International Journal of Biomedical Research

HERBAL PLANTS AND PROPIONIBACTERIUM ACNES: AN OVERVIEW

Deepak Singh*, Bhushan Hatwar & S. Nayak

Bansal College of Pharmacy, Bhopal (M.P.), India.

Corresponding author*: [email protected]

This article is available online at www.ssjournals.com

ABSTRACT
Propionibacterium acnes are gram-positive anaerobic microorganism, which have been
most recognized as a key factor for the development of acne. Acne is the most common skin
disease and Propionibacterium acnes have been recognized as pus-forming bacteria
triggering an inflammation in acne. Acne vulgaris is a chronic inflammatory disease of the
pilosebaceous follicle, characterized by comedones, papules, pustules, cysts, nodules and
often scars in certain sites of predilection, namely, the face, neck, upper trunk and arms. The
present compiled work was conducted to make an overview and correlation between
antimicrobial activities of medicinal plants against these etiologic agents of acne vulgaris.
Different parts of various medicinal plants belongs to families like Liliaceae, Rutaceae,
Zingiberaceae, Myrtaceae, Lamiaceae, etc. contains alkaloids, tannins, flavonoids,
terpenoids, volatile oil and essential oil which are reported with significant effect against
this bacteria.

KEY WORDS: Propionibacterium acnes, Pus, Anaerobic microorganism, Skin disease,

Pimples

1. INTRODUCTION have it, because it is genetic problem

1.1 Acne :Acne vulgaris is a chronic brought on by hormones.4 The major
inflammatory disease of the pilosebaceous hormones involved in the etiology of acne
follicle, characterized by comedones, are androgens, taking into account that 5
papules, pustules, cysts, nodules and often α-reductase type 1, responsible for the
scars in certain sites of predilection, conversion of testosterone into
namely, the face, neck, upper trunk and dehydrotestosterone (DHT), appears to be
arms.1 Propionibacterium acnes release most prevalent in the sebaceous glands of
pro-inflammatory cytokines as well as isolated acne areas and to have greater
antigens and mitogen(s), with cellular and activity in women with moderate to severe
non-cellular responses to these products acne.5,6,7 Acne is a group of disorders that
triggering inflammation.2 Acne vulgaris is causes outbreaks of skin lesions
a common skin disease that involves commonly called pimples factors which
individuals of all ages. It has been contribute to the development of acne
estimated to affect 79% to 95% of the include hormonal imbalance, bacterial
adolescent population, 40% to 54% of infection, stress, food, or cosmetic
individuals older than 25 years, and 12% application additionally some species of
of women and 3% of men in their mid Propionibacterium are found in milk and
ages.3 Acne is genetic and if it runs in cheese and some time in other agricultural
family, three out of four children may product.8 Propionibacterium acnes are a

