Chapter 3
Alternative and Complementary Treatments

Since acne medication can have harmful side effects, many people with acne explore alternative treatments in an effort to find safer treatment options. Moreover, some people with acne use alternative treatments to reduce stress, which, when left unchecked, encourages acne outbreaks. Indeed, the use of alternative treatments has grown widely among acne patients, with many reporting positive results. An acne patient explains why she sought alternative treatment:

The doctor prescribed Retin A. It totally dried out my skin. It even hurt to smile. If anything my face was redder and more inflamed than when I started. I looked like a burn victim! Then, my cousin started using tea tree oil and her skin looked great. She swore by it. She said that it was soothing and gentler than bp [benzoyl peroxide] or Retin A. That's when I decided to switch. After that, one thing led to another. The tea tree oil was great, but I still wasn't totally clear. I started checking out other natural treatments. Now I'm using tea tree oil and zinc, and doing some meditation. My skin's not perfect, but it's a whole lot better, and I feel better about myself.³³

What Are Alternative and Complementary Treatments?

An alternative treatment is a form of treatment that, because of limited studies into its effectiveness and safety, is not approved for use or regulated by the FDA. In fact, rather than exacting scientific tests that are used in studying conventional treatments, alternative treatments often use anecdotal evidence to prove their effectiveness. Such evidence, which is based on reports by patients on how the treatment worked for them, does not usually include a control group or report any negative results. Consequently, most alternative treatments are not widely prescribed by traditional health care providers in the United States, who depend on the government to verify that the advantages of conventional treatments surpass any likely health risks.

Despite these issues, many health care professionals believe that several alternative treatments are effective in treating acne, especially when they are combined with conventional acne treatments in a method known as complementary treatment. Doctors recommend complementary treatment because it can regulate hormones, reduce inflammation, fight infection, and reduce stress.

Three Types of Alternative Treatments for Acne

The most widely used alternative treatments for acne fall into three categories—those that are taken internally, those that are applied on the skin, and those that eliminate stress. Dietary supplements such as herbs, vitamins, and minerals are among the most popular internal treatments. In fact, herbal remedies have been used to treat many diseases, including acne, for thousands of years, and herbs still remain the primary treatment for acne in China and Thailand.

Herbal remedies use the leaves, roots, and stems of plants that are known to have healing properties. Usually taken ground up in capsule form or as a tea, herbal remedies for acne consist of herbs that balance hormone levels, boost the immune system, and reduce inflammation. Because herbs are natural, many people feel that they are gentler and safer than conventional medicines.

Herbs That Balance Hormone Levels

Herbs that balance hormone levels are the most commonly prescribed herbs for acne. They include chaste berry, red clover, black cohosh, wild yam, evening primrose, and dong quai, all of which are prescribed for women. These herbs contain phytoestrogen, a plant-based female hormone-like compound. Therefore, although they are useful for women, they are inappropriate for males due to chemical differences in the male and female body.

Herbalists believe phytoestrol increases the effect of the female sex hormone, estrogen, on the body while counterbalancing the effect of androgen. Although studies into the effectiveness of hormone-balancing herbs on acne are limited, many experts think herbs containing phytoestrogen can help women with hormonal acne. Stanley W. Beyrle, a naturopathic doctor at the Kansas Clinic of Traditional Medicine in Wichita, explains:

Black cohosh works as a regulator or a normalizer of the female reproductive system [the part of a woman's body that produces female sex hormones] by helping to restore hormone balance. When it comes to gynecological complaints [conditions such as hormonal acne that involve female sex hormones and sex organs], there isn't a better herb than black cohosh.³⁴

Herbs to Combat Infection and Inflammation

Other herbs used to treat acne, such as echinacea, burdock, licorice, and dandelion root, are thought to contain compounds that attack bacteria, thus reducing infection and inflammation. Herbs like salvia and red peony, on the other hand, are thought to improve circulation and tissue growth, which increases the skin's ability to heal. The effect of these herbs on acne patients has been studied in China. There they are commonly prescribed for acne in individually formulated combinations based on each patient's particular skin problems. Such combinations are also prescribed for acne patients by practioners of Chinese herbal medicine in the United States and other Western countries. An acne patient who was treated with such an herbal combination explains: "It did work. It's all rather mysterious, with all the herbs, and it's a slow and gradual effect, but it [the patient's acne] calmed down and six months later it's still under control."³⁵

Vitamins and Minerals

Treatment with vitamins and minerals, in particular vitamin B 5, is another widely used alternative treatment for acne. Also known as pantothenic acid, vitamin B 5 is believed by some experts to be as effective in reducing the production of sebum as isotretinoin.

