Acne foods, diet, vitamins, herbs, supplements, natural therapy or cure
Natural and alternative treatment
and home remedies
April 15 2018 by
Ray Sahelian, M.D.

Does diet or food influence acne? What you eat can make a difference
Diet has an influence to a greater degree than is normally accepted by the medical establishment.
Most dermatologist are still in the dark ages regarding the relationship between food, diet and acne. There is little doubt in my mind that eating a lot of sugar and junk foods increases the risk for inflammation and promotes pimple formation.

Can one do without an acne medicine or drug treatment by eating foods that do not cause this skin condition?
    Perhaps, or the required dosage of the medication may be reduced with appropriate dietary changes.

Acne diet, role of food - There is no doubt that diet has an influence
Is there an acne diet or food that can reduce this problem? I suffered with facial acne as a teenager and even had pimples as an adult. I tried many treatments, took medicines, mostly in the form of antibiotics, and tried various products, including a home remedy by my grandmother. However they didn't help much and some of the treatments and medications made me feel sick. After years of trial and error with different foods and diets, and a review of published trials, I believe I have gained some insight regarding dietary influences. I strongly believe food influences skin health although there is no doubt genetics has a major role. Some people can eat anything they want and they still don't get pimples. If you suffer from this dermatological condition I hope the knowledge I have gained is helpful to you and prevents or reduces the possibility of cystic eruptions or acne scars. I prefer to first approach treatment from the food and diet perspective as opposed to prescription and non prescription drugs.

Acne vulgaris is a skin disorder of the pilosebaceous unit that generally develops in adolescence and improves in adulthood. Adolescent males, in particular, can be severely affected, which, if left untreated, can cause scarring. This skin condition can sometimes last well into one's thirties and forties and sometimes beyond. In addition to facial acne, many people can have eruptions on the rest of the body and back.
   Good News: The skin of acne sufferers appears to age more slowly than in those who have not experienced any acne in their lifetime.

Causes, how to reduce the skin eruptions
Genetics has a strong role to play and sometimes one or both parents may have the skin problem.

Hormones have a strong influence and some women notice a monthly eruption associated with their menstrual cycle. Acne often begins in teen years when the body secretes more androgens such as testosterone.

Exposure to oil or grease in the work environment.

Exposure to oil or other substances in skin products. Getting a massage with certain oils and lotions rubbed on the skin can make it worse.

Pressure on the skin from tightly-fitting helmets or sports equipment.

Irritants found in the environment, such as high humidity or air pollution levels.

Picking at or squeezing blemishes on the skin or scrubbing the skin too vigorously.

Being under stress.

Teenage girls who are overweight or obese are significantly more likely to develop this skin problem than their normal-weight peers.

Natural remedy and treatment, how to avoid things that make it worse
Acne is difficult to treat or cure. I do not claim to have a definitive solution, or a magic medication or cure. Basically, this condition is an inflammatory process and the types of food we eat can certainly influence inflammation. Here are some suggestions to prevent, treat, or control acne:

Friction can make it worse
Avoid friction or contact with pimples. Leave them alone, do not play with or pop pimples. Avoid any kind of friction, or prolonged pressure, on your skin areas that are prone to getting clogged up and eruption. This includes massages and massage oil. Friction can occur from backpacks, neck collars on shirts, bicycle helmets and backpacks. Rubbing of the skin or friction with clothing can lead to pimples. At night, try to sleep on your back rather than on your side since the friction of your cheek or side of face against the pillow can clog pores and aggravate any existing pimples. Change and clean pillow cases and towels regularly.

hair products with oil, silicones and plasticizers can clog pores.
Reduce stress of any type if you can. Stress can make the condition worse by releasing certain hormones.
Facial hair
- if you are a male with moderate or severe facial acne, you may consider growing a beard. I did and it helped reduce the severity since shaving was making it worse.

