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The Ellechemy Glossary: What is Boric Acid? The Power House Ingredient in Our Equilibrium Formulation

Who needs to find their Equilibrium? You could argue we all do! But it’s a killer formulation for people perennially irritated by recurring thrush.

Vulvovaginal candidiasis, known colloquially as thrush is a pathological condition of the female reproductive tract affecting an estimated 75% of people who have a vagina at least once in their life.

Around 8% of us – meaning globally a huge number of vulva owners experience recurrent thrush, which can be depressing and have a negative impact on our sexual confidence. Triggers can include the hormonal changes that come with your period, but sometimes it frustratingly feels like there is no reason at all.

Why your vagina loves boric acid

Candida albicans is the most common yeast species rocking the peace of our microbiome, causing up to 90% of so-called thrush or yeast infections, but non-albicans species Candida glabrata and Candida parapsilosis can also be to blame.

Your doctor’s go-to first line treatment will be a member of the azole family of antifungal oral drugs or vaginal creams. Examples include the drugs fluconazole and clotrimazole. Unfortunately, azole drug resistance is on the rise, and for some this treatment is either wholly or partially ineffective with thrush symptoms persisting or quickly returning.  

Broad-spectrum antimicrobial  boric acid is an alternative treatment to successfully treat vulvo-vaginal Candida infections.

Acid? Do I want to put on acid on my vulva?

The name boric acid may sound harsh, but actually it feels incredibly soothing, especially for people prone to recurrent thrush.

What is boric acid?

Boric acid is an inorganic acid, used for decades to treat vulvo-vaginal thrush infections. Your vagina’s pH is meant to be naturally acidic. All of Ellechemy's formulations have pH 4.5 which honours the natural order of your vagina’s biome.  

Benefits of boric acid for vaginal health

Studies have demonstrated multiple pathways where boric acid is more effective at inhibiting Candida growth compared to azole drugs. As the mode of action is different, treatment failure with azoles does not mean you will also be resistant to boric acid treatment.   

Boric acid is effective at slowing or stopping yeast-to-hyphal transition and biofilm growth in C. albicans and penetrates and degrades mature biofilms. 

Approximately 40% of the extracellular matrix of Candida albicans is made up of polysaccharides, built from glucose carbohydrate units. Saccharides and especially glucose have a strong affinity for boric acid. Boric acid can penetrate the extracellular matrix of Candida species biofilm, breaking the matrix apart. Boric acid is also known to disrupt the cytoskeleton of fungal/yeast specific structures called hyphae.

Boric acid has been scientifically proven to be an effective treatment for vulvo-vaginal candidiasis and is a first line alternative to anti yeast azole drugs in the context of treatment resistance.

Final verdict on Boric Acid

Boric acid inhibits metabolic activity in Candida species in a dose-dependent manner. Unlike azole drugs, which neither prevent hyphal formation nor disrupt mature biofilms, boric acid has been shown to effectively do both.

Ellechemy's Equilibrium formulation can be used as both a luxurious lube and as a gentle daily treatment and intimate moisturiser containing boric acid to help banish recurrent thrush and help keep your microbiome happy and balanced.    

References

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Sobel JD. 2007. Vulvovaginal candidosis. Lancet 369:1961–1971. 10.1016/S0140-6736(07)60917-9. 

Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. 2016. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 62:e1–e50. 10.1093/cid/civ933.

Denning DW, Kneale M, Sobel JD, Rautemaa-Richardson R. 2018. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis 18:e339–e347. 10.1016/S1473-3099(18)30103-8.

Cetin M, Ocak S, Gungoren A, Hakverdi AU. 2007. Distribution of Candida species in women with vulvovaginal symptoms and their association with different ages and contraceptive methods. Scand J Infect Dis 39:584–588. 

Linhares LM, Witkin SS, Miranda SD, Fonseca AM, Pinotti JA, Ledger WJ. 2001. Differentiation between women with vulvovaginal symptoms who are positive or negative for Candida species by culture. Infect Dis Obstet Gynecol 9:221–225. 10.1155/S1064744901000369. 

 Pointer BR, Boyer MP, Schmidt M. 2015. Boric acid destabilizes the hyphal cytoskeleton and inhibits invasive growth of Candida albicans. Yeast 32:389–398. 10.1002/yea.3066. 

De Seta F, Schmidt M, Vu B, Essmann M, Larsen B. 2009. Antifungal mechanisms supporting boric acid therapy of Candida vaginitis. J Antimicrob Chemother 63:325–336. 10.1093/jac/dkn486.

Al-Fattani MA, Douglas LJ. 2006. Biofilm matrix of Candida albicans and Candida tropicalis: chemical composition and role in drug resistance. J Med Microbiol 55:999–1008. 10.1099/jmm.0.46569-0.

Peters JA. 2014. Interactions between boric acid derivatives and saccharides in aqueous media: structures and stabilities of resulting esters. Coord Chem Rev 268:1–22. 10.1016/j.ccr.2014.01.016. 

Powell A, Ghanem KG, Rogers L, Zinalabedini A, Brotman RM, Zenilman J, Tuddenham S. Clinicians' Use of Intravaginal Boric Acid Maintenance Therapy for Recurrent Vulvovaginal Candidiasis and Bacterial Vaginosis. Sex Transm Dis. 2019 Dec;46(12):810-812. doi: 10.1097/OLQ.0000000000001063. PMID: 31663976; PMCID: PMC6878170.

Iavazzo C, Gkegkes ID, Zarkada IM, et al. Boric acid for recurrent vulvovaginal candidiasis: the clinical evidence. J Womens Health (Larchmt) 2011;20(8):1245–55.

Van Kessel K, Assefi N, Marrazzo J, et al. Common complementary and alternative therapies for yeast vaginitis and bacterial vaginosis: a systematic review. Obstet Gynecol Surv 2003;58(5):351–8.