Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Cosmeceutical Botanicals


Summary and Key Features

  • There are 1100 herbal ingredients used in topically applied products

  • Secondary metabolites are small molecules from herbs that produce clinical activity

  • Product development of herbal containing formulations is complex with less predictable functionality due to variations of environmental and processing factors

  • Twenty-four herbs applied topically have induced fatalities

  • The five largest selling herbs in the United States are Gingko biloba , St John’s wort, ginseng, garlic and Echinacea species

  • Forty-one herbs have been used to treat photoaging in blinded controlled clinical trials

Introduction

The explosive growth of the cosmeceutical industry has resulted in the introduction of many new ‘active’ ingredients derived from nature, which provide unique marketing stories. About 1100 different ingredients derived from 14 000 plant sources are being incorporated into more than 90 000 cosmeceutical and skin care products ( , ).

Botanicals used for medicinals, flavoring or fragrances are known as herbs. These are the historic foundation of pharmacologic medicine. Secondary metabolites (SM) are the small molecules used for storage or protection and usually are not involved in primary plant metabolism. These SM are the portions of herbs incorporated into skin care and cosmetic products. About 40 000 SM have been identified.

The German Commission E regulates herbal products based on usage, clinical efficacy, and the quality of this evidence. It developed standardization of about 700 herbs and now is the standard throughout the developed world. PhytoPharm U.S. Institute of Phytopharmaceuticals also evaluates clinical evidence and adverse reactions to identify ‘reasonable uses’ for hundreds of herbs ( , ) In the US, herbal remedies are considered dietary supplements or food additives by federal regulators so there are no standards for potency of the components and efficacy of the products.

To prepare herbal based products, the plant is not just pulverized and then inserted into a formulation. Herbal extracts are much more susceptible to quality variations than synthetic products due to environmental and processing factors affecting solubility, stability, pharmacokinetics, pharmacology and toxicity of the active ingredients. These include the:

  • ▪

    Growing conditions of the plant

  • ▪

    Health of the plant

  • ▪

    Harvesting time

  • ▪

    Care of the plant during transport

  • ▪

    Storage time and methods prior to processing

  • ▪

    Selection of the proper anatomic site on the plant

  • ▪

    Processing methods, including air or oven drying, crushing, cold pressing, comminuting (fracturing) and grinding

  • ▪

    Extraction methods, including solvents such as water, alcohol, glycol, hexane, glycerin, ester or oil

  • ▪

    Secondary purification including supercritical fluids and column chromatography ( , , ).

The methods of topical application of herbal products include:

  • ▪

    Water-in-oil or oil-in-water cream and lotion

  • ▪

    Oil- and wax-based ointment

  • ▪

    Powder

  • ▪

    Paste

  • ▪

    Poultice of freshly cut herb

  • ▪

    Fomentation, which is a compress of warmed moistened herb

  • ▪

    Juice

  • ▪

    Tea

  • ▪

    Alcohol-based tincture

  • ▪

    Elixir – a sweetened liquid

  • ▪

    Decoction, which is a watery extract by boiling

  • ▪

    Infusion, where extract is obtained by soaking and administered intravenously or subcutaneously.

The multiple variables of herbal products indicate the need for certain efficacy and safety data. Quality healthcare demands evidence-based decisions. Acceptable evidence-based effectiveness should include complete, marketed products tested in controlled double-blind clinical trials, compared with placebo or a positive control of a prescription product, which are conducted by independent research organizations that enroll a statistically significant number of subjects.

A product labeled as ‘natural’ does not equal a safe product. In 2003, the Food and Drug Administration removed ma huang ( Ephedra sinica ) from the market due to 155 deaths. Twenty-three additional herbs have reported fatalities with topical use. These include Echinacea purpurea, German chamomile, birthwort, Aloevera , Aristolochia , arnica, black mustard, comfrey, cascara, henna, Chinese rhubarb, Croton , kava kava, mistletoe, rue, Rhus species, senna, oleander, Scotch pine, spruce, St. John's wort, tobrandi, yohimbine. Severe mucocutaneous reactions induced by herbal extracts include anaphylaxis, angioedema/urticarial exfoliative erythroderma, linear IgA bullous dermatosis, lupus erythematosus, malignancies, pemphigus, Stevens–Johnson syndrome, Sweet's syndrome, ulcerative stomatitis and vasculitis ( , , , ).