Hormones can aggravate
Avoid androgenic hormones such as DHEA hormone, testosterone hormone, and androstenedione. Androgens and certain steroid hormones lead to severe worsening. Pregnenolone may also cause eruptions. Even as low a dosage as 5 mg of DHEA hormone use can aggravate acne within days.
I am a 35 year old woman, not overweight, with low normal blood pressure. Dr found my adrenals are not what they should be, my DHEA was low. She prescribed 10 mg DHEA and 30 mg Pregnenolone. I have already experience breaking out on my chin with pimples within 5 days so far. My skin is very acne prone so I really don't want to take this if it is going to cause problem skin.

Foods that cause acne:

Sugar and white flour, simple carbohydrates
A low simple carb diet can improve your skin health. Reduce your intake of white flour and sugar (including excessive amounts of fruit juices), sweets, processed flour, baked goods, and trans or hydrogenated fats. Examples include donuts, cookies, pastry, ice cream, pies, etc. Use stevia, the no calorie natural sweetener rather than sugar. Regularly eating breads, cakes, chips and other staples of Western culture is likely to promote acne. Sodas and sweetened beverages are a significant source of sugar. Switch to water, herbal teas, and vegetable juices. You can sweeten herbal teas with stevia.
   Foods that produce a high glycemic load -- such as sugared drinks, white bread and white potatoes -- cause a quick rise in blood sugar. More complex carbohydrates with fiber, such as unrefined cereals or beans, lead to a more gradual change and are considered to have a low glycemic index. Dr. Robyn N. Smith, from the RMIT University in Melbourne, Australia, evaluated acne symptoms in 43 male patients, between 15 and 25 years, who were randomly assigned to a low glycemic load diet or a normal diet. The intervention diet consisted of 25 percent energy from protein and 45 percent from low-glycemic-index carbohydrates. After 3 months, the low-glycemic diet was associated with a significant reduction in acne compared with the normal diet. American Journal of Clinical Nutrition, 2007.
   Comments: One reason for the success of this low glycemic acne diet is that it limited the rise in high insulin levels. Chronically high levels of insulin may lead to blockages in skin pores and extra oil building up under the skin. High sugar levels also contribute to an overall inflammatory process in the body, including the skin.

Nutritionists at RMIT University in Melbourne, Australia enlisted 50 boys with moderate to severe acne and randomly assigned half a typical adolescent boy's diet high in processed foods and refined grain products. The other half were put on a diet high in low-GI foods like wholegrain bread, pasta and legumes, along with lean meat and seafood. The acne of the boys on the higher protein-low GI diet improved dramatically, by more than half. This finding is contrary to the belief held by many dermatologists that there is no link between diet and this skin disorder.

In an issue of the Archives of Dermatology, the study authors report that they found no evidence of acne among 1,200 Kitavan Islanders aged 10 or older, including 300 of them between 15 and 25. They ate primarily fruit, fish, tubers and coconut but almost no cereals or refined sugars. The researchers also saw no acne among 115 Ache hunter-gatherers, including 15 aged 15 to 25. Their diet consisted mostly of the root vegetable sweet manioc, peanuts, maize and rice, as well as some wild game. About 8% of their diet was made up of Western foods such as pasta, sugar and bread. Previous studies also have found that acne is rare or nonexistent in people living in non-industrialized cultures but tends to appear when they transition to a Western way of life.

Are whole grains an acceptable alternative to the processed ones found in white bread.
   Whole grains are much preferable to white bread, and it would be best to eat a multi grain bread as opposed to one grain bread (for instance 100% whole wheat).

Nuts are ok if raw, but in small amounts
Reduce intake of nuts, including brazil nuts, walnuts, almonds, pistachios, and filberts. Peanuts and peanut butter may provoke acne in some individuals. If you eat nuts, limit your intake to small amounts and eat raw nuts rather than roasted.

