Clinical evidence for Acanthus spp. in dermatological conditions: A systematic review

Background : Acanthus ebracteatus Vahl. is a Thai traditional medicine commonly used for skin conditions, but clinical evidence supporting its efficacy remains limited. Objective : To determine clinical effects of Acanthus spp. across various health conditions. Method : We searched PubMed, Embase, CENTRAL, CINAHL, EBSCO, Scopus, ThaiLIS, and ThaiJO until November 2025. Experimental and observational studies of Acanthus spp. in humans were included. Three reviewers independently assessed study quality in pairs using Cochrane Risk of bias tools 2.0 for randomized controlled trials (RCTs) and ROBINS-I (Risk Of Bias In Non-Randomized Studies-of Interventions) for non-RCTs. Findings from included studies were reported descriptively. Results Of the 754 identified records, 8 studies (4 RCTs and 4 non-RCTs) comprising 352 subjects were included. The overall risk of bias across studies ranged from low to critical. For psoriasis, herbal creams demonstrated significant improvements in disease severity and quality of life compared to controls. In addition, serum and tonic products significantly reduced hair fall after combing compared with baseline or placebo (p<0.05). Findings on atopic dermatitis were mixed, the study evaluating an herbal cleanser showed beneficial effects in moisture retention, while another study showed that high-concentration creams were ineffective and caused irritation. For pressure ulcers, herbal oil showed no significant difference in healing scores compared to standard care. Conclusions Current evidence supports the use of Acanthus spp . as a potential treatment option for psoriasis and alopecia. However, these findings should be interpreted with caution, as they are derived from a small number of studies and low-quality trials. High-quality trials with adequate sample sizes are needed to ensure more consistent clinical outcomes.