INTRODUCTION:

The medicinal plants find its use in pharmaceutical, cosmetic, agricultural and food industry. Medicinal herbs used for curing disease have been documented in history of all civilizations. Early humans were probably not aware about the health hazards associated with irrational therapy. With the onset of research in medicine, it was established that plants contain active principles responsible, for curative action of ailments.

There are more than 40 million people who struggle with acne and most of these people treat acne using chemicals such as antibiotics, prescription drugs, benzoyl peroxide and salicylic acid. Generally, herbal medicines have fewer side effects and are not as dangerous as some prescription drugs. This lack of regulation results in many acne products on the market. All it takes to cure, prevent or even cure acne with few, if any, side effects. The truth is there are very few treatments for acne based on plants that are scientifically proven. Chemical treatments are most effective in stopping acne. Only two treatments based on plants that have been clinically proven to help prevent acne, tea tree oil (tea) and green tea cream.

The tea tree oil is natural oil from the Melaleuca alternifolia, a particular type of tea tree found exclusively in Australia. Although it has been used for hundreds of years by indigenous people as a native of treatment for all, it has recently been accepted by modern medicine as a viable anti-bacterial agent¹.

Acne

Acne is a general term used for eruptive disease of the skin. It is sometimes used as a synonym for Acne vulgaris. It is a common human skin disease, characterized by areas of skin with seborrhea (scaly red skin), comedones (blackheads and whiteheads), papules (pinheads), pustules (pimples), nodules (large papules) and possibly scarring². Acne affects mostly skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back. Severe acne is inflammatory, but acne can also manifest in non inflammatory forms³. The lesions are caused by changes in pilosebaceous units, skin structures consisting of a hair follicle and its associated sebaceous gland, changes that require androgen stimulation. Acne occurs most commonly during adolescence, and often continues into adulthood. In adolescence, acne is usually caused by an increase in male sex hormones, which people of both genders accrue during puberty⁴. For most people, acne diminishes over time and tends to disappear — or at the very least decrease — after one reaches one's early twenties. There is, however, no way to predict how long it will take to disappear entirely, and some individuals will carry this condition well into their thirties, forties, and beyond⁵.Some of the large nodules were previously called "cysts" and the term nodulocystic has been used to describe severe cases of inflammatory acne⁶. The "cysts," or boils that accompany cystic acne, can appear on the buttocks, groin, and armpit area, and anywhere else where sweat collects in hair follicles and perspiration ducts. Cystic acne affects deeper skin tissue than common acne.

The several different types of acne are:

· Acne conglobata

· Acne miliaris necrotica

· Tropical acne

· Infantile acne/Neonatal acne

· Excoriated acne

· Acne fulminans

· Drug-induced acne/Acne medicamentosa (Steroid acne)

· Halogen acne

· Chloracne

· Oil acne

· Tar acne

· Acne cosmetic

· Occupational acne

· Acne aestivalis

· Acne keloidalis nuchae

· Acne mechanica,

· Acne with facial edema

· Pomade acne

· Acne necrotica

· Blackhead

· Lupus miliaris disseminatus faciei.

CAUSES OF ACNE:

There are four major factors responsible for causing acne and they act together to cause the characteristic pimples, whiteheads and blackheads associated with acne.

The four factors include:

· Overactive oil glands

· Blockage of the skin pores

· Activity of normal skin bacteria

· Inflammation

Overactive Oil Glands

Oil glands or sebaceous glands are located deep in the skin. The glands produce oil (also known as sebum) that flows to the surface of the skin through these canals to lubricate the hair follicles and the surrounding skin. These glands vary in size, and the larger ones are associated with visible skin pores. The oil glands are stimulated to produce oil by hormones, specifically the male hormones called androgens (women also have these hormones, but in less amount). These hormones are produced by the testes in men and by the ovaries in women. In both sexes, androgens are also produced by the adrenal glands. During times of stress, the adrenal glands produce increased levels of these hormones, causing even greater enlargement of the oil glands. During puberty, the oil glands become overactive in response to hormonal changes.

Blockage of the Skin Pores

Oily skin occurs when an overactive oil gland enlarges and overproduces oil. Acne develops when some of the pores (through which oil normally flows from the oil gland to reach the skin surface) become blocked, resulting in trapping of oil within the skin pores.The pores are blocked by skin cells that have been shed from the lining of the skin pore and have bunched together. The cause for this clogging is not known, but it is not due to poor hygiene. A blackhead or whitehead will develop from this skin pore blockage

Activity of Normal Skin Bacteria

Although acne is not caused by a bacterial infection, bacteria do play a role in making the situation worse. The bacterium Propionibacterium acnes (P. acnes), is a normal part of the skin surface. It keeps the skin from being invaded by harmful bacteria. When oil is trapped in the hair follicles, the normal skin bacteria P. acnes will grow in the blocked pore. The bacteria produce chemicals that alter the composition of the oil, which makes it more irritating to the skin and causes inflammation.

