How To Get Rid of Forehead Acne.
Forehead acne is a common skin concern for a number of people and affects most people at some point in their life. So what causes it and how can you get rid of it? Here’s how to get rid of forehead acne once and for all!
What Causes Forehead Acne?
There are four main factors that overlap to cause forehead acne, these are:
- Excessive oil production
- A build-up of dead skin cells on the surface of the skin
- The p.acnes (now often referred to as c.acnes) bacteria
- Inflammation as part of an immune response to the bacteria.
Other factors can contribute towards forehead acne, but it’s usually because they have some kind of effect on our hormones, the amount of oil our oil glands produce, the rate at which we shed dead skin cells, the bacteria present on our skin, or our body’s inflammatory responses.
Our hormones largely control how much oil is produced by our oil glands and hormonal changes or fluctuations can lead to excessive oil production.
Increased oil production, alone, does not cause acne. However, when this is accompanied by a reduced rate of skin cell turnover (the rate at which dead skin cells are shed from the surface of the skin), dead skin cells can build up on the surface of the skin and trap this oil within the pore.
The p.acnes bacteria are naturally present on all skin and are normally not an issue. However, because the p.acnes bacteria feeds off of our skin’s natural oils, when there is an accumulation of oil with no means of escape, the p.acnes bacteria go on a feeding frenzy. This provides the bacteria with the energy to multiply rapidly.
Our body’s natural response to an increase in bacteria is to send white blood cells to the source of the bacteria in order to ‘fight’ the bacteria and prevent any nasty infections. Once the white blood cells have ‘killed’ the bacteria, they remain in the pore and are, essentially, ‘dead’ (pus is literally just a bunch of dead white blood cells).
Eventually, the body will absorb and break down this pus and any associated inflammation will calm down – effectively getting rid of the forehead acne.
Usually, we’re never just dealing with one little forehead acne pimple though!
How To Work Out What Type of Forehead Acne You Have
Before discussing how to get rid of forehead acne, it is important to understand which type(s) of forehead acne you’re experiencing.
The types of forehead acne can be broken down into non-inflammatory and inflammatory.
Non-inflammatory forehead acne is the initial clogged pore (officially referred to as a comedone).
When oil and dead skin cells are trapped within the pore they may be exposed to the air which causes the blockage to oxidize and turn brown/black in color. This is known as an ‘open comedone’ but is more frequently referred to as a blackhead.
If the blockage is not exposed to the air it is called a ‘closed comedone’ and more frequently referred to as a whitehead. Whiteheads often look and feel like tiny little bumps on the skin and are rarely painful.
Treatments for non-inflammatory forehead acne should mainly focus on increasing skin cell turnover, exfoliating skin, and reducing oil production.
As the p.acnes bacteria begin to multiply non-inflammatory acne can become inflammatory acne.
Inflammatory forehead acne includes papules, pustules, nodules, and cysts.
Papules are small red bumps that may or may not be painful and have no visible signs of pus.
Pustules are similar to papules but pus can be seen on the surface of the skin – these are usually the types of spots that people are tempted to pick and squeeze.
Nodules and cysts are much deeper within the skin and can be very painful and are prone to scarring. The terms are often used interchangeably but generally speaking nodules have no visible pus, while cysts do.
Due to the increased risk of scarring, if your forehead acne includes nodules and cysts, over-the-counter (OTC) treatments are unlikely to be very effective and you ideally need to see a dermatologist for more specialist treatment.
Treatments for inflammatory forehead acne should focus on reducing the levels of bacteria and inflammation as well as increasing skin cell turnover, exfoliating, and reducing oil production.
How To Get Rid Of Forehead Acne
Now that you have determined the type of acne you have we can look at how to get rid of forehead acne.
Treatments for forehead acne may work by:
- Regulating hormones (e.g. oral contraceptives)
- Reducing oil production
- Increasing the rate of skin cell turnover (e.g. exfoliation)
- Controlling the p-acnes bacteria (e.g. antibacterials/antibiotics)
- Reducing inflammation.
Here’s a handy chart of various common skincare ingredients and how they can help to get rid of forehead acne.
*FYI – there is a handy downloadable acne ingredient cheat sheet in our free resources section – to access simply subscribe to sciencebecomesher.com via the pop-up form*
You can read about each ingredient in more detail below.
