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Essential Oils in the Treatment of Acne
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This entry is adapted from the peer-reviewed paper 10.3390/plants12010090

Acne is a chronic, common disease that poses a significant therapeutic, psychological and social problem. Acne treatment is often associated with the long-term use of antibiotics, contributing to the global antibiotic resistance crisis. Complementary and alternative medicines (CAMs) are one of the world’s most widespread sources of medicines. Among CAMs, essential oils are the most popular choice for treating many skin conditions due to their strong antimicrobial properties. 

skin diseases Cutibacterium acnes complementary and alternative medicines (CAMs) essential oils

1. Introduction

Skin diseases are a significant therapeutic, psychological and social problem nowadays. The importance of these conditions is regularly underestimated due to their chronic nature and low mortality, but their frequency can be very high, with estimates ranging from 21% to 87% of the population suffering from some skin disease. They account for a quarter of consultations in primary care due to the significant physical and mental impairments associated with it [1]. The most common skin disease is Acne vulgaris, which affects 80% of the teenage population; it is even believed that 100% of the population suffered from a more or less severe form of this disease at various times in their lives [2]. Acne is a chronic inflammatory disease, and its pathogenesis is very complex and multifactorial; there are no strict guidelines that would define specific reasons for the occurrence of this skin disease. The development of acne is mainly due to increased sebum production, increased proliferation and decreased shedding of keratinocytes, inflammation, and hyper-colonization of Cutibacterium acnes (formerly Propionibacterium acnes) [3][4]. In addition to increased sebum production, modification of its composition is also involved in the pathogenesis of acne. The unfavorable change consists of a decrease in the ratio of nutritional lipids palmitic acid C16:0/ palmitoleic acid C16:1 and an increase in the content of linoleic acid (C18:2), which affects the regulation of monocyte differentiation and secretion of cytokines, which contributes to the formation of inflammatory foci [5]. The basic types of acne lesions are inflammatory (papules, pustules, nodules, and cysts) and non-inflammatory (seborrhoea and open or closed comedones); in some cases, secondary inflammatory changes may occur, which may lead to scarring and discoloration. Although acne is not a life-threatening disease, it can have profound psychosocial consequences, resulting in low self-esteem, social isolation, and depression [6]. The treatment of acne is selected based on the severity of acne lesions and the severity of the disease. Usually, acne is classified according to severity as mild, moderate, and severe (fulminant). The best effectiveness in treating acne is obtained with combination therapy aimed at various pathogenetic mechanisms [7]. The most commonly used substances include retinoids, tetracycline antibiotics (e.g., doxycycline, minocycline), clindamycin, benzoyl peroxide, cationic antimicrobial peptide (omiganan), and azelaic acid. Clinical improvement may take 8 to 12 weeks from initiation of treatment, so people affected by acne must be patient and follow the doctor’s instructions [3][4][5]. One form of acne is rosacea, a common, chronic inflammatory dermatosis of the face that occurs predominantly in fair-skinned women in the Northeastern population. The disease is accompanied by intense redness and erythema, many lamp and pustules, as well as telangiectasias of capillary, and secondary changes such as itching, dry skin, burning, or stinging may also occur [8][9]. The process of rosacea development is influenced by external factors such as stress, UV radiation, excessive physical effort, improper diet, stimulants, and internal factors, which include primarily genetic predisposition [10]. In the pathogenesis of rosacea, infections with Demodex folliculorum and lipophilic yeast (Malassezia fur fur) are also mentioned [11][12].
Due to its location and chronic course, acne can lead to psychosocial disorders. It is crucial to start treatment quickly and take proper care of the skin. Acne treatment therapy is usually selected individually, considering the severity of the disease and its clinical picture, as well as the consequences related to the aesthetic appearance of the skin after its completion. Drugs used in general and external therapy should have anti-seborrhoeic, anti-blackhead, bactericidal, bacteriostatic, and anti-inflammatory properties. Increasing antibiotic resistance of dermal-epidermal acne-causing strains is very difficult to combat, and available synthetic drugs from the group of antibiotics and antimicrobials are becoming less and less effective. The use of retinoids in most cases is complicated by irritant dermatitis, especially after sun exposure, which limits their use in hot seasons [13]. Complementary and alternative medicines (CAMs) are one of the world’s most widespread sources of medicines. Among CAMs, essential oils are the most popular choice for treating many skin conditions due to their strong antimicrobial properties. Resistant strains such as Pseudomonas aeruginosa MRSA and Staphylococcus epidermidis MRSE have recently become problematic microorganisms due to their resistance to antimicrobial agents [14]. A combination of methods seems to be an adequate solution in treating acne, which in most cases allows for the best therapeutic effects. Anti-acne preparations use, among others, essential oils with an antiseptic effect (tea tree oil, lemon, or petitgrain oil), as well as antibacterial and anti-inflammatory oils that prevent plugging of the sebaceous glands of the skin (bergamot, basil, lavender, thyme oil). Lamlertthon et al. [15] showed the inhibition of the growth of C. acnes by 19 essential oils, among which the most potent antibacterial activity was found in the oils of Citrus hystrix DC., Cymbopogon citratus (DC.) Stapf, Syzygium aromaticum (L.) Merr. & Perry and Michelia alba DC. Daud et al. [16] showed the antibacterial effect of cinnamon, tea tree, and rosemary oils on C. acnes and S. epidermidis, considered the main skin bacteria contributing to the formation of acne, evaluating the tested oils as effective anti-acne agents.

