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Case Studies:

Complementary / Alternative Therapies

The use of these modalities has become very popular , which is understandable when people are faced with an intractable, incurable, highly symptomatic condition for which conventional medicine seem to be only partially beneficial. These treatments can be defined as forms of therapy that involve any treatment method without scientific proof of adequate or superior efficacy compared to conventional treatment. Approximately 30 percent of patients with allergies report the use of complementary treatments in Europe; these tend to be younger women with higher educational background. Traditional healers in Africa probably treat large numbers of patients with atopic dermatitis, but no reliable figures or records of treatment methods exist for this group of patients.

  1. Phytotherapy
    1. Chinese herbal medicine (CHM) [1- ; C]

      Conflicting evidence exists regarding the efficacy and toxicity of these medicines, probably because there is a big variation in the actual composition of the different products and used by different practitioners. Some preparations illegally contain potent topical corticosteroids. One meta-analysis showed that there might be some evidence of efficacy in reducing symptoms. Close monitoring of hepatic and renal functions is necessary and treatment is contraindicated in pregnancy and in patients with preexisting liver, renal and cardiac disease.


    2. Kampo (Japanese herbal medicine) [3 ; D]

      These treatments include composite herbs like Zemaphyte, Shofu-san, Ji-zuso-ippo, Eppi-ka-jutsu-to and Hochu-ekki-to. “Kampo and diet” has been proposed as second line treatment for atopic dermatitis in cases where first-line conventional treatment has failed, as first line therapy with Kampo is no more effective than standard treatment. It should, according to the authors, be tried before immunosuppressives are introduced.


    3. Tea tree oil [0]

      No controlled trials to prove efficacy in atopic dermatitis have been done. Allergic contact dermatitis is a frequent complication, mainly due to the sesquiterpine content.

    4. Essential fatty acids [1++ ; 0]

      No benefit could be demonstrated in one excellent meta-analysis of 34 qualifying publications. There are therefore no grounds for the use of these preparations. A single study using hempseed oil after this publication did show some benefit, presumed to be due its effect on essential fatty acid metabolism .

    5. Kiwi fruit extract [2- ; D]

      A single study showed some benefit in improving some signs, but not symptoms, in 51 adults .

    6. Other herbal medicine [0]

      No evidence exists to support the use of Arnica, Calendula flos and German chamomile.

  2. Homeopathy [0]

    3. No evidence for efficacy exists, as no valid clinical studies have been reported.

  3. Hypnotherapy [2- ; D]
    4. Evidence supporting its use is weak, but some studies show promising results

  4. Stress management [2- ; D]

  5. Topical Streptococcal preparation [3 ; D]
    6. One uncontrolled, open trial showed complete “cure” in four cases .

  6. Massage therapy [2- ; D]
    7. One study reported symptomatic improvement with this method, with massage alone, but the addition of a series of essential oils to the massage oils (aromatherapy) brought no additional benefits .

  7. Reiki [0]
    8. No studies to support the use of this modality in atopic dermatitis could be found. The reasoning behind this treatment has been published .

  8. Autologous blood therapy [2- ; D]
    9. One controlled study showed some improvement over placebo .

  9. Other complementary therapies without proven efficacy
    10. Acupuncture , Bioresonance treatment , balneotherapy and cleansing of the colon with enemas fall into this group. Sublingual immunotherapy has shown some promising provisional results in respiratory allergies, but no evidence exists for efficacy in dermatitis .
Interactions between herbs and conventional medicine
The blood levels of anticonvulsant treatment need to be checked and the dosages increased when evening primrose oil (gamolinolenic acid) is administered, because epilepsy can become unstable. Hepatitis can be induced by CHM and echinacea and it can potentiate the hepatic toxicity of drugs like methotrexate . The effectiveness of immunosuppressants can be reduced by the concomitant use of zinc, echinacea and vitamin E .

Complementary and alternative allergy tests
Several of these tests are done regularly, but none has any scientific foundation or proof of validity . These include: The leucocytotoxic test; the IgG ELISA allergy test; applied
kinesiology; electrodermal testing; hair analysis; auriculocardiac reflex; Nampudripad’s allergy elimination technique; live blood analysis and stool analysis and microscopy for yeasts and parasites.