Treatment with vitamin B 5 is based on a theory developed by acne expert Dr. Lit-Hung Leung in 1995 in Hong Kong that a deficiency of vitamin B 5 leads to the development of acne. According to Leung, the body needs vitamin B 5 in order to process fat. When there is a shortage of vitamin B 5, fat that is normally burned for fuel or stored in cells for future use cannot be processed properly. Instead, it accumulates in the bloodstream. Since excess fat in the bloodstream can damage the body by clogging arteries and veins, the body tries to eliminate it. One way the body does this is by producing excess sebum, to which fat binds. In this way, excess fat in the form of sebum is eliminated through the skin. Thus, according to Leung's theory, the presence of excess fat in the bloodstream causes the body to increase sebum production in an effort to eliminate fat. This causes or worsens acne lesions. Therefore, when acne patients increase the level of vitamin B 5 in their bodies, they improve the processing of fat. This insures that fat is burned for energy or stored for future use instead of being used to produce excess sebum.

To test his theory, Leung sponsored a clinical trial in which he treated one hundred acne patients in Central Hospital in Hong Kong in 1997 with vitamin B 5 . The patients, who had various severities of acne, were given ten grams of vitamin B 5 per day in capsule form. Although vitamin B 5 is present in many foods, including beans, nuts, oatmeal, and brewer's yeast, Leung says that some people with acne are so deficient in vitamin B 5 that they cannot get enough of it through food alone.

The study proved successful. Within six months, 90 percent of the subjects' acne had cleared. These results suggested to Leung that vitamin B 5 is an effective acne treatment. Many people concur with Leung. An acne patient who is currently using vitamin B5 describes the results: "Though my skin isn't 100 percent clear yet, it's made excellent progress in that direction over the past five weeks. Far fewer breakouts overall and the oiliness of my skin has definitely decreased."³⁶

Treatments That Are Applied to the Skin

Like herbs and vitamin B 5, topical alternative treatments usually consist of vitamins and minerals or natural ingredients derived from plants. One such popular alternative treatment is tea tree oil, which is applied directly onto pustules. Tea tree oil is an essential oil derived from the Australian ti tree. It is a natural antiseptic that destroys bacteria and draws out impurities, like pus, from acne lesions.

Seaweed, too, has powerful antibacterial properties. First discovered in 2001 in France as a treatment for acne, topical treatments made from seaweed are quite potent. According to a November 2001 report in YM.com, the online edition of YM magazine, seaweed has such a powerful effect on acne-causing bacteria that it takes only two pounds of seaweed to make a ton of acne spot cream.

Other external herbal remedies use herbs such as agrimony, burdock, cloves, lavender, licorice root, and white willow, to name just a few, because of their anti-inflammatory, antiseptic, and pore-cleansing properties. In fact, white willow contains a natural form of salicylic acid. Often these herbs are combined with minerals such as zinc, which aid in the healing of skin tissue, and are applied on the skin systematically in the form of daily cleansers and healing balms and weekly facial masks. A woman whose grandson used such a system describes how it helped him: "My grandson was teased by the horrible acne covering his face. Now there is no sign he ever had acne. Within days of starting your system [one manufacturer's herbal skin care regime] his acne turned to small scabs and then healed without scars. It also worked wonders on his chest and back."³⁷

Ear Acupuncture

Acupuncture is another alternative treatment that is applied to the skin. Developed thousands of years ago in China, acupuncture is based on the concept that everyone has an energy known as chi flowing through their bodies. When this energy flow is blocked, illness occurs. In order to unblock this energy flow, acupuncturists insert small needles into specific points on the body. Acupuncturists think that some of these points, especially those found in the ear, control energy flow to the face, where acne is likely to occur. Therefore, inserting needles into the ear stimulates the flow of energy to the face. Once the flow is restored, blood circulation to the face improves, bringing increased oxygen, collagen, nutrients, and infection-fighting chemicals to acne-affected areas. In addition, acupuncturists believe that acupuncture treatment balances hormone production.

