I found this helpful article online and I thought I should share on here since I will be beginning a herbal/medicinal line of products.
Link to article: https://www.ncbi.nlm.nih.gov/books/NBK92761/
"Most common dermatologic disorders have beneficial herbal treatments available. The disorders are listed in alphabetical order below.
Acne
Fruit acids, such as citric, gluconic, gluconolactone, glycolic, malic, and tartaric acids, used topically have demonstrated some effectiveness in treating acne because of their exfoliative properties. In one study, gluconolactone was found to be as effective in clearing inflamed and noninflamed acne lesions as 5% benzoyl peroxide and more effective than placebo (Hunt et al. 1992). Irritation is the main adverse effect of fruit acids, especially in higher concentrations. When contained in the fruit, they are Class 1. Tannins have natural astringent properties and are used topically to treat acne. Witch hazel (Hamamelis virginiana) bark extract is commonly used as a household remedy 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 and is Class 1 (McGuffin et al. 1997; Peirce, Fargis, and Scordato 1999). Similar astringents can be made from white oak tree bark or the English walnut tree bark. These preparations should be strained before use and can be used two or three times a day. Commercially available preparations are not astringent, as the tannins are lost in the distillation process (Buchness 1998). Tea tree oil is an essential oil extracted from the leaves of Melaleuca alternifolia, a small tree indigenous to Australia. It contains approximately 100 compounds, mainly plant terpenes and their corresponding alcohols (Swords and Hunter 1978). A study of 124 patients compared 5% tea tree oil in a water-based gel with 5% benzoyl peroxide. Although the tea tree oil did not act as rapidly as benzoyl peroxide, it did show statistical improvement in the number of acne lesions at the end of 3 months, and there was a significantly lower incidence of adverse effects such as dryness, irritation, itching, and burning with tea tree oil (44%) than with benzoyl peroxide (79%; Peirce, Fargis, and Scordato 1999). There have been occasional reports of allergic contact dermatitis (de Groot and Weyland 1993; Knight and Hansen 1994; Selvaag, Eriksen, and Thure 1994) and of poisoning if taken internally (Elliot 1993; Moss 1994). However, it is the degradation products of monoterpenes in the tea tree oil that actually appear to be the sensitizing agents (Hausen, Reichling, and Harkenthal 1999). Hence, topical treatment is considered very safe. Oral administration of vitex (Vitex agnus-castus) is effective in treating premenstrual acne. The whole-fruit extract has an amphoteric hormone-regulating effect that is thought to act on follicle-stimulating hormone and luteinizing hormone levels in the pituitary to increase progesterone levels and reduce estrogen levels. It is included in Classes 2b, 2c, and 2d, and may counteract the effectiveness of oral contraceptives. The German Commission E monographs recommend a dose of 40 mg/day. The main adverse effects reported are gastrointestinal tract distress and occurrence of rashes. It should not be taken by pregnant or nursing women (Fleming 2000). Bitter herbs that stimulate digestive function, including acid secretion, may improve acne (Yarnell and Abascal 2006). Commission E also approved topical bittersweet nightshade (Solanum dulcamara; Fleming 2000) and orally administered brewer’s yeast (Saccharomyces cerevisiae; Fleming 2000, 118) for the treatment of acne because of their antimicrobial effects. Topical duckweed (Lemna minor) is used in China to treat acne (Fleming 2000). Herbal mixtures are also used in China both internally and externally to treat acne (Xu 2004).
Alopecia
Essential oils have been studied in a randomized, controlled, double-blind study of 86 patients with alopecia areata (Hey, Jamieson, and Ormerod 1998). A mixture of essential oils including thyme, rosemary, lavender, and cedarwood in carrier oils with grape seed and jojoba (a liquid wax) was massaged into the scalp daily. The control group massaged only the carrier oils into the scalp. Success was evaluated on the basis of sequential photographs, by both a six-point scale and a computerized analysis of areas of alopecia. The treatment group had a statistically significant improvement over the control group (44% vs. 15%). There were no reported adverse effects. A double-blind study that lasted 6 months and in which 396 patients participated evaluated the topical use of a Chinese herbal formula, Dabao (manufactured by Engelbert & Vialle, Venlo, Netherlands), for the treatment of androgenic alopecia (Kessels et al. 1991). The ingredients of Dabao include 50% ethanol, 42% water, and 8% Chinese herbal extracts, including saffron flowers, mulberry leaves, stemona root, fruits of the pepper plant, sesame leaves, skin of the Szechuan pepper fruit, ginger root, Chinese angelica root, bark of the pseudolarix, and fruit of the hawthorn plant. The ingredients of the placebo included 50% ethanol, 48% water, and 2% odorizing and coloring agents consisting of cherry laurel water, cinnamon water, licorice syrup, sugar syrup, and a solution of burned sugar. In both groups, there was an increase in nonvellus hairs. Although the Dabao group was statistically superior to the placebo group in number of nonvellus hairs, the cosmetic improvement in both groups was minimal. There were no reported adverse effects. Other TCM herbal mixtures have also been used for alopecia areata (Xu 2004).
