Traditional Herbs to treat Acne Vulgaris

 

Sonali Syal*, Vinay Pandit, M. S Ashawat

Laureate Institute of Pharmacy, Kathog-Jawalamukhi - Himachal Pradesh, India.

*Corresponding Author E-mail: sonali.syal96@gmail.com

 

ABSTRACT:

Skin is the most vulnerable part of the body. It is a well-known fact that day to day exposure of human skin leads to the number of problems such as acne, pimples, pigmentation and sunburn marks. The most common skin disease now days is acne. Acne vulgaris (commonly called acne) is a follicular skin disease that mainly affects the Pilosebaceous unit of the face, neck, and trunk and is characterized by inflammatory (papules, pustules, nodules, and cysts) and non-inflammatory lesions (Seborrhoea and Comedones) and scarring. Acne is associated mostly with Propionibacterium acnes (P. acnes) which produces inflammation with the release of extracellular enzymatic products like proteases, hyaluronidases, and lipases. About 90-95% of the pubertal population, 25-45% of adults and < 25% of women suffered from skin conditions like acne, black spots etc. Even after 25 years of age, women can suffer from adult female acne. The numbers of topical and systematic therapies using synthetic ingredients are available for so long to cure Acne vulgaris. Due to high risk and side effects associated with synthetic drugs used therapies, internal and external herbal remedies are considered to be a more effective and safe alternative for the treatment for Acne vulgarisAcne vulgaris has been studied and developed and as an outcome, natural approaches to fighting acne and its disfiguring effects have gained popularity due to their effectiveness.

 

KEYWORDS: Acne vulgaris, Propionibacterium acnes, Herbs, Anti-Bacterial, Anti-Inflammatory.

 

 

 

INTRODUCTION:

Skin is the most vulnerable part of the body. It is a well-known fact that day to day exposure of human skin[1] leads to the number of problems such as acne, pimples, pigmentation and sunburn marks[2]. The most common skin disease now days is acne. It is a skin disorder that suppresses an individual’s self-esteem concerning physical appearance and has a clinical onset during puberty and adolescence[3]. Acne vulgaris, a multifarious chronic inflammatory state and mostly happen within a pilosebaceous unit including hair, hair follicles, sebaceous gland of the skin. Acne is categorized by non-inflammatory lesions that are whiteheads, blackheads, and inflammatory lesions that are papules, nobles, pustule, podules, and cysts.

 

It is characterized by several clinical conditions such as scaly red skin (Seborrhoea), erythematous papules and pustules, comedones, nodules, deep pustules, and sometimes pimples, all these symptoms are shown during the process of acne development[4-6].

 

Acne vulgaris is inflammation of the sebaceous (oil) gland of the skin. At first, there is excessive sebum production due to the action of androgens. These glands become blocked causing blackheads and whiteheads due to increased keratinisation of the sebaceous duct. Secondary bacterial infections occur due to Propionibacterium acnes (P. acnes) in the sebum. Lipases are produced which in turn produce free fatty acids (FFA) from the triglycerides in the sebum. There is a normal role of Propionibacterium acnes (P. acnes) to play in the upper layers of the skin with the resultant FFA keeping the skin pH between 5 and 6 which acts as a barrier against other bacteria and viruses. Further down in the follicle close to the dermis the free fatty acids (FFA) become pro-inflammatory, thus provoking inflammation characterised by pimples (red papules, pustules), and deeper lumps (cysts or nodules)[7-9]. (Shown in Figure 1)

 

(Fig. 1)

 

The therapies which are commonly used to the treatment of Acne vulgaris include are hormonal, systemic, topical, herbal and some drugs with combination therapy. The topical drugs used for the treatment and management of Acne vulgaris are benzoyl peroxide, antibiotics, and retinoids. The systemic agents are also being used and they are commonly known as antibiotics and isotretinoin. For the past many year’s the researchers prove that the antibiotics and retinoids have been used mostly and they remain a very good choice for the topical and systemic treatment of Acne vulgaris. But, the use of these drugs produces a numeral of potential side effects andConsumption of antibiotics will usually make the bacteria become resistant and permanent nature multiplies within its host[10].

