Herbal Medicine and EB...Herbal Medicine - Phytotherapy • Use of plant-derived medications in...

©EB –Ambulanz, EB-Haus Austria www.eb-haus.org

Herbal Medicine and EBHope, Opportunities and Limitations

Dr. Anja Diem

EB House Austria |Outpatient Unit| University Hospital of Dermatology Salzburger Landeskliniken (SALK) | Paracelsus Medical University Salzburg (PMU)

Muellner Hauptstrasse 48 | 5020 Salzburg | AustriaT +43 (0) 5 7255-82400 | F +43 (0) 5 7255-82497

[email protected] | www.eb-handbook.org

[email protected]

http://www.eb-haus.org/

http://www.eb-clinet.org/

Herbal Medicine

EB-Ambulanz, EB-Haus Austria www.eb-haus.org

“Doctor, I want to take/use something natural, without side effects. You understand, a herbal

product, simply something gentle, I want something save, organic…!”

“Every disease has a herb to cure it....”X

www.eb-haus.org

They all useplants/herbs in

many different waysand preparations…

Hildegardmedicine

Aroma-therapy

Medical herbalism

Spagyric

Antroposophy

Homeopathy

TCM

Traditional healers

Bachflower

therapy

Home remedies

ECM

….


Herbal Medicine ??

Herbal Medicine - Phytotherapy

• Use of plant-derived medications in treatment and prevention of diseases– Defined type of plant, part(s) of plant (leaves, blossom, bark, root, whole plant)

– Fresh plants (for juice, extraction of essential oil)

– Most common for medical use: dried plants (durability, stability)

• Science-based– Main active substance(s) identified

– Numerous clinical trials and pharmacological studies of specific preparations

– Interpretation and acceptance of such evidence varies

• Increasing interest of patients and medical professionals


Natural = No Harm ??

• When used in effective dosage, plant remedies can also have side effects

• Side effects are mostly mild, but also severe ones are known

• Do not underestimate contamination/pollution burden

• Some plants are (very!) toxic


Belladonna (atropine) Foxglove (digitalis) Monkshood (aconite)

Natural = No Harm ??

„All things are poison, and nothing is without poison;the dosage alone makes it so a thing is not a poison.“

„Alle Dinge sind Gift, und nichts ist ohne Gift; allein die Dosis machts, dass ein Ding kein Gift sei.“

„Toutes les choses sont poison, et rien n’est sans poison; seule la dose fait qu'une chose n’est pas poison.“



• Synthetic pharmaceuticals– Usually only one, well defined active substance

– Standardized amount of active substance in everydosage

– Several „synthetic“ pharmaceuticals are of herbal origin(e.g. morphine, digitalis, theophyllin, taxol..)

• Ongoing search for active substances in plants– ~ 350.000 different plants

– Higher potential in plants used in „ethnomedicine“

“Synthetic” and “Herbal” ??


• Phytopharmaceuticals– Extract = active substance

– Multicomponent mixture, including primary and secondaryplant substances

– Mild effects (and mild side effects)

– Standardized amount of substances only if• exactly the same plant and

• the same extraction method is used

– All „herbal“ effects are based on chemical substances(flavonoids, saponins, terpenoids, polysaccharides...)

– Problem: starting material is of biogenic origin, thereforevariable

– Standardization of manufacturing process is needed

– Good Manufacturing Practice!

– Long and cost-intensive way to licenced product…

“Synthetic” and “Herbal” ??

Self Grown/Collected Plants or Pharmacy Products?


• Homemade and fresh• Experiments are possible• Working with plants is

interesting and rewarding• Cheap• Short way from herb to

product

• Healthy vegetables and herbs

• Good place is needed• Time consuming• No standardized product• Widely varying quality• Contamination with other

plants is common (->higherallergic potential!)

• Durability of mixtures is a problem

• Max. acceptableconcentration of variouscontaminants?

• Legal issues (e.g. cannabis)• Extraction of effective

substance often difficult

“Extract”


Starting material (species, degree of ripeness)

Degree of grinding Roasting

Method of preparation(hot water, steam, intensity,..

Other diversifications(caffeine-free, instant,..)

-> Various products with different effects!!


Phytotherapy and EB


Adjuvant (!) cancer therapy

Possible fields of application

Itch Antimicrobial

Inflammation Wound healing

Mucous membranesPain

All sorts of (mild) additional diseases and problems (e.g. common cold, constipation,

sleeping disorders …)

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• Almond oil, sunflower oil• Ointment, pure oil• Baby skin care, itch• Almond oil or sunflower oil 10,00 ultrasicc/ultrabas aa 200,0

• Lavender oil• Pure oil• Mild sleeping disorders• 3-5 drops on pillow before going to sleep

• Olive oil• Pure oil, ointment• Scaling lesions, scalp, skin care• Oil cap: put pure oil on scalp, cover with transpareny film

leave it for 1-2 hours or overnight, remove film, (gently!)peel off scales(for severe scaling: acidum salicylicum 5,0 + oleum olivae ad 100,0)

