Americans spend billions each year on complementary and alternative medicines.1 My interest in herbal supplements began years ago when a local television channel headlined with a story of a “vitamin” supplement treatment for acne. The treatment contained gugulipid, a standardized extract of the oleoresin of the plant Commiphora mukul. I watched the story and later called the physician who was featured to get some information about the product.
It turned out that the supplement had been marketed based on a small study (10 patients per treatment arm, with no placebo) where efficacy was comparable to tetracycline 500 mg twice daily.2 This may sound like very limited data, but in the area of herbal therapies this is common.
Yet, even though data reviewing efficacy of complementary/alternative therapies are scarce, that hasn’t stopped many patients from gravitating to these treatments. I routinely see patients who have tried some new herbal lotion or cream for their acne. And, less frequently, I know of patients who have taken oral supplements to treat acne. Here is a look at some common types of therapies patients use for acne and what the research indicates about them.
Searching for Legitimate Data
I recently did a Medline search combining alternative/herbal medicines and acne and found 43 referenced articles. Compare that to when I entered the same key words on Google. In an advanced search listing in which I Googled the following, “herbal treatments for acne,” I gathered more than 8,300 hits. This exercise highlights the lack of controlled research we have regarding these types of treatments.
One recent excellent review by Magin et al showcases the lack of data in the area, and I recommend this review as a resource for
questions relating to complementary and alternative medications for acne.3 What these authors have done by reviewing the current literature is to show that there are few studies and that they are generally of poor methodological quality. But this should not be a reason to discount such alternative treatments — rather, it is a reason to conduct more well-designed clinical trials.
So with the lack of solid scientific data out there and many outlandish claims for herbal acne therapies, why should we be concerned? Because, patients use these substances and herbal treatments for diseases are not as far off as they were once thought to be.
In the last few months, the FDA approved a prescription ointment made with a green tea extract for the treatment of genital and perianal verrucae. The medication goes by the branded name of Veregen and has its active ingredient listed as kunecatechins. It is dosed in a 15% ointment, and is used three times a day for up to 16 weeks for those interested. It is made from green tea taken from the Camellia sinesis (L.) O Kuntze. The mode of action is unknown, but such substances are known to have antioxidative capabilities in vitro.
Which Treatment Do I Most Commonly Hear About?
Tea tree oil. This is one of the common alternative treatments that shows up in my clinic repeatedly. So again, I went looking for some proof. Does it work? In a randomized single blind study, tea tree oil did significantly reduce noninflammatory and inflammatory acneiform lesions, but was not as efficacious as 5% benzoyl peroxide lotion.4
However the research subjects did find it less irritating than the benzoyl peroxide. So, in the patient who swears by their tea tree oil product we may want to guide them to more traditional and proven treatments, but in the less irritating category. Again, there can be lessens from patients and from the few trials we have of herbal therapies.
In Vitro Effects
I believe a good place to start with selecting beneficial herbal treatments is with substances where the in vitro effects at least have been studied. For example, recently, 13 Thai medicinal plants have been shown to inhibit Propionibacterium acnes.5 Four of these plants, Senna alata, Eupatorium odoratum, Garcinia mangostana and Barleria lupulina had strong inhibitory effects. Thus, some new antimicrobial substances may be on the horizon. Hopeful news for the war on bacterial resistance.
Besides antibacterial activities, anti-androgenic activity would be another way of targeting the formation of the acne lesion. We would all like an effective anti-androgen to add to our armamentarium of acne treatments. A variety of substances, including green tea have shown anti-androgen activity in vitro.2
When Herbal Remedies Go Wrong
One problem with herbal remedies includes the lack of standardization, especially in homemade medicines. In a recent case report, a young woman presented with symptoms of lead poisoning after ingesting a home-made Chinese medicine for acne with was contaminated with lead.6 Her non-specific musculoskeletal pain and anemia gradually improved after the herbal medicine was stopped.
Topical preparations touted as herbal have also been shown to contain contaminant traditional medications such as potent topical steroids which can lead to steroid acne.2 Finally, irritant and contact dermatitis from alternative topicals is a true concern. Tea tree oil has been documented to cause contact dermatitis as well as have citrus oils.2,7
How Do We Handle the Questions About Herbal Treatments for Acne?
We, as practitioners, can begin to learn some names of the more common herbal treatments. I myself get bogged down with the long scientific names, but we need to begin to familiarize ourselves with these substances.
Ask patients to bring in the products they are using, so that you may identify potential acne aggravators. Also, don’t discount that they may be taking oral supplements. Be sure to ask.
