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An Ancient Solution for Modern Acne
Christopher C. Brown M.D.
Medical Director; Dermazone Solutions

As an internal medicine and infectious disease specialist in private practice, I have treated numerous patients with acne. While the treatment armamentarium is substantial, I am always interested in new and novel approaches to this frustrating disorder.
The frustrations of treating acne stem from variable treatment responses, delayed responses and concerns for the potential of treatment toxicities. In addition, when positive results are achieved, they are often “partial” rather than “complete.” Given the concern in today’s world of drug-resistant bacteria, newer formulations of topical or systemic antibiotics do not appear to be the answer.
These frustrations have fueled a broad-based exploration and interest in “natural” or “alternative” therapies. When I ask patients, their families and other physicians what kind of treatment they would like to see for acne, the responses are remarkably similar. They want non-toxic agents, which are topical, affordable and preferably “natural.” They also want agents that act rapidly, are cosmetically acceptable, and have a sustained response. The practicality and efficacy of “natural” acne products may be more realistic than previously thought. After we discuss the mechanics of acne, we will focus on one ancient “natural” agent which holds promise for the safe and effective treatment of this frustrating disease.

Acne is a disorder of the skin, specifically the pilosebaceous unit.

Acne has been with us since ancient times. The first use of the term “acne”, (“acme” in Greek, meaning peak) was by Aetius Amidenus, court physician to Emperor Justinian. While the term became obsolete in the middle Ages, by the 1800’s it occurred regularly in medical dictionaries. Acne is primarily, but not exclusively, a problem of adolescence, occurring in over 80% of individuals in this age range. The clinical spectrum is broad, ranging from barely noticeable minimal facial acne to “acne fulminans”, a scarring, cosmetically catastrophic disorder with systemic manifestations, including bone involvement, fevers, enlargement of spleen, liver, and significant prostration.
Acne is a disorder of the skin, specifically the pilosebaceous unit. This unit consists of a hair within a hair follicle, around which is wrapped a sebaceous gland which produces sebum, consisting of ceramides, triglycerides, sterols, esters, squalenes and free fatty acids. Sebum production is increased as a consequence of the hormonal changes of puberty.

This effect is seen in both males and females. A comedone (blackhead or whitehead) occurs when excess sebum builds up and blocks the hair follicle. This blockage is also contributed to by excess keratinization, or increased proliferation and retention of epithelial cells, occurring in the hair follicle.
The normal microbial flora of the hair follicle includes a variety of bacteria; (Staphylococcus epidermidus, P acnes, Propionibacterium ovale) as well as fungi (Malessezi species.). The increase in sebum results in overgrowth of P acnes, which feeds on the excess sebum. This process increases the production of various fatty acids which, in turn, cause inflammation by attracting a type of white blood cell called polymorphonuclear leukocytes, more commonly known as neutrophils. The combination of these factors causes the unsightly reddened, nodular and cystic features common to acne.

From the above discussion, we can clearly identify four areas involved in acne pathogenesis; 1). Increased sebum production, 2). Increased epithelial cell production and adhesiveness (keratinization), resulting in plugging of the follicle, 3). Bacterial overgrowth by P acnes, and 4). Inflammation produced by the action of P acnes on the sebum. Most acne medications today act on one, and sometimes two areas of acne pathogenesis. That is why combination therapies, which complicate the issue of complications, are used so commonly today. In addition, antibiotics used in acne treatment today are only effective against bacteria, and not fungi.
Over the past few years I have developed an interest in exploring safer, more “natural” products to be used for the treatment of acne. One such agent which came to my attention was oil of oregano, a popular medicine of antiquity, which is used today by practitioners of holistic medicine to treat acne as well as a variety of other medical conditions where infectious agents and inflammation are important in pathogenesis.

As a first step, my colleagues and I set out to test the anti-bacterial effect of oregano oil against the following bacterial isolates; Pseudomonas aeruginosa, Staphylococcus aureus, and a highly resistant form of S aureus known as MRSA, the letters of which stand for “methicillin-resistant S aureus”. These bacteria were chosen because of their propensity to cause serious and complicated skin infections. Each isolate was obtained through a local hospital microbiology laboratory. These particular isolates had been cultured from patients with aggressive skin infections and were therefore known to be quite virulent.
The results of these initial experiments can only be described as stunning.
The oregano oil strongly inhibited growth in all three isolates, and nearly obliterated any visible growth in several of the agar plates.

