Can Topical Zinc Improve Acne?
It May Help When Combined with Other Treatments
From the research we have thus far, topical zinc by itself is unlikely to clear acne. But researchers have studied only a small number of zinc compounds for their effectiveness in treating acne, so more research is needed to identify what zinc compound, if any, may prove beneficial in treating or preventing acne.
Zinc is an essential micronutrient, meaning that it is an important molecule that the body requires in small amounts. The human body contains around 2 - 3g of zinc, which equates to about half of a teaspoon. Zinc activates over 300 different proteins that work in almost every part of the body, though 90% of zinc is found in the muscle and bone. These zinc-activated proteins promote proper growth, immune function, wound healing, blood clotting, thyroid function, and more in nearly every organ. People obtain zinc through the diet, especially through meats, seafood, dairy, nuts, legumes, and whole grains.
Zinc deficiency can cause mild to severe symptoms throughout the body, including the skin. Zinc deficiency may lead to the development of acne as well as some other skin disorders. Generally, zinc deficiency is treated with an oral zinc supplement, but many forms of topical zinc also exist, and scientists are interested to learn how topical zinc may affect the skin. Research shows that some topical zinc compounds in combination with other acne medications may be beneficial for those with acne-prone skin.1,2
Topical Zinc Compounds
Left to its own accord, zinc does not penetrate the skin. This inability makes zinc an effective ingredient in sunscreen since it sits on top of the skin where it absorbs and reflects the sun's rays. In an attempt to create zinc compounds that can penetrate the skin, and aid in treating skin diseases, including acne, scientists have created new zinc compounds:
- zinc sulfate
- zinc acetate
- zinc ascorbate
The differences in the type of zinc can cause slight changes in how the zinc compound acts on the skin. For example, research demonstrates that, when used alone, zinc sulfate has little effect on acne, whereas zinc ascorbate may reduce levels of acne-associated bacteria on the skin.3
The Effect of Zinc on Acne
The Effect of Zinc in Combination with a Topical Antibiotic on Acne
Researchers have performed one study examining the effect of both topical zinc and erythromycin on acne. Erythromycin is a topical antibiotic that sometimes is used to treat acne. These studies found that topical zinc in combination with erythromycin can improve acne:
Expand to read details of study
A 1980 study published in the Journal of the American Academy of Dermatology examined the effect of topical zinc combined with erythromycin on acne. To perform the study, the researchers divided a group of 141 study participants into four groups:
- Group 1 applied a 1.2% zinc acetate and 4% erythromycin liquid twice daily for 10 weeks.
- Group 2 applied a 1.2% zinc octoate and 4% erythromycin gel twice daily for 10 weeks.
- Group 3 took a 250mg oral antibiotic twice daily for 10 weeks.
- Group 4 was the control group, which did not apply a solution or take a supplement.
Researchers examined the participants every two weeks for the full 10-week study period for a reduction in acne severity and number of acne lesions. They measured acne severity by calculating both the number and type of acne lesion that covered the face and assigned it to a grading scale of 0 - 8. For example, an acne severity grade of 2 meant that ¼ of the face was covered with small papules and comedones (clogged pores), whereas an acne severity grade of 6 meant that ¾ of the face was covered with large papules and comedones.
In the study's conclusion, the researchers found that the zinc acetate/erythromycin solution resulted in a 38% decrease in overall acne severity and that the erythromycin/zinc octoate solution resulted in a 28% decrease. This was equivalent to the third group's acne severity decrease, suggesting that both topical zinc/erythromycin combinations were as equally effective at reducing acne as the oral antibiotic taken by the third group. Interestingly, the zinc acetate/erythromycin liquid was the only combination that resulted in fewer acne lesions, decreasing from an average of 29 to 20 over the course of the study. Although this study shows that a zinc/erythromycin combination was effective at reducing acne severity and number of lesions, it did not examine the effectiveness of topical zinc by itself. Therefore, the researchers concluded that zinc acetate and zinc octoate were effective at reducing acne severity when used in combination with erythromycin. We cannot conclude that it has the same effect on acne as the zinc/erythromycin combinations.4
The Effect of Zinc Compounds by Themselves on Acne
Researchers have performed two studies examining whether topical zinc sulfate is effective at improving acne when applied by itself instead of in combination with other substances, like erythromycin or other antibiotics. This research found that zinc sulfate on its own is not an effective acne treatment. However, scientists have only studied zinc sulfate on its own and have not performed research examining the effectiveness of other topical zinc formulations such as zinc acetate and zinc octoate.
Expand to read details of studies
A 1985 study published in the International Journal of Dermatology examined whether topical zinc sulfate was effective in the treatment of acne. To perform the study, the researchers divided 30 participants with mild to moderate acne into two groups:
- Group 1 applied a topical 2% zinc sulfate solution three times daily for 12 weeks.
- Group 2 applied a topical control solution, which contained no zinc, three times daily for 12 weeks.
After 12 weeks, the researchers found that no change in acne occurred in either group. However, participants who applied the zinc solution did report skin irritation as a side effect, so the researchers concluded that "topical zinc therapy alone is not a significant benefit in the treatment of acne."5
A 2008 study published in the Saudi Medical Journal compared the effectiveness of a 5% zinc sulfate solution to that of a 2% tea solution in the treatment of acne. To perform the study, 47 participants with mild acne were assigned to two groups:
- Group 1 applied a 5% zinc sulfate solution twice daily for two months.
- Group 2 applied a 2% tea solution twice daily for two months.
