Article

A randomized, double-blind, vehicle-controlled, half-side comparison with a herbal ointment containing Mahonia aquifolium, Viola tricolor and Centella asiatica for the treatment of mild-to-moderate atopic dermatitis

Authors:
  • Weber & Weber
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Abstract

Only a few clinical trials have been published on the topical treatment of atopic dermatitis with herbal ointments. An ointment containing extracts from Mahonia aquifolium, Viola tricolor and Centella asiatica has previously been studied in open uncontrolled trials with children. However, no data exist on adult patients in a randomized controlled trial. A total of 88 patients with mild-to-moderate atopic dermatitis were enrolled in a double-blind, vehicle-controlled, randomized, half-side comparison. Patients between 18 and 65 years of age were treated for 4 weeks with an ointment containing Mahonia aquifolium, Viola tricolor and Centella asiatica. The primary endpoint was a summary score for erythema, edema/papulation, oozing/crust, excoriation and lichenification according to a 4-point scale. Secondary efficacy variables were assessment of pruritus severity (10 cm VAS) and a global assessment of effectiveness as well as tolerability. The study ointment reduced the primary and secondary endpoints slightly more than the base cream which was used as vehicle; the differences were not statistically significant. Since the climatic conditions during the study duration varied from very mild and sunny to very cold and dry, a post-hoc subanalysis was performed with a subset of 64 patients whose treatment was at a mean outside temperature of 10 degrees C or less. Under these conditions the primary endpoint showed high statistical significance. In this trial, an ointment containing Mahonia aquifolium, Viola tricolor and Centella asiatica could not be proven to be superior to a base cream for patients with mild-to-moderate atopic dermatitis. However, a subanalysis indicated that the cream might be effective under conditions of cold and dry weather.

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Article
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... A further study compared a topical preparation of Mahonia aquifolium, Viola tricolor and Centella asiatica with the vehicle cream in 88 patients and could not find significant differences. 165 A subgroup analysis revealed superiority of the plant preparation under dry and cool weather conditions. ...
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... With a cream that has been on the market since many years consisting of a combination of mahonia (Mahonia aquifolium), pansy (Viola tricolor hortensis) and Indian pennywort (Centella asiatica) a vehicle-controlled, double-blind, randomized study as a half-side comparison was performed on 88 adults with mild to moderate atopic dermatitis. After four weeks of treatment no superiority of the combination preparation in comparison to vehicle was found [19] (LOE-A). ...
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Plant extracts and isolated compounds are increasingly used in cosmetics and food supplements to improve skin conditions. We first introduce the positive plant monographs with dermatological relevance of the former German Commission E. Subsequently clinical studies with botanicals for atopic dermatitis, psoriasis, acne, condylomata acuminata and herpes simplex are discussed. The best studies have been conducted with atopic dermatitis and psoriasis patients. Mahonia aquifolium, Hypericum perforatum, Glycyrrhiza glabra and certain traditional Chinese therapies have been shown to be effective in the treatment of atopic dermatitis. Mahonia aquifolium, Indigo naturalis and Capsicum frutescens are effective treatments for psoriasis. Green tea extract and tea tree oil have been investigated in the treatment of acne. Podophyllin and green tea extract are effective treatments for condylomata acuminata. Balm mint and a combination of sage and rhubarb have been shown to be effective in the treatment of herpes simplex in proof of concept studies.
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... No significant differences were observed between ointment containing Mahonia aquifolium, Viola tricolor and Centella asiatica alcohol extracts and the base. However, a sub-analysis indicated that the formulation might be useful under conditions of cold and dry weather (Klövekorn et al., 2007). ...
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... A further study compared a topical preparation of Mahonia aquifolium, Viola tricolor and Centella asiatica with the vehicle cream in 88 patients and could not find significant differences. 111 A subgroup analysis revealed superiority of the plant preparation under dry and cool weather conditions. Plant extracts are prone to induce contact sensitization and subsequent contact allergy. ...
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... The pharmacology of V. tricolor has been studies lesser than the other plants. The flowers of this plant are a rich source of many secondary metabolites with anti inflammatory effect such as saponins, flavonoids, salicylic acid, carboxylic phenolic acids (caffeic acid, coumaric acids) and mucilages and have been used in a wide variety of skin disease such as eczema, seborrhea, impetigo and acne [28]. Therefore, the results of this study not only provided partial experimental evidence for the therapeutic efficacy of V. tricolor in the treatment of skin inflammatory disease, but also would be beneficial to the future studies and exploitation of this plant. ...