In addition, the anti-bacterial effect of the oregano oil was stronger than that of the broad-spectrum antibiotics which had been included in the experiments as positive controls. I marveled at how the oil purified from a common herb, could demonstrate an anti-bacterial effect to match, and even exceed, that of an expensive broad-spectrum antibiotic.
Over the next several weeks the results were confirmed time and again. Our microbiology laboratory confirmed that P acnes, the putative bacterial culprit in acne, was also strongly inhibited by this remarkable oil. An extensive literature search corroborated our in vitro findings with reports of oregano oil’s antibacterial effect, in addition to revealing reports on its anti-viral, anti-fungal and anti-parasitic activity.
This remarkable herb, oregano, has been admired and used for its broad-based medicinal properties since ancient times.

The Babylonians used oregano for medical purposes as early as 3000 BC. Oregano also had a tradition as a significant medicinal in ancient Greece, Rome, China and Egypt. The Greek word for oregano was “oreganos”, meaning “joy of the mountains”. Oregano was thought by the ancients to be effective in a broad range of disease, including cardiac, respiratory, gastrointestinal, infectious and venomous disorders. It was also touted as a wound healer and antiseptic. In the fifth century B.C., Hippocrates, often described as the father of Western medicine, described the use oregano to treat respiratory and gastrointestinal disorders. An in-depth description of the medicinal uses of oregano was presented in a book of “Plant History”, written by Theophrastus (372-287 B.C.). In the first century B.C., Dioscouridis the Anazarveas described the medicinal use of oregano in his text “Medicine Material”. Paracelsus (1493-1541 A.D.), who revolutionized pharmacology at the time of the Protestant reformation, treated psoriasis, fungal diseases and diarrhea with oregano.

Oregano, being a favorite medicinal for ancient Greek physicians and herbalists, became a ubiquitous and positive symbol in ancient Greek and Roman culture. If it was seen to grow on a grave, then the departed was assured happiness. The ancient Greeks thought that the goddess Aphrodite bestowed the characteristic sweet smell on the oregano plant, as a symbol of happiness. It was used to crown both Greek and Roman couples at wedding ceremonies as a result of its reported ability to dismiss sadness, promote love and generally bestow good health.
In the seventeenth century, the myriad health benefits of oregano were studied and extolled by English herbalists Gerard, Salmon (Salmon’s Herbal) and William Langham (Garden of Health, 1633). Today, the most public and high-profile discussion of the medical uses of oregano can be found in the works of Cass Ingram D.O. (The Cure is in the Cupboard). Dr. Ingram’s observations and recommendations draw, in part, on literature citations as well as his own personal experience in treating patients with oregano products.

The oregano plant (Oreganum vulgare) is a perennial of the mint family and is found in a variety of locales. Oregano is classified in the division Magnoliophyta, class Magnoliopsida, order Lamiales, and family Labiat. There are over 60 varieties of oregano with very few actually possessing medicinal properties. While medicinal properties have been described with Spanish (Thymus capitus) and Mexican (Lippia) oregano, most of the modern research has been done on the wild, mountain-grown Mediterranean or Greek oregano (Origanum vulgare ssp. hirtum). The term “ssp.” refers to subspecies. This true Greek oregano is the oregano of interest for us, because of its high concentration of essential oils, which contain the medicinal properties. Because of the high content of oils, this oregano is the “hottest”, most pungent, and strongest of the oreganos. The plant is traditionally only found in Greece, Turkey and islands in the Aegean Sea.

The oil content is as high as three percent, accounting for the propensity of this particular herb to cause irritation on the skin of those who harvest it from the fields.
The three preparations of this wild, mountain-grown Mediterranean oregano which retain medicinal properties after processing include oregano oil, crushed oregano, and oregano juice.
Today, suppliers of high-grade oregano oil obtain their oil from the farmed wild, mountain Mediterranean oregano plant (Origanum vulgare spp. hirtum). The oil of oregano is most commonly obtained through a process of steam distillation of the sun-dried, crushed plant. The strong purified oil is worth a great deal more than the less potent dried herb, used primarily for culinary purposes.

In order to make nine pounds of pure oregano oil, two hundred and twenty pounds of dried oregano must be processed.

