context: People with acne often turn to complementary or alternative treatments. These may include gels, creams, and lotions; dietary supplements and herbs; and special dietary routines. Many people swear by alternative acne treatments. But the American Academy of Dermatology ( AAD) says that "all-natural supplements" have not been shown to be effective, and some may even be harmful. For example, the group cites an over-the-counter ( OTC) acne supplement that contained more than 200 times the amount of selenium stated on the label. It caused a wide range of toxic reactions. The AAD also states that there is no evidence that any dietary regimen has an effect on acne. Alternative acne treatments haven't been well-studied. Therefore, sources such as the Natural Medicines Comprehensive Database typically offer only tepid recommendations. For instance, oral zinc supplements are rated as only "possibly effective." The same is true for topical preparations that contain zinc and erythromycin. Until there is better research, it's impossible to say which alternative acne treatments work and which ones don't. Conventional acne treatments don't always work for everyone. They can also cause side effects ranging from skin irritation to birth defects. Another concern, since antibiotics are used in so many conventional acne treatments, is antibiotic resistance. A study in the U. K. reported that more than one out of every two acne patients treated with antibiotics carried resistant strains of two different bacteria often found on the skin. Proponents of alternative treatments point out that acne is unknown in so-called " Stone Age" societies. On the other hand, it affects up to 95% of adolescents in industrialized societies. This suggests, they say, that a Western diet may be a major factor in the development of acne. Hundreds of alternative treatments for acne are promoted on the Internet and elsewhere as being safe and effective. Alternative treatments, though, do not need to be tested and shown to be safe before they are sold online or placed on store shelves in the U. S. So, be sure to discuss the pros and cons of any alternative remedy with your doctor or dermatologist before starting treatment. Research is not conclusive, but some preliminary studies suggest that the following alternative acne treatments might offer some benefits. Manuka honey comes from New Zealand where the manuka bush is indigenous. So-called "active" manuka honey is widely promoted on the Internet as an acne remedy. The claim is mostly based on studies that suggest it has significant antibacterial and wound-healing properties. In one study, researchers observed that honey-impregnated wound dressings have gained increasing acceptance in hospitals and clinics worldwide. But they also pointed out it's unclear how they work. So they investigated the ability of three different types of honey to quench the production of free radicals. In their report, they stated that manuka honey was the most effective. On the Internet, patient testimonials about manuka honey's effects on acne range from glowing to dismissive. To date, however, there have been no definitive studies to prove or disprove the effectiveness of manuka honey. Tea tree oil is an essential oil extracted from the leaves of a small tree native to Australia. It has long been touted as a safe and effective alternative treatment for acne. In 1990, researchers studied 124 acne patients. Some were treated with 5% tea tree oil in a water-based gel. Others were treated with 5% benzoyl peroxide, an ingredient found in many over-the-counter acne remedies. This widely-cited study reported that tea tree oil did not work as quickly as benzoyl peroxide. But, the researchers said, its use resulted in a similar reduction in acne lesions after three months. They also reported a significantly lower incidence of side effects such as dryness, irritation, itching, and burning. Topical treatment with tea tree oil is considered safe for most adults. It may, though, trigger an allergic skin reaction in some people. This is especially true if it has oxidized after exposure to air. Tea tree oil should never be taken orally. It can cause toxic reactions ranging from rash to coma. Some practitioners of alternative and complementary medicine recommend topical treatments containing tannins or fruit acids. Tannins have natural astringent properties. They can be gotten by boiling a mixture of 5 to 10 grams of extract of bark from such trees as witch hazel, white oak, or English walnut in one cup of water. Commercial preparations, though, are not recommended. The distillation process removes the tannins. Fruit acids include citric, gluconic, gluconolactone, glycolic,malic, and tartaric acids. These have natural properties that help them remove skin. Other practitioners recommend treatments which have been approved by the German Commission E. The German Commission E is a European agency that studies herbal remedies. These include oral acne treatments such as: Vitex, a whole-fruit extract for treating premenstrual acne. It's thought to act on follicle-stimulating hormone and luteinizing hormone levels in the pituitary. It's said to increase progesterone levels and reduce estrogen levels. Vitex should not be taken by pregnant or nursing women. Brewer's yeast, which has antimicrobial effects. These practitioners also recommend topical bittersweet nightshade, which also has antimicrobial effects.