... 13 In particular, herbal extracts of V. tricolor have been described to treat inflammatory diseases 4 such as inflammatory atopic dermatitis or psoriasis. 14,15 Although plants contain a number of different bioactive substances, 16 a recent study highlighted that a cyclotide-enriched V. tricolor extract inhibited the proliferation of activated peripheral blood mononuclear cells. 13 Earlier it has been demonstrated that cyclotides isolated form V. tricolor are anti-proliferative agents against cancer cell lines. ...
Article
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Centella asiatica (CA) or Gotu cola is an herbal plant from the Apiaceae family with a long history of usage in different traditional medicines. It has long been used for the treatment of various ailments such as central nervous system (CNS), skin and gastrointestinal disorders especially in the Southeast Asia. This chapter focused on the phytochemical constituent and pharmacological activities of CA based on preclinical and clinical studies. Additionally, botanical description and distribution, traditional uses, interactions, and safety issues are reviewed. Electronic databases of Google Scholar, Scopus, PubMed, and Web of Science were searched to obtain relevant studies on the pharmacological activities of CA. Approximately, 124 chemical compounds including triterpenoids, polyphenolic compounds, and essential oils have been isolated and identified from CA. Ethnomedicinal applications of CA mostly include treatment of gastrointestinal diseases, wounds, nervous system disorders, circulatory diseases, skin problems, respiratory ailments, diabetes and sleep disorders in various ethnobotanical practices. Pharmacological studies revealed a wide range of beneficial effects of CA on CNS, cardiovascular, lung, liver, kidney, gastrointestinal, skin, and endocrine system. Among them, neuroprotective activity, wound healing and treatment of venous insufficiency, as well as antidiabetic activity seem to be more frequently reported. At the moment, considering various health benefits of CA, it is marketed as an oral supplement as well as a topical ingredient in some cosmetic products. Additional preclinical studies and particularly randomized controlled trials are needed to clarify the therapeutic roles of CA.
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Mahonia is an important medicinal plant that has been widely used for the treatment of human diseases for centuries. To explore the molecular mechanisms underlying the different pharmacological functions of Mahonia, organ-specific proteomics was performed. The protein profiles of leaves, stems, and roots from 2-year-old Mahonia plants were determined using gel-free/label-free proteomic technique. A total of 304, 314, and 182 proteins were identified in the leaves, stems, and roots, respectively, and included 36 common proteins. In leaves, the most abundant proteins were related to photosynthesis. Furthermore, the technique of polyethylene glycol fractionation was used to identify low-abundance proteins in leaves. Using this approach, oxidative pentose phosphate-related proteins were identified in the leaves. In stems, the main functional categories of proteins were protein synthesis and redox ascorbate/glutathione metabolism. In roots, the identified proteins were mainly related to protein synthesis, stress, and amino acid metabolism. Of the 36 common proteins identified in three organs, the abundance of calreticulin was markedly higher in roots than that detected in stems and leaves. A number of roots-specific proteins, including S-adenosylmethionine synthetase and (S)-tetrahydroprotoberberine oxidase, which are involved in the biosynthesis of alkaloids, were identified. Consistent with this finding, the levels of the alkaloids which were columbamine, jatrorrhizine, palmatine, tetrandrine, and berberine, were markedly higher in roots compared to those detected in stems and leaves. Taken together, these results suggest that alkaloid biosynthesis is ab important function in Mahonia roots.
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There is a substantial and growing interest in complementary alternative medicine (CAM) in the general population. This paper aims to answer in how far patients with atopic eczema use CAM and, if they do, which techniques. Furthermore, the evidence basis of the efficacy of CAM in the use for atopic eczema should be reviewed. For that purpose randomized controlled trials were searched systematically. In Germany, about 46% of the general population and up to 51% of inpatients with eczema use CAM. Acupuncture, homeopathy, diets and supplements comprise the most popular techniques. Better educated, middle-aged women use CAM more frequently. In general, the evidence basis concerning studies on the efficacy and safety of CAM for atopic eczema with appropriate size and quality is limited. Most studies were found on essential fatty acids and Chinese herbs, whereby the results remain conflicting. There was not enough evidence to assess the efficacy of acupuncture, homeopathy, and salt baths. A single study on bioresonance showed no superiority compared to a sham procedure. Single studies indicated beneficial effects for topical hypericum, autologous blood injection, massage therapy, and vitamin E. These results must be confirmed by future studies. CAM are frequently used in atopic eczema, the evidence basis for that, however, is limited.
