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Skin concern

Acne and breakouts

Primary source

Acne and breakouts: inflammation of the pilosebaceous unit — the follicle and the oil gland it opens into — ranging from blocked, non-inflamed comedones to inflamed papules and pustules, mostly on the face, neck, chest and back. The strongest evidence comes from a 1992 human trial: In a double-blind trial of 150 people with mild-to-moderate acne, a 14% gluconolactone solution and a 5% benzoyl peroxide lotion each reduced inflamed and non-inflamed lesion counts significantly more than the vehicle lotion, and fewer side-effects were reported with gluconolactone than with benzoyl peroxide. 4 ingredients have evidence for Acne and breakouts: Gluconolactone, Glycolic acid, Salicylic Acid, Tea tree leaf extract. 1 of the 7 findings concerns a risk.

The treatments a guideline recommends with strong evidence, benzoyl peroxide and topical retinoids, are sold as cosmetics in some markets and as medicines in others. Moderate, severe, scarring or persistent acne belongs with a clinician.

Where the definition comes from

Source wording

“Acne is a chronic inflammatory disease of the pilosebaceous unit resulting from androgen-induced increased sebum production, altered keratinisation, inflammation, and bacterial colonisation of hair follicles on the face, neck, chest, and back by Propionibacterium acnes.” — the opening sentence of the Lancet 2012 review's abstract. The organism is now named Cutibacterium acnes.

Acne vulgaris (Lancet seminar) The Lancet (Williams, Dellavalle & Garner)

Guidelines of care for the management of acne vulgaris (2024) Journal of the American Academy of Dermatology (Reynolds et al.)

Ingredients at a glance

1992 · 150 people · people with mild-to-moderate acne · PMID 1303072

Ingredient Measured outcome Based on Certainty Year
Gluconolactone Skin effect Human trial Moderate 1992
Glycolic acid Skin effect Human trial Moderate 2018
Salicylic Acid Skin effect Clinical guideline Moderate 2024
Tea tree leaf extract Skin effect Review article Moderate 2026
Tea tree leaf extract Skin effect Human trial Moderate 2007
Salicylic Acid Skin effect Review article Low 2020
Salicylic Acid Irritation Review article Very low 2020

Studies and results

  1. 1 Gluconolactone Skin effect
    A comparative study of gluconolactone versus benzoyl peroxide in the treatment of acne

    In a double-blind trial of 150 people with mild-to-moderate acne, a 14% gluconolactone solution and a 5% benzoyl peroxide lotion each reduced inflamed and non-inflamed lesion counts significantly more than the vehicle lotion, and fewer side-effects were reported with gluconolactone than with benzoyl peroxide.

    Human trial · 1992 · 150 people · people with mild-to-moderate acne · Inflamed and non-inflamed acne lesion counts, and local side-effects, in mild-to-moderate acne. · Confidence intervals or treatment duration. The trial is from 1992 and used a 14% leave-on solution. It compares gluconolactone with benzoyl peroxide and vehicle.

    PMID 1303072

    Read the full finding →
    Source:A comparative study of gluconolactone versus benzoyl peroxide in the treatment of acne
  2. 2 Glycolic acid Skin effect
    Comparative study of buffered 50% glycolic acid (pH 3.0) + 0.5% salicylic acid solution vs Jessner's solution in patients with acne vulgaris

    In a prospective, randomized, evaluator-blind, split-face trial of 20 patients with acne vulgaris, two 50% glycolic acid + 0.5% salicylic acid peels significantly reduced total lesion count (P<0.001) and produced fewer side effects than Jessner's solution.

    Human trial · 2018 · 20 people · patients with acne vulgaris · Patients with acne vulgaris receiving two 50% glycolic acid + 0.5% salicylic acid peels 2 weeks apart (one side vs Jessner's solution on the other). · Small sample (20) and a combination peel (glycolic + salicylic acid); this is a procedural peel.

    PMID 29164826

    Read the full finding →
    Source:Comparative study of buffered 50% glycolic acid (pH 3.0) + 0.5% salicylic acid solution vs Jessner's solution in patients with acne vulgaris
  3. 3 Salicylic Acid Skin effect
    Guidelines of care for the management of acne vulgaris (2024)

    The 2024 American Academy of Dermatology acne guideline lists topical salicylic acid as a conditional recommendation. Strong recommendations in the same guideline go to benzoyl peroxide, topical retinoids, topical antibiotics and oral doxycycline.

    Clinical guideline · 2024 · Acne vulgaris in people aged nine and older, as covered by the guideline's scope.

    PMID 38300170

    Read the full finding →
    Source:Guidelines of care for the management of acne vulgaris (2024)
  4. 4 Tea tree leaf extract Skin effect
    Efficacy and Safety of Melaleuca alternifolia (Tea Tree) Oil for Acne — A Systematic Review and Meta-Analysis

    A 2026 systematic review and meta-analysis pooled seven clinical studies of tea tree oil for acne (445 patients in total). Acne severity was lower with tea tree oil than with the control treatments (pooled odds ratio 0.74, 95% CI 0.63 to 0.88), adverse events were mostly local and mild, and the reviewers judged the overall risk of bias as low.