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 Singh et al Review Article

gram positive microaerophilic bacteria of teenage boys and girls, respectively,

which are responsible for the local and affects 85%, 8% and 3% of people
inflammatory response of acne, with the aged between 12-25, 25-34 and 35-44
activation of monocytes and production of years, respectively.13 It is further
cytokines.5, 9 It is caused by the oil glands classified as14:
present in the skin making too much 1.2.1.1. Papules: Slightly larger, tender,
sebum, an oily substance, which leads to and red or pink blemishes which are most
plugged pores. It is the most common skin often found to be inflamed are called
disease. Propionibacterium acnes are a papules. This type of acne is potentially
common contaminant found in blood and risky to be picked or popped since they
CSF (cerebrospinal fluid) culture.10 can turn into larger and painful cysts with
Although acne is not a serious health some possibility of scarring.
threat, severe acne can lead to disfiguring 1.2.1.2. Macule- A macule is a temporary
and permanent scarring. For many years red, or red-pink, spot that is left after the
antibiotics and hormones were usually acne has healed. This has a well-defined
applied to treat acne. However, these border and may stay for many days before
agents are often accompanied by severe disappearing.
side effects and drug resistance.11 Acne 1.2.1.3. Pustules: Pustules are much like
shows up in the form of filthy lesions like whiteheads, but with greater
blackheads, whiteheads, inflammatory inflammation, larger size, and a visible
lumps or boils such as pustules, papules, center filled with pus. They are generally
cysts, and nodules. Propionibacterium red in color at their base.
acnes are found briefly on the skin of 1.2.1.4. Nodules: Nodules are larger and
neonates, but true colonization begins more deep seated than pustules. These
during the 1-3 years prior to sexual lesions are characterized by painful, firm,
maturity due to hormonal imbalance.12 and solid lumps filled with pus.
Factors promoting the development of 1.2.1.5. Cysts: Acne cysts or cystic acne
acne are: increased sebum production, is the most severe and persistent type of
ductal cornification, hyperkeratinization, acne. These large inflamed lesions are
bacterial colonization of the pilosebaceus oftentimes playing as the most influential
ducts and inflammation.2 threat behind acne scar. More often than
1.2 Types of Acne : Acne could be not, it is found that cystic acne is the
classified into five categories: acne outcome of popping or squeezing pus
vulgaris, acne rosacea, acne conglobata, filled and inflamed smaller comedones.
acne fulminans, and pyroderma faciale. 1.2.2. Acne rosacea: Rosacea is a
Among these acne vulgaris is the most common skin disorder affecting middle-
common and mild type of acne. aged and older adults. Many patients
1.2.1 Acne Vulgaris: Acne vulgaris is the mistakenly assume that early rosacea is
most common cutaneous chronic normally a sign of aging skin and are not
inflammatory disorder of multifactorial aware of effective treatments that exist to
origin with prevalence in adolescents. It prevent progression to permanent
consists of the pilosebaceous follicles disfiguring skin changes. It mainly
characterized by comedones, papules, affectsmiddle- aged and older adults and
pustules, nodules, cysts and often scars in found in cheeks, nose, chin, and
certain sites of predilection, namely the forehead.15
face, neck, chest, arms and back. Acne 1.2.3. Acne conglobata: Acne conglobata
vulgaris is common among 95% and 83% is an uncommon and unusually severe

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 Singh et al Review Article

form of acne characterized by burrowing Propionibacterium granulosum and

and interconnecting abscesses and Propionibacterium avidum have been
irregular scars (both keloidal and identified as etiological agent.20 Acne is
atrophic), often producing pronounced inflammation of the skin, due to blockage
disfigurement. The comedones often of skin’s pores. Blockage occurs due to an
occur in a group of 2 or 3, and cysts excessive secretion from the skin’s oil
contain foul-smelling seropurulent glands and accumulated, dead skin cells.
material that returns after drainage. The This combination encourages the skin
nodules are usually found on the chest, the bacterium Propionibacterium which
shoulders, the back, the buttocks, the multiplies and causes increased skin
upper arms, the thighs, and the face.16 inflammation.14 Hyperkeratinization and
Acne conglobata may develop as a result formation of a plug
of a sudden deterioration of existing of keratin and sebum (a microcomedo) is
active papular or pustular acne, or it may the earliest change. Enlargement of
occur as the recrudescence of acne that sebaceous glands and an increase in
has been quiescent for many years.17 sebum production occur with
1.2.4. Acne fulminans: It is an increased androgen (DHEA-S)
uncommon form of ulcerative acne with dehydroepiandrosterone sulfate
acute onset. It usually affects adolescent production at adrenarche. The
boys who have associated musculoskeletal microcomedo may enlarge to form open
pain and septic fever. Osteolytic bone comedones (blackhead) or closed
lesions have been reported in these comedones (milia). Comedones are the
patients. Severe cystic acne occurs almost direct result of sebaceous glands
equally in both sexes, but it has a less becoming clogged with sebum, naturally
dramatic clinical course than acne occurring oil, and dead skin cells. In these
fulminans and rarely causes ulcerative conditions, the naturally occurring largely
skin lesions and systemic symptoms. In commensal bacterium Propionibacterium
this study we investigated the imaging acnes can cause inflammation, leading to
features of bone lesions associated with inflammatory lesions (papules, infected
acne fulminans and determined if patients pustules, or nodules) in the dermis around
with severe cystic acne have similar bone the microcomedo or comedone, which
lesions.18 results in redness and may result
1.2.5 Pyoderma faciale: Rosacea in scarring or hyperpigmentation.2,21
fulminans is a rare disease of unknown Some causes are:
etiology which occurs mainly in 1.4.1.Genetics: Acne is a multi-factorial
postadolescent women. It is characterized disease, and genetics probably contributes
by an abrupt explosive outbreak without to the development of acne. Studies
prodromes, consisting of papules, indicate that the size, number and activity
pustules, confluent nodules with draining of sebaceous glands are genetically
sinuses on the face. A dull to blue-red, determined. In addition, the concordance
cyanotic erythema of all involved facial rate of acne in identical twins is high,
areas is typical, often accompanied by confirming the role of genetics in the
pronounced facial edema.19 development of acne.
1.4 Causes of Acne: Acne vulgaris is a 1.4.2.Diet: A recent study concluded that
mutifactorial disease affecting the dairy products contribute to the
pilosebaceous follicles for which pathogenesis of acne. This is postulated to
Propionibacterium acnes and, less often, be mediated via the synthetic hormones

