Author(s): Jessica E Hesthammer, Cristina Olteanu and Jaggi Rao

Abstract: Acne vulgaris (AV) is one of the most common skin disorders in the world, costing the US alone 3 billion dollars in treatment costs and productivity losses. AV is an inflammatory disorder involving the pilosebaceous unit resulting from the interplay of genetics, hormonal influences, immune function, and environmental factors. The complex pathogenesis involves dysbiosis of the hair follicle and sebaceous gland microbiome, bacterial colonisation by Cutibacterium acnes, androgen-dependent stimulation, and innate and acquired immune responses. This leads to non-inflammatory lesions, such as open and closed comedones, and inflammatory lesions, such as pustules, nodules, and cysts. Although AV is not physically disabling, the psychological impact drives many people to seek treatment. Typical medical treatment for those suffering from AV include topical therapies, systemic antibiotics, hormonal agents, and retinoids. Because of side effects associated with these medications, patients will seek out "natural" treatments. There are numerous misconceptions about the benefits of oral supplements and herbal remedies. In this review, we discuss probiotics, antioxidants, omega 3 fatty acids, nicotinamide, and herbal remedies founded in Traditional Chinese Medicine (TCM) and their effectiveness. We found that there is some evidence for nicotinamide, antioxidants, and probiotics as adjuvant therapies, but no evidence for use as monotherapy. Omega 3 fatty acid supplementation seems to be beneficial. Finally, the evidence for herbal remedies in the treatment of AV is too limited and the quality too poor to recommend them. Based on these results, dermatologists should keep complimentary oral supplements in their repertoire for patient care.