Scholars LITERATURE La Prensa Medica Argentina

DOI: https://doi.org/10.47275/0032-745X-295 Research Article Volume 107 Issue 1

A Review on the Role of Medicinal Plants in Treatment of Ghassemi M, Sadeghzadeh-Bazargan A, Behrangi E, Roohaninasab M, Goodarzi A and Nobari NN* Department of Dermatology, Rasoul Akram Hospital, Iran University of Medical Sciences, Iran

Abstract Background: Acne Vulgaris is a very common disorder which can present with inflammatory and non-inflammatory lesions chiefly on the face but can also occur on the upper arms, trunk, and back. Treatment of acne is of high importance and acne vulgaris and thus the acne-causing bacterium, P. acnes, has been intensively studied and several solutions have been proposed. Nevertheless, little research has focused on the use of medicinal plants for the treatment of this skin disease. However, there are several medicinal plants used traditionally to treat acne, and this provides the impetus for scientists to explore their medicinal properties. Objective: This work aimed to review medicinal plants-based treatment approaches for acne. Methodology: The authoritative online scientific databases including Pubmed, MEDLINE, Link of Springer, Online Library of Wiley, Science Direct of Elsevier, Cambridge Core, and Cochrane were searched and the useful data associated with the objective of the present study were gathered, combined and then categorized in terms of medicinal plants, acne, Acne Vulgaris, herbs. Conclusion: There is currently a strong focus on medicinal plants at a research level and therefore strong motivation exists for the use of these ingredients in cosmetic care products that need to be proven safe and effective with the aid of clinical research. Keywords: Medicinal Plants; Acne; Acne Vulgaris; Herbs; Treatment; Herbal Medicine

*Correspondence to: Niloufar Najar Nobari, Department of Dermatology, Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran, Tel: +98 2166502040; E-mail: [email protected] Citation: Ghassemi M, Sadeghzadeh-Bazargan A, Behrangi E, et al. (2021) A Review on the Role of Medicinal Plants in Treatment of Acne. Prensa Med Argent, Volume 107:1. 295. DOI: https://doi.org/10.47275/0032-745X-295. Received: June 13, 2020; Accepted: June 27, 2020; Published: July 05, 2020; Journal Issue: February, 2021

Introduction acquired immunity [7]. acnes has been identified as the causative microorganism involved in the progression of acne The skin is the outermost layer of the body that is often easily vulgaris. It is a Gram-positive, aero tolerant anaerobic bacillus with damaged by environmental factors as well as stress and poor eating the ability to produce as a metabolic by-product. This habits. Acne (known also as Acne Vulgaris) is an inflammatory microorganism forms part of the normal skin microflora and remains disorder of the pilosebaceous unit, which runs a chronic course on the skin from birth until death. In 1963, P. acnes was injected into and it is self-limiting. Acne vulgaris is triggered by sterile cysts of steatocystomas (noncancerous cysts originating in the acnes in adolescence, under the influence of normal circulating sebaceous glands), resulting in subsequent inflammation, providing dehydroepiandrosterone (DHEA). It is a very common skin disorder evidence that this microorganism is involved in inflammatory acne [8]. which can present with inflammatory and non-inflammatory lesions In doing so, many studies have been conducted to find more causes chiefly on the face but can also occur on the upper arms, trunk, and for appearance of acne. However, Lajevardi V, et al. [9], for example, back [1,2]. Acne can persist into adulthood, with a 50.9% prevalence found no statistically significant difference in BMI among people with rate of acne in women ages 20 to 29 years versus 26.3% in women ages different severities of acne. 40 to 49 years [3]. Female patients account for two thirds of visits made to dermatologists for acne, and one third of all dermatology office visits Accordingly, acne leads to significant morbidity that is associated for acne are by women who are older than 25 years [4]. The main types with residual scarring and psychological disturbances such as poor of acne scars include icepick, rolling, and boxcar [5,6]. self-image, depression, and anxiety, which leads to a negative impact on quality of life [10]. Inflammation is one of the major symptoms In a nutshell, four key pathogenic processes lead to the formation of acne, resulting in the formation of pustules, papules and cysts. In of acne lesions: alteration of follicular keratinization that leads to more severe cases of inflammatory acne, the formation of cysts is comedones; increased and altered sebum production under androgen often accompanied with the formation of scars. This has a significant control; follicular colonization by Propionibacterium acnes; and impact on psychosocial attributes, especially in teenagers who are complex inflammatory mechanisms that involve both innate and commonly afflicted with acne. Increased efficiency could potentially be

Prensa Med Argent, Volume 107:1 Pages: 1-6 Citation: Ghassemi M, Sadeghzadeh-Bazargan A, Behrangi E, et al. (2021) A Review on the Role of Medicinal Plants in Treatment of Acne. Prensa Med Argent, Volume 107:1. 295. DOI: https://doi.org/10.47275/0032-745X-295.

