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 association with depression and suicide. It has been alleged that Accutane can cause depression and suicidal thoughts. The association between Isotretinoin and depression primarily originated from parents whose children committed suicide, while taking Isotretinoin. However, the majority of the clinical research indicates that Isotretinoin treatment is not statistically related to suicide or suicide attempts.

The alleged association between Isotretinoin (Accutane) and depression was brought to national attention in the United States when Congressman Bart Stupak claimed that Accutane was responsible for his son’s suicide. Congressman Stupak gave a congressional statement to that effect. Many other parents have made similar claims.

However, the alleged relationship between the treatment of acne with Isotretinoin and suicide is not strongly well-supported by the available scientific evidence. It is also possible that the severe acne symptoms themselves contributed to suicide and suicide attempts in many of these individuals. Researchers have shown that acne itself is an important contributor to depression. Thus, effective treatment of acne can improve symptoms of depression and reduce the frequency of suicide ideation.

This conflict between parents and researchers may come down to a difference in perception. Non-acne sufferers often underestimate how traumatizing acne is for someone with the disease. Acne patients who experience depression may become withdrawn, and hide their true feelings from the people around them. When an individual commits suicide, it can seem like it came out of nowhere. That person may have seemed OK on the surface, but they were battling deep emotional trauma on the inside. Family and friends of those left behind often look for a reason, an explanation for how the tragedy could have happened. It is easy to assign the blame to a pill, a real world menace, the product of a callous corporation. It helps to have a reason, something or someone to blame for your loss. It’s understandable. But being understandable does not necessarily make something true.

References

Acne in Victorian adolescents: Associations with age, gender, puberty and psychiatric symptoms. Kilkenny, et al. 1997.
Acne prevalence, knowledge about acne and psychological morbidity in mid-adolescence: a community-based study. Smithard, et al. 2001.
Acne vulgaris and depression: a retrospective examination. Uhlenhake, et al. 2010.
Acne Vulgaris and the Quality of Life of Adult Dermatology Patients. Lasek, et al. 1998.
Acne, anxiety, depression and suicide in teenagers: A cross-sectional survey of New Zealand secondary school students. Purvis, et al. 2006.
Anxiety, Depression, and the Nature of Acne in Adolescents. Aktan, et al. 2000.
Anger and acne: implications for quality of life, patient satisfaction and clinical care. Rapp, et al. 2004.
Association of suicide attempts with acne and treatment with isotretinoin: retrospective Swedish cohort study. Sundstrom, et al. 2010.
Body dysmorphic disorder symptoms among patients with acne vulgaris. Bowe, et al. 2007.
Experiences of appearance-related teasing and bullying in skin diseases and their psychological sequelae: results of a qualitative study. Magin, et al. 2008.
Prevalence, Severity, and Severity Risk Factors of Acne in High School Pupils: A Community-Based Study. Ghodsi, et al. 2009.
Psychiatric Aspects of the Treatment of Mild to Moderate Facial Acne. Gupta, et al. 1990.
Psychological sequelae of acne vulgaris. Magin, et al. 2006.
Psychosocial Aspects of Acne Vulgaris: A Community-based Study with Korean Adolescents. Do ,et al. 2009.
Psychosocial effect of common skin diseases. Barankin, et al. 2002.
Quality of life issues for South Africans with acne vulgaris. Mosam, et al. 2005.
Self-esteem and body satisfaction among late adolescents with acne: Results from a population survey. Dalgard, et al. 2008.
Social Anxiety Level in Acne Vulgaris Patients and its Relationship to Clinical Variables. Yarpuz, et al. 2008.
Suicide in Dermatological Patients. Cotterill, et al. 1997.
The quality of life in acne: a comparison with general medical conditions using generic questionnaires. Mallon, et al. 1999.
Impact of acne on the quality of life: the results of a cross-sectional study among schoolchildren of Kaunas city, Lithuania. Karciauskiene, et al. 2018.
Beliefs, perceptions and psychosocial impact of acne amongst Singaporean students in tertiary institutions. Su, et al. 2015.
Psychological disorder among acne patients.
Pradhan, et al. 2017.
Help-seeking behaviours, opportunistic treatment and psychological implications of adolescent acne: cross-sectional studies in schools and hospital outpatient departments in the UK. Desai, et al. 2017.
Impact of acne vulgaris on quality of life and self-esteem. Hosthota, et al. 2016.
The psychosocial impact of acne vulgaris. Hazarika, et al. 2016.
Oral isotretinoin: ensuring safe use while not limiting access to those who need it. Tan, et al. 2017.
Female gender and acne disease are jointly and independently associated with the risk of major depression and suicide: a national population-based study. Yang, et al. 2014.
Quality of life, anxiety prevalence, depression symptomatology and suicidal ideation among acne patients in Lithuania. Lukaviciute, et al. 2017.

Can Stress Cause Acne?

Answer: Yes. Stress can trigger and/or worsen acne symptoms.

It is well known that putting an organism under stress makes it more susceptible to infection. This is true for humans, animals and even plants. The same neural and biochemical pathways that make stress feel uncomfortable can also disrupt the delicate balance of a properly functioning immune system, which increases your susceptibility to acne.

In the words of the experts:

“Activation of neurohormones by psychological stress occurs largely via the hypothalamic (pituitary) adrenal (HPA) axis, with subsequent upregulation of key stress hormones, such as corticotropin-releasing hormone (CRH), ACTH, and glucocorticoids (Cacioppo et al., 1998; Glaser and Kiecolt-Glaser, 2005). Via these stress-related hormones, accompanied by additional stress response mediators such as neuropeptides or neurotrophins (Webster, 2002), immune responses are profoundly altered (Glaser and Kiecolt-Glaser, 2005). For example, glucocorticoids inhibit the production of IL-12, IFN-y, and tumor necrosis factor by antigen-presenting cells and T helper 1 (Th1) cells but upregulate the production of IL-4, IL-10, and IL-13 by Th2 cells (Wonnacott and Bonneau, 2002).”Arck, et al. 2006.

To summarize that for non-scientists:

Stress causes changes in hormonal balance and that negatively impact your immune system. These changes appear to suppress immune functions that encourage the direct killing of pathogens (like the acne-causing Propionibacterium acnes bacteria), instead shifting the immune response to a more passive approach.

Glucocorticoids and Stress

One of the most well known stress hormones is cortisol (aka hydrocortisone). Cortisol is released by certain tissues in the body in response to stress. Many people have heard the claims on late night infomercials about the effect of stress on weight gain (and how they have a product that can fix it).

Specifically, these infomercials are referencing research that shows that stress induces the release of a molecule called cortisol, which can potentially induce the growth of adipose cells (fat cells). Cortisol is part of a group of molecules called glucocorticoid steroids (corticosteriods). These molecules have many functions, but one of their primary functions is to suppress the immune system.

The release of corticosteroids by the body in response to stress could explain why immune function is diminished in stressed individuals. Corticosteroids are often medically administered to treat severe allergic reactions (eg. poison oak) and inflammation. Corticosteroids are also occasionally injected directly into acne nodes and cysts in order to immediately reduce inflammation. However, because corticosteroids have a suppressive effect on the immune system, long-term use of these mediccations is generally discouraged.

Stress and Acne Symptoms

The hormonal changes that are induced by stress can cause or worsen acne symptoms. Stress can increase the production of sebum by sebaceous glands and suppress the immune system. This combination of effects provides conditions that increase the likelihood of acne. It is well-known that stress relief and relaxation can improve overall health. This also applies to acne. Decreasing psychological and physical stress (e.g. binge drinking, high-sugar diets, insufficient sleep, anxiety, drug use, injuries, etc) can improve acne and general health.

References

Neuroimmunology of Stress: Skin Takes Center Stage. Arck, et al. 2006.
Neuroendocrine regulation of sebocytes and a pathogenetic link between stress and acne. Zouboulis, et al. 2004.
Sebaceous glands in acne patients express high levels of neutral endopeptidase. Nakamura, et al. 2002.
The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stressChiu, et al. 2003.
Stress, Acne and Skin Surface Free Fatty Acids. Kraus. 1970.
Exploring the relationship between stress and acne: a medical student’s perspective. Maleki, et al. 2018.
Effects of stress on immune function: the good, the bad, and the beautiful. Dhabhar, et al. 2014.
Exercise, immune function and respiratory infection: An update on the influence of training and environmental stress. Walsh, et al. 2016.
Repeated Social Defeat Stress Changes Peripheral Immune Status in Rats: Potential Effects on Basolateral Amygdala Function. Munchi, et al. 2017.
A systematic review and meta-analysis of the effort-reward imbalance model of workplace stress with indicators of immune function. Eddy, et al. 2016.
The effects of stress hormones on immune function may be vital for the adaptive reconfiguration of the immune system during fight-or-flight behavior. Adamo. 2014.

What Does Non-Comedogenic Mean?

Answer: Comedogenicity refers to the potential of a substance to cause a comedo, a plugged or inflamed pore.

Non-comedogenic means that in testing, the substance or product has not been shown to cause comedos (clogged or inflamed hair follicle). Some substances (eg. coal tar) are highly comedogenic and produce a type of allergic, acne-like reaction. There is not a clear consensus when it comes to the comedogenicity of many substances, with different tests yielding different results.

How is comedogenicity determined?

The large majority of comedogenicity testing is done on animals, often using a rabbit ear model. In this test, the substance is applied to the inside of the rabbit’s ear, which has a similar structure as human facial skin. The development of comedos is quantified to evaluate the relative comedogenicity of a substance. In some cases, human volunteers are used to evaluate substances. In these tests, the most common treatment area is the skin on the back.

What kinds of things determine comedogenicity?

Comedogenicity is a complicated process that can vary from individual to individual. One interesting observation is that human sebum is itself comedogenic. A substance can be comedogenic for several reasons. It can contribute directly to the formation of a plug in the hair follicle. This could potentially occur with a substance that triggers the coagulation of free sebum.

A substance could also be comedogenic because it triggers an allergic reaction and/or inflammation. Substances like SLS (sodium lauryl sulfate) are common ingredients in topical preparations and but can cause allergic reactions in some individuals and are generally considered comedogenic.

