Adverse Reactions to Herbal Therapy in Dermatology

There are many herbal therapies available for dermatological diseases that patients have already begun to discover. Dermatologists must be educated not only in the benefits of these therapies, but must also be aware of some of the risks and adverse effects. They need information about the effects of herbal remedies in order to better serve their patients who may be using herbs to treat their dermatological conditions. This brief review summarizes some of the more common herbal therapies used by many dermatology patients for their skin diseases, and the adverse reactions and drug interactions that may occur.

The use of herbal therapy by dermatology patients is on the rise. Because of their convenient availability, many patients with chronic dermatological diseases have attempted to take more control over their health by using herbal remedies along with or instead of conventional treatments. Some patients have lost hope; standard treatments have failed to be effective for them. As a result, they seek newer therapies in an attempt to find a “cure” for their problems.

Government Regulations

The exact frequency of herbal use is not known because of its non-regulatory status. However, some regulations do exist at the federal level in Canada with the Natural Health Products Directorate (est. 03-99). Most of these regulations are still under review. However, regulations do exist with regard to definitions, product licensing, adverse reaction reporting, site licensing, good manufacturing practices, clinical trials, and labeling/packaging.

There are many herbal remedies that have scientific merit; they may be of clinical benefit and provide safe, effective and reliable alternatives to conventional medicine. However, herbal products cannot be patented.² They are intended for the self-treatment of a self-diagnosed, self-limiting condition. Although there are numerous herbal therapies that are relevant to the specialty of dermatology, many of these have not been studied in proper randomized, double-blind, placebo controlled trials. Most herbal treatments have evidence that is based on sparse anecdotal reports and word of mouth.

Drug Interactions and Side-Effects

Many of these therapies are considered “natural” and therefore harmless. However, because of the poor regulations that exist in monitoring these drugs, adverse reactions do occur.³ Herbal therapy, therefore, should be avoided in pregnancy, infants and children because of the uncertainty of adverse reactions that could occur. There is little incentive for pharmaceutical companies to investigate or standardize these preparations because it is unlikely patents would be applicable.

Because of the assumed safety of natural products, many patients believe these products have “fewer” side-effects. Herbal therapies should be regarded as drugs. Since drugs have side-effects, such events can be seen with herbals. Drug interactions although infrequent, can also occur with herbal therapies and conventional medications.^4,8 This may be due to altered absorption, distribution, biotransformation and/or excretion.⁶ These interactions are often patient initiated because of the lack of consultation with a physician. These effects can increase or decrease the activity of the corresponding drugs and lead to untoward or unexpected adverse events or changes in drug efficacy. Some herbals may be contaminated with toxic substances or the herbal can be toxic alone. Others may have traces of potent topical steroids.⁷ This makes it even more important for physicians to take a proper and complete drug history, including herbal medications.