We can educate our patients that there is very little evidence based medicine to support the use of herbal/alternative medicines in the treatment of acne. However that is not to say they may not have merit. Therefore, encouraging participation in controlled clinical research trials is necessary
Americans spend billions each year on complementary and alternative medicines.1 My interest in herbal supplements began years ago when a local television channel headlined with a story of a “vitamin” supplement treatment for acne. The treatment contained gugulipid, a standardized extract of the oleoresin of the plant Commiphora mukul. I watched the story and later called the physician who was featured to get some information about the product.
It turned out that the supplement had been marketed based on a small study (10 patients per treatment arm, with no placebo) where efficacy was comparable to tetracycline 500 mg twice daily.2 This may sound like very limited data, but in the area of herbal therapies this is common.
Yet, even though data reviewing efficacy of complementary/alternative therapies are scarce, that hasn’t stopped many patients from gravitating to these treatments. I routinely see patients who have tried some new herbal lotion or cream for their acne. And, less frequently, I know of patients who have taken oral supplements to treat acne. Here is a look at some common types of therapies patients use for acne and what the research indicates about them.
Searching for Legitimate Data
I recently did a Medline search combining alternative/herbal medicines and acne and found 43 referenced articles. Compare that to when I entered the same key words on Google. In an advanced search listing in which I Googled the following, “herbal treatments for acne,” I gathered more than 8,300 hits. This exercise highlights the lack of controlled research we have regarding these types of treatments.
One recent excellent review by Magin et al showcases the lack of data in the area, and I recommend this review as a resource for
questions relating to complementary and alternative medications for acne.3 What these authors have done by reviewing the current literature is to show that there are few studies and that they are generally of poor methodological quality. But this should not be a reason to discount such alternative treatments — rather, it is a reason to conduct more well-designed clinical trials.
So with the lack of solid scientific data out there and many outlandish claims for herbal acne therapies, why should we be concerned? Because, patients use these substances and herbal treatments for diseases are not as far off as they were once thought to be.
In the last few months, the FDA approved a prescription ointment made with a green tea extract for the treatment of genital and perianal verrucae. The medication goes by the branded name of Veregen and has its active ingredient listed as kunecatechins. It is dosed in a 15% ointment, and is used three times a day for up to 16 weeks for those interested. It is made from green tea taken from the Camellia sinesis (L.) O Kuntze. The mode of action is unknown, but such substances are known to have antioxidative capabilities in vitro.
Which Treatment Do I Most Commonly Hear About?
Tea tree oil. This is one of the common alternative treatments that shows up in my clinic repeatedly. So again, I went looking for some proof. Does it work? In a randomized single blind study, tea tree oil did significantly reduce noninflammatory and inflammatory acneiform lesions, but was not as efficacious as 5% benzoyl peroxide lotion.4
However the research subjects did find it less irritating than the benzoyl peroxide. So, in the patient who swears by their tea tree oil product we may want to guide them to more traditional and proven treatments, but in the less irritating category. Again, there can be lessens from patients and from the few trials we have of herbal therapies.
In Vitro Effects
I believe a good place to start with selecting beneficial herbal treatments is with substances where the in vitro effects at least have been studied. For example, recently, 13 Thai medicinal plants have been shown to inhibit Propionibacterium acnes.5 Four of these plants, Senna alata, Eupatorium odoratum, Garcinia mangostana and Barleria lupulina had strong inhibitory effects. Thus, some new antimicrobial substances may be on the horizon. Hopeful news for the war on bacterial resistance.
Besides antibacterial activities, anti-androgenic activity would be another way of targeting the formation of the acne lesion. We would all like an effective anti-androgen to add to our armamentarium of acne treatments. A variety of substances, including green tea have shown anti-androgen activity in vitro.2
When Herbal Remedies Go Wrong
One problem with herbal remedies includes the lack of standardization, especially in homemade medicines. In a recent case report, a young woman presented with symptoms of lead poisoning after ingesting a home-made Chinese medicine for acne with was contaminated with lead.6 Her non-specific musculoskeletal pain and anemia gradually improved after the herbal medicine was stopped.
Topical preparations touted as herbal have also been shown to contain contaminant traditional medications such as potent topical steroids which can lead to steroid acne.2 Finally, irritant and contact dermatitis from alternative topicals is a true concern. Tea tree oil has been documented to cause contact dermatitis as well as have citrus oils.2,7
How Do We Handle the Questions About Herbal Treatments for Acne?
We, as practitioners, can begin to learn some names of the more common herbal treatments. I myself get bogged down with the long scientific names, but we need to begin to familiarize ourselves with these substances.
Ask patients to bring in the products they are using, so that you may identify potential acne aggravators. Also, don’t discount that they may be taking oral supplements. Be sure to ask.