Additionally, a substance can serve as a direct food source for the bacteria responsible for acne, Propionibacterium acnes. P. acnes bacteria eat fatty acids as one of their primary food sources and certain substances like olive oil or other vegetable oils could potentially serve as food sources for these bacteria and encourage their growth. Increased bacteria levels in the skin can then stimulate a local immune response, inflammation and comedogenecity.

Lastly, relatively harmless substances can be converted into allergens and comedogens by the enzymes present in the skin, or even by UV light.

Common Comedogenic Substances

There are several lists of comedogenic substances available in different places on the internet. However, a review of the scientific literature reveals a serious lack of actual testing on commonly used substances. This may be because many companies do their own testing and do not publish the results, but it also casts some doubt on some of these online comedogenic substances lists.

We are currently working to compile a comprehensive comedogenic substance lists from published scientific journal articles. Until then, we have included this table from the original comprehensive comedogenicity testing done by Dr. Fulton, et al. Comedogenicity and irritancy are graded on a scale of 0 to 5, with 0 being no effect and 5 being highly comedogenic:

Comedogenicity Testing Results of Common Substances – Part 1

Comedogenicity Testing Results of Common Substances – Part 2

Comedogenicity Testing Results of Common Substances – Part 3

References

Comedogenicity and Irritancy of Commonly Used Ingredients in Skin Care Products. Fulton, et al. 1989.
A re-evaluation of the comedogenicity concept. Draelos, et al. 2006.
Comedogenicity of Squalene Monohydroperoxide in the Skin after Topical Application. Chiba, et al. 2000.
An Experimental Study on the Comedogenicity of Several External Contactants. Ahn, et al. 1985.
Relationship between acne vulgaris and cosmetic usage in Sri Lankan urban adolescent females. Perera, et al. 2017.
Analysis of comedone, sebum and porphyrin on the face and body for comedogenicity assay. Baek, et al. 2016.
A Clinical Appraisal of Endogenous and Exogenous Factors of Acne Vulgaris in Adolescents and Adults from a Tertiary Care Teaching Hospital in Central Kerala. VG, et al. 2016.
Isopropyl Myristate and Cocoa Butter are not Appropriate Positive Controls for Comedogenicity Assay in Asian Subjects. Lee, et al. 2015.
Enhancement of comedogenic substances by ultraviolet radiation. Mills, et al. 1978.
Comedogenicity of current therapeutic products, cosmetics, and ingredients in the rabbit ear. Fulton, et al. 1984.
An improved rabbit ear model for assessing comedogenic substances. Kligman, et al. 1979.
A reevaluation of fatty acids as inflammatory agents in acne. Puhvel, et al. 1977.

Does Greasy Food, Milk or Chocolate Cause Acne?

Answer: Not exactly. At least not in the way you might think.

Anecdotal associations between acne and particular foods like chocolate, ice cream and pizza have been discredited by scientific research.  But research does point to a connection between overall diet and the development of acne symptoms.

The Connection Between Acne and Overall Diet

Researchers have presented compelling evidence that people whose diets include lots of high glycemic index foods (foods that are high in sugar and simple carbohydrates) tend to experience acne at a greater frequency than those who have low glycemic index diets. However, there is no clear scientific consensus on why this connection exists. Some experts believe that high glycemic index diets may have negative impacts on hormone balance and the immune system.

Common Assumptions About Acne and Diet

There many widely held beliefs about the relationship between certain types of food and acne symptoms. Three of the common are:

Assumption #1: Eating Greasy Food Causes Greasy Skin

True or False?: Mostly False. The grease that you eat is not the same grease that makes your skin oily. Genetics, hormones, stress and environmental factors are much more important players than consumption of fatty or greasy foods when it comes to oily skin.

The substance that makes your skin feel and look greasy is not actually grease at all – it is a natural substance called sebum. The purpose of sebum is to moisturize and protect the skin.

Sebum is produced by a specialized structures called sebaceous glands, which are located deep inside of hair follicles. Sebum is produced from the break-down of sebocytes, which are the specialized cells that make up the sebaceous gland. Sebocytes are rich in lipids (fatty acids) and triglycerides (fats and oils). The sebocytes nearest to the hair follicle die and then dissolve, releasing their contents into the hair follicle. The faster the sebaceous gland proliferates (grows), the faster this process of cell death and sebum production takes place, and the more oily the skin becomes. But eating more grease and fat does not necessarily cause this process to happen any faster.

It is also important to point out that oil is a generic term for a diverse class of molecules. The oils (lipids and triglycerides) in sebum are not the same as the oils that you consume when you eat things like fried foods. There are a lot of intermediate steps between the consumption of dietary oil and the synthesis of sebum, and this makes a direct connection between the two unlikely.

Assumption #2: Chocolate Causes Acne

True or False?: Mostly False. Chocolate itself has not been shown to have a direct connection with acne symptoms. There have been at least two studies that directly examined the relationship between chocolate and acne. In both of these studies, the researchers found no correlation between chocolate consumption and acne.

However, many chocolate-containing products are also high in sugar and/or high-fructose corn syrup, and are therefore high glycemic index foods. Research has shown that diets high in sugar and simple carbohydrates may contribute to acne symptoms.

Chocolate is generally a mixture of ingredients, and different kinds of chocolate can have a dramatically different composition of ingredients, such as sugar. It is also possible for people to develop allergic reactions to particular foods, including chocolate, and these reactions can produce acne-like symptoms. However, most cases an allergic reaction would also have additional symptoms including, itching, hives, throat swelling, fever, rash, joint pain, etc.

Assumption #3: Milk Causes Acne

True or False?: Possibly True. There are a handful of studies that suggest a relationship between high levels of milk consumption and increased incidence of acne. The authors of these studies suggest that it is possible that hormones in the milk (or hormones stimulated by milk consumption) may be to blame.

A particular hormone called Insulin Growth Factor 1 (IGF-1) is present in milk may cause changes in metabolism and hormone balance that can impact acne symptoms. IGF-1 is a naturally occurring hormone, and it is present in all animal milks (even products made from animals that have not been treated with hormones).

Whether or not milk consumption actually causes acne symptoms (and whether this is true for all people) remains to be scientifically proven. People have blamed a lot of medical conditions on milk consumption. There is a large group of people who swear that by stopping milk consumption they were relieved of a range of medical problems, from respiratory infections to acne vulgaris. Not all of these claims are going to be true (at lesat for most people).

Milk consumption may also impact the balance of sex hormones, such as androgens and estrogens (male and female sex hormones). Several studies have demonstrated that elevated androgen levels are associated with more severe acne symptoms in some patients. It is also possible that people with certain types of milk allergies could exhibit acne-like symptoms.

In conclusion, there is some evidence that milk may contribute to symptoms of acne vulgaris, but the exact relationship between milk and acne is not well understood. Regardless, for many people it’s worth a shot to cut milk out of their diet for a few weeks and see if that helps improve their acne symptoms.

References

Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health (Vintage). Taubes. 2008.
The Clear Skin Diet. Logan, et al. 2007.
Glycemic Index and Glycemic Load of Foods. DietGrail. 2011.
Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating. Willett, et al. 2005.
A systematic review of the evidence for ‘myths and misconceptions’ in acne management: diet, face-washing and sunlight. Magin, et al. 2005.
Diet and acne: a review of the evidence. Spencer, et al. 2009.
A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Smith, et al. 2007.
Does diet really affect acne? Ferdowsian, et al. 2010.
Effect of Chocolate on Acne Vulgaris. Fulton, et al. 1969.
Milk consumption and acne in teenaged boys. Adebamowo, et al. 2008.
Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Melnik, et al. 2009.
Linking diet to acne metabolomics, inflammation, and comedogenesis: an update. Melnik, et al. 2015.
A Low Glycemic Index and Glycemic Load Diet Decreases Insulin-like Growth Factor-1 among Adults with Moderate and Severe Acne: A Short-Duration, 2-Week Randomized Controlled Trial. Burris, et al. 2018.
Significance of diet in treated and untreated acne vulgaris. Kucharska, et al. 2016.
Diet and acne update: carbohydrates emerge as the main culprit. Mi, et al. 2014.
The Effects of a Low Glycemic Load Diet on Acne Vulgaris in Adolescents and Young Adults. White. 2015.
The constellation of dietary factors in adolescent acne: a semantic connectivity map approach. Bonci, et al. 2016.
Diet and acne: an exploratory survey study of patient beliefs. Nguyen, et al. 2016.
Dietary Regimes for Treatment of Acne Vulgaris: A Critical Review of Published Clinical Trials. Norstedt, et al. 2016.
The possible role of diet in the pathogenesis of adult female acne. Romańska-Gocka, et al. 2016.

Is Popping a Pimple a Bad Idea?

Answer: It can be, especially if done improperly.

Some pimples and other acne lesions benefit from being drained or popped in order to remove pus and accelerate healing. But other pimples should be left alone to heal on their own. The nodules and cysts of those patients who suffer from severe inflammatory acne (Acne Type: 4) are often lanced and drained by a dermatologist. This can prevent further damage and limit post-acne scarring.

When To Consider Popping a Pimple

The important thing is to identify those zits and pimples which can be effectively popped (and which ones can not). And any popping must be done properly and in a sterile fashion.

Whiteheads and Blackheads are often good candidates for popping/extrusion. Inflammatory pimples and nodules with no clear route for the pus to reach the surface are generally poor candidates for popping. Large, inflamed acne lesions should be treated by a dermatologist. Although it can be tempting to try and pop all zits pimples, in many cases it is more effective to allow the natural progression of the lesion and healing process to take place.

Benefits of Popping a Pimple

In some cases, it can be beneficial to extract the pus from inside of a pimple. Pus (the white stuff, not the clear fluid) is composed largely of specialized white blood cells called Neutrophils. These white blood cells migrate to the site of infection (the zit) and are designed to destroy and phagocytose (eat) the offending bacteria and other foreign material. These white blood cells are most apparent in open comedome lesions (whitehead pimples).

After accumulating in an acne lesion, the white blood cells release powerful enzymes and free radicals that are designed to kill and digest the source of infection. Unfortunately, these weapons also cause collateral damage to the healthy tissue around the infected follicle. In people who suffer from inflammatory acne, it is often an overeager immune response that causes swelling, redness and discomfort. The collateral damage to healthy tissue during this process is what causes the formation of acne scars.

