Acne Solutions

Dermatologists have a nasty name for pimples. The term they use is acne vulgaris. Sounds vulgar, doesn’t it? But vulgaris actually means common in Latin, so the medical term means common facial eruptions.

There are lots of myths about the causes of acne. One of the most prevalent is that only teenagers suffer acne. A related view is that acne is an unavoidable consequence of the hormone surges of adolescence. The fact that 79 to 95 percent of adolescents in places like North America, Europe, Australia and New Zealand are afflicted with acne helps keep that myth alive (Archives of Dermatology, Dec. 2002). 

In actuality, though, many adults are plagued with acne well beyond their teen years. Around half of men and women over 25 have some facial acne, although it is more common in women. Stress, anxiety and sleep loss can all contribute to adult acne, which in turn can be extremely distressing (Journal der Deutshcen Dermatologischen Gesellschaft, Oct. 2018). This vicious cycle may lead to hormonal imbalance that also contributes to the severity of adult acne (Indian Dermatology Online Journal, July 13, 2020).

What Causes Acne?

Common skin bacteria (mostly Propionibacterium acnes, now termed Cutibacterium acnes), the production of oils (sebum) by the skin, and even the impact of hormones all seem to play a role in determining who gets acne and how severe it will be. When an oil-producing hair follicle gets plugged up with dead skin cells, normal skin bacteria go to work feasting on the fatty acids trapped inside it. If the skin microbiome gets out of balance, C. acnes, which usually helps to maintain skin health, can turn nasty and trigger inflammation (Microorganisms, Nov. 7, 2020). That’s what makes the pimple so sore and red.

Medicines That Aggravate Acne

Did you know that common medications can contribute to acne? Prednisone and other corticosteroids can trigger blemishes. So can testosterone (or its precursor, DHEA). Women who take this hormone to boost their libido may complain of adult-onset acne. Lithium for bipolar disorder can also affect complexion. 

Other Drugs That May Contribute to Acne

Generic Drug	Brand Name Drug
Mesalamine	Asacol
Progesterone gel	Crinone gel
Pimecrolimus	Elidel
Fluticasone	Flovent
Cyclosporine	Gengraf, Neoral
Interferon alfa-2b	Intron A
Leuprolide inject.	Lupron
Tacrolimus	Protopic
Sirolimus	Rapamune
Risperidone inject.	Risperdal inject.
Temsirolimus	Torisel
Valganciclovir	Valcyte
Drospirenone	Yaz
Olanzapine	Zyprexa

It now seems likely that a diet high in processed foods that push blood sugar and insulin up quickly may also lead to a cascade of other hormonal changes that can affect the skin.

A review of studies concluded, on the other hand, that milk and other dairy products are strongly associated with the prevalence of acne (International Journal of Dermatology, March 19, 2009). A Norwegian study confirmed an association between high milk intake and acne in high school students (Journal of the European Academy of Dermatology and Venereology, March 2017). Also, a meta-analysis concluded that “any dairy, such as milk, yogurt, and cheese, was associated with an increased OR [Odds Ratio] for acne in individuals aged 7-30 years” (Nutrients, Aug. 9, 2018).

Several years ago a mother shared this story about her son, reinforcing the latest research:

"My son recently returned from a 5-day camping trip where he didn't have milk or any of his acne medicine. To my surprise, his face looked beautiful.  Maybe there’s a connection between clear skin and no milk.  The dermatologist suggested eliminating milk to see what happens."

We don’t know exactly how dairy products increase the risk of acne, but some researchers have suggested that the high levels of the amino acid leucine found in milk may drive the production of excess fatty acids in hair follicles (Dermatoendocrinology, Jan. 1, 2012). They proposed that controlling acne could best be achieved by lowering levels of the enzyme mTORC1: “An attenuation of mTORC1 signaling is only possible by increasing the consumption of vegetables and fruit, the major components of vegan or Paleolithic diets.”

Other scientists looking at the causes of acne vulgaris agree that the mTORC1 (mammalian target of rapamycin complex 1) is among the most important factors (Archives of Dermatological Research, July 2019). A diet low in processed foods and dairy products and high in vegetables can dampen this enzyme’s activity and should prove helpful for clear skin.

People have tried a lot of home remedies to try to abolish their zits. We have heard about a surprising number of potions people put on their faces as home remedies for blemishes. There’s really no good evidence any of them work, but they might be worth a try. We heard from a man who had tried washing his face with milk every day as a teenager and found it helpful. He wasn’t able to convince his daughter to try the same approach, though. We haven’t seen any evidence that a milk face wash is effective, but it shouldn't hurt. In India, milk is mixed with ground nutmeg and applied to blemishes as a treatment.

Clay

Another approach is the clay mask. Versions of this are sold in drugstores and at cosmetics counters. We don’t know quite why it would work, but it has been popular for a long time. Clay is not the only traditional “poultice” that has been applied to blemishes. We’ve heard of one home remedy that calls for a teaspoon of powdered nutmeg to be mixed with a teaspoon of honey and put on the zit for 20 minutes.Then it is washed off, just as the nutmeg-milk mixture or the milk would be. Still another variant is a paste of ground cinnamon and honey, applied to the blemishes and left on overnight.

Milk of Magnesia

Putting milk of magnesia on the blemishes is another improbable but popular method for treating acne. One reader wrote that she volunteers in the theater program of the local high school. She'd suggested to some of the students that they apply milk of magnesia to their faces:

"One parent even told me it was a life-saver for his son. They had spent a small fortune on treatments with a dermatologist. When the father told the dermatologist that MoM worked better than prescribed medications, the physician was not happy."

Milk of magnesia does not appear prominently in the dermatology literature. We were able to find one letter published in a medical journal decades ago: it was a patient reporting success with topically applied MoM (Archives of Dermatology, Jan. 1975). We regret that it has never been properly studied.

Listerine

Numerous readers tell us that the old-fashioned mouthwash, amber Listerine, can be very helpful against acne. We suspect that the essential oils it contains affect the balance of microbes living on the skin. Thymol, for example, has antibacterial effects (Molecules, Aug. 28, 2018). It discourages the overgrowth of Propionibacterium acnes (now called Cutibacterium acnes) and Staphylococcus epidermidis, two types of bacteria that are more abundant on blemished skin. Thymol isn't the only essential oil in Listerine that might be beneficial. Eucalyptol interferes with the inflammatory reaction these skin bacteria cause (International Journal of Molecular Sciences, July 17, 2019). To use Listerine, people dab it on affected areas with a cotton ball once or twice daily.

Tea Tree Oil

One natural product that has been studied is tea tree oil in a 5 percent gel. An Australian study compared such an extract of the Australian tree Melaleuca alternifolia to a standard over-the-counter acne treatment, benzoyl peroxide (Medical Journal of Australia, Oct. 15, 1990). The study included 124 patients to see if the antimicrobial activity of the tea tree product would be useful. The scientists found that although the initial response was slower, the benefits were comparable for non-inflamed lesions after three months of treatment.

Benzoyl peroxide was significantly better at reducing inflamed lesions, but it also produced significantly more undesirable effects such as skin dryness, stinging, itching, burning and redness. If you can’t find a water-based gel, look for a cleanser with tea tree oil. That should be readily available. Some people are allergic to tea tree oil, so it makes sense to try a bit on the inside of your forearm first, to make sure you can handle it.