Complementary and alternative medicine (CAM) in acne vulgaris.

Abstract

Editorial Acne vulgaris is a chronic inflammatory disease of pilosabaceous unit which presents with polymorphic lesions like comedones, papules, pustules and nodulocystic lesions. It is prevalent in 80% of adolescents and 2/3 rd of adults. Its burden is compounded by its psychological outcomes on the patients with stress, anxiety and depression. Western medicine has provided with a number of effective drugs for the same including benzoyl peroxide, topical and systemic retinoids and antibiotics, dapsone, physical modalities like laser, light therapy and chemical peels. However, over the recent years, despite the success of these standard modalities, there is an increasing proportion of the population trying to explore complementary and alternative medicine (CAM) due to their concerns with cost and adverse effects of the conventional ones such as teratogenicity, photosensitivity, dryness, irritation, acne flare, antibiotic resistance and lack of response and relapse after withdrawal. There are a number of unconventional modalities that have been developed in different aspects of medicine [1-3]. Traditional Chinese Medicine (TCM) including herbal medicine, facial mask, diet modification, acupuncture and face cupping is in a growing demand among many patients of acne. TCM mainly relies on its principle that acne is caused due to increased heat and dampness in the body. The selection of the components of the medicine depends on the basic cause of acne i.e. syndrome of blood heat due to lung heat, syndrome of dampness-heat of spleen and stomach, syndrome of dampness-heat of liver and gallbladder, syndrome of heat-toxin stagnated, syndrome of blood stasis and coagulated phlegm. Herbal medicine and facial masks are quite popular, mostly due to less cost and a common belief that medicines made out of natural herbs have lesser risk of side effects. These herbs include Phellodendron amurense, gingseng, astragulus, burdock root, scuttellaria (huang qin), licorice, calendula, etc mostly due to their antioxidant, heat clearing and blood purifying action. If lesions are associated with pus, chuan shan jia (Squama manis) or zao jiao ci (Spina gleditsiae) can be used. If associated with resistant cystic lesions herbs like san leng (Rhizoma sparganii) or xia ku cao (Spica prunellae vulgaris) may be added in the face mask. Dietary modification in TCM is based on the principle that certain food products have higher heat component and are pro-inflammatory such as ginger root, black beans, cinnamon bark, walnut, butter, chicken, lamb, etc. While food items like apple, banana, citrus fruits, broccoli, cauliflower should be encouraged due to their heat clearing and anti-inflammatory property [4-6]. Acupuncture is another popular modality in TCM commonly used for pain management, which is now being successfully