A systematic review of the evidence for 'myths and misconceptions' in acne management: diet, face-washing and sunlight.

Magin P, Pond D, Smith W, Watson A.

Discipline of Genral Practice, University of Newcastle, New South Wales, Australia. Magin@newcastle.edu.au

BACKGROUND: Lay perceptions that diet, hygiene and sunlight exposure are strongly associated with acne causation and exacerbation are common but at variance with the consensus of current dermatological opinion. OBJECTIVES: The objective of this study was to carry out a review of the literature to assess the evidence for diet, face-washing and sunlight exposure in acne management. METHODS: Original studies were identified by searches of the Medline, EMBASE, AMED (Allied and Complementary Medicine), CINAHL, Cochrane, and DARE databases. Methodological information was extracted from identified articles but, given the paucity of high quality studies found, no studies were excluded from the review on methodological grounds. RESULTS: Given the prevalence of lay perceptions, and the confidence of dermatological opinion in rebutting these perceptions as myths and misconceptions, surprisingly little evidence exists for the efficacy or lack of efficacy of dietary factors, face-washing and sunlight exposure in the management of acne. Much of the available evidence has methodological limitations. CONCLUSIONS: Based on the present state of evidence, clinicians cannot be didactic in their recommendations regarding diet, hygiene and face-washing, and sunlight to patients with acne. Advice should be individualized, and both clinician and patient cognizant of its limitations.

Publication Types:
* Review

PMID: 15644386 [PubMed - indexed for MEDLINE]

 

Cutis. 2005 Aug;76(2 Suppl):8-14. Related Articles, Links

Combination therapy is the standard of care.

Tanghetti EA.

University of California at Davis, USA.

Acne is a multifactorial disease characterized by abnormalities in sebum production, follicular epithelial desquamation, bacterial proliferation, and inflammation. Despite these multiple pathogenic factors, most current therapies for acne do not target all 4 areas of acne pathophysiology. Combination therapies using agents with complementary mechanisms of action increasingly are recognized as an effective strategy for treating acne. Several common regimens have shown this multiple-target efficacy, including the combination of a topical antibiotic with benzoyl peroxide. In combination, these agents produce greater and faster results than when each is used as monotherapy. For both initial treatment and maintenance therapy, the ideal combination regimen is often a topical antibiotic and benzoyl peroxide product plus a retinoid that is appropriate for the patient's skin type. Combination regimens should be tailored to the individual patient, bearing in mind the number and types of prevailing lesions and the skin type. Because the vehicle for each agent may have an impact on tolerability, one should pay attention to the combination of vehicles and patient care practices to maximize tolerability.

Publication Types:
* Review

PMID: 16164151 [PubMed - indexed for MEDLINE]

Int J Dermatol. 2003 Dec;42(12):925-7.

Microbiology's principle of biofilms as a major factor in the pathogenesis of acne vulgaris.

Burkhart CN, Burkhart CG.

Department of Medicine, Brown Medical Schools Hospitals, Providence, Rhode Island, USA. cgbakb@aol.com

Propionibacterium acnes reside within the pilosebaceous unit in a biofilm. As such, they live in a community of bacteria that encase themselves within an extracellular polysaccharide lining, which the organisms secrete after adherence to the surface. This gylcocalyx polymer acts as a protective exoskeleton and serves as a physical barrier, limiting effective antimicrobial concentrations within the biofilm microenvironment. The gylcocalyx polymer secreted by P. acnes as a biofilm may explain the immunogenicity of the organism as well as the clinical course of the disease. The P. acnes' biofilm model explains many aspects of acne pathogenesis and therapy, including why prolonged antibiotic treatment is needed, why antibiotic resistance is not a reliable assessment of treatment outcome, why accutane offers long-lasting effectiveness, and why benzoyl peroxide radicals are beneficial. This microbiologic principle of biofilms as applied to acne leads to numerous new pathways of assessment and exploration.

Publication Types:
* Review

PMID: 14636182 [PubMed - indexed for MEDLINE]

Asia Pac J Clin Nutr. 2004;13(Suppl):S67.

The effect of short-term altered macronutrient status on acne vulgaris and biochemical markers of insulin sensitivity.

Smith R, Mann N, Makelainen H, Braue A, Varigos G.

Food Science Department, RMIT University, VIC 3000.