Retinoids (e.g. Retinol, Adapalene, Tretinoin)
Retinoid is a catch-all term for vitamin A derivatives including; retinol, retinoic acid (tretinoin), adapalene (Differin), and retinaldehyde. While retinoic acid and adapalene are usually prescription-only treatments, retinol and retinaldehyde are available in many OTC products.
The effects of retinoid treatments are dose-dependent [1], which means that stronger products and concentrations are more effective than weaker ones. In other words, prescription treatments are going to improve forehead acne faster than OTC products.
The main way in which retinoids work is by increasing skin cell turnover and renewal. However, they also reduce sun damage, boost collagen production, improve the appearance of wrinkles, reduce skin pigmentation, and increase skin hydration [2].
Unfortunately, due to the increase in skin cell turnover, retinoids can also cause an initial ‘skin purging’ by increasing the rate that blemishes are brought to the surface of the skin. This means that your forehead acne is likely to get worse before it gets better.
They can also cause irritation, redness, dryness, and peeling during the first few weeks of use [3]. These initial side-effects are less likely with OTC forms of retinoids.
In addition to the above-mentioned skin benefits, retinoids can also reduce the inflammation that is associated with acne and acne scarring [4], and may have antioxidant [5] and antibacterial effects [6]. Specifically, retinaldehyde has demonstrated antibacterial effects against the p-acnes bacteria, while retinoic acid and retinol have not [6].
Some research also suggests that retinoids may be able to reduce oil production [7]. However, this is limited to studies performed on tissue samples rather than people.
Altogether, this suggests that retinoids can target most of the underlying causes of forehead acne by increasing skin cell turnover, possibly reducing oil production, preventing p-acnes bacteria growth, and reducing inflammation.
In fact, retinoids have been shown to reduce inflammatory and non-inflammatory acne by 40-70% [8].
Chemical Exfoliants
Chemical exfoliants, such as alpha-hydroxy acids (AHAs; e.g. glycolic acid, lactic acid) and beta-hydroxy acids (BHAs; e.g. salicylic acid) work by loosening the top layer of skin and removing dead skin cells.
Glycolic acid alone [9] as well as in combination with retinaldehyde [10] has demonstrated an ability to improve the appearance of acne and acne scarring. This is largely down to its ability to increase skin cell turnover and, thus, prevent the blocking of the pore by dead skin cells.
In addition to increasing skin cell turnover, salicylic acid is anti-inflammatory and oil-soluble which means that it can easily penetrate pores in order to unclog them. It does this by loosening and detaching the dead skin cells and other debris that build up within the pore [11]. Furthermore, due to its ability to dissolve in oil, salicylic acid is easily able to penetrate the oil glands and reduce oil production [12].
Salicylic acid pads were shown to reduce the number of both inflammatory and non-inflammatory acne lesions when used for 12-weeks [13]. In addition, the topical combination of salicylic acid and niacinamide is able to significantly reduce oil production and pore size after 12 weeks of use [14].
Both AHAs and BHAs can help to get rid of forehead acne as well as prevent further breakouts.
Niacinamide
Niacinamide is a water-soluble form of vitamin B3 that can increase collagen levels, shrink pores, improve skin hydration, and reduce redness and pigmentation. In addition, it has antioxidant and anti-inflammatory effects [14], and can reduce oil production [15]. For example, a moisturizer containing 2% niacinamide was able to reduce the rate of oil production after 2-6 weeks of use [16].
The topical application of niacinamide can lead to significant reductions in both inflammatory and non-inflammatory acne when used over an 8-week period [17]. It has also been shown to be more effective at improving the appearance of acne than a commonly used topical antibiotic (clindamycin) [15], although there appears to be no added benefit in using the two treatments together [18].
Not only does niacinamide pair well with salicylic acid for treating forehead acne but, as it is hydrating, it can help improve the skin’s tolerance to retinoids and increase their effectiveness.
Azelaic Acid
Azelaic acid is a naturally occurring dicarboxylic acid that is often used to treat melasma and other pigmentation disorders. However, as it is both an anti-inflammatory and antimicrobial [19], and is particularly effective against the p-acnes bacteria [20], it can also help to get rid of forehead acne.
Some research has found that azelaic acid is as effective as benzoyl peroxide, tretinoin, a topical antibiotic (erythromycin), and an oral antibiotic (tetracycline) at treating mild-to-moderate acne [21].
In addition, it may be an ideal treatment option for those who experience both active forehead acne and post-inflammatory hyperpigmentation as it is an effective ingredient for both conditions [19].