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There is a substantial and growing interest in complementary alternative medicine (CAM) in the general population. This paper aims to answer in how far patients with atopic eczema use CAM and which techniques. Furthermore the evidence basis on the efficacy of CAM in the use for atopic eczema should be reviewed. For that purpose randomised controlled trials were searched systematically. In Germany about 46% of the general population and up to 51% of inpatients with eczema use CAM. Acupuncture, homeopathy, diets and supplements comprise the most popular techniques. Better educated, middle-aged women use CAM more frequently. In general the evidence basis concerning studies on the efficacy (and safety) of CAM for atopic eczema with appropriate size and quality is limited. Most studies were found on essential fatty acids and Chinese herbs, whereby the results remain conflicting. There was not enough evidence to assess the efficacy of acupuncture, homeopathy and salt baths. A single study on bioresonance should no superiority compared to a shame procedure. Single studies indicated beneficial effects for topical hypericum, autologous blood injection, massage therapy,Vitamin E and D, and topical Viatmin B12. These results must be confirmed by future studies. CAM are frequently used in atopic eczema, the evidence basis for that, however, is limited.
Article
Objectives To make comprehensive feature of clinical trials using herbal medicine and their results by today, then help a strategy for herbal medication-derived clinical studies in the future. Methods Through medical website (Pubmed EBSCO Medline), foreign clinical literatures about atopic dermatitis and herbal medicine were searched. And domestic clinical literatures about atopic dermatitis using internet website (OASIS) and hand-searching. Analysis was performed according to distribution mainly by subject, study design, number by year and its efficacy. Results and Conclusions Seventy-nine (Domestic literatures: Fifty, Foreign literatures: Twenty-nine) literatures were selected according to inclusion criteria of clinical study. 80% of domestic clinical literatures were observational studies, 50% of foreign were intervention. There were six adverse effect case studies, two follow-ups, one case report, four translational and four uncontrolled clinical trials in foreign literatures. And nineteen case reports, eighteen case series, two follow-up and five uncontrolled clinical studies in domestic. Six RCTs have established by four external herb therapy and two decoctions in Korea, showed positive effects. Three out of four external applications RCTs, four out of seven decoctions showed positive results in foreign studies. This study revealed the current status of atopic dermatitis clinical research using herbal drugs. To put clinical trials to use of herbal medicine in the treatment atopic dermatitis, scientific and objective-based studies should be needed.
Article
Eczema is a very common chronic inflammatory skin condition. Objectives To update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps. Data sources Electronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs). Review methods Studies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings. Results Of 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; and Mycobacterium vaccae vaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing. Limitations The large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies. Conclusions Although the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease. Funding The National Institute for Health Research Programme Grants for Applied Research programme.
Article
Despite the availability of medicines with proven efficacy, many patients use complementary or alternative medicines (CAMs) to manage atopic eczema (AE). Due to the lack of objective information on topical CAMs, this systematic review (SR) evaluates current evidence of efficacy and safety of topical herbal preparations in AE. Using Cochrane SR methodology, PubMed, Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (via EBSCO), MEDLINE (via EBSCO), Proquest Health and Medical Complete, GREAT and CAM-QUEST were searched from inception until June 2014. Bibliographies of retrieved studies were hand-searched for further relevant trials. All controlled clinical trials of topical herbal medicines for AE in humans of any age were included regardless of the control intervention or randomisation. Only English publications were considered. Eight studies met the inclusion criteria. Seven investigated extracts of single plants and one an extract from multiple plants. Only two studies that showed a positive effect were considered to have a low risk of bias across all domains (those of licorice gel and Hypericum perforatum). In these two, the test product was reported to be superior to placebo. Despite variations in diagnostic criteria and lack of validated tools for outcome assessments in one of these, the promising results may warrant continued research in better designed studies. No meta-analysis was performed due to heterogeneity in all studies. There is currently insufficient evidence of efficacy for any topical herbal extract in AE. Many studies had methodological flaws and even those showing efficacy were single trials with small patient cohorts. This article is protected by copyright. All rights reserved.
