Clinical Briefs: Alternative Therapies in Dermatology
Source: Levin C, et al. Exploration of "alternative" and "natural" drugs in dermatology. Arch Dermatol 2002;138:207-211.
To review some of the promising natural remedies within dermatology and their potential clinical benefit in supplementing conventional drugs, MEDLINE searches were conducted for the period January 1966 to October 2000. Science Citation Index searches were conducted for the period January 1974 to October 2000.
Primary importance was given to in vivo and in vitro controlled studies, the results of which encourage further exploration. The controls used, the statistical approach to analysis, and the validity of the experimental method analyzed were considered particularly important. Data were independently extracted by multiple observers.
Natural remedies seem promising in treating a wide variety of dermatologic disorders, including inflammation, phototoxicity, psoriasis, atopic dermatitis, alopecia areata, and poison oak. The alternative medications presented seem promising, although their true effects are unknown. Many of the presented studies do not allow deduction of clinical effects. Further experimentation must be performed to assess clinical benefit.
Source: Bedi M, et al. Herbal therapy in dermatology. Arch Dermatol 2002;138:232-242.
Herbal therapy is becoming increasingly popular among patients and physicians. Many herbal preparations are marketed to the public for various ailments including those of the skin. Herbal therapies have been used successfully in treating dermatologic disorders for thousands of years in Europe and Asia. In Germany, a regulatory commission oversees herbal preparations and recommended uses. In Asia, herbal treatments that have been used for centuries are now being studied scientifically. Currently, the United States does not regulate herbal products, as they are considered dietary supplements. Therefore, there is no standardization of active ingredients, purity, or concentration. There are also no regulations governing which herbs can be marketed for various ailments. This has made learning about and using these treatments challenging. Information compiled in a practical fashion may enable more patients to benefit from these treatments currently used worldwide.
This review examined herbal medications that show scientific evidence of clinical efficacy, as well as the more common herbs shown to be useful in the treatment of dermatologic disorders. The safety of each herb has been addressed to better enable the physician to know which herbal therapies they may want to begin to use in practice. Common drug interactions and side effects of herbal medicines that may be seen in the dermatologic setting also were studied.
Comment
These two articles summarize the state of the evidence-based art of treatment in dermatology.
Levin and colleague take a therapy-centered approach and report data for tea extracts (for preventing and treating UV-induced photodamage differently than sunscreens); hydroxy acids (for improving the appearance of aging skin); gamma linolenic acid (for atopic dermatitis); essential aromatic oils (for IgE-mediated allergic reactions and alopecia areata), vitamins C and E (for preventing nitrate tolerance in healthy volunteers taking transdermal glycerol trinitrate; and for improving photoprotection against UV-induced erythema); and even Quaternium-18 bentonite, a thickening clay in cosmetics (for preventing poison ivy or poison oak contact dermatitis).
Conversely, Bedi and Shenefelt take a disease-centered approach, and explore alternatives for acne, wounds, burns, herpes simplex, bacterial and fungal infections, scabies, condyloma, verruca vulgaris, dermatitis, psoriasis, chronic venous insufficiency, and alopecia. They cover topical treatments from aloe to honey and licorice to garlic. Their citation manager is substantial, and they have done their homework, though they spend very little time on adverse effects.
Together, these papers are complementary and very useful. Daniel M. Siegel, MD, writes an accompanying, thoughtful editorial summarizing the availability of general references both online and in print.
Recommendation
Any clinician who sees patients with dermatologic questions will find this set of papers useful. Among the most effective, least toxic treatments seem to be oral vitamins C and E for prevention of sunburn, and oral vitex for treatment of premenstrual acne, though not in potentially pregnant women; and, topical capsaicin for psoriasis. The most dangerous treatments, and ones to avoid, seem to be Chinese herbal compounds, which may be contaminated with heavy metals, prescription pharmaceuticals, or other substances, and may affect hepatotoxicity; and those compounds with potential interaction with steroids and immunosuppressants—echinacea and astragalus, among others.
La Puma J. Alternative therapies in dermatology. Altern Med Alert 2002;5:88.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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