Efficacy and safety of polyherbal formulation in the management of acne vulgaris: An open label, baseline-controlled, single center, prospective clinical trial

This article provides guidance on the management of acne vulgaris (AV) and hidradenitis suppurativa (HS) in youth with skin of color (SOC) and youth who are transgender and gender diverse (TGD). Both diseases are associated with delayed diagnosis, treatment disparities, and heightened psychosocial burdens in underrepresented groups. For children with SOC and AV, it is crucial to minimize the risk of postinflammatory hyperpigmentation, with recommendations for starting lower concentrations of retinoids and cautious selection of oral therapies. In children who are TGD, masculinizing hormone therapy for transmasculine individuals may exacerbate acne, necessitating careful treatment planning. In HS, early and aggressive therapy is essential to prevent disease progression and scarring. While biologic agents (eg, adalimumab) demonstrate efficacy, they are underutilized in adolescents. Treatment adherence in both AV and HS can be influenced by systemic barriers to care, highlighting the need for culturally sensitive, multi-disciplinary approaches that address both the dermatologic and psychosocial aspects of care. [Pediatr Ann. 2025;54(6):e209-e216.].

Background: Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous follicular unit that often occurs. Acne is a skin disorder that is not life-threatening but is mostly complained of because it is aesthetically disruptive, which can cause significant psychological problems for sufferers. The management of acne vulgaris in female patients has its challenges. There are many histories of failed therapy using conventional therapy, such as with antibiotics or isotretinoin, and female patients have a predisposition to the condition of androgen excess. Also, the increasing awareness about limiting the use of antibiotics to prevent resistance in dermatological cases, including acne vulgaris, encourages other treatment options in the female patient population, one of which is hormone-based therapy. A systematic review and meta-analysis were performed of randomized clinical trials assessing the effects of Hormone Based Therapies (Spironolactone and Combined Oral Contraceptives) in the management of Acne Vulgaris in Women. Methods: Medline Pubmed, Scopus, Cochrane Library, the reference list, conference proceedings, researchers in the field of eligible studies were searched. Ten studies (n=1906 sub-jects) were included in qualitative analysis, of which two studies (n=1842 subjects) were included in the meta-analysis. The age of the participant was greater than 14 years old. Intervention using combined oral contraceptives (n=8) or oral spironolactone (n=2). Duration of intervention (minimum six months for COC and three months for SL) and out-comes of mean difference number of acne vulgaris lesions before and after treatment. Results: Pooling of data using random-effects model found a significant difference in the mean difference in the number of lesions after treatment in the group receiving hormone-based therapy (spironolactone and combined oral contraceptives) and those receiving control therapy (p = 0.005). The overall mean difference was -0.890 ± 0.316. A negative value indicating the number of lesions after hormone-based therapy (spironolactone and combined oral contraceptives) was significantly lower than those receiving control therapy (p = 0.005). Conclusion: From the results of the systematic review and meta-analysis conducted, it can be concluded that in the group given hormone-based therapy (spironolactone and Combined Oral Contraceptives), there was a decrease in the total number of acne vulgaris lesions compared to before treatment, and the mean difference in the number of lesions was significantly lower after getting hormone-based therapy (spironolactone and combined oral contraceptives) compared with controls.

The multiple etiologic factors involved in acne make the use of various medications necessary to treat the condition. This study aimed to determine the efficacy of mupirocin and rifampin used with standard treatment in the management of acne vulgaris. In a multicentre, randomized controlled, triple-blinded study, a total of 105 acne patients, with a clinical diagnosis of moderate to severe acne,were randomizedly divided into three groups (35 per group), for treatment of acne. The first group was treated with standard treatment alone, the second group received mupirocin plus standard treatment and the third group received rifampin plus standard treatment.There were three study visits according to Global Acne Grading System (GAGS): at baseline and weeks 6 and 12. The absolute changes of GAGS score from baseline to week 6 and 12 demonstrated a reduction in the mean score of GAGS in the three treatment groups (p < 0.001). Due to the difference between GAGS score at the baseline of study, the data were adjusted using the general linear model. The findings showed that all of the treatments significantly improved acne lesions. Nevertheless, none of the treatments was shown to be more effective than the others (p = 0.9). The three treatments were well tolerated, and no serious adverse events were reported. These findings provide evidence on the efficacy of combining mupirocin and rifampin with standard treatment in the management of acne vulgaris, although none of the treatments had superior efficacy compared with the others.

