A Review of Acne Etiology and Treatment in Iranian Traditional Medicine

authors:

avatar Laila Shirbeigi 1 , avatar Laleh Oveidzadeh 2 , avatar Zahra Jafari 2 , avatar Monireh Sadat Motahari Fard 1 , avatar Parvin Mansouri 3 , *

Department of Iranian Traditional Medicine, School of Iranian Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
Faculty of Traditional Medicine, Department of Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Ardakan, Yazd, Iran
Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran

how to cite: Shirbeigi L, Oveidzadeh L, Jafari Z, Motahari Fard M S, Mansouri P. A Review of Acne Etiology and Treatment in Iranian Traditional Medicine. J Skin Stem Cell. 2016;3(1):e39133. https://doi.org/10.5812/jssc.39133.

Abstract

Context:

Iranian traditional medicine (ITM) is based on humoral theory. Temperament or Mizaj is the result of a combination of four cardinal humors. They are blood, phlegm, yellow bile (Safra) and black bile (melancholy). Like any other disease, acne is the result of humoral imbalance. Acne is a highly prevalent dermatologic problem, which has both physical and psychological effects. The aim of this study was to introduce the etiology of acne and its remedies from the perspective of ITM.

Evidence Acquisition:

Etiology and treatment of acne were studied and analyzed from selected medical textbooks of ITM. Some of the effective plants in these books were assessed in a table, and their anti-acne activities were compared with conventional medicine’s database.

Results:

From the perspective of ITM, considering six essential schemes for health, diet and herbal remedies as well as manipulation are recommended for acne treatment. Although the introduced plants have antibacterial, anti-inflammatory and antioxidant effects but some of them have special proven effects on acne formation process. There is also a strong relationship between digestive system and skin.

Conclusions:

This paper was rendered to show ancient Persian scholar’s point of view about acne and its treatment, and it was shown that Iranian traditional medicine has practical recommendations for acne treatment.

1. Context

Acne is a common dermatological disease highly prevalent in the age group of 12 to 25 years. It affects patients both physically and psychologically, resulting impaired psychosocial development, reduced self-esteem and emotional distress due to perceived disfigurement (1). Acne vulgaris is diagnosed by variable clinical manifestations such as white or black comedones, papules and pustules. Acne scarring is the sequel of severe cases (2). The etiology of this problem involves high sebum secretion, bacterial infection, hyperkeratinisation as well as hormonal change in the body (3). Reducing scars and erythematous lesions is the aim of treatment. Hence combination of systemic and topical agents is recommended in severe cases (4, 5). Oral Isotretinoin is the main choice of treatment in severe cases yet side effects like dyslipidemia and dry mucous membranes are usually considered (6, 7). In Iranian traditional medicine (ITM), skin and nervous system have the same origin. Skin can represent internal organs function and its duty is to protect human body from external stressors (8). Body temperature regulation is another crucial task performed by the skin in human body and small pores in the skin play important roles regarding this ability. In addition to this, skin has an ability to secrete surplus substances in different forms of discharges, and acne formation could be the result of this phenomena. According to the theory of humors in ITM, dystemperament or “Suemizaj” may occur when there is an imbalance in humoral quantity or quality (9). This humoral imbalance has very important role in acne formation. Ancient scientists believed that acne could be the result of internal organs dysfunction and all treatment strategies should include and manage internal organs (10, 11). These principles make the differences between traditional approaches and conventional medication for acne treatment. This study was conducted to determine acne etiology and the role of diet and herbal remedies and physical manipulation in acne treatment from ITM point of view.

