Acne

Introduction

Background

Acne vulgaris, the most common type of acne, is a chronic inflammatory skin disease affecting hair follicles, and sebaceous glands and ducts. It occurs on the face in 99% of those affected and, less often, on the back and chest.(Layton 2010).

Characteristic features include overproduction of sebum (seborrhoea); thickening of the follicle stratum corneum, which can lead to blockage and accumulation of sebum to form non-inflamed lesions called comedones; colonisation of the pilosebaceous ducts by Propionibacterium acnes; and inflamed lesions (e.g. papules, pustules, inflamed nodules, pus-filled cysts) that may be superficial or deep.(Layton 2010; Garner 2003) Scarring can result from abnormal wound healing following inflammatory damage.(Layton 2010) Acne conglobata is an uncommon and unusually severe form of acne characterised by burrowing and interconnecting abscesses and irregular scars.

In the UK, around 15 per 1,000 people have acne.(Schofield 2009) The condition usually starts in adolescence and frequently resolves by the mid-20s.(Layton 2010) Severe disease can persist for 12 years or longer.(Layton 2010) Acne can have an impact on psychological well-being.(Schofield 2009; Smithard 2001) The exact cause of acne is unknown, but androgen secretion is the major trigger for adolescent acne.

Conventional treatments include topical products containing azelaic acid or benzoyl peroxide for mild acne, topical or oral antibiotics, topical or oral retinoids and, for women, pills containing anti-androgens (eg Dianette).

Clinical Evidence

Evidence pooled together in a systematic review has shown that acupuncture plus moxibustion is safe and effective for the treatment of acne, and possibly better than routine western medicine.(Li 2009) (see Evidence Summary) In one randomised controlled trial, acupuncture treatment of moderate acne vulgaris was associated with reduction of inflammatory lesions and improvement of the quality of life, but there was no non-acupuncture control for comparison (Son 2010). In another, adding warming moxibustion to a baseline acupuncture treatment improved the outcomes similarly to that of adding the drug isotretinoin(Mi 2010). Finally, one trial found body acupuncture to have some effect in the treatment of acne vulgaris, and that the addition of laser auricular irradiation may improve efficacy (Lihong 2006). There is very little research on acupuncture and acne outside of China. Most of the trials to date are of low quality and the conclusions of the systematic review should be viewed in that light.

Potential mechanisms

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010)

Acupuncture may help to treat acne through one or more of the following general mechanisms, but as yet we have no specific information from studies on people with acne:

• reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);
• enhancing natural killer cell activities and modulating the number and ratio of immune cell types (Kawakita 2008);
• increasing local microcirculation (Komori 2009), which aids dispersal of swelling.