Chinese practitioners are concerned about the well-known side effects of hepatotoxicity, contact dermatitis and teratogenicity which occur in up to a third of people using topical Chinese herbal preparations. Moreover, a significant number of congenital anomalies occur when these herbs are used topically during pregnancy ( ).

Because contact dermatitis is the most common reaction to these herbal products, a routine safety study for contact irritation and sensitization is the Repeat Insult Patch Test (RIPT; ). This test includes a topical application for 50–150 subjects. Although this test is not required for cosmetics, including herbs, as best practice a skin care professional should expect this test to be performed on commercial products. After all, patients/clients come to you believing that you have determined effective and safe treatments, procedures, and products ( ).

There is no consistent definition of ‘natural’ in US skin care products, so it is marketing jargon without functionality ( ). A recently recommended criterion to claim natural is: ‘five percent or more of the ingredients are found in nature.’ Organic products are those that are certified free of synthetic chemical use in the fields and production methods of the ingredients obtained in nature. The US Department of Agriculture now has certification criteria for this designation to include 100% organic, but products can claim to be organic if 95% of their components are organic. Organic-derived can be claimed if 70% of the components are organic. There has been no decision by the FDA about genetically modified foods labeled as ‘natural’ ( , , ).

Most widely used herbs

The top 10 largest selling herbs in the US based on dollar volume, with more than $10 million in sales annually, will be discussed first, as listed in Box 8.1 . This includes both topical and orally administered doses. The top five sales range from $70 to $150 million. The next four have annual sales of $10–45 million. The fickleness of the public's embrace of certain herbs is demonstrated by noni, which had been the largest seller in 2009 but at the time of writing is not in the top 16, with less than $2 million in sales, a drop of 99% ( ).

Box 8.1
Top selling herbs in the US in 2013 (Auger 2014)

  • Ginkgo biloba

  • St John's wort

  • Ginseng

  • Garlic

  • Echinacea

  • Saw palmetto

  • Soy

  • Kava kava

  • Valerian

  • Cranberry

Only six herbal extracts for treating photoaging have been a sole active ingredient in formulations that were tested in blinded, randomized, controlled, clinical trials. These include coffeeberry, date palm kernel, oat, soy milk, total soy, and soy protease inhibitors. These six and the other 35 herbal extracts tested in blinded human trials are listed in Box 8.2 .

Box 8.2
Therapeutic herbs for photoaging with human clinical trial

  • Aloe ( Aloe barbadensis , A. vera)

  • Apple ( Malus domestica )

  • Avocado ( Persea americana )

  • Black cohosh ( Cimicifuga racemosa )

  • Blackberry ( Rubis ursinus )

  • Blueberry ( Vaccinium myrtillus ): oral only

  • Cat's claw ( Uncaria guianensis , U. tomentosa )

  • Coffeeberry ( Coffea arabica ) a

    a = single active in product; + = oral plus topical administration.

  • Comfrey or comphrey ( Symphytum officinale )

  • Date palm kernel ( Phoenix dactylifera ) a

  • Dill ( Anethum graveolens )

  • Flax ( Linum usitatissimum )

  • German chamomile ( Matricaria recutita ) + oral

  • Goji ( Lycium barbarum )

  • Grapefruit ( Citrus x paradisi ): oral only

  • Grape seed ( Vitis vinifera ): oral only

  • Green tea ( Camellia sinensis ) a + oral

  • Lavender ( Lavandula augustifolia )

  • Licorice ( Glycyrrhiza glabra , G. inflate , G. uralensis ): oral only and glabridin topically a

  • Mangosteen ( Garcinia mangostana )

  • Meadowfoam ( Limnanthes alba )

  • Mountain rose ( Rosa canina )

  • Mushroom/wheat complex

  • Oak quercetin

  • Oat a ( Avena sativa )

  • Olive ( Olea europaea )

  • Plum ( Prunus domestica )

  • Pomegranate ( Punica granatum ) + oral

  • Raspberry ( Rubus idaeus )

