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DIAGNOSA, INTERVENSI, DAN LITERATUR JURNAL

GANGGUAN SISTEM INTEGUMEN

Dosen Pembimbing:

Dedi Irawandi,S.Kep.,Ns

Oleh:

1. Ayu Cahyaningtyas (141.0022)


2. Etty Khandhayoni (141.0042)
3. M Iqbal Rinaldhi (141.0066)
4. Nevinda Hervi F (141.0068)
5. Nuril Mufidah C (141.0074)
6. Putri Wardah Nafisah (141.0078)
7. Ridho Fajar Aprilianto (141.0082)
8. Riza Agustin (141.0086)
9. Selviana Dwi S (141.0092)
10. Yuniar Indah Prastiwi (141.0110)

SEKOLAH TINGGI ILMU KESEHATAN HANG TUAH


2016
Diagnosa Medis : Candidiasis

Diagnosa Keperawatan : Hipertermi b.d proses inflamasi

Intervensi Keperawatan :

No. Masalah Keperawatan Tujuan dan Kriteria Hasil Intervensi Rasional

1. Hipertermi b.d proses Setelah dilakukan asuhan 1. Observasi suhu tubuh setiap 1. Mengetahui
inflamasi keperawatan selama 2 x 24 4 jam sekali perkembangan dari status
jam, diharapkan hipertermi kesehatan pasien
2. Berikan kompres hangat di
2. Di ketiak dan lipatan paha
teratasi dengan kriteria hasil :
sekitar lipatan misalnya
terdapat banyak
ketiak, lipatan paha
- Suhu tubuh normal pembuluh darah besar.
(36,5 -37,5)oC Hipertermi mengalami
- Akral hangat
vasodilatasi sehingga
- Mukosa bibir lembab
- Pasien tidak gelisah harus diberi kompres
hangat agar terjadi
memperluas vasodilatasi
dan menyebabkan suhu
3. Ciptakan suasana yang
panas tubuh lebih cepat
nyaman (atur ventilasi) keluar
3. Suhu ruangan harus
diubah untuk
4. Anjurkan kepada pasien
mempertahankan suhu
dan keluarga untuk
mendekati normal
minum, sedikit tapi sering
4. Peningkatan suhu tubuh
mengakibatkan
penguapan tubuh
5. Anjurkan keluarga untuk
meningkat sehingga perlu
tidak memakaikan selimut
diimbangi dengan asupan
dan pakaian yang tebal
6. Kolaborasi : pemberian obat cairan yang banyak.
5. Pakaian tipis membantu
anti mikroba, antipiretik
mengurangi penguapan
pemberian cairan parenteral
tubuh
6. Digunakan untuk
mengurangi demam
dengan aksi sentralnya
pada hipotalamus,
meskipun demam
mungkin dapat berguna
dalam membatasi
pertumbuhan organisme
dan meningkatkan
autodestruksi dari sel-sel
yang terinfeksi.
Diagnosa medis :tinea kapitis:

Masalah Keperawatan: Gangguan citra tubuh b.d perubahan penampilan.

Intervensi

No Diagnosa Tujuan dan kriteria Intervensi Rasional


hasil
1. Gangguan Setelah dilakukan 1. Kaji perubahan pada klien. 1. Menentukan tindakan keperawatan
citra tubuh asuhan keperawatan selanjutnya.
b.d selam 3x24 jam, 2. Dorong pasien melakukan perawatan
2. Meningkatkan rasa kemandirian
perubahan gangguan citra tubuh diri.
dan kontrol klien.
3. Berikan kesempatan kepada pasien
penampilan diharapkan teratasi 3. Mengungkapkan keluhannya dan
untuk menyatakan perasaan tentang
dengan kriteria hasil : memperbaiki kesalah pahaman.
citra tubuhnya dan hospitalisasi.
- Klien sudah
4. Berikan keyakinan pada diri klien.
tidak merasa 5. Dorong interaksi dengan keluarga.
malu.
- Lesi tidak lagi
kasar.
- Lesi tidak lagi
bersisik. 6. Kolaborasi
dengan dokter pemberian
4. Meningkatkan kepercayaan diri
griseofulvin. klien.

5. Mempertahankan komunikasi
dengan mendukung secara terus-
menerus pada klien.
6. Menghilangkan keefektifan
mikroorganisme yang ada pada
rambut.

TINEA KORPORIS
Masalah Keperawatan tinea korporis :

1. Gangguan Integritas kulit berhubungan dengan adanya lesi

Intervensi :

n Diagnosa Tujuan Dan KH Intervensi Rasional


o
1 Gangguan Setelah dilakukan 1. Observasi klien 1. Untuk menentikan tindakan yang
integritas kulit asuhan keperawatan akan dilakukan
2. Untuk mengetahui keparahan
b.d adanya lesi diharapkan tidak ada
lesi dengan kriteria 3. Untuk mengurangi alergi pada kulit
2. Catat perubahan pada kulit 4. Untuk mencegah petumbuhan
hasil : keluhan gatal
jamur
berkurang 3. Hindari makanan yang tinggi
Integritas jaringan kulit protein
memmbaik
4. Kolaborasi pemberian antibiotik

MASALAH KEPERAWATAN PADA TINEA CRURIS


1. Nyeri akut berhubungan dengan perubahan kenyamanan.
2. Kerusakan integritas kulit berhubungan dengan kerusakan permukaan kulit.
3. Gangguan citra tubuh berhubungan dengan perubahan struktur kulit.