Inflammation

Inflamed skin is characterized by redness, swelling, warmth and discomfort. Inflammation of the skin occurs because the body's immune system is acting to rid itself of a foreign substance. In the case of acne, this substance is either bacteria or the irritating compounds they have produced. These four factors contribute to blocked skin pores, which bulge outward to form:

· Blackheads. These form when the pores are clogged close to the surface of the skin. Because they are exposed to the skin surface, blackheads don't usually become inflamed. Blackheads are dark due to the presence of a dark pigment. This color is not the result of dirt in the pores.

· Whiteheads. These develop from a blockage deeper in a pore. Lacking a drainage path, the oil accumulates in the skin, causing small flesh-colored or white-colored bumps. Unlike blackheads, whiteheads are more likely to lead to the red inflammations known as pimples or zits.

· Pustules (also known as pimples or zits) occur when the walls of the blocked follicle ruptures. Oil, dead skin cells, and bacteria normally found on the skin surface get into the skin and irritate it, forming small areas of inflammation.

· Cysts are larger, red, inflamed areas deep in the skin that indicate a more extensive infection¹.

Development of acne

Acne develops as a result of blockages in follicles. Hyperkeratinization and formation of a plug of keratin and sebum (a microcomedo) is the earliest change. Enlargement of sebaceous glands and an increase in sebum production occur with increased androgen (DHEA-S) production at adrenarche. The microcomedo may enlarge to form an open comedone (blackhead) or closed comedone (milia). Comedones are the direct result of sebaceous glands' becoming clogged with sebum, a naturally occurring oil, and dead skin cells. In these conditions, the naturally occurring largely commensal bacterium Propionibacterium acnes can cause inflammation, leading to inflammatory lesions (papules, infected pustules or nodules) in the dermis around the microcomedo or comedone, which results in redness and may result in scarring or hyperpigmentation⁷.

Micro organisms

Propionibacterium acnes (P. acnes) and Staphylococcus epidermidis (S. epidermidis) are two of the major bacterial strains found in acne lesions and among these only P. acnes is implicated in acne inflammation⁸.

Hormonal

Hormonal activity, such as menstrual cycles and puberty, may contribute to the formation of acne. During puberty, an increase in male sex hormones called androgens cause the follicular glands to grow larger and make more sebum⁹. Several hormones have been linked to acne: the androgens testosterone, dihydrotestosterone (DHT)and dehydroepiandrosterone sulfate (DHEAS), as well as insulin-like growth factor 1 (IGF-I). True acne vulgaris in adult women may be a feature of an underlying condition such as pregnancy and disorders such as polycystic ovary syndrome or the rare Cushing's syndrome. Menopause-associated acne occurs as production of the natural anti-acne ovarian hormoneestradiol fails at menopause.

Genetic

The tendency to develop acne runs in families. A family history of acne is associated with an earlier occurrence of acne and an increased number of retentional acne lesions¹⁰.

Psychological

While the connection between acne and stress has been debated, scientific research indicates that increased acne severity is significantly associated with increased stress levels¹¹. The National Institutes of Health (USA) list stress as a factor that can cause an acne flare¹². A study of adolescents in Singapore observed a statistically significant positive correlation between stress levels and severity of acne¹³.

Diet

A high glycemic load diet and cow's milk have been associated with worsening acne. Other associations such as chocolate and salt are not supported by the evidence¹⁴.

Dirt

As mentioned above, "blackheads" are oxidized oil, not dirt. Sweat does not cause acne, therefore, it is not necessary to shower instantly after exercise for fear that sweat will clog pores. On the other hand, excessive washing can dry and irritate the skin.

Cosmetics

Most cosmetic and skin-care products are not pore-clogging ("comedogenic"). Of the many available brands, those which are listed as "water-based" or "oil-free" are generally a better choice.

Plants used as anti acne agents

Some herbs that purify the bloodstream of toxins, by improving liver function, are used to treat acne as well. Some of the major herbs for acne have been listed below.

Burdock (Arctium lappa) has been traditionally used to treat a lot of ailments, more so as a blood purifier to clear the toxins from the blood stream and a diuretic, helping the body to get rid of excess water by increasing urine output. The herb has also been used as a tropical remedy for treating skin problems such as eczema, acne, and psoriasis.

Yellow Dock is botanically known as Rumex crispus. Traditionally, the plant has been used for preventing skin problems from erupting. The powder made from the yellow roots of the herb has also been used to wash face, in order to get rid of acne.