  • Safflower ( Carthamus tinctorius )

  • Sakura leaf ( Prunus speciosa )

  • Southernwood ( Artemisia abrotanum )

  • Soy milk, total soy ( Glycine soja , G. max ), soy protease inhibitors a + oral

  • Spring restharrow ( Ononis spinosa )

  • Sweet orange ( Citrus sinensis ): oral only

  • Tamarind ( Tamarindus indica ) a

  • Tomato ( Lycopersicon esculentum ): oral only

  • White sandalwood ( Santalum album )

  • White tea ( Camellia sinensis ) + oral

  • White willow ( Salix alba )

With the appreciation of multiple clinical components of photoaging that require multiple herbs with different functionalities, all the herbal products published in the last 3 years consist of at least six active ingredients, with one containing 33 different herbal extracts. The contribution of each active is thus difficult to ascertain.

More than 210 herbs have anti-inflammatory functionality with 140 of these having antioxidant activity, listed in Box 8.3 . The other 70+ include anti-inflammatory natural steroids, salicylates, and other non-antioxidants. Twenty-nine herbs have barrier repairing function as listed in Box 8.4 .

Box 8.3
Anti-inflammatory/antioxidant herbs

  • Achiote ( Bixa orella )

  • Agrimony ( Agrimonia eupatoria )

  • Aloe ( Aloe barbadensis , A. capensis , A. vera )

  • American white pond lily ( Nymphaea odorata , N. rosea )

  • Apple ( Malus domestica , M. silvestris , Pyrus malus )

  • Apricot ( Prunus armeniaca , Armeniaca vulgaris , Passiflora incarnata )

  • Arnica ( Arnica montana )

  • Avocado ( Persea americana )

  • Baobab ( Adansonia digitata )

  • Bear's garlic ( Allium ursinum )

  • Behen ( Moringa oleifera )

  • Bistort ( Polygonum bistorta )

  • Bittersweet ( Solanum dulcamara )

  • Black cohosh ( Cimicifuga racemosa )

  • Black nightshade ( Solanum nigrum )

  • Bladderwort ( Utricularia vulgaris )

  • Blueberry ( Vaccinium myrtillus )

  • Bog bilberry ( Vaccinium uliginosum )

  • Bogbean ( Menyanthes trifoliata )

  • Boldo ( Peumus boldus )

  • Borage ( Borago officinalis )

  • Boxwood ( Buxus sempervirens )

  • Broad bean ( Vicia faba )

  • Buckwheat ( Fagopyrum esculentum )

  • Burdock ( Arctium lappa , A. minus , A. tomentosum )

  • Burning bush ( Dictamnus albus )

  • Burr marigold ( Bidens tripartita )

  • Butcher's broom ( Ruscus aculeatus )

  • Cabbage ( Brassica oleracea )

  • Calotropis ( Calotropis procera )

  • Cane-reed ( Costus speciosus )

  • Carrot, wild ( Daucus carota )

  • Cashew ( Anacardium occidentale )

  • Castor bean ( Ricinus communis )

  • Cat's claw ( Uncaria guianensis , U. tomentosa )

  • Cedar, Lebanon ( Cedrus libani )

  • Chamomile ( Matricaria recutita )

  • Chasteberry ( Vitex agnus-castus )

  • Charantais melon ( Melo reticulatus )

  • Chaulmoogra ( Hydnocarpus kurzii )

  • Chickweed ( Stellaria media )

  • Chicory ( Cichorium intybus )

  • Club Moss ( Lycopodium clavatum )

  • Coconut oil ( Cocos nucifera )

  • Coffeeberry ( Coffea arabica )

  • Comfrey ( Symphytum officinale ) [allantoin]

  • Common stonecrop ( Sedum acre )

  • Congorosa ( Maytenus ilicifolia )

  • Cordyceps sinensis mushroom

  • Cornflower ( Centaurea cyanus )

  • Corydalis ( Corydalis cava )

  • Cotton ( Gossypium hirsutum )

  • Cranberry ( Vaccinium macrocarpon )

  • Croton seeds ( Croton tiglium )

  • Dandelion ( Taraxacum officinale )