Q. Hello Dr. Sahelian, I love your site, but I do have a question on your acne tips section. It is in regard to where you write about acne and food "Reduce intake of nuts, including brazil nuts, walnuts, almonds, and filberts." I always thought the inclusion of walnuts, almonds, and brazil nuts, may actually help a person with a skin problem issues especially if eaten raw, and they also have anti-aging effects.
   A. In my experience, eating a lot of nuts leads to acne breakout in many people, but not everyone. Raw nuts are healthier to eat than cooked or roasted nuts, but whether raw nuts cause less acne than roasted is not clear to me.

Dairy, milk, cream, yoghurt
Reduce intake of milk products, including ice cream and cheese. There is a high amount of hormones produced in the milk of cows. Milk from pregnant cows contains progesterone, 5-alpha reduced steroids, and other steroid hormones. These hormones, when consumed, can break down into dihydrotestestosterone (DHT), the final molecule that turns on oil-making cells. Studies show there is an association between milk consumption and acne, and it didn't matter whether the milk was whole, low fat, or skim. For those who eliminate or significantly reduce milk products from their diet, calcium supplements could be helpful. Consider soy milk as a partial alternative. Buy unsweetened soy milk and sweeten it with stevia. Milk also contains high levels of iodine which may be an additional reason to avoid excessive dairy consumption.
I do not know whether lactose free fat free milk would still have some hormones, but drinking small amounts should be fine.

The link between increased dairy consumption and teenage acne may be partly explained by the high iodine content in milk. Farmers give their cows iodine-fortified feed to prevent infection, and they use sanitizing iodine solutions on their cows' udders and milking equipment. Previous research has suggested that teens who consume lots of milk and other dairy products have an increased risk of acne, but the reason why is unknown. Investigators hypothesized that the association may be due to hormones and bioactive molecules in milk. That may be true, but iodine may also play a role. Studies have shown that milk produced in the United States, Britain, Denmark, Norway and Italy have high levels of iodine. American Academy of Dermatology, 2005.

Adebamowo from Harvard University analyzed survey responses from 47,335 women involved in the ongoing national Nurses Health Study II. The women were asked about their diet in high school, particularly the frequency with which they consumed dairy foods and whether they usually drank whole milk, powdered, low-fat or skim / nonfat milk. Although most of the women drank whole milk as teenagers, 20 percent drank low-fat milk, 7 percent drank skim milk and 2 percent drank powdered. Those who reported drinking more than three servings of any type of milk each day were 22 percent more likely to report having had severe acne than those who drank only one or fewer servings per week. While whole milk and low-fat milk were not found to be as greatly associated with teenage acne, other dairy products, such as instant breakfast drinks, sherbet, cream cheese and cottage cheese were associated. Women who ate one or more servings of such products per day as teenagers were much more likely to say they had severe acne during their teen years. Contrary to what some might think, chocolate candy and soda were not associated with teenage acne. Those who regularly consumed French fries and pizza also did not appear to be more likely to report having had teenage acne. Since skim milk was more greatly associated with a history of teenage acne than whole milk, the acne was probably not due to the milk's fat content. The association may instead be caused by the hormones in milk. Journal of the American Academy of Dermatology, 2005.

Vopr Pitan. 2014. Influence of nutritional patterns on the severity of acne in young adults. Regular meals with excess energy value significantly contributes to the progression of disease severity in young people with acne. Excess of the normal daily requirements for carbohydrates also significantly affect the severity of acne. Lack of vitamin A (retinol) and its provitamin (carotene) significantly affect the severity of acne, so does severe acne vitamin D deficiency; and lack of zinc in the diet.

You mentioned that consuming a lot of milk could trigger acne and the main reason you suggested was because of the hormones in the milk. What if organic milk was used instead of regular milk?
   A. Organic milk is certainly healthier and it may have fewer external hormones, but it may actually be the hormones that are normally in the pregnant cow that are found in milk, whether the cow eats organic or non-organic grass.

