Low-risk alternative for prevention, treatment of atopic dermatitis

Key Points

Dr. Wu, an expert in Chinese medicines, says that while botanicals have been used as folk remedies for centuries, scientists have only recently begun to test and hold them to the same rigorous standards as synthetic pharmaceuticals.

"The surprising result is that some natural ingredients have the same anti-inflammatory characteristics as topical steroid creams," she says.

"Many patients don't want to use steroids," Dr. Wu says. "Also, an increasing number of patients are demanding natural and organic ingredients, because they are environmentally concerned about all aspects of their lives."

Feverfew overview

Feverfew has the largest body of science backing it up as an anti-inflammatory, Dr. Wu says. She warns, however, "Pure feverfew can actually cause dermatitis. You don't want patients picking, boiling and using it for self-treatment."

That's because feverfew contains a highly irritating compound, parthenolide. Johnson & Johnson developed Feverfew PFE (parthenolide-free extract); the ingredient is found in its Aveeno Ultra Calming products.

According to research published in the journal Cutis, Feverfew PFE has a number of potent anti-inflammatory properties. It inhibits TNF-alpha, IL-2, IL-4 and IFN-gamma; releases from activated human lymphocytes; reduces neutrophil chemotaxis; inhibits adhesion molecule expression and cytokine release; and decreases NF-kappa beta-dependent gene transcription (Baumann L et al. Cutis. 2006;78(suppl 6):2-19).

Scientists at Johnson & Johnson compared the amount of TNF-alpha release subsequent to topical application of 12 botanical ingredients and discovered that Feverfew PFE was 35 times more powerful than the second-closest contender, green tea.

Dr. Wu, who has worked as a consultant for Johnson & Johnson, cites two clinical studies sponsored by the company. In the first, patients with sensitive skin who were treated with Feverfew PFE had less redness, blotchiness, dryness and tightness compared with the control group.

Another study tested the efficacy of Feverfew PFE in treating dermatitis caused by frequent leg shaving. "By day 14," Dr. Wu says, "patients treated with Feverfew PFE had a significant reduction in irritation and redness."

Botanical treatment

For Dr. Wu's patients with sensitive skin caused by an altered or leaky skin barrier, she recommends products with natural anti-inflammatory agents to soothe and calm the skin.

"In selecting a product, you need a good active ingredient plus an appropriate formulation for sensitive skin," she says.

When a patient presents with atopic dermatitis, Dr. Wu assesses the severity of the condition. For mild cases, she often uses botanicals to break the cycle. Generally, botanical formulations are not as potent as their prescription counterparts, but they will sometimes stop moderate cases of dermatitis. For severe cases, topical corticosteroids are the only option for breaking the cycle.

Licorice benefits

Two varieties of licorice, G. glabra and G. inflata, contain ingredients with anti-irritant and anti-inflammatory properties. Derived from the root extract of the G inflata, licochalcone A is featured in Eucerin Anti-Redness skincare products.

An in vitro study demonstrated that licochalcone A inhibits pro-inflammatory cytokines, eicosanoids and reactive oxygen species in a number of human skin cells. A clinical study found that, when applied twice daily for three days, licochalcone A reduced post-shave skin irritation and UV-induced erythema.

Disclosure: Dr. Wu reports a previous consultancy with Johnson & Johnson.