In acne lesions that are significantly inflamed but easy to drain, removing the pus can limit the amount of collateral damage that occurs and can accelerate the healing process. In addition, the infiltration of the follicle with pus can put a lot of pressure on the surrounding nerves, which can be quite uncomfortable and painful. Draining a lesion may be helpful in relieving this pressure and the accompanying discomfort.

Risks of Popping a Pimple

Many acne lesions (especially nodular and cystic acne lesions) can be very difficult to effectively pop and drain. Small, non-inflammatory acne lesions (Acne Types: 1-2) may not contain significant pus that can be drained. In these cases, attempting to drain the lesion can be unhelpful or cause further damage that slows down the healing process and contributes to more acne scarring.

In many acne pimples and cysts it is not just that the follicle is swollen with white blood cells and edema fluid, but rather the entire region of skin tissue is affected. Channels can form in the sub-cutaneous tissue and these channels can be occupied by bacteria laden white blood cells. Non-productive squeezing of pimples in these cases can force these white blood cells (and bacteria) away from the pimple and into the surrounding tissue. This can further spread the underlying infection and inflammation.

Aggressive squeezing of pimples can cause additional damage to the follicle itself, which leads to more inflammation and extends the amount of time it takes for the damage to be repaired. Lancing or popping an acne lesion in a non-sterile fashion can introduce bacteria or foreign material that can lead to more inflammation or even a secondary infection.

In conclusion, there are a lot of things that can go wrong when popping a pimple. Most of these are related to improperly draining a lesion or attempting to drain an unsuitable lesion, or non-sterile technique.

Considerations for Popping a Pimple

Sterility

It is very important to sterilize the area to be treated both before and after attempting to extract a blackhead or drain a pimple. This includes thoroughly washing your hands, cleaning the treated area and swabbing the lesion with alcohol or medicated wipe before and after extraction/draining. Topical application of an antibacterial ointment like Neosporin can also be used to limit the chances of secondary infection and accelerate healing.

Selecting Appropriate Pimples

It is going to do more harm than good if you try to pop a pimple that is not ready or is not suitable for draining. For example, many whiteheads are good candidates for drainage because the infiltrate (pus) is pooled near the surface. However, many inflammatory acne lesions, like nodules and cysts are poor candidates for drainage because there is no easy way for the infiiltrate to reach the surface.

In acne lesions where you have inflamed red bumps, like nodules and cysts, the infiltrate is fairly deep under the surface of the skin, with no clear exit pathway. In these cases of inflammatory acne, the entire length of follicle above the epicenter of the lesion is likely to be inflamed, and basically swollen shut. Attempting to squeeze or drain these type of lesions often forces the infiltrate (which contains many inflammatory factors) down and out, into the surrounding tissue. This will most likely aggravate the situation, causing more inflammation, scarring and a lengthier healing process.

In general, to effectively drain an inflammatory acne cyst or nodule, they often must be surgically lanced, which is a procedure best done in a dermatology clinic.

Proper Technique

To extract a blackhead, or drain a whitehead, it is important to use good technique. This means applying gentle pressure in a manner that forces the plug or infiltrate up and out. To do this you need to try and get under the main pocket of the lesion and gently work it out. It is important to use gentle rolling pressure.

Vigorous squeezing and applying lots of pressure are much more likely to cause additional damage and aggravate the acne lesion. There are several manual “extractors” used to extract blackheads. These generally have a small ring that fits around the blackhead and are designed to apply even pressure around the follicle. However, research studies into these blackhead extractions show that they produce, at best, a mild improvement compared to doing nothing.

Some dermatologists use a machine that extracts hyperkeratinic plugs and other follicle blockages using a suction based extraction machine. For the casual, at-home user, pore strips offer a means to extract some easily accessible blackheads, but pore strips are not suitable for inflamed lesions (eg. whitehead pimples).

Example Technique

Is Acne Caused By Dirt Or Not Washing My Face Enough?

Answer: Not really.

Topical facial cleansers are generally ineffective treatments for all but the most mild cases of acne (Acne Type: 1). Medicated and non-medicated acne washes are widely available in grocery, drug and department stores as Over The Counter (OTC) products.

Why Washing Your Face More Probably Won’t Improve Your Acne

In most acne lesions (pimples, nodules, cysts, etc.), the site where the infection and inflammation is centered is not near the surface of the skin. Instead, it is near the base of the hair follicle where the sebaceous gland attaches. This is a region of the follicle that is not readily accessible from the surface. Therefore, cleansers and their active ingredients are unlikely to impact the inflammatory processes that drive moderate to severe acne symptoms (Acne Types: 2-4).

Commercials for acne cleansers often have animations that show their product blasting out the debris from deep within pores (follicles). In reality, this does not happen because the follicle shaft is quite narrow relative to its depth. In addition, individuals with acne often have sticky (hyper-keratinized) plugs that are firmly lodged in the follicle. These plugs prevent surface-applied treatments from reaching the interior of the follicle. The inside of the follicle is mostly an anaerobic environment (low levels of oxygen). The interior of the follicle has a different composition of resident bacteria than the surface of the skin.

Clogged Pores

The plugs that clog follicles and contribute to acne do not usually come from dirt or grime on the surface of the skin. Rather these pore-clogging plugs come from sebum, keratin and cell debris which is all produced deep within the follicle. Sebum is a natural product of the sebaceous glands and is responsible for lubricating and protecting healthy skin.

It is important to recognize, however, that foreign debris and bacteria on the surface of the skin can aggravate acne symptoms. This is especially true if you pop a pimple or damage the skin, which allows surface debris and bacteria to enter the open wound. This can potentially cause increased inflammation and even a secondary infection, both of which can worsen existing acne symptoms.

Cleansers and Acne: The Positives

Twice daily use of non-medicated gentle facial cleansers was shown to decrease the number of open-comedos (blackheads) in a small study. However, non-medicated cleansers had no measurable effect on closed comedos and inflammatory acne (whiteheads, nodules, cysts). This is most likely due to the concept mentioned above, that the plug blocking the follicle is not easily accessible from the surface in closed comedo and inflammatory acne lesions.

In the case of a blackhead (open-comedo), the plug is very near the surface of the skin, and is therefore more susceptible to to the action of cleansers. Another study by the same research group showed that a medicated cleanser that contained Triclosan, Salicylic Acid and Azelaic Acid (antibacterial and keratolytic agents) was capable of modestly decreasing the number of acne lesions when compared to a non-medicated control.

Over-The-Counter Acne Cleansers: Common Ingredients

Most Over-The-Counter (OTC) acne products contain the same active ingredients – Triclosan, Salicylic Acid and Benzoyl Peroxide. The available research indicates that when cleansers are used in moderation they can be helpful in reducing minor acne symptoms for some patients.

It is important to note that most of the OTC medications have the same ingredients, and many acne sufferers use several of these products at the same time. Using excessive amounts of products with the same active ingredients will not help improve acne symptoms any more then normal use. The most common result of overuse of these products is dry and irritated skin. The positive effects of keratolytic agents and mild anti-bacterial compounds like triclosan are not cumulative and excessive use is likely to lead to more damage than benefit.

Cleansers and Acne: The Negatives

The primary concern associated with acne face and body washes is overuse. When you have acne, you want to do something about it. That’s a natural response, but all too often that desire to act translates into an over-kill approach, like excessive face washing. Most of the research studies on acne and acne facial/body cleanses found that using these products more than twice a day causes more harm than benefit.

Overuse of cleansers or other abrasive products the skin is likely to aggravate acne symptoms. Excessive washing or use of harsh products can damage and irritate the skin, leading to cracking, redness, inflammation, discomfort and ultimately worsen acne symptoms. The general rule of thumb is to use gentle cleanser in moderation to keep the skin clean. Washing the skin more than that is unlikely to provide much benefit and is more likely to make symptoms worse.

It is also important to limit your expectations for how helpful cleansers and face washing are going to be for your acne. Keep in mind that even the studies that show that cleansers help acne are only talking about moderate improvements for people with mild acne.

Summary

Overall, the consensus of scientific research does not suggest that cleansers help moderate to severe inflammatory acne. At no point do any of these research results indicate that cleansers can “cure” acne. At best, cleansers can only be expected to modestly improve acne symptoms.

References

How to Wash Your Face: America’s Leading Dermatologist Reveals the Essential Secrets for Youthful, Radiant Skin. Kenet, et al. 2002.
A Consumer’s Dictionary of Cosmetic Ingredients, 7th Edition: Complete Information About the Harmful and Desirable Ingredients Found in Cosmetics and Cosmeceuticals. Winter. 2009.
Acne Vulgaris. Shalita, et al. 2011.
A systematic review of the evidence for myths and misconceptions in acne management: diet, face-washing and sunlight. Magin, et al. 2004.
A Single-Blinded, Randomized, Controlled Clinical Trial Evaluating the Effect of Face Washing on Acne Vulgaris. Choi, et al. 2006.
A study of the efficacy of cleansers for acne vulgaris. Choi, et al. 2010.
Clinical evidence for washing and cleansers in acne vulgaris: a systematic review. Stringer, et al. 2018.
Efficacy of the combined use of a facial cleanser and moisturizers for the care of mild acne patients with sensitive skin. Isoda, et al. 2015.
Role of cleansers in the management of acne: Results of an Italian survey in 786 patients. Veraldi, et al. 2016.
Cleansing and moisturizing in acne patients. Goodman. 2009.

How Do Acne Scars Form?

Acne scars are the result of tissue damage caused by inflammatory acne.

Overview

The vast majority of acne scars are caused by from persistent cases of inflammatory acne affecting the same area of skin. Individuals who suffer from frequent nodular and cystic acne outbreaks (Acne Types: 3-4) are at a very high risk of developing permanent acne scarring. This is particularly true when a region is affected by overlapping acne outbreaks, with no opportunity for the skin to completely heal.

When an individual experiences persistent outbreaks of severe inflammatory acne, significant regions of the affected skin and underlying tissue can be damaged. Acne is an inflammatory process that usually involves an infection caused by bacteria (eg. Propionibacterium acnes).

The inflammation that occurs during severe acne prevents the body from mobilizing the cells and materials necessary for the normal healing process that is required to repair the skin. In this situation, the original (healthy) tissue can be replaced by fibrous scar tissue.

The Role of Inflammation in Acne Scarring

What many people may not realize is that acne scarring is primarily due to the body’s own immune response to infection, and not the infection itself. A major component of inflammatory acne is the migration of white blood cells to the hair follicle, sebaceous glands and surrounding tissue. These white blood cells compose much of the “pus” that comes out when you pop a zit.