accompanied by reduced development of resistant strains of P. acnes. [14]. On the other hand, nonmedical device-based therapies are Besides, acne affects the pilosebaceous follicle, a structure comprised of reported to largely improve the treatment of active inflammatory the and its associated . The exact sequence acne vulgaris, especially in patients who are not compliant or eligible and nature of these factors are not yet known, but there is a general to consume acne medications, do not respond to these drugs over a agreement that acne vulgaris is a multifactorial disease. The etiology specified period of time, or do not sustain in the remission phase [15]. of acne is hypothesized to occur in four main steps, namely increased Accordingly, significant advancements have been seen in scare related levels of sebum secretion, hyper cornification (blockage and hardening) acne treatment in the recent decade, including novel skin substitutes, of the follicular duct, proliferation of P. acnes, and inflammation pharmacological interventions, advanced surgical approaches such (Figure 1) [11]. as laser therapy, fat grafting and skin grafting, cosmetic filler and pharmacological method [5]. Furthermore, several studies have been undertaken on the association of acne with diet and serum levels of micronutrients and vitamins, including calcium, vitamin D and zinc, and new treatments such as probiotics [16-19]. However, little research has focused on the use of medicine. Methodology The present study is actually a qualitative work and a careful review and critical analysis of the medical literature. We undertook several searches in such authoritative online databases as Pubmed, MEDLINE, Figure 1: The progression of acne vulgaris that ultimately results in marked inflammation Link of Springer, Online Library of Wiley, Science Direct of Elsevier, [10]. Cambridge Core, and Cochrane. To this end, the special keywords (i.e. Therefore, treatment of acne is of a high importance and acne medicinal plants, acne, Acne Vulgaris, herbs, treatment, and herbal vulgaris and the acne-causing bacterium, P. acnes, have been medicine) associated with the subject of this review were determined, intensively studied and several solutions have been proposed. For based on which the searches were conducted. The time range of the instance, in a comparison between metformin and , investigated content is limited from 2000 to 2019. Behrangi E, et al. (2019) report that metformin is effective in treating The conventional medicinal plants and plant compounds for late-onset or resistant acne and improving metabolic status, without treatment of acne serious side effects [12]. In patients with altered metabolic profiles such as polycystic ovary syndrome (PCOS), metformin seems to be superior First of all, we will represent the medicinal plants which have been to isotretinoin regarding acne treatment. In another comparative study reported by authors to be effective on treatment of acne. Accordingly, between the therapeutic effect of micro needling versus tretinoin in medicinal plants have the potential to be commercialized not only for patients with comedonal acne, micro needling seems to be a more their ability to act as antimicrobial agents but also for the treatment effective, permanent and satisfactory treatment in the treatment of of symptoms associated with acne vulgaris. The species with potential comedonal acne [13]. In addition, Montelukast has been found to be commercial value have been summarized in table 1, which includes the an effective and safe medication for moderate-level acne treatment traditional use and the biological activity that may support their use.

Table 1: Medicinal plants with traditional usage and biological activity for the treatment of acne vulgaris and its symptoms. Plant species Family Distribution Used part/ Traditional used Reported biological activities References form Aloe ferox Mill. Xanthorrhoeaceae South Africa and Lesotho Leaves and Applied topically or ingested Laxative effects, skin and wound healing, [20-23] roots to treat eczema, dermatitis, antioxidant, antiinflammatory, antimicrobial (MIC and acne of 250 μg/mL on Staphylococcus epidermidis), antimalarial, and anticancer Aloe vera (L.) Burm.f. Xanthorrhoeaceae The Caribbean, India, Leaf gel Applied topically to treat skin Antiinflammatory, antiviral, antibacterial and [24] the Mediterranean, North ailments and acne vulgaris antiaging activity Africa and South America Aspalathus linearis Fabaceae South Africa Leaf extract Topical applications Antioxidant, decreased neutrophil infiltration in [23,25,26] (Burm.f.) R. Dahlgren are believed to alleviate acne pustulosa (in vivo study) dermatological problems associated with eczema, acne and nappy rash Bulbine frutescens Asphodelaceae South Africa, Lesotho, Leaf juice Treatment for acne wounds, Cutaneous wound healing in vitro [21,23,27] Willd. and Swaziland burns, rashes, and itches Centella asiatica (L.) Apiaceae South Africa, India, Sri Leaves and , wounds prevention Antimicrobial activity against Propionibacterium [23, 27-30] Urb. Lanka, China, Indonesia, roots of scar tissue and acne acnes (5 mg/mL), antioxidant activity and and Malaysia antiinflammatory activity Glycyrrhiza glabra L. Fabaceae France, Italy, Iran, Iraq, Roots Cysts, dermatitis, eczema, and Antimicrobial activity against P. acnes (200 μg/ [31-35] Spain, Syria, and Turkey pruritus mL ATCC 6919 strain and 100 μg/mL ATCC 11827 strain) and antiinflammatory activity Harpephyllum caffrum Anacardiaceae South Africa, southern Bark Applied externally to treat Tyrosinase inhibitory activity, cytotoxicity, effect [23,25,36,37] Bernh. Mozambique, Swaziland, eczema and acne on melanogenesis, antimicrobial activity against and Zimbabwe various Gram-positive and Gram-negative including P. acnes (MIC 0.18 mg/mL DCM:MeOH and 0.5 mg/mL Aqueous extract) MIC, minimum inhibitory concentration

