Marmara University, Faculty of Pharmacy
"Do you know how acne, also known as pimples, which we encounter at some point in our lives, occurs?"
What is acne, how does it occur?
Do you know how acne, also known as pimples, which we encounter at some point in our lives, occurs? Acne (Acne vulgaris), one of the most common dermatological disorders, is a chronic inflammatory skin disease that affects more than 85% of adolescents and young adults.
It can be said that acne formation occurs in four basic stages. Hyperseborrhea; excessive sebum production due to excessive work of the sebaceous glands, hyperkeratinization; thickening of the skin due to accumulation of epidermal cells, accumulation of bacteria called Cutibacterium acnes and development of inflammatory response constitute these stages. In short, when the oil balance in our skin is disrupted and bacterial accumulation increases, the oily and inflammatory structures we call acne (pimples) shows up.
C. acnes is a gram-positive anaerobic bacterium that stimulates inflammatory and immune responses through various mechanisms. In addition to C. acnes, Propionibacterium acnes and Staphylococcus aureus species are also effective in acne formation. Hormonal changes specific to puberty, especially the increase in androgen levels, are considered the main triggers of acne pathology. In addition, daily routines (sleep and diet, stress factors) also have an effect on acne development. High-fat and carbohydrate-dense nutrition is one of the factors that accelerate the formation and development of acne.
Is acne treatment really necessary?
Acne is usually a mild disease that causes limited damage. However, in some cases, it can cause permanent damage such as scarring and blemishes (hyperpigmentation) on the skin before or after treatment. In addition, individuals exposed to acne may feel uncomfortable due to the disorder in their skin appearance. These disorders can become one of the biggest obstacles to socialization and adaptation to society, especially in individuals during adolescence. In this case, acne is considered a disease that affects the quality of life of individuals and can cause psychiatric disorders.
Why is herbal treatment preferred?
In addition to medical treatments for acne; Chinese herbal medicine, acupuncture and other herbal treatment methods are used. Chinese herbal medicine is generally preferred to alleviate the severity of acne by clearing toxins and moisture from the skin. However, it is known that these treatments are not used much in daily life because the methods of application are too complicated.
If drug treatment is not preferred in acne vulgaris, herbal extracts and formulations of these extracts are mostly used. It is very important that these formulations are prepared correctly and applied at the right time. Some herbs can be used to reduce the severity of acne, some to moisturize the skin, some to remove blemishes and scars that occur after treatment and some to balance the oil level in the skin to prevent acne formation. The herbs used are preferred in acne treatment due to their anti-inflammatory, antibacterial, antioxidant or astringent effects.
Although medical treatments have long been used in the process of preventing and healing acne, the side effects they cause have created a prejudice against these treatments over time. Today, traditional treatments (medical and herbal cures) are suggested as an alternative to drug treatment. The fact that traditional treatments are more accessible and can be safely applied by everyone has made these methods more popular.
Plants used in acne treatment
In particular; tea tree, mangosteen, rosemary, walnut, aloe vera, witch hazel and hops can be given as examples of plants that can be used in acne treatment.
Tea tree: Perhaps the most important extract used in acne treatment is tea tree oil. This extract, obtained from the Melaleuce alternifolia species, is especially preferred for its anti-inflammatory and anti-aging effects. In a study conducted with 124 patients; the effects of 5% tea tree oil and 5% benzoyl peroxide on the skin were compared. It was observed that tea tree oil was at least as effective as benzoyl peroxide on acne. In addition, it was reported that it had fewer side effects on the skin.
Mangosteen: In a clinical study conducted in 2018, a formulation containing Garcinia mangostana (Mangosteen) extract, Lithospermum officinale (Stone) extract, Tribulus terrestris (Iron thorn) extract and Houttuynia cordata (Fishweed) extract was tested on 60 patients. It was observed that these extracts had a strong anti-inflammatory effect against C. acnes and reduced the number of mild to moderate acne lesions.
Rosemary: Rosemary (Salvia rosmarinus) extract, known to act with its rich rosmarinic acid, carnosol and carnosic acid content, reduces inflammation caused by C. acnes and therefore is actively involved in acne treatment.
Walnut: In addition to its consumption as food, it has been observed that the compounds found in walnut leaves and walnut oil (tannins, flavonoids, polyphenols and ascorbic acid) are effective in acne and blackheads.
Aloe vera: Aloe vera gel primarily acts as a powerful moisturizer on the skin. It can have a soothing effect on dry skin during acne treatment, and it can also be included in serum and washing gel formulations with its anti-inflammatory effect. Aloe vera contains high levels of vitamins A and E, various minerals, fatty acids and salicylic acid. In this respect, it has soothing effects on acne, and is also used to heal scars after acne treatment.
Green tea: Green tea extract, which has sebum-balancing and anti-inflammatory properties due to the effect of its rich gallocatechin and polyphenols, is used especially in lotion and serum formulations. In a 6-week study conducted with 20 patients, it was reported that the use of a lotion containing 2% green tea extract had positive effects on acne. A significant decrease in acne lesions was observed with twice-daily use.
