A Biologically Based Approach to Acne and Rosacea
June 2018 | Volume 17 | Issue 6 | Original Article | 611 | Copyright © June 2018
Penelope J. Kallis BS BA,a Alexandra Price MD,a Jacquelyn R. Dosal MD,a Anna J. Nichols MD PhD,a and Jonette Keri MD PhDa,b
aUniversity of Miami Miller School of Medicine, Miami, FL bDermatology Service, Miami VA Healthcare System, Miami, FL
Complementary and alternative medicine (CAM) therapies are increasing in popularity in the field of dermatology. Natural products and holistic approaches are in high demand among patients and research has begun to support their roles in acne and rosacea pathophysiology. In this article, commonly utilized biologically based complementary and alternative therapies for acne and rosacea are reviewed from an evidence-based perspective. Therapies discussed include vitamin C, nicotinamide, zinc, tea tree oil, green tea, resveratrol, curcumin, feverfew, licorice, chamomile, polypodium leucotomos, and nutrition-based approaches. J Drugs Dermatol. 2018;17(6):611-617.
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Alternative medicine is a term used for treatments that are used in place of evidence-based, standard Western medical care. Complementary medicine, which combines these less-mainstream approaches with conventional medicine is used more often.1,2 In the United States, it is estimated that more than 30% of adults and 12% of children use health care practices outside of traditional Western medicine,2 translating to $34 billion spent annually on complementary and alternative medicine (CAM).3 The most common complementary health approach used by Americans in the 2012 National Health Interview Survey was natural products (17.7%), which includes herbs (also known as botanicals), vitamins, minerals, dietary supplements, and probiotics.2 Along with foods and special diets, natural products make up biologically based practices of CAM.1Patients are often frustrated by the chronicity of dermatologic conditions, and this may compel them to experiment with CAM therapies.4 Results from the 2007 National Health survey revealed that among those reporting skin problems in the United States, 84.5% used CAM that year,5 an increase from 49.2% in 2002.6 In a recent study, patients using CAM treatments for acne thought that CAM therapies had less potential for adverse effects and were more efficacious than mainstream topical therapies.7 With increased patient interest in CAM and heightened insight into their role on cutaneous disease processes, it is imperative that dermatologists be made aware of these advances to make appropriate recommendations to patients. The goal of this article is to detail the best evidence for commonly utilized biologically based CAM practices employed for two common dermatoses with significant societal impacts: acne and rosacea.
Antioxidants 1. Vitamin CVitamin C (ascorbic acid) is both an antioxidant and anti-inflammatory agent commonly used topically for skin protection in various dermatologic conditions.4,8 Due to its chemical instability, vitamin C is available in numerous modified formulations that improve stability, with sodium ascorbyl phosphate (SAP) being commonly studied and commercially available.9 SAP may have utility in the treatment of acne due to its strong antimicrobial activity on P. acnes and through reduction of lipid oxidation, which may then lead to a decrease in inflammation and follicular keratinization.8 Several studies have reported the efficacy of topical SAP for the treatment of acne both alone and in combination with other medications. Klock et al reported that 5% SAP cream was more efficacious than 5% benzoyl peroxide (BP) cream for the treatment of acne vulgaris in a 12-week open-label study of 60 patients.8 A randomized control trial (RCT) by Ruamrak et al. found that 5% SAP and 0.2% retinol had synergistic effects in the reduction of inflammatory acne lesions.10 Another RCT demonstrated that monotherapy with 5% SAP lotion led to improvements in Investigator’s Global Assessment Scores, Subject’s Global Assessment Scores, and lesion counts when compared to vehicle.112. NicotinamideNicotinamide, also known as niacinamide, is a form of vitamin B3 regarded as a potential therapy for acne due to its potent anti-inflammatory and antioxidant effects.12 Nicotinamide may reduce comedogenesis via various mechanisms. Draelos et al. performed two separate clinical trials in Japan and the USA to evaluate the effect of 2% topical nicotinamide on sebum production and sebum levels. In the Japanese group, sebum