after starting use of Hormonal Contraceptives.

There are many different types of Hormonal Contraceptives. All Hormonal Contraceptives include versions of the female sex hormones estrogen and/or progesterone. The specific composition of these hormones varies between different types of Hormonal Contraceptives.

Hormones have a major impact on acne symptoms. Female sex hormones (eg. Estrogen, Progesterone) and male sex hormones (eg. Testosterone) control many important functions within the body. Use of Hormonal Contraceptives has been shown to improve acne in some women and worsen it in others, with comparable frequency. Hormonal Contraceptives may improve acne symptoms in some women by blocking the effect of androgen (male) hormones. Androgen hormones can increase the activity of the sebaceous glands and sebum production, which can contribute to the development of acne.

Norethindrone and Ethinyl Estradiol Medications

Balziva, Brevicon, Estrostep, Femcon, Junel, Loestrin, Lomedia, Modicon, Necon, Nortrel, Ortho-Novum, Ovcon, Tilia, Tri-Legest, Tri-Norinyl, Tri-Sprintec, Zenchent, Zeosa.

Norethindrone

Norethindrone Tablets (Errin)

Norethindrone is a Hormonal Contraceptive (birth control) medication. Norethindrone is an analogue of the female hormone Progesterone.

Hormonal contraceptives are not frequently used as a primary treatment for acne, but many women report substantial changes in their acne symptoms after starting use of Hormonal Contraceptives.

There are many different types of Hormonal Contraceptives. All Hormonal Contraceptives include versions of the female sex hormones estrogen and/or progesterone. The specific composition of these hormones varies between different types of Hormonal Contraceptives.

Hormones have a major impact on acne symptoms. Female sex hormones (eg. Estrogen, Progesterone) and male sex hormones (eg. Testosterone) control many important functions within the body. Use of Hormonal Contraceptives has been shown to improve acne in some women and worsen it in others, with comparable frequency. Hormonal Contraceptives may improve acne symptoms in some women by blocking the effect of androgen (male) hormones. Androgen hormones can increase the activity of the sebaceous glands and sebum production, which can contribute to the development of acne.

Norethindrone Medications

Aygestin, Errin, Nor-Qd, Ortho Micronor, Primolut-N, Regestrone.

Norelgestromin and Ethinyl Estradiol

Norelgestromin and Ethinyl Estradiol (Ortho Evra)

Norelgestromin and Ethinyl Estradiol is a Hormonal Contraceptive (birth control) medication. Norelgestromin and Ethinyl Estradiol are analogues of the female hormones Progesterone and Estrogen, respectively. This combination Hormonal Contraceptive available as a transdermal patch that is applied directly to the skin. It is commonly marketed as Ortho Evra.

Hormonal contraceptives are not frequently used as a primary treatment for acne, but many women report substantial changes in their acne symptoms after starting use of Hormonal Contraceptives.

There are many different types of Hormonal Contraceptives. All Hormonal Contraceptives include versions of the female sex hormones estrogen and/or progesterone. The specific composition of these hormones varies between different types of Hormonal Contraceptives.

Hormones have a major impact on acne symptoms. Female sex hormones (eg. Estrogen, Progesterone) and male sex hormones (eg. Testosterone) control many important functions within the body. Use of Hormonal Contraceptives has been shown to improve acne in some women and worsen it in others, with comparable frequency. Hormonal Contraceptives may improve acne symptoms in some women by blocking the effect of androgen (male) hormones. Androgen hormones can increase the activity of the sebaceous glands and sebum production, which can contribute to the development of acne.

Norelgestromin and Ethinyl Estradiol

Ortho Evra, Xulane.

Neem Oil

Neem Tree

Neem Oil is extracted from the leaves and seeds of the Neem Tree (Azadirachta indica). The Neem Tree is native in the Indian subcontinent, however it has been introduced to many other tropical regions.

Neem Oil is a natural insecticide and is widely used as a pest control agent in organic horticulture. Neem Oil also has an important role in Ayurvedic medicine and topical Neem Oil formulations are commonly used to treat a variety of skin infections, including acne. Neem Oil is increasing in popularity as a topical anti-acne treatment in modern Naturopathic medicine.

The best studied compound in Neem Oil is Azadirachtin, which is often used as an insecticide or fungicide (however in humans it is biologically safe). Many other compounds have also been isolated from Neem Oil, some of which exhibit anti-microbial properties in laboratory testing. There has also been a scientific study that found Neem Oil can potentially reduce the inflammation caused by Propionibacterium acnes (the bacterium commonly associated with acne).

There are many different ways that Neem Oil can be used, from oral supplements to topical face washes. Many people have reported that topical Neem Oil face washes helped to improve their acne symptoms.

However, Neem Oil has not been rigorously investigated as an acne treatment in clinical trials. More research needs to be done to reach a conclusion on how to best use Neem Oil to treat acne, and what potential limitations Neem Oil might have. Despite these unknowns, some people may find Neem Oil to be effective for treating their acne and it may be worth a try.

References

Formulation and characterization of solid lipid nanoparticles loaded Neem oil for topical treatment of acne. Vijayan, etal. 2013.
Topical herbal therapies an alternative and complementary choice to combat acne. Kapoor, et al. 2011.
Analysis of components of Neem (Azadirachta indica) oil by diverse chromatographic techniques. Gossa, et al. 2005.
Neem – an omnipotent plant: a retrospection. Brahmachari, et al. 2004.
Antimicrobial potential of Azadirachta indica against pathogenic bacteria and fungi. Asif. 2012.
Azadirachta indica (neem): a plant of multiple biological and pharmacological activities. Atawodi, et al. 2009.
Neem in human and plant disease therapy. Singh, et al. 2002.
Neem (Azadirachta indica): Prehistory to contemporary medicinal uses to humankind. Kumar, et al. 2013.
Effect of neem oil on some pathogenic bacteria. Jahan, et al. 2007.

Nd:YAG Lasers

Nd:YAG Laser Acne Scar Treatment

Nd:YAG lasers are among the most common and widely used class of laser for medical applications.  Nd:YAG lasers are frequently used for the treatment of acne scars. In addition acne scar treatment and other cosmetic applications, Nd:YAG lasers are also routinely employed in eye surgeries, dentistry, cancer treatment and a variety of industrial uses. Nd:YAG lasers are not generally used for treatment of active acne.

There are numerous clinical research studies on the utility of Nd:YAG Lasers for the treatment of acne scars. Overall, the scientific research indicates that Nd:YAG Lasers can help improve the appearance of acne scars. Along with CO2 and Er:YAG lasers, Nd:YAG lasers are one of the most popular and efficacious systems for treating acne scars.

There is also a small amount of research that indicates that Nd:YAG Laser treatment may be a helpful treatment for active acne for some people.
However, improvements in acne symptoms following Nd:YAG treatment tend to be mild and temporary. Achieving good results requires frequent treatments, which can quickly get very expensive. In spite of this challenge, Nd:YAG treatment of active acne is positively reviewed by some patients.

Nd:YAG Lasers are named for the crystal used as the lasing medium, Neodymium-doped Yttrium Aluminium Garnet (Nd:YAG). Nd:YAG Lasers generally produce an infra-red laser (1064 nm), but most systems are adjustable, allowing the system to produce additional colors of laser beam (532, 940, 1120, 1230, 1320, and 1440 nm). Many dermatology clinics use tunable or Q-switched Nd: YAG laser platforms that allow the production of laser wavelengths down to 530 nm.

Like other infra-red lasers (e.g. CO2 Lasers) the Nd:YAG Laser works primarily by heating the water molecules in the treatment area. When used at low power, infra-red lasers are used to stimulate cells by heating them up, but not enough to kill them. When used at high power, infra-red lasers can destroy (ablate) the target tissue very quickly. Ablative laser therapy with Nd:YAG Lasers is a popular technique to resurface the skin and treat acne scars by removing scar tissue.

Laser beams with longer wavelengths are generally capable of penetrating deeper into skin and tissue. Infra-red lasers like Nd:YAG can be quite effective at repairing deep acne scars. Many dermatology laser systems combine an automated coolant spray that is administered simultaneously with the laser treatment. The coolant spray prevents the surface of the skin, the epidermis, from overheating and being damaged. When combined with an infra-red laser like Nd:YAG, this system allows the physician to treat the underlying tissue, while leaving the surface of the skin undamaged.

Nd:YAG laser treatments are almost exclusively performed in a dermatology and cosmetic surgery clinics, along with hospitals. Ablative laser therapy is somewhat invasive and can cause serious damage if done improperly. It is therefore very important to undergo any high-power or ablative laser treatment in a safe, licensed and professional environment.

Common Nd:YAG Laser Systems

Affinity QS, CoolTouch, DermaLase, Excel, Gemini, Genesis, GentleYAG, PhotoSilk, RevLite.

References

A randomized, controlled, split-face clinical trial of 1320-nm Nd:YAG laser therapy in the treatment of acne vulgaris. Orringer, et al. 2007.
Fractional 1320 nm Nd : YAG laser in the treatment of acne vulgaris: a pilot study. Deng, et al. 2009.
Laser resurfacing of the skin for the improvement of facial acne scarring: a systematic review of the evidence. Jordan, et al. 2000.
A Preliminary Study of Utilization of the 1320-nm Nd:YAG Laser for the Treatment of Acne Scarring. Sadick, et al. 2004.
Atrophic and a Mixed Pattern of Acne Scars Improved With a 1320-nm Nd:YAG Laser. Rogachefsky, et al. 2003.
Comparison of a 585-nm pulsed dye laser and a 1064-nm Nd:YAG laser for the treatment of acne scars: A randomized split-face clinical study. Lee. et al. 2006.
Comparison of a Long-Pulse Nd:YAG Laser and a Combined 585/1,064-nm Laser for the Treatment of Acne Scars: A Randomized Split-Face Clinical Study. Min, et al. 2009.
Comparison of a Pulsed Dye Laser and a Combined 585/1,064-nm Laser in the Treatment of Acne Vulgaris. Jung, et al. 2009.
Nonablative 1,064-nm Nd:YAG Laser for Treating Atrophic Facial Acne Scars: Histologic and Clinical Analysis. Keller, et al. 2007.
Nonablative Acne Scar Reduction after a Series of Treatments with a Short-Pulsed 1,064-nm Neodymium:YAG Laser. Lipper, et al. 2006.
Patient Satisfaction and Reported Long-Term Therapeutic Efficacy Associated with 1,320 nm Nd:YAG Laser Treatment of Acne Scarring and Photoaging. Bhatia, et al. 2006.
Subcision and 1320-nm Nd:YAG Nonablative Laser Resurfacing for the Treatment of Acne Scars: A Simultaneous Split-Face Single Patient Trial. Fulchiero, et al. 2004.
Treatment of Atrophic Facial Acne Scars With the 1064-nm Q-Switched Nd:YAG Laser. Friedman, et al. 2004.

Multi-Vitamins

Once Daily Multivitamin

Multi-vitamins are nutritional supplements that combine many vitamins, minerals and other nutrients into a single formulation. Regular intake of a balanced multi-vitamin at the recommended dosage is an excellent way to maintain healthy levels of essential nutrients in your body.

Multi-vitamins are rarely used as a direct treatment for acne, but they are often incorporated into comprehensive acne treatment plans as part of the dietary regimen.

There is no robust evidence that taking Multi-vitamins is an effective treatment for any disease, at least in otherwise healthy people. However, deficiences in essential Vitamins and Minerals can cause a wide range of health problems, suppress the immune system and trigger acne symptoms. For example, B Vitamin (B2, B5 and B6) deficiencies can cause skin problems and acne-like symptoms. Deficiencies in Vitamins A and D, as well as important minerals like Zinc, may also trigger acne symptoms.

Overall, taking a once-daily, balanced multi-vitamin is unlikely to significantly reduce the frequency or severity of acne symptoms in most people. That’s because most people who eat a reasonably well-balanced diet do not have acute Vitamin or Mineral deficiencies. But regular use of multi-vitamins at recommended dosages is generally safe and is an excellent way to ensure your body has all the nutrients that it needs.

Medroxyprogesterone

Depo-Provera (Medroxyprogesterone)

Medroxyprogesterone is a Hormonal Contraceptive (birth control) medication. Medroxyprogesterone is a synthetic analogue of the female hormone Progesterone. Medrocyprogesterone is used as a long-lasting injectable contraceptive (eg. Depo-Provera).

Hormonal contraceptives are not frequently used as a primary treatment for acne, but many women report substantial changes in their acne symptoms after starting use of Hormonal Contraceptives.

Hormones have a major impact on acne symptoms. Female sex hormones (eg. Estrogen, Progesterone) and male sex hormones (eg. Testosterone) control many important functions within the body. Use of Hormonal Contraceptives has been shown to improve acne in some women and worsen it in others, with comparable frequency. Hormonal Contraceptives may improve acne symptoms in some women by blocking the effect of androgen (male) hormones. Androgen hormones can increase the activity of the sebaceous glands and sebum production, which can contribute to the development of acne.

Medroxyprogesterone Medications

Depo-M, Depo-Provera, Meprate

Meditation and Prayer

Meditation and Prayer are both mental practices where one focuses on their own consciousness and its connection to the larger universe.

Prayer often involves communicating with God or either deities, and most religions have their own unique prayer practices. Meditation is often more focused on looking inward into one’s own consciousness and freeing it from the influences of external forces.

Meditation and Prayer are both common techniques for people with and without acne. However, neither Meditation nor Prayer is widely used on its own as a treatment for acne symptoms.

There is little scientific research on the direct connection between Meditation or Prayer and acne. One possible reason that Meditation or Prayer might help improve acne symptoms is through a reduction in stress. Mental stress is believed to disrupt the balance of the immune system, which could trigger the development of acne.

Although there does not appear to be any hard evidence that Meditation or Prayer is likely to help reduce the frequency or severity of acne breakouts, there also does not appear to be any negative risks associated with these techniques. Thus they can be readily incorporated into all holistic acne treatment regimens.

References

Relaxation, meditation, and hypnosis for skin disorders and procedures. Shenefelt. 2008.
Natural Treatments for Acne. Kroll. 1996.
Complementary therapies for acne vulgaris. Leonard, et al. 2006.
Significance of Serenity Prayer and patient satisfaction. Siegfried. 2014.
Breaking Out: A Woman’s Guide to Coping with Acne at Any Age. Voutier. 2005.

Low Glycemic Diet

Paleo Diet Dinner

Low Glycemic Diets are dietary regimens that minimize the consumption of sugar and other easily digestible carbohydrates (eg. refined flour, cereals or mashed potatoes). The purpose of the Low Glycemic Diets are to prevent large spikes in blood glucose (sugar) concentrations.

Individuals with Type 2 diabetes have difficulty regulating their blood glucose levels, and Low Glycemic diets are commonly prescribed for this population. Low Glycemic Diets (especially when combined with protein supplementation) are also commonly used to support healthy weight loss.

Reducing consumption of sugars and refined carbohydrates may help improve acne symptoms for some individuals. There is scientific evidence that high-sugar diets suppress immune function and can trigger hormonal changes, both of which can contribute to the development of acne. Many popular diets, such as the Paleo Diet, are versions of a Low Glycemic Diet.

In general, consumption of significant amounts of sugar (particularly sucrose aka cane sugar) is bad for your health. The reason why sugar, and sucrose in particular, is bad for you is because the human body is not metabolically adapted for its consumption. Refined sugar is a very high-energy, rapidly digested substance that is not readily available in nature. The human metabolic system has been slowly evolving for hundreds of thousands of years based on a diet of largely unrefined plant, fungal and animal products. Refined sugar only became widely available to the general population in the last 200 years. It is no coincidence that rates of obesity, dental caries, heart disease and diabetes track very closely with rates of refined sugar consumption. The bottom line is that eating less refined sugar is a good idea for virtually everyone.

References

Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review. Noakes, et al. 2017.
Sugar consumption in acne vulgaris and seborrhoeic dermatitis. Bett, et al. 1967.
Diet and acne: a review of the evidence. Spencer, et al. 2009.
A systematic review of the evidence for ‘myths and misconceptions’ in acne management: diet, face-washing and sunlight. Magin, et al. 2005.
The role of diet in acne: facts and controversies. Davidovici, et al. 2010.
Diet and acne. Bowe. 2010.
Acne: the role of medical nutrition therapy. Burris, et al. 2013.
Relationships of self-reported dietary factors and perceived acne severity in a cohort of New York young adults.;Burris, et al. 2014.
Nutrition and acne. Danby 2010.
The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides. Smith, et al. 2008.
A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Smith, et al. 2007.

Levonorgestrel and Ethinyl Estradiol

Levonorgestrel and EthinylEstradiol Contraceptive Tablets Amethyst

Levonorgestrel and Ethinyl Estradiol are used in combination as a Hormonal Contraceptive (birth control) medication. Hormonal contraceptives are not frequently used as a primary treatment for acne, but many women report substantial changes in their acne symptoms after starting use of Hormonal Contraceptives.

Levonorgestrel is a synthetic version of progesterone. The combination of Levonorgestrel and Ethinyl Estradiol is used in many different brands of hormonal birth control. High dose Levonorgestrel is used in some ermergency contraceptive medications (eg. Plan B). Levonorgestrel is also included in some hormone replacement regimens.

There are many different types of Hormonal Contraceptives. All Hormonal Contraceptives include versions of the female sex hormones estrogen and/or progesterone. The specific composition of these hormones varies between different types of Hormonal Contraceptives.

Hormones have a major impact on acne symptoms. Female sex hormones (eg. Estrogen, Progesterone) and male sex hormones (eg. Testosterone) control many important functions within the body. Use of Hormonal Contraceptives has been shown to improve acne in some women and worsen it in others, with comparable frequency. Hormonal Contraceptives may improve acne symptoms in some women by blocking the effect of androgen (male) hormones. Androgen hormones can increase the activity of the sebaceous glands and sebum production, which can contribute to the development of acne.

Levonorgestrel and Ethinyl Estradiol Medications

Amethyst, Aviane, Daysee, Enpresse, Jolessa, Lessina, Levora, Loette, Loseasonique, Lybrel, Nordette, Portia, Quasense, Seasonale, Seasonique, Sronyx, Trivora

KTP Lasers

KTP Laser Treatment

KTP lasers are commonly used for minimally invasive ablation and coagulation treatments. KTP lasers have also been used to treat rosacea, spider veins, hyper-pigmented spots and acne, although it is an uncommon acne treatment.

When used for the treatment of acne scars, lower-power KTP lasers that are non-ablative or partially ablative are most commonly used. KTP Lasers are also occassionaly used for Photodynamic Therapy (PDT) of active acne.

KTP lasers are modified Nd:YAG lasers that produce a laser beams with a wavelength near 532 nm (green). In a KTP laser, an Nd:YAG laser beam (infra-red) is used to illuminate a crystal of potassium titanyl phosphate (KTP), to generate another laser (green).

The green light produced by the KTP laser is readily absorbed by skin pigments (eg. melanin) and blood (eg. oxyhemoglobin). This selectivity, allows KTP lasers to efficiently targeting of pigmented lesions and spider veins.

KTP Lasers are occassionally used to treat minor skin discoloration associated with acne scars (eg. hyper-pigmented and erythematous acne scars). KTP Lasers are generally ineffective treatments for most types of acne scarring. For the treatment of moderate to severe acne scars, laser resurfacing technologies that use CO2, Er:YAG and Nd:YAG Lasers are the most common platforms.

Low power KTP Lasers can theoretically be used for the treatment of active acne. In these application, KTP lasers can be used as a form of light therapy and/or Photodynamic Therapy (PDT) to directly target acne-causing Propionibacterium acnes bacteria living in follicles. The green light generated by KTP lasers can activate molecules in P. acnes bacteria called porphyrins. Activation of the bacterial porphyrin releases free radical molecules, which can kill the bacteria. This mechanism of action is the same as that for Blue Light Phototherapy acne treatment. Although green light is less effective at activating porphyrins then blue light, it is able to penetrate more deeply into the skin tissue.

Blue Light Therapy is more popular than KTP Lasers for the treatment of active acne because it has less risk and a lower cost. KTP lasers are not used to treat active acne by most dermatologists. However, there have been scientific research studies that have reported KTP lasers are moderately effective at improving acne symptoms, with results similar to blue light therapy.

The published research indicates that KTP laser treatment does lead to a moderate decrease in the number and severity of acne lesions. In addition, KTP lasers also apparently lead to a moderate decrease in the sebum production in treated areas, although the mechanism is not understood and those results need to be independently validated.

Popular KTP Laser Systems

Aura, DioLite, VariLite

References

Nonablative Phototherapy for Acne Vulgaris Using the KTP 532 nm Laser. Baugh, et al. 2005.
Effects of 532 nm KTP Laser Exposure on Acne and Sebaceous Glands. Bowes, et al. 2003.
Use of the KTP Laser in the Treatment of Rosacea and Solar Lentigines. Bassichis, et al. 2004.

Khadir

Khadir Supplement

Khadir is an herbal supplement made from the Kher plant (Senegalia catechu or Acacia catechu). The Kher plant may go by other names, such as black catechu, black cutch, cachou, catechu, cutchtree and khair. Kher is a thorny, deciduous tree that is native to Asia and parts of India near the Indian Ocean. In Ayurvedic medicine Khadir is used for treatments ranging from sore throats to diarrhea to skin care.

Khadir is commonly used in Ayurvedic medicine as both a topical and oral treatment for acne. Khadir is thought to act as a an astringent, anti-inflammatory and antibacterial agent. The addition of Khadir to Naturopathic face washes is purported to help minimize the redness and swelling associated with acne lesions. However, these claims have not been tested in clinical studiesÂand acne sufferers should not anticipate oral or topical Khadir treatments to dramatically improve their acne symptoms.

Khadir extracts contain several compounds which are believed to have biological activity. The Acacia catechu is so named because the plant contains significant concentrations of catechins, catechols and catecholamines. The utility of these compounds for the treatment of acne is not well understood and requires additional research.

References

Therapeutic plants of Ayurveda: a review of selected clinical and other studies for 166 species. Khan, et al. 2001.
Determination of the predominant catechins in Acacia catechu by liquid chromatography/electrospray ionization− mass spectrometry. Shen, et al. 2006.
In Vitro antimicrobial activity of Acacia catechu and its phytochemical analysis. Negi, et al. 2010.
A medicinal extract of Scutellaria baicalensis and Acacia catechu acts as a dual inhibitor of cyclooxygenase and 5-lipoxygenase to reduce inflammation. Burnett, et al. 2007.
Analgesic effects of a standardized bioflavonoid composition from Scutellaria baicalensis and Acacia catechu. Yiman, et al. 2012.

Jojoba Oil

Jojoba Plant and Immature and Mature Fruit

Jojoba Oil is extracted from the seeds of the Jojoba plant (Simmondsia chinensis). The Jojoba plant is native to the south eastern North America, along the border between the USA and Mexico. Jojoba had many uses for the Native Americans that lived in the area, including the treatment of skin infections and wounds.

Jojoba Oil is widely used in Naturopathic acne treatments, primarily as a carrier oil (base) for blends of essential oils and other plant extracts.

Jojoba-based Naturopathic acne treatments are generally topical. Jojoba oil is generally considered to be non-comedogenic and is not usually irritating to the skin, both of which are attractive qualities for components of topical acne treatments. Jojoba Oil alone does not have significant antibacterial activity and is not expected to have any significant direct effects on acne symptoms.

Jojoba Oil has an unusual chemical structure that is similar to the sebum that is produced by sebaceous glands in the skin. Jojoba Oil is commonly used as a carrier oil for creating blends of other essential oils. Jojoba seeds are very rich in oil, which comprises approximately 50% of the total weight of Jojoba seeds. Raw Jojoba Oil has a clear, dark yellow color. Purified Jojoba oil is often clear.

Detailed information about the chemical composition of Jojoba Oil can be found here.

References

Potential uses of jojoba oil and meal: A review. Wisniak, et al. 1994.
Anti-inflammatory effects of jojoba liquid wax in experimental models. Habashy, et al. 2005.
Clay jojoba oil facial mask for lesioned skin and mild acne: Results of a prospective, observational pilot study. Meier, et al. 2012.
Wound healing properties of jojoba liquid wax: an in vitro study. Ranzato, et al. 2011.
Therapeutic agents and herbs in topical application for acne treatment. Kanlayavattanakul, et al. 2011.
Human synthetic sebum formulation and stability under conditions of use and storage. Wertz, et al. 2009.
Jojoba oil as an organic, shelf stable standard oil-phase base for cosmetic industry. Sandha, et al. 2009.
Formulation and stability of a novel artificial sebum under conditions of storage and use. Stefaniak, et al. 2010.
Jojoba oil. Gunstone, 1990.

Intense Pulsed Light (IPL)

Intense Pulsed Light IPL Treatment

Intense Pulsed Light (IPL) therapy uses short bursts of high intensity light to treat a variety of skin conditions. It is most commonly used for photo-rejuvenation procedures and to treat mild skin discolorations caused by hyper-pigmentation. Intense Pulsed Light (IPL) therapy is also occasionally used to treat active acne symptoms and certain types of mild acne scars.

Intense Pulsed Light (IPL) systems are one of the most commonly administered forms of light therapy for dermatology applications. IPL systems are designed to administer many rapid, high intensity pulses of light. The rapid pulsing prevents thermal damage to the skin and minimizes discomfort of the patient.

IPL is not a common treatment for active acne or acne scars. IPL can be used to improve the appearance of hyper-pigmented acne scars, but other laser systems (eg. C02, Nd:YAG, Er:YAG) are much more effective treatments for acne scars.

IPL has been tested as a treatment for active acne symptoms. For the treatment of active acne, IPL is commonly used as the light source for Photodynamic Therapy (PDT), which uses a topical photo-sensitizer to increase the effectiveness of the treatment. Several clinical research studies have been conducted to evaluate the efficacy of IPL as an active acne treatment. Overall, these studies have found that IPL alone was partially effective at improving acne symptoms. Very few patients experienced dramatic improvement of their acne symptoms in response to IPL treatment.

The light produced by IPL treatment is absorbed more by pigmented tissue than non-pigmented tissue causing thermal damage to pigmented cells. Because hair and hair follicles generally have a higher density of melanin (pigment), IPL can be used to damage those structures. IPL is a common procedure for treating areas of hyper-pigmented skin (eg. melasma).

IPL treatments generally use a broad spectrum and non-coherent light source, much like standard white light. In many cases a special optical filter is used that limits the light to a specific range of wavelengths (colors). One of the most common IPL filters is designed to limit the light to orange and red wavelengths.

IPL is usually administered in a spa or clinical environment. IPL is a non-ablative treatment with a good safety record. The incidence of serious complications and side effects is lower for IPL than with more invasive types of laser treatment. Therefore, IPL can be safely administered in many settings.

There are numerous types of IPL treatment systems, each with its own advantages and disadvantages. Some IPL systems include special filter sets to control the wavelengths of light being used, while others include automated cooling systems to prevent damage to the outer surface of the skin during treatment. Because of the variability in the treatment itself, there is a wide range of efficacy with IPL procedures.

Common Intense Pulsed Light (IPL) Systems

AccelaWave, Chromolite, IPL Quantum SR, LimeLight, StarLux.

References

The use of a novel intense pulsed light and heat source and ALA-PDT in the treatment of moderate to severe inflammatory acne vulgaris. Gold, et al. 2000.
Treatment of Inflammatory Facial Acne Vulgaris with Intense Pulsed Light and Short Contact of Topical 5-Aminolevulinic Acid: A Pilot Study. ROJANAMATIN, et al. 2006.
Effectiveness of Photodynamic Therapy with Topical 5-Aminolevulinic Acid and Intense Pulsed Light versus Intense Pulsed Light Alone in the Treatment of Acne Vulgaris: Comparative Study. Arianee, et al. 2005.
A comparative study of intense pulsed light alone and its combination with photodynamic therapy for the treatment of facial acne in Asian skin. Yeung, et al. 2007.
Treatment of Facial Acne Papules and Pustules in Korean Patients Using an Intense Pulsed Light Device Equipped with a 530 to 750 nm Filter. Chang, et al. 2007.
A comparison of intense pulsed light, combination radiofrequency and intense pulsed light, and blue light in photodynamic therapy for acne vulgaris. Taub, et al. 2007.
Treatment of hypertrophic scars and keloids using intense pulsed light (IPL). Erol, et al. 2008.
Intense pulsed light (IPL): a review. Babilas, et al. 2010.
Intense pulsed light vs. pulsed-dye laser in the treatment of facial acne: a randomized split-face trial. Choi, et al. 2010.
A Comparative Study of Topical 5-Aminolevulinic Acid Incubation Times in Photodynamic Therapy with Intense Pulsed Light for the Treatment of Inflammatory Acne. Oh, et al. 2009.

Honey

Honeycomb

Honey has a medicinal tradition that goes back to ancient times. Honey has become even more popular in recent times with some research indicating that Honey can accelerate wound healing when applied topically. Several products containing medical grade Honey are now available and are widely used in parts of Europe and Asia.

Honey is widely used in Nautropathic acne treatments. Honey can be applied directly to the skin, or blended into complex formulations. The combination of honey, clays and essential oils is a popular way to make anti-acne facial masks.

Many Naturopathic medicine practitioners believe that Honey can be a helpful addition to an acne treatment regimen. But most clinical research has found the topical application of Honey to be fairly ineffective for reducing acne symptoms. Overall, the effectiveness of Honey for the treatment of acne is unclear.

Honey is primarily a mixture of sugars and water. But Honey also contains anti-oxidants, enzymes and antibacterial molecules. There is a difference between raw and pasteurized honey, as the pasteurization process denatures many of the enzymes present in honey. However, both raw and processed honey are used in homeopathic medicine, depending on the application. Honey may have some antibacterial properties and has been reported to be moderately toxic to acne-causing, P. acnes bacteria.

References

A pilot study of topical medical-grade kanuka honey for acne. Holt, et al. 2011.
Honey in dermatology and skin care: a review. Burlando, et al. 2013.
Honey: is it worth rubbing it in? Chowdhury. 1999.
Randomised controlled trial of topical kanuka honey for the treatment of acne. Semprini. 2016.
Antibacterial Activity of Ethanolic Extract of Cinnamon Bark and Honey and Their Combination Effects Against Acne Causing Bacteria. Julianti, et al. 2016.
The protective effects of melittin on Propionibacterium acnes–induced inflammatory responses in vitro and in vivo. Lee, et al. 2014.
Antimicrobial effect of Manuka honey and Kanuka honey alone and in combination with the bioactives against the growth of Propionibacterium acnes ATCC 6919. Wu, et al. 2011.
Honey, a gift from nature to health and beauty: a review. Omar, et al. 2016.
Beliefs, perceptions and sociological impact of patients with acne vulgaris in the Turkish population. Gokdemir, et al. 2011.
Medical uses of honey. Jeffrey, et al. 1996.
Antibacterial activity of honey against strains of Staphylococcus aureus from infected wounds. Cooper, et al. 1999.
Antibacterial activity of honey on bacteria isolated from wounds. Subrahmanyam, et al. 2001.

Goldenseal

Goldenseal Plant

Goldenseal (Hydrastis canadensis) is an herb in the Ranunculaceae family that is native to Eastern North America. According to historical documents, Native Americans relied on the medicinal qualities of Goldenseal for the treatment of a variety of ailments. These ailments include skin infections, digestion problems and cancer. Goldenseal is now occasionally used by modern Naturopathic practitioners for the treatment of acne.

Goldenseal extracts are purported to have anti-inflammatory, antibacterial, antifungal and astringent properties. For the treatment of acne, Goldenseal extracts are both consumed orally or added to topical anti-acne formulations.

Many people have claimed that Naturopathic treatments involving Goldenseal helped to improve their acne symptoms. However, there do not appear to have been any rigorous clinical studies to evaluate how effective Goldenseal extract is for the treatment of acne. In fact, there does not appear to be strong evidence that Goldenseal is an effective treatment for many of the medical conditions for which it is commonly prescribed. The lack of scientific evidence does not prove or disprove the medical utility of Goldenseal, but more research is needed to evaluate many of the claimed benefits of Goldenseal.

Goldenseal does contain significant quantities of several alkaloids which are known to be biologically active, such as berberastine, berberine, canadine and hydrastine. Berberine has been shown to have antibacterial properties, possibly by disrupting their efflux pump system. Berberine has also been reported to be an anti-inflammatory agent when consumed orally, but this claim has not been fully proven.

References

Topical herbal therapies an alternative and complementary choice to combat acne. Kapoor, et al. 2011.
Herbal medicine for acne vulgaris. Yarnell, et al. 2006.
A review on herbal drugs acting against Acne Vulgaris. Patel, et al. 2015.
Human cytochrome p450 inhibition and metabolic-intermediate complex formation by goldenseal extract and its methylenedioxyphenyl components. Chatterjee, et al. 2003.
Goldenseal (Hydrastis canadensis L.) extracts synergistically enhance the antibacterial activity of berberine via efflux pump inhibition. Ettefagh, et al. 2011.
Determination of Hydrastine and Berberine in Goldenseal Raw Materials, Extracts, and Dietary Supplements by High-Performance Liquid Chromatography with UV: Collaborative Study. Brown, et al. 2008.

Glycolic Acid

Glycolic Acid Cream (Glyco-6)

Glycolic Acid is a Keratolytic medication that is used in the treatment of both active acne and mild acne scars. Glycolic Acid is a type of Alpha Hydroxy Acid (AHA) and is a common ingredient in a range of skin care products.

AHAs are organic acids that are naturally produced by sugar cane and certain kinds of fruit. In addition to Glycolic Acid, other AHAs (eg. Lactic Acid, Malic Acid and Citric Acid) are included in many skin care products.

Glycolic Acid is the smallest of the AHAs and it readily penetrates into the skin. Glycolic Acid is used primarily as a chemical exfoliant that breaks up the outermost layer of the skin (epidermis).

Low concentration Glycolic Acid formulations are available as Over-The-Counter (OTC) medications, while higher strength products are available by prescription and are generally administered in a dermatology office or other medical setting.

Glycolic Acid is more commonly used as a treatment of mild acne scarring than for the treatment of active acne. Glycolic Acid face peels can do a good job of reducing minor skin irregularities and improving the overall appearance of the skin. Unfortunately, Glycolic Acid (and most other mild chemical peels) do not work well for the treatment of serious acne scars.

There is some clinical research that suggests that Glycolic Acid treatment can help improve active acne symptoms, but most patients report that Glycolic Acid is generally ineffective for the treatment of active acne symptoms. At low concentrations, Glycolic Acid has a similar effect as other Keratolytic agents, like Salicylic Acid and Benzoyl Peroxide. However, even in research studies that reported improvements after Glycolic Acid treatment, very few of these patients experience significant or complete resolution of their acne symptoms. Keratolytic medications can improve acne symptoms by helping to prevent the formation of clogged pores and pimples.

The most common side effects of topical Glycolic Acid treatment are skin irritation, peeling, redness, and scaling. Some patients experience problems with erythema (persistent redness) and hyperpigmentation. Generally, side effects of Glycolic Acid treatment resolve within 2 weeks of treatment. The improper or excessive use of Glycolic Acid can burn the skin and cause permanent skin damage.

Flutamide

Flutamide (Fugerel) Tablets

Flutamide (Fugerel) is an Androgen Inhibitor medication that blocks the activity of androgens (male hormones). Flutamide is rarely used for the treatment of acne.

Flutamide is a synthetic non-steroidal anti-androgen (NSAA). It is primarily used for the treatment of prostate cancer, hirsutism (excessive body hair growth) and as part of the hormone replacement regimen for transgender women.

Flutamide blocks the ability of a receptor to bind androgen hormones, such as testosterone and dihydrotestosterone (DHT). Flutamide has largely been replaced by a closely-related medication, Bicalutamide, which tends to be more effective and have fewer side effects.

Androgen hormones can contribute to acne symptoms by stimulating the sebaceous glands to grow and produce more sebum. The increased sebaceous gland activity can lead to clogged pores and excessive growth of acne-causing P. acnes bacteria inside follicles. Androgen Inhibitors like Flutamide can improve acne symptoms by decreasing the activity of sebaceous glands, which leads to a decrease in sebum production.

Androgen hormones are an essential part of male biology. Because androgen inhibitors have significant side effects when used in men, they are usually only used to treat acne in women. The use of Androgen Inhibitors can improve acne symptoms for some female patients, but not all. Testosterone is the best known androgen.

Fluridil

Topilutamide aka Fluridil or Eucapil

Fluridil (Topilutamide, Eucapil) is an Androgen Inhibitor medication. Fluridil is available as a topical medication that is primarily used as a treatment for androgenic alopecia (hormone-induced hair loss). Fluridil is rarely used as a treatment for acne. Fluridil is not available in all countries.

Androgen hormones stimulate the growth and activity of the sebaceous glands and production of sebum, both of which contribute to acne symptoms in some individuals. The elevated levels of androgen hormones during puberty can cause acne in some individuals. Studies of adult females with acne have shown that many of these women have abnormally high levels of androgen hormones in their blood. Fluridil may help improve acne symptoms by reducing the effect of elevated androgen levels.

Fish Oil

Fish Oil Supplements

Fish Oil refers to the naturally occurring oils in the flesh of fish. Fish Oil is extracted from many types of fish and is among the most popular nutritional supplements on the market. Fish Oil is purported to have many health benefits, such as decreasing inflammation and improving skin tone. Fish Oil supplements are commonly included in holistic Naturopathic acne treatment plans.

There have been several research studies to investigate whether Fish Oil supplements can help improve acne symptoms. Many of these studies found that regular consumption of Fish Oil led to reduction in the severity and frequency of acne outbreaks. However, these effects tend to be fairly small and Fish Oil is not expected to dramatically improve acne symptoms for most individuals. Fish Oil supplements do not appear to have a significant risk of side effects when consumed at recommended levels and they can be combined with most other acne treatments.

Fish Oil contains significant concentrations of Omega-3 fatty acids, such as EicosaPentaenoic Acid (EPA) and DocosaHexaenoic Acid (DHA).These fatty acids have been reported to provide multiple health benefits and they may be responsible for anti-inflammatory properties of Fish Oil. Fish Oil is approved by the FDA to help lower levels of blood triglycerides (fats).

The powerful anti-acne drug Isotretinoin (Accutane) can cause unsafe increases in blood triglycerides in some individuals. There has been at least one research study which found that Fish Oil supplementation can help limit Isotretinoin-caused increases in blood triglyceride levels. Because of this, some dermatologists prescribe Fish Oil supplements to patients who are undergoing oral Isotretinoin therapy.

Although Fish Oil supplements are an easy way to maintain a steady level of dietary Fish Oil, eating fish itself will accomplish the same thing. Some experts believe that part of the reason why people in certain regions of the world (eg. Mediterranean) have lower frequencies of acne is because their diets are high in fish and other foods that are rich in certain types of fatty acids.

References

Acne vulgaris, mental health and omega-3 fatty acids: a report of cases. Rubin, et al. 2008.
Omega-3 fatty acids and acne. Logan. 2003.
Effects of fish oil supplementation on inflammatory acne. Khayef, et al. 2012.
Effect of dietary supplementation with omega-3 fatty acid and gamma-linolenic acid on acne vulgaris: a randomised, double-blind, controlled trial. Jung, et al. 2014.
Effect of dietary fish oil on hyperlipidaemia due to isotretinoin and etretinate. Marsden, et al. 1987.

Finasteride

Finasteride (Propecia)

Finasteride (Propecia) is an Androgen Inhibitor medication. It is commonly used for the treatment of male pattern baldness and enlarged prostate. Finasteride is not routinely used in the treatment of acne.

Finasteride inhibits the synthesis of the powerful androgen (male hormone), DHT. DHT is closely related to Testosterone, but is more potent. Inhibiting the effects of androgen hormones can help improve acne symptoms in some individuals by slowing the growth of the sebaceous glands. In individuals with androgen-induced acne, high levels of androgen hormones cause increased sebaceous gland activity, which leads to elevated sebum production, clogged pores and excessive growth of acne-causing P. acnes bacteria inside follicles.

Finasteride works by blocking the activity of an enzyme called 5-aplha reductase, which converts testosterone into dihydrotestosterone (DHT). There are two different versions of the 5-alpha reductase enzyme in humans. Dutasteride is an Androgen Inhibitor that is closely related to Finasteride. Dutasteride is a more powerful inhibitor of DHT synthesis than Finasteride because it inhibits both forms of the enzyme, while Finasteride only inhibits one.

Androgen hormones are an essential part of male biology. Because Androgen Inhibitors have significant side effects when used in men, they are usually only used to treat acne in women. However, Finasteride is one of the few Androgen Inhibitors that is routinely used in men. Two of the most common side effects of Androgen Inhbitor use in men are a reduced sex drive and decreased muscle mass.

Finasteride is generally available in oral formulations, but topical Finasteride may be better suited for use as an acne treatment. Finasteride is readily absorbed into the skin, and topically applied Finasteride is expected to have substantially fewer side effects than oral Finasteride. Topical Finasteride solutions are available, although many of them also contain the hair growth stimulator Minoxidil (Rogaine).

Evening Primrose Oil

Evening Primrose

Evening Primrose Oil is extracted from the seeds of several flowering plants in the genus Oenothera, which are found in North America. Evening Primrose Oil is a popular Naturopathic treatment for many types of skin disease, including psoriasis, eczema and acne. Evening Primrose Oil is used in both topical and oral formulations.

Evening Primrose Oil is rich source of Gamma-Linolenic Acid (GLA). GLA is a fatty acid that is purported to have anti-inflammatory and other health benefits when ingested. Prior to European settlement, some Native Americans cultivated the Evening Primrose and it was an important component of their traditional medicine.

Many people have reported that both oral and topical Evening Primrose Oil helped to improve their acne symptoms. There have also been some studies that suggest Evening Primrose Oil may help improve acne symptoms. However, the evidence provided by these studies tends to be weak and their findings should not be considered definitive. Evening Primrose Oil, and GLA in particular, are intriguing Naturopathic acne treatment options and warrant additional research.

References

Evening primrose oil is effective in atopic dermatitis: a randomized placebo-controlled trial. Senapati, et al. 2008.
Essential fatty acid metabolism and its modification in atopic eczema. Horrobin. 2000.
A review of the clinical efficacy of evening primrose. Stonemetz. 2008.
Herbal anti-inflammatory agents for skin disease. Graf. 2000.
Essential‐fatty‐acid metabolites in plasma phospholipids in patients with ichthyosis vulgaris, acne vulgaris and psoriasis. Grattan, et al. 1990.
Topical herbal therapies an alternative and complementary choice to combat acne. Kapoor, et al. 2011.

