Comparison of Clinical and Histological Effects between Lactobacillus-Fermented Chamaecyparis obtusa and Tea Tree Oil for the Treatment of Acne: An Eight-Week Double-Blind Randomized Controlled Split-Face Study

Abstract

Background: Screening of natural compounds for the development of anti-acne therapeutic agents has been steadily required considering various side effects of acne medications. However, previous studies have mainly focused on experimental tests without clinical trials and histopathological analysis. Objectives: To compare the clinical efficacy, safety and histopathological changes between Lactobacillus-fermented Chamaecyparis obtusa (LFCO) and existing tea tree oil (TTO). Methods: A total of 34 patients were instructed to apply 5% LFCO to the involved areas of a randomly allocated side and 5% TTO extract to the other side for 8 weeks in a double-blind split-face clinical trial. Results: After 8 weeks, inflammatory acne lesions were reduced by 65.3% on the LFCO side and by 38.2% on the TTO side. LFCO was also superior to TTO in the onset time of efficacy (p < 0.05). The LFCO side further demonstrated improvement for non-inflammatory lesions (52.6%, p < 0.05), decreased size of sebaceous glands and sebum output reductions. Patients' subjective satisfaction was also higher without severe adverse reactions. Protein expressions of nuclear factor κB decreased earlier on the LFCO side, and those of interleukin-1a (IL-1a), IL-8, insulin-like growth factor 1 receptor and sterol regulatory element-binding protein 1 decreased subsequently. Ultra-performance liquid chromatography/high-resolution mass spectrometry further demonstrated that the contents of dihydroxybenzoic acid, taxifolin and quercetin were increased in LFCO after fermentation. Conclusions: LFCO treatment was rapid and effective for treating acne lesions compared to TTO. Histopathological findings correlated well with the clinical acne grade and treatment response. This novel natural compound appears to be effective and safe for acne treatment.

Treatment of acne with tea tree oil (melaleuca) products: A review of efficacy, tolerability and potential modes of action

“…An extensive literature search found seven publications [15][16][17][18][19][20][21] that have systematically evaluated the efficacy of products containing tea tree oil for treating acne (Table 1). Of these, six [15][16][17][18]20,21] were comparative, of which three [16,17,21] were double-blinded, with an additional study investigator-blinded [15].…”

“…Of these, six [15][16][17][18]20,21] were comparative, of which three [16,17,21] were double-blinded, with an additional study investigator-blinded [15]. Six studies have been published in full (five in English) and the remaining study was published as an abstract only [15].…”

“…No serious adverse events occurred during the study and it is not stated whether any minor adverse events occurred. Kwon et al (2014) recently published a double-blind splitface study comparing 5% tea tree oil to 5% Lactobacillus-fermented Chamaecyparis obtusa (LFCO) extract [21]. A total of 34 participants applied each treatment twice daily to the left or right side of the face for 8 weeks.…”

“…Adverse events were reported after the application of tea tree oil products in five of the seven studies [15][16][17]20,21]. An additional study stated that there were no serious adverse events [18].…”

“…In the remaining study, no details were provided about adverse events in the English abstract [19]. Stated events were minor pruritus, burning, stinging, scaling, itch, redness and dryness [16,17,20,21]. Only one study suggested that one or more patients withdrew due to an adverse event [15].…”