The Safety and Efficacy of Herbal Medicine for Facial Skin Rejuvenation: A Systematic Review

Abstract

The use of herbal medicine in facial skin rejuvenation is expanding globally, yet its clinical efficacy and safety remain debated. This systematic review evaluates current evidence on the efficacy and safety of herbal interventions for facial rejuvenation in adults. A comprehensive literature search was conducted in PubMed, EMBASE, and Scopus on July 15, 2025. Eligible studies were randomized controlled trials, cohort, or case-control studies assessing herbal medicine (topical or oral) for facial skin rejuvenation. Risk of bias was assessed using ROBINS-I for non-randomized studies and the GRADE approach for overall evidence quality. Of nine included studies (n = 489), herbal regimens consisted of topical Centella asiatica or ZACC cream (1–2× daily, 8–12 weeks), red ginseng mixtures (oral 3 g/day, 24 weeks), botanical blends (oral 225 mg/day, 12 weeks), tomato extract (oral 1 capsule/day, 12 weeks), and tea tree oil gel (topical 5%, daily, 6 weeks). Eight studies (89%) demonstrated significant improvements over control in at least one outcome: wrinkle depth (4 studies, mean reduction 10–23%), pigmentation or melasma (3 studies, mean mMASI reduction 1.2–3.6 points), skin hydration (4 studies, mean increase 8–19%), and elasticity (3 studies). Pooled adverse event rate was 2%, limited to mild reactions (transient erythema, dryness, or mild GI upset). We found no serious side effects were reported. Herbal medicine demonstrates promising efficacy and favorable safety in facial skin rejuvenation, particularly for wrinkle reduction and pigmentation improvement. However, further large-scale, high-quality trials are warranted to confirm these findings.