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International Journal of Cosmetic Science, 2011, 33, 289297 doi: 10.1111/j.1468-2494.2011.00647.

Review Article
Therapeutic agents and herbs in topical application for acne

M. Kanlayavattanakul and N. Lourith

School of Cosmetic Science, Mae Fah Luang University, Chiang Rai 57100, Thailand

Received 9 September 2010, Accepted 31 January 2011

Keywords: acne, acne treatment, herbal cosmetics, herbs, topical applications

microorganism in acne. In addition, Staphylococcus epidermidis and

Pitryosporum ovale are present in acne lesions [6]. Proliferation of
Acne vulgaris suppresses an individuals self-confidence by causing these microorganisms, mainly P. acnes, leads to inflammatory
distress with regard to physical appearance, which affects a signifi- lesions and severe acne.
cant number of individuals during puberty and is delineated by Therefore, acne formation needs to be addressed, particularly
adolescence. Several treatments have been introduced to decrease acne vulgaris. In addition to adolescent acne, drugs are a relatively
the aesthetic and psychological problems caused by acne. The topi- common cause of eruptions resembling acne. Drug-induced acne or
cal application of therapeutic agents has been found to be more acneiform dermatoses that can have a sudden onset e.g. within
feasible than hormonal treatment and laser therapy. The ingredi- 1 day of drug administration can be resolved after the drug is
ents in topical acne treatments, particularly herbs and naturally stopped. Acneiform dermatoses have an unusual lesion distribution,
derived compounds, have received considerable interest as they such as inflammatory papules and pustules that are small and
have fewer adverse effects than synthetic agents. uniform in size (monomorphic), and can lead to secondary comedo-
nes of which the earliest histological event is spongiosis followed by
lymphocytic and neutrophilic infiltrates, respectively [7]. Those
drugs capable of producing eruptions have been summarized else-
Lacne vulgaire touche a lassurance dun individu en causant une where [8]. Therefore, although the initial causes are different, the
detresse face a son apparence physique. Elle affecte un nombre pathogenesis of acne vulgaris can be similar. Thus, some treat-
important dindividus pendant la puberte et est associee a ladoles- ments are used for both adolescent and drug-induced acne. In this
cence. Plusieurs traitements ont ete proposes pour diminuer les review, the therapeutic ingredients in topical applications relevant
problemes esthetiques et psychologiques causes par lacne. Lappli- to the pathogenesis of acne vulgaris lesions were evaluated, as topi-
cation topique dagents therapeutiques a ete estimee plus aisee cal application is more feasible [9], especially with the naturally
quun traitement hormonal et une therapie laser. Les ingredients derived compounds already in use and candidate compounds.
des traitements topiques de lacne, particulierement les plantes et
les composes naturels derives ont suscite un interet considerable
Sebaceous glands in acne formation
par leurs moindres effets indesirables que les ingredients synthe-
tiques. Acne is pronounced in puberty and adolescence [10] and is posi-
tively related to sebaceous gland function, particularly in teenage
boys [11], which androgenically stimulates higher sebum secretion
[12]. The secreted sebum normally contains a mixture of lipids,
Acne is a skin disorder that suppresses an individuals self-esteem squalene, wax and cholesterol both in free and in ester forms and
with regard to physical appearance and has a clinical onset during triglycerides that naturally provide a skin barrier function [13].
puberty and adolescence [1]. A high incidence of acne is found in However, the resulting abnormalities in sebaceous glands because
girls aged 1417 and in boys aged 1619 [2]. The pathogenesis of of hormonal effects alter sebum composition and linoleic acid
acne is regulated by sebum hypersecretion in deformed follicles, content is notably decreased [14]. Thus, the skin barrier is
which leads to microcomedones, and the follicular hyperprolifera- impaired and colonization of normal flora is promoted.
tion of microcomedones causes inflammation [3], and comedones
[4] in both open and closed types (black and white comedones)
Propionibacterium acnes in acne formation
appearing in papules, pustules, nodules and cysts [5]. The resulting
skin condition with sebum enrichment is prone to the anaerobic Abnormalities in sebaceous gland function, particularly water-
growth of Propionibacterium acnes, which is the main causative soluble lipids mainly facial triglycerides in sebum, are inflamma-
tory-enhancing factors that promote the metabolism of the normal
Correspondence: Nattaya Lourith, School of Cosmetic Science, Mae Fah flora, such as P. acne. P. acne has a mitogenic effect towards T cells
Luang University, Chiang Rai 57100, Thailand. Tel.: +66 53 916834; [15] by means of heat-shock proteins (HSPs) [16], contributes to
fax: +66 53 916831; e-mail: toll-like receptors (TLRs) [17] and activates CD4+ expressed in

