866 Review Article DOI: 10.1111/j.1610-0387.2010.07472.

Which plant for which skin disease? Part 2:

Dermatophytes, chronic venous insufficiency,
photoprotection, actinic keratoses, vitiligo, hair loss,
cosmetic indications
Juliane Reuter1, Ute Wölfle1, Hans Christian Korting2, Christoph Schempp1
(1) Competence Center skintegral®, Department of Dermatology, University of Freiburg, Germany
(2) Department of Dermatology and Allergy, Ludwig Maximilian University of Munich, Germany

JDDG; 2010 • 8:866–873 Submitted: 15.4.2010 | Accepted: 10.5.2010

Keywords Summary
• actinic keratoses This paper continues our review of scientifically evaluated plant extracts in
• chronic venous insufficiency dermatology. After plants effective against dermatophytes, botanicals with
• polyphenolics anti-edema effects in chronic venous insufficiency are discussed. There is good
• randomized clinical trials evidence from randomized clinical studies that plant extracts from grape vine
leaves (Vitis vinifera), horse chestnut (Aesculus hippocastanum), sea pine (Pinus
maritima) and butcher’s broom (Ruscus aculeatus) can reduce edema
in chronic venous insufficiency. Plant extracts from witch hazel (Hamamelis
virginiana), green tea (Camellia sinensis), the fern Polypodium leucotomos and
others contain antioxidant polyphenolic compounds that may protect the skin
from sunburn and photoaging when administered topically or systemically.
Extracts from the garden spurge (Euphorbia peplus) and from birch bark (Betula
alba) have been shown to be effective in the treatment of actinic keratoses in
phase II studies. Some plant extracts have also been investigated in the treat-
ment of vitiligo, various forms of hair loss and pigmentation disorders, and in
aesthetic dermatology.

Introduction
In a first paper on scientific research on
the effects of plant extracts in dermatol-
ogy studies on atopic dermatitis, psoriasis,
acne and viral infections were discussed
[1]. Here we continue with a review on
plants in the treatment of dermatophytes,
chronic venous insufficiency, sunburn,
actinic keratoses, vitiligo, hair loss and
for cosmetic indications.
Dermatophytes
Tea tree (Melaleuca alternifolia)
The effects of a 25 % and 50 % tea tree
oil preparation for interdigital tinea pedis
was examined in a randomized, double-
blind study on 150 patients. The test
preparations were applied twice daily for
4 weeks with a subsequent 4-week fol-
low-up. With both concentrations the
mycological healing rate was more than
double that of the vehicle alone [2]
(LOE-A). Yet the question remains if
such high concentrations are clinically
relevant and if testing of lower concen-
trations might have been more sensible.
Mexican tomato (Solanum chrysotrichum)
A cream with an extract of the Mexican
tomato variety Solanum chrysotrichum
proved to be just as effective as a 2 %
ketoconazole preparation in the treat-
ment of tinea pedis in a randomized,
double-blind study [3] (LOE-A). De-
spite the fact that the study was per-
formed on over one hundred patients,
the lack of a vehicle control limits the
meaningfulness.
Eucalyptus (Eucalyptus pauciflora)
In an uncontrolled clinical study 1 %
essential oil with a high content of cineol
(Figure 1a) from Snow Gum in an oint-
ment base was applied twice daily over
three weeks for tinea pedis, cruris or cor-
poris in 50 patients. After only two
weeks no mycelia were observed in direct
microscopy in all patients. After three
weeks 60 % of the patients had healed
completely; the remaining 40 % dis-
played significant improvement of signs
and symptoms such as erythema, scaling,
pruritus, maceration, vesicles and pus-
tules. In a microscopically negative case a

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Which plant for which skin disease? Review Article 867

Figure 1: Chemical structure of secondary plant metabolites mentioned in the text.

© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin • JDDG • 1610-0379/2010/0811 JDDG | 11 ˙2010 (Band 8)
868 Review Article
Figure 1: Continued.
recurrence was observed after two
months (LOE-C).
Garlic (Allium sativum)
The biologically active ingredient of
garlic, ajoene (Figure 1b), also possesses
antifungal properties. In an uncontrolled
clinical trial on 34 patients with tinea
pedis after a therapy duration of 7 days
with a 0.4 % ajoene cream complete
clinical and mycological healing was
achieved in 79 % of the cases. The
remaining 21 % healed completely after
7 further days of treatment. In a follow-
up after 90 days all cases were negative in
the direct microscopic examination [5]
(LOE-C).
Chronic venous insufficiency
In the treatment of chronic venous insuf-
ficiency (CVI) phytotherapeuticals can
reduce edema and inflammation, possess
antioxidative and proteolytic effects and
are capable of reducing capillary perme-
ability. Further they increase venous
vessel tonus and improve lymphatic
drainage. A review of botanical venous
therapeuticals, their mechanisms of
action and clinical studies are found in
Reich et al. [6]. Oral phytotherapeuticals
for the venous system are particularly
employed when compression therapy is
contraindicated.
Grape vine (Vitis vinifera)
Red grape vine leaves contain various
flavonoids with the main representatives
being quercetin-3-O-beta-glucuronide
and quercetin-3-O-beta-glucoside. In
a 12-week randomized, double-blind,
placebo-controlled parallel group study
efficacy and safety of orally administered
red grape vine leaf extract at doses of 360
and 720 mg once daily were evaluated on
JDDG | 11 ˙2010 (Band 8)
260 patients with CVI stage I or II. Both
dosages reduced lower leg edema and
lower leg circumference to a similar degree
as compression stockings [7] (LOE-A).
Horse chestnut (Aesculus hippocastanum)
The extract of horse chestnut contains
primarily aescine, a complex of biologi-
cally active triterpenoid saponins which
is traditionally used in the therapy of
CVI. The effectiveness of horse chestnut
extract (HCE) was demonstrated in vari-
ous clinical studies [8]. It is assumed the
good effectiveness of HCE is based on an
inhibition of catalytic degradation of
proteoglycans in the capillary walls. In a
randomized, placebo-controlled, par-
tially blinded parallel group study
240 patients were treated for 12 weeks
either with compression stockings or
2 ⫻ 50 mg HCE daily. After 12 weeks
lower leg volume declined with HCE to
the same extent as with compression
therapy (44 and 46 ml), while it in-
creased by 10 ml in the placebo group
[9] (LOE-A).
Sea pine (Pinus maritima)
An extract from the bark of the sea pine
known as pycnogenol contains over 80 %
oligomeric proanthocyanidines with
antioxidative properties. Pycnogenol was
studied in an 8-week randomized,
placebo-controlled trial on 21 CVI
patients and 18 control patients. Pyc-
nogenol was administered orally in a
dose of 50 mg daily. In comparison to
the placebo group there was a noticeable
reduction of edema with pycnogenol
[10] (LOE-A). In a randomized compar-
ative study on 40 CVI patients the effi-
cacy of 360 mg pycnogenol daily was
compared to that of 600 mg horse chest-
nut extract daily over a time period of
© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin • JDDG • 1610-0379/2010/0811
Which plant for which skin disease?
4 weeks. Pycnogenol was superior to horse
chestnut extract with respect to the reduc-
tion of lower leg edema [11] (LOE-B).
Butcher’s broom (Ruscus aculeatus)
Butcher’s broom extract contains as main
active ingredient a mixture of several
steroid saponins and is used systemically
in the treatment of lower leg edema
within the context of CVI. A random-
ized, placebo-controlled, multicenter
double-blind study on 166 female CVI
patients demonstrated superiority of
butcher’s broom extract in comparison
to placebo after a treatment period of
3 months [12] (LOE-A).
Buckwheat (Fagopyrum esculentum)
Buckwheat herb is rich in antioxidative
flavonoids, especially rutin. A brew from
this plant containing flavonoids served as
tea over a time period of 3 months
showed a greater reduction of lower leg
edema compared to the placebo group in
a randomized, placebo-controlled, dou-
ble-blind study on 67 CVI patients [13]
(LOE-A).
Japanese pagoda tree (Styphnolobium
japonicum)
This plant extract, too, is rich in the
flavonoid rutin. In an open study on
50 CVI patients it was shown that rutin
reduces the extent of microangiopathy,
increases the capillary filtration rate
and counteracts the development of
edema [14] (LOE-B). In a randomized,
placebo-controlled, multicenter, double-
blind study the efficacy of oxerutin was
evaluated on 12 female patients with
CVI stage II. The patients received 1 g
oxerutin or placebo daily over 12 weeks.
Oxerutin treatment in combination with
compression therapy was superior to
Which plant for which skin disease?
compression therapy alone with respect
to edema reduction. Further, the thera-
peutic effects of oxerutin persisted even
after discontinuation of therapy [15]
(LOE-A).
Photoprotection and actinic keratoses
Numerous plant extracts contain antiox-
idative polyphenols (flavonoids and cate-
chins) or carotinoids that can be used
topically as well as systematically to help
protect the skin from sunburn, prema-
ture aging and perhaps from the devel-
opment of non-melanoma skin cancer.
With few exceptions clinical studies on
this subject are preliminary, so that a
larger number of randomized studies are
needed to better support the photopro-
tective effects of specific plant extracts.
Photoprotection
Witch hazel (Hamamelis virginiana)
A topical preparation with 10 %
hamamelis distillate demonstrated anti-