Prensa Med Argent, Volume 107:1 Pages: 2-6 Citation: Ghassemi M, Sadeghzadeh-Bazargan A, Behrangi E, et al. (2021) A Review on the Role of Medicinal Plants in Treatment of Acne. Prensa Med Argent, Volume 107:1. 295. DOI: https://doi.org/10.47275/0032-745X-295.

In addition, although plants contain many constituents, the and development in terms of antiacne activity. The research performed isolation of pure compounds from plants is an important part of at the University of Pretoria, Department of Plant Science has led to the drug discovery process. The isolation of compounds known to the filing of an international (PCT-Patent Cooperation Treaty) patent. be responsible for biological activity may not only enhance both L. sericea was investigated in a full clinical study on human volunteers. the isolation process and the effectiveness but also provide valuable Volunteers of two different skin types were used, Fitzpatrick skin information of the mechanism of action. Table 2 summarizes some type IV and V. The Fitzpatrick skin type system was developed by isolated plant compounds that show activity against P. acnes and acne dermatologist, Thomas B Fitzpatrick in 1975, as a classification system symptoms. for skin types that react differently to light. Type IV is characterized as a moderate brown, typically Mediterranean, which A Review on Recent Studies rarely burns and tans well. Type V is characterized as dark brown, In addition to above mentioned plants, Leucosidea sericea Eckl and typically Middle Eastern, which very rarely burns and tans well. These Zeyh is pointed which is a plant belonging to the Rosaceae family and skin types are more prone to visible scarring and postinflammatory indigenous to South Africa. It is found in the Eastern Cape, Free State, hyperpigmentation caused by acne lesions. In their study, use of and KwaZulu-Natal provinces. It is traditionally used against various Leucosidea sericea was effective in reduction of comedones, papules, ailments including severe inflammation of the eye. In combination pustules and whiteheads compared to placebo control [47]. with other plants, this species is used as an astringent. Astringents are In another study on antibacterial and antioxidant strategies for generally prescribed for patients who suffer from very oily skin [46]. L. acne treatment through plant extracts in Indian society, Vora J, et al. sericea is one of the few plants that has passed through extensive research (2019) [48] revealed that different plant extracts showed noticeable

Table 2: Plant compounds reported to have anti-acne activity Compound Name Structure Activity Reference Aloesin Antiinflammatory activity [20,38]

Anacardic acid Antibacterial activity with an MIC 0.78 μg/mL [39,40] against Propionibacterium acnes Anacardic acid analogue from Syzygium jambos with an MIC of 7.9 μg/mL against P. acnes

Asiaticoside Antibacterial, antiinflammatory has also been used in [41-43] antiacne formulations

Berberine Antimicrobial activity against P. acnes with an MIC [43,44] of 5–25 μg/mL

Plumbagin Antibacterial activity against Staphylococcus [36,45] epidermidis with an MIC of 4.0 μg/mL (microorganism also associated with acne)

MIC, minimum inhibitory concentration.

Prensa Med Argent, Volume 107:1 Pages: 3-6 Citation: Ghassemi M, Sadeghzadeh-Bazargan A, Behrangi E, et al. (2021) A Review on the Role of Medicinal Plants in Treatment of Acne. Prensa Med Argent, Volume 107:1. 295. DOI: https://doi.org/10.47275/0032-745X-295.

