The word "acne" originates in the Greek word "akme" pluralized as "akmas" meaning "summit", "peak", "point" as in a mountain, the highest point. It was latinized in the 6th century as "aknas", switching the original "m" for an "n", resulting in the modern word "acne" for "pimple".
What is acne?
Acne is a complex skin condition and can be caused by many factors. It is also one of the most common skin conditions, affecting people all around the world, of all ages and ethnic origins.
Its main feature is the formation of pustules and papules in areas which are rich in sebaceous glands. It also provokes seborrhea.
Its effects can range from light (a few blackheads and pimples) to severe (abscesses, deep lesions and scarring).
It is prevalent among teenagers and young adults (11 to 30 years-old) due to the influence of androgenic hormones such as testosterone (in both women and men).
People in their 40s and 50s also suffer from it. It is more prevalent in developed countries than in less developed ones.
Acne is Caused by many factors
Several factors come together to provoke acne: thickening of the skin (which is known as hyperkeratosis) and increase in sebum production by pores, causing seborrhea (higher output of the oily secretion of the sebaceous glands, whose ducts open into the hair follicles of the skin).
These secretions cause inflammation and create an environment favorable for the proliferation of the acne-causing bacteria: Propionibacterium acnes.
Propionibacterium acnes is a rod-shaped Gram-positive and anaerobic bacterium so it thrives in environments without oxygen, like plugged pores. But it is also aerotolerant and can live in aireated environments too.
Diet, environment, sedentary lifestyle, genetic predisposition, hormonal, and psychological disorders are all invoked as contributing factors to the appearance of acne.
Blackheads and pimples
Overactive sebaceous glands produce more sebum and this makes the skin more greasy. Furthermore thickened skin (hyperkeratosis) blocks the hair follicles or pores, clogging them.
It is very noticeable on the face which is where we have the greatest number of sebaceous glands.
This "plug" consisting of keratin and sebum and bacterial breakdown producs adopts a dark color, which gives it its name: "blackhead".
The clogged pore also contains bacteria commonly found on our skin, which thrive in that greasy environment: propionibacterium acnes, staphylococcus albus and pityrosporon ovale.
The bacterial colonies cause inflammation, redness, swelling and the typical papules (pimples) of acne.
Treating Acne with Vinegar
The bad news: Apple cider vinegar does not clear up acne.
Why suggest using Vinegar to cure acne?
Conventional wisdom has it that apple cider vinegar (ACV) will work on acne because:
- Vinegar kills microbes
- Its acidic nature will remove dead skin and unclog pores and help to dissolve blackheads
But conventional wisdom isn't always right. Let's look into both of these false assumptions:
Apple Cider Vinegar's Antibacterial properties
Most bacteria tend to grow and thrive in a narrow pH range close to neutral (6.5 to 7.5 pH), therefore logic indicates that a very alkaline or a very acidic environment would destroy them or at least curtail their growth.
As ACV is acidic it should be a good disinfectant and kill microbes. Let's see what scientific tests show us:
Rund (1996) ( 1 ) does not recommend it for treating wounds; the team found that vinegar solutions were not effective in inhibiting the growth of group D Enterococcus, Escherichia coli or Bacteroides fragilis bacteria. It had a very limited effectiveness when applied to Staphylococcus aureus and Pseudomonas aeruginosa bacteria.
However Chen (2016) ( 2 ) found that it was an effective disinfectant on other bacteria: "apple vinegar strongly inhibits the growth of pathogenic bacteria such as Staphylococcus epidermidis, Pseudomonas aeruginosa, Proteus mirabilis, and Klebsiella pneumoniae".
Goodyear (2015) ( 3 ) studied household cleaners found that white vinegar at a 50% solution achieved a 5 log 10 reduction (meaning that the quantity of germs after cleaning was 100,000 times smaller) in microbial colonies on kitchen surfaces. Vinegar was more effective against Escherichia coli than Staphylococcus aureus.
Yang (2009) ( 4 ) found that white distilled vinegar with 5% acetic acid, undiluted applied for 10 minutes at room temperature (77°F - 25°C) was only effective against Salmonella, but not against Listeria monocytogenes or E. coli.
