In 2016, the FDA approved an over-the-counter retinoid drug for acne -- the first new active ingredient available without a prescription since the 1980s.

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Acne vulgaris is characterized by skin lesions on the face, upper chest, and/or back involving blockage and/or inflammation of hair follicles and their accompanying sebaceous glands. Acne has typically been regarded as a teenage condition, but it is now occurring in younger children and is becoming more prevalent in adults, especially adult women._[1-3]

Causes of Acne

Only very recently have researchers discovered that inflammation is the primary underlying cause of acne. There are a number of genetic, hormonal, lifestyle, and environmental triggers that initiate the inflammatory process and keep the acne disease process active. Common acne triggers and aggravating factors include the following:

• Dairy_[4]
• High glycemic load diets_[4,5]
• Nutrient deficiencies_[6,7]
• Stress, elevation of stress hormones_[8]
• Leaky gut syndrome and gut dysbiosis_[9]
• Hormones, especially sex steroid hormones (androgens) and certain endocrine disorders associated with excess androgens, like PCOS
• Certain cosmetics, hair products, and hygiene products, especially those with harsh chemicals
• Certain medications: steroids, lithium, anti-epileptics, iodides
• Smoking, excessive alcohol intake, and recreational drugs

Conventional Treatment

Oral and topical antibiotics and drugs called retinoids, along with oral contraceptives, are the main conventional treatments for acne vulgaris. All are associated with side effects and potential long-term adverse effects. The long-term use of antibiotics can lead to gut dysbiosis and leaky gut syndrome, the very digestive disturbance thought to trigger acne in the first place.10
Treatment with isotretenoin (a synthetic derivative of vitamin A) is reserved for patients with the most severe acne because of its extreme toxicity, including severe birth defects, and its association with inflammatory bowel disease, depression, and suicidality._[11]

The top Natural Acne Treatments

Numerous natural topical treatments, oral supplements, and dietary therapies have been found to effectively treat acne. Those with the greatest evidence for effectiveness are oral zinc supplementation, topical treatment with nicotinamide or tea tree oil, and a low glycemic load/dairy-free diet.

Zinc supplement

Zinc supplements reduce the severity of acne and can be as effective as antibiotics after 12 weeks.12-14 Zinc has antibacterial and anti-inflammatory effects and it may decrease sebum production.15 Early studies used primarily zinc sulfate and zinc gluconate, but more recent research indicates that zinc monomethionine (Opti-Zinc™) may be more effective and less likely to cause stomach upset.16

Take 30 mg of zinc two or three times a day for a few months, then reduce the dose to 30 mg per day thereafter. Long-term zinc supplementation requires 1 to 2 mg of copper per day to prevent copper deficiency.

Topical Treatment

Tea tree oil exerts anti-inflammatory and antioxidant activity and has broad-spectrum antimicrobial activity against bacterial, viral, and fungal infections affecting the skin.17 The topical use of gel or lotion containing 5% tea tree oil is as effective as benzoyl peroxide for common acne, with far fewer side effects._[18,19]

Apply a product containing 5% tea tree oil, such as Tea Tree Medicated Gel for Acne, by Thursday Plantation, twice a day. Leave on for up to 20 minutes and then rinse off with water. Never apply pure (100%) essential oils of any kind directly to your skin.

Another option for natural topical treatment is nicotinamide, also known as niacinamide, a natural form of vitamin B3. Nicotinamide boosts cellular energy and regulates an enzyme with important roles in the regulation of inflammatory compounds and DNA repair.20 Topical application of a product containing 4% nicotinamide twice daily leads to significant improvements in acne, and is more effective and better tolerated than the topical antibiotic clindamycin._[21-23]

Dairy-free, Low Glycemic Load Diets

The more dairy you eat and the higher the glycemic load of your diet, studies show, the more likely you are to have acne and the more severe it is likely to be.24-26 Dairy products and high glycemic foods (such as sugar, white flour, white potatoes, and white rice) are believed to cause acne by increasing insulin and insulin-like-growth-factor-1 (IGF-1)._[27]

Reduce your intake of sugars, fruit juice, white potatoes, grains (especially processed, refined grains like white flour), milk and milk products, while increasing your consumption of vegetables and, if you eat meat, fish. Some researchers recommend the Paleo diet as an acne treatment._[28,29]

The most effective acne treatment involves a comprehensive and holistic approach that addresses the underlying inflammatory triggers, including diet and nutrition, sleep, stress, and other lifestyle factors. But incorporating one of more of the recommendations above will significantly improve acne vulgaris for most people.

Originally published  in 2014, this post has been updated.

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