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Effect of Aloe vera topical gel combined with tretinoin in treatment of mild and moderate acne vulgaris: A randomized, double-blind, prospective trial
Journal of Dermatological Treatment
Abstract
Abstract Background: Topical retinoids are considered first line therapy in the treatment of acne vulgaris, yet can be associated with cutaneous irritations. Combination therapy with natural preparations could be effective in treatment and decreasing adverse events. Objective: The aim of this study was to compare the efficacy and safety of the combination of tretinoin cream (0.05%) and Aloe vera topical gel (50%) with tretinoin and vehicle. Methods: The randomized, double blind, prospective 8-week trial evaluated inflammatory and noninflammatory lesion scores and tolerability in 60 subjects with mild to moderate acne vulgaris (Global Acne Grading System scale). Results: Several formulations of Aloe vera leaf gel were prepared and the most stable one was selected for clinical study based on physicochemical evaluations. The combination therapy showed superior efficacy to tretinoin and placebo. Tretinoin/Aloe gel was significantly more effective in reducing noninflammatory (P=0.001), inflammatory (P=0.011), and total (P=0.003) lesion scores than control group. The highest percentage of adverse cutaneous effect was reported for scaling. At the end of study erythema in the tretinoin/Aloe gel treated group was significantly less severe (P=0.046). Conclusion: The combination tretinoin/Aloe gel was well tolerated and significantly more effective than tretinoin and vehicle for the treatment of mild to moderate acne vulgaris.
... Flavonoids are the most abundant group of active plant compounds; over 5000 flavonoids have been extracted and identified. Many papers have been written about flavonoids and their activities [189]. Flavonoids are derivatives of 1,3-diphenylpropan-1-one (chalcone); the best known groups are the cyclic compounds containing the phenylchromone system (benzogamma-pyrone). ...
... The bond's strength is determined by the proton acidity, which is particularly high in flavones and flavonols. Compounds with a carbonyl group at position 4 increase the acidity of hydroxyl groups at position 7, resulting in partial dissociation and ionic-bond formation with basic amino acid residues [189]. vonoid mixtures scavenge nearly all types of free radicals and ROS [192][193][194]. ...
... The bond's strength is determined by the proton acidity, which is particularly high in flavones and flavonols. Compounds with a carbonyl group at position 4 increase the acidity of hydroxyl groups at position 7, resulting in partial dissociation and ionicbond formation with basic amino acid residues [189]. With regard to cosmetic activity, one of the most important properties of flavonoids binding to proteins is their affinity for both types of estrogenic receptors. ...
In recent years, interest in the health effects of natural antioxidants has increased due to their safety and applicability in cosmetic formulation. Nevertheless, efficacy of natural antioxidants in vivo is less documented than their prooxidant properties in vivo. Plant extracts rich in vitamins, flavonoids, and phenolic compounds can induce oxidative damage by reacting with various biomolecules while also providing antioxidant properties. Because the biological activities of natural antioxidants differ, their effectiveness for slowing the aging process remains unclear. This review article focuses on the use of natural antioxidants in skincare and the possible mechanisms underlying their desired effect, along with recent applications in skincare formulation and their limitations.
... Higher scores indicate greater acne severity (Hajheydari et al., 2014). ...
... As for gender distribution in studies (N = 21), the mean value for the gender of participants was 58.97% female and 41.03% male, and gender was not specified in two studies. Five of the studies (Ghafarzadeh & Eatemadi, 2017;Hajhashemi et al., 2018;Hajheydari et al., 2014;Molazem et al., 2015;Rajar et al., 2008) included only females, whereas two of them (Panahi et al., 2012;Tanaka et al., 2016a) included only males. Inclusion criteria were determined in accordance with the objectives of the studies. ...
... Only five studies (Choonhakarn et al., 2008(Choonhakarn et al., , 2010El-Gammal et al., 2018;Hajheydari et al., 2014;Paulsen et al., 2005) reported adverse effects such as scaling, burning, edema, erythema, itching in 76.7% of the participants in the AV topical gel group and 70% of the participants in the control group composed of patients with acne vulgaris. While 16 studies indicated no side effects, the remaining studies (N = 2) did not report any adverse effects related to the AV interventions (Conley et al., 2014;Hoopfer et al., 2015). ...
Abstract
Aims: To analyse the different types of Aloe vera (AV) effects on various mucocuta- neous problems among adults.
Design: A systematic review and meta-analysis.
Data Sources: An exhaustive scanning of PubMed, Medline, ScienceDirect, and Google Scholar databases was conducted from January 2000–December 2019. Review Methods: Randomized controlled trials (RCTs) publishing reports on the ef- fects of AV in various mucocutaneous problems, psoriasis, burn, wound-healing were included. The standardized mean differences (SMD) with 95% confidence Intervals (CIs) were determined for the main outcomes, heterogeneity was analysed using the I2 test and the risk of bias in the studies was reviewed by the Cochrane risk of bias assessment tool.
Results: The study included 23 trials with a total of 4,023 participants. Six trials were included in the meta-analysis. The results indicated no significant differences in pain scores as assessed by the Visual Analog Scale (VAS) (SMD = 0.11, 95% CI: −0.37 to 0.59). The Psoriasis Area Severity Index (PASI) scores were significantly lower follow- ing AV gel application in two of the studies (SMD = −1.32 95% CI: −1.86 to −0.78). Considering results in a systematic manner, AV accelerated tissue epithelialization and wound-healing process (N = 3), reduced oral mucositis (N = 3), and improved quality of life (N = 1).
Conclusion: AV might have beneficial effects in reducing pain scores and the severity of mucocutaneous problems compared with placebo, especially with limited mild to moderate adverse effects.
Impact: AV may be used as an alternative and integrative approach to reducing symp- tom severity in mucocutaneous problems and the wound-healing process. High qual- ity and well-designed RCTs are still needed to elucidate the effects of AV in a variety of dosages and forms among adults with mucocutaneous problems.
... Moreover, the side effects were significantly lower. 17 Aloe vera can reduce free radicals and inflammatory substances from white blood cells, increase moisture, and cure wounds. All of these factors can increase the efficiency of acne treatment. ...
... All of these factors can increase the efficiency of acne treatment. 17 In addition to acne skin lesions, sequelae, such as acne scars postinflammatory erythema and hyperpigmentation, also affect the quality of life of patients. ...
... In the within-group analysis, after 12 weeks of treatment, the mean porphyrin counts decreased significantly from 1511. 17 ...
Background
Although there is a standard guideline for the treatment of acne, it is still a common skin disease, and suboptimal medication adherence is a major reason for treatment failure. Herbal extracts are an interesting alternative medicine because they consist of a variety of active ingredients. Moreover, herbal extracts may have improved therapeutic efficacy because of the combination of various herbs.
Objectives
To evaluate the effectiveness of herbal extracts for the treatment of mild to moderate acne vulgaris.
Methods
A total of 77 patients were randomized to receive either an herbal extract or 2.5% benzoyl peroxide, which were applied for a period of 12 weeks. Acne lesion counts, adherence, porphyrin counts, the Dermatology Life Quality Index, satisfaction and side effects were assessed.
Result
At the 12‐week point, the acne lesion counts decreased, with statistically significant differences from the baseline values in both groups and for all types of acne (P‐value < 0.001). The adherence rate was significantly higher in the patients using the herbal extract than in the patients using 2.5% benzoyl peroxide (P‐value = 0.002). There was no statistically significant difference in terms of porphyrin counts, spot scores, the Dermatology Life Quality Index or satisfaction with efficacy between the groups; however, satisfaction with drug administration was significantly higher in the patients using the herbal extract (P‐value = 0.001).
Conclusion
Herbal extracts could be beneficial for anti‐acne pharmaceutical preparations and may be used as an alternative medicine for patients with mild to moderate acne vulgaris who do not adhere to benzoyl peroxide treatment.
... The combination significantly reduces skin lipid oxidation and skin inflammation 83 Soothing and hydrating agents has shown good tolerability. 86 Another plant extract water soluble cannabidiol (CBD) was found to decrease inflammation during skin diseases. 103 The antioxidant and anti-inflammatory activity of CBD is regulated via NF-E2-related factor 2 (Nrf2)-target genes, including Heme Oxygenase 1 (HMOX1) but via a mechanism independent of Nrf2. ...
Background
Retinoids, defined as synthetic or natural derivatives of vitamin A, have been extensively studied as anti‐aging molecules that are widely applied in cosmetics. However, due to their physicochemical property, retinoids are highly unstable and extremely sensitive to light, oxygen, and temperature. Moreover, topical application of retinoids often leads to cutaneous irritation. These instabilities and irritant properties of retinoids limit their application in cosmetic and pharmaceutical products.
Aim
Our study aimed to provide a systematic review to summarize the mechanisms underlying the instability and irritant properties of retinoids, as well as recent developments in addressing these challenges.
Methods
A comprehensive PubMed search was conducted using the following keywords: retinoids, chemical instability, skin irritation, retinoid derivatives, nano lipid‐based carriers, liposomes, penetration‐enhancer vesicles, ethosomes, niosomes, nanoemulsions, solid lipid nanoparticles, vitamins, soothing and hydrating agents, antioxidants and metal chelator and retinol combinations. Relevant researches published between 1968 and 2023 and studies related to these reports were reviewed.
Results
The development of new retinoid derivatives, the utilization of new delivery systems like nano lipid‐based carriers and the combination with other compounds like vitamins, soothing agents, antioxidants and metal chelator have been explored to improve the stability, bioavailability, and toxicity of the retinoid family.
Conclusions
Through advancements in formulation techniques, structure modification of retinoid derivatives and development of novel nano lipid‐based carriers, the chemical instability and skin irritation of retinoids has been mitigated, ensuring their efficacy and potency over extended periods.
... Recognizing the severe drawbacks accompanied with commercially available acne vulgaris therapy including FA different topical dosage forms, it has been becoming increasingly important to focus on new strategies to limit these side effects. The combination of herbal drugs with topical antibacterial treatment for the efficient and safe management of acne vulgaris has been investigated lately in order to overcome side effects and multidrug resistance reaching the optimum therapeutic regimen [13][14][15][16]. ...
The combination of herbal drugs with a topical antibacterial for managing a chronic disease like acne vulgaris has emerged lately to settle side effects and bacterial multidrug resistance. Mixed micelles (MMs) incorporated into nanogel were explored for hybrid delivery of curcumin (Cur) and fusidic acid (FA) combination presenting a multi-strategic treatment. Curcumin-fusidic acid–loaded mixed micelles (Cur-FA-MMs) were assessed for size, surface charge, compatibility, in vitro release, and encapsulation. The selected formula was further loaded into nanogel and investigated for viscosity, ex vivo permeation, and in vivo potential. Cur-FA-MMs exhibited uniform nanosized spherical morphology, and negative surface charge affording high encapsulation for both drugs with a biphasic in vitro release over a period of 48h and good colloidal stability. The attained Cur-FA-MM-loaded nanogel had optimum viscosity with remarkable permeation coefficient values nearly 2-fold that related to plain nanogel. The pharmacodynamic effect of Cur on FA was pronounced by the significant improvement of the skin’s degree of inflammation, epidermal hypertrophy, and congestion in animals treated with Cur-FA-MM-loaded nanogel. In conclusion, micellar nanogel could enable the progressive effect of Cur (an antioxidant with reported antibiotic activity) on FA (antibiotic) and decrease the risk of emerging antibiotic resistance by enhancing the solubility and permeation of Cur.
