Site Under Construction

A randomized, comparative study on the efficacy and safety of mangosteen 1% extract gel versus benzoyl peroxide 5% gel in the treatment of mild to moderate acne vulgaris

Janice Natasha C. Ng, MD, FPDS, Maria Vinna N. Crisostomo, MD, DPDS, Margaret Stephanie L. Jimenez, MD, DPDS, Mary Jo Kristine S. Bunagan, MD, FPDS

Abstract

Introduction

Acne vulgaris is a common dermatologic disorder caused by follicular epidermal hyperproliferation, excess sebum production, inflammation, and Cutibacterium acnes (C. acnes). The mangosteen fruit rind contains large amount of xanthones, which has high antimicrobial activity against C. acnes.

 

Objectives

To compare the efficacy and safety of mangosteen 1% extract gel versus benzoyl peroxide (BPO) 5% gel in the treatment of mild to moderate acne vulgaris.

 

Methods

A total of 60 participants with mild to moderate acne or a rating of 2 or 3 in the Investigator’s Global Assessment (IGA) for acne were randomized to receive either mangosteen 1% extract gel or BPO 5% gel applied on the face twice daily over an 8-week period. Primary outcomes measured in the study were clinical remission graded as “clear” or “almost clear” (rating of 0 or 1) based on the IGA and any adverse reaction.

 

Results

At week 8, 73% (23/30) in the BPO group and 53% (16/30) in the mangosteen group achieved clinical remission, although the difference between the two groups were not statistically significant (P = 0.108). In the BPO group, 4% (1/27) had a weak reaction during the 2nd follow up, while in the mangosteen group all participants did not have any reactions; however, this was not statistically significant (P = 0.627).

 

Conclusion

Mangosteen 1% extract gel is a safe and effective alternative treatment for mild to moderate acne vulgaris.