Vitamin C
Vitamin C is an antioxidant that is essential for overall skin health, wound healing, and collagen production. However, only a small amount of vitamin C consumed through diet becomes available to the skin which means that topical application is required to maintain sufficient levels of vitamin C in the skin [22].
While there isn’t a huge amount of research that specifically looks at how effective topical vitamin C is at treating acne, it is a potent anti-inflammatory [23] and some research suggests that blood levels of vitamin C are lower in those with acne [24].
In addition, one form of vitamin C, sodium ascorbyl phosphate (SAP), has demonstrated an ability to reduce inflammatory acne lesions by 49% after 8-weeks of use [25].
This would suggest that vitamin C may help to get rid of inflammatory forehead acne but may have little effect on non-inflammatory forehead acne.
Vitamin E
Vitamin E is an oil-soluble antioxidant that is found at high levels in oil and oil-rich areas (e.g. the upper layers of facial skin). If too much oil is produced by the oil glands, the levels of vitamin E can decrease and lead to an increase in oxidative stress and inflammation [26].
Like vitamin C, blood levels of vitamin E have been found to be lower in those with acne, and even lower still in the case of severe acne [27]. Although there isn’t much research investigating the effect of topical vitamin E on acne-prone skin, one study did find that the addition of vitamin E to a treatment regimen of benzoyl peroxide and salicylic acid reduced the number of acne spots in as little as 2-weeks [28].
However, some people report increased breakouts from using skincare products that contain vitamin E so it should be used with caution when treating forehead acne.
Green Tea
Topical green tea appears to have beneficial effects on a variety of skin conditions which are largely due to the antioxidant molecules (polyphenols) present in green tea. These polyphenols have demonstrated an ability to regulate inflammatory pathways in the skin [29] and, thus, reduce inflammation.
The main polyphenol in green tea is EGCG (epigallocatechin-3-gallate) which seems to be responsible for green teas anti-inflammatory and antioxidant effects.
Some research has demonstrated that a topical green tea lotion can reduce oil-production by 60% after 8-weeks of use [30]. In addition, topical ECGC can improve the overall appearance of acne by reducing inflammation and inflammatory acne lesions by up to 89% and non-inflammatory acne lesions by up to 79% [31].
In other research, a green tea extract was able to reduce blackheads by 61% and pustules by 28% but had no effect on smaller non-inflammatory spots [32]. This suggests that green tea may not be an effective treatment for all types of acne.
However, as EGCG reduces inflammation, oil production, and some research suggests it prevents p-acnes bacteria growth [31], it is likely to be a good candidate for getting rid of forehead acne.
Centella Asiatica
Centella Asiatica (Cica) is a tropical medicinal plant that is native to Southeast Asia. It has been used for centuries to improve wound healing and treat a number of different skin conditions [33]. This is due to the composition of Cica, which contains a number of beneficial saponins (asiaticoside, Asiatic acid, madecassoside, and madasiatic acid) as well as fatty acids, flavonoids, vitamin B & C, and amino acids [34].
Some research has suggested that Centella Asiatica can improve overall acne severity, reduce oil production, and prevent acne-related scarring [35]. In addition, it appears to be effective at reducing certain strains of bacteria [36] and has excellent anti-inflammatory effects [37].
As it is also hydrating, Centella Asiatica may be a good skincare ingredient for those with dehydrated skin as well as forehead acne.
Tea Tree Oil
Tea tree oil has been used medicinally for decades due to its antibacterial and antifungal properties [38]. In addition, research suggests that tea tree oil acts as an anti-inflammatory agent [39].
In one study, a 5% tea tree oil gel was 3.5 times more effective at reducing the total number of acne lesions and 5.75 times more effective at reducing overall acne severity than placebo over a 6-week period [40]. In fact, tea tree oil has demonstrated similar effectiveness to benzoyl peroxide for the treatment of acne but takes longer to see results [41].
Other research found that a topical combination of tea tree oil, propolis, and aloe vera was more effective at reducing the number of acne lesions, as well as the overall severity of acne and red scarring, than a commonly used antibiotic cream [42].
A downside to the use of tea tree oil for acne is that it can cause skin irritation and allergic reactions. However, the research appears to be conflicting regarding this [43]. Nevertheless, it’s probably best to avoid using tea tree oil for forehead acne if you have sensitive skin.
Resveratrol
Resveratrol is an antioxidant that has anti-inflammatory and wound-healing effects [44], more recent research has identified that it is also effective at preventing the growth of the p-acnes bacteria [45].
