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THERAPY
Year : 1990  |  Volume : 56  |  Issue : 5  |  Page : 381-383

Oral gugulipid in acne vulgaris management




Correspondence Address:
Jaideep Dogra


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Source of Support: None, Conflict of Interest: None


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  Abstract 

Gugulipid is the standardized extract of the oleo-resin of Commiphora mukul (Burseraceace) an Indian medicinal plant. The active ingredients are two guggulsterones Z and E. Gugulipid is an effective hypolipidemic agent, has a marked antilipolytic activity in rats. Considering the pathogenesis of acne vulgaris and the pharmacological properties of Gugulipid this trial was initiated. Thirty patients with moderate to severe acne ( Grade 4) were included in this study. Tab Guglip was prescribed in tds dosage for 6 weeks. Excellent, good and moderate response was seen in nine (30%) fourteen (46.66%) and seven (23.33%) patients respectively out of the total thirty. No topical treatment was recommended except for local skin -hygiene. The drug showed excellent tolerance. Only three patients (10%) reported relapse when examined at 3 months follow up.


Keywords: Acne Vulgaris, therapy, Gugulipid


How to cite this article:
Dogra J, Aneja N, Saxena V N. Oral gugulipid in acne vulgaris management. Indian J Dermatol Venereol Leprol 1990;56:381-3

How to cite this URL:
Dogra J, Aneja N, Saxena V N. Oral gugulipid in acne vulgaris management. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2020 Jun 1];56:381-3. Available from: http://www.ijdvl.com/text.asp?1990/56/5/381/3579


To determine the best method for acne management, several factors contributing to the pathogenesis, like the combined roles of pilosebaceous unit, micro-organisms and the host's response to the events that occur within the pilosebaceous unit should be considered. Increased sebum production is usually associated with acne and there seems to be a relationship between sebum production and the severity of acne. Fresh sebum is composed of triglycerides, wax esters and squalene. However, sebaceous material obtained from the surface of the skin contains large amounts of free fatty acids (FFAs)[1].

Several topical preparations are available to control mild to moderate grades of acne[2],[3].The systemic antibiotics like tetracycline[4], minocycline[5], and erythromycin[6] are used in conjunction with topical therapy for severe grades of acne. The latest introduction of isotretinoin (13 cis-retinoic acid) for the treatment of severe, recalcitrant, nodulocystic acne has been one of the most dramatic advances in acne therapy but has significant side effects[7].

Gugulipid is the standardized extract of the oleoresin of Commiphora mukul (Family Burseraceae), an Indian medicinal plant. The active ingredients are two guggulsterones (Z & E). This drug possesses a marked serum cholesterol and lipid lowering capability[8],[9]. It is also reported to have a marked anti lipolytic activity in rats[10]. This study was initiated considering the pharmacological actions of Gugulipid, and the pathogenesis of acne.


  Materials and methods Top


This study was conducted at the Department of Dermatology, C.G.H.S., Jaipur. Thirty patients who had moderate to severe acne (>_ Grade 4) participated. Age group ranged from 16 years to 30 years. Female : Male Ratio was 3 : 1. Informed consent was obtained. An assessment of the overall severity of the acne lesions, using Samuelson grade nine global acne scale" was used. The scale description is as follows

Grade 1 :Sparse comedones with little or no inflammatory process noticeable.

Grade 2 : Moderate comedones with little or no inflammatory process present.

Grade 3 : Comedones with some inflammatory papules present.

Grade 4 : Comedones with several small, superficial pustular and inflammatory lesions.

Grade 5 :Profuse comedones with a few papulopustular lesions.

Grade 6 :Moderate numbers of small superficial pustular and inflammatory lesions and some comedones present.

Grade 7 : Profuse, small, superficial pustular and inflammatory lesions with comedones.

Grade 8 :Deep pustular lesions present and predominating.

Grade 9 :Deep cysts and/or inflammatory nodules present.

The following overall efficacy ratings were employed to describe the degree of improvement

Excellent : Decrease of three or more grade numbers with reduced redness and tenderness.