 

A significant number of new therapeutics are derived from natural bases including plants, as novel drugs (systemic andtopical) and antiseptics, to exchange or to be used in combinationwith existing products. Plant extracts have been developed and proposed for the samepurpose in foods as natural antioxidants and/or antimicrobials. Essential oils, methanol and ethanol extracts are known to possess antimicrobial activity[11]. Therefore, an alternative source for the treatment and management of Acne vulgaris has been studied and developed and as an outcome, natural approaches to fighting acne and its disfiguring effects have gained popularity due to their effectiveness. Nowadays, there are numbers of conventional and novel herbal cosmetics and that are useful to treat damaged skin[12-14].

 

These herbs negligible the adverse effect as compared with modern medicines and become another important aspect to treat Acne vulgaris. Upcoming year’s herbal therapies are gaining more attention from academicians, industrialists, cosmeticians, researches, dermatologists and scientists for the treatment of acne. Acne can be cured by herbs, both externally and internally. Topical treatment of herbs is the first choice of customers as it is easy for application and it suppresses the bitter taste of herbal formulation. Because herbs obtain from natural sources and they have fewer side effects as compare to other therapies. So, that’s the reason herbal remedies are safe, efficacious and the added advantage of multifunctionality, these herbs are increasingly being used in cosmetic products as the main focusing part, including acne - fighting compositions[15-16].

 

Types of acne:

Lesion:

Acne lesions refer to a physical change in the skin caused by a disease process in the sebaceous follicle and range in severity from comedones (blackheads and whiteheads) to nodules and cysts. The Comedo (plural comedones) is a sebaceous follicle plugged by way of sebum, lifeless cells from inside the sebaceous follicle, tiny hairs, and sometimes bacteria. Open comedones (blackheads) and closed comedones (whiteheads) both should not be pressed or squeezed and squeals tissue injured by squeezing or picking and they can become infected by the Staphylococci, Streptococci and other types of bacteria. Squeezing and picking can also increase the risk of scarringthe affected part[17].

 

Papule:

Papules occur when the walls surrounding your pores break down from severe inflammation. In the results the hard, clogged pores that are kind to the touch. The skin around these pores usually became pink[17-18].

 

Pustule:

Pustules can also form when the walls around your pores break down. Unlike papules, pustules are filled with pus. These bumps come out from the skin and the colour is usually red. Frequently, the yellow or whiteheads are found on the top of heads.[18].

 

Nodule:

A Nodular acne is a severe form of acne that causes large, inflamed, and painful breakouts called acne nodules[18] like a papule, a nodule is a solid, dome-shaped or irregularly-shaped lesion. Unlike a papule, a nodule is characterised by inflammation, extends into deeper layers of the skin and may cause tissue destruction that results in scarring[19].

 

Cyst:

Cysts can develop when pores are clogged by a combination of bacteria, sebum, and dead skin cells. The clogs are found deeper within the skin and are further they can found below the surface than nodules. These large red and white bumps cause a painful sensation by touching the affected part. Cysts are the major form of acne, and their development usually results from a severe infection. So, this type of Acne vulgaris is also the most likely to scar[20].

 

Causes of Acne vulgaris:

Infectious contribution:

Staphylococcus aureus and Propionibacterium acnes have been recognised to Acne vulgaris. However, their exact contributions to the process of acne are not completely clear. So, there are many sub-strains of P.acnes present in regular skin and some others in long-term acne problems. Therefore, it is unclear to understand whether these strains are contributing to this condition or they are pathogenically developed. The resistance of P. acnes to commonly used drugs is a growing factor[16]. The above present strains can change, perpetuate, or familiarize to the abnormal oil production, inflammation and insufficient sloughing of acne pores. Infection with Demodex, which is a parasitic mite is linked with the formation of Acne vulgaris. Though, eradication of the mites has not improved or treat Acne vulgaris[21].

 

Dietary Contribution:

The two factors that are diet and acne but the relationship between these two factors is uncleared and there is no good quality evidence for dietary combination. However, a high level of glycaemic diet is associated with the worsening of Acne vulgaris. A positive connection between the use of milk, chocolates or salt, and an increase in the severity of Acne vulgaris has also been recommended. However, the contribution of chocolates is uncertain, as they can be made with different quantities of sugar, with or without milk[22].