A pilot study identified that resveratrol was able to reduce the severity of acne and the size of spots and pimples but suggested that more research was needed to determine whether resveratrol is an effective treatment for acne [46].
Resveratrol is also better than a number of popular brightening ingredients at reducing pigmentation, which means that it may be another great option for those whose forehead acne is causing dark marks.
Other Treatments That May Help Get Rid of Forehead Acne
There are a number of other skincare ingredients that may help to get rid of forehead acne by either reducing inflammation, preventing p.acnes bacteria growth, reducing oil production, or increasing skin cell turnover. However, they are yet to be fully investigated in clinical trials and any research to support their anti-acne effects is so-far lacking.
For example:
- Promotes Wound Healing
- Anti-Bacterial
- Anti-Inflammatory
- Hydrating
Zinc:
- Reduces Oil Production
- Anti-Bacterial
- Anti-Inflammatory
Sulfur:
- Anti-Bacterial
- Increases Skin Cell Turnover
Ceramides:
- Anti-Inflammatory
- Hydrating
Aloe:
- Anti-Bacterial
- Anti-Inflammatory
- Hydrating
- Antioxidant
Witch Hazel:
- Reduces Oil Production
- Anti-Bacterial
- Anti-Inflammatory
- Antioxidant
Eucalyptus Oil:
- Reduces Oil Production
- Anti-Bacterial
- Anti-Inflammatory
Clay/Charcoal
- Reduces Oil Production
- Anti-Bacterial
Licorice:
- Anti-Bacterial
- Anti-Inflammatory
- Antioxidant
How To Get Rid Of Forehead Acne In Other Ways
There are a number of lifestyle factors that may indirectly contribute to the development of forehead acne by affecting either hormones, oil production, dead skin cell build-up (or clogged pores), the p-acnes bacteria, or inflammation.
Reduce Stress
Some research suggests that stress levels are positively correlated with acne severity [47]. This means that the higher a person’s stress level is, the more severe their forehead acne is likely to be.
When the brain senses stress, a hormone called corticotropin-releasing hormone (CRH) is secreted which begins a process that results in the production of cortisol (the main stress hormone in humans) [48].
CRH has also been found to increase oil production [49] and inflammation [50] which may explain the association between stress and acne. However, some research found that, although stress was associated with more severe acne, it was not associated with increased oil production [51].
Either way, reducing stress may be key to getting rid of forehead acne.
A Low GI Diet
The research into the influence of diet on acne has been fairly inconclusive, with the exception of foods with a high glycaemic index (GI). High GI foods are those that cause spikes in blood sugar, such as white bread, pasta, cakes, and other sugary foods.
A diet rich in these foods increases the levels of insulin within the blood which stimulates androgen hormones and increases the production of oil in the skin. This means that diet may indirectly cause forehead acne via its effect on insulin metabolism [52].
In fact, research has found that a low GI diet reduced the severity of acne and improved insulin sensitivity in young men with acne [53]. This may suggest that adopting a low GI diet may help to get rid of forehead acne.
You can read more about the effect of diet on acne here.
Moisturize Regularly
There is a common misconception that those with acne-prone and oily skin don’t need to use a moisturizer. However, often, the increase in oil production that is characteristic of acne can mask the usual signs of dehydrated skin.
In addition, research suggests that acne is associated with an altered skin barrier function [54]. This basically means that individuals with acne tend to have skin that contains too much oil but not enough water.
For this reason, it is important to use a moisturizer to keep your skin hydrated and maintain a strong skin barrier function, particularly if you’re using active skincare ingredients such as retinoids and chemical exfoliants as these can irritate the skin.
Wear Sunscreen Everyday
Sunscreen is the most important part of any skincare routine. This is because the ultra-violet (UV) radiation emitted by the sun causes direct DNA damage (UVB) and indirect DNA damage through the production of free radicals (UVA) which greatly increases the risk of certain types of skin cancer.
In addition, UV radiation can cause pigmentation and break down collagen within the skin – both of which may increase the risk of acne scarring.
Furthermore, some research suggests that free radicals are partially responsible for causing acne. For example, one type of free radical, hydrogen peroxide, has been found to be 43% higher in those with inflammatory acne than in those without [55]. Other research highlights how the levels of antioxidants (the molecules that are able to neutralize free radicals) are reduced in those with acne [56].