Foods that are good:

Fish and fish oils
Increase intake of foods that could improve acne such as fish (halibut, salmon, tuna, sardines). These contain important omega 3 oils such as EPA and DHA. They will make a difference in the health of your skin. Eating more fish is one of the most important dietary steps you can take to improve your skin. If you dine at Japanese restaurants, order Ikura which is the salmon egg sushi. Salmon roe, or fish eggs, I believe, improve the health of skin since they provide many long chained fatty acids which are anti-inflammatory.
Flax seeds are a healthy addition to one's diet. Acne is an inflammatory process and the idea is to eat foods that reduce inflammation. There is some evidence that fish oil supplementation helps to decrease acne severity, especially for individuals with moderate to severe cases.

Acta Derm Venereol. 2014. Effect of dietary supplementation with omega-3 fatty acid and gamma-linolenic acid on acne vulgaris. This study was undertaken to evaluate the clinical efficacy, safety, and histological changes induced by dietary omega-3 fatty acid and γ-linoleic acid in acne vulgaris. A 10-week, randomised, controlled parallel dietary intervention study was performed in 45 participants with mild to moderate acne, which were allocated to either an omega-3 fatty acid group (2,000 mg of eicosapentaenoic acid and docosahexaenoic acid), a γ-linoleic acid group (borage oil containing 400 mg γ-linoleic acid), or a control group. After 10 weeks of omega-3 fatty acid or γ-linoleic acid supplementation, inflammatory and non-inflammatory acne lesions decreased significantly. Patient subjective assessment of improvement showed a similar result. Heamatoxylin and eosin staining of acne lesions demonstrated reductions in inflammation and immunohistochemical staining intensity for interleukin-8. No severe adverse effect was reported. This study shows for the first time that omega-3 fatty acid and γ-linoleic acid could be used as adjuvant treatments for acne patients.

Lipids in Health and Disease 2012. Effects of fish oil supplementation on inflammatory acne. Department of Human Nutrition and Food Science, California State Polytechnic University, Pomona, California, USA. Given that acne is a rare condition in societies with higher consumption of omega-3 (n-3) relative to omega-6 (n-6) fatty acids, supplementation with n-3 may suppress inflammatory cytokine production and thereby reduce acne severity. Individuals with inflammatory acne were given three grams of fish oil containing 930 mg of EPA to their unchanged diet and existing acne remedies for 12 weeks. There was no significant change in acne grading and inflammatory counts at week 12 compared to baseline. However, there was a broad range of response to the intervention on an individual basis. The results showed that acne severity improved in 8 individuals, worsened in 4, and remained unchanged in 1. Interestingly, among the individuals who showed improvement, 7 were classified as having moderate to severe acne at baseline, while 3 of the 4 whose acne deteriorated were classified as having mild acne. There is some evidence that fish oil supplementation is associated with an improvement in overall acne severity, especially for individuals with moderate to severe acne. Divergent responses to fish oil in our pilot study indicates that dietary and supplemental lipids are worthy of further investigation in acne.
   Note by me: I think supplementation with fish oils is not enough, one has to also reduce the production of inflammation in the body by avoiding foods that cause inflammatory responses.

You recommend fish intake but I know fish also contains iodine, which has may cause or aggravate. The recommended daily intake of iodine for my age group (I'm 21) is something like 150mcg, but I'm unsure if this amount would be sufficient for warding off the side effect of acne production. Should I be consuming less than this amount or is this a fine amount to go by?
   A. It's really difficult to know whether iodine present in fish aggravates acne. We just know from our experience that those who eat cold water fish have better skin health, and if iodine in fish has any detrimental effects, it is superseded by the benefits of the fish oils present in fish. This is just an educated guess.

Flax seed oil
Is flax seed oil as beneficial as the fish oil you recommended?
   I prefer the use of fish oil rather than flax seed oil, or better yet eating cold water fish more frequently. I also believe consuming whole flax seeds is healthier than consuming the oil.

Increase your vegetable intake - Eat as many vegetables as you wish, preferably organic. Eat a wide variety, not just the few that most American eat. The combination of fish and vegetables is likely to be the healthiest meal for those with acne.

Increase your intake of water. Drink a glass or two of cold water first thing in the morning to eliminate the bowels. Drink 4 to 8 glasses of water per day, more in hot weather.