Burns (2009) ( 5 ) conducted an "in vitro" (from the Latin words "in glass", meaning a test involving microorganisms in petri dishes) trial using acetic acids in very low concentrations (3% - actually lower than those found in most vinegars). The trials compared the antimicrobial effect of this acetic acid solution against common ansteptics based on povidone-iodine, polyhexanide, chlorhexidine gluconate.
The outcome was that the diluted acetic acid "showed similar -in some bacteria, even better- bactericidal properties" compared to currently used antiseptic solutions.
The trials involved: Escherichia coli, P. vulgaris, P. aeruginosa, A. baumannii, Enterococcus faecalis, Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus (MRSA) and beta-haemolytic Streptococcus group A and B.
But these were "in vitro" (or "test tube") trials, the authors were going to conduct an "in vivo" trial on live subjects to verify if the topical application of acetic acid is effective in killing bacteria on wounds.
They concluded that "acetic acid in a concentration of 3% has excellent bactericidal effect and, therefore, seems to be suitable as a local antiseptic agent", but cautioned that "further clinical studies are necessary".
None of these studies targeted the "acne-causing" bacteria: propionibacterium acnes, staphylococcus albus orpityrosporon ovale in a genuine "in vivo" trial.
ACV's acetic acid used on the skin
Regarding its use to exfoliate dead skin and remove excess sebum, the fact that ACV is a "natural" acid, formed by the action of microorganisms fermenting apple cider does not mean that it is harmless.
Apple cider vinegar is a dilute form of acetic acid, which despite being a weak acid, is nevertheless dangerous: ACV has many Side Effects
In the case of its use on the skin bear in mind that pure Apple Cider Vinegar can burn your skin.
Even if it is diluted in water it can still cause burns on sensitive skin.
ACV can damage the skin
Below we mention two incidents that caused burns using regular apple cider vinegar:
Be wary of internet recipes!, Feldstein (2015) ( 6 ) reports the case of a 14-year-old-girl who searched the Internet for a recipe to remove "ugly moles", the formulation included apple cider vinegar and it was promoted as a "natural remedy". The girl applied several drops of apple cider vinegar on her mole (which was located on her nose), and covered the area with bandages.
The treatment caused skin erosion irritation and significant reddening of the skin (erythema). The mole peeled off, but this kind of home-made treatments increase the risk of scarring, skin becoming darker (hyperpigmentation) and even a malignant transformation of a benign mole).
Feldstein warns that "common vinegars are weak acids that contain 4 to 8 percent acetic acid, which can erode the skin and cause significant chemical burns, especially when applied under occlusion.".
Bunick (2012) ( 7 ) reports chemical burns in an 8-year-old-boy treasted with apple cider vinegar by his mother: she had applied cotton balls soaked with ACV against his leg, next to his knee, covering them with adhesive bandages for a period of 8 hours. The child reported a strong burning sensation and developed a low fever and an irritant contact dermatitis chemical burn due to the vinegar.
Exfoliation of the skin with chemicals is a common practice to remove discolored skin and scars resulting from healed acne lesions. Kapuscinska (2015) ( 8 ) mentions the different "weak" organic acids used in "chemical peeling" of the skin:
- Alpha-hydroxyacids: such as glycolic acid, lactic acid, mandelic acid and citric acid.
- Beta-hydroxyacids (salicylic acid)
- Other organic acids: such as trichloroacetic acid and pyruvic acid
Acetic acid, the main acid component of vinegar which is not included in this list is a carboxylic acid. It is not used in peeling and can have side effects.
Warning: all these acids can cause redness, flaking and skin irritation, and also blistering, burning and skin discoloration. They should be applied by licensed skin care professionals only.
Yet some authors suggest using ACV...
We have found some refrences that suggesst using vinegar to treat acne, and we publish them with some reservations:
Ravisankar (2015) ( 9 ) proposes an acne remedy formulated with: 1 part of vinegar in 3 parts of water. The study suggests that the acetic acid (and also the malic and lactic acids in vinegar) will change the pH balance of the skin, making it alkaline which in turn weakens bacteria (in our opinion a ridiculous notion!). It ads that lemon juice used moderately will dry the excess oil and "flush pores".
