Herbal Medicine for Acne Vulgaris

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DOI: 10.1089/act.2006.12.303
Cite this publication
Abstract
Natural treatments for acne vulgaris, a common condition in industrialized societies, have much to offer although clinical studies are lacking. Several studies have shown that low stomach acid is a common finding in patients who have acne. This suggests that the traditional use of bitter herbs, which act by stimulating digestive function, including acid secretion, may be useful and important for correcting acne vulgaris. Herbs with antimicrobial, inflammation-modulating, anticomedogenic, and, in certain cases, hormone-balancing actions are also useful for treating acne. (See Table 1.) Acne vulgaris remains a common condition in industrialized societies, with many mainstream treatment options available. All these treatments carry risks, and none is completely satisfactory. Natural alternatives are gaining greater research support and have much to offer clinically. Antibiotic resistance in Propionibacterium acnes and Staphylococcus epidermidis has been rising steadily since the 1980s. In one analysis covering 10 years in the United Kingdom, carrying resistant bacteria were noted in more than 50 percent of patients who had acne and who were treated with antibiotics, with most patients carrying multiple different resistant strains on different parts of their bodies. Similar trends have been reported in many other industrialized nations. Despite some efforts by drug manufacturers to inform consumers, the incidence of women exposed to oral tretinoin, a known teratogen, during pregnancy has been increasing, possibly the result of direct-to-consumer drug advertising. These and other concerns, including cost, underscore the need for safer, effective, more-inexpensive approaches, including those offered by herbal medicine. This article focuses primarily on herbal treatments for acne. Few botanical medicines have been evaluated systematically in clinical trials, and there is virtually no research on the common approach of natural-medicine practitioners for acne-recommending multiple lifestyle changes along with multiple natural products. Nonetheless, biologic plausibility has been demonstrated for many therapies in isolation.
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Eric Yarnell, N.D., R.H. (AHG)
and Kathy Abascal, B.S., J.D., R.H. (AHG)
Abstract
Natural treatments for acne vulgaris, a common con-
dition in industrialized societies, have much to offer
although clinical studies are lacking. Several studies
have shown that low stomach acid is a common finding in
patients who have acne. This suggests that the traditional use
of bitter herbs, which act by stimulating digestive function,
including acid secretion, may be useful and important for
correcting acne vulgaris. Herbs with antimicrobial, inflam-
mation-modulating, anticomedogenic, and, in certain cases,
hormone-balancing actions are also useful for treating acne.
(See Table 1.)
Acne vulgaris remains a common condition in industrialized
societies, with many mainstream treatment options available. All
these treatments carry risks, and none is completely satisfactory.
Natural alternatives are gaining greater research support and
have much to offer clinically.
Antibiotic resistance in Propionibacterium acnes and Staphylococ-
cus epidermidis has been rising steadily since the 1980s. In one
analysis covering 10 years in the United Kingdom, carrying resis-
tant bacteria were noted in more than 50 percent of patients who
had acne and who were treated with antibiotics, with most
patients carrying multiple different resistant strains on different
parts of their bodies.1Similar trends have been reported in many
other industrialized nations.2
Despite some efforts by drug manufacturers to inform con-
sumers, the incidence of women exposed to oral tretinoin, a
known teratogen, during pregnancy has been increasing, possi-
bly the result of direct-to-consumer drug advertising.3These and
other concerns, including cost, underscore the need for safer,
effective, more-inexpensive approaches, including those offered
by herbal medicine.
This article focuses primarily on herbal treatments for acne.
Few botanical medicines have been evaluated systematically in
clinical trials, and there is virtually no research on the common
approach of natural-medicine practitioners for acne—recom-
mending multiple lifestyle changes along with multiple natural
products. Nonetheless, biologic plausibility has been demonstrat-
ed for many therapies in isolation.4
Diet, Digestion, Acne, and Herbs
Mainstream dermatology has long maintained that “diet is not
related to acne,” based on outdated, low-quality, and rather
sparse research. Mounting modern research supports that diet
can, in fact, affect acne in multiple ways.5If nothing else, it is
quite clear that people living in “Stone Age societies” have no
acne, compared with rates as high as 95 percent in adolescents in
industrialized societies.6Although diet is not the only difference
between these traditional and industrial societies, it is likely to be
a major factor.
Changing diet and lifestyle are, therefore, still considered to be
critical to any natural approach to acne. Herbal medicine can
potentially help make dietary changes more effective. It is a tenet
of natural medicine that poor digestion may exacerbate poor
dietary intake and contribute to acne.
Several studies have shown that low stomach acid is a com-
mon finding in patients who have acne.7,8 This suggests that the
traditional use of bitter herbs, which act by stimulating digestive
function including acid secretion, may be useful and important
for correcting acne vulgaris. (See box entitled Case Study: Diges-
tive Herbs for Acne.) Some common bitter herbs used include
Taraxacum officinale (dandelion) leaf and root, Achillea millefolium
(yarrow) flowering top, Artemisia absinthium (wormwood) leaf,
Gentiana lutea (gentian) root, and Mahonia aquifolium (Oregon
grape) root.
The concept in natural medicine that liver function is also criti-
cal to avoiding diet-induced acne is more theoretical. The idea is
that, if the liver and its detoxification and excretory functions are
not functioning optimally, the body will attempt to compensate
by eliminating toxic compounds through other routes in the
body, including the skin. It is possible that the liver herbs com-
monly used, such as Arctium lappa (burdock) root, actually work
because of their bitter digestive stimulant actions. Sufficient clini-
cal research has not been done on this line of reasoning to allow a
reasoned analysis of the approach.