Background - It has been suggested that a low-glycemic index diet may alleviate acne and this hypothesis is currently being investigated in a long-term dietary intervention study. A short-term, live-in study was designed to further investigate this link and to provide information on the short-term effects of altered macronutrient levels. Objective - To determine the short-term effects of a low-glycemic load diet on markers of insulin sensitivity and how this relates to the clinical progression of acne vulgaris. Design - Eleven male acne sufferers, aged 15-20, were allocated to either a high protein (HP,n=6, 40-45% energy from carbohydrate, 25% energy from protein) or high carbohydrate group (HC, n=5, 55-60% energy from carbohydrate, 10% energy from protein). Fat intake was maintained at 30-35% energy for each group. All meals were provided on an ad libitum basis for 7 days. Food consumed was measured at baseline and during the live-in study for an overall assessment of an individual's glycemic load. At baseline and day 7, the subject's acne was assessed by a dermatologist and blood was sampled for hormonal markers of acne and HOMA-IR. Conclusion - The sample size and/or study length was insufficient to observe any significant changes in inflammatory counts or HOMA-IR in either the HP or HC groups. Although some results appear promising, further research is needed to confirm the diet-acne connection.

PMID: 15294556 [PubMed - in process]

Skin Pharmacol Appl Skin Physiol. 2002 Mar-Apr;15(2):112-9.

Lymecycline and minocycline in inflammatory acne: a randomized, double-blind intent-to-treat study on clinical and in vivo antibacterial efficacy.

Pierard-Franchimont C, Goffin V, Arrese JE, Martalo O, Braham C, Slachmuylders P, Pierard GE.

Department of Dermatopathology, University Medical Center Sart Tilman, Liege, Belgium.

BACKGROUND: Some antibiotics represent a mainstay in acne treatment. However, studies comparing their efficacies are rare. AIM: To evaluate the clinical and in vivo antibacterial effect of lymecycline and minocycline at different dosages. METHOD: Eighty-six patients with moderate to severe acne were enrolled in a randomized, double-blind, intent-to-treat study comparing in three parallel groups the effect of (1) lymecycline 300 mg daily for 12 weeks, (2) minocycline 50 mg daily for 12 weeks and (3) minocycline 100 mg daily for 4 weeks followed by 50 mg daily for 8 weeks. Evaluations were made at the screening visit and at five on-treatment visits. They consisted of clinical counts of acne lesions and evaluations of bacterial viability using dual flow cytometry performed on microorganisms collected from sebaceous infundibula by cyanoacrylate strippings. RESULTS: Patients receiving minocycline 100/50 mg had the best clinical outcome, particularly in the reduction of the number of papules. By the end of the trial, the microbial response to minocycline 100/ 50 mg was also superior to either of the other two treatments. There were less live and more dead bacteria. CONCLUSION: In this trial, minocycline 100/50 mg was superior for the treatment of inflammatory acne when compared to lymecycline 300 mg and minocycline 50 mg. Copyright 2002 S. Karger AG, Basel

Publication Types:
* Clinical Trial
* Randomized Controlled Trial

PMID: 11867968 [PubMed - indexed for MEDLINE]

Intern Med. 2003 Jan;42(1):48-52.

Drug-induced hepatitis with autoimmune features during minocycline therapy.

Abe M, Furukawa S, Takayama S, Michitaka K, Minami H, Yamamoto K, Horiike N, Onji M.

Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu-cho, Ehime 791-0295.

A 25-year-old woman with no history of liver disease developed liver dysfunction associated with severe jaundice and general malaise following a prolonged therapy with minocycline for acne vulgaris. Serum anti-nuclear antibody was detected and immunoglobulin G level was elevated. Symptoms resolved and liver function normalized following minocycline discontinuation and corticosteroid administration. Our diagnosis was drug-induced hepatitis with autoimmune features, as liver histology revealed acute hepatitis. Drug-induced hepatitis should be considered when liver dysfunction or systemic symptoms develops during long-term minocycline therapy.

Publication Types:
* Case Reports

PMID: 12583618 [PubMed - indexed for MEDLINE]

Clin Chem Lab Med. 2005;43(11):1178-82.

Isotretinoin therapy induces DNA oxidative damage.

Georgala S, Papassotiriou I, Georgala C, Demetriou E, Schulpis KH.

Dermatological Clinic, University of Athens, School of Medicine, A. Syngros Hospital, Athens, Greece.