 

Genetic contribution:

For specific subjects, the predisposition to Acne vulgaris might be clarified by a genetic component. This recommendation has been supported by some studies that have estimated the rate of acne among first degree relatives, along with twin studies. There are varieties of genetic factors, which have been attributed to acne, such as polymorphisms in IL-1α, TNF-α, and CYP1A1 amongst others[23].

 

Hormonal changes:

Hormonal changes, such as puberty and menstrual cycles in the human body, seem to contribute to the development of Acne vulgaris. An increase form of some sex hormones, especially the hormone that are changed during puberty and pregnancy, cause the follicular glands to develop more sebum. The use of anabolic steroids typically has similar effects. Hormones, which have been recognized and present in the formation of acne so, Vulgaris, they consist of testosterone, dehydroepiandrosterone and, dihydrotestosterone, as well as insulin-like growth factor 1 linked with the formation of acne. The formation of Acne vulgaris in adult women might be due to a fundamental condition such as Cushing syndrome, polycystic ovary syndrome or hirsutism[24].

Psychological contribution:

Some scientific and researchers have shown that acne severity is connected with an increase in stress level and stress has also been listed as the main factor attributed to acne flare[25].

 

Herbs used to treat Acne vulgaris

Latin binomials

Common names

Achilleamillefolium flowering top

Yarrow

Aloe barbadensis gel

Aloe vera

Arctiumlappa root

Burdock

Artemisia absinthium leaf

Wormwood

Azardirachta indica leaf

Neem

Berberis vulgaris root

Barberry

Chamaelirium luteum root

False unicorn

Coptischinensis root

Goldthread

Commiphora mukul resin

Guggul

Embeliaribes fruit

Vidanga

Carica papaya fruit Papaya

Carica papaya fruit Papaya

Curcuma longa rhizome

Turmeric

Eucalyptus globulus leaf

Eucalyptus

Eucalyptus maculata leaf

Eucalyptus

Eucalyptus viminalis leaf

Eucalyptus

Gentianalutea root

Gentian

Hemidesmusindicus root

Indian sarsparilla

Holarrhenaanti dysenterica stem bark

Kutaj

Hydrastiscanadensis root

Goldenseal

Mahoniaaquifolium root

Oregon grape

Medicagosativa flowering top

Alfalfa

Melaleuca alternifolia leaf

Tea tree

Mitchellarepens leaf

Partridge berry

Ocimumbasilicum leaf

Basil

Piper longum fruit

Long pepper

Nigella sativaflower

Black cumin

Scutellariabaicalensis root

Asian skullcap, scute

Serenoarepens fruit

Saw palmetto

Taraxacum officinale leaf and root

Dandelion

Terminalia chebula fruit

Chebulicmyrobalan

Terminalia arjuna stem bark

Arjun

Verbena spp. flowering top

Vervain

Vitexagnus-castus fruit

Chaste tree, vitex

Xanthorrhizasimplicissima root

Yellowroot

Zingiberofficinale rhizome

Ginger

Withaniasomnifera root

Ashwagandha

Eugenia caryophyllus fruit

Clove

 

Azadirachta indica:

Azadirachta indica is a versatile medicinal plant and is a unique source of various compounds possessing diverse therapeutic benefits. The most valuable and primary active phytoconstituent is azadirachtin and the others are nimbolinin, nimbidol, nimbin, nimbidin, gedunin, salannin, sodium nimbinate, quercetin are present in Azadirachta indica. Mainly the leaves and bark of Azadirachta indica use to the treatment of Acne             vulgaris [26-28].

 

For many years, it is reported that Neem has been traditionally used for skin and blood purifying conditions. It has a long history of medicinal usage in skin ailments due to its antibacterial and anti-inflammatory properties. Due to its antibacterial properties, it is effective in fighting most epidermal dysfunction such as acne, psoriasis, and eczema [29-30].