2. Evidence Acquisition

This was a review study in which seven valid books of Iranian traditional medicine were investigated. Terminology, etiology and treatment of acne were studied and analyzed, including manuscripts between 9th and 19th centuries AD. These books included Al- Mansuri- Fi- Teb (9th-10th centuries), Canon of medicine (11th century), Mofarah- Al- Gholoub(18th century), Exir- e- Azam (19th century), Makhzan- Al- Advieh (18th century), and Al-shamiland Moalejat - e-Aghili (12th - 13th century). First, the words “acne”, “abscess”, “pustules”, “papules”, “white comedones” and “black comedones” were searched in these resources. Any subject related to acne and its treatment as well as important information about these medications was extracted from each source and notes were taken. Then animal and mineral medications as well as food materials were excluded from the results. Hence 80 herbal plants were left for the study. The medicinal plants, which were toxic or did not have certain scientific names or had several scientific names were excluded from the list, and finally 13 herbal medicines were chosen for this study. Finally, notes were put together and the required concepts were extracted, summarized and classified. These concepts were provided in the results in the form of texts and tables with different names. Electronic databases including Google Scholar, Scopus, PubMed, Web of Science, and the Cochrane library were checked with all scientific names of recommended medicinal plants separately up to December 2015. Inclusion criterion of all selected articles was provision of clinical, animal or in vitro evidence of the efficacy and pharmacological mechanisms on acne healing process. All studies, which exhibited apparent efficacy or indirect effectiveness on acne healing process, were selected for the current research. English language publications were included. The publications without available full text, unpublished data, letters to the editor, case reports and experimental studies without proven biological effects were excluded from the study. Duplication was also avoided by excluding multiple copies of the same article in different databases. The key words were scientific names of each plant in the whole text and the terms” acne healing” or “acne treatments” or “anti -oxidant” or “inflammation” in title and abstract.

3. Results

3.1. Etiology of Acne Formation

According to ITM, human body organs consist of four fundamental humors named cardinal humors including blood, phlegm, yellow bile and black bile. All of them are composed of very specific quantity and quality. Some categories of diseases result from quality or quantity change of these humors (12, 13). In Iranian traditional manuscript, there is a chapter named “Oram and Busoor”, in which physicians discuss swellings and rashes and their treatments. They described white comedo as “Busoor-e-Labnieh”. This disease was defined by Avicenna (11th ). “busoor-e - labnieh” is known as very small swelling-like milky points located mostly on the adults face (10). Actually, busoor is an abnormal swelling that can occur in any organ (11).

3.2. Acne Management Steps

Early practitioners believed that acne treatment with internal medicine approaches could reduce its recurrence significantly. They applied three main steps for acne treatment (Table 1). The first step was dietotherapy. Eating habits and types of foods can exacerbate the problem. Continuous use of some fruits and plants in daily regimen has the ability to reduce this problem. The ingested food undergoes four stages of digestion. These stages are: gastric, liver, vascular and tissue digestion (14). Stomach and liver should be strengthened properly. As a result humoral production would be balanced and proportionate and acne severity decreases prominently (15). Digestive system could be strengthened by consuming different kinds of jams, such as Ginger jam. Complete defecation is one of the treatment rules in ITM, as chronic constipation causes specific toxins accumulation in the intestinal loop and facilitates its spread all over the body (16). Medicinal plants are recommended in the second step. Plenty of medicinal plants were ordered by Iranian scientists to manage acne and its permanent scars. Table 2 shows the most recommended medicinal plants and their chemical fragments and current findings about acne treatments. In the third step, physical manipulation such as venesection, hirudotherapy and wet cupping should be applied to reduce acne scarring or hyperpigmentation.

Table 1.

Acne Treatment Principles in Iranian Traditional Medicine

Acne Treatment PrinciplesExamples
1DietotherapyIt consists of adjusting two main parts:
-Type of foods: barley, plum, pomegranate, sumac, lentil, cucurbit (they decrease skin inflammation)
-Eating habits: reducing intake of three food products, including meat, dairy and sweets in daily regimen
2Medicinal plantsThey are prescribed in order to treat and manage acne and internal problems (Table 2)
3Physical manipulationsVenesection “Fasd”, Wet cupping “Hijamat”, Hirudotherapy , Massaging, “Dalk”