BACKGROUND: Isotretinoin (Iso) is currently indicated for the treatment of cystic acne (CA) and is related to marked teratogenicity. AIM: The aim of the study was to evaluate the relationship between total antioxidant status (TAS) and a serum marker of DNA oxidative damage, 8-hydroxy-2-desoxyguanosine (8-OHdG), in patients on Iso treatment. PATIENTS AND METHODS: Patients with CA (n=18) were evaluated before and 45 days after Iso (0.5 mg/kg per day) treatment and non-diseased controls (n=22) were tested only once. Plasma TAS levels and 8-OHdG were measured spectrophotometrically and with an immunoassay, respectively. Liver biochemical parameters and muscle enzymes were measured on a blood chemistry analyzer. RESULTS: TAS levels were significantly (p<0.0001) lower in patients before treatment (921+/-124 micromol/L) compared with those after treatment (1335+/-93 micromol/L) and in controls (1536+/-126 micromol/L). In contrast, 8-OHdG serum levels were two-fold higher in patients after treatment (0.21+/-0.03 ng/mL) than before treatment (0.11+/-0.02 ng/mL) and three-fold higher than in controls (0.07+/-0.01 ng/mL; p<0.0001). Negative correlations were found between TAS and 8-OHdG (r=-0.754, p<0.0001) in patients before therapy and positive correlations were found between creatine kinase (CK) and 8-OHdG (r=0.488, p<0.001) and liver enzymes after Iso treatment. CONCLUSIONS: High serum levels of 8-OHdG in patients on Iso therapy may be due to a direct effect of Iso on liver, muscle and skin epidermal cells. Regular evaluation of 8-OHdG in sera of patients, especially of women of reproductive age, on Iso treatment could be a sensitive follow-up biomarker of DNA oxidation.

PMID: 16232082 [PubMed - in process]

J Appl Toxicol. 2005 Nov-Dec;25(6):470-8.

Serum levels of albumin, triglycerides, total protein and glucose in rats are altered after oral treatment with low doses of 13-cis-retinoic acid or all-trans-retinoic acid.

Cisneros FJ, Gough BJ, Patton RE, Ferguson SA.

Division of Neurotoxicology, NCTR/FDA, Jefferson, AR, USA. cisneros@ncat.edu

Currently used to treat severe acne, 13-cis-retinoic acid (13-cis-RA) is under investigation for its anticancer effects as is the isomer, all-trans-retinoic acid (all-trans-RA). Here, the effects of oral 13-cis-RA or all-trans-RA treatment on serum chemistry, leptin and adiponectin levels were evaluated. Adult Sprague-Dawley rats were gavaged once daily for 7 consecutive days with 13-cis-RA (7.5 or 15 mg kg(-1)), all-trans-RA (10 or 15 mg kg(-1)) (n=24/sex/dose), or soy oil (n=16/sex) and blood was sampled 30-480 min after the last gavage. The body weight was unaffected; however, the liver/body weight ratios were increased by both doses of all-trans-RA. Sex differences were noted for levels of cholesterol, creatine, triglycerides, albumin, alanine aminotransferase and total protein. Both doses of all-trans-RA reduced albumin levels to approximately 90% of the control and total protein levels to approximately 93% of the control while substantially elevating triglyceride levels to approximately 66%-99% above the control. Additionally, triglyceride levels of the 15 mg kg(-1) 13-cis RA group were approximately 62% higher than the controls and total protein levels were approximately 5% less. Glucose levels were affected by sex and RA treatment in that males treated with 15 mg kg(-1) of 13-cis-RA or 10 mg kg(-1) all-trans-RA had lower (13%-19%) levels than the same-sex controls; however, females were not similarly affected. Neither 13-cis-RA nor all-trans-RA treatment had significant effects on the levels of blood urea nitrogen, aspartate amino transferase, leptin or adiponectin. On a mg kg(-1) basis, all-trans-RA was more potent than 13-cis-RA. These results replicate previous findings of RA-induced increased triglyceride levels. Additionally, several new findings indicate there may be sex-specific effects of RA treatment. Finally, neither treatment appeared to alter the typical diurnal cycles of these endpoints. Copyright (c) 2005 John Wiley & Sons, Ltd.

PMID: 16092084 [PubMed - in process]

Am J Ther. 2004 Nov-Dec;11(6):507-16.

Polar hysteria: an expression of hypervitaminosis A.

O'Donnell J.