Article
Background: Complementary and alternative interventions are becoming increasingly utilized as adjuncts to conventional treatment of atopic dermatitis (AD). While the number of studies continues to grow, the vastness of the subject coupled with the relatively poor quality and small size of the studies limit their usefulness to clinicians. Purpose: Our aim was to comprehensively review randomized controlled trials (RCTs) of complementary and alternative therapies for AD. Methods: Searches were performed on PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, and the Global Resource for EczemA Trial (GREAT) databases, focusing on RCTs of alternative or complementary AD therapies, with a sample size of ≥10, through March 2015 and limited to the English language. A total of 70 manuscripts met the inclusion criteria and were included in the final analysis. Results: There is at least some level I evidence to support the use of acupuncture and acupressure, stress-reducing techniques such as hypnosis, massage, and biofeedback, balneotherapy, herbal preparations (with many important caveats), certain botanical oils, oral evening primrose oil, vitamin D supplementation, and topical vitamin B12. Many other therapies either have sufficient data to suggest that they are ineffective, or simply do not have enough evidence to formulate a verdict. Conclusions: Careful review of the literature reveals several promising therapies in this domain; such findings may help direct further research that is necessary to bolster clinical recommendations for alternative or complementary treatments of AD.
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Patients with atopic dermatitis (AD) exhibit various symptoms, especially itching. Recently, herbal medicines (HMs) are being used in combination with antihistamines for the treatment of AD in Korea. While oral antihistamines can alleviate itching, HMs appear to exert anti-inflammatory effects with minimal side effects. However, there is little evidence regarding the effectiveness and safety of using HMs in combination with antihistamines for AD.
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Complementary and alternative medicines (CAMs) are used in more than 80% of the world's population and are becoming an increasing component of the US health care system, with more than 70% of the population using CAM at least once and annual spending reaching as much as $34 billion. Since the inception of the National Center for Complementary and Alternative Medicine, there has been an enormous increase in the number of basic science and therapy-based clinical trials exploring CAM. The subspecialty of allergy and immunology represents a particularly fertile area with a large number of CAM therapies that have been shown to affect the immune system. Recent work has uncovered potential biochemical mechanisms involved in the immunomodulatory pathway of many supplemental vitamins (A, D, and E) that appear to affect the differentiation of CD4(+) cell T(H)1 and T(H)2 subsets. Other research has shown that herbs such as resveratrol, quercetin, and magnolol may affect transcription factors such as nuclear factor-kappaB and the signal transducer and activator of transcription/Janus kinase pathways with resultant changes in cytokines and inflammatory mediators. Clinically, there have been hundreds of trials looking at the effect of CAM on asthma, allergic rhinitis, and atopic dermatitis. This article reviews the history of CAM and its use among patients, paying special attention to new research focusing on herbals, phytochemicals, and vitamins and their potential interaction with the immune system.
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Little is known about the prevalence of atopic eczema outside Northern Europe. We sought to describe the magnitude and variation in the prevalence of atopic eczema symptoms throughout the world. A cross-sectional questionnaire survey was conducted on random samples of schoolchildren aged 6 to 7 years and 13 to 14 years from centers in 56 countries throughout the world. Those children with a positive response to being questioned about the presence of an itchy relapsing skin rash in the last 12 months that had affected their skin creases were considered to have atopic eczema. Children whose atopic eczema symptoms resulted in sleep disturbance for 1 or more nights per week were considered to have severe atopic eczema. Complete data was available for 256,410 children aged 6 to 7 years in 90 centers and 458,623 children aged 13 to 14 years in 153 centers. The prevalence range for symptoms of atopic eczema was from less than 2% in Iran to over 16% in Japan and Sweden in the 6 to 7 year age range and less than 1% in Albania to over 17% in Nigeria for the 13 to 14 year age range. Higher prevalences of atopic eczema symptoms were reported in Australasia and Northern Europe, and lower prevalences were reported in Eastern and Central Europe and Asia. Similar patterns were seen for symptoms of severe atopic eczema. Atopic eczema is a common health problem for children and adolescents throughout the world. Symptoms of atopic eczema exhibit wide variations in prevalence both within and between countries inhabited by similar ethnic groups, suggesting that environmental factors may be critical in determining disease expression. Studies that include objective skin examinations are required to confirm these findings.
