Therapeutic potential of Boswellia -derived compounds in skin conditions

1 Introduction

Skin diseases are common conditions that affect individuals across all age groups, from neonates to the elderly (Marks and Miller, 2006). Globally, skin and subcutaneous diseases constitute a substantial public-health burden, with an estimated 4.69 billion incident cases and 41.9 million disability adjusted life years (DALYs) in 2021 (World Health Organization, 2025). They are also among the top five reasons people seek medical care. In both developed and industrial nations, skin disorders contribute significantly to the healthcare burden (De Wet et al., 2013).

There are various types of skin disorders, including inflammatory skin diseases such as acne, eczema, dermatitis, and psoriasis; bacterial infections like folliculitis, cellulitis, and impetigo; viral infections such as herpes simplex, warts, chickenpox, and measles; and parasitic infections like scabies and lice. Fungal infections, including ringworm, are also common, as are tumours and cancers like melanoma and squamous cell carcinoma. Other skin conditions include burns, wrinkles, and moles (Salonki, 2011; Tabassum and Hamdani, 2014). While both synthetic and herbal medications are used to prevent and treat skin diseases, natural remedies derived from plants are widely used in the management of skin disorders and continue to attract increasing research interest (Yuan et al., 2016; Jones et al., 2021; Agrawal et al., 2024). Numerous studies have investigated the pharmacological activities and preclinical therapeutic potential of herbal products for dermatological disorders using in vitro and in vivo models (Kombate and Metowogo, 2023).

In traditional medicine, plants have long been used to manage a variety of skin conditions. Alongside commercially traded herbal remedies, many species from local floras are also employed. With chronic skin disorders such as alopecia, genital warts, vitiligo, and psoriasis often proving resistant to standard therapies, research on medicinal plants has expanded significantly in recent years (Males et al., 2019).

In recent years, interest in the traditional medicinal uses of Boswellia species for the treatment of skin diseases has grown considerably. A growing body of in vitro, in vivo, and clinical evidence suggests that Boswellia exhibits promising therapeutic potential in various skin conditions, including psoriasis, eczema, and wound healing. Despite these advances, no comprehensive review has systematically integrated the taxonomic, biological, and pharmacological aspects of Boswellia while highlighting the specific roles of different species and their bioactive compounds in dermatological applications. Therefore, this review aims to fill this gap by combining systematic and narrative approaches to provide a comprehensive overview of the current evidence on Boswellia species and their active metabolites in skin-related conditions. Furthermore, it seeks to identify current knowledge gaps and highlight key priorities for future research to support the development of Boswellia-based therapies for dermatological diseases.

2 Methodology

2.1 Search strategy

A literature search was conducted following the PRISMA guidelines (Figure 1) to identify biological, pharmacological and phytopharmacological studies of Boswellia on skin related conditions. In addition, a general electronic and hand searches focusing on the taxonomy, distribution, phytochemistry, traditional and common uses of the taxon were conducted.

To understand the role of Boswellia in preclinical and clinical skin conditions we performed a broad database search covering biological, pharmacological and phytopharmacological aspects. The main databases included were PubMed, Scopus and ScienceDirect covering studies up to June 2026. The search terms used were {Boswellia or boswellic $ or frankincense or Luban or Weihrauch} and {skin}. Publications in multiple languages, primarily English, but also German, Chinese, French, Russian, and Italian, were considered for inclusion. Where available, the English version of a publication was used. In cases where no English version was available, AI-assisted translation was employed to translate the publication into English for screening and data extraction.

In addition, following the electronic database search, an additional manual search was conducted using the above and additional keywords to ensure that all eligible studies were identified. This retrieved additional studies that met the predefined inclusion criteria and were subsequently included in the review. The database search identified a total of 2,526 records, including 2,315 records from PubMed, 210 from Scopus, and one from ScienceDirect. After removing 179 duplicate records, 2,347 records were screened based on their titles and abstracts. Of these, 2,212 records were excluded, and 135 reports were assessed for eligibility. Following full-text assessment, 98 reports were excluded for not meeting the eligibility criteria, resulting in 37 studies being included in the review. The included studies comprised 16 in vivo studies, 14 in vitro studies, and seven clinical studies. The study-selection process and reasons for exclusion are summarized in the PRISMA flow diagram (Figure 1).