Graphical Abstract
... There is increasing evidence about using polyphenolic compounds in sunscreens due to their ability to absorb UV light and their photostabilizing effect [62]. Flavonoids, thanks to their antiradical properties, are capable of absorbing ultraviolet radiation in a wide range, with maximum far ultraviolet B (250-280 nm) and A (350-385 nm) [68]. ...
Phytochemicals represent a large and diverse group of naturally occurring compounds, bioactive nutrients, or phytonutrients produced by plants, widely found in fruits, vegetables, whole grains products, legumes, beans, herbs, seeds, nuts, tea, and dark chocolate. They are classified according to their chemical structures and functional properties. Flavonoids belong to the phenolic class of phytochemicals with potential solid pharmacological effects as modulators of multiple signal transduction pathways. Their beneficial effect on the human body is associated with their antioxidant, anti-inflammatory, antimutagenic, and anticarcinogenic properties. Flavonoids are also widely used in various nutritional, pharmaceutical, medical, and cosmetic applications. In our review, we discuss the positive effect of flavonoids on chronic skin diseases such as vitiligo, psoriasis, acne, and atopic dermatitis.
... Por outro lado, os achados reportados pelos estudos clínicos analisados objetivando a avaliação da eficácia terapêutica no emprego de extratos fitoterápicos com base em plantas como Cúrcuma longa L., Nigella sativa, Melaleuca alternifolia, Saponaria officinalis, Inula helenium, Solanum nigrum, Aloe vera e Panax ginseng demostraram ser promissoras para intervenção na forma tópica enquanto Berberis vulgaris L., Garcinia mangostana L., Emblica officinalis, Emblica ribes, Zingiber officinale e Holarrhena antidysenterica, mais eficazes em fórmulas orais quando administrados em portadores de acne, evidenciando de modo robusto, o potencial benefício desses ativos no tratamento e controle das lesões causadas pela acne (49)(50)(51)(52)(53)(54)(55)(56)(57)(58). Todos os resultados das publicações examinadas, independentemente das plantas avaliadas, relataram de forma positiva e significativa, a eficácia da utilização desses compostos, tanto de forma oral quanto tópica, embora existam considerações farmacotécnicas e farmacológicas das associações empregadas. ...
Dentre os principais problemas estéticos mais comuns presentes na população jovem, estima-se que a acne seja o mais recorrente. Inúmeras possibilidades de tratamentos para acne, estão disponíveis no mercado, desde medicamentos sintéticos e cosméticos, até diversos medicamentos fitoterápicos e nutracêuticos. Diante desse cenário emergente com inúmeras possibilidades biotecnológicas e farmacêuticas potencialmente aplicáveis para abordagem da acne, o presente trabalho de revisão sistematizada das publicações científicas, pretende sintetizar e avaliar os resultados obtidos dos estudos clínicos e epidemiológicos quanto a efetividade e eficácia dos tratamentos fitoterápicos empregados no controle da acne, considerando-se a diversidade crescente de opções terapêuticas disponíveis no mercado atualmente e as diferentes vias de administração, bem como concomitante necessidade de orientar os profissionais de saúde quanto a escolha da melhor conduta a ser prescrita ao paciente. Dessa forma, seguindo a metodologia preestabelecida pelo Protocolo de Revisão Sistematizada: “Avaliação da eficácia dos tratamentos fitoterápicos empregados em indivíduos com Acne”, foram incluídas examinadas 20 publicações, os quais permitem concluir de modo geral, que o emprego de tratamentos orais e tópicos com extratos de plantas medicinais são relativamente seguros e eficazes para o controle da acne, especialmente quanto a diminuição média e total das lesões, bem como do grau de severidade da acne.
... However, only 11 studies considered the change to be statistically significant. In total, 12 controlled studies included this outcome, of which 7 reported that the herbal medicines tea tree oil, B. vulgaris, A. vera, G. mangostana, and Unani formulation, and the phytochemicals resveratrol and epigallocatechin-3-gallate were significantly more effective than placebo in reducing in the degree of severity of acne (p � 0.000; p < 0.001; p � 0.001; p � 0.042; p < 0.0001; p < 0.001; p < 0.05, respectively) [39,41,42,52,67,68,70]. ...
Over the past few decades, interest in medicinal plants and phytochemicals for the treatment of skin disorders, including acne vulgaris, has progressively increased. Acne vulgaris is a chronic in ammatory disease of the pilosebaceous unit, which mainly occurs in adolescents and young adults. e treatment focuses on the four main factors involved in its pathogenesis: increased sebum production, hyperkeratinization, overgrowth of Cutibacterium acnes, and in ammation. e treatment includes topical retinoids, benzoyl peroxide, antibiotics, and oral isotretinoin. In this regard, the use of herbal medicine as a complementary and alternative medicine is a promising strategy. e main objective of this study was to systematically evaluate the e cacy and safety of medicinal plants and phytochemicals in the treatment of acne vulgaris. ree scienti c databases (PubMed, Web of Science, and Scopus) were searched from inception to January 2021. Clinical trials comparing herbal therapies with placebo or other medicines for the treatment of acne vulgaris were included and analyzed. Outcome measures of interest comprised acne lesions (in-ammatory and nonin ammatory), sebum production, acne severity, and quality of life. e risk of bias in the included randomized controlled trials (RCTs) was assessed using the Cochrane risk-of-bias tool. A total of 34 clinical trials involving 1753 participants met the inclusion criteria for this systematic review. Most trials showed that herbal medicine signi cantly reduces in ammatory and nonin ammatory acne lesions and has a relevant e ect on acne severity. Some medicinal plants revealed equal or higher e cacy to standard treatments. No signi cant di erence between groups in sebum production and quality of life was observed and no severe adverse events were reported. is systematic review provides evidence that medicinal plants and phytochemicals are promising treatments for mild to moderate acne vulgaris. However, more quality of evidence and standardized methodologies are needed to support their e ectiveness and safety claims.
... Propolis was found to have antibacterial, antifungal, antioxidant and antiinflammatory effect due to the presence of polyphenols, pinocembrin and apigenin (76,77). On the other hand, Aloe vera showed antioxidant, anti-inflammatory and soothing effects during the course of acne treatment (71,76,78). ...
Skin is the largest organ of the human body which has been outlined to have more than 20 vital physiological functions. Skin acts as a protective barrier against pressure and trauma. It also acts as a barrier for external environments including pollution, sunlight, radiation, harmful microbes, and chemical. Skincare products are medicinal formulations prepared to be used on external parts of the human body to produce therapeutic topical eff ects and shield the deteriorated skin. Herbal skincare creams have been widely used by many generations for centuries for the purpose of skincare. Nowadays, these herbal skincare creams are becoming more popular and prevalent among people due to their mindset and concerns about synthetic or chemical substances that may lead to adverse eff ects. The main factors that lead to the usage of herbal ingredients in skincare creams are their outstanding antioxidant, antimicrobial, and tyrosinase inhibition properties. The studies on the potential pharmacologically active herbs for skincare creams allow us to understand their importance. In this review, several examples of herbs being used and still undergoing clinical studies were identified according to different skin conditions includes hyperpigmentation, skin aging, and acne. This detailed work might contribute to accomplishing consumer demand.
... A study indicated that a topical product of Aloe vera was significantly better than a placebo in reducing acneinduced lesions (24). A clinical study by Hajheydari et al. showed that a combination of tretinoin and Aloe vera gel could be significantly more effective than tretinoin alone on acne vulgaris with reduced microbial tolerance (31). ...
Background: Acne is the most common chronic skin disease affecting young adults and adolescents worldwide. A characteristic of this disease is the chronic inflammation of sebaceous glands leading to comedones, papules, pustules, nodules, and cysts. Topical and systemic uses of medicines are common approaches to treat acne. However, these medicines are associated with some adverse effects and increased microbial resistance. Objectives: We aimed to prepare and apply an herbal formulation containing several herbs with different effects on mechanisms associated with acne formation. Methods: In this study, 66 patients with mild-to-moderate acne randomly received a packet containing herbal medicine or clindamycin gel. The treatment period was two months, and the total acne lesions and acne severity index were measured every four weeks. After eight weeks of treatment and follow-up, the physician examined clinical outcomes and possible complications. Results: Decreases in total acne lesions and acne severity index were significantly different in both treatment groups (P < 0.05 in both groups). Although the herbal cream provided better improvement than clindamycin, there was no significant difference between the two groups (P > 0.05). Conclusions: The use of the herbal cream could be recommended for treating acne lesions due to few complications, greater patient satisfaction, and avoiding microbial resistance to chemical antimicrobials.
... A previous study suggested that AVG treatment in combination with tretinoin was effective in reducing non-inflammatory and inflammatory acne lesions. However, its adverse effects were also observed in more than 70% of treated patients, such as scaling, burning, and erythema (19). In addition, it has been reported that the high and low frequencies of ultrasound (US) waves have a role in disaggregating the horny layer and stimulating the absorption of the active compounds (20). ...
Background: Acne is a chronic disorder that affects almost 80% of adolescents and young adults, causing psychological and emotional distress. However, the current treatments for acne are either ineffective or have many side effects. This study was designed to confirm and objectively quantify the effect of a new non-drug combined therapy on acne.
Methods: This study innovatively utilized ultrasound, which enhanced the absorption of aloe vera gel, and soft mask to make a purely physical method without any drugs. In both the treatment group and control group, the number of papules/pustules and the area of hyperpigmented lesions were counted, and a smart mirror intelligent face system was used before and after the combined therapy. Alterations in the skin functional index were recorded and analyzed statistically.
Results: In the treatment group, the combined therapy significantly reduced the number of papules and the area of hyperpigmented lesions and improved skin roughness and local blood circulation. In the control group, there was no obvious improvement over 2 months.
Conclusion: This study suggests that the new non-drug combined therapy significantly improved acne, which provided experimental evidence and treatment guidance for patients with mild to severe acne, especially patients with moderate acne. This new therapy may possibly be an appropriate method for patients who seek topical treatments with mild side effects and low antibiotic resistance rates.
... Harper et.al, 2019 detailed a similar polymeric formulation of tretinoin 0.05% lotion with an incidence of erythema, dryness, and skin burning [201]. Combination of tretinoin 0.05% cream and Aloe vera topical gel (50%) with was well tolerated and significantly more effective than tretinoin 0.05% cream alone for the treatment of mild to moderate acne vulgaris [202]. Deshmukh et. ...
Acne, also known as acne vulgaris (AV), is a long-term skin disease that occurs when hair follicles are clogged with dead skin cells and oil from the skin. It is characterized by blackheads or whiteheads, pimples, oily skin, and possible scarring. An intact stratum corneum and barrier, normal natural moisturizing factor and hyaluronic acid levels, normal Aquaporin-3 (AQP3) expression (localized at the basal lateral membranes of collecting duct cells in the kidney), and balanced sebum secretion are qualities of the skin that fall in the middle of the oily–dry spectrum. Patients rarely, if ever, complain about reduced sebum production, but elevated sebum production, yielding oily skin that can be a precursor to acne, is a common complaint. Several factors are known to influence sebum production. AV is mostly triggered by Propionibacterium acnes in adolescence, under the influence of normal circulating dehydroepiandrosterone (DHEA). It is a very common skin disorder which can present with inflammatory and noninflammatory lesions chiefly on the face but can also occur on the upper arms, trunk, and back. Age, in particular, has a significant and well-known impact, as sebum levels are usually low in childhood, rise in the middle-to-late teen years, and remain stable into the seventh and eighth decades until endogenous androgen synthesis dwindles. Sebum, the oily secretion of the sebaceous glands containing wax esters, sterol esters, cholesterol, di- and triglycerides, and squalene, imparts an oily quality to the skin and is well known to play an important role in acne development. Acne can’t be prevented or cured, but it can be treated effectively. The pimples and bumps heal slowly, and when one begins to go away, others seem to crop up. Depending on its severity, acne can cause emotional distress and scar the skin. Acne may cause scarring of the skin, but generally causes no long-term health problems. In self-body image, some parts of the body including face play an important role. Existence of even a minor lesion in this part may be unpleasant for the patient and seems large. This image can cause mental disorders including depression and anxiety, low self-esteem, and decrease in social relationships. However, high levels of anxiety and depression in patients with facial acne are not related to oxidative stress, according to a study published online in the Journal of Cosmetic Dermatology
... Moreover, the acne severity index was decreased to a greater extent than in the control group. 20 A separate combination therapy study using 10% AV showed improvement in papular and scar lesions, with a statistically significant reduction in the erythema index of scars, acne severity index, and TLC. 18 Altogether, these studies reflect that AV may be considered as an effective adjuvant treatment in mild-to-moderate acne vulgaris. ...