Background: Acne vulgaris is one of the most prevalent skin diseases, affecting up to 85% of teenagers and young adults. Multiple treatment options including topical, systemic or physical therapies. However, the effects of conventional therapies are limited due to antibi-otic resistance and adverse effects such as irritation and teratogenicity of isotretinoin. Light-based therapy is an alternative and/or adjuvant therapy in patients who cannot tolerate or unresponsive to conventional therapies that may provide fewer side effects, patient com-fort, fast onset of action, and with equal or greater effectiveness. We aimed to assess the effectiveness of using Pulsed Dye Laser as a treatment option for acne vulgaris. A systemat-ic Review and Meta-analysis was peformed of randomized clinical trials assessing the ef-fectiveness of Pulsed Dye Laser in management of acne vulgaris. Methods: Medline Pubmed, Scopus, Cochrane library, the reference list, conference pro-ceedings, researchers in field of eligible studies were searched. Eight studies (n=275 sub-jects) were included in qualitative analysis of which six studies (n=190 subjects) were in-cluded in meta-analysis. The mean age of the participant was 21,94 years old. Intervention using application of Pulsed dye laser as monotherapy or combination in acne vulgaris pa-tients with follow-up at least 12 weeks. and the outcomes is a decrease mean of acne vul-garis lesions counts after received pulsed dye laser therapy. Results: Pooling of data using random effects model showed that the group that received PDL therapy alone or in combination had a lower number of acne lesions than the control group with the mean difference was -0.593 (95% CI = -1.290 to 0.104), the z value was -1.668 with p = 0.095. This shows that the number of lesions in the group that received sin-gle or combined PDL therapy was lower than the control group. However the difference is insignificant. Conclusion. From the results of the systematic review conducted, it can be concluded that in the group given Pulsed Dye Laser therapy there was a decrease in the total number of acne vulgaris lesions compared to before treatment, and the decrease, which was indicated by the difference in the mean number of acne lesions, was significantly greater compared to the control who was only given placebo. Pulsed Dye Laser therapy can be an alternative treatment option for acne vulgaris in patients who are unresponsive to previous treatment or conditions where there are contraindications to systemic therapy.

The telltale signs of acne vulgaris, a chronic inflammatory disorder of the pilosebaceous apparatus, include comedones, inflammatory papules, pustules, cysts, and scars. Acne vulgaris and Yuvana Pidaka are likely connected, in accordance with Ayurvedic theory. It also goes by the name Mukha Dushika. In order to manage Yuvana Pidaka, formula that includes Vaca (Acorus calamus), Lodhra (Symplocos racemosa) and mustard oil is selected. This review’s objective was to investigate the effectiveness of this herbal formula in the management of acne vulgaris. Information regarding acne vulgaris was gleaned from Ayurvedic scriptures, contemporary texts, and earlier research studies. Subsequently, a comprehensive survey of the literature was conducted for these three herbs in the selected paste, which was then scrutinized for their Pancha Padārtha (five elements of the herb) and pharmacological qualities related to the management of Yuvana Pidaka. Ayurvedic Pancha Padārtha analysis has revealed that the selected herbal formula is efficacious in managing Yuvana Pidaka. While the majority of studies have demonstrated the anti-inflammatory, analgesics, antioxidants, anti-microbials, and proliferatives and performs similar specialized activities to Shotha Hara (reduce swelling), Shula Hara (reduce pain), and Kushtaghna (reduce skin disorders) effects of the herbal formula. Based on the literature review and Pancha Padārtha analysis, the selected herbal formula proves to be valuable in the management of acne vulgaris.

