The (Bumpy!) History of Blemish Treatments

Pimple, spot, zit, bump, pock, boil, blemish, carbuncle, blister...No matter what you call them, blemishes have been plaguing humankind for millennia. And while we’re still trying to understand their exact causes and inner workings, we’ve come a long way in terms of treatment. Here’s a look at the history of blemish remedies through the ages — from the weird, to the revolutionary, to the downright disgusting.

1550 BC. Ancient Egyptian medical document the Ebers Papyrus mentions aku-t, which translates to boil, pustule, or inflamed swelling — typically treated with various animal preparations mixed with honey. Scholars speculate that King Tut had blemishes, since his tomb contained 10 gallons of patchouli oil — known for its antiseptic and anti-inflammatory properties — and literally worth its weight in gold at the time. Many ancient Egyptians believed that breakouts were caused by telling lies, and could be cured by magic spells.

Page from the Ebers Papyrus ancient Egypt acne remedy recipe

Blemish Remedy Recipe from the Ebers Papyrus, Wellcome collection, available on Wikimedia Commons

400-300 BC. Greek physicians (including Aristotle and Hippocrates) described a skin condition called akmḗ, meaning “facial eruption” —a word that eventually morphed into akne. It was commonly treated with plant preparations mixed with honey, which has exfoliating, antibacterial and anti-inflammatory properties.

1st Century AD. In his encyclopaedia entitled De Medicina, Roman scholar and nobleman Cornelius Celsus wrote that although treating pimples was “almost a waste of time,” they were best remedied with “the application of resin to which not less than the same amount of split alum and a little honey has been added.” He also endorsed the popular Roman baths, particularly those containing soothing sulfur.

4th Century AD. The court physician to Roman ruler Theodosius advised blemish sufferers to wipe their “pimples” with a cloth while watching a falling star and claimed that the pimples would subsequently “fall from the body.” Shockingly, this treatment didn’t survive the centuries.

5th Century AD. Byzantine Greek physician and writer Aëtius of Amida includes a blemish remedy in his Libri Medicinales: “Grape hyacinth burnt with bastard-sponge and then smeared on clears away acne.” In case you’re wondering, bastard-sponge is a type of Mediterranean soft coral that may have had peeling properties.

Mint containing vitamin A used as an acne remedy in 1600s

"Mint" by James Jardine is licensed under CC BY-NC-ND 2.0

700-1200 AD. Diseases (including skin conditions like blemishes) are largely regarded as an imbalance of the internal “humours” which could be balanced by diet, herbs, and prayers. As Europe fell into the Dark Ages, Greco-Arabic (Unani) scholars were observing cases of blemishes and prescribing various herbal treatments for it. Similarly, Ayurvedic practitioners treated breakouts (believed to be an imbalance of doshas), with herbal preparations including masks made from ingredients like turmeric (a potent anti-inflammatory), mint (rich in antioxidant vitamin A), and cinnamon (which promotes circulation).

1500s. During the 16th century Elizabethan era, women used lead-based paint to achieve pale skin — which provided ideal conditions for the formation of spots. Some people at that time associated breakouts with witchcraft. To treat pimples, women used highly toxic mercury-based products, which destroyed not only their blemishes, but the surrounding skin. nightingale that produces uguisu no fun geisha facial dried bird feces for acne remedy

1600s. The Japanese begin using uguisu no fun — translation: nightingale faeces — to perfect their complexions. The bird poop is dried, crushed into a fine powder and mixed with water (and sometimes rice bran) to form a paste. Said to address hyperpigmentation and smooth skin by exfoliating, this age-old treatment has enjoyed a recent resurgence as the pricey geisha facial.

As long as we’re on the subject, urine therapy has also been used throughout the centuries to treat many skin conditions, including blemishes. Although urine is sterile, it becomes contaminated when we excrete it and can easily become a breeding ground for bacteria. It does contain a small amount of urea — which is an exfoliant — but not enough to make a real impact on breakouts.

