Shikonin, a naphthoquinone pigment extracted from the roots of Lithospermum erythrorhizon, has been used in traditional Chinese medicine for centuries to treat a variety of skin conditions, including wounds and inflammation. In recent years, scientific studies have investigated its potential benefits for acne. Several in vitro and in vivo studies suggest that shikonin exhibits antibacterial activity against Propionibacterium acnes (now Cutibacterium acnes), the main bacteria implicated in acne pathogenesis. It also demonstrates anti-inflammatory effects by inhibiting key inflammatory mediators such as TNF-α and IL-6, which are elevated in acne lesions.

A small number of animal and laboratory studies support these findings, showing reduced lesion formation and decreased bacterial counts in treated skin. Additionally, shikonin has been noted to inhibit keratinocyte proliferation, which may help prevent follicular plugging.

However, robust clinical trials in humans are limited, and most evidence comes from preclinical research. While topical formulations containing shikonin are marketed in some countries, more high-quality, placebo-controlled human studies are needed to establish efficacy and optimal dosing for acne. Thus, while there is scientific rationale and early evidence supporting its use, the overall strength of evidence remains moderate.