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American Journal of Clinical Dermatology

, Volume 3, Issue 5, pp 341–348 | Cite as

Complementary/Alternative Medicine in Dermatology

Evidence-Assessed Efficacy of Two Diseases and Two Treatments
  • Edzard ErnstEmail author
  • Max H. Pittler
  • Clare Stevinson
Review Article

Abstract

The objective of this article is to provide a brief, but critical, overview of the evidence related to complementary/ alternative medicine (CAM) use, and to offer valid and useful information for dermatologists in clinical practice. Systematic literature searches were conducted on these databases: Medline, EMBASE, The Cochrane Library, CISCOM and AMED (until October 2000). Where appropriate, the evaluation of the published literature was based on systematic reviews and randomized controlled trials. After scanning the literature it was decided to focus on a selection of two conditions (atopic dermatitis and chronic venous insufficiency) and two treatment modalities (aloe vera gel and tea tree oil). Data for the life-time prevalence of CAM use by patients with dermatological disease ranges between 35 to 69%. The most popular modalities include herablism and (other) dietary supplements, while atopic dermatitis is one of the conditions most frequently treated with CAM. For patients with atopic dermatitis the evidence relates to autogenic training, hypnotherapy, diet, herbal medicine, and dietary supplements. Compelling evidence of effectiveness exists for none of these therapies. However, some promising data have been reported for those with a psychological component: autogenic training, biofeedback and hypnotherapy. For chronic venous insufficiency there is relatively convincing evidence for the effectiveness of oral horse chestnut seed extract. The data for aloe vera gel and tea tree oil indicate that for neither is there compelling evidence of effectiveness. The use of CAM treatments is not free of risk; direct and indirect risks associated with CAM must be considered.

Keywords

Atopic Dermatitis Aristolochic Acid Dermatological Condition Chronic Venous Insufficiency Autogenic Training 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors declare no conflict of interest or funding.