Bacterial and Fungal Infections of Skin
Garlic (Allium sativum) contains ajoene, which has been demonstrated to exhibit antifungal activity. In a study of 34 patients treated topically with 0.4% ajoene cream once a day for tinea pedis, 79% noted clearing within 7 days and the remainder reported clearing within 14 days. In a 3-month follow-up, all participants remained free of fungus (Ledezma, De Sousa, and Jorquera 1996). Contact dermatitis has occasionally been reported with frequent topical exposure (Fleming 2000). Oral administration should be avoided while breast-feeding as this is regarded as a Class 2c herb (McGuffin et al. 1997). Prolonged bleeding may occur when garlic is taken orally (Fleming 2000). Tea tree oil (see Section 18.3.1 for a description of tea tree oil) is applied topically for treatment of bacterial and fungal infections. Tea tree oil has shown in vitro activity against a wide variety of microorganisms, including Propionibacterium acnes, Staphylococcus aureus, Escherichia coli, Candida albicans, Trichophyton mentagrophytes, and Trichophyton rubrum (Beylier 1979; Williams, Home, and Zang 1988). Tea tree oil 10% cream was compared in a randomized, double-blind trial of 104 patients with 1% tolnaftate cream and placebo cream. Although symptomatic relief was comparable in tea tree oil and tolnaftate groups, there was significantly greater mycologic cure in the tolnaftate group (85%) than the tea tree oil group (30%). Cure rates between the tea tree oil and placebo groups were not statistically different (Tong, Altman, and Barnetson 1992). Another randomized, double-blind study of 117 patients compared a solution of 100% tea tree oil with 1% clotrimazole solution in the treatment of onychomycosis. The two groups showed comparable results after 6 months of treatment in terms of mycologic cure (11% for clotrimazole and 18% for tea tree oil), clinical assessment, and subjective rating of appearance and symptoms (61% for clotrimazole and 60% for tea tree oil; Buck, Nidorf, and Addini 1994). Tea tree oil may thus have a role in at least the symptomatic treatment of tinea pedis, onychomycosis, and other superficial wounds. However, it should not be used on burns because of its cytolytic effect on epithelial cells and fibroblasts (Faoagali, George, and Leditschke 1997). Thyme oil from thyme (Thymus vulgaris) has been used topically as an antibacterial and an anticandidal agent (van Wyk et al. 2004), and is Class 1 (McGuffin et al. 1997). The traditional Korean antifungal herb Galla rhois was found to have a methanol extract active against Candida albicans (Seong 2007). The TCM herbal mixtures for treating bacterial and fungal infections of the skin are extensively discussed by Xu (2004).
