Potential of Indian herbs and herbs derived compounds in the treatment of Acne – A Commonly occurring skin disease: A Review

Poulomi Biswas, Kaushik Biswas*

Poulomi Biswas, Department of Pharmaceutics, Eminent College of Pharmaceutical Technology,

Barasat - 700126, West Bengal, India.

*Corresponding Author E-mail: kaushikbiswas24@gmail.com

ABSTRACT:

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.

KEYWORDS: C. acnes, Inflammation, Indian herbs, Aloe vera, Azadirachta indica.

INTRODUCTION: 

Acne vulgaris, commonly known as acne, is a recurrent inflammatory disease of skin. Open and closed comedones (blackheads), (whiteheads), inflammatory lesions such as pustules, papule, nodules are listed under this chronic inflammatory dermatosis¹. The acne vulgaris can be severe, moderate, or mild. It is found in around 80% of young adults and adolescents because of the premature puberty onset ². According to Adebamowo et al.³ girls of age group within 12 years and younger are more prone to acne, but boys of age range 15 years or older usually get affected with acne. Small pores on the skin surface get blocked with oil, dead skin cells, and bacteria which results in cropping up of acne. Sebum, an oil produced by the sebaceous gland help to keep the skin soft and slick.

This sebum sometimes gets secreted in excess due to hormonal changes and other factors resulting in the sebum being withdrawn through the follicle that upholds the dead skin cells and bacteria (C. acnes). These substances cause the formation of a plug. C. acnes can populate the duct sebaceous, and follicular ducts which trigger the innate immune response and causes inflammatory reactions⁴.

Follicular hyperkeratinization, boost up of sebaceous gland secretion, inflammation, and C. acnes colonization are considered to be the first line pathogenic factors in acne lesions⁵. At present, isotretinoin and different other topical Retinoids like adapalene, motretinide, retinoyl-β-glucuronide, tazarotene, Antibiotics like erythromycin, clindamycin, systemic Retinoids like azithromycin, clindamycin, co-trimoxazole, doxycycline, erythromycin, levofloxacin, lymecycline, hormonal contraceptives are used for treatments of severe acne lesions⁶. It has been observed that antibiotics and keratolytic strike the pilosebaceous unit⁷. Isotretinoin is considered a promising treatment option for acne vulgaris although some common unwanted effects like a high level of antibiotics resistance limited its uses as a first-line drug⁸.

Table 1: Commonly used plants, their parts and active constituents for acne treatment

Sl No	Plants used in acne treatment	Parts of the plant used	Active constituents for acne	References
1	Aloe vera	Leaf	C-glucosyl chromone	Surjushe et al., 2008
2	Neem	Leaf	Mahmoodin and Margolone	Vijayan et al., 2013
3	Turmeric	Root	Curcumin	Akbik et al., 2014
4	Basil	Leaf	Glutathione S transferase-P1, 6- methylguanine-DNA methyltransferase	Niture et al., 2006
5	Rosemary	Leaf	Rosmarinic acid	Chang et al., 2002
6	Copaiba Oil	Oil resin	Essential oil	Ary et al., 2012
7	Onions	Skin	Quercetin	Aathira et al., 2022
8	Cannabis	Leaf	Cannabinoids	Prager et al., 2018
9	Tea	Leaf	Catechin	Falcinelli et al., 2017
10	Mulethi	Roots	Licochalcone E	Rohinishree et al., 2016

As a result, the use of traditional medicine like drugs of herbal origin is on the rise. Herbal products have lower adverse effects and are cost-effective. These plants have exhibited inhibitory effects on the growth of fungi, and bacteria. There is various clinical evidence about the safety and effectiveness of these herbs in the treatment of acne⁹. It is important to assess their scientific excellence using preclinical and clinical studies. This review will attempt to enumerate the recent research on a few plants and plant derived compounds such as Aloe vera, Azadirachta indica, Curcuma longa, etc that are used in India to treat acne (Table 1).