Antimicrobial Herbs
Various bacteria play a role in the pathogenesis of acne with P.
acnes and S. epidermidis being studied most often. Both of these
microbes, and others potentially related to acne pathogenesis, are
present on normal skin, and none has been shown definitively to
cause acne.9Once either excess sebum production or inflamma-
303
HerbalMedicinefor
AcneVulgaris
tory changes begin, these microbes can and often do overgrow
and worsen inflammation.
Given these facts, antimicrobial herbs are likely to have a role to
play in acne treatment. The best supported natural treatment in
this regard is steam-distilled volatile oil of Melaleuca alternifolia (tea
tree) leaf. A single-blinded trial was conducted comparing a 5 per-
cent gel of tea tree oil with 5 percent benzoyl peroxide lotion in 124
patients with mild-to-moderate acne.10 The two treatments were
304 ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2006
Table 1. Herbs and Formulas Used to Treat Acne Vulgaris
Single herbs
Latin binomials Common names
Achillea millefolium flowering top Yarrow
Aloe barbadensis gel Aloe vera
Arctium lappa root Burdock
Artemisia absinthium leaf Wormwood
Azardirachta indica leaf Neem
Berberis vulgaris root Barberry
Chamaelirium luteum root False unicorn
Coptis chinensis root Goldthread
Commiphora mukul resin Guggul
Embelia ribes fruit Vidanga
Curcuma longa rhizome Turmeric
Emblica officinalis fruit Amalaki
Eucalyptus globulus leafaEucalyptus
Eucalyptus maculata leafaEucalyptus
Eucalyptus viminalis leafaEucalyptus
Gentiana lutea root Gentian
Hemidesmus indicus root Indian sarsparilla
Holarrhena antidysenterica stem bark Kutaj
Hydrastis canadensis root Goldenseal
Mahonia aquifolium root Oregon grape
Medicago sativa flowering top Alfalfa
Melaleuca alternifolia leaf Tea tree
Mitchella repens leaf Partridge berry
Ocimum basilicum leaf Basil
Piper longum fruit Long pepper
Scutellaria baicalensis root Asian skullcap, scute
Serenoa repens fruit Saw palmetto
Taraxacum officinale leaf and root Dandelion
Terminalia chebula fruit Chebulic myrobalan
Terminalia arjuna stem bark Arjun
Verbena spp. flowering top Vervain
Vitex agnus-castus fruit Chaste tree, vitex
Xanthorrhiza simplicissima root Yellowroot
Zingiber officinale rhizome Ginger
Withania somnifera root Ashwagandha
Preparations
Name Contents
Angelica and Sophora Root Pills b
Compound Oldenlandis Mixture b
Sunder Vati 180 mg of Holarrhena antidysenterica
(kutaj) stem bark
30 mg of Emblica officinalis (amalaki) fruit
30 mg of Embelia ribes (vidanga) fruit
10 mg of Zingiber officinale (ginger) rhizome
aShowed potential in vitro; bFull information not provided in studies of this compound.
ultimately equally effective for clearing comedones, although the
tea tree oil took longer to show efficacy. Tea tree oil caused signifi-
cantly less skin irritation than benzoyl peroxide in this trial.
In vitro, microemulsified and liposomally dispersed formulations
of tea tree oil at pH 6.5 have shown optimal follicular penetration
and antimicrobial activity, although it is unclear whether these prod-
ucts are clinically more effective than direct application of the oil.11,12
We have found that 25–50 percent tea tree oil diluted in jojoba
(Simmodsia chinensis) oil applied twice daily is highly tolerable
and effective for most patients, though occasionally the strong
scent of the tea tree oil is unacceptable for daytime application. In
such instances, a 5 percent dilution is usually acceptable scent-
wise for application in the morning, and the stronger application
can be used in the evening or at bedtime.
Because excessive organic matter can interfere with the activity
of tea tree oil (and because mild cleansing seems to be helpful
empirically),13 it is recommended that patients cleanse their skin
gently with soap or other cleansers that do not contain any active
pharmaceutical ingredients prior to applying the tea tree oil. Jojo-
ba oil is used because it is noncomedogenic and has demonstrat-
ed its own inflammation-modulating effects in animal studies.14
Another clinical trial apparently showed that steam-distilled
volatile oil of Ocimum basilicum (basil) leaf was effective for patients
with acne, but full details of the study could not be obtained.15
Basil oil is both antimicrobial and inflammation-modulating.16
In vitro, a methanol-dichloromethane extract of the leaves of
Eucalyptus globulus,E. maculata, and E. viminalis (various species of
eucalyptus) all showed potent anti–P. acnes activity.17 This activity
was strongly associated with flavonoids and chalcones (flavonoid
precursors) in E. maculata, which is surprising as these compounds
are not normally antimicrobial. Eucalyptus steam-distilled volatile
oils have been used successfully and safely for treating skin infec-
tions such as scabies in pilot clinical trials.18 Thus, the potential for
eucalyptus volatile oil to help acne patients is good.
Oregon grape crude root extracts and its alkaloids berberine
and jatrorrhizine all showed minimum inhibitory concentrations
(MIC) of 5–50 mcg/mL against P. acnes in vitro.19 Oregon grape
is often used as an antimicrobial clinically and has at least two
other properties that make it particularly compelling for patients
with acne—the herb is a bitter digestive stimulant and an inflam-
mation-modulator.