Etonogestrel and Ethinyl Estradiol

Etonogestrel and Ethinyl Estradiol (NuvaRing)

Etonogestrel and Ethinyl Estradiol is a Hormonal Contraceptive (birth control) medication. Etonogestrel and Ethinyl Estradiol are analogues of the female hormones Progesterone and Estrogen, respectively. This combination is marketed as NuvaRing.

Hormonal contraceptives are not frequently used as a primary treatment for acne, but many women report substantial changes in their acne symptoms after starting use of Hormonal Contraceptives.

There are many different typesof Hormonal Contraceptives. All Hormonal Contraceptives include versions of the female sex hormones estrogen and/or progesterone. The specific composition of these hormones varies between different types of Hormonal Contraceptives.

Hormones have a major impact on acne symptoms. Female sex hormones (eg. Estrogen, Progesterone) and male sex hormones (eg. Testosterone) control many important functions within the body. Use of Hormonal Contraceptives has been shown to improve acne in some women and worsen it in others, with comparable frequency. Hormonal Contraceptives may improve acne symptoms in some women by blocking the effect of androgen (male) hormones. Androgen hormones can increase the activity of the sebaceous glands and sebum production, which can contribute to the development of acne.

Etonogestrel and Ethinyl Estradiol Products

NuvaRing.

Ethynodiol Diacetate and Ethinyl Estradiol

Ethynodiol Diacetate and Ethinyl Estradiol is a Hormonal Contraceptive (birth control) medication. Ethynodiol Diacetate and Ethinyl Estradiol are analogues of the female hormones Progesterone and Estrogen, respectively.

Hormonal contraceptives are not frequently used as a primary treatment for acne, but many women report substantial changes in their acne symptoms after starting use of Hormonal Contraceptives.

There are many different types of Hormonal Contraceptives. All Hormonal Contraceptives include versions of the female sex hormones estrogen and/or progesterone. The specific composition of these hormones varies between different types of Hormonal Contraceptives.

Hormones have a major impact on acne symptoms. Female sex hormones (eg. Estrogen, Progesterone) and male sex hormones (eg. Testosterone) control many important functions within the body. Use of Hormonal Contraceptives has been shown to improve acne in some women and worsen it in others, with comparable frequency. Hormonal Contraceptives may improve acne symptoms in some women by blocking the effect of androgen (male) hormones. Androgen hormones can increase the activity of the sebaceous glands and sebum production, which can contribute to the development of acne.

Ethynodiol Diacetate and Ethinyl Estradiol Products

Kelnor, Zovia.

Estradiol Valerate and Dienogest

Estradiol Valerate and Dienogest is a Hormonal Contraceptive (birth control) medication. Estradiol Valerate and Dienogest are analogues of the female hormones Estrogen and Progesterone, respectively.

Hormonal contraceptives are not frequently used as a primary treatment for acne, but many women report substantial changes in their acne symptoms after starting use of Hormonal Contraceptives.

There are many different types of Hormonal Contraceptives. All Hormonal Contraceptives include versions of the female sex hormones estrogen and/or progesterone. The specific composition of these hormones varies between different types of Hormonal Contraceptives.

Hormones have a major impact on acne symptoms. Female sex hormones (eg. Estrogen, Progesterone) and male sex hormones (eg. Testosterone) control many important functions within the body. Use of Hormonal Contraceptives has been shown to improve acne in some women and worsen it in others, with comparable frequency. Hormonal Contraceptives may improve acne symptoms in some women by blocking the effect of androgen (male) hormones. Androgen hormones can increase the activity of the sebaceous glands and sebum production, which can contribute to the development of acne.

Estradiol Valerate and Dienogest Products

Natazia, Qlaira.

Er:YAG Lasers

Er:YAG and CO2 Lasers are the systems of choice for ablative laser skin resurfacing. Er:YAG Lasers are commonly used to repair skin damage, including acne scars and melasma (excess pigmentation). Er:YAG lasers are also routinely used to cut bone and tissue. They are used in laser dentistry and other surgical applications.

Er:YAG Lasers work by ablating (vaporizing) the surface layer of the skin. Each pass with the Er:YAG laser removes approximately 10 micrometers of skin tissue (1/100th of a millimeter). This type of technology is the basis for the procedure known as a “laser peel”. Some ER:YAG laser systems can be tuned to produce laser peels of varying depth.

Er:YAG Lasers primarily target the surface of the skin, and are not as effective as CO2 lasers at remodeling the collagen matrix underneath the skin. As a result, Er:YAG lasers are excellent options for repairing minor to moderate scarring and other superficial skin damage, but are less effective for severe scarring, especially pitted acne scars. Because Er:YAG lasers primarily affect the surface of the skin, the recovery times are faster and the side effects are generally milder than more invasive laser resurfacing techniques, such as CO2 Laser resurfacing.

Er:YAG Lasers are primarily used as a treatment for acne scars. They are rarely used for the treatment of active acne. Er:YAG Lasers have a good efficacy profile against mild to moderate acne scarring. Er:YAG Lasers are generally considered to be more effective for the treatment of acne scars purposes than many other light and laser treatment modalities, including as Nd:YAG, Pulsed Dye Lasers (PDL) and Intense Pulsed Light (IPL).

The (relatively) mild side effects of Er:YAG Lasers, combined with decent efficacy and generally positive patient response has made Er:YAG lasers a popular treatment option for superficial acne scars. The biggest limitation of Er:YAg lasers is their inability to effectively treat the extensive and deep scarring that is common in those who have suffered from severe inflammatory and cystic acne. For the treatment of moderate to severe acne scars, C02 Lasers generally provide better improvement. However, CO2 Lasers tend to generate more severe side effects and the recovery period can be significantly longer.

Er:YAG Lasers utilize Erbium-doped Yttrium Aluminium Garnet as the lasing medium. Er:YAG Lasers generate a laser beam with a very long wavelength (~2940 nm). This wavelength is in the infra-red spectrum and is strongly absorbed by water. The longer wavelength of the Er:YAG laser beam helps it to penetrate deeply into the skin tissue.

Er:YAG treatment is administered in cosmetic surgery clinics, dermatology offices and hospitals. Er:YAG Laser treatment can be done as a complete or fractional ablation technique. Complete ablation treats all of the skin in a given region, but fractional treatment leaves small areas of untreated skin in between (like a checkerboard). Recovery times from fractional treatment tend to be substantially shorter than from complete ablation treatments.

Common Er:YAG Laser Systems

Alma Pixel, Contour TRL, Fotona, FRAXEL RE:STORE (fractional Er:YAG laser system), Sciton Profractional, Venus .

References

Resurfacing of Pitted Acne Facial Scars with a Long Pulsed Er:YAG Laser. Jeong, et al. 2001.
Resurfacing of Pitted Facial Acne Scars Using Er:YAG Laser with Ablation and Coagulation Mode. Jeong, et al. 2003.
Treatment of Atrophic Acne Scars with a Dual Mode Er:YAG Laser. Tanzi, et al. 2002.
Minimally Ablative Erbium:YAG Laser Resurfacing of Facial Atrophic Acne Scars in Asian Skin: A Pilot Study. Tay, et al. 2008.

Endurance Training

Endurance Training are exercises designed to increase aerobic performance, as well as cardiovascular and muscular stamina. Common forms of Endurance Training include running, swimming, cycling and cross country skiing.

Endurance Training is a common element of healthy lifestyle changes. Endurance Training is not generally used as a treatment for acne, but it may have a small impact on acne symptoms in some individuals.

Sustained Endurance training triggers a range of physiological adaptations that are beneficial for overall health and wellness. Cardiovascular changes include improved heart performance and blood circulation. Muscle stamina also improves in response to increased mitochondrial capacity, glycogen storage and other metabolic changes.

Endurance Training is often associated with adoption of other healthy lifestyle changes, such as improved dietary choices. Improving overall health and reducing stress can enhance immune function and this may help improve acne symptoms in some individuals.

References

Dermatologic problems of the endurance athlete. Heymann. 2005.
Training-specific changes in cardiac structure and function: a prospective and longitudinal assessment of competitive athletes. Baggish, et al. 2008.
The role of exercise in the rehabilitation of idiopathic inflammatory myopathies. Alexanderson, et al. 2005.
Haemoglobin, blood volume and endurance. Gledhill, et al. 2000.
Acne, sedentary behaviour, malnutrition, and COPD. Rashid. 2014.

Elderberry

Elderberry Supplements are produced from berries of several species of Elderberry tree (Sambucus spp.), most commonly Black Elderberry (Sambucus nigra). The Elderberry plant has been used for centuries by traditional healers to treat respiratory infections and other diseases.

Elderberry is occasionally used in the Naturopathic treatment of acne. Elderberry extracts have been reported to have antibacterial, antiviral and antioxidant properties. There have been some research reports that Elderberry extracts can decrease symptoms of respiratory infections, but the overall evidence is weak. Elderberry extracts have also been reported to have moderate antibacterial activity towards gram positive bacteria, a group which includes the acne-causing P. acnes bacterium.

In regards to acne, Elderberry extracts are often used for their perceived immune boost. The immune benefit may then lead to an improvement in acne symptoms. However, there does not appear to be any reliable evidence that indicates Elderberry extracts are an effective acne treatment when used orally or topically.

References

European elderberry (Sambucus nigra L.) rich in sugars, organic acids, anthocyanins and selected polyphenols. Veberic, et al. 2009.
Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. Krawitz, et al. 2011.
Advanced research on the antioxidant and health benefit of elderberry (Sambucus nigra) in food–a review. Sidor, et al. 2015.
The antimicrobial activity of elderberry (Sambucus nigra L) extract against gram positive bacteria, gam negative bacteria and yeast. Mohammadsadeghi, et al. 2013.
Antibacterial activity of elder (Sambucus nigra L.) flower or berry against hospital pathogens. Hearst, et al. 2010.

Egg Whites

Egg whites contain large quantities of proteins, vitamins, minerals and other nutrients.

Fresh egg whites are commonly used for topical treatments in Naturopathic medicine. Egg Whites contain several enzymes and other molecules that have antimicrobial properties. Face masks that contain fresh egg whites are a popular Naturopathic acne treatment.

Egg Whites from fresh, uncooked eggs contain several proteins that can inhibit the growth of bacteria, including the acne-causing P. acnes bacterium. One of these proteins is an enzyme called Lysozyme which breaks down the cell walls of gram-positive bacteria. Coincidentally, the two bacteria that are usually behind acne breakouts, Propionibacterium acnes and Staphylococcus aureus, are both gram positive bacteria and are susceptible to this enzyme. Egg Whites also contain additional proteins which may have antimicrobial properties, such as Cystatin and Conalbumin.

For acne treatment, egg whites are often prepared into a mask and allowed to dry on the face. They can be mixed with many other ingredients that may have biological activity, such as activated charcoal, clay, colloidal silver or essential oils. Alternatively, Egg White extracts containing the active proteins can be prepared and added to a different preparation. The Lysozyme enzyme is also available alone, it is most often used in beer and wine making to prevent bacterial contamination during fermentation.

Although Egg White masks are a fairly popular Naturopathic acne treatment, there has been little research into whether they are effective. Many people have reported that their acne symptoms improved after beginning regular application of Egg White masks. But there do not appear to be any reliable scientific reports that indicate Egg White masks are an effective acne treatment. Nonetheless, Egg White masks are unlikely to worsen acne symptoms and might be worth trying for interested individuals.

Egg whites are low in carbohydrates and very rich in protein, which make them very popular nutritional choice for people who are trying to lose weight and/or build muscle mass.

References

Comparative antibacterial activity of avian egg white protein extracts. Wellman-Labadie, et al. 2008.
Antibacterial activity of hen egg white lysozyme against Listeria monocytogenes Scott A in foods. Hughey, et al. 1989.
Antimicrobial activity of lysozyme against bacteria involved in food spoilage and food-borne disease. Hughey, et al. 1987.
The antibacterial activity of the egg white protein conalbumin. Feeney, et al. 1952.
Antimicrobial activity of chicken egg white cystatin. Wesierska, et al. 2005.
Susceptibility of Propionibacterium acnes to killing and degradation by human neutrophils and monocytes in vitro. Webster, et al. 1985.
The chicken egg white proteome. Mann. 2007.

Echinacea

Echinacea supplements are prepared from several species of Coneflower (Echinacea spp). The most common Echinacea supplements are extracts from the roots of the Purple Coneflower (Echinacea purpurea).

Echinacea is native to the Eastern North America, and this plant was an important part of the traditional medicines of many Native American groups who lived in the region. Echinacea extracts are purported to have many health benefits and are widely used in Naturopathic Medicine to boost the immune system and to treat respiratory infections, such as the common cold. Echinacea extracts are occasionally used in the Naturopathic treatment of acne.

Despite numerous claims that Echinacea helps support the immune system, there is little scientific evidence that commercially-available Echinacea extracts have any health benefits. One reason for this might be because the composition of Echinacea extracts varies significantly between providers. It is also unclear whether the active ingredients that are present in Echinacea formulations prepared from fresh Echinacea roots are also present in the commercial extracts. Overall, there is no compelling evidence to suggest that commercial Echinacea extracts are helpful for the treatment of infections, including acne.

Echinacea extracts have been claimed to have robust antibacterial properties which may help reduce the growth of acne-causing bacteria, such as Propionibacterium acnes. However, laboratory testing indicates that commercial Echinacea extracts tend to be weakly toxic to gram-positive bacteria, a group which includes P. acnes. Overall, it seems unlikely that commercial Echinacea extracts will be helpful acne treatments. While topical or oral treatments that use fresh Echinacea extract may be helpful for the treatment of acne, more research is needed on that subject.

References

The potential use of Echinacea in acne: control of Propionibacterium acnes growth and inflammation. Sharma, et al. 2011.
Applications of the phytomedicine Echinacea purpurea (Purple Coneflower) in infectious diseases. Hudson. 2011.
A review of phytotherapy of acne vulgaris: perspective of new pharmacological treatments. Azimi, et al. 2012.
Immunotropic activity of Echinacea. Part II. Experimental and clinical data. Balan, et al. 2012.
Medicinal plants for the treatment of acne vulgaris: a review of recent evidences. Nasri, et al. 2015.
Echinacea: an effective alternative to antibiotics. Tierra. 2008.
An Evaluation of Echinacea angustifolia in Experimental Rhinovirus Infections. Turner, et al. 2005.
Evaluation of Selected Medicinal Plants Extracted in Different Ethanol Concentrations for Antibacterial Activity against Human Pathogens. Wendakoon, et al. 2012.

Dutasteride

Dutasteride (Avodart) is an Androgen Inhibitor medication. Dutasteride is primarily used as a treatment of male pattern baldness and enlarged prostate. Dutasteride is not routinely used in the treatment of acne.

Dutasteride inhibits the synthesis of the powerful androgen (male hormone), DHT. DHT is closely related to Testosterone, but is more potent. Inhibiting the effects of androgen hormones can help improve acne symptoms in some individuals by slowing the growth of the sebaceous glands. In individuals with androgen-induced acne, high levels of androgen hormones cause increased sebaceous gland activity, which leads to elevated sebum production, clogged pores and excessive growth of acne-causing P. acnes bacteria inside follicles.

Dutasteride works by blocking the activity of an enzyme called 5-aplha reductase, which converts testosterone into dihydrotestosterone (DHT). There are two different versions of the 5-alpha reductase enzyme in humans. Finasteride is an Androgen Inhibitor that is closely related to Dutasteride. Dutasteride is a more powerful inhibitor of DHT synthesis than Finasteride because it inhibits both forms of the enzyme, while Finasteride only inhibits one.

Dutasteride is generally available in oral formulations, but topical Dutasteride may be better suited for use as an acne treatment. Dutasteride is readily absorbed into the skin, and topically applied Dutasteride is expected to have substantially fewer side effects than oral Dutasteride. Topical Dutasteride solutions may be available in certain regions.

Androgen hormones are an essential part of male biology. Because Androgen Inhibitors have significant side effects when used in men, they are usually only used to treat acne in women. However, Dutasteride is one of the few Androgen Inhibitors that is routinely used in men. Two of the most common side effects of Androgen Inhbitor use in men are a reduced sex drive and decreased muscle mass.

Drospirenone and Ethinyl Estradiol

Drospirenone and Ethinyl Estradiol are used in combination as a Hormonal Contraceptive (birth control) medication.

Hormonal contraceptives are not frequently used as a primary treatment for acne, but many women report substantial changes in their acne symptoms after starting use of Hormonal Contraceptives.

There are many different types of Hormonal Contraceptives. All Hormonal Contraceptives include versions of the female sex hormones estrogen and/or progesterone. The specific composition of these hormones varies between different types of Hormonal Contraceptives.

Hormones have a major impact on acne symptoms. Female sex hormones (eg. Estrogen, Progesterone) and male sex hormones (eg. Testosterone) control many important functions within the body. Use of Hormonal Contraceptives has been shown to improve acne in some women and worsen it in others, with comparable frequency.

Hormonal Contraceptives may improve acne symptoms in some women by blocking the effect of androgen (male) hormones. Androgen hormones can increase the activity of the sebaceous glands and sebum production, which can contribute to the development of acne.

Drospirenone and Ethinyl Estradiol Medications

Beyaz, Ocella, Sayfral, Yamini, Yasmin, YAZ, Zarah

Diode Lasers

Diode Lasers are quickly becoming the preferred laser treatment for inflammatory acne. Diode Lasers are used to selectively target and damage the sebaceous glands, reducing sebaceous hyperplasia, sebum secretion and acne symptoms. Diode Lasers are also commonly used in hair removal and scar treatment applications.

The long wavelength of Diode Lasers is capable of penetrating deeply enough into the cutaneous tissue (skin) to reach the sebaceous glands. The energy from the laser beam is then absorbed by the tissue, which causes thermal damage. This damage can often cause a reduction in the size and activity of a sebaceous gland.

The use of diode lasers to treat inflammatory acne is a relatively new procedure. However, there are an increasing number of studies that indicate that diode laser treatment can be an effective treatment for inflammatory acne. Diode Lasers can be used in combination with many other Pharmaceutical and NaturopathicAcne Treatments. Diode Lasers (and other Light and Laser Acne Treatments) are also excellent options for women who are pregnant because there is no risk of exposing the fetus to medications.

Because Diode Laser treatment can target the sebaceous glands themselves, it is one of the few Light and Laser acne treatments that can offer the promise of providing long-term acne relief. Diode Laser treatment has a semi-permanent effect on the treated sebaceous glands and can lead to long-term reduction of sebum production in the treated region.

Because hyper-active sebaceous glands and the overproduction of sebum directly contribute to the development of acne symptoms, Diode Laser treatment can significantly improve symptoms for many acne patients. Several scientific research studies have reported that Diode Laser treatment can provide-long term improvement in acne symptoms for many patients.

Diode Lasers are also occasionally used for the treatment of acne scars. They have been reported to be somewhat effective as an acne scar treatment, although other modalities, such as Er:YAG and C02 lasers are more popular for this application.

Diode Lasers use semiconductors as the light source, similar to light emitting diodes (LEDs). There are several different kinds of Diode Lasers. Diode lasers are used in common technology products such as laser pointers and CD/DVD players. The most common Diode Lasers used for the treatment of acne produce a beam of laser light with a wavelength near 1450 nm.

Like other forms of laser therapy, diode laser treatment is almost exclusively provided in a dermatology clinic or hospital environment. Diode Lasers only improve acne symptoms in the areas of the skin that are treated. Therefore, Diode Lasers can be cost effective for patients with small, defined areas that are affected by acne. But the cost can be much higher for individuals with large regions of skin that require treatment.

Popular Diode Laser Systems

Acure, Lightsheer, Smoothbeam, Velas.

References

Use of Lasers and Light-Based Therapies for Treatment of Acne Vulgaris. Mariwalla, et al. 2005.
Acne Treatment With a 1,450 nm Wavelength Laser and Cryogen Spray Cooling. Paithankar, et al. 2002.
Sebaceous Hyperplasia Treated With a 1450-nm Diode Laser. No, et al. 2004.
The 1,450-nm Diode Laser Reduces Sebum Production in Facial Skin: A Possible Mode of Action of Its Effectiveness for the Treatment of Acne Vulgaris. Perez-Maldonado, et al. 2007. 
The 1450-nm diode laser for facial inflammatory acne vulgaris: Dose-response and 12-month follow-up study. Jih, et al. 2006.
Treatment of Inflammatory Facial Acne Vulgaris with the 1450-nm Diode Laser: A Pilot Study. Friedman, et al. 2004.
Smoothbeam Patient Reviews @ Realself

Desogestrel and Ethinyl Estradiol

Desogestrel and Ethinyl Estradiol are used in combination as a Hormonal Contraceptive (birth control) medication.

Hormonal contraceptives are not frequently used as a primary treatment for acne, but many women report substantial changes in their acne symptoms after starting use of Hormonal Contraceptives.

Hormonal Contraceptives may improve acne symptoms in some women by blocking the effect of androgen (male) hormones. Androgen hormones can increase the activity of the sebaceous glands and sebum production, which can contribute to the development of acne.

There are many different types of Hormonal Contraceptives. All Hormonal Contraceptives include versions of the female sex hormones estrogen and/or progesterone. The specific composition of these hormones varies between different types of Hormonal Contraceptives.

Hormones have a major impact on acne symptoms. Female sex hormones (eg. Estrogen, Progesterone) and male sex hormones (eg. Testosterone) control many important functions within the body. Use of Hormonal Contraceptives has been shown to improve acne in some women and worsen it in others, with comparable frequency.

Desogestrel and Ethinyl Estradiol Medications

Azurette, Caziant, Cyclessa, Desolon, Femilon, Kariva, Gianvi, Mircette, Reclipsen, Velivet.

Cyproterone

Cyproterone Acetate (Androcur) is an Androgen Inhibitor medication. Androgen Inhibitor medications block the effect of androgen (male) hormones that can contribute to acne symptoms in some individuals.

Cyproterone is occasionally used for the treatment of acne, primarily in women. Cyproterone is not a common treatment for acne, but some patients have reported positive results with this medication. Several clinical research studies have also found that Cyproterone can be an effective treatment for acne in women.

Cyproterone is primarily available in oral formulations, but topical versions of this medication do exist. Cyproterone is not available in all countries (eg. United States).

Androgen hormones stimulate the growth and activity of the sebaceous glands, and production of sebum, contributing to the pathogenesis of acne. Elevated levels of androgen hormones trigger acne symptoms during puberty. Studies of adult females with acne have shown that many of these women have abnormally high levels of androgen hormones in their blood. Cyproterone may help improve acne symptoms by reducing the effect of elevated androgen levels.

Cyproterone is less commonly used than Spironolactone (a different androgen inhibitor) because Spironolactone tends to have fewer side effects. However, the majority of female acne patients that use either Spironolactone or Cyproterone report significant improvement in their acne symptoms.

Cyproterone has a wider range of potential side-effects than Spironolactone, owing to a broader spectrum of activity on the hormonal system. Because Cyproterone blocks the action of androgen hormones on the body, it can have feminizing effects on males who use this medication. These effects are much more significant when this medication is used orally, as opposed to topical use.

One of the most serious potential side effects of Cyproterone use is liver toxicity. Patients undergoing treatment with Cyproterone are often required to take regular blood tests to monitor changes in liver enzymes. Cyproterone treatment may also have adverse effects on metabolic function and the body’s ability to maintain a proper salt balance. These side effects tend to be dose dependent, and severe side effects occur much more often at high dosage levels. Allergic reactions are also possible with this medication. Common symptoms of an allergic reaction include: Skin rashes, joint pain, fever and anaphylaxis.

Because Cyproterone disrupts normal hormone balance, it is not used in women who are pregnant or expect to become pregnant.

Corticosteroid Injections

Corticosteroid Injections are administered by dermatologists directly into an acne nodule or cyst to relieve the inflammation.

The inflammatory immune response in an acne lesion can cause significant damage to the surface of the skin, and the supportive tissue underneath. Corticosteroid injections are used to treat large inflammatory acne lesions that can permanently damage the skin and lead to the formation of acne scars.

Injections of anti-inflammatory corticosteroids can inhibit the recruitment and activation of immune cells, stopping the inflammatory process. However, the effect of corticosteroid injections is temporary. Because corticosteroids inhibit normal immune system function, frequent or systemic use of corticosteroids may occassionally worsen acne symptoms by allowing the bacteria that trigger acne lesions to proliferate. The injectable corticosteroid most commonly used in acne treatment is Triamcinolone.

Colloidal Silver

Colloidal Silver has been used in Naturopathic and Alternative Medicine for many years. Some people consume Colloidal Silver suspensions orally, although it is more commonly applied topically when used as an acne treatment.

Colloidal Silver is often used in the preparations of Naturopathic anti-acne face masks that also contain other active ingredients, such as clays, essential oils or honey. Many people have reported that topical Colloidal Silver treatments helped to improve their acne symptoms, but very little clinical research has been conducted to evaluate the efficacy of Colloidal Silver as an acne treatment.

Evangelists of Colloidal Silver claim that it has an array of health benefits. Although many of these claims are probably not true, one thing that is supported by significant research is the antibacterial activity of silver. Research studies have clearly shown that colloidal silver itself is toxic to many types of bacteria.

Silver can be incorporated into wound dressings, catheters and stents where it helps to decrease infection. Silver is also included in certain topical antibiotic formulations, such as Silver Sulfadiazine.

Despite claims to the contrary, there is little evidence to support the use Colloidal Silver as an oral supplement. There is no scientific research indicating that oral supplementation of colloidal silver is helpful in the treatment of acne. In addition, ingesting significant amounts of colloidal silver can lead to permanent pigmentation of the skin in a condition called argyria.

References

The bactericidal effect of silver nanoparticles. Morones, et al. 2005.
Evaluation of silver nanoparticle toxicity in skin in vivo and keratinocytes in vitro. Samberg, et al. 2010.
A review of the use of silver in wound care: facts and fallacies. Lansdown. 2004.
Silver nanoparticles: synthesis methods, bio-applications and properties. Abbasi, et al. 2016.
Silver in medicine: the basic science. Marx, et al. 2014.
Genotoxicity, acute oral and dermal toxicity, eye and dermal irritation and corrosion and skin sensitisation evaluation of silver nanoparticles. Kim, et al. 2013.
Chemical preparation of the eye in ophthalmic surgery: II. Effectiveness of mild silver protein solution. Isenberg, et al. 1983.
Anti-acne, anti-dandruff and anti-breast cancer efficacy of green synthesised silver nanoparticles using Coriandrum sativum leaf extract. Sathishkumar, et al. 2016.

Colloidal Copper

Colloidal copper is toxic to a wide range of bacteria and fungi. Although it is used less commonly than colloidal silver, colloidal copper is gaining popularity as a treatment for several types of dermatological problems, including acne.

Copper-based compounds are the active ingredient in many anti-fungal, topical solutions. Copper has also been incorporated into fabrics and bandages to slow the growth of disease and odor-causing bacteria. Copper peptides, which are small molecules that are composed of short chains of amino acids connected to copper ions, are also the subject of research efforts for dermatological applications. They are being used in a number of rejuvenating and skin revitalizing treatments.

Colloidal copper and copper salts (copper sulfate) are frequently used in many branches of Naturopathic Medicine. However, the efficacy of copper therapies for the treatment of acne remains largely untested by rigorous clinical trials. More research is needed to determine whether the use of colloidal copper (and other colloidal metals, such as Silver) can significantly improve symptoms for individuals with acne.

References

Green synthesis of copper nanoparticles by Citrus medica Linn.(Idilimbu) juice and its antimicrobial activity. Shende, et al. 2015.
Principles of colloid therapeutics. Smith. 1922.
Effect of nanosized colloidal copper on cotton fabric. Chattopadhyay, et al. 2010.
Strain specificity in antimicrobial activity of silver and copper nanoparticles. Ruparelia, et al. 2008.
Susceptibility constants of Escherichia coli and Bacillus subtilis to silver and copper nanoparticles. Yoon, et al. 2007.
Synthesis and antimicrobial activity of copper nanoparticles. Ramyadevi, et al. 2012.
Synthesis and anti-bacterial activity of Cu, Ag and Cu-Ag alloy nanoparticles: a green approach. Valodkar, et al. 2011.
Nanocarriers and nanoparticles for skin care and dermatological treatments. Gupta, et al. 2013.
Are commercially available nanoparticles safe when applied to the skin? Robertson, et al. 2010.

Cod Liver Oil

Cod Liver Oil is oil derived from the liver of Cod fish (Gadus spp).

Cod Liver Oil has been used for centuries to treat various ailments and is widely lauded for its perceived anti-inflammatory effects. Cod Liver Oil is rarely used on its own as a treatment for acne, but it is often included as a nutritional supplement in holistic Naturopathic acne treatment regimens.

Cod Liver Oil contains high levels of Vitamins A and D, as well as many important fatty acids. There is some research that suggests Cod Liver Oil can reduce blood triglyceride levels and help improve blood pressure. The high levels of Vitamin A are one of the reasons why Naturopathic practitioners use the Cod Liver Oil to relieve their acne symptoms.

Vitamin A is a retinoid and structurally-similar to anti-acne pharmaceuticals, such as Isotretinoin (Accutane) and Tretinoin (Retin-A). Vitamin A supplementation may help reduce sebaceous gland activity, which can help reduce acne symptoms in some individuals. Vitamin D supplementation may help overall immune function, especially in the winter.

Overall, there is very little clinical research on the efficacy of Cod LIver Oil for the treatment of acne. There are some people who have reported positive improvements in their acne symptoms after starting a supplement regimen that contained Cod Liver Oil. Although the available evidence suggests that Cod Liver Oil supplements are safe when used as directed, these supplements are unlikely to dramatically improve acne symptoms for most people.

References

Effect on blood lipids and haemostasis of a supplement of cod-liver oil, rich in eicosapentaenoic and docosahexaenoic acids, in healthy young men. Sanders, et al. 1981.
Complementary and alternative medicine therapies in acne, psoriasis, and atopic eczema: results of a qualitative study of patients’ experiences and perceptions. Magin, et al. 2006.
Effects of ethyl arachidonate, cod-liver oil, and corn oil on the plasma-cholesterol level: a comparison in normal volunteers. Kingsbury, et al. 1961.
Nutritional skin care: health effects of micronutrients and fatty acids. Boelsma, et al. 2001.

Coconut Oil

Coconut Oil is extracted from the fruit of the Coconut Palm (Cocos nucifera).

Raw Coconut Oil, which has a creamy consistency at room temperature, is used extensively for culinary, cosmetic and other purposes. Fractionated Coconut Oil, which is liquid at room temperature, is used as a carrier oil for making blends of essential oils and other plant extracts.

Coconut Oil is occasionally used in the Naturopathic treatment of acne, primarily as a carrier oil for the preparation of topical acne treatments. It is also used to treat the dry skin associated with some acne treatments.

Coconut Oil is very high in saturated fatty acids. It is also very stable, which makes it a popular ingredient in certain cosmetics and soaps. Two of the fatty acids found in Coconut Oil, Capric Acid and Lauric Acid, have been reported to have a antimicrobial properties. Coconut Oil also contains high levels of vitamin E, which may help maintain healthy skin.

References

A randomized double-blind controlled trial comparing extra virgin coconut oil with mineral oil as a moisturizer for mild to moderate xerosis. Agero, et al. 2004.
Topical herbal therapies an alternative and complementary choice to combat acne. Kapoor, et al. 2011.
Comedogenicity of sunscreens: experimental observations in rabbits. Mills, et al. 1982.
Antibacterial Activity of Hydrolyzed Virgin Coconut Oil. Silalahi, et al. 2014.
Antimicrobial activities of skincare preparations from plant extracts. Kareru, et al. 2010.
The antimicrobial activity of liposomal lauric acids against Propionibacterium acnes. Yang, et al. 2009.

C02 Lasers

Carbon Dioxide (C02) Laser systems are ablative laser systems that are commonly used for laser resurfacing procedures.

CO2 Lasers are popular treatments for moderate to severe acne scars. C02 Lasers are capable of penetrating deep into the skin and underlying tissue. C02 Lasers are available at higher fluences (power) than many other laser systems used in dermatology and cosmetic surgery.

Carbon Dioxide (CO2) Lasers use a gas mixture that contains about 20% carbon dioxide as the lasing medium. C02 lasers generate an intense laser beam in the far infra-red spectrum (~10,000 nm). Energy from a CO2 Laser beam is strongly absorbed by water. Because cells are composed mainly of water, they are quickly heated or ablated (vaporized) by CO2 laser treatment.

The ability to penetrate into the supportive tissue underneath the skin surface makes CO2 Lasers a preferred choice for ablative laser resurfacing treatments, such as the repair of skin damage associated with moderate to severe acne scars. The C02 laser penetrates more deeply than the Er:YAG laser (which is another popular laser system for acne scar treatment), and CO2 Lasers are the preferred modality for deep-seated acne scars. CO2 Lasers directly destroy (ablate) scar tissue, which allows new healthy tissue to regrow in the treated area. The process of laser ablation of tissue is called photothermolysis.

Carbon Dioxide (CO2) lasers can be an effective treatment for many types of facial acne scars. In general, both physician and patient satisfaction with the results of CO2 Laser resurfacing are good. For patients with moderate to severe acne scarring, multiple treatments are often necessary to achieve maximum improvement in the appearance of the skin. This is especially true for acne scars around the temple and the middle of the cheeks because these regions tend to respond less favorably to laser resurfacing than other areas of the face.

Ablative CO2 Laser resurfacing treatments are among the most popular and effective methods for repairing acne scars. Treatment is applied to the entire scarred area.

In addition to ablating scar tissue and encouraging the regrowth of healthy skin tissue, CO2 Lasers can be used to shape large acne scars in order to reduce their appearance. CO2 Lasers can be used to ablate the edges and ridges of large scars, which creates a gentler slope and minimizes the apparent depth of the scar. CO2 Laser systems allow for more precise control of the treated area than many other skin resurfacing technologies (eg. Microdermabrasion and Chemical Peels). CO2 Laser resurfacing can also tighten the skin by inducing the contraction of the dermal collagen, which causes scars to appear flatter and less noticeable.

CO2 Lasers can be used for either complete resurfacing or fractional resurfacing. Complete resurfacing treats all of the tissue in a given area, while fractional resurfacing pixelates the laser beam and leaves small regions of untreated skin between the regions of treated skin.

Fractional CO2 laser treatments (eg. Fraxel) are very popular because they tend to have fewer side effects and require shorter healing times than complete resurfacing. Possible side effects of CO2 Laser resurfacing include complications such as edema, prolonged erythema, scarring and hyperpigmentation. Both complete and fractional CO2 treatments have risks of these side effects, although they are substantially higher with complete resurfacing. Patients with darker skin tones appear to be at higher risk of certain types of of side effects (eg. hyper- and hypo- pigmentation) after CO2 resurfacing.

Another advantage of fractional CO2 treatment is that it is safer for higher-power (more aggressive) treatment protocols that ablate tissue to greater depths. This can be helpful for the treatment of deep-seated acne scars.

According to many clinical research studies, the effectiveness of fractional CO2 laser resurfacing for acne scar treatment is comparable to traditional complete resurfacing. Many fractional CO2 Laser systems are now commercially available, and complete CO2 resurfacing is no longer a common procedure in most places. Although they are safer, fractional CO2 systems generally require significantly more treatment sessions than complete CO2 resurfacing to achieve the same level of improvement.

CO2 Lasers are agressive laser resurfacing technologies that can cause significant and permament skin damage if used improperly. They may also require the use of anesthetics. Because of this, CO2 resurfacing procedures are generally only available in a specialized clinical settings.

CO2 Laser treatment of acne scars is a complicated procedure that tends to be substantially more expensive than many other types of Light and Laser Treatments used for acne or acne scars. Effective fractional CO2 treatment of acne scars generally requires 2-6 sessions depending on the specific treatment area, types of acne scars and their severity.

Popular CO2 Laser Systems

Active FX, Affirm CO2, Deep FX, Fraxel Re:pair, Juvia CO2 Fractional, Mixto SX, Mosaic, Pixel CO2 OMNIFIT, Sharplan, SmartXide, Ultra-30 Plus, Ultrapulse.

References

CO2 Laser Resurfacing Patient Reviews @ RealSelf
A clinical and histologic comparison of electrosurgical and carbon dioxide laser peels. Acland, et al. 2001.
A Prospective Survey of Patient Experiences After Laser Skin Resurfacing. Batra, et al. 2003.
Ablative Skin Resurfacing With a Novel Microablative CO2 Laser. Gotkin, et al. 2009.
Carbon Dioxide Laser Abrasion. Trimas, et al. 2000.
Clinical trial of a pinpoint irradiation technique with the CO2 laser for the treatment of atrophic acne scars. Kim. 2008.
CO2 Laser Physics and Tissue Interactions in Skin. Fulton, et al. 1999.
Complications of Fractional CO2 Laser Resurfacing: Four Cases. Fife, et al. 2009.
Efficacy and safety of a carbon-dioxide ablative fractional resurfacing device for treatment of atrophic acne scars in Asians. Manuskiatti, et al. 2009.
Evaluation of a Novel Fractional Resurfacing Device for Treatment of Acne Scarring. Walgrave, et al. 2009.
Fractional photothermolysis: an update. Allemann, et al. 2010.
Laser Punch-Out for Acne Scars. Koo, et al. 2001.
Laser Resurfacing: Usual and Unusual Complications. Rendon-Pellerano, et al. 1999.
Laser resurfacing of the skin for the improvement of facial acne scarring: a systematic review of the evidence. Jordan, et al. 2000.
Long-Term Efficacy of a Fractional Resurfacing Device. Ortiz, et al. 2010.
Successful Treatment of Acneiform Scarring With CO2 Ablative Fractional Resurfacing. Chapas, et al. 2008.
The Efficacy and Safety of 10,600-nm Carbon Dioxide Fractional Laser for Acne Scars in Asian Patients. Cho, et al. 2009.
The principle of a three-staged operation in the surgery of acne scars. Whang, et al. 1999.
The Use of Fractional Laser Photothermolysis for the Treatment of Atrophic Scars. Alster, et al. 2007.

Cimetidine

Cimetidine (Tagamet) is a medication that is used primarily to treat heartburn and peptic ulcers, but also functions as a weak Androgen Inhibitor.

Cimetidine is a histamine H2 receptor antagonist that was once among the most commonly used medications to treat heartburn, but has since been largely replaced by newer medications with fewer side effects. Cimetidine is rarely used as a treatment for acne.

Cimetidine has been shown to be a weak Androgen Inhibitor in several research studies. Cimetidine can block the activity of the androgen hormones testosterone and dihydrotestosterone (DHT), particularly at higher dosages. Cimetidine has also been shown to increase levels of the female hormone estrogen.

Cimetidine was tested as both an oral and topical treatment for acne in several clinical research studies. Treatment with Cimetidine was found to improve acne symptoms a little bit in some patients, but Cimetidine was generally less effective for treating acne than other Androgen Inhibitors (eg. Spironolactone).

Androgen hormones stimulate the growth and activity of the sebaceous glands and production of sebum. Excessive sebaceous gland activity can contribute to acne symptoms. Androgen Inhibitors such as Cimetidine may help improve acne symptoms by reducing the effects of elevated androgen levels.

Oral formulations of Cimetidine are available as Over-The-Counter (OTC) medications for the treatment of heartburn.

Chromium Picolinate

Chromium Picolinate Supplements help raise the amount of chromium present in the body.

Small levels of dietary chromium are essential for normal metabolic function. Chromium-deficient patients have problems with blood sugar regulation and other essential metabolic processes.

Chromium picolinate is a semi-popular supplement for athletic training. Chromium Picolinate supplements are also occasionally used in Naturopathic medicine for the treatment of some skin diseases, such as acne.

Chromium is naturally present in small concentrations in many unprocessed foods and most people are not chromium deficient. There is little evidence that dietary supplementation with Chromium Picolinate has significant effects in people who already have healthy levels of chromium.

Because there is a link between blood glucose (sugar) levels and inflammation, people have attempted to use chromium picolinate to improve their acne symptoms. The idea being that an increase in the amount of Chromium Picolinate will decrease the amount of blood glucose, which leads to decreased inflammation. This would then cause an improvement in acne symptoms. However, there does not appear to be any reliable evidence that indicates Chromium Picolinate supplements are effective as an acne treatment.

References

Acne vulgaris: nutritional factors may be influencing psychological sequelae. Katzman, et al. 2007.
The chromium controversy. Cronin. 2004.
The effect of chromium supplementation on polycystic ovary syndrome in adolescents. Amr, et al. 2015.
The Effects of Chromium Supplementation on Endocrine Profiles, Biomarkers of Inflammation, and Oxidative Stress in Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial. Jamilian, et al. 2016.
The potential value and toxicity of chromium picolinate as a nutritional supplement, weight loss agent and muscle development agent. Vincent. 2003.

Calcium

Calcium Supplements are nutritional supplements that contain bio-available forms of elemental calcium. Calcium is an essential mineral that is most commonly used to improve bone density and limit the effects of osteoporosis.

Many foods are either naturally rich in calcium (eg. Milk, Spinach) or fortified with additional calcium (eg. Breakfast Cereals). Calcium Supplements are rarely used as an acne treatment and there is no evidence that they can improve acne symptoms.

There are various reasons people use Calcium Supplements. They may be trying to prevent osteoporosis or even heal acne scars. However several research studies have questioned the therapeutic validity of Calcium supplementation for those ailments.

Some research studies have even linked calcium supplementation to an increased risk of cardiovascular disease and heart attacks. The increased risk could be due to the important role Calcium plays in maintaining cardiac rhythm. Hypercalcemia, or an excess of blood calcium, can even cause an ECG finding known as an Osborn Wave, which is also seen in hypothermia. Excess calcium may also cause other problems such as kidney stones or gallstones.

Calcium is involved in many cellular processes and signaling pathways, and it is a necessary mineral. So some acne sufferers do feel that calcium supplements can maintain their skin health, control acne or even help heal acne scars. Although there is no evidence that Calcium Supplements will improve acne symptoms, they are considered quite safe when consumed at recommended levels.

References

Diet and acne. Bowe, et al. 2010.
Hypercalcemia associated with oral isotretinoin in the treatment of severe acne. Valentic, et al. 1983.
High school dietary dairy intake and teenage acne. Adebamowo, et al. 2005.
Vitamin D and calcium dysregulation in the polycystic ovarian syndrome. Thys-Jacobs, et al. 1999.

Calamine

Calamine is a mixture of zinc oxide (ZnO) and ferric oxide (Fe2O3) and is the main ingredient in calamine lotion.