Indian Herbs In Acne:

1. Aloe barbadensis (Aloe vera):

The aloe gel obtained from aloe vera extracts (Aloe barbadensis Miller, family- Liliaceae) is a well-known natural remedy that can reduce inflammation¹⁰. The gel has anticancer, antidiabetic, immunomodulatory, and antibiotic properties as well¹¹. A clinical investigation of extracts from aloe vera has been performed by Itrat et al. ¹². The cyclooxygenase pathway is inhibited and the prostaglandin E2 production from arachidonic acid is diminished by the leaf extract of aloe vera¹³. Recently, C-glucosyl chromone a novel anti-inflammatory compound has been isolated from gel extracts and showed promising anti-inflammatory action.¹⁴ Maan et al.¹⁵ evaluated anti-inflammatory properties of aloe vera on colorectal mucosa of humans. The results evidenced that the aloe vera gel inhibit the production of prostaglandin E2 from arachidonic acid and it reduced the secretion of IL-8 secretion. TR Hajheydari et al.¹⁶ investigated to compare efficacy and safety of aloe vera topical gel (AVG) (50%) and tretinoin (TR) cream (0.05%) with the vehicle. A randomized double-blind prospective 8-week trial (60 subjects) was performed. Results showed that vehicle and TR were less potent than the combination of TR/AVG. An experiment performed by Orafidiya et al.¹⁷ with clinically significant acne vulgaris on 84 subjects. They were treated with various test preparations like 2% v/v Ocimum oil formulated as a lotion with graded concentrations ranging 0 ⁓ 100% of placebo, aloe gel, control preparations. Aloe vera gel in combination was found to be promising in enhancing the anti-acne characteristics of oil of Ocimum gratissimum leaf.

2. Azadirachta indica [Neem]:

Azadirachta indica, Meliaceae family, commons by the name of neem in India^18. Palmitic acid (12.6%), Oleic acid (52.8%), linoleic acid (2.1%), and stearic acid (21.4%) are normally present in neem oil¹⁹. Among mahmoodin and margolone of the Neem oil are strongly useful in the inhibition of C. acne²⁰. The leaf extract of neem has antifungal and antibacterial properties^21. Rasheed et al^.22 conducted a study on a moisturizer developed from crude extracts of neem. The potency of ethanol extract of Glycyrrhiza glabra, Andrographis paniculata, A. indica, and Ocimum sanctum to inhibit acne was revealed. Nand et al.²³ explored the presence and capacity of nimbiol, stigmasterol, 4-cymene, sugiol, α-terpinene, vitamin E, and terpinen-4-ol in treating acne. These constituents were evaluated against bacteria like Staphylococcus epidermidis, C. acnes and Staphylococcus aureus, using the agar disc diffusion method. A weak activity against S. epidermidis and S. aureus was observed whereas no antimicrobial activity was recorded against C. acnes. Another study investigated powerful and sustained acne and pimples treatment by incorporating neem oil into solid lipid nanoparticles (SLNs) with different concentrations of tween 80 and lecithin²⁴. The anti-acne gel of herbal origin with hydroalcoholic extract of fruits of nutmeg (Myristica fragrance) and neem leaves (Azadirachta indica) was developed and evaluated by Yamini and Onesimus^25. The investigation revealed that the formulation [Quantity taken per 100 gm gel (in grams)] (Neem: 5, Nutmeg: 2.5, Cabopol934: 1, PEG4000: 5, Propylene Glycol: 15, Purified water: Q.S, Methyl Paraben: 0.2) has comparatively more antimicrobial activity than other formulations.

3. Curcuma longa (Turmeric):

Curcuma longa (Family-Zingiberaceae) have major constituents such as curcuminoids, curcumin and essential oil in high content. Curcumin could be an ideal candidate for acne treatment because of its antimicrobial and anti‐inflammatory properties. Inflammation is modulated by curcumin by diminishing the two main cytokines expression which is TNF-α and interleukin 1 (IL-1), released by macrophages and monocytes²⁶. The action of the NF-κB, a pro-inflammatory transcriptional factor also inhibited by Curcumin²⁷. Downregulation of cyclooxygenase-2 and inducible nitric oxide synthase caused by NFκB activation suppression. Prevention of upregulation of messenger RNA, microvascular angiogenesis, and vascular endothelial growth factor (VEGF) during inflammatory conditions are noticed²⁸. Liu and Huang²⁹ prepared a microemulsion with curcumin‐loaded myristic acid which was proved to be an exquisite vehicle for delivery of curcumin, at the same time inhibits S. epidermidis. It was observed that at concentrations of 0.86-0.87µg/mL curcumin in the microemulsion of myristic acid can inhibit almost 50% of the bacterial growth. The obtained result highlighted the potential of using the microemulsion carrier with the combination of myristic acid and curcumin that synergistically diminish S. epidermidis growth³⁰.

