The skinny on herbal remedies for dermatologic disorders

A growing number of families use herbs to manage dermatologic problems, including acne, minor wounds, fungal infections, herpes, and poison ivy. Are you familiar with what the literature shows about the effectiveness and safety of herbal preparations?

The use of complementary and alternative medicine (CAM) is rising rapidly in the pediatric population. Approximately 20% to 30% of general pediatric patients have used CAM. [1] Anywhere from 30% to 70% of pediatric patients with chronic conditions, such as cancer, asthma, rheumatoid arthritis, and cystic fibrosis, have tried CAM treatments. [2] Parents of hospitalized children report a keen interest in providing CAM to their children, but often have not discussed their interest in or use of CAM with their child's physician. [3,4] If pediatricians want to know what patients and families are using or considering trying, they need to ask.

Herbs and other dietary supplements, such as fish oil and vitamin E, are the most popular CAM therapies. These products are readily available without a prescription in pharmacies and grocery stores and over the Web. They are often perceived as natural--and therefore safe--and are used as part of a cultural tradition or home remedy. Physicians can't possibly ask patients about all of the more than 20,000 herbal products available. But they can and should be familiar with those herbs and dietary supplements most likely to be used by patients suffering from specific illnesses.

In the pediatric population, herbs are frequently used for dermatologic conditions--everything from acne vulgaris, the most prevalent skin problem among adolescents, to poison ivy, the leading cause of contact dermatitis in the United States. In this article, we review the herbs used most often for common dermatologic problems and provide resources to help answer additional clinical questions.

Acne

Nearly 90% of teenagers develop acne, with a peak prevalence at 18 years of age. The four primary causes of acne are stimulation of sebum production by steroid hormone (androgen, for example), plugging of hair follicles by sebum and desquamated cells, infection of the plugs with bacteria (Propionibacterium acnes), and inflammatory reaction to the plugging and infection. Conventional medical treatments are aimed at one or more of these four factors, and include oral contraceptives, retinoic acid, benzoyl peroxide, and topical antibacterial agents. [Editor's note: For more on the pathophysiology and management of acne, see "Acne vulgaris: A treatment update" in the December 2000 issue, also accessible at www.contpeds.com.]

Although mainstream acne treatments are effective and can often be purchased inexpensively without physician consultation or prescription, some patients prefer what they consider a more "natural" approach. Most of these patients are interested in lifestyle factors that they hope will mitigate acne symptoms (cleansers, diet, exercise). Some, recognizing the relationship between stress and more severe Outbreaks, want to pursue stress management techniques. And a few are interested in herbal remedies such as tea tree oil.

Tea tree oil comes from the leaves of the Australian tree Melaleuca alternifolia. It can be found as a pure oil and as an ingredient in skin creams...