Calamine lotion is a topical cream often used to treat inflamed, red or itchy skin associated with conditions such as chicken pox, poison oak, insect bites and sunburn. Calamine is occasionally used as a topical acne treatment to help reduce the redness and swelling associated with acne lesions.

Calamine lotion appears to provide a few beneficial effects for acne prone skin. First, Calamine can act as a anti-inflammatory ant that may help reduce the appearance of acne lesions. Second, Calamine may have some antibacterial properties that can help reduce the growth of acne-causing bacteria, such as Propionibacterium acnes. The antibacterial properties of Calamine are likely because it contains lots of Zinc, which is toxic to many bacteria. Third, Calamine may act as a mild drying agent and this can help improve oily skin.

Many people have reported that topical Calamine treatments helped to improve their acne symptoms. However, there has been little scientific research to investigate how effective Calamine actually is for the treatment of acne. Topical use of Calamine products is generally safe when used as recommended.

Overall, Calamine may be helpful for some people with acne, but this treatment alone is unlikely to dramatically improve acne symptoms for most individuals.

References

Topical drying agents for acne. Bluefarb, et al. 1960.
Care or harm: exploring essential components in skin care regimens. Voegeli. 2010.
Zinc in skin pathology and care. Nitzan, et al. 2006.
Components Analysis and Antibacterial Activity of Calamine. Guo, et al. 2005.
Synthesis, characterization and antibacterial activity of ZnO nanoparticles. Ravichandrika, et al. 2012.

Burdock

Burdock Supplements are extracted from the roots and seeds of the Burdock plant (Arctium spp).

Burdock is native to Eurasia but naturalized in many regions around the world. Burdock root is an important part of the traditional medicine of many cultures in its native range. Burdock is used in Naturopathic medicine to treat many different conditions, including acne.

For the Naturopathic treatment of acne, Burdock seed extracts are often incorporated into topical preparations. Burdock root supplements or teas may be used to “cleanse” the blood in order to help heal the skin.

Although there are some reports that Burdock supplements helped reduce acne symptoms, there is no robust evidence to support these claims. Burdock supplements are unlikely to significantly improve acne symptoms for most people.

Even though there is no scientific evidence proving the usefulness of Burdock as an acne treatment, the extract is rich in important fatty acids. Taking modest amounts of Burdock supplements may have modest health benefits for some individuals, but it is difficult to know without further scientific research. Burdock extracts can also be toxic if consumed in excessive quantities.

Burdock Root References

Observational study of Arctium lappa in the treatment of acne vulgaris.Miglani, et al. 2014.Anticholinergic poisonings associated with commercial burdock root tea.Rhoads, et al. 1984.The effect of the ingestion of burdock root on normal and diabetic individuals a preliminary report.Silver, et al. 1931.Antioxidant activity of burdock (Arctium lappa Linne): its scavenging effect on free-radical and active oxygen.Duh. 1998.Preparation of inulin and phenols-rich dietary fibre powder from burdock root.Lou, et al. 2009.

Blue Light Phototherapy

Blue Light Phototherapy is a treatment for acne that uses high intensity blue light (~415 nm) to directly kill acne-causing Propionibacterium acnes bacteria that are growing in the skin.

P. acnes bacteria produce a molecule called Coproporphyrin III that produces free radicals when exposed to high intensity blue light. Blue Light Phototherapy works by causing Coproporphyrin III to produce enough free radicals to damage and kill P. acnes bacteria. P. acnes bacteria fluoresce when exposed to high intensity blue light, which can be observed with the help of special photographic filters (see attached image).

Multiple clinical research studies have reported that Blue Light Phototherapy can temporarily reduce the number of acne-causing P. acnes bacteria that are growing within hair follicles. This reduction can significantly improve acne symptoms in many patients. However, the effect of Blue Light Photherapy is temporary, so treatment must be repeated on a regular basis.
Blue Light Phototherapy is non-invasive and generally has few side effects. Blue Light Phototherapy complements many other types of acne treatments and can be a helpful component of a comprehensive acne treatment plan.

In some cases, the skin of patients is treated with a sensitizing agent prior to Blue Light Phototherapy. This sensitizing agent (eg. ALA or MAL) causes P. acnes bacteria to increase their production of Porphyrins, thus making them more sensitive to treatment. The combination of Blue Light Phototherapy and a sensitizing agent is called Photodynamic Therapy (PDT). In addition to acne, Photodynamic Therapy is also used to treat certain types of skin cancer.

Blue Light Phototherapy is primarily available in dermatology clinics that have a focus on acne. It may also be available at some spas and wellness centers. Blue Light Phototherapy systems can also be purchased for home use. The effects of Blue Light Phototherapy are temporary and achieving the maximum therapeutic benefit requires regular treatments.

There are many home use Blue Light systems available for purchase on the internet. However, it should be noted that almost all of the acne research studies that reported positive results were using high-intensity Blue Light Phototherapy systems. Many of the small, inexpensive Blue Light products that are sold on the internet are unlikely to produce enough of blue light (in the correct spectrum) to be effective for the treatment of acne. Most home use Blue Light Phototherapy systems use LEDs as the light source.

References

Light-emitting diode 415 nm in the treatment of inflammatory acne: An open-label, multicentric, pilot investigation. Tremblay, et al. 2006.
An open study to determine the efficacy of blue light in the treatment of mild to moderate acne. Morton, et al. 2005.
Clinical Efficacy of Self-applied Blue Light Therapy for Mild-to-Moderate Facial Acne. Gold, et al. 2009.
Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris. PAPAGEORGIOU, et al. 1999.
Blue and Red Light Combination LED Phototherapy for Acne Vulgaris in Patients with Skin Phototype IV. Lee, et al. 2006.
Laser and other light therapies for the treatment of acne vulgaris: systematic review. Hamilton, et al. 2008.
Blue light phototherapy in the treatment of acne. Tzung, et al. 2004.
Acne phototherapy with a high-intensity, enhanced, narrow-band, blue light source: an open study and in vitro investigation. Kawada, et al. 2002.
The effective treatment of acne vulgaris by a high-intensity, narrow band 405-420 nm light source. Elman, et al. 2003.
Eradication of Propionibacterium acnes by its endogenic porphyrins after illumination with high intensity blue light. Ashkenazi, et al. 2003.

 

 

Black Walnut

Black Walnut Extract is prepared from the hulls of the nuts of the Black Walnut Tree (Juglans nigra). Black Walnut is a deciduous flowering tree that is native to Eastern North America, but is now naturalized in many regions. Black walnut was used for centuries by Native Americans for both medicinal purposes and as a dye.

The use of Black Walnut is fairly common in modern Homeopathic and Naturopathic medicine. Black Walnut Extract is a common Naturopathic acne treatment and it is purported to have astringent and antibacterial properties that can help control acne symptoms. For the treatment of acne, Black Walnut Extract is most commonly blended with other active ingredients and administered topically, but it can also be consumed orally as an herbal supplement.

The husk of Black Walnuts contain some compounds that may have biological activity, such as juglone and plumbagin. Juglone has been reported to have antibacterial, antiparasitic and antifungal properties. Black Walnut trees actively secrete chemicals into the surrounding environment that suppress the growth of other plants, in order to give the Black Walnut a competitive advantage. Juglone is one of those chemicals. These chemicals may also help the plant protect against bacterial, fungal, parasitic and viral pathogens. Some Naturopathic practitioners believe that these molecules can also help suppress the growth of acne-causing bacteria, such as Propionibacterium acnes.

Unfortunately, there has been minimal scientific research into whether Black Walnut hull extracts are toxic to acne-causing bacteria, or whether treatments that contain Black Walnut extract help reduce the frequency or severity of acne symptoms. There are some people who claim that their acne symptoms improved after incorporating Black Walnut into their treatment regimens, but these claims can not be independently evaluated. Overall, the effectiveness of Black Walnut extracts for the treatment of acne remains unclear.

References

Topical herbal therapies an alternative and complementary choice to combat acne. Kapoor, et al. 2011.
Herbal remedies for acne. Kumar, et al. 2005.
Antibacterial activity of juglone against Staphylococcus aureus: from apparent to proteomic. Wang, et al. 2016.
Plumbagin inhibits LPS-induced inflammation through the inactivation of the nuclear factor-kappa B and mitogen activated protein kinase signaling pathways in RAW 264.7 cells. Wang, et al. 2014.
Dermatitis due to black walnut juice. Siegel. 1954.
Potential phytotherapy of atopic dermatitis, acne, psoriasis, vitiligo. Khan, et al. 2016.

Benzoyl Peroxide

Benzoyl Peroxide (BPO) is a Keratolytic and antibacterial medication that is widely used as an acne treatment.

Benzoyl Peroxide is an active ingredient in many different kinds of Over-The-Counter (OTC) and Pharmaceutical acne treatments. Benzoyl Peroxide is a very common ingredient in face washes and pimple creams. Benzoyl Peroxide is generally safe and can be a helpful treatment for many individuals with acne, particularly those with mild to moderate acne symptoms (Acne Types: 1-2).

Benzoyl Peroxide has two complementary mechanisms of action that make it a useful acne treatment. Benzoyl Peroxide is a Keratolytic medication that helps prevent the formation of clogged pores by breaking down the outermost layer of the skin (epidermis). Benzoyl Peroxide is also an antibacterial agent that can directly kill acne-causing bacteria, such as P. acnes. When Benzoyl Peroxide comes into contact with the skin it breaks down into benzoic acid and oxygen, which are toxic to many types of bacteria.

Extensive research has shown that Benzoyl Peroxide can be a beneficial treatment for many people suffering from mild-to moderate, non-inflammatory acne (Acne Types: 1-2). However, because of its limited penetration into the skin, Benzoyl Peroxide is largely ineffective in treating cystic and nodular forms of acne (Acne Types: 3-4). Benzoyl Peroxide is commonly combined with antibiotics (eg. Clindamycin, Erythromycin) in prescription topical medications. Topical use of Benzoyl Peroxide is often combined with complementary acne treatments (eg. Antibiotics, Retinoids, Light & Laser Treatments, Naturopathic Treatments) as part of a comprehensive acne treatment regimen.

Most people tolerate Benzoyl Peroxide treatment well with minimal side effects. Common side effects of Benzoyl Peroxide treatment include dry skin, flaking, redness and sensitivity. The risk of side effects is greater when medications that contain Benzoyl Peroxide are used excessively or at higher dosages. Benzoyl Peroxide is also a potent bleaching agent, and contact with clothes or furniture can cause permanent bleach damage.

Aromatherapy

Aromatherapy is a technique that involves using olfactory stimulation to improve mood, relieve anxiety and support a sense of well-being. Application of Aromatherapy can be done topically, via inhalation or water immersion. Essential oils and other plant extracts, as well as many other naturally occurring compounds can be used in Aromatherapy.

It is unclear whether Aromatherapy can be a useful treatment for acne itself. There has been little scientific research on the relationship between olfactory stimulation, the immune system and the development of acne. However, there is some scientific evidence that Aromatherapy may help alleviate the psychological impact of acne.

Aromatherapy is often used in combination with other Naturopathic treatments. There is very little risk of side effects from Aromatherapy, and it can be combined with most other types of Naturopathic and Pharmaceutical acne treatments. Overall, the benefits of Aromatherapy are unclear, but it may be a valuable component of a holistic acne treatment program for some individuals.

Aromatherapy Videos

References

In vitro bioactivities of essential oils used for acne control. Lertsatitthanakorn, et al. 2006.
Aromatherapy in dermatology. Stevensen. 1998.
The clinical impact and cost-effectiveness of essential oils and aromatherapy for the treatment of acne vulgaris: a protocol for a randomized controlled trial. Agnew, et al. 2014.
The Encyclopedia of essential oils: the complete guide to the use of aromatic oils in aromatherapy, herbalism, health, and well being. Lawless. 2013.
Topical and oral complementary and alternative medicine in acne: A consideration of context. Magin, et al. 2012.
Aromatherapy An AZ: The most comprehensive guide to aromatherapy ever published. Davis. 2011.

Desogestrel and Ethinyl Estradiol

Desogestrel and Ethinyl Estradiol are used in combination as a Hormonal Contraceptive (birth control) medication.

Hormonal contraceptives are not frequently used as a primary treatment for acne, but many women report substantial changes in their acne symptoms after starting use of Hormonal Contraceptives.

There are many different types of Hormonal Contraceptives. All Hormonal Contraceptives include versions of the female sex hormones estrogen and/or progesterone. The specific composition of these hormones varies between different types of Hormonal Contraceptives.

Hormones have a major impact on acne symptoms. Female sex hormones (eg. Estrogen, Progesterone) and male sex hormones (eg. Testosterone) control many important functions within the body. Use of Hormonal Contraceptives has been shown to improve acne in some women and worsen it in others, with comparable frequency. Hormonal Contraceptives may improve acne symptoms in some women by blocking the effect of androgen (male) hormones. Androgen hormones can increase the activity of the sebaceous glands and sebum production, which can contribute to the development of acne.

Desogestrel and Ethinyl Estradiol Medications

Azurette, Caziant, Cyclessa, Desolon, Femilon, Kariva, Gianvi, Mircette, Reclipsen, Velivet.

Bicalutamide

Bicalutamide (Casodex) is an Androgen Inhibitor medication that blocks the activity of androgens (male hormones, such as testosterone).

Bicalutamide is rarely used for the treatment of acne.

Bicalutamide is a synthetic non-steroidal anti-androgen (NSAA). It is most frequently used for the treatment of prostate cancer, hirsutism (excessive body hair growth) and as part of the hormone replacement regimen for transgender women. Bicalutamide blocks the ability of a receptor to bind androgen hormones, such as testosterone and dihydrotestosterone (DHT).

Androgen hormones can contribute to acne symptoms by stimulating the sebaceous glands to grow and produce more sebum. The increased sebaceous gland activity can lead to clogged pores and excessive growth of acne-causing P. acnes bacteria inside follicles. Androgen Inhibitors can improve acne symptoms by decreasing the activity of sebaceous glands, which leads to a decrease in sebum production.

Androgen hormones are an essential part of male biology. Because androgen inhibitors have significant side effects when used in men, they are usually only used to treat acne in women. The use of Androgen Inhibitors can improve acne symptoms for some female patients, but not all.

Dairy-Free Diet

Dairy-Free Diets exclude the consumption of milk and all milk-based products, such as yogurt and cheese.

The natural function of milk is to provide the nutrition necessary for the growth and development of young offspring. All female mammals produce milk and the name “Mammal” derives from “Mammary”, which is the gland responsible for milk production. Humans, cows, dogs, cats and mice are all mammals. Milk is a rich nutritional source that contains abundant concentrations of essential compounds, such as proteins, sugars, vitamins and minerals.

Some people are lactose-intolerant, which means that they are not able to properly digest lactose (a sugar naturally found in milk). Dairy-Free Diets are commonly prescribed for people who are lactose-intolerant. Consumption of dairy products can also cause allergic or auto-immune reactions in some people. Although this process is not entirely understood, certain milk proteins (eg. Casein) are known to cause allergic reactions in susceptible individuals.

Milk consumption is one of the dietary factors that has been most frequently correlated with acne symptoms. There have been numerous scientific studies to investigate the relationship between dairy intake and acne. Although there is some disagreement between studies, many of the studies have found that high dairy consumption was associated with more acne symptoms.

There are several possible reasons why dairy consumption might cause more frequent or severe acne outbreaks. One possibility is that some molecules found in milk might trigger hormonal changes that can contribute to acne. Another possibility is that the hormones in milk (milk naturally contains hormones, most milk products no longer contain synthetic hormones, such as bGH Bovine Growth Hormone) directly affect the hormonal balance in the body. A third possibility is that milk can contain high levels of specific molecules (eg. Iodine) that can trigger acne in high doses. Overall, the causative relationship between dairy consumption and acne symptoms remains poorly defined, but warrants deeper investigation.

References

Milk consumption and acne in adolescent girls. Adebamowo, et al. 2006.
High school dietary dairy intake and teenage acne. Adebamowo, et al. 2005.
Food allergy. Its manifestations and control and the elimination diets. A compendium. Rowe, et al. 1972.
Evidence for acne-promoting effects of milk and other insulinotropic dairy products. Melnik, et al. 2011.
Milk consumption and acne in teenaged boys. Adebamowo, et al. 2008.
Acne and milk, the diet myth, and beyond. Danby, et al. 2005.
High glycemic load diet, milk and ice cream consumption are related to acne vulgaris in Malaysian young adults: a case control study. Ismail, et al. 2012.
Role of insulin, insulin‐like growth factor‐1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Melnik, et al. 2009.
Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. Landro, et al. 2012.
The role of diet in acne: facts and controversies. Davidovici, et al. 2010.
Diet and acne. Bowe. 2010.
Acne: the role of medical nutrition therapy. Burris, et al. 2013.

Alpha Lipoic Acid

Alpha Lipoic Acid (aLA) is a compound that is important for the function of many enzymes involved in aerobic (oxygen) respiration. Alpha Lipoic Acid supplements are widely available and are purported to have antioxidant properties and other effects that are beneficial for overall health.

Alpha Lipoic Acid is rarely used for the direct treatment of acne. When used as an acne treatment, Alpha Lipoic acid may be ingested orally, or incorporated into topical anti-acne formulations.

Most people consume a significant amount of Alpha Lipoic Acid as part of their normal diet and it is unlikely that most people have Alpha Lipoic Acid deficiencies. There are a handful of research studies that indicate that consuming oral Alpha Lipoic Acid supplements can increase levels of Alpha Lipoic Acid in the blood, and that this might have beneficial effects. However, the connection between Alpha Lipoic Acid supplements and improvements in specific health conditions and diseases is largely unproven, and the evidence that does exist tends to be weak. There is no direct evidence that Alpha Lipoic Acid supplements have any effect on acne symptoms.

Perhaps the most important role for Alpha Lipoic Acid in relation to acne is its ability to raise Vitamin E levels. Vitamin E helps maintain skin health via its antioxidant properties. Some acne sufferers like to apply Alpha Lipoic Acid as a way of preventing or treating acne scars and others feel that it can reduce the occurrence of acne breakouts. However, neither oral nor topical Alpha Lipoic Acids are likely to dramatically improve acne symptoms for most individuals.

Alpha Lipoic Acid was first discovered in the 1950’s and became a nutritional supplement shortly thereafter. The biologically active form of Alpha Lipoic Acid, RLA, is an essential cellular anti-oxidant. Unlike many other supplements, oral ingestion of RLA rapidly leads to increased levels of bio-available RLA in the blood. While there is not an abundance of research on the role of Alpha Lipoic Acid in the treatment of acne, the research that does exist indicates that Alpha Lipoic Acid may be helpful in decreasing inflammation and improving the immune response to acne. Alpha Lipoic Acid is also available in topical formulations. Alpha Lipoic Acid is approved for use in Germany as a medical treatment for diabetic neuropathy (nerve damage), although it is unclear how effective it is.

References

alpha-Lipoic acid treatment decreases serum lactate and pyruvate concentrations and improves glucose effectiveness in lean and obese patients with type 2 diabetes. Konrad, et al. 1999.
Modern approach to topical treatment of aging skin. Puizina-Ivi, et al. 2010.
Stability, Cutaneous Delivery, and Antioxidant Potential of a Lipoic Acid and alpha-Tocopherol Codrug Incorporated in Microemulsions. Thomas, et al. 2014.
Cosmeceuticals: an evolution. Preetha, et al. 2009.
d-chiro-Inositol and alpha lipoic acid treatment of metabolic and menses disorders in women with PCOS. Cianci, et al. 2015.

Azelaic Acid

Azelaic Acid is Keratolytic medication that also has antibacterial properties.

Azelaic Acid is a common topical treatment for mild to moderate acne symptoms. Keratolytic agents work by causing the outer layer of the skin to loosen and shed.

Azelaic Acidis also occassionally used as a treatment for mild acne scar symptoms, such as hyperpigmentation and rough skin. Azelaic Acid is frequently combined with complementary therapies as part of a holistic acne treatment plan.

Aloe Vera

Aloe Vera is a succulent plant that is widely cultivated for ornamental and medicinal purposes. Aloe Vera gel is extracted from the pulp of the Aloe leaf and is widely used as a topical treatment for skin irritation and to accelerate wound healing. Aloe Vera gel may also be consumed orally, and it is reported to have laxative and other effects.

Aloe Vera gel is commonly used for the treatment of active acne and acne scars. However, there is little evidence that the use of Aloe Vera gel can significantly reduce the frequency or severity of acne symptoms.

Aloe Vera gel has been used for centuries in the traditional medicine of the people who live in its native range. When used topically, Aloe Vera gel appears to be quite safe with minimal risk of side effects. In contrast, Aloe Vera can be toxic when consumed orally in large quantities. Aloe Vera may have some antibacterial and anti-inflammatory properties that are helpful to people with acne symptoms. For some acne sufferers, topical Aloe Vera preparations may be worth trying. Use of fresh or unprocessed Aloe Vera gel may be more effective than processed Aloe Vera products.

Aloe Vera gel contains a mixture of polysaccharides (complex carbohydrates), proteins, minerals and other molecules which may have biological activity.There is some scientific research has shown that Aloe Vera can help decrease swelling and redness associated with sunburns, first or second degree burns. This anti-inflammatory effect may make Aloe Vera a suitable treatment for the redness and inflammation associated with acne breakouts. Aloe Vera may also have moisturizing properties that can help ameliorate the symptoms of certain anti-acne treatments that cause skin dryness, such as Retinoids (eg. Accutane).

Aloe Vera gel is commonly added to many moisturizers, facial washes, masks and other anti-acne formulations. However, some of the compounds found in Aloe Vera gel may be unstable and it is unclear whether these prepared formulations have the same therapeutic properties as fresh Aloe Vera gel. This discrepancy may also explain some of the contradictory research reports regarding the utility of Aloe Vera as a skin care product.

References

Aloe vera: a systematic review of its clinical effectiveness. Vogler, et al. 1999.
The Stimulation of Postdermabrasion Wound Healing with Stabilized Aloe Vera Gel‐Polyethylene Oxide Dressing. Fulton. 1990.
Influence of Aloe vera on collagen characteristics in healing dermal wounds in rats. Chithra, et al. 1998.
Effect of Aloe vera topical gel combined with tretinoin in treatment of mild and moderate acne vulgaris: a randomized, double-blind, prospective trial. Hajheydari, et al. 2014.
Use of aloe in treating leg ulcers and dermatoses. Zawahry, et al. 1973.
Evaluation of aloe vera gel gloves in the treatment of dry skin associated with occupational exposure. West, et al. 2003.
Isolation, purification and evaluation of antibacterial agents from Aloe vera. Lawrence, et al. 2009.
Comparative antimicrobial activity of Aloe Vera gel on microorganisms of public health significance. Shahzad, et al. 2009.
Compositional features of polysaccharides from Aloe vera (Aloe barbadensis Miller) plant tissues. Femenia, et al. 1999.

Alexandrite Lasers

Alexandrite Lasers are commonly used for laser hair removal and to treat areas of hyper-pigmentation on the skin (eg. melasma). Except for the treatment of hyper-pigmentation problems associated with acne scarring, Alexandrite Lasers are rarely used to treat active acne or acne scars.

Alexandrite Gemstone

Alexandrite Lasers make use of the gemstone Alexandrite as the lasing medium. Alexandrite is a unique gemstone in that it changes color depending on the type of light that is illuminating it.

Alexandrite Lasers produce light with a wavelength of approximately 755 nm (Red/Infrared). Melanin, the primary pigment in skin and hair, absorbs energy strongly at this wavelength. As a result, the energy from Alexandrite Lasers is strongly absorbed by areas of tissue with high concentrations of melanin, such as the hair bulb and hyper-pigmented areas of skin. The absorption of the laser beam by the melanin damages the melanin-containing cells. This process is the basis of laser hair removal, which can damage the hair producing cells near the base of the hair shaft, and prevents future hair growth.

There is very little clinical research on the effectiveness of Alexandrite lasers in the treatment of active acne or acne scars. At the current time, Alexandrite Lasers are not considered to be an effective treatment for acne or most acne scarring.

Alexandrite Laser treatments are offered at many dermatology offices, cosmetic surgery clinics and laser hair removal clinics.

Popular Alexandrite Laser Systems

Accolade, Apogee, DEKA MOTUS AX, Epilare, GentleLase, Noblex, Songic.

References

Laser Treatment of Pigmented Lesions. Goldberg. 1997.
Combined Ultrapulse CO2 Laser and Q-Switched Alexandrite Laser Compared with Q-Switched Alexandrite Laser Alone for Refractory Melasma: Split-Face Design. Angsuwarangsee, et al. 2003.
Minocycline-Induced Hyperpigmentation Treated with a 755-nm Q-Switched Alexandrite Laser. Alster, et al. 2004.
A Retrospective Study on the Efficacy and Complications of Q-Switched Alexandrite Laser in the Treatment of Acquired Bilateral Nevus of Ota-Like Macules. Ying-Ming, et al. 2001.

Tretinoin

Tretinoin (Retin-A) is a topical retinoid that is used as a treatment for active acne symptoms and minor acne scarring. Tretinoin was once the most commonly used topical retinoid for the treatment of acne, but newer retinoid medications (eg. Adapalene, Tazarotene) are now becoming more popular.

Tretinoin can be a valuable treatment for individuals with any type of acne (Acne Types: 1-4). Many clinical research studies have shown that regular use of Tretinoin can improve acne symptoms. But clinical research and patient reports demonstrate that complete resolution of acne symptoms is rare when Tretinoin is used alone.

Tretinoin is frequently combined with complementary acne treatments (eg. Antibiotics, Androgen Inhibitors, Light & Laser therapies, etc). Tretinoin and other topical retinoids tend to be more effective for the treatment of mild acne (Acne Types: 1-2) and less effective for moderate and severe forms of the disease (Acne Types: 3-4).

There are topical medications available that combine Tretinoin with a second antibacterial agent, such as the antibiotic Clindamycin (Treclin). These combinations can be synergistic, further decreasing bacterial growth and leading to greater improvements in acne symptoms. Tretinoin may also be combined with Over-The-Counter (OTC) topical treatments, like Benzoyl Peroxide, although this particular combination can be lead to excessive dryness and irritation of the skin.

Retinoids are relatives of Vitamin A. Retinoids can help improve acne symptoms in several ways. Retinoids decrease the activity of the sebaceous glands, which decreases the production of sebum. The decrease in sebum in eliminates decreases the amount of nutrients that are available for acne-causing bacteria that live deep within hair follicles. Retinoids can also affect the growth and differentiation of skin cells, which can help reduce the formation of clogged pores (comedomes). Retinoids also have anti-inflammatory affects which may help improve acne symptoms.

Tretinoin works by entering target cells and binding to to specific receptors called Retinoic Acid Receptors that are in the nucleus of cells. Once the retinoid binds to these receptors it changes how the genes of that cell are expressed. These changes in gene expression are what give retinoids their anti-acne properties.

The most common side effect of Tretinoin treatment is dryness of the skin. Tretinoin treatment decreases the production of sebum, and sebum is essential for moisturizing and protecting the skin. Tretinoin tends to have more significant side effects (eg. Dry skin) than newer topical retinoids, such as Adapalene.

The most serious potential side effect of Tretinoin is a risk of birth defects. All retinoids are teratogens (compounds that can cause birth defects). However, several studies have indicated that there is minimal risk to the fetus from the topical use of retinoids, including Tretinoin. Nonetheless, the use of any type of retinoid is generally avoided in all women who are pregnant or may become pregnant during treatment.

Tazarotene

Tazarotene (Tazorac) is a synthetic retinoid that is used as a topical treatment for certain types of skin disorders, including acne.

Topical retinoids are popular acne treatments that can help improve symptoms for many individuals. Tazarotene is a newer-generation topical retinoid that has a similar efficacy profile as older topical retinoids (eg. Tretinoin) but tends to have milder side effects. Adapalene is another newer-generation retinoid that is more popular than Tazarotene for the treatment of acne because Adapalene tends to be less expensive than Tazarotene and Adapalene is now available as an Over-The-Counter (OTC) medication.

Tazarotene is a moderately popular topical retinoid for the treatment of acne. Research studies have indicated that is has a similar effectiveness as Tretinoin and Adapalene. It also tends to be well tolerated by patients, with minimal side effects. Tazarotene can be a valuable treatment for individuals with any type of acne (Acne Types: 1-4). Many clinical research studies have shown that regular use of Tazarotene can improve acne symptoms. But clinical research and patient reports demonstrate that complete resolution of acne symptoms is rare when Tazarotene is used alone.

Tazarotene is frequently used in combination with complementary anti-acne medications, such as topical or oral antibiotics. These combinations can accelerate improvements in acne symptoms and improve the overall effectiveness of treatment. Tazarotene and other topical retinoids tend to be more effective for the treatment of mild acne (Acne Types: 1-2) and less effective for moderate and severe forms of the disease (Acne Types: 3-4).

Retinoids are derivatives of Vitamin A. Retinoids can help improve acne symptoms in several ways. Retinoids decrease the activity of the sebaceous glands, which decreases the production of sebum. The decrease in sebum in eliminates decreases the amount of nutrients that are available for acne-causing bacteria that live deep within hair follicles. Retinoids can also affect the growth and differentiation of skin cells, which can help reduce the formation of clogged pores (comedomes). Retinoids also have anti-inflammatory affects which may help improve acne symptoms.

Tazarotene works by entering target cells and binding to to specific receptors called Retinoic Acid Receptors that are in the nucleus of cells. Once the retinoid binds to these receptors it changes how the genes of that cell are expressed. These changes in gene expression are what give retinoids their anti-acne properties.

The most common side effect of treatment with Tazarotene is dryness of the skin. Tazarotene treatment decreases the production of sebum, and sebum is essential for moisturizing and protecting the skin. Tazarotene tends to have fewer and milder side effects than older topical retinoids, such as Tretinoin and Isotretinoin.

The most serious potential side effect of Tazarotene is a risk of birth defects. All retinoids are teratogens (compounds that can cause birth defects). However, several studies have indicated that there is minimal risk to the fetus from the topical use of retinoids, including Tazarotene. Nonetheless, the use of any type of retinoid is generally avoided in all women who are pregnant or may become pregnant during treatment.

Topical Isotretinoin

Topical Isotretinoin (Isotrex) is a retinoid medication that is used as a topical treatment for certain types of skin disorders, including acne.

Topical retinoids are popular acne treatments that can help improve symptoms for many individuals. Topical Isotretinoin is an older-generation topical retinoid that has largely been replaced by newer topical retinoids (eg. Adapalene, Tazarotene). Topical Isotretinoin contains the same active ingredient as Accutane, which is the oral form of this medication.

Topical Isotretinoin is becoming less popular over time, for the treatment of acne. Topical Isotretinoin tends to be less effective and have more significant side effects than alternative topical retinoids (eg. Adapalene, Tazarotene, Tretinoin).

Retinoids are derivatives of Vitamin A. Retinoids can help improve acne symptoms in several ways. Retinoids decrease the activity of the sebaceous glands and the production of sebum. The decrease in sebum in reduces the amount of nutrients that are available for acne-causing bacteria that live deep within hair follicles. Retinoids can also affect the growth and differentiation of skin cells, which can help reduce the formation of clogged pores (comedomes). Retinoids also have anti-inflammatory affects which may help improve acne symptoms.

Isotretinoin works by entering target cells and binding to to specific receptors called Retinoic Acid Receptors that are in the nucleus of cells. Once the retinoid binds to these receptors it changes how the genes of that cell are expressed. These changes in gene expression are what give retinoids their anti-acne properties.

Topical Isotretinoin is frequently used in combination with complementary anti-acne medications, such as topical or oral antibiotics. These combinations are often more effective at improving acne symptoms and improve the overall effectiveness of treatment. Topical Isotretinoin and other topical retinoids tend to be more effective for the treatment of mild acne (Acne Types: 1-2) and less effective for moderate and severe forms of the disease (Acne Types: 3-4). Some available medications combine Isotretinoin with another antibacterial compound, such as Erythromycin (eg. Isotrexin).

The most common side effect of treatment of Topical Isotretinoin use is dryness of the skin. Isotretinoin treatment decreases the production of sebum, and sebum is essential for moisturizing and protecting the skin. Isotretinoin tends to have more significant side effects than newer topical retinoids, such as Adapalene and Tazarotene.

The most serious potential side effect of Isotretinoin is a risk of birth defects. All retinoids are teratogens (compounds that can cause birth defects). However, several studies have indicated that there is minimal risk to the fetus from the topical use of retinoids, including Isotretinoin. Nonetheless, the use of any type of retinoid is generally avoided in all women who are pregnant or may become pregnant during treatment.

Oral Isotretinoin (Accutane)

Oral Isotretinoin (Accutane) is a type of acne treatment called a Retinoid. Isotretinoin is available as an oral treatment (Accutane) and as a topical treatment (Isotrex).

Oral Isotretinoin is one of the most effective treatments for moderate to severe acne. Unfortunately, oral isotretinoin also frequently has significant side effects.

Isotretinoin works by decreasing the size and activity of sebaceous glands, thus reducing the production of sebum. The reduced production of sebum limits the growth of acne-causing bacteria within the follicle. Isotretinoin also prevents the formation of the pore-clogging plugs that create blackheads and whiteheads.

Oral Isotretinoin has several side effects, which range from mild to severe. Isotretinoin can cause the skin to become very dry and irritated because sebum is necessary to lubricate and protect the skin. The effects of Oral Isotretinoin are semi-permanent, and some patients experience side effects even after they discontinue use of isotretinoin.

Isotretinoin is a powerful teratogen, and the use of Oral Isotretinoin by pregnant women causes severe birth defects. Because of the risk of this side effect, the use of oral isotretinoin is tightly controlled in many countries. Women who are pregnant or may become pregnant should never use isotretinoin.

Oral Isotretinoin has also been associated with an increased risk of depression and suicidal thoughts. However, this relationship is controversial and is not accepted by all experts. Isotretinoin is used primarily for individuals with severe acne, so it is unclear whether the increased risk of depression is caused by the Isotretinoin itself or from the experience of having severe acne symptoms.

Topical Isotretinoin (Isotrex) has a much lower risk of side effects, but it is rarely used to treat acne because newer topical retinoids (eg. Adapalene, Tretinoin) tend to be more effective and produce fewer side effects. Topical Isotretinoin is generally substantially less effective than Oral Isotretinoin for the treatment of moderate to severe acne symptoms (Acne Types: 3-4).

Adapalene

Adapalene (Differin) is a topical retinoid that is used primarily for the treatment of acne.

Adapalene is one of the most commonly used topical retinoids for the treatment of acne. Adapalene is a synthetic, third-generation retinoid that has better efficacy and safety profiles than older topical retinoids (eg. Isotretinoin, Tretinoin). This medication is now available as an Over-The-Counter (OTC) product in some regions.

Retinoids are structurally similar to Vitamin A. Retinoids can help improve acne symptoms in several ways. Retinoids decrease the activity of the sebaceous glands, which decreases the production of sebum. The decrease in sebum in eliminates decreases the amount of nutrients that are available for for acne-causing bacteria, such as P. acnes. Retinoids can also affect the growth and differentiation of skin cells, which can help reduce the formation of clogged pores (comedomes). Retinoids also have anti-inflammatory affects which may help improve acne symptoms.

Multiple clinical research studies indicate that Adapalene is a little more effective as an acne treatment than other topical retinoids (eg. Tretinoin) and tends to have milder side effects. Adapalene works by entering target cells and binding to to specific receptors called Retinoic Acid Receptors that are in the nucleus of cells. Once the retinoid binds to these receptors it changes how the genes of that cell are expressed. These changes in gene expression are what give retinoids their anti-acne properties.

Adapalene can be a valuable treatment for individuals with any type of acne (Acne Types: 1-4). Adapalene can improve acne symptoms for many patients. Unfortunately, complete resolution of acne symptoms is rare when Adapalene is used alone. Adapalene is frequently combined with complementary acne treatments (eg. Antibiotics, Androgen Inhibitors, Light & Laser therapies, etc). Adapalene and other topical retinoids tend to be more effective for the treatment of mild acne and less effective for moderate and severe forms of the disease.

There are many topical medications available that combine Adapalene with a second antibacterial agent. Adapalene is widely available in combination treatments with Benzoyl Peroxide (Epiduo), Clindamycin (Lacne) and Azithromycin (ATM-A).

The most common side effect of Adapalene treatment is dryness of the skin. Adapalene treatment decreases the production of sebum, and sebum is essential for moisturizing and protecting the skin. The most serious potential side effect of Adapalene is a risk of birth defects. All retinoids are teratogens (compounds that can cause birth defects). However, several studies have indicated that their is minimal risk to the fetus from the topical use of retinoids, including Adapalene. Nonetheless, the use of any type of retinoid is generally avoided in all women who are pregnant or may become pregnant during treatment.

Acupuncture

Acupuncture is an ancient Chinese treatment that involves putting thin needles into the skin and superficial tissue of a patient.

Acupuncture is an important element of Traditional Chinese Medicine (TCM). Acupuncture is believed to help redirect the flow of Qi (life force energy) through the body in a way that can be helpful for healing, pain relief, stress reduction and more. The existence of Qi is virtually impossible to prove via scientific methods, and there is an ongoing debate about whether Qi actually exists. There are many strong opinions on both sides of the issue.

Acupuncture is commonly used as part of holistic treatment plans for many types of medical conditions, including acne. However, Acupuncture is rarely used by itself as a treatment for acne. There are numerous studies in medical and scientific journals that report treatment regimens which include Acupuncture were effective for improving acne symptoms. But, many of these studies do not have appropriate controls and should not be considered as reliable.

Although the scientific evidence for a positive connection between acne and Acupuncture is weak, it is possible that this treatment may be helpful for some individuals. And it should be noted that some people have reported that their acne symptoms improved after undergoing Acupuncture therapy.

Acupuncture is frequently used employed in holistic pain management, as well as many other ailments. There are several possible reasons why Acupuncture may be helpful for the treatment of acne. The most compelling reason is that Acupuncture therapy can reduce stress levels for many people. Consistently elevated levels of stress can suppress the immune system, which can trigger acne symptoms. Acupuncture is considered safe as long as a new, single use needle is used.

Acupuncture Videos

References

Efficacy of ah shi point acupuncture on acne vulgaris. Son, et al. 2010.
Anti-inflammatory effect of Keigai-rengyo-to extract and acupuncture in male patients with acne vulgaris: a randomized controlled pilot trial. Kim, et al. 2010.
He-Ne laser auricular irradiation plus body acupuncture for treatment of acne vulgaris in 36 cases. Lihong, et al. 2006.
Acupuncture, electrostimulation, and reflex therapy in dermatology. Chen, et al. 2003.
Therapeutic effect observation on treatment of acne with acupuncture plus moving cupping and blood-letting. Wang, et al. 2008.
Evaluation of therapeutic effect and safety for clinical randomized and controlled trials of treatment of acne with acupuncture and moxibustion. Li, et al. 2009.
Treatment of acne with ear acupuncture–a clinical observation of 80 cases. Xu. 1989.
Advances in the acupuncture treatment of acne. Dai. 1997.
Acupuncture in dermatology: an historical perspective. Tan. 2007.
Randomized control study on the treatment of 26 cases of acne conglobata with encircling acupuncture combined with venesection and cupping. Liu, et al. 2008.
Clinical and experimental studies on combination of acupuncture with medicine for treatment of female delayed and persistent acne of different TCM syndrome-types. Lan, et al. 2004.

Ylang Ylang Essential Oil

Ylang Ylang Essential Oil is extracted from the flowers of the Cananga odorata tree. Ylang Ylang essential oil has a sweet floral aroma that has been used as a perfume since antiquity.

Ylang Ylang Essential Oil is often used in aromatherapy, and for making topical Naturopathic preparations. The usefulness of Ylang Ylang Essential Oil as an acne treatment is unclear. Some people have reported that topical treatments containing Ylang Ylang Essential Oil helped to improve their acne symptoms. However, these reports are anecdotal and further scientific research is required.

Ylang Ylang Essential Oil appears to have mild antibacterial properties, but it is far less antibacterial than other essential oils (eg. Thyme, Clove, etc). Ylang Ylang Essential Oil is expected to be mildly toxic to the acne-causing P. acnes bacteria. Ylang Ylang may also have a positive impact on skin tone, but there is currently no conclusive evidence about that relationship. The primary molecular compounds found in Ylang Ylang Essential Oil are Linalool, Germacrene D, Caryophyllene, p-Methylanisole, Geranyl Acetate and Benzyl Benzoate.

Vetiver Essential Oil

Vetiver Essential Oil is extracted from the roots of Vetiver or Khus Bunchgrass (Chrysopogon zizanioides). Vetiver grass is a fragrant grass that is widely used for culinary and Naturopathic purposes.

Vetiver Essential Oil is not as well-known or widely-used as many other essential oils, but it has some unique properties that make it a useful addition to Naturopathic treatments for certain skin conditions, such as acne. Although Vetiver Essential Oil is not currently a common ingredient in Naturopathic acne treatments, it does appear to be gaining popularity for this application.

Vetiver is a perennial bunchgrass that is native to the Indian subcontinent. It is a fragrant grass that is similar in appearance to Lemongrass and Citronella. Like these other fragrant grasses, the essential oil of Vetiver appears to have strong antibacterial properties. Laboratory testing indicates that Vetiver Essential Oil is highly toxic to the acne-causing P. acnes bacterium, as well as other gram-positive bacteria.

Vetiver Essential Oil is used in a range of aromatherapy, ayurvedic, cosmedic and naturopathic skin care products.  Vetiver Essential Oil has been claimed to have anti-inflammatory, antiseptic and sedative properties. Although there has been very little clinical research to verify these claims, the antibacterial activity of Vetiver Essential Oil suggests that this essential oil deserves to be further investigated as a topical treatment for acne. Vetiver Essential Oil contains many biologically active molecules, including significant concentrations of a unique molecule called Khusimol, which may be responsible for some of the reported effects of this essential oil.

References

Computer-aided identification of individual components of essential oils using carbon-13 NMR spectroscopy. Tomi, et al. 1995.
Extraction of vetiver essential oil by ethanol-modified supercritical carbon dioxide. Danh, et al. 2010.
Preliminary comparison of vetiver root essential oils from cleansed (bacteria- and fungus-free) versus non-cleansed (normal) vetiver plants. Adams, et al. 2004.
A Study on the Composition of Commercial Vetiveria zizanioides Oils from Different Geographical Origins. Champagnat, et al. 2006.
Qualitative and quantitative analysis of vetiver essential oils by comprehensive two-dimensional gas chromatography and comprehensive two-dimensional gas chromatography/mass spectrometry. Filippi, et al. 2013.
The in vitro Antimicrobial Activity and Chemometric Modelling of 59 Commercial Essential Oils against Pathogens of Dermatological Relevance. Orchard, et al. 2017.
Antibacterial and antifungal activities of essential oils. Hammer, et al. 2011.

