Acne Vulgaris is a common dermatological condition defined as a chronic inflammatory dermatosis of the pilosebaceous unit that affects more than 17 million Americans.^1 Although it is not considered a dangerous condition, it may drastically impair quality of life and leave a substantial psychological impact.^2 Acne’s multifactorial pathogenesis is typically categorized into four aspects: increased sebum production, altered keratinization, inflammation, and bacterial colonization.^3 Dietary factors contribution to the pathogenesis of acne has remained controversial throughout the literature. However, currently there exists a greater understanding between how diet may influence endocrine factors contributing to acne pathogenesis.^4 Additionally, recent published evidence and public paradigm shifts highlighting the relationship between diet and health have caused a resurgence of this topic, particularly among patients seeking a more gentle, alternate solution to current treatments. Some of the most promising recent correlating evidence supports an association between acne prevalence and dairy consumption, particularly skim milk consumption.^5 It is hypothesized that milk consumption affects the presence of both reproductive, non-reproductive hormones, and growth factors in our body, which may contribute to increased acne prevalence.^6 However, there has been a lack of randomized controlled trials to determine the cause and effects nature of this relationship, as all previous studies are observational.^1 Therefore, this study will conduct a randomized controlled trial to determine the significance between dietary non-fermented dairy consumption and acne prevalence in adolescents. We hypothesize the adaptation of a diet of decreased dairy consumption will decrease the prevalence or severity of acne vulgaris in adolescents between the ages of 13-18. It is our hope that the conclusion of this study will advance our understanding of the dietary correlation between dairy and acne vulgaris in order to provide further insight to guide medical practitioners’ ability to help treat this distressing condition.

Acne vulgaris is an extremely common disease, affecting large numbers of adolescents and adults, with substantial physical and psychosocial impacts. Antibiotics have been used for many years in the anti-microbial and anti-inflammatory treatment of acne, and have generated reasonable success rates. In recent years, along with a growing popularity of oral contraceptives to reduce unwanted pregnancies, they have also been applied in acne treatment because of their overall anti-androgenic effects. Very little direct comparisons between these two methods have been published, and this study serves as a preliminary measure for the effectiveness of both treatments against each other. Using an extensive literature search of PUBMED and MEDLINE for randomized clinical trials involving antibiotics or oral contraceptives, data were taken and used in an analysis to assess efficiency of both drug groups in the reduction of lesion counts and percentage reduction in inflammatory acne lesions, non-inflammatory lesions, and total lesions based off original baseline counts in each study. A total of 15 studies were used in the analysis. Antibiotics, oral contraceptives, and placebo treatment groups were evaluated at three months’ time, while oral contraceptives and placebo treatments were also continued out to six months to reflect longer trial durations. In all cases, antibiotics were superior to placebo at three months. Oral contraceptives were also superior to all placebo arms at both three and six months, except for in the average percent reduction of total lesions where the placebo at six months is not significantly different than the contraceptives at three months. Antibiotics and contraceptives showed no significant difference between each other at three or six months times, except for the lesion number reduction at three months for inflammatory lesions compared to antibiotics. All comparisons used the average percentage or number reduction, and 95% confidence intervals to determine significance. After three months, antibiotics showed a 45.40% weighted mean reduction in total lesion counts, compared to 36.41% for oral contraceptives at three months and 43.76% at six months. With the confidence intervals, the ranges for significance are 38.40%-52.40%, 31.92%-40.90%, and 33.87%-53.64% respectively, corresponding to an insignificant difference between all three treatments. Percentage changes for both inflammatory and non-inflammatory lesion reductions were also similar in their confidence intervals overlapping. The study showed a surprising similarity between antibiotics and contraceptives in their ability to treat acne, in both inflammatory and non-inflammatory lesions. With the exception of the three month antibiotics out-performing the oral contraceptives at three months’ time for reduction of inflammatory lesions, the percentage reduction was not significantly different, indicating discrepancies with starting numbers. Overall, both treatments were effective in the treatment of acne lesions, but the limitations of oral contraceptives including their utility is confined to women, and the relatively short recommended treatment time for oral antibiotics each have their drawbacks. Oral contraceptives seem to represent a better long term treatment plan for women who are comfortable taking birth control.

Thesis (M.Tech.: Homoeopathy) - Dept. of Homoeopathy, Durban Institute of Technology, 2003 1 v. (various pagings) / The purpose of this study was to compare the effectiveness of a herbal-complex consisting of (Arctium lappa, Berberis aquifolium, Echinacea purpurea and Taraxacum officinale), as compared to homoeopathic simillimum in terms of the clinical manifestations and the patients’ perception of response to the treatment

Thesis (M.Tech.: Homoeopathy) - Dept. of Homoeopathy, Durban Institute of Technology, 2003 1 v. (various pagings) / The purpose of this study was to compare the effectiveness of a herbal-complex consisting of (Arctium lappa, Berberis aquifolium, Echinacea purpurea and Taraxacum officinale), as compared to homoeopathic simillimum in terms of the clinical manifestations and the patients’ perception of response to the treatment

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Mini-dissertation submitted in compliance with the requirements for the Master's Degree in Technology Homoeopathy, Durban Institute of Technology, 2005. / The purpose of this study was to evaluate the efficacy of the Homoeopathic remedy Kalium bromatum 30CH compared to placebo in the treatment of Acne vulgaris. The study was a double blind placebo controlled study. Participants were recruited via advertisements in local newspapers and notices posted at schools, health shops and pharmacies. Thirty volunteers who complied with the inclusion and exclusion criteria were randomly assigned to an experimental or control group of 15 participants each. The treatment period was four weeks which included three consultations. The effect of treatment was measured by determining the reduction in the number of lesions found on the faces of the participants. The lesions were divided into three groups, namely non-inflamed lesions, inflamed lesions and comedones. The Leeds Technique for assessing Acne vulgaris was used. / M

This randomized clinical study aimed to compare the efficacy of written handouts with that of audio-visual computerized presentations in educating adolescents about acne vulgaris. The study included 101 adolescent patients, aged 13 to 17 years, presenting to a private dermatology practice or one of three pediatric clinics in New Haven, CT. All participants completed a brief enrollment questionnaire to gauge baseline knowledge about acne vulgaris. Subjects were then randomized to receive either a written handout or an audio-visual computerized presentation. Immediately following the intervention, and again at one month, patients were asked to complete identical questionnaires to assess change in knowledge about acne. The main outcome measure was change in knowledge about acne vulgaris, as indicated by performance on pre-intervention, post-intervention, and one-month follow-up questionnaires. Baseline questionnaires were completed by 21 patients in the pilot study and 80 subjects in the revised study; 17 (80.95%) and 77 (96.25%) completed the respective studies. In both the pilot and revised studies, there was no significant difference between intervention groups in terms of baseline knowledge or gain-in-knowledge. Immediately post- intervention, both groups showed significant improvement from baseline (P<.0001 revised study, P<.01 pilot study). At the one-month follow-up, patients in the pilot study randomized to receive the computerized presentation still showed significant gain in knowledge from baseline (p<.05), while those in the handout group did not. Meanwhile, both intervention groups in the revised study continued to show significant gain in knowledge from baseline at one month (p<.0001). From the above results it appears that both written handouts and audio-visual computerized presentations about acne vulgaris confer significant and equivalent benefits in terms of short- and long-term knowledge gains among adolescent patients with acne.

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