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Acné hormonale : la nutrition pour remède ?

Hormonal acne: can nutrition be the remedy?

Genetic and hormonal factors, as well as lifestyle, contribute to the development of acne. We reveal the key foods to help fight acne!
Contents
It is estimated that 50% of women aged 20 to 29 have acne, and around 25% of women aged 40 to 49 [1]. Genetic and hormonal factors, as well as lifestyle, contribute to this pathogenesis.
Take care mama

Hormonal acne is not inevitable. In some cases, genetics or certain conditions are to blame, but most of the time you can take action to make it disappear. 

What is hormonal acne?

During puberty, hormonal acne often appears in the T-zone. This includes the forehead, nose and chin. Adult hormonal acne typically forms on the lower part of the face. This includes the lower cheeks and the jawline.

In some people, hormonal acne takes the form of blackheads, whiteheads and small spots that develop into cysts. Cysts form deep beneath the skin, they do not appear at the surface, and the resulting bumps are often tender to the touch.

Research findings suggest that some people may have a genetic predisposition to acne. Those with this predisposition are more likely to experience adult acne. Genetic predisposition is a factor influencing the number, size and activity of sebaceous glands. Its influence on hormonal regulation has also been observed, as well as on the process of follicular hyperkeratinisation. In one study, adult women with acne reported that first-degree relatives also suffered from acne in adulthood [14].

hormonal imbalance can trigger skin breakouts and acne flare-ups. Women are more prone to these fluctuations, particularly in cases of PCOS or during the following periods: around the time of menstruation, during pregnancy, perimenopause, and after a stopping the pill or at the start of taking the contraceptive pill. 

The role of androgens in the development of hormonal acne is well established. Testosterone, dehydroepiandrosterone sulphate (DHEAS) and dihydrotestosterone (DHT) are all androgens (male sex hormones) that stimulate the growth of the sebaceous glands and therefore sebum production [2].
Oestrogens have the opposite effect: they inhibit androgen secretion, modulate the genes involved in sebaceous gland growth and inhibit their function. Sebaceous gland activity therefore depends on the oestrogen/androgen ratio [2].

Worsening of the condition during the premenstrual period is observed in 60 to 70% of women. During these periods, there is a relative increase in hormones with greater androgenic activity compared to oestrogen, leading to an acne flare-up resulting from excessive sebum production [3]. An excess of oestrogens relative to progesterone can also be observed, which similarly promotes acne.

Researchers have discovered a link between stress and acne flare-ups. In response to stress, our bodies produce more androgens. As we have seen, an excess of androgens can interfere with the hair follicles that regulate skin cells and increase sebum production [4]. This explains why acne can become a persistent problem when we are under constant stress. 

A study highlighted that stress was an aggravating factor for acne in nearly 50% of women [5]. Changes in acne severity are strongly correlated with increases in stress [6].

So it's worth trying to relax and limit stress! Try yoga, meditation, and consider magnesium, which among other things has beneficial effects on people experiencing stress [7].  

Studies have shown that consuming foods with a high glycaemic index and dairy products increases insulin levels and the hormone IGF-1.
These two hormones can bind to receptors in the gonads and sebaceous glands, which stimulates the production of androgens such as testosterone and inhibits the conversion of testosterone into oestrogen. Excess insulin in the blood therefore increases the risk of acne [8].

And it becomes a chain reaction: the rise in insulin and IGF-1 also triggers processes such as: cell proliferation, cell differentiation with increased keratinocyte proliferation (hyperkeratinisation, meaning an abnormal multiplication of cells that blocks the normal drainage of sebum), and increased cell activity in the sebaceous glands, as well as insulin resistance — each mechanism playing a role in the development of acne [9]. 

It is also important to limit inflammatory foods, such as sugar and refined carbohydrates (white bread, pasta, etc.), as well as red meat, which can trigger inflammation and thereby promote excessive sebum production and hyperkeratinisation [10].

Bear in mind that not all meats need to be avoided! Good-quality, organic red meat is rich in omega-3s, which have anti-inflammatory properties. Enjoy it with vegetables rich in antioxidants, which can help limit the inflammatory potential of certain compounds found in meat.

Likewise, increased consumption of trans fats and saturated fats is associated with greater acne severity [11].

If you suffer from acne, pay attention to cosmetic products for your skin and hair. Data suggests that cosmetics trigger acne in 62% of cases. They should therefore be non-comedogenic, non-acnegenic, oil-free and must not clog pores [12].

