Use of topical herbal remedies and cosmetics: a questionnaire-based investigation in dermatology out-patients

Background: Although topical remedies and cosmetics based on herbal ingredients are becoming increasingly popular with the public due to the perception that botanical compounds are safer and healthier than their synthetic counterparts, a large number of adverse cutaneous effects of plant extracts, notably contact sensitization, have been reported in medical literature. Objective: To evaluate the prevalence of herbal compound usage in a dermatological out-patient population and to estimate the incidence of consequent cutaneous side effects. Methods: 400 patients were subjected to a self-administered 15-item questionnaire to assess both prevalence and type of topical botanical preparations used and occurrence of skin adverse reactions. Results: 241 patients (60.25%) reported use of natural topical products, predominantly aloe, marigold, chamomile, propolis and arnica. Females used herbal products, for both medicinal and cosmetic purposes, more frequently than males. 15 patients (6.22%) referred one or more adverse cutaneous reactions. Conclusion: Herbal preparations were widely used in the examined population, but, despite the common belief in the innocuous nature of botanical extracts, the incidence of side effects referred by the patients confirms that they should be regarded as a potential source of adverse skin events. The lack of adequate patch testing in case of suspected contact allergic dermatitis, incomplete or misleading product labelling, and the risk of chemical adulteration may represent further concerns as regards application of botanical products.