2011 The Authors

ICS 2011 Society of Cosmetic Scientists and the Societe Francaise de Cosmetologie 289
Therapeutic agents and herbs in topical application for acne treatment M. Kanlayavattanakul and N. Lourith

keratinocytes and sebocytes and neutrophil function [18]. Coloniza- been formulated mainly in a gel and cream that found more
tion of this anaerobe consequently produces cytokines and other effective than tretinoin [42]. Another retinoid-like activity agent,
proinflammatory compounds including interleukins (IL), tumour tazarotene, which is rapidly converted to its active form, tazarote-
necrosis factors (TNF), interferon (IFN) gamma and granulocyte nic acid, has been introduced. However, it had a greater effect
macrophage colony-stimulating factor (GM-CSF) [5, 19]. In on non-inflammatory than on inflammatory lesions, which was
addition to follicular keratinocytes, IL induction leads to micro- dose dependent [43] as reviewed [44] with the other retinoid
comedone formation, and the bacterium activates TLRs inducing derivatives such as motretinide, retinoyl b-glucuronide and
the attraction of lymphocytes, neutrophils and macrophages. retinaldehyde. Unfortunately, there is no comparative study with
Abnormal keratinization and deficiency of linoleic acid in the tretinoin.
follicle also promote the growth of P. acne [20], which in turn stim-
ulates the production of proinflammatory cytokines/chemokines in
Benzoyl peroxide
sebocytes [21] and provokes chronic inflammatory lesions [22].
The application of benzoyl peroxide, an anti-microbial agent with
high affinity that inhibits P. acnes and S. aureus [36], was incorpo-
Reactive oxygen species in acne formation
rated into various formulations, mainly gels [45]. Benzoyl peroxide
Reactive oxygen species (ROS) are subsequently generated from the improves inflammatory and non-inflammatory lesions [46] by gen-
hypercolonization of P. acnes [5, 23] in addition to metabolism in erating ROS in the sebaceous follicle-inhibiting microorganisms
living organisms and from UV exposure. Although ROS perform a [24, 25] with a reduction in free fatty acids triggering the forma-
useful function in the skin barrier against acne microbes [24, 25], tion of microcomedones [47]. However, its irritancy limits its appli-
excess formation affects skin condition by activating neutrophil cation [48]. Combination products were, therefore, formulated to
infiltration. ROS including singlet oxygen, superoxide anion, hydro- overcome this drawback with an additional benefit on the synergis-
xyl radical, hydrogen peroxide, lipid peroxide and nitric oxide (NO) tic effect when in combination with adapalene [49].
play an important role in inflammatory acne as well as in tissue A comparative study between the combination of erythromycin
injury. ROS stimulate the formation of nuclear factor jB (NF-jB) and benzoyl peroxide and the combination of erythromycin and
[26], promote TNF formation [27] and consequently activate T tretinoin was conducted. The former combination significantly
lymphocytes and keratinocytes. The cytokines IL, TNF, IFN, lipo- improved the treatment of acne vulgaris [50].
polysaccharide (LPS), transforming growth factor (TGF) and prosta-
glandin (PG) are then produced and released [2832].
Salicylic acid
In summary, skin inflammation is initiated by CD4+ in T lym-
phocytes, regulated by TLRs following neutrophil infiltration which Salicylic acid, a mild keratolytic and anti-inflammatory agent [51]