Drug	Side-Effects	Drug Interactions
emaphyte (Chinese Herbal Therapy)6,10-14	Diarrhea, increased liver function tests, reversible dilated cardiomyopathy, reversible acute hepatic illness, fatal hepatic necrosis, symptomatic nephropathy & bladder carcinoma, worsening of atopic dermatitis, acute urticaria	Methotrexate
Evening Primrose Oil (EPO)(Efamol®)4,6,8	GI upset, headaches	phenothiazines, seizure threshold of phenobarbital, phenytoin
Borage Oil15	Potential for hepatotoxicity orally, no toxicity data for topical use	None Known (NK)
Aloe Vera4,6,8,9,16	Contact dermatitis	corticosteroids, Potassium
Calendula (Calendula officionalis)4,8,9,16	Allergic reactions, ACD	NK
Capsaicin (Zostrix®)8,9,16	Severe burning, intolerability, allergy: can cross react with latex, bananas, kiwi, chestnut, avocado	NK
Goldenseal (Hydratis canadensi)4	Allergic Contact Dermatitis	NK
Licorice (Glycyrrhiza glabralensis or ura)4,6,8,16	Contraindicated in hypertension, diabetes mellitus, hypokalemia, liver/kidney disorders	Cyclosporin A (CyA) , digoxin, prednisone, thiazides
Purple Cone Flower (Echinacea angustifolia or internalpupurea) 4	Recurrent erythema nodosum CAUTION!: in HIV, CTD, TB, MS, ragweed, sunflower allergies	Immunomodulators and CyA, Methotrexate, coticosteroids
Slippery Elm Bark (Ulmas fulva)	Dermatitis CAUTION! Oral form induces miscarriage	NK
St. Johns Wort (Hypericum perforatum)4,6	Oral form can cause photosensitivity, erectile dysfunction	amitriptyline CyA , digoxin, paroxetine, HIV protease inhibitors, oral contraceptives, retrovirals
Thyme (Thymus vulgaris)4	Essential oils can be a mucous membrane irritant	NK
Ginkgo (Ginkgo biloba) Garlic, Ginger, Ginseng (Panax ginseng)4,8,17	Can cause spontaneous bleeding	Can potentiate aspirin, NSAIDs, warfarin, heparin
Tea Tree Oil (Melaleuca alternifolia)6,8,9	ext- ACD, burning, dryness, itching, 5 irritation, systemic allergic reactions, can cross react with colophony. int- TOXIC	NK
Bromelain-Pineapple (Ananas comosus)16	ACD, GI upset, diarrhea	Ethyl acrylate
Yarrow (Achillea millefolium)16	ACD	NK
Fenugreek (Trigonella foenum-graecum)16	ext-Skin irritation int-Hypoglycemia	Hypoglycemics
Chamomile (Matricaria recuita L)4,6,9,16,18	ACD, anaphylaxis	Hypersensitivity cross-reactions to ragweed, Chrysanthemums (Compositae family)
Arnica (A Montana)8,9	ext-ACD int-TOXIC	NK
Horse Chestnut seed extract (Aesculus hippocastanum)6,8	ext-ACD int-Dizziness, drug induced lupus, GI upset, headache, pruritus	NK

Table 2: Side-effects and drug interactions of some herbal remedies

The most common dermatologic reaction from herbal therapies is allergic contact dermatitis.⁸ Herbs that are known for causing this condition include: aloe, arnica, bromelain, calendula, chamomile, goldenseal, tea tree oil and yarrow.^6,4,9 However, more serious events have occurred including erythroderma and Stevens-Johnson syndrome from combination herbal preparations.⁸ Serious systemic adverse events have been reported with herbal therapies for the treatment of dermatological diseases as well.⁷ Most are hepatotoxic effects and some have been fatal although this is rare.⁸ Herbals that are recommended for topical use should not be ingested and vice-versa. Drug interactions that most commonly occur are due to immunomodulatory reactions, however effects on anticonvulsants and anticoagulants can occur.⁵

Conclusion

A brief search of the literature reveals many therapies used for dermatological disease however there are fewer reports of their side effects in dermatologic or medical literature. Only those therapies relevant to the specialty of dermatology that also have had reports of side-effects are discussed. Those therapies without known side-effects are excluded from this manuscript. It is important for dermatologists to become aware of these adverse events and interactions in order to better educate their patients and possibly prevent potential and unexpected adverse reactions.⁸

Identifying Skin Lesions - Warts, Moles and SebKs

By Van Le |  While freckles can add to a person’s beauty and uniqueness, other skin lesions such as large moles, skin tags, warts, and seborrheic keratoses can be unsightly and embarrassing. Most lesions are malignant (non-cancerous), however, it is important to be aware of and track any skin abnormalities on your body as a preventative measure.

Freckles

Freckles are irritating for some and embraced by others. They are pigment cells that retain within the skin to form light brown spots, and individuals with lighter complexions are more susceptible to freckles since their skin contains less melanin. Freckles, also known as ephelides, can appear on the face, arms and other sun-exposed areas. Excessive and continued exposure to harmful UV rays can cause more freckles and cause them to appear darker. While they are harmless, it is important to distinguish between freckles and symptoms of melanoma, a type of skin cancer that can grow from an existing freckle. Consult your doctor if you notice any change in freckle size, shape and color.