Thyme Essential Oil

Thyme Essential Oil can be derived from several species of Thyme (Thymus spp). Thyme has been used for culinary and medical purposes for thousands of years. Thyme Essential Oil is widely used in Naturopathic medicine as an antibacterial agent.

Thyme Essential Oil is commonly used in Naturopathic acne face washes. Several research studies have shown that Thyme Essential Oil is toxic to many different kinds of bacteria and fungi. The antibacterial properties of Thyme Essential Oil has may help reduce the growth of the Propionibacterium acnes bacterium, which is a causative agent of acne symptoms. Many people have reported that topical Thyme Essential Oil preparations helped to improve their acne symptoms.

Laboratory tests have shown that Thyme Essential Oil is one of the most effective essential oils at inhibiting bacterial growth. However, there is limited evidence that Thyme Essential Oil is an effective treatment for acne. In pure form, Thyme Essential Oil is a potent irritant of the skin and mucosal tissue. Thyme Essential Oil must be diluted below 5% prior to topical use. Thyme Essential Oil can be blended into an alcohol or carrier oil base to make customized solutions. Small amounts of Thyme Essential Oil may also be added to hot water and applied as a warm compress.

Extracts from plants in the genus Thymus have been used for centuries in medicinal preparations to treat and prevent infection. There are over 300 different species of Thyme and they are grown in most places around the world. Most Thyme Essential Oil is prepared from common Thyme (Thymus vulgaris). Historically, Thyme extracts were used as topical treatments for wounds and infections, and were also used as natural sanitizers. Thyme may also be prepared as a tea that is purported to have anti-inflammatory properties.

The composition of Thyme Essential Oil varies greatly depending on the species of Thymus and the environmental conditions where it was grown. The most abundant compound in Thyme Essential Oil is usually Thymol, which can account for up to 50% of the total volume. However, some samples of Thyme Essential Oil may have high levels of other compounds, such as Camphor and Caravacol. In addition, Thyme Essential Oil usually contains a large number of additional compounds in trace amounts. Many of these compounds are also found in other aromatic essential oils that have antibacterial properties, such as Tea Tree and Clove Essential Oil.

Tea Tree Essential Oil

Tea Tree Essential Oil is distilled from the bark of the Tea Tree (Melaleuca spp), which is native to Australia. There are several species of tea tree, but most essential oil is made from the bark of the Narrow-Leaved Paperbark Tree (Melaleuca alternifolia). Preparations of the bark of this tree have been an important part of Aboriginal medicine for thousands of years.

Tea Tree Essential Oil is used for a wide variety of ailments and it has been shown to have antimicrobial properties. Tea Tree Essential Oil is commonly used as a topical Naturopathic treatment for several kinds of skin infections, including acne. Concentrated Tea Tree Essential Oil is mildly toxic however, and care should be taken to avoid ingestion when applying to acne lesions.

Many people have reported that topical applications of Tea Tree Essential Oil helped to improve their acne symptoms. However, there are only a few real clinical studies about the efficacy of Tea Tree Essential Oil for the treatment of acne. One commonly-cited study found that a topical 5% Tea Tree Oil solution was approximately as effective as topical Benzoyl Peroxide. Basically, the Tea Tree Essential Oil was mildly helpful but did not significantly improve acne symptoms for most patients in the study. On the plus side, Topical Tea Tree Essential Oil had fewer side effects (eg. dry skin, itching, redness) than Benzoyl Peroxide.

The major limitation of Topical Tea Tree Essential Oil is the same as for many other topical acne treatments – the antibacterial compounds do not effectively penetrate the skin and reach the site of infection. This limitation means that Tea Tree Essential Oil (and most other topical treatments) are often ineffective treatments for moderate to severe acne symptoms (Acne Types: 3-4).

The successful use of Tea Tree extracts in indigenous medicine has inspired chemists, biologists and doctors to investigate the efficacy of Tea Tree Essential Oil for the treatment of a wide range of diseases. Several research studies have shown that Tea Tree Essential Oil is toxic to many types of bacteria, including the acne-causing Propionibacterium acnes bacterium. Tea tree oil is commonly used in soaps, lotions and wound dressings in both Naturopathic and modern medical applications.

Some people have reported allergic reactions to topical applications of Tea Tree Essential Oil. This is not unusual, many other essential oils can cause allergic reactions for some patients. Fortunately, a study of over 700 people showed that less than 1% of people had significant skin irritation following the use of a 5% Tea Tree Oil solution. Higher concentrations of Tea Tree Essential Oil are known to cause more frequent and severe side effects. Most naturopathic practitioners recommend diluting Tea Tree Essential Oil to 25% or less, before use.

The bark of the Tea Tree peels away in paper like sheets that can be used for bandages and sleeping mats. In addition, the bark is rich in volatile molecules, which are both pungent and antimicrobial. Numerous studies have that the compounds in Tea Tree Essential Oil are toxic to a wide range of bacteria and fungi. These antibacterial and antifungal compounds originally evolved to protect the Tea Tree from infection and disease. Tea Trees grow in moist and swampy regions in the northern part of Australia, an area where there are a lot of bacterial and fungal plant pathogens.

Standard Tea Tree Essential Oil is a blend of almost 100 different molecules, although most of these are only present in very small quantities. Most of the active compounds in Tea Tree Essential Oil are derivatives of terpene. The major components of tea tree oil are terpinen-4-ol, gamma-terpinene and alpha-terpinene. Terpinen-4-ol is the most well studied of these molecules, and research has shown that it has potent antibacterial properties. Other secondary compounds in tea tree oil are suspected to act synergistically with terpinen-4-0l, to kill bacteria.

Not all Tea Tree Essential Oil is the same because of differences in the source and how it is processed. However, Tea Tree Essential Oil is one of the most popular essential oils and there are international standards for the types of mixtures that can be marketed and sold as Tea Tree Essential Oil.

Sandalwood Essential Oil

Sandalwood Essential Oil is derived from various species of the Sandalwood tree (Santalum spp) that are native to tropical regions. Most Sandalwood Essential Oil is prepared from the Indian Sandalwood Tree (Santalum album).

Sandalwood Essential Oil is occasionally used as a Naturopathic treatment for acne, where it is generally added to topical preparations, such as face masks. Sandalwood Aromatherapy may also be used in the treatment of acne itself and the psychological symptoms of acne.

Skin washes and masks that contain Sandalwood Essential Oil have been reported to have anti-inflammatory properties. Sandalwood Essential Oil does not appear to have substantial antibacterial activity in many laboratory tests. There is minimal clinical research into the efficacy of Sandalwood Essential Oil for the treatment for acne.

Sandalwood Essential Oil is primarily composed of terpene molecule called Santalol. Santalol has two forms, alpha-Santalol and beta-Santalol, both of which are volatile compounds with a pleasant and unique aroma

Sandalwood is held in high regard by many cultures. High demand for Sandalwood and it’s relative rarity combine to make true Sandalwood Extracts quite expensive. With a distinctive and pleasant aroma, sandalwood oil has long been an important part of Ayurvedic medicine, with applications both for physical and mental disorders.

Sage Essential Oil

Sage Essential Oil is prepared from the leaves and flowers of many different species of sage (Salvia spp). Sage plants are common in many regions of the world. Two of the most popular types of Sage Essential Oil are extracted from Garden Sage (Salvia officinalis) and Clary Sage (Salvia sclarea). Sage and it’s essential oil are widely used in many cultures for culinary and medical purposes.

Sage Essential Oil is occasionally used in Naturopathic acne treatments, primarily in topical acne treatments. Clary Sage Essential Oil is more frequently used for acne treatments than other types of Sage Essential Oil. Many people have reported that topical Naturopathic treatments that contained Clary Sage Essential Oil helped to improve their acne symptoms. However, there is a very limited amount of clinical research about the efficacy of Sage Essential Oil for the treatment of acne.

Laboratory testing indicates that Sage Essential Oil is mildly toxic to many types of bacteria. However, the antibacterial activity of Sage Essential Oil is substantially less than that of many other common essential oils. In addition, Sage Essential Oil has been reported to be less effective against many types of gram-positive bacteria, a group which includes the acne-causing Propionibacterium acnes bacteria.

Essential Oils from Garden Sage and Clary Sage have important differences in their compositions. All Sage Essential Oil contains significant quantities of a molecule called Thujone. Thujone is a biologically active molecule that has several effects and can be toxic at high doses. Clary Sage Essential Oil contains large amounts of Linalool and Linalyl Acetate, while Garden Sage Essential Oil does not. Other compounds that can be found in Sage Essential Oil include Camphor, Geranyl Acetate and alpha-Pinene.

References

Essential oils: their antibacterial properties and potential applications in foods a review. Burt. 2004.
Chemical Composition, Antimicrobial and Antioxidative Activity of Laurel, Sage, Rosemary, Oregano and Coriander Essential Oils. Baratta, et al. 1998.
Essential Oils from Dalmatian Sage (Salvia officinalis L.): Variations among Individuals, Plant Parts, Seasons, and Sites. Perry, et al. 1999.
Composition and Antifungal Activity on Soil-Borne Pathogens of the Essential Oil of Salvia sclarea from Greece. Pitarokili, et al. 2002.

Rosewood Essential Oil

Rosewood Essential Oil that is available in stores is usually extracted from the Brazilian Rosewood tree (Aniba rosaeodora). There are many other types of trees that are called Rosewood, including many species from the family Dalbergia. Rosewood Essential Oil is isolated by steam distillation of the wood and bark.

Rosewood Essential Oil is not commonly used in the Naturopathic treatment of acne. When Rosewood Essential Oil is used to treat acne, it is generally diluted and added to topical preparations. Rosewood Essential Oil is mildly toxic to many gram-positive bacteria, including acne-causing Propionibacterium acnes. There is very little clinical research and few patient reports about the efficacy of Rosewood Essential Oil for improving acne symptoms.

The primary molecular component of Rosewood Essential Oil is Linalool. Linalool is a volatile molecule that is very aromatic and accounts for up to 85% of the total oil content. Linalool can irritate the skin and cause allergic reactions in some individuals.

Rosewood Essential Oil is used extensively in perfumes and aromatherapies. Rosewood is more expensive than most other essential oils because of limited supply. The Brazilian Rosewood tree is endangered, but because the farmed supply of Brazilian Rosewood is not sufficient to meet demand, wild trees continue to be harvested.

Rosemary Essential Oil

Rosemary Essential Oil is extracted from the leaves of the Rosemary bush (Rosmarinus officinalis). Rosemary is a woody, evergreen plant with fragrant needle-like leaves. Whole rosemary leaves and Rosemary Essential Oil are widely used for culinary and Naturopathic applications.

Because of its antibacterial properties, Rosemary Essential Oil is often incorporated into topical Naturopathic acne treatments. Laboratory testing indicates that Rosemary Essential Oil is toxic to many types of bacteria, including acne-causing P. acnes bacteria. Rosemary Essential Oil has been shown to more effective at killing gram-positive bacteria (eg. P. acnes) than many other popular essential oils.

Rosemary Essential Oil is also purported to have anti-inflammatory properties, to reduce oily skin and to improve skin tone.  All of these effects would be helpful to most acne sufferers, but unfortunately there is little clinical research to support these specific claims.

Rosemary Essential Oil contains a number of phytochemicals that are known to have biological activity. Rosemary Essential Oil contains significant concentrations of 1,8-cineole (Eucalyptol), alpha-Pinene, beta-Pinene, Camphor, Camphene and Borneol. Several of these compounds have been shown to have antibacterial properties that can help reduce the growth of acne-causing bacteria. For some users, concentrated Rosemary Essential Oil can be irritating to the skin. Therefore, diluted Rosemary Essential Oil is generally used for Naturopathic skin care applications.

References

Investigation of antibacterial activity of rosemary essential oil against Propionibacterium acnes with atomic force microscopy. Fu, et al. 2007.
Chemical composition and antimicrobial activity of the essential oil of Rosemary. Jiang, et al. 2011.
Chemical composition, plant genetic differences, antimicrobial and antifungal activity investigation of the essential oil of Rosmarinus officinalis L. Angioni, et al. 2004.
Chemical composition and antimicrobial activity of Rosmarinus officinalis L. essential oil obtained via supercritical fluid extraction. Santoyo, et al. 2005.

Rose Flower Essential Oil

Rose Flower Essential Oil is made from the flower petals of many species of rose (Rosa spp.). There are two main types of Rose Essential Oil: Rose otto (aka attar of rose) and rose absolute oil. Rose otto is harvested via steam distillation and Rose absolute oil is harvested via solvent extraction.

Rose Flower Essential Oil is occasionally used as a Naturopathic treatment for acne. Small amounts of Rose Flower Essential Oil are generally added to a blend of other essential oils, plant extracts or clay and used in Naturopathic face masks and creams. Rose Flower Essential Oil is also used extensively in Aromatherapy.

Rose Flower Essential Oil is purported to have anti-inflammatory effects which can help improve acne symptoms. However, there is little clinical research and few patient reports about the efficacy of Rose Flower Essential Oil as a treatment for acne. Laboratory testing indicates that Rose Flower Essential Oil has weak antibacterial activity. Three of the main molecular components of Rose Flower Essential Oil are Citronellol, Geraniol and Nonadecane.

Pure Rose Flower Essential Oil is relatively expensive due to the large amount of rose flowers needed to produce a small amount of essential oil. Because of the expense of pure Rose Flower Essential Oil, many products that claim to be Rose Flower Essential Oil are actually blends of other essential oils that may contain little or no actual Rose Flower Essential Oil.

Patchouli Essential Oil

Patchouli Essential Oil is extracted from the leaves of several species of plants in the genus Pogostemon. Patchouli Essential Oil is widely used in Aromatherapy and perfumes.

Patchouli Essential Oil is occasionally used in Naturopathic treatments for skin diseases, such as acne. When used in Naturopathic acne treatments, Patchouli Oil is often blended with other essential oils and active ingredients, and then applied topically.

Patchouli Essential Oil is purported to have antibacterial, anti-fungal and anti-inflammatory properties that can be helpful for individuals with skin infections, such as acne. It is also been claimed that Patchouli Essential Oil can improve skin tone and is a useful treatment for fine lines and uneven skin tone. However, few of these claims have been investigated in scientific studies. Patchouli Essential Oil is also used as a natural insect repellent.

Laboratory testing indicates that Patchouli Essential Oil has moderate antibacterial activity towards gram-positive bacteria, a group which includes the acne-causing P. acnes bacterium. However, many other essential oils have been shown to have stronger antibacterial properties than Patchouli Essential Oil.

The composition of Patchouli Essential Oil is variable and depends on the specific source material and how it was processed. Several species of Pogostemon are used to produce Patchouli Essential Oil, including Pogostemon cablin, P. commosum, P. heyneasus, P. hortensis,  and P. plectranthoides. Patchouli Essential Oil contains many biologically-active molecules, including abundant concentrations of alpha-Guaiene, delta-Guaiene, beta-Caryophyllene and alpha-Patchoulene.

References

Comparison of extraction of patchouli (Pogostemon cablin) essential oil with supercritical CO2 and by steam distillation. Donelian, et al. 1999.
Antimicrobial activity of essential oils and other plant extracts. Hammer, et al. 1999.
Antibacterial and antifungal activity of ten essential oils in vitro. Pattnaik, et al. 1995.
The effect of essential oils on methicillin-resistant Staphylococcus aureus using a dressing model. Edwards-Jones, et al. 2004.
Patchouli alcohol, an essential oil of Pogostemon cablin, exhibits anti-tumorigenic activity in human colorectal cancer cells. Jeong, et al. 2013.
Composition and comparison of essential oils of Pogostemon cablin (Blanco) Benth.(Patchouli) and Pogostemon travancoricus Bedd. var. travancoricus. Sundaresan, et al. 2009.
The Encyclopedia of essential oils: the complete guide to the use of aromatic oils in aromatherapy, herbalism, health, and well being. Lawless. 2013.
The in vitro antimicrobial activity and chemometric modelling of 59 commercial essential oils against pathogens of dermatological relevance. Orchard, et al. 2017.
Efficiency of Vanilla, Patchouli and Ylang Ylang Essential Oils Stabilized by Iron Oxide C14 Nanostructures against Bacterial Adherence and Biofilms Formed by Staphylococcus aureus and Klebsiella pneumoniae Clinical Strains. Bilcu, et al. 2014.

Oregano Essential Oil

Oregano Essential Oil is derived from the common Oregano herb (Origanum vulgare). Oregano is a perennial herb that is related to other common herbs, including Mint and Thyme.

Oregano Essential Oil is a popular component of many Naturopathic treatments for skin problems. Oregano Essential Oil is a common addition to topical Naturopathic acne treatments.

Several research studies have shown that Oregano Essential Oil has strong antibacterial properties, particularly against gram-positive bacteria (eg. Propionibacterium acnes). In fact, Oregano may be one of the essential oils that is most toxic to the acne-causing P. acnes bacterium. In spite of its known antibacterial activity, there has been minimal clinical research into the efficacy of Oregano Essential Oil as a topical treatment for acne. However, many individuals have reported that Oregano Essential Oil helped to improve their acne symptoms.

Oregano Essential Oil contains many molecules which are known to have antimicrobial properties and other biological activity. Oregano Essential Oil contains significant concentrations of Thymol, Carvacrol, p-Cymene and y-Terpinene. Thymol and Carvacrol in particular are known to be toxic to many types of bacteria.

References

In vitro bioactivities of essential oils used for acne control. Lertsatitthanakorn, et al. 2006.
Composition of oregano essential oil (Origanum vulgare) as affected by drying method. Figiel, et al. 2010.
A study of the minimum inhibitory concentration and mode of action of oregano essential oil, thymol and carvacrol. Lambert, et al. 2001.
Susceptibility of methicillin-resistant staphylococci to oregano essential oil, carvacrol and thymol. Nostro, et al. 2004.
Chemical composition, antimicrobial and antioxidative activity of laurel, sage, rosemary, oregano and coriander essential oils. Baratta, et al. 1998.
Antibacterial and antifungal properties of essential oils. Kalemba, et al. 2003.

Neroli Essential Oil

Neroli Essential Oil is extracted from the flowers of the Bitter Orange tree (Citrus aurantium). 

Neroli Essential Oil is coveted for its alluring fragrance, and is widely used in Perfumery, Aromatherapy and as a flavoring additive. Bitter Orange Trees are native to Africa and Asia, but are now cultivated in many regions around the world.

Neroli Essential Oil is occasionally for the Naturopathic treatment of acne. As an acne treatment, Neroli Essential Oil is typically added to face wash blends and clarifying masks. Neroli Essential Oil has been reported to have antibacterial and anti-inflammatory properties. It is also believed to have a lower risk of causing skin irritation than many other essential oils. Many Naturopaths and their patients have reported that topical preparations containing Neroli Essential Oil helped to improve their acne symptoms. However, there does not appear to be any publicly-available clinical research studies that support these claims.

Neroli Essential Oil contains a range of chemical compounds, many of which are known to have biological activity. Neroli Essential Oil contains significant concentrations of Linalool, Linalyl Acetate, Limonene, Farnesol, alpha-Terpineol and Nerolidol. Laboratory testing indicates that Neroli Essential Oil is only mildly toxic to gram-positive bacteria, a group which includes the acne-causing P. acnes bacterium. Many other essential oils are known to have significantly stronger antibacterial properties.

References

Bioactivity of selected plant essential oils against Listeria monocytogenes. Lis‐Balchin, et al. 1997.
Chemical composition and in vitro antimicrobial and antioxidant activities of Citrus aurantium l. flowers essential oil (Neroli oil). Ammar, et al. 2012.
Quantification and determination of chemical composition of the essential oil extracted from natural orange blossom water (Citrus aurantium L. ssp. aurantium). Jeannot, et al. 2005.
Chemical composition of essential oils from flowers, leaves and peel of Citrus aurantium L. var. amara from Tunisia. Boussaada, et al. 2006.
Volatile constituents and antioxidant activity of peel, flowers and leaf oils of Citrus aurantium L. growing in Greece. Sarrou, et al. 2013.
Screening for inhibitory activity of essential oils on selected bacteria, fungi and viruses. Chao, et al. 2000.
The in vitro antimicrobial activity and chemometric modelling of 59 commercial essential oils against pathogens of dermatological relevance. Orchard, et al. 2016.

Myrrh Essential Oil

Myrrh Essential Oil is extracted from the resin species of Myrrh trees (Commiphora Spp). Myrrh resin is used extensively in Traditional, Naturopathic and Ayurvedic Medicine, as well as Aromatherapy.

In the regions where it grows, the humans have used Myrrh throughout recorded history. For example, Myrrh was one of the gifts brought by the Magi to celebrate the birth of Jesus.

As a treatment for acne, Myrrh is often combined with other ingredients in topical Naturopathic formulations. Many Naturopathic practitioners and their patients believe that Myrrh Essential Oil can help relieve symptoms of acne. Myrrh is purported to have antiseptic, astringent and anti-inflammatory properties.

Some research studies have found that Myrrh Essential Oil is toxic to cancer cells that are grown in the laboratory. However, there is very little clinical research about the efficacy of Myrrh Essential Oil as a treatment for acne. Laboratory testing indicates that Myrrh Essential Oil is weakly toxic to gram-positive bacteria, a group which includes the acne-causing P. acnes bacterium.

Myrrh Essential Oil can be produced from the resin of several species of Myrrh, the most common of which is Commiphora myrrha (molmol). Myrrh plants are native to regions of East Africa and the Middle East. Myrrh is in the same family as Frankincense (Burseraceae). Myrrh Essential Oil contains significant concentrations of biologically-active molecules, including Furanodiene, Furanoeudesma-1,3-diene, Lindestrene and beta-Elemene.

References

Composition and potential anticancer activities of essential oils obtained from myrrh and frankincense. Chen, et al. 2013.
Antimicrobial activity of essential oils and other plant extracts. Hammer, et al. 1999.
Essential oils of some Boswellia spp., Myrrh and Opopanax. Baser, et al. 2003.
Components, therapeutic value and uses of myrrh. Ashry, et al. 2003.
The Encyclopedia of essential oils: the complete guide to the use of aromatic oils in aromatherapy, herbalism, health, and well being. Lawless. 2013
The in vitro Antimicrobial Activity and Chemometric Modelling of 59 Commercial Essential Oils against Pathogens of Dermatological Relevance. Orchard. 2017

Mint Essential Oil

Mint Essential Oil is derived from several species of the mint plant (Mentha spp), which can be found worldwide. The mint plant has been used by humans for thousands of years and has a wide variety of uses, such as cooking, skin care, toothpaste, aromatherapy and more.

Mint Essential Oil has been shown to have some antimicrobial properties and is moderately toxic to acne-causing bacteria, such as Propionibacterium acnes. Many people have reported that topical application of solutions that contain Mint Essential Oil have helped to improve their acne symptoms. While there is little clinical research into the efficacy of Mint Essential Oil as a treatment for acne, it is possible that some users may find it to be helpful addition to their acne treatment regimen.

The two most common types of Mint Essential Oil are Peppermint (Mentha piperita) and Spearmint (Mentha spicata). These essential oils contain different mixtures of molecules. The dominant compounds in Peppermint Essential oil tend to be Menthol and Menthone, while the Spearmint Essential Oil contains abundant Carvone and Limonene.

Lemongrass Essential Oil

Lemongrass is a group of grasses (Cymbopogon spp.) that are native to Asia, Africa and Australia. Lemongrass has multiple uses that range from cooking to insect repellent to skin care. Lemongrass Essential Oil and Citronella Essential Oil are produced from species of Lemongrass and can be used interchangeably.

Lemongrass Essential Oil is commonly used in topical preparations for the Naturopathic treatment of skin infections, including acne. It contains several molecules that are toxic the the acne-causing bacterium, Propionibacterium acnes. Laboratory testing indicates that Lemongrass Essential Oil is among the most effective essential oils for inhibiting the growth of P. acnes bacteria.

Lemongrass Essential Oil contains an abundance of vitamins, minerals and other nutrients. The primary components of Lemongrass Essential Oil are Geranial and Neral, which are subtypes (enantiomers) of a molecule called Citral.

Lavender Essential Oil

Lavender Essential Oil is extracted from the several species of the Lavender plant (Lavandula sp). Lavender essential oil is purported to have both antibacterial and antiseptic properties.

Lavender Essential Oil is used in a variety of topical Naturopathic preparations, including many acne treatments. Many people report that products with Lavender essential oil helped to improve their acne symptoms. However, there is little direct scientific research on the utility of Lavender as an acne treatment. Lavender is also used extensively for aromatherapy, and it is used as a scent in many household products.

Lavender Essential Oil appears to be moderately toxic to the acne-causing Propionibacterium acnes bacterium. The primary components of Lavender Essential Oil are 1 5-dimethyl-1-vinyl-4-hexenyl butyrate (Linalyl butanoate), 1,3,7-Octatriene, 3,7-dimethyl- (Ocimene), Eucalyptol, Caryophyllene and Camphor.

Kaffir Lime Essential Oil

Kaffir Lime Essential Oil is a type of essential oil that is derived from the leaves and fruit rinds of the Kaffir Lime plant (Citrus hystrix).

Kaffir Lime Essential Oil is occasionally used for the Naturopathic treatment of acne. Generally, Kaffir Lime Essential Oil is added to topical preparations, such as face washes and masks. However, there is little clinical research and few patient reports about the usefulness of Kaffir Lime Essential Oil when used as acne treatment.

Kaffir Limes are native to mountainous and tropical areas of southeast Asia. Lime Leaf Essential Oil and whole Kaffir Lime leaves and peels are used extensively for culinary and Naturopathic applications.

Laboratory testing indicates that Kaffir Lime Essential Oil. is moderately toxic to gram-positive bacteria, a group which includes the acne-causing Propionibacterium acnes. However, many other kinds of essential oils have been shown to have substantially greater antibacterial activity than Kaffir Lime Essential Oil.

Kaffir Lime Essential Oil rich in antioxidants, terpenes and other nutrients. Major components of this essential oil are beta-pinene, sabinene and citronellal. Some research studies have reported that these molecules have antibacterial properties that might help control the growth of acne-causing P. acnes bacteria.

Juniper Berry Essential Oil

Juniper Berry Essential Oil is extracted from the fruits of many species of Juniper tree (Juniperus spp).

There are more than 50 species of juniper and they can be found in many regions of the Northern Hemisphere. Junipers are an important part of traditional Naturopathic medicine for many indigenous cultures.

Juniper Essential Oil is a popular ingredient in topical Naturopathic acne treatments. There is very little clinical research about the efficacy of Juniper Berry Essential Oil as a treatment for acne. However, many users have reported that topical treatments that contain Juniper Berry Essential Oil helped to improve their acne symptoms.

Laboratory testing indicates that Juniper Berry Essential Oil is moderately toxic to gram-positive bacteria, including the acne-causing P. acnes bacteria. More research is needed to determine whether Juniper Berry Essential Oil should be more widely used as an acne treatment.

Essential Oil can be made from both the needles and the berries of Juniper trees, but Juniper Berry Essential Oil is the more common source. Juniper Berry Essential Oil contains significant concentrations of alpha-Pinene, beta-Pinene, Myrcene, Humulene and Terpinen-4-ol. Several of these molecules are known to have biological activity and/or antibacterial properties.

References

Antibacterial and antifungal activity of juniper berry oil and its selected components. Filipowicz, et al. 2003.
Analysis of Juniperus communis subsp. alpina needle, berry, wood and root oils by combination of GC, GC/MS and 13C-NMR. Gonny, et al. 2005.
Comparative analysis of the composition of essential oils and supercritical carbon dioxide extracts from the berries and needles of Estonian juniper (Juniperus communis L.). Orav, et al. 2010.
Chemical composition, cytotoxic activity and antimicrobial activity of essential oils of leaves and berries of Juniperus phoenicea L. grown in Egypt. El-Sawi, et al. 2007.
Solid lipid microparticles (SLM) containing juniper oil as anti-acne topical carriers: preliminary studies. Gavini, et al. 2005.
The Encyclopedia of essential oils: the complete guide to the use of aromatic oils in aromatherapy, herbalism, health, and well being. Lawless. 2013.

Geranium Essential Oil

Geraniums (Pelargonium) are a diverse group of plants that contains over 100 species. Geranium Essential Oil is most commonly extracted from the leaves of the Rose Scented Geranium (Pelargonium graveolens ). This species of geranium is native to the Southern Africa.

Geranium Essential Oil is widely used for Naturopathic and Aromatherapy applications. It is occasionally included in topical Naturopathic treatments for acne.

Geranium Essential Oil is purported to have many properties that make it a valuable addition to Naturopathic skin care products. It has been claimed that Geranium Essential Oil has antibacterial, antifungal, antioxidant and anti-inflammatory properties. However, very little clinical research has been conducted to investigate these claims. Laboratory testing indicates that Geranium Essential Oil is toxic to the acne-causing P. acnes bacterium.

Geranium Essential Oil is a rich source of the molecule Citronellol, which is known to have potent antibacterial properties. Geranium Essential Oil also contains significant concentrations of Linalool, Geraniol and Isomenthone.

References

Variation in essential oil composition of rose-scented geranium (Pelargonium sp.) distilled by different distillation techniques. Babu, et al. 2005.
Biomass yield, essential oil yield and essential oil composition of rose-scented geranium (Pelargonium species) as influenced by row spacings and intercropping with cornmint (Mentha arensis L.f. piperascens Malinv. ex Holmes). Rao. 2002.
Antibacterial and antifungal properties of essential oils. Kalemba, et al. 2003.
Topical herbal therapies an alternative and complementary choice to combat acne. Kapoor, et al. 2011.
Antimicrobial, Antioxidant, and Anti-Inflammatory Activities of Essential Oils from Five Selected Herbs. Tsai, et al. 2011.

Frankincense Essential Oil

Frankincense Essential Oil is extracted from the resin of various species of Frankincense tree (Boswellia spp). There are many species of Frankincense tree, most of which are native to Eastern Africa and the Middle East.

Ancient texts and oral histories indicate that Frankincense resin has been used by the people of the region for thousands of years. For example, Frankincense was one of three gifts that the Magi brought to celebrate the birth of Jesus.

Frankincense is widely used in Ayurvedic, Naturopathic and many forms of Traditional Medicine. Pure frankincense resin is consumed orally to treat a range of digestive tract problems. Frankincense is used extensively in Aromatherapy. Several research studies have reported that Frankincense is toxic to cancer cells, but these studies were all done in test tubes and it is unclear whether Frankincense would be a useful cancer treatment in humans or animals.

For Naturopathic acne treatments, Frankincense Essential Oil is generally used as a topical treatment. It can be added to topical formulations where it is purported to help ameliorate acne symptoms by reducing inflammation, suppressing bacterial growth and accelerating healing. Some Naturopathic practitioners may also prescribe Frankincense resin as an oral treatment for acne, although this is uncommon.

Despite the fact that many Naturopaths and their patients report improvements in their acne symptoms with the use of Frankincense Essential Oil, there is very little clinical research on this topic. There do not appear to be any controlled studies about the efficacy of Frankincense for the treatment of acne. Laboratory testing indicates that Frankincense is not strongly toxic to gram-positive bacteria, a group which includes the acne-causing P. acnes bacterium.

Because Frankincense Essential Oil can be produced from the resin of several species of Frankincense (Boswellia) tree, there is considerable variation in the composition of Frankincense Essential Oil. Frankincense is most commonly obtained from the resin of the following Frankincense species: Boswellia carteriiBoswellia frereana, Boswellia papyrifera, Boswellia sacra and Boswellia serrata. Frankincense Essential Oil contains significant concentrations of many biologically-active molecules, including alpha-Pinene, Limonene, p-Cymene and B-Caryophyllene.

Populations of native Frankincense trees are declining in many regions, largely due to unsustainable harvesting of Frankincense resin. A substantial proportion of Frankincense trees grow in countries that have high levels of poverty and weak environmental protections. Resin extraction can slow the growth of Frankincense trees, reduce their seed production or even kill them outright. Consumers can help protect Frankincense populations by purchasing resin and oils that are sustainably harvested.

References

Composition and potential anticancer activities of essential oils obtained from myrrh and frankincense. Chen, et al. 2013.
Volatile composition and antimicrobial activity of twenty commercial frankincense essential oil samples. Van Vuuren, et al. 2010.
Chemistry and immunomodulatory activity of frankincense oil. Mikhaeil, et al. 2003.
Chemical composition and antimicrobial activity of some oleogum resin essential oils from Boswellia spp.(Burseraceae). Camarda, et al. 2007.
The Encyclopedia of essential oils: the complete guide to the use of aromatic oils in aromatherapy, herbalism, health, and well being. Lawless. 2013.

Eucalyptus Essential Oil

Eucalyptus Essential Oil is derived from the eucalyptus plant (Eucalyptus spp.) and has been used by aboriginal people in Australia for thousands of years.

Eucalyptus Essential Oil is occasionally used in Naturopathic acne treatments. It is generally added as an antibacterial agent to Naturopathic acne face cleansers.

Eucalyptus Essential Oil has antiseptic and antibacterial properties. Eucalyptol (a primary component of Eucalyptus Essential Oil) is an active ingredient in some cough drops and mouth washes. Surgeons even used it in the 1800s to prevent post-surgery infections.

Some people have reported that topical application of Eucalyptus Essential Oil helped to improve their acne symptoms.Laboratory testing has also shown that Eucalyptus Essential Oil is moderately toxic to the acne-causing Propionibacterium acnes bacterium. The primary molecular compounds found in Eucalyptus Essential Oil are 1,8-Cineol (aka Eucalyptol) and alpha-Pinene. Both of these compounds are known to have biological activity.

Fun fact: Koala bears eat Eucalyptus Leaves.

Cypress Essential Oil

Cypress Essential Oil is extracted from the needles and branches of the Cypress tree, usually the Mediterranean cypress (Cupressus sempervirens).

Cypress Essential Oil is widely used in the traditional medicine of the people who live in regions where Cypress trees are found. Cypress Essential Oil is occasionally used for the Naturopathic treatment of acne. As an acne treatment, Cypress Essential Oil is generally added to topically-applied formulations.

There is little clinical research about Cypress Essential Oil as a treatment for acne. However, many Naturopathic practitioners and their patients report that Cypress Essential Oil helped control their acne symptoms. Cypress Essential Oil is purported to have antimicrobial properties, to improve circulation, to improve digestion and to reduce inflammation. Cypress Essential Oil is included in many Naturopathic skin care products that are intended to brighten the skin and improve overall complexion.

Laboratory testing indicates that Cypress Essential Oil has some antibacterial properties, but less than many other essential oils. Cypress Essential Oil does not appear to be particularly toxic to gram-positive bacteria, a group which includes the acne-causing P. acnes bacterium. Cypress Essential Oil contains significant concentrations of alpha-Pinene, carene, alpha-terpinolene and limonene.

References

Chemical composition of cypress essential oils: volatile constituents of leaf oils from seven cultivated Cupressus species. Pierre-Leandri, et al. 2003.
Chemical composition of Algerian cypress essential oil. Chanegriha, et al. 1993.
GC and GC/MS leaf oil analysis of four Algerian cypress species. Chanegriha, et al. 1997.
Chemical composition and antimicrobial activity of essential oils of Cupressus arizonica Greene. Chraif, et al. 2007.
Chemical composition, antimicrobial and antibiofilm activity of the essential oil and methanol extract of the Mediterranean cypress (Cupressus sempervirens L.). Selim, et al. 2014.
Biological effects of essential oils: a review. Bakkali, et al. 2008.
Antibacterial and antifungal effects of essential oils from coniferous trees. Hong, et al. 2004.
The Encyclopedia of essential oils: the complete guide to the use of aromatic oils in aromatherapy, herbalism, health, and well being. Lawless. 2013.

Coriander Essential Oil

Coriander Essential Oil is isolated from the seeds of the Cilantro plant (Coriandrum sativum).

Coriander essential oil contains high levels of vitamin D and other nutrients that are beneficial for the skin. Coriander Essential Oil is not frequently used in Naturopathic acne treatments.

There is some preliminary research which indicates that the Coriander Essential Oil may have antibacterial effects that inhibit the growth of the acne-causing Propionibacterium acnes bacterium. However, it is unclear how effective Coriander Essential Oil is for the treatment of acne. The primary molecular components of Coriander Essential Oil are Linalool, Terpinene, alpha-Pinene and Camphor.

Clove Essential Oil

Clove Essential Oil is derived from the clove plant (Syzygium aromaticum), which is native to Indonesia.

Clove Essential Oil has antiseptic and analgesic properties, and it is extensively used in both western and traditional medicine. Before the advent of modern numbing agents, concentrated Clove Essential Oil was commonly used in dentistry as a local anesthetic and disinfectant.

Clove Essential Oil is used as extensively as a Naturopathic treatment for respiratory diseases and skin diseases, such as acne. Many people have reported that the pain and infection relieving properties of Clove Essential oil helped to improve their acne symptoms. Clove Essential is often diluted and blended with other essential oils and plant extracts for use as a topical acne treatment.

The primary component of Clove Essential Oil is eugenol. Laboratory research has shown that eugenol is highly toxic to Propionibacterium acnes, the bacteria commonly involved in acne infections. However, eugenol and concentrated Clove Essential Oil are known skin irritants. Because of this, clove oil is almost always diluted prior to use.

References

The antibacterial activity of clove essential oil against Propionibacterium acnes and its mechanism of action. Fu, et al. 2009.
Antibacterial and antifungal properties of essential oils. Kalemba, et al. 2003.
Biological effects of essential oils: A review. Bakkali, et al. 2008.
Antifungal activities of the essential oils in Syzygium aromaticum (L.) Merr. Et Perry and Leptospermum petersonii Bailey and their constituents against various dermatophytes. Park, et al. 2007.
The Encyclopedia of essential oils: the complete guide to the use of aromatic oils in aromatherapy, herbalism, health, and well being. Lawless. 2013.
Antimicrobial activity of essential oils against five strains of Propionibacterium acnes. Luangnarumitchai, et al. 2007.
In vitro bioactivities of clove buds oil (Eugenia caryophyllata) and its effect on dermal fibroblast. Khunkitti, et al. 2012.
Global yields, chemical compositions and antioxidant activities of clove basil (Ocimum gratissimum L.) extracts obtained by supercritical fluid extraction. Leal, et al. 2006.

Citrus Essential Oil

Citrus Essential Oils are extracted from the rinds of lemon, lime, orange and other citrus fruits (Citrus spp). Citrus Essential Oils are common ingredients in a wide range of products, including cosmetics and cleaning products.

Citrus Essential Oils are not commonly used on their own as an acne treatment. However, they are used as an additive in many OTC and Naturopathic acne treatment products. In Naturopathic Medicine, Citrus Essential Oil is often blended with other essential oils for topical use, or is used as an aromatherapy.

Several research studies have demonstrated that Citrus Essential Oils are toxic to many types of bacteria, including acne-causing Propionibacterium acnes bacteria. Citrus Essential Oil is also toxic to many types of fungi and other microbes. Citrus Essential Oil may have anti-inflammatory and immune-boosting properties, but these claims have not been rigorously proven. Citrus Essential Oil also contains many anti-oxidant molecules.

Citrus Essential Oils readily dissolve sebum, and may be helpful for patients with oily skin. However, the removal of natural sebum oils may also be irritating to the skin. Citrus Essential Oils are known skin irritants, particularly at higher concentrations.

Citrus Essential Oil can be produced from the left-over byproducts of juice processing, and are therefore among the most abundant and inexpensive of the essential oils. Citrus Essential Oils are excellent solvents that can be used to dissolve a wide range of substances. Because of their dissolving power, Citrus Essential Oils have been widely used as topical cleansers and disinfectants.

There are many types of citrus fruit and the chemical composition of their essential oils are each a little different. For most Citrus Essential Oils, the primary component is limonene. Limonene is a colorless liquid with a pungent citrus aroma. Limonene is a type of hydrocarbon called a terpene. Pure limonene is combustible and has been investigated for use as a renewable biofuel. Orange essential oils tend to contain higher concentrations of limonene then lemon and lime oils. Citrus Essential Oils also contain low concentrations of pinene, sabinene, myrcene, terpinene and geranial.

References

Biological activities of Korean Citrus obovoides and Citrus natsudaidai essential oils against acne-inducing bacteria. Kim, et al. 2008.
Chemical composition and biological activities of essential oils extracted from Korean endemic citrus species. Baik, et al. 2008.
Activities of ten essential oils towards Propionibacterium acnes and PC-3, A-549 and MCF-7 cancer cells. Zu, et al. 2010.
In vitro bioactivities of essential oils used for acne control. Lertsatitthanakorn, et al. 2006.
Antimicrobial activity of Turkish Citrus peel oils. Kirbalar, et al. 2009.
Antibacterial and antifungal properties of essential oils. Kalemba, et al. 2003.
Limonene suppresses lipopolysaccharide-induced production of nitric oxide, prostaglandin E2, and pro-inflammatory cytokines in RAW 264.7 macrophages. Yoon, et al. 2010.
Chemical composition and antimicrobial activity of essential oil of Citrus limettioides Tanaka. Vasudeva, et al. 2012.
Study antimicrobial activity of lemon (Citrus lemon L.) peel extract. Dhanavade, et al. 2011.
The Encyclopedia of essential oils: the complete guide to the use of aromatic oils in aromatherapy, herbalism, health, and well being. Lawless. 2013.
Current and potential use of citrus essential oils. Palazzolo, et al. 2013.
Chemical composition of commercial citrus fruit essential oils and evaluation of their antimicrobial activity acting alone or in combined processes. Espina, et al. 2011.
Comprehensive two-dimensional GC for the analysis of citrus essential oils. Mondello, et al. 2005.

Citronella Essential Oil

Citronella Essential Oil is an extract from certain species of Lemongrass (Cymbopogon spp.). 

Citronella Essential Oil is also occasionally used as a topical Naturopathic treatment for some types of skin infections, including acne. Citronella Essential Oil is often diluted and added to face washes and scrubs. Several research studies have reported that Citronella is moderately toxic to acne-causing Propionibacterium acnes bacteria.

The primary components of Citronella Essential Oil are Geraniol and Citral. Both of these molecules have been reported to have some antibacterial properties against the P. acnes bacteria.