  • Date palm ( Phoenix dactylifera )

  • Dogwood ( Cornus florida )

  • Dong quai/ferulic acid ( Angelica sinensis )

  • Echinacea ( Echinacea angustifolia , E. pallida , E. purpurea )

  • English ivy ( Hedera helix )

  • English plantain ( Plantago lanceolata )

  • Eucalyptus ( Eucalyptus globulus )

  • European elder ( Sambucus nigra )

  • European water hemlock ( Cicuta virosa )

  • Evening primrose ( Oenothera biennis )

  • Evodia ( Evodia rutaecarpa )

  • Eyebright ( Euphrasia officinalis )

  • Fennel ( Foeniculum vulgare )

  • Fenugreek ( Trigonella foenum-graecum )

  • Fernblock ( Evodia rutaecarpa )

  • Feverfew ( Tanacetum parthenium )

  • Field scabious ( Knautia arvensis )

  • Flax ( Linum usitatissimum )

  • Foxglove ( Digitalis purpurea )

  • Frankincense ( Boswellia carteri, B. sacra, B. serrata )

  • Fumitory ( Fumaria officinalis )

  • Garlic ( Allium sativum )

  • German chamomile ( Matricaria recutita )

  • Ginger ( Zingiber officinale )

  • Gingko ( Gingko biloba )

  • Ginseng, American ( Panax quinquefolius )

  • Ginseng, Asian ( Panax ginseng )

  • Ginseng, Siberian ( Eleutherococcus senticosus )

  • Golden fern ( Polypodium leucotomas )

  • Golden shower tree ( Cassia fistula )

  • Gold thread ( Coptis chinensis ) [yellow root]

  • Gotu Kola ( Centella asiatica )

  • Grape ( Vitis vinifera )

  • Grapefruit ( Citrus x paradisi )

  • Graviola [durian] ( Annona muricata )

  • Great burnet ( Sanguisorba officinalis )

  • Green, black, white, oolong teas ( Camellia sinensis )

  • Ground ivy ( Glechoma hederacea )

  • Guava ( Psidium guajava )

  • Haronga ( Haronga madagascariensis )

  • Heartsease ( Viola tricolor )

  • Heather ( Calluna vulgaris )

  • Hemp [marijuana] ( Cannabis sativa )

  • Henna ( Lawsonia inermis )

  • Herb Robert ( Geranium robertianum )

  • Hibiscus ( Hibiscus sabdariffa )

  • Horse chestnut ( Aesculus hippocastanum )

  • Houseleek ( Sempervivum tectorum )

  • Indian nettle ( Acalypha indica )

  • Jambolana ( Syzgygium cumini )

  • Japanese mint ( Mentha arvensis var. piperascens , M. canadensis )

  • Jasmine ( Jasminum officinale )

  • Jewel weed ( Impatiens pallida )

  • Knotweed ( Polygonum aviculare )

  • Kombucha [sweetened fermented black tea]

  • Kudzu ( Pueraria lobata )

  • Kukui [tung seed] ( Aleurites cordatus )

  • Labrador tea ( Ledum latifolium )

  • Lady's mantle ( Alchemilla vulgaris )

  • Larch ( Larix decidua )

  • Lavender ( Lavandula augustifolia )

  • Lemon ( Citrus x limon )

  • Licorice ( Glycyrrhiza glabra , G. inflate , G. uralensis )

  • Lycium bark ( Lycium chinense )

  • Macadamia ( Macadamia integrifolia , M. tetraphylla )

  • Maitake mushroom ( Grifola frondosa )

  • Mallow ( Malus sylvestris )

  • Mangosteen ( Garcinia mangostana )

  • Marigold ( Calendula officinalis )

  • Marshmallow ( Althaea officinalis )

  • Matico ( Piper elongatum )

  • Meadowfoam ( Limnanthes alba )

  • Mezereon ( Daphne mezereum )

  • Milk thistle ( Silybum marianum ) [silymarin]

  • Moneywart ( Lysimachia nummularia )

  • Monkshood ( Aconitum napellus )

  • Mullein ( Verbascum densiflorum )

  • Mulberry ( Morus alba , m.nigra )