Ultimately, it is clear that an antimicrobial approach does not
cure most cases of acne, and that the organisms involved are
almost certainly responding to other pathologic processes. This
broader approach using herbs is completely logical.
Inflammation-Modulating Herbs
Inflammation plays a major role in the pathogenesis of acne.
As microcomedones form, a lymphocytic infiltrate occurs and
triggers inflammation.20 This tends to trigger follicular ker-
ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2006 305
Taraxacum officinale (dandelion).
Arctium lappa (burdock).
Extract of the leaves of Eucalyptus globulus,E. maculata, and E. viminalis
(various species of eucalyptus) all showed potent anti–P. acnes activity.
atinocytes further to produce more keratin, as well as stimulating
increased sebum production and reducing linoleic acid content in
the sebum generated by the sebaceous glands. Most Westernized
people have experienced the inflammatory nature of acne vul-
garis, given the various red, swollen, tender lesions associated
with it, particularly papules, pustules, nodules, and cysts.
Herbs that relieve inflammation could therefore also be useful
for limiting or resolving acne. Berberine-containing herbs,
besides their antimicrobial action already discussed, have been
shown to be inflammation-modulating.21 Besides Oregon grape,
Berberis vulgaris (ba r berry), Coptis chinensis (goldthread),
Hydrastis canadensis (goldenseal), and Xanthorrhiza simplicissima
(yellowroot) all contain berberine and similar alkaloids. Oregon
grape has been shown repeatedly to be helpful in clinical trials
for patients with psoriasis, another inflammatory skin condi-
tion.22 Acne clinical trials are still lacking but sorely needed.
Scutellaria baicalensis (Asian skullcap, scute) root extracts are
well-established inflammation modulators from traditional Asian
medicine.23 Attention has focused on scute’s flavonoids, wogo-
nin and baicalein in particular, as potent inflammation-modula-
tors.24,25 The potential for internal and topical administration of
this herb to help patients with acne is great, although clinical tri-
als are unfortunately lacking.
Magnolia spp. (magnolia) stem bark is used quite frequently in
traditional Asian medicine. Its diphenylpropanid constituents
honokiol and magnolol have low MICs against P. acnes in vitro.26
The compounds also reduced inflammatory reactions to the
microbe in this study, and were nonirritating when applied to
the skin of healthy human volunteers. The inflammation-modu-
lating effects of magnolol and honokiol have been shown to be
related to their ability to suppress the critical inflammatory medi-
ator NF-kappaB.27 Clinical trials are needed on this promising
herb and its constituents.
Preliminary evidence looks promising, but much work remains
to be done to prove the value of inflammation-modulating herbs
for acne. Many inflammation-modulating herbs or herbal com-
pounds have additional actions, including the antimicrobial
effects discussed above. These herbs and compounds often also
appear to affect comedone formation.
Anticomedogenic Herbs
A comedone arises when a hair follicle is blocked by excess ker-
atin and sebum. If the lipids and/or sebum involved are exposed
to air, they oxidize, turning black (forming the infamous “black-
head”). If the follicle is completely closed and an anaerobic envi-
ronment forms, the material is cream-colored (thus forming a
“whitehead”). Several natural keratolytics, such as glycolic acid or
salicylic acid, are well-established as treatments for comedones.
However, these keratolytics tend to be painful when applied and
can cause bizarre whitening patterns on the skin. These substances
also do not resolve the underlying causes of the comedones.
In contrast, several natural products have been shown to inhib-
it abnormal lipogenesis—directly and significantly—in hamster
sebaceous glands.28 Berberine and wogonin were the most active
in this study. In a separate study, a crude extract of goldthread
root (which contains berberine alkaloids) at a concentration of
just 0.01 percent also had a strongly antilipogenic effect in seba-
ceous glands.29
While no further work has been done to clarify the clinical rele-
vance of these findings, they indicate yet another way in which
the herbs containing these compounds may operate in acne.
Thus, one cannot focus too closely on any single action for most
herbs that could be beneficial for acne, as research continually
shows they have multiple ways of affecting the disease.
In a double-blinded clinical trial, tetracycline 500 mg twice
daily or an extract of Commiphora mukul (guggul) providing 25
mg guggulsterone twice daily were compared in 20 patients with
nodulocystic acne.30 After 3 months, all subjects had similar
reductions in the number of inflammatory lesions (approximate-
ly 65 percent). Three (3) months after discontinuation of therapy,
4 patients who were previously on tetracycline and 2 who were
on guggul relapsed. The researchers suggested that patients with
306 ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2006
Case Study
Digestive Herbs for Acne
A 23-year-old male patient with mild-to-moderate papulopustular
acne on the face, back, and chest that had not responded to systemic
erythromycin treatment sought naturopathic care. He also
complained of having claylike stools. He was a vegan (and had been
for 7 years) except for occasional dairy-product intake and was in a
stressful educational program. He used no medication but was taking
a multivitamin and vitamin C. Blood tests revealed that he had low-
grade macrocytic anemia. Stool fecal-fat analysis indicated elevated
fecal-fat levels. Celiac disease was excluded by a negative serum
antiendomysial antibody test.
The initial treatment for this patient included:
• Increasing omega-3 fatty acid-rich foods in his diet, particularly
(Linum usitatissimum) flax oil
• An elimination/challenge diet (which revealed that he had various
negative reactions to dairy products, avocados, and chocolate)
• One intramuscular (IM) vitamin B12 shot weekly for 6 weeks.a
After 3 months on this protocol, the patient had a moderate
reduction in number of acne lesions and his anemia was resolved, but
his stools had not improved much. Therefore, a bitter tincture
formula containing 50 percent Gentiana lutea (gentian) root, 30
percent Taraxacum officinale (dandelion) leaf, and 20 percent Mahonia
aquifolium (Oregon grape) root was prescribed at a dose of 2
droppers-full before meals. The patient also decided to start eating
fish and began taking 6 g of fish oil per day.