2.2 Eligibility criteria

Studies were considered eligible for the systematic evidence synthesis if they were original studies investigating Boswellia species, Boswellia-derived preparations, frankincense, or boswellic acids in relation to skin conditions or dermatologically relevant outcomes. Eligible evidence included clinical studies and relevant in vivo and in vitro experimental studies. The presence of a comparator or control group was not required for inclusion. Publications in multiple languages, primarily English, but also German, Chinese, French, Russian, and Italian, were considered for inclusion. Where available, the English version of a publication was used. In cases where no English version was available, AI-assisted translation was employed to translate the publication into English for screening and data extraction. Grey literature was not systematically searched. Studies were excluded if they investigated Boswellia exclusively in non-dermatological conditions, evaluated other plants without providing specific findings for Boswellia, or did not report skin-related outcomes. Reviews, books and book chapters, conference papers, guidelines, letters, editorials, notes, and abstract-only publications were excluded from the systematic evidence synthesis. Studies evaluating multi-herbal preparations in which the specific contribution of Boswellia could not be determined were also excluded. Review articles and other secondary sources were used, where appropriate, only to provide background information on taxonomy, distribution, traditional uses, phytochemistry, and general pharmacological aspects and were not included among the 37 studies in the systematic evidence synthesis.

2.3 Methodological quality assessment

Given the heterogeneity of the included studies, methodological quality was assessed narratively. For clinical studies, key features including randomization, blinding, allocation concealment, sample size, and use of a comparator were considered where applicable. For animal studies, sample size, control groups and randomization, were considered. For in vitro studies, the use of appropriate controls, tested concentrations, exposure duration, and characterization of the tested preparation were considered. For in silico studies, the computational approach and validation procedures were considered. Information not provided in the original studies was recorded as “not reported.”

3 Results and discussions

3.1 Taxonomy and traditional uses of Boswellia spp.

The genus Boswellia (Burseraceae) comprises more than 20 recognized species, which are widely distributed across the Indian subcontinent, the southern Middle East, West and East Africa, and the Horn of Africa, with Socotra Island harboring nearly half of the known species (Iram et al., 2017; Al-Harrasi et al., 2018; World Flora Online, 2026; POWO, 2026). Their geographical distribution, selected traditional uses and conservation status are summarized in Table 1. The taxonomy of Boswellia is continuously evolving, with several species having been added or reclassified in recent years, while genetic studies continue to provide new insights into species relationships (Johnson et al., 2022).

TABLE 1. Distribution, conservation status of different Boswellia species and their traditional medicinal uses.

Note: “Not reported” indicates that no traditional use information was identified in the sources reviewed.

Boswellia has long been used in traditional African, Arabian, and Indian medicine for the treatment of a wide range of diseases, primarily owing to its anti-inflammatory, antiviral, immunomodulatory, antidiabetic, and antibacterial properties (Bongers et al., 2019; Efferth and Oesch, 2022; Banno et al., 2006; al-Saidi et al., 2012; Al-Yasiry and Kiczorowska, 2016). In addition, Boswellia has traditionally been used to promote skin health and has gained increasing attention as a potential therapeutic agent for various dermatological conditions (Han et al., 2017).

Different Boswellia species exhibit diverse traditional uses depending on their geographical distribution and cultural background (Table 1). Among the most important ones are B. sacra (synonym B. carterii), which is distributed in the Arabian Peninsula (Oman and Yemen) and Somalia, and B. serrata originating from India. B. papyrifera is a widely distributed plant in Ethiopia, Eritrea, and Sudan and B. frereana is found in Northern Somalia (Elhaddad et al., 2023; POWO).

The term frankincense refers to the oleo-gum-resin obtained from several Boswellia species. For thousands of years, people have been collecting the resins by scraping off natural exudate or creating tiny knife cuts into the bark, waiting for the resin to seep out, allowing it to dry, scraping the “tears” and then reopening the wound to begin the harvest cycle again (Johnson et al., 2024). Boswellia species are used in an array of coating material, adhesives and cosmetic preparations (Roy et al., 2019).