Chronic Venous Insufficiency
Chronic venous insufficiency (CVI) and varicosities occur in at least 10–15% of men and 20–25% of women (Callam 1994) and results in and morbidity. Compliance with current treatments such as compression stockings is poor, leading to the search for alternative therapies (Abascal and Yarnell 2007). The German Commission E approves the oral administration of butcher’s broom (Ruscus acuteatus) and sweet clover (Melilotus officinalis) for relief from symptoms such as pain, heaviness, pruritus, and swelling associated with venous insufficiency. In animal studies, butcher’s broom was demonstrated to increase venous tone and to also exhibit diuretic properties, whereas sweet clover was found to increase venous reflux, better termed “venous return” (Fleming 2000). Both butcher’s broom, which is Class 1, and sweet clover appear to be safe when used as recommended (McGuffin et al. 1997; Fleming 2000). Ginkgo (Ginkgo biloba) has been used orally in China for centuries and has come to use more recently in Europe and the United States for treating numerous conditions, including heart disease, asthma, vertigo, tinnitus, impotence, cerebral and vascular insufficiency, peripheral vascular disorders, dementia, and other conditions. Research indicates that ginkgo promotes vasodilation, thereby improving many of these conditions. Most research on ginkgo focuses on cerebral insufficiency and claudication. Studies suggest ginkgo may be more useful for these vascular disorders than for CVI (Hadley and Petry 1999; Peirce, Fargis, and Scordato 1999). Caution should be used when ginkgo is taken orally, as there have been reports of subarachnoid and intracerebral hemorrhage, as well as increased bleeding time (Fleming 2000), although it is Class 1 (McGuffin et al. 1997). Several double-blind trials conducted in France studied the effects of grape seed (Virus vinifera) extract on CVI. Grape seed extract contains oligomeric proanthocyanidins, which are bioflavonoids demonstrated to be beneficial by strengthening capillaries. Dosages in the studies varied from 50 mg orally once a day to 100 mg thrice a day. No serious adverse effects were reported (Fleming 2000). Horse chestnut seed extract (HCSE) is one of the most researched herbal alternatives. Horse chestnut (Aesculus hippocastanum) contains the plant compounds known as “terpenes,” with the most active component being aescin (Peirce, Fargis, and Scordato 1999). The mechanism of action appears to be related to the inhibition of leukocyte activation, an important pathophysiological mechanism contributing to CVI. Aescin is also thought to decrease vascular leakage by inhibiting elastase and hyaluronase, which are involved in proteoglycan degradation at the capillary endothelium (Pittler and Ernst 1998). Many double-blind, randomized trials of orally administered HCSE have been conducted on patients with CVI. It was demonstrated that HCSE decreases lower-leg volume as well as calf and ankle circumference. Patients also showed decreased symptoms such as fatigue, tenderness, and pruritus. One study showed the relative equivalency of using HCSE compared with grade II compression stockings for treatment of CVI (Diehm 1996). Most of the studies achieved statistically significant results for treatment of CVI with doses of HCSE containing 100–150 mg of aescin per day, most often taken as 50 mg twice a day. Adverse effects reported were minimal and included gastrointestinal tract discomfort, dizziness, headache, and pruritus. Rates of reported adverse effects were from 0.9% to 3.0% and in several studies were not statistically different from rates of adverse effects observed with placebo. Although there are no long-term studies of orally administered HCSE in treating CVI and its sequelae, these results seem promising and offer patients a safe alternative to compression stockings. In Europe, HCSE has also been used in the form of a topical gel, lotion, or ointment to reduce inflammation and discomfort associated with varicose veins, phlebitis, and hemorrhoids (Peirce, Fargis, and Scordato 1999). It must be noted that the seeds of horse chestnut tree are poisonous and must be specially prepared by a reputable manufacturer to remove all toxins. Once the toxins have been removed, it is considered relatively safe when taken orally. There has been one case report of drug-induced lupus attributed to Venocuran (manufactured by Knoll AG, Ludwigshafen, Germany), a drug for venous insufficiency containing HCSE (Peirce, Fargis, and Scordato 1999). Contact dermatitis has occasionally been reported when HSCE was used topically (Bisset and Wichtl 2001). Witch hazel (H. virginiana) contains considerable amounts of tannin (see the details of preparation in Section 18.3.1), making it a useful astringent. It has been used topically to soothe inflammation of the skin and mucous membranes in disorders such as varicose veins and hemorrhoids. Animal research suggests that witch hazel extract has local styptic and vasoconstrictive effects. The alcohol fluid extract has also been found to cause venous constriction in rabbits. It is often used orally for CVI in Europe. Although it appears safe when taken orally and is included in Class 1, the efficacy of such treatment has not been studied well in humans (McGuffin et al. 1997; Blumenthal et al. 1998). Various TCM herbal mixes for treating stasis dermatitis are listed by Xu (2004).
