Apple Cider Vinegar for treating acne
Can ACV cure your acne?
First published: 11.Oct.2018
There are plenty of online resources and publications recommending the use of apple cider vinegar (ACV) as a "natural" treatment for acne.
But, does it actually work?
Is it safe?
In this article, we will review what causes acne, how to treat it, and if ACV is a good treatment or not.
Learn the true facts and the science behind the causes of acne and how to treat it.
Evidence-based data is always your best choice. It will help you make better decisions.
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 that 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 an 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 acne-causing bacteria: Propionibacterium acnes (P. acnes for short).
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 aerated 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 products 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
First, 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) does not recommend it for treating wounds (1); Rund found that vinegar solutions were not effective in inhibiting the growth of Group D Enterococcus, Escherichia coli or Bacteroides fragilis bacteria. It had limited effectiveness when applied to Staphylococcus aureus and Pseudomonas aeruginosa bacteria.
However Chen et al. (2016) found that it was an effective disinfectant on other bacteria (2): "apple vinegar strongly inhibits the growth of pathogenic bacteria such as Staphylococcus epidermidis, Pseudomonas aeruginosa, Proteus mirabilis, and Klebsiella pneumoniae".
Goodyear et al. (2015) studied household cleaners found that white vinegar at a 50% solution achieved a 5 log 10 reduction (meaning that the number of germs after cleaning was 100,000 times smaller than the initial quantity) in microbial colonies on kitchen surfaces. Vinegar was more effective against Escherichia coli than Staphylococcus aureus (3).
Yang (2009) found that undiluted white distilled vinegar with 5% acetic acid applied for 10 minutes at room temperature (77°F - 25°C) was only effective against Salmonella, but not against Listeria monocytogenes or E. coli (4).
Burns (2009) 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) (5).
This study compared the antimicrobial effect of this acetic acid solution against common antiseptics based on povidone-iodine, polyhexanide, chlorhexidine gluconate.
The outcome showed 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-hemolytic 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 or pityrosporon ovale in a genuine "in vivo" trial.
Applying Apple cider vinegar 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
Caution: 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) reported the case of a 14-year-old-girl who searched the Internet for a recipe to remove "ugly moles" (6).
The formulation she found 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 ate away the surface of her skin (skin erosion), irritation, and significant reddening of the skin (erythema). The mole peeled off, but this kind of home-made treatment increases the risk of scarring, may darken the skin (hyperpigmentation), and provoke a malignant transformation of a benign mole.
Feldstein warned 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) described chemical burns in an 8-year-old-boy treated with apple cider vinegar by his mother (7): She had applied cotton balls soaked with ACV against his leg, next to his knee, covering them with adhesive bandages for 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) mentions the different "weak" organic acids used in "chemical peeling" of the skin (8):
- Alpha-hydroxy acids: such as glycolic acid, lactic acid, mandelic acid, and citric acid.
- Beta-hydroxy acids (salicylic acid)
- Other organic acids: such as trichloroacetic acid and pyruvic acid
Acetic acid, the main acid component of vinegar (including apple cider vinegar) is not included in this list, because it is a potent carboxylic acid.
It is not used in peeling and can have side effects.
Warning: all of these acids mentioned above can cause redness, flaking, and skin irritation, and also blistering, burning, and skin discoloration. They should be applied by licensed skincare professionals only.
Yet some authors suggest using ACV!
We have found some references that suggest the use of vinegar to treat acne, and we mention them below with some reservations:
Ravisankar (2015) proposes an acne remedy formulated with (9): 1 part of vinegar in 3 parts of water. The study suggests that the acetic acid (and also the malic and lactic acids present in vinegar) will change the pH balance of the skin, making it alkaline which in turn weakens bacteria (in our opinion a surprising notion!). It also states that lemon juice used moderately will dry the excess oil and "flush pores".
Diane Bunker filed a U.S. patent application for an exfoliating lotion for use in cases of acne; its formula is shown below (10):
- 35-50% vegetable oil (soybean oil, flaxseed oil, sesame seed oil, sunflower oil, palm oil, palm kernel 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 with a 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 silica gel).
- 0.25-1% emulsifier (lecithin, carrageenin and lactose).
- 7% of water.
This lotion 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 dermatological composition ensures that the composition will have significant antiseptic qualities".
Factors that cause acne
Kucharska (2016) studied the role of diet in acne and its treatment and found two critical elements that influence the occurrence of acne vulgaris: Milk & dairy products and Foods with a high glycemic index (11):
Milk and dairy products
Milk contains a chemical called insulin-like growth factor 1 (IGF-1) which stimulates the growth and proliferation of sebocytes. Sebocytes are specialized cells found in the outer layer of the skin that produce sebum.