An overview on the anti-acne properties of herbal essential oils

Acne vulgaris is the most common skin condition in the US, affecting up to 50 million Americans. The American Academy of Dermatology (AAD) guidelines on acne treatment were developed to provide recommendations for the diagnosis, grading, and treatment of acne in adolescents and adults to support clinicians in their therapeutic decision-making process. The most recent acne guidelines were published in 2016, and the approach to care and the therapeutic landscape of acne have evolved since that time. The Acne Management Consensus Roundtable was convened in 2022 to discuss unmet needs in the management of acne. The main focus of the meeting was the role of androgens in acne pathology; the evaluation of clascoterone, the first topical anti-androgen that specifically addresses sebum production in acne; and the identification of the place of clascoterone in therapy. Clascoterone was approved by the US Food and Drug Administration for the treatment of acne in patients 12 years and older in 2020. This report aims to highlight important limitations of the 2016 AAD treatment guidelines and to familiarize practitioners with clascoterone and its indication, efficacy and safety profile, and potential use across diverse patient populations. With its new mechanism of action, clascoterone may be able to fulfill important unmet needs in acne treatment. Baldwin H, Farberg AS, Frey C, et al. Unmet needs in the management of acne vulgaris: a consensus statement. J Drugs Dermatol. 2023;22(6):582-587. doi:10.36849/JDD.7587.

Acne vulgaris is one of the common chronic inflammatory diseases of the pilosebaceous unit with multiple pathophysiologies affecting adolescents mainly. Aims: To evaluate the efficacy of Shahtra (Fumaria indica) orally along with the topical use of Zimad Muhasain and the management of moderate to severe category of acne vulgaris on the Global Acne Grading System (GAGS) scale. Material &amp; Methods: This was a randomized standard control clinical study. The test group patients were given Shahtra ( 500 mg), 2 capsules twice daily with a local application of Zimad Muhasa paste once daily; the control group patients were given tablet Azithromycin 500 mg thrice weekly with a local application of Benzoyl peroxide 5% gel once daily for 8 weeks. Result: In the test group, there was a 77.3% reduction in the GAGS score at the final follow-up with p&lt;0.0001; in the control group, there was a 69.8% reduction in GAGS score with p&lt;0.0001, showing extremely significant improvement in both groups. The results indicate the superiority of the test group regimen over the control group by at least 7%. Furthermore, adverse effects like burning sensation, dryness, and itching due to Benzoyl peroxide and diarrhoea due to Azithromycin were only reported in the control group whereas the Unani formulations were found to be free of such adverse effects. Conclusion: The test formulations comprising a dried aqueous extract of Shahtra and Zimad Muhasa were found to be more effective and safe in the management of acne vulgaris in moderate to severe acne, compared to the control combination of Azithromycin and Benzoyl peroxide gel.

Prospective, Multicentric Phase II Randomized Trial Comparing the Efficacy of Methotrexate or Cyclophosphamide in Large Granular Lymphocytic Leukemia: A French National Study. Report on the Interim Analysis