Witch hazel: Thanks to its high tannin compounds, witch hazel (Hamamelis virginiana) has an astringent effect on skin pores. Thanks to this effect, it helps shrink blackheads and other pores that appear before acne formation. In addition, it can be included in acne soothing serums due to its high anti-inflammatory effect.
Hops: In a study conducted with hops (Humulus lupulus), whose extract is known to have anti-inflammatory effects, it was reported that the 0.3% gel form showed high effectiveness on P. acnes and S. aureus species. It is thought that it will be an effective treatment for acne-prone skin when sufficient clinical studies are conducted.
Acne and moisturizing afterwards
Moisturizing is very important in order to support dry skin during or after the treatment process, repair the skin barrier and gain flexibility. To provide moisturization, water-based/oil-based moisturizers or organic oils can be used depending on the skin type. It is possible to come across organic oils or some plants in moisturizing cream and lotion formulations.
One of the most preferred natural solutions for moisturizing the skin is organic oils. Organic oils protect the skin's natural moisture balance and provide nourishment without irritating the skin. Shea butter, obtained from the shea tree grown in Africa, is frequently used in dermocosmetic formulations due to its anti-inflammatory and antioxidant properties. Shea butter also contains many fatty acids and triglycerides. In this respect, it provides high levels of softening, flexibility and moisturizing on the skin. It can be preferred to eliminate dryness on the skin after acne treatments.
One of the vegetable oils used to moisturize the skin is avocado oil. Avocado oil is rich in vitamin A and oleic acid, which are beneficial in renewing dead cells on the skin. It is included in various serums and moisturizing lotions thanks to its rapid penetration into human skin.
What should be used for scars and spots?
One of the biggest problems that bothers individuals after acne treatments is the scars and spots left behind. Plastic surgery methods can be used to heal scars and correct pigmentation. These are high-cost and uncomfortable processes. As an alternative to these methods, various plant extracts can be used in treatments.
One of the plants that provides the highest effect in wound healing is Centella asiatica. C. asiatica increases collagen synthesis in the skin and strengthens weakened veins by protecting connective tissues. With these properties, it ensures rapid healing of wounds on the skin. When used as an oral supplement, it has stimulating effects on fibroblast division, collagen synthesis and cell renewal. For this reason, C. asiatica is used especially in the healing of damaged skin after acne treatment.
One of the plants known to have an effect on wound healing is St. John's wort. St. John's wort, also known as St. John's wort, contains many bioactive compounds that provide antimicrobial, antitumor and wound healing effects. Animal studies have shown that St. John's wort regenerates epithelial cells on the skin and reduces inflammation. In addition, St. John's wort can cause skin discoloration when exposed to the sun. For this reason, special care should be taken to protect from the sun when using St. John's wort.
Pomegranate peel extract can also be used in wound healing after acne treatment. The components found in pomegranate peel reduce inflammation in the skin and lighten scars. These components, which stimulate cytokines and growth factors in the skin, also increase the production of essential proteins in the wound healing process. When pomegranate peel extract is applied to the skin, it has been observed that it reduces erythema in the skin and reduces the production of melanin pigment. In this respect, pomegranate peel extract can be included in the content of spot treatments.
Why is sun protection important?
Did you know that sun protection is very important during and after acne treatment? UVA and UVB radiation, which we are exposed to a lot, especially in the summer months, affect our skin differently. UVA radiation reduces inflammation on the skin, while UVB radiation causes an increase in cytokines that cause inflammation. These rays also increase sebum production on the skin. In a study conducted with 452 acne patients, it was observed that more than 50% of the individuals reported flare-ups and worsened their acne in the summer months.
Some medications used in acne treatment, such as isotretinoin or tetracyclines, cause the skin to become sensitive to the sun. More marks and spots may be seen on the skin due to the effects of these medications. In a study conducted on 106 patients treated with tetracycline for 2 years, phototoxicity (sun sensitivity) was observed in approximately 40% of the patients. For this reason, sunscreen products should be included in the daily routine in order to both reduce flare-ups during the acne treatment process and minimize the formation of spots after treatment.
Some herbal extracts, like the physical and chemical filters found in sunscreen creams, also act as protectors against the harmful effects of UV rays. Studies have shown that quercetin and rutin compounds found in plants with high flavonoid density are at least as effective as chemical filters in UV protection.
It has been shown in many studies that some components in plant extracts (polyphenols, flavones, tannins, lipids) can absorb visible light and UVB radiation. It can be said that these components act as natural UV filters on the skin. Some Antarctic plants (Deschampsia antarctica, Colobanthus quietnsis, Polytrichum juniperinum), Buddleja cordata, Coffea genus, Commiphora mukul, Crataegus pentagyna, Feijoa sellowiana, Schinus terebinthifolius and some lichen species show these effects on the skin.
In addition, pomegranate extract has a strong antioxidant effect thanks to the phenolic compounds it contains. In vitro studies have shown that pomegranate extract protects against damage caused by UVA and UVB. In studies with mice, it has been seen that resveratrol, found in some fruits, also protects the skin against UVB.
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Yang J. H. et al., Clinical efficacy of herbal extracts in treatment of mild to moderate acne vulgaris: an 8-week, double-blinded, randomized, controlled trial, (2021).
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