From the Guidelines
Antihistamines are not considered a primary treatment for reducing inflammation in acne vulgaris, but they may be used as adjunctive therapy in certain cases, particularly when itching or allergic components are present. The most recent and highest quality study, 1, provides evidence-based recommendations for the management of acne vulgaris, but does not specifically address the use of antihistamines as a treatment option. However, based on the available evidence, antihistamines like doxepin, diphenhydramine, and hydroxyzine have been used as adjunctive therapy for acne, particularly when itching or allergic components are present. These medications work by blocking histamine receptors, which can reduce redness, swelling, and irritation associated with inflammatory acne lesions. For those interested in trying this approach, topical antihistamines may be applied directly to affected areas, while oral options like loratadine (10mg daily) or cetirizine (10mg daily) might provide systemic anti-inflammatory effects with fewer sedating side effects than older antihistamines.
- Key points to consider:
- Conventional acne treatments like benzoyl peroxide, retinoids, or antibiotics remain more effective and should be considered primary interventions.
- Antihistamines may be used as complementary options, especially for patients with concurrent allergic conditions or inflammatory acne that hasn't responded well to standard treatments.
- Second-generation antihistamines are generally preferred as they cause less drowsiness.
- The scientific rationale stems from the role of histamine in inflammatory processes - by blocking histamine's effects, the inflammatory cascade that contributes to acne formation may be interrupted.
- The use of antihistamines in acne treatment is not universally recommended and should be considered on a case-by-case basis, taking into account the individual patient's needs and medical history, as suggested by 1 and 1.
From the Research
Antihistamines and Acne Inflammation
- Antihistamines have been studied for their potential to reduce inflammation in acne vulgaris, with some evidence suggesting they may be beneficial in combination with other treatments 2.
- A randomized controlled trial found that the combination of isotretinoin and antihistamine (levocetirizine) resulted in a more significant decrease in acne lesion counts and global acne grading system scores compared to isotretinoin alone 2.
- The antihistamine levocetirizine was found to inhibit inflammatory mediators, reduce itching, and decrease squalene and sebum production, which may contribute to its potential anti-inflammatory effects in acne treatment 2.
Mechanisms of Action
- Antihistamines may reduce inflammation in acne by inhibiting the release of histamine and other inflammatory mediators, which can contribute to the development of acne lesions 2.
- The reduction of squalene and sebum production by antihistamines may also help to decrease the formation of comedones and inflammatory lesions 2.
Comparison to Other Treatments
- Topical antimicrobial agents, such as benzoyl peroxide and clindamycin, are commonly used to treat mild to moderate acne vulgaris and have been shown to reduce inflammatory and non-inflammatory lesions 3, 4.
- Oral antibiotics, such as isotretinoin, are often used to treat more severe cases of acne and have been shown to be effective in reducing acne lesions, but may have significant side effects 5, 6.
- The combination of antihistamines with other treatments, such as isotretinoin, may provide a synergistic effect and minimize side effects 2.