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.
Lifestyle
Light Therapy
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 [5].
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
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.
A number of studies support the use of exfoliation with chemicals such as salicylic acid, lactic acid, Jessner’s solution, and phenol as an adjuvant therapy for acne [9].
Another method of exfoliation (microdermabrasion) improved acne and scarring in two small trials [10, 11].
Reducing Stress
Studies in adolescents and young adults have associated stress with increased acne severity, especially in males [12, 13].
In a small clinical trial, a relaxation therapy combining biofeedback and cognitive imagery helped improve acne [14].
The hormones released during stress are believed to increase both fat production and inflammation in the skin. Stress may also slow the repair of acne wounds [15, 16, 17].
We recommend addressing sources of stress in your life, either by taking up a stress-busting hobby (such as yoga or meditation) or seeking professional help.
Diet
Avoiding High-Glycemic Index Foods
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 [18].
In line with this, populations not eating refined carbohydrates don’t suffer from acne. Moreover, a low-glycemic index diet followed for 12 weeks improved acne in two clinical trials [19, 20, 21].
Limiting Dairy Intake
Acne is absent in populations not consuming milk or dairy products [19].
Two studies on adolescents have associated high intake of milk and dairy products with acne, possibly due to the hormones and bioactive molecules found in milk [22, 23].
Green Tea
In 2 clinical trials, taking decaffeinated green tea extract daily for 4 weeks reduced acne lesions on the nose, chin, and around the mouth [24, 25].
Cell-based studies found that epigallocatechin gallate can block fat secretion in the skin and inhibit a microbe that causes acne (Cutibacterium acnes) [25].
Fatty Fish (Omega-3 Fatty Acids)
Several studies have associated low dietary intake of fish and seafood, both rich in omega-3 fatty acids, with increased incidence and severity of acne [26, 27, 28].
Fatty fish such as mackerel, salmon, sardines, and herrings are especially rich in omega-3 fatty acids [29].
Zinc
Research shows that people with low zinc levels are more likely to have severe forms of acne [30, 31].
Good dietary sources of zinc include red meat, seafood, dairy products, nuts, legumes, and whole grains [32].
Supplements
Alpha Hydroxy Acids (AHAs)
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 [33].
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 [33].
Zinc
A number of small clinical trials suggest that taking zinc supplements (either zinc sulfate or zinc gluconate) can improve acne [42, 43, 44, 45, 46, 47, 48].
A topical combination of zinc with the antibiotic erythromycin also improved acne and reduced fat production in the skin in several trials [49, 50, 51, 52].
The use of zinc supplements is likely safe as long as doses do not exceed the upper limit of 40 mg per day (for adults). Taking too much can cause stomach pain and gut irritation [53, 54].
Niacinamide
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].
However, adding niacinamide to clindamycin had no effect or was only slightly better than clindamycin alone in 3 additional studies [66, 67, 68].
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].
Fish Oil/Omega-3 Fatty Acids
The omega-3 fatty acids in fish oil (DHA and EPA) have anti-inflammatory effects, possibly helping with acne-associated inflammation [71].
Fish oil supplementation improved overall acne severity in two clinical trials and a few case studies, especially for those with moderate-to-severe acne [72, 73, 74].
Tea Tree Oil
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 [84].
Green Tea
Green tea contains anti-inflammatory and antibacterial compounds such as flavonoids and tannins [85, 86].
Topical solutions with 2-3% green tea reduced fat production in healthy volunteers and the number of acne lesions in people with this condition [87, 88, 89, 90].
A topical solution with the green tea compound epigallocatechin gallate (EGCG) reduced acne severity in another study [91].
Cell-based studies found that epigallocatechin gallate can block fat secretion in the skin and inhibit a microbe that causes acne (Cutibacterium acnes) [25].
Aloe Vera
Aloe vera helps fight bacteria, reduce inflammation, and promote wound healing when applied on the skin, making it a popular treatment for a variety of skin conditions [92, 93, 94].
Aloe components such as lupeol, salicylic acid, urea nitrogen, cinnamic acid, phenols, and sulfur can all fight acne-causing bacteria [94, 95].
A topical gel with aloe vera combined with tretinoin cream was more effective for acne than either treatment alone in a clinical trial [96].
In another study, a topical lotion with aloe vera and clove-basil oil improved acne. The higher the concentration of aloe vera in the preparation, the more effective it was [97].
Neem Oil
Oral and topical formulations containing neem oil and other herbs have shown effectiveness against acne in several low-quality studies [98, 99, 100, 101].
Neem reduced inflammation and oxidative stress in response to Cutibacterium acnes in a cell-based study [102].
Probiotics
In a small clinical trial, a probiotic containing Lactobacillus acidophilus, Lactobacillus delbrueckii, and Bifidobacterium bifidum reduced the number of acne lesions [103].
In another trial, a Saccharomyces boulardii strain called CBS 5926 taken for 5 months improved the appearance of acne [104].
Milk Thistle
In a clinical trial, the milk thistle compound silymarin reduced acne severity when taken by mouth daily for 2 months. However, it was less effective than the antibiotic doxycycline [105].
In another trial, a combination of silymarin, N-acetylcysteine, and selenium reduced acne after 8 weeks by 53% [106].
L-Carnitine
Applying a formulation with L-carnitine and other compounds to the face twice daily for 8 weeks reduced the number of acne lesions and improved quality of life in 2 clinical trials [107, 107].
Alternatively, L-carnitine supplementation improved muscle pain and fatigue from the isotretinoin treatment for cystic acne in a study [108].
Brewer’s Yeast
In a clinical trial, a brewer’s yeast preparation healed or improved pimples in more than 80% of people [104].
Brewer’s yeast may help with acne through its antibacterial effects [109, 110].
Hemp Seed Oil
A cream with 3% hemp seed oil reduced skin fat production and redness, suggesting it may help treat acne [111].
In test tubes, hemp seed extract killed the acne-causing microbe Cutibacterium acnes [112].
N-Acetylcysteine (NAC)
In one study, a 5% NAC gel helped reduce mild to moderate acne [113].
Guggul
A small clinical trial found that oral guggul supplements may be as effective as the antibiotic tetracycline for the treatment of nodulocystic acne, a severe form of acne [114].
Resveratrol
Resveratrol is a plant compound with antioxidant and anti-inflammatory properties. It can be found in grapes, red wine, and some types of berries [115].
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 [116].
European Barberry
The extract of European barberry fruit improved moderate-to-severe acne without major adverse effects in a small trial on teenagers [117].
Phellodendron
In a preliminary clinical trial, applying a facial mask with phellodendron over 8 weeks reduced the severity of acne lesions [118].