  • Myrrh [guggal] ( Commiphora molmol , C. myrrha , C. wightii )

  • Oak ( Quercus robur )

  • Oak gall ( Quercus infectoria )

  • Oat ( Avena sativa )

  • Olive ( Olea europaea )

  • Onion ( Allium cepa )

  • Ox-eye daisy ( Chrysanthemum leucanthemum )

  • Papaya ( Carica papaya )

  • Paper mulberry ( Broussonetia papyrifera )

  • Pasque flower ( Pulsatilla pratensis )

  • Pau d'arco ( Tabebuia impetiginosa )

  • Peanut ( Arachis hypogaea )

  • Periwinkle ( Vinca minor )

  • Picrorhiza ( Picrorhiza kurroa )

  • Pineapple ( Ananas comosus )

  • Pine ( Pinus maritima , P. pinaster ) [pycnogenol]

  • Plantain ( Musa x paradisiaca )

  • Plumbago ( Plumbago zeylanica )

  • Pomegranate ( Punica granatum )

  • Prickly pear ( Optuntia ficus-indica )

  • Psyllium ( Plantago ovata )

  • Pumpkin ( Cucurbita pepo )

  • Purple gromwell ( Lithospermum erythrorhizon )

  • Purple loosestrife ( Lythrum salicaria )

  • Quassia ( Picrasma excelsa )

  • Quinine ( Circhona pubescens )

  • Rapeseed [canola] ( Brassica napus )

  • Raspberry ( Rubus idaeus )

  • Rauwolfia ( Rauvolfia serpentine )

  • Red clover ( Trifolium pratense )

  • Red-rooted sage ( Salvia miltiorrhiza )

  • Reishi mushroom ( Ganoderma lucidum )

  • Rooibos ( Aspalathus linearis )

  • Rose geranium ( Pelargonium graveolens )

  • Rose hips ( Rosa canina )

  • Rosemary ( Rosmarinus officinalis )

  • Rue ( Ruta graveolens )

  • Sage ( Salvia officinalis )

  • Safflower ( Carthamus tinctorius )

  • Sarsaparilla ( Smilax febrifuga , S. aristolochiifolia )

  • Saw palmetto ( Serenoa repens )

  • Scarlet pimpernel ( Anagallis arvensis )

  • Sea buckthorn ( Hippophae rhamnoides )

  • Sea fennel ( Crithmum maritimum )

  • Shea butter ( Vitellaria paradoxa )

  • Shiitake mushroom ( Lentinula edodes )

  • Soapwort ( Saponaria officinalis )

  • Solomon's seal ( Polygonatum multiflorum )

  • South African geranium ( Pelargonium sidoides )

  • Soybean ( Glycine soya )

  • Spanish needle ( Bidens pilosa )

  • Speedwell ( Veronica officinalis )

  • Spurge ( Euphorbia resinifera )

  • St John's wort ( Hypericum perforatum )

  • Storax ( Liquidambar orientalis )

  • Sunflower ( Helianthus annuus )

  • Sweet clover ( Melilotus officinalis )

  • Sweet gale ( Myricia gale)

  • Sweet orange ( Citrus sinensis )

  • Sweet yellow melilot ( Melilotus officinalis )

  • Tea-tree ( Melaleuca alternifolia )

  • Thyme ( Thymus vulgaris )

  • Tolu balsam ( Myroxylon balsamum )

  • Tomato ( Lycopersicon esculentum )

  • Tumeric [curcumin] ( Curcuma longa )

  • Tung seed [Kukui] ( Aleurites moluccanus )

  • Vervain ( Verbena officinalis )

  • Walnut ( Juglans regia )

  • Wheat ( Triticum aestivum )

  • White birch ( Betula alba , B. pendula )

  • White Kwao Krua ( Pueraria mirifica )

  • White lily ( Lilium candidum )

  • White nettle ( Lamium album )

  • White sandalwood ( Santalum album )

  • White willow ( Salix alba )

  • Wild indigo ( Baptisia tinctoria )

  • Wild yam ( Discorea villosa )

  • Witch hazel ( Hamamelis virginiana )

  • Wormseed ( Chenopodium ambrosioides )

