Acne is most common at puberty due to increased levels of the male sex hormone testosterone.  Although men have higher levels of testosterone than women, during puberty there is an increase of testosterone in both sexes, making girls in this age group just as susceptible to acne.  Testosterone causes the sebaceous glands to enlarge and produce more sebum.  In addition, the cells that line the skin pore produce more keratin, a waxy protein.  The combination of increased secretion of sebum and keratin can lead to blockage of the pore and the formation of a blackhead.  With the blockage of the pore, bacteria are allowed to overgrow and release enzymes that break down sebum and promote inflammation.  This process can lead to the formation of a whitehead or pimple.  If there is no passageway to discharge the contents to the surface of the skin, it can lead to a cyst or boil (a deep nodule full of white blood cells and fluid)

In addition to a healthy diet, a few specific food prescriptions are in order.  All refined carbohydrates and fried foods must be eliminated, and foods containing trans-fatty acids (margarine, shortening, and other synthetically hydrogenated vegetable oils) or oxidized fatty acids (fried oils) should be avoided, as these foods may aggravate acne.  Consumption of milk and milk products should also be limited or eliminated due to their potential hormone content.  Specific nutrients have been shown to exert a positive effect in treating acne.  They include zinc, vitamin A, selenium, vitamin E, and chromium (brewers yeast).  Zinc, in particular, is vitally important in the treatment of acne.  As discussed, in the section on zinc, this important mineral plays a role in the action of many hormones as well as in wound healing, the immune response, and tissue regeneration.  As it relates to acne, too little zinc seems to enhance the effect of testosterone on increasing sebum and keratin secretion and makes it difficult for the skin to heal quickly.  Zinc supplementation in the treatment of acne has been the subject of much controversy and many double-blind studies.  However, the inconsistency of the results may be due to differences in absorption of the various zinc salts used.  For example, studies using effervescent zinc sulfate show effectiveness similar to that of the antibiotic tetracycline (with fewer side effects from chronic use) while those using plain zinc sulfate have shown less beneficial results.  The majority of patients required twelve weeks of supplementation before good results were achieved, although some showed dramatic improvement immediately.  Zinc levels are lower in 13 and 14 year old males than in any other age group, so it is particularly important for this group to supplement, and the best way to do that is through natural food sources.  Foods rich in zinc include most nuts, whole grains, and legumes.  Also important are dietary antioxidants, as male acne patients have significantly decreased levels of antioxidant enzymes.  This normalizes when vitamin E and selenium are supplemented in the diet.  What's more, the acne of both men and women improves with this treatment.  This improvement is probably due to inhibition of lipid peroxide formation and suggests the use of other antioxidants.  In addition to regular daily consumption of 1/4 to 1/2 cup of raw nuts and seeds, supplementing the diet with selenium (100 to 200 microgram per day) and vitamin E (200 to 400IU per day) appears indicated.  Brewer's yeast may also be of benefit in healing acne.  In one double-blind study, in more than 80 percent of the patients given brewer's yeast, the acne was either completely healed or considerably improved after 5 months of use, while the corresponding figure among those receiving a placebo was only 26 percent.  This improvement was thought to be to the high content of chromium within the brewer's yeast, though other nutrients may also have been responsible.  The widespread belief that chocolate per se causes or aggravates acne is apparently not true. Two studies, one conducted at the Pennsylvania School of Medicine and the other at the U.S Naval Academy, eating chocolate did not produce any significant changes in the acne conditions of study participants.  Nonetheless, we recommend that individuals with acne choose dark chocolate since it has the highest levels of anti-inflammatory phenols and that they avoid sweet chocolate products (too much sugar!) and those that contain trans-fatty acids.  Milk chocolate should also be avoided to to the high hormone content of most commercially available milk.

Here are six additional recommendations that should help to clear up acne:
1.  Avoid medications that contain bromides or iodides.
2.  Avoid exposure to oils and greases.
3.  Avoid the use of greasy creams or cosmetics.
4.  Thoroughly cleanse the face daily with sulfur-containing soap or a suitable alternative, such as calendula soap.
5.  Extract blackheads every two to three days, and have cystic lesions incised and drained by a physician every two weeks.
6.  Topical treatment with tea tree oil has produced results equal to those of benzoyl peroxide, but with fewer side effects.