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

Source of funding: none Conflict of interest: none Corresponding author: Michael Vince D. Busa, MD, DPDS email: michaelvincebusa@gmail.com INTRODUCTION cne vulgaris is a common dermatologic disorder that affects individuals of all races and ethnicities.1 There are four factors in the pathophysiology of acne: increase and alteration of androgen-dependent sebum production, alteration in keratinization leading to the comedone formation, follicular colonization of Propionibacterium acnes and inflammation due to the release of pro-inflammatory mediators.2,3 Acne is common in adolescents. However, it can occur in all age groups. It affects approximately 85% of young people between ages 12 to 24 years.3,5 To some degree, this disease may persist into adulthood particularly in women.3 Acne was reported in 8% of adults aged 25 to 34 years and 3% of adults aged 35 to 44 years.5 In 2015, the Philippine Dermatological Society (PDS)Health Information System (HIS) ranked acne vulgaris as the most common consult among the 11 training institutions accredited by the PDS.6 Due to its prevalence, it is often mistaken as physiologic. Individuals with acne can be affected psychologically with an increased likelihood of social isolation, depression and even suicidal ideation.4 Though this skin disease may be self-limiting, it can cause permanent physical, emotional and psychological scars unless provided with an effective long-term treatment.3,8 Medications for acne should target the multiple factors causing the disease. It should be able to eradicate existing lesions, prevent the development of new ones and avoid the long-term effects of scarring.4,7 Topical therapy, which includes comedolytics, anti-inflammatory agents and antibiotics, is the recommended first-line management of mild to moderate acne. Examples of common topical medications for acne include topical retinoids and benzoyl peroxide.4 Benzoyl peroxide is a potent bactericidal agent with a mild comedolytic property that reduces the number of P. acnes within the hair follicle.4,5 It is safe and effective even for those who are pregnant and those planning to be pregnant.8 Its safety profile and anti-acne ability justify its use as a first-line treatment in mild to moderate acne.2 However, benzoyl peroxide can cause bleaching or discoloration of clothes and beddings.9 It may also cause local irritation or allergy in 1% of patients.4,5,9 The coconut (Cocos nucifera L.) is referred to as the “tree of life” due to its many uses, ranging from biofuel to food.10 The coconut oil has been traditionally used by different cultures for ritualistic practices as well as for treatment of ailments including A Background: Acne vulgaris is a common dermatologic disorder caused by follicular colonization of Propionibacterium acnes leading to inflammation. Enzymatic virgin coconut oil monoglyceride has been shown to have anti-inflammatory effects and antimicrobial activity against Propionibacterium acnes. Objectives: To compare the efficacy and safety of enzymatic virgin coconut oil monoglyceride (EVCO) 2% cream versus benzoyl peroxide (BPO) 5% cream in the treatment of mild to moderate acne vulgaris. Methods: 100 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 EVCO 2% cream or BPO 5% cream applied on the face twice daily over an 8-week period. Primary outcomes measured in the study were clearance rate graded as “clear” or “almost clear” (rating of 0 or 1) based on the IGA and adverse reaction rate. Results: At week 8, the clearance rate was achieved in 56% (28/50) of participants in the BPO group and 46% (23/50) in the EVCO group. The difference between the two groups was not statistically significant (p=0.319). Adverse reactions observed in the BPO group were erythema (16%), pruritus (14%), scaling (12%), dryness (6%) and burning/stinging (6%) and while in the EVCO group only burning/stinging (2%) was noted; however, this was not statistically significant (p=0.1806). Conclusion: EVCO 2% cream is an efficacious and safe alternative treatment for acne vulgaris.