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used in cows in the milk industry. Caution Therefore, extracts of the following plants
must be used in interpreting such studies from different families which contain
and the general recommendations remains different phytoconstituents like essential
for individuals to eat a well-balanced diet. oils, 11 flavonoids, tannins, 24 alkaloids, 30
1.4.3.Hormones: Sebaceous gland terpenoids, 32 volatile oil 35 and phenolic
excretion may be stimulated by male sex compounds44 having potential activity
and adrenal gland hormones. During against Propionibacterium acnes.
puberty, the levels of these hormones are Propionibacterium acnes have been most
not elevated, but the sebaceous glands are recognized as a key factor for the
more sensitive to them. There are certain development of acne and the plants which
medical conditions which can lead to are use as antiacne or to prevent acnes are
inappropriately high levels of male sex enlisted in table no. 1.
hormones, thereby producing acne.
1.4.4.Drugs: Acne form eruptions can CONCLUSION
occur as an adverse drug eruption, and Propionibacterium acnes have been
stopping the offending drug will often recognized as pus-forming bacteria
alleviate the problem. This must be done triggering an inflammation in acne.
in consultation with the prescribing Propionibacterium acnes is a Gram-
physician, with a detailed review of risks positive, anaerobic microorganism, which
and benefits of stopping the offending has been most recognized as a key factor
medication undertaken. for the development of acne.11 Acne
1.4.5.Hair grooming agents-Pomade vulgaris is a chronic inflammatory disease
acne: Excessive use of hair pomades (also of the pilosebaceous follicle,
known as hair moisturizers, hair styling characterized by comedones, papules,
products and hair grease), which are often pustules, cysts, nodules and often scars in
part of the hair care regime of blacks, can certain sites of predilection, namely, the
lead to the development of acne. This face, neck, upper trunk and arms. Factors
occurs especially around the hairline and which contribute to the development of
forehead. Counseling and review of the acne include hormonal imbalance,
hair care regime can alleviate pomade bacterial infection, stress, food, or
acne. cosmetic application.11 The use of oral
1.4.6.Cosmetics: Acne can result from antibiotics for the treatment of acne may
heavy cosmetic use and the associated be associated with adverse effects.22 The
pigmentation changes may be exacerbated plants having phytoconstituents like
by harsh agents applied to the skin as part alkaloids, phenolic compounds, volatile
of an individual’s grooming practice and oil, essential oil, might be used for the
vigorous washing of the skin with rubbing preparation of topical herbal formulations.
and scrubbing, or using puffs or abrasive Currently the problem associated with the
sponges can also cause or worsen acne. therapy for acne is that the topical
products available are either cream based
2. PLANTS USED FOR THE (mostly oily) or associated with adverse
PROPIONIBACTERIUM ACNES effects contributed to their chemical
The aim of this study was to compile the nature and natural remedies are more
antimicrobial medicinal plant used in acceptable in the belief that they are safer
Ayurveda and traditional medicinal with fewer side effects than the synthetic
system for treatment of manifestations ones so, herbal anti-acne solution which
caused by Propionibacterium acnes. is approximately non-toxic, safe, effective

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 Singh et al Review Article

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treatment of acne. J Dermatol 1991; strains of Propionibacterium acnes,
18, pp.489 – 499. journal of pharmaceutical sciences,
68. Isao Kubo, Hisae Muroi, Aya Kubo. 2007, 34(1-4), pp.60-64.
Naturally occurring antiacne agents. J
Nat Prod 1994; 57(1), pp. 9-1 7.