B. sacra (often referred to by its synonym B. carterii) is used worldwide in various religious ceremonies, as well as in social, religious and other cultural practices (Al-Harrasi et al., 2019) and today especially due to the high use in global bioeconomies (Mykhailenko et al., 2025) is a ‘Near Threatened’ species (Table 1). It was used by the ancient Egyptians in painting, perfumes, chewing gum and beverages (Al-Saidi et al., 2012; Miran et al., 2022). B. sacra have been used in the Middle east traditionally for various health conditions (Al-Yahya et al., 2020). Also, in recent years, owing to its anti-inflammatory properties and its potential to promote skin health, frankincense has gained increasing attention as a medicinal product in Europe (Han et al., 2017; Mishra et al., 2020). It is used in pharmaceutical preparation, food, beverages, perfumes, cosmetics and detergents (Al-Saidi et al., 2012; El-Nagerabi et al., 2014). In Arab, African and Middle East countries B. sacra is used as a chewing gum because of its flavour. It is also used as a water extract of the gum resin for stomach and liver ailments and against cough (Asad and Alhumoud, 2015).

B. serrata has longstanding cultural importance because of its aromatic gum-resin. More broadly, frankincense obtained from Boswellia species has been used as incense in religious and cultural ceremonies since the beginning of written history and was historically valued by several ancient civilizations, including Greek and Roman societies (Moussaieff and Mechoulam, 2009).

Several African and Socotran species have primarily been associated with the treatment of respiratory conditions, inflammatory disorders, and other traditional health applications. In India, B. serrata is the most extensively studied species and is traditionally used for inflammatory diseases, including arthritis, asthma, inflammatory bowel diseases, and psoriasis (Sahoo et al., 2020), similarly to the use of B. sacra from the Arabian Peninsula. Although numerous Boswellia species have been documented in traditional medicine, many remain insufficiently investigated. Among the most extensively studied frankincense-producing species are B. sacra, B. serrata, and to a lesser degree B. papyrifera and B. frereana (Miran et al., 2022; Elhaddad et al., 2023).

3.2 Bioactive metabolites of Boswellia species

Frankincense resin is primarily composed of essential oils, triterpenes, and gum (polysaccharides) (Elhaddad et al., 2023). The essential oil fraction (approximately 5%–15% of the resin) contains a variety of mono-, di-, and triterpenes, while the resin fraction is rich in pentacyclic triterpenes, particularly boswellic acids. Boswellic acids are the most extensively studied metabolites of Boswellia species and are considered the principal bioactive compounds responsible for many of the pharmacological effects attributed to frankincense (Ammon, 2006; Mertens et al., 2009; Sharma et al., 2009). For their structures see Figure 2. Although both tetracyclic and pentacyclic triterpenes are present in Boswellia resins, the content of boswellic acids varies considerably between species: B. frereana contains only trace amounts, whereas B. papyrifera, B. serrata, and B. sacra are characterized by substantially higher levels (Elhaddad et al., 2023; POWO). An important source of heterogeneity across the available studies is the use of different Boswellia-derived preparations, including resin extracts, essential oils, fixed oils, isolated boswellic acids, synthetic derivatives, and formulated topical products. These preparations should not be considered pharmacologically interchangeable because their chemical composition and concentrations of bioactive constituents may differ considerably. In particular, the content of individual boswellic acids, including KBA and AKBA, was not consistently reported across studies. Such variability may influence the observed pharmacological activity and complicates direct comparison and clinical interpretation of the findings. Therefore, detailed phytochemical characterization and standardization of Boswellia-derived preparations are important for future preclinical and clinical studies.

3.3 Pharmacological activities of Boswellia species and boswellic acids and their therapeutic potential in dermatology

3.3.1 Pharmacological activities of boswellic acids

3.3.1.1 Anti-inflammatory activity

Boswellic acids are the principal bioactive metabolites of Boswellia and are widely recognized for their anti-inflammatory properties. The major boswellic acids include α- and β-boswellic acid (α-BA and β-BA), acetyl-α- and acetyl-β-boswellic acid (AαBA and AβBA), KBA and AKBA (Figure 2) (Shah et al., 2009; Togni et al., 2014; Ammon, 2019). All are pentacyclic triterpene acids (Wu et al., 2024). Among them, KBA and particularly AKBA exhibit the strongest anti-inflammatory activity (Siddiqui, 2011; Alluri et al., 2019).

The concentration of individual boswellic acids varies considerably among Boswellia species and according to their geographic origin. For example, African Boswellia samples generally contain lower levels of KBA than AKBA, whereas Indian samples contain approximately equal amounts of both compounds (Ammon, 2006).