Department of Pharmacology, Rush University Medical Center, Chicago, Illinois, USA. JOdonn1935@aol.com

Isotretinoin (Accutane) is a drug closely related to the chemical structure of Vitamin A. The pharmacology and toxicology of these two retinoids is similar enough to warrant comparison. Accutane is a powerful drug which its manufacturer, Roche, indicates is limited for severe recalcitrant nodular acne. This potency is also reflected in Accutane's well-known ability to produce severe birth defects if taken during pregnancy. Less well-known is the risk of this lipid soluble chemical to affect the Central Nervous System. Reports of intracranial hypertension, depression, and suicidal ideation with Accutane use have prompted an examination of this serious and life threatening potential. Though Roche has added a warning to its product label for signs of depression and suicidal ideation, this product is being overprescribed for all forms of acne, including mild cases and moderate acne that have not been treated with alternative medications, which have a lesser risk of depression and suicide. There is no contesting that this drug is effective at clearing up the most severe forms of acne, but the public must be informed of its proper, limited indication for use; depression and suicide can follow in patients with no prior history of psychiatric symptoms or suicide attempts.

Publication Types:
* Historical Article
* Review

PMID: 15543093 [PubMed - indexed for MEDLINE]

Dermatol Ther. 2003;16(2):106-13.

From medical herbalism to phytotherapy in dermatology: back to the future.

Dattner AM.

Integrative Medicine and Dermatology, New Rochelle, New York 10805, USA. drdattner@yahoo.com

Plant-based therapeutic preparations are cyclically returning to complement dermatologic therapy. They serve as therapeutic alternatives, safer choices, or in some cases, as the only effective treatment. Folk medicine tradition provides different indicators for use than the medical disease model. Advantages of multiple synergistic components of crude extracts are discussed, as well as herbs already used in dermatology. Bitter digestive stimulants are used for vitiligo. Bioflavinoids from buckwheat and horse chestnut are used for varicose veins, and silymarin is used for liver protection. Gotu kola and sarsaparilla are used for inflammatory skin conditions. Oregon grape root has synergistic antibacterial, anti-inflammatory, and bile-stimulating properties which make the crude extract useful in acne. Philosophical differences in herbology compared to medicine exist in the application of science toward improving elimination and strengthening the host as opposed to destroying the vector or manifestation of the disease.

Publication Types:
* Review

PMID: 12919112 [PubMed - indexed for MEDLINE]

J Antimicrob Chemother. 2003 Feb;51(2):241-6.

Herbal medicines for treatment of bacterial infections: a review of controlled clinical trials.

Martin KW, Ernst E.

Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, UK. karen.martin@pms.ac.uk

OBJECTIVES: Many hundreds of plant extracts have been tested for in vitro antibacterial activity. This review is a critical evaluation of controlled clinical trials of herbal medicines with antibacterial activity. METHODS: Four electronic databases were searched for controlled clinical trials of antibacterial herbal medicines. Data were extracted and validated in a standardized fashion, according to predefined criteria, by two independent reviewers. RESULTS: Seven clinical trials met our inclusion criteria. Four of these studies were randomized. Three trials of garlic and cinnamon treatments for Helicobacter pylori infections reported no significant effect. Bacterial infections of skin were treated in four trials. Positive results were reported for an ointment containing tea leaf extract in impetigo contagiosa infections. Two trials of tea tree oil preparations used for acne and methicillin-resistant Staphylococcus aureus, and one trial of Ocimum gratissimum oil for acne, reported results equivalent to conventional treatments. CONCLUSIONS: Few controlled clinical trials have been published and most are methodologically weak. The clinical efficacy of none of the herbal medicines has so far been demonstrated beyond doubt. This area seems to merit further study through rigorous clinical trials.

Publication Types:
* Review

PMID: 12562687 [PubMed - indexed for MEDLINE]

Clin Ther. 2002 Jul;24(7):1117-33.

A randomized, double-blind comparison of a clindamycin phosphate/benzoyl peroxide gel formulation and a matching clindamycin gel with respect to microbiologic activity and clinical efficacy in the topical treatment of acne vulgaris.

Cunliffe WJ, Holland KT, Bojar R, Levy SF.

Department of Dermatology, The General Infirmary, Leeds, United Kingdom.