Complementary and alternative medicine (CAM) treatments are growing in popularity as alternative treatments for common skin conditions.
Objectives: To perform a systematic review and meta-analysis to determine the tolerability and treatment response to CAM treatments in acne, atopic dermatitis (AD), and psoriasis. Methods: PubMed/Medline and Embase databases were searched to identify eligible studies measuring the effects of CAM in acne, AD, and psoriasis. Effect size with 95% confidence interval (CI) was estimated using the random-effect model.
Results: The search yielded 417 articles; 40 studies met the inclusion criteria. The quantitative results of CAM treatment showed a standard mean difference (SMD) of 3.78 (95% CI [-0.01, 7.57]) and 0.58 (95% CI [-6.99, 8.15]) in the acne total lesion count, a SMD of -0.70 (95% CI [-1.19, -0.21]) in the eczema area and severity index score and a SMD of 0.94 (95% CI [-0.83, 2.71]) in the scoring of atopic dermatitis score for AD, and a SMD of 3.04 (95% CI [-0.35, 6.43]) and 5.16 (95% CI [-0.52, 10.85]) in the Psoriasis Area Severity Index score for psoriasis.
Limitations: Differences between the study designs, sample sizes, outcome measures, and treatment durations limit the generalizability of data.
Conclusions: Based on our quantitative findings we conclude that there is insufficient evidence to support the efficacy and the recommendation of CAM for acne, AD, and psoriasis.
... Aloe vera contains multiple antioxidant compounds which have anti-inflammatory effects including superoxide dismutase, vitamins C and E, etc. (18). Previous studies showed that Aloe vera has been widely used to treat various conditions such as burn wound, radiation-related dermatitis, mucositis, esophagitis, acne vulgaris, and psoriasis vulgaris but none of them investigated the effect of this dry and warm weather plant in ARP (1,(19)(20)(21). ...
Background Acute radiation proctitis (ARP) is a common complication of radiation therapy (RT). This adverse effect in severe cases ultimately results in interruption of RT and poor outcome. Aloe vera contains multiple antioxidant and anti-inflammatory compounds This study was aimed to evaluate the preventive effects of Aloe vera in ARP in colorectal cancer.
Method: twenty eligible colorectal cancer patients, who received radiation, were randomized to receive Aloe vera 3% ointment or placebo for six weeks. At each weekly visit, ARP symptoms were evaluated by Radiation Therapy Oncology Group (RTOG) and clinical presentation criteria. The lifestyle impact of the symptoms, depression and anxiety for assessment of psychosocial status of patients, and quantitative CRP were evaluated as secondary endpoints.
Results there was a significant improvement in the symptom index for diarrhea and total RTOG scores and quantitative CRP levels (between-subject differences or group effect) (p < 0.05) in Aloe group. The overall time trend (within-subject differences or time effect) was statistically significant for rectal bleeding, rectal pain, total clinical scores, proctitis, cystitis, and total RTOG (P < 0.05) in Aloe vera group. The median lifestyle score improved significantly with Aloe vera. Intervention patients had a lower probability of presenting anxiety in their overall HAD scale during RT.
Conclusion The use of topical formulation of Aloe vera 3% diminished the severity of ARP in colorectal cancer patients. Trial registration: Current Controlled Trials IRCT201606042027N6, registrations date: 2016-04-09.
... Harper et.al, 2019 detailed a similar polymeric formulation of tretinoin 0.05% lotion with an incidence of erythema, dryness, and skin burning [203]. Combination of tretinoin 0.05% creamand Aloe vera topical gel (50%) with was well tolerated and significantly more effective than tretinoin 0.05% cream alone for the treatment of mild to moderate acne vulgaris [204]. Deshmukh et al. [197] 2019 found that topical combination of 1% Nadifloxacin and 0.025% Tretinoin was caused greater reduction in facial acne lesions than 1% Clindamycin and 0.025% Tretinoin in patients of mild to moderate AV. ...
... The specific contribution of the Aloe to the improvement, however, is not clear. Another clinical study compared efficacy of A. vera topical gel (50%) combined with tretinoin cream (0.05%) in 60 patients [86]. Treatment of the mild to moderate acne vulgaris lasted for 8 weeks and noninflammatory, inflammatory and total lesions were assessed. ...
The skin is the largest organ and functions as a barrier to protect the underlying tissues against the elements and pathogens, while also fulfilling many physiological roles and biochemical functions such as preventing excessive water loss. Skin disorders vary greatly in terms of origin, severity, symptoms and affect persons of all ages. Many plants have been used for medicinal purposes since ancient times including the treatment of skin disorders and diseases. Aloe represents one of the earliest medicinal plant species mentioned in antique scriptures and even in rock art dating back thousands of years. Different Aloe species and materials have been used in the prevention and treatment of skin related disorders. Aloe vera is the most commonly used Aloe species for medicinal purposes. Some of the most prominent skin related applications and disorders that Aloe materials have been investigated for are discussed in this paper, which include cosmetic, radiation, cancer, wound and antimicrobial applications. Both in vitro and in vivo studies are included in the discussions of this paper and comprehensive summaries of all these studies are given in tables in each section. Although some contradictory results were obtained betweenamong studies, certain Aloe materials have shown excellent efficacy and exhibited potential for the treatment of skin related disorders and cosmetic applications.
... It is also easy for patients to handle and apply, and has the advantage of not containing BP which can bleach hair and fabrics [198]. ClinP/Tret gel has a favorable safety profile following UV/visible irradiation and a low potential for phototoxicity and photo-allergy, currently available for the once-daily topical treatment of acne [199]. Patients with Fitzpatrick Skin Type V and VI treated with clindamycin phosphate 1.2%/ BP 3.75% gel experienced significant reductions in facial acne severity, lesion counts and PIH severity/distribution. ...
Acne, also known as acne vulgaris (AV), is a long-term skin disease that occurs when hair follicles are clogged with dead skin cells and oil from the skin. It is characterized by blackheads or whiteheads, pimples, oily skin, and possible scarring. An intact stratum corneum and barrier, normal natural moisturizing factor and hyaluronic acid levels, normal Aquaporin-3 (AQP3) expression (localized at the basal lateral membranes of collecting duct cells in the kidney), and balanced sebum secretion are qualities of the skin that fall in the middle of the oily-dry spectrum. Patients rarely, if ever, complain about reduced sebum production, but elevated sebum production, yielding oily skin that can be a precursor to acne, is a common complaint. Several factors are known to influence sebum production. AV is mostly triggered by Propionibacterium acnes in adolescence, under the influence of normal circulating dehydroepiandrosterone (DHEA). It is a very common skin disorder which can present with inflammatory and non-inflammatory lesions chiefly on the face but can also occur on the upper arms, trunk, and back. Age, in particular, has a significant and well-known impact, as sebum levels are usually low in childhood, rise in the middle-to-late teen years, and remain stable into the seventh and eighth decades until endogenous androgen synthesis dwindles. Sebum, the oily secretion of the sebaceous glands containing wax esters, sterol esters, cholesterol, di-and triglycerides, and squalene, imparts an oily quality to the skin and is well known to play an important role in acne development. Acne can't be prevented or cured, but it can be treated effectively. The pimples and bumps heal slowly, and when one begins to go away, others seem to crop up. Depending on its severity, acne can cause emotional distress and scar the skin. Acne may cause scarring of the skin, but generally causes no long-term health problems. In self-body image, some parts of the body including face play an important role. Existence of even a minor lesion in this part may be unpleasant for the patient and seems large. This image can cause mental disorders including depression and anxiety, low self-esteem, and decrease in social relationships. However, high levels of anxiety and depression in patients with facial acne are not related to oxidative stress, according to a study published online in the Journal of Cosmetic Dermatology.
... The significant reduction in skin redness may have been from the presence of anti-inflammatory, such as aloe vera gel extract. 14,15,21 Moreover, after 28 days of application, the AGC group presented significant depigmentation, which was not seen in the CG group. This may have resulted from the activity of the green-tea and mangosteen-rind extracts contained in the AGC. ...
Objective: We compared the efficacy of an antiacne hydrogel formulated with a combination of Aloe barbadensis leaf extract, Garcinia mangostana peel extract, and Camellia sinensis leaf extract (AGC) at a ratio of 50:25:1 with a marketed 1% clindamycin gel (CG) formulation on antiacne and antiblotch activities.
Methods: A single-center, parallel-arm, randomized controlled trial was performed from November 2017 to April 2018. Sixty subjects with mild–moderate acne severity according to the the American Academy of Dermatology were enrolled for the study. Outcome end points were total acne lesions (TALs) and acne-severity index (ASI) by counting the inflamed lesions and comedones and skin colors using erythema and melanin values.
Results: For TALss, a decrease (P<0.0001) in the number of total inflamed lesions from baseline was evidenced in AGC group, but not in the CG group. Higher reduction in mean ASI in the AGC group was seen than in the CG group. However, there was no statistically significant difference regarding reduction in ASI between the AGC and CG groups. For erythema, a remarked reduction in skin redness from baseline was clearly seen at day 3 (P<0.05) in the AGC group. No significant decrease in erythema values from baseline was seen in the CG group. A significant decrease (P=0.037) in mean melanin value from baseline was seen in the AGC group after 14 days of twice-daily use, but not in the CG group. Both products were well tolerated, with no reports of severe adverse events.
Conclusion: An anti-acne hydrogel containing a combination of mangosteen rinds, aloe vera gel, and green tea–leaf extracts was superior to 1% clindamycin gel in antiacne and antiblotch activities when measured by TALs and erythema and melanin values.
... 12 In another study, a 50% gel was used in combination with tretinoin, which was significantly more effective in reducing non-inflammatory, inflammatory, and total lesion scores than in control group. 31 In our study, PTAC was compared to 3% erythromycin cream as a positive control. The erythromycin was chosen, especially, for its easy availability and tolerability. ...
Introduction:
Antibiotics that suppress Propionibacterium acnes are the standard treatment for acne but are becoming less effective, due to the appearance of antibiotic-resistant strains. Many plants are known to have innate antimicrobial action and can be used as alternatives to antibiotics; thus, it is necessary to prove their effectiveness in vivo. This study aimed to evaluate the anti-acne efficacy of a new cream based on three natural extracts, comparing it to erythromycin cream and placebo.
Patients and methods:
Sixty patients with mild to moderate acne vulgaris were randomly divided into three groups: treated with cream containing 20% propolis, 3% "tea tree oil", and 10% "Aloe vera" (PTAC) (n=20); or with 3 % erythromycin cream (ERC) (n=20); or with placebo (n=20). At baseline, after 15 and 30 days, investigators evaluated response to treatment by counting acne lesions through noninvasive measurements and macrophotography.