Citronella Essential Oil is commonly used in aromatherapy and as a natural mosquito repellant. There are two different kinds of Citronella Essential Oil that are widely available – Java and Ceylon. Citronella Essential Oil and Lemongrass Essential Oil are both produced from species of Lemongrass and can be used interchangeably.

References

Chemical composition and antifungal activity of essential oil from Cymbopogon nardus (citronella grass). Nakahara, et al. 2013.
The effect of lemongrass oil and its major components on clinical isolate mastitis pathogens and their mechanisms of action on Staphylococcus aureus DMST 4745. Aiemsaard, et al. 2011.
Antimicrobial activity of essential oils against five strains of Propionibacterium acnes. Luangnarumitchai, et al. 2007.
The Encyclopedia of essential oils: the complete guide to the use of aromatic oils in aromatherapy, herbalism, health, and well being. Lawless, et al. 2013.
Antibacterial activity of citronella oil solid lipid particles in oleogel against Propionibacterium acnes and its chemical stability. Lertsatitthanakorn, et al. 2008.
Effect of citronella oil on time kill profile, leakage and morphological changes of Propionibacterium acnes. Lertsatitthanakorn, et al. 2010.
In vitro antimicrobial and anti-inflammatory effects of herbs against Propionibacterium acnes. Tsai, et al. 2010.

Cinnamon Essential Oil

Cinnamon is a spice derived from the bark of the Cinnamon tree (Cinnamomum spp.).

Cinnamon is thought to have antibacterial, anti-inflammatory and antioxidant effects. It is widely used in food preparation.

Cinnamon Essential Oil is occasionally used as a Naturopathic treatment for a range of health ailments. Cinnamon Essential Oil is rarely used in the treatment of acne.

Cinnamaldehyde is the main component of Cinnamon Essential Oil and this molecule may be responsible for some of cinnamon’s antibacterial properties. In addition to cinnamaldehyde, Cinnamon Essential Oil also contains significant amounts of Coumarin and 3-Methoxy-1,2-propanediol.

Some individuals with acne have reported that Cinnamon Essential Oil and/or topical treatments that contain ground Cinnamon powder helped to reduce their acne symptoms. Laboratory testing suggests that Cinnamon Essential Oil is moderately toxic to the acne-causing P. acnes bacterium.

Topical facial creams that contain a mixture of ground cinnamon and honey are a popular Naturopathic treatment for acne.

Chamomile Essential Oil

Chamomile Essential Oil is extracted from several species of Chamomile plant. German Chamomile (Matricaria chamomilla) and Roman Chamomile (Chamaemelum nobile) are the two species that are most commonly used to produce essential oil.

Chamomile Essential Oil is used in many Naturopathic skin care remedie. However, the efficacy of Chamomile essential oil as an acne treatment remains uncertain.

Chamomile essential oil contains a number of molecules with antibacterial activity. These molecules may help reduce the growth of acne-causing bacteria, including P. acnes bacteria. The primary family of molecular compounds found Chamomile Essential Oil are called Bisabolols.

In addition to topical preparations, Chamomile tea is very popular and is reported to have anti-anxiety and sleep-inducing properties. Chamomile is also routinely used in Aromatherapy.

Cedarwood Essential Oil

Cedarwood Essential Oil is extracted from the needles and wood of several species of Juniper (Juniperus spp), Cypress (Cupressus spp) and Cedar (Cedrus spp). 

Because Cedarwood Essential Oil is produced from many different sources, the composition and properties of this essential oil are quite variable. Cedarwood Essential Oil is widely used in Aromotherapy and Naturopathic medicine. Cedarwood Essential Oil is rarely used in Naturopathic treatments for acne.

When used for the treatment of acne, Cedarwood Essential Oil is often blended into topical Naturopathic formulations that contain additional essential oils and other active ingredients. Cedarwood Essential Oil is purported to help improve skin tone. It has been claimed that Cedarwood Essential Oil has antibacterial, anti-fungal, astringent, insect repellent and sedative properties.

Cedarwood Essential Oil has also been claimed to improve metabolic and digestive function. However, very few of these claims have been scientifically investigated, so it is difficult to know whether they are true or not. Cedar wood itself is well known to be resistant to microbes and insects, and cedar is widely used to create storage chests for clothing, and other items.

Cedarwood Essential Oil is most commonly produced from about 4 species of conifer: Blue Atlas Cedar (Cedrus atlantica), Himalayan Cedar (Cedrus deodora), Mexican Juniper (Juniperus mexicana) and Red Cedar (Juniperus virginiana). The chemical composition of Cedarwood Essential Oil depends on the source material. Major components of Cedarwood Essential Oil include alpha-Cedrene and Cedrol.

Laboratory testing indicates that Cedarwood Essential Oil tends to be weakly toxic to gram positive bacteria, a group which includes the acne-causing P. acnes bacterium.

References

Computer-aided identification of individual components of essential oils using carbon-13 NMR spectroscopy. Tomi, et al. 1995.
Antimicrobial activity of essential oils and other plant extracts. Hammer, et al. 1999.
Cedar wood oil — Analyses and properties. Adams, et al. 1991.
In vitro antibacterial activity of some plant essential oils. Prabuseenivasan, et al. 2006.
Supercritical carbon dioxide extraction of cedarwood oil: a study of extraction parameters and oil characteristics. Eller, et al. 2007.
The Encyclopedia of essential oils: the complete guide to the use of aromatic oils in aromatherapy, herbalism, health, and well being. Lawless. 2013.

Bergamot Essential Oil

Bergamot Essential Oil is harvested from the rinds of the Bergamot Orange fruit (Citrus bergamia).

Bergamot is widely used for cooking, perfume making and Naturopathic skin treatments. Bergamot Essential Oil is occasionally included in topical Naturopathic acne treatments.

Bergamot Essential Oil is purported to help improve acne symptoms and skin tone when used topically. Unfortunately, there is virtually no clinical research into the use of Bergamot Essential Oil as an acne treatment. Laboratory testing indicates that Bergamot Essential Oil is mildly toxic to some types of gram-positive bacteria, such as the acne-causing P. acnes bacterium. However, these laboratory test results found that many other types of essential oil (eg. Rosemary) had significantly more antibacterial activity than Bergamot Essential Oil.

Bergamot Essential Oil is a complex mixture of many types of molecules. Bergamot Essential Oil contains significant concentrations of Limonene, Linalyl Acetate and Linalool. These, and other compounds found in Bergamot Essential Oil are known to have biological activity. Bergamot Essential Oil can also contains a molecules (eg. Psoralen) that act as photosensitizers. Topical use of Bergamot Essential Oil can increase the sensitivity of the skin to sunlight and UV radiation.

References

The effect of lemon, orange and bergamot essential oils and their components on the survival of Campylobacter jejuni, Escherichia coli O157, Listeria monocytogenes, Bacillus cereus and Staphylococcus aureus in vitro and in food systems. Fisher, et al. 2006.
Effects of Rootstock on the Composition of Bergamot (Citrus bergamia Risso et Poiteau) Essential Oil. Verzera, et al. 2003.
Activities of Ten Essential Oils towards Propionibacterium acnes and PC-3, A-549 and MCF-7 Cancer Cells. Zu, et al. 2010.
Antimicrobial activity of flavonoids extracted from bergamot (Citrus bergamia Risso) peel, a byproduct of the essential oil industry. Mandalari, et al. 2007.
In vitro antimicrobial effects and mechanism of action of selected plant essential oil combinations against four food-related microorganisms. Lv, et al, 2011.

Basil Essential Oil

Basil Essential Oil is extracted from the leaves of several species of Basil (Ocimum spp).

Basil is widely used for culinary purposes and many strains of this plant are cultivated around the world. Basil Essential Oil is also a popular component of many Naturopathic skin care treatments. Basil Essential Oil is occasionally included in topical Naturopathic acne treatments.

Basil has been cultivated for thousands of years and plays an important role in the traditional cuisine of many cultures. Basil Essential Oil has been shown to have a wide range of antimicrobial properties. Laboratory testing indicates that Basil Essential Oil is moderately toxic to many gram-positive bacteria, a group which includes the acne-causing P. acnes bacterium. Basil Essential Oil and other basil extracts are used in some Ayurvedic treatments for skin diseases, including acne.

When used for the treatment of acne, Basil Essential Oil is often blended into topical formulations that contain other essential oils and active ingredients.

Basil Essential Oil has been purported to have anti-inflammatory, antibacterial, antiviral and diuretic properties. Although there are few clinical research studies about the efficacy of Basil Essential Oil for the treatment of acne, the observed antibacterial properties of this essential oil warrant further investigation.

Basil Essential Oil contains significant concentrations of several biologically-active molecules, such as Linalool and Methyl Chavicol.

References

Comparison of extraction methods for the rapid determination of essential oil content and composition of basil. Charles, et al. 1990.
Chemical composition, antioxidant and antimicrobial activities of basil (Ocimum basilicum) essential oils depends on seasonal variations. Hussain, et al. 2008.
Inhibitory effect of thyme and basil essential oils, carvacrol, thymol, estragol, linalool and p-cymene towards Shigella sonnei and S. flexneri. Bagamboula, et al. 2004.
Analysis of the essential oils of two cultivated basil (Ocimum basilicum L.) from Iran. Sajjadi, et al. 2006.
Composition and antimicrobial activity of essential oils from aromatic plants used in Brazil. Sartoratto, et al. 2004.
Evaluation of in vitro antimicrobial activity of Thai basil oils and their micro-emulsion formulas against Propionibacterium acnes. Viyoch, et al. 2006.
In vitro bioactivities of essential oils used for acne control. Lertsatitthanakorn, et al. 2006.
Antibacterial and antifungal properties of essential oils. Kalemba, et al. 2003.
Antimicrobial activity of essential oils against five strains of Propionibacterium acnes. Luangnarumitchai, et al. 2007.

Trimethoprim

Trimethoprim (TMP) is an antibiotic that is used to treat certain types of urinary tract, ear and intestinal infections that are caused by bacteria. It is is commonly included in combination antibiotics with Sulfamtheoxazole, Dapsone and other Sulfonamide antibiotics.

Trimethoprim inhibits the ability of bacteria to synthesize vitamin B9 (Folate) by a mechanism that complements the antibacterial activity of Sulfonamide antibiotics.

Trimethoprim is occasionally used alone as a treatment for acne. There is limited clinical research into the efficacy of Trimethoprim alone as an acne treatment, but some acne patients have reported positive results with this medication.

Laboratory testing indicates that the acne-causing P. acnes bacterium tends to be moderately susceptible to Trimethoprim, but Trimethoprim-resistant P. acnes are becoming more common in some places.

The combination of Trimethoprim plus Sulfamethoxazole (CoTrimoxazole) is a more common and effective acne treatment. Oral Cotrimoxazole can be a very effective treatment for some individuals with moderate to severe inflammatory acne symptoms. CoTrimoxazole is a popular choice for acne patients who have not responded to other types of antibiotics (eg. Doxycycline, Minocycline, Erythromycin).

Tobramycin

Tobramycin (Tobrex) is an antibiotic in the Aminoglycoside family. It is used topically to treat certain kinds of bacterial infections of the skin and eye.

Tobramycin is rarely used as a treatment for acne. Tobramycin has minimal activity against most gram-positive bacteria, a group which includes the acne-causing P. acnes bacterium. Laboratory testing has consistently confirmed that P. acnes bacteria are highly resistant to members of the Aminoglycoside antibiotic family. It is unlikely that Tobramycin will be an effective treatment for most individuals with acne.

Thiamphenicol

Thiamphenicol (Biothicol) is an antibiotic in the Amphenicol family. It is primarily used to treat certain types of urinary tract and sexually transmitted bacterial infections.

Thiamphenicol is rarely used for the treatment of acne. Thiamphenicol is not approved for human use in all countries, but it is widely used in other countries.

Laboratory testing indicates that acne-causing Propionibacterium acnes bacteria are moderately susceptible to Thiamphenicol, as well as it’s closely-related cousin Chloramphenicol. High-level antibiotic resistance to to Thiamphenicol among P. acnes bacteria is rare. There is also a small amount of clinical research that suggests Thiamphenicol can be an effective treatment for individuals with moderate to severe acne.

Additional research and patient reports are needed to determine the best role (if any) of Thiamphenicol in acne treatment regimens.

Tetracycline

Tetracycline is a broad spectrum antibiotic in the Tetracycline family. It is used to treat many different kinds of bacterial infections, including those of the respiratory tract, urinary tract and skin.

Tetracycline was once a popular acne treatment, but it has largely been replaced by two closely related antibiotics – Doxycycline and Minocycline. Tetracycline is available in oral and topical formulations, both of which are used as acne treatments.

Tetracycline can be an effective acne treatment, but tetracycline-resistant P. acnes bacteria are becoming common in many regions of the world. Some acne patients find that Tetracycline significantly improves their acne symptoms. But many other patients (particularly those from the United States and Europe) find that antibiotics in the Tetracycline family are ineffective treatments for controlling their acne symptoms.

Telithromycin

Telithromycin (Ketek) is an antibiotic in the Macrolide family. It is primarily used to treat certain types of bacterial respiratory infections.

Telithromycin is rarely used as a treatment for acne symptoms. There have been some safety concerns about the effect that this antibiotic has on the liver. The use of this medication in the United States was curtailed in 2007, and it is not widely used and may not be available in all countries.

Tedizolid

Tedizolid (Sivextro) is an antibiotic in the Oxazolidinone family. It is primarily used for the treatment of certain types of bacterial skin infections. Tedolizid is a relatively new antibiotic that is not yet widely used and may not be available in all countries.

Tedolizid is rarely used as a treatment for acne. There is very little clinical research or laboratory testing on the effectiveness of Tedolizid for the treatment of acne. It is not currently marketed as an acne treatment. However, laboratory testing has shown that Tedizolid does have activity against many gram-positive bacteria, a group that includes the acne-causing P. acnes bacterium.

Tedizolid is an antibiotic that warrants further investigation into its utility as an acne treatment. Because this medication is not available in generic form, it will likely be substantially more expensive than many alternative antibiotics.

Sulfathiazole

Sulfathiazole (Sulfatiazol) is an antibiotic in the Sulfonamide family. It is used as a topical antibacterial to prevent and treat bacterial infections of the skin.

Sulfathiazole is occasionally used as a topical treatment for acne. This medication is often combined with other antibiotics (eg. Penicillin, Trimethoprim) in topical antibacterial ointments.

There is limited clinical or laboratory research into the effectiveness of Sulfathiazole for the treatment of acne symptoms. However, laboratory testing does indicate that the acne-causing P. acnes bacterium tends to moderately susceptible to antibiotics in the Sulfonamide family, such as Sulfathiazole.

Topical ointments that combine Sulfathiazole with a complementary antibiotic (eg. Penicillin G) are more likely to be effective at improving acne symptoms than Sulfathiazole alone. Topical Sulfathiazole may better control acne symptoms when be combined with complementary therapies.

A very old medical report (1951) suggested that direct injection of a Sulfathiazole solution into inflammatory acne cysts was an effective treatment, but this approach has not been widely practiced. Other members of the Sulfonamide family (eg. Dapsone, Silver Sulfadiazine, Sulfacetamide) are more commonly used as topical treatments for acne.

Sulfamethoxazole

Sulfamethoxazole (SMX) is an antibiotic in the Sulfonamide family. It is used to treat certain types of respiratory tract, urinary tract and skin infections that are caused by bacteria. Sulfamethoxazole is rarely used alone. It is primarily available in combination with another antibiotic called Trimethoprim. This combination is called Co-Trimoxazole, and it is a very common antibiotic.

Sulfamethoxazole is rarely used by itself as a treatment for acne. However, Co-Trimoxazole is a popular treatment for moderate to severe acne symptoms. Both clinical research and laboratory testing indicates that Co-Trimoxazole can be an excellent acne treatment, particularly for individuals with inflammatory acne symptoms.

Laboratory testing has indicated that the acne-causing P. acnes bacteria is moderately susceptible to Sulfamethoxazole. P. acnes bacteria are also moderately susceptible to Trimethoprim. These two antibiotics are synergistic, and the combination is substantially more toxic to P. acnes bacteria.

Sulfafurazole

Sulfafurazole is an antibiotic in the Sulfonamide family. It is a short-lived antibiotic that is active against certain types of gram-positive and gram-negative bacteria. This medication is not available in all countries and it is not a commonly used medication.

Sulfisoxazole is rarely used to treat acne. For the treatment of active acne symptoms, other Sulfonamide family antibiotic (eg. Sulfamethoxazole, Dapsone, Silver Sulfadiazine) are much more commonly used.

Sulfadoxine

Sulfadoxine (Sulphadoxine) is an antibiotic in the Sulfonamide family. It is primarily used in combination with Pyrimethamine for the treatment of malaria.

Sulfadoxine is rarely used as a treatment for acne. There is minimal clinical research or laboratory testing on the utility of Sulfadoxine as an acne treatment. Laboratory testing indicates that the acne-causing P. acnes bacterium is tends to be moderately sensitive to Sulfonamide family antibiotics, such as Sulfadoxine.

For the treatment of active acne symptoms, other Sulfonamide family antibiotics (eg. Sulfamethoxazole, Dapsone. Sulfadiazine) are more commonly prescribed.

Sulfadimethoxine

Sulfadimethoxine (Albon) is an antibiotic in the Sulfonamide family. It is primarily used in veterinary medicine, but it is approved for human use in several countries (eg. Russia).

Sulfadimethoxine is rarely used as an acne treatment. For the treatment of active acne symptoms, other oral Sulfonamide antibiotics (eg. Sulfamethoxazole) are far more commonly prescribed. Sulfadimethoxazole is primarily available in oral formulations.

Clinical research on this medication as an acne treatment is limited. But the research that does exist indicates that Sulfadimethoxine is a partially effective treatment for patients with moderate to severe acne vulgaris. However, this research also found that Tetracycline and Erythromycin were substantially more effective than Sulfadimethoxine.

Sulfacetamide

Sulfacetamide is a topical antibiotic in the Sulfonamide family. It is used to topically to treat certain types of skin infections, including acne. Sulfacetamide is available in topical formulation by itself or in combination with Sulfur.

Sulfacetamide is commonly used to treat acne symptoms and it is marketed directly for this purpose. Research and patient reports indicate that Sulfacetamide is effective for some patients, particularly those with mild to moderate acne symptoms. Laboratory antibiotic susceptibility testing indicates that that the acne-causing P. acnes bacterium tends to be moderately susceptible to Sulfonamide family antibiotics, such as Sulfacetamide.

Spiramycin

Spiramycin (Spirex) is an antibiotic in the Macrolide family. It has both antibacterial and antiparasitic properties. Spiramycin is used to treat a limited range of infections, and this medication is not available in all countries.

Spiramycin is rarely used as a treatment for acne. There is minimal clinical research into the efficacy of Spiramycin as an acne treatment. Other members of the Macrolide family (eg. Erythromycin, Azithromycin, etc) are more widely available and commonly used. Laboratory testing indicates that the acne-causing P. acnes bacteria is less susceptible to Spiramycin than to other Macrolide family antibiotics.

Sparfloxacin

Sparfloxacin (Zospar) is an antibiotic in the Quinolone family. It is used to treat certain types of bacterial infections of the respiratory tract, urinary tract and skin.

Sparfloxacin is rarely used as a treatment for acne. There is minimal clinical research into the efficacy of Sparfloxacin as a treatment for active acne symptoms. However, laboratory testing does suggest that Sparfloxacin has certain properties that could make it a uniquely effective acne treatment.

Antibiotic susceptibility testing indicates that the acne-causing P. acnes bacterium is highly sensitive to Sparfloxacin. In addition, Sparfloxacin is absorbed by certain types of white blood cells, which may help the immune system better control the growth of acne-causing bacteria. Lastly, Sparfloxacin has been shown to accumulate in the skin following oral administration.

More research is needed on the utility of Sparfloxacin for the treatment of acne, but it is an antibiotic that deserves further investigation.

Sparfloxacin is only available in oral formulations and this medication is not available in all countries (eg. United States).

Silver Sulfadiazine

Silver Sulfadiazine (Silvadene) is an antibiotic in the Sulfonamide family. Silver Sulfadiazine also contains ionic silver, which has antibacterial properties. Silver Sulfadiazine is used to treat certain types of bacterial skin infections, and is commonly used to prevent secondary infections in burn patients.

Silver Sulfadiazine is occasionally used as a topical treatment for acne. Although there is minimal clinical research on the efficacy of Silver Sulfadiazine for the treatment of acne, some patients have reported that this medication helped improve their acne symptoms.

Antibiotic susceptibility testing indicates that the acne-causing P. acnes bacterium tends to be moderately susceptible to Sulfonamide antibiotics, including Sulfadiazine. Silver Sulfadiazine is likely to be most effective when combined with complementary systemic or topical acne treatments. Silver Sulfadiazine is a medication that deserves further investigation into its utility as an acne treatment.

Roxithromycin

Roxithromycin (Roxicin) is an antibiotic in the Macrolide family. It is used to treat certain types of respiratory, urinary and soft tissue infections that are caused by susceptible bacteria.

Roxithromycin is occasionally used to treat acne. Clinical research has indicated that Roxithromycin (and other Macrolide family antibiotics) can be effective acne treatments. Roxithromycin may be particularly helpful for the treatment of acne because this antibiotic can accumulate inside of certain types of white blood cells. This accumulation may help the immune system better control the growth of the acne-causing P. acnes bacterium. This accumulation may also help limit the inflammation that causes acne symptoms such as pimples, nodules, cysts and scars.

Laboratory testing has demonstrated that Macrolide family antibiotics, including Roxithromycin, are active against P. acnes bacteria. However, P. acnes bacteria that are highly resistant to Macrolide family antibiotics are becoming increasingly common in many places in the world. Patients with acne infections caused by these resistant bacteria are less likely to see a benefit from antibiotic therapy with Roxithromycin, and other Macrolides.

Roxithromycin is not available in all countries (eg. United States).

Rifapentine

Rifapentine (Priftin) is an antibiotic in the Rifamycin family. It is an important component of the combination antibiotic therapy used to treat tuberculosis, and other mycobacterial infections.

Rifapentine is not generally used in the treatment of acne. Laboratory testing indicates that the acne-causing Propionibacterium acnes bacterium is highly sensitive to Rifamycin family antibiotics, including Rifapentine.

Rifapentine and other Rifamycin family antibiotics may be useful components of comprehensive treatment regimens for people with severe acne symptoms. Additional clinical research and patient reports are needed to evaluate the utility of this family of antibiotics for the treatment of acne.

Rifampicin

Rifampicin (Rifampin) is an antibiotic in the Rifamycin family. It is an important component of the combination antibiotic therapy used to treat tuberculosis. Rifampicin is used to treat several types of infections, particularly those that are caused by anaerobic gram-positive bacteria, which is a group of bacteria that includes the acne-causing Propionibacterium acnes bacterium.

Rifampicin is occasionally used to treat certain types of severe acne. Laboratory testing indicates that P. acnes bacteria are very sensitive to Rifamycin family antibiotics, including Rifampicin. There is also some clinical research that suggests Rifampicin can be helpful for patients with moderate to severe acne symptoms.

Rifampicin and other Rifamycin family antibiotics may be useful components of comprehensive treatment regimens for people with severe acne symptoms. Additional clinical research and patient reports are needed to evaluate the utility of this family of antibiotics for the treatment of acne.

Rifampicin can inhibit the activity of hormonal birth control. Sexually active women of child-bearing age should take additional precautions to prevent pregnancy while taking this medication. Rifampicin is very inexpensive in many parts of the world, but the monthly cost can be quite high in certain countries (eg. United States).

Rifabutin

Rifabutin (Mycobutin) is an antibiotic in the Rifamycin family. It is primarily used in the treatment of mycobacterial infections (eg. tuberculosis).

Rifabutin is rarely used for the treatment of acne and their is very little clinical research into the efficacy of Rifabutin as an acne treatment.

Rifabutin is active against many gram-positive bacteria, including the acne-causing Propionibacterium acnes. Laboratory testing indicates that P. acnes bacteria are very sensitive to Rifamycin family antibiotics, including Rifabutin.

Rifamycin family antibiotics may be useful components of acne treatment regimens, particularly for individuals with moderate to severe acne symptoms. But more clinical research and patient reports are needed to evaluate the utility of this family of antibiotics for the treatment of acne.

Retapamulin

Retapamulin is a an antibiotic in the Pleuromutilin family. It is used as a topical treatment for certain kinds of skin bacterial infections, including acne.

Retapamulin is a relatively new antibiotic that is quickly becoming a popular treatment for acne. In laboratory testing, Retapamulin has shown excellent antibacterial activity against the acne-causing P. acnes bacterium. Research and patient reports also suggest that Retapamulin can be an effective acne treatment, particularly when combined with complementary therapies (eg. Oral Antibiotics, Retinoids, Light and Laser Therapies, etc).

Retapamulin is still under patent protection and this antibiotic can be substantially more expensive than many other topical acne treatments. It may not be available in all regions.

Pristinamycin

Pristinamycin (Pyostacine) is an antibiotic that is used to treat certain types of infections caused by gram-positive bacteria (eg. Staph infections). Pristinamycin is a natural combination of two complementary antibiotics – Pristinamycin IA an Pristinamycin IIA. Pristinamycin IA is a cyclic hexadepsipeptide antibiotic, and Pristinamycin IIA is in the Macrolide family of antibiotics.

Pristinamycin is rarely used as an acne treatment, but laboratory testing indicates that the acne-causing P. acnes bacterium is susceptible to Pristinamycin. Pristinamycin is occasionally used to treat non-acne infections that are caused by P. acnes bacteria.

Pristinamycin is only available in a few countries. But in countries where it is available, Pristinamycin is an antibiotic that warrants further investigation as an acne treatment.

Penicillin V

Penicillin V (Phenoxymethylpenicillin) is an antibiotic in the Penicillin family. Penicillin V is used to treat many different types of bacterial infections. This antibiotic is primarily active against gram-positive bacteria, which includes the acne-causing Propionibacterium acnes bacterium.

Penicillin V is available in topical and oral formulations. Penicillin V is occasionally used as an oral antibiotic for the treatment of acne. For topical use, the closely-related Penicillin G is more commonly prescribed.

Penicillin V and Penicillin G are notable because they consistently score very well in laboratory testing of antibiotic susceptibility of the P. acnes bacterium. These antibiotics kill P. acnes bacteria at very low concentrations, and Penicillin-resistant P. acnes bacteria are very uncommon.

Clinical research and patient reports have indicated that oral treatment with Penicillin family antibiotics (eg. Amoxicillin, Ampicillin, Penicillin V) is effective at improving acne symptoms for many patients. The topical use of Penicillin also appears to be a useful acne treatment.

Penicillin G

Penicillin G (Benzylpenicillin) is an antibiotic in the Penicillin family. Penicillin G is used to treat a wide range of bacterial infections. This antibiotic is primarily active against gram-positive bacteria, which includes the acne-causing P. acnes bacterium.

Penicillin G is occasionally used in the treatment of acne, usually as a topical treatment. For oral antibiotic treatment, Penicillin V (which is closely related to Penicillin G) is much more popular than Penicillin G because it is more stable in the digestive tract.

Penicillin G and Penicillin V are notable because they consistently score very well in laboratory testing of antibiotic susceptibility of the P. acnes bacterium. These antibiotics kill P. acnes bacteria at very low concentrations, and Penicillin-resistant P. acnes bacteria are very uncommon. Clinical research and patient reports have indicated that oral treatment with Penicillin family antibiotics (eg. Amoxicillin, Ampicillin, Penicillin V) can be very effective at improving acne symptoms for many patients.

Topical Penicillin G appears to be a useful treatment for acne. Creams and ointments that contain Penicillin G are available Over The Counter (OTC) in many countries. Penicillin-containing ointments are especially popular in Central and South America. Several of these ointments combine Penicillin G with a complementary antibiotic from a different antibiotic family (eg. Sulfonamide).

Clinical research on the use of these Penicillin G combination ointments for acne treatment is currently limited. But patient reports and laboratory antibiotic susceptibility testing both suggest that some of these combination ointments (eg. Penicillin plus Sulfathiazole) may be uniquely effective acne treatments. More research is needed, but this subset of topical antibiotic treatments clearly warrants greater interest from the acne community.

Paromomycin

Paromomycin (Gabbroral) is an antibiotic in the Aminoglycoside family. It is used to a limited subset of skin and digestive tract infections.

Paromomycin is available in topical and oral formulations. Topical Paromomycin is rarely used as an acne treatment, and it is only available in some countries. Oral Paromomycin is never used as an acne treatment because this medication is not absorbed into the bloodstream from the digestive tract.

Laboratory testing has demonstrated that the acne-causing P. acnes bacteria is naturally resistant to Aminoglycoside family antibiotics, including Paromomycin.

Oxytetracycline

Oxytetracycline is an antibiotic in the Tetracycline family. It is a broad-spectrum antibiotic that is used to treat a range of bacterial infections, including those of the respiratory tract, urinary tract and skin.

Oxytetracycline was a very common acne treatment in the 20th century. Oxytetracycline is still occasionally used as an acne treatment, but other Tetracycline family antibiotics (eg. Minocycline, Doxycycline) are increasingly used for this purpose. Oxytetracycline is available in oral and topical formulations.

Clinical studies have reported that Oxytetracycline can be a very effective treatment for some patients with moderate to severe acne symptoms. Unfortunately, acne-causing P. acnes bacteria that are resistant to Oxytetracycline (and other Tetracycline family antibiotics) are becoming increasingly common in many places around the world. In head-to-head testing, the newer generation of Tetracycline antibiotics (eg. Minocycline, Doxycycline) tend to be more effective at killing P. acnes bacteria and controlling acne symptoms than the older Tetracycline antibiotics, such as Oxytetracycline. However, this may vary from region to region.

Ofloxacin

Ofloxacin (Floxin) is an antibiotic in the Quinolone family. Ofloxacin is a mixture of two closely related molecules, Levofloxacin and Dextrofloxacin. Levofloxacin provides the majority of the antibacterial activity of Oflaxcin. The use of Oflaxcin has declined in recent years as a pure Levofloxacin (Levaquin) has become more widely available.

Ofloxacin is rarely used to treat active acne. There is little clinical research about the efficacy of Ofloxacin as a treatment for acne. However, laboratory antibiotic susceptibility testing indicates that the acne-causing P. acnes bacterium is generally sensitive to Quinolone family antibiotics, including Ofloxacin.

Ofloxacin is available in oral and topical formulations. For the treatment of acne, other Quinolone family antibiotics (eg. Levofloxacin, Moxifloxacin, Ciprofloxacin) are generally preferred over Ofloxacin.

Topical Ofloxacin may be useful as an acne treatment. But laboratory and clinical research suggest that other topically-applied Quinolones (eg. Nadifloxacin) may be better suited for use in treating acne.

Norfloxacin

Norfloxacin (Norflox) is an antibiotic in the Quinolone family. It is a broad spectrum antibiotic that is used to treat certain types of respiratory, urinary tract and sexually transmitted bacterial infections.

Norfloxacin is rarely used as an acne treatment, and there is little clinical research into the effectiveness of Norfloxacin for improving acne symptoms. Other Quinolone family antibiotics (eg. Ciprofloxacin, Nadifloxacin) are more commonly used in acne treatments.

Laboratory antibiotic susceptibility testing has indicated that more strains of P. acnes bacteria are resistant to Norfloxacin, than other comparable Quinolone antibiotics. When a strain of P. acnes is susceptible to Norfloxacin, sensitivity to this antibiotic tends to be similar to that of Ciprofloxacin.

Norfloxacin has been reported to have a higher rate of adverse events compared to other members of the Quinolone antibiotic family. Because of this, and the fact that there is little evidence that Norfloxacin is significantly better than alternative antibiotics, the use of Norfloxacin is fairly limited in many regions.

Norfloxacin is generally used as an oral antibiotic, but topical formulations are available in some regions.

Nitrofurantoin

Nitrofurantoin (Macrodantin) is an antibiotic that is used to treat certain kinds of bacterial infections, primarily urinary tract infections. Nitrofurantoin is not a commonly used antibiotic, but the increasing incidence of antibiotic-resistant bacteria has generated renewed interest in this medication.

Nitrofurantoin is rarely used as a treatment for acne. There is very little clinical or laboratory research into the effectiveness of Nitrofurantoin as a treatment for active acne symptoms, or into the sensitivity of the acne-causing P. acnes bacterium to this antibiotic. However, laboratory testing does indicate that gram-positive bacteria, a group which includes P. acnes, tend to be susceptible to Nitrofurantoin.

Additional clinical testing and patient surveys will be required to evaluate the utility of Nitrofurantoin as a component of acne treatment regimens.

Neosporin

Neosporin is a topical antibiotic ointment that is a combination of three medications – Neomycin, Polymyxin B and Bacitracin. Neopsporin is a very popular Over The Counter (OTC) topical antibacterial treatment for minor skin injuries and infections.

P. acnes bacterium has some natural resistance to each of the antibiotics included in Neosporin.

Neomycin

Neomycin is an antibiotic in the Aminoglycoside family. It is primarily available as a topical ointment and is used to treat certain types of skin infections. Neomycin is often combined with other antibiotics into combination topical ointments (eg. Neosporin) that are used in first aid skin care.

Topical Neomycin ointment is rarely used as a treatment for acne. Many gram-positive bacteria, including the acne-causing P. acnes bacterium, are naturally resistant to Neomycin and other Aminoglycoside family antibiotics. There is limited clinical research into the effectiveness of topical Neomycin as a treatment for active acne.

Neomycin-containing topical ointments, such as Neosporin, are most commonly used to prevent infection and accelerate healing after draining an acne lesion (popping/lancing a pimple).

Nalidixic Acid

Nalidixic Acid (Wintomylon) is an antibiotic in the Quinolone family. It is primarily used to treat certain infections caused by gram-negative bacteria.

Nalidixic Acidis rarely used as an acne treatment. Nalidixic Acid has weak antibacterial against most gram-positive bacteria, which includes the acne-causing P. acnes bacterium. Laboratory testing indicates that many strains of P. acnes bacteria are highly resistant to Nalidixic Acid. There is little clinical research and few patient reports about the efficacy of Nalidixic Acid as a treatment for acne.

Nadifloxacin

Nadifloxacin (Nadixa) is a topical antibiotic in the Quinolone family. Nadifloxacin is used to treat certain types of bacterial skin infections.

Nadifloxacin is occassionally used for the treatment of acne. Clinical research and patient reports suggest that Nadifloxacin can be a very useful acne treatment, particularly when combined with complementary therapies. Laboratory antibiotic susceptibility testing indicates that the acne-causing P. acnes bacterium tends to be sensitive to Nadifloxacin.

Nadifloxacin< is not approved for use in all countries (eg. United States). But Nadifloxacin is an exciting new topical treatment for acne that is likely to become more commonly used for acne patients.

Mupirocin

Mupirocin is a topical antibiotic that is used to treat certain types of bacterial skin infections, including acne.

The use of Mupirocin for the treatment of acne is somewhat controversial. Many individuals have reported that using Mupirocin helped improve their acne symptoms. However, laboratory antibiotic susceptibility testing has shown that many strains of the acne-causing P. acnes bacterium are naturally resistant to Mupirocin. Because of this natural resistance, Mupriocin is frequently ineffective as an acne treatment.

Mupirocin is also used to treat a variety of skin infections that are caused by gram-positive bacteria, including methicillin resistant S. aureus (MRSA). The activity of Mupirocin against other types of bacteria than P. acnes, may explain some of the benefit that certain patients have reported.

Moxifloxacin

Moxifloxacin (Avelox) is a broad-spectrum antibiotic in the Quinolone family. Moxifloxacin is used to treat a variety of bacterial infections. It is widely available in oral and topical (opthalmic) formulations.

Moxifloxacin is rarely used as a treatment for acne. But there is some evidence to suggest that Moxifloxacin can be a useful acne treatment. Laboratory testing indicates that the acne-causing P. acnes bacterium is moderately more susceptible to Moxifloxacin than Ciprofloxacin, which is a more commonly used antibiotic in the Quinolone family.

Minocycline

Minocycline (Minocin) is a broad spectrum antibiotic in the Tetracycline family. It is used to treat a wide range of bacterial infections, including Lyme disease and acne.

Minocycline is one of the most commonly prescribed oral antibiotics for the treatment of acne symptoms. There is a large amount of clinical research and numerous patient reports that demonstrate Minocycline can significantly improve acne symptoms for many individuals. However, Minocycline is not an effective acne treatment for all people.

Laboratory antibiotic susceptibility testing indicates that the acne-causing P. acnes bacteria is generally very sensitive to Minocycline. However, Minocycline-resistant P. acnes bacteria are becoming common in many regions of the world. This problem is particularly widespread in Europe and North America. Patients with acne caused by these resistant bacteria are unlikely to benefit from treatment with Minocycline, or other Tetracycline family antibiotics (eg. Doxycycline).

Minocycline tends to be a little more effective at improving acne symptoms than Doxycycline and Tetracycline. However, the risk of side effects when using Minocycline is a little higher than with Doxycycline.

Metronidazole

Metronidazole (Flagyl) is an antibiotic and antiparasitic medication. It can be used both topically and orally to treat certain types of infection.

Metronidazole is occassionally used as a treatment for acne. Metronidazole is usually applied topically when used for the treatment of acne symptoms.

Metronidazole has been reported by some patients to improve their acne symptoms. But the use of Metronidazole as an acne treatment is somewhat controversial. On one hand, several clinical studies have reported that topical Metronidazole is an effective treatment for acne, especially a specific type of acne – Acne Rosacea. On the other hand, laboratory testing has consistently indicated that the acne-causing P. acnes bacteria is naturally resistant to Metronidazole.

Continued clinical investigation and patient surveys will be required to determine the utility of Metronidazole for the treatment of acne.

Mafenide

Mafenide is an antibiotic in the Sulfonamide family. Mafenide is a topical antibiotic that is used to treat certain kinds of skin infections. It is commonly used to treat burn injuries and prevent secondary infections.

Mafenide is rarely used as an acne treatment. However, there have been some patient reports that suggest that Mafenide can be a useful treatment for people with mild to moderate acne symptoms. Laboratory testing indicates that the acne-causing P. acnes bacterium tends to be moderately sensitive to Sulfonamide family antibiotics, such as Mafenide.

Topical Mafenide may be most effective when combined with a complementary treatment as part of a comprehensive acne treatment plan.

Lymecycline

Lymecycline (Tetralysal) is an antibiotic in the Tetracycline family. It is used to treat certain types of respiratory, skin and sexually-transmitted bacterial infections.

Lymecycline is occasionally used as an acne treatment, but is a less common treatment for acne than other Tetracycline family antibiotics (eg. Minocycline, Doxycycline). Lymecycline is administered orally when used as an acne treatment.

Lymecycline can be an effective treatment for mild to severe acne symptoms in some patients. Clinical testing has indicated that the efficacy of Lymecycline as an acne treatment is comparable to that of Minocycline. Unfortunately, acne-causing P. acnes bacteria that are broadly resistant to Tetracycline family antibiotics (including Lymecycline) are becoming common in many regions of the world. Because the increase in tetracycline-resistant P. acnes bacteria, this family of antibiotics is ineffective for many patients.

Linezolid

Linezolid (Zyvox) is an antibiotic in the Oxazolidinone family. Linezolid is used to treat certain types of skin and respiratory infections. It has antibacterial activity against many Gram-positive bacteria, including the acne-causing P. acnes bacterium.

Linezolid is rarely used as a treatment for acne. Linezolid is only recommended for short-term use, long-term use of Linezolid can cause significant side effects. Therefore, the utility of Linezolid as an acne treatment would be limited to short-term use for the purpose of treating acute cases of severe inflammatory acne.

Linezolid is a relatively new antibiotic that was approved by the FDA (United States) in 2000. In many countries where generic Linezolid is not available (eg. United States) this medication can be very expensive.

Levofloxacin

Levofloxacin (Levoflox) is an antibiotic in the Quinolone family. It is used to treat a range of bacterial infections, including respiratory, eye and urinary tract infections.

Levofloxacin is rarely used as an acne treatment. However, laboratory testing indicates that the acne-causing P. acnes bacterium is generally susceptible to this antibiotic. Several studies have indicated that oral Levofloxacin may be more effective at controlling acne symptoms than other members of the Quinolone antibiotic family (eg. Ciprofloxacin).

Levofloxacin is available in oral and topical formulations. Oral Levofloxacin is a more commonly used as an acne treatment than topical Levofloxacin. Topical Levofloxacin is generally available as an opthalmic ointment, but these medications can be applied directly to the skin.

Josamycin

Josamycin (Josaxin) is an antibiotic in the Macrolide family. It is used to treat certain types of bacterial infection, particularly those caused by anaerobic bacteria.

Josamycin is rarely used as an acne treatment. Laboratory testing indicates that the acne-causing P. acnes is moderately susceptible to this antibiotic. Additionally, Josamycin may retain antibacterial activity against some P. acnes bacteria that are resistant to other Macrolide antibiotics (eg. Erythromycin).

Josamycin has a moderately short half-life and is often taken multiple times a day. This drug is not recommended for people with liver problems. Josamycin is not approved for human use in all countries.

Isoniazid

Isoniazid (isonicotinylhydrazide) is an antibiotic that is part of the standard antibiotic regimen for treating tuberculosis infections.

Isoniazid is an antibiotic that is only active against a certain type of bacteria (Mycobacteria). Isoniazid is not used as a treatment for acne. In fact, Isoniazid use has been reported to increase acne symptoms in some patients.

Gramicidin

Gramicidin is a topical antibiotic that is used to treat certain skin infections that are caused by gram-positive bacteria. Gramicidin is commonly included with other antibiotics in combination antibacterial ointments for topical use.

Gramicidin is a mixture of several closely related antibacterial molecules, Gramicidin A, Gramicidin B and Gramicidin C.

Gramicidin containing ointments are occasionally used as topical treatments for acne symptoms. The acne-causing P. acnes bacterium appears to have some natural resistance to this antibiotic. It is also unclear whether topically applied Gramicidin penetrates the skin and reaches the sebaceous glands in significant concentrations.

Topical Gramicidin ointments are more likely to be effective at preventing secondary infections after acne lesions have been “popped” or drained, and these antibiotics may accelerate healing time and help prevent some scarring.

Gentamicin

Gentamicin (Garamycin) is an antibiotic in the Aminoglycoside family. Topical Gentamicin is used to treat certain skin infections that are caused by gram-negative bacteria.

