Human sebaceous glands and hair follicles were not somehow different just because people lived in Joseon Korea.
But what interested me was not simply,
“Did people in the past get acne too?”
I wanted to know:
What did they call it?
What did they think caused it?
And perhaps most interestingly, what did they put on it?
Once I started looking through the historical records, the story became much more interesting than I expected.
Acne in Joseon Korea: Bunja (粉刺)
The Korean Traditional Knowledge Portal describes bunja (粉刺) as a traditional condition corresponding to what we now recognize as acne.
What is particularly interesting is how detailed some of the descriptions are.
They describe small, millet-like skin lesions, black-tipped lesions, lesions that could become red, swollen, and painful, and even lesions that released white, sticky material when squeezed or opened.
To a modern physician, these descriptions naturally bring to mind open and closed comedones, along with inflammatory acne lesions.
The phrase describing a “black tip” is especially striking.
“People were observing lesions like this 400 years ago.”
That was one of the first things that stood out to me.
Of course, we should not assume that the traditional concept of bunja was exactly identical to the modern diagnosis of acne vulgaris.
The medical framework used to explain disease at the time was very different from ours.
What Did People Think Caused Acne?
Traditional medical texts explained bunja in terms such as heat accumulating in the lungs and stomach, or heat remaining in the blood.
It was also associated with excessive consumption of rich or strongly flavored foods.
This is obviously a very different framework from the concepts we use in modern medicine, such as:
- sebum production
- abnormal follicular keratinization
- Cutibacterium acnes (C. acnes, often referred to as the “acne bacterium”)
- immune and inflammatory responses
And yet, this difference is exactly what I find fascinating.
Their explanations for why the disease occurred were completely different from ours, but their observations of the visible skin lesions could be surprisingly detailed.
The language used to explain disease was different, but people were already looking at the skin and recognizing that “this lesion looks different from that one.”
They had no microscopes and no microbiology, but that did not mean they lacked the ability to observe the skin.
This is one of the things I find most interesting when reading the history of medicine.
Modern medicine allows us to understand disease mechanisms at a far deeper level, but the starting point is still something physicians hundreds of years ago were doing as well: observation.
So how did people at the time actually try to treat these acne-like skin lesions?
How Did People Treat Acne in Joseon Korea?
When we look at treatments associated with bunja in the Donguibogam, one somewhat unexpected ingredient appears.
Sulfur.
The Korean Traditional Knowledge Portal includes a preparation called Yuhwang-go (硫黃膏).
This formula, recorded in the external medicine section of the Donguibogam, actually contains sulfur.
The ingredients were ground into powder and combined with substances including sesame oil and beeswax to create an ointment-like preparation, which was then applied to the face after washing.
Some of the ingredients in historical prescriptions would not be appropriate to apply directly to the skin according to modern medical standards.
So this is not a suggestion that people should reproduce a Donguibogam prescription and use it for acne today.
But it raises an interesting question:
Out of all the possible ingredients, why sulfur?
Western Medicine Used Sulfur for Acne Too
When we look at the history of acne treatment, sulfur does not appear only in East Asian medicine.
Historical reviews of acne treatment in the Western world also describe substances such as honey and sulfur, and sulfur continued to appear repeatedly throughout the later history of acne treatment.
In other words, people in very different parts of the world were using sulfur for similar skin problems long before they could possibly exchange medical papers with one another.
This was one of my favorite details when I first came across it.
They certainly were not messaging each other, yet both East and West somehow arrived at sulfur.
Of course, historical preparations and modern sulfur-containing dermatologic products should not be treated as the same therapy.
What is interesting is that people living in different places and different periods repeatedly selected a similar substance through observation of the skin.
Where Did the Name “Acne” Come From?
The history of the name itself is also interesting.
In ancient Greece, acne-like lesions were already associated with puberty.
The term ionthoi, for example, has been described in historical medical literature as being related to the period when the beard first begins to grow.
In other words, people had recognized for a very long time that these skin lesions commonly appeared around puberty.
The term Acne vulgaris as we use it today is generally attributed to Fuchs in 1840.
And the word vulgaris is worth mentioning.
Modern English speakers may associate vulgar with something crude or offensive, but in medical terminology vulgaris means common or ordinary.
So acne vulgaris essentially refers to the common form of acne.
How Does Modern Medicine Understand Acne?
Acne has existed for centuries, but the way we explain it has changed dramatically.
Today, acne vulgaris is understood as a chronic inflammatory skin disease involving the pilosebaceous unit —the hair follicle and its associated sebaceous gland.
Several major biological processes interact with one another.
First: sebum.
Sebaceous gland activity is influenced by androgens, and changes in both the amount and composition of sebum play an important role in acne pathophysiology.
But acne cannot be explained simply by saying, “There is too much oil.”
Second: abnormal follicular keratinization.
When keratinocytes within the follicle do not shed normally and begin to accumulate, a microcomedone can form.
This may eventually develop into the visible open and closed comedones we recognize clinically.
Third: C. acnes.
Because Cutibacterium acnes is often referred to as the “acne bacterium,” it is easy to assume:
“More bacteria simply means more acne.”
But C. acnes is not a bacterium found only in people with acne. It is also present on normal skin.
Modern research therefore looks beyond bacterial quantity alone and considers factors such as different C. acnes strains, the overall skin microbial environment, and the way the immune system responds to them.
Fourth: inflammation.
Acne was once often explained as a relatively simple sequence: the follicle becomes blocked, bacteria proliferate, and inflammation follows.
We now understand that immune and inflammatory activity can be involved much earlier, including during the formation of microcomedones, before a visibly red inflammatory lesion appears.
Ultimately, acne is not caused by just one factor.
Sebum, follicular keratinization, microorganisms, and immune-inflammatory responses interact with one another to produce the disease we call acne.
The Acne Stayed. Our Explanation Changed.
In Joseon Korea, physicians spoke about heat in the lungs and stomach.
Ancient Greek observers noticed the relationship between these lesions, puberty, and the beginning of beard growth.
By the nineteenth century, the modern disease name had begun to take shape.
Today, physicians study sebum, follicular keratinization, the skin microbiome, immunity, and inflammation.
And yet, the skin lesions described hundreds of years ago can still sound surprisingly familiar to us today.
Reading through the history of acne left me with one thought:
Acne has been with humans for thousands of years.
What has kept changing is the story we use to explain it.
And perhaps fifty years from now, a dermatologist will look back at some of the things we currently believe about acne and its treatment and say:
“So that was how they understood it back then.”
References
- Korean Traditional Knowledge Portal — Bunja (粉刺)
- Korean Traditional Knowledge Portal — Yuhwang-go (硫黃膏)
- The age-old problem of acne
- Acne treatment in antiquity: can approaches from the past be relevant in the future?
- Association of different cell types and inflammation in early acne vulgaris
- The Skin Microbiome: A New Actor in Inflammatory Acne
Dr. Sangkyung
I am a physician practicing aesthetic medicine in Seoul, Korea.
I write about skin and aesthetic medicine,
the history of medicine and dermatologic treatments,
and the culture and science of beauty.
Through a doctor's eyes.
© 2026 Dr. Sangkyung.
When quoting or sharing portions of this article,
please credit Dr. Sangkyung and link to the original article at
www.drsangkyung.com.
Unauthorized reproduction or redistribution of this article in its entirety,
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