Complementary and Alternative Medicine in Dermatology

According to survey data, 35-69% of patients with skin disease have used complementary and alternative medicine (CAM) in their lifetime. A literature search on this subject reveals a number of studies on the efficacy of CAM treatment for dermatologic conditions, as well as a number of articles showing the growing prevalence of CAM use amongst patients suffering from these conditions. Given the consensus amongst these articles that dermatologists require increased education on CAM, this paper presents an overview of some of the most widely used systems of alternative medicine to serve as a tool for practicing dermatologists. Specifically, the history and theory behind psychocutaneous therapies, traditional Chinese medicine (including acupuncture), homeopathy, and Ayurvedic medicine will be described, along with current evidence for their efficacy and reports of their adverse effects. The authors conclude that more evidence and better studies are needed for each of the major CAM modalities before they may be considered as independent therapeutic options. Moreover, given the shortage of evidence supporting the efficacy and safety of CAM, dermatologists should obtain a thorough history of CAM use from their patients. In general, ingestible substances including most homeopathic, Ayurvedic, and traditional Chinese medicine herbal formulations that are not US FDA regulated should be viewed with caution as they may cause severe adverse effects such as arsenicosis and hepatotoxicity. On the other hand, less invasive techniques such as acupuncture and psychocutaneous therapies may be more acceptable given their low-risk profile. Ultimately, until the availability of more sound data, these treatments should primarily be used in combination with conventional treatment and rarely independently.     

Managing dermatology patients who prefer “all natural” treatments

Dermatology patients are expressing a growing interest in complementary and alternative medicine (CAM) and natural treatment options for management of dermatologic conditions. Counseling on the optimal integration of CAM with conventional therapeutic approaches can be daunting for practitioners who do not feel well-versed in these modalities. A productive conversation between the clinician and patient seeking natural treatments should address the appropriate role and scope of CAM in a therapeutic plan, which is best suited for use as maintenance therapy or to augment traditional pharmaceutical or procedural interventions. Understanding the patient’s goals, discussing evidence-based conventional and complementary treatment options, and employing shared decision making can enhance the clinical encounter and strengthen the physician-patient relationship.     

Complementary and alternative medicine use among patients with psoriasis

Despite the growing attention on safety and efficacy of conventional treatments, there is little information available on complementary and alternative medicine (CAM) used in psoriasis. In order to collect comprehensive information on CAM use, we conducted a face‐to‐face interview with 122 patients with psoriasis. All unconventional treatments for psoriasis used in the last 12 months were recorded. Fifty‐seven patients (46.7%) used one of the CAM methods in the previous year, including topical and systemic antipsoriatics, dietary supplements, and diet. Forty‐one different nonconventional topical treatments were used. Seven patients (5.7%) took nonconventional systemic medication, and 15.5% used dietary supplements. There were three patients who reported current adherence to a diet as treatment of psoriasis. Clinicians are often not informed that their patients are using complementary therapies. CAM may offer benefits as well as risks to patients with psoriasis. It is important to remind patient to report all ongoing and past topical and systemic treatments. The use of medications with unknown composition, efficiency, and safety should be discouraged.     

A cross-sectional survey of complementary and alternative medicine use in patients with atopic dermatitis.

BACKGROUND: Studies from Europe reveal that a large percentage of patients with atopic dermatitis use some form of complementary and alternative medicine for the treatment of their skin disease. There are no studies from the United States that examine the prevalence and types of complementary and alternative medicine use among patients with atopic dermatitis. OBJECTIVE: The goal of this study was to determine the prevalence of complementary and alternative medicine use and the patterns of this use among atopic dermatitis patients referred to a university clinic. METHODS: Using a self-administered questionnaire, investigators performed a cross-sectional survey of 70 consecutive patients diagnosed with atopic dermatitis. RESULTS: Of the patients surveyed, 50.4% used some form of complementary and alternative medicine for the management of their skin disease. Common motivating factors were dissatisfaction with conventional treatment and frustration with the chronic nature of the condition. Vitamin supplementation and herbal creams were the most common alternative treatments used. CONCLUSION: The significant percentage of patients seeking alternative care for atopic dermatitis underscores the need for physicians to be familiar with alternative therapies for skin disease.     