generates ROS, and protease enzymes leading to follicular wall that inhibits PG synthesis, was used to remove follicular clog [36]
rupture of sebaceous glands. This consequently changes the com- in various formulations, particularly an alcoholic solution for
position of sebum, particularly linoleic acid. Hyperkeratinization is cleansing. This formulation posed better efficacy than benzoyl per-
initiated as well as a reduction in desquamation. Subsequently, the oxide [52]. Salicylic acid is a milder agent compared with retinoids.
proinflammatory cytokines, NF-jB, IL, TNF, IFN, LPS, TGF, PG and A combination of salicylic acid, and benzoyl peroxide would
GM-CSF are released causing microcomedones. The resulting micro- increase treatment efficacy as their mechanisms are differ [45]. In
comedones further develop into comedones and inflammatory addition to being a cleansing product, skin peeling using salicylic
lesions. acid was found to significantly reduce comedones [53].
The topical agents used in the treatment of acne have been sum-
marized, particularly the naturally derived compounds as they are
Azelaic acid
believed to be safer than the synthetic compounds [33]. In addi-
tion, P. acne resistance to some antibiotics used in the treatment of Naturally occurring azelaic acids possess comedolytic activity [54],
acne has been observed [34, 35]. anti-bacterial properties against P. acnes [55] including the normal-
ization of keratinization [56] and anti-inflammatory effects on neu-
trophil function [57] as well as skin-lightening properties [58]. In
Active ingredients for topical acne treatment
addition to a single treatment with azelaic acid, combination treat-
ments with other anti-acne agents, particularly benzoyl peroxide,
Retinoic acid and derivatives
enhanced efficacy [59]. Furthermore, azelaic acid is safer with less
Keratolytic agents such as cis-retinoic acid, retinol and retinol irritation and phototoxic response [60]. In addition, P. acne resis-
ester are commonly used to normalize keratinization as they have tance to azelaic acid has not been reported [56].
a suppressive effect on sebaceous gland function [9, 36, 37].
These vitamin A derivatives suppress TLRs expression and inhibit
Vitamin B
IL and IFN production. Cell migration of CD4+ and CD8+ T lym-
phocytes and macrophage is inhibited [38, 39]. Tretinoin or Similar to vitamin A that is extensively used in acne, vitamin B3
trans-retinoic acid is also used as a comedolytic agent. It normal- or nicotinamide is useful as it inhibits IL-8 production in keratino-
izes follicular epithelium desquamation by unplugging the follicle. cytes through NF-jB induced by P. acnes during the early phase of
The growth of P. acnes is reduced consequently. However, topical inflammation [61]. Consequently, melanosomes transferring to
application of anti-inflammatory retinoids [40] leads to irritation, keratinocytes are reduced [62]. In addition, nicotinamide was
which is dose responsive [41]. Therefore, appropriate vehicles believed to suppress leucocyte peroxidase that damaged skin barrier
should be used to diminish this effect in addition to structural function including enhancing sebum synthesis and consequently
modification. Adapalene, a retinoid-like activity agent, with reducing transepidermal water loss. Therefore, it was regarded as
comedolytic and anti-inflammatory effects was synthesized. It has the newest vitamin for inflammatory lesion treatment.

