Though science and ingredient technology have produced multiple treatments shown to help with acne, many of the best, and most effective, acne ingredients come from nature. While isolated chemical components and patented delivery systems claim to have a more concentrated and direct action on the problem, absorption and bioavailability are constant and complex issues. While natural ingredients (such as herbs, clays, carrier oils, and essential oils) might seem simpler and not as advanced as some of the science-based products on the professional market, sometimes simpler is better.

“Outside the United States, the World Health Organization reports that 75 to 85 percent of the world's population continues to rely on botanical medicines dispensed by traditional healers for primary healthcare, as they have always done.”¹ Though not all of these plants have been proven by empirical research to prevent or treat acne, many of them have centuries to millennia of traditional wisdom and anecdotal evidence of efficacy behind them.

WHY WHOLE PLANTS?

Humans have utilized plants for healing and health since the beginning of their existence. Plants themselves are most effective for skin and overall health when they are used in a form as close to whole as possible. Science has begun to study the benefits and efficacy of individual phytochemical constituents on the skin, such as isolated antioxidants branded as Resveratrol^® Pycnogenol^®, as well as amino acids and peptides. While these, in addition to isolated vitamins and minerals, may have measurable benefits, absorption and delivery are often an issue because when an individual part is separated from the whole, its benefits begin to degrade and its bioavailability is reduced. Ingredients like these need to be packaged into phospholipids and other delivery systems and preserved before they are added to a formulation.

Why does this happen? The reason is that though certain components of plants may show more benefit than others, those “others” may in fact be important nutrients which serve cofactors for the vitamin or phytochemical desired in the formulation. Cofactors are “‘helper molecules’ that help in the biochemical transformations.”² Coenzymes are a type of cofactor, and for the purposes of this article, will be referred to as cofactors. They are needed to enhance the star nutrient’s bioavailability – meaning its ability to be recognized, absorbed, and utilized by the body. Skin care nutrition that is introduced to the skin in a form as close to whole as possible, with the least amount of processing possible, contains the necessary cofactors for bioavailability and, therefore, efficacy.

Consider vitamin A as an example. Retinols and other vitamin A metabolites and precursors are some of the most common and most controversial ingredients in skin care. Though there are known, scientifically proven benefits of vitamin A for various skin conditions including acne, there are problems with many forms of vitamin A used in skin care. The most commonly used retinols in over-the-counter products are low quality. Higher quality, cosmetic grade retinols (retinyl palmitate, pro-retinol) have concerns with absorption, leading to topical oxidation and inflammation, in addition to phototoxicity. Pharmaceutical retinoids, such as tretinoin and retinoid acid, are known to be skin irritant, drying, and phototoxic. Other vitamin A precursors, such as retinaldehyde and retinyl propionate, are known to be less sensitizing and more bioavailable, but are less stable and more expensive – and while the skin is able to store these more than other retinols, these may still be too strong and sensitizing for some people. However, properly extracted plant oils that naturally contain carotenoid antioxidants plus cofactors (such as carrot seed oil, rosehip seed oil, sea buckthorn oil, sunflower seed oil, and others) are easily recognized by the skin, and since many are oils, are more likely to absorb than water-soluble actives can without further processing.

The same action is demonstrated in the world of nutrition. While certain individual vitamins show benefit for specific health benefits (vitamin C’s positive effect on the immune system, for example), taking a vitamin in supplement form is not as effective or as bioavailable as consuming it in a whole food form (eating citrus fruits, for example). And like with supplements, not all individual skin nutrients and chemicals are created equal. The purity, quality, solubility, and many other factors determine efficacy and bioavailability.

One of the main causes of acne is vitamin deficiency, “either because not enough of the vitamin is obtained from dietary sources (primary deficiency) or because there is a problem with the absorption, transportation, or utilization of the vitamin (secondary deficiency).”³ Common deficiencies associated with acne are vitamins A, B complex, C, D, E, and K, in addition to mineral deficiencies of zinc and selenium. Vitamins A and D are cofactors of zinc; vitamin K is a co-factor for vitamin D; many of the B vitamins are cofactors for each other; and so on.

