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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