2. Essential Oils with Potential Anti-Acne Effects

2.1. Tea Tree Essential Oil

Tea tree oil (TTO) is obtained by steam distillation of the leaves and twigs of the native Australian tree Melaleuca alternifolia Maiden & Betche of the Myrtaceae family. In Australia, it has been used for a long time for therapeutic purposes, cleaning and treating wounds, against colds, and headaches, for oral hygiene and inhalation, as an anti-scorbutic agent, and for the preparation of disinfectants [17]. TTO is characterized by high bioactivity and is an effective bactericidal, fungicide, and antiseptic agent, relatively safe and effective, with significant potential for use in the health and cosmetics industry. TTO is often sold as a pure oil or a component of ready-made antiseptic and antibacterial products (soaps, creams, kinds of toothpaste, mouthwashes, balms, and acne serums) [18][19]. TTO is a colorless or light yellow, multi-component liquid with a characteristic peppery-spicy aroma, sometimes reminiscent of camphor. It also has a cooling effect similar to menthol but less intense [18]. The oil contains about 100 components present in various concentrations, among which the following predominate: terpenen-4-ol, γ-terpinene, α-pinene, and α-terpinene (Table 1).
Table 1. The main compounds of M. alternifolia leave essential oil.
Table
Compound Content (%) References
Terpinen-4-ol 17.3–48.0 [20][21][22][23][24][25]
γ-terpinene 10.8–23.1 [20][21][22][23][24][25]
α-pinene 1.0–21.6 [20][21][22][23][24][25]
α-terpinene 2.6–11.3 [20][21][23][24][25]
Limonene 1.6–9.4 [23][24][25]
α-terpineol 1.5–8.0 [20][21][22][23][24][25]
1,8-cineole 0.0–15.0 [20][21][22][23][24][25]
ρ-cymene 0.5–8.0 [20][21][22][23][24][25]
α-terpinolene 1.5–6.4 [20][21][22][23][24][25]
TTO has a broad spectrum of antimicrobial activity, showing effects in treating acne [26][27]. It is usually used in various topical preparations. It contains over 80–90% of monoterpenes, including terpinen-4-ol, p-cymene, α-terpinene, 1,8-cineole, limonene, α-terpineol, terpinolene, sabinene and α-pinene [20][28][29]. Furthermore, it exhibits antioxidant, anti-inflammatory, analgesic, and anticancer activity [20]. Such numerous and valuable properties make it very popular. It supports the therapy of many skin diseases and their appendages, such as acne vulgaris, dandruff, dandruff versicolor, psoriasis, seborrhoeic dermatitis, diaper rash and eczema, corns and hardening, foot and scalp mycoses, nail yeast infections, diabetic ulcers and varicose veins, burns, boils, and paronychia. TTO is considered one of the most potent natural antiseptics. Antibacterial (S. epidermidis, C. acnes), antifungal (Candida albicans, Trichophyton mentagrophytes, Microsporum canis, M. gypseum), anti-inflammatory and antioxidant effects of tea tree oil have been demonstrated [28]. Lee et al. [30] showed that TTO and its components, terpinen-4-ol, α -terpinolene, α -terpinene, and α -terpineol, had strong inhibitory activities against C. acnes and S. aureus. The authors note that while terpinen-4-ol is the primary active ingredient responsible