Three (3) months of this program led to a near-total resolution of
all lesions as well as normalization of his stools. The bitters were
discontinued after 1 more month, and the acne remained almost
entirely resolved.
After 1 year that was associated with a severe time of stress,
some of his acne lesions recurred, but these were reduced when his
stress passed. Reinstituting bitters, occasional use of topical tea tree
(Melaleuca alternifolia)oil in jojoba (Simmodsia chinensis) oil, and stress
reduction were sufficient to control these episodes. After 4 years of
this treatment, the patient would often go for months with no
lesions, and acute outbreaks would consist of no more than 4–5
lesions on his back and face.
aVitamin B12 has been reported to exacerbate acne in some cases, but this patient was
vitamin B12–deficient and, clearly, the vitamin was indicated (and it did not exacerbate his
acne). This is an instance that illustrates the value of individualized medicine.
more oily skin reacted best to the guggul, raising the possibility
that this agent works by addressing comedogenesis. Guggul also
may have antimicrobial and inflammation-modulating activities.
Multiherbal Approaches from Traditional
Asian Medicine
In traditional Asian herbal medicines, the standard approach is
to combine multiple herbs into a formula suited to an individual
patient. While this approach is also used by many herbal practi-
tioners in the western world, it is difficult for mainstream health
care providers to understand. When one is schooled in a system
of medicine that focuses on single molecular entities to treat dis-
ease in broad groups of people, and also having been taught that
combining multiple agents is potentially dangerous, polyphar-
macy makes the use of polyherbal formulas seem quite foreign.
Nevertheless, ample experience and published clinical trial data
support that this approach can be quite effective.
In a double-blinded trial, four different herbal and mineral
combinations were compared with a charcoal placebo in Indian
patients with acne vulgaris. Only one of the formulas, Sunder
Vati, showed a significant improvement in inflammatory and
noninflammatory lesions compared with baseline or placebo.31
Sunder Vati contains Holarrhena antidysenterica (kutaj) stem bark
180 mg, Emblica officinalis (amalaki) fruit 30 mg, Embelia ribes
(vidanga) fruit 30 mg, and Zingiber officinale (ginger) rhizome 10
mg for a total of 250 mg, administered at a dose of 500 mg, three
times per day.
A similar double-blinded trial compared various combinations
of internal and external herbal formulas. A combination of Aloe
barbadensis (aloe vera), Azardirachta indica (neem), Curcuma longa
(turmeric), Hemidesmus indicus (Indian sarsparilla), Terminalia
chebula (chebulic myrobalan), Terminalia arjuna (arjun), Withania
somnifera (ashwagandha) and Piper longum (long pepper) was
given orally combined with either a gel or cream of the same for-
mula but without long pepper (which is used orally to increase
absorption of other herbs).32
One group took herbs orally and applied a placebo topically
and one group took an oral placebo and an active topical treat-
ment. All groups who used the herbal preparation had improve-
ment compared with no improvement in the placebo group. The
active cream preparation combined with oral herbs was judged
to be the most effective.32 These inflammation- and immune-
modulating herbs definitely should be investigated further for
helping patients who have acne.
One preparation, known as Compound Oldenlandis Mixture
(COM) in Chinese medicine was compared with Angelica and
Sophora Root Pills (ASRP) in 120 patients with acne.33 COM led
ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2006 307
Tell Your Patients
Proposed Acne Vulgaris Protocol
Increase omega-3 fatty acid, fruit, and vegetable intakes.
Eliminate or greatly reduce trans-fatty acid and simple
carbohydrate intake. Reduce or eliminate animal product ingestion,
and use only organic animal products if any are taken to avoid
exogenous hormones. Avoid iodized salt and swimming in
chlorinated water.
Use bitter herbs before meals for any suspected or documented
problems with malabsorption, hypochlorhydria, or other digestive
atony.
Cleanse the skin with non-medicated soap gently on a daily basis.
Apply 5–50 percent tea tree (Melaleuca alternifolia)oil diluted in
jojoba (Simmodsia chinensis) oil topically one to two times per day as
needed. Apply after skin cleansing.
Use natural skin moisturizers as needed for dry skin.
As needed, use inflammation-modulating (IM), antimicrobial (AM),
and anticomedogenic (AC) herbs internally and topically. A typical
formula would be:
Mahonia aquifolium (Oregon grape) fresh root tincture, 20–30
percent (IM, AM, AC, bitter)
Scutellaria baicalensis (scute) decocted dried root tincture, 20–30
percent (IM, AC)
Achillea millefolium (yarrow) fresh flowering top tincture, 10–20
percent (IM, AM, bitter)
Curcuma longa (turmeric) fresh root tincture, 10–20 percent (IM)
Commiphora mukul (guggul) resin tincture, 5–10 percent (AC, IM)
Glycyrrhiza glabra (licorice) dried root fluid extract, 5–10 percent
(IM, AM, flavor enhancer)
Oplopanax horridum (devil’s club) fresh root bark glycerite, 5–10
percent (if stress is a problem)
Vitex agnus-castus (chaste tree) mature fruit tincture, 10–20
percent (for hormone balancing)
Serenoa repens (saw palmetto) mature fruit tincture, 10–20 percent
(if androgens are a factor).
