Herbal Remedies for Psoriasis: What Are Our Patients Taking?

Tace Steele, MD; Cindy J. Rogers, MD; Sharon E. Jacob, MD

Disclosures

Dermatology Nursing. 2007;19(5):448-463. 

In This Article

Discussion

As the consumer demand for al ternative medicine increases, so does the need for reliable scientific data on the safety and efficacy of such treatments. Herbal remedies are of specific interest to dermatology, as approximately one-third of all "traditional herbal medicines" are used for treating wounds and skin disorders, compared to only 1% to 3% of modern drugs (Mantle, Gok, & Lennard, 2001). In a recent United Kingdom study of the 717 patients who completed the complementary and alternative medicine usage questionnaire, 48% of the CAM users reported use for dermatologic conditions with 30% of the CAM users reporting use for psoriasis. Notably, the herbal remedies group was the most frequent CAM user (Huang, Wen, & Hsiao, 1997). There are more than three dozen herbal remedies reportedly used in the treatment of psoriasis and many do not have clinical trials investigating their use.

Herbal medicine practices raise several medical standard-of-care concerns. Patients rely on the In ter net, lay press, friends, health food store workers, product labels, and physicians for information. To illustrate the magnitude and diversity of publicly available information, we searched |the Internet sites Yahoo (www.yahoo.com) and Google (www.google.com) for "herbal medicine" and "psoriasis" [HM & PSO] and "complementary & alternative medicine and psoriasis" [CAM & PSO] and compared it with the information available through the National Psoriasis Foundation (www.psoriasis.org) and National Library of Medicine (www.pubmed.gov) (see Table 2 ). There were over one million sites offered by Yahoo versus the 31 articles available on PubMed, when HM & PSO were searched. This disparity speaks to the fact that the efficacy supported by the lay "literature" is not supported by the scientific evidence found in the medical literature.

The information reported in the lay literature may be distorted. Often, protocol violations and liberal inclusion criteria lead to erroneous conclusions. Unfortunately, consumers of lay literature are likely not aware of these study difficulties and assume that when a study is quoted that the information is accurate (Graber, Roller, & Kaeble, 1999).

Of important note, the Food and Drug Administration does not control what "extra" substances may be added to a product, or monitor product components to assure compliance with the listed ingredients. Adulter ation of CAM products is an established problem. For example, a Taiwanese study examined 2,609 traditional Chinese medications ob tained from eight hospitals (Baron, Goodwin, Nicolau, Blackford, & Goulden, 2005). The researchers found approximately half of the products contained chemical substances not prescribed or labeled as part of the intended use. Over 50% contained two or more adulterants, with steroids making up 6 of the top 25 most frequently "added" substances found. Moreover, the Cali fornia Department of Health Ser vices analyzed 260 Asian patient medications, containing herbs, plants, animal by-products, or mineral salts. They found that 32% contained undeclared pharmaceuticals and/or heavy metals (Ko, 1998).

Keane, Munn, du Vivier, Taylor, and Higgins (1999) examined 11 Chinese herbal creams used in treating eczema and found that eight contained dexamethasone, which was not a listed ingredient. Table 3 lists adulterants that have been found in herbal preparations. Despite documentation of mechanisms and outcomes, without assurance of what substances are included in herbal preparations, we would be remiss to endorse their use. Ultimately, clinicians need to be aware of their patients' use of herbal remedies. Familiarity with these herbal names, uses, efficacies, and side effects may encourage dialogue with patients and improve clinical care.

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