Results:
All the clinical and instrumental values studied were statistically different from placebo except for sebometry, pHmetry, and erythema index values, measured on healthy skin. Unlike in the placebo group, papular and scar lesions showed high erythema reduction after 15 and 30 days of PTAC and ERC application.
Conclusion:
The PTAC formulation was better than ERC in reducing erythema scars, acne severity index, and total lesion count.
... The system was homogenized and neutralized by triethanolamine in formulations containing carbopol as gelling agent. The formulations were kept in 4 ºC, 25 ºC and 40 ºC for physical stability evaluation (viscosity, syneresis, swelling, color change) during 2 weeks (17). The selected formulation for clinical trial was controlled microbiologically based on USP 30 (United States Pharmacopoeia 30) (18). ...
... Prolonged use of plant juice is reported to increase the risk of colorectal cancer. Various A. vera constituents and extracts were found activive against number of diseases such as Seborrheic dermatitis, [242] psoriasis vulgaris, [141,142] genital herpes, [243,244] skin burns, [245] diabetes (type 2), [246] HIV infection, [247] cancer prevention, [248,249] and ulcerative colitis [230] and used in wound healing, [250] pressure ulcers, [251] mitigate potential worsening and dermal wound [252,253] mucositis, [254] radiation dermatitis; [255] acne vulgaris, [256] lichen planus, [257] frostbite, [258] aphthous stomatitis, [259] and constipation [223] . ...
The present review explains therapeutic and pharmaceutical potential of Aloe vera a well-known plant grows in semi-arid climate of tropical and subtropical regions. This article emphasizes important uses of A. vera constituents as dietary nutraceutical, medicinal, and therapeutic potential. Plant is cultivated for agricultural and medicinal and decoration purposes for indoors as a potted plant. Plant is a good depository of chemical constituents which display a very wide array of biological activities such as anticancer, antiparasitic, antidiabetic, anti-inflammatory, anti-arthritic, antiparasitic, antitumor, antioxidant, chemopreventive, hepatoprotective, and gastroprotective. Plant is used to prepare skin protective/care gels mainly for soothing, moisturizing, and wound healing. Thick watery plant sap works are added as key ingredient in many beauty products. Plant leaves are used to generate aroma, beverages, skin lotion, cosmetics, or ointments for minor burns. Plant contains vitamins, enzymes, minerals, sugars, lignin, saponins, salicylic acids, and amino acids as main ingredients. Plant is a good source of Vitamins A, C, and E, which are antioxidants. It also contains Vitamin B12, folic acid, and choline watery juicy of A. vera leaf which contains important minerals such as calcium, chromium, copper, selenium, magnesium, manganese, and potassium. Plant ingredients were found active against gingivitis, psoriasis, and used for herbal therapy in inflammatory bowel disease. A. vera contains important fatty acids mainly steroids such as cholesterol, campesterol, β-sitosterol, and lupeol. Aloin and emodin act as analgesics, antibacterials, and antivirals while lupeol shows antiseptic and analgesic properties. It also contains auxins and gibberellin hormones that help in wound healing and have anti-inflammatory action. Saponins that are the soapy substances display cleansing and antiseptic properties.
... Aloe vera demonstrates several beneficial properties including antioxidant (Imaga et al., 2014), antibacterial (Ali et al., 2014), anti-inflammatory and as immunity regulator (Bałan et al., 2014). The antibacterial properties of Aloe vera gel has a great potential to be used for the treatment of skin conditions such as acne vulgaris (Hajheydari et al., 2014). In HaCaT keratinocytes, aloe vera was shown to decrease UVA induced redox imbalance, decrease UVA associated lipid membrane oxidation and increase overall cell survival (Rodrigues et al., 2016). ...
Human skin exposed to solar ultraviolet radiation (UVR) results in a dramatic increase in the production of reactive oxygen species (ROS). The sudden increase in ROS shifts the natural balance toward a pro-oxidative state, resulting in oxidative stress. The detrimental effects of oxidative stress occur through multiple mechanisms that involve alterations to proteins and lipids, induction of inflammation, immunosuppression, DNA damage, and activation of signaling pathways that affect gene transcription, cell cycle, proliferation, and apoptosis. All of these alterations promote carcinogenesis and therefore, regulation of ROS levels is critical to the maintenance of normal skin homeostasis. Several botanical products have been found to exhibit potent antioxidant capacity and the ability to counteract UV-induced insults to the skin. These natural products exert their beneficial effects through multiple pathways, including some known to be negatively affected by solar UVR. Aging of the skin is also accelerated by UVR exposure, in particular UVA rays that penetrate deep into the epidermis and the dermis where it causes the degradation of collagen and elastin fibers via oxidative stress and activation of matrix metalloproteinases (MMPs). Because natural compounds are capable of attenuating some of the UV-induced aging effects in the skin, increased attention has been generated in the area of cosmetic sciences. The focus of this review is to cover the most prominent phytoproducts with potential to mitigate the deleterious effects of solar UVR and suitability for use in topical application.
... [9] Antibacterial (against acne vulgaris). [10] Anti-oral inflammation (oral lichen planus). [11] (Plaque and gingivitis reduction). ...
Since ages plants are being used for food and fuel, shelter and
medicine. Some of ornamental plants are grown in home gardens
mainly for decorative purpose. In addition to ornamental importance,
many plants have are having useful medicinal properties as well. One
should know how to manage minor health problems and there is a need
to know about natural medicine. A good kitchen/home garden not only
lends flavour to our culinary skills, it even keeps germs at bay. The
present study illuminates the ethnomedicinal/traditional herbal
knowledge of ornamental plants that are generally grown in every
home/kitchen garden for beauty and decorative purpose. The medicinal
significance of selected 20 ornamental plants like Adhatoda vasaka, Bryophyllum calycinum,
Coleus aromaticus, Hibscus rosasinensis, Jasmine officinale, Jasminum sambac, Nelumbo
nucifera, Nyctanthes arbortristis, Rosa centifolia etc. in treatment of various ailments in day
to day life have been discussed. The literature summarizes the habit, major chemical
constituents and various reported pharmacological and clinical trials of the selected plants for
the further study. This literature unveils the medicinal values of above mentioned ornamental
plants. In rural India where people have limited income and poor access to advanced medical
facilities there the medicinal plants of home gardens can prove to be important source of
health care.
... For 8-week Sixty subjects with mild to moderate acne vulgaris significant improvement in mild to moderate acne vulgaris [130] 14 Chronic anal fissure pain, wound healing and hemorrhaging upon defection A. vera Topical cream containing 0.5% Aloe juice powder A prospective double blind clinical trial Three times per day for 6 weeks ...
... In addition, it also helps in the wound healing. [257][258][259][260][261][262][263] The higher moisture, bioactive compound, and mineral content of aloe gel enhance the moisturizing effects and skin protection. Therefore, aloe is often used in cosmetic products such as creams, lotions, and gels. ...
Phytocompounds have been used in cosmeceuticals for decades and have shown potential for beauty applications, including sunscreen, moisturizing and antiaging, and skin-based therapy. The major concerns in the usage of phyto-based cosmeceuticals are lower penetration and high compound instability of various cosmetic products for sustained and enhanced compound delivery to the beauty-based skin therapy. To overcome these disadvantages, nanosized delivery technologies are currently in use for sustained and enhanced delivery of phyto-derived bioactive compounds in cosmeceutical sectors and products. Nanosizing of phytocompounds enhances the aseptic feel in various cosmeceutical products with sustained delivery and enhanced skin protecting activities. Solid lipid nanoparticles, transfersomes, ethosomes, nanostructured lipid carriers, fullerenes, and carbon nanotubes are some of the emerging nanotechnologies currently in use for their enhanced delivery of phytocompounds in skin care. Aloe vera, curcumin, resveratrol, quercetin, vitamins C and E, genistein, and green tea catechins were successfully nanosized using various delivery technologies and incorporated in various gels, lotions, and creams for skin, lip, and hair care for their sustained effects. However, certain delivery agents such as carbon nanotubes need to be studied for their roles in toxicity. This review broadly focuses on the usage of phytocompounds in various cosmeceutical products, nanodelivery technologies used in the delivery of phytocompounds to various cosmeceuticals, and various nanosized phytocompounds used in the development of novel nanocosmeceuticals to enhance skin-based therapy.
... It seems that nicotinamide along with the new suggested topical and systemic therapy can be effective for treatment of the acne vulgaris.[131415] ...
Acne vulgaris is considered one of the most common disorders for which patients seek dermatologic care. In the current study, we evaluated efficacy of the 5% nicotinamide gel versus 2% clindamycin gel in the treatment of the mild-moderate acne vulgaris.
This was a randomized, controlled clinical trial that was performed in 2009-2010. Sixty female patients with mild or moderate acne vulgaris were recurited to be treated either with 5% nicotinamide or 2% clindamycin gel for 8 weeks. Acne severity index (ASI) was used to evaluate response to treatment and SPSS software was used to analyze the data.
The mean of ASI at the baseline was 16.85 ± 8.5 and 18.2 ± 12.27 in nicotinamide gel and clindamycin gel, respectively (P > 0.05). The mean of ASI was significantly decreased compared with baseline ASI during the time in both groups (P < 0.0001). However, there was not a significant difference regarding reduction of ASI between the nicotinamide and clindamycin gel (P = 0.583).
Five percent nicotinamide gel is as effective as 2% clindamycin gel for treatment of mild to moderate acne vulgaris. No side effect was observed during the treatment.
Since ancient times, Aloe vera L. (AV) has attracted scientific interest because of its multiple cosmetic and medicinal properties, attributable to compounds present in leaves and other parts of the plant. The collected literature data show that AV and its products have a beneficial influence on human health, both by topical and oral use, as juice or an extract. Several scientific studies demonstrated the numerous biological activities of AV, including, for instance, antiviral, antimicrobial, antitumor, and antifungal. Moreover, its important antidepressant activity in relation to several diseases, including skin disorders (psoriasis, acne, and so on) and prediabetes, is a growing field of research. This comprehensive review intends to present the most significant and recent studies regarding the plethora of AV’s biological activities and an in-depth analysis exploring the component/s responsible for them. Moreover, its morphology and chemical composition are described, along with some studies regarding the single components of AV available in commerce. Finally, valorization studies and a discussion about the metabolism and toxicological aspects of this “Wonder Plant” are reported.
Acne, known as acne vulgaris, is said to be a recurrent disease related to the skin that becomes visible and the blockage of hair follicles becomes irresistible with skin cells that are supposed to be dead, bacteria, and sebum or oil. Hypersecretion of sebum in disrupted follicles can be considered for the pathogenesis of acne which leads to the formation of microcomedones. Inflammation occurs as the cause of hyperproliferation insisted by the follicles of microcomedones and comedones in both closed and open types. Then the appearance of pustules, papules, cysts, and nodules was observed. The aforementioned state of the skin with sebum or oil confinement is said to be a predisposed condition to the anaerobic growth of C. acnes. Various synthetic drugs are available for the treatment of acne but they are responsible for several adverse effects and show resistance of C. acnes to the available antibiotics. Plant parts or plant-derived compounds are traditionally used in the treatment of acne in India. Even today also a large section of the Indian population is using herbs to cure acne. So, the herbal agents derived from nature, have received considerable interest as they show hardly any detrimental effect and are cost-effective. This article aims to enumerate the role of a few Indian herbs such as Aloe vera, Azadirachta indica, Curcuma longa, etc. in the treatment of acne.
L’acné est l’affection dermatologique la plus commune touchant 80 % de la population âgée entre 11 et 30 ans. Les anti-acnéiques les plus efficaces
sont les rétinoïdes et le peroxyde de benzoyle. Cependant, l’un de leurs effets indésirables les plus remarqués est la xérodermie, appelée aussi
xérose ou sécheresse cutanée, qui peut affecter la qualité de vie du patient surtout quand elle se situe au niveau du visage.