activity against different test organisms. The plant extracts of R. with 200 mg/L of tea tree and rosemary oils, respectively. officinalis, M. Chamomilla and A. nilotica showed significant activity De Canha MN, et al. (2020) [54] investigated the methanolic against P. acnes with diameter of 8 mm, 6 mm and 4 mm inhibition extract of Helichrysum odoratissimum (L.) Sweet (HO-MeOH) for zone respectively. The extracts of R. officinalis, A. nilotica and A. indica its ability to target bacterial growth and pathogenic virulence factors also exhibited moderate antioxidant activity with IC value of 109.3, 50 associated with acne progression. The extract showed high specificity 136.9 and 108 μg/ml, respectively. The outcome of the study suggested against C. acnes cell aggregation at sub-inhibitory concentrations, that R. officinalis, M. chamomilla and A. nilotica plant extracts could be preventing biofilm formation. Mature C. acnes biofilms were disrupted possible to use as the natural anti-acne formulations. at a sub-inhibitory concentration of 3.91 µg/ml. At 100 µg/ml, HO- In a comparative study between the effectiveness of the antibiotics MeOH reduced interleukin-1α (IL-1α) cytokine levels in C. acnes- and medicinal plants to influence the bacteria Propionibacterium induced human keratinocytes (HaCaT) by 11.08%, highlighting its acne, Abdulhussein HH, et al. (2019) [49] showed the effect of aquatic potential as a comedolytic agent for the treatment of comedonal extracts of leaves of Ocimum basilicum oil Lavandula, Azadirachata acne. The extract exhibited a 50% inhibitory concentration (IC50) of indica starting from the lowest user concentration of 100 mg/ml down 157.50 µg/ml against lipase activity, an enzyme responsible for to the largest inhibiting zone with a concentration of 500 mg/ml. They sebum degradation, ultimately causing inflammation. The extract also believe that the differential effect on is caused by inhibited pro-inflammatory cytokine levels of IL-8 by 48.31% when both types of use due to the characteristic chemical composition of compared to C. acnes-induced HaCaT cells at 7.81 µg/ml. It exhibited the plants under study and the emergence of antibiotic resistance in cyclooxygenase-II (COX-II) enzyme inhibition with an IC50 of 22.87 bacteria as a result of excessive use of antibiotics or the abandonment µg/ml. Intracellular nitric oxide (NO) was inhibited by 40.39% at 7.81 of treatment. µg/ml when compared with NO production in lipopolysaccharide (LPS)-induced RAW264.7 cells. The intracellular NO inhibition was Similarly, Ali MJ, et al. (2019) [50] investigated antibacterial potentially due to the 2.14 fold reduction of inducible nitric oxide activity for acne treatment through medicinal plants extracts including synthase (iNOS) expression. The HO-MeOH extract exhibited an Camellia sinensis, Azadirachta indica, and Cassia acutifolia. Their IC50 of 145.45 µg/ml against virulent hyaluronidase enzyme activity, results revealed that different plant extracts showed noticeable activity which is responsible for hyaluronan degradation and scar formation. against different test organisms. The acetone extracts of Camellia sinensis, Azadirachta indica and Cassia acutifolia, showed higher In a randomized clinical study, Shakiba R, et al. (2019) [55] antibacterial susceptibility of the mean of inhibition zone against examined effectiveness of Cedar (Ziziphus spina-christi) topical bacterial isolates, reaching to 34.67, 18.76, and 12.76 mm, respectively. solution in mild to moderate acne vulgaris in terms of acne severity By comparison, the antimicrobial susceptibility was exhibited by the index (ASI) and total acne lesions counting (TLC). In their study, the 95% ethanolic and the aqueous extracts of medicinal plants did not topical cedar solution plus 1% was more effective and safe exhibit an inhibitory effect against the tested microorganisms. Also, than placebo plus 1% clindamycin for the treatment of acne vulgaris. the acetonic extracts of Camellia sinensis, Azadirachta indica exhibited Addiionally, Singgih M, et al. (2019) [56] investigated the effective antibacterial preparation against bacterial isolates. antibacterial activity of water spinach (Ipomoea aquatic Forsk.) herbs Mohammed RK, et al. (2020) [51] analyzed effectiveness of extract against bacteria Propionibacterium acnes. All three extracts Thymus vulgaris alcoholic extract on (causative of water spinach herbs had better antibacterial activity against Gram- marketers of acne). In their study, special concentrations of alcoholic positive bacteria than Gram-negative bacteria. The ethanol-water extract (5, 10, 15 mg/ml) prompted accelerated diameters of bacterial spinach herbs extract had the best antibacterial activity against P. boom inhibition zones (20, 40, 27.7, and 30mm respectively) as acnes. The minimum inhibitory concentration (MIC) value of ethanol- compared to the control (20 mm). Increased diameters of inhibition water spinach herbs extract on P. acnes was 1280 µg/ml while the zones (20.6, 32.33, 22 mm) have been additionally determined in minimum bactericidal concentration (MBC) value was >5120 µg/ml. response to remedy with extraordinary concentrations of plants crucial The equivalency of ethanol-water spinach herbs extract to oil (0.5, 1.5, and 2 p.c respectively) in evaluation to the manage (0.0%). hydrochloride presented 1163.87 µg ethanol extract (with density 1% extract: 0.780) equal to 1 µg tetracycline hydrochloride. All three Lall N, et al. (2019) [52] examine the antityrosinase, anti-acne, extracts of water spinach herbs had antibacterial activity against P. antioxidant and cytotoxic potential of 25 ethanolic extracts from acnes. They finally concluded that the ethanol extract had the best 16 different plant families which were collected in the Jongilanga antibacterial activity against P. acnes among all three extracts. community in the Mpumalanga province. The highest anti-acne activity was noted for Harpagophytum procumbens (Burch.) with a Satpute K, et al. (2019) [57] examined effectiveness of herbal cream minimum inhibitory concentration (MIC) of 31.25 μg/mL, followed by for treatment of acne. Their findings suggest that boswellia oil herbal S. brachypetala (125 μg/mL) and C. collinum, Ozoroa sphaerocarpa R. formulations would inhibit the growth of P. acnes, S. epidermidis Fern and A. Fern and Pterocarpus rotundifolius DC which all showed and creams showed significance antimicrobial activity against these MIC values of 250 μg/mL. bacteria as compared to standard. Furthermore, Esmael A, et al. (2020) [53] investigated the Nelson K, et al. (2016) [58] investigated anti-acne activity of Italian antibacterial activity of some plant oils against acne-inducing bacteria. medicinal plants used for skin infection. Following evaluation of 157 In vitro investigations of eleven Egyptian plant oils, identified tea extracts from 10 fungi and 58 plants, they identified crude extracts tree and rosemary oils to exhibit antibacterial activity against the from seven species exhibiting growth inhibitory activity (MICs 64-256 antibiotic-resistant acne isolates. Tea tree and rosemary oils exhibited μg mL−1). All active extracts were examined for cytotoxicity against bacteriostatic and bactericidal activity against all the strains with MICs/ HaCaTs; extracts from one fungal and one plant species were toxic MBCs ranging between 39-78 mg/L for and 39-156 mg/L for (IC50 256 μg mL−1). HPLC analysis with chemical standards revealed rosemary oil. All the isolates were killed after 4 and 6 h upon growing many of these extracts contained chlorogenic acid, p-coumaric acid,

