Managing Acne Problems Professionally

24 Pages·2014·3.61 MB·English

M 10 T R
APP ECHNICAL EPORT
Managing Acne Problems Professionally
Active ingredient: Commiphora Wightii
Commiphora Wightii is made from the sap (gum resin) of the Commiphora tree,
which is native to India. This tree has been used in Ayurvedic medicine for
centuries, and Ayurvedic texts dating back to 600 BC recommend it for treating
atherosclerosis.
Commiphora Wightii is the resin of Mukul myrrh tree, a small, thorny plant found
predominantly in the rocky, dry regions of India. Commiphora Wightii, the
yellowish resin produced in the stem of the Commiphora mukul tree is obtained
by tapping the tree throughout the year. This resin is the source of the active
components, Z-guggulsterone and E-guggulsterone as well as another eight
sterols, acids, several aromatic acids, terpenes and fatty acid alcohols. Some
components seem to focus on cholesterol reduction activity, some are anti-
inflammatories and some appear to work synergistically.
Today Commiphora Wightii is used for arthritis, lowering high cholesterol,
atherosclerosis (hardening of the arteries), acne, weight loss and other skin
diseases.
Commiphora Wightii contains substances that lower cholesterol and triglycerides.
One of these substances also decreases the redness and swelling that occurs in
some types of acne.
Commiphora Wightii is the same genus as Commiphora Myrrha, the myrrh of the
bible. The plant has been used in Ayurvedic medicine for centuries. It was cited
in the Ayurvedic texts dating back to 600BC for treating atherosclerosis. In most
preparations of Ayurvedic medicine in India, serum lipids were found to be
lowered by Commiphora Wightii. Commiphora Wightii is one of the components
of various formulations of traditional Ayurvedic medicine to treat inflammation,
obesity and lipid disorders. Guggul or guggulu (also Commiphora Mukul), more
popularly known as Bdellium, is derived from the gummy resinous exudate of a
plant closely related to myrrh that is found in arid to semi-arid areas of Northern
India, Bangladesh and Pakistan.
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Its oleo-resins are excreted through the skin and mucus membranes, disinfecting
their secretions. It is an excellent alternative to non-steroidal-anti-inflammatory
drugs (NSAIDs) in its ability to relieve pain, skin and other inflammations as well
as promoting healing of the underlying cause. (East West School of Planetary
Herbology)
The lipid-lowering effect of Commiphora Wightii may help control cystic acne,
and reduce excess production of sebum that may lead to the formation of acne.
The first documented evidence of the anti-inflammatory activity of Commiphora
Wightii was reported in 1960 by Gujral.
Commiphora Wightii showed inhibitory action against both gram-positive and
gram-negative bacteria (International Journal of Pharmacognosy and
Phytochemical Research 2014) in the treatment of acne, specifically nodulocystic
acne.

Reference: Thappa, D.M., Dogra, J. J Dermatol. 21(10): Nodulocystic acne: oral
gugulipid versus tetracycline. [Online] October 1994. [Cited: January 18, 2011.]
http://www.ncbi.nlm.nih.gov/pubmed. PMID: 7798429