Excessive consumption of vitamin B6 and/or vitamin B12, generally due to an overly high intake of women's food supplement or the fact that they are overdosed, can trigger acne. This phenomenon also occurs with excessive iodine intake from food supplements [13]. 

Pink Balance, a delicious red berry powder for hormonal balance. It contains maca and shatavari to help rebalance hormones, beetroot to help reduce inflammation, and it is naturally rich in B vitamins! It is also interesting to take during menopause supplement, notably thanks to vitamin B6, which is one of the essential vitamins for the menopause

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What diet can help reduce acne?

A diet tailored for blood sugar balance

Foods with a low glycaemic index
 

Diets with a reduced glycaemic index (an index representing the capacity of a carbohydrate-containing food to raise blood sugar levels) or a reduced glycaemic load (which represents the glycaemic index multiplied by the quantity of carbohydrates in the portion) have a low carbohydrate content. The glycaemic index and glycaemic load have been shown to affect the pathways involved in the pathogenesis of acne. For example, a low glycaemic load diet reduces the free androgen index and increases IGF1-binding protein, and a diet low in glycaemic index and glycaemic load decreases IGF1 levels [15].

It is therefore beneficial to consume foods with a low glycaemic index and glycaemic load, such as: certain fruits (apple, pear), nuts and seeds (pecans, cashews), vegetables, and pulses [16].  

Be mindful of fruits with a high glycaemic index, such as mango, melon, pineapple, watermelon, cherries, papaya, grapes, banana, and dried fruits.

Reducing consumption of unhealthy fats


In one study, a low-fat diet increased circulating levels of IGF1-binding proteins, which may suggest a reduction in the biological activity of IGF1 and therefore a decrease in sebum production and acne [17].

Not all fats should be avoided! Consuming healthy fats can support better blood sugar regulation.

Foods that help lower insulin levels 
 

Excess insulin in the blood increases the proliferation of keratinocytes (skin and hair cells) and stimulates hormone production, which may contribute to the pathogenic factors of acne. Polyphenols play a role in regulating glucose and therefore insulin [18].

It is therefore beneficial to consume foods that contain them, such as fruits (principally red fruits, berries, and grapes), vegetables, cacao, green tea, cinnamon, and olive oil.  

Barberry, a small red berry with a tangy, astringent, and sweet flavour, has very interesting properties with regard to acne. A study highlighted that this berry was at least as effective at reducing acne as conventional treatments. This is attributed to the presence of its compound berberine, which acts on insulin resistance as well as on skin microbes [19].  

Omega-3s to reduce inflammation

Omega-3 fatty acids have been shown to reduce IGF1, which is involved in sebum production and follicular occlusion. 
Omega-3 fatty acids also inhibit the synthesis of an inflammatory compound, which reduces the inflammatory lesions of acne [20].

Some studies have also shown an association between lower fish consumption and increased acne severity [21]. 
Consume fish rich in omega-3, such as salmon, for example. 

Our omega-3 pregnancy, Omega Mama, is the vegan DHA food supplement rich in omega-3. It covers DHA requirements and is ideal for all women. 

You can also consume shellfish, vegetable oils (such as linseed and walnut oil), seeds, and nuts to boost your omega-3 intake.  

Zinc for healthy skin

Studies have shown that low blood zinc levels are linked to the severity and type of acne lesions in certain patients with acne [22]. This may be due to the fact that zinc plays a role in wound healing and reducing inflammation [23]. Therefore, consuming zinc supplement may help to increase blood levels and reduce acne.

To do so, consume seafood, liver (care should be taken with liver during the preconception period and during pregnancy due to its high retinol content, a substance that is teratogenic at high doses), pulses, and wholegrains such as brown rice.

This diet is also suitable when trying for a baby, and nutrition remains the best food supplement to conceive

A full complement of vitamins to combat acne

Vitamins A and E
 

Studies have highlighted that low plasma levels of vitamins A and E play an important role in the pathogenesis of acne and in its worsening [24].

A vitamin A deficiency dramatically affects skin biology, such as skin dryness. This nutrient is found in part in the skin, particularly in the sebaceous glands [25]. Vitamin E, for its part, has an antioxidant action that may be beneficial in people with acne [26].

It is therefore beneficial to consume foods rich in vitamin A, such as liver, orange fruits and vegetables, and leafy green vegetables. For vitamin E, consume vegetable oils (sunflower, avocado, hazelnut), sunflower seeds, eggs, or sardines!  