References

  1. 1.
    Eisenberg D., David R.B., Ettner S.L., et al. Trends in alternative medicine use in the United States, 1990–1997. JAMA 1998; 280: 1569–1575PubMedCrossRefGoogle Scholar
  2. 2.
    Ernst E., White A.R. The BBC survey of complementary medicine use in the UK. Complement Ther Med 2000; 8: 32–36PubMedGoogle Scholar
  3. 3.
    Ernst E. The usage of complementary therapies by dermatological patients: a systematic review. Br J Dermatol 2000; 142: 857–861PubMedCrossRefGoogle Scholar
  4. 4.
    Jensen P. Use of alternative medicine by patients with atopic dermatitis and psoriasis. Acta Derm Venereol 1990; 70: 421–424PubMedGoogle Scholar
  5. 5.
    Fleischer A.B., Feldman S.R., Rapp S.R., et al. Alternative therapies commonly used within a population of patients with psoriasis. Cutis 1996; 158: 216–220Google Scholar
  6. 6.
    Söllner W., Zingg-Schir M., Rumpold G., et al. Attitude towards alternative therapy, compliance with standard treatment, and need for emotional support in patients with melanoma. Arch Dermatol 1997; 133: 316–321PubMedCrossRefGoogle Scholar
  7. 7.
    Ramos-Remus C., Gamez-Nava J.I., Gonzalez-Lopez L, et al. Use of alternative medicine in a consecutive sample of patients with systemic lupus erythematosus. J Rheumatol 1997; 24: 2490–2491PubMedGoogle Scholar
  8. 8.
    Berg M., Arnetz B. Characteristics of users and nonusers of alternative medicine in dermatologic patients attending a university hospital clinic: a short report. J Altern Complement Med 1998; 4: 277–279PubMedCrossRefGoogle Scholar
  9. 9.
    Clark C.M., McKay R.A., Fortune D.G., et al. Use of alternative treatments by patients with psoriasis. Br J Gen Pract 1998; 48: 1873–1874PubMedGoogle Scholar
  10. 10.
    Augustin M., Zschocke I., Buhrke U. Attitudes and prior experience with respect to alternative medicine among dermatological patients: the Freiburg Questionnaire on Attitudes to Naturopathy (FAN). Forsch Komplementärmed 1999; 6: 26–29PubMedGoogle Scholar
  11. 11.
    Ehlers A., Stangier U., Gieler U. Treatment of atopic dermatitis: a comparison of psychological and dermatological approaches to relapse prevention. J Consult Clin Psychol 1995; 63: 624–635PubMedCrossRefGoogle Scholar
  12. 12.
    Lever R., MacDonald C., Waugh P., et al. Randomised controlled trial of advice on an egg exclusion diet in young children with atopic eczema and sensitivity to eggs. Pediatr Allergy Immunol 1998; 9: 13–19PubMedCrossRefGoogle Scholar
  13. 13.
    Atherton D.J., Sewall M., Soothill J.F., et al. A double-blind controlled cross-over trial of an antigen-avoidance diet in atopic eczema. Lancet 1978; 25: 401–403CrossRefGoogle Scholar
  14. 14.
    Neild V.S., Marsden R.A., Bailes J.A., et al. Egg and mild exclusion diets in atopic eczema. Br J Dermatol 1986; 114: 117–123PubMedCrossRefGoogle Scholar
  15. 15.
    Cant A.J., Bailes J.A., Marsden R.A., et al. Effect of maternal dietary exclusion on breast fed infants with eczema: two controlled studies. BMJ 1986; 293: 231–233PubMedCrossRefGoogle Scholar
  16. 16.
    Kramer M.S. Maternal antigen avoidance during pregnancy for preventing atopic disease in infants of women at high risk (Cochrane Review). Available in The Cochrane Library [database on CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 2. Oxford: Update Software, 2002Google Scholar
  17. 17.
    Kramer M.S. Maternal antigen avoidance during lactation for preventing atopic disease in infants of women at high risk (Cochrane Review). Available in The Cochrane Library [database on CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 2. Oxford: Update Software, 2002Google Scholar
  18. 18.
    Baslau M., Thaci D. Atopic dermatitis: borage oil for systemic therapy. Zeitschr Dermatol 1996; 182: 131–136Google Scholar
  19. 19.
    Henz B.M., Jablonska S., Van de Kerkhof P.C.M., et al. Double blind, multicentre analysis of the efficacy of borage oil or patients with atopic eczema. Br J Dermatol 1999; 140: 685–688PubMedCrossRefGoogle Scholar
  20. 20.
    Borreck S., Hildebrandt A., Forster J. Borage seed oil and atopic dermatitis. Klinische Pädiatrie 1997; 209: 100–104CrossRefGoogle Scholar
  21. 21.
    Armstrong N., Ernst E. Treatment of eczema with Chinese herbs: a systematic review of randomised clinical trials. Br J Clin Pharmacol 1999; 48: 262–264PubMedCrossRefGoogle Scholar
  22. 22.
    Fung A.Y., Look P.C., Chong L.Y., et al. A controlled trial of traditional Chinese herbal medicine in Chinese patients with recalcitrant atopic dermatitis. Int J Dermatol 1999; 38: 387–392PubMedCrossRefGoogle Scholar
  23. 23.
