Acne — NZ Condition Guide | KiwiMeds

What is Acne?

Acne is a common skin condition that occurs when hair follicles become plugged with oil and dead skin cells. It causes whiteheads, blackheads, pimples, nodules, and cysts, primarily on the face, neck, chest, and back. Acne affects around 85% of adolescents and continues into adulthood in many people. While not dangerous, acne can cause significant psychological distress and, in severe cases, permanent scarring.

Overview

Acne types range from non-inflammatory (comedones — blackheads and whiteheads) to inflammatory (papules, pustules, nodules, and cysts). Nodulocystic acne — the most severe form — causes large, painful, deep cysts that are at high risk of scarring. Acne is caused by excess sebum production (influenced by androgens), blocked follicles, Cutibacterium acnes bacteria, and inflammation. Contrary to popular belief, diet has a limited evidence base, though high-glycaemic diets and dairy may worsen acne in some people.

Treatment in New Zealand

Treatment is stepped according to severity. Topical options (funded by Pharmac) include benzoyl peroxide, topical retinoids (tretinoin, adapalene), topical antibiotics (clindamycin), and combination products. Oral antibiotics (doxycycline, minocycline) are used for moderate acne. The oral contraceptive pill helps hormonally driven acne in women. For severe nodulocystic acne, isotretinoin (Roaccutane) — funded by Pharmac via dermatologist prescription — is highly effective and can induce long-term remission.

NZ-Specific Information

Isotretinoin (Roaccutane) is funded by Pharmac via specialist prescription. It has strict prescribing requirements due to its teratogenicity (must not be used in pregnancy) and requires monthly monitoring. A dermatologist referral is required. Many GPs can initiate moderate acne treatment — see your GP first.

Frequently Asked Questions

Does diet cause acne? Some evidence suggests high-glycaemic foods and dairy may worsen acne in susceptible individuals, but diet is not the primary cause. How long does acne treatment take to work? Most topical treatments take 6–12 weeks to show results. Patience and consistency are essential. Will I scar? Early and appropriate treatment reduces scarring risk. Nodulocystic acne has the highest scarring risk.

Supplements That May Support Management

⚠️ Important: The supplements listed below have varying levels of clinical evidence. They are not a substitute for prescribed medications and should only be considered as adjunctive support under the guidance of a qualified healthcare professional. Always inform your GP or pharmacist before commencing any supplement, as interactions with prescribed medicines are possible.

• Zinc — Zinc has anti-inflammatory, sebum-regulating, and antimicrobial properties against P. acnes. Multiple randomised trials support zinc supplementation (30–45 mg elemental zinc/day as zinc gluconate, picolinate, or citrate) for reducing acne lesion counts. Efficacy is below that of antibiotic therapy but meaningful as an adjunct or for those avoiding antibiotics.
• Vitamin A (within safe limits) — Vitamin A is the basis for retinoid acne therapy. Moderate dietary vitamin A sufficiency supports skin cell turnover. However, supplemental vitamin A doses above 10,000 IU/day are potentially teratogenic and hepatotoxic — supplementation should only be under medical guidance.
• Omega-3 Fatty Acids — Omega-3 supplementation reduces inflammatory acne lesions by lowering insulin-like growth factor 1 (IGF-1) and leukotriene B4 — both drivers of inflammatory acne.
• Vitamin D — Vitamin D deficiency is associated with more severe acne. Supplementation where deficiency is present may reduce inflammatory acne burden via antimicrobial peptide modulation.
• Nicotinamide (Vitamin B3, topical and oral) — Topical 4% nicotinamide gel has demonstrated equivalence to 1% clindamycin for inflammatory acne with no antibiotic resistance risk. Oral nicotinamide (75 mg, as in some proprietary supplements) has supporting evidence for acne reduction.

Relevant Vaccinations

Individuals living with acne may benefit from the following vaccinations. Please discuss your vaccination status with your GP or practice nurse, as eligibility and funding through the New Zealand National Immunisation Schedule may apply.

• Influenza (annual) — People on systemic acne treatments (isotretinoin, long-term antibiotics) benefit from annual influenza vaccination as part of good health maintenance.
• HPV — HPV vaccination is recommended for young people of acne-relevant age as part of comprehensive preventive health.

Dietary Guidance

Evidence-based dietary modifications play a meaningful role in the management of acne. The following foods are generally recommended as part of a balanced, condition-appropriate diet. A referral to a registered dietitian may be beneficial for personalised nutritional planning.

• Low glycaemic index dietary pattern — The most evidence-based dietary intervention for acne. High-GI diets raise insulin and IGF-1, which stimulate sebum production and keratinocyte proliferation. Replacing refined carbohydrates with low-GI alternatives significantly reduces acne lesion counts in randomised trials.
• Zinc-rich foods (oysters, pumpkin seeds, legumes, lean meat) — Dietary zinc supports skin antimicrobial defence and reduces sebaceous gland inflammation.
• Oily fish and omega-3 rich foods — Reduces IGF-1 signalling and inflammatory eicosanoid production driving acne lesion formation.
• Fermented foods and vegetables — Support gut microbiome diversity, which modulates systemic inflammation relevant to acne pathophysiology.
• Limit: dairy milk (particularly skim milk) — Whey proteins in dairy (particularly skim milk) stimulate IGF-1 signalling and insulin secretion. Several studies support associations between dairy consumption and acne. Fermented dairy (yoghurt, cheese) has less pronounced effects than liquid milk.
• Limit: high-glycaemic foods (white bread, sugary drinks, confectionery) — Strong clinical trial evidence links high-GI dietary patterns to increased acne severity. These foods represent the most modifiable dietary acne risk factor.

Related Conditions & Medications

Related conditions: PCOS. Related medications: Isotretinoin, Doxycycline.