Dermatitis
Arnica is derived from the dried flowers of Arnica montana or other arnica species. Although oral administration can cause severe health hazards even in small amounts, preparations for external use are very safe and effective. Arnica has been used for centuries as an anti-inflammatory drug to rub into sore muscles and joints, bruises, insect bites, boils, inflamed gums, acne eruptions, and hemorrhoids. It is also an ingredient found in many seborrheic dermatitis and psoriasis preparations. It is approved by Commission E for topical treatment of skin inflammation (Blumenthal et al. 1998). When used as a compress, 1 tablespoon (tbsp; 15 mL) of tincture is mixed with 0.5 L of water; if used as an infusion, 2 g of dried arnica is mixed with 100 mL of water. Cream or ointment preparations should contain a maximum of 15% arnica oil or 20–25% tincture (Bisset and Wichtl 2001; Peirce, Fargis, and Scordato 1999). The active ingredients of arnica are the sesquiterpene lactones such as helanalin, 11α,13-dihydrohelenalin, chamissonolid, and their ester derivatives. These components reduce inflammation by inhibiting the transcription factor nuclear factor κB (NF-κB). The factor NF-κB controls the transcription of many genes, including cytokines such as interleukin (IL)-1, IL-2, IL-6, IL-8, and tumor necrosis factor α, as well as adhesion molecules such as intercellular adhesion molecule 1, vascular cellular adhesion molecule 1, and endothelial leukocyte adhesion molecule 1. It also inhibits many genes responsible for antigen presentation and activation of cyclooxygenase 2 (Lyss et al. 1997). There are reports of contact dermatitis caused by arnica. There are also several reports of irritation when arnica is used at stronger concentrations or for longer periods than are recommended. It is not recommended for use on open wounds or broken skin, and is included in Class 2d (McGuffin et al. 1997). It is important to buy arnica from a reputable source, because it is a protected species in some countries and other plants are substituted fraudulently. German chamomile (Matricaria recutita), a member of the daisy family, has been used for centuries, both internally and externally, for treating many conditions, especially gastrointestinal tract symptoms, oral or skin inflammation, as well as dermatitis. A tea is made by using 2–3 teaspoons (tsp; 10–15 mL) of dried flowers per cup of water and is taken internally or used as a compress. Topical preparations with cream or ointment bases are also used and researched in Germany (Bisset and Wichtl 2001). Studies have demonstrated that topical chamomile is comparable with 0.25% hydrocortisone and shows improvement in sodium lauryl sulfate–induced contact dermatitis (Brown and Dattner 1998). A small double-blind trial found that chamomile significantly decreased the surface area of wounds and, in animal studies, healing time was found to be reduced with chamomile. Chamomile also shows in vitro antimicrobial activities (Peirce, Fargis, and Scordato 1999). The main adverse effect reported is allergic contact dermatitis. Chamomile is considered safe to use topically and orally, and is included in Class 1 (McGuffin et al. 1997). The anti-inflammatory, wound-healing, and antimicrobial effects of German chamomile are attributed to an essential blue oil that contains sesquiterpene alcohol, α-bisabolol, chamazulene, and flavinoids. These substances showed anti-inflammatory and antispasmodic properties in animal studies, due in part to the inhibition of cyclooxygenase and lipoxygenase in vitro. The flavinoids also act by inhibiting histamine release from antigen-stimulated human basophilic polymorphonuclear leukocytes (Brown and Dattner 1998). The substance α-isabolol also demonstrated promotion of granulation tissue in wound healing (Peirce, Fargis, and Scordato 1999). Bittersweet nightshade (S. dulcamara) and brewer’s yeast (S. cerevisiae) are thought to have similar anti-inflammatory and antibacterial effects. Herbal medicine derived from TCM for the treatment of atopic dermatitis has been reported effective by British studies. In TCM, the body is treated as a whole and the aim of therapy is to restore harmony to the functions of the body (Atherton et al. 1992). A mixture of various herbs is individually formulated for a patient (Sheehan et al. 1992), making it difficult to undertake randomized, controlled trials. Two randomized, placebo-controlled crossover trials were performed in England to study the effects of standardized oral herbal TCM in the treatment of atopic dermatitis cases for which traditional Western therapy had failed (Sheehan et al. 1992; Sheehan and Atherton 1992; Armstrong and Ernest 1999). The investigators were aided by a Chinese physician who created a standardized mixture of 10 herbs useful for treating atopic dermatitis characterized by erythema, lichenification, and