Tip: vitamin A is better absorbed when consumed alongside vegetable oils [27].

Vitamin D

The role of vitamin D in acne should not be underestimated, as it regulates the proliferation and differentiation of keratinocytes, and may also have anti-comedogenic properties. There is an association between hormonal acne and vitamin D deficiency [28]. This is due to the fact that vitamin D supports improvement of inflammation as well as the formation of antimicrobial compounds [29].

Sunny Mummy, the vitamin D food supplement in a pipette bottle, with vitamin D3 to meet your needs. 

Our women's multivitamin will help you get a full supply of vitamins B, C, D, E, and zinc. 

A few tips

Be mindful of your cosmetics 
Reduce stress (yoga, meditation, magnesium)
Avoid sugars 
Consume omega-3s 
Try acupuncture! 

Did you know?

Some plants can act on acne by influencing hormonal levels: chasteberry, hops, red clover, and ginseng. 

What are the natural remedies for acne?

Some natural remedies can be effective against acne. 

Tea tree essential oil works by reducing the inflammation that can contribute to acne (avoid use if you are pregnant or breastfeeding). One study found that 5% tea tree oil applied topically relieved symptoms in people with mild to moderate acne [30].

As an infusion, you can consume stinging nettle, which is traditionally used to help maintain healthy skin, as well as wild pansy, recognised for helping blemishes fade and supporting skin health (please note: never consume stinging nettle as an infusion during pregnancy, as it is known to contain a uterine stimulant).

Certain plants can act on acne by influencing hormonal levels. For example, chaste tree, hops, and red clover (caution: do not consume chaste tree or red clover if you are pregnant or breastfeeding) bind to oestrogen receptors — and since low oestrogen levels contribute to the development of acne, this is particularly relevant. Ginseng also has some oestrogenic activity. Their role as oestrogen analogues gives them interesting properties for reducing acne [31].

Saw palmetto, or dwarf palm, acts on androgen levels. It blocks the action of testosterone, which may help reduce acne-related breakouts [32]. 

A scientific analysis of several studies has highlighted that acupuncture and auricular acupressure (which involves placing blunt instruments, such as small metal ball bearings, at specific points on the outer ear) have statistically the same effects as recommended drug treatments, with chances of acne improvement of between 30 and 50% [33].
Indeed, it has been shown that auricular acupressure, for example, reduces testosterone levels, which in turn reduces the development of acne [34].
Similarly, moxibustion, which involves the controlled burning of a substance, generally mugwort (Artemisia vulgaris), at certain points or areas of the body surface, has been found to be effective in combating acne [35]. 

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A word of caution about acne medications
Standard treatments recommended for acne include retinoids and antibiotics, whose efficacy has been demonstrated in the treatment of acne [36]. However, long-term use of antibiotics can contribute to antibiotic resistance, and retinoids have serious adverse effects such as teratogenicity and must be used with caution in people of childbearing age. 
Not to mention that medications put long-term strain on our liver. And a "tired" liver becomes unable to manage hormone detoxification — which is important for maintaining healthy hormonal balance. 

Conclusion

Hormonal acne is a condition caused by an imbalance between oestrogen and androgen hormones. Certain factors such as heredity, stress, or lifestyle can make it worse. Tackling acne calls for a holistic approach, working on stress levels as well as consuming foods that are good for your skin, such as omega-3s, zinc, and vitamins A, E, and D.

Stress management and diet are not miracle cures — they may help reduce your acne, but their effects will depend on its severity. Do not hesitate to consult a professional such as a dermatologist to find out more.


Be careful not to self-supplement or use essential oils without advice from a doctor, pharmacist, or naturopath trained in aromatherapy.

Dietary supplements are not without risk — they can interact with other supplements, foods, and medications, and may not be suited to your personal situation; choosing the right ones and adjusting dosages correctly also matters. It is therefore preferable to seek advice from a health practitioner specialising in nutrition (such as a naturopath or nutritional therapist).

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Hormonal acne: can nutrition be the remedy?