UV radiation may also lead to an overgrowth of oil glands and a temporary increase in the production of oil, although this finding was based on a research study that used hamsters instead of humans [57].
Either way, sunscreen is essential for healthy skin and may help to prevent forehead acne.
A number of acne treatments, particularly prescription treatments, AHAs, and retinoids, can increase the skin’s sensitivity to the sun which means that you are more likely to experience sunburn and skin damage while using these ingredients.
Additional Tips To Prevent Forehead Acne
- Change your pillowcases regularly as dirt, oil, bacteria, and any other debris from your face can transfer to your pillow when you sleep and after a while it can build up and clog pores.
- Opt for pH balanced cleansers with a pH level of around 5.5 as acne is associated with an increased skin surface pH.
- Consider consuming probiotic drinks or supplements as these have been shown to improve some inflammatory skin conditions.
- Keep hats, helmets, and headbands clean as these can contribute to forehead acne.
- Always remove make-up at the end of the day and consider double-cleansing to ensure that all the dirt and debris that builds up throughout the day is washed away and unable to clog pores.
Summary – How To Get Rid Of Forehead Acne
Forehead acne is a common skin complaint for many people that is caused by four main, direct, factors and may be influenced by a number of indirect factors.
In order to get rid of forehead acne, it is important to first know what type of acne you are trying to treat. Treatments for forehead acne usually work by either:
- Reducing oil production
- Increasing skin cell turnover
- Reducing/preventing the growth of p.acnes bacteria
- Reducing inflammation
Other factors that may help get rid of forehead acne include:
- Reducing stress
- Following a low GI diet
- Moisturizing regularly
- Wearing sunscreen every day
- Changing pillowcases regularly
- Using pH balanced cleansers
- Supplementation with probiotics
- Always removing make-up
- Keeping hats, helmets, headbands, and anything else that covers your forehead clean.
Check out the resource library to download your free acne ingredient cheat sheet! (Subscription required).
References
- Leyden, J., Stein-Gold, L. & Weiss, J. (2017). ‘Why topical retinoids are mainstay therapy for acne’, Dermatol Ther., 7(3), 293-304. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574737/
- Mukherjee, S., Date, A., Patravale, V. et al. (2006). ‘Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety’, Clin Interv Aging, 1, 327-348. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699641/
- Song, X., Xu, A., Pan, W. et al. (2008). ‘Nicotinamide attenuates aquaporin 3 overexpression induced by retinoic acid through inhibition of EGFR/ERK in cultured human skin keratinocytes’, Int J Mol Med., 22(2), 1107-3756. Available at: https://www.spandidos-publications.com/ijmm/22/2/229
- Tan, J., Tanghetti, E., Baldwin, H., Stein Gold, L. & Lain, E. (2019). ‘The role of topical retinoids in prevention and treatment of atrophic acne scarring: Understanding the importance of early effective treatment’, J Drugs Dermatol., 18(3), 255-260. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30909329
- Sorg, O., Tran, C. & Saurat, J. (2001). ‘Cutaneous vitamins A and E in the context of ultraviolet- or chemically-induced oxidative stress’, Skin Pharmacol Appl Skin Physiol., 14, 363-372. Available at: https://www.karger.com/Article/Abstract/56370
- Pechere, M., Germanier, L., Siegenthaler, G., Pechere, J. & Saurat, J. (2002). ‘The antibacterial activity of topical retinoids: the case of retinaldehyde’, Dermatology, 205(2), 153-158. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12218231
- Zouboulis, C., Korge, B., Akamatsu, H., Xia, L., Schiller, S., Gollnick, H. & Orfanos, C. (1991). ‘Effects of 13-cis-retinoic acid, all-trans-retinoic acid, and acitretin on the proliferation, lipid synthesis and keratin expression of cultured human sebocytes in vitro’, J Invest Dermatol., 96(5), 792-797. Available at: https://www.ncbi.nlm.nih.gov/pubmed/1708801/