The dose is 1 tsp, three times per day, in water, sipped before
meals.
Terminalia chebula (chebulic myrobalan). Drawing © 2006 by Kathy
Abascal, B.S., J.D., R.H. (AHG).
to a cure rate of 73 percent compared with 47 percent for the
ASRP. While the full details of what was in these formulas are
not available, and although arguably a known active treatment
was not used as a control, this study still provides some evidence
that multiple herbs working in synergy can be quite effective for
patients who have acne.
In a similar trial, a topical formula known as xiao cuo fang (full
details of the contents of this formula were not available) was
combined with 0.1 percent adapalene (a synthetic retinoid) gel
and compared with topical 0.03 percent retinoic acid cream in 133
patients with acne.34 The adapalene and herbal combination was
significantly more effective at reducing the number of acne lesions
compared with retinoic acid. Adverse effects caused by the herbal
formula were minimal. More-rigorous follow-up research is nec-
essary, but this trial again shows the potential benefit of poly-
herbal formulas applied topically in patients with acne vulgaris.
Hormonal Acne
Very often, acne flareups are related to the impending onset of
menses. This particular type of acne highlights the fact that acne
is often affected by hormone balance in the body. Much work has
focused on the potential negative impact of androgens on acne;
estrogen and progesterone can definitely also be involved.35
Two herbs are commonly used for addressing hormonal issues
that arise in acne. The first is Vitex agnus-castus (chaste tree, vitex)
fruit. This plant acts in the pituitary gland to balance secretion of
lutetinizing and follicle-stimulating hormones, thus regulating
estrogen and progesterone levels.36
Preliminary German research confirms that chaste tree can
help moderate hormonal acne.37 Chaste tree should be taken
throughout the menstrual cycle for optimal effects. Vitex is often
used together with vitamin B6, which has also proven to be quite
helpful for resolving hormonal acne, although one comparative
trial found that vitex was superior to vitamin B6for helping
patients with symptoms of premenstrual syndrome.38
When androgens are a problem in acne vulgaris, Serenoa repens
(saw palmetto) fruit is the first herb most clinicians use. If polycys-
tic ovarian syndrome or documented high serum androgens are
present, saw palmetto should be considered to help offset the neg-
ative effects of excessive androgens. Saw palmetto does this by
moderately inhibiting 5-_reductase (which activates testosterone
to the much more potent dihydrotestosterone form) and by antag-
onizing the androgen receptor.39 No clinical trials were located on
the efficacy of saw palmetto in acne. The only other well-docu-
mented antiandrogenic herb is Glycyrrhiza glabra (licorice),
although it also has not been studied for acne in clinical trials.40,41
Other hormone-balancing herbs may have a role in acne vul-
garis, including but not limited to, Medicago sativa (alfalfa),
Chamaelirium luteum (false unicorn root), Verbena spp. (vervain),
and Mitchella repens (partridge berry). This is yet another fruitful
area for more study.
Conclusions
Much disparate and introductory research exists on the
effects of herbs on multiple aspects of acne. A comprehensive
appr oach com bining m ult iple her bs as well as lifesty le and
dietary changes has helped people with acne in preliminary
clinical trials.
The continued resistance of mainstream dermatology to the
possibility of this approach does not optimally serve patients
who might be significantly helped by natural therapies. There are
sufficient pilot data to warrant larger trials on various herbal
medicines in isolation and combined with each other and other
natural therapies. The data are also sufficient to support a recom-
mendation for use of these herbs in clinical practice. This is par-
ticularly true, given how safe they are. Overall, herbal medicine
has much to offer to improve our ability to deal with the complex
issues acne presents.
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308 ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2006
Clinical Trial of Combination
Therapies for Acne
In an open clinical trial, 90 of 98 patients had significant
improvement on the following protocol over 6 or more months’
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Supplements
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Eric Yarnell, N.D., R.H. (AHG), is president of the Botanical Medicine
Academy, a specialty board for using medicinal herbs, and is an adjunct
faculty member at Bastyr University, Kenmore, Washington. Kathy
Abascal, B.S., J.D., R.H. (AHG), is executive director of the Botanical
Medicine Academy, Vashon, Washington.
To order reprints of this article, write to or call: Karen Ballen, ALTERNA-
TIVE & COMPLEMENTARY THERAPIES, Mary Ann Liebert, Inc., 140
Huguenot Street, 3rd Floor, New Rochelle NY 10801, (914) 740-2100.
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  • ... However, two main problems with conventional topical drugs are antibiotic resistance and local adverse reactions 8 . Therefore, medicinal plants are promising agents for developing new anti-acne products with fewer side effects 9 . In Persian and Greek medicine, a long list of herbs has been mentioned in the literature for dermatologic conditions, such as acne. ...
    ... Since the available anti-acne treatments are not completely satisfactory and safe, finding new alternative efficient treatments with fewer side effects for acne treatment is necessary. Considering the multifactorial pathogenesis of acne, use of medicinal plants with multiple mechanisms of action could be promising 9 . ...