INTERVENSI PADA TINEA CRURIS

No Diagnosa Tujuan & Kriteria Intervensi Rasional


. Keperawatan Hasil
1. Nyeri akut Setelah dilakukan - Catat lokasi, lamanya intensitas (skala - Mengetahui lokasi nyeri dan berat
berhubungan asuhan keperawatan 0-10) dan penyebaran. Perhatikan ringannya nyeri.
- Perawatan kulit dengan baik akan
dengan selama 3x24 jam tanda non-verbal, contoh peningkatan
membuat px nyaman sehingga
perubahan diharapkan nyeri TD dan nadi, gelisah, merintih,
mempercepat penyembuhan dan
kenyamanan pasien berkurang/ menggelepar.
mengurangi resiko infeksi
(gatal) hilang, dengan - Lakukan perawatan kulit dengan tepat - Pengetahuan pasien terhadap nyeri
krirteria hasil : dan baik dapat membuat pasien lebih patuh
- Nyeri hilang atau - Ajarkan teknik relaksasi dan distraksi pada pengobatan.
teradaptasi - Membantu mengurangi nyeri,
- Skala nyeri - Kolaborasi pemberian analgetik
Analgesik memblok stimulus rasa
minimal 1-4 dari (mempridin)
nyeri
skala (1-10)
- Pasien tampak
rileks
2. Gangguan Setelah dilakukan - Kaji kondisi luka klien (area, warna, - Mengetahui kondisi luka secara
integritas asuhan keperawatan bau, kelembaban, turgor). umum
kulit selama 3x24 jam - Menganjurkan pasien untuk
berhubungan diharapkan pasien menghindari atau mengkonsumsi
- Mengurangi timbulnya rasa gatal
dengan dapat mengalami makanan yang tinggi protein
- Beri pasien pengetahuan tentang factor yang berlebihan
kerusakan penyembuhan, dengan
factor yang bisa mengakibatkan lesi
permukaan kriteria hasil :
atau penyakit bisa bertambah parah - Meminimalkan adanya komplikasi
kulit - Pasien - Kolaborasi dengan dokter untuk
menunjukkan pemberian obat antibiotik
penyembuhan
jaringan progresif
- Berkurangnya
- Mencegah untuk pertumbuhan
gangguan jaringan
jamur pada daerah luka
epidermis, lesi,
eritema, dan
pruritis
3. Gangguan Setelah dilakukan - Pantau dan tanyakan mengenai - Membuat pasien dan percaya diri
citra tubuh asuhan keperawatan masalah, penanganan, perkembangan, - nformasi dapat membuat pasien
berhubungan selama 3x24 jam prognosis kesehatan. lebih lebih tahu tentang
- Berikan informasi yang dapat permasalahannya
dengan diharapkan menerima
dipercaya dan perkuat informasi yang - Orang terdekat mempunyai pengaruh
perubahan perubahan citra
telah diberikan. lebih dominan ntuk membantu
struktur kulit tubuhnya dengan
- Anjurkan orang terdekat untuk pasien menerima keaadaannya
kriteria hasil:
memberikan support system terhadap sekarang ketika sudah di masyarakat.
- Pasien
perubahan fisik dan emosional. - Untuk membuat pasien bisa
menerima
- Mengungkapkan perasaannya menerima keaadaannya sekarang
penampilan
membuat pasien merasa lebih nyaman
yang sekarang
setelahnya
- Pasien tidak
malu bertemu
dengan kerabat
atau orang lain
- Pasien bisa
beraktivitas
seperti biasa
tanpa rasa
malu atau
minder

Diagnosa Medis : Tinea Pedis

Diagnosa Keperawatan : Gangguan pola tidur berhubungan dengan pruritus (rasa gatal)

Intervensi Keperawatan :
No. Masalah Keperawatan Tujuan dan Kriteria Hasil Intervensi Rasional
Gangguan pola tidur
1. Setelah dilakukan 1. Kaji tingkat tidur 1. Untuk mengetahui
berhubungan dengan
asuhan keperawatan pasien kualitas tidur pasien
pruritus (rasa gatal)
2. Anjurkan pasien untuk 2. Untuk mencegah efek
diharapkan kebutuhan
menghindari minuman samping dari kafein
tidur pasien terpenuhi
yang mengandung
dengan kriteria hasil : 3. Memberikan efek
kafein menjelang tidur
yang menguntungkan
malam hari
untuk tidur jika
3. Anjurkan pasien untuk
dilakukan di sore hari
melakukan gerak
4. Meberikan obat
badan secara teratur
diharapkan pasien
4. Kolaborasi dengan
dapat tidur
dokter pemberian obat
anti histtamin
DAFTAR PUSTAKA
Adhi Djuanda, prof. Dr.1999. Ilmu Penyakit kulit & Kelamin. Jakarta.
Doenges, Marylinn E. 1999. Rencana Asuhan Keperawatan. Edisi III. Jakarta. EGC
Nanda International.2009. Diagnosis Keperawatan Nanda 2009-2011. Jakarta : EGC
Taylor, C. M., & Ralph, S. S. (2013). Diagnosis Keperawatan Dengan Rencana Asuhan. Jakarta:
EGC.
REVIEW

Herbal Therapy in Dermatology


Monica K. Bedi, MD; Philip D. Shenefelt, MD

H
erbal 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 com-
mission 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 stan-
dardization of active ingredients, purity, or concentration. There are also no regulations govern- ing
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 pa- tients to
benefit from these treatments currently used worldwide. We reviewed the herbal medi- cations 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 were also studied. Arch Dermatol. 2002;138:232-242
Herbal medicine dates back thousands of From the Division of Dermatology and
years. It originated in India and China and Cutaneous Surgery, University of South
it is still widely used in Asia. In India, Florida, Tampa.
Ayur- vedic medicine dates back to 3000
BC. Ayur- vedic medicine combines
physiological and holistic principles. It is
based on the con- cept that the human
body is composed of S energy elements
that also make up the uni- verse: earth,
water, fire, air, and space. In- teraction of
these elements gives rise to the
3 doshas (forces), 7 dhatus (tissues), and 3
malas (waste products). All diseases are
at- tributed to an imbalance between the 3
doshas. Diagnosis is made by an elaborate
system of examination of the physical
find- ings, the pulse, and the urine, as well
as an
8-fold detailed examination to evaluate
both the physical and mental aspects of
the con- dition. Treatment is then
individually tai- lored to the findings.l
Chinese medicine dates back about on the physical examina- tion of the
4000 years and is aimed at treating the whole person. It is based on the tongue, iris, and pulse of the in- dividual
complementary forces yin and yang. In healthy individu- als, the yin and to determine the cause of the imbalance
yang are in balance, and ill- ness occurs when there is inequality be- and then to determine the ap- propriate
tween the forces. The Chinese evaluate the individual treatment. Treatment is usually
a mixture of herbs, massage, and
See also pages 207 and 251 acupuncture.2
In Western medicine, herbal therapy
exchange between the environment and the body, such as food, drink, and began as folk medicine. In the United
air into the body and waste leaving the body. Special at- tention is placed States, it began in the colonial days, when
homemade botanicals were provided by the women in the from white oak tree or the English walnut tree. These
home.3 Native American use of botanical treatments also preparations should be strained before use and can be
greatly influenced the use of herbal therapy in the United used 2 or 3 times per day. Commercially available
States. In the 19th century, these traditions were preparations are not recommended, as the tannins are lost
expanded and used by a group of physicians known as in the distillation process.11
the Eclectics. As herbal medicine has developed in the
United States, it has also been influenced by European
and Chinese practices.4
Herbal therapy has recently become increasingly
popular among patients seeking alternative treatment
options. The number of visits to alternative medicine
practitioners in the United States is growing rapidly. In
1997, the number of visits was estimated to be 629 mil-
lion, which exceeded the number of visits to all primary
care physicians.5 Approximately $27 billion was spent
out of pocket for these alternative therapies in 1997, and
$3.24 billion of this was spent on herbal therapy.6
It is estimated that about 50% of the population uses
some form of alternative medicine, and many patients do
not share this information with their physicians. In a
previous survey, those most likely to use unconven-
tional treatment modalities were nonblack, college edu-
cated, and between the ages of 25 and 49 years and had
an annual income greater than $35000.7 Most patients
seeking the alternatives do so because conventional
therapy has failed or they feel there are fewer side
effects, as the products are natural. This recent increase
in alternative medicine has led to more research and
education on the subject to enable physicians to better
inform and care for their patients.
In the United States, herbal remedies are sold as
dietary supplements, and standards of potency and effi-
cacy are not currently required. In Germany, a regula-
tory authority known as Commission E has performed an
extensive review of common botanicals. The com-
mission has evaluated the quality of evidence, clinical
efficacy, and uses of 300 herbal preparations.8,9 This
evaluation has led to standardization of herbal treat-
ments. Several herbal therapies for dermatologic
conditions have stood the test of time for their efficacy
and some show significant scientific evidence of use-
fulness. In this day of advanced communication be-
tween physicians worldwide, it is important that we share
information on herbal therapy, effects, and in- teractions,
so that we may offer alternatives to our patients.