In the plant world, the whole is always greater than the sum of its parts, and the parts depend on each other. The whole human body will always benefit more from whole plant and whole food nutrition – topically and internally. Thus, it is possible to use food and plants as medicine. In the United States, however, most plants are not considered medicine.

While traditional healers, medicine men, and wise women are experts in herbology and can apply herbal wisdom to heal conditions, such as acne, without going to medical school or studying pharmacology, the laws in the United States are different. Though organizations exist that offer certifications and accreditations for the study of clinical herbology and clinical aromatherapy, herbalists and aromatherapists are not considered licensed medical professionals and cannot legally dispense herbs to heal certain conditions. They cannot refer to herbs and other natural ingredients in a way that implies that the plants can cure a disease or condition. They are limited to what words they can use to describe what the plants do in a similar way to how aestheticians are limited to cosmetic terminology.

Acne itself — and its different stages — is considered a disease of the skin which must technically (and legally) be diagnosed and treated by a licensed medical professional. However, there are multiple aesthetic treatments and products that can help support the skin (and the client) during the healing process and improve the appearance of acne and acne scars.

This is an important distinction, because though some professional skin care products contain ingredients that have been FDA-approved as over-the-counter acne medications, the majority of skin care products do not. They are cosmetics — even those marketed exclusively to and sold by professionals — and must be used and referred to using cosmetic terminology within the scope of an aesthetics license.

This can be frustrating because many ingredients (natural and synthetic) have shown antibacterial properties and efficaciousness in preventing and eradicating acne, as well as reducing scars. However, an aesthetician (or product manufacturer or representative, for that matter), legally must not imply that cosmetics produce drug-like reactions on the skin.

Over the past several years, the FDA has begun to pay more attention to claims made by product manufacturers and unlicensed medical professionals, especially regarding natural ingredients like herbs and essential oils. They have sent out warning letters and assessed fines, which can be devastating for a small business owner. Thus, it must be noted that all herbal recommendations in this article are for informational purposes only and must be used within the scope of aesthetics.

OTHER REASONS TO USE HERBS FOR ACNE

When taken internally, many herbs help to support the detoxification pathways in the body, particularly the liver and lymphatic system. Keeping these pathways clear and moving is essential for clear skin, because the skin itself is a detoxifying organ. While there is conflicting research on whether or not the skin takes on extra detoxification responsibilities when the liver and other detoxing organs and systems of the body are overloaded, there is research that indicates a causal relationship between non-alcoholic fatty liver disease (NAFLD) and acne.⁴ While the causes of NAFLD are related to diet and lifestyle, supporting liver health with herbs may certainly have a protective effect on the skin when it comes to acne.

When taken topically and internally, the naturally occurring sugars and fibers in herbs act as prebiotics, which support healthy gut and skin microbiota. Skin health and gut health are intimately linked and the health of both is largely reliant on a strong and diverse population of beneficial bacteria and fungi. These beneficial microflorae are commonly known as probiotics. While it is possible to supplement the gut directly with probiotics in the form of supplements and raw, fermented foods, topical application of probiotics has limited efficacy. This is due to the fact that most strains will die off once a preservative is applied during formulation, or after being bottled and stored. What is left will actually be prebiotics, but it is not necessary to go through this process (which can be unpredictable and expensive) to get prebiotics for topical use. Topical herbal preparations serve as excellent prebiotics to nourish the skin’s microbiome. “In cosmetic formulations, prebiotics can be applied to the skin microbiota directly and increase selectively the activity and growth of beneficial ‘normal’ skin microbiota.”⁵ Little is currently known about the efficacy of topically applied prebiotics, since this is a fairly new area of research; however, ongoing research of the skin’s microbiome and what can be used to fortify it is underway. “Nutritional products containing prebiotics and/or probiotics have a positive effect on skin by modulating the immune system and by providing therapeutic benefits for atopic diseases.”⁵

Continuing the discussion of the link between gut health and skin health, proper digestion is essential for a healthy gut, as well as the body’s ability to detoxify itself on a consistent basis. Many herbs, when taken regularly, have been shown to support healthy digestion; and, thus, will also support clear, healthy skin.