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Clinical Trials
In a trial mentioned in the Journal of Dermatology, this Ayurvedic herb is found to
be equally effective as Tetracycline in the treatment of Cystic Nodular Acne. In
this trial, 500 mg of extract was given twice a day.
One double-blind clinical trial reported in the Natural Solutions to Healthy Living
publication (1994), tested Commiphora Wightii against the antibiotic drug
Tetracycline for the treatment of cystic acne. The results showed that
Commiphora Wightii compared favorably in its effects to outcomes realized by
patients treated with Tetracycline.
In one older 3-month study published in 1994 involving 20 patients suffering from
severe acne with nodules and cysts, those given a Commiphora Wightii tablet
twice a day had a 68% reduction in inflammatory lesions. This was statistically
the same as results experienced by the group randomly assigned to take 500 mg
of the antibiotic tetracycline twice daily (65.2% reduction in lesions). Those
patients with oily skin responded much better to the Commiphora Wightii
treatment. Also of note is that while four of the tetracycline-treatment group
relapsed to pre-treatment acne status three months after treatment, only two of
the Commiphora Wightii group did.
Nodulocystic acne: oral Commiphora Wightii versus tetracycline.
Abstract
Twenty patients with nodulocystic acne were randomly allocated to one of two
treatment schedules: 1) Tetracycline 500 mg or 2) Commiphora Wightii
(equivalent to 25 mg guggulsterone). Both were taken twice daily for 3 months
and both produced a progressive reduction in the lesions in the majority of
patients. With Tetracycline, the percentage reduction in the inflammatory lesions
was 65.2% as compared to 68% with Commiphora Wightii; on comparison, this
difference was statistically insignificant (P > 0.05). Follow-up at 3 months showed
a relapse in 4 cases on tetracycline and 2 cases on Commiphora Wightii. An
interesting observation was that the patients with oily faces responded
remarkably better to Commiphora Wightii.

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Author information
Department of Dermatology, C.G.H.S., Bajaj Nagar, Jaipur, India
Reference: Thappa DM1, Dogra J.
Journal of Dermatology. Published 1994 Oct;21(10):729-31.

Chemical Properties
Also known as:
Devadhahupa, Gomme Guggul, Gomme-Resine de Guggul, Guggul, Guggul
Gum, Guggul Gum Resin, Guggul Limids, Commiphora Wightii ,Guggulimpid,
Guggulsterone, Guggulsterones, Guggulu, Guggulu Suddha, Guglidid, Gugulipid,
Gum Guggul, Gum Guggulu, Indian Bdellium-Tree, Indian Bdellium, Indian
Guggulipids, Koushika, Mukul Myrrh Tree, Palankasha, Yogaraja Guggul Gum
resin

Scientific name:
Commiphora Wightii
Synonyms – Balsamodendrum wightii, Balsamodendrum mukul.
Family – Burseracaea.

Traditionally used for: Orally, Commiphora Wightii is used for arthritis,
lowering high cholesterol, atherosclerosis, nodulocystic acne, skin diseases
and weight loss.

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Safety:
Possibly Safe… when the prepared extract is used orally and appropriately.
It has been safely used in clinical trials for up to 24 weeks (see clinical trials
section in this document). Some evidence also suggests that long-term use
up to 75 weeks may be safe.
Pregnancy: Likely unsafe…avoid using orally. Commiphora Wightii appears
to stimulate menstrual flow and the uterus.
Lactation… Insufficient reliable information available, avoid using.

Effectiveness:
Possibly Safe… Nodulocystic acne: Taking Commiphora Wightii orally is
comparable to oral tetracycline in the treatment of nodulcystic acne. Both
treatments decreased inflammation and the number of relapses.
Possibly Ineffective…Hypercholesterolemia: taking Commiphora Wightii
orally in doses of 3000 & 6000mg per day doesn’t seem to lower total
cholesterol or triglycerides, or raise high density lipoprotein (HDL) cholesterol
in people on Western diets. It seems to increase low density lipoprotein (LDL)
cholesterol by 9 % to 10%.
This is in contrast to studies of Commiphora Wightii in Indian populations,
where Commiphora Wightii seems to lower cholesterol, LDL and triglycerides.

Mechanism of Action:
Commiphora Wightii might reduce secretion of sebum and inhibit bacterial
metabolism of triglycerides which induces acne. Commiphora Wightii acts as
agonists of the pregame X receptor (PXR), estrogen-alpha receptor, and
progesterone receptor. The PXR induces the expressions of the cytochrome
P450 enzyme CYP3A4.
Preliminary evidence suggests that Commiphora Wightii also has protective
effects against drug-induced myocardial necrosis.
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Commiphora Wightii seems to antagonize the farnesoid X receptor (FXR),
which reduces the production of bile acids.
Commiphora Wightii also has the thyroid-stimulating activity. It seems to
increase the T3 synthesis by increasing conversion of T4 to T3.
Commiphora Wightii seems to have anti-inflammatory activity. Commiphora
Wightii might also lower lipoprotein (a) and C-reactive protein. Preliminary
evidence also suggests Commiphora Wightii might have antiplatelet and
anticoagulant activity.