Basic knowledge in psychodermatology

BACKGROUND: The authors try to define the framework of this approach, what should be acquired by "well-informed" dermatologists and what is required to be a pyschodermatologist. OBJECTIVE: To better define the necessary knowledge to practice psychodermatology. RESULTS: 1) The first level is dermatology psychology: there is a psychotherapeutical implicit effect of the dermatological consultation with a goal that is not psychological change. This effect can be improved by acquiring better communication skills and information. The second level needs a possibility to change the emotional individual process and the relational context in a continuum between counselling and psychotherapy. To practice this level a complete psychotherapeutic education with some specificity is needed. This can be reached by a dermatologist also being a psychotherapist or by a team consisting of both dermatologist-psychotherapist. 2) The psychodermatological patient is characterized by alexithymia. He/she needs to be understood through the body language he/she presents. This kind of patient is coming from families where the theme of loss seems to dominate the histories and be associated with deep emotional experiences of separation anxiety. These characteristics must be known together with the different psychodermatological disorders and the mind-body interaction to handle these patients. 3) Taking all of this complexity into account, the psychodermatologist or the psychodermatological team should be able to integrate the different points and adapt attitudes to the patient's difficulty during the whole therapeutic process. 4) The evaluation of the problem should be done using psychological tools here described. CONCLUSION: The European Academy of Dermatology and Venereology (EADV) together with the European Society for Dermatology and Psychiatry (ESDaP) are able to provide the specific education for dermatologist and psychotherapist. In the future, they could be responsible for the recognition of these special abilities and treatments on a governmental and European political level.     

Treatment of Cutaneous Warts

Cutaneous warts are common skin lesions caused by human papillomavirus infection. Treatment is aimed at relieving the patient's physical and psychological discomfort and at preventing the spread of infection by autoinoculation. Among the available medical and destructive therapeutic options for cutaneous warts, none is uniformly effective or virucidal. Moreover, in most cases their safety and efficacy has not been assessed in double-blind, controlled clinical trials, so that the reproducibility of many of the listed treatments is difficult to evaluate and a possible placebo effect cannot be ruled out. The aim of this article is to describe the outcome of current therapies for each clinical wart type according to evidence-based medicine studies published in the literature. For each clinical form, the existing treatments are classified as first-, second-, and third-line therapy. First-line therapy includes medical treatments (salicylic acid, silver nitrate, glutaraldehyde) that are useful to treat a single wart or a few and/or small common warts of short duration (less than 1 year). If these treatments have failed or are contraindicated, cryotherapy may be considered as second-line therapy. For recurrent or difficult-to-treat lesions, third-line therapy includes a variety of alternative therapeutic options (topical, intralesional, systemic, and physical destruction) that are generally off-label (not US FDA approved), and whose use is limited by drawbacks or adverse effects. From pooled evidence-based medicine data, it is possible to conclude that significantly higher remission rates may be expected only with cryotherapy and salicylic acid used in combination.     

Russian traditional medicine in dermatology

The use of herbal remedies for various medical issues is becoming increasingly commonplace in all fields of medicine, and dermatology is no exception. This review focuses on traditional dermatologic herbal remedies, commonly used in Russia, as the rich array of 11 different plant zones has resulted in a great variety of medicinal plants. Herbal remedies warrant deeper investigation and research, especially due to their active substance content, which may interfere with or reinforce the effect of modern medications, something that medical professionals should be aware of when prescribing treatments. Although there are a great number of traditional herbal treatments in Russia, only the most commonly used and known treatments and applications will be described as an introduction to the field, which has had many books of varying quality written about it. The preparation and application of treatments for vitiligo, pyodermas, parasitic and infectious skin diseases, acne, dermatitides, rosacea, hyperpigmentation, rhytides, psoriasis, and hyperhidrosis are discussed.     

The use of alternative medicine in pediatric patients with atopic dermatitis

Alternative medicine has been defined as forms of therapy or examination that have no scientific basis and for which no effective or diagnostic reliability has been demonstrated by scientific methods. The use of complementary or alternative medicine is increasing and controlled clinical trials on the subject are few. We performed a questionnaire-based study of 80 pediatric patients with atopic dermatitis. This questionnaire assessed the duration of treatment, the reason(s) for trying alternative therapy, the approximate cost and the success of the treatment, the duration of the childhood eczema, and whether the child had ever required hospital admission for eczema. Of the total, 34 (42.5%) patients had used alternative medicine. Herbal remedies and homeopathy were used most often. Most treatments were reported to show no benefit and in three instances deterioration was reported. This study has prompted us to enquire routinely regarding alternative medicine use. Alternative therapies are subject to minimal regulation and have been associated with serious side effects. We would recommend enquiries regarding alternative medicine use in all pediatric dermatology patients.     