ACNE

Tannins

Tannins have been used topically to treat acne because of


their natural astringent properties. Witch hazel
(Hamamelis virginiana) bark extract is commonly used
by making a decoction from 5 to 10 g of herb in 1 cup
(0.24 L) of water. Witch hazel is considered very safe to
use topically.10 Other similar astringents can be made
Fruit Acids Vitex

Fruit acids, such as citric, gluconic, gluconolactone, gly- Vitex (Vitex agnus-castus) taken orally has been shown to
colic, malic, and tartaric acids, have been used topically be effective in treating premenstrual acne. The whole-
and have shown promise in treating acne because of their fruit extract is thought to act on follicle-stimulating
exfoliative properties. In one study, gluconolactone was hormone and luteinizing hormone levels in the pituitary
as effective in clearing inflamed and noninflamed acne to increase progesterone levels and reduce estrogen
lesions as 5% benzoyl peroxide and more effective than levels. The Ger-
placebo.12 Irritation is the main adverse effect, espe- manCommissionEmonographsrecommend40mg/d.The
cially in higher concentrations. main adverse effects reported are gastrointestinal tract
up- set and rash. It should not be taken by pregnant or
Tea Tree Oil nursing women.20(p176)
TheGermanCommissionEhasalsoapproved topical
Tea tree oil may also play a role in topical acne treat- bittersweet nightshade (Solanum dulcamara) and orally
ment. It is an essential oil extracted from the leaves of administered brewer's yeast (Saccharomyces cerevi- siae)
Melaleuca alternifolia, a small tree indigenous to Austra- for the treatment of acne because of their antimicro-
lia. It contains approximately 100 compounds, mainly bialeffects.20(p88,118) InChina,topicalduckweed(Lemmami-
plant terpenes and their corresponding alcohols.13 In nor) is used to treat acne.20(p258)
1990, a study of 124 patients compared 5% tea tree oil in
a water- based gel with 5% benzoyl peroxide. Although WOUNDS AND BURNS
the tea tree oil did not work as quickly as benzoyl
peroxide, it did show statistical improvement in the Aloe Vera
number of acne lesions at the end of 3 months. Also,
there was a signifi- cantly lower incidence of adverse Aloe vera leaves produce 2 substances, a gel and a juice
effects such as dry- ness, irritation, itching, and burning or latex. The gel is obtained from the inner part of the
with the tea tree oil (44%) than with benzoyl peroxide leaf and has been used topically for centuries for the
(79%).10(p629) There are occasional reports of allergic treat- ment of wounds and burns. The juice or latex refers
contact dermatitis and of poisoning if taken internally.14-18 to a bitter yellow fluid extracted from the specialized
However, the degrada- tion products of monoterpenes in areas of the inner leaf skin and is generally sold as a
the tea tree oil actu- ally appear to be the sensitizing powder that has very potent laxative effects.10(p31)
agents.19 Therefore, topi- cal treatment is considered very Several case reports and animal studies have
safe. demon- strated that aloe vera reduces burning, itching,
and scar-
ring associated with radiation dermatitis.21 It has also vitro it has been shown to have antibacterial and
been shown to accelerate healing of chronic leg ulcers, antifungal ac- tivity to organisms commonly infecting
surgi- cally induced wounds, and frostbite. The surgical wounds.27
mechanism of ac- tion has been studied by in vivo animal In 1998, a small study was performed of 9 infants with
studies. Aloe vera decreases thromboxane A2, large, open, culture-positive postoperative wound
thromboxane B2, and prosta- glandin 2 , which cause infections in which standard treatment (>14 days of
vasoconstriction and platelet ag- gregation. This is appropriate intra- venous antibiotics and cleansing with
thought to increase dermal perfusion, re- ducing the risk chlorhexidine) failed. These wounds were then treated
of tissue loss from ischemia.21 In vitro studies have with 5 to 10 mL of fresh unprocessed honey twice a day.
shown a carboxypeptidase that inactivates bradyki- nin By day 5, there was marked clinical improvement, and
(potent pain-inducing agent at sites of acute inflam- by day 21, the wounds were all closed, clean, and
mation), thereby possibly decreasing pain at the treat- sterile.28 In another randomized con- trolled trial, honey-
ment site.22 Salicylic acid has been shown to be present in
impregnated gauze was compared with a polyurethane
aloe vera; it acts as an analgesic and anti-inflammatory
by inhibiting prostaglandin production.23 Magnesium film (OpSite; Smith & Nephew, North Hum- berside,
lactate is also present in aloe vera. It is thought to act as England) for partial-thickness burns. The honey- treated
an anti- pruritic by inhibiting histidine decarboxylase, wounds healed statistically earlier (mean, 10.8 days vs
which con- trols the conversion of histidine to histamine 15.3 days) and with equal complications such as infec-
in mast cells.21 tion, overgranulation, and contracture compared with the
Relief of inflammation is also thought to be due to the polyurethane film-treated wounds.29 The wound-healing
im- munomodulatory properties of the gel properties of honey are thought to result from the debrid-
polysaccharides, es- pecially the acetylated mannans.24 ing properties of the enzyme catalase, absorption of
Aloe vera has also shown bactericidal and antifungal edema because of honey's hygroscopic properties, its
activity in vitro. The main ad- verse effect of topical aloe ability to pro- mote granulation and reepithelialization
vera gel is allergic contact der- matitis. There have also from the wound edges, and its antimicrobial properties.30
been reports of delayed healing af- ter laparotomy or Although there have been reports of contact dermatitis to
cesarean section. Taken orally, aloe vera is considered honey, there have been no reports of significant adverse
very safe when used properly.25(p7) effects.30

Honey Marigold

Honey has been used topically for centuries to accelerate Calendula officionalis, more commonly known as mari-
wound healing. It has been reported to be helpful in treat- gold, has been used topically since ancient times and is
ing burns, decubitus ulcers, and infected wounds.26 In
currently approved by the German commission as an an- alists continue to recommend a topical preparation for the
tiseptic and to heal wounds.9(p119) Contemporary herb- treatment of wounds, ulcers, burns, boils, rashes, chapped
hands, herpes zoster, and varicose veins. Gargles are also
popular for mouth and throat inflammation.10(p129) It is
widely accepted as a topical treatment for diaper derma-
titis or other mild skin inflammation.31 This is treated
with an application several times a day of an ointment or
cream made by mixing 2 to5g of the flower heads with
100 g of ointment. A gargle or lotion can also be used,
which is made by mixing 1 to 2 tsp (5-10 mL) of tincture
with
0.25 to 0.5 L of water.10(p130) The main adverse effect is
allergic contact dermatitis. No serious adverse effects
have been reported, and it is considered safe to use both
topically and orally.25(p22)
The anti-inflammatory effects of marigold are
thought to be due to the triterpenoids. In animal studies
Calendula appears to stimulate granulation and increase
glycoproteins and collagen at wound sites.31 It also
shows in vitro antimicrobial and immune-modulating
properties.10(p130)

