complementary and alternative medicine and acne vulgaris: a … · 2020-06-08 · acne, 6% (1/17)...
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Complementary and Alternative Medicine and Acne Vulgaris: A Review of the LiteratureTyler Evans MD, Shauna Higgins MD, Ashley Wysong MS, MD.Department of Dermatology, University of Nebraska Medical Center, Omaha, NE 68198
Objective
To systematically review and consolidate the literature regarding complementary and alternative medicine and its use in the
treatment of acne
CAM and Acne Evidence Results
ConclusionAvoidance of high glycemic load foods and skim or 1% milk, in
addition to use topical tea tree oil had the most methodologically sound level 1 and 2 evidence supporting treatment of acne. This
review can be used for providers and patients alike as they search for up to date literature on CAM and acne in search of alternative or complementary treatments to standard medical
therapy.
References
Design
The authors conducted a PubMed search in July of 2018 using the keywords “acne,” AND “complementary and alternative
medicine,” “diet,” “stress,” “acupuncture,” and/or “essential oils.” Articles were selected and reviewed based on relevance,
diversity, and year of publication.
ABSTRACTAcne has been reported to affect up to 50 million Americans annually to make it the most common skin condition in the United States (US). Its prevalence is compounded by its
psychological consequences. Acne can lead to permanent scarring that engenders poor self-esteem and has also been strongly correlated with depression and anxiety1.
Thus, effective therapies are in high demand as evident by the estimated value of the acne market reaching
approximately $3 billion in 20162. In the context of growing antibiotic resistance, however, in addition to an overall
increased patient interest in alternative therapies, complementary and alternative medicine (CAM) may be
able to provide sustainable solutions
Of the 17 studies qualitatively analyzed, six were level 1 evidence, six were level 2, one was level 3, four were level 4, and zero were level 5. Fifty-three percent (9/17) explored diet and its effects on acne, 6% (1/17) of the articles explored acupuncture, 23% (4/17) discussed essential oils and their ability to reduce acne severity,
12% (2/17) were in regards to stress as a causative agent in acne flares, and 6% (1/17) examined meditation and hypnosis as
possible treatments for acne.
Available upon request.
Author
CAM Therapy
Level of Evidence
Study Type
Outcome
Significance
Smith RN, et al
Diet (low glycemic load)
1
Randomized control trial
Decreased lesion count from baseline in low glycemic load (-21.9) vs high glycemic load (-13.8)
P= .01, .001
LaRosa CL, et al
Diet (milk)
3
Case control
Increased skim/1% milk intake in teenagers with acne vs those without
P= 0.01
Adebamowo CA, et al
Diet (milk)
4
Cross sectional
Positive association between skim milk intake and presence of acne
P= 0.003
Adebamowo CA, et al
Diet (milk)
2
Prospective cohort
Positive association between skim milk and acne in teenage males
P= 0.02
Saric S, et al
Diet (tea)
1
Randomized control trial
Decrease lesion count on nose, perioral area, and chin in tea consumption group.
P= 0.03
Nguyen QG
Diet (tea)
4
Cross sectional
Positive association between tea consumption and presence of acne
not reported
Vongraviopap S
Diet (chocolate)
2
Prospective cohort
Increase in lesion count from baseline (11.84) to end of 12-week study (20.28)
P= 0.01
Delost GR
Diet (chocolate)
2
Prospective cohort
Increase in lesion count 48hrs after consumption of 1.55oz Hershey's chocolate bar
P= 0.0001
Cengiz FP
Diet (whey protein)
4
Case series
Increased acne formation after starting whey protein supplementation
na
Mansu SSY, et al
Acupuncture
1*
Meta analysis
Likelihood of achieving acne burden reduction was not statistically different when using acupuncture vs pharmacotherapy
RR: 1.07 (95% CI 0.98-1.17)
Bassett IB
Essential oil (tea tree oil)
1
Randomized control trial
Significant reduction in lesion count when using topical 5% tea tree oil and benzoyl peroxide
P= 0.01
Enshaieh S, et al
Essential oil (tea tree oil)
1
Randomized control trial
Significant reduction in lesion count when using topical 5% tea tree oil (21.16 to 11.33) vs placebo (19.53 to 17.23)
P= 0.0001
Kwon HH, et al
Essential oil (LFCO)
1
Randomized control trial
Reduction in lesion count when using topical LFCO (65.3% decrease) vs topical tea tree oil (38.2% decrease)
P < 0.05
Moy RL, et al
Essential oil (sandalwood oil)
2
Prospective cohort
42/47 patients had notable reduction in lesions when using sandalwood oil in combination with 0.5% salicylic acid twice daily for eight weeks
not reported
Yosipovitch G, et al
Stress Reduction
2
Prospective cohort
Positive correlation between stress levels and acne severity
P= 0.029
Chiu A
Stress Reduction
2
Prospective cohort
Increased acne severity was associated with increase stress levels
P < 0.01
Shenefelt PD
Meditation and Hypnosis
4
Case reports
Meditation and hypnosis associated with decreased acne burden in multiple patients
not reported
*Article noted that meta-analysis was based on studies with poor methods and reporting standards
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