plaques of dermatitis in the absence of active exudation or clinical infection. The 10 herbs used were Potentilla Chinensis, Class 1; Tribulus terrestris; Rehmannia glutinosa, Class 2d; Lophatherum gracile; Clematis armandii, Class 1; Ledebouriella saseloides, Class 1; Dictamnus dasycarpus; Paeonia lactiflora, Class 1; Schizonepeta tenuifolia; and Glycyrrhizia glabra, Class 1 (Sheehan and Atherton 1992; McGuffin et al. 1997). These herbs were placed in sachets and boiled to make a decoction that was orally administered daily as a tea. The placebo consisted of a decoction made from several herbs with similar smells and tastes that have no known efficacy in the treatment of atopic dermatitis. The first study with 37 children demonstrated a median decrease in erythema score of 51.0% in the treatment group compared with only a 6.1% improvement in the placebo group. The percentage surface involvement also decreased by 63.1% and 6.2% for the herb-treated and placebo groups, respectively. In this initial study, no serious adverse effects were found. These 37 children were offered continued treatment with the TCM herbal mixture and were then followed up for 1 year (Sheehan and Atherton 1994). Eighteen children 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 further response to treatment, unpalatability of the tea, or difficulty in preparation of the treatment. By the end of 1 year, seven patients were able to discontinue therapy without relapse. Asymptomatic elevation of aspartate aminotransferase level was noted in two patients, the levels returning to normal after discontinuing treatment. No serious adverse effects were observed. The design was similar in the other study that involved 31 adult patients with atopic dermatitis (Sheehan et al. 1992). The decrease in erythema and surface damage was statistically superior in the herb-treated group compared with the placebo group. There was also subjective improvement in itching and sleep. These patients also were followed up for 1 year, with reports of continued improvement and no serious adverse effects, although the patients who discontinued treatment noted a relapse in their condition (Sheehan and Atherton 1994). Although the sample sizes were limited, initial results were promising for patients for whom standard therapy had failed. The main limiting issue seemed to be the taste and the preparation of the decoction. It should be emphasized that although no serious adverse effects were noted in this study, careful monitoring of complete blood cell count and liver function is recommended, as liver failure and even death have been reported with these TCM herbs when baseline laboratory values were not followed (Graham-Brown 1992; Mostefa-Kara et al. 1992; Koo and Arain 1998). It is known that the specific herbs used in these studies have anti-inflammatory, antibacterial, antifungal, antihistaminic, immunosuppressant, and corticosteroid-like effects. A few of the ingredients are also smooth muscle relaxants, and inhibit the platelet-activating factor. Several studies have attempted to elucidate the mechanism of action of this group of 10 herbs (Zemophyte, manufactured by Phytotech Limited, Godmanchester, England) in treating atopic dermatitis. Patients with atopic dermatitis are known to have elevated levels of the low-affinity IgE receptor CD23 expressed on circulating monocytes. In studies of IL-4-induced CD23 expression on monocytes, there appeared to be a reduction in CD23 expression when the cells were exposed to the aqueous herb extracts (Latchman et al. 1994, 1996). Another study examined immunologic markers for T cells, macrophages, Langerhans cells, and low-affinity and high-affinity IgE receptors in biopsy specimens of lesional skin treated with Zemophyte compared with biopsy specimens of nonlesional skin (Xu et al. 1997). The investigators found clinical improvement similar to that seen in the aforementioned Sheehan studies, and also found that the improvement was associated with a statistically significant reduction in CD23 antigen-presenting cells. However, an attempt to replicate the Zemophyte double-blind randomized placebo-controlled study in Hong Kong failed to achieve a statistically significant effect of Zemophyte over placebo (Fung et al. 1999). A different TCM herbal mixture called PentaHerbs formula, with Paeonia suffruticosa root bark, Class 1; Phellodentron chinensis bark, Class 2b; Lonicera japonica flower, Class 1; Mentha haplocalux aerial part, Class 1; and Atractylodes lancea rhizome Class 1 in a ratio of 2:2:2:1:2, known clinically to be useful in the management of atopic dermatitis, was tested on rat peritoneal mast cells and found to suppress histamine release and prostaglandin D2 synthesis (Chan et al. 2008). The bark of the birch tree (Betula platyphylla var. japonica), which is used to treat atopic dermatitis, was