Source 1 : Acne: Who Gets and Causes, American Academy of Dermatology Association

Source 2 : Beyond Acne: Current Aspects of Sebaceous Gland Biology and Function, 2016

Source 3, 8 : Adult female acne: a guide to clinical practice, 2019

Source 4 : Adult Acne, American Academy of Dermatology Association

Source 5 : An Epidemiological Study of Acne in Female Adults: Results of a Survey Conducted in France, 2001

Source 6 : The Response of Skin Disease to Stress: Changes in the Severity of Acne Vulgaris as Affected by Examination Stress, 2003

Source 7 : Magnesium Status and Stress: The Vicious Circle Concept Revisited, 2020

Source 9 : Potential role of FoxO1 and mTORC1 in the pathogenesis of Western diet-induced acne, 2013

Source 10 : Effects of Diet on Acne and Its Response to Treatment, 2021

Source 11 : Relationships of Self-Reported Dietary Factors and Perceived Acne Severity in a Cohort of New York Young Adults, 2014

Source 12: Emerging Issues in Adult Female Acne, 2017

Source 13 : Acne Related to Dietary Supplements, 2020

Source 14 : The Familial Risk of Adult Acne: A Comparison between First-Degree Relatives of Affected and Unaffected Individuals, 1999

Source 15 : Effects of Diet on Acne and Its Response to Treatment, 2021

Source 16: Guide des index glycémiques IG et valeurs nutritionnelles, 2011

Source 17 : A Pilot Study to Determine the Short-Term Effects of a Low Glycemic Load Diet, 2008

Source 18 : Polyphenols and Glycemic Control, 2016

Source 19 : Edible Plants and Their Influence on the Gut Microbiome and Acne, 2017

Source 20 : Effects of Diet on Acne and Its Response to Treatment, 2021

Source 21 : Relationships of Self-Reported Dietary Factors and Perceived Acne Severity in a Cohort of New York Young Adults, 2014

Source 22 : Correlation between the Severity and Type of Acne Lesions with Serum Zinc Levels in Patients with Acne Vulgaris, 2014

Source 24 : Does the Plasma Level of Vitamins A and E Affect Acne Condition?, 2006

Source 25, 27 : The relationship of diet and acne, 2009

Source 26 : Addressing Free Radical Oxidation in Acne Vulgaris, 2016

Source 28: Serum 25-hydroxy vitamin D levels in patients with acne vulgaris and its association with disease severity, 2015

Source 29 : Hormonal and dietary factors in acne vulgaris versus controls, 2018

Source 30: The Efficacy of 5% Topical Tea Tree Oil Gel in Mild to Moderate Acne Vulgaris, 2007

Source 31 : Edible Plants and Their Influence on the Gut Microbiome and Acne, 2017

Source 32: How To Treat Hormonal Acne Naturally – Top 3 Ingenious Ways, 2020

Source 33 : Acupuncture for Acne Vulgaris: A Systematic Review and Meta-Analysis, 2018

Source 34 : The effect of acupuncture combined with auricular acupoint - pressing therapy on the main morbidity factors of acne vulgaris, 2002

Source 35: Evaluation of therapeutic effect and safety for clinical randomized and controlled trials of treatment of acne with acupuncture and moxibustion, 2009.

Source 36 : Guidelines of Care for the Management of Acne Vulgaris, 2016

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[2] Zouboulis, Christos C., Mauro Picardo, Qiang Ju, Ichiro Kurokawa, Dániel Törőcsik, Tamás Bíró, et Marlon R. Schneider. 2016. « Beyond Acne: Current Aspects of Sebaceous Gland Biology and Function ». Reviews in Endocrine & Metabolic Disorders 17 (3): 319‑34.https://doi.org/10.1007/s11154-016-9389-5.

[3] Bagatin, Edileia, Thais Helena Proença de Freitas, Maria Cecilia Rivitti Machado, Beatriz Medeiros Ribeiro, Samanta Nunes, et Marco Alexandre Dias da Rocha. 2019. « Adult female acne: a guide to clinical practice ». Anais Brasileiros de Dermatologia 94 (1): 62‑75.https://doi.org/10.1590/abd1806-4841.20198203.

[4] « Adult Acne ». American Academy of Dermatology Association. https://www.aad.org/public/diseases/acne/really-acne/adult-acne.

[5] Poli, F., B. Dreno, et M. Verschoore. 2001. « An Epidemiological Study of Acne in Female Adults: Results of a Survey Conducted in France ». Journal of the European Academy of Dermatology and Venereology: JEADV 15 (6): 541‑45. https://doi.org/10.1046/j.1468-3083.2001.00357.x.

[6] Chiu, Annie, Susan Y. Chon, et Alexa B. Kimball. 2003. « The Response of Skin Disease to Stress: Changes in the Severity of Acne Vulgaris as Affected by Examination Stress ». Archives of Dermatology 139 (7). https://doi.org/10.1001/archderm.139.7.897.