Phytotherapy in EB – Examples

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• Sage (Salvia officinalis)• hyperhydrosis, anti-inflammatory• sweating:

• Nosweat ® (standardized product)• tea: not more than 1-2 cups/day

• painful blistering in mouth:• tea (cooled down) for mouthwash

• Witch Hazel (Hamamelis virginiana)• anti-inflammatory, adstringent• many creams available (e.g. Hametum®, Mirfulan®)• cave: allergic potential

• Balloon plant (Cardiospermum halicacabum)• anti-itch• ointments available (e.g. Halicar® Salbe, ECR® Creme)





• Marigolg (Calendula officinalis)• wound healing, antiphlogistic• (many!) standardized creams with 2-5% calendula extract• herbal brew (1-2g/150ml water) for mouthwash• cave: allergic potential (family Asteraceae/Compositae!)

• Chamomille (Chamomilla recutita)• wound healing, anti-inflammatory, spasmolytic• indigestion• oral intake, compresses, lavation (wounds, eyes),

inhalation• cave: do not mix up with mayweed (Anthemis arvensis! ->

high allergic potential)

• Psyllium, Desert Indianwheat (Plantago ovata)• dietary fiber• seed husks can help to reduce the symptoms of both

constipation and mild diarrhea

Example: Cannabis


• > 100 diverse sorts of Cannabis sativa (vary immensely in THC- and CBD- content)

• > 60 cannabinoids, and other components (e.g. terpene)• most interesting (and discussed) components:

• delta-9-tetrahydrocannabinol (Δ9-THC)

• cannabidiol (CBD)

• CBD and THC have various properties we could use in EB care• pain medication• itch relief• antiinflammatory potential• woundhealing??

• application „EB-friendly“• inhalative – topical – oral

Example: Cannabis


• Herbal cannabis/flos cannabis= “medical marijuana”• dried blossom and small leaves

• standardized content of THC and CBD, various concentrations

• available only in few countries (but changing…)

• Licenced drugs (Austria)• Dronabinol® (THC, half-synthetic until 2008, since then herbal extract)

• Canemes® (Nabilone, THC derivate, synthetic)

• Sativex® (Nabiximols, herbal extract with standardizes THC and CBD content)

• few indications (severe conditions)• chronic, neuropathic pain, spasticity (multiple sclerosis), AIDS

(cachexy, loss of appetite), severe cancer pain, few rare diseases

Example: Cannabis


• Children ≠ adults• Growing evidence for negative effects on brain development and IQ

• Hall W et al: The health and social effects of nonmedical cannabis use, WHO 2016

no oral and inhalative THC-containing medicines for children, adolescents and young adults (~age 25) (despite few specific diseases...)

• Topical use of low THC/high CBD products ?• Topical use of flos cannabis? • CBD is promising and expected to be acceptable

• …but CBD is a pure substance, extracted fromherbal cannabis, strictly said no „herbal product“

• Hemp(-seed) oil• no THC, no CBD• Skincare, dry skin, itch• Example: Beeswax 20,00 + sheabutter 20,00 + hempseed oil 60,00


Phytotherapy in EB – Cave!


• Purple coneflower (Echinacea)• „Immunmodulation“ • Very popular for supportive treatment of recurrent viral

infections• Should be okay for milder types of EB• But be cautious with more severe types, particulary when

diagnosed with skin cancer

• St. John‘s wort• Capsules and tea: effective antidepressants• Oil, ointments: skincare, wound healing, itch• But take care:

• oral intake interacts with MANY medications• makes skin more sensitive to sunlight (sunburns!)


Chemotherapy – Cave!


• Never take these herbs (or products including theseherbs) without agreement of your oncologist:

• Purple coneflower (Echinacea)• Ginkgo (Ginkgo biloba)• Red clover (Trifolium pratense)• Peppermint (Mentha piperita)• Valerian (Valeriana officinalis)• Garlic (Allium)• Green tea (Camellia sinensis)• Ginseng (Panax ginseng)

• This list does not claim to be complete! –> Always ask before using herbal products!!

Summary

• It is NOT herbal medicine vs. pharmacology

• It is about having options and making good choices for long term treatment

• Herbal medicine provides adjuvant opportunities

• …but it doesn’t “go natural”- there is a lot to know and to consider!


Dr. Anja Diem

EB House Austria |Outpatient Unit| University Hospital of Dermatology Salzburger Landeskliniken (SALK) | Paracelsus Medical University Salzburg (PMU)

Muellner Hauptstrasse 48 | 5020 Salzburg | AustriaT +43 (0) 5 7255-82400 | F +43 (0) 5 7255-82497

[email protected] | www.eb-handbook.org

(all pictures: pixabay.com)

Please share your experience!


[email protected]

http://www.eb-haus.org/

http://www.eb-handbook.org/

Herbal Medicine and EB...Herbal Medicine - Phytotherapy • Use of plant-derived medications in...

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