Prensa Med Argent, Volume 107:1 Pages: 4-6 Citation: Ghassemi M, Sadeghzadeh-Bazargan A, Behrangi E, et al. (2021) A Review on the Role of Medicinal Plants in Treatment of Acne. Prensa Med Argent, Volume 107:1. 295. DOI: https://doi.org/10.47275/0032-745X-295.

ellagic acid, gallic acid, and tannic acid. They concluded that species mountain grape root (M. aquifolium) and gluconolactone of S. bulderi, used in traditional medicine for the skin exhibited significantly greater and gugulipid to treat acne. Efficacy and clinical safety trials of H. (p < 0.05) growth inhibitory and biofilm eradication activity than perforatum, C. sativum, B. serrata, U. barbata, R. officinalis and green random species, supporting the validity of an ethnobotanical approach tea are also essential in bacterial skin infections. to identifying new therapeutics. The anti-acne activity of three extracts There is currently a strong focus on medicinal plants at a research was reported for the first time: vinifera leaves, Asphodelus level and therefore strong motivation exists for the use of these microcarpus leaves, and Vicia sativa aerial parts. ingredients in cosmetic care products that need to be proven safe and Smida I, et al. (2018) [59] examined anti-acne, antioxidant and effective with the aid of clinical research. Furthermore, mechanism of cytotoxic properties of ludwigia peploides leaf extract. In their study, action of these plants is another important subject, which should be a strong inhibitory activity against Propionibacterium acnes (MIC = addressed. Phenolic compounds derived from plants have been shown 1.9 µg mL-1) was registered for the extract, which had a bactericidal to possess antibacterial activity. Most of the presented plants in this effect against Staphylococcus aureus, Staphylococcus epidermidis, and review possess these compounds. Nevertheless, in most cases it is not Salmonella enterica. known how much these compounds are responsible for their anti-acne activity. It should be noted that a lot of other plants have phenolic Conclusion compounds. Hence, if these compounds are solely responsible for Acne vulgaris is one of the common skin problems affecting many the observed anti-acne activities, all plants with phenolic compounds people’s lives. In consideration of several key aspects for the therapy should have anti-acne properties, which worth examining. of acne, an integrated therapeutic approach is required to achieve References the preferred reports. Many clinical researches have proven that the 1. Yan HM, Zhao HJ, Guo DY, Zhu PQ, Zhang CL, et al. (2018) Gut microbiota alterations traditional herbs have shown very promising effects in treating the in moderate to severe acne vulgaris patients. J Dermatol 45: 1166-1171. acne. The use of medicinal plants that are used by local communities, 2. Juhl CR, Bergholdt HK, Miller IM, Jemec GB, Kanters JK, et al. (2018) Dairy traditional healing practitioners, as well as those known to contain intake and acne vulgaris: a systematic review and meta-analysis of 78,529 children, medicinally beneficial compounds, plays a vital role in the search for adolescents, and young adults. Nutrients 10: 1049. new and more effective treatments for acne. 3. Collier CN, Harper JC, Cantrell WC, Wang W, Foster KW, et al. (2008) The prevalence In a nutshell, the most conventional medicinal plants used for of acne in adults 20 years and older. J Am Acad Dermatol 58: 56-59. treatment of acne are mentioned as follows: 1) Aloe ferox Mill which is 4. Yentzer BA, Hick J, Reese EL, Uhas A, Feldman SR, et al. (2010) Acne vulgaris in the from the family Xanthorrhoeaceae and its leaves and roots are topically United States: a descriptive epidemiology. Cutis 86: 94-99. or orally used to treat eczema, dermatitis, and acne; 2) Aloe vera (L.) 5. Behrangi E, Goodarzi A, Roohaninasab M, Sadeghzadeh-Bazargan A, Nobari NN, et Burm.f. which is from the family Xanthorrhoeaceae and its leaf gel is al. (2019) A review of scar treatment related to acne and burn. J Crit Rev 7: 2020. topically used to treat skin ailments and acne vulgaris; 3) Aspalathus 6. Goodarzi A, Behrangi E, Ghassemi M, Nobari NN, Sadeghzadeh-Bazargan A, et al. linearis (Burm.f.) R. Dahlgren which is from the family Fabaceae and (2020) Acne scar: a review of classification and treatment. J Crit Rev 7: 1108-1114. its leaf extract is topically used to alleviate dermatological problems 7. Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, et al. (2016) Guidelines associated with eczema, acne and nappy rash; 4) Bulbine frutescens of care for the management of acne vulgaris. J Am Acad Dermatol 74: 945-973. Willd which is from the family Asphodelaceae and its leaf juice is taken 8. Cogen A, Nizet V, Gallo R (2008) Skin microbiota: a source of disease or defence?. Br to treat acne wounds, burns, rashes, and itches; 5) Centella asiatica (L.) J Dermatol 158: 442-55. Urb. which is from the family Apiaceae and its leaves and roots are 9. Lajevardi V, Ghodsi SZ, Daneshpazhooh M, Kazemi H, Aryanian Z, et al. (2014) The topically used to prevent scar tissue and acne; 6) Glycyrrhiza glabra relationship between body mass index and the severity of acne. Iran J Dermatol 17: L. which is from the family Fabaceae and its roots are topically used 13-17. to treat cysts, dermatitis, eczema, and pruritus; and, 7) Harpephyllum 10. Ramos‐e‐Silva M, Ramos‐e‐Silva S, Carneiro S (2015) Acne in women. Br J Dermatol caffrumBernh which is from the Anacardiaceae and its bark is topically 172: 20-26. used to treat eczema and acne. Besides, many other plants seem to have 11. Falcocchio S, Ruiz C, Pastor FJ, Saso L, Diaz P (2006) Propionibacterium acnes GehA inhibitory effects on the growth of bacteria, fungi and viruses in vitro. lipase, an enzyme involved in acne development, can be successfully inhibited by Also, some plants have been shown to have anti-inflammatory and defined natural substances. J. Mol. Catal., B Enzym 40: 132-137. anti-fat properties. However, there are a few clinical evidences about 12. Elham B, Somayeh S, Afsaneh SB, Azadeh G, Mohammadreza G, et al. (2019) The the effectiveness and safety of these plants in the treatment of acne and effect of metformin in the treatment of intractable and late onset acne: a comparison other skin infections. For this reason, chemical drugs seem to still be with oral isotretinoin. Iran J Dermatol 22: 47-52. the first choice in the treatment of acne and skin infections. However, 13. Mehran G, Sepasgozar S, Rohaninasab M, Goodarzi A, Ghassemi M, et al. (2019) the efficacy and safety of synthetic drugs are under question in the Comparison between the therapeutic effect of microneedling versus tretinoin in patients treatment of acne and other skin infections. Some plants reviewed in with comedonal acne: a randomized clinical trial. Iran J Dermatol 22: 87-91. this paper have shown promising results. Hence, they might possibly be 14. Behrangi E, Arasteh E, Tavakoli T, Mehran G, Atefi N, et al. (2015) Comparing efficacy used alone or as adjuvant with other therapeutic measures or in mild to of Montelukast versus in treatment of moderate acne. J Res Med Sci 20: 379. moderate situations. Possible contact sensitization especially in topical 15. Goodarzi A (2019) Non-medical treatments for inflammatory acne vulgaris: a or oral use should be considered. Some plants, especially the roots of comprehensive review on laser, radiofrequency and microneedling. Iran J Dermatol mountain grapes, tea tree oil, Saccharomyces, and perhaps Ocimum 22: 97-106. basilicum due to their effectiveness and safety can be compared to 16. Goodarzi A, Behrangi E, Ghassemi M, Mehran G, Teymoori N, et al. (2020) alternative treatments with synthetic drugs for mild to moderate Comparative serum levels of calcium, vitamin-D, phosphorous and C-reactive between acne patients and healthy subjects. Iran J Dermatol 23: 16-20. acne. Further clinical studies validated with controls are required to use plants particularly the three species of eucalyptus (E. globulus, 17. Goodarzi A, Rohaninasab M, Behrangi E, Ghassemi M, Ghahremani A, et al. (2020) Serum parameters, diet and body mass index in acne vulgaris: a mini review. Iran J E. maculata, E. viminalis), G. glabra, U. barbata, L. minor, green tea, Dermatol 23: 32-34.