Foods that I consider to have no major influence on acne, or to be relatively neutral, include meats, turkey, and chicken. I am not sure about coconut oil, whether it helps or makes it worse.

You did not mention eggs, boiled or otherwise, and I am wondering if you believe they are linked in any way.
   I'm not sure about the role of eggs.

Q. Are there any links between acne and soy milk?
    It is possible that in rare cases some people may have an acne eruption from soy, but I do not think this is the norm. Soy milk should be fine for skin health as long as it is not sweetened with sugar. You can buy unsweetened soy milk and sweeten it with stevia.

Probiotics, friendly bacteria
Wiad Lek. 2018. Indicators of phagocytosis in women with acne during comprehensive treatment that included immunotherapy and probiotics. Supplementation with probiotics could be of some benefit.

Alcohol, acne and beer
I read your write up on diet; I love it! How bad is beer for acne on the face?
    I have not seen any research regarding alcohol, specifically beer, and acne, but my guess is that beer has no major influence one way or another. I have observed people who drink a lot of alcohol and have not noticed a greater incidence of outbreaks on their face.

I don't think caffeine has a major influence, but I am not sure.

Studies have provided mixed results. If you do plan to eat chocolate, eat high percentage cacao dark chocolate without milk added to it and consume as little as you can. You can also buy raw cacao powder and add stevia, the natural no-calorie sweetener.

Lifestyle factors
Relax, meditate, do yoga, take long walks, attempt to change your response to perceived stressful experiences. Acne prevention is easier than the best treatment. 
How to get rid o f acne.

Does chocolate influence Acne?
I'm not sure. I don't think cocoa itself is a cause, but most likely the sugar and milk used to chocolate may have an influence. If you do wish to eat chocolate, try small amounts of the low sugar, dark, 70% cocoa variety. As an experiment you can try
cacao supplements that do not have sugar to see if your skin reacts to pure cacao by itself without the sugar and milk.

Smoking, tobacco, cigarettes
Smoking has a negative effect on the
skin as it does with other organs and tissues of the body. Smoking could make acne worse.
Dermatoendocrinology 2009. Acne and smoking.

Supplements and herbs
It is possible that certain compounds in herbs have a beneficial effect. Some cell studies show that flavonoid, alkaloid, essential oil, phenol and phenolic compounds, tannins, xanthones may be of help. Animal studies show that diterpene acid, phenylpropanoid glycosides, acteoside and flavonoids have anti-inflammatory activity. Some human studies show that Camellia sinensis has 5α-reductase inhibitory and anti-inflammatory activities. Also anti-bacterial effect is shown by oleoresin of Commiphora mukul.

J Cutan Med Surg. 2013. Prospective, Randomized, Open-Label Trial Comparing the Safety, Efficacy, and Tolerability of an Acne Treatment Regimen with and without A Probiotic Supplement and Minocycline in Subjects with Mild to Moderate Acne. Probiotics may be considered a therapeutic option or adjunct for acne vulgaris by providing a synergistic anti-inflammatory effect with systemic antibiotics while also reducing potential adverse events secondary to chronic antibiotic use.

What about taking DMAE supplements for skin and acne treatment in teenagers? do you recommend it?
   DMAE supplements are not likely to have an influence.

Does curry eating cause pimples? What about arginine amino acid found in protein foods?
    I don't suspect that eating curry or taking curcumin / turmeric pills would cause a skin break out, nor would arginine.

Does saw palmetto help acne pimples?
   We have seen no evidence at this time that saw palmetto helps.

I take the following supplements and wondering if you know if they have an influence, msm for joints, beta glucan for cholesterol levels and serrapeptase enzyme.
   I don't suspect they would have a major influence.

