Herbal topicals: 'Natural' products can be useful, but term can be misleading

Key Points

Herbs are classified by "herbal actions," and there are 47 different types of herbal actions.

It can get complicated, says Helen M. Torok, M.D., medical director of Trillium Creek Dermatology & Surgery.

Herbal therapies have been used successfully in treating dermatologic disorders for thousands of years in Europe and Asia.

In Asia, herbal treatments that have been used for centuries are now being studied scientifically.

In Germany, a regulatory commission oversees herbal preparations and recommended uses.

In the United States, herbal remedies are considered nutritional supplements, according to a study by Bedi, et al, published in Archives of Dermatology in 2002.

"Anyone can use herbal remedies or herbal topicals, because they are nutritional supplements or topicals and, therefore, not FDA-monitored medications," Dr. Torok tells Dermatology Times.

There are several different types of herbal actions in the dermatology arena, including anti-bacterial, anti-inflammatory, analgesic, antiseptic, antioxidant and antimicrobial.

Although it is not known how many dermatologists are using herbal remedies to treat dermatitis and other dermatological conditions, Dr. Torok says the number is thought to be low.

"The most commonly used herbal by dermatologists is aloe, from the aloe plant. Aloe is antibacterial, anti-inflammatory and antiseptic," she says.

Licorice also is a very commonly used herb for its anti-inflammatory effects.

"There is a prescription topical herbal that is called Atopiclair (Graceway Pharmaceuticals). It is made from glycyrrhizin, the main component of the root extract of Glycyrrhiza glabra (licorice)," Dr. Torok says.

"This is used for the treatment of atopic dermatitis," she says.

Calendula, an herbal flower, can also be used for treatment of eczema. This topical is antiseptic, anti-inflammatory and antibacterial, and it also has an astringent effect.

In addition, chamomile also can be used for eczema or any inflamed area, such as sunburn, burn or scrape.

Rosemary can be added to bath water to help treat the itching associated with eczema.

Other derm applications

Many companies are putting green tea into their products, because it is an antioxidant.

"Tea tree oil is a topical herbal remedy that can be used for acne, because it has antiseptic and antibacterial properties. It is also an anti-inflammatory, and it can take the heat out of a sunburn. It is also used topically for warts," Dr. Torok says.

Another herbal treatment for warts is thuja. It is made from the thuja tree and is used orally and topically.

Caution ahead

There are several issues to consider when using topical herbal products to treat dermatitis and other skin conditions.

"You must be careful of the source of the herbal remedies," Dr. Torok says, adding that the products could be contaminated with pesticides or heavy metals that can cause side effects, but more so when taken orally.

"Herbal remedies aren't all created equal. It depends what vehicle the herbal is put in. For example, a product may have a label that says 'contains aloe.' Therefore, it is not a pure product; sometimes it is mixed with preservatives, lanolin and/or fragrances," she says.

These types of products can lead to problems. For instance, for a patient with eczema, a dermatologist may want to prescribe calendula cream, but if it is not pure calendula cream in a Vaseline base, or if there is another vehicle, a fragrance and/or preservatives, a flare in the eczema may result.

"The vehicle, the amount of active herbal that is in the product, and the source of the herbal are all important factors," Dr. Torok says.

"In the last 10 years, the herbal market has doubled from $12 billion to $24 billion. It is a large market, and people want what they call 'natural products.' They think that natural is better, but you must be careful, because 'natural' doesn't always have a vehicle that won't cause irritation.

"Probably 25 percent to 35 percent of out-patients have tried something herbal for their symptoms, whether it is topical or oral."

When taking a full medical history, Dr. Torok recommends dermatologists ask patients if they are using any herbs, topically, orally or in the bath.

"Often, we forget to ask patients: 'What have you used herbally or in the bath water?' Then that will absorb into inflamed skin as well," she says.

Overall, herbs can be helpful in dermatology, but care and knowledge of herbal products and their side effects is needed by anyone who uses them, she says.