Topical Gentamicin is rarely used as an acne treatment. This is largely due to the fact that the acne-causing P. acnes bacterium is naturally resistant to most Aminoglycoside antibiotics, including Gentamicin.

Gemifloxacin

Gemifloxacin (G-Cin) is a broad spectrum antibiotic in the Quinolone family. Gemifloxacin is used to treat certain types of bacterial respiratory infections.

Gemifloxacin is rarely used as an acne treatment, and there is minimal evidence regarding its efficacy for this purpose. Laboratory research indicates that the acne-causing P. acnes bacteria is moderately susceptible to Quinolone family antibiotics, including Gemifloxacin.

Gatifloxacin

Gatifloxacin (Tequin) is an antibiotic in the Quinolone family. Gatifloxacin is used to treat certain types of respiratory and eye infections.

Gatifloxacin is rarely used as a treatment for acne and there is limited evidence regarding its efficacy as an acne treatment. Other Quinolone family antibiotics are more commonly used in acne treatment regimens. Gatifloxacin is available in oral and topical formulations. The topical formulations are generally designed for opthalmic use, but Gatifloxacin ointments could be applied directly to the skin.

Gatifloxacin is associated with more frequent severe side effects than many other comparable antibiotics. Because of the elevated risk of side effects, Gatifloxacin is no longer available in many countries.

Fusidic Acid

Fusidic Acid (Fucidin) is an antibiotic that is primarily used to treat bacterial skin infections. It is a unique antibiotic that works by preventing susceptible bacteria from synthesizing new proteins.

Fusidic Acid has recently gained renewed interest as a treatment for acne. Topical Fusidic Acid has become a popular treatment for individuals with mild to moderate acne symptoms (Acne Types: 1-3). Fusidic Acid is also available in oral formulations, but these are rarely used as acne treatments.

Clinical research and patient reports suggest that topical Fusidic Acid can be an effective treatment for many people. Laboratory testing indicates that the acne-causing P. acnes bacterium tends to be moderately susceptible to Fusidic Acid. P. acnes bacteria that are highly resistant to Fusidic Acid appear to be rare in most places.

Topical Fusidic Acid is often combined with other therapies as part of a comprehensive acne treatment plan, especially for patients more serious cases of acne.

Fosfomycin

Fosfomycin (Munorol) is a broad-spectrum antibiotic that is used to treat certain urinary tract and respiratory infections. Fosfomycin works by inhibiting the development of bacterial cell walls.

Fosfomycin is rarely used for the treatment of acne, and laboratory testing indicates that the acne-causing P. acnes bacterium is naturally resistant to this antibiotic.

Flucloxacillin

Flucloxacillin (Floxapen) is an antibiotic in the Penicillin family. Flucloxacillin is a narrow-spectrum antibiotic that is used to treat a subset of respiratory, skin and other bacterial infections.

Flucloxacillin is rarely used to treat acne. Laboratory research indicates that the acne-causing P. acnes bacterium is susceptible to Penicillin family antibiotics, including Flucloxacillin. But there is little clinical research into the efficacy of Flucloxacillin as a treatment for acne.

Flucloxacillin is not currently available in all countries.

Finafloxacin

Finafloxacin (Xtoro) is an antibiotic in the Quinolone family. It was recently approved for use in the United States for the treatment of bacterial ear infections.

Finafloxacin is not currently used for the treatment of acne, but the acne-causing P. acnes bacterium is likely to be sensitive to this antibiotic. For treating acne, other members of the Quinolone family (eg. Nadifloxacin, Ciproflocaxin) are more commonly used.

Erythromycin

Erythromycin is an antibiotic in the Macrolide Family. It is a widely used antibiotic that can be applied topically or ingested orally. Erythromycin is used to treat many types of bacterial infections, including those of the respiratory tract, urinary tract and skin.

Erythromycin is commonly used for the treatment of acne symptoms. Topical erythromycin is a popular choice for treating mild to moderate acne symptoms (Acne Types: 1-3). Oral Erythromycin is occasionally used as an acne treatment, but other Macrolide family antibiotics are often preferred for oral use because they tend to have fewer side effects.

Many clinical research and patient reports have shows Erythromycin can be an effective treatment for many individuals with acne. Antibiotic susceptibility testing indicates that the acne-causing P. acnes bacterium is generally sensitive to Macrolide family antibiotics, including Erythromycin. However, P. acnes bacteria that are resistant to Erythromycin and other Macrolide antibiotics are becoming common in many regions of the world. Individuals with acne symptoms caused by these resistant bacteria are not likely to benefit from treatment with Erythromycin.

Erythromycin is often combined with benzoyl peroxide in topical formulations (eg. Benzamycin). Topical Erythromcyin is often combined with complementary treatments (eg. Oral Antibiotics, Retinoids, Hormonal Treatments, etc) as part of a comprehensive acne treatment plan.

Doxycycline

Doxycycline (Vibramycin) is an antibiotic in the Tetracycline family. Doxycycline is one of the most frequently used oral antibiotics for acne treatment. It is also used to treat certain types of skin, respiratory and sexually-transmitted infections that are caused by bacteria.

Doxycycline can be an effective treatment for many people with moderate to severe acne. A substantial amount of clinical research and positive patient reports support the use of Doxycycline for the treatment of acne.

Unfortunately, acne-causing P. acnes bacteria that are resistant to Doxycycline (and other Tetracycline antibiotics) are becoming increasingly common. Because of this antibiotic resistance, Doxycycline is ineffective for many patients.

Dirithromycin

Dirithromycin (Dynabac) is an antibiotic in the Macrolide family.

Dirithromycin is rarely used for the treatment of acne. There is little evidence on the efficacy of dirithromycin as an acne treatment. This medication is not currently available in all countries (eg. United States).

Dicloxacillin

Dicloxacillin (Diclocil) an antibiotic in the Penicillin family. Dicloxacillin is a narrow spectrum antibiotic that is used primarily against Gram-positive bacteria that produce an enzyme called beta lactamase. Dicloxacillin is used to treat a variety of skin infections that are caused by Staphylococcus bacteria.

Dicloxacillin is rarely used to treat acne. For the treatment of acne, other Penicillin family antibiotics (eg. Amoxicillin, Ampicillin) are more common. Laboratory research indicates that the acne-causing P. acnes bacterium is very sensitive to Penicillins, including Dicloxacillin. Therefore, this medication may have some utility as an acne treatment. Dicloxacillin is widely available in combination with Amoxicillin or Ampicillin.

Demeclocycline

Demeclocycline (Declomycin) is an antibiotic in the Tetracycline family. Demeclocycline is a wide spectrum antibiotic that is used to treat a range of bacterial infections, including acne.

Demeclocycline is rarely used to treat acne, but other Tetracycline family antibiotics (eg. Minocycline, Doxycycline, Tetracycline) are commonly used as acne treatments.

Tetracycline family antibiotics can be very effective treatments for moderate to severe acne, but tetracycline-resistant acne infections are becoming increasingly common in many places.

Dapsone

Dapsone is an antibiotic in the Sulfonamide family. It is used to treat a range of infections, including Leprosy, respiratory and skin infections.

Dapsone was a popular choice for treating moderate to severe acne in the mid 20th century. But the use of dapsone as an acne treatment declined when oral Isotretinoin (Accutane) was introduced. However, Dapsone is now regaining popularity as an acne treatment.

Antibiotic susceptibility testing indicates that the acne-causing P. acnes bacterium tends to be moderately susceptible to Dapsone. A wealth of clinical research demonstrates that oral Dapsone can be an effective treatment for individuals with inflammatory acne. Patients have also reported positive results from the use of topical Dapsone gel.

Dapsone is widely available in oral and topical formulations. Topical Dapsone is a relatively new formulation that is specifically marketed as an acne treatment. Cotrimoxazole (also in the Sulfonamide antibiotic family) is more commonly used oral antibiotic than Dapsone, but it is unclear which of these medications is a more effective acne treatment.

Cotrimoxazole

Cotrimoxazole is a combination of two antibiotics – Trimethoprim and Sulfamethoxazole. Cotrimoxazole is used to treat many kinds of bacterial infections, such as urinary tract, respiratory and skin infections.

Sulfamethoxazole is a member of the Sulfonamide family. Sulfamethoxazole and Trimethoprim work together to prevent bacteria from synthesizing folic acid, an essential B vitamin.

Cotrimoxazole is occasionally used to treat acne. Clinical research and patient reports suggest that cotrimoxazole can be a very effective treatment for some people with moderate to severe inflammatory acne (Acne Types:2-4). Clotrimoxazole is often effective for individuals who have not benefited from common anti-acne antibiotics (eg. Minocycline, Doxycycline, Clindamycin). Antibiotic susceptibility testing indicates that the acne-causing P. acnes bacteria tends to be moderately susceptible to Sulfamethoxazole and Trimethoprim, individually. The combination (Cotrimoxazole) is substantially more toxic to P. acnes bacteria.

There is a greater risk of significant side effects and allergic reactions when using Cotrimoxazole than many of the other oral antibiotics used to treat acne. In particular, Cotrimoxazole has been associated with an auto-immune reaction called Stevens Johnson syndrome, which can be life-threatening. Although the risk is small, this may explain why Cotrimoxazole is not more widely used for the treatment of acne. Individuals with a history of allergic reactions to Sulfonamide antibiotics should avoid using Cotrimoxazole.

Colistin

Colistin (Polymyxin E) is an antibiotic in the Polypeptide family. It is available topical formulations. Colistin is rarely used as a treatment for acne.

Colistin is not usually active against Gram-positive bacteria. Because the acne-causing P. acnes bacterium is Gram-positive, Colistin is not expected to be a useful treatment for acne patients. Colistin is commonly used in veterinary medicine.

Cloxacillin

Cloxacillin (Cloxapen) is an antibiotic in the Penicillin family. It is used to treat several types of bacterial infections.

Cloxacillin is rarely used for the treatment of acne symptoms. However, laboratory research indicates that the acne-causing P. acnes bacteria is highly sensitive to Penicillin family antibiotics, such as Cloxacillin. There is little clinical research and few patient reports about the efficacy of Cloxacillin as an acne treatment.

Clindamycin

Clindamycinis an antibiotic in the Lincosamide Family. Clindamycin is closely related to antibiotics in the Macrolide family (eg. Erythromycin, Azithromycin). It is used to treat a variety of bacterial infections.

Clindamycin is frequently used as a treatment for acne. Topical Clindamycin is one of the most common antibiotic treatments for acne. Oral Clindamycin is also occasionally used as to treat acne. Many patients have reported that Clindamycin helped to improve their acne symptoms. Their is also a wealth of clinical research that demonstrates that Clindamycin can be an effective acne treatment.

Laboratory antibiotic susceptibility testing indicates that the acne-causing P. acnes bacterium is usually sensitive to Clindamycin. However, Clindamycin-resistant P. acnes bacteria are becoming common in many regions of the world. Individuals with acne symptoms that are caused by Clindamycin-resistant bacteria are not likely to benefit from this medication. Bacteria that are resistant to Clindamycin are often also resistant to Macrolide antibiotics, such as Erythromycin.

Topical Clindamycin is often combined with complementary treatments, such as oral antibiotics, retinoids or light-based treatments.

Clarithromycin

Clarithromycin (Biomycin) is an antibiotic in the Macrolide family. Clarithromycin has a broad spectrum activity of activity against many types of bacteria, including those that cause strep throat, pneumonia, skin infections and stomach ulcers.

Clarithromycin is ocassionally used for the treatment of acne symptoms. Topical Clarithromycin is occasionally prescribed as an acne treatment. Oral Clarithromycin is rarely used to treat acne. Other antibiotics in the Macrolide family (eg. Azithromycin, Erythromycin) are more commonly used as acne treatments.

Antibiotic susceptibility testing indicates that Clarithromycin tends to be active against the acne-causing P. acnes bacterium. However, P. acnes bacteria that are highly resistant to Clarithromycin (and other Macrolide family antibiotics) are becoming increasingly common in many regions. Clinical research and patient reports suggest that Clarithromycin (particularly topical Clarithromycin) can significantly improve acne symptoms for some patients. Topical Clarithromycin is often combined with a complementary treatments.

Ciprofloxacin

Ciprofloxacin is an antibiotic in the Quinolone Family. Ciprofloxacin is a commonly used antibiotic that is used to treat a variety of infections, including bone, joint, respiratory, skin, and urinary tract infections.

Ciprofloxacin is rarely used to treat acne. There is limited clinical evidence regarding the efficacy of Ciprofloxacin as a treatment for acne, although some individuals have reported that this medication helped improve their acne symptoms. Antibiotic susceptibility testing indicates that the acne-causing P. acnes bacterium is generally sensitive to Quinolone family antibiotics, including Ciprofloxacin.

When used to treat acne, Ciprofloxacin is often combined with a complementary antibiotic. Ciprofloxacin is available as an oral or topical medication, although it is usually administered orally.

Chloramphenicol

Chloramphenicol (Clorin) is an antibiotic that is used to treat a wide range of bacterial infections. Chloramphenicol is used as a topical treatment for bacterial conjunctivitis (eye infections).

Chloramphenicol is generally used as a topical treatment for acne. Oral Chloramphenicol is rarely used to treat acne. Laboratory research suggests that the acne causing P. acnes bacteria is moderately susceptible to chloramphenicol. User reports suggest that topical chloramphenicol may be a useful acne treatment.

Cephalexin

Cephalexin (Keflex) is an antibiotic in the Cephalosporin Family. Cephalexin is a very common antibiotic that is used to treat a variety of bacterial infections.

Cephalexin is occasionally used to treat acne. There is limited clinical research into the efficacy of Cephalexin as an acne treatment. However, come patients have reported that Cephalexin improved their acne symptoms. Antibiotic susceptibility testing indicates that the acne-causing P. acnes bacterium is generally sensitive to Cephalosporin fmaily antibiotics, including Cephalexin.

Ceftibuten

Ceftibuten (Cedax) is an antibiotic in the Cephalosporin Family. Ceftibuten is used to treat respiratory tract, urinary tract and other bacterial infections.

Ceftibuten is rarely used as an acne treatment. Laboratory antibiotic susceptibility testing does indicate that the acne-causing P. acnes bacteria is generally sensitive to Cephalosporin family antibiotics, including Ceftibuten. There is little clinical research and few patient reports about Ceftibuten as a treatment for acne.

Cefradine

Cefradine is an antibiotic in the Cephalosporin Family. Cefradine is used to treat respiratory tract, urinary tract and skin infections. Note: Cefradine is not approved for human use in all countries.

Cefradine is rarely used as an acne treatment. Laboratory antibiotic susceptibility testing does show that the acne-causing P. acnes bacteria is generally sensitive to Cephalosporin antibiotics, including Cefradine. However, there is minimal clinical research into the use of Cefradine as a treatment for acne.

Cefprozil

Cefprozil (Cefzil) is an antibiotic in the Cephalosporin Family. Cefprozil is used to treat bronchitis, ear infections and skin infections.

Cefprozil is rarely used as an acne treatment. Laboratory antibiotic susceptibility testing does indicate that the acne causing P. acnes bacteria tends to be sensitive to Cephalosporin family antibiotics, including Cefprozil. There is little clinical research about the utility of Cefprozil for the treatment of acne.

Cefpodoxime

Cefpodoxime (Cefpo) is an antibiotic in the Cephalosporin Family. Cefpodoxime is used to treat a range of infections, including gonorrhoea, tonsillitis, pneumonia, and bronchitis.

Cefpodoxime is rarely used as an acne treatment. However, laboratory research indicates that the acne causing P. acnes bacteria tend to be susceptible to Cephalosporin family antibiotics, including Cefpodoxime. There is currently little clinical research and few patient reports on the efficacy of Cefpodoxime for the treatment of acne symptoms.

Cefixime

Cefixime (Suprax) is an antibiotic in the Cephalosporin family. Cefixime is commonly used to treat infections of the respiratory tract as well as the ear and urinary tract.

Cefixime is rarely used as an acne treatment. There is little clinical research about Cefixime as a treatment for acne and their are few patient reports. Laboratory research does indicate that the acne causing P. acnes bacteria is generally susceptible to Cephalosporin antibiotics, including Cefixime.

Cefdinir

Cefdinir (Omnicef) is an antibiotic in the Cephalosporin family. Cefdinir is often used to treat respiratory tract infections such as pneumonia, bronchitis and sinusitis.

Cefdinir is rarely used to treat acne, but antibiotic susceptibility research suggests that the acne causing P. acnes bacterium is likely to be susceptible to Cephalosporin family antibiotics, including Cefdinir. There is little clinical research on the utility of Cefdinir in the treatment of acne.

Cefadroxil

Cefadroxil is an antibiotic in the Cephalosporin Family. Cefadroxil is a broad spectrum antibiotic that can treat a variety of infections.

Cefadroxil is occasionally used as an acne treatment, but there is limited research into ability of Cefadroxil to improve acne symptoms. Laboratory testing indicates that the acne-causing P. acnes bacterium is moderately susceptible to Cephalosporin antibiotics, including Cefadroxil. Oral antibiotic therapy with Cefadroxil may combined with complementary treatments, including topical retinoids and light-based treatments.

Cefaclor

Cefaclor is an antibiotic in the Cephalosporin Family. Cefaclor is a broad spectrum antibiotic that can treat a variety of infections.

Cefaclor is rarely used as an acne treatment and currently there is insufficient evidence to determine it’s efficacy as an acne treatment. However, laboratory testing indicates that the acne-causing P. acnes bacterium is moderately susceptible to Cephalosporin antibiotics, including Cefaclor. Oral antibiotic therapy with Cefaclor may combined with complementary treatments, including topical retinoids and light-based treatments.

Bacitracin

Bacitracin is an antibiotic that is a mixture of closely related antibacterial molecules. Bacitracin can inhibit the growth of many kinds of bacteria, including S. aureus and P. acnes.

Bacitracin is applied topically for the treatment of acne. However, user and research reports suggest that Bacitracin is not an effective acne treatment, particularly for moderate to severe inflammatory acne. Triple antibiotic ointments (eg. Neosporin) usually include Bacitracin as an active ingredient.

Azithromycin

Azithromycin is an antibiotic in the Macrolide Family. Azithromycin is a very common antibiotic that is used to treat many different kinds of infections.

Azithromycin is rarely used to treat acne. However, there are some reports that Azithromycin helped improve acne symptoms. Antibiotic susceptibility testing indicates that the acne-causing P. acnes bacterium tends to be susceptible to antibiotics in the Macrolide family, including Azithromycin. However, Macrolide-resistant P. acnes bacteria are becoming common in many regions of the world.

Ampicillin

Ampicillin is an antibiotic in the Penicillin Family. Ampicillin is a very common antibiotic that is used to treat many different kinds of infection.

Ampicillin is rarely used to treat acne. There is limited evidence about the efficacy of Ampicillin for treating acne symptoms. Antibiotic susceptibility testing indicates that the acne-causing P. acnes bacterium tends to be highly sensitive to antibiotics in the Penicillin family, including Ampicillin.

Amoxicillin

Amoxicillin an antibiotic in the Penicillin family. Amoxicillin is a very common antibiotic that is used to treat many different kinds of infection.

Amoxicillin is occasionally used to treat acne. Many acne patients have reported that Amoxicillin helped improve their acne symptoms. Antibiotic susceptibility testing indicates that the acne-causing P. acnes bacterium tends to be highly sensitive to antibiotics in the Penicillin family, including Amoxicillin.

Acne Scar Treatments

Acne scars are caused by the infection and inflammation associated with inflammatory acne. There are many treatments available that can help repair this damage.

Overview

Inflammatory acne (acne types: 3-4) can permanently damage the skin and underlying tissue, leaving behind acne scars. While the most important thing is to take immediate action to control your acne and prevent further damage, there is hope for people who have from acne scars.

The best choice of acne scar treatment depends on the type of scarring. Minor damage can be repaired with relatively mild topical treatments. Repairing moderate to severe acne scars may require surgical treatments. On this page you can find answers about how acne scars form, an overview of the many types of acne scars, and the types of treatments available for acne scars.

What Causes Acne Scars?

Inflammatory acne causes damage to the skin and the underlying tissue, which can ultimately result in acne scars. In the area within and around an inflammatory acne lesion (pimple, nodule or cyst), white blood cells release enzymes that damage the surrounding tissue. This process can cause permanent damage to the underlying collagen matrix that supports the skin. Large areas of damage may not be properly repaired and damaged tissue is instead replaced by fibrous scar tissue, leading to permanent acne scars. For a more detailed discussion about how acne scars form, continue reading here.

Types of Acne Scars

There are many types of acne scars. The development of acne scars depends on the severity, location and duration of an acne lesion, along with other factors, such as the genetics of the affected person. For a more detailed discussion about the many types of acne scars form, continue reading here.

Topical Acne Scar Treatments

Topical Pharmaceutical and Over The Counter (OTC) Treatments are excellent options for mild to moderate acne scars, and many types of abnormal pigmentation. Topical retinoids have been shown to stimulate cell turnover at the skin surface and the growth of new tissue and collagen in the dermis. Topical hydroquinone can inhibit the production of melanin, helping to gradually lighten dark spots. OTC and Spa-type exfoliating treatments can help relieve minor uneven and rough skin tone. Glycolic acid, azelaic acid, alpha hydroxy acid and others are available as part of OTC and prescription chemical peels. For more information about Topical Acne Scar Treatments, continue reading here.

Light and Laser Acne Scar Treatments

Light and Laser Treatments are excellent options for all types of acne scars, from mild to severe. Red light therapy can be helpful in accelerating healing and collagen production. Intense Pulsed Light (IPL) is very effective at improving the appearance of many types of abnormal pigmentation. Laser-based therapies are quickly becoming the dominant technology in cosmetic dermatology.

Laser systems can be used for both ablative (invasive) and non-ablative (non-invasive) skin resurfacing. Specialized laser treatments are available for the treatment of irregular pigmentation, erythema (permanent redness) and a wide range of scar types. Because the wavelength (color) and intensity of a laser determines the depth that it penetrates the skin and what kinds of molecules it excites, laser therapy is a highly flexible and functional tool.

In this section we overview many of the available laser technologies and their applications. For a more detailed discussion about the many light and laser-based treatments for acne scars, continue reading here.

Clinical/Surgical Scar Treatments

Clinical/Surgical Treatments are often the most effective approach for repairing the damage associated with moderate to severe acne scars. There are many different types of surgical approaches that are used in acne scar treatment.  To review the many surgical treatments for acne scars, continue reading here.

Surgical Acne Treatments

Overview

Surgical interventions are used for the treatment of both active acne and acne scars. Surgical techniques are specific to each application.

Surgical Treatments for Active Acne

Surgical treatments for Active Acne can range from simple comedome extractions to drainage and/or removal of infected cysts. Surgical treatments for active acne are are generally used as a complement to conventional acne treatments, such as antibiotic therapy. The benefits of surgical treatments for active acne are generally temporary. This section includes a range of medical procedures for active acne that are generally administered by a dermatologist.

Surgical Treatments for Acne Scars

Surgical Solutions for Acne Scars can be an effective way to repair moderate to severe acne scar damage. Microdermabrasion and chemical peels are frequently used to treat moderate cases of acne scarring. Surgical approaches (subcision, punch excision, fillers, etc) are often the most effective treatments for severe acne scars. Aggressive chemical peels and full-face laser-resurfacing are invasive procedures that should be conducted in an appropriate medical/surgical setting. This section covers the spectrum of surgical procedures that are used to treat acne scars.

Light and Laser Acne Treatments

Light and Laser Treatments use high-intensity light sources to treat active acne and acne scars.

Overview

Light and Laser treatments are an increasingly popular way to treat acne symptoms. There are a wide range of these systems available. Most Light and Laser treatments for active acne symptoms are non-invasive and can be combined with Pharmaceutical, Naturopathic and OTC acne treatments to create comprehensive acne treatment regimens.

Light and Laser Treatments for acne can be divided into two major categories: Treatments for Active Acne and Treatments for Acne Scars. This page is devoted to Light and Laser treatments for active acne. The page for laser treatment of acne scars canbe found here.

Light and Laser Treatment for Active Acne

Several Light and Laser treatments have been shown to improve acne symptoms. However, the benefits of these treatments are often temporary. For many patients, treatments must be repeated on a regular basis to achieve the maximum benefit. These treatments also tend to be more expensive than many of the common Pharmaceutical treatments that are available. Nonetheless, Light and Laser treatments are excellent options for most people, especially when used in combination with other types of treatments. Below is our complete guide to the Light and Laser Treatments available for Active Acne.

Blue Light Phototherapy

Blue Light Phototherapy is a treatment for acne that uses high intensity blue light (~415 nm) to directly kill acne-causing Propionibacterium acnes bacteria that are growing in the skin. P. acnes bacteria produce a molecule called porphyrin that produces free radicals when exposed to high intensity blue light. Blue Light Phototherapy works by causing porphyrin to produce enough free radicals to damage and kill P. acnes bacteria.

Diode Lasers

Diode Lasers are becoming a popular laser treatment for inflammatory acne. Diode Lasers are used to selectively target and damage the sebaceous glands, reducing sebaceous hyperplasia, sebum secretion and acne symptoms. Diode Lasers are also commonly used in hair removal and scar treatment applications. The benefits of Diode Laser acne treatment are often longer-lasting than many other light and laser therapies.

Intense Pulsed Light (IPL)

Intense Pulsed Light (IPL) therapy uses short bursts of high intensity light to treat a variety of skin conditions. IPL is most commonly used for photo-rejuvenation procedures and to treat mild skin discolorations caused by hyper-pigmentation. Intense Pulsed Light (IPL) therapy is also occasionally used to treat active acne symptoms and certain types of mild acne scars.

KTP Lasers

KTP Lasers are commonly used for minimally invasive ablation and coagulation treatments. KTP lasers have also been used to treat rosacea, spider veins, hyper-pigmented spots and acne, although it is an uncommon acne treatment. KTP Lasers are occassionaly used as the light source for Photodynamic Therapy (PDT) of active acne.

Photodynamic Therapy (PDT)

Photodynamic Therapy (PDT) is the generic name for a class of treatments that use specialized medications called photosensitizers to increase the effectiveness of a light-based treatment. PDT is used treat certain types of skin problems, including acne and some forms of cancer. Numerous clinical research studies have reported that Photodynamic therapy (PDT) can decrease bacterial levels in the skin and help improve acne symptoms. PDT appears to be more effective for treating inflammatory acne lesions (Acne Types: 2-4) than non-inflammatory acne lesions (Acne Types: 1-2).

Ultraviolet Light (UV) and Tanning

Ultraviolet (UV) light is electromagnetic radiation with wavelengths that are just shorter than visible light. UV light is most commonly found in sunlight and artificial UV sources, such as tanning beds and blacklights. Exposure to UV light causes significant changes in the affected skin tissue, and these changes can impact acne symptoms. Many people strongly believe that tanning improves their complexion.

Naturopathic and Lifestyle Acne Treatments

Nature is the fundamental source of all medicine.

Overview

Humans have been utilizing the medicinal properties of plants, animals, fungi and minerals since before the dawn of civilization. This section is devoted to covering Naturopathic, Homeopathic, Ayurvedic, Nutritional/Dietary and Lifestyle solutions that may be helpful for people wih acne. The goal of this Naturopathic Treatments section is to help you identify solutions that are likely to be effective for you, understand what they are and how they work.

What is Naturopathic Medicine?

There are huge numbers of biologically active molecules that can be isolated from natural sources. When it comes to naturopathic medicine, the biggest challenge is to separate fact from fiction. While some naturopathic treatments are based on solid scientific reasoning and have a long history of successful medicinal use, others are fraudulent at best and dangerous at worst. The challenge is to identify the legitimate naturopathic therapies in a sea of snake oil.

A lot of people, particularly those in the medical profession, dismiss naturopathic solutions as ineffective quackery. On the other side of the fence, many practitioners and patients of naturopathic and homeopathic medicine are inherently suspicious of the medical establishment and commercial pharmaceuticals.

The reality is that naturopathic medicine, like most anything else, contains both truth and falsehoods. Indeed, truth can be found on both sides of the fence.

Essential Oils

Essential oils and other plant extracts can contain significant quantities of biologically active small molecules and enzymes. Often times these molecules are part of the plant’s own defense mechanism against viral, bacterial and fungal infection.

Numerous plant extracts have been shown to have potent anti-bacterial activity against the two types of bacteria most commonly implicated in acne outbreaks (P. acnes and S. aureus). Other extracts have been shown to contain retinoid family compounds that are similar, if not identical, to those contained in prescription medications, such as Tretinoin (Retin-A). Some plant compounds have effective anti-inflammatory agents that could potentially decrease the swelling and pain associated with acne. Continue reading here…

Herbal Supplements

Herbal Supplements (aka Botanicals) often come in the form of capsules that contain dried and powdered pieces of specific plants. There are lots and lots (and lots) of herbal supplements on the market. A number of these have been marketed specifically for the treatment of acne.

While many herbal supplements provide legitimate support for certain medical conditions, they are usually not effective treatments for acne. This section covers the few herbal supplements that may actually be beneficial to acne sufferers, as well as many others that are commonly marketed as acne treatments but are most likely useless.

Nutritional Supplements

Nutritional Supplements are a very common naturopathic remedy for all types of acne. It is well known that deficiencies in essential vitamins and minerals can cause or worsen numerous health problems, including skin diseases like acne. What is less well understood is whether supplementation with high levels of vitamins, minerals or other compounds can improve health or help resolve disease. In this section we analyze the potential benefits and risks of supplementation with vitamins, minerals, extracts and more.

Dietary

Dietary choices – what you eat and do not eat – have a huge impact on your metabolism, immune system and overall health. Thus, it is reasonable to expect that diet also has a direct impact on acne symptoms.

Sugar, milk, chocolate and many other foods have been suggested to contribute to acne. Although some of these claims are probably not true, others are supported by compelling scientific evidence. This section covers common dietary regimens (eg. vegan, Atkins, Mediterranean, etc.) and specific dietary restrictions (dairy, chocolate, sugar, etc).

Lifestyle – Physical and Spiritual

Physical exercise is a critical component of overall health. Exercise boosts the immune system directly and indirectly by impacting hormones, body composition, metabolism and mental state. There are many ways to engage in physical activity.

Spiritual interventions (eg. Prayer, Meditation), Aromatherapy, Acupuncture are also approaches that some people take to help treat their acne symptoms. This section covers a range of physical and spiritual activities, from Yoga to weight-lifting, and explores how these activities might impact acne. Continue reading here…

Topical Naturopathic Remedies

Topical Naturopathic Remedies extend beyond essential oils and plant extracts to include a wide variety of alternative treatments, many of which have a long and successful history in medicine. Sulfur, yogurt, silver, calamine, honey and many other substances are all commonly used to create topical acne treatments.

This section covers these topical naturopathic remedies (along with many more) and explores there history, science and effectiveness as acne treatments.

Pharmaceutical (Rx) Acne Treatments

Pharmaceutical (Rx) Acne Treatments are medications which are generally only available via a prescription from your doctor (in the United States, at least)

Overview

Pharmaceutical Treatments are an essential part of many effective acne treatment regimens. These medications can be particularly useful for patients with moderate to severe acne symptoms.

A wide variety of medications are routinely used to treat acne symptoms, but almost all of them are members of one of four major pharmaceutical types: Antibiotics, Retinoids, Keratolytics or Hormonal Treatments. Each class of medications is has a unique complement of advantages and disadvantages. These families are profiled below.

Antibiotics

Antibiotics kill bacteria. The overgrowth of certain species of bacteria in the skin is often a major contributor to acne symptoms. Inhibiting bacterial growth with antibiotics can help improve acne symptoms for many people.

There are several types of antibiotics that are routinely used to treat acne. Antibiotic-based acne treatments may be administered topically or taken orally. This section contains information and reviews about all of the antibiotics that are regularly used as acne treatments.

Keratolytics

Keratolytics help improve acne symptoms by preventing the formation of “clogged pores”. They work by helping to soften and remove the outermost layer of the skin. This helps open up plugged pores and follicles. Keratolytics, and other types of exfoliants, can also helpful for improving the appearance of mild acne scars and small areas of uneven skin.

Many keratolytics are available at low concentrations in Over The Counter products (eg. Benzoyl peroxide). Higher concentration keratolytic products  are often administered by a physician.

Keratolytics are primarily used for the treatment of mild acne vulgaris (Acne Types: 1-2). They are usually poorly ineffective treatments for moderate to severe acne symptoms (Acne Types: 3-4). This section contains information and reviews about all of the keratolytic medications that are regularly used as acne treatments.

Retinoids

Retinoids are medications that decrease the production of sebum (oil) in the skin. Retinoids can improve acne symptoms by decreasing the growth of bacteria in the skin and preventing formation of hyper-keratinized plugs (clogged pores). Retinoids also increase cellular turnover in the skin and are a common treatment for mild acne scars and fine lines.

Retinoids are available in both topical and oral formulations. Topical retinoids are applied directly to the skin and are a very common treatment for all types of acne, although they tend to be less effective against moderate to severe acne. Topical retinoids are often combined with a complementary medication, such as an antibiotic.

Oral retinoids (eg. Accutane) are ingested and affect the entire body. Oral retinoids can have significant side effects and are generally only used in the treatment of moderate to severe acne (Acne Types: 3-4). For some people with moderate to severe acne, oral retinoids can be very effective. This section contains information and reviews about all of the retinoids that are regularly used as acne treatments.

Hormonal Treatments

Hormones can contribute to acne in many ways. Androgen hormones (eg. testosterone) can stimulate the growth of sebaceous glands and increase the production of sebum (oily skin). Overactive sebaceous glands and excessive sebum production can contribute to the growth of acne-causing bacteria, and can lead to hyper-keratinized follicles (clogged pores).

Treatments that suppress the activity of androgen hormones are helpful for many women who are struggling with acne (hormonal treatments are rarely used in men because of the side effects). Birth control regimens may improve or worsen acne symptoms.

Hormonal treatments can be used to treat all types of acne in women (Acne Types: 1-4). Hormonal birth control pills (“The Pill”) are the most common hormonal treatment in the world and these medications can have a significant impact on acne symptoms. Other types of hormonal treatments include androgen inhibitors and corticosteroids. This section contains information and reviews about all of the hormonal treatments that are regularly used as acne treatments.

Over The Counter (OTC) Acne Treatments

Over The Counter (OTC) acne treatments are products that do not require a doctor’s prescription to obtain (in the United States).

Overview

There are hundreds of OTC acne products available in stores, although most of these products use the same basic active ingredients. OTC treatments can be helpful for people with mild acne. However, they tend to be ineffective for people with moderate to severe acne. Individuals with significant acne symptoms should not rely solely on OTC treatments. Instead, they should work with their healthcare provider to implement an effective treatment plan.

Types of OTC Acne Treatments

Acne Washes

Medicated face and body washes are a popular type of OTC acne treatment. Acne cleansers can be helpful for drying out oily skin. However, cleansers are not usually effective treatments for inflammatory acne (Acne Types: 2-4). This is because inflammatory acne is not caused by dirt or bacteria on the surface of the skin that can be washed away. Despite the claims in many commercials and advertisements, these cleansers do not penetrate deeply into follicles and are therefore are not capable of treating the root causes of acne.

Most cleansers contain triclosan, an antibacterial compound, as their active ingredient. In general, washing your face with a gentle cleaner once or twice a day is a good idea. Washing more than this is generally not helpful and can often cause irritation and dry skin. Detailed discussion about the various face and body cleansers can be found here.

Acne Cleanser Pads

Cleanser Pads are nice because when you are done using them you can often see the “dirt” on the pad and it feels like you have done something concrete about your acne. Unfortunately, the “dirt” that you see on the pad is unlikely to be the source of your acne symptoms. While some people do find that cleanser pads help with their oily skin and mild acne symptoms, most people experience minimal overall improvement in the condition of their skin.

Like other topical OTC treatments, the active ingredients in cleanser pads are unlikely to penetrate deeply enough into the follicle to unclog blocked pores or suppress the growth of bacteria in the skin. Most cleanser pads contain a combination of alcohol and salicylic acid, which are both antibacterial and keratolytic. Overuse of these products can cause skin irritation.

Acne Gels and Creams

Acne Creams and Gels are very popular and there are a huge number of these products on the market. The active ingredient in most of these product is either contain salicylic acid or benzoyl peroxide. Other products may contain active ingredients such as sulfur, tea tree oil or glycolic acid.

In general, pimple creams are somewhat effective for mild acne symptoms (Acne Types: 1-2). They are generally ineffective for the treatment of inflammatory acne (Acne Types: 3-4) because they do not penetrate deeply into the skin. Like other topical OTC acne treatments, overuse of these products can irritate the skin.

Pore Strips

Pore Strips are neat. They may not actually prevent or treat acne, but it is cool to pull off a pore strip and see all of the little towers of gunk that come out of the pores with it. Pore strips are most helpful for removing mild blackheads (open comedones, horny impactions). They are best suited for people with mild acne (Acne Types: 1-2).

There is little scientific research on whether pore strips improve acne symptoms. One study did compare the efficacy of Biore pore strips to standard dermatological extraction (manual extraction) of blackheads and found that the pore strips were nearly as effective and were less invasive.

It is important to keep in mind that pore strips only work well with pores that are clogged, but open (blackheads). Acne lesions with closed pores, (eg. whiteheads, pimples, nodules and cysts) are not easily accessible to the sticky material that coats the pore strip. Thus, pore strips are generally ineffective for people with moderate to severe acne symptoms (Acne Types: 3-4).

Exfoliants

Most OTC exfoliants are combine a gentle cleanser with some sort of abrasive ingredient. Gentle exfoliation every once in a while can even skin tone and improve areas of rough skin. OTC exfoliants are generally NOT helpful for treating active acne symptoms.

It is important to be aware that many other topical acne treatments are keratolytic agents, which are essentially chemical exfoliants. Combining these treatments can cause significant skin irritation and dryness. For dry skin, a non-comedogenic moisturizer, such as Cetaphil, is often a more effective treatment than exfoliation.

Acne Facial Masks

Facial Masks are a mainstay of spa treatments. They can also be helpful as acne treatments. But it really depends what the mask is made of. High quality facial masks may help improve mild acne symptoms and improve skin tone and moisture.

Many of the inexpensive OTC facial masks that are sold in drugstores contain a liquid polymer that dries into a thin, clear sheet that you then pull off. There is no published research on the efficacy of this type of product (but in my own experience, they did absolutely nothing helpful).

More expensive facial mask products often contain various types of clay in conjunction with other potentially active ingredients such as essential oils or colloidal metals. While there is limited scientific research on this topic, many of these products are well reviewed, particularly for improving oily skin.

Active Ingredients in OTC products

Despite the diversity of OTC acne products, most of these products use the same core set of active ingredients. The active ingredients are primarily antibacterial or keratolytic agents that are designed to kill bacteria, exfoliate the surface of the skin and remove blackheads (open comedones). The most common active ingredients in OTC acne products are discussed below.

Salicylic Acid

Salicylic Acid is widely used in OTC acne products, particularly face washes and cleanser pads. At the low concentrations found in OTC acne products, salicylic acid works as mild keratolytic and comedolytic agent.

The majority of the scientific research indicates that salicylic acid is moderately effective for the treatment of mild acne symptoms (Acne Types: 1-2). Salicylic Acid tends to have efficacy rates that are similar to Benzoyl Peroxide. However, because salicylic acid treatments do not penetrate deeply into the skin, they are poor options for people suffering from nodular and cystic acne (Acne Types 3-4).

Salicylic Acid weakens the bonds between the keratinized cells on the outer surface of the epidermis, causing them to shed more rapidly and encourages new cell growth. At higher concentrations, salicylic acid is toxic and is used in chemical peels and wart removal treatments.

Salicylic Acid is usually well tolerated, but some people are allergic to it. Salicylic acid is a molecular cousin of aspirin, and people who are sensitive to aspirin are more likely to be sensitive to salicylic acid. The primary side effects of salicylic acid treatments are dry skin, sensitivity and redness. Excessive use of salicylic acid treatments, or combinations with other topical acne treatments, can exacerbate these side effects.

Benzoyl Peroxide

Benzoyl peroxide is both a keratolytic agent and antibacterial agent.  Keratolytic agents cause the outer layer of the skin (epidermis) to shed. Antibacterial agents kill bacteria.

When benzoyl peroxide comes into contact with the skin it breaks down into benzoic acid and oxygen, which are toxic to many types of bacteria (including the acne-causing Propionibacterium acnes bacteria).  Benzoyl peroxide is a very common ingredient in face washes and pimple creams.

Extensive research has shown that benzoyl peroxide can be a beneficial treatment for many people suffering from non-inflammatory acne (Acne Types: 1-2). However, because of its limited penetration into the skin, benzoyl peroxide is largely ineffective in treating cystic and nodular forms of acne (Acne Types: 3-4).

Benzoyl peroxide is commonly combined with antibiotics, such as clindamycin and erythromycin, in prescription topical medications. Benzoyl peroxide can be combined with many other types of treatments in a comprehensive acne treatment regimen.

Most people tolerate benzoyl peroxide treatment well, with side effects most commonly associated with higher dosages and excessive use. Common side effects of benzoyl peroxide treatment include dry skin, flaking, redness and sensitivity. Benzoyl peroxide is also a potent bleaching agent, and contact with clothes or furniture can cause permanent bleach damage.

Triclosan

Triclosan is an antibacterial agent that is found in many OTC acne treatment products, such as soaps and cleansers. Triclosan is toxic to many bacteria, including the acne-causing Propionibacterium acnes.

Clinical research and patient reports indicate that face washes with Triclosan are somewhat helpful for people with mild acne symptoms (Acne Types: 1-2). Like salicylic acid and benzoyl peroxide, triclosan does not penetrate deeply into the skin and is a poor option for inflammatory acne (Acne Types: 3-4).

Use of triclosan containing washes is usually well tolerated by the user with minimal side effects.Excessive use of any face wash (with our without Triclosan) can cause dryness and skin irritation.

There are some concerns that triclosan can degrade into toxic substances such as chlorophenol, dioxin and formaldehyde. However, normal use of topical antibacterial products that contain Triclosan is unlikely to generate toxic concentrations of these molecules. There is currently no evidence that demonstrates a specific health risk from the exposure associated with normal use of Triclosan-containing products.

Astringents

Astringents are used primarily to tighten the skin, diminish redness and relieve oily skin. Astringents are also one of the oldest acne treatments in existence, with their use going back hundreds (or even thousands) of years.