Adverse Reactions:
Orally, Commiphora Wightii can cause headaches, nausea, vomiting, loose
stools, diarrhoea, belching, bloating and hiccups. Commiphora Wightii can
also cause hypersensitivity reactions including rash and pruritus. Commiphora
Wightii can also cause non-allergic adverse skin reactions. The risk of skin
reactions appears to be dose dependant. In one study, the incidence of skin
reactions was 3% with a dosage of 1000 mg three times daily, compared to
15% with a dosage of 2000 mg three times daily. The severity of the
reactions ranged from pruritus to swelling and erythema of the face to bullous
lesions on the lower legs associated with headaches, myalgias and pruritius.

Interactions with herbs & supplements:
Antiplatelet and anticoagulant Herbs and supplements: Preliminary
research suggests that guggul might have antiplatelet and anticoagulant
activity. Concomitant use of herbs that have constituents that might affect
platelet aggregation could theoretically increase the risk of bleeding in some
people. These herbs include angelica, clove, danshen, garlic, ginger, gingko,
red clover, turmeric and others.
Herbs with Estrogenic Activity: Theoretically, Commiphora Wightii could be
additive or antagonistic with other herbs that have estrogenic activity. Some

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of these herbs include alfalfa, black cohosh, chasteberry, flaxseed, hops,
ipriflavone, kudzu, liquorice, red clover and soy.

Interactions with drugs:
Antiplatelet / anticoagulant drugs <<interacts with>> Commiphora
Wightii
Interaction Rating: Moderate be cautious with the combination.
Severity: High • Occurrence = Possible • level of Evidence = B
Commiphora Wightii might have antiplatelet and anticoagulant effects.
Theoretically, taking Commiphora Wightii with other antiplatelet or
anticoagulant drugs might increase the risk of bruising and bleeding. Some of
these drugs include aspirin, clopidgrel (Plavix), nonsteroidal anti-inflammatory
drugs (NSAIDS) such before diclofenac (Voltaren, Cataflam, others),
ibuprofen (Advil, Motrin, others) and naproxen (Anaprox, Naprosyn, others),
deltearin (Fragmin), enoxapatin (Lovenox), heparin, warfarin (Coumadin) and
others.

Contraceptive drugs <<interacts with>> Commiphora Wightii
Interaction Rating: Moderate be cautious with the combination.
Severity: High • Occurrence = Possible • level of Evidence = D
Theoretically, concomitant use of large amounts of Commiphora Wightii might
increase the adverse effects of contraceptive drugs through estrogen-alpha
receptor agonist activity.

Cyctochrome P450 (CYP3A4) <<interacts with>> Commiphora Wightii
Interaction Rating: Moderate be cautious with the combination.
Severity: Moderate • Occurrence = Probable • level of Evidence = D
Preliminary research suggests that Commiphora Wightii induce cytochrome
P4503A4. Use caution when considering concomitant use of Commiphora
Wightii and other drugs affected by these enzymes. Some medications are
changed and broken down by the liver. Commiphora Wightii might increase
how quickly the liver breaks down some medications. Taking Commiphora
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Wightii long with some medications that are broken down by the liver can
decrease the effectiveness of some medications. Before taking Commiphora
Wightii talk to your healthcare provider if you are taking any medications that
are changed by the liver. Inhibitors that are substrates of CYP 3A4 include
atorvastatin (Lipitor) and lovastatin (Lovastaatin). Other drugs that might be
affected include some calcium channel blockers (dilitiazem, nicardipine,
verapamil), chemotherapeutic agents (etoposide, paclitaxel, vinblastine,
vindestine), antifungals (ketoconazole, itraconazole), glucocorticoids,
cisapride (Propulsid), alfentanil (Alfenta), fentanyl (sublimemaze), losartan
(Cozaar), fluoxetine (Prozac), midazolam (Versed), omeprazole (Prilosec),
ondansetron (Zofran), propranolol (Inderal), fexofenadine (Allegra) and
numerous others.