studied in NC/Nga mice. It decreased scratching and skin inflammation, as well as decreasing IgE and IL-4 messenger ribonucleic acid (mRNA) levels, suggesting that it suppresses the T-helper 2 cellular response (Kim et al. 2008). Other TCM herbal mixes for dermatitis are listed by Xu (2004). Jewelweed (Impatiens biflora) is alleged to be useful topically for treating poison ivy contact dermatitis, but research results are conflicting. In one study, treatment with jewelweed was found to be comparable with standard treatment for poison ivy contact dermatitis, and in 108 of 115 patients studied, the symptoms cleared within 2–3 days (Lipton 1958). However, in another study, jewelweed extract failed to decrease symptoms of poison ivy dermatitis (Guin and Reynolds 1980). In yet another study, no prophylactic effect of jewelweed in treating poison ivy dermatitis was reported (Long, Ballentine, and Marks 1997). Jewelweed has been said to be most effective if applied to the area where the poison ivy touched as soon as possible after contact, but this aspect was not addressed by the aforementioned studies. There have been no reports of topical jewelweed causing adverse effects (Peirce, Fargis, and Scordato 1999, 365). Several herbs contain a substance called “mucilage,” which is useful topically to soothe and act as an emollient on skin. Heartseases (Viola tricolor), Class 1; marshmallow (Althea officinalis); English plantain (Plantago lanceolata), Class 1; fenugreek (Trigonella foenum-gaecum), Class 2b; mullein (Verbascum thapsus), Class 1; slippery elm (Ulmus fulva), Class 1; and flax (Linum usitatissimum) contain mucilages, which act as emollients on and soothe the skin. Mucilage quickly swells into a gooey mass when exposed to water, thereby ameliorating dry or mildly inflamed skin. Mucilage also dries as a mild adhesive and can be used as an herbal bandage for minor wounds (McGuffin et al. 1997; Peirce, Fargis, and Scordato 1999; Fleming 2000). Oats (Avena sativa) have been used topically in baths for hundreds of years for their soothing and antipruritic properties, and they are approved for this use by the German regulatory authority Commission E and are listed as Class 1 (McGuffin et al. 1997; Fleming 2000; Bisset and Wichtl 2001). Colloidal oatmeal turns to a gooey sticky mass when mixed with liquid which can be used to coat the skin and sealing in moisture. This soothing and moisturizing property is attributed to the gluten content of the plant. This can be useful in treating atopic dermatitis as well as idiopathic pruritus of the elderly. Pansy flower (V. tricolor hybrids) infusion is recommended as a nontoxic treatment for seborrheic dermatitis, especially in infants. The infusion is made by mixing 1–2 tsp of flowers per cup of water and is used as a wet dressing. Salicylic acid in concentrations of about 0.3% appears to be the active ingredient. It also contains saponins and mucilage, which have softening and soothing effects. No adverse effects have been reported with topical use, and pansy is included in Class 1 (McGuffin et al. 1997; Peirce, Fargis, and Scordato 1999). In treating dermatitis, tannins used topically act by coagulating the surface proteins of cells and exudates, thereby reducing permeability and secretion. The precipitated proteins also form a protective layer on the skin (Brown and Dattner 1998). Tannins may also have antimicrobial properties. Tannins found in agrimony (Agrimonia eupatoria), Class 1; jambolan bark (Syzygium cumini), Class 1; oak bark (Quercus robur), Class 2d; English walnut leaf (Juglans regia), Class 2d; Labrador tea (Ledum groenlandicum); goldenrod (Solidago spp.), Class 2d; lady’s mantle (Alchemilla spp.), Class 1; lavender (Lavandula angustifolia), Class 1; mullein (Verbascum thapsus), Class 1; rhatany (Krameria spp.), Class 1; Chinese rhubarb (Rheum officinale), Class 2b, 2c, 2d; yellow dock (Rumex crispus), Class 2d; witch hazel bark (H. virginiana), Class 1; and St. John’s wort (Hypericum montana), Class 2d, act as astringents. Oat straw (A. sativa) included in Class 1 is also approved for its soothing and antipruritic qualities (McGuffin et al. 1997; Blumenthal et al. 1998; Peirce, Fargis, and Scordato 1999; Fleming 2000; Bisset and Wichtl 2001). One study showed that a witch hazel extract in a phosphatidyl choline base was less effective in reducing erythema from ultraviolet (UV) radiation and cellophane tape stripping in 24 healthy patients than 1% hydrocortisone (Korting et al. 1993). In another clinical trial, one group with atopic dermatitis (n = 36) and another group with contact dermatitis (n = 80) compared witch hazel extract with control. In the atopic group, the witch hazel was slightly superior in reducing inflammation and itching. There are also anecdotal reports of witch hazel’s usefulness in treating atopic dermatitis (Brown and Dattner 1998).
