Complementary and Alternative Medicine in Dermatology
Complementary and Alternative Medicine in Dermatology
Homeopathy was born near the end of the 18th century and predates modern principles of pharmacology. It follows two basic principles – the Law of Similars and the Law of Infinitesimals. The former states simply that "like treats like," or that the appropriate treatment of an illness should elicit in a healthy person the symptoms of the malady it is intended to treat. The German physician Hahnemann developed this theory when he experimentally ingested cinchona bark – used to treat malaria – and discovered that it triggered the same symptoms as malaria itself. Hahnemann concluded that drugs function by replacing the pathologic disruption in the life force with similar artificial symptoms, which the life force then has the capability to overwhelm.
Realizing the danger in administering treatments that mimic disease, Hahnemann developed the concept of dilutions and infinitesimals – the idea that the homeopathic remedies should be diluted to the point where they result in no symptoms. A dilution of 1:100 is denoted 1C and a dilution of 1:10 000 is 2C. Assuming one started with all the atoms estimated to exist in the universe (approximately 6 × 10), a dilution of 40C would result in a 50% chance of there being only one molecule left in the solution. Most homeopathic dilutions are done to the order of 200C. To explain the efficacy of these infinitesimal levels of medicine, Hahnemann developed the theory of dynamization, whereby the healing power of the substance remains even when the substance itself has been eliminated through multiple dilutions. In 1988, Davenas et al. reported proving the "Memory of Water" theory after triggering the degranulation of basophils through a homeopathic high dilution of IgE antiserum. The results were not reproducible and, thus, controversial. In fact, a group published a counter-article in Nature after attempting to duplicate the exact methods of the original experiment without success.
The absence of an active ingredient in homeopathic preparations has led to questions regarding their mechanism of action and potential for toxicity. Is homeopathy simply a placebo? As such, can it be harmful? No systematic study of homeopathic adverse effects exists, but most investigators agree that harm may occur through the delay of potentially therapeutic conventional medicine or through the ingestion of unregulated ingredients.
Despite the paucity of research, as of a decade ago an estimated 2.5 million Americans used homeopathy. It is still the most widely sought alternative system among patients favoring CAM for the treatment of their skin diseases.
Because dermatologic conditions are considered in homeopathy to be manifestations of internal processes, treatment for these diseases is largely systemic. While no large-scale trials have been performed, a number of case reports and smaller studies have described positive results. Stibbe was the first to list dermatologic conditions for which homeopathic remedies had been reported anecdotally to be useful, including seborrheic dermatitis, acne, actinic keratoses, herpes, warts, and chicken pox. However, as with all anecdotal reports, these findings may not be generalizable. One report compared homeopathic gel with placebo, and showed a reduction in erythema when applied to mosquito bites. Stibbe mentions the use of Arsenicum album (derived from arsenic) for rosacea, and a dilution of poison ivy toxin for the treatment of chicken pox.
However, a number of studies have demonstrated no benefit with homeopathic treatments. A homeopathic preparation of sublingual Thuja occidentalis (Eastern White Cedar), antimonium crudum (derived from antimony), and nitric acid on plantar warts showed no difference from placebo. Another study comparing an individually selected homeopathic treatment of warts in children with placebo showed no significant improvement. Sublingual Arnica montana, a plant in the sunflower family, did not prevent postoperative hematomas following saphenous vein stripping.
In essence, the literature on homeopathic efficacy in dermatology reveals variable results, a finding that may ultimately point to either a study deficit, a shortcoming in the research methodology, or a true lack of reproducible efficacy. Of concern, adverse effects may occur when conventional, potentially life-saving treatment is withheld in favor of homeopathic remedies. An infant developed bullous pemphigoid while treated homeopathically for atopic dermatitis, with worsening of her condition while corticosteroids were withheld.
True homeopathic preparations require specific dilutions. However, in the US they are sold as dietary supplements and thus evade regulation by the FDA. A report from the All-India Institute for Medical Sciences states that toxic levels of arsenic have been found in some low-potency homeopathic and Ayurvedic preparations. Another report describes argyria after ingestion of homemade colloidal silver a patient distilled using a device purchased at a homeopathic convention.
Given the possibility of serious adverse effects related to homeopathic preparations, the dermatologist should elicit a thorough history of CAM use and discourage the use of unregulated substances.