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    Background: Acne vulgaris is a common chronic disorder of the pilosebaceous unit. Topical therapy is the mainstay of treatment for mild-to-moderate acne. Two main problems with conventional anti-acne treatments are antibiotic resistance and local side effects. In this regard, medicinal herbs could be an alternative choice for developing new products with fewer side effects. Objective: The purpose of this study was to evaluate the safety and efficacy of a topical formulation of cinnamon in patients with facial acne. Method: In this open-label, assessor-blind, and uncontrolled clinical trial, 20 patients (18F/2M) with mild-to-moderate facial acne were treated with topical cinnamon gel twice-daily for eight weeks. The outcomes of acne lesion count, red fluorescence parameters and skin biophysical profile were evaluated at baseline, 4th and 8th week. For safety assessment, any adverse drug reaction was recorded during the study. Results: Two months after using cinnamon gel, there was a significant reduction in the total (47%, p=0.000), inflammatory (42%, p=0.026), and non-inflammatory (48%, p=0.002) lesion count. Also, the size of red fluorescence spots was significantly reduced (p<=0.05). In skin biophysical measurement, there was a significant decrease in erythema (61.31+/-68.25), sebum (31.05+/-36.15), and hydration (10.05+/-10.16), as well as a significant increase in pH (0.63+/-0.75). Some patients experienced mild, transient erythema and burning immediately after applying the gel, but no serious side effects were reported. Conclusion: Our results suggest that topicalcinnamongel is efficient and safe for the treatment of mild-to-moderate facial acne. IRCT registration code: IRCT2016031126938N3
  • ... Natural alternatives are blooming as they are being explored for healing multiple factors related with acne (8). Topical approach is useful in treatment of acne whereas it can also be effectively used for deramatophytosis, candidiasis, Tinea nigra and fungal keratitis (9). ...
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    Acne is an exclusive disease associated with skin occurs when sebaceous glands attain special conditions at face, chest and back in the pre pubertal child. This disease occurs in both male and female, there is no preference among them but the course is more severe in males. Though, there are several treatment methods to treat acne, no particular medication claims a satisfactory and complete remedy. A wide range of synthetic therapeutic agents have also been reported to treat acne but have severe adverse effect. Medicinal plants by virtue of their safe nature and easy availability may lend themselves as potential anti-acne therapy. The present review deals with the proven medicinal plants to treat acne.
  • ... Natural alternatives are blooming as they are being explored for healing multiple factors related with acne (8). Topical approach is useful in treatment of acne whereas it can also be effectively used for deramatophytosis, candidiasis, Tinea nigra and fungal keratitis (9). ...
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    Full-text available
    Acne is an exclusive disease associated with skin occurs when sebaceous glands attain special conditions at face, chest and back in the pre pubertal child. This disease occurs in both male and female, there is no preference among them but the course is more severe in males. Though, there are several treatment methods to treat acne, no particular medication claims a satisfactory and complete remedy. A wide range of synthetic therapeutic agents have also been reported to treat acne but have severe adverse effect. Medicinal plants by virtue of their safe nature and easy availability may lend themselves as potential anti-acne therapy. The present review deals with the proven medicinal plants to treat acne
  • ... The major components include potassium, calcium and low amount of phosphorus. The anthraquinones present are rhein, emodin, and chrysophanol in this plant and is used to relieve the pain and reduce the itching property, which can lead to psoriasis as well as acne vulgaris [57]. ...
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    Acne is the most common skin condition with substantial cutaneous and psychological disease burden characterized by different areas of scaly red skin, papules, blackheads and whiteheads, nodules and pimples. The pathogenesis and existing treatments for acne is difficult. The severity of acne varies greatly among the individuals and genetic background plays a vital role in its development. Propionibacterium acnes (P. acne) have been recognized as pus-forming bacteria which triggers the inflammation in acne. The present study was conducted to evaluate antimicrobial activities of Indian medicinal plants against the etiologic agents of acne vulgaris. Pathogenic factors include increased sebum production, hyper cornification of pilosebaceous ducts, abnormal bacterial function, and production of inflammation. The therapy includes yearlong administration of synthetic medicines, which can cause severe side effects. Hence, the less toxic and safe substances are needed for the treatment. Herbal or herbal based medicines are safe alternatives in which extracts of natural origin are used as medicines. The aim of herbal therapy is to provide safe, efficient and economical medicines so that the people can utilize them. In present review input of herbs in the treatment of acne is summarized. Different databases were searched for retrieving all the medicinal plants with anti-acne activity.
  • ... Other factors such as androgens, poor digestion, or smoking habits (Leyden, 1995) are also important in the development and persistence of the disease. Treatments should focus not only on the consequences but also on the causes of acne and could combine cross-acting compounds to reduce sebum production, correct stomach acidity for better digestion, while also reducing inflammation (Yarnell and Abascal, 2006). Previous studies reported the interesting potential of botanical combinations in treatments to reduce acne (Lalla et al., 2001;Kılıç et al., 2019). ...
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    Acne vulgaris is a common skin disease affecting adolescents and young adults of all ethnic groups, negatively impacting self-esteem, self-confidence, and social life. The Gram-positive bacteria Cutibacterium acnes colonizes the sebum-rich follicle and contributes to inflammation of the pilosebaceous gland. Long-term antibiotic therapies targeting C. acnes lead to the development of antimicrobial resistance, and novel acne vulgaris therapies are needed. This study investigated the C. acnes inhibitory activity of Callicarpa americana leaves, a native Southeastern United States shrub historically used by Native Americans to treat fever, stomachache, and pruritis. Flash chromatography fractions of the ethyl acetate-soluble C. americana ethanol leaf extract (649C-F9 and 649C-F13) exhibited MICs ranging from 16 to 32 µg ml−1 and IC50 range of 4–32 μg ml−1 against a panel of 10 distinct C. acnes isolates. Cytotoxicity against an immortalized human keratinocyte cell line (HaCaTs) skin was detected at more than eight times the dose required for growth inhibitory activity (IC50 of 256 μg ml−1 for 649C-F9 and IC50 of >512 μg ml−1 for 649C-F13). This work highlights the potential of C. americana leaf extracts as a cosmeceutical ingredient for the management of acne vulgaris. Further research is necessary to assess its mechanism of action and in vivo efficacy.