Prensa Med Argent, Volume 107:1 Pages: 5-6 Citation: Ghassemi M, Sadeghzadeh-Bazargan A, Behrangi E, et al. (2021) A Review on the Role of Medicinal Plants in Treatment of Acne. Prensa Med Argent, Volume 107:1. 295. DOI: https://doi.org/10.47275/0032-745X-295.

18. Goodarzi A, Mozafarpoor S, Bodaghabadi M, Mohamadi M (2020) The potential of 40. Chung S, Shin EJ, Choi HK, Park JH, Hwang JT (2020) Anacardic acid mitigates probiotics for treating acne vulgaris: A review of literature on acne and microbiota. liver fat accumulation and impaired glucose tolerance in mice fed a high‐fat and high‐ Dermatol Ther 33: e13279. sucrose diet. Food Sci Nutr 8: 796-804.

19. Goodarzi A, Rohaninasab M, Atefi M, Sadeghzadeh-Bazargan A, Ghassemi M, et al. 41. James JT, Dubery IA (2009) Pentacyclic triterpenoids from the medicinal herb, Centella Determination of serum levels of zinc in acne vulgaris: a case control study. Iran J asiatica (L.) Urban. Molecules 14: 3922-3941. Dermatol 23: 28-31. 42. Yingchun L, Huihan W, Rong Z, Guojun Z, Ying Y, et al. (2019) Antitumor activity 20. Chen W, Van Wyk B-E, Vermaak I, Viljoen AM (2012) Cape aloes-A review of the of asiaticoside against multiple myeloma drug-resistant cancer cells is mediated by phytochemistry, pharmacology and commercialisation of Aloe ferox. Phytochem Lett autophagy induction, activation of effector caspases, and inhibition of cell migration, 5: 1-12. invasion, and STAT-3 signaling pathway. Med Sci Monit 25: 1355-1361.

21. Coopoosamy R, Naidoo K (2012) An ethnobotanical study of medicinal plants used by 43. Liu TH, Zhang XM, Tian SZ, Chen LG, Yuan JL (2020) Bioinformatics analysis of traditional healers in Durban, South Africa. Afr J Pharm Pharmacol 6: 818-823. endophytic bacteria related to berberine in the Chinese medicinal plant Coptis teeta Wall. 3 Biotech 10: 96. 22. Mokhele M, Tswaledi D, Aboyade O, Shai J, Katerere D (2020) Investigation of Aloe ferox leaf powder on anti-diabesity activity. S Afr J Bot 128: 174-1781. 44. Slobodníková L, KoSt’álová D, Labudová D, Kotulová D, Kettmann V (2004) Antimicrobial activity of Mahonia aquifolium crude extract and its major isolated 23. Van Wyk BE, Oudtshoorn BV, Gericke N (1997) Medicinal plants of South Africa. alkaloids. Phytother Res 18: 674-676. Briza, South Africa. 45. Chang HC, Lu CY, Chen CC, Kuo CL, Tsay HS, et al. (2019) Plumbagin, a plant- 24. Surjushe A, Vasani R, Saple D (2008) Aloe vera: a short review. Indian J Dermatol derived naphthoquinone production in tissue cultures of Drosera spatulata Labill. 53: 163. Biotechnol 18: 24-31.

25. Joubert E, Gelderblom W, Louw A, de Beer D (2008) South African herbal teas: 46. Sehlakgwe PF, Lall N, Prinsloo G (2020) 1H-NMR metabolomics and LC-MS analysis Aspalathus linearis, Cyclopia spp. and Athrixia phylicoides-A review. J Ethnopharmacol to determine seasonal variation in a cosmeceutical plant Leucosidea sericea. Front 119: 376-412. Pharmacol 11: 219.

26. Carraz-Bernabei E (2011) African teas. In: Healing teas for your body, mind & soul. 47. Sharma R, Kishore N, Hussein A, Lall N (2014) The potential of Leucosidea sericea Apex Publishing Ltd, England. against Propionibacterium acnes. Phytochem. Lett 7: 124-129.

27. Van Wyk BE (2008) A broad review of commercially important southern African 48. Vora J, Srivastava A, Modi H (2019) Antibacterial and antioxidant strategies for acne medicinal plants. J Ethnopharmacol 119: 342-355. treatment through plant extracts. Inform Med Unlocked 13: 100229.

