Herbal medicine Eriobotrya japonica formula for acne vulgaris: A systematic review

Acne vulgaris is a common inflammatory skin condition characterized by comedones. Current pharmacotherapies are effective but are associated with adverse events (AEs) such as mood disorders and antibiotic resistance. The Eriobotrya japonica Formula (EJF) contains six herbs commonly used in traditional Chinese medicine clinical practice. This paper evaluates the experimental evidence and clinical efficacy of EJF for acne vulgaris. Searches of 11 English and Chinese databases were conducted to identify eligible randomized controlled trials (RCTs). PubMed was searched for experimental evidence of herbs included in EJF. Meta-analyses were performed to analyse the clinical effects of EJF compared to pharmacotherapies. Ingredients in EJF were reported to have an effect on inhibiting TNF-alpha, PPAR-gamma and IL-6 cytokines. Some also inhibited P. acnes and had anti-androgenic and anti-lipogenic effects. There were 15 RCTs included in the clinical review. The number of people achieving a clinical improvement based on lesion count was higher with EJF than pharmacotherapies. The effective rate of EJF was greater than antibiotics and benzoyl peroxide (2 studies, RR: 1.47 [1.23, 1.77], I-2=0%), and antibiotics with topical supplements (2 studies, RR: 1.77 [1.18, 2.67], I-2=0%). There were 107 mild AEs reported in 7 trials, 33 in the intervention groups and 74 in the control groups. No serious AEs were reported. There is some evidence that EJF can decrease inflammatory lesions in acne vulgaris with fewer AEs in the short-term. However, due to methodological limitations of the included trials, results on clinical efficacy should be interpreted with caution.