inflammatory effects in a UV erythema
test significantly superior to vehicle in a
randomized, vehicle-controlled, double-
blind study on 41 subjects. The effects
were, however, weaker than 1 % hydro-
cortisone [16] (LOE-A).
Green tea (Camellia sinensis)
Unfermented green tea extract contains
large amounts of oligomeric catechin tan-
ning agents such as catechin (Figure 1c),
epicatechin and epigallocatechin gallate
(Figure 1d). These are potent antioxi-
dants with photoprotective properties.
They reduce UV-induced oxidative stress
and inhibit various cytokines involved in
the induction of skin cancer [17] (LOE-D).
The in vivo demonstration of cancer-
protecting effects in clinical studies is
still lacking. Nevertheless, various clini-
cal studies show that green tea extract in
both topical and oral use can prevent UV-
induced inflammation [18] (LOE-A).
Sage (Salvia officinalis)
The leaves of this plant have a high
content of antioxidative phenolic diter-
penes such as carnosol and carnosic acid
(Figure 1e). In a randomized, placebo-
controlled, double-blind study topical
use of a cream with 2 % sage extract in
40 trial subjects demonstrated a stronger
inhibition of UV-induced erythema in
comparison to vehicle alone, comparable
to that of 1 % hydrocortisone [19]
(LOE-A).
© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin • JDDG • 1610-0379/2010/0811
Golden serpent fern
(Polypodium leucotomos)
An aqueous extract of this fern rich in
polyphenols used in nutritional supple-
ments as well as sun protection products
was studied in several in vitro and in vivo
trials. In an open pilot study with
healthy trial subjects systemic (n = 8) and
topical (n = 5) use of golden serpent fern
extract reduced PUVA erythema and the
psoralen-induced phototoxic skin reac-
tion [20] (LOE-B). In a further non-ran-
domized study with systemically admin-
istered golden serpent fern extract
protection from UV-induced erythema
was shown clinically and histologically in
9 test subjects [21] (LOE-B).
Yellow weed (Reseda luteola)
Yellow weed, used in the past to dye
textiles, has a high content of luteolin
(Figure 1f ). In recent years pronounced
antioxidative, antiinflammatory and
anticarcinogenic properties have been
demonstrated for luteolin in vitro and in
animal models [22, 23]. In a placebo-
controlled, randomized, double-blind
study with 40 subjects a luteolin-rich
extract of Reseda luteola inhibited UV-
induced erythema in a dose-dependent
fashion to a similar extent as 1 % hydro-
cortisone and significantly more than
vehicle [24] (LOE-A).
Cocoa (Theobroma cacao)
Cocoa powder derived from the seed of
the cocoa tree contains the catechin
mixture flavonol with the main
monomers catechin and epicatechin
(Figure 1c). In a randomized, compara-
tive, double-blind study 24 female test
subjects consumed cocoa powder, which
was either rich or poor in flavonol,
dissolved in water, over a time period of
12 weeks. It was observed that the
flavonol-rich cocoa powder significantly
reduced UVB-induced erythema. In the
group receiving flavonol-poor cocoa
powder no effect on UVB-induced
erythema was seen. Consumption of
flavonol-rich cocoa powder also led to
increased skin circulation, skin firmness
and skin moisture [25] (LOE-A).
Carotenoids
The carotenoids ␤-carotene (Figure 1g)
and lycopene (Figure 1h) can as nutri-
tional supplements used regularly result
in a moderate inhibition of UV-induced
erythema. In a randomized, placebo-
Review Article 869
controlled parallel group study 36 trial
subjects received either ␤-carotene, a
carotenoid mixture or placebo orally
over a time period of 12 weeks. Skin ery-
thema was measured directly before and
6 and 12 weeks after the start of the study.
The carotenoid mixture was equally effec-
tive as 24 mg ␤-carotene alone after
12 weeks of administration [26] (LOE-A).
A further study performed over 12 weeks
showed similar results for lycopene with
maximum erythema inhibition in the
12th week of the study [27] (LOE-A).
Actinic keratoses
Garden spurge (Euphorbia peplus)
Garden spurge contains the toxic diter-
pene ester ingenol mebutate (Figure 1i).
A randomized, double-blind, vehicle-
controlled multicenter study with
200 patients evaluated safety, tolerability
and efficacy of an ingenol mebutate gel
for actinic keratoses outside of the face
over an 8-week time period. Here a
0.025 % or 0.5 % ingenol mebutate gel
or placebo was applied once daily for
three days. Both concentrations were
highly effective with a mean healing rate
of the actinic keratoses of 75 % and
100 % as opposed to 0 % in the placebo
group. First a localized necrosis of the
skin developed followed by transient in-
flammation with subsequent crusting of
the treated skin area. Scarring was not
observed after healing [28] (LOE-A).
These results were confirmed in another
randomized, double-blind, vehicle-con-
trolled multicenter phase II study [29]
(LOE-A).
Birch (Betula alba)
A triterpene extract of the outer birch
bark with over 80 % betulin (Figure 1k)
[30] proved to be equally effective as
cryotherapy in the treatment of actinic
keratoses in a non-randomized [31] and
in a randomized study [32] (LOE-B).
Histological and experimental studies
suggest a differentiation-promoting ef-
fect as the main mechanism of action of
betulin in actinic keratoses [33]. Further
randomized clinical trials in comparison
to placebo with histological grading are
required to confirm the high response
rate of the lesions of about 80 %.
Vitiligo
In a detailed review of natural products
the overall poor quality of studies on the
therapy of vitiligo with plant extracts was
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870 Review Article Which plant for which skin disease?