- Halder, A. & Shaw, J. (2004). ‘Treatment of acne vulgaris’, JAMA, 292(6), 726-735. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15304471/
- Wang, C., Huang, C., Hu, C. & Chan, H. (1997). ‘The effect of glycolic acid on the treatment of acne in Asian skin’, Dermatologic Surg, 23(1), 23-29. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1524-4725.1997.tb00003.x
- Poli, F., Ribet, V., Lauze, C., Adhoute, H. & Morinet, P. (2005). ‘Efficacy and safety of 0.1% retinaldehyde/ 6% glycolic acid (Diacneal) for mild to moderate acne vulgaris’, Dermatology, 210(Supp 1), 14-21. Available at: https://www.karger.com/Article/Abstract/81498
- Davies, M. & Marks, R. (1976). ‘Studies on the effect of salicylic acid on normal skin’, Br J Dermatol., 95(2), 187-192. Available at: https://www.ncbi.nlm.nih.gov/pubmed/952756/
- Marczyk, B., Mucha, P., Budzisz, E., Rotsztein, H. (2014). ‘Comparitive study of the effect of 50% pyruvic and 30% salicylic peels on the skin lipid film in patients with acne vulgaris’, J Cosmet Dermatol, 13(1), 15-21. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24641601/
- Decker, A. & Graber, E. (2012). ‘Over-the-counter acne treatments – A review’, J Clin Aesthet Dermatol., 5(5), 32-40. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3366450/
- Berson, D., Osborne, R., Oblong, J., Hakozaki, T., Jonson, M. & Bissett, D. (2014). ‘Chapter 10: Niacinamide: A topical vitamin with wide-ranging skin appearance benefits’, Cosmeceuticals and Cosmetic Practice: First Edn. John Wiley & Sons ltd. Available at: https://onlinelibrary.wiley.com/doi/pdf/10.1002/9781118384824.ch10
- Shalita, A., Smith, J., Parish, L., Sofman, M. & Chalker, S. (1995). ‘Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris. International Journal of Dermatology, 34, 434-437. Available at: https://www.ncbi.nlm.nih.gov/pubmed/7657446
- Draelos, Z., Matsubara, A. & Smiles, K. (2006). ‘The effect of 2% niacinamide on facial sebum production’. Journal of Cosmetic Laser Therapy, 8, 96-101. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16766489/
- Kaymak, Y. & Onder, M. (2008). ‘An investigation of efficacy of topical niacinamide for the treatment of mild to moderate acne vulgaris’. Journal of the Turkish Academy of Dermatologists, 2(4), https://www.researchgate.net/publication/228503323_An_Investigation_of_Efficacy_of_Topical_Niacinamide_for_the_Treatment_of_Mild_and_Moderate_Acne_Vulgaris
- Sardesai, V. & Kambli, V. (2003). ‘Comparison of efficacy of topical clindamycin and nicotinamide combination with plain clindamycin for the treatment of acne vulgaris and acne resistant to topical antibiotics’, Indian J Dermatol Venereol Leprol., 69(2), 138-139. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17642859/
- Canavan, T., Chen, E. & Elewski, B. (2016). ‘Optimizing non-antibiotic treatments for patients with acne: a review’, Dermatol Ther., 6(4), 555-578. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5120627/
- Sieber, M. & Hegel, J. (2014). ‘Azelaic acid: Properties and mode of action’, Skin Pharmacol Physiol., 27(Suppl 1), 9-17. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24280644/
- Fitton, A. & Goa, K. (1991). ‘Azelaic acid. A review of its pharmacological properties and therapeutic efficacy in acne and hyperpigmentary disorders’, Drugs, 41(5), 780-798. Available at: https://www.ncbi.nlm.nih.gov/pubmed/1712709
- Al-Niaimi, F. & Chiang, N. (2017). ‘Topical vitamin C and the skin: mechanisms of action and clinical applications’, J Clin Aesthet Dermatol, 10(7), 14-17. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605218/#B3
- Farris, P. (2006). ‘Topical vitamin C: A useful agent for treating photoaging anf other dermatologic conditions’, Dermatol Surg., 31, 814-818. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1524-4725.2005.31725
- Abuldnaja, K. (2009). ‘Oxidant/antioxidant status in obese adolescent females with acne vulgaris’, Indian J Dermatol., 54(1), 36-40. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800868/
- Ruamrak, C., Lourith, N. & Natakankitkul, S. (2009). ‘Comparison of clinical efficacies of sodium ascorbyl phosphate, retinol, and their combination in acne treatment’, Int J Cosmet Sci., 31(1), 41-46. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19134126/