Despite the lack of evidence proving that chi exists, a number of studies have shown acupuncture to be an effective treatment for acne. For example, one 1989 Chinese study reported in the Journal of Traditional Chinese Medicine treated eighty patients with moderate to severe acne with ear acupuncture every other day for a total of sixteen treatments. Seventy-seven percent of the patients were reported completely cured, while the skin of 14 percent showed a marked improvement. A 1990 Chinese study reported similar results.

Another study conducted at the University of Heidelberg, Germany, in 1992 investigated the effects of ear acupuncture on women with hormonal acne. In this study, half the subjects were treated with conventional hormone therapy, and half were treated with acupuncture. At the study's conclusion, researchers reported that the skin of subjects treated with acupuncture was more improved than that of subjects treated with hormones. In addition, unlike the subjects treated with hormones, the subjects treated with acupuncture experienced no side effects.

Based on these and other studies, many medical doctors support the use of acupuncture as an acne treatment. Dr. Palle Rosted, a medical doctor and acupuncturist at Weston Park Hospital in Sheffield, England, reports on the benefit of acupuncture as an acne treatment: "The various studies generally testify to many cases of total recovery, and for the remaining patients a considerable degree of improvement."³⁸

Treatments That Relieve Stress

Whereas some patients use alternative treatments as a substitute for conventional medicines, other patients combine conventional treatments with stress-relieving alternative treatments. Since controlling stress reduces the release of the hormone cortisol, which stimulates sebum production, controlling stress reduces the severity of acne. The most popular stress-relieving treatments for acne include relaxation response therapy, yoga, and aromatherapy.

Relaxation response therapy involves using the mind to help lower stress and thus reduce acne outbreaks. There are a number of ways acne patients do this. One way is through the use of relaxation tapes. Just as the name implies, relaxation tapes are audiotapes specifically designed to help listeners relax. Such tapes help listeners to concentrate their minds on relaxation by guiding them through a serious of exercises. The exercises provide acne patients instructions on ways to slow their breathing and relax their muscles, which reduce the body's response to stress. At the same time, the tapes often offer soothing background sounds such as the sound of the ocean or a gentle rain, which help listeners clear their minds of distressful thoughts. Relaxation tapes have proven so useful that the Acne Support Group, the largest acne support group in Great Britain, has developed tapes specifically for its members.

Meditation and Guided Imagery

While some people with acne use relaxation tapes to help concentrate their minds on relaxation, others use meditation or guided imagery to achieve similar results. Meditation involves using concentration techniques to clear the mind in order to relax the body and relieve stress. While meditating, people silently repeat a word or phrase until they feel calm and all stressful thoughts are removed from their minds. Research has shown that during meditation, the production of cortisol decreases and remains lowered when individuals practice meditation often. As a result, sebum production and acne outbreaks are reduced.

Guided imagery is a type of meditation in which people center their thoughts on relaxing and healing their bodies. For example, when faced with a stressful situation, many acne patients use guided imagery to imagine themselves in a tranquil environment, such as a forest or beach, where they feel relaxed and happy. At the same time, they envision their complexion without acne. The feelings evoked during guided imagery help people with acne lower their stress levels and strengthen their resolve to heal. An acne patient explains:

I light scented candles, pop in a CD, and imagine myself walking on the beach in Mazatlan [a beach resort in Mexico]. I think about how good I feel, how peaceful the beach is, and how the sun warms my face and heals my skin. I imagine the sun cleansing and clearing my skin from the outside, and my own body doing it from the inside. In my mind, my skin is perfect and I'm beautiful. When I'm done, I'm relaxed and more confident, too.³⁹

Yoga

Practicing yoga, a form of exercise that originated in ancient India, is another way people with acne relieve stress. Yoga exercises involve slow, controlled stretching and breathing, which relax the body while lowering cortisol levels. Because yoga is a form of exercise, it also improves blood circulation. Improved circulation brings more oxygen and bacteria-fighting cells to areas affected by acne. Yoga practioners say that specific yoga postures such as the lion, standing and seated sun, and cobra have distinct healing effects on the body, including relaxation, internal cleansing, and releasing blocked energy. Although there is little proof that yoga does all these things, it is so popular for reducing stress that many physicians recommend it to their patients.

