Acne — Scientific Evidence

Based on scientific evidence the following approaches have shown to be effective. To review the supporting scientific evidence, select a treatment option.

In order to help interpret the strength of the scientific evidence (the level of proof) provided, descriptions of the different types of studies, reviews and guidelines are available in the glossary. Please click on each term for a discussion of the topic: Case review, consensus statement, controlled clinical trial, guidelines and recommendations, literature review, meta-analysis, multi-center study, outcome study, systematic review.

Acupuncture
Author(s):
Son BK, Yun Y, Choi IH
Institution:
Department of Oriental Dermatology, Kyung Hee University, East-West Neo Medical Center, Seoul, Korea
Title:
Efficacy of ah shi point acupuncture on acne vulgaris.
Source:
Acupuncture in medicine : journal of the British Medical Acupuncture Society. 28(3):126-9, 2010.
Type of study:
Randomized controlled trial
Control/comparison:
acupuncture at general acupuncture points only 12 times over 6 weeks
Sample characteristics:
36 patients with acne vulgaris
Type of intervention:
or at both general acupuncture points and ah shi points 12 times over 6 weeks
Primary outcome measure(s):
inflammatory lesion count, a quality-of-life scale (Skindex-29) and a subjective symptom score.
Outcome:
After 12 treatment sessions, there was a significant reduction in the inflammatory acne lesion counts, the Skindex-29 scores and the subjective symptom scores from baseline in both groups, but no significant difference between groups. Acupuncture treatment of moderate acne vulgaris was associated with reduction of inflammatory lesions and improvement of the quality of life.
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Ayurveda
Author(s):
Paranjpe P, Kulkarni PH
Institution:
Acne Clinic, Nanal Hospital, India
Title:
Comparative efficacy of four Ayurvedic formulations in the treatment of acne vulgaris: a double-blind randomised placebo-controlled clinical evaluation
Source:
Journal of Ethnopharmacology. 49(3)127-32, 1995
Type of study:
randomized placebo-controlled clinical trial
Control/comparison:
placebo
Sample characteristics:
82 patients with acne
Type of intervention:
4 different Ayurvedic treatments given orally for 6 weeks
Primary outcome measure(s):
clinical investigations and lesion count were carried out at 2 week intervals
Outcome:
A significant reduction in lesion count was observed in patients receiving Sundar Vati
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Biofeedback
Author(s):
Hughes H, Brown BW, Lawlis GF, et al.
Institution:
Department of Psychology, North Texas State University, Denton, TX
Title:
Treatment of acne vulgaris by biofeedback relaxation and cognitive imagery
Source:
Journal of Psychosomatic Research. 27(3):185-91, 1983
Type of study:
randomized controlled clinical trial
Control/comparison:
attention and conventional medical care
Sample characteristics:
30 patients matched on age, sex, pre-treatment and acne severity
Type of intervention:
biofeedback-assisted relaxation and cognitive imagery treatment, 12 sessions over six weeks
Primary outcome measure(s):
acne severity as measured by Cook, Centner and Michaels photographic standards
Outcome:
The treatment resulted in a significant reduction of acne severity compared to the attention and medical care. Treatment group patients who continued home practice until follow-up maintained their gains, whereas those who discontinued failed to maintain gains.
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Herbal Medicine
Author(s):
Bassett IB, Pannowitz DL, Barnetson RS
Institution:
Department of Dermatology, Royal Prince Alfred Hospital, Camperdown, NSW
Title:
A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne
Source:
Medical Journal of Australia. 153(8):455-8, 1990
Type of study:
randomized controlled clinical trial.
Control/comparison:
efficacy and skin tolerance of 5% benzoyl peroxide
Sample characteristics:
124 patients with mild to moderate acne
Type of intervention:
use of 5 tea-tree oil gel on skin
Primary outcome measure(s):
number of inflamed and non-inflamed lesions (open and closed comedones)
Outcome:
The results of this study showed that both 5% tea-tree oil and 5% benzoyl peroxide had significant effect in ameliorating the patients’ acne by reducing the number of inflamed and non-inflamed lesions (open and closed comedones). Although the onset of action in the case of the tea-tree oil was slower, fewer side effects were experienced by the patients treated with tea-tree oil.

