Herbal therapies for acne vulgaris: A systematic review of clinical evidence

Acne Vulgaris (AV) is a common chronic inflammatory skin disorder with multifactorial pathogenesis.Comprehensive approach and long-term treatment are required to prevent AV complications such as scarring, and psychosocial distress.Limitations in conventional therapy, including irritation and antibiotic resistance, have encouraged interest in the use of herbal agents.This systematic review evaluates the efficacy, safety, and mechanisms of action of topical herbal agents for the management of AV.A comprehensive search was conducted in PubMed, Scopus, and Cochrane for clinical trials published from 2015 to 2025 evaluating herbal preparations in AV.Eligible studies included randomized controlled trials (RCTs) and open-label studies assessing clinical outcomes such as lesion counts, Investigator's Global Assessment (IGA), Dermatology Life Quality Index (DLQI), and adverse events.Data extraction was performed for study design, intervention, comparator, outcomes, duration, and adverse effects.Twenty-six clinical studies were included, investigating both single-herb (e.g., Curcuma longa, Garcinia mangostana, Melaleuca alternifolia, Camellia sinensis, Nigella sativa, Rhodomyrtus tomentosa) and multi-herbal formulations.Most interventions demonstrated significant reductions in inflammatory and noninflammatory lesion counts, with some achieving efficacy comparable to benzoyl peroxide or clindamycin.Mechanisms of action included antiinflammatory, antibacterial, antioxidant, and sebum-regulating effects.Adverse events were minimal and transient, with better tolerability than conventional agents.Evidence quality was moderate due to heterogeneity in formulations, small sample sizes, and short follow-up periods.Conclusion: Herbal agents offer multifaceted therapeutic action and are potentially effective, safe, and well tolerated for mild to moderate AV.They were potentially as alternatives or adjuncts to standard treatments.Standardized formulations, larger RCTs with rigorous methodologies, and longer-term follow-up are needed to confirm sustained benefits.