AKBA is considered the most pharmacologically active boswellic acid because of its potent inhibitory effects on inflammatory cells and mediators, resulting in reduced inflammatory activity. Numerous studies have elucidated the molecular mechanisms underlying boswellic acids’ anti-inflammatory effects. These compounds directly inhibit key inflammatory targets, including 5-lipoxygenase (5-LOX) and microsomal prostaglandin E synthase-1 (mPGES-1), thereby suppressing the biosynthesis of pro-inflammatory mediators (Cui et al., 2024; Börner et al., 2021). In particular, inhibition of 5-LOX prevents the conversion of arachidonic acid into pro-inflammatory leukotrienes. Boswellic acids exert anti-inflammatory effects through mechanisms that differ from those of non-steroidal anti-inflammatory drugs (NSAIDs), including modulation of 5-lipoxygenase and other inflammatory pathways (Abdel-Tawab et al., 2011; Cui et al., 2024; Börner et al., 2021). However, differences in mechanism of action should not be interpreted as evidence of superior safety, particularly because direct comparative clinical data between Boswellia-derived topical preparations and systemic NSAID therapy are lacking.

3.3.1.2 Antimicrobial activity

AKBA also exhibits the strongest antibacterial activity, particularly against Gram-positive bacteria, with minimum inhibitory concentrations (MICs) ranging from 2 to 8 µg/mL (Raja et al., 2011a). Against Staphylococcus aureus ATCC 29213, AKBA demonstrated bacteriostatic activity, producing an approximately 2-log10 reduction in bacterial viability at 4× and 8× the MIC over 24 h (Raja et al., 2011a). Mechanistic studies indicate that AKBA disrupts bacterial membrane integrity (Raja et al., 2011a). Treatment with AKBA increased propidium iodide uptake by S. aureus cells, suggesting enhanced membrane permeability due to structural damage (Raja et al., 2011a). In addition, intracellular components absorbing at 260 and 280 nm, supporting disruption of the bacterial membrane permeability barrier (Raja et al., 2011a). AKBA has also been shown to inhibit biofilm formation by several Gram-positive oral and opportunistic pathogens, including Actinomyces viscosus, S. mutans, S. aureus, and S. epidermidis, and to reduce the biomass of established biofilms (Raja et al., 2011a; Raja et al., 2011b).

3.3.1.3 Cytotoxic and anticancer activity

Boswellic acids have demonstrated cytotoxic and anticancer-related effects in experimental cancer models. In highly metastatic B16F10 melanoma cells, boswellic acid acetate (BC-4) inhibited proliferation, induced marked melanocytic differentiation, reduced cell migration, induced G1-phase cell-cycle arrest, and decreased topoisomerase II activity (Zhao et al., 2003). Additionally, 3-O-acetyl-β-boswellic acid (β-ABA) has been reported to exert selective cytotoxic effects, showing lower toxicity toward normal cells while inducing DNA fragmentation in melanoma cells (Kumar et al., 2016). Boswellic acids, particularly AKBA, have demonstrated antitumor effects in various cancer cell models, including colon, prostate, leukocyte, liver, and brain tumor cells (Shen et al., 2012). Depending on the cancer type and cellular context, boswellic acids may inhibit tumor progression and metastasis through multiple mechanisms, including suppression of angiogenesis, induction of apoptosis, downregulation of AKT phosphorylation, and inhibition of tumor vascularization (Liu et al., 2002; Uthaman et al., 2012). However, these findings are predominantly preclinical and do not establish clinical anticancer efficacy of boswellic acids in melanoma or other cancers.

3.3.2 Dermatological applications of Boswellia species and boswellic acids

3.3.2.1 Anti-inflammatory skin disorders

Boswellia species and their bioactive compounds have been most extensively investigated for inflammatory skin disorders, reflecting their well-established anti-inflammatory properties (Table 2 and 3). Boswellic acids, particularly AKBA and related derivatives, have been shown to modulate several inflammatory pathways, including 5-lipoxygenase activity, NF-κB signaling, MAPK activation, and the production of pro-inflammatory cytokines. These mechanisms suggest a potential therapeutic role of Boswellia-derived compounds in chronic inflammatory dermatoses.

TABLE 2. Boswellia species and boswellic acids investigated in eczema and psoriasis.

TABLE 3. Boswellia species and boswellic acids investigated in atopic dermatitis.