L’objectif principal de cette étude est de recenser les remèdes naturels utilisés par les acnéiques en Algérie pour traiter la xérodermie et de justifier,
par une étude bibliographique, l’usage de ces remèdes.
Il s’agit principalement d’une étude descriptive transversale, la collecte des données est faite à travers un questionnaire en ligne. Les critères
d’inclusion sont : la résidence en Algérie, l’atteinte d’acné et le traitement par des anti-acnéiques. Les remèdes recensés ont fait l’objet d’une
recherche bibliographique.
L’échantillon est constitué de 185 personnes dont 35,1 % ont eu recours à l’utilisation d’un remède naturel. 31 remèdes ont été recensés, les plus
cités sont : l’huile d’olive, le gel d’Aloe vera et le miel .95,4 % ont considéré le remède naturel comme étant efficace dont 44,6 % ont remarqué
une amélioration juste après quelques jours d’utilisation.
Selon la bibliographie, l’huile d’olive a une composition similaire au sébum. Quant à l’aloe vera, il a été démontré que son extrait lyophilisé à
différentes concentrations a significativement amélioré l’hydratation cutanée par rapport au contrôle. D’autre part, le miel est inclus dans « the
International Nomenclature of Cosmetic Ingredients » (INCI) et il est classé comme un produit émollient, humectant et hydratant.
Cette étude nous a permis de recenser les remèdes naturels utilisés traditionnellement pour traiter la xérodermie, la bibliographie a pu confirmer
ces usages. Ceci pourrait donc constituer une base de données intéressante pour les laboratoires pour de nouvelles recherches et formulations.
Objetivo: Evidenciar a importância da espécie Aloe vera L. e o seu uso na área da estética. Revisão bibliográfica: Os resultados mostram que de suas folhas obtém-se uma seiva incolor e viscosa, formada por água e compostos ativos como polissacarídeos, flavonoides, saponinas, esteroides, aminoácidos, sais minerais e vitaminas. O seu uso para a indústria da beleza é vantajoso devido sua ação hidratante e cicatrizante, por estimular fibroblastos, além de fornecer mais oxigênio para os tecidos resultando no aumento da vascularização e na quantidade de produção de colágeno no processo de cicatrização. Considerações finais: A facilidade de cultivo e a popularidade de Aloe vera a torna uma espécie utilizada na indústria cosmética e farmacêutica e que desperta o interesse para o desenvolvimento de cosméticos com diversas finalidades, por apresentar princípios ativos encontrados na seiva incolor presente no interior de suas folhas, sendo utilizados como hidratante e auxiliar no processo de cicatrização.
Aloe is a succulent plant grown in tropical climates that is cultivated for medicinal use. Its history dates back 6000 years to ancient Egypt. The gel from the pulp of aloe leaves can be used topically to treat wounds and burns, among other skin conditions. Aloe is also available in capsule and liquid forms. Researchers have investigated clinical use of aloe for diseases of the mouth and oral cavity, diabetes, irritable bowel syndrome, Alzheimer’s disease, gastroesophageal reflux, HIV, cancer, and more. This chapter examines some of the scientific research conducted on aloe, both alone and in combination formulas, for treating numerous health conditions. It summarizes results from several in vitro and human studies of aloe’s use in treating several cardiometabolic, neurologic, oncologic, and gastrointestinal conditions. Finally, the chapter presents a list of aloe’s Active Constituents, different Commonly Used Preparations and Dosage, and a Section on “Safety and Precaution” that examines side effects, toxicity, and disease and drug interactions.
Traditional textiles have been utilized for the purposes of covering, protection, support, and ornamentation. Recently, with the increasing tendency of people to care for their bodies in natural and healthy ways, it is not only textile products that have improved comfort properties such as temperature and humidity control, but also hygienic, odor-releasing, color and appearance changeable, advanced protective and functional clothing, home textiles or textile-based care products have stood out. Textile engineers, biochemists, pharmacists, cosmetics and health experts make important contributions to the field of cosmetics textiles with multidisciplinary studies. Various metallic, vegetable and animal originated ingredients are used in pure or derivative form to gain cosmetic functionality to textile products. Cosmetic textiles are designed to transfer an active agent serving for a cosmetic purpose during contact with human skin. The cosmetic and / or pharmaceutical components are transferred to the fabric forming the garment so that the component(s) can be transferred to the skin by the natural movement of the body over a long period of time. The aim of this study is to provide a general summary of the existing literature
on the functionalities, characterizations and performance tests of cosmetic textiles to the national literature.
INTISARI Ekstrak kering lidah buaya dan ekstrak kental daun sirih merah mengandung senyawa alkaloid, flavonoid, tanin, saponin dan fenol yang mempunyai aktivitas sebagai antibakteri penyebab jerawat. Penelitian ini bertujuanUntuk menentukan konsentrasi ekstrak kering lidah buaya (Aloe vera (L) brum f), untuk menentukan ekstrak kental daun sirih merah (Piper crotacum ruiz dan pav) mempunyai daya hambat ter terhadap bakteri Propionibacterium acnes dan Staphylococcus aureus penyebab jerawat dan untuk menentukan konsentrasi kombinasi ekstrak kering lidah buaya (Aloe vera (L) brum f) dan ekstrak kental daun sirih merah (Piper crotacum ruiz dan pav)mempunyai daya hambat terterhadap bakteri Propionibacterium acnes dan Staphylococcus aureus penyebab jerawat.Tahap-tahap penelitian yaitu determinasi tanaman lidah buaya dan daun sirih merah, pembuatan ekstrak, pemeriksaan ekstrak meliputi organoleptik, pH, uji skrining fitokimia serta pengujian aktivitas masing-masing ekstrak kering lidah buaya dengan konsentrasi 10%, 15%, 20%, 25%, 30% dan 35%, ekstrak kental daun sirih merah dengan konsentrasi 25%, 12,5%, 7,16%, 3,13%, 1,78% dan 0,78% serta kombinasi ekstrak kering lidah buaya dan ekstrak kental daun sirih merah dengan konsentrasi 50%, 25%, 12,5%, 7,16%, 3,13%, dan 1,56 terhadap bakteri Propionibacterium acnes dan Staphylococcus aureus. Kombinasi ekstrak kering lidah buaya dan ekstrak kental daun sirih merah memiliki aktivitas antibakteri terhadap bakteri Staphylococcus aureus pada konsentrasi 1,56 % dan Propionibacterium acne pada konsentrasi 3,13 Kata kunci : Lidah buaya, daun sirih merah, Propionibacterium acnes, Staphylococcus aureus. ABSTRACT Dried aloe vera extract and thick red betel leaf extract contains alkaloid compounds, flavonoids, tannins, saponins and phenols that have activity as an antibacterial cause of acne. The aim of this study was to determine the concentration of Aloe vera (L) brum f) extract, to determine the thick red betel leaf extract (Piper crotacum ruiz and pav) to have the inhibitory effect against the bacteria Propionibacterium acnes and Staphylococcus aureus causes acne and to determine the concentration of Aloe vera (L) brum f) and red thick betel leaf extract (Piper crotacum ruiz and pav) have inhibitory effect on bacteria Propionibacterium acnes and Staphylococcus aureus cause acne. The research stages are the determination of aloe vera and red betel leaf, extract preparation, extract examination including organoleptic, pH, phytochemical screening test and activity test of dry aloe vera extract with concentration 10%, 15%, 20%, 25% , 30% and 35%, thick red betel leaf extract with concentration of 25%, 12.5%, 7.16%, 3.13%, 1.78% and 0.78%, and combination of aloe vera extract and viscous extract red betel leaves with concentrations of 50%, 25%, 12.5%, 7.16%, 3.13%, and 1.56 against the bacteria Propionibacterium acnes and Staphylococcus aureus. The combination of dry extract of aloe vera and thick red betel leaf extract have antibacterial activity against Staphylococcus aureus bacteria at concentration 1.56% and Propionibacterium acne at concentration 3,13 %. Keywords: aloe vera, red betel leaf extract, Propionibacterium acnes, Staphylococcus aureus
Natural molecules are becoming more accepted choices as cosmetic agents, many products in the market today claim to include natural components. Plants include many substances that could be of a value in the whitening skin and working as anti-aging agents. A wide range of articles related to natural skin whitening and anti-aging agents have been reviewed. Many plant-derived and natural molecules have shown to affect melanin synthesis by different mechanisms, examples include Arbutin, Ramulus mori extract, Licorice extract, Glabridin, Liquiritin, Kojic acid, Methyl gentisate, Aloesin, Azelaic acid, Vitamin C, Thioctic acid, Soya bean extracts, Niacinamide, α and β-hydroxy acids, Lactic acid, Chamomile extract, and Ellagic acid. Some of the widely used natural anti-aging products as natural antioxidants, collagen, hyaluronic acid, and coenzyme Q can counteract the effects of reactive oxygen species in skin cells and have anti-aging properties on the skin. It was concluded that many natural products including antioxidants can prevent UV-induced skin damage and have whitening and anti-aging effects. It is very important to develop and stabilize appropriate methods for the evaluation of the whitening and anti-aging capacity of natural products and their exact mechanism of action to ensure real efficacy based on evidence-based studies. The attention should be oriented on the formulations and the development of an appropriate vehicle to ensure suitable absorption of these natural products in addition to evaluating the suitable concentration of these molecules required having the desired effects without causing harmful side effects.
Aloe is a perennial succulent of Liliaceae family and long been recognised for diverse medicinal
preparations, extraction of drug and flavouring liquors. The exact origin of Aloe is uncertain, but is mainly grown in relatively warm and dry climate Two major products derived from the leaves are the yellow bitter juice consisting of aloin and the gel rich in polysaccharides. It also includes vitamins, enzymes, anthraquinones /anthrones, chromones and many other primary as well as secondary metabolites. These are extensively used as active ingredients in laxative and in anti-obesity medicines, as
emollient or wound healer in various cosmetic and pharmaceutical formulations. Many tribals have their
own indigenous formulations from Aloe species to manage various ailments since ages. However, in
spite of scores of beneficial role, sometimes a few chemicals present in Aloe make the products toxic
which, of course, depends on the source, locality, person to be used, etc. The present study extensively
reviews the phytochemistry, multi-dimensional health benefits and toxicological profile of Aloe species.
Background:
The use of complementary and alternative medicine (CAM) is increasing in western countries, including in the area of dermatology. However, western healthcare providers have not integrated CAM into regular practice due to a lack of reliable data supporting its use. In order to encourage high quality research related to the use of CAM and specifically herbal interventions, the CONSORT extension criteria on reporting herbal interventions (hCONSORT) were published in 2006.
Objectives:
This study aimed to evaluate the adherence of randomized controlled trials investigating herbal interventions for 3 common dermatoses (acne, atopic dermatitis, and psoriasis) to the hCONSORT criteria.
Methods:
A comprehensive search of Medline, Embase, and Cochrane library databases was conducted. Randomized control trials published between 2009 and 2014 assessing therapeutic outcomes of plant-based interventions for acne, atopic dermatitis, or psoriasis were included. Investigators determined the number of unique hCONSORT criteria satisfied per report. Analysis of variance was used to examine differences in scores by disease entity.
Results:
The vast majority of reviewed studies reported less than 50% of information recommended in the hCONSORT criteria.