4. Conclusions

According to conventional medicine, bacterial colonization, sebum secretion, hormonal change as well as follicular hyperkeratinisation are the main causes of acne formation (3). In ITM humoral imbalance is one of the etiologies of this problem. Hence, there may be an excess or deficit of these four humors. In acne treatment, like any disease in ITM, the six essential schemes (weather, food and drink, action and inactivity, retention and release, sleep and wakefulness as well as sensual states) are considered as main preventive approaches (17). The role of diet is significant in prevention and treatment in the first step. Restricted consumption of meat, dairy products and sweets reduce cystic acne formation. Legumes, cucurbit, pomegranate and barley decrease skin inflammation (10, 11). Barley consists of peptide lunasin so it has anti-inflammatory properties and is a powerful antioxidant agent (18, 19) and it can play a role in acne treatment, especially when it is consumed in patient’s daily diet. Although in conventional medicine the relationship between diet and acne pathogenesis is controversial, some articles support this idea (20). However, the effective mechanism is not clearly defined. This means that dermatologists should have enough information about the relationship between nutrients and the complexity of skin and sebum production. It is usually recommended that people with acne should restrict their consumption of chocolate and oily or fatty foods (21). Glucose-containing foods increase glycemic indexes, which lead to hyperinsulinemia and increased IGF- 1 in the body. Therefore, alteration of retinoid pathway, which mediates acne formation, occurs gradually. According to ITM, increased consumption of glucose-containing foods can disturb normal humoral production in the liver, which results in acne exacerbation (8, 10, 22). Also, digestive system strengthening aids successful acne treatment, and conventional medicine believes that there is a strong relationship between skin and digestive system. There are various types of systemic disease that involve both internal organs such as gastrointestinal tract and skin, which need to be treated at the same time, as controlling the internal disease leads to skin protection (23). Medicinal plants are the second step in acne treatment. According to conventional medicine, the major role of Propionibacterium acnes at different stages of disease, such as pro-inflammatory cytokines production and reactive oxygen species release, is well understood. Hence, anti-acne remedies should have antioxidant, antimicrobial and anti-inflammatory effects. In vitro studies have shown that flavonoids such as kaempferol and quercetin possess antibacterial activities against P. acnes (24). However, recommended medicinal plants include pomegranate, Rhus coriaria l (25), Viola tricolor, and Ficus carica and Trigonella foenum composed of quercetin and kaempferol as their main compounds. Physical manipulations such as hirudotherapy are the third step of treatments in ITM. This procedure is a well-known manipulation, especially in cosmetic surgeries in conventional medicine (26). This paper was performed to show ancient Persian scholars opinion on the acne management. Recommended diets, reported medicinal plants and physical manipulation could be valuable items for clinical trials in the future. Therefore, ITM can introduce practical treatments with lower complication for acne treatment.

Table 2.

The Most Recommended Herbs for Acne Treatment in Iranian Traditional Medicine

Plant FamilyScientific NameTraditional NamePartCurrent FindingsFraction/ Constituent
AlliaceaeAllium cepaBasalbulbOnion gel improves scar softness, redness, texture (27), tumor inhibitory effect in lab studies (28), antibiotic effect (29)Flavonols Organosulfur such as Allicin
CompositaeCichorium intybusHendabaDried leaves and root and stemAntioxidant (30), antibacterial and antifungal activity, anti- inflammation, wound healing (31)Phenolic acids Organic acid Inhibition of TNF-α Hyaluronidase and collagenase inhibition
UmbelliferaeCoriandrum sativum L.kosboraLeaves and dried ripe fruitAntiseptic, effect on gram-positive skin infection, anti inflammation (32), antioxidant, protection against UV-B induced photo aging, increases procollagen type1 (33) Linolenic acid
MoraceaeFicus caricaTinfruitAntioxidant, decreases skin melanin, increases skin hydration value, reduces sebum content (34)Phenolic compounds, gallic acid, catechins Vit C Quercetin, kaempferol, syringic acid
PoaceaeHordeum distichonShaeerseedsAnticancer, antioxidant (35), restoration of healthy skin (36)Lunasin Biotin vitamins
LinaceaeLinum usitatissimumGhortomSeedsAntimicrobial activity against acne causing bacteria, skin hydration(37)Linolenic acid Linoleic acid
CompositaeMatricaria chamomillaBabunajFlowersAnti-inflammatory effect, antioxidant effect, effective for hand dermatoses (38), immunoregulatory potential for alleviating atopic dermatitis (39), Approved by commission E: inflammation of skin, anti-microbial (40)Inhibition of leukotriene B Flavonoids GC oil α- bisabolol
LythraceaePunica granatumRommanFruitAntioxidant, anticancer and has apoptotic effects (41), protection from the adverse effects of UV-B radiation (42), inhibitory effect on pigmentation in the human skin (43), anti acne activity as compared to clindamycin (43, 44)Phenolic acids, Ellagic acid, Ellagiltannins, Estrogenic flavonols
RosaceaeRosa damascenaVard- e-ahmarFlowerAntibacterial activity against gram positive and negative (45, 46) bacteria. Antioxidant properties (47), UV absorption, anti- solar activity (48)Phenolics flavonoids
CombretaceaeTerminalia chebulaHalilehFruitPromotes cutaneous wound healing in rats (49). Anti- aging activity in vivo (50), antimicrobial activity (49-51), antioxidant (52)Tannins, Gallic acid Flavonoids
FabaceaeTrigonella foenum- graecumHolbehSeedsApproved by commission E: inflammation of the skin. The extract inhibits allergic skin inflammation as well as Th₂ mediated allergic response (53). Anti -microbial effect (54) and skin cleanser. decrease in pruritus, reduction of wrinkles, effective inhibitor of hyper pigmentation (55) Isoflavones, plant hormones and sterols diosgenin
PoaceaeTriticum vulgareHantehSeedsSignificant increase in skin hydration (56) and excellent antioxidant (57)Rich in vitamin E
ViolaceaeViola tricolor L.BanafsajFlowersAntioxidant, anti-inflammatory effect (58-60), sun protection activity (59), extract compress soothes and relive pain associated with acne (60)Flavonols (quercetin and kaempferol) Phenolic compounds, saponins, glycoside, gaultherin, salicylic compounds