Tannins

There are also many herbs containing tannins that act as


astringents, thereby helping to dry oozing and bleed- ing
wounds. Some of the more commonly reported tannin-
containing herbs that may be helpful for the topical
treatment of wounds include English walnut leaf,
goldenrod, Labrador tea, lavender, mullein, oak bark,
rhatany, Chinese rhubarb, St John's wort, and yel- low
dock.10(p709)

HERPES

SIMPLEX Balm

Balm (Melissa officinalis) is a lemon-scented member of


the mint family. The leaves can be steam distilled to pro-
duce an essential oil. Topical uses include treating her-
pes simplex and minor wounds. In a randomized double-
blind trial of 116 patients with herpes lesions, 96% had
complete clearing of lesions at day 8 after using 1% balm
extract cream 5 times a day.32 In another trial, balm ex-
tract was placed on lesions within 72 hours of onset of
symptoms. The size of the lesions and healing time were
statistically better in the group treated with balm.31 A tan-
nin and polyphenols appear to be responsible for its an-
tiviral effect.10(p58) Balm appears very safe to use both
topi- cally and orally.10(p58),25(p75) Other herbal preparations
have also shown test tube activity against herpes sim-
plex, but clinical studies have not yet been performed.
These include Echinacea, sweet marjoram, peppermint,
and propolis.10(p702)

