Acne

What is Acne?

Acne vulgaris is a long-lasting inflammatory disorder of the pilosebaceous unit, the hair follicle and its oil gland. It is most common in teenagers, but it can affect people of any age.^[1] Worldwide it affects about 9% of people, and roughly 85% of those aged 12 to 24.^[2]

Common symptoms

Acne appears as comedones (blackheads and whiteheads), red papules, pustules and, in more severe cases, deep nodules. It occurs mainly on the face and can also affect the upper arms, trunk and back.^[1]

Severe or inflamed acne can leave scars or dark marks and can affect mood and self-image.^[1] A meta-analysis of 42 studies found that acne is associated with both depression and anxiety.^[3]

Causes and risk factors

Acne forms when several factors act together in the follicle: excess oil, blocked follicles, skin bacteria and inflammation.^[1] Hormones matter too. Oil gland activity is regulated by androgens and by other hormones and cell signals.^[4]

Acne is not limited to teenagers and can continue into or begin in adult life.^[1] Some people notice a link with diet, and we discuss that below.

How it is diagnosed and treated conventionally

Acne is usually diagnosed by looking at the skin, and most cases do not need special tests.^[2] First-line treatments are topical retinoids, benzoyl peroxide, azelaic acid or combinations of these. For more severe acne, doctors add oral antibiotics such as doxycycline, hormonal treatments such as combined oral contraceptives or spironolactone, or isotretinoin.^[2]

A 2024 American Academy of Dermatology guideline strongly recommends benzoyl peroxide, topical retinoids, topical antibiotics and oral doxycycline. It recommends oral isotretinoin for severe acne, acne causing distress or scarring, or acne that fails standard treatment.^[5]

Why Acne calls for a whole-person approach

Acne is driven by more than clogged pores. Hormones, inflammation, diet and mood can all play a part, and they differ from person to person.

Dermatology treatment targets the skin directly. Looking at the other contributing factors is a reasonable addition to that treatment, as long as it does not delay or replace it.

Hormones and oil production

Oil gland activity responds to androgens and other hormonal signals.^[4] Hormone-related acne is evaluated and treated by a physician.

Inflammation

Acne is an inflammatory disease of the follicle, and inflammation is what produces red, swollen and painful lesions.^[1] Treatments aimed at inflammation are a common target of both conventional and complementary research.

Diet

A systematic review of 53 studies found that high glycemic index and glycemic load foods, dairy products, fatty foods and chocolate were linked with more acne, while fruit, vegetables and some fatty acids were linked with less. The authors said the role of specific foods is still unresolved.^[6] Most of these studies were observational, so they show an association, not proof of cause.

Stress, mood and sleep

Living with acne is linked to depression and anxiety.^[3] Stress and low mood can make skin care harder to keep up, and the emotional effects of acne deserve attention in their own right. Acne that is causing significant distress is a reason to tell your physician.^[2]

Acupuncture for Acne

What the research shows

The research on acupuncture for acne is limited, and the best controlled trial found no benefit over sham treatment. In that trial, patients with moderate or severe acne received 12 sessions of real or sham acupuncture over 4 weeks. There were no significant differences in symptoms, lesion counts or quality of life, apart from one emotional subscale at the end of treatment. The authors noted that the course was short and that sham acupuncture may not be inert.^[7]

A Cochrane review of 35 trials of complementary therapies found inconsistent results for acupuncture, herbal medicine and wet cupping. It could not draw firm conclusions because of study quality.^[8] A 2025 scoping review mapped 114 studies, most from China, and rated the overall methods of the randomized trials as moderate with few high-quality studies. It reported that acupuncture generally appeared safe, although fire needling caused more adverse events than other methods.^[9]

In a small Korean pilot trial of 44 men, adding acupuncture to an herbal extract was suggested to help inflammatory lesions, but the study was small, and quality-of-life scores did not change significantly.^[10]

How acupuncture may work

One review proposes that acupuncture acts on the underlying processes that drive acne, and describes the techniques and devices used. The exact mechanism has not been established, and these are proposed explanations, not settled facts.^[11] The one sham-controlled trial did not show a clear clinical benefit.^[7]

What treatment involves

Treatment uses fine, sterile, single-use needles, often at points on the face, limbs and body chosen for the person, usually left in place for about 20 to 40 minutes. We reassess after a short course of visits. The sham-controlled trial used 12 sessions over four weeks.^[7]

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[12] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). Skin that is actively infected or very inflamed may need to be avoided.