Many acne patients find yoga to be effective in reducing stress as well as improving their complexion. They report feeling more relaxed and calm, along with seeing a noticeable improvement in the brightness and healthiness of their skin.

Aromatherapy

Aromatherapy is another popular alternative treatment for reducing stress. It is based on the theory that scent influences the way people feel. Aromatherapy uses candles scented with essential oils extracted from plants. It also uses aroma lamps and diffusers that spray the oil into the air in a mist. These oils are derived from plants such as jasmine, chamomile, vanilla, lemon balm, and lavender and are believed to have calming properties. Indeed, people report feeling calmer and less stressed after inhaling them.

Studies into the effectiveness of aromatherapy are limited. However, neurologists at the Smell and Taste Treatment and Research Foundation in Chicago have been conducting research on aromatherapy for seventeen years. Their findings support the theory that scent has a powerful effect on an individual's mood and behavior. The reason for this, they say, is that inhaling certain scents alters brain waves and affects the pleasure center of the brain.

One study in particular investigated how aromatherapy can change an individual's mood. In this study, which was conducted in 2002 at the University of Southampton School of Medicine in England, fifteen extremely nervous psychiatric patients inhaled lavender oil for two hours a day every other day for ten days. On these days, 60 percent of the patients were reported to be calmer and happier. On the alternate days, however, when the patients inhaled a mist of pure water, there was no change in their mood.

Many acne patients report that aromatherapy has a similar effect on their response to stress. A former acne patient explains: "Even now, I still get an occasional acne breakout. It seems to happen most when I'm under stress at work. One of the ways I handle stress is by filling my oil lamp with lemon balm, and lighting it up right beside my hot tub. The combination of the warm bubbling water and the scented oil drains away my worries. No worries means no frown lines, and no pimples."⁴⁰

Risks and Side Effects of Alternative Treatments

Although many people are turning to alternative treatments hoping to find safer forms of treatment, alternative treatments can also pose health risks. Vitamin B5, for example, is known to cause iron deficiencies in some people. This can lead to serious health problems such as anemia. Other side effects of the vitamin include fatigue, weakness, dizziness, and dry skin that easily wounds.

Other problems occur due to lack of regulation of alternative products. Herbal products, in particular, can cause serious problems. Herbs can be as powerful as prescription drugs. But, unlike in prescription drugs, the level of active ingredients in herbal products and the dosage is not monitored by government agencies. Often, herbal products themselves, as well as the recommended dosages, are too strong for patients. But many people are unaware of this. They assume that because herbs are natural and have been used for thousands of years, these products are safe. However, high doses of certain herbs can cause nausea, stroke, heart problems, and hypersensitive skin. In addition, patients are just as likely to have an allergic reaction to herbs as to conventional medications. Moreover, scientists do not know what the long-term effect is of treatment with these products. This is a special problem when it comes to treatment with phytoestrogen. As yet, scientists do not know whether long-term phytoestrogen treatment, like conventional hormonal therapy, is linked to cancer and heart disease.

In addition, due to the lack of regulation, herbal products may contain herbs, chemicals, and drugs that are not listed on the label. For example, a 1999 random sampling in London, England, of eleven different herbal creams used to treat acne found that eight of the eleven products tested contained dexamethasone, a powerful steroid drug that was not listed on the labels. A 2003 article in SKINmed, a journal for dermatologists, explains:

Guidelines concerning correct identification of the herb, the labeling of active ingredients, and establishment of purity are nonexistent. Lack of quality control too often leads to misidentification and contamination with toxic ingredients including pesticides, chemicals, heavy metals, and hidden drugs with their resultant ill effects.… From the reports of adverse reactions, it is becoming obvious that a history of traditional use is not a guarantee of safety.⁴¹

Yet these problems have not stopped millions of people with acne from turning to alternative treatments. "There are problems with every treatment," an acne patient explains. "Personally, I feel like natural treatments are gentler. Even if I'm wrong, when prescription products make your acne worse, and you can't look in the mirror without wanting to cry, you're willing to take a chance and try something different."⁴²