Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
American Journal of Clinical Dermatology
Published in: American Journal of Clinical Dermatology 5/2002

01-08-2002 | Review Article

Complementary/Alternative Medicine in Dermatology

Evidence-Assessed Efficacy of Two Diseases and Two Treatments

Authors: Professor Edzard Ernst, Max H. Pittler, Clare Stevinson

Published in: American Journal of Clinical Dermatology | Issue 5/2002

Login to get access

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.
Literature
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: 1569–1575PubMedCrossRef
2.
Ernst E., White A.R. The BBC survey of complementary medicine use in the UK. Complement Ther Med 2000; 8: 32–36PubMed
3.
Ernst E. The usage of complementary therapies by dermatological patients: a systematic review. Br J Dermatol 2000; 142: 857–861PubMedCrossRef
4.
Jensen P. Use of alternative medicine by patients with atopic dermatitis and psoriasis. Acta Derm Venereol 1990; 70: 421–424PubMed
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: 216–220
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: 316–321PubMedCrossRef
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: 2490–2491PubMed
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: 277–279PubMedCrossRef
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: 1873–1874PubMed
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: 26–29PubMed
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: 624–635PubMedCrossRef
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: 13–19PubMedCrossRef
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: 401–403CrossRef
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: 117–123PubMedCrossRef
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: 231–233PubMedCrossRef
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, 2002
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, 2002
18.
Baslau M., Thaci D. Atopic dermatitis: borage oil for systemic therapy. Zeitschr Dermatol 1996; 182: 131–136
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: 685–688PubMedCrossRef
20.
Borreck S., Hildebrandt A., Forster J. Borage seed oil and atopic dermatitis. Klinische Pädiatrie 1997; 209: 100–104CrossRef
21.
Armstrong N., Ernst E. Treatment of eczema with Chinese herbs: a systematic review of randomised clinical trials. Br J Clin Pharmacol 1999; 48: 262–264PubMedCrossRef
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: 387–392PubMedCrossRef
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: 75–90PubMedCrossRef
24.
Berth-Jones J., Brown G. Placebo-controlled trial of essential fatty acid supplementation in atopic dermatitis. Lancet 1993; 341: 1557–1560PubMedCrossRef
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: 77–84PubMed
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: 115–120PubMedCrossRef
27.
Hederos C.A., Berg A. Epogam evening primrose oil treatment in atopic dermatitis and asthma. Arch Dis Childhood 1996; 75: 494–497CrossRef
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: 145–154
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: 359–362PubMed
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: 507–510PubMed
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: 443–447PubMedCrossRef
32.
Rudofsky G., Diehm C., Gruß J.D., et al. Chronisch venöse insuffizienz. Münch Med Wschr 1990; 132: 205–210
33.
Weindorf N., Schultz-Ehrenburg U. Kontrollierte Studie zur oralen Venentonisierung der primären Varikosis mit Ruscus aculeatus und Trimethylherperidinchalkon. Z Hautkr 1987; 62: 28–38PubMed
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: 277–283PubMed
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: 7–11PubMedCrossRef
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: 299–304PubMed
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: 46–50PubMedCrossRef
38.
Allergra C., Pollari G., Criscuolo A. L’estratto di Centella asiatica nelle flebopatie degli arti iferiori. Clin Ther 1981; 99: 507–513
39.