1.3 Differentiation points between types of acne.

Acne Vulgaris Acne rosacea Acne conglobata Acne Pyoderma

fulminans faciale
It is the most It is a common It is an It is an It is rare disease
common skin disorder uncommon and uncommon of unknown
cutaneous affecting unusually severe form of etiology.
chronic middle-aged form of acne ulcerative acne It occurs mainly
inflammatory and older characterized by with acute in
disorder of adults. burrowing and onset. postadolescent
multifactorial It mainly affects interconnecting It usually women.
origin. middle-aged abscesses and affects Found at facial
Found in face, and older irregular scars. adolescent areas.
neck, arms, and adults. Found in chest, boys.
back Found in shoulders, back,
Common for cheeks, nose, buttocks, upper
teenage chin, and arms, thighs and
forehead. face.

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Table no.1: List of plants used for treating the Propionibacterium acnes
S.No. Plant and family Plant part Solvent used Reference
/preparation
1. Albizia lebbeck Whole plant Pet.ether, K. Sudharameshwari et al. (2007)
Fabaceae water

2. Aloe vera Leaves Water Bhaskar G et al. (2009)

Liliaceae

3. Alpinia galanga Rhizome Ethyl acetate Niyomkam P et al. (2010)

Zingiberaceae

4. Apis mellifera Venom Water Han et al. (2010)

Apidae

5. Azadirachta indica Leaves Ethanol Mamgain, R.K. et al. (2000),

Meliaceae Harisaranraj. R. et al. (2010)
6. Barleria lupulina Whole plant ND M.T.Chomnawang et al. (2005)
Acanthaceae
7. Cardiospermum halic Leaves Ethanol Harisaranraj. R. et al. (2010)
acabum
Sapindaceae
8. Casuarina equisetifoli Fruit Ethanol Harisaranraj. R. et al. (2010)
a Casuarinaceae

9. Cinnamomum ND Essential oils Yuangang Zu. et al. (2010)

zeylanicum
Lauraceae
10. Citrus hystrix DC. Leaf Essential oils S.Luangnarmithai et al. (2007),
Rutaceae Aranya manosroi et al. (2008)
11. Citrus limon Fruit Essential oils Yuangang Zu. et al. (2010)
Rutaceae
12. Citrus paradisi Grape fruit Essential oils Yuangang Zu. et al. (2010)
Rutaceae
13. Coscinium Stem Methanol Sudhir Chaudhary. et al. (2010)
fenestratum Kumar. et al. (2007)
Menispermaceae
14. Cucurbito pepo L. Seeds Ethanol Kumar. et al. (2007)
Cucurbitaceae
15. Cynodon dactylon Leaves Ethanol Harisaranraj. R. et al. (2010)
Poaceae
16. Cymbopogon citrates Leaves Methanol S.Luangnarmithai et al. (2007),
Stapf. Aranya manosroi et al. (2008),
Gramineae Tsai T et al. (2010)

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17. Eclipta alba Fruit Ethanol Kumar. et al. (2007)

Asteraceae
18. Eucommia ulmoides Leaves Methanol Tsai T et al. (2010)
Eucommiaceae
19. Eucalyptus globules Leaves Methanol– Eric Yarnell et al. (2006),
Myrtaceae dichlorometh T. Takahashi et al. (2004)
ane (1:1)
20. Eucalyptus maculate Leaves Methanol– T. Takahashi et al. (2004), Eric
Myrtaceae dichlorometh Yarnell et al. (2006),
ane (1:1)
21. Eucalyptus viminalis Leaves Methanol– T. Takahashi et al. (2004), Eric
Myrtaceae dichlorometh Yarnell et al (2006),
ane (1:1)
22. Euphorbia hirta Root Ethanol Harisaranraj. R. et al. (2010),
Euphorbiaceae Kumar. et al. (2007)
23. Eupatorium odoratum Whole plant ND M.T.Chomnawang et al. (2005)
Asteraceae
24. Excoecaria ND Ethanol, water P. Leelapornpisid. et al.
cochinchinensis
Euphorbiaceae
25. Ficus religiosa Leaves Ethanol Harisaranraj. R. et al. (2010)
Moraceae
26. Garcinia mangostana Fruit Ethanol W. Pothitirat et al. (2009),
Guttiferae M.T.Chomnawang et al. (2005),
U Sukatta et al. (2008)
27. Glycyrrhiza glabra Rhizome Ethanol C. Nam et al. (2003)
Leguminosae
28. Hemidesmus indicus Root Ethanol Kumar. et al. (2007)
Apocynaceae
29. Hibiscus sabdariffa Whole plant ND M.T.Chomnawang et al. (2005)
Malvaceae
30. Houttuynia cordata Whole plant ND M.T.Chomnawang et al. (2005)
Saururaceae
31. Jasminum grandiflora Flower Essential oils Yuangang Zu. et al. (2010)
Oleaceae
32. Jasminum sambac Flower, leaf Ethanol, Harisaranraj. R. et al. (2010),
Oleaceae methanol Tsai T et al. (2010)
33. Jasminum officinale Flower Ethanol Kumar. et al. (2007)
Oleaceae
34. Lavandula angustifolia Leaf Methanol Tsai T et al. (2010)
Lamiaceae
35. Lavandula stoechas ND Essential oils Yuangang Zu. et al. (2010)
Lamiaceae
36. Lawsonia inermis Whole plant Pet.ether, K. Sudharameshwari et al. (2007)
Lythraceae water
37. Llex paraguariensis Leaves Methanol Tsai T et al. (2010)

