I get tired of hearing so-called experts say things like, “A poor diet and stress are the primary reasons for most acne problems, and only antibiotics can really treat acne.” To this I say, “Whatever!” While diet and stress do have some impact on acne, for many individuals these are only a small part of the cause.
And most people should not take antibiotics to prevent or treat acne because the harm outweighs the benefit. One of my favorite recommendations is to make your own topical treatment to fight acne.
Simply crush four to six noncoated, plain, full-size aspirin, mix them in a cup with several tablespoons of water to form a paste (if too pasty, add more water; if not pasty enough, add another aspirin), and then apply it to the pimples with an applicator (like a cotton swab). Leave the mixture on for 10 to 15 minutes, and do this two or three times a week (make a new batch each time). Otherwise, many over-the-counter products work well.
What is Acne?
The most common skin condition in the United States, acne is caused by hair follicles that become plugged with oil, dead skin cells, and, ultimately, bacteria (such as Propionibacterium acnes). It can range from a small, noninflammatory black-head (called an open comedone, in doctor circles) to angry, red pimples (known as inflammatory acne), and it can appear on the face, neck, chest, back, and shoulders.
Stress and diet can be contributing causes, but so can hormonal fluctuations, genetics, and hygiene. Here’s a surprise: Although we usually associate acne with teenagers, one-third or more of acne sufferers are in their thirties, forties, and fifties.
Acne Home Remedies
1. Zinc 15 milligrams of elemental zinc gluconate twice a day
Zinc’s infection-fighting abilities and its antibacterial and healing properties make it a natural for treating inflammatory acne. (I’ve noticed that when some individuals use topical sunscreen with zinc oxide, their skin improves!) In some men and women, zinc also blocks the conversion of testosterone into a more potent form of testosterone, which can encourage acne growth.
Be careful not to exceed 15 milligrams of elemental zinc per dose (that’s why I have recommended taking it in two doses) or you may experience nausea and even vomiting, and always take it with food. In general, most of the good clinical studies that have been done have not exceeded 3 months. You can take it longer, but there is no evidence of how effective and safe it is beyond that point.
There are other forms of zinc available, including zinc acetate, zinc sulfate, and zinc oxide, but they have not been well studied for acne except at ridiculously high doses that have more potential for short- and long-term side effects, including the loss of taste and smell!
Keep in mind that the Recommended Dietary Allowance for zinc is 8 to 12 milligrams per day from the age of 9 and up. Taking high doses like what I’m recommending here can cause a copper deficiency (and possibly anemia), so make sure your multivitamin or zinc supplement also has 1 to 2 milligrams of copper in it if you’re taking 30 milligrams of elemental zinc daily.
Keep in mind, it’s almost impossible to get 30 milligrams of zinc per day from food unless you like to eat a lot of oysters (I love oysters, but every day? No way!), so you are better off sticking with a supplement.
2. Niacinamide (vitamin B3 or nicotinamide) combination see dosage information to follow
Vitamin B3 can take two forms, niacinamide or niacin (which is also known as
nicotinic acid). Only niacinamide has anti-inflammatory properties that may help several dermatologic conditions, including acne and rosacea (see the Rosacea section). Niacin, which some people take to reduce cholesterol, can cause temporary facial flushing and can make your skin worse, so make sure you don’t get them confused when you’re perusing store shelves.
In the Nicomide Improvement in Clinical Outcomes Study (also known as NICOS), a dietary supplement containing niacinamide (750 milligrams), zinc (25 milligrams), copper (1.5 milligrams), and folic acid (500 micrograms) reduced the number and severity of acne pimples (and also rosacea) after 4 and 8 weeks of daily use. This is the dosage I recommend. (Some people may experience nausea and stomachache, so take this supplement combo during or right after a meal.)
Additionally, I’ve had patients see reduced redness and faster skin healing with a 2 percent niacinamide facial moisturizer (use it alone or with oral niacinamide). Although clinical trials with both (alone or in combination) are still ongoing, I wonder why oral and topical niacinamide aren’t tested more often for inflammatory skin conditions? Probably because there’s no profit in it for drug companies!
The exact product used in the NICOS trial, called Nicomide, is available, but you have to ask your doctor about it, or you can make your own version, which is pretty inexpensive to do. There is also a new prescription dietary supplement known as NicAzel that contains nicotinamide, azelaic acid, zinc, B6, copper, and folic acid. It reduces acne and scarring and accelerates healing, which shouldn’t come as a surprise based on the NICOS results. Ask your doctor about it.
