What Causes Acne?

Acne is partly caused by male sex hormones. These increase in puberty in both sexes. However it is also caused by the Western diet and is rare in those not eating this diet. Sugar, refined carbohydrates (most bread, white flour, cooked potatoes, chips, white rice) and milk (because of its high hormone content) are the foods which have the biggest potential to cause acne. Cutting down on these can be crucial when healing acne.


Acne can be difficult to treat. The basic treatment is with creams but they need patience and they need to be used in the right way. Oral (by mouth) treatments are sometimes required but can cause serious side effects so it’s important to give creams a good try first.

A major problem in acne is excessive grease production. The mainstay of treatment is topical retinoids such as adapelene (gel or cream) or isotretinoin gel with or without benzoyl peroxide (Epiduo). (Antibiotic creams are less effective).

These preparations can be drying so start with a small amount in the evening and wash off before going to bed for a few days then leave on overnight. Use alternate days if there is much drying. Use a cream (rather than a gel) if you have sensitive skin.

It is better to use azelaic acid (Skinoren) if pregnant or planning pregnancy even though no problems have ever been recorded with topical retinoids.

          Another useful substance to use on the skin is 3% hydrogen peroxide. Apply once or twice daily with a cotton bud.


Zinc is the key mineral for skin health. Try 20mg to 30mg daily. Other nutrients that can sometimes help are Vitamin A, Selenium and Vitamin B6. Vitamin A is generally good for the skin but needs large doses (15-25,000iu per day). Take less than 10,000iu if there is any chance of pregnancy. Vitamin B6 is useful for premenstrual acne (take 50mg daily beginning one week before the period and continuing through the period). Vitamin B6 is also helpful for acne of the forehead. Essential fats are also useful, especially if the skin is dry (see separate leaflet). Coconut oil reduces bacterial contamination of the skin.  Liquid Vitamin E applied to the skin helps scars.

High Strength Supplements

          Vitamins are different to drugs. The main mistake with vitamins is using too low a dose. Some like Vitamin C and most B vitamins are safe at very high levels (up to 100 grams daily have been used safely in the case of Vitamin C) and sometimes the body needs these large doses.

Dr Abram Hoffer once saw a 16 year old with acne which was so grotesque that he became suicidal. Hoffer considered acne to be a disease of nutritional deficiency and advised him to stop sugar and milk and treated him with niacinamide (Vitamin B3) 3000mg daily, Vitamin C 3 grams daily, pyridoxine (Vitamin B6) 250mg daily and zinc 50mg. His acne resolved within a month. Hoffer treated many such patients with this regime with few failures. When progress was slow, increasing the dose was usually the solution. Vitamin B5 has also been used at high dosage (10 grams daily) to alleviate acne. The dose can be reduced once improvement continues.

          Note: although the dose of Vitamin B3 is high it is incredibly safe with an upper limit of 40,000mg daily. The doses of Vitamin B6 should be reduced after 1-2 months to 50mg and zinc to 15mg.         

Obstacles to Success

Cosmetics and make-up especially if thick and oily can make acne worse. Use water-based cosmetics. Remove make-up in evening and wash with soap twice daily.

Picking spots can make matters much worse and can become a habit.

What to Do if the Creams not Working

Treatments include oral (by mouth) antibiotics. These are usually used for several months at a time. These do work in the short-term but damage gut bacteria (known as the microbiome). We are now learning more and more about the microbiome and how crucial it is for our long-term health and immunity. So be wary of this treatment.

For girls there is the option of some contraceptive pills such as Dianette and those containing drospirenone (Yasmin, Yacella, Lucette, Eloine, Yiznell, Daylette, Acondro and Dretine. These pills block the male hormone. All pills have higher rates of thrombosis but the rates of thrombosis are higher with these particular pills.

However consider high dose vitamin B5 (pantothenic acid), plus high strength Vitamin C and B3. These are all very safe with no toxicity. The highest strength tablets available of B5 seem to be 500mg (try health food shops or Nature’s Best). Doses of up to 10 grams (20 tablets daily) can be used.

Severe Acne

Severe acne, often occurring later in life (after the teenage years) is becoming commoner. In those cases Roaccutane is often used. It is a specialist only preparation, which needs regular blood tests. It was originally a cancer drug. It can cause liver damage and serious mental disturbance in some people. A particular concern is suicide without any warning in people with no history of mental illness. It can also cause inflammatory bowel disease and Hoffman-Roche have had to pay out millions to patients in compensation because of this. It is a treatment of last resort.

Sometimes acne is caused by polycystic ovary syndrome (PCOS). PCOS can also cause irregular period, infertility and hirsutism (hair growth). It is caused by excess androgens (male hormones). There are blood tests to detect this condition. However acne can also occur in people exposed to toxicity such as pesticide poisoning. The common factor in these types of acne is exposure to gender-bender chemicals, commonly found in plastics and pesticides.

It is interesting that people often come out in spots when they go on fasts and healthy diets. The reason for this is that the body is trying to eliminate toxins. Although this is beyond the scope of this leaflet, ways to reduce toxicity of this kind includes reducing our exposure to chemicals such as pesticides, plastics, perfumes and many personal care products, regular sweating (exercise, saunas), and using supplements.

A more unusual type of acne is that caused by bromides (found in fire retardants and personal care products) and fluorides (found in toothpaste, Teflon pans). Research has found we now have increasing levels of these in our bodies. Ways to help include reducing exposure and using iodine to displace them. (See separate leaflet.)