Author(s):
Higaki S., Nakamura M., Morohashi M, et al.
Institution:
Dr. S. Higaki, Department of Dermatology, Faculty of Medicine, Toyama Medical/Pharmaceutical University , 2630 Sugitani, Toyama-she 930-01, Japan
Title:
Activity of eleven Kampo formulations and eight Kampo crude drugs against Propionibacterium acnes isolated from acne patients: Retrospective evaluation in 1990 and 1995
Source:
Journal of Dermatology. 23: 871-875, 1996
Type of study:
in vitro lab study
Control/comparison:
comparing the minimum inhibitory concentrations (MIC) in 1990 and 1995 of 11 Kampo formulations and 8 Kampo crude drugs against Probionibacterium acnes isolated from acne
Sample characteristics:
Propionibacterium acne strains
Type of intervention:
11 Kampo formulations and 8 Kampo crude drugs
Primary outcome measure(s):
Primary outcome measure(s): examining the minimum inhibitory concentrations (MIC) in 1990 and 1995 of 11 Kampo formulations and 8 Kampo crude drugs against Probionibacterium acnes isolated from acne
Outcome:
Probionibacterium acne strains were most sensitive to Oren-gedoku-to (OGT) among these Kampo formulations. Coptidis Rhizoma (CR) and Phellodendri Cortex (PC) inhibited the growth of Probionibacterium acnes significantly among the eight Kampo crude drugs examined. No significant increases in MIC of Kampo formulations and Kampo crude drugs to Probionibacterium acne were observed. The speculation was made that Kampo crude drugs such as CR and PC were better than minocycline or erythromycin from the point of a progressive increase in MIC to Probionibacterium acne. CR and PC, which were each an ingredient of OGT, might contain some components with strong antibacterial activity to Probionibacterium acne.
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Nutrition/Supplementation
Author(s):
Vahlquist A, Michaelsson G, Juhlin L
Institution:
Department of Dermatology and Clinical Research, Uppsala University Hospital, Uppsala, Sweden
Title:
Effects of oral zinc and vitamin A in acne
Source:
Archives of Dermatology. 113(1):31-6, 1977
Type of study:
controlled clinical trial
Control/comparison:
vitamin A and placebo
Sample characteristics:
64 patients, 38 male and 26 female, between 13 and 25 years of age with grades 2 to 4 acne.
Type of intervention:
135 mg oral zinc sulfate daily alone and in combination with 300,000 IU vitamin A daily on acne lesions
Primary outcome measure(s):
change in number of comedones, papules, pustules, and infiltrates were counted at each visit
Outcome:
After 4 weeks there was a significant decrease in the number of papules, pustules, and infiltrates in the zinc-treated groups. After 12 weeks of treatment, the mean acne score had decreased from 100% to 15%. The effects of zinc plus vitamin A was not better than zinc alone.

Author(s):
Gandola M, Argeniano G, Barba C, et al.
Institution:
 
Title:
Topical vitamin A acid in the treatment of acne vulgaris (a controlled multicenter trial)
Source:
Archives of Dermatological Research - Archiv fur Dermatologische Forschung. 255(2):129-38, 1976
Type of study:
controlled multi-center trial
Control/comparison:
salicylic acid and placebo
Sample characteristics:
211 acne patients in comparable groups
Type of intervention:
application of topical retinoid acid against sulfur-resorcinol--salicylic acid and placebo
Primary outcome measure(s):
uniform evaluation criteria
Outcome:
After 8 weeks' treatment in comparable groups of patients, retinoic acid proved to be superior to the standard and to the placebo. The difference was statistically significant. Side effects were present in a number of patients treated with the active substances and with the placebo (mainly erythema), but rarely was the treatment discontinued.