Limitations:
Limitations include small number of dermatologic conditions examined, exclusion of reports based on language, and lack of assessment of overall adherence to CONSORT criteria CONCLUSIONS: Our data indicates lack of adherence to hCONSORT extension criteria. Adherence to hCONSORT guidelines should be encouraged in order to provide high quality reporting of research on herbal interventions in dermatology. Doing so may ease the integration of CAM into conventional medical practice and provide actionable data to providers. This article is protected by copyright. All rights reserved.
Acne has been estimated to affect the majority of people at some point in their life and is common in Middle Eastern countries. While acne is frequently perceived to be a self-limited disease of adolescence, there is an increasing population of adults with acne. Information about the management of acne in the Middle East is somewhat sparse; however, several studies have recently been conducted and will be discussed in this supplement.
Acne is a chronic skin disease caused by inflammation led by Propionibacterium acnes (P. acnes) in the pilosebaceous unit. This study investigated whether plant Aloe ferox (AF) components may have anti-P. acnes and anti-inflammatory properties that may serve for acne treatment. Extracts of Aloe ferox (500 g) were prepared by extracting with 4 L volumes of distilled water (AFW), 50% ethanol (AF50), or 95% ethanol (AF95). AF95 was further fractionated with 2 L volumes of ethyl acetate (AF95E), butanol (AF95B) or water (AF95W). The antibiotic potency against P. acnes was determined by the paper disc diffusion method along with measuring minimal inhibitory concentration and minimal bactericidal concentrations. The anti-inflammatory effect of Aloe ferox was determined by measuring TNF-α, IL-1β, IL-6, and IL-8 levels in THP-1 cells co-cultured with P. acnes. Proliferation of P. acnes was inhibited by 25 mg/mL AFW, AF50 and AF95; however, AF95 had the highest anti-P. acnes activity. AF95 and all its fractions (AF95E, AF95 B and AF95W) remarkably reduced P. acnes-induced elevated levels of inflammatory cytokines (TNF-α, IL-1β, IL-6, and IL-8). From these fractions, AF95E had the largest cytokine dampening. In conclusion, extracts of Aloe ferox had anti-P. acnes and anti-inflammatory effects, suggesting that Aloe ferox could be further studied as a potential treatment for acne.
The use of medicinal plants for the treatment of acne and other infectious skin diseases is very common. Here, pharmacological studies on the medicinal plants which may be effective in the treatment of acne and infective skin diseases published in the databases PubMed and Scopus from the beginning of the year 1980 to the end of April of the year 2013 have been searched and discussed. Keywords including medicinal plants, herbs, botanicals, phytomedicine, phytotherapy, herbal therapy and herbal medicine with dermatology, skin, acne vulgaris, antibacterial, antiviral, antifungal and antimicrobial were entered in the databases. Totally 56 articles concerning clinical and nonclinical studies were found. Afterward, the quality of each study was determined. Examples of such plants include Vitex agnus-castus, Ocimum gratissimum, Aloe vera , Solanum dulcamara, Commiphora mukul, Mahonia aquifolium, Melaleuca alternifolia, species of the genus Eucalyptus, Camellia sinensis and Allium sativum. Medicinal plants can have an important role in the treatment of acne and other infectious skin diseases. However, scant studies have been conducted in this field so far and more studies especially on the efficacy and safety of the plants' clinical use in humans are needed.
Objective To evaluate clinically the efficacy of Zimade Muhasa, a Unani anti acne formulation, for Busoore labaniya (Acne vulgaris) against 5% benzoyl peroxide. Methods The randomized, single-blind, standard controlled trial of 6 weeks evaluated the efficacy and tolerability of Unani topical antiacne formulation against standard control i.e. 5% benzoyl peroxide in 48 patients of either sex on the basis of Global Evaluation of Acne Scale (GEA Scale) along with arbitrary scale for assessment of effect over postinflammatory hyperpigmentation, scarring and fairness. In addition quality of life was assessed according to Cardiff Acne Disability Index (CADI) questionnaire. The alterations in improvement and possible complications were regularly assessed. Results After 6 weeks of treatment, compared with baseline both the treatment preparations decreased the acne lesions (P < 0.001). Further, the test formulation improved postinflammatory hyperpigmentation (P < 0.001), scarring (P=0.025) and complexion (P=0.001). There was significant (P < 0.001) improvement in the quality of life in treatment groups at the end of study. Conclusion The test formulation was well-tolerated and equivalent to 5% benzoyl peroxide in alleviating acne lesions. Test formulation was also more effectual concerning the effects over scars, post inflammatory hyperpigmentation and fairness. This formulation can be used safely to treat active acne as well as in patients with post acne scarring. The clinical relevance may be clarified by longer duration treatment.
Background and purpose: Diabetic foot ulcers are one of the major causes of morbidity and mortality in diabetic patients. For centuries Aleo vera has been used in treatment of diabetic foot ulcers. In this study, a mixture of honey and Aloe vera was used for diabetic foot ulcer healing. Materials and methods: In a double-blind clinical trial, patients with nonischemic, noninfected diabetic foot ulcers (attending Imam Khomeini Hospital Diabetes Center, Sari, Iran) were divided into two groups, a treatment group (n= 24) and a placebo group (n=15). To compare the effect of the mixture t-test and qui square were applied. Results: A total of 39 patients (19 males and 20 females) with diabetic foot ulcers were enrolled. Mean age of the patients, mean body mass index, and mean duration of diabetes were 56.3 ±10.2, 31.2 ± 4.2, 16.2 ± 6.6, respectively which were not significantly different between the two groups. Wound size was determined using a ruler that showed no significant difference between the two groups (P=0.36). Debridement, offloading and washing were done for all participants. Combined gel of Aleo vera and honey was used for treatment group. Wound healing was seen in 21 (95.5%) patients in treatment group and in 11 (78.6%) patients in placebo group. Conclusion: In small, non-infected, non-ischemic ulcers the effect of honey and Aloe vera gel was the same as that of the placebo. Offloading, debridement and washing with normal saline have similar effect to the mixture in healing diabetic foot ulcers. © 2015 Mazandaran University of Medical Sciences. All rights reserved.
Lately, it has been shown that topical Aloe vera extract is effective against acne lesions. The objective of this study was to investigate the effectiveness of oral Aloe vera juice in a group of patients with mild-to-moderate acne vulgaris. In this double-blind, placebo-controlled, randomized clinical trial, 40 volunteers with mild-to moderate acne vulgaris were randomized equally into two, age and sex-matched groups, receiving either 50 cc of freshly prepared Aloe vera (Aloe barbadensis Miller) juice or placebo once daily for 30 consecutive days. Facial acne noninflamed, inflamed and total (noninflamed plus inflamed) lesion counts were documented at baseline on week 2 and at endpoint (day 30) by an observer who was blind to the grouping of patients. There were 12 males (60%) and 8 females (40%) with a mean age of 17.5±5.1 years (range: 12-27) in the case group and 10 males (20%) and 10 females (20%) with a mean age of 17.4±5.6 years (range: 12-29) in the control group (p = 0.53 and 0.98, respectively). Although, the mean number of inflamed and total acne lesions decreased frombaseline to the endpoint in the case group, these changes were not statistically different from those documented in the control group (p = 0.96 and 0.91, respectively). In conclusion, oral Aloe vera juice may be helpful in decreasing noninflamed and total facial acne lesion counts in patients with mild-to-moderate acne vulgaris, this beneficial effect is not significant when compared to controls.
Background
The validity of randomized controlled trials (RCT) is determined by several statistical factors.Objective
To determine the level of recent statistical reporting in RCT from the dermatology literature.Methods
We searched MEDLINE for all RCT published between May 1, 2013 and May 1, 2014 in 45 dermatology journals.ResultsTwo hundred and ten articles were screened, of which 181 RCT from 27 journals were reviewed. Primary study outcomes were met in 122 (67.4%) studies. Sample size calculations and beta values were reported in 52 (28.7%) and 48 (26.5%) studies, respectively, and non-significant findings were supported in only 31 (17.2%). Alpha values were reported in 131 (72.4%) of studies with 45 (24.9%) having two-sided P-values, though adjustment for multiple statistical tests was performed in only 16 (9.9% of studies with ≥2 statistical tests performed). Sample size calculations were performed based on a single outcome in 44 (86.3%) and multiple outcomes in 6 (11.8%) studies. However, among studies that were powered for a single primary outcome, 20 (45.5%) made conclusions based on multiple primary outcomes. Twenty one (40.4%) studies relied on secondary or unspecified outcomes. There were no differences for primary outcome being met (Chi-square, P=0.29), sample size calculations and beta values (P=0.55), alpha values (P=0.65), correction for multiple statistical testing (P=0.59), two-sided alpha (P=0.64), support of non-significant findings (Fisher's exact, P=0.23) based on the journal's impact factor.Conclusion
Levels of statistical reporting are low in RCT from the dermatology literature. Future work is needed to improve these levels of reporting.This article is protected by copyright. All rights reserved.
The comparative antimicrobial activities of the gel and leaf of Aloe vera were tested against Staphylococcus aureus, Pseudomonas aeruginosa, Trichophyton mentagraphytes, T. schoeleinii, Microsporium canis and Candida albicans. Ethanol was used for the extraction of the leaf after obtaining the gel from it. Antimicrobial effect was measured by the appearance of zones of inhibition. Antimicrobial susceptibility test showed that both the gel and the leaf inhibited the growth of S. aureus (18.0 and 4.0 mm, respectively). Only the gel inhibited the growth of T. mentagrophytes (20.0 mm), while the leaf possesses inhibitory effects on both P. aeruginosa and C. albicans. The results of this study tend to give credence to the popular use of both Aloe vera gel and leaf.
Topical formulations (Gel) have been developed containing hydro-alcoholic extract of Ocimum sanctum, ethanolic extract of Tabernaemontana divaricata, Aloe vera concentrate gel powder and tea tree oil. In vitro antibacterial activity was performed against Propionibacterium acnes (P. acnes), a causative organism for Acne vulgar for the developed formulations using agar well diffusion method. The measured zones of inhibitions of the formulations were compared with standard antibiotic (tetracycline), standard marketed topical herbal preparation for acne and active ingredients of the formulations. Results of the investigation showed that formulation 5 has greater antibacterial activity (zones of inhibition >16 mm) than other formulations and which is comparable to that of standard marketed topical herbal preparation. When compared with hydro-alcoholic extract of Ocimum sanctum (Zone of inhibition < 9 mm), ethanolic extract of Tabernaemontana divaricata (Zone of inhibition < 8 mm) and tea tree oil (Zone of inhibition 9 mm-10 mm); all formulations had shown greater activity while the activity was found less on comparison with the standard antibiotic solution (zone of inhibition > 17 mm).
The antagonistic properties of indigenous microflora from cassava starch, flour and grated cassava were investigated using the conventional streak, novel ring and well diffusion methods. Antagonism was measured by zone of inhibition between the fungal plug and bacterial streak/ring. Bacillus species were more effective to inhibit the growth of Aspergillus niger, A. fumigatus, Fusarium moniliforme and Rhizoctonia sp. Pseudomonas fluorescens, Escherichia coli and Saccharomyces sp. inhibited the growth of A. niger, A. flavus and F. moniliforme. There were considerable variations in inhibitory activity. The zone of inhibition was more apparent in the novel ring method. Percentage inhibition increased to 78% in the Ring method and 62% in streak method after 168 h of incubation. Lactobacillus brevis, L. acidophilus and Bacillus subtilis inhibited the growth of E. coli and Staphylococcus aureus. Inhibition of the pathogenic microorganisms was probably due to the production of organic acids and bacteriocins.
