Therapeutic approaches to Acne vulgaris in Unani medicine: A review of classical texts and recent clinical evidence

Background Acne vulgaris (AV) is a chronic inflammatory disorder of the pilosebaceous unit, affecting approximately 85% of adolescents and young adults, with a global prevalence of 9.4%. Although conventional treatments are effective, they are associated with limitations such as irritation, relapse, and antibiotic resistance, prompting interest in traditional systems like Unani medicine. Objective This review critically examines classical Unani perspectives on AV and evaluates contemporary clinical evidence supporting Unani treatments to inform their integration into evidence-based dermatological practice. Methods A manual review of 20 classical Unani medical texts, including Al-Qānūn fi’l Ṭibb, Khazā’in al-Adwiya, Bayāż-i-Kabīr, and Kāmil al-Ṣanā‘a, was conducted to identify oral and topical formulations. Drug names were correlated with botanical equivalents using standard databases. A structured search was performed in PubMed, ScienceDirect, and Google Scholar using relevant keywords. Only clinical studies evaluating Unani interventions were included. Results A total of 9 clinical studies, including randomized controlled and open-label trials, were identified. Frequently studied formulations included Ṭilā’ Mohasa, Zimād Mohasa, and polyherbal combinations containing Nigella sativa Linn., Azadirachta indica A Juss., and Fumaria parviflora Lam. These interventions demonstrated significant improvements in subjective parameters (comedones, papules, pustules) and objective measures, including Global Acne Grading System (GAGS), Investigator’s Global Assessment (IGA), and Cardiff Acne Disability Index (CADI), with severity reductions up to 60–77%. The effects are attributed to antibacterial, anti-inflammatory, and antioxidant properties. Conclusion Unani medicine (UM) offers a holistic approach to AV with promising clinical outcomes. However, larger multicentric trials are required to strengthen evidence for its integration into modern dermatological practice.