The white blood cells that make up the pus in acne pimples, nodules and cysts are not uniform. Instead the pus contains a mixture of many different sub-types of white blood cells, such as macrophages, neutrophils, dendritic cells, T cells, granulocytes, mast cells and others. Neutrophils are one of the body’s front-line defenses against infection and these cells are usually the most abundant white blood cells in an acne lesion.

Many of the white blood cells (and especially neutrophils) produce powerful degradative enzymes that can damage health tissue. These cells also produce inflammatory molecules, super-oxides and free radicals. These weapons are designed to help neutralize pathogens and foreign invaders, but they can also cause damage to the surrounding healthy tissue.

In inflammatory acne, the damage caused by these white blood cells can actually cause the underlying bacterial infection to spread, leading to more inflammation and tissue damage. This can create a vicious, self-fulfilling cycle of tissue damage that leads to permanent acne scars.

Neutrophils and Acne Scars

When it comes to scarring, perhaps the most important type of white blood cell is the neutrophil. The neutrophil is one of the first responders to the infected follicle, and can accumulate in great numbers. Neutrophils are kind of like the suicide bombers of the cellular world. When they reach the site of infection they can undergo apoptosis (controlled suicide) and degranulation, which releases many anti-microbial molecules, DNA and proteases into environment. These proteases that can cause tremendous damage to the surrounding tissue, which ultimately results in scarring. The proteases digest the elastin and collagen matrix that provides support and elasticity to the skin.

The Structure of Scar Tissue

Healthy skin is supported by a complex matrix (scaffolding) that provides structural support and nutrients to the skin surface. When skin is damaged, this matrix helps guide the healing process. Without this matrix to guide healing, the body has a very difficult time properly repairing and re-creating the damaged tissue.

In cases of persistent infection and inflammation, the body is not able to repair the matrix fast enough to keep up with the damage. In these cases, the body begins to build scar tissue, which is simple and tough. The scar tissue can permanently replace the more complex and delicate healthy matrix. This process underlies not only the formation of acne scars, but of other diseases marked by chronic inflammation, such as chronic obstructive pulmonary disorder (emphysema) and rheumatoid arthritis.

Scar tissue is composed largely of collagen, which is the same material that comprises much of a healthy sub-cutaneous matrix. However, unlike the healthy matrix – which is a complex, spacious and interconnected web of collagen and other proteins – the collagen in scar tissue is much different. In scar tissue, the collagen becomes tightly bundled and tends to line up in a single direction, instead of the original, interconnected web pattern.

In scar tissue there is much less open space than healthy tissue, and many of the essential accessory proteins and molecules that are essential for the maintenance of healthy skin are absent. This alignment of the collagen fibers and their closely packed arrangement creates a denser, less elastic tissue.

Scar tissue becomes impermeable to migration by many cell types, preventing the formation of blood vessels and a regrowth of complex structures, such as hair follicles and sweat glands. This is why scar tissue is generally monotone, feels tough and dense to the touch, and is hairless. It also explains why the body has such a difficult time replacing scar tissue with healthy tissue.

Repairing Scar Tissue

Once scar tissue has been generated at a site of injury, it is relatively permanent (without medical intervention). In some cases, the body will gradually replace some scar tissue with the healthy tissue, but this process is so slow that is largely irrelevant. The single best treatment for acne scarring, is to prevent it in the first place. This means aggressively attacking the infection and treating the inflammation as it arises.

Fortunately, there are many different treatments available to help repair acne scar damage. The ideal type of treatment is largely dependent on the specific types of acne scarring. Acne scar treatment generally involves either surgically removing the scar tissue, or breaking it apart with laser, heat or surgical treatments.

Light and Laser treatments can be very effective treatments for many different kinds of acne scars. Invasive and non-invasive surgical treatments can also be very helpful.

Topical Retinoids may also be helpful for very mild acne scars and uneven skin tone.

References

Physiopathology of acne vulgaris: recent data, new understanding of the treatments. Pawin, et al. 2004.
Topical ALA Photodynamic Therapy for the Treatment of Acne Vulgaris. Hongcharu, et al. 2000.
Human b Defensin-1 and -2 Expression in Human Pilosebaceous Units: Upregulation in Acne Vulgaris Lesions. Chronnell, et al. 2001.
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.
Acne scarring: a classification system and review of treatment options. Jacob, et al. 2001.
The role of elastic fibers in scar formation and treatment. Cohen, et al. 2017.
The pivotal role of inflammation in scar/keloid formation after acne. Shi, et al. 2017.
Mechanical stress and the development of pseudo‐comedones and tunnels in Hidradenitis suppurativa/Acne inversa. Boer, et al. 2016.
Effect of basic fibroblast growth factor combined with laser on content of a variety of cytokines in acne scar wound. Dong, et al. 2016.
Scar prevention and remodeling: a review of the medical, surgical, topical and light treatment approaches. Kerwin, et al. 2014.
Post acne scarring: a review. Goodman, et al. 2003.
The molecular basis of keloid and hypertrophic scar formation. Tuan, et al. 1998.
Postacne scarring: a review of its pathophysiology and treatment. Goodman, et al. 2000.
Acne scar treatment. Rusciani, et al. 2015.
Acne scar treatment: a multimodality approach tailored to scar type. Zaleski-Larsen, et al. 2016.
Atrophic scar formation in acne patients involves long‐acting immune responses with plasma cells and alteration of sebaceous glands. Carlavan, et al. 2018.
The pivotal role of inflammation in scar/keloid formation after acne. Shi, et al. 2017.
Prospective Study of Pathogenesis of Atrophic Acne Scars and Role of Macular Erythema. Tan, et al. 2017.
Expression of inflammatory and fibrogenetic markers in acne hypertrophic scar formation: focusing on role of TGF-β and IGF-1R. Yang, et al. 2018.
The role of elastic fibers in scar formation and treatment. Cohen, et al. 2017.
Current Concepts in Acne Pathogenesis: Pathways to Inflammation. Tan, et al. 2018.

Augmentin (Amoxicillin + Clavulanic Acid)

Augmentin is a combination antibiotic that includes Amoxicillin and Clavulanic Acid. Amoxicillin is an antibiotic in the Penicillin family. Clavulanic Acid prevents bacteria from inactivating Amoxicillin by blocking the activity of a bacterial enzyme called beta-lactamase.

Augmentin is not a common acne treatment, but there is some evidence to suggest that Augmentin can effective for individuals with acne. The acne-causing P. acnes bacterium tends to be very sensitive to Penicillin family antibiotics. Augmentin is expected to be at least as effective than Amoxicillin alone, but Augmentin tends to be substantially more expensive than basic Amoxicillin.

Individuals who are allergic to Amoxicillin, Ampicillin or Penicillin have an increased risk of side effects from Augmentin treatment.

Sebum

Sebum is a naturally occurring substance that moisturizes, lubricates and protects the skin and hair.

Overview

Sebum is produced by the sebaceous glands of mammals. Healthy sebum production is essential for the integrity and normal function of the skin as a protective organ. Sebum is also an important source of energy (food) for acne-causing Propionibacterium acnes bacteria.

Sebum and Health Skin

Human skin is composed of three primary layers: the stratum corneum, the epidermis, and the dermis. The outermost layer of the skin, the stratum corneum, functions as the primary barrier to the external environment, preventing water loss and the invasion of microorganisms. Sebum is secreted to the stratum corneum from the sebaceous glands and helps maintain an effective, hydrophobic (water-resistant) barrier.

Normal sebum levels help to maintain healthy skin, but abnormal sebum production or composition can contribute to a variety of diseases, including acne.

Chemical Composition of Sebum

Sebum is a complex mixture of naturally produced fats, oils, waxes, cholesterols and other molecules. It is important to point out that the fats and oils present in sebum do not originate directly from the fats and oils consumed in the diet. Rather, sebum is manufactured and stored by the sebaceous glands under the direction of a highly specialized biological process.

Most mammals (but not whales and dolphins) produce some sort of sebum, and each animal has its own unique blend. In addition to sebaceous glands and sebum, there are other structures in the skin that produce a sebum-like mixture called “epidermal lipids”.

Human sebum is composed primarily of glycerides, free fatty acids, wax esters and squalenes. Glycerides are more commonly known as “fats” and are molecules of two or three free fatty acids connected together by a glycerol backbone. Free Fatty Acids are the building blocks of glycerides and other molecules. They are composed of a polar head group and a non-polar (aliphatic tail). Wax Esters are molecules composed of fatty acids linked to fatty alcohols by an ester bond. Squalenes are hydrophobic chains of carbon atoms that serve as the basic building block for naturally occurring steroids and other types of intercellular signaling molecules.

The Biological Role of Sebum in Acne Vulgaris

Several research studies have found a direct relationship between increased sebum secretion and increased acne symptoms. People with sebaceous gland disorders (e.g. sebaceous hyperplasia) that lead to very high sebum levels often have severe forms of acne and other skin diseases. However, there are several possible explanations for how sebum production may contribute to acne, and there is not unanimous agreement between experts when it comes to explaining this relationship.

The most common explanation for why elevated sebum production leads to acne symptoms is that increased sebum production leads to increased follicular plugs (clogged pores). Clogged pores create an low oxygen (hypoxic) environment that supports the growth of acne-causing P. acnes bacteria. Sebum is also a source of food for P. acnes bacteria. The accumulation of sebum within plugged follicles provides ideal growing conditions for P. acnes bacteria and can lead to large numbers of these bacteria growing in the skin.

Research has also found that sebum itself can lead to increased inflammation. Byproducts of the sebum metabolism may cause the accumulation of molecules that trigger an inflammatory immune response. It is possible that this mechanism is at work in some individuals with inflammatory acne.

Research has also shown that people with abnormally high sebum production tend to make sebum that has a different composition than the sebum from people with normal levels. Apparently, people with acne tend to have decreased levels of free fatty acids, but increased levels of glycerides and squalene. Some scientists have proposed that these compositional changes play a role in the development of acne symptoms.

The Regulation of Sebum Production

Acne symptoms are often associated with sebum overproduction, which can increase the incidence of clogged pores, stimulate inflammation, provide nutrients for bacterial growth. Overproduction of sebum is generally the result of excessive growth and activity of the sebaceous glands. Overactive sebaceous glands and sebum overproduction can be caused by many factors, such as hormones, genetics, stress and environmental stimuli.