    Morse P.F., Horrobin D.R., Manku M.S., et al. Meta-analysis of placebo-controlled studies of the efficacy of Epogam in the treatment of atopic eczema: relationship between plasma essential fatty acid changes and clinical response. Br J Dermatol 1989; 121: 75–90PubMedCrossRefGoogle Scholar
  24. 24.
    Berth-Jones J., Brown G. Placebo-controlled trial of essential fatty acid supplementation in atopic dermatitis. Lancet 1993; 341: 1557–1560PubMedCrossRefGoogle Scholar
  25. 25.
    Biagi P.L., Bordini A., Hrelia S., et al. The effect of gamma-linolenic acid on clinical status, red cell fatty acid composition and membrane microviscosity in infants with atopic dermatitis. Drugs Exp Clin Res 1994; 20: 77–84PubMedGoogle Scholar
  26. 26.
    Whitaker D.K., Cilliers J., de Beer C. Evening primrose oil (Epogam) in the treatment of chronic hand dermatitis: disappointing therapeutic results. Dermatology 1996; 193: 115–120PubMedCrossRefGoogle Scholar
  27. 27.
    Hederos C.A., Berg A. Epogam evening primrose oil treatment in atopic dermatitis and asthma. Arch Dis Childhood 1996; 75: 494–497CrossRefGoogle Scholar
  28. 28.
    Sokel B., Christie D., Kent A., et al. A comparison of hypnotherapy and biofeedback in the treatment of childhood atopic eczema. Contemp Hypnosis 1993; 10: 145–154Google Scholar
  29. 29.
    Fairris G.M., Perkins P.J., Lloyd B., et al. The effect of atopic dermatitis of supplementation with selenium and vitamin E. Acta Derm Venerol 1989; 69: 359–362PubMedGoogle Scholar
  30. 30.
    Ewing C.I., Gibbs A.C., Ashcroft C., et al. Failure of oral zinc supplementation in atopic eczema. Eur J Clin Nutr 1991; 45: 507–510PubMedGoogle Scholar
  31. 31.
    Ihme N., Kiesewetter H., Jung F., et al. Leg edema protection from a buckwheat herb tea in patients with chronic venous insufficiency: a single blind, randomised, placebo-controlled clinical trial. Eur J Clin Pharmacol 1996; 50: 443–447PubMedCrossRefGoogle Scholar
  32. 32.
    Rudofsky G., Diehm C., Gruß J.D., et al. Chronisch venöse insuffizienz. Münch Med Wschr 1990; 132: 205–210Google Scholar
  33. 33.
    Weindorf N., Schultz-Ehrenburg U. Kontrollierte Studie zur oralen Venentonisierung der primären Varikosis mit Ruscus aculeatus und Trimethylherperidinchalkon. Z Hautkr 1987; 62: 28–38PubMedGoogle Scholar
  34. 34.
    Cappelli R., Nicora M., Di Perri T. Use of extract of ruscus aculeatus in venous disease in the lower limbs. Drugs Exp Clin Res 1988; 14: 277–283PubMedGoogle Scholar
  35. 35.
    Janssens D., Michiels C., Guillaume G., et al. Increase in circulating endothelial cells in patients with primary chronic venous insufficiency: protective effect of Ginkgor Fort in a randomized double-blind, placebo-controlled clinical trial. J Cardiovasc Pharmacol 1999; 33: 7–11PubMedCrossRefGoogle Scholar
  36. 36.
    Cesarone M.R., Laurora G., De Sanctis M.T., et al. The microcirculatory activity of Centella asiatica in venous insufficiency: a double-blind study. Minerva Cardioangiol 1994; 42: 299–304PubMedGoogle Scholar
  37. 37.
    Pointel J.P., Bocaalon H., Cloarec M., et al. Titrated extract of Centella asiatica (TECA) in the treatment of venous insufficiency of the lower limbs. Angiology 1987; 38: 46–50PubMedCrossRefGoogle Scholar
  38. 38.
    Allergra C., Pollari G., Criscuolo A. L’estratto di Centella asiatica nelle flebopatie degli arti iferiori. Clin Ther 1981; 99: 507–513Google Scholar
  39. 39.
    Pittler M.H., Ernst E. Horse-chestnut seed extract for chronic venous insufficiency: a criteria-based systematic review. Arch Dermatol 1998; 134: 1356–1360PubMedCrossRefGoogle Scholar
  40. 40.
    Kiesewetter H., Koscielny J., Kalus U., et al. Efficacy of orally administered extract of red vine leaf AS 195 (folia vitis viniferae) in chronic venous insufficiency (stages I-II): a randomized, double-blind, placebo-controlled trial. Arzneimittel Forschung 2000; 50: 109–117PubMedGoogle Scholar
  41. 41.
    Ernst E., Saradeth T., Resch K.L. Complementary treatment of varicose veins: a randomized, placebo-controlled, double-blind trial. Phlebology 1990; 5: 157–163Google Scholar
  42. 42.
    Ernst E., Saradeth T., Resch K.L. A single blind randomized controlled trial of hydrotherapy for varicose veins. Vasa 1991; 20: 147–152PubMedGoogle Scholar
  43. 43.
    Saradeth T., Ernst E., Resch K.L. Hydrotherapy for varicose veins: a randomized, controlled trial. Eur J Phys Med Rehabil 1993; 3: 123–124Google Scholar
  44. 44.
    Hartmann B., Drews B., Bassenge E. Effects of bathing in CO2-containing thermal water on the venous hemodynamics of healthy persons with venous diseases. Phys Med Rehabil Kurortmed 1993; 3: 153–157CrossRefGoogle Scholar
  45. 45.
    Fetrow C.W., Avila J.R. Complementary and alternative medicines. Philadelphia (PA): Springhouse, 1999Google Scholar
  46. 46.
