External Application of Herbal Medicines for Acne Vulgaris: A Systematic Review and Meta Analysis

Abstract

Aim of the study: The objective of this systematic review is to critically evaluate the evidence of the effectiveness and safety of external application of herbal medicines (EAHM) for acne vurgalis (AV).Methods: English, Chinese and Korean language databases were searched up to May 2018. Randomized clinical trials (RCTs) that reported the effects of EAHM for AV were included and analysed.Results: A total of 10 randomized trials with 656 AV patients were identified. A meta-analysis of two RCTs indicated that EAHM had a significant effect on improving primary outcome 'global assessment' compared with placebo (mean difference (MD) = -2.62, confidence interval (CI) = -4.84 to -0.40, p = 0.02). Furthermore, data extracted from two RCTs showed that EAHM significantly reduce primary outcome 'inflammatory lesion count of acne' (MD = -1.25, CI = -1.68 to -0.83, p < 0.00001) and 'non-inflammatory lesion count of acne' (MD = -1.32, CI = -1.75 to -0.90, p < 0.00001). No significant difference was observed between groups in secondary outcome 'sebum of skin' (MD = -0.21, CI = -0.53 to 0.11, p = 0.20) and 'patient-reported changes in symptom' (relative risk (RR) = 2.56, CI = 0.43 to 15.22, p = 0.30). No severe adverse events (AEs) were found and no treatment was stopped due to AEs of EAHM.Conclusions: EAHM seems to have affirmative effects, but quality of evidence, and non-standardized use of EAHM make our conclusion weak. Our suggestion is rigorously designed RCTs and standardization of EAHM are required in the future.

Effects and safety of acne vulgaris with external application of herbal medicines

“…Clinical trials with no treatment, placebo, or CM will be considered as control groups. CM, for instance, zinc sulfate solution and benzoyl peroxide gel [28] . Additionally, trials comparing EAHM with any other therapies will be excluded.…”

“…CM, for instance, zinc sulfate solution and benzoyl peroxide gel. [28] Additionally, trials comparing EAHM with any other therapies will be excluded. What's more, the control interventions using unproven drugs such as herbal medicine will be ruled out.…”

“…Herbal medicines, a characteristic therapy in Chinese and Korean, based on unique theories, have been applied internally and externally to cure various diseases over thousands of years. Meanwhile, physicians have accumulated abundant experiences and knowledge in the fight against skin disease [28] . External treatment of herbal medicines includes applying drugs on the skin, exhibiting the strength of convenience, safety, comfort, and low cost than conventional medicines (CM) [29] …”

“…External application of herbal medicines (EAHM) have been widely applied in the treatment of AV. The published systematic reviews have demonstrated the benefits of EAHM for AV in clinical studies [28] . However, only a small amount of studies were included in the systematic review and meta analysis, published by Korean Medicine, and the sample size is insufficient evidence to assess the efficacy and safety of EAHM with AV.…”

“…Meanwhile, physicians have accumulated abundant experiences and knowledge in the fight against skin disease. [28] External treatment of herbal medicines includes applying drugs on the skin, exhibiting the strength of convenience, safety, comfort, and low cost than conventional medicines (CM). [29] External application of herbal medicines (EAHM) have been widely applied in the treatment of AV.…”