An oral treatment for acne vulgaris

Published: 17-Mar-2023

Acne vulgaris (acne) is the eight most common skin disease in the world and, perhaps surprisingly, is not just an adolescent problem, reports Dr David Daguet, Scientific Director, Vidya Europe

This common skin disease affects approximately 9.4% of the world’s population. With a predominance in younger people, it is estimated that 35–100% of adolescents have acne at some point … and that it affects more than 90% of males and 80% of females.

Even if adolescents are the most affected demographic, though, acne may also affect adults; for example, it may be triggered by pregnancy.

Because acne affects the skin and typically occurs on the face, chest or upper back, it is very visible. Skin manifestations typically comprise comedones, papules and pustules. Open comedones, also known as blackheads, are clogged follicles within which the contents (dead skin, oil) remain open to the air.

The distension of hair follicle with keratin results in the open follicle, the oxidation of lipids and the deposition of melanin — giving the blackhead its colour.

Conversely, closed comedones, also known as white heads, are clogged follicles with no opening; they’re similar to the papules formed by the accumulation of sebum.

Other inflammatory manifestations, such as papules, nodules, pustules and cysts may also occur. The inflammatory manifestations result from follicle rupture, which triggers an inflammatory response.

Owing to the extent and the different types of lesions, acne severity is classified on a scale of mild to severe.

And, because acne is an aesthetic problem, its psychological impact is very important; it can trigger embarrassment, social awkardness, a lack of self-esteem and/or body confidence.

These negative impacts sometimes lead to unemployment, psychological disorders, depression and anxiety. The associated substantial financial cost must also be considered.

Acne vulgaris: an unknown physiopathology
Even if the physiopathology of acne is not well known, this chronic problem seems to originate within the pilosebaceous follicles. Four interrelated processes appear to be involved:

  • the overproduction of sebum caused by sebaceous gland and hormonal activity
  • the abnormal shedding of the follicular epithelium
  • the follicular colonisation by Cutibacterium acnes (previously called Propionibacterium acnes); this commensal bacterium, normally involved in the maintenance of a healthy skin, can also act as an opportunistic pathogen in acne vulgaris and take part in the inflammatory response
  • the inflammatory response.

Does diet have an impact?
Even if other factors such as genetics, hormones, psychological stress, smoking tobacco and damaged or unhealthy skin may be involved in the development of acne, it seems that certain foods and drinks — particularly those with a high glycaemic index (sugary drinks, starchy and/or highly processed foods) and skimmed milk — may affect acne severity.

For example, the influence of chocolate intake on acne severity is still the subject of much debate.

Treatments and alternatives
Topical treatments are the most common, such as retinoids and antibiotics that are applied to the skin. Oral treatment including isotretinoin can be used to treat severe nodular acne and refractory acne in adults and adolescents … but with very restrictive conditions and, potentially, very severe side effects.

Natural alternative treatments of vegetal origin are also available. One of them is derived from the guggul plant (Commiphora mukul); the active principles in the titrated extract are guggulsterones.

A clinical study on 20 patients has shown that a guggul extract had a positive effect on nodulocystic acne that was comparable with tetracycline — an antibiotic commonly used to treat inflammatory acne.1

Also, with common acne vulgaris in mind, Vidya Herbs has done a clinical study involving patients suffering from facial acne. This prospective, randomised, double-blind placebo-controlled study (placebo versus guggul extract) was done with 30 subjects (inflammatory and non-inflammatory lesions, mild to moderate acne). The participants took a 500 mg capsule, twice a day, for 90 days.

This trial results demonstrated a reduction in the number of both white heads (69.60%) and black heads (48.90%) compared with the placebo (32.51% and 6.38%, respectively), and a decreased inflammatory lesion count (62.20%) versus the placebo (4.55%). 

Regarding hormonal levels, the amount of free testosterone in the blood decreased by 67.67% with the guggul extract compared with 15.03% for the placebo.

The investigator global assessment (IGA) reported a greater improvement for those subjects taking the guggul extract compared with the placebo; the mean quality of life score (QOLS) increased from 15.71 at screening to 18.21 for the verum subjects, whereas no significant increase was observed for those taking the placebo (from 16.07 to 16.5).

Even if the mechanisms of action of the guggul extract need to be studied further, and the real physiopathology of acne is still being debated, it is clear that natural oral alternatives such as a guggul extract may offer an efficient solution to this widespread skin problem.

As acne is associated with significant negative impacts on the quality of life of adolescents, this effective beauty solution could, of course, complement a dedicated and personalised topical skin hygiene regime.


  1. D.M. Thappa and J. Dogra, “Nodulocystic Acne: Oral Gugulipid versus Tetracycline,” Journal of Dermatology 21(10), 729–731 (1994).

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