Use of psychotropic drugs in dermatology: Unique perspectives of a dermatologist and a psychiatrist

Psychocutaneous morbidity is commonly found in dermatologic practice. Patients generally refuse referral to psychiatry, and dermatologists cannot always provide psychotherapeutic support. By establishing an alliance with these patients and with working knowledge of the common psychotherapeutic agents used in dermatology, these patients can be managed comfortably by the clinician. The major categories of psychodermatologic agents include antipsychotics, antidepressants, anxiolytics, and antiobsessive compulsive drugs. In addition, cutaneous dysesthesia and pruritus can be treated with psychotherapeutic agents when other treatments have been exhausted. The motivated dermatologist can apply this knowledge to treat these common yet challenging cases.     

Complementary psychocutaneous therapies in dermatology

The skin and the nervous system develop side by side in the fetus and remain intimately interconnected and interactive throughout life. Because of the skin-nervous system interactions, there is a significant psychosomatic or behavioral component to many dermatologic conditions. This permits complementary nonpharmacologic psychotherapeutic interventions, such as acupuncture, aromatherapy, biofeedback, cognitive-behavioral therapy, hypnosis, placebo, and suggestion, to have positive impacts on many dermatologic diseases. Complementary pharmacologic psychotherapeutic interventions, such as herbs and supplements, also may help improve some dermatologic disorders.     

应关注男性不育的药物治疗：睾酮，用还是不用

在治疗男性不育症中是否使用睾酮是一个大问题。2013年欧洲泌尿外科学会（EAU）的《男性不育指南》指出：雄激素补充治疗被严格禁止用于男性不育的治疗，这种观点引起强烈关注和质疑。尽管一些临床研究的证据目前还没有支持用于男性不育的药物治疗，但不应该妨碍证明这些药物有效的机会，药物治疗的广泛探索应该被鼓励和加强，而不是简单地禁止。无论是从医学基本原则、促进医学发展、医学研究现状以及人文医学角度，男性不育的经验性药物治疗（包括睾酮）应该成为一线选择或基础选择。因此，笔者认为EAU《指南》的上述结论考虑不周，故对在治疗男性不育症中应用睾酮的主要理由进行了论述。     

Somatosensory pleasure circuit: from skin to brain and back

The skin senses serve a discriminative function, allowing us to manipulate objects and detect touch and temperature, and an affective/emotional function, manifested as itch or pain when the skin is damaged. Two different classes of nerve fibre mediate these dissociable aspects of cutaneous somatosensation: (i) myelinated A‐beta and A‐delta afferents that provide rapid information about the location and physical characteristics of skin contact; and (ii) unmyelinated, slow‐conducting C‐fibre afferents that are typically associated with coding the emotional properties of pain and itch. However, recent research has identified a third class of C‐fibre afferents that code for the pleasurable properties of touch – c‐tactile afferents or CTs. Clinical application of treatments that target pleasant, CT‐mediated touch (such as massage therapy) could, in the future, provide a complementary, non‐pharmacological means of treating both the physical and psychological aspects of chronic skin conditions such as itch and eczema.     

Antibiotic use in dermatologic surgery

Few situations in dermatologic surgery require prophylactic antibiotics. The AHA has decreased the dose for endocarditis prophylaxis from antibiotics before and after the procedure to only 1 hour prior to the procedure. In the 1997 guidelines, fewer procedures are listed as requiring antibiotics compared with prior guidelines. In fact, several authors have questioned the efficacy of prophylactic antibiotics. The sequela of endocarditis or an infected prosthetic joint are certainly serious and possibly life-threatening conditions, yet this should not be a justification for using a therapy that is not proven and has potential serious side effects of its own. The authors suggest not using antibiotics on clean or clean-contaminated wounds regardless of cardiac history. Patients with prosthetic joint replacements probably do not need prophylactic antibiotics in cutaneous surgery unless mucosa is invaded; in such cases the guidelines set by the ADA and the AAOS should be followed. The authors believe that antibiotics should be reserved for contaminated or infected wounds when their application is therapeutic. Table 2 contains a summary of the authors' recommendations for the use of antibiotics in cutaneous surgery. Each patient should be evaluated on an individual basis, and consultation with the patient's primary physician, cardiologist, or orthopedist should be sought when the need arises.     

