Inflammatory and Noninflammatory Lesions
Protocol development in integrative medicine is not typically a simple process. Individuals require individualized care, and what works for one patient may not work for another.
To establish these protocols, we first developed a Rating Scale that could be used to discern the rigor of evidence supporting a specific nutrient’s therapeutic effect.
The following protocols were developed using only A through C-quality evidence.
Skin lesions such as acne affect a large portion of the population. Teenagers between the ages of 13 and 18 typically experience the highest rates, affecting approximately 80% of individuals. (18)
Addressing the possible underlying mechanisms involved in the development of skin lesions is vital to an integrative treatment plan. Certain topical and dietary supplement therapies show promising results. For example, decreasing sebum production may play a role in improving total lesion count. (4)(23) Other interventions suggest that inducing anti-inflammatory mechanisms via the suppression of NF-κB and AP-1 pathways may subsequently decrease the number of inflammatory lesions. (23)
Based on the research findings, the ingredients presented in the protocol below have demonstrated efficacy in alleviating skin lesions such as comedones, inflammatory papules, and pustules.
30 mg elemental zinc from zinc gluconate (preferably, although other forms may be effective), once per day, 6-12 weeks (7)
- A decrease in inflammatory score demonstrated by the number of inflammatory lesions was observed in individuals receiving zinc gluconate supplementation when compared to placebo (4)(6)(7)
- Compared to baseline, zinc sulfate supplementation resulted in a decreased number of papules, pustules, infiltrates, and cysts in 58% of patients (16)(21)
- Overall improvement in lesion counts following zinc sulfate supplementation when compared to placebo, with improved efficacy over the duration of 12 weeks (10)(15)
- Systematic review and meta-analysis found zinc relieved symptoms of acne by decreasing the number of inflammatory papules (22)
- Systematic review found both topical and oral zinc to be effective for acne treatment, potentially due to antibacterial, anti-inflammatory, and decreased sebum production (4)
- Zinc was inferior to minocycline however still resulted in 31.2% clinical success rate in the treatment of inflammatory acne (7)
Tea tree oil (Melaleuca alternifolia)
Note: It is suggested to dilute tea tree essential oil with a carrier oil (e.g., olive oil) to avoid skin irritation (3)
- Application of tea tree oil gel decreased total number of inflamed and non-inflamed acne lesions, being 3.55 times more effective than placebo on total acne lesion count and 5.75 times more effective than placebo on acne severity index (8)
- Decreased number of open and closed comedones for inflamed and non-inflamed lesions when treated with tea tree oil of benzoyl peroxide; fewer side effects observed in those treated with tea tree oil gel when compared with benzoyl peroxide lotion (2)
- Tea tree oil gel and face wash used twice daily was found to improve acne via a decrease in mean total lesion count and mean investigator global assessment score (13)
Green tea extract (Camellia sinensis)
- Decreased revised Leeds score, which assesses inflammatory and noninflammatory acne lesions such as papules, pustules, nodules, cysts, and comedones, following topical application of both 1% and 5% EGCG; EGCG regulated the AMPK-SREBP-1 signaling pathway, inhibited NF-κB and AP-1 signaling pathways and caused cytotoxicity of SEB-1 sebocytes, thereby reducing inflammation, sebum production and P. acnes (23)
- Lesion count of acne vulgaris decreased with 2% green tea topical lotion application compared to baseline and placebo (19)
- Oral supplementation (856 mg EGCG per day, 4 weeks) reduced number of facial inflammatory lesions on the nose, perioral area, and chin, when compared to baseline in women with post-adolescent acne (12)
- Systematic review and meta-analysis of five randomized controlled studies found topical green tea extract improved acne by decreasing number of inflammatory lesions (11)
Turmeric (Curcuma longa)
- Systematic review of 18 studies found both oral and topical turmeric preparations to be effective in alleviating skin conditions such acne, atopic dermatitis, pruritus, and psoriasis compared to control (20)
