School of Pharmacy, G. H. Raisoni University, Saikheda, Dist.- Pandhurna, Madhya Pradesh, India 480337.
Acne vulgaris is a chronic inflammatory disease that affects the hair follicle, sebaceous gland, and surrounding structures. It primarily occurs in adolescents but can persist into adulthood, impacting around 650 million people globally. Acne is influenced by genetic, hormonal, and environmental factors, with Propionibacterium acnes playing a key role in its development by promoting keratinocyte hyperproliferation, excessive sebum production, and inflammation. Apple cider vinegar (ACV), made from fermented apple juice, has gained popularity as a potential natural acne treatment due to its acetic acid content, which has antimicrobial properties against acne- causing bacteria like P. acnes, Staphylococcus aureus, and Streptococcus pyogenes. ACV also helps maintain skin pH balance and contains alpha hydroxy acids (AHAs), which can exfoliate the skin, potentially reducing blocked pores and preventing acne. Despite its potential benefits, ACV carries risks, such as skin irritation, chemical burns, and allergic dermatitis, especially when used undiluted. It is important to dilute ACV and perform patch tests to check for skin sensitivity. While initial studies and anecdotal evidence support its antimicrobial effects, further clinical research is needed to establish its long-term safety and effectiveness.
Acne vulgaris is a chronic inflammatory condition affecting the pilosebaceous unit, which includes the hair follicle, shaft, and sebaceous gland. It features non-inflammatory open and closed comedones that can progress to inflammatory papules, pustules, nodules, or scars. Predominantly affecting the face, neck, upper trunk, and arms, acne impacts approximately 650 million people worldwide, ranking as the 8th most common disease globally. It is most prevalent between the ages of 15 and 18, with increased rates in women during adolescence. The condition is primarily influenced by genetic factors and hormonal changes, particularly increased androgens during puberty that stimulate sebum production. Cutibacterium acnes, a bacterium contributing to acne, also plays a significant role. Other contributing factors include climate, medications, a diet high in dairy or glycemic foods, oil-based cosmetics, and psychological stressors such as anger and anxiety. (Abbas et al., 2025)
Clinical Classification of Acne:
|
|
Types of acne |
Injury type |
Degree |
Gravity |
|
Non inflammatory |
Comedonica |
Blackhead |
I |
Mild |
|
Inflammatory |
Papular-pustular |
Pimple |
II |
Moderate |
|
Pustule |
||||
|
Nodular |
Nodule |
III |
Moderate to Severe |
|
|
Cyst |
IV or conglobata |
Severe |
||
|
Scar |
V or fulminant |
Serious |
(Batista & Ana, 2016)
(Zaenglein, 2018)Fig. no. 1 Types of acne
Brief introduction about apple cider vinegar:
Apple species belong to the genus Malus of the Rosaceae family, and thousands of cultivars are grown worldwide. This is one of the most important economic fruit species. According to the Food and Agriculture Organization (FAO), global apple production reached 97.34 million metric tons in 2023. (FAOSTAT, n.d.) (Y. Li et al., 2020) Apples are recognized as providing many bioactive compounds with health-promoting benefits. They are major dietary sources of flavonoids, being particularly rich in the flavonol quercetin and its derivatives(Herranz et al., 2019), which are bioactive compounds object of several studies that confirm their antioxidant(Wang et al., 2020), anti-inflammatory(Tian et al., 2021), antimicrobial(Yong et al., 2020)properties. Fermentation is a potent process through which microorganisms, including bacteria and fungi, effectively transform one substance into another under specific conditions. This transformation occurs in both aerobic and anaerobic environments. The product of a fermentation process is decisively shaped by the type of microorganism at work, the processing conditions applied, and the substrate involved in the fermentation (Couto & Sanromán, 2006; The Art of Fermentation: An In-Depth Exploration of Essential Concepts and ... - Sandor Ellix Katz - Google Books, n.d.).
Fig. No. 2 Apple Cider Vinegar
Apple cider vinegar, common in Western Europe as an alcohol-free drink, is made from apple juice through a double fermentation process—first alcoholic fermentation, then acetic fermentation. Considering the overproduction of apple cider, this product is often redirected to vinegar processing. Apple cider vinegar is consumed in Western European countries as a functional alcohol-free beverage. Apple vinegar, or cider vinegar, is made with apple juice or concentrated apple juice via a double fermentation process—alcoholic fermentation followed by acetic fermentation(Guiné et al., 2021).
Chemical Constituent:
The Acetic acid (AA), produced through the fermentation of ethyl alcohol, plays a vital role in cellular metabolism and energy production. The acetic acid content in vinegar typically ranges from 4% to 8%. Trichloroacetic acid (TCA), an acetic acid derivative, is used as a chemical peeling agent for skin issues. Vinegar's historical use in treating skin diseases, dating back to Hippocrates, continues today as a popular home remedy for issues like acne, eczema, and toenail fungus(Acetic Acid and the Skin: A Review of Vinegar in Dermatology - Elhage - 2022 - International Journal of Dermatology - Wiley Online Library, n.d.).
Exfoliating Activity:
ACV contains alpha hydroxy acids (AHAs), which help in treating specific skin conditions, such as acne, hyperpigmentation, and photodamage, varying depending on the type and severity of the condition and the patient’s skin type and colour(Almeman, 2024).
