The field of alternative medicine is increasing in popularity among dermatologists in the United States, particularly among their patients. Though conventional treatment approaches can be effective in quelling the symptoms associated with atopic dermatitis and other cutaneous diseases and conditions, “natural” remedies can also be of significant value in carefully selected patients.
QuickRead: The trend for alternative treatment approaches in dermatology is on the rise, particularly among those patients whose disease or condition is recalcitrant to standard conventional therapies.
Miami Beach, Fla. - The field of alternative medicine is increasing in popularity among dermatologists in the United States, particularly among their patients. Though conventional treatment approaches can be effective in quelling the symptoms associated with atopic dermatitis and other cutaneous diseases and conditions, “natural” remedies can also be of significant value in carefully selected patients.
Alternative medicine largely remains a frowned upon fringe field in medicine. However, according to Dr. Peter Lio, many dermatologists are increasingly showing an interest in alternative approaches and realize their potential healing benefits, possibly in part fueled by the great interest some of their patients have in this field.
“While conventional medicine still holds most of the answers, it may not have them all. Our patients are aware of this and many are searching in the ‘alternative’ realm for treatment solutions. I find that if I do not mention or discuss alternative approaches with my patients, particularly those with a chronic and debilitating disease such as atopic dermatitis, they will often be quickly discouraged and seek help elsewhere,” says Peter Lio, M.D., assistant professor of clinical dermatology and pediatrics, Northwestern University Feinberg School of Medicine, Chicago.
Evidence-based conventional medicine is practiced by mainstream dermatologists largely because of the traditional education they receive in medical school and specialist training.
According to Dr. Lio, physicians may be discouraged from thinking outside the box in terms of alternative medicine because of their traditional education and training.
“Dermatologists may not be aware of the positive data that is out there regarding the treatment successes achieved with alternative therapies and therefore, they should not be too quick to discard the whole of alternative treatments as humbug,” Dr. Lio says.
In his lectures, Dr. Lio tries to raise the awareness of alternative treatment approaches that are evidence-based and reasonable therapies that have shown efficacy in patients. In controlled settings, many treatments have been tested and found not to work as claimed or hoped. Dr. Lio said however, a much larger number of therapies do not yet have sufficient evidence upon which to pass judgment. Therefore, he encourages physicians to keep an open mind regarding the potential healing benefits of alternative treatment approaches.
In one study, researchers found that 51 percent of patients with eczema reported use of one or more forms of alternative medicine, with homeopathy, health foods and herbal remedies being the most common. (Jensen P. Acta Derm Venereol. 1990. 70(5):421-424). A similar questionnaire-based study of 70 patients with atopic dermatitis gave almost identical results, with 50 percent reporting use of one or more forms of alternative medicine for their skin disease. (Simpson EL, Basco M, Hanifin, J. Am J Contact Dermat. 2003;14(3):144-147).
“Even if you are pessimistic regarding the positive data available on alternative therapies, I think it is still important to embrace it and talk about it with your patients, leaving no stone unturned in the planning of the patient’s comprehensive treatment strategy,” Dr. Lio said.
Some alternative therapies that have been shown to ameliorate the symptoms of atopic dermatitis include the supplementation of essential fatty acids, traditionally thought to be deficient in atopic patients.
According to Dr. Lio, the topical application of sunflower seed oil, coconut oil, borage oil and primrose oil as well as vitamin B12 has all been shown to be effective in improving the symptoms of atopic dermatitis in some studies, possibly due to the anti-inflammatory and/or anti-bacterial effects that these agents have. Oral vitamin D supplementation and probiotics have also been shown to be effective in improving symptoms of atopic dermatitis.
The use of these alternative treatments can sometimes significantly help improve the symptoms of a condition Dr. Lio said, which could result in the patient requiring less topical pharmacological-based medicines and a tapering off of systemic medicines.
“Though efficacy with these alternative therapies has been shown in varying degrees, more research is required before they can be considered as potentially viable treatment options. A better understanding of their mechanisms is needed in order to ensure more robust effects and safety before their roles can be more clearly defined,” Dr. Lio said.
Many parents or guardians of pediatric patients will often prefer and request more natural treatment approaches based in alternative medicine Dr. Lio said, because they are apprehensive of pharmacological-based treatments such as topical and oral corticosteroids, in part due to the associated potential adverse events.
However, the more severe the disease or condition Dr. Lio said, the more the potential risk one may have to take in its treatment. The “riskiness” of a given medicine is usually very closely associated with its potency and therapeutic effect, and according to Dr. Lio, finding the delicate balance in the risk-benefit ratio of a proposed therapy is key in choosing optimal treatment in patients, whether conventional or alternative treatment approaches.
“I think there are a lot of situations in dermatology where conventional medicines do not work well enough and here, alternative treatments could help fill that void. In those patients who are interested in other less-conventional approaches and when their disease is not life or health-threatening, alternative medicine could be tried, particularly where traditional medicine has failed,” Dr. Lio said.
Disclosures: Dr. Lio reports no relevant financial interests.