Licorice and Hibiscus

Herpes zoster and postherpetic neuralgia have been


treated with a topical licorice (Glycyrrhiza glabra,
Glycyrrhiza uralensis) gel preparation.33(p155-156)
Glycyrrhizen, one of the active components of licorice,
has been shown to in- hibit replication of varicella
zoster.34 However, there have been no clinical studies to
support this. Topical use ap-
pears very safe, but care should be used when it is taken topically with hibiscus (Hibiscus sabdariffa).20(p394) This
orally.25(p58) In China, herpes zoster is commonly treated has been shown to be very safe topically and orally.25(p61)
and scabies.10(p452) It appears safe in adults, but it can be
BACTERIAL AND FUNGAL poisonous to children.10(p453) Numerous other herbs have
been used for centuries in India and China to treat sca-
INFECTIONS Tea Tree Oil bies.20
Tea tree oil (see the "Acne" section for a description) has CONDYLOMA AND VERRUCA
been widely used topically for the treatment of bacterial VULGARIS
and fungal infections. Tea tree oil has shown in vitro
activity against a wide variety of microorganisms, in-
cluding Propionibacterium acnes, Staphylococcus There are also herbal preparations for the topical treat-
aureus, Escherichia coli, Candida albicans, ment of condyloma and verruca vulgaris. Podophyllin,
Trichophyton mentag- rophytes, and Trichophyton used to treat condyloma acuminata, comes from the root
rubrum.35,36 In a randomized double-blind trial of 104 of the American mayapple (Podophyllum peltatum).20(p510)
patients, 10% tea tree oil cream was compared with 1% It should not be used during pregnancy.25(p89) The German
tolnaftate cream and placebo cream. Symptomatic relief commis- sion has approved bittersweet nightshade (S
was comparable in the tea tree oil and the tolnaftate dulcamara) and oat straw (Avena sativa) for the
groups; however, there was signifi- cantly greater treatment of common warts.20(p88,552) Calotropis
mycologic cure in the tolnaftate group (85%) than the tea (Calotropis procera) is used in In- dia and greater
tree oil group (30%). Cure rates between the tea tree oil celandine (Chelidonium majus) is used in China for the
and placebo groups were not statistically dif- ferent.37 treatment of warts.20(p142,170) Bittersweet night- shade and
Another randomized double-blind study of 117 patients celandine should also be avoided in pregnancy and while
compared a solution of 100% tea tree oil with breastfeeding.20(p88,170)
1% clotrimazole solution in the treatment of onychomy-
cosis. After 6 months of treatment, the 2 groups showed DERMATITIS AND
comparable results on the basis of mycologic cure (11%
for clotrimazole and 18% for tea tree oil) and clinical as- PSORIASIS Chinese Herbal
sessment and subjective rating of appearance and symp-
toms (61% for clotrimazole and 60% for tea tree oil).38 Medicine
Therefore, tea tree oil may have a role in at least symp-
tomatic treatment of tinea pedis and onychomycosis and Traditional Chinese herbal medicine (CHM) for the treat-
other superficial wounds. However, it should not be used ment of atopic dermatitis and psoriasis has recently re-
for burns because of its cytolytic effect on epithelial cells ceived much attention. In traditional Chinese medicine,
and fibroblasts.39 the body is treated as a whole and the aim of therapy is to
restore harmony to the functions of the body.41 This
Garlic requires a mixture of various herbs individually formu-
lated for the patient,42 making randomized controlled tri-
Garlic (Allium sativum) contains ajoene, which has been als difficult to undertake. Recently, 2 randomized
shown to have antifungal activity. In a study of 34 pa- placebo- controlled crossover trials were performed in
tients treated with 0.4% ajoene cream topically once a England to study the effects of orally administered CHM
day for tinea pedis, 79% noted clearing within 7 days and in the treat- ment of atopic dermatitis in which traditional
the remainder had clearing within 14 days. At a 3-month Western therapy had failed.42-44 The investigators were
follow-up, all participants remained free of fungus.40 aided by a Chinese physician who was able to create a
There are reports of contact dermatitis with frequent standard- ized mixture of 10 herbs useful in treating
topical ex- posure.20(p328) Oral administration should be atopic der- matitis characterized by erythema,
avoided while breastfeeding.25(p6) There are also reports lichenification, and plaques of dermatitis in the absence
of prolonged bleeding when garlic is taken orally.20(p328) of active exudation or clinical infection. The 10 herbs
used were Potentilla chinensis, Tribulus terrestris,
SCABIES Rehmannia glutinosa, Lo- phatherum gracile, Clematis
armandii, Ledebouriella sa- seloides, Dictamnus
Certain other common dermatologic infections have been dasycarpus, Paeonia lactiflora, Schi- zonepeta tenuifolia,
treated for centuries with herbal preparations. Anise and G glabra.43 These herbs were placed in sachets and
(Pimpinella anisum) seeds are a source of an essential oil boiled to make a decoction that was orally administered
that has displayed antibacterial and insecticidal activity in daily as a tea. The placebo arm consisted of a decoction
vitro and has been used topically to treat scabies and made from several herbs with similar smells and tastes
head lice. It should not be used in pregnancy.25(p86) Neem that have no known efficacy in the treatment of atopic
(Azadirachta indica) is indigenous to India, and every dermatitis. The first study focused on 37 chil- dren and
part of the plant has been used medicinally. In a report of showed a median decrease in erythema score of 51.0% in
more than 800 villagers in India, a paste of neem and tur- the treatment group compared with only a
meric applied topically appeared to treat chronic ulcers 6.1% improvement in the placebo group. The percent-
age surface involvement also decreased by 63.1% and
6.2% for the treatment and placebo groups, respectively.
In this initial study, no serious adverse effects were
found. These
37 children were offered continued treatment with the
CHM and then followed up for 1 year.45 Eighteen chil-
dren completed the year of treatment and showed 90%
reduction in eczema activity scores. The children who
withdrew from the study did so because of lack of fur-
ther response to treatment, unpalatability of the tea, or
difficulty in preparation of the treatment. By the end of 1 was equivalent; however, there were fewer adverse
year, 7 patients were able to discontinue therapy without effects such as nausea and dizziness in the group treated
relapse. Asymptomatic elevation of aspartate aminotrans- with the CHM and UV-A.46 There are also topical
ferase level was noted in 2 patients, which returned to nor- preparations made from herbs that have shown systemic
mal with discontinuing treatment. No other serious se- efficacy against pso- riasis, but are too toxic when given
quelae were observed. In the other study, the design was systemically.53 One ex- ample is the topical CHM
similar; however, the investigators studied 31 adult pa- composed of the plant Campto- theca acuminata decne.
tients with atopic dermatitis.42 Again, the decrease in ery- An open trial including 92 patients with psoriasis found
thema and surface damage was statistically superior in the that this CHM was statistically more effective than 1%
treatment group compared with the placebo group. There hydrocortisone. However, allergic con- tact dermatitis
was also subjective improvement in itching and sleep. was seen in 9% to 15% of the patients in the CHM group.
These patients were also followed up for a year, with Several other studies have compared various Chinese
continued improvement and no serious adverse effects, herbal preparations with ethyliminum, which is a popular
whereas the patients who discontinued treatment noted a "Western remedy" in China, although it is no longer used