An excess of sebocytes may provoke the appearance of acne lesions.
Milk also contains hormones and substances that are hormone precursors such as dihydrotestosterone (DHT) which stimulate the production of sebum.
Skim milk has a more marked effect than whole milk probably due to the addition of whey proteins during its manufacture -whey is linked via increase insulin levels to male hormones and acne (12). It also contains less estrogen, and since estrogen helps suppress acne, this is a disadvantage when trying to avoid acne (13).
The authors found that acne was positively associated with a reported quantity of milk ingested, particularly skim milk: More milk, more acne.
Glycemic index (GI)
GI is a relative ranking of the carbohydrate content in foods according to how they affect blood glucose levels.
Refined sugars and highly processed carbohydrates (bread, cookies, pasta, starchy vegetables) are foods with a high GI which increases insulin production. Insulin stimulates the production of androgens (hormones) that in turn increase sebum output.
Insulin also increases levels of IGF-1 which, as mentioned further up, also promotes acne.
A high glycemic index diet may have a significant effect on the occurrence of acne.
This is the reason for suggesting that a diet with a low GI may help prevent acne (avoiding sugar, eating whole grains and fiber, fruit, green leafy vegetables, etc.).
In this context, the anti glycemic properties of vinegar may help control acne:
Vinegar and its anti glycemic effects
A study by Shishehbor (2017) found that "vinegar can be effective in reducing postprandial glucose and insulin levels..." meaning that it reduces insulin and sugar in the blood after a meal (postprandial means "after a meal"), finding vinegar a "tool for improving glycemic control" (14).
Another study by Johnston (2004) reported that "vinegar improves insulin sensitivity to a high carbohydrate meal ... even in individuals with marked insulin resistance" (15).
Other factors influencing acne
Kucharska also looked into other factors that could provoke acne, 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 zinc has side effects.
- Vitamin A. One study showed that it was effective at high doses, but it also had side effects.
A 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 lifestyle changes along the lines of Kucharska's study; such as replacing skim milk with whole milk and reduce the intake of high GI foods, substituting them with low GI ones.
The usual treatment is to apply antimicrobials to eliminate bacterial infection. Benzoyl peroxide or topical antibiotics are used for this purpose. (16).
Benzoyl peroxide is a topical disinfectant and an antibacterial agent effective against P. acnes, yet it has no effect on sebum production.
Erythromycin or 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 acne symptoms.
Oral antibiotics are used in serious cases, and also topical retinoids (16). However, the continuous use of antibiotics has led to the increasing development of resistance by the P. acnes strains.
For mild acne, you could try an over-the-counter treatment. However, self-medication is never the answer, and we recommend that you visit a dermatologist who can prescribe a treatment suitable for your needs.
Vinegar has the 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 before using it on your skin:
> > Side effects of Apple Cider Vinegar.
The risks and adverse effects of ACV.
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) Heng, A. and Chew, F. T. (2020). Systematic review of the epidemiology of acne vulgaris. Scientific reports, 10(1), 5754. https://doi.org/10.1038/s41598-020-62715-3
(13) Bansal, P., Sardana, K., Vats, G., Sharma, L., Garga, U. C., and Khurana, A. (2020). A Prospective Study Examining Trigger Factors and Hormonal Abnormalities in Adult Female Acne. Indian dermatology online journal, 11(4), 544–550. https://doi.org/10.4103/idoj.IDOJ_500_19
(14) 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
(15) 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
(16) Sagransky M, Yentzer BA, Feldman SR. (2009). Benzoyl peroxide: a review of its current use in the treatment of acne vulgaris. Expert Opin Pharmacother;10(15):2555-2562. doi:10.1517/14656560903277228
(17) Chivot M. (2005). Retinoid therapy for acne. A comparative review. Am J Clin Dermatol. 2005;6(1):13-19. doi:10.2165/00128071-200506010-00002
About this Article
Apple cider vinegar to treat acne, A. Whittall
©2018 Fit-and-Well.com, 11 Oct. 2018. Updated. 12 Sep. 2020. https://www.fit-and-well.com/health/apple-cider-vinegar-acne.html
Tags: Apple Cider Vinegar acne, glycemic index and acne, diet and acne, apple cider vinegar side effects, apple cider vinegar, ACV antimicrobial, ACV cleaners, ACV disinfectant, acetic acid, Apple Cider Vinegar uses
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