We can educate our patients that there is very little evidence based medicine to support the use of herbal/alternative medicines in the treatment of acne. However that is not to say they may not have merit. Therefore, encouraging participation in controlled clinical research trials is necessary
Americans spend billions each year on complementary and alternative medicines.1 My interest in herbal supplements began years ago when a local television channel headlined with a story of a “vitamin” supplement treatment for acne. The treatment contained gugulipid, a standardized extract of the oleoresin of the plant Commiphora mukul. I watched the story and later called the physician who was featured to get some information about the product.
It turned out that the supplement had been marketed based on a small study (10 patients per treatment arm, with no placebo) where efficacy was comparable to tetracycline 500 mg twice daily.2 This may sound like very limited data, but in the area of herbal therapies this is common.
Yet, even though data reviewing efficacy of complementary/alternative therapies are scarce, that hasn’t stopped many patients from gravitating to these treatments. I routinely see patients who have tried some new herbal lotion or cream for their acne. And, less frequently, I know of patients who have taken oral supplements to treat acne. Here is a look at some common types of therapies patients use for acne and what the research indicates about them.
Searching for Legitimate Data
I recently did a Medline search combining alternative/herbal medicines and acne and found 43 referenced articles. Compare that to when I entered the same key words on Google. In an advanced search listing in which I Googled the following, “herbal treatments for acne,” I gathered more than 8,300 hits. This exercise highlights the lack of controlled research we have regarding these types of treatments.
One recent excellent review by Magin et al showcases the lack of data in the area, and I recommend this review as a resource for
questions relating to complementary and alternative medications for acne.3 What these authors have done by reviewing the current literature is to show that there are few studies and that they are generally of poor methodological quality. But this should not be a reason to discount such alternative treatments — rather, it is a reason to conduct more well-designed clinical trials.
So with the lack of solid scientific data out there and many outlandish claims for herbal acne therapies, why should we be concerned? Because, patients use these substances and herbal treatments for diseases are not as far off as they were once thought to be.
In the last few months, the FDA approved a prescription ointment made with a green tea extract for the treatment of genital and perianal verrucae. The medication goes by the branded name of Veregen and has its active ingredient listed as kunecatechins. It is dosed in a 15% ointment, and is used three times a day for up to 16 weeks for those interested. It is made from green tea taken from the Camellia sinesis (L.) O Kuntze. The mode of action is unknown, but such substances are known to have antioxidative capabilities in vitro.
Which Treatment Do I Most Commonly Hear About?
Tea tree oil. This is one of the common alternative treatments that shows up in my clinic repeatedly. So again, I went looking for some proof. Does it work? In a randomized single blind study, tea tree oil did significantly reduce noninflammatory and inflammatory acneiform lesions, but was not as efficacious as 5% benzoyl peroxide lotion.4
However the research subjects did find it less irritating than the benzoyl peroxide. So, in the patient who swears by their tea tree oil product we may want to guide them to more traditional and proven treatments, but in the less irritating category. Again, there can be lessens from patients and from the few trials we have of herbal therapies.
In Vitro Effects
I believe a good place to start with selecting beneficial herbal treatments is with substances where the in vitro effects at least have been studied. For example, recently, 13 Thai medicinal plants have been shown to inhibit Propionibacterium acnes.5 Four of these plants, Senna alata, Eupatorium odoratum, Garcinia mangostana and Barleria lupulina had strong inhibitory effects. Thus, some new antimicrobial substances may be on the horizon. Hopeful news for the war on bacterial resistance.
Besides antibacterial activities, anti-androgenic activity would be another way of targeting the formation of the acne lesion. We would all like an effective anti-androgen to add to our armamentarium of acne treatments. A variety of substances, including green tea have shown anti-androgen activity in vitro.2
When Herbal Remedies Go Wrong
One problem with herbal remedies includes the lack of standardization, especially in homemade medicines. In a recent case report, a young woman presented with symptoms of lead poisoning after ingesting a home-made Chinese medicine for acne with was contaminated with lead.6 Her non-specific musculoskeletal pain and anemia gradually improved after the herbal medicine was stopped.
Topical preparations touted as herbal have also been shown to contain contaminant traditional medications such as potent topical steroids which can lead to steroid acne.2 Finally, irritant and contact dermatitis from alternative topicals is a true concern. Tea tree oil has been documented to cause contact dermatitis as well as have citrus oils.2,7
How Do We Handle the Questions About Herbal Treatments for Acne?
We, as practitioners, can begin to learn some names of the more common herbal treatments. I myself get bogged down with the long scientific names, but we need to begin to familiarize ourselves with these substances.
Ask patients to bring in the products they are using, so that you may identify potential acne aggravators. Also, don’t discount that they may be taking oral supplements. Be sure to ask.
We can educate our patients that there is very little evidence based medicine to support the use of herbal/alternative medicines in the treatment of acne. However that is not to say they may not have merit. Therefore, encouraging participation in controlled clinical research trials is necessary
