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CAM in dermatology: Telling fact from fiction

Today, many dermatological patients try one form of complementary/alternative medicine (CAM) or another. Survey data suggest that lifetime prevalence of CAM use by dermatological patients ranges from 35 to 69%. 1 The reasons for this increasing 2 popularity of CAM are complex 3 but partly relate to the fact that patients are being bombarded by the popular media with the message that CAM is effective and largely devoid of the adverse effects of orthodox treatments. 4 We recently evaluated seven popular CAM books and found numerous recommendations for CAM use in dermatological conditions: for acne 61 different CAM modalities were advised, for allergies and dermatitis the figure was 57 in both cases, for eczema 55, fungal infection 75, herpes 69, and for psoriasis 57 CAM treatments were advocated. 3 Only for very few of these therapies was there any evidence of efficacy. What is more, there was an almost total lack of agreement between the authors of these books. While physicians are able to recognize the fiction promoted in the media for what it is, patients will not easily be able to make sense of such confusion. The fiction on CAM is readily available in every bookstore, health food shop or via the Internet, but the facts are less easy to find. They are also quite sobering. Our attempt to systematically review the existing evidence yielded only few promising findings in dermatology. 3 We found encouraging trial data for autogenic training (a method for relaxation using self-hypnotic techniques), biofeedback, exclusion diets and hypnotherapy as complementary treatments for atopic eczema. In all cases, however, the evidence was far from compelling. In particular, too few rigorous trials were available, and there was an unfortunate lack of independent replication. The situation for chronic venous insufficiency was marginally better; several herbal remedies have shown considerable promise in more than one rigorous clinical trial: butcher’s broom, gotu kola, horse chestnut and red vine leaf extract. 3 Finally for herpes simplex, we found good trial data for topical lemon balm treatment and preliminary evidence for Siberian ginseng and propolis. 3