3.3.2.1.1 Psoriasis and inflammatory eczema

Psoriasis and eczema are among the most systematically investigated dermatological applications of Boswellia (Table 2). A randomized, placebo-controlled clinical trial demonstrated that topical application of a 0.5% B. serrata preparation (Bosexil®) improved psoriasis-associated scaling and erythema, as well as itching and erythema in patients with erythematous eczema (Togni et al., 2014). However, findings obtained with specific commercial Bosexil® formulations may not be directly generalizable to other Boswellia extracts or topical formulations with different compositions and degrees of standardization. Furthermore, preclinical studies have demonstrated that boswellic acid derivatives, including AKBA and cyclohexanecarbonyl-11-keto-β-boswellic acid (CKBA), reduce psoriasis-like inflammation in animal models by suppressing IL-17A-driven inflammatory responses, inhibiting dendritic cell activation, and reducing cytokine production (Wang et al., 2018; Lou et al., 2024). Recent formulation approaches, such as B. serrata nanoemulsion gels, further indicate improved topical efficacy in reducing erythema, scaling, and skin thickening (Fereidouni et al., 2025). Collectively, these findings support Boswellia-derived topical preparations as promising multi-target agents that ameliorate key psoriatic and eczematous features.

However, the current evidence base is constrained by short treatment durations, and a lack of adequately powered trials, leaving optimal dosing, long-term safety and the translational relevance of these mechanistic pathways in diverse psoriasis and eczema phenotypes as important unresolved issues.

3.3.2.1.2 Atopic dermatitis

The potential of boswellic compounds in atopic dermatitis has been investigated mainly through in vitro and in vivo models (Table 3). α-BA was shown to improve skin barrier dysfunction, reduce inflammatory cell infiltration, and suppress NF-κB and MAPK-related pathways in keratinocyte and mouse models of atopic dermatitis (Tsai et al., 2022). Similarly, CKBA topical treatment reduced epidermal hyperplasia, collagen degradation, IgE levels, and mast cell-associated inflammatory mediators in an experimental model of atopic dermatitis (Tong et al., 2023). Additionally, B. sacra volatile and fixed oils demonstrated protective effects against allergic dermatitis by modulating inflammatory biomarkers such as ICAM-1 and leukotriene B4 (Ibrahim et al., 2025).

However, the current evidence remains limited by the absence of controlled clinical trials, heterogeneous experimental designs and formulations, and a lack of long-term safety, leaving optimal dosing, vehicle selection and the clinical relevance of these mechanistic effects as important unresolved questions.

Overall, current evidence indicates that boswellic acids may represent promising candidates for the management of inflammatory skin diseases. However, most studies remain limited to experimental models, and further clinical investigations are required to establish optimal formulations, doses, and long-term efficacy.

3.3.2.2 Skin aging, photoaging, and extracellular matrix remodeling

Beyond inflammatory disorders, Boswellia-derived compounds have attracted interest for their potential role in skin aging due to their effects on oxidative stress, collagen metabolism, and extracellular matrix remodeling (Table 4).

TABLE 4. Boswellia species in photoaged skin.

A randomized split-face clinical study showed that topical application of 0.5% boswellic acid cream derived from B. serrata improved photoaging-related parameters, particularly fine surface lines and tactile roughness, without significant adverse effects (Calzavara-Pinton et al., 2010). These effects were attributed to the anti-inflammatory properties of boswellic acids and their potential influence on collagen and elastin metabolism.

These promising anti-aging results are limited to small, short-term studies using a single low-dose cream, so the durability of benefit, best dose and effects on deeper photoaging features, and long-term safety of Boswellia-based products all remain uncertain.

In addition, B. papyrifera essential oil demonstrated anti-aging potential through inhibition of collagenase and elastase activity, with limonene and α-pinene contributing to synergistic effects (Kotb et al., 2023). The same study showed that frankincense oil-loaded solid lipid nanoparticles provided enhanced protection against UVB-induced skin damage compared with free oil formulations.

Studies using human dermal fibroblasts further support these findings (Tables 5 and 6). Enriched B. serrata extracts standardized in boswellic acids reduced inflammatory markers such as TNF-α and nitric oxide, suggesting potential applications in maintaining dermal homeostasis and supporting collagen formation (Sudhakar et al., 2021). Similarly, frankincense essential oil reduced inflammation-associated markers, including ICAM-1 and IP-10, in pre-inflammatory dermal fibroblast models (Han et al., 2017).

TABLE 5. Boswellia species investigated in dermal fibroblast.

TABLE 6. Boswellia species investigated in striae distensae (dermal scarring resulting from the stretching of the dermis).