The proliferation of sebaceous glands and production of sebum is directly regulated by a complex system of hormones and other cellular signals. At a deeper level, these hormonal signals are controlled by an even more complex balance that includes genetics, environmental conditions, metabolic conditions, stress, diet, injury and many other factors. Despite this extraordinary complexity, scientists have begun to unravel the central relationships in sebaceous gland biology.

Several of the central factors that control sebum production have been identified and are currently being investigated by scientists. The major regulators of sebaceous gland activity include:

Androgens

Androgens are male sex hormones, like testosterone. Acne symptoms commonly develop in males during adolescence, when levels of androgen hormones in the body are their highest. Androgens drive the development of many male characteristics, like muscle and body hair growth. They also stimulate the proliferation of sebaceous glands, particularly those located on the face, chest and upper back.

Individuals with excessively high levels of androgen hormones tend to have higher levels of sebaceous gland proliferation, sebum production and acne vulgaris. Women with elevated androgen levels tend to have higher levels of acne and hirsuitism (excess body hair growth). The effect of androgens on sebaceous gland activity is also why the use of anabolic steroids, which increase androgen levels, can cause acne symptoms.

Estrogens

Estrogens are female sex hormones. In most cases, estrogens antagonize (suppress) the effects of androgen hormones. This relationship partially explains why acne symptoms tend to change over the course of a woman’s menstrual cycles, or during and after pregnancy. Men do not usually produce significant levels of estrogen hormones. Estrogens may also directly modulate sebaceous gland activity, although this relationship is not well studied.

Insulin-Like Growth Factor 1 (IGF-1)

IGF-1 is a protein hormone that is produced in the liver and is similar in structure to insulin. Researchers have reported that high IGF-1 levels correlate with elevated sebum production. Levels of IGF-1 tend to be highest during adolescence. Since insulin is similar in structure to IGF-1, it is possible that elevated levels of insulin could cause increased sebum production.

Insulin levels are often elevated in individuals who consume a high glycemic diet (high sugar/carbohydrate), or who have Type 2 diabetes. This relationship could explain the observed correlation between high glycemic diets, obesity and increased incidence of acne vulgaris. Increased IGF-1 has also been linked to milk consumption, although these studies are not necessarily conclusive. IGF-1 hormone production is stimulated by human growth hormone (hGH).

Retinoids

Retinoids are intercellular signalling molecules that are derived from Vitamin A. Retinoid is the generic name for a diverse class of related molecules that play essential roles in many human biological systems, including development of the human embryo. The proliferation of sebaceous glands and the production of sebum is directly controlled by specific retinoid signal molecules. Accutane (Isotretinoin, 13-cis-retinoic acid) is a retinoid that is a powerful anti-acne drug. Binding of Isotretinoin molecules to specialized receptors on the surface of sebocyte cells causes them to slow down their growth and sebum production. The natural balance of different retinoids in the body has a direct impact on sebaceous gland activity.

Environmental Conditions

Recent research has shown that sebum secretion levels change in response to seasonal and environmental changes. While the changes are not drastic, researchers observed that sebum secretion levels were highest during the summer. These changes may be due to the increased fluidity of sebum in warmer conditions, or something else entirely.

Generally speaking, acne sufferers tend to observe an improvement in their acne symptoms during the summer, although this could be more directly related to factors such as UV light exposure or stress levels, than to sebum production. Overall, the research indicates that sebum production is modulated by environmental conditions, although it is less clear whether these normal fluctuations play a role in the development of acne or other skin conditions.

Stress

Several research studies have reported that there is a direct correlation between stress and increased acne symptoms. However, other research studies have found that stress does not appear to increase the levels of sebum production. While it is well understood that stress can modulate levels of certain hormones, like cortisol, it does not appear that these pathways directly impact sebaceous gland activity.

Treatments for Excessive Sebum Production

Treatments that reduce the production of sebum are commonly used for the management of acne symptoms. Common sebum-reducing treatments include Retinoids (eg. Accutane, Differin), Androgen Inhibitors (eg. Spironolactone, Cyproterone) and Laser Treatments (eg. PDT, Diode Lasers).

Retinoids

Retinoids are the most common course of treatment for individuals with hyperactive sebaceous glands and abnormally high sebum production. Retinoids can be an effective acne treatment for many people. Retinoids cause side effects related to decreased sebum production, such as dry and sensitive skin.

The oral retinoid, Isotretinoin (Accutane), is a potent anti-acne medication that can dramatically reduce sebum production. For many individuals, treatment with isotretinoin can lead to significant, long-lasting improvement in their acne symptoms. However, Accutane can have significant side effects, causes severe birth defects in pregnant women, and is tightly controlled in many countries.

Topical retinoid medications are commonly used to treat acne and other skin conditions. Popular topical retinoids include tretinoin (Retin-A), adapalene (Differin), tazarotene (Tazorac) and isotretinoin (Isotrex). These treatments also decrease sebum production, although the effect is often less dramatic than that of oral retinoids.

Retinoids are also used in Naturopathic acne treatments. Retinoids are naturally present in some plant extracts, such as Rose Hip Seed Oil.

Androgen Inhibitors

Androgen Inhibitors can block the activity of the androgen hormones that stimulate sebum production. Androgen inhibitors like spironolactone (Aldactone) and cyproterone (Androcur) can partially block the effects of androgen hormones and decrease sebaceous gland activity. Androgen Inhibitors are available in both oral and topical formulations.

Hormonal Contraceptive medications can also block the effect of androgen hormones. Both anti-androgen medications and birth control medications are usually reserved for use in females, because their effects can disrupt the normal function of the male hormone system.

Light and Laser Treatments

Light and Laser Treatments have become increasingly popular for the treatment of acne and other skin disorders. Certain light and laser treatments, like Photo Dynamic Therapy (PDT) and Diode Laser Therapy, can be used to directly target the sebaceous glands. Damaging the sebaceous glands with laser treatments can decrease the production of sebum at the treatment site. Depending on the specific type of laser treatment, these effects can be semi-permanent.

References

Transient Receptor Potential Vanilloid-1 Signaling as a Regulator of Human Sebocyte Biology. Toth, et al. 2009.
Comparative Chemistry of Sebum. Nikkari. 1974.
Comprehensive analysis of the major lipid classes in sebum by rapid resolution high-performance liquid chromatography and electrospray mass spectrometry. Camera, et al. 2010.
Quantitative evaluation of sebum lipid components with nuclear magnetic resonance. Robosky, et al. 2008.
Sebaceous gland lipids. Picardo, et al. 2009.
Variation in Sebum Fatty Acid Composition Among Human Adults. Green, et al. 1984.
Sebaceous gland lipids: friend or foe? Smith, et al. 2007.
Sebum analysis of individuals with and without acne. Pappas, et al. 2009.
Does facial sebum excretion really affect the development of acne? Youn, et al. 2005.
Sebum output as a factor contributing to the size of facial pores. Roh, et al. 2006.
Comparison of sebum secretion, skin type, pH in humans with and without acne. Kim, et al. 2006.
Can sebum reduction predict acne outcome? Janiczek-Dolphin, et al. 2010.
Human Neutrophils Convert the Sebum-derived Polyunsaturated Fatty Acid Sebaleic Acid to a Potent Granulocyte Chemoattractant. Cossette, et al. 2008.
Peroxisome Proliferator-Activated Receptors Increase Human Sebum Production. Trivedi, et al. 2006.
Sebum Free Fatty Acids Enhance the Innate Immune Defense of Human Sebocytes by Upregulating b-Defensin-2 Expression. Nakatsuji, et al. 2010.
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.
Differentiation of the sebaceous gland. Niemann. 2009.
Correlation of facial sebum to serum insulin like growth factor-1 (IGF-1) in patients with acne. Vora, et al. 2008.
The Role of Specific Retinoid Receptors in Sebocyte Growth and Differentiation. Kim, et al. 2000.
The Effect of Marked Inhibition of Sebum Production with 13-Cis-Retinoic Acid on Skin Surface Lipid Composition. Strauss, et al. 1980.
Regional and seasonal variations in facial sebum secretions: a proposal for the definition of combination skin type. Youn, et al. 2005.
Study of Psychological Stress, Sebum Production and Acne Vulgaris in Adolescents. Yosipovitch, et al. 2007.
Acne is an inflammatory disease and alterations of sebum composition initiate acne lesions. Zouboulis, et al. 2014.
Use of lipidomics to investigate sebum dysfunction in juvenile acne. Camera, et al. 2016.
A Topical Medication of All-Trans Retinoic Acid Reduces Sebum Excretion Rate in Patients With Forehead Acne. Pan, et al. 2017.
The relevance of sebum composition in the etiopathogeny of acne. da Cunha, et al. 2018.
Evaluation of Seasonal Changes in Facial Skin With and Without Acne. Meyer, et al. 2015.
Sebum secretion of the trunk and the development of truncal acne in women: do truncal acne and sebum affect each other?. Kim, et al. 2015.
Relationship between sleep quality and facial sebum levels in women with acne vulgaris. Bilgiç, et al. 2016.
A review of the role of sebum in the mechanism of acne pathogenesis. Li, et al. 2017.
The relevance of sebum composition in the etiopathogeny of acne. da Cunha, et al. 2018.
Lipidomics reveals skin surface lipid abnormity in acne in young men. Zhou, et al. 2018.
Acne vulgaris: The metabolic syndrome of the pilosebaceous follicle. Melnik, et al. 2018.
Developing an in vitro artificial sebum model to study Propionibacterium acnes biofilms. Spittaels. 2018.

The Types of Acne Scars

Acne scars come in many different shapes, sizes and even colors.

Each type of acne scar has its own unique characteristics and features. Because of these differences, the best treatment for acne scars varies from person to person. It is important to carefully choose the treatment that best matches your needs in order to achieve optimal results.

Acne scars can be classified into three main groups:

  • Depressed (pitted scars)
  • Raised (keloid scars)
  • Discoloration scars

Depressed (Pitted) Acne Scars

Depressed scars are the most common type of scarring that results from inflammatory acne. Depression acne scars rest on top of a patch of fibrous, collagen rich scar tissue. This fibrous tissue anchors the base (bottom) of the scar to the sub-cutaneous tissue, maintaining the depression and preventing the regrowth of healthy tissue.