A patent by Diane Bunker ( 10 ) mentions an exfoliating lotion for use in cases of acne:
- 35-50% vegetable oil (soybean oil, flax seed oil, sesame seed oil, sunflower oil, palm oil, palm kern el oil, avocado oil, olive oil, corn oil, safflower oil, peanut oil, canola oil, grape seed oil, and mixtures thereof)
- 15-30% sugar (dextrose, fructose, glucose, honey, invert sugar, lactose, maltose, and sucrose)
- 15-20% dilute acetic acid witha 4-8% concentration (this dilute acetic acid can be any kind of vinegar)
- 2.7-4.3% dehydrated egg yolk.
- 1-3% thickener (modified starch, agar and slica gel)
- 0.25-1% emulsifier (lecithin, carrageenin and lactose)
- 7% water
It is used to remove dead epidermal skin cells by rubbing the skin with it.
The patent states that vinegar is used for its biocide and antiseptic properties: "As acetic acid is a well-known anti-bacteriological agent, the inclusion of that compound in the disclosed cosmetic and dermatalogical composition ensures that the composition will have significant antiseptic qualities".
Factors that cause acne
Kucharska (2016) ( 11 ) studied the role of diet in acne and its treatment and found two critical elements that influence the occurrance of acne vulgaris: Milk & diary products and Foods with a high glycemic index:
Milk and dairy products
Milk contains a chemical called insulin-like growth factor 1 (IGF-1) which stimulates the growth and proliferation of sebocytes which in turn causes the appearance of acne lesions.
Milk also contains hormones and precursors such as dihydrotestosterone (DHT) which stimulate production of sebum.
Skim milk has a more marked effect than whole milk probably due to the additon of whey proteins during its manufacture. It also contains less estrogen -which may help reduce acne.
The authors found that acne was positively associated with a reported quantity of milk ingested, particularly skim milk. The authors speculated that bioavailability of comedogenic compo
Several studies show a link between milk consumption and acne.
Glycemic index (GI)
GI is a relative ranking of carbohydrate conten in foods according to how they affect blood glucose levels. Carbohydrates (starches and sugars) impact on insulin production, increasing it, which in turn stimulates production of androgens (hormones) that increase production of sebum.
Insulin also increases levels of IGF-1 which, as mentioned further up promotes acne.
A high glycemic index diet may have a significant effect on the occurrence of acne
In this context, the antiglycemic properties of vinegar may help control acne:
Vinegar and its antiglycemic effects
A study by Shishehbor (2017) ( 12 ) found that "vinegar can be effective in reducing postprandial glucose and insulin levels..." meaning that it reduces insulin and sugar in blood after a meal (postprandial means "after a meal"), finding vinegar a "tool for improving glycemic control".
Another study, Johnston (2004) ( 13 ) found that "Vinegar improves insulin sensitivity to a high carbohydrate meal ... even in individuals with marked insulin resistance".
Other factors influencing acne
Kucharska also looked into other factors, and reached the following conclusions:
- Dietary fiber: two studies showed that fiber may improve skin condition.
- Chocolate they did not find a correlation between chocolate ingestion and acne. The issue remains open.
- Fatty acids (omega-3, fish-oil derived EPA) may reduce inflammation and reduce symptoms of acne.
- Antioxidants, unclear role but Selenium and flavonoids found in green tea seem to have a positive effect against acne.
- Zinc: oral supplements are effective, but has side effects.
- Vitamin A. Astudy showed that it was effective at high doses, but also had side effects.
Point in favor of ACV: its antioxidant properties may help to treat acne if the product is ingested.
Conventional Medical Treatment for Acne
Having reviewed the use of acne and the different factors that may lead to acne outbreaks, our suggestion is to follow a traditional approach to treating acne and to introduce some changes along the lines of Kucharska's study into your lifestyle (replace skim milk with whole milk and reduce your intake of high GI foods).
The usual treatment is to apply anti-microbials to eliminate bacterial infection, so benzoyl peroxide or topical antibiotics are used for this purpose.
Benzoyl peroxide is a topical disinfectant and an antibacterial agent effective against P. acnes, it has no effect on sebum production.
Erythromycin orn Clindamycin are antibiotics that are applied topically against P. acnes.
The use of exfoliants to remove dead skin layers and sebum from the outer sections of hair follicles also help alleviate these symptoms.
