PracticeUpdate: Dermatology - Winter 2018

EDITOR’S PICKS 18

A Biologically Based Approach to Acne and Rosacea Journal of Drugs in Dermatology Take-home message

" …complementary and

alternative therapies are frequently used, and one has only to make a point of asking patients to find out. "

• In the United States, there is an increasing preference for natural products for the treatment of diseases, especially skin diseases. According to the National Health Survey, 84.5% of individuals with skin disease used complementary and alternative medicine (CAM) in 2007. The authors of this article reviewed the medical literature to determine which CAMs show evidence of effectiveness in the treatment of acne and rosacea. They found that certain antioxidants, botanicals, and diet changes have been shown to be more effective than placebo and, in some cases, more effective than commonly used medications, often with lower side-effect profiles. • As the demand for CAM in dermatology continues to rise, it is important for der- matologists to know which CAM treatments have shown effectiveness as well as which ones may cause harm. Caitlyn T. Reed MD

Abstract Complementary and alternative medicine (CAM) therapies are increasing in popularity in the field of dermatology. Natural products and holistic approaches are in high demand among patients and research has begun to support their roles in acne and rosacea pathophysiology. In this article, commonly utilized biologically based complementary and alternative therapies for acne and rosacea are reviewed from an evi- dence-based perspective. Therapies discussed include vitamin C, nicotinamide, zinc, tea tree oil, green tea, resveratrol, curcumin, feverfew, licorice, chamomile, polypodium leucotomos, and nutrition-based approaches. A Biologically Based Approach to Acne and Rosacea. J Drugs Dermatol 2018 Jun 01;17(6)611- 617, PJ Kallis, A Price, JR Dosal, AJ Nichols, J Keri.

www.practiceupdate.com/c/70019

COMMENT By Christine Jaworsky MD T his article is a compilation of various studies of alternative and comple- mentary remedies reported in the literature for the treatment of acne and rosacea. A brief summary of the postu- lated mechanism of action of each agent precedes the listing of studies and results. Most of the studies are small and are not randomized or controlled. Because acne and rosacea are multifactorial, it is difficult to draw meaningful conclusions. The studies with 100 patients or more sug- gest that: • Oral dietary supplements that contain zinc oxide, nicotinamide, azelaic acid, pyridoxine, copper, and folic acid improve acne with 4 to 8 weeks of therapy. Similar supplements improve rosacea as well.

• Tea tree oil, used almost as often as 2.5% benzoyl peroxide, can reduce the number of inflammatory and noninflam- matory acne lesions. It, however, has a slower onset of action and can cause contact dermatitis. • Chamomile extract used topically can reduce erythema and improve mod- erate rosacea. • Oral omega-3 fatty acid supplements may benefit patients with rosacea with dry eye symptoms. Treatments, including vitamins, photopro- tectants, probiotics, and other agents, are included in the discussion. To summarize, complementary and alter- native therapies are frequently used, and one has only to make a point of asking patients to find out. Oral supplements, as

noted above, may be a good alternative for patients who cannot tolerate or do not wish to take oral antibiotics. Topical agents may be slower to take effect but are less costly than many prescription medications in use. They have few untoward effects, other than contact dermatitis. Larger ran- domized controlled studies of alternative therapeutic agents are needed to draw meaningful conclusions regarding their therapeutic efficacy.

Dr. Jaworsky is a Professor of Dermatology at the Case Western Reserve School of Medicine and a staff member of the MetroHealth

Medical Center in Cleveland, Ohio.

PRACTICEUPDATE DERMATOLOGY