Herbal Medicine for Acne Vulgaris

N atural treatments for acne vulgaris, a common condition in industrialized societies, have much to offer although clinical studies are lacking. Several studies have shown that low stomach acid is a common finding in patients who have acne. This suggests that the traditional use of bitter herbs, which act by stimulating digestive function, including acid secretion, may be useful and important for correcting acne vulgaris. Herbs with antimicrobial, inflammation-modulating, anticomedogenic, and, in certain cases, hormone-balancing actions are also useful for treating acne. (See Table 1.) Acne vulgaris remains a common condition in industrialized societies, with many mainstream treatment options available. All these treatments carry risks, and none is completely satisfactory. Natural alternatives are gaining greater research support and have much to offer clinically. Antibiotic resistance in Propionibacterium acnes and Staphylococcus epidermidis has been rising steadily since the 1980s. In one analysis covering 10 years in the United Kingdom, carrying resistant bacteria were noted in more than 50 percent of patients who had acne and who were treated with antibiotics, with most patients carrying multiple different resistant strains on different parts of their bodies.1 Similar trends have been reported in many other industrialized nations.2 Despite some efforts by drug manufacturers to inform consumers, the incidence of women exposed to oral tretinoin, a known teratogen, during pregnancy has been increasing, possibly the result of direct-to-consumer drug advertising.3 These and other concerns, including cost, underscore the need for safer, effective, more-inexpensive approaches, including those offered by herbal medicine. This article focuses primarily on herbal treatments for acne. Few botanical medicines have been evaluated systematically in clinical trials, and there is virtually no research on the common approach of natural-medicine practitioners for acne—recommending multiple lifestyle changes along with multiple natural products. Nonetheless, biologic plausibility has been demonstrated for many therapies in isolation.4 Diet, Digestion, Acne, and Herbs Mainstream dermatology has long maintained that “diet is not related to acne,” based on outdated, low-quality, and rather sparse research. Mounting modern research supports that diet can, in fact, affect acne in multiple ways.5 If nothing else, it is quite clear that people living in “Stone Age societies” have no acne, compared with rates as high as 95 percent in adolescents in industrialized societies.6 Although diet is not the only difference between these traditional and industrial societies, it is likely to be a major factor. Changing diet and lifestyle are, therefore, still considered to be critical to any natural approach to acne. Herbal medicine can potentially help make dietary changes more effective. It is a tenet of natural medicine that poor digestion may exacerbate poor dietary intake and contribute to acne. Several studies have shown that low stomach acid is a common finding in patients who have acne.7,8 This suggests that the traditional use of bitter herbs, which act by stimulating digestive function including acid secretion, may be useful and important for correcting acne vulgaris. (See box entitled Case Study: Digestive Herbs for Acne.) Some common bitter herbs used include Taraxacum officinale (dandelion) leaf and root, Achillea millefolium (yarrow) flowering top, Artemisia absinthium (wormwood) leaf, Gentiana lutea (gentian) root, and Mahonia aquifolium (Oregon grape) root. The concept in natural medicine that liver function is also critical to avoiding diet-induced acne is more theoretical. The idea is that, if the liver and its detoxification and excretory functions are not functioning optimally, the body will attempt to compensate by eliminating toxic compounds through other routes in the body, including the skin. It is possible that the liver herbs commonly used, such as Arctium lappa (burdock) root, actually work because of their bitter digestive stimulant actions. Sufficient clinical research has not been done on this line of reasoning to allow a reasoned analysis of the approach.