  • ... Natural alternatives are blooming as they are being explored for healing multiple factors related with acne [6]. Topical approach is useful in treatment of acne whereas it can also be effectively used for deramatophytosis, candidiasis, tineanigra and fungal keratitis [7]. ...
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    Objective: The present work was undertaken to validate the folk use of traditional Indian medicinal plant in the treatment of skin disorder by using scientific methods. Method: The anti-acne potential of methanol extract of the fruits of Embelia ribes were evaluated against Propionibacterium acnes, Staphylococcus epidermidis and Malassezia furfur using well diffusion method. Result: The result showed that drugs were active against all microorganisms. The minimum inhibitory concentration (MIC) value of the E.ribes fruits extract against test S.epidermidis, P. acne, and M. furfur were found to be 500 μg/ml, 600 μg/ml, and 400 μg/ml, respectively. Conclusion: It was concluded from the study that the plant materials Embelia ribes are effective in acne vulgaris, and hence this can be used in topical anti-acne preparations.
  • ... In USA, 61.9% of population aged 18 years and older were seen in clinics for acne vulgaris 5 . Natural alternatives are blooming as they are being explored for healing multiple factors related with acne 6 . Topical approach is useful in treatment of acne whereas it can also be effectively used for deramatophytosis, candidiasis, tineanigra and fungal keratitis 7 . ...
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    In current investigation, an attempt has been taken to explore the in vitro antiacne activity of methanolic extract of dried fruit of Embelia ribes. The minimum inhibitory concentration value of the Embelia ribes fruits extract against test S.epidermidis, Propionibacterium acne and Malassezia furfur was found to be 500 μg/ml, 600μg/ml and 400μg/ml respectively. It clearly indicated that methanolic extract of dried fruit of Embelia ribes is promising anti-acne agent against the test microorganisms. © 2018, International Journal of Pharmaceutical Quality Assurance. All rights reserved.
  • ... Vitex extracts have been known to affect the pituitary glands to balance secretion of luteinizing and follicle-stimulating hormones, and to regulate estrogen and progesterone levels in hormonal acne (Fig. 1). 28 ...
  • ... Die antiinflammatorische Wirkung eines Hexan Extraktes konnte auch schon klinisch beobachtet werden [22]. Erforscht werden zudem der Einsatz bei Prostatakarzinomen sowie topische Anwendungen bei androgenetischer Alopezie und Akne, eine Einnahme bei Polyzystischem Ovar Syndrom (PCOS) ist zumindest denkbar [15,27,30,32,35,45]. ...
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    Von den nordamerikanischen Ureinwohnern wurde die Sägepalme (Serenoa repens (W. Bartram) Small) vielfältig genutzt, eine medizinische Verwendung lässt sich aber nicht sicher nachweisen. Als Arzneipflanze hatte die Sägepalme eine erste Blüte im späten 19. und frühen 20. Jahrhundert, als verschiedene Zubereitungen in der Pflanzenheilkunde und der Homöopathie beliebt waren. Neue wissenschaftliche Impulse kamen gegen Ende des 20. Jahrhunderts aus Europa, wo Sägepalmenfrüchte heute zur symptomatischen Behandlung der benignen Prostatahyperplasie (BPH) anerkannt sind. Daneben werden auch topische Anwendungen erforscht. Saw Palmetto - From crop and foodstuff to a recognized medicinal plant Indigenous North Americans have extensively used saw palmetto (Serenoa repens (W. Bartram) Small), although its medical use cannot be proven with certainty. Saw palmetto became a more recognised medicinal plant in the late 19th and early 20th century, during the popularity of various preparations in phytotherapy and homeopathy. New scientific impulses came from Europe towards the end of the 20th century, and today saw palmetto berries are used in the symptomatic treatment of benign prostate hyperplasia (BPH). Research is underway regarding topical application of saw palmetto.
  • ... It is a well-known fact that day to day exposure of human skin to the external environment leads to a number of problems such as acne, pigmentation and sunburn marks 1 . Acne is a common skin disorder encountered in the age group of 15-25 years owing to increased production of sebum followed by the attack of Propionibacterium acnes [2][3][4] . The proposed research work is designed to study the impact of topical herbal approach to combat acne. ...
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    Current research work is intended to study the impact of herbal approach to treat acne, an extremely common cutaneous inflammatory disorder of multifactorial origin with prevalence in adolescents. Acne is common disease of skin and is usually treatable. An attempt had been taken to investigate the in vitro antiacne activity of ethanolic extract of stem of Berberis aristata. The MIC value of the B. aristata extract against S. epidermidis, P. acnes and M. furfur were found to be 600 μg/ml, 200 μg/ml and 100 μg/ml respectively. In vitro antimicrobial screening using erythromycin as a positive control clearly indicated that ethanolic extract of B. aristata is promising antimicrobial against the test microorganisms.