 

In the earlier studies, the detectives have confirmed the role of this plant as an anti-inflammatory, antarthritic, antipyretic, hypoglycaemic, antigastric ulcer, antifungal, antibacterial, and antitumor activitiesof this plant [31-32]. (Shown in figure 2)

 

Fig. 2: Azadirachta indica

 

Aloe barbadensis:

Aloe barbadensis (Aloe Vera) belongs to the Liliaceal family, of which there are about 360 species [33]. Aloe vera contains mostly water (90-99.5%) and other potentially active constituents of Aloe vera include sugars, lignin, saponins, anthraquinones, salicylic acid, and amino acids [34]. A variety of different minerals like aluminum, boron, barium, calcium, iron, magnesium, sodium, phosphorus, silicon and strontium are present in the Aloe plant.

 

Traditionally Aloe Vera plant as a natural remedy for the inhibition of variousinfections and extracts was found effective against skin acne and skin pimples [35]. It is a succulent that is a popular treatment for various skin conditions, particularly sunburns. Now a days Aloe Vera is effective in combination with more conventional acne medications [36]. This miracle herbal plant is reported to be in different types of disorders e.g.: antipyretic, anthelmintic, decoagulant, demulcent, diuretic, emollient, worms excellent, hair stimulant, purgative, analgesic, tonic, pain killer, anti-asthmatic, antileukopenic, hypoglycaemic, insecticides, liver stimulant, local anesthetic, rejuvenate, appetite stimulant, stomach-ache, uterine stimulant, parasite killer and all the above disorders are effectively treated because of the excellent therapeutic effect of aloe           plant [36].

 

Besides, a majority of people using a different forms of Aloe vera gel and juice to treat acne as a safer therapeutic and prophylactic formula. Aloe vera has antibacterial properties especially skin commensal bacteria responsible for the acne formation i.e. Propionibacterium acnes, it's speculated that multicomponent of Aloe gel play a potential role in reducing these bacteria colony in ex vivo studies [37]. (Shown in Figure 3)

 

Fig. 3: Aloe barbadensis

 

Eucalyptus Globulus:

Eucalyptus Globulus Plant from Family Myrtaceae. Eucalyptus Globulus is a widely observed plant that has incredible medicinal importance. A variety of eucalyptus species have also been widely studied for their various therapeutic activities, like analgesic, antiviral, anti-inflammatory, antibacterial, antidiabetic, ant oxidative, antitumor, antihistaminic, anticancer, and hepatoprotective properties[38].

 

Traditionally this plant claims the anti-inflammatory, analgesic, and anti-bacterial properties[39]. Eucalyptus globulus, E. maculata and E. viminalis were able to inhibit the growth of six gram-positive bacteria including Propionibacterium acnes, Staphylococcus aureus, Enterococcus faecalis, Bacillus cereus and Alicyclobacillusacido terrestris, and fungi[40-41].

 

Now the essential oil of Eucalyptus shows antibacterial activity against a wide range of bacteria including Propionibacterium acne[42-43]. (Shown in Figure 4)

 

Fig. 4: Eucalyptus globulus

 

Curcuma longa:

Curcuma longa belonging to the family, Zingiberaceae. The primary biologically active component of turmeric is curcumin and curcumin has effective antioxidant, anti-inflammatory and wound-healing properties, which may prove to be therapeutic against acne[44].

 

Ayurvedic and Chinese medicine have used turmeric for centuries to treat various health problems[45]. It is said to be a treatment for anything from indigestion to inflammation. It can also be found in folk medicine as a treatment for diaper rash, psoriasis, and acne[46]. Curcuma longa has not been verified to treat acne or acne scars. Although turmeric, and its constituent curcumin, has shown some promise, as of yet it hasn't been proven to affect any dermatological issue[47].

 

Earlier investigators have confirmed their role as anti-inflammatory, anti-HIV, antibacterial, antioxidant, nematocidal, anti-parasitic, antispasmodic and anticarcinogenic activities[48]. (Shown in Figure 5)

 

Fig. 5: Curcuma longa

 

Terminalia arjuna:

The Terminalia arjuna belongs to the family Combretaceae and plants from this genus have been used traditionally to treat several health disorders such as diarrhea, skin rashes, cancer, inflammation, wound healing, cardiac stimulant, hemoptysis, lithontriptic and also useful in bilious infections, diarrhea and in acne[49].