Acknowledgements

References

  • 1.

    Leyden JJ. A review of the use of combination therapies for the treatment of acne vulgaris. J Am Acad Dermatol. 2003;49(3 Suppl):S200-10. [PubMed ID: 12963896].

  • 2.

    Layton A. Disorders of the Sebaceoum glands. In: Breathnash S, Griffiths C, editors. Rook's text book of dermatology. 8 ed. Hoboken, New Jersey: Wiley- Black Wel; 2010.

  • 3.

    Fried R, Friedman A. Psychosocial sequelae related to acne: looking beyond the physical. J Drugs Dermatol. 2010;9(5 Suppl ODAC Conf Pt 1):s50-2. [PubMed ID: 20518360].

  • 4.

    Oberemok SS, Shalita AR. Acne vulgaris, II: treatment. Cutis. 2002;70(2):111-4. [PubMed ID: 12234157].

  • 5.

    Ghosh VK, Nagore DH, Kadbhane KP, Patil MJ. Different approaches of alternative medicines in acne vulgaris treatment. Orient Pharm Exp Med. 2011;11(1):1-9. https://doi.org/10.1007/s13596-011-0006-6.

  • 6.

    Marqueling AL, Zane LT. Depression and suicidal behavior in acne patients treated with isotretinoin: a systematic review. Semin Cutan Med Surg. 2007;26(4):210-20. [PubMed ID: 18395669]. https://doi.org/10.1016/j.sder.2008.03.005.

  • 7.

    Enders SJ, Enders JM. Isotretinoin and psychiatric illness in adolescents and young adults. Ann Pharmacother. 2003;37(7-8):1124-7. [PubMed ID: 12841827].

  • 8.

    AgiliKhorasani MH. Kholase Al- Hekme [ in Persian ]. Qom: Esmaelian; 2006.

  • 9.

    Jackson WA. A short guide to humoral medicine. Trends Pharmacol Sci. 2001;22(9):487-9. [PubMed ID: 11543877].

  • 10.

    Kitab al- Qanun Fi al- tibb( Canon of Medicine Tehran) [in Persian]. 3. Iran: Soroosh; 1988.

  • 11.

    Shah- Arzani MA. Tibb - e- Akbari ( Akbar's Medicine). Qom, Iran: Jalal- ed- Din; 2008.

  • 12.

    Mojahedi M, Naseri M, Majdzadeh R, Keshavarz M, Ebadini M, Nazem E, et al. Reliability and Validity Assessment of Mizaj Questionnaire: A Novel Self-report Scale in Iranian Traditional Medicine. Iran Red Crescent Med J. 2014;16(3):15924. [PubMed ID: 24829785]. https://doi.org/10.5812/ircmj.15924.

  • 13.

    Farsani G, Movahhed M, Motlagh A, Hosseini S, Yunesian M, Farsani T, et al. Is the Iranian Traditional Medicine warm and cold temperament related to Basal Metabolic Rate and activity of the sympathetic-parasympathetic system? Study protocol. J Diabet Metabol Disorder. 2014;13(1):74. https://doi.org/10.1186/2251-6581-13-74.

  • 14.