Herpes Simplex
Lemon balm (Melissa officinalis) is a lemon-scented member of the mint family. An essential oil can be steam-distilled from the cut leaves. Topical uses include treatment of herpes simplex and minor wounds. In a randomized, double-blind trial of 116 patients with herpes simplex lesions, 96% reported complete clearing of lesions at day 8 after using 1% balm extract cream five times a day (Wobling and Leonhardt 1994). In another trial where balm extract was placed on lesions within 72 hours of the onset of symptoms, the size of the lesions and healing time were found to be statistically better in the group treated with balm (Brown and Dattner 1998). Tannin and polyphenols appear to be responsible for the antiviral effect of the balm (Peirce, Fargis, and Scordato 1999). Balm is included in Class 1, and is very safe to use both topically and orally (McGuffin et al. 1997; Peirce, Fargis, and Scordato 1999). Other herbal preparations that have reported in-vitro activity against herpes simplex include Echinacea spp., sweet marjoram, peppermint, and propolis, although clinical studies for the latter three have not yet been performed (Peirce, Fargis, and Scordato 1999). A small, randomized, placebo-controlled crossover clinical trial found no statistically significant differences between Echinacea extract of 800 mg twice per day for 6 months and placebo controls in treating recurrent genital herpes (Basch et al. 2005). The TCM herbal mixtures for treating herpes simplex are listed by Xu (2004).
18.3.7. Herpes Zoster Capsaicin, the main ingredient in cayenne pepper (Capiscum frutescens, Class 1 internally but Class 2d externally; McGuffin et al. 1997) is available as a cream for the treatment of postherpetic neuralgia. It is applied four or five times a day and initially causes a burning sensation. With continued use, it depletes substance P in the regional peripheral nerves, reducing pain. In China, herpes zoster is commonly treated topically with hibiscus (Hibiscus sabdariffa; Fleming 2000). Hibiscus has been proved to be a very safe Class 1 herb, both topically and orally (McGuffin et al. 1997). The TCM herbal mixtures for herpes zoster are listed by Xu (2004). Herpes zoster and postherpetic neuralgia have been treated with a topical licorice (Glycyrrhiza glabra, G. uralensis) Class 1 gel preparation (Lininger 2000). Glycyrrhizen, one of the active components of licorice, has been demonstrated to inhibit the replication of varicella zoster in vitro (Baba and Shigeta 1987). There are so far no clinical studies to support this. Topical use is reported to be very safe, but care should be taken when it is taken orally as it is included in both Classes 2b and 2d (McGuffin et al. 1997).
Hyperhidrosis
By precipitating surface proteins, topical tannins can reduce the openings of sweat ducts and thus reduce sweating locally. Tannins also have antimicrobial properties that help to reduce odorous bacterial by-products (van Wyk and Wink 2004). See Section 18.3.5 for information about specific sources of tannins. Black tea also contains tannins.
18.3.9. Pruritus Camphor is derived from the camphor tree (Cinnamomum camphora) Classes 2b and 2d distillate of the wood (McGuffin et al. 1997, 30). It is toxic in large doses. As an antipruritic, it can be added to lotions or creams at one-half percent. Menthol is derived from Japanese mint (M. arvensis), which is included in Class 1 (McGuffin et al. 1997). It has a cooling, antipruritic, and antibacterial effect. Lotions and creams typically contain 1–5% essential oil. As noted in Section 18.3.5, oats also have a soothing, antipruritic effect. Tars derived from birch (Betula spp.), beech (Fagus spp.), or juniper (Juniperus spp.) trees (van Wyk and Wink 2004) are antipruritic and antiproliferative. They are used in a 5–10% concentration in creams, gels, and soaps. They are photosensitizing compounds, and judicious exposure to sunlight can be beneficial.
