Alternative therapies are popular; 49% of patients with a skin problem reported using herbal supplements within the past year, and patients with chronic disease (including eczema and psoriasis) are most likely to use herbal medicines. Herbs have beneficial anti-inflammatory, antioxidant, antibacterial, antifungal and antihistaminergic effects. Regulation of herbal therapies is challenging, and the use of remedies is not without risk, thus they should be administered by an experienced professional.
We have been running a herbal medicine clinic alongside our dermatology department since 2000, allowing patients to safely benefit from Western herbal medicine within a hospital setting. Medical herbalists undergo years of rigorous scientific training and are regulated by professional bodies. Once diagnosed by a consultant dermatologist, patients may be referred to the medical herbalist. Medical herbalists prescribe herbs in a number of forms, and take into account all known interactions with other drugs.
We collected data from all patients (new and followup) who attended the herbal medicine clinic during a 99-month period. Patient self-assessment was performed by completion of a symptom or problem-specific profile prior to treatment and at each visit thereafter, using the validated ‘Measure Yourself Medical Outcomes Profile’ (MYMOP). Each patient recorded up to five ‘problems’ (P1 to P5) and four ‘activities’ (A1 to A4) for which they wanted help. Patients were also asked to record an overall ‘wellbeing’ score (W). For a timescale of during the past week, each question is self-rated on a seven-point scale, with 0 being the least severe and 6 being the most severe. MYMOP considers score changes 0.5 to be clinically significant. Responses were analysed using the Wicoxon signed-ranks tests to determine statistical significance.
In total, 348 patients (73% female; age range 10 months to 91 years) used our service during the review period. The median time between condition onset and referral to the clinic was 5 years (range 1 month to 52 years). Patients were most commonly referred because of failure of standard treatment or because of patient preference. The majority (91%) of patients were referred for a single condition, most commonly eczema (17%), alopecia (13%) and acne (11%). Of the 348 patients, 186 returned ≥ 2 MYMOPs; 85% of patients reported problems in addition to those for which they were referred, mainly dermatological (26%) psychological (18%) and gastrointestinal (17%). Between their first and last appointments, patients reported a statistically significant improvement in their top four problems, dermatological or otherwise, as well as their top two activities and general wellbeing (P < 0.05) (Table 1). P5 and A3–A4 received inadequate numbers of responses to analyse.
All problems that patients considered their main concern (P1) achieved a score change of at least 0.5, although numbers were too small to draw meaningful conclusions. The greatest score changes were observed for rosacea, acne, psoriasis and eczema (Table 2), and thus we tentatively conclude that herbal medicine may be most effective in treating inflammatory skin conditions. Our dermatology herbal medicine service has had a demonstrable impact on patient-reported health outcomes. Dermatologists should consider herbal medicine as an option when conventional treatments have failed or patients express an interest in alternative therapy.
The Full text, plus tables and references can be found via this download