Skin tags

Skin tags are pieces of skin that hang from the surface of a surrounding area. Like freckles, they are benign, but can cause irritation if located on an area that is exposed to constant contact, such as the eyelids or areas where they can be snagged by jewelry or clothing. Skin tags can vary from a small pin-point size to a large grape size. While some can fall off on their own, there are several ways to medically remove skin tags, including freezing and burning. There are home remedies as well as creams available on the market to remove unwanted and embarrassing skin tags.

Seborrheic keratoses

Seborrheic keratoses, another benign skin lesion, can form anywhere on the body, but is commonly found on the chest and back. They can be distinguished from other types of lesions due to their waxy, stuck-on-the-skin appearance and often described as brown candle wax stuck on the skin. While the cause is still unknown, scientists have found that they can be hereditary and not affected by sun exposure.

Warts

Most warts are skin infections caused by viruses of the human papillomavirus (HPV) family. Basically, warts are benign tumors of the epidermis (outer layer of skin), and can occur in people of all ages, but are most commonly found on children and teenagers. There are different types, including flat and plantar warts. Flat warts are small in size but can be high in quantity, can spread to other areas of the body by shaving or scratching, and can be transferred person-to-person by physical contact. Plantar warts grow on the heel, ball or sole of the foot, and pressure from standing or walking pushes them into the deeper layers of skin.

Skin lesions like warts, seborrheic keratoses and skin tags are often harmless, but they can be embarrassing. While they can be surgically removed, there are creams and ointments available on the market to remove and reduce their appearance. If you have further questions about a particular skin lesion, consult your doctor or pharmacist for proper diagnosis and treatment.

Van Le is a staff writer for the CSU Daily Titan and writing intern for Vivoderm Laboratories in Los Angeles, California. She is currently pursuing a Journalism degree at California State University, Fullerton.

For the latest findings on skin lesions and treatments, you can also link to http://www.dermatosispapulosanigra.net

Guidelines for Using Zinc Oxide to Treat Acne

There has been a lot of press recently about Zinc and Zinc Oxide in skincare and cosmetic products. Zinc can be found in many natural sunscreens ans well as moisturizing lotions and creams.  Zinc - or Micronized zinc oxide -  is produced by high temperature processing of minerals that contain zinc. Some brands contain micronized zinc oxide, combined with an inert ingredient derived from silica. The result is a naturally protective product to protect you from the sun’s damaging UV and UVB rays.

Zinc is a mineral and it is also believed that it has curative properties on a skin where there are acne growths and can reduce the symptoms of acne. Many alternative studies have indicated that this is not the case. So is there a connection between the two?

According to research carried out in recent years, zinc has the same properties of antibiotics such as tetracycline and it can fight the acne bacteria efficiently without the negative effects of antibiotics. Reportedly, zinc also enhances the immunity of the body when ingested as a supplement. So what is zinc and what is the zinc acne connection all about? How does the zinc acne treatment affect the sufferers and what is the best way to use this treatment?

You will find traces of the zinc mineral in various food items such as mushrooms, soybeans, legumes, fish, sunflower seeds, egg yolks, soy lecithin and also in whole grains. Zinc is also present in many herbs such as dandelion, eyebright, cayenne, chamomile, mullein, nettle, milk thistle, alfalfa and in the burdock root. Zinc forms a part of insulin and can be found in the tissues.

There are many useful properties of zinc like providing the person with energy, prohibiting blindness, aiding the process of digestion by being a part of enzymes, supporting the reaction of more than 30 enzymes, strengthening the immunity, regulation of Vitamin E in the blood, helping the body absorb Vitamin A and B, speeding up the process of healing, regulating insulin, and it also fights bacteria. Zinc is also present in estrogen, testosterone and growth hormones.

So how does zinc help a person suffering from acne?  Zinc moisturizers and sunscreens may be a good first step to taking care of your skin from the outside.