Dandelion (Taraxacum officinale)roots and leaves have been traditionally used by Native Americans for the treatment of not just skin problems, but also conditions like kidney disease, swelling, heartburn, and upset stomach. The herb is known to be very effective against acne and other skin problems as well.

Red Clover is botanically known as Trifolium pretense. In present times, ointments made from this herb are used to treat skin problems such as acne, psoriasis and eczema. Red clover also contains minerals such as calcium, magnesium, chromium, potassium, and vitamins such as niacin, thiamine and vitamin C, which are known to promote a healthy skin.

Sarsaparilla(Hemidesmus indicus): Many shamans and herbal practitioners use the roots of the Sarsaparilla plant for treating leprosy and other skin problems, such as psoriasis and dermatitis. It has also been used to treat acnes and pimples.

Plants used tropically

There are also many natural acne treatments that have been used to prevent acne or to reduce acne outbreaks. Some of these natural acne treatments are

Grape is found to be an excellent allergenic, antibacterial, anti-edemic, anti-inflammatory, antioxidant, antiseptic, anti-acne, anti-fungicide and antiviral.

Celery is good for allergenic, analgesic, antibacterial, antihistaminic, anti-inflammatory, antiseptic, antiviral, anti-acne, fungicide , sedative, anesthetic and anti-allergic.

Basil is used for allergenic reactions, analgesia, anesthetic, antibacterial, antihistaminic, anti-inflammatory, antioxidant, antiseptic, antiviral, anti-acne, fungicide and sedative.

Rosemary is found to be good for allergenic, analgesic, antibacterial, anesthetic, antiedemic, anti-inflammatory, antioxidant, antiseptic, antiviral, anti-acne, fungicide and sedative.

Dill: Excellent: allergenic, analgesic, anti-inflammatory, antioxidant, antiseptic, and antiviral. Good: anti-edemic, anti-acne, fungicide and antihistaminic.

Yarrow is used in allergenic conditions, analgesia, antibacterial, anti-inflammatory, antioxidant, antiseptic, antiviral, anti-acne, fungicide and sedative.

Licorice is used in inflammation, antiseptic, anti-acne, fungicide and antiviral.

Ginger is used as antibacterial, anti-histaminic, anti-inflammatory, antioxidant, antiseptic, antiviral, anti-acne, fungicide and essential amino acids.

Thyme is an antiseptic, antiviral, anti-acne, fungicide, sedative; a good anesthetic, anti-allergic, anti-edemic, and anti-histaminic agent.

Juniper is a good analgesic, anti-acne, fungicide and anti-edemic.

Oregano is an antiseptic, antiviral, sedative, anesthetic, allergenic, anti-edemic, anti-acne, fungicide and anti-histaminic.

Sage is good for anti-acne, fungicide, allergenic, anti-edemic, and anti-histaminic.

Ginkgo is an antibacterial, anti-inflammatory, antioxidant, antiseptic, and fungicide. Good: analgesic, anti-allergic, anti-acne, and sedative.

Black Pepper is found to be antibacterial, antiseptic, antiviral, fungicide, anesthetic and anti-acne.

Grapefruit is an antibacterial, anti-inflammatory, antioxidant, antiseptic, antiviral, fungicide, anti-acne and antihistaminic.

Ginseng is antioxidant, analgesic, anti-acne, anti-allergic, anti-edemic, anti-histaminic, antiviral and fungicide.

Orange: is used as anti-acne, antibacterial, anti-inflammatory, antioxidant, antiseptic, antiviral, and fungicide.

Some easy home treatments include

· Washing skin with tea tree oil prevent infections.

· Intake of Vitamin A helps in the healing process.

· Omega-3 fatty acids have antibacterial and anti-inflammatory effects.

· Rub fresh garlic on or around pimples.

· Groundnut oil/lime juice prevents the formation of pimples.

· Rub papaya on pimples to reduce swelling.

· Apply ripe tomato pulp to acne, leave 1 hour and rinse¹⁵.

Ayurveda

Acne vulgaris is called as Yauvan pidika in Ayurveda and is known to be an internal constitutional disorder of the body. It is not an infectious and hence this problem is not caused due to microorganisms. The cause lies with the general constitution of the person. According to Ayurveda, the main cause of yauvan pidika is an increased vata and kapha dosha in the person. An increase in the rakta and medha dhatu also can cause yauvan pidika. This system of medicine believes that yauvan pidika is a disease that is caused due to improper diet and other internal factors. Ayurvedic treatment essentially depends on plants to cure the outbreaks of acne. A combination of the natural products listed below will provide relief from acne and all its associated problems.

