Using natural therapies to manage acne

There continues to be a lot of interest in alternative and complementary therapies especially in people with mild acne.  We’ve reviewed some of the more popular therapies that have been shown to be useful in acne here.  

It’s still important to talk with your doctor if you are thinking about commencing some of these therapies. ‘Natural’ therapies do not mean they are harmless.  Evidence is limited and more research is needed to determine efficacy and long-term safety.

Unlike pharmaceutical products and prescribed medications, manufacturers of complementary medicines are not subject to the same mandatory testing prior to selling their products. 

Certain products may contain other ‘natural ingredients’ with or without labelling this on the product.  Allergy or irritation may be caused by one of these alternative ingredients. A well-respected manufacturer understands the importance of producing high quality products so choose these products in preference to unknown manufacturers.

Like other medications, using more of a complementary or natural product is not necessarily better and may cause excessive irritation. Use the product as directed. If there are no clear instructions – use a small amount to provide a thin smear over your face.

Tea tree oil

Since the early 1990s it has been proven that tea tree oil can be useful in the treatment of acne, particularly mild acne. Recent studies have confirmed that 5% tea tree oil (as a gel) used daily can have effects comparable to the daily use of 5% benzoyl peroxide and may have less side effects. However, the evidence does show that the effect of tea tree oil is often slower and can take months rather than weeks to show a comparable result to benzoyl peroxide.

Generally, tea tree oil is well tolerated. 

Most commonly reported side effects are dryness and irritation. It is possible to have severe allergic reactions from tea-tree oil, which occurs in around 1 in 40 individuals. Testing the product on a very small area of skin away from the face daily, for 2-3 consecutive days can be useful in determining if you will respond badly to your particular product. 

Azelaic acid

Azelaic acid is a ‘natural’ acid found in wholegrain cereals and other animal products. It has been shown to have an anti-inflammatory action.  Azelaic acid was first discovered in disorders of pigmentation and this may be what helps people with acne by reducing post-inflammatory pigmentation. 

Studies have shown that a formulation of 20% azelaic acid is comparable to topical retinoid and antibiotic preparations in the treatment of acne when used twice a day over four weeks for mild to moderate acne. More recent studies have shown good effect at slightly less concentration too.

Your doctor may choose to combine this therapy with other conventional therapies to treat acne.

The most common side effects are burning sensations and itchiness at the commencement of therapy.  Irritation can also occur but azelaic acid is generally well tolerated.

Alpha hydroxy acid (also known as fruit acid)

Alpha hydroxy acid (or fruit acid) can help remove the top layer of dead skin cells. Fruit acids are contained in a number of facial treatments and over the counter preparations. Although these are used in many products sold and marketed for acne, there are no good quality studies to show they work better than daily facial cleansing.  

There are some studies that have indicated alpha hydroxy acid may be beneficial in reducing post-inflammatory changes.

Increased photo-sensitivity and the chance of sunburn, irritation and redness are the most commonly reported side effects. If you have allergies to certain foods you may still develop a severe allergic reaction applying the acid of that food to your face. Most commonly reported side effects are dryness and irritation. 

Zinc

Zinc is an important trace  mineral that people need to stay healthy. Zinc can be useful for some people with mild to moderate ‘inflammatory’ facial acne lesions, as long as they are not severe. 

The recommended daily intake of zinc is 11mg daily for males and 9mg daily for females, over the age of 14. In some people, zinc may cause gastrointestinal upset including nausea, vomiting and diarrhoea. There may be long term side effects using high dose zinc including damage to kidneys.  

Do not exceed the recommended daily dose of zinc.  Remember zinc is also in certain foods e.g. some types of seafood, pork, cashews, etc.

Green tea extract

Green tea extract has been shown to have some antimicrobial and anti-inflammatory properties. 

In a  high quality study with 80 post adolescent female participants, a dose of 1500mg green tea extract was administered for four weeks against placebo. There was no significant reduction in total lesion count but some evidence to show less inflammatory lesions. 

Green tea extract can also be applied topically in a 2% solution which has shown some improvement in mild acne.

Side effects of oral green tea extract can include constipation and gastrointestinal upset. However, green tea extract is generally, reasonably well-tolerated. Topical green tea extract can cause irritation, redness, sensitivity or allergy.

Vitamin A

High dose vitamin A does help acne but it ’s actually toxic at the doses needed to improve acne! A number of prescription creams contain vitamin A derivatives. 

If you are planning to become pregnant you should avoid taking high dose vitamin A. 

Colloidal oatmeal

If you develop irritation from harsh cleansing, colloidal oatmeal can have a calming and anti-irritant effect. It can also protect or minimise irritation. 

There are a number of gentle washes available containing oatmeal.