Hamid Nasri 1 ; Mahmoud Bahmani 2 ; Najmeh Shahinfard 3 ; Atefeh Moradi Nafchi 4 ;Shirin Saberianpour 4 ; and Mahmoud Rafieian Kopaei 4, *
1 Department of Nephrology, Division of Nephropathology, Isfahan University of Medical Sciences, Isfahan, IR Iran
2 Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad, IR Iran
3 Virtual School, Department of E-Learning in Medical Education, Tehran University of Medical Sciences, Tehran, IR Iran
4 Medical Plants Research Center, Shahrekord University of Medical Sciences, Shahrekord, IR Iran
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Context: Acne vulgaris affects about 85% of teenagers and may continue to adulthood. There are about two million visits to physicians per year for teenagers and the direct cost of acne treatment in the US exceeds $1 billion per year.
Evidence Acquisition: A wide variety of treatment regimens exist for acne vulgaris including benzoil peroxide, retinoids, isotretinoids, keratolytic soaps, alpha hydroxy acids, azelaic acid, salicilic acid as well as hormonal, anti-androgen or antiseborrheic treatments. However, none of these methods is free of side effects and their exact role in therapy is not clear. In this paper apart from presenting the possible causes of acne vulgaris and its available drugs, recently published papers about medicinal plants used in the treatment of acne vulgaris were reviewed.
Results: Consumption of alternative and complementary medicine, including medicinal plants, is increasing and is common amongst patients affected by acne and infectious skin diseases. Medicinal plants have a long history of use and have been shown to possess low side effects. These plants are a reliable source for preparation of new drugs.
Conclusions: Many plants seem to have inhibitory effects on the growth of bacteria, fungi and viruses in vitro. However, there are a few clinical evidences about the effectiveness and safety of these plants in the treatment of acne and other skin infections.
Keywords: Acne Vulgaris; Medicinal Plants; Herbal Medicines; Infectious Disease; Skin Diseases
Acne vulgaris (or simply acne) is an infectious disease and one of the most prevalent human diseases. It is characterized by different areas of scaly red skin (seborrhea), pinheads (papules), blackheads and whiteheads (comedones), large papules (nodules), and sometimes scarring (piples). Severe acne is usually inflammatory, however it may also be non-inflammatory. In acne, the skin changes, due to changes in pilosebaceous unit skin structures including hair follicles and their associated sebaceous glands. These changes usually require androgen stimulation (1). Acne vulgaris is usually due to an increase in body androgens, and occurs more often in adolescence during puberty, regardless of sex. Acne is usually seen on the face, upper part of the chest, and the back of subjects who possess greater numbers of oil glands (2).
Acne infection affects about 85% of teenagers and may continue to adulthood. There are about two million visits to physicians per year for teenagers and 0.2 million visits are by patients aged over 35 years. The direct cost of acne treatment in the US exceeds $1 billion per year. Furthermore, these patients spend more than $100 million on none-prescription acne products (1). Psychological, social, and emotional impairment that result from acne have been estimated to be equal and in some instances higher than that of diabetes, arthritis, epilepsy and asthma. Acne vulgaris may cause scarring, leading to lifelong problems regarding self-esteem. These patients are prone to depression and are more likely to be unemployed (3). It has been estimated that acne affects 650 million people globally and is the eitgth most common diseases in the world. Most people believe that acne vulgaris tends to disappear and diminishes or decreases over time by age. However, there is no method to estimate how long it would take to start to decrease or disappear entirely (4).
The acne treatment strategy depends on its severity. For patients with large distributed pustules and papules (severe acne) both topical and oral therapies are usually prescribed. Then, after six to eight weeks, the efficacy, compliance and the adverse effects are assessed and again the regimen is adjusted, accordingly (2). A wide variety of treatment regimens exist for acne vulgaris including benzoil peroxide, retinoids, isotretinoids, keratolytic soaps, alpha hydroxy acids, azelaic acid, salicilic acid as well as hormonal, anti-androgen or antiseborrheic treatments (2). The direct injection of steroids into inflamed cysts, microdermabrasion, chemical peels, radiofrequencies, light or lasers have been shown to result in the relief of acne, however, none of these regimens is free of side effects. Furthermore, more investigations are needed to clarify the exact role of these methods in therapy (2, 5). Using alternative and complementary medicine, including medicinal plants, is also common within patients affected by acne and infectious skin diseases (6).