The Role of Herbal Medicine in the Treatment of Acne Vulgaris: A Systematic Review of Clinical Trials

Polyherbal Antiacne Gel: In Vitro Antibacterial Activity and Efficacy Evaluation Against Cutibacterium acnes

Acne is a common skin condition that affects people of all ages and can lead to significant physical and psychological distress. The first line of action against acne is topical products, though the most effective are topical antibiotics. In such a scenario, the development of effective and safe herbal formulations for the treatment of acne is of great importance. Rubia cordifolia, Aloe barbadensis, and Allium cepa extracts are rich sources of bioactive metabolites and are safe compared with antibiotics, in addition to being cost effective, sustainable, and eco-friendly. Also, their combination has not been studied for treating acne, and their potential benefits need to be investigated. The present study aimed to develop an effective polyherbal gel formulation of R. cordifolia, A. barbadensis, and A. cepa combined extract for treating acne and validate its effect with reference to conventional antibiotics. Plant materials were extracted in water by the reflux method, and phytochemical analysis was done for flavonoid, anthraquinone, and phenolic contents. The combined extract (R. cordifolia, A. barbadensis, and A. cepa extracts) was formulated in gel. The selected polyherbal gel was evaluated for in vitro antibacterial activity using agar well diffusion against Cutibacterium acnes (P. acnes) culture. Phytochemical analysis of the composite extract revealed the rich presence of flavonoids, phenolics, and anthraquinones. The polyherbal gels showed good physicochemical properties; however, FCEG-4 was selected for further studies. It was found to be effective against C. acnes (MTCC 1951) in agar well diffusion, as it showed a similar zone of inhibition as that of standard. Also, during in vivo studies, FCEG-4 showed comparable efficacy with clindamycin gel. It was concluded from the study that composite extracts incorporated in an aqueous-based gel system were effective in topical therapy of mild acne vulgaris, showing similar efficacy to that of clindamycin cream.

In silico studies on the anti-acne potential of Garcinia mangostana xanthones and benzophenones

Garcinia mangostana fruits are used traditionally for inflammatory skin conditions, including acne. In this study, an in silico approach was employed to predict the interactions of G. mangostana xanthones and benzophenones with three proteins involved in the pathogenicity of acne, namely the human JNK1, Cutibacterium acnes KAS III and exo-β-1,4-mannosidase. Molecular docking analysis was performed using Autodock Vina. The highest docking scores and size-independent ligand efficiency values towards JNK1, C. acnes KAS III and exo-β-1,4-mannosidase were obtained for garcinoxanthone T, gentisein/2,4,6,3',5'-pentahydroxybenzophenone and mangostanaxanthone VI, respectively. To the best of our knowledge, this is the first report of the potential of xanthones and benzophenones to interact with C. acnes KAS III. Molecular dynamics simulations using GROMACS indicated that the JNK1-garcinoxanthone T complex had the highest stability of all ligand-protein complexes, with a high number of hydrogen bonds predicted to form between this ligand and its target. Petra/Osiris/Molinspiration (POM) analysis was also conducted to determine pharmacophore sites and predict the molecular properties of ligands influencing ADMET. All ligands, except for mangostanaxanthone VI, showed good membrane permeability. Garcinoxanthone T, gentisein and 2,4,6,3',5'-pentahydroxybenzophenone were identified as the most promising compounds to explore further, including in experimental studies, for their anti-acne potential.

Curcumin/Fusidic Acid Bitherapy Loaded Mixed Micellar Nanogel for Acne Vulgaris Treatment: In Vitro and In Vivo Studies

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.

Efficacy of Oxybrasion and Cosmetic Acids on Selected Skin Parameters in the Treatment with Acne Vulgaris

Purpose

The present study aimed to evaluate the efficacy of an oxybrasion treatment applied alone and an oxybrasion treatment combined with cosmetic acids in improving acne-prone skin and selected skin parameters.

Patients and Methods

A single-blind placebo study in a sample of 44 women diagnosed with acne vulgaris was conducted. Group A (n = 22) had a series of five oxybrasion treatments, while group B (n = 22) received a synergy of five oxybrasion treatments and a mixture of phytic, pyruvic, and lactic and lactic ferulic acids at 40% pH 1.4. Cosmetic treatments were performed every 14 days, and The Derma Unit SCC3 apparatus (Courage & Khazaka, Cologne, Germany) Sebumeter SM 815 and Corneometer CM825 and GAGS scale were used to check their effectiveness.

Results

A Bonferroni post hoc test showed that group A and B did not differ from each other in acne severity before treatment (p = 1.00). However, these samples differed significantly after treatment (p < 0.001), suggesting that combined treatment of oxybrasion and cosmetic acids has a better effect than oxybrasion alone. Also, two treatment conditions (before and after) were statistically different for groups A and B separately (p < 0.001), indicating a similar efficacy of both treatments on acne severity.

Conclusion

Cosmetic treatments improved acne-prone skin and selected skin parameters. Better results were obtained by combining an oxybrasion treatment with cosmetic acids.

Clinical Trial Approval

The clinical trial with ID ISRCTN 28257448 approved this study.