criticized [34]. Here three meaningful

studies will be examined.

Golden serpent fern

(Polypodium leucotomos)
In a randomized, double-blind and
placebo-controlled study with 50 vitiligo
patients over a therapy period of 25 weeks
it was shown that the combination of
250 mg golden serpent fern extract
administered orally twice daily with nar-
row-band UVB (311 nm) phototherapy
twice weekly significantly improved
repigmentation of the neck and hands in
comparison to placebo [35] (LOE-A).

Ginkgo (Ginkgo biloba)

In a randomized, placebo-controlled,
double-blind study with 52 vitiligo
patients 40 mg of ginkgo extract was
administered orally three times daily in
the form of capsules over a time period
of 6 months. In the verum group, but
not with placebo, the progression of the
disease was inhibited. Ten patients treated
with ginkgo displayed complete repig-
mentation as opposed to two patients of
the placebo group. Antioxidative and
immunomodulatory properties of ginkgo
are discussed as mechanism of action
[36] (LOE-A).
Xiaobai mixture
Xiaobai mixture of traditional Chinese
medicine is composed of 30 g walnut,
10 g red flowers, 30 g black sesame, 30 g
black beans, 10 g Zhi Bei Fu Ping (duck-
weed), 10 g Lu Lu Tong (sweetgum fruit,
Liquidambaris fructus) and 5 plums. In a
randomized, controlled study 74 vitiligo
patients treated over a therapy time pe-
riod of 3 months with 160 ml brew of
the xiaobai mixture once daily or with
PUVA. The therapeutic effect was better
in the xiaobai mixture group than in the
PUVA group [37] (LOE-B).
Alopecia areata and adrogenetic
alopecia
Onion (Allium cepa)
Fresh onion juice, which contains nu-
merous compounds containing sulfur
was evaluated in a single-blind, placebo-
controlled clinical study on 62 patients
with localized alopecia areata. Here fresh
onion juice as opposed to tap water was
applied twice daily for 2 months to the
affected skin areas. Even though only
23 patients of the onion group and
15 patients of the tap water group com-
Figure 2: “Natural anti-wrinkle cream”. Cartoon by Matthias Emde (Frankfurt a. M.).
pleted the study significantly better re-
sults with respect to renewed hair growth
were observed for the use of onion ex-
tract in comparison to tap water [38]
(LOE-B).
Saw palmetto (Serenoa repens)
The extract of the fruit of the saw pal-
metto has a high content of phytosterols
such as ␤-sitosterol or phytosterol glyco-
sides that inhibit the enzyme 5␣-reduc-
tase (5AR). In a randomized, placebo-
controlled, double-blind study with
26 patients the efficacy of an orally
administered combination of 200 mg
saw palmetto fruit extract with 50 mg
␤-sitosterol twice daily in the treatment
of androgenetic alopecia was evaluated.
After an observation period of 5 months
60 % of patients in the verum group were
classified as improved as opposed to
11 % in the placebo group [39] (LOE-A).
Eclipta (Eclipta alba)
An extract of this plant has traditionally
been used to stimulate hair growth. In a
minoxidil-validated, placebo-controlled
animal study a methanol extract of the
entire plant showed a dose-dependent
effect on hair growth in form of an
increase in hair thickness and in the
number of hair follicles [40] (LOE-D).
These results must be re-examined in
humans.
Aesthetic dermatology
Cosmetic-aesthetic dermatology is also
increasingly using plant extracts for the
treatment of wrinkles, cellulite, hyper-
pigmentation or improvement of scars.
Yet, the number of high-quality clinical
studies is still limited in this field.
Agents against wrinkles
and anti-aging agents
The market for agents against wrinkles
and anti-aging agents is booming and
the number of creams, sera and nutri-
tional supplements promising effects in
this segment of the market can hardly be
kept in view (Figure 2). Unfortunately
the number and quality of studies com-
patible with the criteria of evidence-
based cosmetics [41] which would be
particularly needed here is quite low.
Horse chestnut (Aesculus hippocastanum)
In a non-randomized study on 40 women
a gel with 3 % horse chestnut extract,
which was applied three times daily to
the periocular region was tested. The
contralateral side remained untreated.