Few plants used in Ayurveda are

· Haritaki (Terminalia chebula)

· Amalaki (Embelica officinalis)

· Lajjalu (Mimosa pudica)

· Gokshura (Tribulus terrestris L)

· Guduchi (Tinospora cordifolia)

· Kumari (Aloe vera)

^·Ikshu (Saccharum officinarum)^16,17

Homeopathy Treatments for Acne:

§ In case of itchy acne Kali bromatum 6X three times daily until an improvement is achieved.

§ People who sweat profusely, and have rough, hard skin, and frequently suffer from constipation, take 6X Sulfur 3 times daily.

§ Those who have pus filled pimples, take a 6X dose of Antimonium tartaricum, 3 times daily until an improvement is seen.

Plants used in Siddha

Curcuma longa (Turmeric): Turmeric is potent in skin care, treating the effects of skin inflammations, acne and insect bites, as well as improving skin tone.

Ocimum basilicum (basil) extract: Medicinally, basil has been used in various topical applications throughout the centuries: as a salve for acne, insect bites, as a gargle or mouthwash, or as a bathing herb. When added to massage oils, basil has been used to soothe sore muscles while the dried herb is burned as antiseptic incense. Basil essential oils have also demonstrated antimicrobial properties effective in dealing with acne. Studies indicate basil may produce the same healing effects as synthetic cosmetic preparations, without the side effects of drying or peeling. When applied topically, basil essential oil has shown the ability to enhance the luster of dull looking hair or skin tone.

Other approaches for acne are: Aromatherapy. acupressure, juice therapy, reflexology and yoga.

Scientifically proved anti acne plants¹⁸:

· Andrographis paniculata Nees. (Acanthaceae)

· Azadirachta indica A.Juss. (Meliaceae)

· Barleria lupulina Lindl. (Acanthaceae)

· Carthamus tinctorus L. (Astaraceae)

· Centella asiatica (L.) Urban (Mackinlayaceae)

· Clinacanthus nutas (Burm. F.) Lindau. (Acanathaceae)

· Cymbopogon citrates (DC) stapf. (Gramineae)

· Eupatorium odoratum L. (Asteraceae)

· Garcenia mangostana L. (Clusiaceae)

· Hibiscus sabdariffa L. (Malvaceae)

· Houttuyina cordata thumb (Sarauarceae)

· Lawsonia inermis L. (Lythraceae)

· Lycopersicum esculentum L. (solanaceae)

· Murdannia loriformis Hassk (Commelinaceae)

· Psidium guajava L. (Myrtaceae)

· Senna alata (L) Roxb. (Fabaceae)

· Senna occidentalis L. (Fabaceae)

· Senna siamea (Lam) Irwin (Fabaceae)

· Tagetes erecta L. (Compositeae)

· Alpinia galangal (L.) willd (Zingiberaceae)

· Boesenbergia pandurata (Roxb.) Holtt. (Zingeberaceae)

· Cinnamomum verum J. Presl. (Lauraceae)

· Dioscorea membranacea Pierre. (Dioscoreaceae)

· Morus alba L. (Moraceae)

· Ocimum americanum L. (Lamiaceae)

· Ocimum sanctum L. (Lamiaceae)

· Piper bitle L. (Piperaceae)

· Plumbago zeylanica L. (plumabaginaceae)

· Punica granatum L. (Lythraceae)

· Rhinacanthus nasutus L. (Acanthaceae)

· Syzygium aromaticum (L.) Merrill andperry (Myrtaceae)

· Senna alata (L.) Roxb. (Fabaceae)

· Zingiber officinalis Roscoe. (Zingiberaceae) .

· Allium sativum L. (Alliaceae)

· Aracangelisia flava (L.) Merr. (Menispermaceae)

· Cassia fistula L. (Fabaceae)

· Eugenia cumini (L.) Druce . (Myrtaceae)

· Gynura pseudochina (L.) DC. (compositae)

· Impatients balsamina L. (Balsaminaceae)

· Mimusops elengi L. (Sapotaceae)

· Morinda citrifolia L. (Rubaceae)

· Muntingia calabura L. (muntingiaceae)

· Nelumbo nucifera Gaertn. (Nelumbonaceae)

· Phyllanthus emblica L. (phyllanthaceae)

· Plumbago indica L. (plumbaginaceae)

· Psidium guajava L. (Myrtaceae)

· Purica granatum L. (Lythraceae)

· Quercus infectoria Oliv. (Fagaceae)

· Rhinacanthus nasutus L. (Acanthaceae)

· Uncaria gambia Roxb. (Rubaceae).

ACKNOWLEDGEMENT:

The authors are highly grateful to Management of Nalanda College of Pharmacy for providing all the facilities in the library in carrying out this review article.

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Received on 07.03.2011 Accepted on 10.05.2011

Res. J. Topical and Cosmetic Sci. 2(2): July – Dec. 2011 page 40-44