Archives of Medicine and Health Sciences

MEDICAL HISTORY
Year
: 2019  |  Volume : 7  |  Issue : 2  |  Page : 293--297

History of acne vulgaris and topical drugs in Unani medicine


Shabnam Ansari 
 Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi, India

Correspondence Address:
Dr. Shabnam Ansari
Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi
India

Abstract

Acne is a common skin disorder that affects both adolescents and adults. Acne vulgaris affects about 85% of teenagers and may continue to adulthood. There are about two million visits to physicians per year for teenagers and the direct cost of acne treatment in the US exceeds $1 billion per year. Psychological, social, and emotional impairments that result from acne have been estimated to be equal and in some instances higher than that of diabetes, arthritis, epilepsy, and asthma. There is no ideal treatment for acne until now. Conventional drugs are associated with recurrence of acne and disastrous side effects on long-term usage. Unani medicines are gaining increased popularity due to their advantages, such as better patient tolerance, long history of use, fewer side effects, and relatively less expensive. Furthermore, they have provided good evidence for the treatment of a wide variety of difficult-to-cure diseases. More importantly, other than consumption as preventive or treatment remedy, they might be accompanied by synthetic drugs to reduce their side effects. Topical Unani drugs are an important part of the treatment strategy in dealing with acne. Many Unani topical drugs with anti-inflammation, wound healing, and antibacterial activities are used in different ways in the treatment of acne and other infective diseases. The present paper presents a list of topical Unani drugs used in the prevention and treatment of acne vulgaris for centuries.



How to cite this article:
Ansari S. History of acne vulgaris and topical drugs in Unani medicine.Arch Med Health Sci 2019;7:293-297


How to cite this URL:
Ansari S. History of acne vulgaris and topical drugs in Unani medicine. Arch Med Health Sci [serial online] 2019 [cited 2020 May 25 ];7:293-297
Available from: http://www.amhsjournal.org/text.asp?2019/7/2/293/273057


Full Text



 Introduction



Acne is a chronic inflammatory disease of the pilosebaceous unit resulting from androgen-induced increased sebum production, altered keratinization, inflammation, and bacterial colonization of hair follicles on the face, neck, chest, and back by Propionibacterium acnes.[1] Although early colonization with P. acnes and family history might have important roles in the disease, exactly what triggers acne and how treatment affects the course of the disease remain unclear.[2],[3] Other factors such as diet have been implicated, but not proven. Facial scarring due to acne affects up to 20% of teenagers. Acne can persist into adulthood, with detrimental effects on self-esteem.[1],[3] Acne lesions often leave lifelong scars and hyperpigmentation. Both scarring and hyperpigmentation may result in substantial disfigurement that can affect the patients' self-image, impacting considerably on their emotional health and quality of life.[2] Comparisons with other chronic illnesses have shown that acne patients have levels of social, psychological, and emotional impairments that are similar to those reported by patients with more serious diseases such as asthma, epilepsy, diabetes, back pain, or arthritis.[3] It is necessary to find an effective treatment to reverse this social and psychological disability.

 Background



According to epidemiological studies, acne is a common condition affecting 80% of young people between 12 and 18 years of age as well as 5% of females and 1% of males in adulthood. It is also the most common reason for consultation in private dermatology practices.[1] The average age of onset of acne is 11 years in girls and 12 years in boys.[4],[5] Acne is increasing in children of younger ages, with the appearance of acne in patients as young as 8 or 9 years of age. This trend toward earlier development of acne is thought to be related to the decreasing age of onset of puberty that has been observed in the United States.[6] Acne is more common in males in adolescence and early adulthood, which is a trend that reverses with increasing age.[7],[8] It is well known that adult acne is more common in women. Adult acne typically represents chronic acne persisting from adolescence, not new-onset disease. Acne ranks second only to skin ulcers and wounds in annual cost burden for dermatologic illness. A typical aspect of acne is the lesional pleomorphism with different lesions simultaneously present in the same patient.[4],[7],[8]