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Herbal therapy is becoming increasingly popular among patients and physicians. Many herbal preparations are marketed to the public for various ailments including those of the skin. Herbal therapies have been used successfully in treating dermatologic disorders for thousands of years in Europe and Asia. In Germany, a regulatory commission oversees herbal preparations and recommended uses. In Asia, herbal treatments that have been used for centuries are now being studied scientifically. Currently, the United States does not regulate herbal products, as they are considered dietary supplements. Therefore, there is no standardization of active ingredients, purity, or concentration. There are also no regulations governing which herbs can be marketed for various ailments. This has made learning about and using these treatments challenging. Information compiled in a practical fashion may enable more patients to benefit from these treatments currently used worldwide. We reviewed the herbal medications that show scientific evidence of clinical efficacy, as well as the more common herbs shown to be useful in the treatment of dermatologic disorders. The safety of each herb has been addressed to better enable the physician to know which herbal therapies they may want to begin to use in practice. Common drug interactions and side effects of herbal medicines that may be seen in the dermatologic setting were also studied.
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Glycyrrhiza glabra L. has been used in herbal medicine for skin eruptions, including dermatitis, eczema, pruritus and cysts. The effect of licorice extract as topical preparation was evaluated on atopic dermatitis. The plant was collected and extracted by percolation with suitable solvent. The extract was standardized, based on Glycyrrhizinic acid by using a titrimetry method. Different topical gels were formulated by using different co-solvents. After standardizing of topical preparations, the best formulations (1% and 2%) were studied in a double-blind clinical trial in comparison with base gel on atopic dermatitis over two weeks (30 patients in each group). Propylene glycol was the best co-solvent for the extract and Carbopol 940 as gelling agent showed the best results in final formulations. The quantity of glycyrrhizinic acid was determined 20.3% in the extract and 19.6% in the topical preparation. Two percent licorice topical gel was more effective than 1% in reducing the scores for erythema, oedema and itching over two weeks (p<0.05). The results showed that licorice extract could be considered as an effective agent for treatment of atopic dermatitis.
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To study the efficacy and tolerability of borage oil, which contains a high concentration of gamma linolenic acid, in children and adults with atopic eczema. Single centre, randomised, double blind, placebo controlled, parallel group trial. Acute district general hospital in Nuneaton, England. 151 patients, of whom 11 failed to return for assessment, leaving an evaluable population of 140 (including 69 children). Adults received four capsules of borage oil twice daily (920 mg gamma linolenic acid), and children received two capsules twice daily, for 12 weeks. Change in total sign score at 12 weeks measured with the six area, six sign, atopic dermatitis (SASSAD) score (primary endpoint); symptom scores, assessed on visual analogue scales; topical corticosteroid requirement, assessed on a five point scale; global assessment of response by participants; adverse events and tolerability. The mean SASSAD score fell from 30 to 27 in the borage oil group and from 28 to 23 in the placebo group. The difference between the mean improvements in the two groups was 1.4 (95% confidence interval -2.2 to 5.0) points in favour of placebo (P = 0.45). No significant differences occurred between treatment groups in the other assessments. Subset analysis of adults and children did not indicate any difference in response. The treatments were well tolerated. Gamma linolenic acid is not beneficial in atopic dermatitis.
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Unlabelled: The global incidence of atopic eczema is escalating. While new treatment options are becoming available, previous treatments with certain confirmed benefits are still worth investigating as safe and effective therapies. One such treatment, Efamol evening primrose oil (EPO), was proven efficacious in a 1989 meta-analysis of randomized, double-blind, placebo-controlled clinical trials. A decade of further testing and subsequent independent reanalysis of 26 clinical studies including 1207 patients presented here, establishes that Efamol EPO has a simultaneous, beneficial effect on itch/pruritus, crusting, oedema and redness (erythema) that becomes apparent between 4 and 8 weeks after treatment is initiated. However, the magnitude of this effect is reduced in association with increasing frequency of potent steroid use. This and other confounding variables that are now being reported in the literature may account for historically reported inconsistent patient response. Recent research has uncovered unique complexities in fatty acid metabolism and immune response in the atopic condition beyond those previously reported and may well have identified a subcategory of non-responders and has helped established those that can consistently derive significant benefit. Further research is needed to provide a better understanding of the physiology behind this complex disorder and the beneficial role that fatty acids can play in its development and management. Conclusion: Efamol EPO has a simultaneous, beneficial effect on itch/pruritus, crusting, oedema and redness (erythema) that becomes apparent between 4 and 8 weeks after treatment is initiated. However, the magnitude of this effect is reduced in association with increasing frequency of potent steroid use.