These fibroblast studies indicate that Boswellia extracts and frankincense oils can directly suppress inflammatory mediators, but their relevance to skin disease remains uncertain because they rely on simplified cell models, variable preparations and lack confirmatory human in vivo data.

3.3.2.3 Wound healing and radiation-induced skin injury

The anti-inflammatory and tissue-protective properties of Boswellia may also contribute to applications in wound healing and treatment of therapy-related skin damage (Table 7 and 8).

TABLE 7. Boswellia species and boswellic acids investigated in wound healing.

TABLE 8. Boswellia species investigated in radiotherapy skin damage.

A randomized placebo-controlled clinical trial evaluated a 2% B. serrata cream formulation (Bosexil®) in breast cancer patients undergoing radiotherapy (Table 8) (Togni et al., 2015). Topical treatment reduced radiation-induced erythema and decreased superficial symptoms, including itching and burning sensations, suggesting a protective effect against radiation-associated skin reactions (Togni et al., 2015).

Additionally, a case report described the successful use of orally and topically administered B. sacra in a patient with recurrent pilonidal sinus disease (Table 9) (Al Hashmi and Harvey, 2023). Treatment resulted in wound closure, cessation of bleeding, and absence of recurrence during follow-up (Al Hashmi and Harvey, 2023). Although promising, these findings require confirmation in controlled clinical studies.

TABLE 9. Boswellia species investigated in pilonidal sinus disease.

3.3.2.4 Antimicrobial and protective effects against skin pathogens

In studies of skin-associated microorganisms (Table 10), methanolic extracts of B. serrata demonstrated antibacterial activity against S. aureus and Listeria monocytogenes with stronger effects observed against Gram-positive bacteria (Todorović et al., 2025). Similarly, B. sacra extracts exhibited antibacterial activity against S. aureus, B. cereus, P. aeruginosa, and E. coli (Al-Saban et al., 2025). These studies primarily evaluated activity against planktonic microorganisms; biofilm formation or established biofilms were not evaluated.

TABLE 10. Boswellia species investigated in skin pathogens.

These findings provide preliminary evidence of the antibacterial activity of Boswellia-derived preparations against several skin-associated microorganisms. However, the available evidence is predominantly based on in vitro studies, and direct comparisons with standard topical antimicrobials are lacking. Therefore, the clinical usefulness of these findings for the prevention or treatment of dermatological infections cannot yet be established. Further studies are required to determine clinically relevant concentrations, appropriate topical formulations, and skin safety profiles.

3.3.2.5 Emerging applications: pigmentation disorders and melanoma

Recent research has expanded the potential dermatological applications of Boswellia beyond inflammatory and regenerative processes (Table 11). Frankincense volatile oil demonstrated antioxidant, anti-inflammatory, and pigmentation-modulating effects in zebrafish models by reducing melanin production, reactive oxygen species, and neutrophil aggregation (Yan et al., 2024). However, these findings are exploratory and are limited to zebrafish and in vitro models. The authors highlight that formulation challenges (poor solubility and dark colour), lack of acute and chronic toxicity data, and the need for multi-omics validation and clinical studies remain unresolved before frankincense volatile oil can be translated into a potential pigmentation-modulating agent (Yan et al., 2024), which however, is at a very early stage and several of the methods used are of no or very limited pharmacological relevance.

TABLE 11. Frankincense volatile oil investigated in pigmentation disorders.

Furthermore, boswellic acid derivatives have demonstrated preliminary anticancer related activity in melanoma models (Table 12). Boswellic acid acetate and 3-O-acetyl-β-boswellic acid inhibit melanoma cell migration, induce apoptosis, and affect cell-cycle progression in vitro (Zhao et al., 2003; Jamshidi-Adegani et al., 2023). Although these findings are preliminary and do not establish clinical anticancer efficacy in melanoma, Further preclinical and clinical investigations are required to determine their therapeutic relevance.

TABLE 12. Boswellic acids investigated in melanoma.