In Saudi Arabia, Acne vulgaris is a very predominant ailment and Pharmacists currently have standardized protocols at their disposal for the treatment of acne. Pharmacists often prescribe medications for minor cases of acne. Therefore, this study aimed to explore community pharmacists (CPs)' knowledge, attitudes, and practice toward acne management in Riyadh, Saudi Arabia. An online cross-sectional study was conducted among CPs working in Riyadh, Saudi Arabia from January and April 2021, using a self-administered, questionnaire, was divided into four sections that collected information from the CP's Knowledge, attitudes, and practices and the management of acne vulgaris. The data were analyzed using the Statistical Package for the Social Sciences version 26 (SPSS). A total of 313 CPs were enrolled in the study who successfully returned the questionnaire. The mean score of knowledge on etiology, pathophysiology, and therapy for AV was 5.3 ± (SD = 1.5). However, the majority of CPs had a moderate level of knowledge (80.8%), followed by mild to moderate (12.8%). This study showed that CPs had an insufficient level of knowledge about ace management, about 6% of CPs have a high level of knowledge. Inadequate knowledge was revealed in their management practice, only 0.3% of CPs treated patients with acne on their own without a referral. In addition, CPs showed a positive attitude toward acne management. There is a need to improve CPs' understanding of acne care and to contribute to participating in organized training sessions on the management of AV.

The occurrence of pustules, comedones, nodules, and cysts defines acne vulgaris, a prevalent chronic inflammatory dermatological condition. In the past few decades, essential oils extracted from varied natural sources have acquired recognition due to their potential medicinal applications in acne therapy. However, there is not yet sufficient medical data to fully characterize this interaction. Multiple factors contribute to the development of acne vulgaris, including excessive sebaceous production, inflammatory processes, hyperkeratinization, and infection with Cutibacterium acnes. Essential oils, including oregano, lavender, lemon grass, myrtle, lemon, thyme, eucalyptus, rosemary, and tea tree, have been found to possess anti-inflammatory, antioxidant, and antimicrobial properties, which may target the multifactorial causes of acne. Analytical methods for determining antioxidant potential (i.e., total phenolic content, diphenyl-1-picrylhydrazyl free radical scavenging assay, reducing power assay, ferrous ion chelating activity, thiobarbituric acid reactive species assay, β-carotene bleaching assay, etc.) are essential for the evaluation of these essential oils, and their method optimization is crucial. Further studies could include the development of novel acne treatments incorporating essential oils and an assessment of their efficacy in large clinical trials. In addition, further research is necessary to ascertain the mechanisms of action of essential oils and their optimal doses and safety profiles for optimal implementation in the management of acne vulgaris.

Acne vulgaris is a common, chronic inflammatory skin disease affecting up to 80% of young adults and adolescents. The pathogenesis of acne is multifactorial and involves the pilosebaceous units of the skin. As a result of the disease process, skin lesions such as open and closed comedones, nodules, pustules, and papules appear on the skin. In recent years, acne has been increasingly observed in younger patients, which is associated with the earlier onset of puberty. Moreover, acne is increasingly diagnosed in individuals over 20 years of age, particularly in women, which is referred to as adult female acne (AFA). Effective and rapid implementation of treatment is crucial to prevent complications such as post-inflammatory hyperpigmentation and acne scars, as well as to mitigate the negative psychological impact of the disease on patients. The article discusses both topical treatment and aesthetic medicine procedures in the management of acne vulgaris. Topical treatments include the use of retinoids, antibiotics, benzoyl peroxide, clascoterone, dapsone, azelaic acid, and combination therapies. Aesthetic procedures such as chemical peels, microdermabrasion, photodynamic therapy, blue light therapy, and laser therapies can be beneficial as adjunctive treatments. The article also addresses the issue of acne as a comorbid condition in patients seeking aesthetic medicine treatments, even if it is not the primary reason for their visit.

(1956). The Management of Acne Vulgaris in the 12 to 17 Year Age Group. Postgraduate Medicine: Vol. 19, No. 2, pp. 144-146.