Glycyrrhiza glabra L. has been used in herbal medicine for skin eruptions, including dermatitis, eczema, pruritus and cysts. The effect of licorice extract as topical preparation was evaluated on atopic dermatitis. The plant was collected and extracted by percolation with suitable solvent. The extract was standardized, based on Glycyrrhizinic acid by using a titrimetry method. Different topical gels were formulated by using different co-solvents. After standardizing of topical preparations, the best formulations (1% and 2%) were studied in a double-blind clinical trial in comparison with base gel on atopic dermatitis over two weeks (30 patients in each group). Propylene glycol was the best co-solvent for the extract and Carbopol 940 as gelling agent showed the best results in final formulations. The quantity of glycyrrhizinic acid was determined 20.3% in the extract and 19.6% in the topical preparation. Two percent licorice topical gel was more effective than 1% in reducing the scores for erythema, oedema and itching over two weeks (p<0.05). The results showed that licorice extract could be considered as an effective agent for treatment of atopic dermatitis.
The present study was carried out to examine the anti-inflammatory activity of the inner leaf gel component of Aloe barbadensis Miller. A simple in vitro assay was designed to determine the effect of the inner gel on bacterial-induced pro-inflammatory cytokine production, namely TNF-alpha and IL-1 beta, from peripheral blood leukocytes stimulated with Shigella flexneri or LPS. This report describes the suppression of both cytokines with a freeze-dried inner gel powder and a commercial health drink from the same source. Comparison was made with a human monocytic cell-line (THP-1 cells) and a similar trend in responses was demonstrated.
More than a cosmetic nuisance, acne can produce anxiety, depression, and other psychological problems that affect patients' lives in ways comparable to life-threatening or disabling diseases. Emotional problems due to the disease should be taken seriously and included in the treatment plan. A purely dermatological therapy by itself may not achieve its purpose. Even mild to moderate disease can be associated with significant depression and suicidal ideation, and psychologic change does not necessarily correlate with disease severity. Acne patients suffer particularly under social limitations and reduced quality of life. Psychological comorbidities in acne are probably greater than generally assumed. Attention should be paid to psychosomatic aspects especially if depressive- anxious disorders are suspected, particularly with evidence of suicidal tendencies, body dysmorphic disorders, or also in disrupted compliance. Therefore, patients who report particularly high emotional distress or dysmorphic tendencies due to the disease should be treated, if possible, by interdisciplinary therapy. The dermatologist should have some knowledge of the basics of psychotherapy and psychopharmacology, which sometimes must be combined with systemic and topical treatment of acne in conjunction with basic psychosomatic treatment.
Topical retinoids are important tools in the management of acne because they act against comedones and microcomedones and have direct anti-inflammatory effects. The substances approved for acne treatment comprise tretinoin (all-trans-retinoic acid),isotretinoin (13-cis retinoic acid) as well as the synthetic third-generation polyaromatic retinoids adapalene and tazarotene,the latter being approved for acne treatment in the US only.Retinaldehyde is used in cosmetic preparations against acne.
All topical retinoids are effective as single agents in mild to moderate acne but differ in efficacy and tolerability. Tazarotene 0.1% is more effective than tretinoin 0.025% or 0.1% microsphere gel or adapalene 0.1% gel or cream (EBM-level 2c). Adapalene 0.1% is equally effective to tretinoin 0.025% or tretinoin microsphere 0.1% gel or tretinoin 0.05% cream or isotretinoin 0.05% gel (EBM-level 2c). Adapalene 0.1% gel is significantly better tolerated than tazarotene 0.1% gel, tretinoin 0.025% and tretinoin 0.05% gel, tretinoin 0.05% cream,tretinoin microsphere 0.1% gel or isotretinoin 0.05% gel (EBM-level 2c).The safety profile of topical retinoids differs from their systemic counterparts and is related mainly to local adverse effects, such as erythema, dry-ness,itching and stinging.The currently available evidence justifies the use of topical retinoids in most types of acne and during maintenance treatment.
Acne is common but not trivial. It affects up to 85% of adolescents to some extent. Less commonly, it occurs in infancy. The pathophysiology centres on occluded pilosebaceous follicles and is multifactorial. An underlying pathological cause is rare, and investigations are not usually indicated. The psychosocial impact of acne may be significant and it can affect employment opportunities. Quality of life indices indicate that its impact can be as high as diseases such as diabetes mellitus. Although treatment is often effective. it is slow to work and there are frequent minor side-effects; this may affect compliance. Early treatment may prevent scarring, and this is particularly important in severe nodulo-cystic acne. We will review the topical and oral treatments suitable for use in children and discuss how to tailor treatment depending on the severity of the acne and the types of lesion present.
Acne vulgaris, a multifactorial condition often conferring significant psychosocial morbidity, affects an estimated 40 million people in the United States. The majority of these individuals are adolescents and young adults. The pathophysiology of the condition is still not fully known, but it is believed to be related in part to excess sebum production, follicular hyperkeratinization, microbial colonization by P acnes, and inflammation. Prior to initiating treatment in a female patient, a hyperandrogenic state must be considered and ruled out through history, physical exam, and laboratory evaluation if necessary. Treatment options are vast and include hormonal therapy among others. Hormonal therapies have long been noted to reduce acne lesions and offer a valuable adjuvant to standard therapy. Hormonal agents are thought to improve acne by blocking the androgen receptor and/or decreasing circulating androgens which leads to decreased sebum production. Hormonal treatment options include spironolactone, other antiandrogens, and oral contraceptives. The use of these agents to effectively treat acne has been demonstrated in several randomized, placebo-controlled clinical trials. Optimal results are often achieved with combination therapy with the goal of targeting multiple pathogenic pathways in acne development.
The positive influence of Aloe vera, a tropical cactus, on the healing of full-thickness wounds in diabetic rats is reported. Full-thickness excision/incision wounds were created on the back of rats, and treated either by topical application on the wound surface or by oral administration of the Aloe vera gel to the rat. Wound granulation tissues were removed on various days and the collagen, hexosamine, total protein and DNA contents were determined, in addition to the rates of wound contraction and period of epithelialization. Measurements of tensile strength were made on treated/untreated incision wounds. The results indicated that Aloe vera treatment of wounds in diabetic rats may enhance the process of wound healing by influencing phases such as inflammation, fibroplasia, collagen synthesis and maturation, and wound contraction. These effects may be due to the reported hypoglycemic effects of the aloe gel.
Topical retinoids have been in clinical use for the treatment of chronic skin conditions, including acne, photodamage, and psoriasis, for 30 years.
A systematic literature review was conducted to assess the incidence of noncutaneous adverse events (AE) among patients treated with topical retinoids with a focus on topical tretinoin studies reported before the Veterans Affairs Topical Tretinoin Chemoprevention trial.
Electronic literature searches were conducted in Embase and MEDLINE for literature reporting development of nonteratogenic, noncutaneous AE among patients treated with topical retinoids published through September 2008.
The search yielded 2778 citations, of which 20 studies met inclusion criteria. Tretinoin was used in 14 of the studies. Other retinoids assessed included isotretinoin, adapalene, alitretinoin, and tazarotene. Within patients receiving topical tretinoin, 27.9% reported the occurrence of at least one noncutaneous AE. The majority of noncutaneous AE were transient and judged not to be related to tretinoin treatment.
The conclusions of this study apply largely to tretinoin compared with other topical retinoids. Many of the included trials were designed to evaluate the efficacy of topical treatment and reporting of safety events concentrated on incidence of localized AE, rather than systemic or noncutaneous events.
We found no clear evidence of a relationship between the use of topical tretinoin and the development of noncutaneous AE before a recent report of excess mortality in a clinical trial. The majority of noncutaneous AE reported by patients receiving topical retinoids consisted of nonsevere, nonspecific symptoms that were judged not to be related to treatment.
Acne vulgaris suppresses an individual’s self-confidence by causing distress with regard to physical appearance, which affects a significant number of individuals during puberty and is delineated by adolescence. Several treatments have been introduced to decrease the aesthetic and psychological problems caused by acne. The topical application of therapeutic agents has been found to be more feasible than hormonal treatment and laser therapy. The ingredients in topical acne treatments, particularly herbs and naturally derived compounds, have received considerable interest as they have fewer adverse effects than synthetic agents.
L’acné vulgaire touche à l’assurance d’un individu en causant une détresse face à son apparence physique. Elle affecte un nombre important d’individus pendant la puberté et est associée à l’adolescence. Plusieurs traitements ont été proposés pour diminuer les problèmes esthétiques et psychologiques causés par l’acné. L’application topique d’agents thérapeutiques a été estimée plus aisée qu’un traitement hormonal et une thérapie laser. Les ingrédients des traitements topiques de l’acné, particulièrement les plantes et les composés naturels dérivés ont suscité un intérêt considérable par leurs moindres effets indésirables que les ingrédients synthétiques.
Topical spironolactone may be effective for the treatment of acne patients with increased sebum secretion.
To evaluate the efficacy of 5% spironolactone gel in the treatment of mild to moderate acne vulgaris.
This study was a double-blind clinical trial, performed randomly in two demographically equivalent groups. In this study, 78 patients with mild to moderate acne vulgaris participated. The patients, as groups of cases (38 patients) and controls (40 patients), took 5% spironolactone gel and placebo, respectively. The response to treatment was evaluated by the total acne lesions (TLC) and acne severity index (ASI).
The mean age of the case patients was 21.5 ± 4.2 years and of the control patients was 22.2 ± 4.06 years. The difference in TLC was statistically significant between the two groups (p = 0.007), but no statistically significant difference was seen between the two groups for ASI (p = 0.052).
The 5% spironolactone topical gel resulted in a decrease in the TLC in acne vulgaris, while it had no significant efficacy in the ASI.
More than a cosmetic nuisance, acne can produce anxiety, depression, and other psychological problems that affect patients' lives in ways comparable to life-threatening or disabling diseases. Emotional problems due to the disease should be taken seriously and included in the treatment plan. A purely dermatological therapy by itself may not achieve its purpose. Even mild to moderate disease can be associated with significant depression and suicidal ideation, and psychologic change does not necessarily correlate with disease severity. Acne patients suffer particularly under social limitations and reduced quality of life. Psychological comorbidities in acne are probably greater than generally assumed. Attention should be paid to psychosomatic aspects especially if depressive-anxious disorders are suspected, particularly with evidence of suicidal tendencies, body dysmorphic disorders, or also in disrupted compliance. Therefore, patients who report particularly high emotional distress or dysmorphic tendencies due to the disease should be treated, if possible, by interdisciplinary therapy. The dermatologist should have some knowledge of the basics of psychotherapy and psychopharmacology, which sometimes must be combined with systemic and topical treatment of acne in conjunction with basic psychosomatic treatment.
Topical retinoids are important tools in the management of acne because they act against comedones and microcomedones and have direct anti-inflammatory effects. The substances approved for acne treatment comprise tretinoin (all-trans-retinoic acid), isotretinoin (13-cis retinoic acid) as well as the synthetic third-generation polyaromatic retinoids adapalene and tazarotene, the latter being approved for acne treatment in the US only. Retinaldehyde is used in cosmetic preparations against acne. All topical retinoids are effective as single agents in mild to moderate acne but differ in efficacy and tolerability. Tazarotene 0.1 % is more effective than tretinoin 0.025 % or 0.1 % microsphere gel or adapalene 0.1 % gel or cream (EBM-level 2c). Adapalene 0.1 % is equally effective to tretinoin 0.025 % or tretinoin microsphere 0.1 % gel or tretinoin 0.05 % cream or isotretinoin 0.05 % gel (EBM-level 2c). Adapalene 0.1 % gel is significantly better tolerated than tazarotene 0.1 % gel, tretinoin 0.025 % and tretinoin 0.05 % gel, tretinoin 0.05% cream, tretinoin microsphere 0.1 % gel or isotretinoin 0.05 % gel (EBM-level 2c).The safety profile of topical retinoids differs from their systemic counterparts and is related mainly to local adverse effects, such as erythema, dryness, itching and stinging. The currently available evidence justifies the use of topical retinoids in most types of acne and during maintenance treatment.
