Clinical Considerations

General comments

– Psoriasis is a cornification disorder occurring in intermittent attacks. The disease is characterized by the development of reddish plaques covered by grossly lamellar scales.

– Psoriatic attacks are provoked by certain medications, alcohol, stress, and other skin-damaging factors.

– Different types of psoriasis can be distinguished. Apart from the skin, the nails and especially the joints of the hands and feet can also be affected.

– Psoriasis affects a substantial portion of the Western European population (1–3%), with about 7 million sufferers of psoriasis in the United States alone. The disease is congenital but the cause is unknown.

General and herbal treatment measures

– Several treatment strategies are available: Topical preparations containing salicylic acid, cignolin, retinoids, glucocorticoids and tar can be used as well as selective ultraviolet radiation in combination with psoralen. More severe cases may warrant systemic therapy with retinoids, cyclosporin A and/or methotrexate.

– Intensive phytotherapy and regular physical measures are important when joint regions are affected.

Clinical value of herbal medicine

– Smaller-scale clinical studies have demonstrated that psoriasis improves with aloe vera and Oregon grape bark.

– These herbs should only be used in mild psoriasis. No data are available on their use in more severe cases.

– Sarsaparilla was formerly used for psoriasis in folk medicine, but the Commission E negative monograph states that prolonged use can damage the kidney. Therefore, we do not recommend it.

Recommended Herbal Remedies and Range of Applications

– Clinical value: These preparations appear to be effective remedies for mild psoriasis. Further clinical study is required for a final assessment.

Clinical Considerations

General comments

– Eczema is a noncontagious type of dermatitis that is usually triggered by hypersensitivity to certain substances.

– Acute attacks are characterized by skin reddening and swelling with papule and blister formation. Crusting and scaling develop after the blisters burst open. Additional skin damage often occurs due to itching and scratching, which is often leads to purulent secondary bacterial infections.

– Chronic eczema is common and can lead to leathery hypertrophy of the skin, or lichenification.

– Different types of eczema are distinguished:

• Allergic contact eczema is precipitated by contact with allergens such as nickel, chromium, preservatives, perfumes, ointment bases, and plant extracts (e. g., arnica).

• Toxic contact eczema is caused by direct skin damage due to ultraviolet radiation exposure (e. g., sunburn and so-called sun rash).

• Chronic contact eczema occurs due to constant contact with water and soap, acids, lyes and/or solvents (often job-related).

General and herbal treatment measures

– Avoidance of trigger substances is the first and foremost pillar of treatment.

– Standard treatment of acute contact eczema consists of the application of cool, wet compresses with or without short-term cortisone or hydrocortisone treatment as needed. Greasy ointments may also be necessary if skin thinning occurs due to chronic inflammation.

– All of the herbal remedies are applied topically.

Clinical value of herbal medicine

– Chamomile flower, witch hazel leaf and bark, balloonvine herb, and oak bark have proven benefits in weeping and, in some cases, bacterially infected, purulent eczema.

– Chamomile flower extract is indicated in mild eczema with or without bacterial infection. Recent studies have shown that chamomile extract is superior to ointment base alone and to 0.5% hydrocortisone in the treatment of toxic eczema.

– Witch hazel leaf and bark preparations are weaker than 1% hydrocortisone products and are therefore more suitable for treatment of mild symptoms.

– Balloonvine herb has antipruritic and anti-eczematous effects.

– Oak bark is indicated in acute weeping eczema and is also helpful in secondary bacterial superinfection.

– Bittersweet has not been tested for effectiveness in eczema, but a beneficial effect of the herb seems probable. Bittersweet has a very low rate of side effects and is suitable for long-term use.

Recommended Herbal Remedies and Range of Applications

• Chamomile extract contains anti-inflammatory compounds (chamazulene and bisabolol) as well as mucilaginous substances that counteract irritation.

• Witch hazel contains hamamelitannins that reduce skin redness by decreasing the blood flow to the skin and flavones that inhibit histamine release. Bacteriostatic action has also been reported.

• Oak bark has a high content of tannins that react with proteins in the superficial layer of the skin and mucous membranes to prevent the penetration of harmful organisms.

• Bittersweet stems contain tannins as well as steroid alkaloid glycosides with anti-inflammatory, antipruritic, and antiallergic effects.

– Contraindications: Oak bark should not be used if there is extensive skin damage. Treatment should be limited to a total of 2 to 3 weeks.

– Dosage and administration

• Cold wet compresses made with chamomile flower extract or oak bark decoction are applied to the affected areas of the skin 3 times daily for periods of 1 to 2 hours each (see standard treatment section, Section 4).

• Exchange the compress for a fresh cold one as soon as it becomes warm and dry. After treatment, place a wet compress over the affected skin and wrap loosely. Do not cover the compress with airtight material.

• Oak bark decoction: Boil 2 tablespoons (10 g) of the herb in 500 mL of water for 15 minutes, then strain. Allow to cool before use. Prepare fresh each day.

• If commercial products are preferred, they should be used as directed by the manufacturer.

– Side effects

• Bittersweet stem: Ointment preparations contain small quantities of alcohol that may cause burning on broken skin.

• Chamomile flower: Although rare, chamomile flower may induce contact eczema. This is usually attributable to adulteration with other plants.

– Clinical value: The above herbal treatments are well-tolerated remedies. The efficacy of some has been scientifically proven. They are safe for long-term use. The efficacy of bittersweet, balloonvine, and witch hazel in mild to moderate eczema has been confirmed in clinical studies.

Clinical Considerations