BACKGROUND: One approach to suppressing the overgrowth of antibiotic-resistant bacteria is to develop combination products composed of active constituents with complementary but distinct mechanisms of antibacterial action. OBJECTIVE: The purpose of this study was to compare the antimicrobial and clinical efficacy and tolerability of clindamycin phosphate 1%/benzoyl peroxide 5% gel formulation with matching clindamycin 1% gel in the treatment of acne vulgaris. METHODS: This 16-week, single-center, double-blind, randomized, parallel-group study compared the combination gel with clindamycin monotherapy applied BID in patients 13 to 30 years of age with mild to moderate acne and facial Propionibacterium acnes counts > or = 10(4) colony-forming units per square centimeter of skin. RESULTS: Seventy-nine patients were enrolled and randomly assigned to receive the combination gel (n = 40) or clindamycin monotherapy (n = 39). Seventy patients (50 males, 20 females; mean age, 18.2 years) were included in the intent-to-treat group. The combination gel treatment produced significantly greater reductions (P < or = 0.046) from baseline in total lesion counts and in numbers of inflammatory lesions and comedones compared with clindamycin monotherapy. Greater reductions in the severity of acne also were observed in the physician's and patient's Clinical Global Improvement scale scores and in other secondary efficacy measurements. Reductions in clindamycin-resistant P acnes counts were observed relative to baseline in the combination gel group; in contrast, P acnes counts increased by >1,600% in the clindamycin monotherapy group at week 16 (P = 0.018 vs combination gel). Reductions in inflammatory (r2 = 0.31; P = 0.016) and total (r2 = 0.28; P = 0.027) lesions were correlated with decreases in clindamycin-resistant bacteria. Also, significant correlations were observed between the percent change from baseline in total lesion counts (r2 = 0.44; P < 0.001) and comedo counts (r2 = 0.50; P < 0.001) and the log10 change from baseline in total P acnes counts. CONCLUSIONS: The total P acnes count (P = 0.002) and the clindamycin-resistant P acnes count (P = 0.018) were significantly reduced after 16 weeks of treatment with combination gel compared with clindamycin monotherapy. These reductions in total P acnes and clindamycin-resistant P acnes counts correlated with reductions in total acne lesions.

Publication Types:
* Clinical Trial
* Randomized Controlled Trial

PMID: 12182256 [PubMed - indexed for MEDLINE]

J Dermatolog Treat. 2005 Dec;16(5):287-94.

A randomized double-blind study to assess the effects of silicic acid compared to placebo in patients with mild to moderate acne.

Fernandez C, Adamson K, Dale M, Cunliffe WJ.

Clinical Trials Unit, Leeds Foundation for Dermatological Research, Department of Dermatology, General Infirmary at Leeds, Leeds, UK.

Objective: To establish the efficacy and safety of silicic acid in comparison to placebo in patients with mild to moderate acne vulgaris. Patients and methods: Forty adult patients with facial acne vulgaris were randomized to silicic acid or placebo applied twice daily for 8 weeks. Efficacy was assessed by number of acne lesions, acne grade and sebum excretion rate (SER). Clinical safety and tolerance were also assessed and global assessments and psychological profile questionnaires were completed. Results: There were no significant differences between silicic acid and placebo in the number of inflamed lesions (the primary efficacy variable). In contrast, silicic acid significantly reduced the number of non-inflamed lesions, total acne lesions and the acne grade after 8 weeks and SER over 4 weeks when compared with placebo. There were no significant differences between silicic acid and placebo in the responses to the questionnaires or the global assessments after 8 weeks. Silicic acid was well tolerated with few adverse events. Conclusions: Silicic acid may have a positive treatment effect on the non-inflammatory component of mild to moderate facial acne. These preliminary findings now need to be confirmed by similar studies.

PMID: 16428147 [PubMed - in process]

Indian J Dermatol Venereol Leprol. 2005 Mar-Apr;71(2):87-90.

Tolerance and safety of superficial chemical peeling with salicylic acid in various facial dermatoses.

Bari AU, Iqbal Z, Rahman SB.

Department of Dermatology, Military Hospital, Rawalpindi, Pakistan. albariul@yahoo.com.

