Botanicals in Dermatology: An Evidence-based Review

Juliane Reuter; Irmgard Merfort; Christoph M. Schempp


Am J Clin Dermatol. 2010;11(4):247-267. 

In This Article

9. Discussion

Botanicals applied to wounds and skin diseases are perhaps the oldestmedicines of humankind, and they still have their place in modern medicine. Three mechanisms of botanical medicines are especially important in the modern view: anti-inflammatory, antimicrobial, and antioxidant properties, which are often combined in a single plant extract andmay be based on a number of ingredients rather than on single compounds. This combination is relevant for some actual trends in dermatology: the increasing number of inflammatory skin diseases in industrial nations; the emergence of microbial strains resistant to conventional antibacterials; and the increased challenges for the skin from lifestyle and environmentally caused irradiation. Plants offer a huge range of substances and combinations that may be used for more and more specific and individual therapies. It is worthwhile to search for more valuable botanicals in folk medicines all over the world.

Botanicals are often used in trivial afflictions of the skin as home remedies or in skin care products before professional medical help is necessary. Although not all herbs used traditionally are clinically well documented in a modern sense, drugs like chamomile, marigold, arnica, and others seem well established empirically and supported by pharmacologic understanding of their mechanisms of action. Dermatologists should not try to discredit this use but know about their indications and mode of application, and also about risks and limitations. In acute and serious cases, botanicals may often not be sufficient treatment but are still helpful as adjuvants. For example, astringent and wound healing effects may complement measures to suppress acute inflammation, infection, or pain that require treatment with stronger remedies.

Scientific evidence for clinical efficacy of botanicals is often scarce. A number of controlled clinical trials have been conducted, e.g. in AD, but only very few when a specific plant species is examined, and with limited numbers of patients and not always with positive results. More investigations are necessary to definitely confirm whether Mahonia, Glycyrrhiza, or Hypericum are effective in AD, and whether Mahonia and capsaicin are effective in psoriasis. There is strong evidence for the use of botanicals in UV protection. However, this is only to a minor extent related to medical treatment but rather to diet recommendations and cosmetic care. Nevertheless, plant-derived topical formulations can be used for treatment of sunburns, amelioration of adverse effects in PUVA, or enhancement of efficacy in UVB treatment. Birch extract even seems to be effective in the therapy of precancerous skin deletions caused by long-term irradiation.

UV protection is also important for cosmetic purposes in antiaging treatment.Another field of cosmetic application is cellulite; many products are advertised as effective, but clinical evidence only supports mild short-term improvement up to now.[162,163] Caffeine and other botanicals may be efficient, but delivery in special formulations seems necessary to reach the relevant tissues.[164,165] Redness of the face may be a cosmetic problem but is also associated with rosacea; there is preliminary evidence that certain botanical treatments might help in rosacea, but more rigid application of diagnostic criteria is necessary in this field.[166]

Research in phytomedicine is always associated with the search for active principles, and some examples were given where specific molecules have been identified as the (only?) therapeutically meaningful ingredients of a traditionally used plant, which are now accepted as standard therapies in their isolated form. However, many botanicals contain combinations that are probably superior to their isolated components in that they induce different but synergisticmechanisms in the organism. Application of complex natural products raises questions of reproducibility and quality control. Clinical investigations should therefore use well defined, standardized formulations.


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