    Zarshenas M, Khademian S, Moein M. Diabetes and related remedies in medieval Persian medicine. Indian J Endo Metabol. 2014;18(2):142. https://doi.org/10.4103/2230-8210.129103.

  • 15.

    Yosefi SS, Moradi Kor N, Sadeghpour O, Jokar A, Askarfarashah M. New aspects to digestive process and importance of stomach as basic cause for disease. Euro J Exp Biol. 2014;4(3):209-10.

  • 16.

    Shirbeigi L, Iranzadasl M, Mansouri P, Hejazi S, Aliasl J. Skin Aging Remedies in Traditional Persian Medicine. J Skin Stem Cell. 2015;2(1). https://doi.org/10.17795/jssc3028.

  • 17.

    Naseri M. The school of traditional Iranian medicine: The definition, origin and advantages. Iran J Pharm Res. 2010:20-3.

  • 18.

    Hernandez-Ledesma B, Hsieh CC, de Lumen BO. Chemopreventive properties of Peptide Lunasin: a review. Protein Pept Lett. 2013;20(4):424-32. [PubMed ID: 23016582].

  • 19.

    Jeong HJ, Jeong JB, Hsieh CC, Hernández-Ledesma B, de Lumen BO. Lunasin Is Prevalent in Barley and Is Bioavailable and Bioactive in In Vivo and In Vitro Studies. Nutr Cancer. 2010;62(8):1113-9. https://doi.org/10.1080/01635581.2010.515529.

  • 20.

    Spencer EH, Ferdowsian HR, Barnard ND. Diet and acne: a review of the evidence. Int J Dermatol. 2009;48(4):339-47. [PubMed ID: 19335417]. https://doi.org/10.1111/j.1365-4632.2009.04002.x.

  • 21.

    El-Akawi Z, Abdel-Latif Nemr N, Abdul-Razzak K, Al-Aboosi M. Factors believed by Jordanian acne patients to affect their acne condition. East Mediterr Health J. 2006;12(6):840-6. [PubMed ID: 17333831].

  • 22.

    Letter: "Iatrogenic": etymologic riposte. N Engl J Med. 1976;295(3):175-6. [PubMed ID: 1272346].

  • 23.

    Callen JP, Wortmann RL. Dermatomyositis. Dermatol. 2006;24(5):363-73.

  • 24.

    Mullika TC, Suvimol S, Veena SN, Wandee G. Fitotherapia 782007. p. 401-8.

  • 25.

    Azadegan H. Synergistic effect of water extract of sumac( Rhus coriaria L.) on some antibiotics against propioni bacterium acne skin isolate.Msc thesis [in Persian]. Tehran, Iran: Islamic Azad University Pharmaceutics Branch;

  • 26.

    Mamelak AJ, Jackson A, Nizamani R, Arnon O, Liegeois NJ, Redett RJ, et al. Leech therapy in cutaneous surgery and disease. J Drugs Dermatol. 2010;9(3):252-7. [PubMed ID: 20232587].

  • 27.

    Zoe DD. The ability of onion extract gel to improve the cosmetic appearance of post- surgical scars. J Cosmetic Dermatol. 2008;7(2):101-4. https://doi.org/10.1111/j.1473-2165.2008.00371.x.

  • 28.

    Arabbi PR, Genovese MI, Lajolo FM. Flavonoids in vegetable foods commonly consumed in Brazil and estimated ingestion by the Brazilian population. J Agric Food Chem. 2004;52(5):1124-31. [PubMed ID: 14995109]. https://doi.org/10.1021/jf0499525.

  • 29.

    Kim JH. Anti-bacterial action of onion (Allium cepa L.) extracts against oral pathogenic bacteria. J Nihon Univ Sch Dent. 1997;39(3):136-41. [PubMed ID: 9354029].

  • 30.

    Abbas ZK, Saggu S, Sakeran MI, Zidan N, Rehman H, Ansari AA. Phytochemical, antioxidant and mineral composition of hydroalcoholic extract of chicory (Cichorium intybus L.) leaves. Saudi J Biol Sci. 2015;22(3):322-6. [PubMed ID: 25972754]. https://doi.org/10.1016/j.sjbs.2014.11.015.

  • 31.