JDDG | 11 ˙2010 (Band 8) © The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin • JDDG • 1610-0379/2010/0811
Which plant for which skin disease?
Using a photoscore after 9 weeks a stronger
reduction of wrinkles in comparison to
the untreated side was observed [42]
(LOE-B).
Date palm (Phoenix dactylifera)
A cream with a 5 % extract of date palm
kernels containing phytohormones was
studied in a vehicle-controlled half-side
study on 10 women twice daily in the
periocular region over a time period of
5 weeks. On the basis of impressions on
a silicone mold and photographic docu-
mentation the test preparation reduced
the extent and depth of wrinkles better
than the vehicle [43] (LOE-B).
Indian pennywort (Centella asiatica)
The main active ingredient of Indian
pennywort leaves is asiaticoside (Figure 1l).
In a half-side comparison study 27 women
treated periocular wrinkles twice daily
over a time period of 12 weeks on one
side with a cream containing asiaticoside
and the other side with vehicle. On the
basis of a silicone impression mold a
stronger reduction of “crow’s feet” was
seen with the asiaticoside cream [44]
(LOE-B).
Striae gravidarum and cellulite
Indian pennywort (Centella asiatica)
A cream with an extract of Indian penny-
wort, tocopherol and a collagen-elastin
hydrolysate was employed in a random-
ized, vehicle-controlled, double-blind
study on 80 pregnant women from early
pregnancy until delivery. Superiority of
the test preparation over placebo with re-
spect to the number and severity of striae
developed was found. In women who
already had striae in puberty the preven-
tive effect was greatest [45] (LOE-A).
Licorice (Glycyrrhiza glabra)
The steroid saponin glycyrrhetinic acid
(Figure 1m) is the main active ingredient
of licorice extract. A randomized, two-
arm double-blind study with 18 women
studied the efficacy of a cream contain-
ing 2.5 % glycyrrhetinic acid on subcu-
taneous fat of the thigh. After four weeks
of twice daily application a significant re-
duction of thigh circumference in com-
parison to the contralateral untreated
side and to the placebo group was ob-
served [46] (LOE-A). The authors con-
cluded that glycyrrhetinic acid was able
to reduce subcutaneous fat deposits. As
mechanism of action it was discussed
© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin • JDDG • 1610-0379/2010/0811
that cortisol biosynthesis is reduced lo-
cally by the interaction of glycyrrhetinic
acid with 11-hydroxysteroid dehydroge-
nase thus inhibiting adipocyte formation
and growth maturation.
Hyperpigmentation and melasma
Soybean (Glycine maxima)
In the extract of soybean are found
among others serine protease inhibitors
which are attributed a skin-lightening
potential. In a double-blind, placebo-
controlled study 65 women used a mois-
turizing cream containing soya protease
inhibitors over a time period of
12 weeks. Signs of photoaging such as
pigmentation, lentigines and reduced
skin tone were examined as parameters.
After 12 weeks the soy cream was supe-
rior to vehicle alone in terms of all stud-
ied parameters [47] (LOE-A).
Sea pine (Pinus maritimus)
Pycnogenol, a standardized polyphenolic
extract of the bark of sea pine, is a potent
antioxidant. In an non-controlled clini-
cal study 30 women with melasma were
administered one tablet containing 25 mg
pycogenol each three times daily over a
time period of one month. A reduction
of pigmentation and the surface area of
melasma was observed in 80 % of the
women [48] (LOE-B).
Licorice (Glycyrrhiza glabra)
Lipophilic glabridin found in licorice
roots (Figure 1n) demonstrated an inhibi-
tion of tyrosine kinase and thus melano-
genesis on melanocytes and in animal
models. Application of a topical prepara-
tion with 0.5 % glabridin on guinea pig
skin has an inhibitory effect on UVB-in-
duced pigmentation [49] (LOE-D).
Improvement of scars
Onion (Allium cepa)
Effects on scar formation of an onion ex-
tract were examined in a randomized,
placebo-controlled study on 59 patients
following a surgical procedure. It was
shown that after three weeks healing
time the subsequent use of an onion ex-
tract over 10 weeks improved redness,
softness, texture and the general appear-