Many herbs, oils, and essential oils have naturally occurring antimicrobial properties that have shown efficacy in inhibiting the growth of bacteria, as well as other pathogens that might contribute to acne. Plants naturally containing phenolic compounds, specifically, seem to provide the most natural antibacterial properties, though more research is needed to determine their specific action, as well as how much of the plant and what percentage of the compound is necessary to combat the Propionibacterium acnes and Staphylococcus aureus bacteria and other microbes that contribute to acne vulgaris.⁶

Another way herbs work to improve acne is because many have naturally soothing and calming properties. Inflammation – both internally, as well as topically – is a strong contributing factor for acne, in addition to other skin conditions. So, introducing naturally anti-inflammatory herbs, both to the diet and to the topical skin care regimen, are beneficial.

Some herbs with solid evidence for their antibacterial, antifungal, and anti-inflammatory benefits specifically studied for acne include, but are not limited to, Roman and German chamomile (Matricaria recutita), calendula (Calendula officinalis), witch hazel (Hamamelis virginiana), white oak bark (Quercus alba), lavender (Lavandula angustifolia), dandelion (Taraxacum officinale), St. John’s wort (Hypericum perforatum), green tea (Camellia sinensis), onion and garlic extracts (Allium Cepa and Allium Sativum), CBD and hemp seed oil (Cannabis sativus), purple coneflower (Echinacea purpurea), tea tree (Melaleuca alternifolia), rosemary (Rosmarinus officinalis), and neem (Azadirachta indica).

Herbs to take internally, either as a tea or extract, to help the body fight acne include milk thistle (Silybum marianum), schisandra (Schisandra chinensis), gotu kola (Centella asiatica), burdock root or seed (Arctium lappa), ginger (Zingiber officinalis), and chasteberry (Vitex angus-castus).

Must-have herbs to have in a topical acne apothecary include calendula (Calendula officinalis), elderflower (Sambucus nigra), rose (Rosa rugosa or Rosa damascena), lavender (Lavandula angustifolia) and chamomile (Matricaria chamomilla).

COMMON WAYS TO INCORPORATE HERBS IN SKIN CARE

There are numerous ways to incorporate herbs into a healthy skin regimen, such as infusions, herbal compresses, and steam.

Infusions and Decoctions, Also Known as Herbal Teas

Both infusions and decoctions use boiling water to extract therapeutic properties from whole plant matter – either dried or fresh. For an infusion, water is first brought to a boil, then removed from the heat. The plant matter is steeped in the boiling water for 20 minutes before being strained out. This method is best for more fragile plant parts such as leaves, flowers, and soft stems.

For a decoction, the water is brought to a boil, then the plant matter is added to the boiling water, where it remains for 20 minutes before it is removed from the heat and the spent plant matter strained out. This method is better for harder and more resilient plant parts like roots, fibrous stems, and seed pods. These may be used topically or taken internally as tea, and may also be used in some Lucas sprayers and steamers (check with the equipment manufacturer to ensure these are appropriate for use in the machine). These must be used quickly, as they will harbor microbial growth. They may be stored in the refrigerator in a closed jar, and used within three days.