Effective treatments for depressed acne scars usually involve disrupting or removing this scar tissue to allow the body to replace it with functional, healthy tissue.

There are three main types of depressed acne scars:

  • Rolling Scars
  • Boxcar Scars
  • Icepick Scars

Rolling scars

Rolling acne scars are relatively broad depressions in the skin that have rounded, sloping edges. The presence of many of this types of scar in a region of skin gives it a rolling appearance, hence the name.

Rolling scars are common for in individuals who have had patches of skin that have been afflicted by long-term inflammatory acne. They tend to become more pronounced as the skin ages and loses its original elasticity and fullness.

Because rolling scars have sloping edges, many of the available scar treatment techniques are capable of producing positive results. Laser resurfacing (ablative and non-ablative), chemical peels, micro-dermabrasion, needling, subcision and even red light phototherapy can produce improvements in the appearance of rolling scars. Cosmetic fillers are also occasionally used, but many times the large size of the affected area makes fillers an unappealing option.

Boxcar scars

Boxcar acne scars are also relatively broad depressions, but they have steep, defined edges.

Because box car scars have steeper edges than rolling scars, it is more difficult to smooth them out and blend them into the surrounding skin. Laser resurfacing, particularly ablative laser resurfacing (eg. Er:YAG, Nd:YAG, CO2) often produces good results. Multiple laser treatments may be necessary to achieve maximum improvement for patients with significant scarring.

Box car scars often cover smaller areas than rolling scars and can be better candidates for cosmetic fillers. Shallow box car scars can be treated with chemical peels and/or micro-dermabrasion, but these treatments are not very effective for deep scars. Surgical options include punch- out excisions, needling and surgical subcisions.

Icepick scars

Icepick acne scars are deep and narrow scars. In many cases, icepick scars resemble a large, empty pore in the skin.

Ice pick scars are often the most difficult type of acne scar to treat without surgical procedures. Ice pick scars are often quite deep, making them very difficult to treat with standard resurfacing techniques. Chemical peels, micro-dermabrasion and many types of laser resurfacing are unlikely to have a significant impact on ice pick scars because those techniques do not remove enough tissue to be effective.

Some laser treatments may be effective at disrupting the underlying scar tissue. Because ice pick scars are quite narrow, punch-out excisions are a popular, mildly invasive and effective treatment technique.

Hypertrophic and Keloid Scars

Hypertrophic (Keloid) scars occur when excess scar tissue forms at the site of the injury. Hypertrophic scars are regions of fibrous and firm scar tissue which is raised relative to the surrounding healthy tissue. These scars present a set of different challenges than depressed scars and are addressed with different treatments.

When scar tissue forms in great excess, it can become a large nodule of dense, rubbery scar tissue that is known as a keloid. The development of hypertrophic and keloid scars is less common in acne patients than the development of depressed scars. A number of factors can potentially be involved in the process, including acne severity and duration, genetics and secondary infections.

Because hypertrophic acne scars are raised, they can often be treated with ablative laser resurfacing and micro-dermabrasion. They can also be surgically removed. Hypertrophic scars are generally less responsive to treatments like chemical peels, because the scar tissue is much more resistant to the ingredients in a chemical peel than healthy tissue.

Discoloration and Pigmentation Scarring

The tissue damage caused by inflammatory acne can cause many abnormal conditions in the skin. One of the most common types of long-term form of acne scarring is the abnormal discoloration of the skin.

Hyper-pigmentation

Hyper-pigmentation is a condition where elevated levels of the pigment melanin accumulate in the skin. This creates the appearance of freckle-like spots or blotches. Hyper-pigmentation occurs when melanocytes (the cells that produce the melanin pigment) begin to proliferate at the site of injury, or when an existing population of melanocytes begins to produce excess amounts of melanin. Both of these events can result from the trauma caused by an inflammatory acne lesion.

Hyper-pigmentation is often treated with light and laser treatments that specifically target melanin, such as KTP Lasers, Pulsed Dye Lasers (PDL), and Intense Pulsed Light (IPL) therapy. Hyperpigmentation is also addressed with the prescription medications like hydroquinolone, which inhibits the production of melanin, and topical Retinoids, which increase the rate of cellular turnover in the skin.

Hypo-Pigmentation

Hypo-pigmentation occurs when melanocytes are depleted from the injury site or lose their ability to produce melanin. Hypopigmentation is common in areas of skin that have been replaced with scar tissue, which tends to have a light, pinkish appearance. It can also occur in otherwise healthy looking regions of skin.

Hypo-pigmentation is generally more noticeable in those individuals with darker base skin tones. Vitiligo is a condition in which melanocytes lose the ability to produce melanin. There are not many effective treatments available for hypo-pigmentation, although chemical peels and laser resurfacing may be helpful for some individuals.

Erythema (Permanent Redness)

Erythema is a condition in which small capillaries near the surface of the skin become damaged or permanently dilated. This condition presents as a region of redness in the skin. Individual capillaries may be visible, or the area may have general redness. Erythema is somewhat common in acne patients and is most visible in patients with lighter skin tones.

Erythema may be treated with topical prescription medications to decrease vasodilation, but the results are generally temporary. Erythema generally responds well to laser and light based treatments that selectively target hemoglobin, such as Argon and Pulsed Dye Lasers. Red Light Phototherapy may also be a useful treatment for erythema in some individuals.

References

Acne Scars: Pathogenesis, Classification and Treatment. Fabbrochini, et al. 2010.
Resurfacing of Different Types of Facial Acne Scar With Short-Pulsed, Variable-Pulsed, and Dual-Mode Er:YAG Laser. Woo, et al. 2004.
Resurfacing the Acne Scarred Face. Fulton, et al. 1999.
The Management of Post-Acne Scarring. What are the Options for Treatment? Goodman, et al. 2000.
Acne scarring: A review and current treatment modalities. Rivera, 2008.
Acne scarring: A classification system and review of treatment options. Jacob, et al. 2001.
Effective Treatments of Atrophic Acne Scars. Gozali, et al. 2015.
Acne scar treatment: a multimodality approach tailored to scar type. Zaleski-Larsen, et al. 2016.
Acne scarring: A review of available therapeutic lasers. Cohen, et al. 2016.
Fractional CO2 lasers for the treatment of atrophic acne scars: A review of the literature. Magnani, et al. 2014.
Safety and efficacy of microdermabrasion in the treatment of skin disorders: A systematic review. Asgharzadeh, et al. 2017.
Evaluation of microneedling fractional radiofrequency device for treatment of acne scars. Chandrashekar, et al. 2014.
Chemical peels in active acne and acne scars. Kontochristopoulos, et al. 2017.

What Causes Acne?

Inflammatory-Acne-Papules-Skin-and-Cellular-View

Acne is a complex disease and many factors can contribute to the development of symptoms. Every case of acne is unique and the blend of factors that cause acne varies between individuals. Overall, the most important factors in the development of acne are:

  • Genetics
  • Hormones
  • Bacteria
  • Environment
  • Stress
  • Diet

Genetics

A person’s genetic makeup is a dominant factor in determining their likelihood of developing acne and how severe their acne symptoms will be. People inherit their genes from their parents. If either of your parents experienced significant acne symptoms, you are substantially more likely to develop acne yourself.

Genetics impact the structure of the hair follicle, sebaceous gland activity, hormone levels and the immune response to bacteria. For example, many people who suffer from inflammatory acne have immune cells that are less effective at killing the acne bacteria. Or the immune cells in their skin produce more inflammatory molecules than the general population. As a result of genetic differences, their body may respond more vigorously (but less effectively) to acne causing bacteria than the average person. This can result in more frequent and more severe acne breakouts.

Hormones

Hormones are an important factor in the development of acne. Hormones regulate many of the factors that are involved in acne, including the activity of the sebaceous glands, the production of sebum and the immune system’s response to acne-causing bacteria (eg. P. acnes). Hormones largely explain why women tend to experience worsening acne symptoms during certain times of their menstrual cycle, or during/after pregnancy. Hormones also explain why acne symptoms tend to peak during adolescence for males.

Men and women tend to experience acne differently and much of this difference can be explained by hormones. 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.

Men, particularly adolescent males, produce abundant quantities 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 P. acnes. Additionally, high levels of sebum production can increase the incidence of hyper-keratinized follicular plugs (clogged pores) that encourage the development of acne symptoms like pimples, nodules and cysts.

Bacteria

Acne (especially inflammatory acne) is usually connected to bacteria growing deep within pores and hair follicles in the skin. The bacteria most commonly associated with acne symptoms is Propionibacterium acnes (P. acnes). These bacteria produce molecules which cause an immune response, leading to inflammation and acne symptoms.

High levels of bacterial growth within follicles is associated with a higher incidence of acne and more severe symptoms. Although P. acnes bacteria are generally thought of as a causative agent of acne, other bacteria (eg. Staphylococcus aureus) can also live in the skin and may also contribute to the development of acne. Antibiotics are commonly used to control the growth of bacteria and can greatly improve symptoms for many acne sufferers.

There are many different strains of P. acnes bacteria.  Many of these P. acnes strains have developed resistance to one or many different antibiotics. As a result, some antibiotics, including erythromycin and tetracycline, are becoming less effective in some countries (eg. United States) because many people who suffer from acne carry strains of bacteria that are resistant. Fortunately for acne sufferers, there are still many antibiotics available that do not have this shortcoming.

Environment

Environmental conditions, like temperature, sun exposure, humidity and allergens can play a big role in acne outbreaks. Low temperatures may decrease the fluidity of the sebum passing through the follicle and increase the risk of developing a plug. Or low humidity levels can dry the skin, causing the body to increase sebum production in a bid to protect the skin, which then increases the formation of clogged pores and the growth of acne-causing bacteria. Sunlight can affect both the bacteria and the skin, causing physiological changes or damage to various structures. Allergic reactions may exacerbate skin problems, or cause new ones.

Many people notice that their acne tends to improve or worsen depending on the weather, and this is because the environmental conditions can directly affect the way the body functions. The effect of specific environmental conditions on acne symptoms varies greatly between individuals.

Stress

Stress is well known to disrupt normal hormonal balance and depress the immune system. Both of these changes can lead to a worsening of acne symptoms. Acne is a type of infectious disease, and elevated levels of stress can make people more susceptible to all types of infection, including acne.

