Clearing up naturally

Reena N. Rupani, MD

Conventional pharmaceutical agents are not the only solutions to common dermatologic problems. Natural products can offer practical alternatives for acne, rosacea, hair loss, immunologic disorders, and other common issues.

“My three favorite herbs are chasteberry, neem, and ashwagandha,” said Reena N. Rupani, MD, dermatologist at Mount Sinai Beth Israel, at Thursday’s “Natural Compounds in Addressing Common Dermatologic Problems” (U007). “These agents can be good choices for patients who don’t want to be on a ‘drug’ or who want something more natural.”

Chasteberry affects the pituitary, but is not anti-androgenic and can be used with anti-androgens, Dr. Rupani said. It can be useful for hormonal acne, but can cause GI upset and should be taken with food. Chasteberry can also affect the effectiveness of hormonal contraception.

Neem is an anti-inflammatory and anti-microbial that can help with seborrheic dermatitis and other inflammatory conditions. Neem seed oil is particularly helpful for dandruff and lice, but most neem products have a sulfurous smell that patients may find objectionable.

Ashwagandha, sometimes called Indian ginseng, is helpful when stress is a factor, including alopecia.

There are few FDA-approved hair loss products, such as minoxidil for women and finasteride for men. Plant-based 5-alpha-reductase inhibitors  including pumpkin seed oil, saw palmetto, procyanidin B-2, and ginseng  all have some degree of clinical evidence.

“The study results are not as dramatic as minoxidil or finasteride, but these are viable alternatives,” said Nicole Elaine Rogers, MD, assistant clinical professor of dermatology at Tulane University. “It is useful to be able to offer natural alternatives to our patients.”

Acne and rosacea are increasingly recognized as immune reactions rather than infections.

“Patients using alternative options want to fix the host, not kill the bugs and contribute to antibiotic resistance,” said Hilary E. Baldwin, MD, medical director of The Acne Treatment Research Center in Morristown, New Jersey. “Natural products for acne and rosacea are not only helpful, but often preferred by patients because they are more tolerable.”

Tea tree oil, resveratrol, aloe vera, niacinamide, and electro-acupuncture can serve as anti-microbial and anti-inflammatory agents and act as de-greasers or exfoliators.

A gluten-free diet can help patients with dermatologic manifestations of celiac disease as well as non-celiac gluten sensitivity.

“Gluten-free diet is the only long-term treatment for celiac and dermatitis herpetiformis,” said Matthew S. Goldberg, MD, assistant professor of dermatitis and pathology at the Icahn School of Medicine. “It is easier than ever to keep a gluten-free diet in our current climate.”


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