2011 The Authors

ICS 2011 Society of Cosmetic Scientists and the Societe Francaise de Cosmetologie
290 International Journal of Cosmetic Science, 33, 289297
Therapeutic agents and herbs in topical application for acne treatment M. Kanlayavattanakul and N. Lourith

Vitamin C Herbs for acne treatment

Ascorbic acid or vitamin C, the most well known anti-oxidant, poses The use of natural remedies is a highly approached in human
anti-inflammatory properties that are appraisal in the treatment of health [78], in particular cosmetics with an ongoing search for
acne [63]. It scavenges the generated radicals terminating inflam- novel biologically active botanical agents [79]. Traditional thera-
mation accordingly. However, it is unstable in a free form. There- peutics, for instance ayurvedic formulations [80], which are some-
fore, structural modification, for example sodium ascorbyl phosphate times classified as complementary and alternative medicine (CAM),
achieving stability, was carried out. This more stable derivative was have been used in acne treatment. Therefore, plants that are
used to treat the inflammatory lesions in addition to retinol. The currently used and those with a high potential are summarized as
combination treatment significantly reduced the lesions [9]. follows:
Serum zinc level was found to be low in patients with acne [64].
Treatment with zinc was therefore shown to improve inflammatory
Already used herbs
acne [65].
In addition, oral and topical antibiotics have been used in the Aloe vera extract is used as a component in Ayurvedic formula-
treatment of acne. This article will briefly discuss only macrolides tions. It significantly reduced acne lesions [80]. This Asian derma-
and tetracyclines, which are the main antibiotics used for acne, as tological remedy was in accord with the therapeutic use of Aloe
informative reviews have been presented [34, 6668]. spp. in South Africa [81]. However, A. vera was insignificant to
suppress P. acnes-induced ROS and proinflammatory cytokines
[82]. In the same ayurvedic formulation, Azadirachta indica,
Curcuma longa and Hemidesmus incidus were used for acne treat-
In addition to the aforementioned active agents, topical administra- ment [80]. These herbs significantly suppressed the production of
tion of antibiotics particularly macrolides are used in the treatment ROS induced by P. acnes [82]. Accordingly, their anti-inflammatory
of acne. Oral administration is used for severe acne and acne that activity should be stronger than A. vera, highlighting their potential
is resistant to topical treatment [1]. The macrolides, erythromycin in inflammatory lesions treatment.
and clindamycin, are used with respect to their anti-oxidant and A common spice, poultice onion (Allium cepa), was traditionally
anti-inflammatory activities [69, 70]. However, P. acne resistance used for acne [83] owing to its mild keratolytic, anti-fungal and
[35] as well as gastrointestinal irritation and vaginal candidiasis bacteriostatic properties with respect to its sulphur containing [84]
especially photosensitivity including drug interactions were found including its anti-inflammatory flavonoids [85]. However, its mal-
following applications of macrolides [66]. Although a structural odor limits the application as well as the possibility of irritation.
modification in a fewer gastrointestinal side-effect agent, azithromy- Asia is not the only continent using traditional herbs for the
cin, was carried out. It was found to accumulate in breast milk treatment of acne vulgaris. Centella asiatica was used as a general
[71]. tonic for leprosy and wounds particularly for acne in Africa [86].
Although its mechanism remains unknown, skin care products
containing C. asiatica are widely commercialized in Asia.
Essential oils of Eucalyptus radiate and Melaleuca alternifolia
Another class of antibiotic that is widely used in acne treatment is commonly known as Australian eucalyptus and tea tree,
tetracyclines. Tetracyclines show anti-inflammatory activity inhibit- respectively, have been extensively used in acne treatment [87].
ing PG synthesis as well as NO synthase suppression [72, 73]. M. alternifolia oil gel was found to effectively reduce acne lesions
However, the adverse effects of tetracyclines are similar to those of compared with benzoyl peroxide at the same concentration but fewer
macrolides. The most common side effects are lightheadedness, side effects [88]. Its inhibitory activity against skin flora including
dizziness and tinnitus [74] including yellow staining of teeth and S. aureus, S. epidermidis and P. acnes was contributed by the major
nail diseases such as photo-onycholysis, although these side effects aroma components, terpinen-4-ol, a-terpineol and a-pinene [89].
are not common in doxycycline and minocycline. Light sensitivity However, terpene and limonene in tea tree oil caused allergies in
has been demonstrated following the administration of doxycycline hypersensitive skin [90]. Thus, caution regarding the dose used
[75]. should be taken. However, adverse reaction of tea tree oil is rare.
To overcome the adverse effects of antibiotics, combination ther- Therefore, it is one of the most popular and effective over-the-counter
apy with a systemic treatment should be conducted. Stepwise treat- acne treatments [45]. In addition, juniper (Juniperus communis) oil
ment must be carried out to minimize antibiotic exposure was also found to be effective in the treatment of acne [87].
diminishing microbial resistance. Licorice or Glycyrrhiza glabra, an herb native to Asian countries,
In addition to the aforementioned treatments, hormonal therapy was topically applied in the treatment of acne [91] because of its
with anti-androgens such as spironolactone, flutamine and cypro- anti-inflammatory effect [92]. However, its anti-oxidant activity
terone acetate has been used to treat acne. However, adverse was low [93]. In addition, Gossypium barbadense, an anti-microbial
effects have been noted [10, 76]. Laser and light-based therapy and anti-oxidant herb [94], was used as a folk remedy for acne in
potentially clear acne with improvements in acne scarring and skin Yemen owing to its biologically active terpenoids [95].
texture. Nonetheless, these methods are costly and pain causing Basil or O. gratissimum was used to treat acne both in combina-
[77]. tion with A. vera gel [96] or alone [97] because of the powerful
Thus, a natural therapy lacking adverse effects is highly desired anti-inflammatory activity of the containing linolenic acid [98].
with respect to its conceivable safety [33] and rare P. acne resis- Rosa damascene, which is mostly used as a fragrance, was found
tance. Naturally derived compounds, particularly those from herbs, to effectively inhibit P. acnes with respect to its anti-inflammatory
are therefore reviewed in this article. The herbs included are those action [99]. Similarly, rose oil was used in the treatment of acne
of well known and candidate herbs used in the future development [87]. Therefore, rose should be incorporated into cosmetic products
of anti-acne products. as a multifunctional ingredient. Red clover or Trifolium pretense was