3.3.3 Research gaps and future perspectives

Although increasing evidence supports the dermatological potential of Boswellia species, current studies remain limited by small sample sizes, short treatment durations, and a predominance of in vitro and animal models. The methodological quality and reporting of the included studies were also heterogeneous, particularly regarding sample size, randomization, blinding, controls, and reporting of experimental conditions. These limitations should be considered when interpreting the overall robustness of the available evidence. Boswellic acids are highly lipophilic compounds with limited aqueous solubility and are known to exhibit poor oral bioavailability. In topical dermatological applications, their local availability may be influenced by drug release from the formulation, percutaneous absorption, and the composition of the topical vehicle. Therefore, optimization of the vehicle is an important consideration for improving the dermal delivery of boswellic acids. An additional translational limitation is that concentrations producing biological effects in in vitro models may not necessarily be achieved within human skin following topical application. Data on dermal absorption, distribution and retention across different skin layers, and local metabolism of boswellic acids remain limited. Consequently, direct translation of experimentally effective concentrations to clinically relevant topical doses should be approached cautiously. Advanced delivery systems, including nanoemulsions, phytosome-based formulations, and lipid-based delivery systems, may improve dermal delivery and local availability of boswellic acids. However, evidence regarding their comparative skin penetration, long-term safety, formulation stability, and scalability remains limited. Safety data for topical Boswellia-derived preparations also remain limited and inconsistently reported across studies. Although some clinical studies have reported topical formulations to be generally well tolerated, systematic evidence regarding local irritancy, sensitization, allergic contact dermatitis, and phototoxicity remains limited. Data on cytotoxicity toward normal keratinocytes and dermal fibroblasts, systemic absorption following topical application, and potential interactions with conventional dermatological treatments are also limited. These safety considerations are particularly relevant for essential oils and concentrated resin preparations, especially when applied to inflamed, damaged, or irradiated skin. Further studies should therefore include systematic assessment and reporting of local and systemic adverse effects, skin irritation and sensitization, phototoxicity, cellular safety, systemic exposure, and concomitant treatment use. Future studies should integrate skin-permeation and pharmacokinetic assessments with pharmacological outcomes to determine whether experimentally active concentrations can be achieved safely in human skin. In addition, future research should focus on well-designed clinical trials, standardized extracts, species-specific comparisons, and improved delivery systems to determine the therapeutic value of Boswellia-derived compounds in dermatology.

4 Conclusion

This review highlights the growing evidence supporting the dermatological potential of Boswellia species and their bioactive metabolites, particularly boswellic acids. A core basis for any further use and development is ascertaining the sustainable sourcing especially of the resin from B. sacra, which is threatened due to its bioeconomical overuse, risks linked to climate change, a very low reproductive success and general low population levels (Mykhailenko et al., 2025). Current findings indicate that Boswellia-derived preparations exert multiple biological effects relevant to skin health, including anti-inflammatory, immunomodulatory, antioxidant, antimicrobial, and tissue-remodeling effects.

Among the dermatological indications investigated, psoriasis has received considerable preclinical attention and limited clinical evaluation. Experimental studies demonstrated that boswellic acids, particularly AKBA and CKBA, modulate psoriasis-associated inflammatory pathways, including IL-17-mediated signaling, NF-κB activation, and cytokine production. Moreover, preliminary clinical evidence with topical B. serrata formulations suggests improvements in psoriasis severity parameters, supporting further investigation of frankincense-based topical therapies.

Despite these promising findings, several methodological limitations are consistently observed across the available literature. Current evidence remains limited by heterogeneous study designs, small clinical cohorts, short intervention periods, and variations in Boswellia species, extraction methods, and concentrations. Importantly, many studies provide insufficient methodological detail regarding therapeutic plant preparations, including the exact Boswellia species used, the quantity of plant material, dosing, and formulation protocols, which reduces transparency and hinders reproducibility and clinical translation. Therefore, direct comparison between studies remains challenging. The lack of standardized preparations also complicates the interpretation of pharmacological effects, clinical efficacy and the identification of the most therapeutically relevant Boswellia species and bioactive metabolites.

Future research should prioritize chemically well-characterized and ideally Boswellia preparations standardized to defined amounts of pentacyclic triterpenes, comprehensive reporting of experimental methodologies, and well-designed preclinical and clinical studies. In particular, well-designed clinical trials evaluating standardized frankincense-based topical formulations are warranted to determine their efficacy, safety, optimal dosage, and therapeutic positioning in psoriasis management. Such studies are required to determine whether Boswellia-derived topical preparations may have a future role in the management of chronic inflammatory skin diseases.

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Footnotes

Edited by: Harish Dureja, Maharshi Dayanand University, India

Reviewed by: Shardendu Kumar Mishra, KIET Group of Institutions, India

Vinay Kumar, KIET School of Pharmacy (KSOP), India