Astringents, particularly Witch Hazel, are generally well-reviewed by acne patients, particularly for mild acne symptoms (Acne Types: 1-2). Astringents tend to be most useful for cleansing the skin and for providing a fast-acting, short term improvement in redness and inflammation.

There are many different types of astringents including tannins, gallic acid, witch hazel and alum. The most common OTC astringent is Witch Hazel, which can be found at most stores and pharmacies. Interesting fact: Astringents, particularly tannins, are what gives unripe fruit and banana peels to create that puckering, sand-papery mouth feel.

Astringents work by denaturing and/or precipitating proteins. How this helps to improve acne symptoms is uncertain. However, there is very little scientific research on the efficacy of astringents as a treatment for acne.

Astringents are not expected to be effective acne treatments when used alone. Astringents are unlikely to have a significant effect on the fundamental causes of acne and are generally considered to be short-acting, symptomatic treatments. They can be used by patients with all types of acne (Acne Types: 1-4) and can be combined with many other types of acne treatment.

Avoiding Negative Interactions Between Medications

What Does Contraindicated Mean?

A medication is contraindicated when there is an existing condition that makes its use inadvisable. Certain medications can be contraindicated in specific groups of people (eg. pregnant women) or in combination with other medications (eg. aspirin and warfarin).

Some medications are contraindicated with one another because taking them together is known to cause potentially serious problems. Before using any medication, it is important to verify (preferably through consultation with a licensed medical provider) that the medication is not contraindicated with any medical conditions you may have, or with any medications you may already be taking.

Educate Yourself About Your Medications

The more you learn about a particular topic, the more likely you are to make good decisions and avoid mistakes when dealing with that topic. This is especially true for medical conditions and medications. At the end of the day, it is your body and you are responsible for what you put in it (or on it). It is the patient’s responsibility to educate themselves as best as possible about any medications they are taking, or are considering taking.

An excellent way to start educating yourself about the medications that you are taking is by reading the patient inserts that come with a medication. This information outlines many of the important features, and risks, of a medication. For more detailed information, the physician’s insert for the medication is a good start. These can be found online by using google to search for the term Physician Insert plus the name of your medication. The Physicians’ Desk Reference is another excellent resource to learn more about medications and their contraindications.

The Physician’s Desk Reference (PDR)

The Physicians’ Desk Reference (PDR) is a an annually updated compilation of manufacturers’ prescribing information for prescription medications. It is designed to provide physicians with the all of the legally mandated information relevant to available prescription medications. While it is widely used by medical professionals, it is also a valuable resource for patients and consumers. The Physician’s Desk Reference is available in many libraries, bookstores and online from sources like Amazon.com.

The Antibacterial Activity of Essential Oil

Overview

Many essential oils and other plant extracts have antimicrobial properties which can be helpful for health and wellness applications.There is an incredible diversity of essential oils and other plant extracts available on the market today. Both professional and casual practitioners of Naturopathic remedies have a plethora of options for the treatment of acne.

Antimicrobial Properties of Essential Oil

Much of what makes up an essential oil are molecules which are part of a plant’s natural defense system. These molecules have been designed by millions of years of evolution to protect the plant against potential enemies. These enemies can be bacteria, fungi, viruses, other plants, insects and other animal predators.

Some components of essential oil have antibacterial, anti-viral and anti-fungal activity. Other components in the essential oil are designed to prevent predation by insects and other animals. Some essential oils may even be toxic to other plants and are designed to help inhibit the growth of competing plants.

In the last twenty years, a great deal of scientific research has been done to characterize the antimicrobial activity of many essential oils. Using this knowledge can help guide better decisions when designing effective Naturopathic treatments for acne.

The Antibacterial Activity of an Essential Oil Depends on the Species of Bacteria

Some essential oils are highly toxic to certain species of bacteria, but are harmless to others. While some essential oils are effective against a broad spectrum of different bacteria, others are only useful against very specific types of bacteria.

When designing a Naturopathic acne treatment that includes essential oils, it is important to be aware of these differences. To better improve the design of acne treatments, we have compiled scientific reports from many sources in order to help identify which essential oils are likely to be most effective against acne-causing bacteria, such as Propionibacterium acnes (P. acnes) and Staphylococcus aureus (S. aureus).

Many essential oils also have anti-inflammatory properties which may also help in the treatment of acne symptoms.

What Essential Oils are Effective Against Propionibacterium acnes Bacteria?

Scientific research reports indicate that there are many types of essential oil that are active against P. acnes bacteria. Tea Tree essential oil is one of the most popular essential oils for skin care applications, and the research shows that it is indeed toxic to P. acnes bacteria (although not as much as some other essential oils). Thyme, Clove and Cinnamon essential oil have broad spectrum antibacterial properties, and are also effective against P. acnes as well.

Unfortunately, many of the essential oils with significant antibacterial activity against P. acnes bacteria can also be fairly irritating to the skin, particularly at high concentrations. However, there are several essential oils which have excellent antibacterial properties and a lower risk of skin irritation. For example, several different kinds of Citrus essential oils, were highly toxic to P. acnes bacteria but tend to be fairly mild to the skin. Lemongrass essential oil is another a potentially useful option for acne treatments.

Antibacterial Activity of Essential Oil Against Other Bacterial and Fungal Infections

There have been many research studies which examine the ability of different essential oils to inhibit or kill different kinds of infectious bacteria and fungi. No matter what kind of application you have in mind – whether it is designing a Naturopathic acne treatment or developing a natural disinfectant – understanding the antimicrobial properties of different essential oils is a critical first step. To help improve the understanding of these properties, we are working on developing a comprehensive database that about essential oils and their antimicrobial activities.

References

Activities of Ten Essential Oils towards Propionibacterium acnes and PC-3, A-549 and MCF-7 Cancer Cells. Zu, et al. 2010.
Antimicrobial Activity of Essential Oils Against Five Strains of Propionibacterium acnes. Luangnarumitchai, et al. 2007.
Antimicrobial activity of essential oils and other plant extracts. Hammer, et al. 1999.
Antioxidant Activities and Volatile Constituents of Various Essential Oils. Wei, et al. 2007.
Antimicrobial activity of the essential oil of Melaleuca alternifolia. Carson, et al. 1993.
A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne. Bassett, et al. 1990.
Preliminary Clinical Tests on Topical Preparations of ocimum gratissimum Linn Leaf Essential Oil for the Treatment of Acne Vulgaris. Orafidiya, et al. 2003.
Antimicrobial Activity of Ternary Essential Oil Mixtures in Topical Cosmetic Preparations Against Acne Vulgaris-Associated Bacteria. Owen, et al. 2017.
The in vitro antimicrobial evaluation of commercial essential oils and their combinations against acne. Orchard, et al. 2018.
Aromatherapy, botanicals, and essential oils in acne. Winkleman, 2018.
Chemical diversity and anti-acne inducing bacterial potentials of essential oils from selected Elsholtzia species. Phetsang, et al. 2017.

How Do Bacteria Become Resistant to Antibiotics?

Answer: Bacteria adapt, evolve and acquire antibiotic resistance.

The extensive use of antibiotics in human patients does contribute to increased antibiotic resistance among infection-causing bacteria. But, the short-term use of antibiotics to treat infections in an outpatient setting is not the primary cause of the increase in antibiotic-resistant bacteria.

There are several factors which contribute to the growing problem of antibiotic-resistant bacteria. This post discusses the many ways that antibiotic resistance may occur, as well as the conditions and environments that promote the development of antibiotic-resistant bacteria.

What is Antibiotic Resistance?

Antibiotics are molecules that inhibit the growth and/or kill bacteria. Antibiotics are small molecules that disrupt essential biological processes that are unique to bacteria.

Antibiotic resistance refers to a situation where a strain of bacteria becomes less sensitive to a particular antibiotic (or class of antibiotics). Antibiotic resistance occurs because the resistant bacteria have developed or acquired an ability to prevent the normal function of the antibiotic.

There are many types of antibiotics, and there are many types of bacteria. Most antibiotics are only good at killing certain types of bacteria. Some bacteria are naturally resistant to certain antibiotics. It is important to select antibiotics which are toxic to the specific type of bacteria that is causing an infection.

Adaptation and Evolution of Antibiotic Resistance

Epigenetic Adaptation (No Genetic Mutation)

Bacteria that consistently encounter sub-inhibitory levels of an antibiotic (concentrations of the antibiotic that are too low to kill it) can develop a temporary resistance to that antibiotic. This type of resistance is called Epigenetic Adaptation. This type of antibiotic resistance does not produce permanent genetic changes that can be inherited by subsequent generations of bacteria.

Epigenetic Adaptation is roughly equivalent to an athlete who develops large muscles from weight lifting and physical training. Bacteria exposed to sub-inhibitory levels of an antibiotic can mobilize defenses such as pumps to expel the antibiotics, enzymes to break them down, or they can simply decrease the permeability of their cell wall to decrease their exposure to the antibiotic molecules.

Genetic Adaptation (Genetic Mutation and Selection)

Genetic mutations are permanent changes in an organisms genetic code. Most mutations are very small and involve the change of a single nucleotide (an individual letter in the genetic code). Some mutations involve large rearrangements of the genome.

Genetic mutations occur naturally during DNA replication. Mutations can also occur as a result of exposure to mutagens like ionizing radiation (UV light) or chemicals. Many genetic mutations happen in regions of the genome that are not essential for the organism and don’t significantly change how that organism functions. When a mutation does occur in something important, it is usually disruptive and weakens the organism. Mutations that improve the fitness of an organism are rare.

Some antibiotics are more likely than others to become less effective as the result of genetic mutations in the target bacteria. This is because resistance to some antibiotics can be acquired as a result of a single genetic mutation, while other antibiotics require a bacteria to develop multiple mutations in order to become resistant.

One example of a class of antibiotics that are susceptible to single mutation resistance is the Quinolone family of antibiotics (eg. Ciprofloxacin, Nadifloxacin). Antibiotics in the Quinolone family target a bacterial enzyme called DNA gyrase. The antibiotic binds very tightly to this enzyme, which prevents the bacteria from reading and replicating its own DNA. A single mutation at a specific site in this enzyme can stop the antibiotic from binding. This specific mutation allows the bacteria to become resistant to that antibiotic. Antibiotics that can be inactivated by simple genetic mutations, such as Ciprofloxacin, are not generally recommended for long-term use because of the increased risk of generating resistant bacteria.

Genetic Acquisition (Plasmids, Transposons, Viruses, Conjugation, Naked DNA)

Bacteria can acquire large pieces of DNA from other bacteria, viruses and the environment. Genetic Acquisition is the mechanism by which bacteria acquire high-level resistance to many types of antibiotics. This is especially true for antibiotics which can not be inactivated by simple genetic mutations.

It is virtually impossible for a bacteria to randomly evolve a brand new gene or enzyme that provides resistance against a particular antibiotic (at least within a time-frame of weeks, months and years). But what does happen is that bacteria acquire big chunks of foreign DNA that contain many genes. Bacteria have many ways to acquire these large pieces of DNA that contain the genes that confer high-level antibiotic reistance:

  • Plasmids are mobile pieces of DNA (often circular) that bacteria can easily trade amongst themselves or simply acquire from the environment. Many bacteria have multiple plasmids. Plasmids can contain genes that inactivate a particular antibiotic. For example a gene called Beta Lactamase provides resistance to Penicillin family antibiotics and is commonly shared by bacteria via plasmid.
  • Transposons are sections of DNA that can jump from one place in the genetic code to another, or even to the genetic code of another organism.
  • Viruses (Bacteriophages) can infect bacteria and these viruses can copy and paste genetic code into the genomes of the bacteria they infect.
  • Conjugation is where two bacteria that are directly adjacent to one another create a direct connection and share DNA (think “”conjugal visit””). Conjugation is probably the closest thing that bacteria have to sex.
  • Naked DNA is DNA that bacteria find in the environment and internalize. This DNA can be from bacteria that have been killed, or part of a biofilm structure (some bacteria use DNA as a scaffold structure to anchor themselves to a surface).

Bacteria can utilize one of these techniques (or all of them) to acquire pieces of genetic code that provide resistance to a specific antibiotic (or a whole family of antibiotics).

Conditions That Allow Antibiotic Resistance To Develop

The Necessity of Selective Pressure

The average bacterial genome (a bacteria’s entire genetic code) is approximately 1000 times smaller than the genome of an animal (including humans). This is not because bacteria are smaller than human cells (although they usually are).

Bacterial genomes tend to be very small because of competition and a concept called genomic streamlining. A genome is not free. It takes energy and resources to maintain and replicate a genome. The bigger the genome, the more energy it takes to keep it up and running, and to duplicate it during reproduction. At the same time, the competition between bacteria for resources is incredibly intense.

Bacteria grow much faster, and in much larger numbers, than most other organisms. For example, in a single handful of dirt there are more bacteria than the entire human population of the world. The huge bacterial population and intense competition is like “survival of the fittest” on steroids. Weak and inefficient bacteria are quickly squeezed out by stronger, more efficient bacteria. Excess DNA is “dead weight” in this competition and it is quickly eliminated. If a section of bacterial DNA is not essential for survival or does not confer a consistent selective advantage, it is rapidly mutated and removed from the genome by the quickly evolving bacterial population.

How Does Selective Pressure Impact Antibiotic Resistance?

In order for a gene to remain functional and a part of a bacteria’s genome for any extended period of time, that gene must help improve the survival and/or competitiveness of the bacteria. If a gene stops being helpful it will eventually become non-functional and will be removed from the genome.

This means that the development and maintenance of antibiotic resistance is usually dependent on the bacterial population being frequently exposed to non-lethal doses of the antibiotic (note: some bacteria are intrinsically resistant to particular antibiotics). This process eliminates those bacteria that have lost resistance, and increases the percentage of resistant bacteria. From a big picture perspective, this means that antibiotic resistance is likely to develop and persist in specific environments where bacteria are frequently exposed to antibiotics. On an individual level, this means that a person is more likely to develop an antibiotic resistant infection from undergoing long-term or prophylactic antibiotic treatment, as opposed to short-term antibiotic treatments of acute infections. This also means that bacteria may lose resistance to antibiotics that are no longer frequently used.

Environments that Facilitate the Development of Antibiotic Resistance

If you have read the above sections, you now know that infectious bacteria do not randomly become resistant to antibiotics. The development of antibiotic resistance requires an environment that provides a good source of hosts (people/animals to infect), consistent selective pressure (frequent antibiotic use) and ideally, lots of other bacteria with which to share antibiotic resistance genes. It is because of this combination of factors that antibiotic resistance is not simply about using antibiotics too much, but also about where and how antibiotics are used. That said, there are some environments which uniquely support the development of antibiotic resistance:

Hospitals

Hospitals are often the perfect environment for bacteria to develop, acquire and maintain high-level antibiotic resistance. Hospitals have a many of the features that are necessary for antibiotic resistance to emerge. including:

  • A lot of infected people and contaminated surfaces (lots of bacteria hanging around).
  • A high density of potential hosts for bacteria infection (lots of new people to infect).
  • The frequent and sustained use of antibiotics (consistent selective pressure).

Hospital Acquired Infections (HAIs) are often the most difficult types of infection to treat because they are can be highly resistant to standard antibiotic treatments. Hospitals are a reservoir for antibiotic resistance, and in many cases are the primary source of antibiotic resistant bacteria in the surrounding population.

In the United States, and other highly developed countries, hospitals are reasonably sterile and there are a number of systems in place to prevent hospital acquired infections. Despite these safeguards, HAIs are one of the leading causes of morbidity among patients admitted to hospitals in the United States. In many other countries hospital conditions are less sanitary, which encourages the transmission of disease from patient to patient. In hospitals that have a high rate of antibiotic use but poor sterility, the development of antibiotic resistant bacteria is accelerated.

It is not a coincidence that outbreaks of virulent antibiotic-resistant bacteria, such as Multi-drug Resistant Staphylococcus Aureus (MRSA) and Mycobacterium tuberculosis(XDR-TB), often originate in hospitals in countries like South Africa and Russia. In these places and others like them, high patient density, poor sterility, HIV/AIDs (see below) and high antibiotic usage combine to drive the rapid evolution of drug resistant bacteria.

Feedlots and Industrial Animal Farms

Many people may do not realize that industrial animal farming operations are among the largest consumers of antibiotics in the world. Industrial operations involve large amounts of animals, packed densely into enclosed spaces. In this type of environment, disease transmission is a major problem. To prevent disease outbreaks, many operations treat their animals prophylactically (continuously) with antibiotics. In fact, in the United States animal farming consumes more antibiotics than are used in human medicine.

Like highly unsanitary and overcrowded hospitals, the high level of antibiotic use in industrial animal farming drives the evolution of antibiotic resistance in bacteria. In addition, the sewage produced by these operations can contain significant levels of un-metabolized antibiotics. These residual antibiotics combined with the huge and diverse population of bacteria living in the untreated sewage encourages the transfer of antibiotic resistance genes among different species of bacteria. Industrial animal farms can also cause the spread of antibiotic resistant bacteria to neighboring wildlife. It also partly explains why detectable levels of antibiotics are found in many rivers, lakes and other waterways.

Nursing Homes, Sanitoriums and Other Residential Institutions

Many countries around the world place people who are elderly, infirm or disabled into various types of institutions. While the United States has started to moved away from the large-scale housing of these individuals, the practice is still common in many places around the world. In wealthier countries, these people are often placed into assisted living facilities, retirement homes and hospices.

These environments contain dense populations of people who have weakened immune systems, which allows for more frequent and longer lasting infections. Antibiotic use can be very high in many of these environments and prophylactic antibiotic use is common. The combination of large populations of immune-compromised people and extensive antibiotic use can contribute to the emergence of antibiotic resistant bacteria.

HIV and AIDS

HIV and AIDS lead to higher rates of antibiotic resistance for two closely related reasons. First, because people who suffer from HIV and AIDS have an impaired immune system they are often highly susceptible to bacterial infection. As a result, many physicians place these patients on a permanent course of antibiotics to prevent infection. (Note: This is becoming less of a factor in places where effective anti-retrovirals are available, because they mitigate the need for prophylactic antibiotic treatment.)

The second reason HIV and AIDS foster antibiotic resistant bacteria is that they cause more infections to happen and they make antibiotics less effective (indirectly). Even in a person with a healthy immune system, a bacterial infection may not be completely eliminated by a course of antibiotics. However, in most cases the antibiotic weakens and kills most of the bacteria and the immune system is able to target and eliminate the surviving bacteria. But in a person with HIV, this small population of bacteria that remain after antibiotic treatment are not cleared by the immune system. This process selects for those bacteria that are slightly more resistant to the antibiotic treatment. Over time this process can drive Epigenetic Adaptation and select for Genetic Mutations that confer resistance.

Antibiotic Resistance and Acne Treatment

In the last ten years numerous studies have been done profiling the antibiotic susceptibility of the acne-causing bacteria, Propionibacterium acnes. The results tell a fascinating story. In countries where antibiotics are more frequently used to treat individuals with acne, antibiotic-resistant P. acnes bacteria tend to be more common. This means that in places like the United States and Europe, a significantly higher percentage of P. acnes bacteria have high-level antibiotic resistance than in places like Mexico, Chile and India.

Interestingly, the frequency of P. acnes bacteria resistant to a particular antibiotic varies from country to country, and this appears to reflect the differences in prescribing frequencies of different antibiotics for acne treatment between countries. In the United States, laboratory testing indicates that P. acnes bacteria that are resistant Macrolide and Tetracycline family antibiotics (the two antibiotic families most commonly used to treat acne) are becoming more common. But this trend is not true for all countries.

References

The Antibiotic Families

Overview

There are many different families of antibiotics. Each antibiotic family targets bacteria in a unique way. Each antibiotic family tends to be more effective against certain types of bacteria, and less effective against others.

Antibiotics and Acne Treatment

Antibiotics from several different families are used for the treatment of acne. The antibiotic families most commonly used in acne treatment are Macrolides, Tetracyclines, Pleuromutilins, Sulfonamides and Quinolones. Antibiotics can be used applied topically or ingested orally. The route of delivery, the ability of an antibiotic to accumulate in the skin and the susceptibility of P. acnes bacteria to an antibiotic all impact the efficacy of a given antibiotic treatment.

For more information about the sensitivity of Propionibacterium acnes (P. acnes) to specific antibiotics, visit our Antibiotic Susceptibility of Propionibacterium acnes page. For more information about the P. acnes bacterium, visit our What Is Propionibacterium acnes? page.

Antibiotic Families

Below is a summary of the different antibiotic families that are used in the treatment of acne:

Aminoglycosides

Aminoglycoside Family Members: Gentamicin (Garamycin), Neomycin (Neosporin), Paromomycin (Gabbroral), Tobramycin (Tobrex).
Frequency of Use For Acne Treatment: Uncommon.
General Efficacy as Acne Treatments: Poor.
Frequency of High-Level Antibiotic Resistance: Very Common.

Aminoglycoside antibiotics tend to be ineffective treatments for acne vulgaris. The acne-causing P. acnes bacterium is naturally resistant to most antibiotics in the Aminoglycoside family.

Aminoglycoside antibiotics are modified sugar molecules that are pimarily effective against gram-negative bacteria (P. acnes bacteria are gram-positive). Aminoglycoside antibiotics work by binding to bacterial ribosomes and inhibiting the bacteria’s ability to synthesize new proteins. Aminoglycosides are popular antibiotics for topical first-aid treatments (the primary ingredient in Neosporin is neomycin, an aminoglycoside). Topical aminoglycoside ointments (eg. Neosporin) may help prevent secondary infections of damaged skin and/or popped pimples. Therefore, they may help prevent mild acne scarring and accelerate the healing process.

Amphenicols

Amphenicol Family Members: Chloramphenicol (Clorin), Thiamphenicol (Biothicol).
Frequency of Use For Acne Treatment: Rare.
General Efficacy as Acne Treatments: Unknown.
Frequency of High-Level Antibiotic Resistance: Rare.

Amphenicols are a family of broad spectrum antibiotics that are used in many topical antibacterial medications, such as opthalmic solutions (eye drops). Amphenicols work by disrupting the ability of bacteria to synthesize new proteins. Antibiotic susceptibility testing indicates that P. acnes bacteria tend to be moderately susceptible to Amphenicols, and P. acnes bacteria with high-level resistance to Amphenicols are rare.

Amphenicols are rarely used for the treatment of acne. But topical formulations of Amphenicols (eg. Chloramphenicol) may be a useful acne treatment for some individuals. Topical Amphenicols may complement other types of acne treatments.

Cephalosporins

Cephalosporin Family Members: Cefaclor (Ceclor), Cefadroxil (Duricef), Cefdinir (Omnicef), Cefixime (Suprax), Cefpodoxime (Cefpo), Cefprozil (Cefzil), Cefradine (Cefradune), Ceftibuten (Cedax), Cephalexin (Keflex).
Frequency of Use For Acne Treatment: Occasional.
General Efficacy as Acne Treatments: OK.
Frequency of High-Level Antibiotic Resistance: Uncommon.

Cephalosporins are occasionally used as oral antibiotic treatments for moderate to severe acne symptoms (Acne Types: 2-4). Many individuals with acne have reported positive results from treatment with various Cephalosporin antibiotics. But not all acne patients achieve significant improvement with Cephalosporins.

Cephalosporins are type of beta-lactam antibiotic and they are structurally-related to the Penicillins. Cephalosporins kill bacteria by disrupting their cell walls via inhibition of peptidoglycan layer assembly. In contrast to Penicillins, Cephalosporins are effective against a broader range of bacteria and are more resistant to a bacterial antibiotic-resistance enzyme called Penicillinase. In antibiotic susceptibility testing, Cephalosporins were effective against P. acnes bacteria, but they tend to be less toxic to P. acnes than Penicillins.

Fusidic Acid

Fusidic Acid Family Members: Fusidic Acid (Fucidin).
Frequency of Use For Acne Treatment: Occasional.
General Efficacy as Acne Treatments: OK.
Frequency of High-Level Antibiotic Resistance: Uncommon.

Fusidic Acid is an antibiotic that prevents bacteria from synthesizing proteins by disrupting the function of a bacterial protein, Elongation Factor G (EF-G). Fusidic acid is available in oral and topical formulations. Topical Fusidic Acid is the form of this antibiotic that is generally used for the treatment of acne.

Antibiotic susceptibility testing indicates that the acne-causing P. acnes bacterium tends to be moderately susceptible to Fusidic Acid. Many patients have reported positive results with the use of topical Fusidic Acid. Fusidic Acid is generally used in combination with a complementary antibiotic.

Lincosamides

Lincosamide Family Members: Clindamycin (Cleocin).
Frequency of Use For Acne Treatment: Very Common.
General Efficacy as Acne Treatments: Good.
Frequency of High-Level Antibiotic Resistance: Occasional (Increasing).

One member of the Lincosamide family, Clindamycin, is frequently used for the treatment of acne. Clindamycin is generally used as a topical medication, but oral versions of this antibiotic are also available. Topical Clindamycin can be an effective treatment for mild to moderate acne symptoms (Acne Types: 1-3).

Lincosamides are structurally related to the Macrolide family of antibiotics. Lincosamides work by binding to the bacterial 23S ribosome, which inhibits the ability of the bacteria to synthesize new proteins. Lincosamides are generally very toxic to P. acnes bacteria, but Lincosamide-resistant P. acnes bacteria are becoming increasingly common. Research reports indicate that Clindamycin-resistant P. acnes bacteria are especially common in the United States and Europe.

Macrolides

Macrolide Family Members: Azithromycin (Zithromax), Clarithromycin (Biaxin), Dirithromycin (Dynabac), Erythromycin (E-Mycin), Josamycin (Josalid), Pristinamycin (Pyostacine), Roxithromycin (Roximycin), Spiramycin (Spirex), Telithromycin (Ketek).
Frequency of Use For Acne Treatment: Common.
General Efficacy as Acne Treatments: Good.
Frequency of High-Level Antibiotic Resistance: Occasional (Increasing).

Macrolides are a diverse class of antibiotics that includes several medications that are commonly used for the treatment of acne. Macrolides work by preventing bacteria from synthesizing new proteins. They do this by binding to a bacterial enzyme called Peptidyltransferase and/or binding to the bacterial 50S ribosome subunit. Macrolides are structurally related to Lincosamide antibiotics.

Macrolides are commonly used to treat infections caused by gram-positive bacteria. Topical macrolide antibiotics (eg. Erythromycin) are a very common treatment for acne, but oral Macrolides are also widely used. Antibiotic susceptibility testing indicates that Macrolides are usually very toxic to acne-causing P. acnes bacteria. However, Macrolide-resistant P. acnes bacteria are becoming increasingly common in many areas. Current research now indicates that a significant proportion of acne-associated P. acnes bacteria in the United States and Europe have now acquired some level of resistance to Macrolide antibiotics.

Nitroimidazoles

Nitroimidazole Family Members: Metronidazole (Flagyl).
Frequency of Use For Acne Treatment: Occasional.
General Efficacy as Acne Treatments: Poor.
Frequency of High-Level Antibiotic Resistance: Very Common.

Nitroimidazole antibiotics are used to treat infections that are caused by both bacteria and parasites. Nitroimidazoles work by disrupting the ability of microbes to synthesize new DNA.

Metronidazole is the only member of the Nitroimidazole family that is routinely used in the treatment of acne. Topical Metronidazole is also a common treatment for Rosacea. Antibiotic susceptibility testing indicates that P. acnes bacteria are naturally resistant to Metronidazole. However, many individuals with acne report improvements in their symptoms following use of Metronidazole. These improvements may be the result of Metronidazole’s ability to kill other types of bacteria that can contribute to acne symptoms (eg. S. aureus).

Oxazolidinones

Oxazolidinone Family Members: Linezolid (Zyvox) and Tedizolid (Sivextro).
Frequency of Use For Acne Treatment: Rare.
General Efficacy as Acne Treatments: Unknown.
Frequency of High-Level Antibiotic Resistance: Rare.

Oxazolidinones are a relatively new class of antibiotics that are used to treat certain types of inections caused by gram-positive bacteria. Oxazolidinones prevent bacteria from synthesizing new proteins by preventing N-formylmethionyl-tRNA from binding to the bacterial ribosome.

Oxazolidinones are rarely used in the treatment of acne. However, antibiotic susceptibility testing indicates that they are active against the acne-causing P. acnes bacteria. These antibiotics may become more widely used as acne treatments in the future.

Penicillins

Penicillin Family Members: Amoxicillin (Amoxil), Ampicillin (Polycillin), Ampicillin + Clavulanic Acid (Augmentin), Cloxacillin (Cloxapen), Dicloxacillin (Diclocil)Flucloxacillin (Floxapen), Penicillin G (BenzylPenicillin), Penicillin V (Phenoxymethylpenicillin).
Frequency of Use For Acne Treatment: Occasional.
General Efficacy as Acne Treatments: Good.
Frequency of High-Level Antibiotic Resistance: Rare.

Penicillin was discovered in 1920s by the Nobel Prize winning scientist Alexander Fleming. The discovery of Penicillin revolutionized the treatment of bacterial infections and initiated the modern era of antibiotics. Penicillins are beta lactam antibiotics that are structurally related to the Cephalosporins. Penicillin antibiotics work by damaging the cell wall of susceptible bacteria. They are most effective against gram positive bacteria, a group that includes the acne-causing P. acnes bacterium.

Penicillins are available in topical and oral formulations, both of which are occasionally used for the treatment of acne. Individuals with acne have generally reported positive results from treatments with Penicillin family antibiotics. Antibiotic susceptibility testing has shown that most P. acnes bacteria are extremely sensitive to Penicillins.

Pleuromutilins

Pleuromutilin Family Members: Retapamulin (Altabax).
Frequency of Use For Acne Treatment: Occasional.
General Efficacy as Acne Treatments: Good.
Frequency of High-Level Antibiotic Resistance: Rare.

Pleuromutilins are new class of antibiotics that are used to treat certain types of infections caused by gram-positive bacteria. Pleuromutilins work by preventing bacteria from synthesizing new proteins via inhibition of a bacterial enzyme called Peptidyl Transferase.

Antibiotic susceptibility testing indicates that P. acnes bacteria are highly sensitive to Pleuromutilin antibiotics, such as Retapamulin. Retapamulin is the only antibiotic in this family that is currently approved for human use. Retapamulin is used as a topical treatment for several kinds of skin infections, including acne. Patient reports and clincal research indicate that topical Retapamulin can significantly improve acne symptoms for most patients. The use of topical Retapamulin as a treatment for acne is likely to become more common as this medication becomes more widely available.

Quinolones

Quinolone Family Members: Ciprofloxacin (Cipro), Gatifloxacin (Tequin), Gemifloxacin (Toplon), Levofloxacin (Levaquin), Moxifloxacin (Avelox), Nadifloxacin (Nadixa), Nalidixic Acid (Wintomylon), Norfloxacin (Norflox), Ofloxacin (Floxin) and Sparfloxacin (Zagam).
Frequency of Use For Acne Treatment: Uncommon.
General Efficacy as Acne Treatments: Good.
Frequency of High-Level Antibiotic Resistance: Rare.

Quinolones are a class of broad-spectrum antibiotics that were discovered in the 1960s. Quinolones inhibit bacterial growth by preventing bacteria from reading and duplicating their DNA. Quinolones are effective against both gram-negative and gram-positive bacteria.

Quinolones are commonly used in combination with other antibiotics. They are rarely used for long term treatments or prophylaxis. This is because bacteria can develop resistance to Quinolones easire than they can to most other antibiotics. Quinolones also tend to have higher rates of side effects than other antibiotics.

Laboratory testing indicates that P. acnes bacteria are generally susceptible to most antibiotics in the Quinolone family. However, Quinolones are not commonly used for the treatment of acne vulgaris. Patient reports indicate that oral Quinolones can improve acne symptoms in many patients, at least temporarily. Most Quinolones are only available in oral formulations, but there is one fairly new Quinolone for topical use that is gaining some buzz – Nadifloxacin. Topical Nadifloxacin is not available in all countries, but several studies suggest that this medication can significanly improve acne symptoms in some individuals. Because it is administered topically, Nadifloxacin has a much better safety profile than most oral antibiotics.

Rifamycins

Rifamycin Family Members: Rifabutin (Mycobutin), Rifampicin (Rifampin), Rifapentine (Priftin).
Frequency of Use For Acne Treatment: Rare.
General Efficacy as Acne Treatments: Unknown.
Frequency of High-Level Antibiotic Resistance: Rare.

Rifamycins were discovered in the 1950’s. Rifamycins work by preventing bacteria from reading their own DNA (they block RNA synthesis). Rifamycins are important components of the combined antibiotic therapies used to treat tuberculosis. Because Rifamycins are an essential part of anti-tuberculosis therapy, their use in the treatment of other infections has been restricted in some places. Antibiotic resistance to Rifamycins tend to develop faster than resistance to other antibiotics.

Antibiotic susceptibility testing indicates that Rifamycins are very toxic to most strains of P. acnes bacteria. However, Rifamycins are rarely used for the treatment of acne vulgaris. Several research and patient reports suggest that Rifamycins (Rifampicin in particular) can be very effective at improving acne symptoms for some individuals. More research is needed on the utility of Rifamycin family antibiotics in the treatment of acne. Rifamycines are generally only available in oral formulations.

Sulfonamides

Sulfonamide Family Members: Co-Trimoxazole (Bactrim), Dapsone (Aczone), Mafenide (Sulfamylon), Silver Sulfadiazine (Silvadene), Sulfacetamide (Clenia), Sulfadimethoxine (Albon), Sulfadoxine (Sulphadoxine), Sulfafurazole (Sulfisoxazole), Sulfamethoxazole (SMX) and Sulfathiazole (Sulfatiazol).
Frequency of Use For Acne Treatment: Occasional.
General Efficacy as Acne Treatments: Good.
Frequency of High-Level Antibiotic Resistance: Rare.

Sulfonamides are a class of antibiotics whose molecules all contain sulfur atoms. They were among the first oral antibiotics to be used in human medicine and their use became widespread in the 1930s. Sulfonamides work by preventing bacteria from synthesizing an essential vitamin, Folate (Vitamin B9).

Antibiotics in the Sulfonamide family are available in many oral and topical formulations. Sulfonamides are also widely used in veterinary medicine. Antibiotic susceptibility testing indicates that ance-causing P. acnes bacteria tend to be moderately susceptible to Sulfonamides. Topical sulfonamides (eg. Dapsone, Mafenide, Silver Sulfadiazine and Sulfacetamide) are occassionally used for the treatment of mild to moderate acne symptoms (Acne Types: 1-3) and many individuals have reported positive results with these medications. Because Sulfonamides have a unique mechanism of action, they can be combined with many other acne medications.

Only one oral Sulfonamide antibiotic is routinely used as an acne treatment – Co-Trimoxazole. Co-Trimoxazole is a combination of two antibiotics Sulfamethoxazole and Trimethoprim. These two antibiotics work synergistically and are substantially more effective in together than either is alone. Co-Trimoxazole is an important acne treatment because it can be very effective for individuals with moderate to severe inflammatory acne (Acne Types: 3-4). However, Co-trimoxazole is not routinely prescribed for the treatment of acne vulgaris in many places. This is primarily the result of two factors. First, allergic reactions to oral Sulfonamides can be more severe than allergic reactions caused by other antibiotics. Second, the use of Co-Trimoxazole as an acne treatment is considered “”off-label”” in many countries, including the United States. As a result, many physicians do not feel comfortable considering Co-Trimoxazole for the treatment of acne. But for those patients without allergies to Sulfonamides, Co-trimoxazole treatments may yield substantial improvements in difficult-to-treat acne cases.

Tetracyclines

Tetracycline Family Members: Demeclocycline (Declomycin), Doxycycline (Vibramycin), Lymecycline (Tetralysal), Minocycline (Minocin), Oxytetracycline and Tetracycline (Sumycin).
Frequency of Use For Acne Treatment: Very Common.
General Efficacy as Acne Treatments: OK.
Frequency of High-Level Antibiotic Resistance: Common.

Tetracyclines were discovered in the 1940s by the plant scientist Benjamin Duggar. Tetracyclines are a class of broad-spectrum antibiotics that work by inhibiting protein synthesis in susceptible bacteria via disruption of the 30S Ribosome. In the past, Tetracyclines were frequently used for the treatment of many different types of infections. But in the last thirty years, the efficacy of Tetracyclines has decreased substantially due to the spread of Tetracycline-resistant bacteria.

Tetracyclines are the antibiotic family of choice for many dermatologists when treating acne. Oral Tetracyclines are commonly used for the treatment of moderate to severe acne symptoms (Acne Types: 2-4). However, antibiotic susceptibility reports clearly demonstrate that Tetracycline-resistant P. acnes bacteria are common, particularly in certain regions of the world (eg. United States and Europe).

When acne is caused by Tetracycline-susceptible bacteria, treatment with Tetracyclines (particularly Minocycline) can be very effective. But current patient reports and clinical research indicate that Tetracyclines yield little to no improvement in acne symptoms for many individuals. The likely reason why Tetracyclines are so frequently used for the treatment of acne, despite their mediocre efficacy and the prevalence of Tetracycline-resistant P. acnes bacteria, is that many of the prescribing guidelines now in use for the treatment of acne were developed decades ago, when the patterns of antibiotic resistance among P. acnes bacteria were different.

Additional Antibiotics

BACITRACIN

Frequency of Use For Acne Treatment: Occasional.
General Efficacy as Acne Treatments: Unkown.
Frequency of High-Level Antibiotic Resistance: Common.

FOSFOMYCIN

Frequency of Use For Acne Treatment: Rare.
General Efficacy as Acne Treatments: Unkown.
Frequency of High-Level Antibiotic Resistance: Very Common.

GRAMICIDIN

Frequency of Use For Acne Treatment: Occasional.
General Efficacy as Acne Treatments: Unkown.
Frequency of High-Level Antibiotic Resistance: Common.

MUPIROCIN

Frequency of Use For Acne Treatment: Occasional.
General Efficacy as Acne Treatments: Poor.
Frequency of High-Level Antibiotic Resistance: Very Common.

NITROFURANTOIN

Frequency of Use For Acne Treatment: Rare.
General Efficacy as Acne Treatments: Unknown.
Frequency of High-Level Antibiotic Resistance: Rare.

TRIMETHOPRIM

Frequency of Use For Acne Treatment: Occasional.
General Efficacy as Acne Treatments: OK.
Frequency of High-Level Antibiotic Resistance: Rare.

The Antibiotic Susceptibility of Propionibacterium acnes

Overview

Antibiotics are medications that are used to treat bacterial infections, including acne. The acne-causing Propionibacterium acnes (P. acnes) bacterium is naturally resistant to some antibiotics, and naturally susceptible to others. For the past 50 years, physicians and researchers have been screening the susceptibility of P. acnes bacteria to different antibiotics. The results from these studies clearly demonstrate that in many places, P. acnes bacteria are becoming more resistant to certain classes of antibiotics.

The Rise of Antibiotic Resistance in P. acnes Bacteria

In many countries, a significant percentage of the P. acnes bacteria isolated from acne patients are now resistant to the some of the antibiotics that are commonly used in acne treatment (eg. Clindamycin, Erythromycin, Tetracycline, Doxycycline and Minocycline). The patterns of antibiotic resistance among acne-causing P. acnes bacteria tend to vary between countries. These variations are influenced by many factors. Not all of these factors are directly associated with acne vulgaris.

What Does Antibiotic Resistance and Susceptibility Mean?

Not all antibiotics are created equal. The same is true for bacteria. Some types of antibiotics are highly effective against certain types of bacteria, but useless against other types of bacteria. Antibiotic susceptibility and resistance is a dynamic process that is constantly changing. Over time, certain types of bacteria may gain or lose resistance to particular antibiotics. The general trend is that over time, bacterial resistance to commonly-used antibiotics increases, but this is not a uniform process.

How Does Antibiotic Susceptibility Testing Work?

Antibiotic susceptibility testing is usually conducted by growing bacteria in special petri dishes with small disks that contain known amount of antibiotics. When scientists test the susceptibility of bacteria to different antibiotics, they generally focus on the Minimum Inhibitory Concentration (MIC) of an antibiotic. The MIC is defined as the lowest concentration of an antimicrobial compound that will inhibit the visible growth of a microorganism after overnight incubation.

The Limitations of Antibiotic Resistance Testing

The primary limitation of conventional antibiotic resistance testing is that the susceptibility of a bacteria to an antibiotic is often different when it is growing on a petri dish versus when it is growing in the body. There are 2 main reasons for this:

The first reason for these differences are because bacteria adapt to their environment. P. acnes bacteria that is growing in a hair follicle and feeding on sebum from the sebaceous glands has a different metabolic profile than one growing on a petri dish and feeding on a bacterial nutrition supplement. In addition, bacteria can modulate expression of surface proteins, cell wall structures and antibiotic resistance genes in response to changes in their environment. The adaptation of a bacteria to its specific environment can have a profound effect on its susceptibility to a particular antibiotic.

The second major limitation with antibiotic susceptibility testing is that antibiotics are not evenly dispersed throughout the different tissues in the body. Different types of antibiotics tend to accumulate in different tissues. Many antibiotics do not effectively accumulate in the skin, which means that they may not inhibit acne-causing bacteria growing deep inside follicles. Even if a bacteria is highly susceptible to a particular antibiotic in laboratory testing, if that antibiotic does not make it to the site of infection at a sufficient concentration, it is not going to be an effective treatment.

What Causes Antibiotic Resistance?

A commonly held belief is that the over-use of antibiotics in an outpatient setting and patients that fail to complete their prescribed antibiotic treatments are the primary causes of emerging antibiotic resistance. While these two factors do contribute to the growing incidence of antibiotic resistant infections, they are far from the only causes. Other sources of antibiotic-resistant bacteria include antibiotic use in commercial livestock farming, unsatisfactory hygiene in institutional settings (hospitals, nursing homes, prisons) and HIV/AIDS. For an in-depth discussion of both the mechanisms and causes of antibiotic resistance read – How Do Bacteria Become Resistant to Antibiotics?

The Emergence of Antibiotic Resistant Strains of P. acnes

Starting in the 1990’s some popular antibiotics started becoming less effective for the treatment of acne. This change was particularly pronounced in places where acne vulgaris was routinely treated with antibiotics (eg. North America and Europe). A 2001 study by Ross, et al examined P. acnes isolated from acne patients and found that the bacteria was much more likely to be resistant to commonly used anti-acne antibiotics than they had been in the past. In particular, they found that most of the bacteria was resistant to Macrolide Family (eg. Erythromycin, Azithromycin, Clindamycin) and Tetracycline Family (Minocycline, Doxycycline) antibiotics. It is unlikely to be a coincidence that these two families of antibiotics include the most commonly used anti-acne antibiotics.