  • Yquem ( Sauternes wine )

Box 8.4
Barrier repairing herbs

  • Almond ( Prunis dulcis )

  • Aloe ( Aloe barbadensis , A. capensis , A. vera )

  • Avocado ( Persea americana )

  • Bladderwrack ( Fucus versiculosus )

  • Borage ( Borago officinalis )

  • Candelilla ( Euphorbia antisyphilitica )

  • Carnauba ( Copernicia prunifera )

  • Castor ( Ricinum communis )

  • Coconut ( Cocos nucifera )

  • Cucumber ( Echballium elaterium )

  • Fenugreek ( Trigonella foenum-graecum )

  • Flax ( Linum usitatissimum )

  • Grape ( Vitis vinifera )

  • Greater plantain ( Plantago officinalis )

  • Jojoba ( Simmondsia chinensis )

  • Licorice ( Glycyrrhiza glabra , G. inflate , G. uralensis )

  • Macadamia ( Macadamia integrifolia , M. tetraphylla )

  • Mallow ( Malva sylvestrius )

  • Oarweed ( Laminaria digitata )

  • Oat ( Avena sativa )

  • Olive ( Olea europaea )

  • Peanut ( Arachis hypogaea )

  • Pomegranate ( Punica granatum )

  • Ribwort ( Plantago lanceolata )

  • Safflower ( Carthamus tinctorius )

  • Sea lettuce ( Ulva lactuca )

  • Sesame ( Sesamum orientale )

  • Shea butter ( Vitellaria paradoxa )

  • Slippery elm ( Ulmus rubra )

  • Sunflower ( Helianthus annuus )

Depigmenters/lighteners/brighteners, listed in Box 8.5 , consist of 33 herbs that lessen or reverse mottled pigmentation, melasma and/or lentigines that have been documented to effectively treat hyperpigmentation in blinded clinical trials. Another 39 are claimed to be effective depigmenters/lighteners/brighteners, but have nonblinded, uncontrolled, open trials or clinical observations. A total of 130 herbs are reported to inhibit one or more melanin synthetic molecules in vitro. The 16 herbs listed in Box 8.6 firm the skin, reverse skin laxity and help reverse wrinkles. Box 8.7 lists 17 photoprotective herbs when administered by topical and/or oral routes ( , , ).

Box 8.5
Depigmenters/lighteners/brighteners

  • Aloesin ( Aloe barbadensis , A. capensis , A. vera )

  • Bearberry ( Arctostaphylos uva-uris )

  • Blueberry ( Vaccinium angustifolium )

  • Blue skull cap ( Scutellaria lateriflora )

  • Carrot ( Daucus carota )

  • Citrus fruit flavonoid [hesperidin]

  • Cranberry ( Vaccinium macrocarpon , V. oxycoccos , V. erythrocarpus )

  • Cucumber ( Echballium elaterium )

  • Curcumin ( Curcuma longa )

  • Date palm fruit ( Phoenix dactylifera )

  • Echinacea ( Echinacea angustifolia , E. pallida , E. purpurea )

  • Feverfew ( Tanacetum parthenium )

  • Flax lily ( Dianella ensifolia )

  • Ginseng, American ( Panax quinquefolius )

  • Ginseng, Siberian ( Eleutherococcus senticosus )

  • Gingko ( Gingko biloba )

  • Grape seed ( Vitis vinifera )

  • Hibiscus ( Hibiscus sabdariffa )

  • Indian dooseberry ( Emblica officinalis )

  • Licorice ( Glycyrrhiza glabra , G. inflate , G. uralensis ) [ammonium glycyrrhizinate], [glabridin], [liquiritin]

  • Mangosteen ( Garcinia mangostana )

  • Oat ( Avena sativa )

  • Olive ( Olea europaea )

  • Pear ( Pyrus communis )

  • Sakura leaf ( Prunus serrulata )

  • Saxifrage ( Pimpinella saxifrage )

  • Soy ( Glycine soja , G. max )

  • Turmeric ( Curcuma longa )

  • White mulberry ( Morus alba )

  • White willow ( Salix alba )

  • Wild carrot ( Daucus carota )