decline in their condition.45 Although the sample sizes as standard therapy for psoriasis in Western medicine.
were limited dur- ing the course of the study, initial results Therefore, although results were promising, there is no
were promising for patients in whom standard therapy applicability, since ethyliminum is no longer used or
failed. The main limi- tation appeared to be the taste and comparable with other current therapy. More double-
the preparation of the decoction. It should be emphasized, blind placebo-controlled trials are needed to compare
however, that, al- though no serious adverse effects were these herbal preparations with current standard Western
noted in this study, careful monitoring of complete blood treat- ment. However, this is difficult, because the
cell count and liver function is recommended, as reports of mixture of herbs prescribed varies individually
liver failure and even death have been reported when depending on the subtype of psoriasis ("blood-heat" type,
baseline laboratory values were not followed up.46-48 "blood deficiency dry- ness" type, and "blood stasis"
It is known that specific herbs used in these studies type), which is determined in traditional Chinese
have anti-inflammatory, antibacterial, antifungal, anti- medicine by many findings, includ- ing the lesions of
histaminic, immunosuppressant, and corticosteroidlike psoriasis, the pulse, and the condition of the tongue.46
effects. A few ingredients also are smooth muscle relax-
ants and inhibit platelet activating factor. Several stud- Aloe Vera
ies have tried to elucidate the mechanism of action of this
group of 10 herbs (Zemophyte; Phytotech Limited, God- As previously described, aloe vera has been used for cen-
manchester, England) in treating atopic dermatitis. It is turies for wound healing and has recently been shown to
known that patients with atopic dermatitis have el- evated be a potential treatment for psoriasis. In a double- blind
levels of the low-affinity IgE receptor CD23 ex- pressed placebo-controlled study, 60 patients with slight to
on circulating monocytes. In studies of interleu- kin (IL) moderate plaque psoriasis were treated topically with
4-induced CD23 expression on monocytes, there either 0.5% hydrophilic aloe cream or placebo. The aloe-
appeared to be a reduction of the CD23 expression when treated group showed statistically significant improve-
the cells were exposed to the aqueous herb extracts.2,49 ment (83.3%) compared with placebo (6.6%). There were
Another study examined immunologic markers for T no adverse effects in the treatment group.54
cells, macrophages, Langerhans cells, and low-affinity
and high- affinity IgE receptors in biopsy specimens of Capsaicin
lesional skin treated with Zemophyte compared with
biopsy speci- mens of nonlesional skin.50 The The main ingredient in cayenne pepper, Capiscum fru-
investigators found clini- cal improvement similar to that tescens or capsaicin, has also been studied for the treat-
seen in the studies de- scribed above and also found that ment of psoriasis. Two trials have shown that 0.025%
the improvement was associated with statistically cream used topically is effective in treating psoriasis. The
significant reduction in CD23 antigen-presenting cells. first study showed significant decrease in scaling and
In a survey of patients with psoriasis at a large uni- erythema during a 6-week period in 44 patients with
versity dermatology practice, 51% of patients used 1 or moderate and severe psoriasis.55 The second was a
more alternative therapeutic modalities.51 This is double- blind study of 197 patients with psoriasis treated
compatible with previous Norwegian surveys of patients with the cream 4 times daily for 6 weeks. It showed a
with psoriasis.52 signifi- cant decrease in scaling, thickness, erythema,
Herbal therapy is one of the most frequently chosen alter- and pruritus.56 The main adverse effect reported was a
native therapies. Psoriasis has been treated for centuries short- lived burning sensation at the application site.
with herbal preparations, both topical and oral. There are Capsa- icin is contraindicated on injured skin or near the
many herbal preparations composed of furocoumarins, eyes, and Commission E suggests it not be used for more
which act as psoralens when combined with UV-A. One than 2 consecutive days, with a 14-day lapse between
common CHM, known as Radix Angelicae dahuricae, applications.25(p23)
contains the furocoumarins imperatorin, isoimpertorin,
and alloim- peratorin. In a study involving 300 patients OTHER HERBS FOR TOPICAL
with psoria- sis, this CHM, taken orally, was combined USE
with UV-A therapy and compared with standard
treatment of psoralen- UV-A with methoxsalen. The In Europe, especially Germany, there is much attention to
efficacy of the 2 treatments the use of topical herbal preparations as corticosteroid-
sparing agents for the treatment of skin inflammation, testinal tract symptoms, oral or skin inflammation, and
including dermatitis and psoriasis. Several herbs are cur- dermatitis. A tea is made by using 2 to 3 tsp (10-15 mL)
rently approved by Commission E for topical treatment of dried flowers per cup of water and is taken internally
of skin inflammation. These include the following bo- or used as a compress. Other topical preparations with
tanicals: Arnica (Arnica montana), German chamomile cream or ointment bases have also been used and stud-
(Matricaria recutita), bittersweet nightshade (S dulca- ied in Germany.9(p324) Studies have shown that topical
mara), and brewer's yeast (S cerevisia) are thought to chamomile is comparable with 0.25% hydrocortisone and
have anti-inflammatory and antibacterial effects. showed improvement in a sodium lauryl sulfate-
Heartseases (Viola tricolor), English plantain (Plantago induced contact dermatitis.31 One small double-blind trial
lanceolata), fenugreek (Trigonella foenum-gaecum), and found that chamomile significantly decreased the sur-
flax (Linum usitatissimum) contain mucilages, which act face area of wounds, and, in animal studies, healing time
as emol- lients and soothe. Agrimony (Agrimonia was reduced with chamomile. It has also shown in vitro
eupatoria), jam- bolan bark (Syzygium cumini), oak antimicrobial activities.10(p157) The main adverse effect re-
(Quercus rubar), wal- nut (]uglans regia), and St ported is allergic contact dermatitis, and it is considered
John's wort (Hypericum montana) contain tannins and safe to use topically and orally.25(p74)
act as astringents. Oat straw (A sativa) is also approved The anti-inflammatory, wound-healing, and anti-
for its soothing and antipu- ritic qualities.8,9,10,20
microbial effects of German chamomile are attributed to
a blue essential oil that contains sesquiterpene alcohol, u-
Arniea
bisabolol, chamazulene, and flavinoids. These com-
ponents have shown anti-inflammatory and antispas-
Arnica comes from the dried flowers of A montana or
modic properties in animal studies. This is partially at-
other arnica species. Although oral administration can
tributed to the inhibition of cyclo-oxygenase and
cause severe health hazards in even small amounts, the
lipoxygenase in vitro. The flavinoids also act by inhib-
external preparations appear to be very safe and effective.
iting histamine release from antigen-stimulated human
Arnica has been used for centuries as an anti-
basophilic polymorphonuclear leukocytes.31 Bisabolol has
inflammatory aid to rub into sore muscles and joints,
also been shown to promote granulation tissue in wound
bruises, insect bites, boils, inflamed gums, acne
healing.10(p157)
eruptions, and hemor- rhoids. It is also an ingredient
found in many seborrheic dermatitis and psoriasis Mueilage-Containing Herbs
preparations. When used as a compress, 1 tbsp (15 mL)
of tincture is mixed with 0.5 Several herbs contain a substance called mucilage, which