ance of the scar in comparison to vehicle
alone [50] (LOE-A).
Acknowledgments
The Competence Center skintegral® is
supported by the Software AG Stiftung,
Review Article 871
Darmstadt, Germany, Zukunftsstiftung,
Gesundheit Bochum, Germany, Dr.
Hauschka Stiftung and WALA Com-
pany, Bad Boll, Germany.
Conflicts of interest
H.C. Korting cooperates with the firm
Creaderm, Hannover, Germany, in
the development of cosmetics. C.M.
Schempp is participating in the registra-
tion of a patent on Reseda (PCT WO
2004/075816 A2) and has conducted
studies for the firm Birken, Niefern-
Öschelbronn, Germany. <<<
Correspondence to
Prof. Dr. Dipl. Biol. Christoph M. Schempp
Competence Center skintegral®
Department of Dermatology
University of Freiburg
Hauptstraße 7
D-79104 Freiburg, Germany
Tel.: +49-761-2706-701
Fax: +49-761-2706-829
E-mail: christoph.schempp@uniklinik-
freiburg.de
References
1 Reuter J, Wölfle U, Weckesser S,
Schempp CM. Which plant for which
skin disease? Part 1: Atopic dermatitis,
psoriasis, acne, condyloma and herpes
simplex. J Dtsch Dermatol Ges
2010; DOI: 10.1111/j.1610-0387.2010.
07496.x
2 Satchell AC, Saurajen A, Bell C,
Barnetson RS. Treatment of interdigital
tinea pedis with 25 % and 50 % tea tree
oil solution: a randomized, placebo-
controlled, blinded study. Australas J
Dermatol. 2002; 43: 175–8.
3 Herrera-Arellano A, Rodriguez-Soberanes
A, de los Angeles Martinez-Rivera M,
Martinez-Cruz E, Zamilpa A, Alvarez
L, Tortoriello J. Effectiveness and
tolerability of a standardized phytodrug
derived from Solanum chrysotrichum on
Tinea pedis: a controlled and randomi-
zed clinical trial. Planta Med 2003; 69:
390–5.
4 Shahi SK, Shukla AC, Bajaj AK,
Banerjee U, Rimek D, Midgely G,
Dikshit A. Broad spectrum herbal
therapy against superficial fungal
infections. Skin Pharmacol Appl Skin
Physiol 2000; 13: 60–4.
5 Ledezma E, DeSousa L, Jorquera A,
Sanchez J, Lander A, Rodriguez E,
JDDG | 11 ˙2010 (Band 8)
872 Review Article
Jain MK, Apitz-Castro R. Efficacy of
ajoene, an organosulphur derived from
garlic, in the short-term therapy of
tinea pedis. Mycoses 1996; 39: 393–5.
6 Reich S, Altmeyer P, Stücker M. Evi-
denzbasierte Daten zur Wirksamkeit
der Pharmakotherapie bei chronisch-
venöser Insuffizienz. Vasomed 2007;
19: 79–83.
7 Kiesewetter H, Koscielny J, Kalus U,
Vix JM, Peil H, Petrini O, van Toor BS,
de Mey C. Efficacy of orally admini-
stered extract of red vine leaf AS 195
(folia vitis viniferae) in chronic venous
insufficiency (stages I–II). A randomi-
zed, double-blind, placebo-controlled
trial. Arzneimittelforschung 2000; 50:
109–17.
8 Suter A, Bommer S, Rechner J. Treat-
ment of patients with venous insuffi-
ciency with fresh plant horse chestnut
seed extract: a review of 5 clinical stu-
dies. Adv Ther 2006; 23: 179–90.
9 Diehm C, Trampisch HJ, Lange S,
Schmidt C. Comparison of leg com-
pression stocking and oral horse-chest-
nut seed extract therapy in patients
with chronic venous insufficiency.
Lancet 1996; 347: 292–4.
10 Cesarone MR, Belcaro G, Rohdewald
P, Pellegrini L, Ledda A, Vinciguerra G,
Ricci A, Gizzi G, Ippolito E, Fano F,
Dugall M, Acerbi G, Cacchio M, Di
Renzo A, Hosoi M, Stuard S, Corsi M.
Rapid relief of signs/symptoms in
chronic venous microangiopathy with
pycnogenol: a prospective, controlled
study. Angiology 2006; 57: 569–76.
11 Koch R. Comparative study of venosta-
sin and pycnogenol in chronic venous
insufficiency. Phytother Res 2002; 16
Suppl 1: S1–5.
12 Vanscheidt W, Jost V, Wolna P, Lucker
PW, Muller A, Theurer C, Patz B,
Grutzner KI. Efficacy and safety of a
Butcher’s broom preparation (Ruscus
aculeatus L. extract) compared to pla-
cebo in patients suffering from chronic
venous insufficiency. Arzneimittelfor-
schung 2002; 52: 243–50.
13 Ihme N, Kiesewetter H, Jung F,
Hoffmann KH, Birk A, Muller A,
Grutzner KI. Leg oedema protection
from a buckwheat herb tea in patients
with chronic venous insufficiency: a
single-centre, randomised, double-
blind, placebo-controlled clinical trial.
Eur J Clin Pharmacol 1996; 50: 443–7.
14 Cesarone MR, Belcaro G, Ricci A,
Brandolini R, Pellegrini L, Dugall M,
JDDG | 11 ˙2010 (Band 8)
Di Renzo A, Vinciguerra G, Gizzi G,
Cornelli U, Errichi BM, Corsi M,
Ippolito E, Adovasio R, Cacchio M,
