Eczema product review: TOPICMedis Calming Lotion (traditional Chinese herbal)

My take on traditional Chinese medicine (TCM), of the herbal variety, is that the theory is bullshit. Yin/yang? The "five elements" being wood, fire, earth, metal, and water? "Energy meridians"? Medieval thinking.

Herbal medicine, though, is a major foundation of modern pharmacy. TCM herbs contain molecules that are biologically active--what Western medicine would call drugs.

This is why I doubt that the TCM practice of dosing with several (sometimes nine or ten) herbs in combination is a good idea. The potential for side effects and drug interactions is too high.

I acknowledge that empirical, practical knowledge is a powerful way to solve problems, and that TCM could work for certain conditions in the right circumstances. You would need to have a very experienced TCM practitioner treating a patient for a condition that the expert was familiar with. You could get results--even though the theory is bunk.

But I am skeptical when companies market TCM herb-containing products directly to consumers. The treatment can't be tailored to the patient. The dosing and quality control are dubious. How do you know what the active ingredients are, and are they consistent from batch to batch?

And most importantly, who has verified that these things work and aren't toxic?

The answer is: nobody.

Recently I was asked whether I would review TOPICMedis Calming Lotion, a product of the Israeli company Kamedis. The lotion contains four TCM herbal extracts. I was intrigued, and agreed--because I wanted to learn which TCM herbs might be useful in treating eczema.

So what's in TOPICMedis Calming Lotion?

The first three ingredients listed are "water, glycerin, dimethicone & cyclotetrasiloxane & polysilicone-11."

I like dimethicone. It's a rubbery polymer that Aveeno includes in their Daily Moisturizing Lotion and I find it seals moisture into my skin. Not exactly a traditional herb though.

The lotion contains extracts from four herbs: Rheum palmatum, Scutellaria baicalensis, licorice root, and Cnidium monnieri. I couldn't find any information about how much of any of these was actually in the product.

Right now I have eczema in a number of places including the backs of my hands. I rubbed Kamedis lotion into my left hand, and used the usual stuff on my right hand: Eucerin and Aveeno. I tried this for three days. I saw no difference between my right hand and my left. (No improvement in either.)

As weak as my trial was as a scientific exercise, I did better than Kamedis in one respect: I used a control. Kamedis tells me they have conducted a clinical trial that shows their lotion improves symptoms in 20 patients with eczema. They did not use a control group: either a group that received no treatment or a group that received a standard treatment. Therefore their trial is of no value.

This prompted me to look at how TCM herbs regulated in the United States. I hadn't thought about this before. I was surprised--and appalled--to learn that to a great degree TCM herbs are not regulated at all.

Amazing, isn't it? Drug companies pay huge settlements when it turns out that a new drug has a fatal side effect in a tiny subset of users. Drugs must undergo an enormous battery of tests to verify efficacy and non-toxicity in animals and humans. Drug manufacturers employ stringent quality control to ensure the same dose is in every pill or ointment. TCM herbs don't have to pass any tests. We're supposed to rely on folk wisdom and the goodwill of the company selling the product.

We can thank the Dietary Supplement Health and Education Act of 1994 (DSHEA) for tying the FDA's hands when it comes to regulating dietary supplements. The Kamedis lotion isn't a supplement, it's a cosmetic, and the FDA is supposed to regulate cosmetics, but TCM falls into a category that isn't controlled strongly if at all--and I am sure there are loopholes that companies can use to get pretty much any products on the shelves in stores or on the internet.

If anyone knows more than I do about TCM regulation in the United States, I would appreciate clarification.

I remain appreciative of TCM's potential, but it is a jungle out there. There's way too much potential for quackery (expensive placebos), danger for side effects and drug interactions with TCM components and conventional therapies. And even if you have the right TCM herb, how can you ensure the same amount of active ingredient is in each batch?

I appreciate the opportunity Kamedis gave me to test their lotion--at the very least, it alerted me to four herbs that (I'm guessing) TCM practitioners have used over the ages to treat eczema. Maybe one or more of them contain novel molecules that can be formulated to provide real, quantifiable benefit.