Many people observe that they tend to break out especially bad after pulling an all-nighter, drug/alcohol consumption or other activities that put stress on the body. Inadequate sleep is a very common form of stress. Avoiding stress and identifying strategies to reduce stress (eg. Exercise, Yoga, Meditation, etc) are important components of a holistic approach to treating acne.

Diet

Scientific evidence does not appear to support the common claims that there is a connection between eating greasy foods or chocolate and the development of acne. However, scientific research has identified a connection between high glycemic index diets and increased incidence of acne. High glycemic diets are those that are high in sugar and simple carbohydrates.

Excessive consumption of sugar and starch is the primary cause of high blood sugar levels, and blood sugar levels are the primary regulator of metabolic function. Consistently elevated blood sugar levels are a type of stress, and they appear to negatively affect the body in ways that are similar to other forms of stress. This type of metabolic stress may cause or worsen acne symptoms in some individuals. Besides increased acne symptoms, high blood sugar levels can lead to other problems, like type 2 diabetes.

Eating a balanced, healthy diet that is rich in protein, whole grains and vegetables is important for overall health and can help minimize acne symptoms. There is some evidence that specific dietary plans (eg. Mediterranean or Vegan diets) may help improve acne for some individuals, but these claims require further scientific investigation.

References

Pathogenesis of Acne. Toyoda, et al. 2001.
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.
Neuroimmunology of Stress: Skin Takes Center Stage. Arck, et al. 2006.
Neuroendocrine regulation of sebocytes and a pathogenetic link between stress and acne. Zouboulis, et al. 2004.
Sebaceous glands in acne patients express high levels of neutral endopeptidase. Nakamura, et al. 2002.
The Response of Skin Disease to Stress. Chiu, et al. 2003.
Stress, Acne and Skin Surface Free Fatty Acids. Kraus. 1970.
Transient Receptor Potential Vanilloid-1 Signaling as a Regulator of Human Sebocyte Biology. Toth, et al. 2009.
Comparative Chemistry of Sebum. Nikkari. 1974.
Comprehensive analysis of the major lipid classes in sebum by rapid resolution high-performance liquid chromatography and electrospray mass spectrometry. Camera, et al. 2010.
Quantitative evaluation of sebum lipid components with nuclear magnetic resonance. Robosky, et al. 2008.
Sebaceous gland lipids. Picardo, et al. 2009.
Variation in Sebum Fatty Acid Composition Among Human Adults. Green, et al. 1984.
Sebaceous gland lipids: friend or foe? Smith, et al. 2007.
Sebum analysis of individuals with and without acne. Pappas, et al. 2009.
Does facial sebum excretion really affect the development of acne? Youn, et al. 2005.
Sebum output as a factor contributing to the size of facial pores. Roh, et al. 2006.
Comparison of sebum secretion, skin type, pH in humans with and without acne. Kim, et al. 2006.
Can sebum reduction predict acne outcome? Janiczek-Dolphin, et al. 2010.
Human Neutrophils Convert the Sebum-derived Polyunsaturated Fatty Acid Sebaleic Acid to a Potent Granulocyte Chemoattractant. Cossette, et al. 2008.
Peroxisome Proliferator-Activated Receptors Increase Human Sebum Production. Trivedi, et al. 2006.
Sebum Free Fatty Acids Enhance the Innate Immune Defense of Human Sebocytes by Upregulating b-Defensin-2 Expression. Nakatsuji, et al. 2010.
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.
Differentiation of the sebaceous gland. Niemann. 2009.
Correlation of facial sebum to serum insulin like growth factor-1 (IGF-1) in patients with acne. Vora, et al. 2008.
The Role of Specific Retinoid Receptors in Sebocyte Growth and Differentiation. Kim, et al. 2000.
The Effect of Marked Inhibition of Sebum Production with 13-Cis-Retinoic Acid on Skin Surface Lipid Composition. Strauss, et al. 1980.
Regional and seasonal variations in facial sebum secretions: a proposal for the definition of combination skin type. Youn, et al. 2005.
Study of Psychological Stress, Sebum Production and Acne Vulgaris in Adolescents. Yosipovitch, et al. 2007.
New insights into acne pathogenesis: exploring the role of acne-associated microbial populations. Kumar, et al. 2016.
On the TRAIL to truth, or on a road to nowhere? van Steensel. 2017.

Frequently Asked Acne Questions

Frequently Asked Questions

There are many claims about what causes acne and what treatments are effective for improving acne symptoms. Some of these claims are entirely true, some are partially true, and many are completely false. There is also a tremendous amount of contradictory information about acne available from lots of different sources.

In this FAQs section we address the most common acne-related questions on topics such as diet, hygiene, bacteria, hormones, acne science and more. For in-depth discussions the scientific aspects of acne, refer to our Acne Science page.

Most Common Acne Questions

What is Acne?

Acne is a difficult to treat and often debilitating disease that affects the skin, usually the face. The most common form of acne (acne vulgaris) is an infection within a hair follicle. This infection causes varying degrees of inflammation, which manifest as pimples, nodules and cysts. When the inflammation is severe, it can cause permanent damage to the skin and create acne scars. This section covers the basics of what acne is and the different types of acne.

What is the Best Acne Treatment for Me?

Choosing the best acne treatment(s) for each individual depends on many factors. The type and severity of your acne, your age, gender, treatment history and personal preferences are all important. If possible, you should work with your dermatologist or healthcare provider to develop a comprehensive acne treatment plan that is specifically tailored to your needs.

Treatments for active acne and acne scars can be roughly divided into 6 different categories: Over The Counter (OTC) Treatments, Pharmaceutical (Rx) Treatments, Naturopathic/Homeopathic/Lifestyle Treatments, Light & Laser Treatments, Surgical Treatments and Acne Scar Treatments. This section contains detailed information about all of the available acne treatments.

Is Popping a Pimple a Bad Idea?

The answer is that it can be, especially if done improperly. Some pimples and other acne lesions benefit from being drained or popped in order to remove pus and accelerate healing, but other pimples should be left alone to heal on their own.

The nodules and cysts of those patients who suffer from severe inflammatory acne (Acne Type: 4) are often lanced and drained by a dermatologist. This can prevent further damage and limit post-acne scarring. The important thing is to identify those zits and pimples which can be effectively popped (and which ones can not), and to do that properly and in a sterile fashion. This section discusses the risks, benefits and techniques for draining acne lesions.

The Origins of Acne

What Causes Acne?

Acne is a complex disease and many factors can contribute to the development of acne symptoms. Every case of acne is unique and the blend of factors that cause acne varies between individuals. This section contains a list and discussion about the factors that are major contributors to the development of acne symptoms.

Is acne caused by dirt or not washing my face enough?

The answer is usually NO. In most acne lesions (pimples, nodules, cysts, etc.), the center of infection and inflammation is not near the surface of the skin. Instead, it is near the base of the hair follicle where the sebaceous gland attaches. This is a region of the follicle that is not readily accessible from the surface.

Facial cleansers and their active ingredients are unlikely to impact the inflammatory processes that drive moderate to severe acne symptoms (Acne Types: 2-4). This section discusses the benefits, risks and uses of acne facial cleansers.

Does Greasy Food, Milk or Chocolate Cause Acne?

The answer is probably not. Anecdotal associations between acne and particular foods like chocolate, ice cream and pizza have largely been discredited by scientific research.

However, research does point to a connection between overall diet and the development of acne symptoms. Researchers have shown that people whose diets include lots of high glycemic index foods (foods that are high in sugar and simple carbohydrates) tend to experience acne at a greater frequency than those who have low glycemic index diets. Unforunately, there is no clear scientific consensus on why this connection exists. This section discusses several of common claims about the association of specific types of food and acne symptoms.

Can Stress Cause Acne?

Stress can inhibit the function of the immune system and trigger or worsen acne symptoms It is well known that putting an organism under stress makes it more susceptible to infection. This is true for humans, animals and even plants.

The same neural and biochemical pathways that make stress feel uncomfortable can also disrupt the delicate balance of a properly functioning immune system. This section discusses the relationship between stress and the development of acne symptoms.

What Does Non-Comedogenic Mean?

Comedogenicity refers to the potential of a substance to cause a comedo, a plugged or inflamed pore. Non-comedogenic means that in testing, the substance or product has not been shown to cause comedos (clogged or inflamed hair follicle). Some substances (eg. coal tar) are highly comedogenic and produce a type of allergic, acne-like reaction.

There is not a clear consensus among scientists/doctors when it comes to the comedogenicity of many substances. Different tests performed by different laboratories often yield contradictory results. This section discusses what comedogenicity is, how it is tested and which products and substances are likely to be comedogenic.

Is Acne Different Between Men and Women?

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. For men, 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. This section discusses key differences in acne symptoms between men and women, and why these differences exist.

What is the Relationship Between Pregnancy and Acne?

There are a tremendous number of 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. This section discusses the effects that pregnancy can have on acne symptoms.

What is the Relationship Between Anabolic Steroids and Acne

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. They are widely used as performance enhancing drugs (PEDs) in athletics.

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. This section discusses the biology of anabolic steroids and their role in the development of acne symptoms.

Acne Scars

What are the Different Types of Acne Scars?

Acne scars come in many different shapes, sizes and even colors. Each type of acne scar has its own unique characteristics and features. Because of these differences, the available treatments for acne scars are not one size fits all. It is important to carefully choose the treatment that best matches your needs in order to achieve optimal results.

Acne scars can be classified into three main groups: Depressed (pitted scars), Raised (keloid scars) and Discoloration scars. This section discusses the different types of acne scars and the features that define each group.

How Do Acne Scars Form?

Acne scars are the result of tissue damage caused by inflammatory acne. The vast majority of acne scars are caused by from persistent cases of inflammatory acne affecting the same area of skin.

Individuals who suffer from frequent nodular and cystic acne outbreaks (Acne Types: 3-4) are at a very high risk of developing permanent acne scarring. This is particularly true when a region is affected by overlapping acne outbreaks, with no opportunity for the skin to completely heal between outbreaks. This section discusses the different factors that contribute to the development of acne scars.

The Relationship Between Acne and Bacteria

What is Propionibacterium acnes?

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 (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. This section details what P. acnes bacteria are and how it contributes to acne symptoms.