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Aquifoliaceae
38. Magnolia grandiflora Stem ND J. Park et al. (2004)
Magnoliaceae
39. Matricaria ND Essential oils Yuangang Zu. et al. (2010)
chamomilla
Compositae
40. Mentha piperita Leaves Ethanol Kumar. et al. (2007)
Lamiaceae
41. Mentha spicata Leaves Essential oils Yuangang Zu. et al. (2010)
Lamiaceae
42. Michelia alba DC. ND Essential oils S. Luangnarmithai et al. (2007)
Magnoliaceae
43. Momordica charantia Fruit Ethanol Harisaranraj. R. et al. (2010)
Cucurbitaceae
44. Ocimum sanctum Leaves Ethanol Harisaranraj. R. et al. (2010),
Lamiaceae Aranya manosroi et al. (2008)
45. Ocimum Americana Whole plant ND Aranya manosroi et al. (2008)
Lamiaceae
46. Ocimum basilicum Leaves Water Aranya manosroi et al. (2008),
Lamiaceae Eric Yarnell et al. (2006)
47. Piper nigrum Seed Ethanol Harisaranraj. R. et al. (2010)
Piperaceae
48. Phyllanthus niruri Whole Ethanol Harisaranraj. R. et al. (2010)
Euphorbiaceae plants
49. Pongamia pinnata Seeds Ethanol Kumar. et al. (2007)
Fabaceae
50. Psidium guajava Leaf Water R.M.P. Guti´errez et al. (2008),
Myrtaceae Qadan et al. (2005),
Girish Kumar Gupta et al.(2011)
51. Quercus infectoria Whole plant Methanol Sudhir Chaudhary. et al. (2010)
Fagaceae
52. Rauwolfia serpentina Root Ethanol Harisaranraj. R. et al. (2010)
Apocynaceae
53. Rosa damascena Leaf Methanol Yuangang Zu. et al. (2010),
Rosaceae Tsai T et al. (2010)
54. Salvia officinalis Leaf Ethanol, water P. Leelapornpisid. et al.
Lamiaceae
55. Senna alata Whole plant ND M.T.Chomnawang et al. (2005)
Fabaceae
56. Symplocos racemosa Bark Ethanol Kumar. et al. (2007)
Symplocaceae
57. Syzygium aromaticum Flowering Essential oils S.Luangnarmithai et al. (2007)
Myrtaceae bud
58. Tephrosia purpurea Root Ethanol Kumar. et al. (2007)
Fabaceae
59. Terminalia arjuna Bark Acetone A.Vijayalakshmi et al. (2011)

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Combretaceae
60. Thespesia populnea Root Ethanol Kumar. et al. (2007)
Malvaceae
61. Thymus vulgaris ND Essential oils Yuangang Zu. et al. (2010)
Lamiaceae
62. Tinospora cordyfolia Root Ethanol Kumar. et al. (2007)
Menispermaceae
63. Zingiber officinale Rhizome Essential oils Yuangang Zu. et al. (2010),
Zingiberaceae Eric Yarnell et al (2006)

ND: Not Defined in articles.

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