Article
In einer offenen monozentrischen Studie nach GCP-Richtlinien wurde die Wirksamkeit und Verträglichkeit der pflanzlichen Heilsalbe Ekzevowen® derma bei 27 Kindern mit leichter bis mittelschwerer atopischer Dermatitis über 2 bis maximal 4 Wochen untersucht. Symptome wie Juckreiz, Rötung, Ödem/Papelbildung, Nässen/Krusten, Exkoriation und Lichenifizierung verbesserten sich durch die Behandlung deutlich. Bei 22 % der Patienten konnte eine vollständige Abheilung erzielt werden, bei weiteren ca. 60 % erfolgte eine Besserung. Die meisten Patienten würden die Studiensalbe auch zukünftig bei Beschwerden wieder einsetzen, deren Verträglichkeit von über 90 % als sehr gut oder gut bewertet wurde.
Article
Atopic dermatitis is an inflammatory skin disease characterized by dryness and itch of the skin. In this study, we measured the phospholipid content and the fatty acid pattern of lesional and lesion-free epidermal keratome biopsies on 15 patients. For comparison, epidermal biopsies were obtained from healthy individuals undergoing plastic surgery. The phospholipid content of atopic epidermis was nearly twice as high as in healthy epidermis. Monounsaturated fatty acids in the phosphoglycerides were significantly increased (p less than 0.001) and n-6 fatty acids were significantly decreased (p less than 0.001) in lesional atopic epidermis compared to lesion-free epidermis. The content of esterified arachidonic acid in phosphatidylcholine from lesional epidermis was only 49% of that found in healthy epidermis (p less than 0.001). The content of free arachidonic acid was 47% higher (p less than 0.05), whereas the content of free long-chain saturated fatty acids was decreased by 29% (p less than 0.01), in lesional compared to lesion-free atopic epidermis. The disease severity, calculated as an arbitrary index, correlated inversely with the n-6 fatty acid content of lesion-free atopic epidermis (r = -0.89, p less than 0.001). Our findings suggest that atopic epidermis is characterized by an increased activity of phospholipase A2 and an incomplete transformation of phospholipids into other lipid classes.
Article
In a double-blind, randomized, paired trial lasting 14 days in 72 patients with moderately severe atopic eczema, hamamelis distillate cream (5.35 g hamamelis distillate with 0.64 mg ketone/100 g) was compared with the corresponding drug-free vehicle and 0.5% hydrocortisone cream, and reductions of the basic criteria of severe atopic eczema (delta values of the sum scores), i.e. itching, erythema and scaling, were evaluated. Thirty-six patients in each group were treated, which allowed the detection of a 10% difference between verum and control (confirmatory study). Effects were compared using Wilcoxon's test. The mean sum scores of the basic criteria of the test areas were 5.3-5.5. All treatment regimens significantly reduced itching, erythema and scaling after 1 week. Hydrocortisone proved superior to hamamelis distillate. The basic criteria scores decreased by 2.7 and 1.6, respectively. The delta values of the minor criteria and the global rating of efficacy were also used to indicate the difference between these preparations. Hamamelis distillate cream, however, did not differ from the vehicle. Mean delta values of basic criteria were 1.8 and 2.0, respectively. All preparations were well tolerated. Unwanted cutaneous reactions occurred in six patients, although due to their inflammatory nature and their confinement to vehicle-treated patients, they may not represent true adverse effects but rather a lack of efficacy. The results prove the superiority of low-dose hydrocortisone cream over hamamelis distillate cream, and the therapeutic outcome following this preparation was no better than following the base preparation. The mild, yet unmistakable anti-inflammatory effect of hamamelis cream in experimental models of inflammatory skin disease was thus not reflected by an efficacy in patients with atopic eczema greater than that obtained from the base preparation.