Portrait of a Young Man with a Beauty Spot on his Cheek by Daniel Dumoustier

Portrait of a Young Man with a Beauty Spot on his Cheek by Daniel Dumoustier, public domain

1700s. Women and men began using patches made from expensive silk and velvet (and for those who couldn’t afford better, mouse fur!) to cover up scars and blemishes left by smallpox and spots. Known as mouches (flies in French), the trend became so popular that some courtiers sported elaborate shapes that covered much of their faces.

18th–early 20th Century. Advances in the fledgling field of dermatology (including the discovery of pores and sebaceous glands in 1746) laid the foundation for our modern understanding of blemishes. Physicians and scholars began experimenting with chemical substances like zinc oxide, sulfur, and acids (including acetic, citric and lactic) to shrink pores and combat spots.

Illustration of a woman from 1800s with acne from TH Burgess

From TH Burgess, Eruptions of the face, head, and hands: with the latest improvements in the treatment of diseases of the skin, Wikimedia Commons

1920. Revlon’s Jack Breitbart uses benzoyl peroxide (a drug first observed to heal burns and leg tumors) to treat blemishes. It’s discovered to be a potent (and less pungent) alternative to sulfur that effectively kills blemish-causing bacteria.

1930s. American doctors theorize that blemishes (aka “chastity pustules”) result from a buildup of toxins caused by a lack of sexual activity in teens. Naturally, they prescribe laxatives to rid the body of these blemish-causing poisons, since the alternative method of releasing them was, well, unchaste.

Up until World War II when the bombing of Hiroshima changed public opinion about the safety of radiation, X-ray therapy for blemishes was considered extremely effective (and often used in conjunction with laxatives). The subsequent discovery that those patients had an increased incidence of basal cell carcinoma (aka skin cancer) ultimately put an end to the practice.

Vintage laxative tins from 1930s history of acne remedies by SLMD Skincare

"Vintage Tins of Ramon's Mild Laxative Pills, Trade Mark - 'The Little Doctor', NOS" by France1978 is licensed under CC BY-SA 2.0

1950s–1960s. Oral antibiotics tetracycline and its cousin, doxycycline — the latter of which has fewer side effects and can better penetrate to the sebaceous glands — are found to be effective for the treatment of moderate to severe blemishes.

1971. Dr. Albert Kligman, dermatologist at the University of Pennsylvania, licenses his discovery of topical blemish-fighting superstar tretinoin (aka retinoic acid) to Johnson & Johnson — which introduces Retin-A to the market. Kligman would later come under scrutiny for having relied on prison inmates to test dosages of the drug.

1975. Laxatives make a comeback in the U.S., when a dermatologist publishes a letter (not a clinical study!) claiming that milk of magnesia — in conjunction with oral antibiotics — helped heal his patients' spots. MoM can strip oil from skin, but it doesn’t penetrate into pores and its pH is not compatible with skin’s surface.

1983. Oral isotretinoin (brand name Roaccutane) is approved for the treatment of severe blemishes. Because of the potential of severe side effects (including birth defects) patients must take a pregnancy test and receive counsel from their doctor prior to receiving a prescription for the highly-effective drug.

2000s. Light and laser therapy gains popularity based on an ability to reduce P. acnes bacteria, inflammation, and oil production. These modalities are most effective for treating moderate to severe inflammatory blemishes when combined with more traditional treatments, like oral antibiotics or isotretinoin. Lasers and light are also useful for addressing blemish scarring.

Salicylic Acid Cleanser, BP Lotion, Retinol Serum, Facial Moisturizer Acne System by SLMD Skincare

Dr. Lee’s last word

When it comes to treating blemishes and other skin conditions, there are a host of proven ingredients — some of which have been used for centuries, like sulfur and lactic acid — that are still in use today. Patients today are better off than in the past, because we’ve also got an arsenal of powerful treatments like retinol and antibiotics. As a dermatologist, I’m always keeping up with what’s happening in the field, so when new advances are made, I’ll incorporate them into my practice.

—Dr. Sandra Lee

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