The causes of acne are all internal and they are imbalance in the level of hormones and build up toxic materials within the body. The hormones are responsible for producing oils, and the zinc can regulate the oil glands, and so if you can take them correctly (that is in the right quantity, quality and the correct essential fatty acids) you will be able to have some control over the level of hormones and this will ease the symptoms of your acne greatly.

Zinc also helps absorb Vitamin A, and fights the bacteria that causes acne by strengthening the immune system, helps the body heal wounds and contains anti oxidant properties. All these are useful in tackling the secondary causes of acne and will help you greatly reduce the symptoms of acne.

Another ability of zinc for acne is that it can regulate the production of hormones, which is a main reason one acquires acne. However for this to happen, it needs to be taken in the correct quantity and in combination with essential fatty acids. This mineral needs to be properly absorbed within the body and work together with other nutrients for the hormones to be balanced.

While zinc as an acne treatment may be effective, it is very important however to take care and not mix it with some chemical substances, supplements and food items because they will make the zinc less effective.  You should always consult your doctor or research a supplement before taking any internal treatments.

There are some food items, ( inhibitors) like supplements and physical conditions that can prevent zinc from being properly absorbed in the body. This may significantly reduce the impact of zinc on the acne.

One of these inhibitors is Phytic acid.  Usually found in high levels in grains. The acid can reduce the absorption by about 15%.  And thus, those who are suffering from acne need to reduce their grain consumption to one to two servings a day. Grains may lead to mucus and acidity and taking them with zinc for acne can be a challenge.

Another zinc inhibitor is soy protein. If you are using zinc for an acne treatment, you need to eat less soy as it can bind to minerals and lead to less zinc absorption. Then there are other minerals like copper and inorganic iron. They also come in the way of zinc for acne bio-availability. However this issue can be solved easily, unless of course you are suffering from copper toxicity. Try not to take copper more than 2-3 mg a day and also do not take inorganic iron supplements.

Too much of physical exertion may lead to an increased demand by the body for zinc and thus, when you are exercising, you need to also take more zinc for acne treatments.

Following these tips and zinc guidines should have you well on your way to beautiful skin in no time!

Removing Blackheads and Comedones

Eliminate blackheads and whiteheads

Blackheads are tiny, dark spots caused by a small plug in the opening of a follicle (pore) on the skin. Blackheads are also called open comedomes. A blackhead is a type of acne vulgaris. It is caused by excess oils that have accumulated in the sebaceous gland ’s duct. Blackheads are typically caused by excessive oil and makeup, which can facilitate the multiplication of the bacterium propionibacterium acnes, the predominant anaerobe of the normal skin flora. The substance found in these bumps mostly consists of keratin and modified sebum (an oily secretion of the sebaceous gland ), which darkens (resembling dirt) as it oxidizes.

If you suffer from blackheads or whiteheads and need to know which products are best. Look for non-comedogenic products - they are less likely to cause blackheads (called open comedones) or whiteheads (closed comedones). Most brands of make-up are non-comedogenic, which means they won’t clog your pores. If your skin is prone to acne or
especially sensitive, try to find products that are non-comedogenic, oil-free (water-based), hypoallergenic (unlikely to cause an allergic reaction) and fragrance free. It may be helpful to remove make-up before exercise, as the products can travel across the face through sweat and clog your pores. However, since no product is non-comedogenic for everybody, it’s a good idea to first test any new product on a small area of your own skin.

Blackheads are the slightly different sibling of pimples, and like pimples, squeezing them can be damaging. Composed of the same oil, or sebum, that contributes to the production of pimples, blackheads result from a building up of this oil in pores. The difference in appearance than that of a pimple is the result of the blackhead’s exposure to the air.
The oxidation (or darkening)  of the the oil causes the trademark black color of these blemishes.

While blackheads are more easily obscured by makeup, they can seem less offensive to the sufferer, and as a result, less damaging to squeeze. But squeezing is not good for blackheads. It can leave a permanent scar on skin and also leaves your skin open to infection. Comedones (blackheads and whiteheads) are caused by the densely packed skin cells. Comedones, commonly appear on the face and shoulders, but they may also develop on the trunk, arms, legs,
and buttocks. They are most common in teenagers but can occur at any age, even in infants.