Antibacterial Activity:
Streptococcus Pyogenes:
Streptococcus pyogenes causes infections in the superficial epidermis, subcutaneous tissue, fascia, or muscle. Flavonoids present in apple cider vinegar are quercetin which has antibacterial activity and can increase the permeability of bacterial cell membranes, so that it can change the structure and function of cell membranes that cause denaturation of membrane proteins so that cell membranes will be damaged and lysis. Quercetin is hydrophilic and lipophilic, so that it can lower the surface tension of cells, which causes bacterial destruction which leading to a decrease the bacterial growth (Yulion et al., 2023).
Staphylococcus Aureus:
Staphylococcus aureus (S. aureus) is the leading cause of skin and soft tissue infections such as abscesses (boils), furuncles, and cellulitis. ACV reduces the release of inflammatory cytokines during mononuclear leukocyte infection and enhances monocyte phagocytic capacity. The underlying mechanisms involve alterations in microbial protein physiology, leading to the destruction of structural pathogenic proteins and metabolic enzymes. ACV may also alter the bacterial cell wall, leading to increased permeability and, ultimately, bacterial cell death(Antibacterial Apple Cider Vinegar Eradicates Methicillin Resistant Staphylococcus Aureus and Resistant Escherichia Coli | Scientific Reports, n.d.; Yagnik et al., 2018).
Propionibacterium Acnes:
Propionibacterium acnes (P. acnes) causes keratinocyte hyperproliferation in the hair follicle, excessive sebum secretion, and increased proliferation, which naturally occurs in the follicular unit and leads to acne. In addition, inflammation induced by bacterial antigens contributes to these conditions. Apple cider vinegar (ACV), particularly due to its acetic acid content, shows antimicrobial properties. This acetic acid is effective against Propionibacterium acnes (P. acnes), a primary bacterium associated with acne development. It helps to disrupt the cell membrane of P. acnes, inhibiting its growth and potentially reducing the bacterial load within hair follicles. The concentration of acetic acid present in vinegar gives the variation of antibacterial properties (ANTIMICROBIAL EFFECTIVENESS OF APPLE CIDER VINEGAR IN THE GROWTH OF Staphylococcus Epidermidis and Propionibacterium Acnes, 2022; Z. Li et al., 2024).
Skin pH balance:
Apple cider vinegar (ACV) is often touted for its potential benefits in maintaining skin pH balance. The skin's natural pH is typically around 4.7, which is slightly acidic, and this acidity is crucial for various skin functions, including barrier integrity and microbiome maintenance (‘Formulating at pH 4-5’, 2008; Luki? et al., 2021). ACV, being acidic due to its acetic acid content, can help in restoring and maintaining this optimal pH level when applied topically.
Safety and side effects:
Using apple cider vinegar (ACV) to treat acne can be beneficial due to its antimicrobial properties, such as inhibiting acne-causing bacteria like Propionibacterium acnes and Staphylococcus epidermidis, reducing the growth of bacteria (Prabowo et al., 2022). However, its acidic nature can also irritate the skin, leading to potential risks for skin health if not used carefully, and can cause adverse reactions on the skin.
Skin irritation risk:
Chemical burns: ACV contains a high acidity content which can cause chemical burns, especially when it is used undiluted. This can lead to redness of the skin, peeling, and discomfort in the skin (Elhage et al., 2022).
Contact Dermatitis: In some cases, some individuals may develop contact dermatitis from ACV, which leads to rashes or irritation (MB, 2013).
Sensitivity Reactions: Prolonged use of ACV may increase skin sensitivity, and irritation may also lead to adverse reactions in susceptible individuals (Elhage et al., 2022).
Recommendation For Safe Use
Dilution: It is advisable to dilute ACV with water before application to minimize irritation risks.
Patch Testing: Conducting a patch test on a small area of skin can help to identify the potential of ACV and reduce the allergic reaction before spreading all over the skin (Cannavó & Goossens, 2023).
Even though ACV has effectiveness against acne, its high concentration can cause skin irritation, and proper usage of the guidelines should be done to avoid the adverse effects of ACV.
Future perceptive:
The future perceptive of apple cider vinegar (ACV) as an anti-acne treatment holds promise but requires further research. Large-scale clinical trials are essential to determine its effectiveness, optimal concentration, and safety for long-term use. Combining ACV with other acne treatments and exploring its interaction with the skin’s microbiome could enhance its effectiveness. Customizing ACV formulations for different skin types may decrease irritation and improve results. Comparative studies with conventional treatments will establish its role in acne treatment. Additionally, alternative delivery methods, such as creams or gels, could make ACV more user-friendly. With its affordability and accessibility, ACV has the potential to be a valuable acne remedy, but more research is essential to confirm its safety and effectiveness.
CONCLUSION:
Apple cider vinegar (ACV) demonstrates significant antimicrobial properties against acne- causing bacteria such as Propionibacterium acnes, Staphylococcus aureus, and Streptococcus pyogenes, making it an effective natural treatment option for acne vulgaris. Its acetic acid content is influential in maintaining skin pH balance and delivering potent antibacterial effects. While ACV offers these advantages, its high acidity can pose risks, including skin irritation, chemical burns, contact dermatitis, and heightened sensitivity when used undiluted. To moderate these risks, it is essential to dilute ACV properly and conduct a patch test before wide-ranging application. With careful use and further exploration, the antimicrobial benefits of ACV can be harnessed effectively without compromising skin safety.
REFERENCES
Harshal Kuhite, Sanjana Nishad*, Dr. V. S. Babu Agala, The Efficacy of Apple Cider Vinegar in Treating Acne Vulgaris: Review of Literature, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 4, 732-739 https://doi.org/10.5281/zenodo.15165653
10.5281/zenodo.15165653