4. Camellia sinensis (Tea plant):

C. sinensis of the Theaceae family, known as green tea, is the second most regular refreshment worldwide³¹. The most influential compound against anti-acne action is catechins³². Kim et al.³³ investigated green tea extract (GTE) for the treatment of acne, using a meta-analysis with five randomized-controlled studies. It was observed that topical application of GTE remarkably reduced the non-inflammatory and inflammatory counts of the lesion. Rios et al.³⁴ performed a randomized, controlled, double-blind clinical trial with 60 volunteers of age between 18 - 25years. The extract from leaves of C. sinensis manifests a suitable control of the sebaceous secretion without producing dryness to the skin.

5. Ocimum sanctum (Basil):

Ocimum basilicum L. or basil, family-Lamiaceae, is the most popular and enduring spice. The extract obtained from the leaves of basil still used in acne³⁵. The presence of gums, mucilage, glycoside, tannins, phenolic compounds, steroids, triterpenoids, sterols has been confirmed in the extract of O. basilicum³⁶. Studies showed that the main effective enzymes in the antioxidant pathways are glutathione S transferase-P1, 6- methylguanine-DNA methyltransferase which can be found in ethanolic and aqueous extracts of O. basilicum ³⁷. Matiz et al.³⁸ prepared a gel with acetic acid and essential oils to assess its effectiveness in patients with prominent acne vulgarise. A clearance of acne lesions from 43% to 75% in all groups was observed. Han and Hyun³⁹ formulated an anti-acne cream from crude herbal extracts of O. basilicum. The micro-emulsion with invasomes suggests an advanced drug delivery with improved stability and efficacy of the formulation in treating acne. Prabu et al.⁴⁰ synthesized silver nanoparticles from O. gratissimum, and incorporated into gel base for the treatment of acne vulgaris. The formulation developed reported promising inhibitory action against Escherichia coli, Staphylococcus aureus, and C. acne.

6. Rosmarinus officinalis (Rosemary):

Rosmarinus officinalis, a member of lamiaceae family, used as flavoring agents in food and cosmetics⁴¹. It promotes various health benefits due to its antioxidant, anti-inflammatory, anti-carcinogenic, and anti-antimicrobial properties⁴². Rosmarinus officinalis oil was also found to be active against C. acnes and it inhibit inflammation induced by C. acnes⁴³. Antibacterial properties of essential oil obtained from R. officinalis against C. acnes was evaluated using atomic force microscopy (AFM)⁴⁴. Minimum inhibitory concentration was 0.56mg/mL against C. acnes. Methanolic extracts of Rosmarinus officinalis showed antibacterial activities against Staphylococcus aureus, C. acnes, Kocuria sp, Escherichia coli, Bacillus subtilis, and Pseudomonas aeruginosa.⁴⁵

7. Copaiba oil:

Copaiba oil-resin is used widely due to its antiseptic, and anti-inflammatory properties⁴⁶. A double-blind placebo controlled clinical trial was conducted by Kumar et al.⁴⁷. The topical gel formulation with copaiba oil was developed to enhance its effect against acne. Healing of pre-existent pustules and reduction in the area of erythema was reported by using the prepared topical gel.

8. Allium cepa (onions):

Allium cepa belongs to the Liliaceae family, commonly known as onion⁴⁸. Quercetin is reported to show reduction of inflammation⁴⁹ and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-jB) suppression induced by receptor activator of NF-jB ligand (RANKL) in MC3T3-E1 preosteoblastic cell line ⁵⁰. An occlusive intensive patch medical device (OIP) was developed by Welf and Gerd⁵¹ with onion extract and allantoin. To access the quality of the scar of the patient in a Global Aesthetic Improvement Scale and Observer Scar Assessment Scale (POSAS), an observer-blind, intra-individual randomized, controlled study prominent with post-surgery dermatologic scars in adults was considered. OIP advanced healing of scar safely as reported and concluded from this study.