The medicinal properties of oregano oil appear to derive from over twenty-seven different chemicals. The most important of these are the two phenols, thymol and cavacrol, which together comprise up to 90% of the pure oregano oil. While each of the phenols alone demonstrates significant antimicrobial activity, added together the effect is compounded. The antimicrobial capabilities of different varieties of the oregano plant depend primarily upon their thymol and cavacrol content and concentration.

Thymol is the primary reason for the antimicrobial properties seen with oil of thyme, another herb with antimicrobial properties, which are not as potent as those of oregano.
Since P acnes plays an important role in the pathogenesis of acne, and since oregano oil strongly inhibits the growth of P acnes, it seems a simple matter to treat acne with oregano oil.
As we have already learned, the pathogenesis of acne is not simple, and still not well understood. Oregano oil acts on three and possibly all four of the steps of acne pathogenesis. It is well-known, by parents and physicians alike, that all acne treatments on the market today can be associated with side-effects, some of which can be quite serious. While oregano oil applied directly to the skin can be irritating, the use of a carrier system which delivers the oregano oil into the epidermis dramatically reduces the irritation. Other than a potential for short-lived and concentration dependant local irritation, we know of no short or long-term adverse effects of oregano oil.
You might ask why pure or diluted oregano oil could not be applied directly to the skin to treat acne. First, oregano oil is too irritating to apply directly, even when diluted in other oils. Second, the raw oil can be occlusive, thereby further blocking hair follicles, and aggravating the acne. Third, the oil must be emulsified and then carried or delivered into the deeper layers of the epithelium, in closer proximity to the site of acne pathogenesis. To accomplish all this requires a carrier system which can successfully encapsulate the volatile oil, emulsify it in order to deliver it in protected form through the stratum corneum, the outermost layer of the skin, and establish a depot of oil which can have a long-lasting therapeutic effect, which is so important to the effective treatment of acne.
With an effective delivery system, oregano oil may become an ancient solution for the modern day problem of acne. It can be used by aestheticians as well as physicians, and can provide the modern day spa with a natural, non-toxic and historically fascinating tool for treating acne.

General References

1. Ayres SJ, al e: Acne vulgaris: therapy directed at pathophysiologic defects. Cutis 1981; 28(1): 41-42.

2. Baumann L: Cosmetic Dermatology: Principles and Practice, 1st ed. New York: McGraw-Hill, 2002.

3. Blumenthal M, Busse WR, Goldberg A, et al : The Complete German Commission E Monographs: Theraputic Guide to Herbal Medicines. Boston: Integrative Medicine Communications, 1998; 358-359.

4. Bolognia J, L., Jorizzo J, L., Rapini R, P.: Dermatology, 1st ed, Vol. 2. New York: Mosby, 2003.

5. Brook I, Frazier EH: Infections caused by Proprionibacterium species. Reviews of Infectious Disease 1991; 13: 819-822.

6. Dorman HJ, al e: Antimicrobial agent from plants: antibacterial activity of plant volatile oils. Journal of Applied Microbiology 2000; 88(2): 308-316.

7. Doyle E: Should You Change the Way You Treat Acne? Skin and Aging 2004; 12(8): 30-35.

8. Draelos Z, D.: Atlas of Cosmetic Dermatology. Philadelphia: Churchill Livingstone, 2000.

9. Fried R, G.: Contemplating the Comedone. Skin and Aging 2004; 12(8).

10. Hammer KA, Carson CF, Riley TV: Antimicrobial activity of essential oils and other plant extracts. Journal of Applied Microbiology 1999; 86(6): 985-990.

11. Ingram C: The Cure is in the Cupboard: Knowledge House, 1997.

12. Mandell G, L., Bennett J, E., Dolin R: Principles and Practice of Infectious Diseases, 5th ed, Vol. 1. New York: Churchill Livingstone, 2000.

13. Tuleya S: An Update on Acne and Rosacea Treatments. Skin and Aging 2004; 12(8): 38-43.

14. Valencia I, C., Kirsner R, S., Kerdel F, A.: Microbiologic evaluation of skin wounds: Alarming trend toward antibiotic resistance in an inpatient dermatology service during a 10-year period. Journal of the American Academy of Dermatology 2004; 50(6): 845-849.

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