Author(s):
Elsaie ML. Abdelhamid MF. Elsaaiee LT. Emam HM.
Institution:
Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami FL
Title:
The efficacy of topical 2% green tea lotion in mild-to-moderate acne vulgaris.
Source:
Journal of Drugs in Dermatology: JDD. 8(4):358-64, 2009.
Type of study:
clinical trial
Control/comparison:
Not applicable
Sample characteristics:
20 patients with mild-to-moderate acne vulgaris
Type of intervention:
2% green tea lotion applied twice daily for a period of 6 weeks
Primary outcome measure(s):
total lesion count (TLC) and their devised severity index (SI)
Outcome:
The mean total lesion count (TLC) decreased from 24 to 10 after 6 weeks of, a reduction of 58.33%. The difference was statistically significant. The mean severity index (SI) decreased from 2.05 to 1.25 after 6 weeks of treatment, a decrease of 39.02%. The difference was also statistically significant. Topical 2% green tea lotion was found to be an effective, cost-effective treatment for mild-to-moderate acne vulgaris.

Author(s):
Niren NM. Torok HM.
Institution:
University of Pittsburgh Medical Center, Pennsylvania
Title:
The Nicomide Improvement in Clinical Outcomes Study (NICOS): results of an 8-week trial.
Source:
Cutis. 77(1 Suppl):17-28, 2006.
Type of study:
multicenter study
Control/comparison:
nicotiname plus antiobiotic therapy
Sample characteristics:
198 patients with acne vulgaris and/or rosacea.
Type of intervention:
nicotinamide 750 mg, zinc 25 mg, copper 1.5 mg, and folic acid 500 microg, marketed as Nicomide (Nic/Zn)
Primary outcome measure(s):
patient global evaluation and patient evaluation of the percentage of reduction in inflammatory lesions after 4 and 8 weeks of treatment; overall patient satisfaction also was recorded
Outcome:
After weeks, the number of patients enrolled in the study who reported improvement was significantly greater than the number who reported either no change in or worsening of their condition. Of the patients studied, 79% reported their improvement in appearance as moderately better or much better and 55% reported moderate (26%-50%) reduction in lesions or substantial improvement after 4 weeks of treatment. The percentage of patients who responded to therapy continued to increase through the 8 weeks of treatment. When comparing patients who received also oral antibiotic therapy (26%) with those who received Nic/Zn tablets as their only oral therapy (74%), the percentage of patients who responded to treatment was not significantly different between treatment groups. It appears that the addition of an oral antibiotic to a treatment regimen that includes Nic/Zn tablets may not be necessary because the combination did not significantly increase the percentage of patients responding. Nic/Zn tablets appear to be an effective oral therapy for the treatment of acne vulgaris and rosacea when used alone or with other topical therapies and should be considered a useful alternative approach to oral antibiotics for the treatment of acne vulgaris and rosacea.

Author(s):
Smith RN. Braue A. Varigos GA. Mann NJ.
Institution:
School of Applied Sciences, RMIT University, Australia.
Title:
The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides
Source:
Journal of Dermatological Science. 50(1):41-52, 2008
Type of study:
Randomized controlled- clinical trial.
Control/comparison:
carbohydrate dense diet
Sample characteristics:
31 male acne patients aged between 15 and 25
Type of intervention:
low glycemic load diet for 12 weeks
Primary outcome measure(s):
Acne lesion counts and the follicular sebum outflow and composition of skin surface triglycerides were assessed
Outcome:
After 12 weeks, subjects on the low glycemic load diet showed fewer acne lesions.

Author(s):
Bowe WP. Joshi SS. Shalita AR.
Institution:
State University of New York Downstate Medical Center, New York
Title:
Diet and acne.
Source:
Journal of the American Academy of Dermatology. 63(1):124-41, 2010
Type of study:
[Review] [109 refs]
Control/comparison:
Not applicable
Sample characteristics:
Not applicable
Type of intervention:
Not applicable
Primary outcome measure(s):
Not applicable
Outcome:
Compelling evidence exists that high glycemic load diets may exacerbate acne. Dairy ingestion appears to be weakly associated with acne, and the roles of omega-3 fatty acids, antioxidants, zinc, vitamin A, and dietary fiber remain to be elucidated.
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