    Street RA, Sidana J, Prinsloo G. Cichorium intybus: Traditional Uses, Phytochemistry, Pharmacology, and Toxicology. Evid Based Complement Alternat Med. 2013;2013:579319. [PubMed ID: 24379887]. https://doi.org/10.1155/2013/579319.

  • 32.

    Casetti F, Bartelke S, Biehler K, Augustin M, Schempp CM, Frank U. Antimicrobial activity against bacteria with dermatological relevance and skin tolerance of the essential oil from Coriandrum sativum L. fruits. Phytother Res. 2012;26(3):420-4. [PubMed ID: 21815228]. https://doi.org/10.1002/ptr.3571.

  • 33.

    Hwang E, Lee DG, Park SH, Oh MS, Kim SY. Coriander leaf extract exerts antioxidant activity and protects against UVB-induced photoaging of skin by regulation of procollagen type I and MMP-1 expression. J Med Food. 2014;17(9):985-95. [PubMed ID: 25019675]. https://doi.org/10.1089/jmf.2013.2999.

  • 34.

    Khan H, Akhtar N, Ali A. Effects of Cream Containing Ficus carica L. Fruit Extract on Skin Parameters: In vivo Evaluation. Indian J Pharm Sci. 2014;76(6):560-4. [PubMed ID: 25593393].

  • 35.

    Wolosik K, Markowska A, Kuzmicz I. Lunasin--a novel chemopreventive peptide [ in Polish ]. Postepy Biochem. 2014;60(1):84-9. [PubMed ID: 25033546].

  • 36.

    Misir R, Blair R. Effect of biotin supplementation of a barley-wheat diet on restoration of healthy feet, legs and skin of biotin deficient sows. Res Vet Sci. 1986;40(2):212-8. [PubMed ID: 3704339].

  • 37.

    De Spirt S, Stahl W, Tronnier H, Sies H, Bejot M, Maurette JM, et al. Intervention with flaxseed and borage oil supplements modulates skin condition in women. Br J Nutr. 2009;101(3):440-5. [PubMed ID: 18761778]. https://doi.org/10.1017/S0007114508020321.

  • 38.

    Lee SH, Heo Y, Kim YC. Effect of German chamomile oil application on alleviating atopic dermatitis-like immune alterations in mice. J Vet Sci. 2010;11(1):35-41. [PubMed ID: 20195063].

  • 39.

    Munir N, Iqbal A, Altaf I, Bashir R, Sharif N, Saleem F, et al. Evaluation of antioxidant and antimicrobial potential of two endangered plant species Atropiabelladonna and MatricariaChamomilla. Afr J Tradit Complement Altern Med. 2014;11(5):111-7.

  • 40.

    Dikmen M, Ozturk N, Ozturk Y. The antioxidant potency of Punica granatum L. Fruit peel reduces cell proliferation and induces apoptosis on breast cancer. J Med Food. 2011;14(12):1638-46. [PubMed ID: 21861726]. https://doi.org/10.1089/jmf.2011.0062.

  • 41.

    Afaq F, Khan N, Syed DN, Mukhtar H. Oral feeding of pomegranate fruit extract inhibits early biomarkers of UVB radiation-induced carcinogenesis in SKH-1 hairless mouse epidermis. Photochem Photobiol. 2010;86(6):1318-26. [PubMed ID: 20946358]. https://doi.org/10.1111/j.1751-1097.2010.00815.x.

  • 42.

    Kasai K, Yoshimura M, Koga T, Arii M, Kawasaki S. Effects of oral administration of ellagic acid-rich pomegranate extract on ultraviolet-induced pigmentation in the human skin. J Nutr Sci Vitaminol (Tokyo). 2006;52(5):383-8. [PubMed ID: 17190110].

  • 43.

    Del Rosso JQ. Evaluating the role of topical therapies in the management of rosacea: focus on combination sodium sulfacetamide and sulfur formulations. Cutis. 2004;73(1 Suppl):29-33. [PubMed ID: 14959943].

  • 44.

    Karodi RS, Mahendrakumar CB, Bhise K. Evaluation of anti-acne activity of hydroalcoholic extract of Punica granatum Linn. J Pharma Phytoth. 2013;5(9):160-3.

  • 45.

    ozkan G. Note: Antioxidant and Antibacterial Activities of Rosa Damascena Flower Extracts. Food Sci Technol Int. 2004;10(4):277-81. https://doi.org/10.1177/1082013204045882.