Pittler M.H., Ernst E. Horse-chestnut seed extract for chronic venous insufficiency: a criteria-based systematic review. Arch Dermatol 1998; 134: 1356–1360PubMedCrossRef
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: 109–117PubMed
41.
Ernst E., Saradeth T., Resch K.L. Complementary treatment of varicose veins: a randomized, placebo-controlled, double-blind trial. Phlebology 1990; 5: 157–163
42.
Ernst E., Saradeth T., Resch K.L. A single blind randomized controlled trial of hydrotherapy for varicose veins. Vasa 1991; 20: 147–152PubMed
43.
Saradeth T., Ernst E., Resch K.L. Hydrotherapy for varicose veins: a randomized, controlled trial. Eur J Phys Med Rehabil 1993; 3: 123–124
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: 153–157CrossRef
45.
Fetrow C.W., Avila J.R. Complementary and alternative medicines. Philadelphia (PA): Springhouse, 1999
46.
Pizzorno J.E., Murray M.T. Textbook of natural medicine. Edinburgh: Churchill Livingstone, 1999
47.
Vogler B.K., Ernst E. Aloe vera: a systematic review of its clinical effectiveness. Br J Gen Pract 1999; 49: 823–828PubMed
48.
Fulton J.E. The stimulation of postdermabrasion wound healing with stabilised aloe vera gel-polyethylene oxide dressing. J Dermatol Surg Oncol 1990; 16: 460–467PubMed
49.
Schmidt J.M., Greenspoon J.S. Aloe vera dermal wound gel is associated with a delay in would healing. Obstet Gynecol 1991; 1: 115–117
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: 505–509PubMedCrossRef
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: 345–349PubMedCrossRef
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: 294–295
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: 99–102CrossRef
54.
Ernst E., Huntley A. Tea tree oil: a systematic review of randomized clinical trials. Forsch Komplementärmed 2000; 7: 17–20CrossRef
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: 455–458PubMed
56.
Tong M.M., Altman P.M., Baretson R. Tea tree oil in the treatment of tinea pedis. Aust J Dermatol 1992; 33: 145–149CrossRef
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: 601–605PubMed
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: 284–287PubMedCrossRef
59.
60.
Davies E.G., Pollock I., Steel H.M. Chinese herbs for eczema [letter]. Lancet 1990; 336: 177
61.
62.
MacGregor F.B., Abernethy V.E., Dahabra S., et al. Hepatotoxicity of herbal remedies. BMJ 1989; 229: 1156–1157CrossRef
63.
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: 592–593PubMedCrossRef
65.
Shaw D., Leon C., Kolev S. Traditional remedies and food supplements: a 5-year toxicological study (1991–1995). Drug Saf 1997; 17: 342–356PubMedCrossRef
66.
Lord G.M., Tagore R., Cook T., et al. Nephropathy caused by Chinese herbs in the UK. Lancet 1999; 354: 481–482PubMedCrossRef
67.
Koo J., Arian S. Traditional Chinese medicine for the treatment of dermatologic disorders. Arch Dermatol 1998; 134: 1388–1393PubMedCrossRef
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: 1649–1681
69.
Ernst E., Hentschel C.H. Diagnostic methods in complementary medicine: which craft is witchcraft? Int J Risk Safety Med 1995; 7: 55–63
70.
Ernst E., Pittler M.H., Stevinson C., et al. The desktop guide to complementary and alternative medicine. Edinburgh: Mosby, 2001
Metadata
Title
Complementary/Alternative Medicine in Dermatology
Evidence-Assessed Efficacy of Two Diseases and Two Treatments
Authors
Professor Edzard Ernst
Max H. Pittler
Clare Stevinson
Publication date
01-08-2002
Publisher
Springer International Publishing
Published in
American Journal of Clinical Dermatology / Issue 5/2002
Print ISSN: 1175-0561
Electronic ISSN: 1179-1888
DOI
https://doi.org/10.2165/00128071-200203050-00006

Other articles of this Issue 5/2002

American Journal of Clinical Dermatology 5/2002 Go to the issue

Pharmacovigilance

Cutaneous Drug Reaction Case Reports

Adis Drug Evaluation

Clindamycin/Benzoyl Peroxide Gel

Current Opinion

Vitiligo

Leading Article

Self-Tanning Lotions

Leading Article

Human Herpesvirus 7 in Dermatology

Review Article

Adverse Cutaneous Reactions to Antidepressants