2011 The Authors

ICS 2011 Society of Cosmetic Scientists and the Societe Francaise de Cosmetologie
International Journal of Cosmetic Science, 33, 289297 291
Therapeutic agents and herbs in topical application for acne treatment M. Kanlayavattanakul and N. Lourith

employed as an acne remedy because of its anti-inflame flavonoids should be further formulated in acne care products and clinically
[100]. evaluated to prove its efficacy in human volunteer.
The susceptibility of P. acnes and S. epidermidis was tested on
hop (Humulus lupus)-isolated compounds, lupulones and xanthohu-
Subjectively used herbs
mol. Lupulones were the most potent bactericidal compounds
In addition to the aforementioned herbal extracts, the following against P. acne and S. epidermis at a MIC of 0.1 lg ml)1, whereas
herbs have been used subjectively in acne treatment: xanthohumol, a strong S. epidermidis inhibitor, showed stronger
The anti-inflammatory effects of Roman and German chamom- anti-oxidant activity [107].
iles (Anthemis nobilis and Matricaria recutita) were applied in skin Jojoba liquid wax, a common ingredient of cosmetics, was found
inflammation treatment owing to their biologically active flavo- to effectively reduce neutrophil infiltration by reducing myeloperox-
noids, particularly apigenin, a-bisabolol and chamazulene [101]. idase activity. Nitric oxide level was reduced as well as TNF-a
Comparable activity against P. acnes and S. epidermidis was release [108], which is appraisal for inflammatory acne treatment.
found between tea tree and Abies koreana oils containing bornyl The oriental anti-inflammatory herb [109], Magnolia officinalis,
acetate, limonene, a-pinene and camphene as the main com- has long been used in East Asian countries. Its magnolol and hon-
pounds. In addition to acne pathogenesis inhibition, A. koreana oil okiol potently inhibit P. acnes and P. granulosum (MIC = 34 and
exhibited anti-inflammatory effects towards LPS, TNF, IL, NO and 9 lg ml)1, respectively) with the proven anti-inflammatory effects
PG [102]. In addition to those mentioned biologically active essen- [110].
tial oils, S. epidermidis was found to be inhibited by Salvia sclarea Radical scavenging activities of emblica or Phyllanthus emblica
(minimum inhibitory concentration; MIC = 1.52 mg ml)1) [103] were found to be appropriate for acne treatment because of its
and Ziziphora clinopodioides [104] oils. Furthermore, the essential active components that were mainly ascorbic acid, gallic acid and
oils of Anthemis aciphylla [105] and Tamarix bovena [105] were skin whitening agents, quercetins, and ellagic acid. In particular,
found to inhibit facial flora that would applicable in acne care the isolated geraniin showed the highest activities in DPPH and
product. lipid peroxidation assays as well as NO scavenging activity [111
Eucommia ulmoids, a traditional tonic used in East Asia, was 114].
found to potently inhibit P. acnes (MIC = 0.5 mg m)1) and reduced Biological activity assessments of Punica granatum, which is
the secretion of proinflammatory cytokines [99]. Thus, this herb an edible fruit, were made using radical, lipid peroxidation and