Good : Decrease of two grade numbers with reduced redness and tenderness.

Moderate : Decrease of one grade number with reduced redness and tenderness.

None : No change.

Worse : Increase of one or more grade numbers or increased tenderness and redness with the same grade number.

Tab. Guglip (Cipla Ltd., India) equivalent to 25 mg. guggulsterone was started in t.d.s. dosage for a period of 6 weeks. Laboratory investigations including complete blood counts, liver function tests, urine analysis and serum lipid profile were done prior to, and at the completion of treatment. No topical treatment was recommended except for local skin hygiene. Patients were reviewed for relapses after 3 months of completion of therapy.


  Results Top


In the study based on efficacy scale evaluation, the following results were obtained. An excellent clearance was observed in nine patients (30%) while another fourteen patients (46.66%) showed good response and in remaining seven patients (23.33%) a moderate improvement was noticed. A curious observation was that patients with excessive basal sebum secretion responded to a larger extent. No major adverse effect Was reported and the drug was well tolerated. Twelve patients (40%) reported 2-4 semi-formed stools while on the drug. Only three patients (10%) showed relapse when examined at 3 months follow up.


  Comments Top


Gugulipid, a standardized drug of ancient Indian medicine, has a remarkable effect on acne vulgaris. The drug was hypothesized for use in acne by action of reducing sebum, probably by its systemic hypolipidemic action. Secondly, its marked anti lipolytic activity as proved in rats, probably inhibits the lipolysis of triglycerides by bacterial lipases to FFA which induce acne inflammation.

In conclusion, Gugulipid has an encouraging potential in acne management with practically no major adverse effect. With proper patient selection complete clearing and prolonged remissions can be achieved in many of these patients. It is, therefore, recommended that this drug be further used for wider trials.[11]

 
  References Top

1.Boss JG : Acne Vulgaris and free fatty acids. A review and criticism, Arch Dermatol, 1973; 109: 894.  Back to cited text no. 1    
2.Leyden JJ, Marples RR, Mill OH and Kligman AM : Topical antibiotics and topical antimicrobial agents in acne therapy, Acta Derm Venerol, 1980; 60 (Suppli 89) : 75.  Back to cited text no. 2    
3.Rappaport W, Puhvel SM and Reisner RM : The valuation of topical erythromycin and oral tetracycline in acne vulgaris, Cutis, 1982; 30 : 122.  Back to cited text no. 3    
4.Cunliffe WJ et al : Tetracycline and acne vulgaris, a clinical and laboratory investigation, Brit Med J, 1973; 4: 332  Back to cited text no. 4    
5.Hubbel CG, Hobbs ER, Rist T and While JW Efficacy of minocycline compared with tetracycline in the treatment of acne vulgaris, Arch Dermatol, 1982; 118 : 989.  Back to cited text no. 5    
6.Ad Hoc Committee : The use of systemic antibiotics for treatment of acne vulgaris. Efficacy and Safety, Arch Dermatol, 1975 ; 111 : 1630.  Back to cited text no. 6    
7.Farrel ILN, Strauss JS and Stranieri AM : The treatment of severe cystic acne with 13 cisretinoic acid, JAmer Acad Dermatol, 1980; 3 : 602.  Back to cited text no. 7    
8.Satyavti GV, Dwarkanath C and Tripathi SN Experimental studies on the hypocholesterolemic effect of Commiphora mukul, Ind J Med Res, 1969; 57 : 1950.  Back to cited text no. 8    
9.Nityanand S and Kapoor NK : Hypocholesterolemic effect of Commiphora mukul resin (Guggul) Ind J Exp Biol, 1971; 9 : 376.  Back to cited text no. 9    
10.Kapoor NK and Nityanand S : Effect of guggul steroids on cholesterol biosynthesis in rats, Ind J Biochem Biophy, 1978; 15 : 77.  Back to cited text no. 10    
11.Samuelson JS : An accurate photographic for grading acne : Initial use in a double blind clinical comparison of Minocycline and Tetracycline, J Amer Acad Dermatol, 1985; 12 : 461.  Back to cited text no. 11    


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