Full-face dermabrasion provided an ideal opportunity to document the effects of dressings on wound healing management. Following the procedure, the abraded face was divided in half. One side was treated with the standard polyethylene oxide gel wound dressings. The other side was treated with a polyethylene oxide gel dressing saturated with stabilized aloe vera. The polyethylene oxide dressing provided an excellent matrix for the release of aloe vera gel during the initial 5 days of wound healing. By 24-48 hours there was dramatic vasoconstriction and accompanying reduction in edema on the aloe-treated side. By the third to fourth day there was less exudate and crusting at the aloe site, and by the fifth to sixth day the reepithelialization at the aloe site was complete. Overall, wound healing was approximately 72 hours faster at the aloe site. This acceleration in wound healing is important to reduce bacterial contamination, subsequent keloid formation, and/or pigmentary changes. The exact mechanism of acceleration of wound healing by aloe vera is unknown.
Preclinical study and human patch tests indicate polyolprepolymer-2 may reduce cutaneous tretinoin-induced irritation.
This study compared the clinical efficacy and safety of a 0.025% tretinoin cream containing polyolprepolymer-2 and its vehicle to a commercially-available 0.025% tretinoin cream.
In this 12-week multicenter, double-blind, parallel group study in patients with mild to moderate acne, objective lesion counts and the investigators' global evaluations evaluated efficacy. Subjective evaluations of skin irritation were used to study safety.
A total of 271 patients were enrolled. The active treatments demonstrated comparable efficacy that was statistically significantly greater than that of the vehicle. Safety evaluations of cutaneous and noncutaneous adverse events also indicated comparable results of the active treatments.
The commercially-available 0.025% tretinoin cream and the 0.025% tretinoin cream containing polyolprepolymer-2 demonstrated comparable efficacy and safety.
Topical tretinoin has been a mainstay of acne therapy for nearly 25 years. It is available in a number of formulations and concentrations, including 0.025%, 0.05% and 0.1% cream, 0.1% and 0.25% gel, and 0.1% liquid solution. A new formulation, incorporating 0.1% in a microsphere gel formulation, has recently become available. CAUSE AND PATHOGENESIS OF ACNE Any sensible approach to the therapy of acne is based on an understanding of its complex pathogenesis. Acne is a multifactorial disease involving hormonal influences, altered keratinization, inflammation, and immunity. Inflammation in acne results from the immune response to the normal follicular bacterium Propionibacterium acnes. P. acnes is an exceedingly tough organism to degrade; as such, it can persist in tissue and serve as a continuing stimulus for inflammation. 1
Research since the 1986 review has largely upheld the therapeutic claims made in the earlier papers and indeed extended them into other areas. Treatment of inflammation is still the key effect for most types of healing but it is now realized that this is a complex process and that many of its constituent processes may be addressed in different ways by different gel components. A common theme running though much recent research is the immunomodulatory properties of the gel polysaccharides, especially the acetylated mannans from Aloe vera, which are now a proprietary substance covered by many patents. There have also been, however, persistent reports of active glycoprotein fractions from both Aloe vera and Aloe arborescens. There are also cautionary investigations warning of possible allergic effects on some patients. Reports also describe antidiabetic, anticancer and antibiotic activities, so we may expect to see a widening use of aloe gel. Several reputable suppliers produce a stabilized aloe gel for use as itself or in formulations and there may be moves towards isolating and eventually providing verified active ingredients in dosable quantities
The use of aloe vera is being promoted for a large variety of conditions. Often general practitioners seem to know less than their patients about its alleged benefits.
To define the clinical effectiveness of aloe vera, a popular herbal remedy in the United Kingdom.
Four independent literature searches were conducted in MEDLINE, EMBASE, Biosis, and the Cochrane Library. Only controlled clinical trials (on any indication) were included. There were no restrictions on the language of publication. All trials were read by both authors and data were extracted in a standardized, pre-defined manner.
Ten studies were located. They suggest that oral administration of aloe vera might be a useful adjunct for lowering blood glucose in diabetic patients as well as for reducing blood lipid levels in patients with hyperlipidaemia. Topical application of aloe vera is not an effective preventative for radiation-induced injuries. It might be effective for genital herpes and psoriasis. Whether it promotes wound healing is unclear. There are major caveats associated with all of these statements.
Even though there are some promising results, clinical effectiveness of oral or topical aloe vera is not sufficiently defined at present.
Oral and externally used dermatological preparation for acne vulgaris employing herbal extracts have been developed and standardized, the herbal extracts used here were of the plants described in ayurvedic treatise like Bhavprakasha Nighantu and Charak Samhita. The efficacy of the treatment using the oral formulation with or without external preparation has been assessed through conduct of Phase II clinical trials in 53 patients for 4 weeks in a randomized, double-blind, placebo-controlled fashion and following Good Clinical Practices guidelines. The results were statistically analyzed and indicated that combination of use of internal and external preparation showed better efficacy as compared to the use of oral formulation alone.
Propionibacterium acnes, an anaerobic pathogen, plays an important role in the pathogenesis of acne by inducing certain inflammatory mediators. These mediators include reactive oxygen species (ROS) and pro-inflammatory cytokines. In the present study, ROS, interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) were used as the major criteria for the evaluation of anti-inflammatory activity. To prove the anti-inflammatory effects of herbs, polymorphonuclear leukocytes (PMNL) and monocytes were treated with culture supernatant of P. acnes in the presence or absence of herbs. It was found that Rubia cordifolia, Curcuma longa, Hemidesmus indicus, and Azadirachta indica caused a statistically significant suppression of ROS from PMNL. Sphaeranthus indicus caused a smaller, still significant suppression of ROS. Aloe vera had no effect on ROS production. In the case of proinflammatory cytokine-induced monocytes, maximum suppression was shown by Azadirachta indica and Sphaeranthus indicus, followed by Hemidesmus indicus, Rubia cordifolia, and Curcuma longa. Aloe vera showed insignificant inhibitory activity. Thus, these herbs shows anti-inflammatory activity by suppressing the capacity of P. acnes-induced ROS and pro-inflammatory cytokines, the two important inflammatory mediators in acne pathogenesis.
Acne vulgaris is a common skin disease, affecting about 70-80% of adolescents and young adults. It is a multifactorial disease of the pilosebaceous unit.(1) The influence of androgens at the onset of adolescence leads to an enlargement of the sebaceous gland and a rise in sebum production. Additional increased proliferation and altered differentiation of the follicular epithelium eventually blocks the pilosebaceous duct, leading to development of the microcomedo as the primary acne lesion. Concomitantly and subsequently, colonization with Propionibacterium acnes increases, followed by induction of inflammatory reactions from bacteria, ductal corneocytes, and sebaceous proinflammatory agents (Fig 1).(2-5)
Several pathogenic factors contribute to the development of acne, among them, seborrhea, follicular hyperkeratosis, propionibacteria, and inflammatory events. This article reviews current knowledge of these pathogenic factors.
The development of a hydrogel to stabilize and solubilize clindamycin and tretinoin provides a single, once-daily treatment for acne vulgaris.
Our aim was to compare the efficacy and safety of the combination of clindamycin (1%) and tretinoin (0.025%) with each agent alone and vehicle.
Two randomized, double-blind, active drug- and vehicle-controlled 12-week studies evaluated inflammatory and noninflammatory lesion counts and the Investigator's Static Global Assessment in 2219 subjects with acne vulgaris.
The combination demonstrated superior efficacy to clindamycin, tretinoin, and vehicle. Combination hydrogel was significantly more effective in reducing inflammatory (P < .005), noninflammatory (P < or = .0004), and total (P < .0001) lesion counts than the other treatments and vehicle. The proportion of subjects with clear or almost clear skin on the Investigator's Static Global Assessment was greater with the combination (P < .0001).
A majority of subjects (82.6%) had grade 2-3 acne vulgaris at baseline; therefore these overall results may not be representative of the response in the subjects (17.4%) with grade 4-5 acne.
The combination clindamycin/tretinoin hydrogel was well tolerated and significantly more effective than clindamycin, tretinoin, or vehicle for the treatment of acne vulgaris.
The following article reviews treatment for acne vulgaris. Selection of therapy should be based on clinical appearance taking into account lesion type and severity, as well as identification of acne scarring and the psychosocial disability caused by the disease.
To determine whether the medical prescription of testosterone gel can successfully increase facial hairs in young men with beta-thalassemia major.
Thirty-two men with beta-thalassemia major, at least 15 years old (tanner stage 4), were randomized in four blocks according to age and serum testosterone level. The cases received 2.5% testosterone gel. The changes in the number of terminal hairs were evaluated by a dermatologist after 6 months. Student's t-test and paired t-test were used to compare the results.
The serum testosterone levels of controls and cases were 9.5+/-5.7 (mean+/-SD) and 10.5+/-9.6 ng/l, respectively. The number of terminal hairs (per cm2) in cases (29.8+/-13.6) was significantly higher than that for controls (13.9+/-13.2) (p<0.005). One patient from each group complained of a sense of irritation.
The 2.5% testosterone gel was effective and well tolerated in inducing the transformation of the terminal hairs of the beard area of thalassemic males.
Long-pulsed dye laser (LPDL)-assisted photodynamic therapy has been suggested to be superior to laser alone for acne vulgaris but no evidence is available.
To evaluate the efficacy and safety of LPDL alone versus LPDL in photodynamic therapy with methylaminolevulinic acid (MAL-LPDL) for acne vulgaris.
Fifteen patients received a series of 3 full-face LPDL treatments and half-face prelaser MAL treatments; the latter being randomly assigned to the left or right side.
Inflammatory lesions were reduced more on MAL-LPDL-treated than on LPDL-treated sides (week 4: 70% vs 50%, P = .003; week 12: 80% vs 67%, P = .004). Noninflammatory lesions reduced similarly. Patient satisfaction was slightly greater with MAL-LPDL versus LPDL treatments (scale 0-10: week 4: 7 vs 6, P = .034; week 12: 8 vs 7.5, P = .034). Fluorescence measurements detected photobleaching with MAL-LPDL (35.3%) and LPDL (7.3%) treatments (P < .001). Erythema, edema, and pustular eruptions intensified from MAL incubation. No patients experienced pigment changes or scarring.
The sample size was limited. The split-face design in this randomized controlled trial does not allow us to draw conclusions about the efficacy of the LPDL, only about the efficacy of MAL-LPDL compared with LPDL alone.
MAL-LPDL is slightly superior to LPDL for the treatment of inflammatory acne.
Double-blind, vehicle-controlled, multicenter comparison of two 0.025% tretinoin creams in patients with acne vulgaris
- A W Lucky
- S I Cullen
- T Funicella
- M T Garratt
- T Jones
- M E Reddick
Long-pulsed dye laser versus long pulsed dye laser assisted photodynamic therapy for acne vulgaris: a randomized control trial
- M Hedersdal
- K Togsverd-Bo
- S R Wiegel
- H C Wulf
Hedersdal M, Togsverd-Bo K, Wiegel SR, Wulf HC. Long-pulsed dye
laser versus long pulsed dye laser assisted photodynamic therapy for
acne vulgaris: a randomized control trial. J Am Acad Dermatol. 2008;
58:387-394.
Acne: topical treatment
- A Krauthem
- Hpm Gollnick
- Shaw L