  • Wormwood ( Artemisia absinthium )

  • Yellow dock ( Rumex crispus , R. obtusifolius )

Box 8.6
Skin firmers

  • Birch ( Betula alba )

  • Cinnamon ( Cinnamomum verum )

  • Flax ( Linum usitatissimum )

  • Ginger ( Zingiber officinale )

  • Gingko ( Gingko biloba )

  • Green tea ( Camellia sinensis )

  • Hops ( Humulus lupulus )

  • Horse chestnut ( Aesculus hippocastanum )

  • Meadowfoam ( Limnanthes alba )

  • Mountain rose ( Rosa canina )

  • Peppermint ( Mentha piperita )

  • Red sandalwood ( Pterocarpus santalinus )

  • Rosemary ( Rosmarinus officinalis )

  • Sage ( Salvia lavandula , S. lavandulifolia, S. fruticosa )

  • Spearmint ( Mentha spicata )

  • Witch hazel ( Hamamelis virginiana )

Box 8.7
UVL protection

  • Black tea ( Camellia sinensis )

  • Cocoa ( Theobroma cacao ): oral only

  • Feverfew ( Tanacetum parthenium )

  • Golden fern ( Polypodium leukotomos ): oral only

  • Grapeseed ( Vitis vinifera ) + oral

  • Green tea ( Camellia sinensis ) + oral

  • Kale ( Brassica oleracea )

  • Oat ( Avena sativa )

  • Olive ( Olea europaea )

  • Pomegranate ( Punica granatum ) + oral

  • Ringworm bush ( Cassia alata )

  • Spinach ( Spinacia oleracea )

  • Strawberry ( Fragaria )

  • Tamarind ( Tamarindus indica )

  • Tomato ( Solanum lycopersicum )

  • White sandalwood ( Santalum album )

  • Wild carrot ( Daucus carota )

Gingko biloba

Gingko biloba is the largest selling herb in the US with sales of nearly $150 million in 2012. Gingko is used traditionally to reverse manifestations of atopy as well as skin ulcers, chilblains, Raynaud's, venous insufficiency, decreased vascular perfusion and scabies. Clinical trials have proven the efficacy of gingko for use on peripheral vascular disease and Raynaud's. An open study suggested benefit in treating vitiligo.

Gingko contains rutin, quercetin and other flavonoids, proanthocyanidins, and terpenoids including gingkolides. These provide antioxidant and anti-inflammatory effects as well as vascular relaxation and tone, thus increasing blood flow. Gingko also modulates neurotransmitter and glucocorticoid synthesis. This herb is antimicrobial to yeast, Gram-positive bacteria and parasites ( ). Gingko cutaneous adverse reactions include generalized erythematous pustulosis and Stevens–Johnson syndrome as well as contact allergic reactions. It cross-reacts with Rhus species, mango, and cashew. This herb should be avoided in pregnancy ( , , ).

St John's wort

St John's wort ( Hypericum perforatum ) is the second largest selling herb with sales exceeding $100 million. It is a clinically proven wound healing agent due to its antistaphylococcal, anti-inflammatory, and T-lymphocyte stimulation activity. In folk medicine, St John's wort is also used to treat dermatitis, bites, burns, and vitiligo by oral and topical administration. A clinical trial documented its efficacy in wound healing.

This herb's primary effects are through its components hypericium, hyperforin and other neurotransmitter modulators. Other actives include flavonoids, such as quercitrin, and oligomeric procyanidins (OPCs), xanthones, acylphloroglucinols, volatile oils, caffeic acid derivatives, anthracenes including hypericin.

The major adverse reactions include death, Sjögren's syndrome, and radiation recall dermatitis and a high rate of phototoxicity. St John's wort should not be used in pregnancy ( , , , ).

Ginseng

The three species of ginseng produced annual sales of $84 million. The most potent is Siberian ginseng ( Eleutherococcus senticosus ); however, of the American varieties, Panax ginseng is more commonly used versus Panax quinquefolius . The main active components are steroidal saponins known as gingenosides, polysaccharides and polylenes. Lignans, coumarins, steroids and caffeic acids are only present in E. senticosus . These actives provide immune stimulating, anti-inflammatory, and glycation inhibition. This herb has antioxidant and antiviral activity. Oral Siberian ginseng effectively treated herpes simplex II, and hair growth was stimulated with topical ginseng in an open clinical trial.