生殖器疱疹中西医结合诊疗共识（2020年）

生殖器疱疹反复发作给患者的身心健康和生活质量带来很大影响。为了给临床医生诊治生殖器疱疹提供指导意见，中国中西医结合学会皮肤性病专业委员会性病学组在2009年版生殖器疱疹中西医结合诊疗指南的基础上修订本指南。依据流行病学史、临床表现及实验室检查结果进行综合分析后诊断生殖器疱疹，根据不同类型生殖器疱疹的严重程度选择中医、西医或中西医结合治疗，并给以健康教育。     

Complementary medicine and psoriasis: linking the patient's outlook with evidence-based medicine

BACKGROUND: There is increasing evidence for the extensive use of complementary and alternative medicine (CAM) by patients with psoriasis. Clinical research in the arena of CAM and psoriasis treatment is evolving and includes some randomized controlled trials. OBJECTIVE: To study CAM use among patients with psoriasis attending a dermatology clinic in a major university hospital in northern Israel. Prevalence, reasons for CAM use and its relevance to doctor-patient communication were emphasized. METHODS: Semistructured interviews were conducted with psoriasis patients in a dermatology clinic. Consent was obtained for 78 patients. Post-visit questionnaires were given to 5 physicians. RESULTS: Seventy-eight patients with psoriasis were interviewed and 77 were studied. Sixty-two percent used CAM. Fifty-eight percent of users had seen a CAM practitioner. The study found a trend of CAM use among patients with psoriasis from Arab compared to Jewish descent (p=0.087). CAM users reported on average 2 different CAM modalities. Herbal medicine and nutritional treatments ranked first, followed by homeopathy, traditional Chinese medicine and nutritional supplements. The main reason for CAM use was stated to be to do everything to heal the disease, followed by a quest for improved quality of life. Others mentioned an interest in a less toxic treatment, disappointment with conventional treatment and stress reduction. Well over half of the study participants and their dermatologists did not initiate a discussion about CAM use. The dermatologists' ability to predict CAM use in their patients was relatively low. CONCLUSION: There is growing evidence of extensive CAM use among patients with psoriasis. Most patients use CAM as a complementary treatment, rather than an alternative to conventional treatment. Teaching CAM should be integrated into the dermatology residency curriculum. Dermatologists need to increase their awareness of CAM use by their patients in order to improve therapeutic communication.     

Alternative Treatments for Atopic Dermatitis: An Update

Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease in which management with topical anti-inflammatory agents during exacerbations remains the mainstay of treatment. With no cure in sight, a significant proportion of patients elect to incorporate complementary and alternative medicine (CAM) as an adjunct to conventional treatment. Many clinicians find it difficult to provide recommendations as the field covers an extensive number of very disparate therapies, with limited quality evidence to indicate efficacy. Since publication of the last review on this topic in the Journal that compiled and analyzed randomized controlled trials (RCTs) on CAMs in 2015, several new studies have surfaced. This update aims to aggregate and review these new data. A literature search was conducted in the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Global Resource for EczemA Trials (GREAT) databases for RCTs on complementary and alternative therapies in AD from March 2015 through May 2018, resulting in 15 studies being included in this review. The preliminary results for many treatments such as vitamin E, East Indian Sandalwood Oil (EISO), melatonin, l-histidine, and Manuka honey show positive clinical effects, but there is currently not enough evidence to recommend their use in AD therapy. Future investigative efforts should focus on reproducing some of these studies with a larger sample size whose clinical characteristics and demographics are more reflective of the general AD population, and standardizing the process to produce reliable data.

     