    Review article · 2026 · 445 people · patients across seven clinical studies of acne · Acne severity across seven clinical studies of topical tea tree oil, the condition that most often starts in the teenage years. · The pooled result is a modest reduction in severity. The seven studies used different tea tree oil formulations and the follow-up was short; the authors call for larger trials with standardised formulas. It also reports more mild itching, dryness and stinging in some comparisons.

    PMID 42098589

    Read the full finding →
    Source:Efficacy and Safety of Melaleuca alternifolia (Tea Tree) Oil for Acne — A Systematic Review and Meta-Analysis
  5. 5 Tea tree leaf extract Skin effect
    The efficacy of 5% topical tea tree oil gel in mild to moderate acne vulgaris: a randomized, double-blind placebo-controlled study

    In a randomized, double-blind, placebo-controlled trial of 60 people with mild-to-moderate acne, 5% tea tree oil gel was 3.55 times more effective than placebo in improving total lesion counts and 5.75 times more effective in improving the acne severity index over 45 days.

    Human trial · 2007 · 60 people · people with mild-to-moderate acne · Total acne lesion counts and acne severity index over 45 days. · Cochrane rates tea tree oil evidence for acne as low quality, based largely on this single 60-participant trial.

    PMID 17314442

    Read the full finding →
    Source:The efficacy of 5% topical tea tree oil gel in mild to moderate acne vulgaris: a randomized, double-blind placebo-controlled study
  6. 6 Salicylic Acid Skin effect
    Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha-hydroxy acid) for acne

    Against topical tretinoin, salicylic acid showed similar values in overall acne improvement (RR 1.00, 95% CI 0.92 to 1.09; one trial, 46 participants). The review graded the certainty of that finding as low.

    Review article · 2020 · 46 people · People with mild to moderate acne, mostly aged 12 to 30 · Topical salicylic acid for mild to moderate acne. Most participants in the review were 12 to 30 years old, and most studies ran longer than eight weeks. · The review covers 49 trials with 3880 participants, salicylic acid appears in a small part of them: 41 to 86 participants per comparison. Every salicylic acid comparison was graded low or very low certainty.

    PMID 32356369

    Read the full finding →
    Source:Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha-hydroxy acid) for acne

Risks found for this concern

  1. 1 Salicylic Acid Irritation
    Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha-hydroxy acid) for acne

    Trials of topical salicylic acid for acne reported application-site reactions such as scaling and redness.

    Review article · 2020 · People with mild to moderate acne in the included trials · Topical salicylic acid in acne trials, mainly leave-on use over eight weeks or longer. · The review graded the salicylic acid adverse-event comparisons as very low certainty.

    PMID 32356369

    Read the full finding →
    Source:Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha-hydroxy acid) for acne

Study limits

Study conditions and measured outcomes.

  • Gluconolactone Human trial · 1992

    Confidence intervals or treatment duration. The trial is from 1992 and used a 14% leave-on solution. It compares gluconolactone with benzoyl peroxide and vehicle.

  • Glycolic acid Human trial · 2018

    Small sample (20) and a combination peel (glycolic + salicylic acid); this is a procedural peel.

  • Tea tree leaf extract Review article · 2026

    The pooled result is a modest reduction in severity. The seven studies used different tea tree oil formulations and the follow-up was short; the authors call for larger trials with standardised formulas. It also reports more mild itching, dryness and stinging in some comparisons.

  • Tea tree leaf extract Human trial · 2007

    Cochrane rates tea tree oil evidence for acne as low quality, based largely on this single 60-participant trial.

  • Salicylic Acid Review article · 2020

    The review covers 49 trials with 3880 participants, salicylic acid appears in a small part of them: 41 to 86 participants per comparison. Every salicylic acid comparison was graded low or very low certainty.

  • Salicylic Acid Review article · 2020

    The review graded the salicylic acid adverse-event comparisons as very low certainty.

Products with a basis for this

13 products · Acne Control Cleanser · AHA 30% + BHA 2% Peeling Solution · 1992 · 150 people · people with mild-to-moderate acne · PMID 1303072

Common questions

Which ingredients have been studied for Acne and breakouts?
Ingredients with evidence for Acne and breakouts: Gluconolactone, Glycolic acid, Salicylic Acid, Tea tree leaf extract.
How many people were studied?
7 findings · 1992 · 150 people · people with mild-to-moderate acne · PMID 1303072
What can I use for Acne and breakouts?
Gluconolactone, Glycolic acid, Salicylic Acid · 1992 · 150 people · people with mild-to-moderate acne · PMID 1303072

Other concerns

Acne marks and scars Barrier damage Blackheads Bumps and rough texture Closed comedones Combination skin Dark circles Dark spots Skincare for deeper skin tones Dehydrated skin Dryness Dull skin Eczema and atopic dermatitis Hyperpigmentation Large pores Loss of firmness Melasma Skincare for men Oily skin Skincare while on acne medication Peeling and flaking Perioral dermatitis Skincare during pregnancy Psoriasis Facial redness Rosacea Sebaceous filaments Sensitive skin Sun damage Sun protection Teenage skin Uneven skin tone Wrinkles and fine lines