Herbal Extracts (Tinctures or Glycerites)

Extracts are made when fresh or dried plant matter — typically the roots, stems, leaves, or flowers — are added to a liquid solvent (usually ethanol; vinegar, though it is rarely used topically; glycerine; or butylene glycol), which extracts concentrated amounts of the therapeutic benefits of the plant. These may be diluted and taken internally in most cases, applied directly to the skin topically (referred to as a liniment), or used as skin care ingredients within a formulation. Extracts are stronger than infusions or decoctions (though glycerites are very gentle), and, in many cases, are able to remove components of the plant that infusions and decoctions cannot. These should be stored in dark, glass jars; away from heat, light, and moisture; and should be used within a year.

Herbal Oils (Infused or Macerated)

Infused, or macerated, oils are made similar to herbal extracts wherein the plant matter is added to a solvent; though, in this case, the solvent is a carrier oil. Common oils used for herb infused oils are jojoba, olive, and sunflower. The oil, with the help of heat (either from the sun, a simmering double boiler, or a slow cooker) extracts the therapeutic components from the plant. These phytochemicals then synergistically blend with those already present in the carrier oils themselves to create highly bioavailable plant medicine. It is best to use dried plant matter to prevent mold growth due to water contamination. Once the plant matter is removed, the infused oils need to be stored similarly to herbal extracts: in dark, glass jars; away from heat, moisture, and light; and used within one year. It is also helpful to add an antioxidant, such as rosemary oleoresin or vitamin E oil, to help prevent rancidity and degradation of the phytochemicals.

Herbal Compresses and Poultices⁷

A poultice resembles a large teabag or burrito. It is simply fresh or dried herbs wrapped or folded into cheesecloth, gauze, or muslin and dampened with warm water. Apply this directly to the skin for 10 to 15 minutes at a time (depending on the herb). Compresses are made by soaking strips or squares of fabric (can be a washcloth or small towel) in a hot tea (infusion) or tincture and applied to the skin for 10 to 20 minutes. These treatments are great for softening the skin, drawing out toxins and impurities, and delivering the plant’s healing properties directly into the skin. depending on the herbs used, use caution around the eye area. The nostrils and mouth should be left uncovered for easy breathing.

Herbal Steam⁷

Steam is often used in facial treatments in spas to soften the follicles and help the products used during the treatment penetrate the deeper layers of the skin. People can use herbs for skin care at home simply by steaming skin over a pot of boiling water infused with fresh or dried herbs and flowers. The steam releases and carries the healing properties of the plants and soothes the skin. Steam is contraindicated for extremely inflamed acne, or acne associated with rosacea; in this case, a cool infusion may be delivered in the form of a compress or in a Lucas sprayer.

Aromatherapy

Essential oils are extremely popular now and are often used topically and in an aroma therapeutic sense, both in the treatment room and at home. Most essential oils on the market are extracted using the steam distillation method, though some are cold pressed, solvent extracted, or obtained using supercritical CO₂ extraction method. Essential oils are extremely concentrated – up to 70 percent more concentrated than other herbal preparations – and contain highly volatile plant compounds. Because of this, they must be highly diluted in a carrier oil for topical use. Many clinical aromatherapists advise against using them on the face at all, though many advise safe usage for some essential oils up to two percentage concentration. Though some essential oil companies claim their oils are safe to use at full strength due to supposed purity, this is not advisable because, over time, sensitization and permanent intolerance of that plant’s compounds may occur. Furthermore, it is completely unnecessary to use essential oils at high concentrations, because only a minute amount is necessary for the therapeutic benefit to occur. Essential oils are oil-soluble and should not be added directly to water, as they will separate. The proper aromatherapeutic preparations to use in water are hydrosols, hydrolats, or distillates – also obtained through the steam distillation process. These contain the same therapeutic benefits as the essential oils do, but are far less concentrated, may be used safely at full strength, and run far less risk of sensitization or intolerance.