Diltiazem<<interacts with>> Commiphora Wightii
Interaction Rating: Moderate be cautious with the combination.
Severity: Moderate • Occurrence = Probable • level of Evidence = B
Concomitant oral administration can reduce diltiazembio availability and
might reduce therapeutic effects. Taking Commiphora Wightii can decrease
how much diltiazem (Cardizem) that the body absorbs. Taking Commiphora
Wightii along with diltiazem (Cardizem) might decrease the effectiveness of
diltiazem (Cardizem).

Estrogen <<interacts with>> Commiphora Wightii
Interaction Rating: Major - do not take this combination.
Severity: High • Occurrence = Possible • level of Evidence = B
Large amounts of Commiphora Wightii might theoretically increase the side
effects of estrogen. Some estrogen pills include conjugated equine estrogens
(Premarin), ethinylestradiol, estradiol and others.

Propranol (Inderal) <<interacts with>> Commiphora Wightii
Interaction Rating: Moderate be cautious with this combination.
Severity: Moderate • Occurrence = Probable • level of Evidence = B
Concomitant oral administration can reduce propranolol bioavailability and
might reduce therapeutic effects. Commiphora Wightii might decrease how
much propranolol (Inderal) the body absorbs. Taking Commiphora Wightii
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along with propranolol (Inderal) might decrease the effectiveness of
propranolol (Inderal).

Tamofixifen (Nolvadex) <<interacts with>> Commiphora Wightii
Interaction Rating: Moderate be cautious with this combination.
Severity: High • Occurrence = Probable • level of Evidence = B
Theoretically, concomitant use of large amounts of Commiphora Wightii might
interfere with Tamoxifen through estrogen-alpha receptor agonist activity.
Some types of cancer are affected by hormones in the body. Estrogen-
sensitive cancers are cancers that are affected by estrogen levels in the
body. Tamoxifen (Nolvadex) is used to help treat and prevent these types of
cancer. Commiphora Wightii could theoretically affect estrogen levels in the
body. By affecting estrogen in the body, Commiphora Wightii might decrease
the effectiveness of Tamoxifen (Nolvadex). Do not take Commiphora Wightii if
you are taking Tamoxifen (Nolvadex).

Thyroid Hormone <<interacts with>> Commiphora Wightii
Interaction Rating: Moderate be cautious with this combination.
Severity: Moderate • Occurrence = Probable • level of Evidence = B
Theoretically, concomitant use might interfere with therapy to normalize
thyroid function, monitor.

Interactions with food:
None known.
Interactions with Lab Tests:
Serum Cholesterol: Commiphora Wightii can reduce serum cholesterol and
low density lipoprotein (LDL) cholesterol concentrations by test results.
Serum Triglycerides: Commiphora Wightii can reduce serum triglycerides by
test results
Thyroid Stimulating Hormone (TSH): Theoretically, Commiphora Wightii can
lower TSH feedback from increased Triiodothyronine (T3). Commiphora
Wightii might increase thyroid hormone in the body. Taking Commiphora

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Wightii along with thyroid hormone pills might increase the effects and side
effects of thyroid hormones.
Triiodothyronine: Theoretically, Commiphora Wightii can increase T3 levels
by stimulating T3 production.

Interactions with diseases or conditions:

Hormone Sensitive Cancer/Conditions: Some preliminary research
suggests that Commiphora Wightii might have agonist effects on estrogen-
alpha and progesterone receptors. Women with hormone sensitive conditions
should avoid Commiphora Wightii. Some of these conditions include breast
cancer, uterine cancer, ovarian cancer, endometriosis and uterine fibroids.
Surgery: Commiphora Wightii has antiplatelet effects. Commiphora Wightii
might cause excessive bleeding if used preoperatively. Discontinue use at
least two weeks before elective surgical procedures.
Thyroid Disorders: Theoretically, concomitant use might interfere with
therapy for hyperthyroid or hypothyroid conditions. Please monitor.

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