3. Homeopathy
Homeopathy was born near the end of the 18th century and predates modern principles of pharmacology. It follows two basic principles – the Law of Similars and the Law of Infinitesimals. The former states simply that "like treats like," or that the appropriate treatment of an illness should elicit in a healthy person the symptoms of the malady it is intended to treat. The German physician Hahnemann developed this theory when he experimentally ingested cinchona bark – used to treat malaria – and discovered that it triggered the same symptoms as malaria itself. Hahnemann concluded that drugs function by replacing the pathologic disruption in the life force with similar artificial symptoms, which the life force then has the capability to overwhelm.
Realizing the danger in administering treatments that mimic disease, Hahnemann developed the concept of dilutions and infinitesimals – the idea that the homeopathic remedies should be diluted to the point where they result in no symptoms. A dilution of 1:100 is denoted 1C and a dilution of 1:10 000 is 2C. Assuming one started with all the atoms estimated to exist in the universe (approximately 6 × 10), a dilution of 40C would result in a 50% chance of there being only one molecule left in the solution. Most homeopathic dilutions are done to the order of 200C. To explain the efficacy of these infinitesimal levels of medicine, Hahnemann developed the theory of dynamization, whereby the healing power of the substance remains even when the substance itself has been eliminated through multiple dilutions. In 1988, Davenas et al. reported proving the "Memory of Water" theory after triggering the degranulation of basophils through a homeopathic high dilution of IgE antiserum. The results were not reproducible and, thus, controversial. In fact, a group published a counter-article in Nature after attempting to duplicate the exact methods of the original experiment without success.
The absence of an active ingredient in homeopathic preparations has led to questions regarding their mechanism of action and potential for toxicity. Is homeopathy simply a placebo? As such, can it be harmful? No systematic study of homeopathic adverse effects exists, but most investigators agree that harm may occur through the delay of potentially therapeutic conventional medicine or through the ingestion of unregulated ingredients.
Despite the paucity of research, as of a decade ago an estimated 2.5 million Americans used homeopathy. It is still the most widely sought alternative system among patients favoring CAM for the treatment of their skin diseases.
3.1 Homeopathy in Dermatology
Because dermatologic conditions are considered in homeopathy to be manifestations of internal processes, treatment for these diseases is largely systemic. While no large-scale trials have been performed, a number of case reports and smaller studies have described positive results. Stibbe was the first to list dermatologic conditions for which homeopathic remedies had been reported anecdotally to be useful, including seborrheic dermatitis, acne, actinic keratoses, herpes, warts, and chicken pox. However, as with all anecdotal reports, these findings may not be generalizable. One report compared homeopathic gel with placebo, and showed a reduction in erythema when applied to mosquito bites. Stibbe mentions the use of Arsenicum album (derived from arsenic) for rosacea, and a dilution of poison ivy toxin for the treatment of chicken pox.
However, a number of studies have demonstrated no benefit with homeopathic treatments. A homeopathic preparation of sublingual Thuja occidentalis (Eastern White Cedar), antimonium crudum (derived from antimony), and nitric acid on plantar warts showed no difference from placebo. Another study comparing an individually selected homeopathic treatment of warts in children with placebo showed no significant improvement. Sublingual Arnica montana, a plant in the sunflower family, did not prevent postoperative hematomas following saphenous vein stripping.
In essence, the literature on homeopathic efficacy in dermatology reveals variable results, a finding that may ultimately point to either a study deficit, a shortcoming in the research methodology, or a true lack of reproducible efficacy. Of concern, adverse effects may occur when conventional, potentially life-saving treatment is withheld in favor of homeopathic remedies. An infant developed bullous pemphigoid while treated homeopathically for atopic dermatitis, with worsening of her condition while corticosteroids were withheld.
True homeopathic preparations require specific dilutions. However, in the US they are sold as dietary supplements and thus evade regulation by the FDA. A report from the All-India Institute for Medical Sciences states that toxic levels of arsenic have been found in some low-potency homeopathic and Ayurvedic preparations. Another report describes argyria after ingestion of homemade colloidal silver a patient distilled using a device purchased at a homeopathic convention.
Given the possibility of serious adverse effects related to homeopathic preparations, the dermatologist should elicit a thorough history of CAM use and discourage the use of unregulated substances.