I�m a 38 year old female who�s had acne since high school. My father is a dermatologist, so I�ve tried every medication without success, except for a two year period following Accutane. I�ve taken Sam-e natural antidepressant pills periodically for mood, with excellent results. I�ve noticed, though, that my skin completely clears up when I take it. This is the third time it�s happened over a period of three years, so I don�t think it�s a coincidence. I don�t think it�s related to the mood effects of Sam-e, because my acne has been consistent, regardless of the amount of stress in my life. Do you know if Sam-e has been known to improve acne or by what means it may do so?
    This is interesting but I have not had anyone else mention this up to now and I don't know how it would work. Does it influence hormone levels perhaps? Not sure.

Tongkat ali is from Malaysia and used for sexual pleasure improvement. Do you know if it makes pimples worse, what about horny goat weed supplement?
    Not that I know of.

Could liver malfunction cause acne problems in teens? Would milk thistle help? I have tried all kinds of skin care products available for an acne cure but nothing has worked so far on my daughter.
   It is unlikely that liver disease is a common cause of acne in teens. I have not seen human research with milk thistle.

What about oral herbs such as mangosteen?
Antimicrobial effects of Thai medicinal plants against acne-inducing bacteria.
J Ethnopharmacol. 2005.
The results from disc diffusion method showed that 13 medicinal plants could inhibit the growth of Propionibacterium acnes. Among those, Senna alata, Eupatorium odoratum, Garcinia mangostana, and Barleria lupulina had strong inhibitory effects. Antimicrobial activity from fractions of column chromatography revealed one of the active compounds in mangosteen could be mangostin, a xanthone derivative. Taken together, our data indicated that Garcinia mangostana had a strong inhibitory effect on Propionibacterium acnes and Staphylococcus epidermidis. Therefore, this plant would be an interesting topic for further study and possibly for an alternative treatment for acne.

Vitamin E supplement
Reduce or avoid vitamin E supplements. I have come across some patients who have noticed acne pimples after taking vitamin E. I am not certain of this connection, but until more is known you may wish to stop taking high dose supplements of this vitamin. There have also been rare case reports of aggravation following very large intake of B vitamins.
I am not aware of pantothenic acid being able to reduce or improve an acne problem.

Acneiform eruption due to "megadose" vitamins B6 and B12.
Cutis. 1991 Aug.
Medications and other exogenous factors are known to be capable of exacerbating acne or precipitating acneiform eruptions. This case illustrates an eruption resembling acne rosacea that was temporally associated with daily ingestion of high-dose B vitamin supplement. The eruption failed to respond to the usual treatment regimens for rosacea, but promptly improved when use of the vitamin supplement was discontinued.

Herbal acne research study

Chinese Herbs
Anti-acne effects of Oriental herb extracts: a novel screening method to select anti-acne agents.
Skin Pharmacol Appl Skin Physiol. 2003.
The acne-therapeutic effects of Oriental herb extracts were investigated in terms of antichemotactic effect on polymorphonuclear leucocytes and antibacterial activity against Propionibacterium acnes. The ethanol extract of Angelica dahurica markedly suppressed neutrophil chemotaxis, comparable to the effect of erythromycin, whereas a strong antilipogenic effect was obtained with rhizoma coptidis (Coptis chinensis) extract, leading to a higher efficacy than that of retinoic acid. Interestingly, only Glycyrrhiza glabra licorice showed a remarkable antibacterial activity against P. acnes, resulting in negligible induction of resistance, in comparison with a marked development of resistance in the bacteria treated with erythromycin. We suggest that an appropriate formulation containing Angelica dahurica, rhizoma coptidis and G. glabra could be helpful for the prevention and treatment of acne lesions.

Physiological cause
At least four factors are important in the development of acne: plugging of the hair follicle with abnormally cohesive desquamated cells, sebaceous gland hyperactivity, proliferation of bacteria (especially Propionibacterium acnes) within sebum, and inflammation.