There is no ideal treatment for acne, although a suitable regimen for reducing lesions can be found for most patients. Good-quality evidence on the comparative effectiveness of common topical and systemic acne therapies is scarce. Topical therapies including benzoyl peroxide, retinoids, and antibiotics when used in combination usually improve control of mild-to-moderate acne.[1],[2] Treatment with combined oral contraceptives can help women with acne. Patients with more severe inflammatory acne usually need oral antibiotics combined with topical benzoyl peroxide to decrease antibiotic-resistant organisms. Oral isotretinoin is the most effective therapy and is used early in severe disease, although its use is limited by teratogenicity and other side effects. Availability, adverse effects, and cost limit the use of photodynamic therapy. New research is needed into the therapeutic comparative effectiveness and safety of the many products available and to better understand the natural history, subtypes, and triggers of acne.[1],[2],[7],[8]

 Acne Vulgaris in Unani Medicine



In Unani literature, the description, pathology, and treatment of acne vulgaris are present under the title of disease entity “basoore labaniya.” The meaning of “Basoor” in Arabic is “boil” and the meaning of “labaan” is “milk.” Due to the resemblance of the lesion (boils) to a point of milk, it is called “basoore labaniya.”[9] In acne vulgaris, the word “acne” probably came from the Greek for a “point” and “vulgaris” in Latin word meaning “common” because a person is more likely to develop acne than any other disease and the resemblance of acne lesion to a point is also called “acne vulgaris.”[10] According to classical Unani literature, Basoor (acne) is a type of warm (inflammation) which differs only in size. Acne is a small type of a warm. Ibn Sina (AD 980–1037) in his famous encyclopedia “Al Qanoon Fit-tibb” described the disease as sometime whitish boils appear at the nose and cheeks, resembling “nuqtae-labaan” (milk drop/point).[10] Other Unani physicians such as Tabri (AD 985) and Azam Khan (AD 1917) have defined the disease that mostly occurs at puberty, on the face and cheeks as whitish basoor (boil) appear like a “nuqtae sheer” (point or drop of milk) and upon squeezing, an oily secretion comes out like roghan-e-zard (ghee). In the classical Unani text “Kitab al-Hawi” by Zakariya Razi, it is mentioned as Atiasoos – “small and dry basoor of face”. It is hard and chronic in natural course.[10],[11],[12] According to Qarshi, it is a muttaaddi (infectious) disease in which small white eruptions appear on the face, nose, and cheeks and on pressing a cheesy material expressed out from it.[11]

The etiology is considered to be madda-e-sadeediyah (suppurative material), which comes toward the skin surface due to bukharat (vapors) of the body and is not resolved in the skin due to its viscosity. In other words, the yellow pus (madda-e-sadeediyah) originates due to the bukharat-e-badan (vapors) and later gets shifted toward skin and clog the pores.[10],[11],[12] The Unani scholars have pointed multifactorial etiology for the development of acne. Impurity in blood, hot and spicy food, indigestion, pregnancy, and menstruation are some of the causes. According to Hippocrates, variation in heat and moisture and climatic changes cause the imbalance of humors. Balance is restored using opposite treatment of heat and moisture in the diet and in hygiene.[13] The nature of eruption depends on the type of humor involved. When the eruption is limited to face and around the nose, white colored and without itching is called as basoore labaniya. The humor involved is balgham (phlegm). When the phlegm is viscid and thick, pus is formed.[11],[13] According to Tabri (AD 985), in his book of 10th cent AD “Firdausul Hikmat,” the lesion kooks red and swollen after it get ripped, “sadeed” (pus) and “keel” come out.[12] As per Azam Khan and Ibne Sina, on squeezing these lesion, a cheesy material like “Ghee” comes out from it.[9],[11] According to Kabeerudin, if pustules does not stop recurring or if the quantity of the “sadeed” (pus) is high, then after healing, they leave permanent scar. If “ghudade duhaniya” gets destroyed, hair does not grow there again.[11]