3. (tie) Tea tree oil 5 percent topical gel applied twice a day
This antibacterial oil (from the native Australian tree Melaleuca alternifolia) also accelerates skin healing. In one large study, a 5 percent tea tree oil gel significantly reduced both inflammatory and noninf lammatory acne lesions after 45 days. It doesn’t work as fast as benzoyl peroxide, but I’m always a fan of other options for acne because benzoyl peroxide isn’t very effective for a small group of people. Many companies do not report the concentration of tea tree oil they use in their products, but if it’s the active or main ingredient, then it should be effective. When applying the gel, leave it on for 20 minutes, then wash it off.
3. (tie) Vitamin A 5,000 to 10,000 IU a day
Oral vitamin A (retinol) has been shown to fight acne, but the doses used in past studies were way too high (300,000 IU daily for women and 400,000 for men). These are potentially toxic levels that can cause dry skin, inflammation of the lips, and liver damage.
I suggest you start with a more realistic 5,000 to 10,000 IU dose to see if it’s effective. Over-the-counter topical retinol and retinoid prescriptions may also be beneficial. Vitamin A and its derivatives have always been a tale of two cities when it comes to skin health.
It’s known to improve the appearance and smoothness of the skin (which is why it’s also used as an antiwrinkle agent topically), but in some people it can cause dryness and irritation. Bottom line: Never take even slightly more than what’s recommended in this article without talking to your physician.
4. A combination of omega-3s and omega-6s
A combination of omega-3s and omega-6s may help with mild to moderate acne, according to a recent Korean randomized trial. The benefit in combining them is that they fight inflammation in different ways. Many sources of omega- 3s (like flaxseed) also contain some omega-6s and vice versa, however, larger doses are often needed to really see a benefit.
If you want to combine them for acne, try taking 2,000 milligrams of fish oil plus up to 400 milligrams of gamma-linolenic acid.
What May Worsen Acne?
Look, I love protein powder more than chocolate (that is a lot of love), especially flavored whey protein isolate, but there is some recent evidence that states using higher quantities (25 to 50-plus grams per day) could raise insulin and growth factors, such as IGF-1 (insulin-like growth factor 1), in the body.
Both of these can exacerbate acne. If you or your teenager is using huge quantities of whey protein or other protein powders and cannot get acne to go away, try backing off or switching to a protein powder that has no sugar and taking it with water instead of juice or milk. You should get no more than half your weight in grams of protein per day (for example, a 150-pound person should get a maximum of 75 grams per day).
Many experts tout chromium for improving skin (it helps with two factors that can exacerbate pimples, blood sugar and weight loss), but it hasn’t been studied for treating acne. I’m all for this mineral when it comes to some other problems (like diabetes), though! High doses (more than 1,000 micrograms) can increase the risk of rash (urticaria), which can look like acne.
This mineral is found in many supplements. But in large amounts (more than 200 micrograms daily), selenium may increase insulin resistance, which increases the risk of type 2 diabetes. Insulin resistance means you have more sugar in your blood, and bacteria (including those found in acne) thrive on sugar. I tell patients to stay away from selenium in high doses because it can only make your skin worse.
What Lifestyle Changes Can Help With Acne?
Cut back on carbs
Recent research suggests that eating a low-carbohydrate, highfiber diet rich in omega-3s might reduce the risk of acne, and I suspect this is because it helps normalize blood sugar and insulin and can lead to weight loss. High blood sugar and insulin levels create a bacteria-friendly environment in the body.
This is why doctors should not only treat acne but also determine if there are any underlying health problems, especially in moderate to severe cases. Recent research shows that acne may be a signal of something else wrong in the body, such as polycystic ovary syndrome.
What Else To Know About Acne Treatment?
Benzoyl peroxide lotions, like Proactiv (which I love and recommend all the time), are very effective and safe.
If you find the right strength, they can work as well as prescription topical and systemic (oral) antibiotics. I’m not a fan of antibiotics in general unless they’re absolutely necessary because they can lead to antibiotic resistance and side effects ranging from diarrhea to intestinal infection.
I am not a dermatologist and I do not play one on TV; ask your doctor about using multiple treatments (such as benzoyl peroxide and zinc gluconate pills) before doing so.