Genetics as a cause
A teenager's odds of developing moderate to severe acne is more likely if their parents had the skin problem. Most teenagers have occasional breakouts, with the hormonal shifts of adolescence, particularly elevations in testosterone, the prime culprit. But some teens, and adults, develop more-extensive eruptions. Dr. Christos C. Zouboulis, of the Dessau Medical Center in Germany found that 14 percent of Iranian students had moderate to severe acne, with the prevalence varying significantly based on family history. Of teenagers whose parents or siblings ever had moderate to severe acne, 20 percent had the same problem. In contrast, the rate was 10 percent among teens with no such family history. Teenagers whose mothers had ever had moderate to severe problems were three times as likely to develop the problem as their peers were. When fathers had the skin condition, their children's risk increased two- fold. Teens with oily skin are more likely than their peers with normal skin to have moderate to severe pimples. And for girls, the problem is more likely to flare up shortly before their menstrual periods. Dr. Christos C. Zouboulis research can be found in the Journal of Investigative Dermatology, September 2009.

The Inflammatory process
Earliest changes in the hair follicle occur when the follicular canal becomes blocked with abnormally keratinized desquamating cells. This plug starts above the opening of the sebaceous gland into the follicular canal and causes gradual expansion of cells and sebum within the canal. The plug becomes visible at the skin surface as a white papule ("whitehead," or closed comedo). If the opening of the follicular canal dilates, this plug protrudes from the canal and turns a dark color ("blackhead," or open comedo). Bacteria, most importantly P. acnes, are present in increased numbers in persons who have acne. Much of the inflammation that eventually occurs arises from the action of enzymes produced by the bacteria. These enzymes hydrolyze sebum into free fatty acids, which stimulate the inflammatory process. Chemotactic factors are released by this reaction, attracting neutrophils (a type of white blood cell). As the follicular wall becomes inflamed, an red papule appears at the skin surface. With increased sebum production, obstruction and bacterial colonization, the follicular unit ruptures, spilling its contents into the dermis. The inflow of neutrophils causes the formation of pustules. Continuation of severe inflammation leads to formation of nodules and subsequent acne cysts.

Acne face wash
I don't think washing your face more than required is going to help get rid of pimples since the cause is mostly internal due to diet and hormone levels. According to one study, washing one's face twice a day provides the best outcome.

To clarify the effect of frequency of face washing on acne vulgaris, we designed a single-blinded, randomized, controlled clinical trial to be conducted on males with mild to moderate acne vulgaris. Subjects washed their faces twice daily for 2 weeks with a standard mild cleanser before being randomized to one of three study arms, in which face washing was to be done once, twice, or four times a day for 6 weeks. At the end of the study no statistically significant differences were noted between groups. However, significant improvements in both open comedones and total noninflammatory lesions were observed in the group washing twice a day. Worsening of acne condition was observed in the study group washing once a day, with significant increases in erythema, papules, and total inflammatory lesions. Pediatr Dermatol. 2006. A single-blinded, randomized, controlled clinical trial evaluating the effect of face washing on acne vulgaris. Harvard Medical School, Boston, Massachusetts, USA.

Medicine and medication
There is no known cure with medicine, but it can be controlled. Most acne medicines take several weeks to work. The best results happen after taking them for three months.

Isotretinoin if nothing else works
Low doses of isotretinoin (brand name, Roaccutane or Accutane) are effective for treating moderate acne. The efficacy of isotretinoin at (regular doses) as a treatment is well established but has several mild and serious side effects. However, using low doses of isotretinoin such as 20 milligrams daily for six months can offer benefits with fewer medicine side effects.

