Herbal remedies: A growing body of knowledge
From November/December 2005 Psoriasis Advance
Related chart: 15 herbal/essential nutrient remedies used to treat psoriasis
When psoriasis patients visit Miami dermatologist Sharon E. Jacob, M.D., they can expect to discuss the usual subjects: symptoms, medications and something a little out of the ordinary in a
typical doctor's office—herbal remedies. Through a series of questions, Dr. Jacob finds out what her patients are taking, and advises them that every substance has a potential side effect or interaction with other medications.
"I caution my patients that 'herbal' and 'natural' are not synonymous with safe," says Dr. Jacob, assistant professor of clinical dermatology and director of the Contact Dermatitis Clinic at the Department of Dermatology and Cutaneous Surgery, University of Miami/Miller School of Medicine. A specialist in contact dermatitis—skin inflammation triggered by contact with a substance—and psoriasis, Dr. Jacob estimates that 70 percent of her patients use alternative treatments, from herbals to vitamin supplements, teas and infusions and skin lotions.
Dr. Jacob is among a growing number of traditional doctors taking an interest in complementary and alternative medicine (CAM), which is the practice of combining conventional medicine with alternative treatment such as acupuncture, chiropractic care, massage, naturopathy, herbal remedies or other healing methods.
While she believes herbals hold a lot of promise for treatment, many have not been scientifically tested yet. Herbal remedies are natural—that is, derived from a plant or mineral—but they are, in essence, drugs, because they elicit a response in the body, she says. And not enough doctors know everything their patients are taking, opening the door for potentially dangerous drug interactions.
Herbal treatment for psoriasis is the subject of Dr. Jacob's recent research paper, currently being reviewed for publication in a major dermatology journal. We spoke with Dr. Jacob about her
research, her work and her interest in herbal medicine.
How did you become interested in herbal medicine?
My interest came from my clinical experience in the Contact Dermatitis Clinic, seeing psoriatic patients with adverse reactions to "natural" products. For example, I have seen dermatitis triggered by cayenne pepper and aloe vera. When I researched these herbs for my patients, I found information on cayenne causing intestinal ailment and sweating, and aloe vera causing low potassium and seizures. This piqued my interest in the systemic effects of these herbals.
Can you tell us about your research paper?
The article is a review of scientific studies and case reports that exist to provide support for the use of these herbals in psoriasis, and to point out the herbs for which scientific studies have not been performed. We highlight the efficacy and side effect profiles of these remedies. We reviewed 30 herbs and all of them had a systemic effect, from dermatitis, diarrhea and gastrointestinal upset to more serious effects, such as heart problems.
Why is this research important to you?
I feel it is my duty to know what my patients are taking. If you don't know what your patient is taking there is the potential for some serious reactions. Doctors don't always ask, and patients often forget to tell them or don't think of a tea or a vitamin supplement as a treatment.
How do you handle alternative treatments with your own patients?
When I ask what they are taking, I will ask in a lot of different ways: What medicines have you been prescribed? What teas or infusions are you drinking? What herbal therapies do you use? What natural products? What vitamin supplements? What kinds of balms are you applying?
I also encourage my patients to bring in all their medicines, including vitamins, and herbal and natural products, so I can make an intervention if the product has the potential to interact with their conventional medications, for example. I ask them to bring the actual bottles with the ingredients listed.
What are some known side effects of herbs used to treat psoriasis?
Wintergreen or boxberry, which has been used to treat psoriasis and psoriatic arthritis, can cause ringing of the ears, vomiting and even respiratory collapse. Aloe vera, when drank as an infusion, can interact with diuretics, anti-diabetic medication and medications used to treat abnormal rhythms in the heart.
How do your patients respond to your interest in alternatives?
Some are surprised at first, but I think they like it. They bring in herbs and substances, and if I don't know what they are I look them up. It's part of my own ongoing educational process. We didn't have a course on herbals in medical school.
Do you have any advice for patients who come across herbals and other alternatives on the Internet?
The Internet has become a widely used resource by patients and doctors alike. However, you can't believe everything you read on the Internet. It's best to talk to your doctor before adding anything to your treatment regimen.
What do alternative treatments offer that conventional treatments do not?
I think they offer hope when the conventional therapies don't seem to be working. They also offer
an avenue for improving therapies. People who are trying alternative remedies are helping bring those ingredients to the forefront so they can be studied. There are many ongoing clinical trials* that will ultimately streamline many of these treatments into conventional medical practice. We need to keep trying to find remedies that work.
*EDITOR'S NOTE: Clinical trials are under way for a variety of herbal remedies, including many discussed in this article, such as chamomile, glucosamine, fish oil and milk thistle—although not necessarily specifically related to psoriasis. For more information on complementary and alternative treatments, including clinical trials, go to http://nccam.nih.gov
Also visit www.psoriasis.org/treatment/psoriasis/alternative
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DID YOU KNOW?
In 1998, researchers reported in the Journal of the American Medical Association (JAMA) that
more than 40 percent of Americans had used at least one CAM product during the prior year. Additionally, patients in the United States are estimated to be paying more than $27 billion out of pocket for complementary and alternative medicine products each year.
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