Some unconventional therapies may be worth a closer look

Denver - Active chemicals found in the neem tree (Azadirachta indica) have important benefits for a variety of skin disorders, according to one expert who spoke at the 72nd Annual Meeting of the American Academy of Dermatology. 

Among botanical agents, the neem tree stands tall, according to Reena Rupani, M.D., assistant professor of dermatology at SUNY Downstate Medical Center, Brooklyn, N.Y.

Also known as the Indian lilac, the tree's Swahili name translates to "tree of the 40," she says, because it is believed to cure 40 ailments. The United Nations has called it "the tree of the 21st century," she adds.

Chemically speaking, researchers have identified more than 300 compounds from the tree's flowers, bark, roots and seeds, Dr. Rupani says. Like the buffalo to Native American populations, "The entire neem tree is of value. Even today, its twigs are used as toothbrushes. Leaf juice and seed oil are used for a variety of skin disorders ranging from acne to eczema, psoriasis and even warts. The major active chemicals are triterpenoids, of which azadirachtin is the most important."

Derived from seed kernels, "Neem oil's properties are anti-inflammatory, as well as broadly antimicrobial," Dr. Rupani says. Additionally, studies have shown that azadirachtin may inhibit tumor necrosis factor (TNF)-induced biological responses, specifically by interacting with cell-surface TNF receptors. "Other studies have shown inhibition of retinoic acid-mediated biologic responses," she notes.

A Google search for neem-based products produces thousands of results ranging from shampoos and masks to oral supplements, Dr. Rupani says. However, she says the following - brought in by her patients - rank among her favorites:

• Neem Skin Salve (NeemAura Naturals, Lotus Brands): With a petroleum jelly-like consistency, this product also contains sandalwood oil to mask the neem oil's garlic-and-peanut-butter pungency. "I have found it very useful for treating mild seborrheic dermatitis in the glabella, eyebrows and alar creases. It's cosmetically very acceptable. I've also found it useful for nummular dermatitis and mild psoriasis, particularly in my pediatric patients," Dr. Rupani says.
• Pure neem oil (various manufacturers): Due to its aroma, "I've relegated is use to as far away from the nose as possible - I keep it on the feet, for tinea pedis and focal distal lateral onychomycosis (applied twice daily for four to six weeks)," she says.
• Purifying Neem Pack (Himalaya Herbals): This facial mask also includes turmeric and Fuller’s earth, a type of clay. "It's very good for acne-prone and oily skin," Dr. Rupani says. "My patients apply it two to three times weekly for about 10 minutes."
• Neem Cream (TheraNeem Naturals): "It's a light moisturizer that I like for the face," she says. "It can be used for a variety of skin types. It’s paraben-free and nonirritating," with a vanilla scent.

"Given that all these products exist, what's in our official dermatology literature? Sadly, not much" regarding neem products. Rather, Dr. Rupani says, available data comes from blogs, textbooks and folklore. "It's sad that we, in our Western conceptions of what's considered a rigorous trial and rigorous evidence, don't necessarily accept that folklore is useful. But there's a wealth of information there (Shah B, Sheth F, Parabia M. Indian Journal of Traditional Knowledge. 2011;10(2):372-374)."

On the downside, she says, triterpenoids have negligible water solubility. Other problems include the difficulty of patenting traditional remedies, Dr. Rupani says.