Table I Functions and applications of herbs for topical acne treatment

Name Function Application/Dosage

Abies koreana P. acnes and S. epidermidis inhibitions and anti-inflame [102] Essential oil
Allium cepa Anti-inflame [83] Poultice
Aloe vera Anti-inflame [8082] Cream, gel
Anthemis aciphylla Anti-bacterial [105] Essential oil
Anthemis nobilis Anti-inflame [101] Cream, ointment
Aralia continentalis Anti-inflame [117] Not available
Azadirachta indica Anti-inflame [80] Cream, gel, essential oil
Centella asiatica Wounds and acne scar healings [86] Tonic
Clerodendron trichotomum Anti-inflame [118] Not available
Curcuma longa Anti-bacterial, anti-inflame [80, 82, 119] Cream, gel
Garcinia mangostana P. acnes and S. epidermidis inhibitions, anti-oxidant [121123] Not available
Glycyrrhiza glabra Anti-inflame, anti-oxidant [9193] Not available
Gossypium barbadense Anti-microbial, anti-oxidant [94, 95] Decoction
Eucommia ulmoides P. acnes inhibition and anti-inflame [99] Tonic
Hemidesmus incidus Anti-inflame [80, 82] Cream, gel
Humulus lupus P. acnes and S. epidermidis inhibitionsand anti-oxidant [107] Not available
Magnolia officinalis P. acnes and P. granulosum inhibitionsand anti-inflame [110] Decoction
Matricaria recutita Anti-inflame [101] Cream, ointment
Melaleuca alternifolia P. acnes, S. aureus and S. epidermidis inhibitions[8789] Cream, gel, essential oil
Ocimum gratissimum Anti-inflame [96, 97] Gel
Phyllanthus emblica Anti-oxidant [111114] Not available
Punica granatum Anti-oxidant [115] Not available
Rosa damascene P. acnes inhibition and anti-inflame [99] Tea
Salvia sclarea S. epidermidis inhibitions [103] Essential oil
Selginella involvens Anti-inflame, anti-oxidant and P. acnes inhibition [116] Not available
Tamarix bovena Anti-microbial [106] Essential oil
Trifolium pretense Anti-inflame [100] Lotion
Ziziphora clinopodioides S. epidermidis inhibition [104] Essential oil

2011 The Authors

ICS 2011 Society of Cosmetic Scientists and the Societe Francaise de Cosmetologie
292 International Journal of Cosmetic Science, 33, 289297
Therapeutic agents and herbs in topical application for acne treatment M. Kanlayavattanakul and N. Lourith

Table II Herbs enrich active compounds against acne

Active compounds Herbs

Terpinen-4-ol, a-terpineol, a-pinene Australian eucalyptus and tea tree oils [89]
Apigenin, a-bisabolol, chamazulene Roman and German chamomiles [101]
Magnolol, honokiol Magnolia [110]
Lupulones, xanthohumol Hop [107]
Linoleic and lauric acids Apricot, argan, avocado, baobab, black currant seed, borage seed, cranberry seed, corn, coconut, cotton seed,
evening primrose, grape seed, hazelnut, linseed, manketti nut, moringa, palm, poppy seed, pumpkin, rapeseed,
raspberry seed, rice bran, safflower, sesame, sorghum, soybean, sunflower, sweet almond, walnut, wheat germ
[124126, 134]
Salicylic acid Anise, bay, basil, canella, caraway, cayenne, celery, cinnamon, chilli, coriander, fenugreek, parsley, meadowsweet,
mint, mustard, oregano, paprika, pepper, rosemary, sage, turmeric, thyme, willow [127132]
Azelaic acid Barley, rye, sorghum, wheat [134]