Ginseng species have potential as treatments for photoaging. In vitro, Panax ginseng stimulated fibroblast type I collagen synthesis. Ginsenosides in vivo inhibited cyclooxygenase-2, nuclear factor kappa B, activating protein-1, and melanogenesis. Hyaluronan and epidermal growth factor synthesis were stimulated, as was matrix metalloproteinase I. It also promotes release of nitric oxide.

Cases of vaginal bleeding from a topical face cream have been rarely reported. Stevens–Johnson syndrome, anaphylaxis and death are very rare. Avoid in pregnancy ( , , ).

Garlic

Garlic ( Allium sativum ) ties for third place in sales with ginseng. This herb's activity is primarily due to allicin, the major alkylcysteine sulfoxide responsible for not only the therapeutic activity but also odor. Other components include polysaccharides, saponins and vitamins A, B 2 and C. It has potent antioxidant activity and stimulates immunity. Aged garlic appears promising in treating photoaging due to its inhibition of glycation end products ( ).

Garlic's antibacterial activity is against Gram-positive and Gram-negative bacteria with potency comparable to many prescription antibiotics. Its anti-yeast activity is comparable to nystatin while its activity against dermatophytes is superior to seven marketed antifungals and effectively treats tinea infections. Garlic inhibits six viruses including herpes simplex. It effectively treated warts in 2 weeks in one trial. Garlic also treated corns effectively.

Topically, garlic rarely induces dermatitis, bullae, ulcers and scars. Anaphylaxis, urticarial/angioedema are also reported. Avoid in pregnancy and lactation ( , , ).

Echinacea

This is the fifth largest selling herb with over $70 million in sales. Echinacea angustifolia was originally used by the Sioux Native Americans, not only for the treatment of snake bites and war wounds because of its antiseptic and analgesic properties, but also for insect bites, gonorrhea, measles, abscesses and ulcers. The other two American Echinacea species are E. purpurea and E. pallida .

E. purpurea contains the immunostimulating polysaccharides and glycoproteins, flavonoids, caffeic and ferulic acid derivatives, volatile oils, alkamides, polyenes, and pyrrolizidine alkaloids. E. pallida and E. angustifolia contain the same actives except glycoproteins and pyrrolizidine alkaloids.

These extracts have not shown immune boosting effects in healthy people. All three Echinacea species stimulate immunity, protect type III collagen, and have antioxidant activity. Thus, by protecting collagen from UV damage and blocking hyaluronidase, photoaging therapy is promising. These herbs are also cytotoxic to multiple bacteria, viruses and fungus.

E. purpurea is approved by the German Commission E for the treatment of stomatitis, wounds, and burns, and to treat and prevent infection. Research has further documented effectiveness in treating psoriasis, herpes simplex, and vaginal candidiasis.

Echinacea species have a nearly 10% rate of anaphylactic reactions with topical sensitization in atopic patients. About 7% of children given it orally develop an allergic rash. It is known to activate Sjögren's syndrome. These herbs cross-react with ragweed, chrysanthemums, marigolds and daisies. These herbs appear safe during pregnancy ( , , ).

Saw palmetto

Sales of this herb ( Serenoa repens ) is about $45 million. The major components of saw palmetto ( Serenoa repens ) include sterols, glucosides, flavonoids, volatile oils, free fatty acids, and polysaccharides. Thus it has documented anti-androgenic, anti-estrogenic, anti-inflammatory, anti-proliferative, and anti-exudative effects. It is a traditional remedy for dermatitis, mucositis, cancer and alopecia in folk medicine. This herb inhibits 5-alpha-reductase, TNF-alpha, interleukin-1 beta, lipoxygenase and cyclooxygenase-2. When used with two other herbs in an open clinical trial of 20 patients, a significant reduction in sebum production occurred with topical application. Combined with beta-sitosterol in an oral formulation, saw palmetto effectively treated androgenic alopecia. Avoid during pregnancy and lactation ( , ).

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here