- Systematic review of 11 studies found turmeric supplementation to show benefit in patients with skin conditions such as psoriasis, pruritus, and facial redness (14)
- Systematic review of 12 studies found Curcuma longa and Curcuma aeruginosa to aid in decreasing inflammation and improve skin conditions such as radio-dermatitis (1)
- Reduced inflammatory lesions by 20.2% and non-inflammatory lesions by 23.5% compared to baseline in patients with mild to moderate facial acne (17)
- Systematic review of six studies found lactoferrin may alleviate acne, psoriasis, and diabetic ulcerations (9)
- Decreased total lesion count compared to placebo in patients with mild to moderate acne (5)
DisclaimerView template in-app
- Barbalho, S. M., de Sousa Gonzaga, H. F., de Souza, G. A., de Alvares Goulart, R., de Sousa Gonzaga, M. L., & de Alvarez Rezende, B. (2021). Dermatological effects of Curcuma species: a systematic review. Clinical and Experimental Dermatology. https://pubmed.ncbi.nlm.nih.gov/33522006/ (A)
- Bassett, I. B., Pannowitz, D. L., & Barnetson, R. S. (1990). A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne. The Medical Journal of Australia, 153(8), 455–458. https://pubmed.ncbi.nlm.nih.gov/2145499/ (C)
- Boehm, K., Büssing, A., & Ostermann, T. (2012). Aromatherapy as an adjuvant treatment in cancer care–a descriptive systematic review. African Journal of Traditional, Complementary, and Alternative Medicines: AJTCAM / African Networks on Ethnomedicines, 9(4), 503–518. https://pubmed.ncbi.nlm.nih.gov/23983386/ (A)
- Brandt, S. (2013). The clinical effects of zinc as a topical or oral agent on the clinical response and pathophysiologic mechanisms of acne: a systematic review of the literature. Journal of Drugs in Dermatology: JDD, 12(5), 542–545. https://pubmed.ncbi.nlm.nih.gov/23652948/ (A)
- Chan, H., Chan, G., Santos, J., Dee, K., & Co, J. K. (2017). A randomized, double-blind, placebo-controlled trial to determine the efficacy and safety of lactoferrin with vitamin E and zinc as an oral therapy for mild to moderate acne vulgaris. International Journal of Dermatology, 56(6), 686–690. https://pubmed.ncbi.nlm.nih.gov/28369875/ (B)
- Dreno, B., Amblard, P., Agache, P., Sirot, S., & Litoux, P. (1989). Low doses of zinc gluconate for inflammatory acne. Acta Dermato-Venereologica, 69(6), 541–543. https://pubmed.ncbi.nlm.nih.gov/2575335/ (C)
- Dreno, B., Moyse, D., Alirezai, M., Amblard, P., Auffret, N., Beylot, C., Bodokh, I., Chivot, M., Daniel, F., Humbert, P., Meynadier, J., Poli, F., & Acne Research and Study Group. (2001). Multicenter randomized comparative double-blind controlled clinical trial of the safety and efficacy of zinc gluconate versus minocycline hydrochloride in the treatment of inflammatory acne vulgaris. Dermatology , 203(2), 135–140. https://pubmed.ncbi.nlm.nih.gov/11586012/ (C)
- Enshaieh, S., Jooya, A., Siadat, A. H., & 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 Journal of Dermatology, Venereology and Leprology, 73(1), 22–25. https://pubmed.ncbi.nlm.nih.gov/17314442/ (B)
- Hassoun, L. A., & Sivamani, R. K. (2017). A systematic review of lactoferrin use in dermatology. Critical Reviews in Food Science and Nutrition, 57(17), 3632–3639. https://pubmed.ncbi.nlm.nih.gov/26857697/ (A)
- Hillström, L., Pettersson, L., Hellbe, L., Kjellin, A., Leczinsky, C. G., & Nordwall, C. (1977). Comparison of oral treatment with zinc sulphate and placebo in acne vulgaris. The British Journal of Dermatology, 97(6), 681–684. https://pubmed.ncbi.nlm.nih.gov/146511/ (B)
- Kim, S., Park, T. H., Kim, W. I., Park, S., Kim, J. H., & Cho, M. K. (2021). The effects of green tea on acne vulgaris: A systematic review and meta-analysis of randomized clinical trials. Phytotherapy Research: PTR, 35(1), 374–383. https://pubmed.ncbi.nlm.nih.gov/32812270/ (A)
- Lu, P. H., & Hsu, C. H. (2016). Does supplementation with green tea extract improve acne in post-adolescent women? A randomized, double-blind, and placebo-controlled clinical trial. Complementary Therapies in Medicine, 25, 159–163. https://pubmed.ncbi.nlm.nih.gov/27062963/ (B)
- Malhi, H. K., Tu, J., Riley, T. V., Kumarasinghe, S. P., & Hammer, K. A. (2017). Tea tree oil gel for mild to moderate acne; a 12 week uncontrolled, open-label phase II pilot study. The Australasian Journal of Dermatology, 58(3), 205–210.