Stuard S, Larnier C, Candiani C,
Cerritelli F. Prevention of edema and
flight microangiopathy with Venoruton
(HR), (0-[beta-hydroxyethyl]-rutosides)
in patients with varicose veins. Angio-
logy 2005; 56: 289–93.
15 Großmann K. Vergleich der Wirksam-
keit einer kombinierten Therapie mit
Kompressionsstrümpfen und Oxerutin
(Venoruton®) versus Kompressions-
strümpfen und Placebo bei Patienten
mit CVI. Phlebologie 1997; 26:
105–10.
16 Hughes-Formella BJ, Filbry A,
Gassmueller J, Rippke F. Anti-inflam-
matory efficacy of topical preparations
with 10 % hamamelis distillate in a UV
erythema test. Skin Pharmacol Appl
Skin Physiol 2002; 15: 125–32.
17 Camouse MM, Hanneman KK,
Conrad EP, Baron ED. Protective
effects of tea polyphenols and caffeine.
Expert Rev Anticancer Ther 2005; 5:
1061–8.
18 Katiyar SK. Silymarin and skin cancer
prevention: anti-inflammatory, antioxi-
dant and immunomodulatory effects
(Review). Int J Oncol 2005; 26: 169–76.
19 Reuter J, Jocher A, Hornstein S,
Monting JS, Schempp CM. Sage
extract rich in phenolic diterpenes
inhibits ultraviolet-induced erythema
in vivo. Planta Med 2007; 73: 1190–1.
20 Gonzalez S, Pathak MA, Cuevas J,
Villarrubia VG, Fitzpatrick TB. Topical
or oral administration with an extract
of Polypodium leucotomos prevents acute
sunburn and psoralen-induced photo-
toxic reactions as well as depletion of
Langerhans cells in human skin. Pho-
todermatol Photoimmunol Photomed
1997; 13: 50–60.
21 Middelkamp-Hup MA, Pathak MA,
Parrado C, Goukassian D, Rius-Diaz F,
Mihm MC, Fitzpatrick TB, Gonzalez
S. Oral Polypodium leucotomos extract
decreases ultraviolet-induced damage
of human skin. J Am Acad Dermatol
2004; 51: 910–8.
22 Seelinger G, Merfort I, Schempp CM.
Anti-oxidant, anti-inflammatory and
anti-allergic activities of luteolin. Planta
Med 2008; 74: 1667–77.
23 Seelinger G, Merfort I, Wolfle U,
Schempp CM. Anti-carcinogenic
effects of the flavonoid luteolin. Mole-
cules 2008; 13: 2628–51.
© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin • JDDG • 1610-0379/2010/0811
Which plant for which skin disease?
24 Casetti F, Jung W, Wolfle U, Reuter J,
Neumann K, Gilb B, Wahling A,
Wagner S, Merfort I, Schempp CM.
Topical application of solubilized
Reseda luteola extract reduces ultraviolet
B-induced inflammation in vivo.
J Photochem Photobiol B 2009; 96:
260–5.
25 Heinrich U, Neukam K, Tronnier H,
Sies H, Stahl W. Long-term ingestion
of high flavanol cocoa provides
photoprotection against UV-induced
erythema and improves skin condition
in women. J Nutr 2006; 136: 1565–9.
26 Heinrich U, Gartner C, Wiebusch M,
Eichler O, Sies H, Tronnier H, Stahl
W. Supplementation with beta-
carotene or a similar amount of mixed
carotenoids protects humans from
UV-induced erythema. J Nutr 2003;
133: 98–101.
27 Aust O, Stahl W, Sies H, Tronnier H,
Heinrich U. Supplementation with
tomato-based products increases lyco-
pene, phytofluene, and phytoene levels
in human serum and protects against
UV-light-induced erythema. Int J
Vitam Nutr Res 2005; 75: 54–60.
28 Anderson L, Schmieder GJ, Werschler
WP, Tschen EH, Ling MR, Stough DB,
Katsamas J. Randomized, double-blind,
double-dummy, vehicle-controlled study
of ingenol mebutate gel 0.025 % and
0.05 % for actinic keratosis. J Am Acad
Dermatol 2009; 60: 934–43.
29 Siller G, Gebauer K, Welburn P,
Katsamas J, Ogbourne SM. PEP005
(ingenol mebutate) gel, a novel agent
for the treatment of actinic keratosis:
results of a randomized, double-blind,
vehicle-controlled, multicentre, phase
IIa study. Australas J Dermatol 2009;
50: 16–22.
30 Laszczyk M, Jager S, Simon-Haarhaus
B, Scheffler A, Schempp CM. Physical,
chemical and pharmacological charac-
terization of a new oleogel-forming
triterpene extract from the outer bark
of birch (betulae cortex). Planta Med
2006; 72: 1389–95.
31 Huyke C, Laszczyk M, Scheffler A,
Ernst R, Schempp CM. Treatment of
actinic keratoses with birch bark ex-
tract: a pilot study. J Dtsch Dermatol
Ges 2006; 4: 132–6.
32 Huyke C, Reuter J, Rodig M, Kersten
A, Laszczyk M, Scheffler A, Nashan D,
Schempp C. Treatment of actinic
keratoses with a novel betulin-based
oleogel. A prospective, randomized,
Which plant for which skin disease? Review Article 873