9. Cannabis sativa:

Cannabinoids (CBD) from Cannabis sativa for their use in skin health condition improvement gained attention in the main media⁵². Essential oil from hemp contains terpenes that showed antimicrobial effects against C. acnes. In a study conducted by Ali and Akhtar⁵³ the use of seeds extracts of cannabis (3%) in a cream formulation was investigated. After its application to the cheek region of the male prominent with acne for 12 weeks daily twice the result was diminished erythema and sebum content with effective tolerance of the cream.

10. Glycyrrhiza glabra:

Glycyrrhiza (family: Leguminosae) also known as liquorice has been used in medicines for more than 4000 years⁵⁴. Around 30 various species including G. inflata, G. uralensis, G. eurycarpa, G. glabra, G. korshinskyi, and G. aspera⁵⁵ are found. In India, it is commonly known as Mulethi that possesses antimicrobial activity ⁵⁶. It can be used for the treatment of acne⁵⁷. Some of the bioactive compounds active against acne-causing bacteria are licochalcone E, the total extract of licorice, and Licochalcone A⁵⁸. In an in vitro study⁵⁹ major antimicrobial actions of methanolic extract of G. glabra showed strong antimicrobial activity against S. aureus (MIC: 2.5mg/ml), S. epidermidis (MIC: 2.5mg/ml), and P. acnes (MIC: 1.25mg/ml).

CONCLUSION:

Acne is a typical difficulty of skin disturbing the lives of millions. Numerous significant considerations are there as treatment options for acne based on its causes. Studies uncovered that the traditional plants are concealing ample wonderful spices that can be used to treat acne. The anti-inflammatory properties of these herbs are principal action for their uses against acne. Although few of the many plants reviewed and mentioned in this paper have shown striking results and used alone or as adjuvant with different other adjuvent to treat acne.

ABBREVIATIONS:

C. acnes: Cutibacterium acnes

PGE2: Prostaglandin E2

AVG: aloe vera topical gel

TR: Tretinoin

A. indica: Azadirachta indica

S. aureus: Staphylococcus aureus

SLNs: solid lipid nanoparticles

TNF-α: Tumor necrosis factor

IL1: interleukin 1

NF-κB: Nuclear factor-κB

VEGF: vascular endothelial growth factor

DMSO: dimethyl sulfoxide

C. sinensis: Camellia sinensis

GTE: green tea extract

RNA: Ribonucleic acid

DNA: Deoxyribonucleic acid

O. sanctum: Ocimum sanctum

O. gratissimum: Ocimum gratissimum

AFM: Atomic force microscopy

LPS: lipopolysaccharide

IC50: inhibitory concentration

OIP: Occlusive intensive patch

RANKL: Receptor activator of NF-jB ligand

POSAS: Global Aesthetic Improvement Scale and Observer Scar Assessment Scale

CBD: Cannabinoids

MIC: Minimum inhibitory concentration

P. acnes: Propionibacterium acnes

S. aureus: Staphylococcus aureus

S. pyogenes: Streptococcus pyrogens

S. epidermidis: Staphylococcus epidermidis

AUTHORS CONTRIBUTION:

Poulomi Biswas contributed to the conception, design, acquisition, manuscript preparation. Dr. Kaushik Biswas involved in critical revision, review and finalization of the manuscript. All the authors agree with the content of manuscript.

CONFLICT OF INTEREST:

The authors declare that they have no conflict of interest.

ACKNOWLEDGMENTS:

We are thankful to Dr. Suchandra Sen, Principal-Eminent College of Pharmaceutical Technology, for her constant support and encouragement to conduct research and publish articles. We would like to thank Dr. Sandip Dolui for helping in checking plagiarism.

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Received on 27.03.2023            Modified on 12.06.2023

Accepted on 18.08.2023           © RJPT All right reserved

Research J. Pharm. and Tech 2023; 16(12):5844-5849.

DOI: 10.52711/0974-360X.2023.00946