[7] Pickering, Gisèle, André Mazur, Marion Trousselard, Przemyslaw Bienkowski, Natalia Yaltsewa, Mohamed Amessou, Lionel Noah, et Etienne Pouteau. 2020. « Magnesium Status and Stress: The Vicious Circle Concept Revisited ». Nutrients 12 (12). https://doi.org/10.3390/nu12123672.

[8] Bagatin, Edileia, Thais Helena Proença de Freitas, Maria Cecilia Rivitti Machado, Beatriz Medeiros Ribeiro, Samanta Nunes, et Marco Alexandre Dias da Rocha. 2019. « Adult female acne: a guide to clinical practice ». Anais Brasileiros de Dermatologia 94 (1): 62‑75.https://doi.org/10.1590/abd1806-4841.20198203.

[9] Melnik, Bodo C, et Christos C Zouboulis. 2013. « Potential role of FoxO1 and mTORC1 in the pathogenesis of Western diet-induced acne ». Experimental Dermatology 22 (5): 311‑15. https://doi.org/10.1111/exd.12142.

[10] Baldwin, Hilary, et Jerry Tan. 2021. « Effects of Diet on Acne and Its Response to Treatment ». American Journal of Clinical Dermatology 22 (1): 55‑65. https://doi.org/10.1007/s40257-020-00542-y.

[11] Burris, Jennifer, William Rietkerk, et Kathleen Woolf. 2014. « Relationships of Self-Reported Dietary Factors and Perceived Acne Severity in a Cohort of New York Young Adults ». Journal of the Academy of Nutrition and Dietetics 114 (3): 384‑92. https://doi.org/10.1016/j.jand.2013.11.010.

[12] Zeichner, Joshua A., Hillary E. Baldwin, Fran E. Cook-Bolden, Lawrence F. Eichenfield, Sheila F. Friedlander, et David A. Rodriguez. 2017. « Emerging Issues in Adult Female Acne ». The Journal of Clinical and Aesthetic Dermatology 10 (1): 37‑46.

[13] Zamil, Dina H., Ariadna Perez-Sanchez, et Rajani Katta. 2020. « Acne Related to Dietary Supplements ». Dermatology Online Journal 26 (8).https://doi.org/10.5070/D3268049797.

[14] Goulden, V., C. H. McGeown, et W. J. Cunliffe. 1999. « The Familial Risk of Adult Acne: A Comparison between First-Degree Relatives of Affected and Unaffected Individuals ». The British Journal of Dermatology 141 (2): 297‑300. https://doi.org/10.1046/j.1365-2133.1999.02979.x.

[15] Baldwin, Hilary, et Jerry Tan. 2021. « Effects of Diet on Acne and Its Response to Treatment ». American Journal of Clinical Dermatology 22 (1): 55‑65. https://doi.org/10.1007/s40257-020-00542-y.

[16] Thierry Souccar. "Guide des index glycémiques IG et valeurs nutritionnelles: charge glycémique, calories, graisses, fibres, …". 2011.

[17] Smith, Robyn, Neil Mann, Henna Mäkeläinen, Jessica Roper, Anna Braue, et George Varigos. 2008. « A Pilot Study to Determine the Short-Term Effects of a Low Glycemic Load Diet on Hormonal Markers of Acne: A Nonrandomized, Parallel, Controlled Feeding Trial ». Molecular Nutrition & Food Research 52 (6): 718‑26. https://doi.org/10.1002/mnfr.200700307.

[18] Kim, Yoona, Jennifer B. Keogh, et Peter M. Clifton. 2016. « Polyphenols and Glycemic Control ». Nutrients 8 (1): 17.https://doi.org/10.3390/n耐017.

[19] Clark, Ashley K., Kelly N. Haas, et Raja K. Sivamani. 2017. « Edible Plants and Their Influence on the Gut Microbiome and Acne ». International Journal of Molecular Sciences 18 (5): 1070. https://doi.org/10.3390/ijms18051070.

[20] Baldwin, Hilary, et Jerry Tan. 2021. « Effects of Diet on Acne and Its Response to Treatment ». American Journal of Clinical Dermatology 22 (1): 55‑65. https://doi.org/10.1007/s40257-020-00542-y.

[21] Burris, Jennifer, William Rietkerk, et Kathleen Woolf. 2014. « Relationships of Self-Reported Dietary Factors and Perceived Acne Severity in a Cohort of New York Young Adults ». Journal of the Academy of Nutrition and Dietetics 114 (3): 384‑92. https://doi.org/10.1016/j.jand.2013.11.010.