  • 46.

    Tofighi Z, Molazem M, Doostdar B, Taban P, Shahverdi AR, Samadi N, et al. Antimicrobial Activities of Three Medicinal Plants and Investigation of Flavonoids of Tripleurospermum disciforme. Iran J Pharm Res. 2015;14(1):225-31. [PubMed ID: 25561928].

  • 47.

    Yassa N, Masoomi F, RohaniRankouhi SE, Hadjiakhoondi A. Chemical composition and antioxidant activity of the extract and assential oil of Rosa Damascina from Iran, population of Gilan [in Persian]. Daru. 2009;17:175-80.

  • 48.

    Tabrizi H, Mortazavi SA, Kamalinejad M. An in vitro evaluation of various Rosa damascena flower extracts as a natural antisolar agent. Int J Cosmet Sci. 2003;25(6):259-65. [PubMed ID: 18494908]. https://doi.org/10.1111/j.1467-2494.2003.00189.x.

  • 49.

    Li K, Diao Y, Zhang H, Wang S, Zhang Z, Yu B, et al. Tannin extracts from immature fruits of Terminalia Chebula fructose Retz. promodecutaneus wound healing in rats. BMC Complementary Altern Med. 2011;11(86). https://doi.org/10.1186/1442-.

  • 50.

    Manosroi A, Jantrawut P, Akihisa T, Manosroi W, Manosroi J. In vitro and in vivo skin anti-aging evaluation of gel containing niosomes loaded with a semi-purified fraction containing gallic acid from Terminalia chebula galls. Pharm Biol. 2011;49(11):1190-203. [PubMed ID: 22014267]. https://doi.org/10.3109/13880209.2011.576347.

  • 51.

    Ahmad I, Beg AZ. Antimicrobial and phytochemical studies on 45 Indian medicinal plants against multi-drug resistant human pathogens. J Ethnopharmacol. 2001;74(2):113-23. [PubMed ID: 11167029].

  • 52.

    Aqil F, Ahmad I, Mehmood Z. Antioxidant and free radical scavenging properties of twelve traditionally used Indian medicinal plants. Turkish J Biol. 2006;30(3):177-83.

  • 53.

    Bae MJ, Shin HS, Choi DW, Shon DH. Antiallergic effect of Trigonella foenum-graecum L. extracts on allergic skin inflammation induced by trimellitic anhydride in BALB/c mice. J Ethnopharmacology. 2012;144(3):514-22. https://doi.org/10.1016/j.jep.2012.09.030.

  • 54.

    Abdel- Massih R, Abdou E, Baydoun E. Antibacterial activity of the extracts obtained from Rosmarinus officinalis, Origanummajorana, and Trigonella foenum- graecum on highly drug- resistance gram negative bacilli. J Botany. 2010.

  • 55.

    Dweck AC. Isoflavones, phytohormones and phytosterols. J ApplCosmetol. 2006;24:17-33.

  • 56.

    Guillou S, Ghabri S, Jannot C, Gaillard E, Lamour I, Boisnic S. The moisturizing effect of a wheat extract food supplement on women's skin: a randomized, double-blind placebo-controlled trial. Int J Cosmet Sci. 2011;33(2):138-43. [PubMed ID: 20646083]. https://doi.org/10.1111/j.1468-2494.2010.00600.x.

  • 57.

    Kapoor S, Saraf S. Assessment of viscoelasticity and hydration effect of herbal moisturizers using bioengineering techniques. Pharmacogn Mag. 2010;6(24):298-304. [PubMed ID: 21120032]. https://doi.org/10.4103/0973-1296.71797.

  • 58.

    Rimkiene S, Ragazinskiene O, Savickiene N. The cumulation of Wild pansy (Viola tricolor L.) accessions: the possibility of species preservation and usage in medicine. Medicina (Kaunas). 2003;39(4):411-6. [PubMed ID: 12738912].

  • 59.

    Khazaeli P, Mehrabani M. Screening of sun protective activity of the ethyl acetate extracts of some medicinal plants. Iran J Pharma Res. 2010;7(1):5-9.

  • 60.

    Kapoor S, Saraf S. Topical Herbal Therapies an Alternative and Complementary Choice to Combat Acne. Res J Med Plant. 2011;5(6):650-9. https://doi.org/10.3923/rjmp.2011.650.669.