Treatment of Acne With Special Emphasis on Herbal Remedies

Anil Kumar; Sanjula Baboota; SP Agarwal; Javed Ali; Alka Ahuja

Disclosures

Expert Rev Dermatol. 2008;3(1):111-122. 

In This Article

Abstract and Introduction

Acne is a cutaneous pleomorphic disorder of the pilosebaceous unit involving abnormalities in sebum production and is characterized by both inflammatory (papules, pustules and nodules) and noninflammatory (comedones, open and closed) lesions. Propionibacterium acnes and Staphylococcus epidermidis are common pus-forming microbes responsible for the development of various forms of acne vulgaris. Common therapies that are used for the treatment of acne include topical, systemic, hormonal, herbal and combination therapy. Topically used agents are benzoyl peroxide, antibiotics and retinoids. Systemically used agents are antibiotics and isotretinoin. These drugs produce a number of potential side effects and development of resistance to frequently used antibiotics. This leads to treatment failure with previously used successful therapy. A variety of ayurvedic drugs, such as Sookshma Triphala, Thiostanin, Sunder Vati and Amalakimashi Vati, are used to treat acne. These are very safe and effective. This review focuses on the use of herbal drugs for the treatment of acne vulgaris that have been found to be very safe and effective.

Acne vulgaris is the most common cutaneous chronic inflammatory disorder of multifactorial origin with prevalence in adolescents.[1,2] It consists of the pilosebaceous follicles characterized by comedones, papules, pustules, nodules, cysts and often scars in certain sites of predilection, namely the face, neck, chest, arms and back.[3,4,5] Acne is common among 95 and 83% of teenage boys and girls, respectively, and affects 85, 8 and 3% of people aged between 12-25, 25-34 and 35-44 years, respectively.[3,6,7]

Propionibacterium acnes (obligate anaerobic bacteria) and Staphylococcus epidermidis (aerobic bacteria) are the common pus-forming bacteria that trigger inflammation in acne.[7,8] The affected patients are prone to embarrassment, depression, anger, social withdrawal, anxiety, scorn and stigmatization.[9,10] There are four main processes that have been suggested as factors responsible for the development of acne vulgaris: sebaceous gland hyperplasia with increased sebum production, follicular colonization with P. acne, altered follicular growth and differentiation, and inflammation.[10,11,12,13]P. acnes acts as an immunostimulator that can produce a variety of biologically active molecules and enzymes, such as lipases, proteases, hyaluronidase and chemotactic factors, which are involved in the development of inflammatory acne.[14,15] It has also been suggested that P. acnes secretes peptidoglycon, which can stimulate the production of proinflammatory cytokines, such as IL-1, IL-8 and TNF-α, by human monocytic cell lines that are also involved in the inflammation.[16,17] Acne bacteria P. acnes can also initiate chemotactic factors their are responsible for the activation of neutrophils, leading to reactive oxygen species (ROS) generation and thus inflammation.[18]

Genetic and hormonal factors, diet and hygiene also play a role, possibly by providing the follicular environment suitable for the growth of P. acnes or by affecting the inflammatory response.[19,20] Such understanding has led to the use of sebum-reducing agents, antibiotics, antiandrogens and estrogens in conventional treatments.[20] Systemic antimicrobial therapy, normally required to reduce inflammatory papules and cysts, often leads to uncomfortable side effects, which include gastrointestinal symptoms, headaches and vulvovaginal candidiasis.[21,22] For the treatment of acne vulgaris, doctors have divided the condition into mild, moderate and severe. Mild disease consists of open and closed comedones that are inflammatory. Moderate acne includes comprehensively more frequent papules and pustules with mild scarring, and severe disease contains open and closed inflammatory comedones, papules, pustules and nodular abscesses or cysts, which lead to extensive scarring.[20,23] The development of antibiotic resistance is multifactorial, which includes the specific nature of the relationship of bacteria to antibiotics, antibacterial agents usage, host characteristics and environmental factors.[9,24,25]

For determining appropriate treatment, a complete medical and familial history must be obtained. There are certain medications that may aggravate acne and interact with the prescribed drugs, and a familial history of severe acne determine more protected treatment. Compliance is also another important parameter for successful treatment, so it is also kept in mind for the treatment of acne.

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