Actinic keratoses and herbal medicine interventions
Creators: name: HILTERMAN, Karina
Publisher: name: RMIT University
Year: 2024
Subjects: classificationCode: 420803
subject: Traditional Chinese medicine and treatments

description: Background<br><br>
An actinic keratosis [AK] is a common form of sun-induced skin disease, which may develop after many years exposure to the sun. An AK may progress to become a non-melanoma skin cancer [NMSC]. Considering Australia has the highest prevalence of sun-induced skin disease world-wide and has an ageing population, seeking effective and safe remedies for AKs is prudent. Through recorded history herbs have been used for treating skin disease, yet little research has been undertaken to validate historical and traditional claims of use, efficacy and safety. Thus, in treating sun-damaged skin, it is reasonable to investigate natural herbal treatments that have been used historically for skin conditions to assess whether extracts from plants can provide effective AK treatments with minimal adverse effects. <br><br>

Aims<br><br>
This study aims to assess AKs from the perspectives of biomedical science and herbal medicine, and to review the classical and modern literature relating to the use of herbal and pharmaceutical medicines for treating sun-damaged skin and AKs. An additional aim is to assess whether professional herbalists and naturopaths recognise and treat AKs, and if so, what treatments are favoured.<br><br>

Methods<br><br>
The initial investigation of AKs included the history of its nomenclature, the pathophysiology, epidemiology and the effects of solar radiation on human skin. A priority was to discern the range of current treatments; both herbal and medical. The traditional use of herbal medicine for treating skin conditions was investigated.<br><br>

A systematic literature review was undertaken, following the 'Cochrane Systematic Review' methods, to determine what clinical research had been conducted on AKs using herbal medicines and to discern the efficacy and safety of the treatments. Six major databases and search engines namely Science Direct, PubMed, CINHAL, Scopus, EBSCOhost and Cochrane were searched to identify relevant literature. This review focused on clinical studies on humans and excluded in vitro and in vivo designs or research on animals.<br><br>

Further investigation of the literature was undertaken to assess the traditional use of herbal medicine for treating skin conditions and to discern which therapeutic actions are relevant for treating sun-induced skin damage.<br><br>

An anonymous survey of herbalists and naturopaths from professional associations was conducted to discern their knowledge of AKs and to assess the range of herbs and methods used to treat patients. To endorse the various herbs considered to be potentially suitable as AK treatments, a series of monographs has been written utilising the format and style familiar to practitioners of Western Herbal Medicine [WHM].<br><br>

Results<br><br>
AKs were only named as such in 1958. Therefore limited references to them exist in both historical and modern literature. However, information on herbal medicine for treating skin conditions is well documented in classical literature.<br><br>

Within the systematic review, 11 clinical studies were identified. The herbs or herbal extracts utilised in these studies were: Colchicum autumnale, Betula species, Hypericum perforatum, Euphorbia peplus, Perillyl alcohol and Solanum incanum. They were all topical treatments; the dosages and treatment durations reported in the literature varied considerably. Due to the diversity of herbal treatments and differing treatment protocols discerned from this review, data pooling and meta-analysis could not be performed. Therefore the results were assessed by comparative, descriptive and narrative methods.<br><br>

No study fulfilled all the desired outcomes without any adverse events. Two studies that investigated birch bark extracts reported a lesion clearance response rate of 79% to 86% with minimal adverse effects.<br><br>

From the survey of herbalists, only eight percent (8%) were confident in identifying an AK and only four percent (4%) stated that that they would always treat an AK, whereas 52% would never treat them. In addition, many respondents lacked an understanding of AKs. Of those who would treat, a diverse range of treatments was revealed. The following herbs were the most frequently used: Symphytum spp (Comfrey), Trifolium pratense (Red Clover), Viola odorata (Sweet Violet), and Sanguinaria canadensis (Bloodroot).<br><br>


Implications<br><br>
The findings from the systematic review strengthen the need for further research to be conducted to discern herbs which have the indicated constituents and therapeutic actions required for efficacious treatments. It is important to research herbs that have recorded historical or traditional benefits for skin diseases, in addition to those containing suitable phytochemical profiles. Further examination of these herbs, under the scrutiny of well-designed and conducted clinical trials is required, to satisfy the demand for safe, effective natural treatments.<br><br>

From the survey of herbalists, a gap in training was identified. This indicates scope for continuing practitioner education and a review of student curriculum content. For those that do treat AKs, a diverse range of herbal and other medications is available. Further professional protocol development for treating this skin condition is required.<br><br>