Article
In this review, we discuss some common herbal preparations historically used for dermatologic conditions and recent studies that support their use. The traditional practice of topically treating dermatologic conditions with plant-derived medicines predates the cultures of ancient Egypt and remains vital today in the industrialized cultures of both the United States and Europe. Recent scientific studies lend support to some of the claims of herbal practitioners for the safety and efficacy of many herbs. The studies also elucidate, in some cases, the mechanisms by which these herbs act. With the growing interest in alternative and complementary therapies, practitioners need more information. Clinical studies and collected observations will help define specific indications for choice of herbal treatment based on both the skin disorder and the unique characteristics of the patient involved.
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Atrophy is a distressing side effect of potent corticosteroids. After open application of a high potency steroid, we monitored atrophogenicity by a variety of non-invasive methods. Volar forearms were treated twice daily for 3 or 4 weeks, with clobetasol propionate cream (Temovate). The following methods were used: 1) confocal microscopy, 2) transepidermal water loss (TEWL), 3) dimethyl sulfoxide whealing, 4) sodium hydroxide erosions, 5) analysis of stratum corneum lipids, and 6) B-scan ultrasound. Confocal microscopy revealed thinning of the epidermis, decreased microvasculature and decreased size of keratinocytes. Evaporimetry demonstrated transepidermal water loss. Whealing to dimethyl sulfoxide was enhanced. Sodium hydroxide erosions formed more quickly. The amount of ceramides, cholesterol, and free fatty acids was reduced. Ultrasound showed thinning of the dermis. Non-invasive methods are very useful for quantifying the atrophogenicity of topical corticosteroids.
Article
The frequent clinical observation that the course of atopic eczema, a skin disease involving a disturbed cutaneous barrier function, is influenced by climate and weather motivated us to analyse these relationships biometrically. In the Swiss high-mountain area of Davos the intensity of itching experienced by patients with atopic eczema was evaluated and compared to 15 single meteorological variables recorded daily during an entire 7-year observation period. By means of univariate analyses and multiple regressions, itch intensity was found to be correlated with some meteorological variables. A clear-cut inverse correlation exists with air temperature (coefficient of correlation: -0.235, P < 0.001), but the effects of water vapour pressure, air pressure and hours of sunshine are less pronounced. The results show that itching in atopic eczema is significantly dependent on meteorological conditions. The data suggest that, in patients with atopic eczema, a certain range of thermo-hygric atmospheric conditions with a balance of heat and water loss on the skin surface is essential for the skin to feel comfortable.
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To review some of the promising natural remedies within dermatology to explore their potential clinical benefit in supplementing conventional drugs. MEDLINE searches from January 1966 through October 2000 and Science Citation Index searches from January 1974 through October 2000 were conducted. Primary importance was given to in vivo and in vitro controlled studies, the results of which encourage further exploration. The controls used, the statistical approach to analysis, and the validity of the experimental method analyzed were considered particularly important. Data were independently extracted by multiple observers. Natural remedies seem promising in treating a wide variety of dermatologic disorders, including inflammation, phototoxicity, psoriasis, atopic dermatitis, alopecia areata, and poison oak. The alternative medications presented seem promising, although their true effects are unknown. Many of the presented studies do not allow deduction of clinical effects. Further experimentation must be performed to assess clinical benefit.
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The incidence of atopic dermatitis is increasing, and this poses a major burden on health care costs. A precise understanding of the genetic and immunologic mechanisms is crucial for development of effective treatment strategies for atopic dermatitis. Various studies indicate that it has a multifactorial cause, with activation of complex immunologic and inflammatory pathways. The current review will examine recent advances that have been made in our understanding of the genetic and pathophysiologic prerequisites that form the basis of this common recalcitrant skin disorder.
Article
Herbal medicine is again popular and its widespread use demands that we assess its effectiveness objectively. The evidence in this area has grown considerably in recent years, not least due to the endeavors of the Cochrane Collaboration. They show amongst other things that it is possible to evaluate herbal medicines in much the same way as conventional drugs. By far the biggest hindrance to research into herbal medicine is the lack of funds available for this line of scientific investigation. In view of the present popularity of herbal medicine it seems necessary to overcome obstacles to rigorous research and establish which herbal medicines do more good than harm for which conditions.