The Antibiotic Susceptibility of Propionibacterium acnes

Propionibacterium acnes is a bacteria that grows within hair follicles and contributes to acne symptoms. Antibiotics reduce the growth of acne-causing bacteria and are a common treatment for acne symptoms.

For the past 50 years, physicians and researchers have been screening the susceptibility of Propionibacterium acnes (P. acnes) bacteria to different antibiotics. The results from these studies clearly demonstrate that in many places, P. acnes bacteria are becoming increasingly resistant to certain classes of antibiotics. This section discusses the results of research studies about the antibiotic sensitivity of P. acnes bacteria.

The Antibiotic Families

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 from several different families are used for the treatment of acne. 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. This section discusses the different classes of antibiotics that are used in the treatment of acne.

How Do Bacteria Become Resistant to Antibiotics?

Bacteria can become resistant to antibiotics that they were susceptible to in the past. There are several factors which contribute to the growing problem of antibiotic-resistant bacteria. This section discusses the many ways that antibiotic resistance may occur, as well as the conditions and environments that promote the development of antibiotic-resistant bacteria.

The Antibacterial Activity of Essential Oil

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.

Essential Oils are widely used by both professional and casual practitioners of Naturopathic medicine. Essential oils are used to treat many health problems, including acne. This section discusses the scientific research into the antibacterial properties of plant essential oils.

How Do I Avoid Negative Interactions Between Medications?

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). Basically, some medications are contraindicated with one another because taking them together is known to cause potentially serious problems. This section discusses how to learn more about medications and avoid negative drug interactions.

Acne and Psychology

What is the Relationship Between Acne, Depression and Suicide?

Acne can have a profound 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. This section discusses the connections between acne, stress, depression and suicide.

Acne Science

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. This section discusses the formation of acne lesions at a microscopic level.

What are The Sebaceous Glands?

Sebaceous glands produce and secrete 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. This section discusses the structure and function of the sebaceous glands.

What is Sebum?

Sebum is a naturally occurring substance that moisturizes, lubricates and protects the skin and hair. Sebum is produced by the sebaceous glands of mammals. Healthy sebum production is essential for the integrity and normal function of the skin as a protective organ. Sebum is also an important source of energy (food) for acne-causing Propionibacterium acnes bacteria. This section discusses the biology of sebum and its role in the development of acne symptoms.

What Is Acne?

Type-2-3-Acne-on-Chin

Acne is a difficult to treat and often debilitating disease that affects the skin, usually the face. The most common form of acne (acne vulgaris) is an infection within a hair follicle. This infection causes varying degrees of inflammation, which manifest as pimples, nodules and cysts. When the inflammation is severe, it can cause permanent damage to the skin and create acne scars.

Types of Acne

Acne can range from small patches of red skin with tiny bumps to large cysts that are painful to the touch. Different types of acne can have profoundly different underlying causes and understanding precisely what type of acne you have can help you identify what solutions are going to have the best chance of being effective.

Type 1 Acne

  • Minimal inflammation
  • Minimal affected area
  • Not painful
  • Irregular outbreaks

Type 1 Acne is the most mild form of acne and generally is the least damaging and easiest to treat form of the disease. It is characterized by a lack of inflammation and is usually not particularly painful. The area of the body affected by the acne is usually limited.

Type 1 acne is often transient and often resolves on its own after about a week. Non-inflamed blackheads and small red bumps (papules) are common with this form of acne. This form of acne appears to be particularly common in females and often affects the forehead, cheeks, nose and neck. Topical treatments are often effective at resolving the symptoms associated with Type 1 acne.

Type 2 Acne

  • Mild inflammation
  • Some painful pimples
  • Regular outbreaks

Type 2 Acne is similar to Type 1 acne, but is characterized by increased levels of inflammation and more frequent outbreaks. With Type 2 acne, pimples can range from small red bumps to medium sized whiteheads.

Unlike Type 1 acne blemishes, pimples associated with Type 2 acne are often painful to the touch. Over-The-Counter (OTC) topical treatments are often partially effective at decreasing the severity and duration of outbreaks, but are frequently inadequate for Type 2 acne. Topical antibiotics, Topical Retinoids and Light-Based Therapies can be quite effective for this type of acne. In some instances it may be necessary to explore oral antibiotics or oral retinoids, if the acne does not respond completely to topical treatments.

In general, Type 2 acne is minimally scarring if allowed to resolve on its own. However, it is important to practice good hygiene and avoid exacerbating the situation by “”popping”” pimples without cleaning and sterilizing the area before and after.

Type 3 Acne

  • Large, painful pimples
  • Nodular pimples
  • Frequent outbreaks

Type 3 Acne is characterized by the presence of medium to large nodules and pustules that are frequently painful. With Type 3 acne, pimples are often associated with significant amounts of inflammation. Large whiteheads and large, painful red bumps (nodules and cysts) are common. Individual pimples can take a long time to resolve, up to 10-14 days.

In type 3 acne, much of the inflammation and infection originates deeper in the skin tissue than in Acne Types 1 and 2. Because the source of the problem is deep within the skin, Type 3 acne is usually unresponsive to OTC medications, and many other topical treatments.

Topical antibiotics and topical retinoids are often innefective treatments for people with Type 3 acne. In many cases, oral antibiotics, oral retinoids (Isotretinoin) and laser-based therapies are the only effective treatments. The increased inflammation associated with Type 3 acne poses a significant risk of permanent scarring.

Type 4 Acne

  • Large and painful nodules.
  • Abundant Pustules and Cysts.
  • Persistent Outbreak.

Type 4 Acne is the most severe form of the disease. In most cases, Type 4 acne will cause permanent skin damage and scarring. Like Type 3 acne, Type 4 acne is characterized by inflammatory infections deep within the hair follicle and surrounding tissue. Large, painful cysts and nodules are a common feature in Type 4 acne.

Type 4 acne is generally non-responsive to OTC medications. Topical antibiotics, topical retinoids and naturopathic treatments are poorly effective in many cases. Type 4 acne is a serious medical condition that should be evaluated and treated immediately by a dermatologist, if possible. Treating Type 4 acne often requires aggressive treatment regimens that combine topical and oral pharmaceuticals. Type 4 acne is often extremely painful, both physically and psychologically.

Acne Treatments

What is the best acne treatment for you?

Choosing the best acne treatment(s) for each individual depends on many factors:

  • Type and severity of your acne
  • Age and gender
  • Genetics
  • Treatment history
  • Personal preferences

Whenever possible, you should work closely with your dermatologist or healthcare provider to develop a comprehensive acne treatment plan that is specifically tailored to your needs.

Treatments for active acne and acne scars can be roughly divided into 6 different categories:

Over The Counter (OTC) Treatments

When people first develop acne symptoms, they often begin treatment with Over The Counter (OTC) acne products. These products are generally topical medications and they are widely available at grocery stores, department stores and pharmacies. Common OTC acne products include face washes, creams, masks, astringents and pore strips. Many of these products contain one of two active ingredients – Benzoyl Peroxide and Salicylic Acid.

Pharmaceutical (Rx) Treatments

For many individuals with moderate to severe acne (Acne Types: 2-4), Pharmaceutical Treatments are required to significantly improve their acne symptoms. Pharmaceutical treatments include oral and topical medications that are available primarily from a clinician or pharmacy. There are many different types of Pharmaceutical medications that are used in the treatment of acne, including Antibiotics, Retinoids and Hormonal Treatments.

Naturopathic and Lifestyle Treatments

Many modern medicines are derived from natural products that have been used in traditional medicine for thousands of years. Many plant extracts and other natural products have properties that can be helpful for individuals with acne. Naturopathic, Homeopathic and Lifestyle acne treatments include include Essential Oils, Herbal Supplements, aromatherapies, special/restrictive diets, nutritional supplements, exercise and more.

Light & Laser Treatments

Light and Laser therapies are available for the treatment of both active acne and acne scars. Light-based treatments such as Blue Light Phototherapy can be valuable additions to a comprehensive acne treatment regimen. Laser-based treatments such as Fraxel are among the most effective treatments for established acne scars.

Surgical Treatments

Surgical Treatments are available for the treatment of active acne and acne scars. Many dermatologists routinely perform simple surgical procedures such as comedome (blackhead) extraction for their patients. Individuals with severe inflammatory acne may have nodules and cysts that may need to be surgically lanced and drained, in order to heal. Surgical Treatments are often the best option for patients with Moderate to severe acne scarring. There are many types of surgical Treatments for acne scars, including Chemical Peels, Microdermabrasion, Needling, Subcision and more.

Acne Scar Treatments

Acne Scars can be difficult to repair, but fortunately there are many different kinds of Acne Scar Treatments available. The best treatment for an individual with Acne Scars depends on the type and severity of their scars. Treatments specifically for Acne Scars can be found in each of the categories listed above. This section contains a collection of treatments, selected from the above categories, that are specifically useful for treating acne scars.

Acne Knowledge

What is Acne?

Acne is a difficult to treat and often debilitating disease that affects the skin, usually the face. The most common form of acne (acne vulgaris) is an infection within a hair follicle. This infection causes varying degrees of inflammation, which manifest as pimples, nodules and cysts. When the inflammation is severe, it can cause permanent damage to the skin and create acne scars. This section covers the basics of what acne is and the different types of acne.

Frequently Asked Acne Questions

There are many claims about what causes acne and what treatments are effective for improving acne symptoms. Some of these claims are entirely true, some are partially true, and many are completely false. There is also a tremendous amount of contradictory information about acne available from lots of different sources. In the FAQs section we address the most common acne-related questions on topics such as diet, hygiene, bacteria, hormones and more.

Acne Treatments

Choosing the best acne treatment(s) for each individual depends on many factors. The type and severity of your acne, your age, gender, treatment history and personal preferences are all important. If possible, you should work with your dermatologist or healthcare provider to develop a comprehensive acne treatment plan that is specifically tailored to your needs.

Treatments for active acne and acne scars can be roughly divided into 6 different categories: Over The Counter (OTC) Treatments, Pharmaceutical (Rx) Treatments, Naturopathic/Homeopathic Treatments, Light & Laser Treatments, Surgical Treatments and Acne Scar Treatments. This section contains detailed information about all of the available acne treatments.

Acne Science

Acne is a complex disease. There are many factors that contribute to the development of acne symptoms, and they vary greatly between individuals. The Acne Science section covers a range of scientific topics related to the development of acne and the available treatments.