- Thiele, J., Weber, S. & Packer, L. (1999). ‘Sebaceous gland secretion is a major physiologic route of vitamin E delivery to skin’, J Invest Dermatol., 113(6), 1006-1010. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10594744/
- Ozuguz, P., Dogruk Kacar, S., Ekiz, O., Takci, Z., Balta, I. & Kalkan, G. (2014). ‘Evaluation of serum vitamins A and E and Zinc levels according to the severity of acne vulgaris’, Cutan Ocul Toxicol., 33(2), 99-102. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23826827/
- Mills, O., Criscito, M., Schlesinger., Verdicchio, R. & Szoke, E. (2016). ‘Addressing free radical oxidation in acne vulgaris’, J Clin Aesthet Dermatol., 9(1), 25-30. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756869/
- Katiyar, S. & Elmets, C. (2001). ‘Green tea polyphenolic antioxidants and skin photoprotection (review)’, Int J Oncol., 18, 1307-1313. Available at: https://www.spandidos-publications.com/ijo/18/6/1307
- Mahmood, T., Akhtar, N., Khan, B. & Saeed, T. (2010). ‘Outcomes of 3% green tea emulsion on skin sebum production in male volunteers’, Bosn J Basic Med. Sci., 10(3), 260-264. Available at: https://www.ncbi.nlm.nih.gov/pubmed/20846135/
- Yoon, J., Kwon, H., Min, S., Thiboutot, D. & Suh, D. (2013). ‘Epigallocatechin-3-gallate improves acne in humans by modulating intracellular molecular targets and inhibiting P.acnes’, J Invest Dermatol, 133(2), 429-440. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23096708/
- Jung, M., Ha, S., Son, J., Song, J., Houh, Y., Cho, E., Chun, J., Yoon, S., Yang, Y., Bang, S., Kim, M., Park, H. & Cho, D. (2012). ‘Polyphenon-60 displays a therapeutic effect on acne by suppression of TLR2 and IL-8 expression via down-regulating the ERK1/2 pathway’. Arch Dermatol Res, 304(8), 655-663. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22684779/
- Gohil, K., Patel, J. & Gajjar, A. (2010). ‘Pharmacological Review on Centella Asiatica: A potential herbal cure-all’, Indian J Pharm Sci., 72(5), 546-556. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116297/
- Singh, S., Gautam, A., Sharma, A. & Batra, A. (2010). ‘Centella Asiatica: A plant with immense medicinal potential but threatened’, Int J Pharm Sci Rev Res., 4(2), 9-17. Available at: https://pdfs.semanticscholar.org/adb8/1f48529661d55292bd153bef1c82a8f11c7d.pdf
- Beltrami, B., Vassallo, C., Berardesca, E. & Borroni, G. (2001). ‘Antinflammatory, antimicrobial, comedolytic effects of a topical plant complex treatment in acne vulgaris: A clinical trial’, J Appl Cosmetol., 19, 11-20. Available at: http://iscd.it/files/ANTINFLAMMATORY,-ANTIMICROBIAL,-COMEDOLYTIC-EFFECTS-OF-A-TOPICAL-PLANT-COMPLEX-REATMENT-IN-ACNE-VULGARIS—A-CLINICAL-TRIAL.pdf
- Nasution, Y., Restuati, M., Pulungan, A., Pratiwi, N. & Diningrat, D. (2018). ‘Antimicrobial activities of centella asiatica leaf and root extracts on selected pathogenic micro-organisms’, J Med Sci., 18, 198-204. Available at: https://scialert.net/fulltextmobile/?doi=jms.2018.198.204
- Ho, J., Sung, J., Cheon, K. & Tae, J. (2018). ‘Anti-inflammatory effect of Centella asiatica phytosome in a mouse model of phthalic anhydride-induced atopic dermatitis’, Phytomedicine, 43, 110-119. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29747743
- Cox, S., Mann, C., Markham, J., Bell, H., Gustafson, J., Warmington, J. & Willey, S. (2000). ‘The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil)’, J Appl Microbiol., 88(1), 170-175. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10735256/
- Hart, P., Brand, C., Carson, C., Riley, T., Prager, R. & Finlay-Jones, J. (2000). ‘Terpinen-4-ol, the main component of essential oil of Melaleuca alternifolia (tea tree oil), supresses inflammatory mediator production by activated human monocytes’, Inflamm Res., 49(11), 619-626. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11131302/
- Enshaieh, S., Jooya, A., Siadat, A., Iraji, F. (2007). ‘The efficacy of 5% topical tea tree oil gel in mild to moderate acne vulgaris: a randomized, double-blind placebo-controlled study’, Indian J Dermatol Venereol Leprol., 73(1), 22-25. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17314442/