L of water; if used as an infusion, 2 g of dried arnica is is useful topically to soothe and act as an emollient on
mixed with 100 mL of water. The cream or ointment skin. Mucilage quickly swells into a gooey mass when it
preparations should contain a maximum of 15% arnica comes in contact with water, thereby aiding in dry or
oil or 20% to 25% tincture.9(p85),10(p45) mildly inflamed skin. The material will also dry and can
It has been known since the 1980s that the active be used as an herbal bandage for minor wounds. The
ingredients of arnica are the sesquiterpene lactones such herbs most notable for their mucilage content are flax,
as helanalin, 11u,13-dihydrohelenalin, chamissonolid, fenu- greek, English plantain, heartseases, marshmallow,
and their ester derivatives. It appears that these compo- mul- lein, and slippery elm.10,20
nents act to reduce inflammation by inhibiting the tran-
scription factor nuclear factor-KB. Nuclear factor-KB Oats
controls the transcription of many genes, including
cytokines such as IL-1, IL-2, IL-6, IL-8, and tumor ne- Oats have been used topically for several hundred years
crosis factor u, as well as adhesion molecules intercel- for their soothing and antipruritic properties when placed
lular adhesion molecule 1, vascular cellular adhesion in baths, and they are approved for this use by the Ger-
molecule 1, and endothelial leukocyte adhesion mol- man commission.9(p97),20(p552) Colloidal oatmeal turns to a
ecule 1. It also inhibits many genes responsible for an- gooey mass when mixed with liquid, thereby coating the
tigen presentation and for cyclo-oxygenase II.57 skin and sealing in moisture. This soothing and mois-
Although most individuals tolerate the external turizing property is attributed to the gluten content in the
preparations well, there have been many reports of con- plant. This can be useful in atopic dermatitis as well as
tact dermatitis. There are also several reports of irrita- idiopathic pruritus of the elderly.
tion when arnica is used at stronger concentrations or for
longer periods than are recommended. It is not recom- Tannins
mended to use it on open wounds or broken skin.25(p14)
Also, it is important to buy arnica from a reputable As previously mentioned, several herbs contain tan- nins,
source, as it is a protected species in some countries and which act as astringents. Tannins used topically are
other plants have been surreptitiously used. thought to be beneficial in treating dermatitis by coagu-
lating surface proteins of cells, thereby reducing perme-
German Chamomile ability and secretion. The precipitated proteins also form
a protective layer on the skin.31 They may also have an-
German chamomile (M recutita), a member of the daisy timicrobial properties. Several herbs are known to con-
family, has been used for centuries, internally and ex- tain tannins. Some of the more commonly used agents
ternally, for almost all ailments, most notably gastroin-
for the treatment of dermatitis include witch hazel, oak wort. Although there is limited research on the use of
bark, English walnut leaf, agrimony, jambolan bark, La- these agents, one study showed that a witch hazel extract
brador tea, goldenrod, lady's mantle, lavender, mullein, in a phosphatidyl choline base was less effective in
rhatany, Chinese rhubarb, yellow dock, and St John's reducing erythema from UV radiation and cellophane
tape strip- ping in 24 healthy patients than 1% mechanism of action appears to be related to inhibiting
hydrocortisone.58 In another clinical trial, one group with leukocyte activation, an important physiological com-
atopic dermatitis (n=36) and another group with contact ponent of CVI. It is also thought to prevent vascular leak-
dermatitis (n=80) compared witch hazel extract with age by inhibiting elastase and hyaluronase, which are in-
control. In the atopic group, the witch hazel was slightly volved in proteoglycan degradation at the capillary
superior in reducing inflammation and itching. There are endothelium.63 There have been many double-blind ran-
also anecdotal re- ports of witch hazel's usefulness in domized trials of oral HCSE for patients with CVI. It has
treating atopic der- matitis.31 been shown that HCSE decreases lower-leg volume as
well as calf and ankle circumference. There were also de-
Pansy Flower creased symptoms such as fatigue, tenderness, and pru-
ritus. Another study showed relative equality of using
Pansy flower infusion is recommended by German health HCSE compared with grade II compression stockings for
authorities for the topical treatment of seborrheic der- treatment of CVI.64 Most of these studies achieved sta-
matitis, especially in infants. The infusion is made by tistically significant results for treatment of CVI with
mix- ing 1 to 2 tsp of flowers per cup of water and is doses of HCSE containing 100 to 150 mg of aescin per
used as a wet dressing. Salicylic acid in concentrations of day, most commonly taken as 50 mg twice a day.
about Adverse effects reported were minimal and included
0.3% appears to be the active ingredient. It also contains gastrointestinal tract symptoms, dizziness, headache, and
saponins and mucilage, which have softening and sooth- pruritus. The rates of reported adverse effects were from
ing action. No adverse effects have been reported with its 0.9% to 3.0% and in several studies were not statistically
topical use.10(p480) different from rates of adverse effects with placebo.
Although there are no long-term studies of oral HCSE in
treating CVI and its sequelae, these results seem
Jewelweed
promising and offer patients a safe alternative to
compression stockings. In Europe, HCSE has also been
Jewelweed (Impatiens biflora) is reputed to be useful in used in the form of a topi- cal gel, lotion, or ointment to
topically treating poison ivy contact dermatitis. How- reduce inflammation and discomfort associated with
ever, research results are conflicting. In a 1958 study, varicose veins, phlebitis, and hemorrhoids.10(p344)
treat- ment with jewelweed was comparable with The seeds of the horse chestnut tree are poisonous
standard treat- ment for poison ivy contact dermatitis; in and must be specially prepared by a reputable manufac-
108 of 115 patients, symptoms cleared within 2 to 3 turer, such as those seeds currently on the American
days.59 How- ever, in a 1980 study, not only did market, to remove all toxins. Once the toxins have been
jewelweed extract fail to reduce symptoms of poison ivy removed, it is considered relatively safe taken orally.
dermatitis, but symp- toms became worse, and in a recent There has been one case report of drug-induced
study there was no prophylactic effect of jewelweed in lupus attributed to Venocuran (Knoll AG,
poison ivy dermati- tis.60,61 Jewelweed has been Ludwigshafen, Germany), a drug for venous
mentioned to be most help- ful if applied to the area the insufficiency containing HCSE.10(p344-345) There have been
poison ivy touched as soon after contact as possible; reports of contact der- matitis when used topically.9(p269)
however, this was not ad- dressed in the studies. There
have been no reports of topi- cal jewelweed causing Grapeseed
adverse effects.10(p365)
In France there is also research on the use of herbs in
CHRONIC VENOUS CVI. Several double-blind trials have studied the effects
INSUFFICIENCY of grapeseed extract on CVI. Grapeseed extract contains
oligomeric proanthocyanidins, which are bioflavinoids
Chronic venous insufficiency (CVI) is a common con- shown to be beneficial in strengthening capillaries. The
dition affecting at least 10% to 15% of men and 20% to dosage in the studies varied from 50 mg orally once a
25% of women.62 It is a source of great cost and morbid- day to 100 mg 3 times per day. No serious adverse effects
ity. Compliance with current treatments such as com- have been reported.20(p363-364)
pression stockings is poor, which has led to the search for
alternative therapies. Ginkgo

