AD treatments from the kitchen, garden

With a growing emphasis on natural and organic foods and remedies, patients are increasingly asking their dermatologists to recommend alternatives to traditional pharmaceutical or prescription treatments for atopic dermatitis and other skin conditions.

Los Angeles dermatologist Jessica Wu, M.D., says some patients go so far as to refuse pharmaceuticals.

"They are eating organically and taking herbal supplements, and many are seeing an alternative health practitioner, who has told them to not use topical steroids, topical antibiotics or other pharmaceutical treatments that they consider to be chemical," Dr. Wu tells Dermatology Times.

"It is not only the patients themselves, but parents are coming in asking for alternative therapies for their children's skin conditions."

While a number of topical and oral treatments have been proposed as possible complementary therapies for the treatment of atopic dermati-tis, scientific data backing the claims is slim. And plant botanicals are tough to study, Dr. Wu says.

"It is not so easy to pinpoint the scientific activity of herbal and natural botanical ingredients, because most of these plant-based compounds are mixtures of different biologically active components," she says.

So the story goes ...

Still, some have shown promise - anecdotally, at least.

Evening primrose oil and flaxseed oil are botanical lipids that in their oral forms, Dr. Wu says, seem to have good track records as adjuvant and maintenance therapies, with few and only mild side effects. The active ingredient in evening primrose oil is gamma linolenic acid, whereas in flaxseed oil, it is alpha linoleic acid.

"One thing that has been demonstrated is that patients with atopic dermatitis have altered fatty acid metabolism, which may contribute to their diminished skin barrier function. That discovery led to the thought that, perhaps, supplementing dietary essential fatty acids could replenish the fatty acids in the skin of people with atopic dermatitis," Dr. Wu says.

Dr. Wu informs her patients who ask about natural remedies that while it has not yet been scientifically proven, oral evening primrose oil or flaxseed oil might help with symptoms. She says that, as with any supplement, there can be mild side effects, such as gastrointestinal problems. For now, she relies on what she sees and hears anecdotally from patients.

"There are small studies, especially in the pediatric literature and individual reports, that suggest that supplementation with oral evening primrose oil does effectively clear atopic dermatitis, but then larger, controlled trials in adults showed no benefit," she says.

Tasty treat and therapeutic topical?

Oatmeal and licorice may be on many a grocery list, but they may also be topical options in the realm of natural atopic dermatitis therapies.

"We know that the skin barrier is abnormal in patients with atopic dermatitis, and colloidal oatmeal contains a number of different compounds that help to replenish the skin barrier," Dr. Wu says.

"It contains lipids that help to enhance the skin barrier and protein and polysaccharides that help to hold water in the skin. Oatmeal is Food and Drug Association (FDA) approved as a topical ingredient to soothe irritated, itchy skin. It is available in different commercial products."

There have also been small case reports and studies looking at topical licorice as an anti-inflammatory, she adds.

Many of Dr. Wu's patients will use oatmeal and other over-the-counter natural products when their dermatitis is mild, hoping to - possibly - prolong the periods between more severe symptoms.

The dermatologist does not recommend over-the-counter preparations with tea tree oil, which manufacturers promote as an antiseptic and antibacterial. Tea tree oil can be irritating - potentially aggravating atopic dermatitis in those who use it as a remedy.