Ayurvedic medicine for Acne

The Ayurvedic view

In Ayurveda, acne is traditionally called Yauvana Pidika or Mukhadushika, meaning pimples of youth or of the face. It is described as a result of aggravated Kapha and Pitta, with the blood tissue involved. These are traditional categories used to choose treatment, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine, such as limiting very oily, spicy and sweet foods and keeping regular meal and sleep times
• Gentle skin care using herbal pastes or washes
• Herbs such as neem, turmeric, manjistha, amalaki and guduchi, prescribed individually by a qualified practitioner
• Panchakarma cleansing procedures, only in selected cases

Panchakarma is not appropriate during pregnancy, acute illness or frailty, and it is not a substitute for dermatology care.

What the research shows

The research on Ayurveda for acne is limited. A PubMed search found no systematic reviews of Ayurvedic treatment for acne. One older double-blind, placebo-controlled trial of 53 patients tested an oral and an external herbal preparation based on Ayurvedic texts for four weeks, and reported that using both worked better than the oral preparation alone.^[13]

A 2026 placebo-controlled trial of 88 people with mild to moderate acne tested an amalaki and guduchi (Phyllanthus emblica and Tinospora cordifolia) formulation for 12 weeks. Lesion counts fell in a dose-related way, but the difference from placebo was not statistically significant. Quality-of-life scores improved compared with baseline, and no serious adverse events were reported.^[14] Larger, better trials are needed.

Herbal medicine for Acne

Herbs and formulas that have been studied

Studied preparations include Chinese herbal formulas taken by mouth or applied to the skin, tea tree oil, and various plant extracts.^{[8, 15]} A Japanese formula, Keigai-rengyo-to, has been tested together with acupuncture.^[10] Herbal preparations applied to the skin may be offered through our transdermal medication therapy.

What the research shows

The evidence is limited and mostly low quality. A systematic review of 23 trials of botanical treatments found favorable results in every trial and no serious adverse events, but few studies were rigorous and each botanical had been tested in only one or two trials.^[15] A meta-analysis of 10 trials of herbal medicines applied to the skin found better global assessment and lesion counts than placebo in small pooled analyses of two trials each, and the authors rated the evidence as weak.^[16]

A multicenter placebo-controlled trial of 220 people with a Chinese medicine pattern of dampness and blood stasis reported a higher effective rate with a modified Qufeng Runmian powder than with placebo (about 84% versus 32%) over four weeks.^[17] This is one trial of one formula. A 2021 meta-analysis of complementary treatments for acne, eczema and psoriasis concluded that there was insufficient evidence to recommend them for acne.^[18]

For tea tree oil, the Cochrane review found potential benefit in a single 60-person trial, with low-quality evidence and mild adverse effects reported.^[8]

Safety and herb-drug interactions

Herbs are active substances and can cause skin irritation or allergy, and they can interact with medicines. Case reports describe bleeding when warfarin was combined with herbs including dang gui, dan shen, ginger, ginseng and Boswellia.^[19] Mild adverse effects from herbal medicines were reported in the Cochrane review.^[8]

Tell us about every prescription you take, especially isotretinoin, antibiotics, hormonal medicines, spironolactone and blood thinners. In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources. Tell us if you are pregnant or breastfeeding, or have liver or kidney disease.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes acne as damp-heat or heat in particular channels, sometimes with blood stasis.^{[11, 17]} Researchers studying acne measure things that loosely parallel this picture: inflammation, oil gland activity and hormonal signaling.^[1]

Ayurveda's Kapha and Pitta describe oily, hot, inflamed skin. No study has shown that a dosha corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for acne is complementary. Keep your dermatologist or primary care physician, and do not stop or change prescribed medicines, including isotretinoin, antibiotics or hormonal treatments, without your prescriber. We do not diagnose the cause of acne or manage it medically.

Please bring your diagnosis, a list of the creams, medicines and supplements you use, and any recent test results. Severe, scarring or sudden-onset acne needs a physician's assessment.^[5]

When to seek urgent medical care

See a doctor promptly if acne changes quickly or is accompanied by symptoms of illness.

• Sudden, severe, painful acne with fever or joint pain
• Spreading redness, warmth, swelling or pus suggesting a skin infection
• Deep, painful nodules or cysts that are scarring
• Acne that starts suddenly in adulthood, with irregular periods or excess facial or body hair
• Low mood, hopelessness or thoughts of self-harm, which may be linked to acne^[3]
• Swelling of the face or lips, or trouble breathing after using a new product

For thoughts of suicide, call or text 988. For emergencies, call 911 or go to the nearest emergency department.