BACKGROUND: Chemical peeling is a skin-wounding procedure that may have some potentially undesirable side-effects. AIMS: The present study is directed towards safety concerns associated with superficial chemical peeling with salicylic acid in various facial dermatoses. METHODS: The study was a non-comparative and a prospective one. Two hundred and sixty-eight patients of either sex, aged between 10 to 60 years, undergoing superficial chemical peeling for various facial dermatoses (melasma, acne vulgaris, freckles, post-inflammatory scars/pigmentation, actinic keratoses, plane facial warts, etc.) were included in the study. Eight weekly peeling sessions were carried out in each patient. Tolerance to the procedure and any undesirable effects noted during these sessions were recorded. RESULTS: Almost all the patients tolerated the procedure well. Mild discomfort, burning, irritation and erythema were quite common but the incidence of major side-effects was very low and these too, were easily manageable. There was no significant difference in the incidence of side-effects between facial dermatoses (melasma, acne and other pigmentary disorders). CONCLUSION: Chemical peeling with salicylic acid is a well tolerated and safe treatment modality in many superficial facial dermatoses.

PMID: 16394379 [PubMed - in process]

J Dtsch Dermatol Ges. 2004 Oct;2(10):841-7. 

[Azelaic acid 15% gel in the treatment of acne vulgaris. Combined results of two double-blind clinical comparative studies]

[Article in German]

Gollnick HP, Graupe K, Zaumseil RP.

Univ.-Hautklinik Magdeburg. harald.gollnick@medizin.uni-magdeburg.de

BACKGROUND: Topical measures are still the mainstay in the therapy of mild-to-moderate acne vulgaris. Azelaic acid 20% in a cream formulation has been established as an efficacious and safe topical drug for 15 years. A new non-alcoholic hydrogel formulation containing 15% azelaic acid was clinically tested against two standard drugs--5% benzoyl peroxide (BPO) and 1% clindamycin. PATIENTS AND METHODS: In two independent, randomized, blinded comparative trials 15% azelaic acid gel was clinically tested against 5% benzoyl peroxide (BPO) gel in 351 patients and against 1% clindamycin gel in 229 patients. The drugs were applied b.i.d. for 4 months. RESULTS: Azelaic acid 15% gel proved to be as effective as BPO and clindamycin with median % reduction of the inflamed lesion (papules and pustules) of 70%, and 71% respectively. The azelaic acid gel was well-tolerated, the side effects (local burning and irritation) were distinctly less than with BPO but more pronounced than with clindamycin. Despite these side effects, the treatment was well-accepted by the majority of patients. CONCLUSIONS: Azelaic acid gel is an effective topical monotherapy for mild-to-moderate acne vulgaris; its new gel form is an enrichment of acne therapy.

Publication Types:
* Randomized Controlled Trial

PMID: 16281587 [PubMed - indexed for MEDLINE]

Arch Dermatol. 1981 Sep;117(9):551-3.

Topical erythromycin vs blank vehicle in a multiclinic acne study.

Jones EL, Crumley AF.

A stable solution of erythromycin was developed using a vehicle of ethanol, propylene glycol, and citric acid buffer. In a controlled, randomized, double-blind comparison, a 2% solution of erythromycin applied to moderately severe facial acne was found to be superior to the blank vehicle in reducing the number of inflamed papules. During a period of 12 weeks, such papules were reduced by 56% in the erythromycin group, compared with 33% in the blank vehicle group. In the erythromycin group, 62% of the subjects had a good or excellent response, compared with 27% of those in the blank vehicle group. Adverse effects were similar in type in both groups and included redness, scaling, dryness, oiliness, burning, itching, and irritation of the eyes. No allergic reactions or skin infections were encountered.

Publication Types:
* Clinical Trial
* Randomized Controlled Trial

PMID: 6457568 [PubMed - indexed for MEDLIN

Skin Pharmacol Appl Skin Physiol. 2003 Mar-Apr;16(2):84-90.

Anti-acne effects of Oriental herb extracts: a novel screening method to select anti-acne agents.

Nam C, Kim S, Sim Y, Chang I.

Skin Reserach Institute, Pacific R&D Center, Yongin, Korea. cjnam@pacific.co.kr

The acne-therapeutic effects of Oriental herb extracts were investigated in terms of antichemotactic effect on polymorphonuclear leucocytes, antilipogenic actions, antibacterial activity against Propionibacterium acnes and resistance induction potency in the bacteria. The ethanol extract (0.01%) of Angelica dahurica markedly suppressed neutrophil chemotaxis, comparable to the effect of erythromycin (0.01%), whereas a strong antilipogenic effect was obtained with rhizoma coptidis (Coptis chinensis) extract (0.01%), leading to a higher efficacy than that of retinoic acid (0.01%). Interestingly, only Glycyrrhiza glabra showed a remarkable antibacterial activity against P. acnes, resulting in negligible induction of resistance, in comparison with a marked development of resistance in the bacteria treated with erythromycin. We suggest that an appropriate formulation containing A. dahurica, rhizoma coptidis and G. glabra could be helpful for the prevention and treatment of acne lesions. Copyright 2003 S. Karger AG, Basel

PMID: 12637783 [PubMed - indexed for MEDLINE]

J Int Med Res. 1997 Sep-Oct;25(5):255-65.