Psoriasis
Aloe vera (Aloe vera), which is Class 1 internally and Class 2d externally (McGuffin et al. 1997), has been used for centuries in wound healing and was recently found to be a potential treatment for psoriasis. In a double-blind placebo-controlled study, 60 patients with slight to moderate plaque psoriasis were treated topically with either 0.5% hydrophilic aloe cream or placebo. The aloetreated group showed statistically significant improvement (83.3%) compared with the placebo group (6.6%). There were no adverse effects reported in the treatment group (Syed et al. 1996). Capsaicin is the main ingredient in cayenne pepper (C. frutescens), which is Class 1 internally but Class 2d externally (McGuffin et al. 1997); it has also been studied for the treatment of psoriasis. In vitro, capsaicin was found to inhibit phorbol ester-induced activation of transcription factors NF-κB and AP-1 (Surh et al. 2000). Two trials showed that 0.025% cream used topically is effective in treating psoriasis. The first study showed a significant decrease in scaling and erythema during a 6-week period in 44 patients with moderate and severe psoriasis (Bernstein et al. 1986). The second was a double-blind study of 197 patients in whom psoriasis was treated with the capsaicin cream four times daily for 6 weeks, with a significant decrease in scaling, thickness, erythema, and pruritus (Ellis et al. 1993). The main adverse effect reported was a brief burning sensation at the application site. Capsaicin is contraindicated on injured skin or near the eyes, and the German authority Commission E suggests it should not be used for more than 2 consecutive days, with a 14-day lapse between applications. A survey of patients with psoriasis at a large university dermatology practice revealed that 51% of patients used one or more alternative therapeutic modalities (Fleischer et al. 1996). This is consistent with previous Norwegian surveys of patients with psoriasis (Jensen 1990). Herbal therapy is one of the most frequently chosen alternative therapies. Psoriasis has been treated for centuries with herbal preparations, both topical and oral. There are many herbal preparations composed of furocoumarins, which act as psoralens when combined with ultraviolet A (UV-A, 320–400 nm). Furocoumarins derived from Ammi majus and related plants that produce 8-methoxy-psoralen when applied topically or taken orally intercalate with DNA. Further, when coupled with exposure to UV-A from the sun or a an ultraviolet light-box, the photoactivation causes cross-linkages with the thymine in the DNA, inducing cell death (van Wyk and Wink 2004). This, in turn, inhibits hyperproliferation in psoriatic lesions. One commonly used TCM, Radix Angelicae dahurica, included in Class 1 (McGuffin et al. 1997), contains the furocoumarins imperatorin, isoimperatorin, and alloimperatorin. In a study involving 300 patients with psoriasis, this TCM, taken orally, was combined with UV-A therapy and was compared with the standard treatment of psoralen—UV-A with methoxsalen. The efficacy of the two treatments was equivalent; however, there were fewer adverse effects such as nausea and dizziness in the group treated with TCM and UV-A (Koo and Arain 1998). In addition, there are topical preparations made from herbs that show systemic efficacy against psoriasis, but are too toxic when given systemically (Ng 1998). Topical TCM of the plant Camptotheca acuminata in an open trial including 92 patients with psoriasis found that this TCM was statistically more effective than 1% hydrocortisone. A disadvantage was that allergic contact dermatitis was seen in 9–15% of the patients in the TCM group. Comparison of TCM mixtures in clinical trials is difficult, because the mixture of herbs prescribed varies individually depending on the subtype of psoriasis (“blood-heat” type, “blood deficiency dryness” type, and “blood stasis” type), which is determined in TCM by many findings, including lesions of psoriasis, the pulse, and the condition of the tongue (Koo and Arain 1998). Some types of TCM may act in part on the microcirculation of the psoriatic lesion (Zhang and Gu 2007). Additional TCM herbal mixtures for psoriasis are listed by Xu (2004). About 5% curcumin is present in turmeric (Curcuma longa), which is included in Classes 2b and 2d (McGuffin et al. 1997; see also Chapter 13 on turmeric). Turmeric has been used for centuries in India to provide glow and luster to the skin. It has antimicrobial, antioxidant, astringent, and other useful effects that help to heal wounds and reduce scarring (Chaturvedi 2009). In vitro, the purified turmeric extract curcumin has been found to inhibit phorbol ester-induced activation of transcription factors NF-κB and AP-1 (Surh et al. 2000). The resulting suppression of phosphorylase kinase activity correlates with the resolution of psoriasis when curcumin is applied topically to the lesions (Heng et al. 2000). Microencapsulation of curcumin reduces the yellow staining produced by application of topical curcumin on the skin, while prolonging the bioavailability of curcumin (Aziz, Peh, and Tan 2007). Tars have been used for centuries to treat psoriasis. Tars derived from birch (Betula spp.), beech (Fagus spp.), or juniper (Juniperus spp.) trees (van Wyk and Wink 2004) are antipruritic and antiproliferative. They are used in a 5–10% concentration in creams, gels, and soaps. They are photosensitizing compounds, so judicious exposure to sunlight can be beneficial, or they can be used in conjunction with ultraviolet B (UV-B; 250–320 nm) or narrowband UV-B (311 nm)."
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