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    Accutane (isotretinoin, Roche Laboratories, Nutley, NJ) is a prescription drug approved by the US Food and Drug Administration to treat severe, treatment-resistant nodular acne that may cause major birth defects when the fetus is exposed in the first trimester of pregnancy. It is contraindicated in pregnancy, and the package carries an explicit warning. Despite the manufacturer instituting a Pregnancy Prevention Program (PPP) in 1988, exposed pregnancies continued to occur. In 1996 the manufacturer began a direct-to-consumer advertising campaign. The investigators examined recent trends in the use of Accutane by women of reproductive age (15-44 years). Data were taken from IMS HEALTH National Prescription Audit Plus and the National Disease and Therapeutic Index. In addition, 14 women with recent exposed pregnancies were interviewed to identify possible ways of preventing exposure. Between 1980 and 1999 the estimated annual number of Accutane prescriptions more than doubled to more than 1,800,000. The number written for women remains fairly stable at about 50%. Women of reproductive age consistently account for about 90% of all prescriptions for women. Assuming that the average prescription was for 30 days and that the average patient used Accutane for 5 months, an estimated 150,000 reproductive-aged women in the United States (2.5 per 1000) used the drug in 1999. Interviews revealed that most of the 14 exposed pregnancies were not contraceptive failures but rather failures to use contraception. Eight women acknowledged having intercourse at least once without using any form of contraception at the time of the exposed pregnancy. Ten women had a pregnancy test before starting to use Accutane, but three of them were in fact pregnant at this time despite a negative test (two urine tests and one blood test). Ten women were prescribed Accutane by a dermatologist, but two of them had used leftover medication from an earlier prescription. Half the women reported seeing an advertisement for prescription acne treatment before taking Accutane. All 14 women knew that the drug should not be used while pregnant, but none had seen all components of the PPP, and four did not see any components other than what is on the pill packet. One infant was born with major malformations consistent with Accutane embryopathy, while four others seemed well. There were four spontaneous and five induced abortions. Reproductive-age women are using Accutane to treat severe acne at an increasing rate. It is the most widely used teratogenic medication in the United States. When the drug is necessary, the physician should provide precautions and all elements of the PPP, and all recommended contraceptive measures should be followed. No woman of childbearing age who is not under care by a physician familiar with Accutane should use this medication.
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    Scutellaria baicalensis GEORGI has been used to treat inflammatory-related disorders in China and Japan for centuries. The plant root has a particularly high flavonoid content, over 35 percent, giving it a yellow color, and its traditional name of golden root. These flavonoids selectively inhibit enzymes in the arachidonic acid cascade, in particular lipoxygenases, as well as possessing antioxidant, antiviral, antiretroviral, antitumor, antibacterial, and sedative properties. Scutellaria is used in traditional Chinese medicine to "cleanse heat," "dry moisture," and "remove toxins.".
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    The objective of the present study was to determine the efficacy and tolerability of a new solid formulation (capsules) of Agnolyt®(*)) in a randomized, controlled trial versus pyridoxine in women with PMTS over a period of three treatment cycles (Vitex agnus castus (VAC): 1 capsule + 1 placebo capsule/day, n = 90; pyridoxine (B6): 2 capsules day, n = 85). The therapeutic response was assessed using the premenstrual tension syndrome scale (PMTS scale), the recording of six characteristic complaints of the syndrome, and the clinical global impression scale (CGI scale). Upon completion of the trial, efficacy of the treatment was assessed by the physician as well as by the patient. On the PMTS scale, treatment with VAC and B6 produced a reduction in score points from 15.2 to 5.1 (-47,4%) and from 11.9 to 5.1 (-48%)(*), respectively. In comparison with pyridoxine, VAC caused a considerably more marked alleviation of typical PMTS complaints, such as breast tenderness, edema, inner tension, headache, constipation, and depression. Analogous results were obtained with the CGI scale. In both treatment groups, efficacy was rated as at least adequate by more than 80% of the investigators; however, VAC treatment was rated as excellent by 24.5% and pyridoxine treatment by 12.1% of the investigators. According to the patients' assessment, 36.1% of the cases in the VAC group and 21.3% in the pyridoxine group were free from complaints. Adverse events (gastrointestinal and lower abdominal complaints, skin manifestations and transitory headache) occurred in 5 patients under B6 and in 12 patients under VAC. Serious adverse events were not observed. The results of the present study confirm the efficacy and safety of Agnolyt® capsules in the treatment of PMTS.
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    Tea-tree oil (an essential oil of the Australian native tree Melaleuca alternifolia) has long been regarded as a useful topical antiseptic agent in Australia and has been shown to have a variety of antimicrobial activities; however, only anecdotal evidence exists for its efficacy in the treatment of various skin conditions. We have performed a single-blind, randomised clinical trial on 124 patients to evaluate the efficacy and skin tolerance of 5% tea-tree oil gel in the treatment of mild to moderate acne when compared with 5% benzoyl peroxide lotion. The results of this study showed that both 5% tea-tree oil and 5% benzoyl peroxide had a significant effect in ameliorating the patients' acne by reducing the number of inflamed and non-inflamed lesions (open and closed comedones), although the onset of action in the case of tea-tree oil was slower. Encouragingly, fewer side effects were experienced by patients treated with tea-tree oil.
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    Twenty patients with nodulocystic acne were randomly allocated to one of two treatment schedules: 1) Tetracycline 500 mg or 2) Tab. Gugulipid (equivalent to 25 mg guggulsterone). Both were taken twice daily for 3 months, and both produced a progressive reduction in the lesions in the majority of patients. With tetracycline, the percentage reduction in the inflammatory lesions was 65.2% as compared to 68% with gugulipid; on comparison, this difference was statistically insignificant (P > 0.05). Follow-up at 3 months showed a relapse in 4 cases on tetracyline and 2 cases on gugulipid. An interesting observation was that the patients with oily faces responded remarkably better to gugulipid.