In the following sections, we’ll outline complementary approaches that may help you deal with acne. The below strategies are not meant to replace your standard medical treatment. Make sure to consult with your doctor before making any significant changes to your day-to-day routine.
Light therapy applies light of specific wavelengths through human skin to elicit certain effects in the underlying tissue.
Red light, blue light, and their combination have all been shown to improve acne. In one study, the combination was more effective than not only either wavelength alone, but also the FDA-approved medication benzoyl peroxide [1, 2, 3, 4].
Most of red light’s effects are through the cells’ mitochondria absorbing light. In cell studies, the cytochrome c oxidase in the mitochondria absorbs red light, which causes it to release nitric oxide, increase ATP, and decrease oxidative stress .
Blue light activates proteins that contain light-sensitive molecules (porphyrins and flavones) and increase mitochondrial activity and oxidative stress. Skin cells respond by releasing molecules that promote inflammation and control skin growth. Additionally, blue light killed the acne-causing bacteria Cutibacterium acnes in test tubes [6, 7, 8].
Exfoliation is the removal of dead skin cells by using a brush/scrub or applying an acid that dissolves them. Exfoliation is believed to help with acne by removing the skin cells that clog pores and allowing anti-acne treatments to penetrate deeper.
In a small clinical trial, a relaxation therapy combining biofeedback and cognitive imagery helped improve acne .
Evidence shows that insulin increases fat production in the skin. This suggests that foods that quickly increase blood insulin levels (high-glycemic index foods) such as bread, cakes, candies, sugary soft drinks, and pastries may increase the risk and severity of acne, while low-glycemic index foods such as fruits, vegetables, legumes, nuts and whole grains may be protective .
Acne is absent in populations not consuming milk or dairy products .
Cell-based studies found that epigallocatechin gallate can block fat secretion in the skin and inhibit a microbe that causes acne (Cutibacterium acnes) .
Fatty fish such as mackerel, salmon, sardines, and herrings are especially rich in omega-3 fatty acids .
Good dietary sources of zinc include red meat, seafood, dairy products, nuts, legumes, and whole grains .
Alpha hydroxy acids (AHAs) are a class of chemical substances that can be naturally found in certain foods or synthetically produced. They are common ingredients in cosmetic products .
AHAs such as glycolic acid and gluconolactone, as well as creams containing specific mixes of AHAs, reduced the severity of mild-to-moderate acne and improved the appearance of acne scars when applied on the skin in several trials [34, 35, 36, 37, 38, 39, 40, 41].
Topical AHA products are likely safe when used appropriately. However, high concentrations (greater than 10%) may cause skin burns .
Niacinamide is one of the two forms of vitamin B3 (niacin). Niacinamide is needed to make NAD+/NADH and NADP+/NADPH, which slow aging and support cell repair, immune function, and energy use in the body [55, 56].
Niacinamide lowered excessive skin oil production, a common cause of acne, in two clinical trials. Other studies showed it also increases beneficial skin lipids called ceramides, thus strengthening the skin barrier and helping moisturize the skin [57, 58, 59, 60, 61].
In clinical studies of people with mild-to-moderate acne, niacinamide gel improved acne and decreased acne lesions. Niacinamide worked better in people with oily skin and was as effective as the antibiotic clindamycin in some studies [62, 63, 64, 65].
Oral niacinamide combined with zinc, copper, azelaic acid, pyridoxine, and folic acid reduced acne severity and improved overall skin appearance as effectively as antibiotic therapy in two clinical trials [69, 70].
Tea tree oil has antimicrobial properties against different microbes, including the acne-causing bacteria Cutibacterium acnes and Staphylococcus epidermidis. Moreover, it even killed 3 bacterial strains that may cause antibiotic-resistant acne (belonging to Staphylococcus aureus, Staphylococcus epidermidis, and Cutibacterium acnes) [75, 76, 77, 78].
Topical tea tree oil reduced the severity of mild-to-moderate acne in 3 clinical trials. One of the formulations was as effective as benzoyl peroxide lotion, although it appeared to work slower. Similarly, multi-herbal gels with tea tree oil were at least as effective as conventional treatments in 2 studies [79, 80, 81, 82, 83].
Tea tree oil is very potent and can cause redness and irritation when applied directly to the skin, but is safe when diluted with a carrier oil. Conversely, ingested tea tree oil is unsafe .
A topical gel with aloe vera combined with tretinoin cream was more effective for acne than either treatment alone in a clinical trial .
Neem reduced inflammation and oxidative stress in response to Cutibacterium acnes in a cell-based study .
Alternatively, L-carnitine supplementation improved muscle pain and fatigue from the isotretinoin treatment for cystic acne in a study .
In test tubes, hemp seed extract killed the acne-causing microbe Cutibacterium acnes .
In a pilot study, a resveratrol-containing gel reduced face acne severity by almost 70% and improved overall skin health by over 50% over 2 months. The team discovered that cosmetic products with resveratrol are stable and don’t degrade when kept in the fridge .
The extract of European barberry fruit improved moderate-to-severe acne without major adverse effects in a small trial on teenagers .
In a preliminary clinical trial, applying a facial mask with phellodendron over 8 weeks reduced the severity of acne lesions .