Horse Chestnut Ginkgo (Ginkgo biloba) has been used orally in China
for centuries and more recently in Europe and the United
Horse chestnut seed extract (HCSE) is one of the most States for numerous conditions, including heart dis- ease,
stud- ied herbal alternatives. Horse chestnut (Aesculus asthma, vertigo, tinnitus, impotence, cerebral and
hippocas- tanum) contains the plant compounds known vascular insufficiency, peripheral vascular disorders, de-
as terpenes, and the active component appears to be mentia, and other conditions. Much research indicates
aescin.10(p343) The that ginkgo promotes vasodilation, thereby improving
many of the conditions above. Most of this research on
ginkgo relates to cerebral insufficiency and claudica-
tion, suggesting that it may be more useful for these vas-
cular disorders than for CVI.10(p293),65 Care should be used Witch Hazel
when ginkgo is taken orally, as there have been reports of
subarachnoid and intracerebral hemorrhage, as well as Witch hazel (H virginiana) contains considerable
increased bleeding time.20(p344) amounts of tannin, making it a useful astringent. It has
been used topically to soothe inflammation of the skin
and mu- cous membranes in such disorders as varicose
veins and hemorrhoids. Animal research suggests that the blind placebo trial, which lasted 6 months. The compo-
witch ha- zel extract has local styptic and nents of Dabao include 50% ethanol, 42% water, and 8%
vasoconstrictive effects. The alcohol fluid extract has Chinese herbal extracts, including saffron flowers, mul-
also been shown to cause venous constriction in rabbits; berry leaves, stemona root, fruits of the pepper plant,
thus, it is often used orally for CVI in Europe. Although sesame leaves, the skin of the Szechuan pepper fruit, gin-
it appears safe when taken orally, efficacy of such ger root, Chinese angelica root, bark of the pseudolarix,
treatment has not been well stud- ied in humans.8(pp670- and fruit of the hawthorn. The components of the pla-
672),25(p59)
cebo included 50% ethanol, 48% water, and 2% odor and
coloring agents consisting of cherry laurel water, cinna-
Butcher's Broom and Sweet Clover mon water, licorice syrup, sugar syrup, and a solution of
burned sugar. In both groups there was an increase in
In addition to horse chestnut, the German commission nonvellus hairs. Although the Dabao group was statisti-
has approved orally administered butcher's broom (Rus- cally superior to the placebo group in number of non-
cus acuteatus) and sweet clover (Melilotus officinalisis) vellus hairs, the cosmetic improvement in both groups
for relief of symptoms associated with venous was minimal. Therefore, although there were no re-
insufficiency such as pain, heaviness, pruritus, and ported adverse effects, improvement is unlikely.
swelling. In ani- mal studies, butcher's broom has been
shown to in- crease venous tone and also has diuretic SKIN
properties. Sweet clover has been shown to increase
venous reflux.20(p132) However, reflux is probably a CANCER Tea
misnomer, as the term is generally used to describe a
backward flow, and in the case of venous return it would There has been much research on the use of teas in the
indicate undesired pool- ing. A better description of the
effect of sweet clover would be to say that it increases prevention and treatment of skin cancer. Tea is manu-
venous return. Both butcher's broom and sweet clover factured from the leaf and bud of Camellia sinensis. The
appear to be safe when used as recommended.20(p132),25(p100) majority of tea consumed worldwide is in the form of
black tea. However, in Asia, green tea is most commonly
con- sumed, and oolong tea is popular in China. Teas
ALOPECIA con- tain polyphenolic compounds, which have
antioxidant properties. The oxidative states of these
Essential Oils compounds vary between the different tea formulations.
Green tea is pro- duced from the fresh leaves, and
Few randomized trials have studied herbal remedies for preparation is aimed at avoiding oxidation and
alopecia. Recently, a randomized controlled double- polymerization of the polyphe- nols. Production of black
blind study of 86 patients with alopecia areata was per- tea involves a controlled fer- mentation process. Green
formed.66 A mixture of essential oils including thyme, tea has been shown in several mouse models to have anti-
rose- mary, lavender, and cedarwood in carrier oils; inflammatory and antitu- morigenic properties. This is
grapeseed; and jojoba (a liquid wax) was massaged into thought to be due to the polyphenolic constituent (-)-
the scalp daily. The control group massaged only the epigallocatechin-3- gallate. Numerous studies of green
carrier oils into the scalp. Success was evaluated on the tea and skin cancer were recently reviewed.68 It was
basis of se- quential photographs, by both a 6-point scale found that topical ap- plication or oral consumption of
and a com- puterized analysis of areas of alopecia. green tea protects against inflammation, chemical
Overall, the treat- ment group had statistically significant carcinogenesis, and photocar- cinogenesis. Green tea has
improvement over the control group (44% vs 15%). This been shown to block many mediators in the inflammatory
improvement com- pares with the success of standard process important in the early steps of skin tumor
treatment practices used conventionally. There were no promotion. It also appears that there is inhibition of
adverse effects. biochemical markers of chemical carcinogenesis,
inhibition of UV-induced oxidative stress, and prevention
Chinese Herbal Medicine of UV-induced immunosuppression.68
There is also evidence that green tea protects against pso-
Another study evaluated the topical use of a Chinese ralen-UV-A-induced photochemical damage to the skin.69
herbal formula, Dabao (Engelbert : Vialle, Venlo, the Therefore, many cosmetics and skin care products re-
Netherlands), for the treatment of androgenic alope- cia.67 cently have been supplemented with green tea. How-
In this study, 396 patients participated in the double- ever, more research in humans is needed to understand
the true benefits.
There is also evidence that black tea may play a role
in the prevention of skin tumors. It appears that the the-
aflavins are the active components in chemopreven-
tion.70 Several studies have provided evidence that topi-
cal application of constituents in black tea can decrease
UV-B-induced erythema, inhibit tumor initiation, and act
as an antitumor promoter.71,72 Oral administration of black
tea also appears to inhibit tumor proliferation and pro-
motes tumor apoptosis in nonmalignant and malignant
skin tumors.73 A recent survey of older patients com- nonconsumers.74 Studies comparing the effectiveness of
pared tea consumption and history of squamous cell car- black and green teas in protecting against UV-induced
cinoma. There was a lower risk of squamous cell carci- skin tumors are conflicting as to which is more benefi-
noma in patients who consumed hot black tea than in cial.75-78 However, it does appear that caffeinated teas are
more protective than decaffeinated teas and that caf- motion. Topically applied silymarin appeared to pos- sess
feine alone has some inhibitory effects on UV-B- high protective effects against chemically induced skin
induced carcinogenesis.76-78 tumor promotion in mice. This may involve inhi- bition
of promoter-induced edema, hyperplasia, and pro-
Rosemary liferation as well as the oxidant state.82 These results are
promising, yet more research involving human models is
There are also a few reports of other herbs playing a role needed. Silymarin appears to be safe to use topically and
in the prevention of skin tumors in mice. Rosemary (Ros- orally when used appropriately.25(pl07)
marinus officinalis) extract has been reputed to have an-
tioxidant activity. Recently, a methanol extract of the ADVERSE EFFECTS OF HERBAL THERAPY
leaves was evaluated for its effects on skin tumors in
mice. It was found that topically applied rosemary Many patients have the misconception that, because
inhibited in- duction and promotion of skin tumors in herbs are "natural," there are no adverse effects.
mice treated with known chemical carcinogens. Although Physicians of- ten do not question patients about herbal
the exact mechanism of action is still under study, it supplements, and patients are often reluctant to divulge
appears that several components of the extract are the use of these agents for fear of criticism from their
important in this process. This finding suggests that it physician. It is im- portant that dermatologists become
was not the anti- oxidant properties alone that were aware of the most common, as well as the more serious,
beneficial in the pre- vention of skin tumors.79 Rosemary effects. This will aid in better education of patients, as
should not be used in pregnancy.25(p99) well as better di- agnosis of possible fatal sequelae.
Herbal therapies vary greatly in their therapeutic in-
Propolis dexes. For example, some are consumed as foods and
have high therapeutic indexes, and others are highly
Propolis is a resinous material produced by honeybees biologi- cally active and must be used very carefully.
from the buds and bark of certain plants and trees. It has Safety of the herbs mentioned in this article were
been used for centuries for antimicrobial, anti- addressed in each section, and further discussion of
inflammatory, analgesic, and antitumor effects. These interactions of herbal therapies that may be encountered
properties are thought to be due to the flavinoid and re- in the dermatologic setting follows.
lated phenolic acids that are components of propolis. Re- Many cutaneous reactions to herbal preparations
cently, a tumoricidal component, clerodane diterpe- noid, have been reported. The most common cutaneous ad-
was isolated. This compound was studied for its topical verse effect of herbal preparations is allergic contact der-
effects on skin tumorigenesis in mice. Clero- dane matitis. However, more serious cutaneous reactions have
diterpenoid appeared to reduce the incidence of been reported. Two patients developed erythroderma af-
chemically induced dysplastic papillomas by inhibiting ter using topical herbal treatments for psoriasis and
the synthesis of DNA in a de novo pathway and by sup- atopic dermatitis, and l patient developed Stevens-
pressing the growth of tumors by decreasing DNA syn- Johnson syn- drome after taking "Golden Health Blood
thesis in a salvage pathway.80 Purifying Tab- lets," which contained multiple herbs,
including red clo- ver, burdock, queen's delight, poke
Red Ginseng root, prickly ash, sassafras bark, and Passiflora.83 There
have been reports of bullous and nodular lichen planus
Red ginseng is a classic traditional Chinese medicine induced by inges- tion of native African medicines.84 A
thought to enhance immune function of the body. In a young woman has also been described with leukemia-
recent study, red ginseng extracts used topically ap- related Sweet syn- drome elicited by pathergy to topical
peared to inhibit chemically induced skin tumors in mice. arnica cream.85
This is thought to be due to immune-modulating prop- Serious systemic adverse effects have been re-
erties of the red ginseng.8l ported with the use of CHM for the treatment of derma-
tologic disorders. The most common are hepatotoxic ef-
Silymarin fects. Although most patients recover without serious
consequences as long as the medication is stopped, there
Silymarin is a flavinoid isolated from milk thistle (Sily- have been reports of patients with acute liver failure and
bum marianum) and is approved by the German com- death. There are also reports of renal failure and agranu-
mission for liver disease because of its antioxidant prop- locytosis.46-48 One patient has been described with adult
erties. Recently, a study was performed to assess whether respiratory distress syndrome after administration of a
this antioxidative effect would protect against tumor pro- CHM, Kamisyoyo-san, for seborrheic dermatitis.86 An-
other patient was described with reversible dilated car-
diomyopathy after treatment for her atopic dermatitis
with a Chinese herbal tea.87 There are also several reports
of Chinese and Indian herbal medicines containing heavy
metals, such as lead, arsenic, and mercury. Prescription
medications have also been found in over-the-counter
herbal formulations from other countries.
There are many possible drug interactions with
herbs and prescription medications. The most important
in the
dermatologic setting are discussed. The immune- falfa sprouts, vitamin E, and zinc may decrease the effi-
modulating effects of Echinacea, Astragalus, licorice, al- cacy of corticosteroids and immunosuppressants.88 There
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8. Blumenthal M, Gruenwald J, Hall T, Rister RS, eds. The Complete
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Herbs containing gamolenic acid, such as evening 9. Bisset NG, Wichtl M, eds. Herbal Drugs and Phytopharmaceuticals.
primrose oil, which has been used for dermatitis, 2nd ed. Boca
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psoriasis, and xero- sis, lower the seizure threshold, and 10. Peirce A, Fargis P, Scordato E, eds. The American Pharmaceutical
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