for TTO’s antimicrobial effectiveness, minor TTO components also contributed to its effectiveness. The strong antibacterial effect of tea tree oil is obtained even at low concentrations. It has been proven that in the concentration range of 0.6–30 mg/mL, it inhibits the development of Gram-positive aerobic cocci of S. epidermidis, and in the concentration of 1–5 mg/mL, it has a bactericidal effect against 32 strains of C. acnes bacteria, which were isolated from acne lesions [26][31]. TTO significantly decreased acne formation by inhibiting the growth of acne-related bacteria, C. acnes and S. aureus, and reducing acne-caused inflammation. TTO concentration of less than 5% is more suitable and safer for treating acne than higher concentrations [30].
Using the oil on the external parts of the body is safe, and side effects are rare. Skin side effects, which usually occur only in people with sensitive or allergic skin, can be reduced using low concentrations of the preparation. TTO is applied to the skin within 30 min. and absorbed rapidly. It can migrate to the dermis (cutis verai) and get into the bloodstream, lymphatic system, and skin nerve endings. Applied topically while penetrating the skin layers, it does not change its chemical composition, thus retaining its original healing properties [17][27]. The lipophilic components of the oil can also quickly get inside the cells of microorganisms, causing inhibition of metabolism and their death [32]. TTO has great potential in treating acne due to its antimicrobial effects, ability to reduce scars, and ability to promote wound healing. In addition, it offers advantages over antibiotics due to its low impact on the development of antimicrobial resistance and susceptibility [33]. A broad spectrum of antibacterial and anti-inflammatory properties is critical in treating acne; hence TTO may be a valuable therapeutic ingredient. Mazzarello et al. [34] proved that a cream containing TTO 3%, propolis 20%, and Aloe vera 10% has antibacterial and anti-inflammatory properties and is more effective in reducing acne, erythematous scars, acne severity index, and the total number of lesions compared to the preparation of synthetic origin, e.g., erythromycin. Azelaic acid (AzA) poses some application problems in treating acne due to poor water solubility, low skin permeability, and dose-dependent side effects. Bisht et al. [35] proposed a synergistic combination of AzA with TTO in the form of a hydrogel composite based on microemulsion, assessing it as effective and safe in in vitro, in vivo, and ex vivo tests. The formulations developed protected the direct exposure of the drug to the skin, thereby reducing side effects and showing the best penetration and retention characteristics in the skin compared to formulations available on the market. The in vitro antibacterial efficacy of the products revealed an improved zone of inhibition and low MIC values against Staphylococcus aureus, S. epidermidis and C. acne. The above positive reports allow the use of TTO as an alternative therapy for treating various forms of acne.