28. Chomnawang MT, Surassmo S, Nukoolkarn VS, Gritsanapan W (2005) Antimicrobial 49. Abdulhussein HH, Al-Awsi GRL (2019) Comparing the effectiveness of the antibiotics effects of Thai medicinal plants against acne-inducing bacteria. J Ethnopharmacol 101: and medicinal plants to influence the bacteria Propionibacterium acne which causing 330-3;33. acne. International Journal of Research in Pharmaceutical Sciences. Int J Res Pharm 29. Orhan IE (2012) Centella asiatica (L.) Urban: from traditional medicine to modern Sci 10: 515-518. medicine with neuroprotective potential. Evid Based Complementary Altern Med: 50. Ali MJ, Obaid RF (2019) Antibacterial activity for acne treatment through medicinal 946259. plants extracts: novel alternative therapies for acne. J Pure Appl Microbiol 13: 1245- 30. Oyedeji O, Afolayan A (2005) Chemical composition and antibacterial activity of the 1250. essential oil of Centella asiatica. Growing in South Africa. Pharm Biol 43: 249-252. 51. Mohammed RK, Musa FH, Mehdi BY, Al-Rawe AM (2020) Impacts of the alcoholic 31. Nam C, Kim S, Sim Y, Chang I (2003) Anti-acne effects of Oriental herb extracts: a extract and essential oil of Thymus vulgaris L. against the causative agent of acne novel screening method to select anti-acne agents. Skin Pharmacol Appl Skin Physiol formation (Staphylococcus aureus). Sys Rev Pharm 11: 495-498. 16: 84-90. 52. Lall N, van Staden AB, Rademan S, Lambrechts I, De Canha MN, et al. (2019) 32. Saeedi M, Morteza‐Semnani K, Ghoreishi MR (2003) The treatment of atopic Antityrosinase and anti-acne potential of plants traditionally used in the Jongilanga dermatitis with licorice gel. J Dermatolog Treat 14: 153-157. community in Mpumalanga. S Afr J Bot 126: 241-249.

33. Mapunya MB, Nikolova RV, Lall N (2012) Melanogenesis and antityrosinase activity 53. Esmael A, Hassan MG, Amer MM, Abdelrahman S, Hamed AM, et al. (2020) of selected South African plants. Evid Based Complement Alternat Med 2012: 374017. Antimicrobial activity of certain natural-based plant oils against the antibiotic-resistant acne bacteria. Saudi J Biol Sci 27: 448-455. 34. Srivastava M, Singh G, Sharma S, Shukla S, Misra P (2019) Elicitation enhanced the yield of Glycyrrhizin and antioxidant activities in hairy root cultures of Glycyrrhiza 54. De Canha MN, Komarnytsky S, Langhansova L, Lall N (2020) Exploring the anti- glabra L. J Plant Growth Regul 38: 373-384. acne potential of impepho [Helichrysum odoratissimum (L.) Sweet] to combat virulence. Front Pharmacol 10: 1559. 35. Esmaeili H, Karami A, Hadian J, Ebrahimi SN, Otto LG (2020) Genetic structure and variation in Iranian licorice (Glycyrrhiza glabra L.) populations based on morphological, 55. Shakiba R, Nilforoushzadeh MA, Hashem-Dabaghian F, Minaii Zangii B, Ghobadi phytochemical and simple sequence repeats markers. Ind Crops Prod 145: 112140. A, et al. (2019) Effect of Cedar (Ziziphus spina-christi) topical solution in mild to moderate acne vulgaris: a randomized clinical study. J Dermatolog Treat 2019: 1-6. 36. Mabona U, Van Vuuren S (2013) Southern African medicinal plants used to treat skin diseases. S Afr J Bot 87: 175-193. 56. Singgih M, Ivan A, Fidrianny I (2019) Antibacterial activity of water spinach herbs against acne-inducing bacteria. Int J Res Pharm Sci 10: 3481-3488. 37. Seepe H, Amoo S, Nxumalo W, Adeleke R (2020) Sustainable use of thirteen South African medicinal plants for the management of crop diseases caused by Fusarium 57. Satpute K, Kalyankar T (2019) Development and evaluation of herbal cream for the species-An in vitro study. S Afr J Bot 130: 456-464. treatment of acne. J Pharmacogn Phytochem 8: 2618-2624.

38. Mulat M, Khan F, Muluneh G, Pandita A (2020) Phytochemical profile and antimicrobial 58. Nelson K, Lyles JT, Li T, Saitta A, Addie-Noye E, et al. (2016) Anti-acne activity of effects of different medicinal plant: current knowledge and future perspectives. Curr Italian medicinal plants used for skin infection. Front Pharmacol 7: 425. Tradit Med 6: 24-42. 59. Smida I, Sweidan A, Souissi Y, Rouaud I, Sauvager A, et al. (2018) Anti-acne, 39. Sharma R, Kishore N, Hussein A, Lall N (2013) Antibacterial and anti-inflammatory antioxidant and cytotoxic properties of ludwigia peploides leaf extract. effects of Syzygium jambos L.(Alston) and isolated compounds on acne vulgaris. BMC Complement Altern Med 13: 292.

Prensa Med Argent, Volume 107:1 Pages: 6-6