Dr. Sahelian's personal journey for a solution
Ever since I was a child I remember questioning everything told to me by parents, teachers, or anyone that represented authority. At an early age I realized that adults did not have all the answers. I don't know what made me such a rebel, but it makes sense how this attitude led me to explore alternative medicine.
   Although I grew up eating very healthy as a child, during my teenage years I went overboard eating lots of candy, sweets, cakes, and ice cream. I think this diet, and genetics (my mom had acne), led me in my teenage years to have a moderate, and at times severe, case. I ended up going to several dermatologists who recommended antibiotics. I tried them for a few months and all they did was make me sick and tired. I asked these dermatologists if diet had anything to do with acne, and they all said no. (Even now, more than 30 years later, many doctors deny such a relationship). I started questioning the wisdom of these doctors and modern medical knowledge. I began exploring on my own for natural ways to treat this skin disorder. At age 20 one such path led me to visit health food stores and search for books dealing with natural ways to deal with skin disorders. I become so interested in natural health that I was spending more time reading health books than books on business, which happened to be my major at Drexel University in Philadelphia. In my third year of college I finally switched to nutrition science and, after a superhuman effort cramming biology, physics, biochemistry, organic chemistry, physiology, and calculus all within a year, and taking the MCAT medical school admission test, I got accepted to Thomas Jefferson Medical School in Philadelphia. I remember receiving the acceptance letter on a late November day, the weather was dry and biting cold. The temperature was in the low 40s but for several days I walked around campus with only a tee shirt. I was so euphoric that I did not even notice the frigid temperature.
   The reason I have given you this background is to put in perspective and share with this page on natural acne treatment that indicates diet does have an influence on acne. I also want to make the point that on even some basic concepts modern medicine can be way off the track. Hence, we should not take anything doctors say as the final word, but to keep in mind that in many cases alternatives exist.

My daughter,15 years old, has high testosterone levels. She has severe acne. The endocrinologist prescribed spironolactone but I prefer a natural approach instead.

I've been on the contraceptive pill since I was 16, I am now 26. I had no acne as a teenager but I briefly tried a contraceptive implant when I was 20 and this is when the acne started. I came off the implant and was put on Dianette to clear acne. I'm quite health conscious so I am aware of the risks of the pill and the fact it's just masking underlying problems. So I would go through phases of wanting to come off pill for health reasons and severe acne would flare up, and stayed like that for up to 12 months. Then as soon as I started pill again (Dianette or Yasmin) it would clear up straight away. I know I have some sort of hormonal imbalance but doctors here say the only option I have is the contraceptive pill. Would I be correct in thinking if I take pregnenolone when coming off pill it will help create the hormones I am lacking?
   A. Pregnenolone, DHEA, testosterone, would make acne worse.


Carbohydrates and acne
Molecular Nutrition and Food Research 2008. A pilot study to determine the short-term effects of a low glycemic load diet on hormonal markers of acne: a nonrandomized, parallel, controlled feeding trial. School of Applied Sciences, RMIT University, Melbourne, Australia. To investigate the effect of a low glycemic load (LGL) diet on endocrine aspects of acne vulgaris, 12 teen male acne sufferers completed a feeding trial involving a 7-day admission to a housing facility. Subjects consumed either an LGL diet (25% energy from protein and 45% from carbohydrates) or a high glycemic load (HGL) diet (15% energy from protein, 55% energy from carbohydrate). Study outcomes included changes in insulin resistance, sex hormone binding globulin (SHBG), free androgen index (FAI), insulin-like growth factor-I (IGF-I), and its binding proteins (IGFBP-I and IGFBP-3). SHBG levels decreased significantly from baseline in the HGL group, while IGFBP-I and IGFBP-3 significantly increased in the LGL group. Increases in dietary glycemic load may augment the biological activity of sex hormones and IGF-I, suggesting that these diets may aggravate potential factors involved in acne development.

Testosterone and DHEA
Exp Dermatology 2010. Testosterone synthesized in cultured human SZ95 sebocytes derives mainly from dehydroepiandrosterone. Human sebaceous gland possesses all the steroidogenic enzymes required for androgen synthesis. Using testosterone radioimmunoassay, we found that testosterone was barely detectable in the supernatant of cultured human SZ95 sebocytes when cholesterol was added alone. A two-fold increase of testosterone production was observed in supplementation of DHEA as compared to pregnenolone or progesterone.

Dermatology. 2014. Higher 17α-hydroxyprogesterone levels aggravated the severity of male adolescent acne in northeast china. Higher androstenedione and testosterone levels are significant risk factors in the occurrence of adolescent acne.