Evidence based integrative medicine

Integrative approaches have played an essential role in the treatment of dermatological diseases since a long time. Many current standard treatments can be considered integrative such as phototherapy, climate therapy (such as staying at high altitude or at the sea), special training on how to handle a disease, special diets and psychological approaches. Furthermore the amount of well-controlled studies on complementary medicine in the treatment of dermatological disorders has increased within the last years. Besides different therapies derive from natural remedies, such as fumaric acid or psoralene (used e.g. in the treatment of psoriasis).

An example reflecting the integrative approach in dermatology is the treatment of atopic eczema—an inflammatory, chronically relapsing, non-contagious and pruritic skin disease.

Amongst others it consists in rehydration, anti-inflammation, antisepsis, avoidance of trigger factors and anti-pruritic strategies. The large number of emollients currently used includes many naturally derived topical agents. Anti-inflammatory standard treatment with corticosteroids and calcineurin-inhibitors is complemented by e.g. phototherapy or topical usage of e.g. soaked black tea pads as further treatment options. In case of antimicrobial treatment a variety of natural agents such as tea tree oil, lemongrass and cinnamon oil proved a strong anti-bacterial effect. Due to their potency to induce contact allergies they are, however, not recommended; neither are antibiotics. Non-irritating antiseptics are the agents of choice.

Avoidance of triggering factors includes amongst others staying at high altitude or at the sea as well as special diets and avoidance of allergens. Antipruritic treatment includes topical therapies with anesthetics and corticosteroids as well as cold showers.

Within the last years some promising new approaches have evolved, which have to further be evaluated regarding its clinical effect on atopic eczema: Recent experimental studies have e.g. shown an effect of acupuncture on histamine- and allergen-induced itch and an influence of allergen-induced basophil activation. Sangre de grado, an Amazonian medicinal, showed to be a potent antimicrobial, anti-inflammatory and inhibitor of sensory afferent nerve mechanisms.

Future studies will have to further focus on the role of integrative medicine in dermatology.