Oral antibiotics are used in serious cases, and also topical retionids. However the continuous use of antibiotics has led to the increasing development of resistance by the P. acnes strains.
For a mild acne you could try an over-the-counter treatment, and if the case is more severe visit a dermatologist who can prescribe a treatment suitable for your needs.
Vinegar has potential in treating health conditions such as high blood pressure, cholesterol, blood sugar, and body weight issues, but in our opinion it is ineffective against acne.
It can also cause burns if applied on sensitive skins so please visit our webpage where we discuss its Side Effects:
Learn about Apple Cider Vinegar Side Effects at our:
Apple Cider Vinegar Side Effects
Dental enamel erosion, loss of potassium and some interactions with diabetic patients... Read more.
Cite this article:
A. Whittall. ©2018. Apple Cider Vinegar acne. Patagonia Wellness, 11 Oct. 2018 http://www.patagoniawellness.com/health/apple-cider-vinegar-acne.html
Subject: Apple cider vinegar and acne. Is Apple Cider Vinegar a treatment for acne?
References and Further Reading
(1) Rund CR. (1996). Nonconventional topical therapies for wound care. Ostomy Wound Manage, 1996;42:22-24.h
(2) Hengye Chen, Tao Chen, Paolo Giudici, Fusheng Chen, (2016). Vinegar Functions on Health: Constituents, Sources, and Formation Mechanisms, https://doi.org/10.1111/1541-4337.12228 Comprehensive Reviews in Food Science and Food Safety Vol 15:6 Nov 2016, 1124-1138
(3) Goodyear N, Brouillette N, Tenaglia K, Gore R, Marshall J., (2015). The effectiveness of three home products in cleaning and disinfection of Staphylococcus aureus and Escherichia coli on home environmental surfaces, J Appl Microbiol. 2015 Nov;119(5):1245-52. doi: 10.1111/jam.12935
(4) Yang, H., Kendall, P., Medeiros, L., Sofos, J. (2009). Inactivation of Listeria monocytogenes, Escherichia coliO157:H7, and Salmonella Typhimurium with compounds available in households, I. J. Food Prot. 72(6); 1201-1208
(5) Burns (2009). The antimicrobial effect of acetic acid - an alternative to common local antiseptics?, Aug;35(5):695-700. doi: 10.1016/j.burns.2008.11.009.
(6) Stephanie Feldstein, Maryam Afshar, and Andrew C. Krakowski, (2015). Chemical Bum from Vinegar Following an Internet-based Protocol for Self-removal of Nevi, J Clin Aesthet Dermatol. 2015 Jun; 8(6): 50.
(7) Christopher G. Bunick, et al., (2012). Chemical burn from topical apple cider vinegar, JAAD October 2012 Vol 67:4, e143-e144 https://doi.org/10.1016/j.jaad.2011.11.934
(8) Kapuscinska A, Nowak I, (2015). Use of organic acids in acne and skin discolorations therapy, Postepy Hig Med Dosw (Online). 2015 Mar 22;69:374-83
(9) P. Ravisankar et al. (2015), Acne causes and amazing remedial measures for acne, Indo American Journal of Pharmaceutical Research, 2015 ISSN NO: 2231-6876
(10) Diane Bunker (2004). Patent application US20070031363A1, US Application, 2004-06-18
(11) Alicja Kucharska, Agnieszka Szmurlo, and Beata Sinska, (2016). Significance of diet in treated and untreated acne vulgaris, Postepy Dermatol Alergol. 2016 Apr; 33(2): 81-86. Published online 2016 May 16. doi: 10.5114/ada.2016.59146
(12) Shishehbor F, Mansoori A, Shirani F., (2017). Vinegar consumption can attenuate postprandial glucose and insulin responses; a systematic review and meta-analysis of clinical trials , Diabetes Res Clin Pract. 2017 May;127:1-9. doi: 10.1016/j.diabres.2017.01.021. Epub 2017 Mar 2
(13) Johnston CS, Kim CM, Buller AJ, (2004). Vinegar improves insulin sensitivity to a high carbohydrate meal in subjects with insulin resistance or type 2 diabetes mellitus, Diabetes Care. 2004;27:281-282