Similarly, a severe variety of acnes are also mentioned in Unani literature followed by therapies for prevention and treatment. The line of treatment of acne is based upon the root cause of the disease as per the dominated humors. “Istafragh” (Evacuation) and “Tanqiyah-e-badan” (detoxification) by systemic drugs such as joshanda aftimoon or habbe ayarij “Musaffiyate khoon” (blood purifiers) are also advised. Indigestion, constipation, and menstrual irregularity are treated. Topical formulation to prevent excessive oiliness and to provide cleansing, soothing, alleviating inflammation and swelling, healing pustules and wounds, and lightening scars have been mentioned.[9],[11],[12] Hence, traditional drugs from AYUSH side can be utilized in place of allopathic drugs to prevent and control acne reoccurrence.

 Topical Unani Drugs



Unani physicians have been treating acne vulgaris for centuries. Unani system of medicine provides a treatment approach based on the use of oral blood purifiers and alteration of abnormality of a specific humor along with usage of topical Unani drugs which are anti-inflammatory, analgesics, wound healer and with detergent property altogether best tolerated by adolescents and adults. Several topical drugs are mentioned in the treatment of acne in Unani classical text. Some of which are mentioned in [Table 1].{Table 1}

Compound topical formulations for acne in Unani medicine:

Tiryaq muhasa[42]Dawae bassor labani[17]Tilae akbar[29]Zimad muhasa[22]Tilae muhasa[53]Habbe kalaf[13]Zimad majali[13]Dawae muhasa[13]Dawae chuhara[13]Ubtan ajeeb.[13]

 Conclusion



Acne vulgaris is a very common skin disorder which can present with inflammatory and noninflammatory lesions chiefly on the face but can also occur on the upper arms, trunk, and back. Acne vulgaris is an inflammatory disorder of the pilosebaceous unit, which runs a chronic course and it is self-limiting. Acne vulgaris is triggered by P. acnes in adolescence, under the influence of normal circulating dehydroepiandrosterone. Acne vulgaris is a chronic condition affecting more than 85% of adolescents and two-third of adults aged 18 years and older. Patients experience psychological burdens such as depression, anxiety, and low self-esteem because of acne. A wide variety of treatment regimens exist for acne vulgaris including benzoil peroxide, retinoids, isotretinoids, keratolytic soaps, alpha hydroxy acids, azelaic acid, salicylic acid as well as hormonal, anti-androgen or anti-seborrheic treatments. The direct injection of steroids into inflamed cysts, microdermabrasion, chemical peels, radiofrequencies, light, or lasers have been shown to result in the relief of acne; however, none of these regimens are free of side effects. Furthermore, more investigations are needed to clarify the exact role of these methods in therapy. Long usage of antibiotics causes antibiotic resistance and gastrointestinal and kidney disorders. Other the other hand, Unani medicine provides a cost-effective traditional prevention and treatment approach with negligible side effects upon long-term usage. Oral usage of blood purifying plants is indeed a common strategy in combating the disease. Topical Unani drugs are also extensively used in the treatment of different varieties of acne including the scars. Some of the Unani drugs are used singly or used in combination with other drugs (compound) in paste, ointment, oil, or liquid form. Sometimes, these drugs are used alone or in combination with allopathic drugs to treat diseases. The single Unani drugs such as dill, European birthwort, milkvetch, margosa tree, lemon, coriander, mango ginger, fig, fumitory, black hellebore, iris, henna, Indian kamala, minimum/vermilion, black cumin, olive, screw pine, bitter almond, pomegranate flowers, radish, and rose water and compound topical preparation such as tiryaq muhasa, dawae bassor labani, tilae akbar, zimad muhasa, tilae muhasa, habbe kalaf, zimad majali, dawae muhasa, dawae chuhara, and ubtan ajeeb have been used by Unani physicians for local application on acne lesion since centuries with beneficial outcomes. Hence, clinical studies should be conducted on the line of mentioned Unani treatment to substantiate their efficacy in prevention and control of acne vulgaris.

Acknowledgments

The author is thankful to the librarian and library assistant of the department of moalajat and school of Unani medicine, Jamia Hamdard, New Delhi.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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