- Mata, I. R. da, Mata, S. R. da, Menezes, R. C. R., Faccioli, L. S., Bandeira, K. K., & Bosco, S. M. D. (2020). Benefits of turmeric supplementation for skin health in chronic diseases: a systematic review. Critical Reviews in Food Science and Nutrition, 1–15. https://pubmed.ncbi.nlm.nih.gov/32713186/ (A)
- Michaëlsson, G., Juhlin, L., & Ljunghall, K. (1977). A double-blind study of the effect of zinc and oxytetracycline in acne vulgaris. The British Journal of Dermatology, 97(5), 561–566. https://pubmed.ncbi.nlm.nih.gov/145237/ (C)
- Michaëlsson, G., Juhlin, L., & Vahlquist, A. (1977). Effects of oral zinc and vitamin A in acne. Archives of Dermatology, 113(1), 31–36. https://pubmed.ncbi.nlm.nih.gov/137693/ (C)
- Mueller, E. A., Trapp, S., Frentzel, A., Kirch, W., & Brantl, V. (2011). Efficacy and tolerability of oral lactoferrin supplementation in mild to moderate acne vulgaris: an exploratory study. Current Medical Research and Opinion, 27(4), 793–797. https://pubmed.ncbi.nlm.nih.gov/21303195/ (C)
- Purdy, S., & de Berker, D. (2011). Acne vulgaris. BMJ Clinical Evidence, 2011. https://pubmed.ncbi.nlm.nih.gov/21477388/ (A)
- Sharquie, K. E., Al-Turfi, I. A., & Al-Shimary, W. M. (2006). Treatment of acne vulgaris with 2% topical tea lotion. Saudi Medical Journal, 27(1), 83–85. https://pubmed.ncbi.nlm.nih.gov/16432600/ (C)
- Vaughn, A. R., Branum, A., & Sivamani, R. K. (2016). Effects of Turmeric (Curcuma longa) on Skin Health: A Systematic Review of the Clinical Evidence. Phytotherapy Research: PTR, 30(8), 1243–1264. https://pubmed.ncbi.nlm.nih.gov/27213821/ (A)
- Verma, K. C., Saini, A. S., & Dhamija, S. K. (1980). Oral zinc sulphate therapy in acne vulgaris: a double-blind trial. Acta Dermato-Venereologica, 60(4), 337–340. https://pubmed.ncbi.nlm.nih.gov/6163281/ (B)
- Yee, B. E., Richards, P., Sui, J. Y., & Marsch, A. F. (2020). Serum zinc levels and efficacy of zinc treatment in acne vulgaris: A systematic review and meta-analysis. Dermatologic Therapy, 33(6), e14252. https://pubmed.ncbi.nlm.nih.gov/32860489/ (A)
- Yoon, J. Y., Kwon, H. H., Min, S. U., Thiboutot, D. M., & Suh, D. H. (2013). Epigallocatechin-3-gallate improves acne in humans by modulating intracellular molecular targets and inhibiting P. acnes. The Journal of Investigative Dermatology, 133(2), 429–440. https://pubmed.ncbi.nlm.nih.gov/23096708/ (C)
Fullscript content philosophy
At Fullscript, we are committed to curating accurate, and reliable educational content for practitioners and patients alike. Our educational offerings cover a broad range of topics related to integrative medicine, such as supplement ingredients, diet, lifestyle, and health conditions.
Medically reviewed by expert practitioners and our internal Integrative Medical Advisory team, all Fullscript content adheres to the following guidelines:
- In order to provide unbiased and transparent education, information is based on a research review and obtained from trustworthy sources, such as peer-reviewed articles and government websites. All medical statements are linked to the original reference and all sources of information are disclosed within the article.
- Information about supplements is always based on ingredients. No specific products are mentioned or promoted within educational content.
- A strict policy against plagiarism is maintained; all our content is unique, curated by our team of writers and editors at Fullscript. Attribution to individual writers and editors is clearly stated in each article.
- Resources for patients are intended to be educational and do not replace the relationship between health practitioners and patients. In all content, we clearly recommend that readers refer back to their healthcare practitioners for all health-related questions.
- All content is updated on a regular basis to account for new research and industry trends, and the last update date is listed at the top of every article.
- Potential conflicts of interest are clearly disclosed.