The management of acne in its early stages is important for disease prognosis. Patients with acne usually present at the primary healthcare (PHC) centers during the early stages of their disease. Assessment of the current knowledge and practice of the physicians treating these patients is required. The aim of our study was to assess the knowledge and practice of physicians working at PHC centers in the Qassim region of Saudi Arabia on the management of acne vulgaris. A cross-sectional survey was conducted on 142 physicians working at PHC centers of the Qassim province, Saudi Arabia. Physicians were asked to answer a pretested specially-designed questionnaire on the management of acne vulgaris that comprised questions evaluating the knowledge on disease causes, aggravating or relieving factors, and treatment practices. This survey revealed that physicians working at PHC centers had inadequate knowledge on disease management; 38.7% of doctors had a low level of knowledge, whereas only 11.3% had a high level of knowledge. Participating physicians indicated that the main causes of acne are (a) hormonal factors (58.5%), (b) infections (16.9%), and (c) genetic abnormalities (12%). Lack of sufficient knowledge of physicians reflected on their treatment practices; only one-third of them independently dealt with acne cases without referral, and 23.9% referred the cases without medication. Physicians with a low level of knowledge showed six times more referrals than those with a high level of knowledge (P<0.001; odds ratio: 6.0). This study revealed that physicians practicing at PHC centers have inadequate knowledge and practice for management of acne. Steps should be taken to improve and update the dermatological knowledge of physicians working at PHC centers. Lectures, workshops, and other training activities should be arranged for them by dermatologists with expertise in acne. Further studies are required to analyze the current situation of practice for other common dermatological disorders.

The purpose of this study was to investigate the efficacy and safety of the NADA (National Acupuncture Detoxification Association)-standardized ear acupuncture protocol in comparison to medical acupuncture (MA) in the treatment of chronic nonspecific low back pain (LBP) in older adults. This was a prospective, clinical, single center, open label, comparative study. A total of 60 older patients with chronic nonspecific LBP were enrolled in the study. The patients were divided into two groups. The MA group received treatment with medical acupuncture (MA), while the NADA group received NADA ear acupuncture once a day for 20 min, for a total of 10 sessions. The co-primary outcome measures were the reduction in pain intensity evaluated by the Numeric Rating Scale (NRS) compared to baseline and improvement in patients' quality of life (QOL) assessed in the SF-36 questionnaire before and after treatment; this was compared between the two groups. After two weeks of treatment, a significant reduction compared to baseline was observed in the NRS scores following treatment with medical acupuncture as well as after the utilization of NADA ear acupuncture protocol: NRS score for average pain experienced by the patients over the previous week (NRSa) MA: p = 0.002; NADA: p < 0.001, maximum NRS score in the past week (NRSm) MA: p < 0.001; NADA: p < 0.001, and NRS score at the time of examination (NRSe) MA: p = 0.001; NADA: p < 0.001. Reduction of the NRSa score compared to baseline was significantly greater in the NADA group (p = 0.034). Significant improvements in the QOL of patients according to the SF-36 questionnaire compared to baseline were observed in the MA group in the following domains: PF (p = 0.003), RP (p = 0.002), SF (p = 0.041), RE (p = 0.005), MH (p = 0.043), HT (p = 0.013), PCS (p = 0.004), and MCS (p = 0.025); and in the NADA group, in the following domains: PF (p = 0.004), RP (p = 0.048), BP (p = 0.001), VT (p = 0.035), RE (p = 0.006), MH (p < 0.001), HT (p = 0.003), PCS (p < 0.001), and MCS (p < 0.001). There were minor complications observed in 35% of patients (total of 20 participants); 31% (9 patients) in the MA group and 39% (11 patients) in the NADA group. These were minor and quickly resolved, including insertion point pain, minor bleeding after needle removal, and one instance of fainting. No patients in either group reported worsening of LBP. These complications occurred in 4.14% of MA sessions (12 times/290 sessions) and in 6.07% of NADA acupuncture sessions (16 times/280 sessions). The outcomes of this study suggest that both MA and NADA ear acupuncture could be a valuable and personalized component of a comprehensive approach to managing chronic nonspecific LBP in older patients. Incorporation of MA and NADA ear acupuncture into the clinical management of chronic nonspecific LBP in elderly patients has the potential to reduce pain intensity and improve the overall quality of life of affected individuals. However, further studies are needed to confirm our findings.