Acne Vulgaris: Integrating Pathophysiology with Conventional, Herbal, and Nanocarrier-Based Therapeutic Strategies

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit, affecting 9.4% of the population globally, and is one of the most prevalent dermatoses globally. It is most common in adolescents but can continue through adulthood, causing physical and emotional health deterioration. Acne is a multifactorial process involving genetic factors, hormonal factors, sebum production, hyperkeratinization of the follicular lumen, colonization by Cutibacterium acnes bacteria and inflammation [Ma2.1]. Inflammation is now recognised as a critical process from microcomedone formation to the development of inflammatory lesions and scarring, with emerging evidence of the role of epigenetic changes. Conventional therapeutic approaches include topical retinoids, benzoyl peroxide, topical and systemic antibiotics, and hormonal therapies. Nonetheless, they have a low efficacy due to antimicrobial resistance and side effects. New therapies are also focusing on new pathways such as nitric oxide donors, cytokine suppressors, leukotriene suppressors, biologics, as well as optimized retinoid regimens. Plant-based medicines are becoming a popular complementary form of medicine because of their antimicrobial and anti-inflammatory effects. Extracts from Aloe vera, Azadirachta indica, Camellia sinensis, Rosmarinus officinalis, cannabidiol, and Withania somnifera have shown promise against C. acnes and inflammation. Nanotechnology-based vehicles include liposomes, niosomes, ethosomes, and nanofibers, which improve drug stability, penetration, and controlled delivery to increase efficacy and improve tolerance. The paper combines the pathophysiology of acne vulgaris and traditional approaches to treatment with new herbal-based therapeutics and drug delivery systems based on nanocarriers as complementary approaches to enhance the effectiveness, safety, and targeting of follicles. The article provides a targeted system of interconnection between disease processes and developed delivery systems and phyto-medicine interventions to manage acne optimally.