Treatment for whiteheads and blackheads depends on the severity of the condition. Treatment may include lotions or gels placed on blemishes or sometimes entire areas of skin, such as the chest or back (topical medications). Oral medications, such as antibiotics, may be prescribed.

Causes of Blackheads

Blackheads are caused when excess skin oil, sebum and congesting toxins are expelled through your skin from the blood and lymph fluid that supplies your skin with nutrients. These congesting toxins combined with skin oil and sebum clogs your pores causing blackheads, whiteheads, and full blown acne. Dirt also plays a big role in developing skin blackheads. The dirt stored on the face or other parts of body help the bacteria to develop.

Symptoms of Blackheads

Blackheads and whiteheads are a combination of oils, sebum and cellular fragments that form firm to hard plugs within hair follicles. Blackheads are open to the skin’s surface and become darkened at the surface by exposure to oxygen (oxidation). They are called open comedones (or comedo, singular). Whiteheads are closed from the skin’s surface by
cellular debris at the follicle opening. Because they are closed from oxygen they do not oxidize or turn brown. They form a light or yellow-white lump and are called milia (or milium, singular). When bacteria is added to these plugs, the condition can lead to acne.

Treatment of of Blackheads

Mild cases of acne can be self-treated with over-the-counter topicals (applied to the skin) creams typically with benzoyl peroxide. Zinc Oxide is also a safe natural alternative to reduce infections. There are also a variety of different medications that your family physician might prescribe that come as creams, ointments, and pills. Some of the stronger medications for acne are not to be used if you are pregnant, so make sure you tell your doctor if this is a possibility. Most acne medications work by reducing the next “crop” of acne, so don’t get discouraged if the treatment does not work right away.

Home Remedy for Blackheads
1. In 3-4 cup boiled water, add 2 tsp of soda bicarbonate. Steam a towel with this. Thereafter, place the towel gently on your face. Do it for about 5-6 times. Make a paste by mixing 1 tsp curd and 1 tsp rice flour.  Apply the paste on the affected area. After some time, wash your face with cold water.

2. Take about 1 tsp of juice extracted from fresh coriander leaves and add ½ tsp of turmeric powder in it. Apply this mixture while going to bed. Wash your face the next morning with cold water.

3. Take a pinch of soft portion of glycerin soap and mix with a pinch of table salt. Apply this mixture on the blackheads. Do it for about a week and see the magical results.

4. Salicylic acid, glycolic acid, benzyl peroxide, etc. can be counter-productive to softening and dissolving blackheads and whiteheads as they can dehydrate dry, normal and combination skin

5. Make a paste by mixing 1 tsp limejuice and 1 tsp of finely powdered cinnamon. Apply it on the affected area before going to bed. Wash it off in the morning.
When looking over other strategies on how to remove blackheads, you want to make sure that you are not using your fingernails to squeeze. Your fingernails could be loaded with all kinds of bacteria, which could cause infections. If you do decide to squeeze, make sure you are properly cleaning and sterilizing your hands or using a tissue, to reduce the risk of infection.

Exercise caution. Squeezing a blackhead too much or too soon may lead to the rupturing of a blood vessel. Even though this is a rare occurrence, it can still happen. If you find this happening to you, do not continue to squeeze the blackhead because you may make it worse.

Skin Needling Treatment Reduces Acne and Wrinkles

What is Skin Needling?

Skin Needling or “derma rolling” has become quite popular in the last few months. Indeed, one Google search on “dermarollers” returned hundreds of links.

I was unfamiliar with this new anti-aging tool, so, I decided to research it further. At a recent beauty expo, the cosmetic representatives I spoke to claim these new facial rollers could increase collagen production and reduce wrinkles.

The process of skin needling uses a very small rolling device that contains 192 micro points made of surgical steel. Studies show that when this device is rolled over the skin, it creates small puncture wounds that cause the body to produce collagen in an attempt to heal the skin. Our collagen production falls dramatically after about age 35 or so.