comparative pilot study. J Dtsch Der-
matol Ges 2009; 7: 128–33.
33 Woelfle U, Laszczyk MN, Kraus M,
Leuner K, Kersten A, Simon-Haarhaus
B, Scheffler A, Martin SF, Muller WE,
Nashan D, Schempp CM. Triterpenes
promote keratinocyte differentiation in
vitro, ex vivo and in vivo: a role for the
transient receptor potential canonical
(subtype) 6. J Invest Dermatol 2010;
130: 113–23.
34 Szczurko O, Boon HS. A systematic
review of natural health product treat-
ment for vitiligo. BMC Dermatol
2008; 8: 2.
35 Middelkamp-Hup MA, Bos JD,
Rius-Diaz F, Gonzalez S, Westerhof W.
Treatment of vitiligo vulgaris with
narrow-band UVB and oral Polypo-
dium leucotomos extract: a randomized
double-blind placebo-controlled study.
J Eur Acad Dermatol Venereol 2007;
21: 942–50.
36 Parsad D, Pandhi R, Juneja A. Effec-
tiveness of oral Ginkgo biloba in trea-
ting limited, slowly spreading vitiligo.
Clin Exp Dermatol 2003; 28: 285–7.
37 Liu ZJ, Xiang YP. [Clinical observation
on treatment of vitiligo with xiaobai
mixture] Zhongguo Zhong Xi Yi Jie He
Za Zhi 2003; 23: 596–8.
38 Sharquie KE, Al-Obaidi HK. Onion
juice (Allium cepa L.), a new topical
treatment for alopecia areata. J Derma-
tol 2002; 29: 343–6.
39 Prager N, Bickett K, French N, Marcovici
G. A randomized, double-blind, placebo-
controlled trial to determine the effec-
tiveness of botanically derived inhibitors
of 5-alpha-reductase in the treatment of
androgenetic alopecia. J Altern Comple-
ment Med 2002; 8: 143–52.
40 Datta K, Singh AT, Mukherjee A, Bhat
B, Ramesh B, Burman AC. Eclipta alba
extract with potential for hair growth
promoting activity. J Ethnopharmacol
2009; 124: 450–6.
41 Pavicic T, Steckmeier S, Kerscher M,
Korting HC. Evidence-based cosmetics:
concepts and applications in photoa-
ging of the skin and xerosis. Wien Klin
Wochenschr 2009; 121: 431–39.
42 Fujimura T, Tsukahara K, Moriwaki S,
Hotta M, Kitahara T, Takema Y. A
horse chestnut extract, which induces
contraction forces in fibroblasts, is a
potent anti-aging ingredient. Int J
Cosmet Sci 2007; 29: 140.
43 Bauza E, Dal Farra C, Berghi A, Oberto
G, Peyronel D, Domloge N. Date palm
kernel extract exhibits antiaging pro-
perties and significantly reduces skin
wrinkles. Int J Tissue React 2002; 24:
131–6.
44 Lee J, Jung E, Lee H, Seo Y, Koh J, Park
D. Evaluation of the effects of a
preparation containing asiaticoside on
periocular wrinkles of human volun-
teers. Int J Cosmet Sci 2008; 30:
167–73.
45 Mallol J, Belda MA, Costa D, Noval A,
Sola M. Prophylaxis of Striae gravi-
darum with a topical formulation. A
double blind trial. Int J Cosmet Sci
1991; 13: 51–7.
46 Armanini D, Nacamulli D, Francini-
Pesenti F, Battagin G, Ragazzi E, Fiore
C. Glycyrrhetinic acid, the active
principle of licorice, can reduce the
thickness of subcutaneous thigh fat
through topical application. Steroids
2005; 70: 538–42.
47 Wallo W, Nebus J, Leyden JJ. Efficacy
of a soy moisturizer in photoaging:
a double-blind, vehicle-controlled,
12-week study. J Drugs Dermatol
2007; 6: 917–22.
48 Ni Z, Mu Y, Gulati O. Treatment of
melasma with Pycnogenol. Phytother
Res 2002; 16: 567–71.
49 Yokota T, Nishio H, Kubota Y,
Mizoguchi M. The inhibitory effect of
glabridin from licorice extracts on
melanogenesis and inflammation. Pig-
ment Cell Res 1998; 11: 355–61.
50 Draelos ZD. The ability of onion extract
gel to improve the cosmetic appearance
of postsurgical scars. J Cosmet Derma-
tol 2008; 7: 101–4.

© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin • JDDG • 1610-0379/2010/0811 JDDG | 11 ˙2010 (Band 8)