Effect of keigai-rengyo-to, a Japanese kampo medicine, on neutrophil functions: a possible mechanism of action of keigai-rengyo-to in acne.

Akamatsu H, Asada Y, Horio T.

Department of Dermatology, Kansai Medical University, Osaka, Japan.

On the basis of recent reports that keigai-rengyo-to (TJ-50), an oral Japanese Kampo (herb) medicine, is clinically effective in treating acne, and that tetracyclines are effective against acne by acting directly as an antioxidant on infiltrated neutrophils, we investigated the effect of TJ-50 on the generation of reactive oxygen species (ROS), using human neutrophils and a cell-free, xanthine-xanthine oxidase system. The species investigated were superoxide radical anion (O2-), hydrogen peroxide (H2O2), and hydroxyl radical (OH.). In addition, neutrophil chemotaxis, phagocytosis and calcium concentration, [Ca2+]i in neutrophils were also assessed. TJ-50 significantly decreased neutrophil-generated O2-, H2O2 and OH. in a dose-dependent manner. Three kinds of ROS generated in the cell-free system were also reduced in the presence of TJ-50. On the other hand, the medicine did not markedly affect neutrophil chemotaxis, phagocytosis or [Ca2+]i in neutrophils. Our results indicate that the clinical effectiveness of TJ-50 in the treatment of acne may be due partly to its antioxidant action on infiltrated neutrophils.

PMID: 9364288 [PubMed - indexed for MEDLINE]

http://www.tsumura.co.jp/english/kampo/today/04/4-2-02.htm

Professor Morohashi and his colleagues at Toyama Medical and Pharmaceutical University were recognized at this year's Congress for their accomplishments in scientifically evaluating the effectiveness of Kampo formulations for various types of dermatological problems using current medical and pharmacological methodologies. Specifically, they treated patients suffering from common acne vulgaris, atopic dermatitis, and common psoriasis vulgaris with Kampo formulations, carrying out both clinical evaluation and basic research at the same time.

In regard to acne vulgaris, by measuring the anti-bacterial action of ten Kampo formulations and 21 varieties of their constituent herbs against P. acnes in terms of minimum inhibitory concentration (MIC) and then using an electron microscope to inspect minute changes in the skin's structure, Professor Morohashi's team was able to confirm that two formulations long cited for treatment of acne vulgaris in clinical reports; namely, Seijo-bofu-to and Keigai-rengyo-to; showed the lowest MIC value. Moreover, the team was able to make clear that among the constituent herbs of the two formulations, Coptis Rhizome (MIC value: 1.5 - 6.1 µg/ml) and Phellodendron Bark (MIC value: 6.1 - 24 µg/ml); two herbs containing berberine, a compound with strong anti-bacterial action; were equal to or almost as potent in terms of MIC as tetracycline (value: 1.5µg/ml).

In addition, using organ hamster culture skin to examine anti-lipid formation activity in sebaceous glands, it was confirmed that among the herbs used in Kampo formulations, Scutellaria Root, Coptis Rhizome, Phellodendron Bark and Forsythia Fruit have strong anti-lipid formation action. These same herbs are the principal ingredients of the aforementioned formulas, Seijo-bofu-to and Keigai-rengyo-to. Thus Professor Morohashi and his colleagues were able to establish a pharmacological basis for the clinical effectiveness of formulations used to treat acne vulgaris.

The Department of Japanese Oriental (i.e., Kampo) Medicine at Toyama Medical and Pharmaceutical University was designated a Collaborating Center for Traditional Medicine by the World Health Organization in 1988. The work recognized by the prize from the Medical Pharmaceutical Society for WAKAN-YAKU exemplifies the on-going research the Department carries out in cooperation with specialized researchers in various fields.

COPT6 $14 at Emerson Ecologics.com

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Coptis Rhizome 1.5 g
Phellodendron Bark 1.5 g
Scutellaria Root 3.0 g
Gardenia Fruit 2.0 g

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