Complementary/alternative therapies: Recommendations

What is the effectiveness and what are the potential side effects of complementary/alternative therapies in the treatment of adult acne and acne vulgaris in adolescents to adults, including:

  • Herbal agents
  • Homeopathy
  • Psychological approaches
  • Massage therapy
  • Hypnosis/biofeedback

Herbal and alternative therapies have been used to treat acne. Although most of these products appear to be well tolerated, very limited data exist regarding the safety and efficacy of these agents to recommend their use in acne.    

  Strength of Recommendation  Level of Evidence 
Complementary and alternative therapies
(tea tree oil, herbal, biofeedback) 

Two clinical trials have shown that topical tea tree oil is effective for the treatment of acne.150,151 In 1 study, it was comparable to BP but better tolerated. Other herbal agents, such as topical and oral ayurvedic compounds, oral barberry extract, and gluconolactone solution have been reported to have value in the treatment of acne.152-155

The psychological effects of acne may be profound, and it is the opinion of the expert work group that effective acne treatment can improve the emotional outlook of patients. There is weak evidence of the possible benefit of biofeedback-assisted relaxation and cognitive imagery.156,310


150. Bassett IB, Pannowitz DL, Barnetson RS. A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne. Med J Aust. 1990;153:455-458.

151. Enshaieh S, Jooya A, Siadat AH, Iraji F. 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. 2007;73:22-25.

152.Fouladi RF. Aqueous extract of dried fruit of Berberis vulgaris L. in acne vulgaris, a clinical trial. J Diet Suppl. 2012;9:253-261.

153. Hunt MJ, Barnetson RS. A comparative study of gluconolactone versus benzoyl peroxide in the treatment of acne. Australas J Dermatol. 1992;33:131-134.

154. Lalla JK, Nandedkar SY, Paranjape MH, Talreja NB. Clinical trials of ayurvedic formulations in the treatment of acne vulgaris. J Ethnopharmacol. 2001;78:99-102.

155. Paranjpe P, Kulkarni PH. Comparative efficacy of four Ayurvedic formulations in the treatment of acne vulgaris: a double-blind randomised placebo-controlled clinical evaluation. J Ethnopharmacol. 1995;49:127-132.

156. Hughes H, Brown BW, Lawlis GF, Fulton JE Jr. Treatment of acne vulgaris by biofeedback relaxation and cognitive imagery. J Psychosom Res. 1983;27:185-191.

310. Kim KS, Kim YB. Anti-inflammatory effect of Keigai-rengyo-to extract and acupuncture in male patients with acne vulgaris: a randomized controlled pilot trial. J Altern Complement Med. 2012;18:501-508. 

View the AAD guidelines disclaimer.