    Pizzorno J.E., Murray M.T. Textbook of natural medicine. Edinburgh: Churchill Livingstone, 1999Google Scholar
  47. 47.
    Vogler B.K., Ernst E. Aloe vera: a systematic review of its clinical effectiveness. Br J Gen Pract 1999; 49: 823–828PubMedGoogle Scholar
  48. 48.
    Fulton J.E. The stimulation of postdermabrasion wound healing with stabilised aloe vera gel-polyethylene oxide dressing. J Dermatol Surg Oncol 1990; 16: 460–467PubMedGoogle Scholar
  49. 49.
    Schmidt J.M., Greenspoon J.S. Aloe vera dermal wound gel is associated with a delay in would healing. Obstet Gynecol 1991; 1: 115–117Google Scholar
  50. 50.
    Syed T.A., Ahmad S.A., Holt A.H., et al. Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study. Trop Med Int Health 1996; 1: 505–509PubMedCrossRefGoogle Scholar
  51. 51.
    Williams M.S., Burk M., Loprinzi C.L., et al. Phase III double-blind evaluation of an Aloe vera gel as a prophylactic agent for radiation-induced skin toxicity. Int J Radiat Oncol Biol Phys 1996; 36: 345–349PubMedCrossRefGoogle Scholar
  52. 52.
    Syed T.A., Cheema K.M., Ashfaq A., et al. Aloe vera extract 0.5 % in a hydrophilic cream versus Aloe vera gel for the management of genital herpes in males: a placebo-controlled, double-blind, comparative study [letter]. J Eur Acad Dermatol Venereal 1996; 7: 294–295Google Scholar
  53. 53.
    Syed T.A., Afzal M., Ahmad S.A., et al. Management of genital herpes in men with 0.5% Aloe vera extract in a hydrophylic cream: a placebo-controlled doubleblind study. J Dermatol Treat 1997; 8: 99–102CrossRefGoogle Scholar
  54. 54.
    Ernst E., Huntley A. Tea tree oil: a systematic review of randomized clinical trials. Forsch Komplementärmed 2000; 7: 17–20CrossRefGoogle Scholar
  55. 55.
    Bassett I.B., Pannowitz D.L., Barnetson R. A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne. Med J Aust 1990; 153: 455–458PubMedGoogle Scholar
  56. 56.
    Tong M.M., Altman P.M., Baretson R. Tea tree oil in the treatment of tinea pedis. Aust J Dermatol 1992; 33: 145–149CrossRefGoogle Scholar
  57. 57.
    Buck D.S., Nidorf D.M., Addino J.G. Comparison of two topical preparations for the treatment of onychomycosis: Melaleuca alternifolia (tea tree) oil and clotrimazole. J Fam Pract 1994; 38: 601–605PubMedGoogle Scholar
  58. 58.
    Syed T.A., Qureshi Z.A., Ali S.M., et al. Treatment of toenail onychomycosis with 2% butenafine and 5% Melaleuca alternifolia (tea tree) oil in cream. Trop Med Int Health 1999; 4: 284–287PubMedCrossRefGoogle Scholar
  59. 59.
    Ernst E. Adverse effects of herbal drugs in dermatology. Br J Dermatol 2000; 143: 923–929PubMedCrossRefGoogle Scholar
  60. 60.
    Davies E.G., Pollock I., Steel H.M. Chinese herbs for eczema [letter]. Lancet 1990; 336: 177Google Scholar
  61. 61.
    Graham-Brown R. Toxicity of Chinese herbal remedies [letter]. Lancet 1992; 340: 673PubMedCrossRefGoogle Scholar
  62. 62.
    MacGregor F.B., Abernethy V.E., Dahabra S., et al. Hepatotoxicity of herbal remedies. BMJ 1989; 229: 1156–1157CrossRefGoogle Scholar
  63. 63.
    Carlsson C. Herbs and hepatitis [letter]. Lancet 1990; 336: 1068PubMedCrossRefGoogle Scholar
  64. 64.
    Ferguson J.E., Chalmers F.J.G., Rowlands D.J. Reversible dilated cardiomyopathy following treatment of atopic eczema with Chinese herbal medicine. Br J Dermatol 1997; 136: 592–593PubMedCrossRefGoogle Scholar
  65. 65.
    Shaw D., Leon C., Kolev S. Traditional remedies and food supplements: a 5-year toxicological study (1991–1995). Drug Saf 1997; 17: 342–356PubMedCrossRefGoogle Scholar
  66. 66.
    Lord G.M., Tagore R., Cook T., et al. Nephropathy caused by Chinese herbs in the UK. Lancet 1999; 354: 481–482PubMedCrossRefGoogle Scholar
  67. 67.
    Koo J., Arian S. Traditional Chinese medicine for the treatment of dermatologic disorders. Arch Dermatol 1998; 134: 1388–1393PubMedCrossRefGoogle Scholar
  68. 68.
    Ernst E. Risks associated with complementary therapies. In: Dukes M.N.G., Aronson J.K., editors. Meyler’s side effects of drugs. 14th ed. Amsterdam: Elsevier Science, 2000: 1649–1681Google Scholar
  69. 69.
    Ernst E., Hentschel C.H. Diagnostic methods in complementary medicine: which craft is witchcraft? Int J Risk Safety Med 1995; 7: 55–63Google Scholar
  70. 70.
    Ernst E., Pittler M.H., Stevinson C., et al. The desktop guide to complementary and alternative medicine. Edinburgh: Mosby, 2001Google Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  • Edzard Ernst
    • 1
    Email author
  • Max H. Pittler
    • 1
  • Clare Stevinson
    • 1
  1. 1.Department of Complementary Medicine, School of Sport and Health SciencesUniversity of ExeterExeterUK

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