Episciences, Inc., Boise, and CT Derm, Fruitland, Idaho, and Oregon Health Sciences University, Portland, Oregon, U. S.A.
Botanicals used for medicinal, flavoring, or fragrances are known as herbs (1,2). The guiding principle of herbal medicine is the naturally occurring mixture of active compounds in plants is more effective and safer than individual molecules and man-made combinations of synthetic molecules. The natural composition is the comminuted, powdered, or galenic extracts of the whole or specific anatomic parts of the plant. Botanical medicinals are focused more on treatment of signs and symptoms of disease while improving total “body condition” than reversing the disease etiology.
The foundation of modern pharmacologic medicine is rooted in ethnobotanical traditions utilizing indigenous flora. Over 200 indigenous medicinals were listed in the first U. S. Pharmacopeia in 1820 including podophyllin resin, white willow bark, wintergreen, and juniper tar, which are still used today (1).
Several botanical treatments for cutaneous diseases have stood the test of time for their effectiveness as documented by modern scientific evidence. Podophyllotoxin is a prescription purified podophyllin resin, a galenic extract of Mayapple (Podophyllum peltatum). Capsaicin is a nonprescription therapy for pruritis and pain extracted from Cayenne peppers (Capsicum species). Henna (Lawsonia inermis) is a hair dye used by people sensitized to other commercial coloring agents (3).
Botanical sales in 2004 exceeded $4 and one-third billion, growing by one-third over only six years. Noni/Morinda was the largest selling botanical in 2004 with sales of nearly $220 million. Now about 70 different herbs are formulated into cosmeceuticals. Botanical product growth has flourished to now consume 25% of all health – and lifestyle-related dollars (4). Thus dermatologists must have a working knowledge of botanicals, especially the most common ones, to provide optimal preventive medical care.
Herbal medicine plays a vital role in current healthcare by: (i) providing alternatives to prescription medications, (ii) enhancing therapeutic effects of other prescriptives, (iii) protecting against adverse reactions to allopathic therapy, and (iv) providing treatment for diseases which there is no current prescription therapy or only poorly effective or high-risk therapy. Herbal and other alternative medical strategies are utilized by over half of the population and especially by those suffering chronic diseases such as psoriasis and those
with less hope for cure such as human immunodeficiency virus (HIV) and terminal diseases (5,6). Extensive public use of complementary and alternative medicine resulted in the National Institute of Health establishing the Office of Alternative Medicine in the United States in 1995 (1).
Unfortunately, two major myths taint herbal medicine. Most patients believe the myth that there are no side effects because herbal medicine uses “natural substances.” In fact, experienced Chinese practioners are concerned about the well-known side effects of hepatotoxicity and contact dermatitis with oral and topical Chinese herbal medicinal and preparations, respectively (7).
Many allopathic physicians believe the myth that double-blinded, placebo – controlled studies do not exist for ancient and herbal medicines. Yet, there have been many such studies conducted throughout Asia and India including studies investigating mechanisms of action of the medicinal botanicals (7).
The understanding of the function, metabolism, and interaction of these herbal medicines is often lacking. The specific scientific issues include documenting: (i) complete characterization of the multiple active compounds in each plant source, (ii) activity and synergistic or additive interaction of each of these compounds and their metabolites, (iii) interaction of these active components with food, nutrients, nutritional supplements, and other medicines, and (iv) how the potential toxicity of specific compounds is blunted (2). For example, there are the castor bean in the source of ricin, one of the most poisonous compounds known to man, and azelaic acid, a nontoxic prescription dermatological medicine.