- Bassett, I., Pannowitz, D. & Barnetson, R. (1990). ‘A comparative study of tea-tree oil versus benzoyl peroxide in the treatment of acne’, Med J Aust., 153(8), 455-458. Available at: https://www.ncbi.nlm.nih.gov/pubmed/2145499/
- Mazzarello, V., Donadu, M., Ferrari, M., Piga, G., Usai, D., Zanetti, S. & Sotgiu, M. (2018). ‘Treatment of acne with a combination of propolis, tea tree oil, and aloe vera compared to erythromycin cream: two double-blind investigations’, Clin Pharmacol., 10, 175-181. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298394/
- Carson, C., Hammer, K. & Riley, T. (2006). ‘Melaleuca alternifolia (Tea Tree) Oil: a review of antimicrobial and other medicinal properties’, Clin Microbiol Rev., 19(1), 50-62. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360273/
- Baur, J. & Sinclair, D. (2006). ‘Therapeutic potential of resveratrol: the in vivo evidence’, Nat Rev Drug Discov., 5(6), 493-506. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16732220/
- Taylor, E., Yang, Y., Champer, J. & Kim, J. (2014). ‘Resveratrol demonstrates antimicrobial effects against propionibacterium acnes in vitro’, Dermatol Ther., 4(2), 249-257. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4257953/
- Fabbrocini, G., Staibano, S., De Rosa, G. et al. (2011). ‘Resveratrol-containing gel for the treatment of acne vulgaris: a single-blind, vehicle-controlled, pilot study’, Am J Clin Dermatol., 12(2), 133-141. Available at: https://www.ncbi.nlm.nih.gov/pubmed/21348544
- Chiu, A. Chon, S. & Kimball, A. (2003). ‘The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress’, Arch Dermatol., 139(7), 897-900. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12873885/
- Chen, Y. & Lyga, J. (2014). ‘Brain-skin connection: stress, inflammation and skin aging’, Inflamm Allergy Drug Targets., 13(3), 177-190. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4082169/
- Zouboulis, C., Seltmann, H., Hiroi, N., Chen, W., Young, M., Oeff, M., Scherbaum, W., Orfanos, C., McCann, S. & Bornstein, S. (2002). ‘Corticotropin-releasing hormone: an autocrine hormone that promotes lipogenesis in human sebocytes’, Proc Nati Acad Sci USA., 14(99), 7148-7453. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12011471/
- Zbytek, B., Mysliwski, A., Slominski, A., Wortsman, J., Wei, E. & Mysliwska, J. (2002). ‘Corticotropin-releasing hormone affects cytokine production in human HaCaT keratinocytes’, Life Sci., 70(9), 1031-1021. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11860150/
- Yosipovitch, G., Tang, M., Dawn, A., Chen, M., Goh, C., Chan, Y. & Seng, L. (2007). ‘Study of psychological stress, sebum production and acne vulgaris in adolescents’, Acta Derm Venereol, 87(2), 135-139. Available at: https://www.medicaljournals.se/acta/content/html/10.2340/00015555-0231
- Emiroglu, N., Cengiz, F. & Kemeriz, F. (2015). ‘Insulin resistance in severe acne vulgaris’, Postepy Dermatol Alergol., 32(4), 281-285. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4565837/
- Smith, R., Mann, N., Braue, A., Makelainen, H. & Varigos, G. (2007). ‘A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomised controlled trial’, Am J Clin Nutr., 86(1), 107-115. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17616769/
- Yamamoto, A., Takenouchi, K. & Ito, M. (1995). ‘Impaired water barrier function in acne vulgaris’, Arch Dermatol Res., 287(2), 214-218. Available at: https://www.ncbi.nlm.nih.gov/pubmed/7763094
- Bowe, W. & Logan, A. (2010). ‘Clinical implications of lipid peroxidation in acne vulgaris: old wine in new bottles’, Lipids Health Dis., 9, 141. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012032/
- El-Akawai, Z., Abdel-Latif, N. & Abdul-Razzak, K. (2006). ‘Does the plasma level of vitamins A and E affect acne condition?’ Clin Exp Dermatol., 31, 430-434. Available at: https://www.ncbi.nlm.nih.gov/pubmed/16681594
- Akitomo, Y., Akamatsu, H., Okano, Y., Masaki, H. & Horio, T. (2003). ‘Effects of UV irradiation on the sebaceous gland and sebum secretion in hamsters’, J Dermatol Sci., 31(2), 151-159. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12670726/