This puncturing will then cause a type of wound-healing reaction for the dermal layer to begin production of collagen fibers, elastin, and other skin cells that helps to fill in lines, wrinkles, remove stretch marks and fill in deep pitted scars – also allowing the derma roller to be a great acne scar treatment. In addition, the derma roller allows for optimum absorption of any anti-aging cream you may use afterwards.

While it goes by different names, ‘skin needling,’ ‘dermaroller,’ or ‘meso roller,’ among many others, it appears to be a simple and natural method that promises to prevent skin aging, restore collagen, smooth out scars, pitted skin, and stretch marks - or your money back in some cases.

Research on Skin Needling

The skin needling device is used along with your normal skincare routine to remove acne scars, stretch marks, wrinkles, fine lines. Representatives say it can even help with big pores, black heads, and white heads. This micro needling or skin needling anti-aging technique is also used to perform collagen induction therapy (CIT). Skin rejuvenating results with skin needling are similar to laser treatment, dermabrasion or chemical peels but much less expensive, less invasive, does not damage the skin, and can be done at home for pennies.

Celebrity Endorsements

More than a few sites claimed famous celebrities used derma rollers or a type of skin needling technique to keep their skin look young and healthy and reduce acne scars. The London Daily Mail Online, reported, “ It looks like an implement of torture, but this spiky roller is thought to be the secret to Angelina Jolie’s plump, glowing skin.”

The Rachael Ray show hosted a segment titled ‘The Human Lab,’ where Rachael selected members of her audience to test several anti-aging creams and devices and report a few weeks later on their results. See the You Tube clip here.

The Studies

Study results by plastic surgeons and dermatologists claim in that addition to reducing the appearance of sun damage and wrinkles such as crows feet, skin needling can help lessen or remove stretch marks, cellulite, acne scars, surgical scars and smooth out pitted skin and dimpling.

Dr. Philippe Simonin, a Swiss Dermatologist, performed a study on 600 people divided into two groups — the skin aging group and the scar reduction group. Published results found that - in the skin aging group there was a 40% significant improvement and an impressive 60% improvement in scar reduction group. And this was only after 5 to 6 treatments!

See the link here: http://www.scar-reduction.com/needling.html

Another doctor, Dr. Andre Camirand, a plastic surgeon from Canada, found that skin needling improved the texture and depression of scars and also improved over-all skin color and texture. The best part is this remodeling process can go on up to 12 months from each treatment.

Other benefits of the skin needling are:

• Dramatically increases the effectiveness of your hair & skin products through increased penetration.

• Stimulates blood flow through directly massaging the scalp, face and body.

• Gentle exfoliation of dead skin cells accumulating in the hair follicles, face and body.

• The process is not painful (a tickling sensation).

• Medical grade stainless steel makes the needles non-allergenic to human tissue.

• Cost effective compared to expensive commercial treatments

• It can be used on all areas of the scalp, face, neck and body. Can be used on all skin types.

• It can be used anytime at your own convenience (no restrictive treatment session times).

• Removes old collagen fibers and rapidly stimulates new collagen growth.

• Clears blocked pores and stimulates blood flow.

• Natural process requiring no lasers or chemical peels.

• Does not induce sun sensitivity.

• Does not damage the skin.

• No risk of hypo– or hyper– pigmentation.

• Short healing time.

There are many skin rollers on the market with different needle lengths, so do your research if you do decide to purchase one of these new tools.

Skin needling devices range in price from $25-$200 depending on where you purchase them and the type of device you choose.

Professional sites advise using a skin needle length at 0.5mm for use on the face, a 1.0mm for most of the body and a 1.5mm for very fleshy areas such as the stomach, thighs and backside.

Each brand is slightly different. Certain features make different derma roller brands suitable for different needs. The more expensive brands benefit from superior build quality, narrower needles and a better overall look and feel. As with any product though, the results you achieve are not necessarily dependant on choosing the most expensive model.

~ R. Dupree