 

Bark of Terminalia arjuna was found to contain flavonoids, tannins, triterpenoid and glycosides. Tannins exhibit cytotoxic, antitumor, astringent, anti-haemorrhagic, anti-oxidant, anti-bacterial[50]. (Shown in Figure 6)

 

Fig. 6: Terminalia arjuna

 

Withaniasomnifera:

Withania somnifera (Ashwagandha) is also recognized as Indian ginseng, supports to fight infections, prevents oil plugs from being formed on the skin, and is a natural and healthy way to treat acne and acne scars[51]. Propionibacterium acnes, Staphylococcus epidermidis are the gram-positive bacteria are the main organisms which play an important role in the pathogenesis of Acne vulgaris[52] .Ashwagandha contains some biologically active steroids known as withaferin A, 3-b-hydroxy-2 and 3-dihydrowithanolide F and these steroids have promising anti-inflammatory properties. Thus Ashwagandha helps to treat acne inflammation.

 

Earlier investigators have confirmed their role as an antioxidant, anxiolytic, adaptogen, memory enhancing, antiparkinsonian, antivenom, anti-inflammatory, anti-tumor properties. Various other effects of Ashwagandha are immunomodulation, hypolipdemic, antibacterial, cardiovascular protection. (Shown in Figure 7)

 

Fig. 7: Withania somnifera

 

Gentianalutea:

It consists of dried rhizome and roots of Gentianalutea Linn belonging to the family Gentianaceae. The active principles of Gentianalutea are the bitter-tasting secoiridoid glycosides, gentiopicrin and amarogentin. The abstract of the gentian root has anti-inflammatory properties. So, when applied on irritated, red skin, it delivers a cooling sensation. Another property belongs to the extract is its antiseptic property for the skin. It stabilizes both the product as well as the skin surface from injurious microorganisms. Thus, particularly for acne-prone skin and irritated skin, it can provide healing benefits[53]. (Shown in Figure 8)

 

Fig. 8: Gentianalutea

 

Eugenia caryophyllus

Clove belonging to the dried flower buds of Eugenia caryophyllus Thumb, of family Myrtaceae. Clove oil tops the grade of essential oils for treating acne in terms of efficacy. It is extremely effective and destroys the acne initiating bacteria entirely. Clove oil not just treats acne and zits but it also supportive in treating acne scars, blemishes and spots [54]. (Shown in figure 9)

 

Fig. 9: Eugenia caryophyllus

 

CONCLUSION:

Medicinal and herbal plants have a long history of use and have been shown to possess low side effects. These plants are a reliable source for the preparation of new drugs. Several plants seem to have inhibitory effects on the growth of bacteria, fungi and viruses. Also, some plants have shown anti-inflammatory and anti-bacterial properties. Medicinal plants and herbs have many different treatment options that are available for the treatment of acne. Many studies revealed that our traditional heritage is hiding a number of miraculous herbs which are safe and effective alternative to cure acne. Pharmaceuticals are searching possible alternative for desperate teenagers and other people to escape from conditions ranging from unsightly blemishes to disfiguring inflammation occurred due to acne. Essential is to the involvement of sustained and continuous research using innovative technologies targeting these herbs as effective up-to-date skincare ingredients. It is expected that this paper will motivate researchers, cosmeticians, academicians, pharmacists, industrialists and dermatologists to utilize more precisely these herbs in the topical dermato-cosmetic formulation so that consumers can get maximum benefits of natural substances. Though, there are a few clinical pieces of evidence about the effectiveness and safety of these medicinal and herbal plants in the treatment of Acne vulgarise and other skin infections or skin disorders. Acne vulgaris is a common skin disorder impacting the lives of millions. Many herbs and plants are used to treat the acne because all these traditional plants and herbs have some antibacterial, antiviral and antifungal activity, so they help in the treatment the acne.

 

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Received on 21.04.2020          Modified on 18.05.2020

Accepted on 27.06.2020   ©Asian Pharma Press All Right Reserved

Asian J. Pharm. Res. 2020; 10(3):195-201.

DOI: 10.5958/2231-5691.2020.00034.9