2.2. Eucalyptus Essential Oil

Eucalyptus globulus Labill. is one of the most widely used medicinal plants in the world. The species comes from Australia but is now cultivated in many countries due to its ease of adaptation and cultivation, tolerance to a wide range of environmental conditions, and rapid growth. There are about 900 different species of eucalyptus, of which only about 30% contain an essential oil that can be harvested on a larger scale. The above-ground parts of eucalyptus have been used for centuries as a traditional medicine for various health problems, such as respiratory infections, toothache, diarrhea, and stomatitis [36][37]. E. globulus oil (EGO) is distilled from the leaves with a yield of 2.6% [37]. The oil composition shows significant differences depending, e.g., on the time of harvest, geographical region, method of cultivation, or distillation (Table 2). The essential components of EGO include 1,8-cineole (eucalyptol), α-pinene, globulol, terpinen-4-ol, β-phellandrene, caryophyllene, α-terpinyl acetate, limonene, aromadendrene [38][39][40][41]. Referring to the British and European Pharmacopoeia, oil is a pharmaceutical grade if it contains at least 70% 1,8-cineole [42]. The content of 1,8-cineole in EGO from different parts of the world can be very high: 83.9–90.0% (Brazilian oil from São Paulo state), 85.8% (Brazilian oil from Minas Gerais state), 86.5% (Indonesia), 85.8% (Montenegro), 81.9% (India), 90.0% (Australia), 95.5% (Italy) and 98.9% (Argentina) [36].
Table 2. The main compounds of E. globulus essential oil.
Table
Compound Content (%) References
1,8-cineole 11.3–76.6 [37][39][40][41][42][43][44][45]
p-cymene 8.8–20.2 [37][40][41][44][45]
α-pinene 5.6–20.1 [39][40][41][42][43][44][45]
D-limonene 6.2 [41][42][45]
γ-terpinene 8.9 [40][41][44]
α-terpineol acetate 4.8 [40][41][45]
Alloaromadendrene 4.0 [43]
Recent studies have highlighted the antibacterial, antifungal, analgesic, and even anticancer properties of eucalyptus leaf extracts and essential oil, which are associated with the reported anti-inflammatory and antioxidant properties [46]. EGO, by inhibiting the production of tyrosinase and melanin, has a depigmenting and even skin tone effect, effectively reducing acne scars [41]. Research conducted by Bhatt et al. [47] determined the range of biocidal activity against various bacterial strains using eucalyptus oil, showing the inhibitory effect of EGO on some pathogenic bacteria associated with the development of acne. It has also been found that the oil is very effective in reducing the size of enlarged sebaceous glands and thus controlling the production of sebum, the excessive amount of which promotes the formation of acne lesions. The EGO has been proven to have a dual effect, reducing sebum production and controlling the secondary infectious stage by other microorganisms, establishing an alternative pathway for acne management [47]. Göger et al. [45] suggest that the EGO and its major constituent, 1,8-cineole works against skin pathogenic bacteria and show an anti-inflammatory effect. The authors confirmed the inhibitory effect of EGO on the activity of C. acnes, S. aureus, and S. epidermidis (80.2% 1,8-cineole), especially against humans pathogen S. epidermidis. 1,8-cineole was found to be much more effective against S. epidermidis compared to other tested strains. The research of Athikomkulchai et al. [48] shows that EGO has antimicrobial activity against C. acnes. An oil-in-water cream containing 2% eucalyptus oil was more effective than a commercial anti-acne gel with 5% benzoyl peroxide [47]. Bey-Ould Si Said et al. [49] confirmed the antibacterial and bactericidal effect of essential oil from E. globulus fruit on reference pathogenic strains: Bacillus subtilis, Listeria innocua, Escherichia coli, and Pseudomonas aeruginosa. Interesting information was provided by Assaggaf et al. [50], describing the synergism of EGO with honey. It was proven that this combination enhanced the anti-inflammatory, antioxidant, and dermatoprotective effects and could inhibit lipid peroxidation, possibly due to the synergistic effect [51]. Due to its confirmed anti-inflammatory and antiseptic effect against bacteria involved in the pathogenesis of acne, EO is one of the alternative forms of support in the fight against bacterial or inflammatory skin diseases.

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Subjects: Plant Sciences
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Renata Nurzyńska-Wierdak
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Dominika Pietrasik
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Magdalena Walasek-Janusz
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Update Date: 05 Jan 2023
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