[22] Rostami Mogaddam, Majid, Nastaran Safavi Ardabili, Nasrollah Maleki, et Maedeh Soflaee. 2014. « Correlation between the Severity and Type of Acne Lesions with Serum Zinc Levels in Patients with Acne Vulgaris ». BioMed Research International 2014: 474108.https://doi.org/10.1155/2014/474108.

[23] « Natural Acne Treatment: What's Most Effective? » 2020. Mayo Clinic.

[24] El-akawi, Z., N. Abdel-Latif, et K. Abdul-Razzak. 2006. « Does the Plasma Level of Vitamins A and E Affect Acne Condition? » Clinical and Experimental Dermatology 31 (3): 430‑34. https://doi.org/10.1111/j.1365-2230.2006.02106.x.

[25] Pappas, Apostolos. 2009. « The relationship of diet and acne ». Dermato-endocrinology 1 (5): 262‑67.

[26] Mills, Otto H., Maressa C. Criscito, Todd E. Schlesinger, Robert Verdicchio, et Ernest Szoke. 2016. « Addressing Free Radical Oxidation in Acne Vulgaris ». The Journal of Clinical and Aesthetic Dermatology 9 (1): 25‑30.

[27] Pappas, Apostolos. 2009. « The relationship of diet and acne ». Dermato-endocrinology 1 (5): 262‑67.

[28] Toossi, Parviz, Zahra Azizian, Hassan Yavari, Tannaz Hoseinzade Fakhim, Seyed Hadi Sadat Amini, et Ramin Enamzade. 2015. « Serum 25-hydroxy vitamin D levels in patients with acne vulgaris and its association with disease severity ». Clinical Cases in Mineral and Bone Metabolism12 (3): 238‑42. https://doi.org/10.11138/ccmbm/2015.12.3.238.

[29] Stewart, Thomas Jonathan, et Carl Bazergy. 2018. « Hormonal and dietary factors in acne vulgaris versus controls ». Dermato-endocrinology10 (1): e1442160. https://doi.org/10.1080/19381980.2018.1442160.

[30] Enshaieh, Shahla, Abolfazl Jooya, Amir Hossein Siadat, et Fariba Iraji. 2007. « The Efficacy of 5% Topical Tea Tree Oil Gel in Mild to Moderate Acne Vulgaris: A Randomized, Double-Blind Placebo-Controlled Study ». Indian Journal of Dermatology, Venereology and Leprology 73 (1): 22‑25.https://doi.org/10.4103/0378-6323.30646.

[31] Clark, Ashley K., Kelly N. Haas, et Raja K. Sivamani. 2017. « Edible Plants and Their Influence on the Gut Microbiome and Acne ». International Journal of Molecular Sciences 18 (5): 1070. https://doi.org/10.3390/ijms18051070.

[32] Jessica Gremley. "How To Treat Hormonal Acne Naturally – Top 3 Ingenious Ways". 2020.

[33] Mansu, Suzi S. Y., Haiying Liang, Shefton Parker, Meaghan E. Coyle, Kaiyi Wang, Anthony L. Zhang, Xinfeng Guo, Chuanjian Lu, et Charlie C. L. Xue. 2018. « Acupuncture for Acne Vulgaris: A Systematic Review and Meta-Analysis ». Evidence-based Complementary and Alternative Medicine: eCAM 2018 (mars): 4806734. https://doi.org/10.1155/2018/4806734.

[34] Li F., Wu H., Wang X., Bao Y., Zou R. The effect of acupuncture combined with auricular acupoint - pressing therapy on the main morbidity factors of acne vulgaris. Journal Chinese Acupuncture. 2002;3:161–164.

[35] Li, Bo, Hua Chai, Yuan-hao Du, Li Xiao, et Jun Xiong. 2009. « [Evaluation of therapeutic effect and safety for clinical randomized and controlled trials of treatment of acne with acupuncture and moxibustion] ». Zhongguo Zhen Jiu = Chinese Acupuncture & Moxibustion 29 (3): 247‑51.

[36] Zaenglein, Andrea L., Arun L. Pathy, Bethanee J. Schlosser, Ali Alikhan, Hilary E. Baldwin, Diane S. Berson, Whitney P. Bowe, et al. 2016. « Guidelines of Care for the Management of Acne Vulgaris ». Journal of the American Academy of Dermatology 74 (5): 945-973.e33.https://doi.org/10.1016/j.jaad.2015.12.037.

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