References

  1. Zaenglein A, Thiboutot D. Acne vulgaris. In: Bolognia J, Jorizzo J, Schaffer J, eds. Dermatology. 3rd ed. Edinburgh: Elsevier; 2012:545-559.
  2. Zaenglein A, Graber E, Thiboutot D. Acne Vulgaris and Acneiform Eruptions. In: Goldsmith L, Katz S, eds. Fitzpatrick’s dermatology in general medicine. 8th ed. New York: McGraw-Hill; 2012:897-917.
  3. Leyden J. A review of the use of combination therapies for the treatment of acne vulgaris. J Am Acad Dermatol. 2003 Sep 30;49(3). DOI: 10.1067/
    s0190-9622(03)01154-x.
  4. Philippine Dermatological Society Health Information Systems. Philippine Dermatological Society; 2011. pdshis@outlook.com. Accessed October 3, 2016.
  5. Pothitirat W, Chomnawang MT, Gritsanapan W. Anti-acne-inducing bacterial activity of mangosteen fruit rind extracts. Med Princ Pract. 2010;19(4):281-286. DOI: 10.1159/000312714.
  6. Azimi H, Fallah-Tafti M, Khakshur AA, Abdollahi M. A review of phytotherapy of acne vulgaris: perspective of new pharmacological treatments. Fitoterapia. 2012;83(8):1306-1317. DOI: 10.1016/j.fitote.2012.03.026.
  7. Motaparthi K, Hsu S. Topical Antibacterial Agents. In: Wolverton S, ed. Comprehensive Dermatologic Drug Therapy. 3rd ed. Edinburg: Elsevier; 2012:454.
  8. Khumsupan P, Gritsanapan W. Anti-acne activity of Garcinia mangostana L.: A review. Plant Science Today. 2014 Aug 14;1(3):147-150. DOI: 10.14719/pst.2014.1.3.39.
  9. Pedraza-Chaverri J, Cárdenas-Rodríguez N, Orozco-Ibarra M, Pérez-Rojas JM. Medicinal properties of mangosteen (Garcinia mangostana). Food Chem Toxicol. 2008;46(10):3227-3239. DOI: 10.1016/j.fct.2008.07.024.
  10. Osman M, Milan A. Mangosteen Garcinia mangostana L. In: Williams JT, Smith RW, Haq N, Dunsiger Z, eds. Chichester, England, UK: Southampton Centre for Underutilised Crops; 2006.
  11. Dweck A. A review of Mangosteen (Garcinia mangostana) Linn. 2003:8. Accessed 2016 Sept 27.
  12. Priya V, Jainu M, Mohan S, Saraswathi P, Gopan S. Antimicrobial activity of pericarp extract of Garcinia mangostana Linn. Int J Pharm Sci Res. 2010;1:278-281.
  13. Sutono T. Efficacy of Garcinia mangostana L. (mangosteen rind extract) to reduce acne severity. Med J Indones. 2013 Aug 1;22(3):167-172. DOI:  10.13181/mji.v22i3.586.
  14. Jansook P, Sompukdee A, Rattranakosekit M, Kokiatinun A, Pothitirat W. Development and evaluation of anti-acne microemulsion gel containing extracts of mangosteen fruit rind. Thai J Pharm Sci. 2010;36:158-161.
  15. Sukatta U, Rugthaworn P, Pitpiangchan P, Dilokkunanant U. Development of mangosteen anti-acne gel. Kasetsart J (Nat Sci). 2008;42(5):163-168.
  16. Lueangarun S, Sriviriyakul K, Tempark T, Managit C, Sithisarn P. Clinical efficacy of 0.5% topical mangosteen extract in nanoparticle loaded gel in treatment of mild-to-moderate acne vulgaris: A 12-week, split-face, double-blinded, randomized, controlled trial. J Cosmet Dermatol. 2019. DOI: 10.1111/jocd.12856.
  17. Gallega G, Bunagan M, Visitacion L. A pilot study on the efficacy of mangosteen 40% extract ointment compared to clobetasol propionate 0.05% ointment in the treatment of plaque type psoriasis vulgaris. In: Philippines; 2009.
  18. Rassameemasmaung S, Sirikulsathean A, Amornchat C, Maungmingsook P, Rojanapanthu P, Gritsanaphan W. Topical application of Garcinia mangostana L. pericarp gel as an adjunct to periodontal treatment. Complement Ther Med. 2008;16(5):262-267. DOI: 10.1016/j.ctim.2007.12.004.
  19. Fonacier L, Bernstein DI, Pacheco K, et al. Contact dermatitis: a practice parameter-update 2015. J Allergy Clin Immunol Pract. 2015;3(3 Suppl):S1-39. DOI: 10.1016/j.jaip.2015.02.009.
  20. Delima C, Belisario M, Bunagan M. A randomized investigator-blinded clinical trial evaluating the efficacy and safety of Ocimum basilicum (Sweet Basil) 2% cream vs benzoyl peroxide 5% cream in the treatment of mild to moderate acne vulgaris. In: Philippines; 2010.
  21. Busa M, Ng J, Lacuesta-Gutierrez M. A prospective, randomized, double-blind, comparative study on the efficacy and safety of 2% enzymatic virgin coconut oil monoglyceride cream versus 5% benzoyl peroxide cream in the treatment of mild to moderate acne vulgaris. J Phil Dermatol Soc. 2018;27(2):18-30.
  22. Chomnawang MT, Surassmo S, Nukoolkarn VS, Gritsanapan W. Effect of Garcinia mangostana on inflammation caused by Propionibacterium acnes. Fitoterapia. 2007;78(6):401-408. DOI: 10.1016/j.fitote.2007.02.019.
  23. Chomnawang MT, Surassmo S, Nukoolkarn VS, Gritsanapan W. Antimicrobial effects of Thai medicinal plants against acne-inducing bacteria. J Ethnopharmacol. 2005;101(1-3):330-333. DOI: 10.1016/j.jep.2005.04.038.
  24. Nakatani K, Atsumi M, Arakawa T, et al. Inhibitions of histamine release and prostaglandin E2 synthesis by mangosteen, a Thai medicinal plant. Biol Pharm Bull. 2002;25(9):1137-1141. DOI: 10.1248/bpb.25.1137.
  25. Yang JH, Hwang EJ, Moon J, et al. Clinical efficacy of herbal extracts in treatment of mild to moderate acne vulgaris: an 8-week, doubleblinded, randomized, controlled trial. J Dermatolog Treat. 2021;32(3):297-301. DOI: 10.1080/09546634.2019.1657792.
  26. Schmidt N, Gans EH. Clindamycin 1.2% Tretinoin 0.025% Gel versus Clindamycin Gel Treatment in Acne Patients: A Focus on Fitzpatrick Skin Types. J Clin Aesthet Dermatol. 2011;4(6):31-40. PMCID: PMC3140902.
  27. Gold LS, Tan J, Cruz-Santana A, Papp K, Poulin Y, Schlessinger J, Gidner J, Liu Y, Graeber M; Adapalene-BPO Study Group. A North American study of adapalene-benzoyl peroxide combination gel in the treatment of acne. Cutis. 2009 Aug;84(2):110-6. PMID: 19746769.

REquesting Permission

A randomized, comparative study on the efficacy and safety of mangosteen 1% extract gel versus benzoyl peroxide 5% gel in the treatment of mild to moderate acne vulgaris