  1. Jensen P. Use of alternative medicine by patients with atopic dermatitis and psoriasis. Acta Dermatol Venereol 1990;70(5):421-4
  2. Artik S, Ruzicka T. Complementary therapy for atopic eczema and other allergic skin diseases. Dermatologic Therapy 2003;16:150-63
  3. Schafer T. Epidemiology of complementary alternative medicine for asthma and allergy in Europe and Germany. Ann Allergy Asthma Immunology 2004;93(Suppl 1):S5-10
  4. Koo J, Arain S. Traditional Chinese medicine for the treatment of dermatological disorders. Arch Dermatol 1998;134:1388-93
  5. Ferguson JE, Chalmers RJG, Rowlands DJ. Reversible dilated cardiomyopathy following treatment of atopic eczema with Chinese herbal medicine. Br J Dermatol 1997;136:592-3
  6. Ramsay HM, Goddard W, Gill S, Moss C. Herbal creams used for atopic eczema in Birmingham, UK, illegally contain potent corticosteroids. Arch Dis Child 2003;88(12):1056-7
  7. Zhang W, Leonard T, Bath-Hextall F, Chambers CA, Lee C, Humphreys R, Williams HC. Chinese herbal medicine for atopic eczema. Cochrane Database Syst Rev 2004;(4)CD002291:1-22
  8. Kobayashi H, Takahashi K, Mizuno N, Kutsuna H, Ishii M. An alternative approach to atopic dermatitis: Part I – Case series presentation. Evid Based Complement Alternat Med 2004;1(1):49-62
  9. Kobayashi H, Takahashi K, Mizuno N, Kutsuna H, Ishii M. An alternative approach to atopic dermatitis: Part II – Summary of cases and discussion. Evid Based Complement Alternat Med 2004;1(2)145-55
  10. Bedi MK, Shenefeldt PD. Herbal therapy in dermatology. Arch Dermatol 2002;138:232-42
  11. Van Gool CJAW, Zeegers MPA, Thijs C. Oral essential fatty acid supplementation in atopic dermatitis – a meta-analysis of placebo-controlled trials. Br J Dermatol 2004;150:728-40
  12. Callaway J, Schwab U, Harvima I, et al. Efficacy of dietary hempseed oil in patients with atopic dermatitis. J Dermatolog Treat 2005;16:87-94
  13. Mraz S, Miller B, Bocko A, Tschen E. A multicenter, double-blind, placebo-controlled study of the effectiveness of kiwi-fruit extract in adults with atopic dermatitis of moderate severity. J Am Acad Dermatol 2006;54(3):AB3
  14. Stewart AC, Thomas SE. Hypnotherapy as a treatment for atopic dermatitis in adults and children. Br L Dermatol 1995;132:778-83
  15. Baron S, Layton A, Goulden V. A pilot study of hypnotherapy to treat adults and children with moderate to severe atopic dermatitis. J Am Acad Dermatol 2006;54(3):AB2
  16. Horiuchi Y. Topical Streptococcal preparation, OK-432, for atopic dermatitis. J Dermatolog Treat 2005;16(2):117-20
  17. Anderson C, Lis-Balchin M, Kirk-Smith M. Evaluation of massage with essential oils on childhood atopic eczema. Phytother Res 2000;14(6):452-6
  18. Nield-Anderson L, Ameling A. The empowering nature of Reiki as a complementary therapy. Holist Nurs Pract 2000;14(3):21-9
  19. Pittler MH, Armstrong NC, Cox A, Collier PM, Hart A, Ernst E. Randomized, double-blind, placebo-controlled trial of autologous blood therapy for atopic dermatitis. Br J Dermatol 2003;148:307-13
  20. Koo J, Arain S. Traditional Chinese medicine for the treatment of dermatological disorders. Arch Dermatol 1998;134:1388-93
  21. Schoni MH, Nicolaizik WH, Schoni-Affofter F. Efficacy trial of bioresonance in children with atopic dermatitis. Int Arch Allergy Immunol 1997;112:238-46
  22. Pajno GB, Barberio G, Boner AL. Efficacy of sublingual immunotherapy in asthma and eczema. Chem Immunol Allergy 2003;82:77-88
  23. Ferguson JE, Chalmers RJG, Rowlands DJ. Reversible dilated cardiomyopathy following treatment of atopic eczema with Chinese herbal medicine. Br J Dermatol 1997;136:592-3
  24. Miller LG. Herbal medicinals. Arch Intern Med 1998;158:2200-8
  25. Morris, A. Complementary and alternative allergy tests. Current Allergy Clin Immunol 2006;19(1):26-8

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