Esthetic and cosmetic dermatology

The field of esthetic and cosmetic dermatology has gained remarkable interest all over the world. The major advantage of recent years is the high scientific levels of the most significant new developments in techniques and pharmacotherapy and other nonsurgical approaches. The present paper reviews selected fields of interest under this view. Sexual hormones are involved in the aging process of men and women. Skin function, in particular the epidermal barrier, is affected by a loss of endocrine activity. Hormone replacement therapy has only recently been introduced in treatment of aging males. This is an area of gender-medicine in dermatology with a strong well-aging attempt. Botulinum toxin therapy for hyperfunctional lines has become not only well-established but evidence-based medicine on its highest level. Recent advantages were gained in objective evaluation and monitoring the effect. Digital imaging techniques with various facets have been introduced to assess the achievements of treatment in the most objective way. This may become an example for other techniques as peeling, laser therapy, or radiofrequency in esthetic and cosmetic dermatology. Botulinum toxin has become a valuable tool for brow lifts. Details of the technique are discussed. Cellulite is a strongly female gender-related condition. During the past decades numerous treatments had been recommended but only recently a more critical scientific approach led to improvements in therapy of this common and disfiguring condition. Three major approaches are developed: (a) skin loosing with techniques such as subcision, (b) skin tightening with radiofrequency and other approaches, and (c) improving circulation in blood and lymphatic microvasculature using both physical treatments and pharmacotherapy. The last two chapters are devoted to body sculpturing by lipotransfer and lipolysis. Lipotransfer for facial or body sculpturing has a history of about 100 years. Nevertheless, recently the role of adult stem cells in adipose tissue has gained much interest. By optimizing the harvesting, storage, and transplantation of adipose tissue, remarkable long-standing results have been obtained. Here the present authors will focus on midface contouring, where lipotransfer competes with dermal fillers. Lipolysis is another effective tool in body sculpturing. The present authors will focus on recent advances in laser-assisted lipolysis for delicate body sculpturing in the submental region but also for gynecomastia abdominal region, flanks, and hips. In conclusion, esthetic and cosmetic dermatology has become a scientific-based subspeciality of dermatology with evidence-based treatments and a great variety of high-tech approaches to provide more effective, more selective, and safer therapeutic options.     

2020 European guideline on the management of genital molluscum contagiosum

Molluscum contagiosum is a benign viral epidermal infection associated with high risk of transmission. The guideline is focused on the sexually transmitted molluscum contagiosum. The diagnosis is clinical with characteristic individual lesions, termed ‘mollusca’, seen as dome‐shaped, smooth‐surfaced, pearly, firm, skin‐coloured, pink, yellow or white papules, 2 ‐ 5 mm in diameter with central umbilication. Dermoscopy may facilitate diagnosis. Therapeutic options are numerous, including physical treatments (cautery, curettage and cryotherapy), topical chemical treatments (e.g. podophyllotoxin and imiquimod) or waiting for spontaneous resolution in immunocompetent patients. In pregnancy, it is safe to use physical procedures (e.g. cryotherapy). Immunosuppressed patients develop severe and recalcitrant molluscum lesions that may require treatment with cidofovir, imiquimod or interferon. Patients with molluscum contagiosum infection should be offered to be screened for other sexually transmitted infections.     

Multiple chemical sensitivity (MCS) – a guide for dermatologists on how to manage affected individuals

Multiple chemical sensitivity (MCS) is a condition characterized by a subjectively perceived increase in sensitivity to environmental chemicals. Individuals affected report a wide variety of nonspecific complaints, and frequently attribute cutaneous and mucosal symptoms to chemical exposures. Dermatologists should therefore be familiar with this condition. MCS is a diagnosis of exclusion. Other causes for the patients’ symptoms should be ruled out by routine laboratory tests, allergy tests and, if indicated, monitoring for toxic (environmental) substances. The primary job of dermatologists is to rule out skin diseases or hypersensitivities as possible causes of the complaints. Interdisciplinary patient management is essential, especially in severe cases in which those affected have problems coping with everyday life. Relevant specialties in this context include environmental medicine, psychosomatic medicine as well as occupational and social medicine. Cutaneous symptoms are usually addressed with symptomatic treatment using basic skin care products. There are currently no evidence‐based treatment recommendations for MCS. It is crucial that MCS patients be protected from unnecessary treatments and thus from mental, social and financial strain. In addition to medical skills, managing MCS patients requires communicative and psychosocial competence in particular. Physicians involved in the treatment will benefit from training in psychotherapy. Irrespective of the mechanisms that lead to MCS, diagnosis and treatment of this condition require an actively supportive attitude towards these patients, a good doctor‐patient relationship and interdisciplinary cooperation.     

Antiaging – a scientific topic or just a social trend?

The number of nonsurgical anti-aging procedures have increased in recent years. Reasons for this trend are various: The World Wide Web distributes an immense amount of information throughout the world within seconds, which in turn generates a great demand on information. Active and aggressive medias, which were almost absent 50 years ago, have made our society ambitious; the perception of which is attractive, desirable, and sexy gets globalized. In addition, our lifestyle has changed with the fast-growing offer of leisure activities. Wrinkles, fat deposits, and sun-damaged skin do not fit into our neat society. The increasing demand for aesthetic treatments has prompted many physicians without any knowledge in aesthetic medicine to offer various nonsurgical aesthetic treatments with the danger that aesthetic dermatology stands to lose its scientific relevance. Evidence-based medicine should be applied not only in medical procedures but also in aesthetic dermatology.