CONTRAINDICATIONS AND RESPONSIBLE USE OF PLANTS FOR THE SKIN

Though many herbs, essential oils, and carrier oils have few reported side effects, allergies and reactions may occur with anyone, at any time. It is important to ask about allergies (particularly to ragweed and other seasonal allergies) during the client consultation, prior to using or recommending any plants. Be aware that anyone can be allergic to anything at any time, regardless of allergy history or past allergy test results. Patch testing is always a good idea.

Phototoxicity is another legitimate concern. Be careful with herbs in the citrus or mint families, topical application of St. John’s wort, any herbs containing high amounts of vitamins A or C, or furocoumarins during the daytime. Always recommend using sunscreen, free from vitamins A and C, during the day when outdoors.

If taking pharmaceutical medicine, consult with a health professional versed in both herbal and pharmaceutical medicine to check for interactions. Conventional medical doctors and pharmacists often will not have accurate knowledge of the effects of herbs or potential drug interactions. Naturopathic, integrative, and functional medical doctors, as well as Chinese and Ayurvedic medical doctors, are more likely to have had this type of training.

If a client is pregnant, breastfeeding, has an open wound, or has been diagnosed with infection or disease (including acne), it is best to check with a licensed health professional or clinical herbalist before utilizing herbs.

Due to the increased popularity of aromatherapeutic and herbal remedies in general, it is increasingly important to use herbs mindfully and sparingly. Many precious medicinal herbs are now in danger of extinction due to overharvesting without replanting. Always source herbs, or purchase herbal professional products, from companies that harvest their plants ethically and sustainably.

References

1. McKenna, D. “How Long Have Humans Used Botanicals?” Taking Charge of Your Health & Wellbeing, University of Minnesota, www.takingcharge.csh.umn.edu/explore-healing-practices/botanical-medicine/how-long-have-humans-used-botanicals.

2. “Differences Between Cofactor and Coenzyme.” Difference Between Similar Terms and Objects, Difference Between, 26 Dec. 2013, www.differencebetween.net/science/biology-science/differences-between-cofactor-and-coenzyme/.

3. “Vitamin Deficiency and Acne.” Vitamin Deficiency and Acne - ProgressiveHealth.com, Progressive Health, www.progressivehealth.com/acne-vitamin-deficiency.htm.

4. Wolfstein, R. “Is A Toxic Liver The Real Cause Of Acne?” Supernatural Acne Treatment, Supernatural Acne Treatment, 8 Feb. 2016, supernaturalacnetreatment.com/is-a-toxic-liver-the-real-cause-of-acne/.

5. Al-Ghazzewi, F H, and R F Tester. “Impact of Prebiotics and Probiotics on Skin Health.” Beneficial Microbes., U.S. National Library of Medicine, 1 June 2014, www.ncbi.nlm.nih.gov/pubmed/24583611.

6. Nasri, H., et al. “Medicinal Plants for the Treatment of Acne Vulgaris: A Review of Recent Evidences.” Jundishapur Journal of Microbiology, Kowsar, Nov. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4740760/.

7. Pontillo, R. “5 Ways Herbs Can Save Your Skin.” Rachael Pontillo, Holistically Haute, 8 Oct. 2014, R.com/herbs-for-skin care/.

8. Pontillo, R. “The Importance of Whole Food Nutrition in Your Skin care Products.” Rachael Pontillo, Holistically Haute, 19 Aug. 2017, rachaelpontillo.com/whole-food-nutrition-skin care-products/.

Rachael Pontillo is the bestselling author of Love Your Skin, Love Yourself, and co-author of the cookbook, The Sauce Code. She is an award winning AADP board-certified holistic health and image coach, certified metaphysical practitioner, licensed aesthetician, natural skin care formulator, and educator. She is the creator of the popular blog and lifestyle site, holisticallyhaute.com, and the six-week online course, Create Your Skin care™. Pontillo is a recipient of the Institute for Integration®’s esteemed Health Leadership Award and is also a brand ambassador and spokesperson for NeoCell™. Pontillo is currently working towards a Ph.D. in Holistic Life Counseling.