Antibiotic resistance testing clearly indicates that acne-causing P. acnes bacteria are becoming increasingly resistant to the antibiotics commonly used as acne treatments. Particularly in places like Europe and the United States, a significant percent of bacteria isolated from acne patients are now show an elevated level of antibiotic resistance. Generally speaking, the data indicates that in Europe, resistance to Macrolide antibiotics is very high, and resistance to Tetracycline antibiotics is also elevated. The situation is similar in the US, but Tetracycline resistance appears to be more common.

The scientific research also clearly shows that some of the antibiotic treatments that have been the mainstay of dermatologists in the fight against acne, are now becoming ineffective. As a result, for patients who have P. acnes infections that are resistant to these common treatments, it may be helpful to explore alternative types of anti-acne medications, such as Retinoids, Hormonal Treatments, Naturopathic Treatments and Light & Laser Therapies.

Antibiotic Resistance and Susceptibility Test Results for Propionibacterium acnes

Scientists have been testing antibiotics against P. acnes bacteria for over forty years. To summarize this history of testing into a single document, we have compiled a composite chart that includes the results of many of these research studies on the antibiotic susceptibility screens of P. acnes bacteria.

How To Read Our Composite Antibiotic Susceptibility Chart

Many studies use different standards and measurements. We have translated these various results into a simple 1 (Worst) to 5 (Best) scale. The lower the value the LESS effective the antibiotic was in testing. The higher the value the MORE effective the antibiotic was. The average score for each medication is listed on the left hand side of the chart and is color coded (red = least effective, yellow = moderately effective, green = most effective). The average score for each family of antibiotic is also listed next to the name of that family. On the chart itself, a box that is highlighted in red indicates that scientists detected P. acnes bacteria that were highly resistant to that particular antibiotic.

Sebaceous Glands

Sebaceous glands produce sebum, which is responsible for moisturizing and protecting skin and hair. Sebaceous glands are essential components of healthy skin. Damaged or malfunctioning sebaceous glands contribute to many dermatological conditions, including acne vulgaris.

Structure of the Sebaceous Glands

Sebaceous glands are clusters of specialized cells in the skin. These specialized cells are called sebocytes. Sebocytes are responsible for the synthesis and secretion of sebum. Sebum is a complex blend of fatty acids, waxes, lipids and other molecules that are responsible for moisturizing, lubricating and protecting the skin.

Sebocytes are similar to adipose cells (fat cells) because they accumulate large amounts of fats and lipids. But unlike adipose cells, sebocytes do not store energy. Rather, like true patriots, they sacrifice themselves for the greater good and undergo apoptosis (commit suicide). The death of the sebocyte releases the sebum stored within the cell and this sebum is exported through the hair follicle to the skin surface. Once at the skin surface, the sebum then diffuses into the epidermis where it moisturizes and protects the tissue.

Sebocyte Development

Sebaceous glands are composed of two main types of sebocyte cells – Peripheral Sebocytes and Central Sebocytes. Peripheral Sebocyte Cells (PCs) line the outer edge of the sebaceous gland. Peripheral sebocytes are where the cellular reproduction happens, and where the sebaceous gland originates and grows. Peripheral sebocytes accumulate relatively little sebum compared to their more mature counterpart, Central Sebocyte Cells (CCs). Central sebocytes originate from proliferating peripheral sebocytes.

As central sebocytes mature, they migrate from the edges to the center of the sebaceous gland. During this process they begin to synthesize and accumulate large reserves of sebum, which they store in specialized storage structures inside the cell, called vacuoles. As they continue to mature, they migrate towards the hair follicle. When completely mature sebocytes reach the follicle opening, they undergo cellular suicide and spill their contents (sebum) into the follicle. This sebum then travels up the follicle to the surface of the skin, where it is essential for the maintenance of the epidermis.

Sebaceous Glands and Acne

Sebaceous glands can contribute to the development of acne in several ways. One of the most common problems faced by acne sufferers involves overactive sebaceous glands and sebaceous hyperplasia (enlarged sebaceous glands). These conditions can lead to an overproduction of sebum. Excess sebum can facilitate the growth of bacteria (eg. Propionibacterium acnes) that contribute to acne symptoms. These bacteria can utilize sebum as a food source and large food supplies encourage bacterial growth.

Excess sebum production by overactive sebaceous glands can also cause the formation keratinized plugs (clogged pores) that block the follicle and spur the development of inflammatory lesions. Sebum itself and the byproducts of its breakdown can also be directly comedogenic (acne-causing) because byproducts of sebum metabolism can cause inflammation.

Sebaceous Glands and Hormones

Androgen (male) hormones stimulate the growth and activity of the sebaceous glands. Hormonal changes are largely responsible for the increase in acne that can occur during adolescence, particularly among males. Women with elevated androgen levels can also experience problems with androgen-dependent sebaceous hyperplasia. Excessive levels of androgen hormones can be treated with androgen inhibitors, which suppress their effects. Sebaceous glands also appear to respond to non-androgen hormones, like Insulin Growth Factor (IGF), a hormone that has been loosely tied to milk consumption.

Sebaceous Glands and Retinoids

Retinoids are a class of acne treatment that can reduce the activity of sebaceous glands. When sebocytes are exposed to retinoid medications, it initiates a cascade of changes that dramatically alter their growth pattern. Retinoids cause sebaceous glands to slow their frowth rate and decrease in overall size. These changes can result in a significant reduction of sebum production. In some cases, treatment with oral retinoids (such as Accutane/Isotretinoin) can decrease the production of sebum by up to 90%.

Retinoids can also affect the proliferation of other types of cells. The broad activity of retinoids on a diverse range of cells contributes to many of the possible side effects of this class of medication. The most dangerous side effect of retinoid treatment is potential damage to a developing fetus. Retinoids dramatically disrupt normal embryonic development and leads to severe birth defects. For this reason, oral retinoids (eg. Isotretinoin/Accutane) are tightly controlled in many countries, particularly for women.

Retinoid Medications

Retinoids are available in both oral and topical formulations. Isotretinoin (Accutane) is the only retinoid widely available as an oral treatment. Isotretinoin, Tretinoin, Adapalene and Tazarotene are all retinoids that are available as topical treatments. Topical retinoids tend to be less effective acne treatments than oral retinoids, but have fewer side effects.

Additional Treatments for Sebaceous Hyperplasia

Emerging therapies that utilize Light and Laser Treatments are becoming increasingly popular options for dealing with problematic sebaceous glands. Specialized Photodynamic Therapy (PDT) and Diode Lasers can be used to specifically target, damage and destroy sebaceous glands. While these treatments can be quite expensive and incompletely effective, their development offers the promise of additional treatments for acne sufferers.

References

Sebaceous Gland Lipids: Friend or Foe? Smith, et al. 2008.
Sebaceous Gland Receptors. Zouboulis. 2009.
Differentiation of the Sebaceous Gland. Niemann. 2009.
The Sebocyte Culture: A Model to Study the Pathophysiology of the Sebaceous Gland in Sebostasis, Seborrhoea and Acne. Zouboulis, et al. 2008.
The Role of Specific Retinoid Receptors in Sebocyte Growth and Differentiation in Culture Kim, et al. 1999.
Sebaceous Gland Lipids Picardo, et al. 2009.
Isotretinoin Revisited: Pluripotent Effects on Human Sebaceous Gland Cells Zouboulis. 2006.
Selective photothermolysis of the sebaceous glands for acne treatment. Lloyd, et al. 2002.
Significant reduction of inflammation and sebaceous glands size in acne vulgaris lesions after intense pulsed light treatment. Barakat, et al. 2017.
Role of sebaceous glands in inflammatory dermatoses. Shi, et al. 2015.
Beyond acne: Current aspects of sebaceous gland biology and function. Zouboulis, et al. 2016.
Photodynamic Therapy for Acne Vulgaris and Sebaceous Gland Hyperplasia. Taub, et al. 2016.
The role of androgen under normal and pathological conditions in sebaceous glands: the possibility of target therapy. Azmahani, et al. 2016.
Modulation of Toll Like Receptor-2 on sebaceous gland by the treatment of adult female acne. Rocha, et al. 2017.

Acne at a Cellular Level

Most people can recognize acne when it presents on the face or body. Most people also have the vague understanding that acne is associated with oily skin and an excess production of sebum. But beyond that, few people really grasp what is actually happening at the microscopic level of a pimple.

Understanding the physiological and pathological processes behind acne can help you sort out what treatments and advice can help you make positive changes in your acne. A better understanding of the science of acne can also help you identify the claims that have no basis in scientific reality and should be ignored.

What Causes Acne?

Acne is caused by a combination of factors that result in blocked pores, an accumulation of sebum, bacterial growth and inflammation. Acne generally occurs within the hair follicle, when excess sebum is produced by the sebaceous glands and creates a plug that blocks the follicle.

Clogged follicles create a micro-environment that favors the growth of certain types of bacteria, such as Propionibacterium acnes and Staphylococcus aureus. The presence of this bacteria triggers an immune response, which is characterized by inflammation, increased blood flow (redness) and the recruitment of white blood cells to the follicle.

The initial inflammation of an acne lesion can cause damage to the follicle and surrounding tissue. This inflammation can then increase the growth of bacteria, which creates a positive feedback loop of additional inflammation. In some individuals, this process becomes a vicious cycle and leads to extensive acne and significant damage to the skin and the subcutaneous matrix that supports healthy skin. Severe and repeated damage that is caused by inflammatory acne lesions can cause permanent acne scars.

Sebum and a Healthy Follicle

Sebum is a mixture of fatty acids and lipids that is essential for lubricating and protecting healthy skin. Sebum is produced by Sebaceous Glands, which are attached to the base of hair follicles. In a healthy follicle, the sebaceous gland produces the appropriate amount of sebum to maintain the health of the surrounding skin, and the sebum is efficiently extruded along with the hair.

For individuals with acne, several things can happen that disrupt the delicate balance of sebum production. Normal sebaceous glands are relatively small and produce a minimal amount of sebum. However, excessive growth of the sebaceous glands (sebaceous hyperplasia) and overproduction of sebum can be an important contributor to acne symptoms. Sebaceous hyperplasia can be triggered by increases in androgen hormones, which is common for males during puberty.

Sebum itself is created by the breakdown of the cells that form the sebaceous gland. Sebaceous cells replicate at the base of the gland and move up towards the hair follicle as the new cells proliferate. As the maturing cells approach the hair follicle, they undergo apoptosis and die. The cells are lipid rich (oil) and the byproducts left over as the cells dissolve composes the sebum that lubricates and protects the hair. Proliferation of the sebaceous glands causes an increase in the production of sebum, which can present as oily skin and hair.

Sebum can also serve as a nutrition source for bacteria that reside inside the hair follicle, such as P. acnes and S. aureus. Excess amounts of sebum can encourage bacterial growth and lead to inflammation, redness and an infiltration of white blood cells (pus). If a hair follicle is plugged near the surface, this process can often lead to the formulation of a surface pustule (whitehead). However, for many people who suffer with inflammatory acne, the pustules are often formed deep in the tissue and away from the surface. These deep-seated pustules are responsible for nodular and cystic acne symptoms (Acne Types: 3-4).

The deep-seated pustules that form in nodular and cystic acne lesions are surrounded by tissue and it is difficult to drain the pus and bacteria to the surface (eg. “pop” or lance the pimple). Individuals with acne lesions that are significantly inflamed or painful should generally avoid trying to pop these pimples at home. Effectively and safely draining these lesions can reduce symptoms and accelerate healing, but these procedures should be performed by a trained medical professional. Many times, continued sebum production, bacterial growth and inflammation within a plugged follicle can cause the follicle to rupture and drain into the surrounding tissue. This process can lead to further inflammation, dissemination of the bacterial infection, worsening acne symptoms and the formation of acne scars.

References

The human sebocyte culture model provides new insights into development and management of seborrhoea and acne. Zouboulis, et al. 1998.
Severity of acne and sebum excretion rate. Cotterill, et al. 1971.
Genetic control of sebum excretion and acne—a twin study. Walton, et al. 1988.
A review of the role of sebum in the mechanism of acne pathogenesis. Li, et al. 2017.
From new findings in acne pathogenesis to new approaches in treatment. Gollnick. 2015.
A systematic review and meta-analysis on Staphylococcus aureus carriage in psoriasis, acne and rosacea. Totte, et al. 2016.
Evolving perspectives on the etiology and pathogenesis of acne vulgaris. Eichenfield, et al. 2015.

What is Propionibacterium acnes?

Answer: Propionibacterium acnes (P. acnes) is a bacteria that can colonize the the skin and hair follicles. Excessive growth of this bacteria in the skin contributes to acne vulgaris.

Propionibacterium acnes – The Basics

Propionibacterium acnes (P. acnes) is a bacteria that grows deep inside of pores, where it feeds on the sebum that is produced by the sebaceous glands that surround the base of the hair shaft. Most individuals with acne symptoms have an overgrowth of P. acnes bacteria in their skin. Several research studies have indicated that specific strains of P. acnes bacteria are commonly associated with acne vulgaris. However, other bacteria (e.g. Staphylococcus and Corynebacterium) can also reside in the skin and contribute to acne.

Biology of Propionibacterium Acnes

P. acnes are a type of “gram-positive” bacteria. Gram-positive bacteria produce a positive result in the Gram stain test, which is a common way to test for bacterial infections. Gram positive bacteria have thick cell walls that that help protect them from their environment. There are many other types of gram-positive bacteria that cause infections, such as Staphylococcus (MRSA), Streptococcus (Strep Throat) and Listeria (food poisoning).

P. acnes is an oxygen-tolerant, anaerobic bacteria that prefers to grow in low oxygen environments (like deep within a plugged follicle). P. acnes bacteria can form sticky clumps of bacteria known as biofilms that help them to attach to surfaces and modulate their environment. In many cases, bacterial biofilms have been shown to contribute to long term infections, and may play a role in the persistence of P. acnes infection in some individuals.

The Relationship Between Sebum and Propionibacterium acnes

P. acnes bacteria use sebum as an energy source (food). Sebum production is partially controlled by hormones (androgens) and sebum production is elevated in many people with acne. The excess production of sebum increases the growth of P. acnes bacteria, causes oily skin and creates plugs that block the opening of the hair follicle. In a plugged follicle, the low oxygen levels and accumulating sebum create an excellent environment for the growth of P. acnes bacteria.

P. acnes bacteria produce specialized enzymes that help them digest the fatty acids and triglycerides that are abundant in sebum. In an anaerobic environment, P. acnes ferments the fatty acids and triglycerides, and releases short chain fatty acids and propionic acid as metabolic byproducts (that’s why it’s called Propionibacterium). Research indicates that the breakdown of sebum by P. acnes can create comedogenic byproducts, and this may be a contributing factor to the severity of acne symptoms. There is also some evidence that presence of P. acnes bacteria may directly stimulate the sebaceous glands to produce additional sebum. If this is true, it is possible that the bacteria has adapted to the environment of the follicle, and part of this adaptation includes a mechanism to get more food (sebum) from the surrounding tissue.

Propionibacterium acnes, Inflammation and Acne

The P. acnes bacteria itself does not directly cause significant damage to the skin. Instead, most of the damage caused by inflammation that results from the body’s own immune response to the presence of the P. acnes bacteria.

Particularly for individuals who suffer from inflammatory acne (Acne Types: 2-4), the immune system over-reacts to the presence of bacteria and sends in lots of white blood cells. Each person’s immune system is different, and some immune systems are more sensitive to P. acnes bacteria than others. People with a naturally strong immune response to P. acnes bacteria have an increased risk of developing acne symptoms.

Many of the individual components that make up the bacteria are easily recognized by the immune system as “foreign” molecules. This material includes components of the bacterial cell wall, like peptidoglycans, lipopolysacharides and proteins. Even the DNA from P. acnes bacteria is recognized as foreign by the immune system. The bacteria doesn’t even have to be alive to trigger a powerful immune response, dead bacteria can also set off alarms within the immune system.

Dysfunctional Immune Responses and Acne vulgaris

In some people who suffer from moderate to severe acne (Acne Types: 2-4), the root of the problem can be traced back to a faulty immune response. There are two main types of immune system malfunctions that can lead to acne symptoms:

Hyper-Sensitive Response

In a hyper-sensitive immune response, an individual’s immune system reacts over-aggressively to the presence of the bacteria and produces large amounts of inflammatory signals. These inflammatory cytokines induce white blood cells to release large amounts of digestive enzymes and free radicals into the site of infection.

For individuals with acne, this immune response is often poorly-targeted against the infectious agent and it causes a lot of unnecessary collateral damage to the surrounding tissue. This collateral damage can actually make it more difficult for the immune system to fight off the infection. The damage often stimulates the production of more inflammatory signals and this can become a vicious cycle. This type of inflammatory cycle is responsible for the symptoms observed in moderate-to-severe inflammatory acne. This inflammation can also permanently damage the skin and lead to acne scars.

Impaired Bacterial Killing Ability

Another type of dysfunctional immune response can occur when an individual’s white blood cells do not effectively destroy and process the bacteria that they encounter. In an ideal situation, white blood cells called Macrophages capture (phagocytose) all of the bacteria that they come in contact with. Once captured, the Macrophage isolates the bacteria into an special intracellular compartment called a phagosome. It then pumps antibacterial molecules and digestive enzymes into this compartment. These molecules and enzymes kill the bacteria and break it down into small pieces. Some of these pieces are then used by the immune system to design antibodies that target the bacteria and prevent future infections. The immune system uses certain pieces of the digested bacteria to train specialized white blood cells to identify and respond to infections caused by that bacteria.

Some individuals who suffer from chronic inflammatory infections (eg. acne) have white blood cells that are able to ingest bacteria normally, but are not able to efficiently kill certain types of bacteria that they ingest. In this situation, the white blood cell will often continue to secrete lots of inflammatory signals till it exhausts itself and dies in a process called apoptosis. After the white blood cell dies, the bacteria may not be dead, in which case it can sometimes escape and continue proliferating.

Genetics

Both of the above examples of immune system dysfunction are usually genetic in origin. The susceptibility to acne vulgaris is appears to be partially hereditary. Individuals whose parents experienced difficulty with acne have an increased risk of developing acne symptoms.

How to Treat P. acnes Bacteria

Antibiotics and Other Antibacterial Compounds

Extensive screening has been done to test the susceptibility of P. acnes bacteria to different classes of antibiotics. In general, what researchers have found is that P. acnes is moderately susceptible, when directly exposed, to many classes of antibiotics.

Researchers have also found that P. acnes bacteria is becoming increasingly resistant to some of the common antibiotics used to treat acne, like erythromycin and tetracycline family drugs (tetracycline, doxycycline and minocycline). Interestingly, numerous studies have shown that P. acnesbacteria is extremely sensitive to Penicillin, which was one of the first antibiotics ever developed.

It is important to keep in mind that these tests are primarily done on a Petri dish in a laboratory. When asking whether an antibiotic is effective when treating a clinical acne infection there are additional factors that need to be considered. The biggest question is whether the antibiotic makes it to the site of infection. Many antibiotics may be effective at killing P. acnes bacteria on a Petri dish, but they do not accumulate in sufficient concentration in the follicle and sebaceous glands to be effective at treating active acne infections.

Several Over-The-Counter medications, like benzoyl peroxide and triclosan, are also directly toxic to P. acnes bacteria. However, these topically applied medications have difficulty penetrating to the base of the hair follicle, which is where the P. acnes bacteria are causing problems.

Retinoids and Hormonal Treatments

P. acnes bacteria use the fatty acids and triglycerides found in sebum as its primary food source. Limiting the amount of sebum production can suppress the growth of P. acnes bacteria by reducing its food supply.

Treatment with retinoids can decrease the production of sebum in the skin. This is true for both oral retinoids (eg. Isotretinoin/Accutane) and topical retinoids (eg. Tretinoin/Retin-A, Adapalene/Differin). Hormonal treatments such as androgen inhibitors (eg. Spironolactone, Cyproterone) and birth control pills may also decrease sebum production.

Light and Laser Treatments

Certain light and laser therapies can also decrease the production of sebum. Diode lasers can be used to treat overactive sebaceous glands, thereby reducing the amount of sebum.

Blue light phototherapy and Photodynamic Therapy (PDT) can be used to directly kill P. acnes bacteria growing in the skin. These therapies work by using high intensity light of a specific color (wavelenght) to excite a bacterial molecule called a porphyrin. Porphyrin is produced in large quantities by P. acnes bacteria. Excitation of porphyrins with blue light causes them to release free radicals into the bacteria and killing them.

Essential Oils

Many essential oils have been shown to contain antibacterial molecules that are toxic to P. acnes bacteria. Some essential oils, such as Tea Tree Essential Oil and Thyme Essential Oil are commonly used as topical acne treatments.

Other Naturopathic Treatmens

Besides essential oil, many natural compounds (eg. Aloe vera gel and natural honey) have been shown to have antibacterial properties against P. acnes. Certain metals (eg. silver and copper) and other elements (eg. sulfur) are also toxic to P. acnes bacteria in pure form. There are numerous Naturopathic treatments for acne.

References

The complete genome sequence of Propionibacterium acnes, a commensal of human skin. Brüggemann, et al. 2004.
Acne and Propionibacterium acnes. Bojar, et al. 2004.
Induction of proinflammatory cytokines by a soluble factor of Propionibacterium acnes: implications for chronic inflammatory acne. Vowels, et al. 1995.
Propionibacterium acnes resistance: a worldwide problem. Eady, et al. 2003.
Eradication of Propionibacterium acnes by its endogenic porphyrins after illumination with high intensity blue light. Ashkenazi, et al. 2003.
Propionibacterium acnes strain populations in the human skin microbiome associated with acne. Fitz-Gibbon, et al. 2013.
Induction of toll‐like receptors by Propionibacterium acnes. Jugeau, et al. 2005.
Propionibacterium acnes and lipopolysaccharide induce the expression of antimicrobial peptides and proinflammatory cytokines/chemokines in human sebocytes. Nagy, et al. 2006.
Formation of Propionibacterium acnes biofilms on orthopaedic biomaterials and their susceptibility to antimicrobials. Ramage, et al. 2003.
Biofilm formation by Propionibacterium acnes is associated with increased resistance to antimicrobial agents and increased production of putative virulence factors. Coenye, et al. 2007.
The role of Propionibacterium acnes in acne pathogenesis: facts and controversies. Dessinioti, et al. 2010.
A comparative study of Cutibacterium (Propionibacterium) acnes clones from acne patients and healthy controls. Lomholt, et al. 2017.
Propionibacterium acnes: an update on its role in the pathogenesis of acne. Beylot, et al. 2014.
Antagonism between Staphylococcus epidermidis and Propionibacterium acnes and its genomic basis. Christensen, et al. 2016.

Anabolic Steroids and Acne

What are Anabolic Steroids?

Anabolic Steroids (aka Roids, Juice, AAS, etc) are molecules that mimic the shape and function of androgen hormones (eg. Testosterone). Anabolic Steroids are generally used to stimulate protein synthesis and muscle growth.

The Difference Between Anabolic Steroids and Corticosteroids

Anabolic steroids should not be confused with corticosteroids, which are immune suppressants and can actually inhibit muscle growth. Corticosteroid injections are sometimes used to treat acute inflammation in severe acne lesions. Anabolic Steroids are never used as an acne treatment, and their use can cause or worsen acne symptoms.

Anabolic Steroids as Performance Enhancing Drugs

There are numerous medical conditions for which Anabolic Steroids are legitimately used as treatments, but Anabolic Steroids are better known for their use as performance enhancing drugs. All major sporting leagues ban the use of Anabolic Steroids, although this doesn’t necessarily prevent their use by athletes. Anabolic Steroids use by individuals for aesthetic purposes is also common in some populations.

Risks and Side Effects of Anabolic Steroid Use

There is widespread concern and controversy about the danger posed by both aesthetic and performance enhancing use of Anabolic Steroids. While some of the danger may be overstated, there are many well-known side effects associated with the use of Anabolic Steroids, including: Growth disruption in adolescents, hormone balance problems, accelerated male pattern balding, cardiovascular problems, contaminated/counterfeit medications, psychological problems (e.g. roid rage) and acne vulgaris.

Research shows that negative side effects of Anabolic Steroid use tend to occur in a dose dependent fashion. Higher and more frequent dosing of Anabolic Steroids is generally associated more frequent and severe side effects. The side effect profile is also dependent on the precise type of Anabolic Steroid being used. With the rapid expansion in designer Anabolic Steroids over the last two decades, a tremendous diversity of options now exists in the marketplace.

How Anabolic Steroids Work

Androgens are the primary hormones responsible for many of the masculine characteristics that differentiate males and females. While females naturally produce androgen hormones like testosterone, they tend to produce much less than males. Anabolic Steroids are usually compounds that are structurally similar to the testosterone.

Focused scientific development of Anabolic Steroids was pioneered by the Soviet Union to improve their competitiveness in international athletic competitions (e.g. the Olympics. The first Anabolic Steroids were simple blends of testosterone and its naturally occurring derivatives. However, these first generation steroids not only increased muscle growth but also had potent masculinizing effects on the user. These effects were most evident in female athletes, with the women of the East German Olympic teams of the 1970’s and early 80’s being the most famous examples. Starting in the 1970’s doctors and scientists began researching new testosterone derivatives that would encourage muscle growth with fewer side effects, so called “designer steroids”.

Many of the cells that compose the human body have sensors called “androgen receptors” that mediate cellular responses to androgen hormones. When the androgen hormone is detected by the cell it stimulates changes in gene expression and metabolism in the cell. However, not all cells respond the same way when they are activated by an androgen hormone. Whereas muscle cells may be stimulated to grow and multiply, other cells, like those in the testes, may actually slow their growth.

Androgen receptors are not exactly the same from cell to cell. There are slight differences between the androgen receptors (and their downstream signalling pathways) depending on the type of cell. The androgen receptors on certain have a high affinity for some androgen hormone derivatives, but a low affinity for others. Over the last thirty years, scientists have been working to develop “designer steroids” that preferentially stimulate the androgen receptors on muscle cells. Significant progress has been made in this pursuit, and today’s designer steroids have far fewer androgenic side effects than those used by the Soviet Union thirty years ago. That said, virtually all Anabolic Steroids still have some level of negative side effects.

Anabolic Steroids and Acne

One of the most common side effects of Anabolic Steroid use is the development of acne on the face, chest and back. The development of acne symptoms is generally caused by the increased activity of the sebaceous glands in response to elevated levels of androgen hormones. High concentrations of androgens (eg. Testosterone) in the body can increase the size and growth rate of the sebaceous glands.

The increase in sebaceous gland activity generally leads to a corresponding increase in sebum production. High levels of sebum production can increase the incidence of clogged pores and induce the growth of acne-causing bacteria, such as Propionibacterium acnes. P. acnes bacteria use sebum as a nutritional source. Increased sebum levels can also contribute to increased inflammation in and around the follicle, worsening acne symptoms, contributing to tissue damage and increasing the risk of acne scarring.

Different types of designer Anabolic Steroids have different profiles of androgenic side effects. Anabolic steroids like testosterone and dihydrotestosterone have a relatively high androgenic to anabolic (muscle building) profile, while some synthetics like Oxandrolone tend to have fewer androgenic side effects, relative to the dose.

Sebaceous gland activity is not only regulated by androgens, but also by other compounds that may be used in “performance enhancement” applications. For example, Human Growth Hormone (hGH) is a commonly used muscle building supplement that can also potentially contribute to acne symptoms. Human growth hormone stimulates the production of another growth factor Insulin-Like Growth Factor 1 (IGF-1) which has also been shown to increase sebaceous gland activity.

There are a lot of variables and cross-reacting factors when it comes to Anabolic Steroids and their side effects, like acne. As always, it is strongly recommended that any steroid therapy be done under the supervision of a qualified medical professional. Illicit steroid use can be quite dangerous not only because of the known side effects and legal restrictions (in many countries), but also because of the high incidence of poorly labeled, impure and counterfeit product being sold as Anabolic Steroids in the unregulated market.

Treatment of Anabolic Steroid Induced Acne

Obviously, stopping the use of Anabolic Steroids is the best solution, although maybe not realistic in all cases. Additionally, stopping use might not actually be enough to completely resolve acne symptoms that were caused by prior Anabolic Steroid use. In most cases of acne (steroid-induced acne included), a central feature of acne is a persistent infection of P. acnes bacteria within hair follicle. Once established, this infection may persist long after steroid use is stopped. Fortunately, individuals with steroid related acne have many treatment options available to them, including:

Retinoids

Both oral retinoids and topical retinoids can help decrease sebaceous gland activity and improve acne symptoms in many individuals. However, there is some research that indicates that oral retinoids (Accutane) may negatively impact athletic performance and recovery times. As a result, oral retinoids are rarely prescribed to competitive athletes who are in active competition. Topical retinoids are effective in some cases, but they tend to be less effective against inflammatory, nodular and cystic forms of acne. Unfortunately, inflammatory acne is fairly common with steroid use.

Antibiotics

There are a wide range of topical and oral antibiotics that have been shown to be viable anti-acne treatments. Like topical retinoids, topical antibiotics usually have reduced efficacy against inflammatory forms of acne. Some oral antibiotics have been shown to have both antibacterial and anti-inflammatory properties.

Androgen Inhibitors

While it is unlikely that an individual who is using Anabolic Steroids would be interested in using a systemic androgen inhibitor, there are some topical androgen inhibitors available which have a minimal systemic impact. These topical androgen inhibitors have been used to decrease the effect of anabolic steroids on the skin in a targeted fashion. However, there is not much research on this approach and minimal evidence about its efficacy.

Over The Counter (OTC) Medications

For mild cases of steroid induced acne, Over The Counter (OTC) medications that contain benzoyl peroxide, salicylic acid and other antibacterial/keratolytic compounds may be helpful in improving acne symptoms. These medications are generally most effective with mild, non-inflammatory (Acne Types: 1-2) and are less effective against moderate and severe acne symptoms (Acne Types: 3-4).

Common Anabolic Steroids and Their Chemical Structures

Diagram of how steroid modifications affect anabolic vs androgenic
Diagram of how steroid modifications affect anabolic vs androgenic

Chemical Structures of Common Anabolic Steroids (Fragkaki)
Chemical Structures of Common Anabolic Steroids (Fragkaki)

References

A league of their own: demographics, motivations and patterns of use of 1,955 male adult non-medical anabolic steroid users in the United States. Cohen, et al. 2007.
Adverse health effects of anabolic androgenic steroids. Amsterdam, et al. 2010.
Anabolic steroid abuse: Psychiatric and physical costs. Talih, et al. 2007.
Pharmacology of anabolic steroids. Kicman. 2008.
Social capital: Implications from an investigation of illegal anabolic steroid networks. Maycock, et al. 2007.
Structural characteristics of anabolic androgenic steroids contributing to binding to the androgen receptor and to their anabolic and androgenic activities: Applied modifications in the steroidal structure. Fragkaki, et al. 2009. 
Control of Human Sebocyte Proliferation in Vitro by Testosterone and 5-DHT is Dependent on the Localization of the Sebaceous Glands. Akamatsu, et al. 1992.
Anabolic-Androgenic Steroids (AAS) Related Disorders. Hassan, et al. 2017.
The cutaneous bacterial microflora of the bodybuilders using anabolic-androgenic steroids. Zomorodian, et al. 2015.
A qualitative study of anabolic steroid use amongst gym users in the United Kingdom: motives, beliefs and experiences. Kimergård. 2015.
Drug-induced acne. Kazandjieva, et al. 2017.
Acute and chronic adverse reaction of anabolic–androgenic steroids. van Amsterdam, et al. 2014.
Sex hormones and acne. Ju, et al. 2017.

What is the Relationship Between Pregnancy and Acne?

Answer: There are many changes that take place in the female body during pregnancy and these changes can have both positive and negative effects on acne symptoms.

Many women experience dramatic changes in their acne both during and after pregnancy. Hormones that control the natural processes of menstruation and pregnancy have wide-ranging effects throughout the body. Onset of acne or a worsening of acne symptoms is very common during pregnancy. At the same time, a smaller percentage of women report an improvement in their acne symptoms during pregnancy.

Pregnancy and Hormones

Hormones can play a major role in the development of acne symptoms. Pregnancy causes large changes in hormone balance. During pregnancy, women produce increasing amounts of the female hormones progesterone and estrogen. In addition, blood sugar levels rise to provide additional energy to the growing fetus. These blood sugar changes also affect hormone balance. The fetus itself and the placenta produce additional hormones.

Sex Hormones and Acne

The fundamental regulators of pregnancy are the sex hormones. These sex hormones include both female hormones (progesterone and estrogen) and male hormones (testosterone and other androgens). Both sets of hormones cause major physiological and metabolic changes in the body. During pregnancy, levels of all of these hormones tend to rise. Increasing levels of progesterone and estrogen help to stabilize the uterus, direct nutrients to the placenta and facilitate growth of the fetus.

The role of male sex hormones (androgens) in the process of pregnancy is less well understood. What is known is that androgen levels increase throughout pregnancy and spike in the third trimester. Androgen hormones tends to stimulate proliferation of the sebaceous glands and the production of sebum, both of which can worsen acne symptoms. Elevated levels of androgens are strongly correlated with increased frequency and severity of acne symptoms. Signs of elevated androgen levels in women include increased body and facial hair growth (hirsutism), hair thinning (on the head) and masculinization of features (in severe cases).

The Role of Post-Pregnancy Sex Hormones

Research indicates that pregnancy can induce long-lasting changes in a woman’s hormonal balance. This can include elevated levels of both male and female sex hormones. Many women report experiencing problems with acne that began with a pregnancy and continued long after the birth of their child.

Lasting acne symptoms that began during pregnancy could be the result of semi-permanent changes in sex hormone levels. It could also be a result of continuing infection with acne causing bacteria that began during pregnancy. For women who are not pregnant, there are several medications available to modulate hormone levels and to treat acne directly. These include androgen inhibitors, which can block the effect of elevated androgen levels.

Common Changes in the Skin during Pregnancy

In most cases, pregnancy induces noticeable changes in the appearance of the skin, especially in facial skin. People often refer to a “glow” in the skin of pregnant women. These changes result from vascular (blood vessel) dilation and proliferation which results in increased blood flow to the skin. Another very common change is hyper-pigmentation, which occurs in approximately 90% of women. Approximately 50% of women experience pregnancy induced melasma, which is increased pigmentation of patches of skin, primarily found on the nose, cheeks and upper lip. Some of these effects subside after completion of pregnancy, but some remain permanently.

Acne Medications and Pregnancy

Pregnant women have limited acne treatment options, compared to men or non-pregnant women. Because pregnancy is such a delicate process, it is essential that pregnant women maintain a healthy diet and limit their exposure to substances that may effect the development of the fetus. Some acne medications, like Retinoids (eg. Isotretinoin, Accutane) are highly toxic to the fetus and even small amounts of these drugs can cause birth defects or death of the fetus. Other medications like Tetracyclines (eg. Doxycycline, Minocycline) or Androgen Inhibitors (eg. Spironolactone, Cyproterone) can disrupt normal fetal development.

Allergic reactions to medications can also be dangerous to the fetus. Even homeopathic treatments, such as Herbal and Mineral supplements (eg. Zinc, Copper), can be dangerous to a developing embryo. It is important to thoroughly discuss any medication or homeopathic treatment with your physician or Ob/Gyn before beginning treatment.

Acne Treatment Options for Pregnant Women

In general, topical treatments are significantly safer for pregnant women than oral medications. Most Topical Antibiotics and Topical Naturopathic Treatments do not enter the body in concentrations high enough to risk harm to the developing fetus. Light and Laser Treatments, such as Blue Light Phototherapy, are also generally safe for use by pregnant women.

References

Physiologic Skin Changes During Pregnancy: A study of 140 Cases. Muzaffar, et al. 1998.
Acne and Pregnancy. O’Connell, et al. 2000.
Maternal serum androgens in human pregnancy: early increases within the cycle of conception. Castracane, et al. 1998.
Treatment of acne in pregnancy. Chien, et al. 2016.
Inflammatory facial acne during uncomplicated pregnancy and post‐partum in adult women: a preliminary hospital‐based prospective observational study of 35 cases from Taiwan. Yang, et al. 2016.
Acne in pregnant women: a French survey. Dreno, et al. 2014.
Dermatologic therapy in pregnancy. Tyler, 2015.
Sex hormones and acne. Ju, et al. 2017.
An overview of pregnancy dermatoses. McNulty-Brown, et al. 2016.
Inflammatory and glandular skin disease in pregnancy. Yang, et al. 2016.
Acne and rosacea in pregnancy. Bechstein, et al. 2017.

Is Acne Different Between Men and Women?

Answer: Yes, and it mostly comes down to hormones.

Men and women tend to experience acne differently. Men are more likely to develop acne during puberty and are more likely to develop severe and inflammatory forms of the disease. Acne symptoms tend to peak during adolescence and recede during a male’s mid 20’s. In contrast, women tend to experience less acne and less severe acne than men, but rates of acne actually increase for women in the 20-40 age range. Many women who have never had complexion problems begin to experience acne symptoms during pregnancy, and sometimes acne continues to persist after completion of the pregnancy.

Why Is Acne Different Between Men and Women?

While there are many contributing factors to acne, the main differences between men and women can be traced to hormones. Men, particularly adolescent males, tend to have elevated levels of male hormones called androgens. Androgens include hormones like testosterone. Among other things, androgens stimulate the growth of sebaceous glands, which increases the amount of sebum produced by the skin. Increased sebum production fosters the growth of bacteria that feed on sebum, such as Propionibacterium acnes. Additionally, high levels of sebum production can increase the incidence of clogged pores that block the opening of the hair follicle and encourage the development of acne symptoms like pimples, nodules and cysts.

Androgen Inhibitors and Acne

Androgen Inhibitors are a class of medication designed to block the function of endogenous androgens. Androgen Inhibitors are commonly used in women to treat elevated androgen levels, which can lead to hirsutism (excess hair growth) and masculinization. They are also used in men to treat male pattern baldness and certain kinds of cancer.

Androgen Inhibitors can be an effective treatment for women who experience androgen-dependent acne. Androgen inhibitors have a feminizing effect on men and are generally not recommended for use in males. Androgen inhibitors are often used as part of the hormone therapy involved in male to female sex change operations.

References

Correlation Between Serum Levels of Insulin-like Growth Factor 1, Dehydroepiandrosterone Sulfate, and Dihydrotestosterone and Acne Lesion Counts in Adult Women. Cappel, et al. 2005.
Acne in Victorian adolescents: Associations with age, gender, puberty and psychiatric symptoms. Kilkenny, et al. 1997.
Post-adolescent acne: a review of clinical features. Goulden, et al. 1997.
Prevalence of facial acne in adults. Goulden, et al. 1999.
Acne and Androgens. Chen, et al. 2014.
Plasma androgens in women with acne vulgaris. Lucky, et al. 1983.
Sex hormones and acne. Ju, et al. 2017.
Hormonal treatment of acne vulgaris: an update. Elsaie, 2016.

What is the Relationship Between Acne, Depression and Suicide

Answer: Acne can have a significant negative impact on the psychological well-being of acne sufferers. Acne can increase the risk of bullying, depression and suicide.

For the millions of people who have suffered with acne, the psychological toll of the disease is well understood. The face is the window that connects one’s consciousness with the outside world. The face is also an essential factor in how the outside world perceives an individual. More than any other part of the body, diseases that affect the appearance of the face can have severe emotional and psychological consequences.

Impact of Acne on Quality of Life

Scientific research overwhelmingly demonstrates the negative effect that acne has on the quality of life of individuals with acne. Research has consistently shown that severe acne increases the incidence of depression, anxiety, bullying and suicide. Acne, especially severe acne (Acne Types: 3-4), can dramatically alter how an individual interacts with others and how they perceive themselves.

Despite these the profound impact acne can have on people, acne-free individuals often underestimate the impact that acne can have on self esteem and overall mental health. This phenomenon can leave acne sufferers feeling very alone. To better understand the psychological toll that acne can have (and to let people know that they aren’t alone), we have synthesized the data from many studies into four basic categories.

Acne, Anxiety and Depression

For acne sufferers, it is virtually impossible to escape the constant reminders of the disease. Every reflection in the mirror becomes a depressing reality check, and the physical pain associated with inflammatory acne makes it’s presence inescapable. For many acne sufferers, dealing with acne and acne scarring is extremely challenging, both mentally and physically.

Virtually every study conducted on the psychological impact of acne vulgaris has shown that the disease causes a statistically significant increase in anxiety, depression and related mental health problems. On balance, the research indicates that rates of anxiety and depression among individuals with significant acne symptoms are roughly twice as high compared to non-acne sufferers. Acne also causes significant increases in rates of body dysmorphia, anti-social behavior and suicide.

The psychological impact of acne is not all in the mind of the person with acne. Research indicates that children and adolescents that suffer from acne and other skin diseases, experience increased levels of bullying and teasing. Too often this psychological trauma is overlooked or dismissed by parents, physicians and other decision makers. As a result, acne sufferers often fail to get the psychological and psychiatric treatment that they need.

Research shows that the level of anxiety and depression is directly related to the severity of acne symptoms (which seems like an obvious conclusion). Fortunately, improving acne symptoms through effective treatment also improves many of these psychological problems. Effective treatment of the acne itself, in combination with the appropriate mental health support, offers the highest chance of improving the quality of life of acne sufferers.

The Impact of Acne on Social Interactions

Acne vulgaris can have a very negative impact on the social interactions of an affected person. One on hand, acne causes psychological trauma to the sufferer, often decreasing their confidence and self-esteem. On the other hand, the outside world can be hurtful and harsh. Facing challenges from both sides, acne sufferers will often withdraw from interpersonal relationships. Some acne sufferers develop symptoms of anti-social behavior patterns. Anger levels tend to be elevated in acne sufferers.

For acne sufferers who do withdraw from interpersonal relationships and social interactions, the increasing isolation increases the danger of developing a self reinforcing cycle of self loathing. Basically, it’s tough to function normally when you are dealing with problem acne.

Acne and Suicide

Research indicates that people who have acne vulgaris have increased rates of both suicide ideation (thinking about suicide) and suicide itself. The fact that acne symptoms can cause and worsen symptoms of clinical depression make it a risk factor for suicide.

The Role of Acne Medications in Depression

There are some acne medications that are suspected to cause or worsen symptoms of depression. People with a history of depression, mood disorders or any other mental health issue, should discuss these with their medical provider.

Isotretinoin (Accutane) is the acne medication with the most high-profile associatio