At the end of the study, the researchers observed that 15% of the participants using the zinc sulfate solution experienced at least a 50% reduction in the number of acne lesions; 50% of participants had a 10 - 50% reduction, and 35% had less than a 10% reduction. Overall, the zinc sulfate solution caused the average number of papules to decrease from 19.5 to 14.4 and of pustules to decrease from 19.4 to 15.2. These papule and pustule counts were not statistically significant, meaning that the observed decrease in acne lesions could be due just to random variations in acne lesion counts and not due to the treatment. Further, the study reported that 25% of patients reported a burning sensation, and 10% of patients reported an itching sensation after using the zinc sulfate solution. This study concluded that zinc sulfate was not an effective treatment for acne.6
How Might Zinc Help with Acne?
Although the research thus far has found that topical zinc sulfate is not effective on its own for treating acne, zinc, in general, still remains an interesting area of study because of how important zinc is to our bodies, particularly our skin. So far, studies have included zinc when looking at skin oil (sebum) secretion and acne bacteria (P. acnes).
First, let's look at what sebum and P. acnes are and then we'll look at the, so far, quite weak evidence that topical zinc might help.
- Sebum is skin oil, which is produced by glands attached to the sides of a hair follicle. Acne-prone skin tends to produce excess sebum, which can build up inside a pore to form a clogged pore, leading to acne.
- P. acnes is a type of bacteria that is found in both healthy and acne-prone skin. A clogged pore contains an excess of sebum but little to no oxygen, and P. acnes thrives in such environments. This causes an overgrowth of the bacteria inside the pore, which can make a simple clogged pore turn into a larger, red, sore lesion, such as a papule or pustule.
Scientists have performed several studies examining the effect of topical zinc along with erythromycin on sebum production and on P. acnes growth and found that certain topical zinc compounds, when combined with erythromycin, may be able to decrease the amount of sebum produced and kill P. acnes bacteria. But could zinc help with either sebum or P. acnes on its own? That remains unknown.
Effect of Zinc on Sebum Production
Researchers have performed two studies examining the effect of topical zinc compounds, along with erythromycin, on sebum production. These studies found that topical zinc acetate + erythromycin is effective at reducing sebum secretion.
Expand to read details of studies
A 1993 study published in the journal of Clinical and Experimental Dermatology examined whether an erythromycin/zinc acetate solution was effective at reducing sebum production. To perform the study, the researchers had five men apply a solution of 4% erythromycin and 1.2% zinc acetate to half of their forehead twice daily for 18 weeks. The second half of the forehead was not treated but served as the study's control. The researchers evaluated sebum output once every three weeks. They found that after nine weeks of treatment, the solution decreased sebum production and that this decrease lasted until the end of the study. The researchers concluded that an erythromycin/zinc acetate solution was effective at reducing sebum secretion. However, this study did not examine whether zinc by itself has the same effect on sebum secretion as it did in combination with erythromycin.7
A 1995 study published in the European Journal of Clinical Pharmacology examined what effect zinc had on decreasing sebum secretion when used as zinc acetate in combination with erythromycin. To perform the study, the researchers had 14 participants apply a solution of 4% erythromycin and 1.2% zinc acetate on the left half of their forehead and a 4% erythromycin solution, with no zinc, on the right side of their forehead twice daily for 12 weeks. At the end of the study, the researchers found that only the zinc/erythromycin solution reduced sebum secretion, by 20%. This led the researchers to conclude that zinc was necessary in the solution to cause the observed reduction in sebum secretion.8
Effect of Zinc on P. Acnes
Researchers have performed two studies examining the effect of topical zinc compounds, along with erythromycin, on P. acnes. These studies found that topical zinc acetate + erythromycin is effective at reducing the number of P. acnes in the skin of acne patients. The studies found also that zinc ascorbate, when put into a petri dish with P. acnes, could limit the growth of the P. acnes bacteria.
Expand to read details of studies
A 1984 study published in the Journal of the American Academy of Dermatology examined what effect a zinc/erythromycin solution had on the number of P. acnes in the skin of acne patients. To perform the study, the researchers divided the 22 participants into two groups:
- Group 1 applied a 1.2% zinc acetate and 4% erythromycin solution to their skin twice daily for 10 weeks.
- Group 2 applied a placebo solution, without zinc acetate and erythromycin, to their skin twice daily for 10 weeks.
The researchers found that after 10 weeks, the group receiving the zinc/erythromycin treatment had a decreased number of P. acnes on their skin, from an average of 2.93 to 0.97 million bacteria. Further, the treatment group noticed a 59% decrease in the number of inflammatory acne lesions, while the placebo group had only a 13% decrease. The researchers concluded that the zinc acetate/erythromycin solution was able to decrease the number of P. acnes on the skin.9
A 2011 study published in the journal of Clinical, Cosmetic, and Investigational Dermatology studied whether zinc was able to kill P. acnes in a laboratory setting. To perform the study, the researchers isolated samples of this bacteria from the skin of patients with acne. It was then stored in a laboratory and treated with either zinc ascorbate or zinc ascorbate in combination with the antibiotics, clindamycin, erythromycin, or chloramphenicol. They found zinc ascorbate was able to stop the growth of P. acnes at a small concentration of 0.064%, which included clindamycin-resistant strains. They concluded that zinc ascorbate may be useful in preventing the excessive growth of P. acnes in acne-prone skin. However, scientists need to perform this research in the skin of acne patients in order to confirm that it prevents acne in a real-life setting.10
In short, topical zinc, on its own, has not been shown to be an effective treatment for acne. Zinc combined with the antibiotic erythromycin may aid in the prevention of acne formation by reducing the amount of sebum and P. acnes bacteria in the skin, but we don't yet know if any topical zinc compounds on their own will help with acne.
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- Iinuma, K. et al. Susceptibility of Propionibacterium acnes isolated from patients with acne vulgaris to zinc ascorbate and antibiotics. Clin Cosmet Investig Dermatol 4, 161 - 5 (2011).