superoxide assays [115]. Its anti-oxidant quality was high high- rice bran (Oryza sativa), safflower (Carthamus tinctorius), sesame
lighting its capacity in the development of acne care products that (Sesamum indicum), soybean (Glycine soja), sweet almond (Prunus
have already been commercialized in Asia. amygdalus), walnut (Juglans regia) and wheat germ (Triticum vulg-
The inhibition of NO production and scavenging activity of Selgi- are) oils, which contain more than 10% (w w)1) of linoleic acid
nella involvens were found to be dose dependent. This herb also has [126], are used in the treatment of acne. However, evaluation of
an anti-inflammatory effect towards IL in keratinocytes. Further- these vegetable oils in acne treatment should be performed.
more, its non-antibiotic, anti-microbial potential on P. acnes has Furthermore, salicylic acid that is used to remove follicular clog
been reported and was non-cytotoxic at a concentration in acne treatment in addition to its skin peeling effect that signifi-
<50 lg ml)1 [116]. cantly reduced comedones with less irritation than retinoids [45]
There were anti-inflammatory reports of Chinese medicinal has been found in several herbs. Salicylic acid was originally
plants root and leaf extracts. These include Aralia continentalis via isolated from meadowsweet (Spiraea ulmaria) or Filipendula ulmaria
inhibition of cyclooxygenase-2 (COX-2) and NO expression includ- [127, 128] including F. hexapetala [129] and willow (Salix alba)
ing NF-jB deactivation [117]. Clerodendron trichotomum was found [130]. Anise, bay, basil, canella, caraway, cayenne, celery, cinna-
to suppress PGE2 production [118], which appropriates for inflam- mon, chilli, coriander, fenugreek, parsley, mint, mustard, oregano,
matory acne treatment. paprika, pepper, rosemary, sage, turmeric and thyme are used as
Prevention of acne was traditionally carried out using Ayurvedic natural sources of salicylic acid [131, 132]. These herbs and spices
formulations containing Curcuma longa [80, 119], which have anti- in addition to fruits, for instance lemon, have been found to con-
bacterial and anti-inflammatory activities [120]. This plant has tain free salicylic acid in high content [133].
long been used in Thai folk remedies for skin care and for its aro- As previously mentioned, azelaic acid is an efficacious acne
matherapy aspects in various traditional preparations, for instance treatment. Therefore, herbs containing azelaic acid should be effec-
masks, and compresses. tive in the treatment of acne. Sorghum bicolor is a cereal crop that
Garcinia mangostana is another economic fruit of Thailand. Its contains azelaic acid and linoleic acid in adequate yield [134] simi-
pericarp consisted of xanthones that potently inhibit P. acnes and lar to wheat, rye and barley that contain azelaic acid.
S. epidermidis [121]. These anti-bacterial activities were found Thus, application of these mentioned herbs is appraisal in acne
increased in a mature fruit [122]. Furthermore, it was found to be care product supplying highly interest and demand in naturally
highly effective in free radical scavenging following P. acnes induc- derived cosmetics.
tion and suppressed the production of TNF-a, a pro-inflammatory
cytokine [123], particularly in young fruit [122].
The anti-inflammatory effects of free fatty acid in sebum particu-
larly linoleic and lauric acids were found to inhibit P. acnes [124]. Tea tree oil has been widely commercialized as an over-the-
Therefore, plants containing linoleic acid may be applicable in acne counter acne treatment and may be preferred owing to its efficacy
lesion reduction. Sunflower (Helianthus annuus) and pumpkin and safety. However, the oriental tonic particularly E. ulmoids is
(Cucurbita pepo) seed oils as well as flax or linseed oil (Linum sp.), considered an alternative herb for acne treatment as its crude
which have a high fatty acid content mainly linoleic and linolenic extract potently inhibits P. acnes as well as magnolia and hop.
acids, were incorporated into a preparation for dermatological Those of linoleic acidenriched and azelaic acidenriched herbs
treatments including acne [125]. In addition to those natural oils, are capable for anti-acne formulation development, especially sor-
apricot (Prunus armeniaca), argan (Argania spinosa), avocado (Persea ghum. Similarly, the essential oils especially from S. sclarea and
gratissima), baobab (Adansonia digitata), black currant seed (Rines Z. clinopodioides should be developed into anti-acne products as
nigrum), borage seed (Borago officinalis), cranberry seed (Vaccinium well as from A. koreana in addition to their functions as
macrocarpon), corn (Zea mays), cotton seed (Gossypium sp.), evening fragrance. In particular, rose should be promoted as a multifunc-
primrose (Oenothera biennis), grape seed (Vitis vinifera), hazelnut tion active ingredient for acne treatment. Moreover, those edible
(Corylus americana), manketti nut (Schinziophyton rautanenii), morin- fruits with anti-oxidant and anti-bacterial activities, for example
ga (Moringa oliefera), palm (Elaesis guineensisi), poppy seed (Papaver G. mangostana, P. emblica and P. granatum, should be developed as
orientale), rapeseed (Brassica napus), raspberry seed (Rubus idaeus), acne care products.

2011 The Authors

ICS 2011 Society of Cosmetic Scientists and the Societe Francaise de Cosmetologie
International Journal of Cosmetic Science, 33, 289297 293
Therapeutic agents and herbs in topical application for acne treatment M. Kanlayavattanakul and N. Lourith

hypersensitive skin. Strict quality control will ensure their safety and
efficacy. In addition, combination treatment should be conducted as
The herbs summarized in Tables I and II were found to effectively it was found to be more effective than the application of a single prod-
reduce inflammatory acne lesions through mechanisms related to uct with regard to synergistic effects on the pathogenesis of acne.
sebaceous glands, P. acnes and ROS. However, an appropriate deliv-
ery system should be developed to impart their efficacies in addition
to the standardization of these herbs. Furthermore, an optimized and
effective dose should be evaluated prior to the development of The authors acknowledge Mae Fah Luang University on facility
preparations in order to avoid irritation or allergy in subjects with support during this manuscript preparation.

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