"Natural" does not necessarily mean "good for you"

You can generally separate eczema bloggers and tweeters into three groups. In increasing size of their representation on the web:

• Those (e.g., me) who believe that Western science and medicine have good solutions to offer
• People who believe that Western medicine is a conspiracy designed solely to funnel money into the pockets of big pharma (generally, wackos, although they may have a point)
• Those who won't go as far as the second group, but who favor "natural" products and therapies instead of refined, "artificial' pharmaceuticals

I had an experience on the weekend that gave me a new look at the "natural" versus "artificial" debate. The idea that because something is part of a fresh or recently harvested plant (think Chinese herbs here) it's somehow kinder, softer, less likely to mess you up.

This is utterly wrong.

So, I found this cluster of healthy, clean-looking weeds outside my back gate. It looked like Italian parsley. It smelled like parsley. Did it taste like parsley? Whoa--let's not taste it right now, I thought.

And I'm a fan of wild mushrooms. I pick them and taste them raw. There is no mushroom that will kill you if you spit it out. Something just told me not to taste this plant.

I called my father-in-law, a biologist and naturalist, and he brought over a pile of books to help identify my weed. We narrowed it down to a few candidates that grow in our region.

• Actual feral parsley
• Water hemlock
• Poison hemlock

Poison hemlock, according to our books, is the same herb the ancient Greeks used to kill Socrates. Next to the entry for poison hemlock, one of the books noted: "FATAL TO TASTE."

It also said that since so many plants in the parsley family are extremely poisonous, you shouldn't eat them unless you have absolutely, positively, identified them.

I don't know what this stuff is, but even though it's all-natural, I won't be using it to garnish my pasta.

And, by contrast, the same night I quite happily popped a few pills of ibuprofen to reduce my back pain. They worked just fine, like they always do. I don't mind paying big pharma for ibuprofen.

I know the comparison between poison hemlock and ibuprofen is hardly a fair one, and that most practitioners of Chinese medicine know what they're handling, but it did starkly illustrate the point that "natural" plants can produce some of the most evil toxins we know.

Which alternative therapies for eczema are worth considering?

The recent issue of The Advocate, the newsletter of the National Eczema Association, features two positive articles on alternative therapies for eczema--an account of an acupressure study conducted by Peter Lio of Northwestern University in Chicago, and a review of alternative, complementary, and integrative medicine that Lio seems to have had a hand in editing.

The review is well done, and mentions a new center set up at the NIH to study these therapies, but my initial reaction was one of dismay. There is nothing physical that operates outside the rules of Western science. I'm 100% for evidence-based medicine and I think most alternative treatments offer nothing more than a placebo effect.

But I like to treat people fairly, so I had a look at the Wikipedia page for traditional Chinese medicine. My opinion was reinforced. The theories--what a load of hogwash. It's like going back to medieval days, when doctors believed illnesses were caused by an imbalance in the four Hippocratic humours--blood, phlegm, black bile and yellow bile--and treated nearly everything with leeches.

But, as I keep reminding myself that this blog has a POSITIVE outlook on eczema research and therapies, and that the point is not to get caught up in criticizing quack medicine or poor studies, as much fun as that may be, I decided to map out for myself whether I could get enthusiastic about any alternative therapies at all.

I drew a plot of where common alternative therapies for eczema lie on two axes: how probable it is that they will do what the people promoting them say they will, and how probable it is that they could cause harm to a patient in some way. Here's my plot. For comparison, I included two standard treatments for eczema: straight-up moisturizing, with something like Eucerin or Aveeno; and low-potency steroids such as 1% hydrocortisone.

I found it illuminating to do this. Let me elaborate my thoughts:

• Homeopathy, the practice of ultra-diluting reagents, has zero chance of working. You're just drinking water.
• NAET, in which practitioners claim to diagnose allergies by "applied kinesiology," not only has zero chance of working, but could actually harm patients if they take the practitioner's word that they aren't allergic to a substance that they really are.
• Acupressure and acupuncture might counteract the itch stimulus with pressure or pain. But based on the mediocre results from small-group studies I've read, I don't really think they do anything. And with acupuncture you are poking holes in your skin, which is never a good idea.
• Vitamin D is a fad, but it seems true that many people have levels below the recommended 30 ng/ml. Taking vitamin D to boost your levels to normal makes sense. Taking more does not. You could poison yourself if you took too much.
• Probiotics--consuming foods that contain live, benign microbes to normalize your gut flora--make a lot of sense (especially since more links between gut flora and systemic inflammation are emerging) but I haven't seen any knock-'em-dead studies that really show they significantly relieve eczema.
• Herbal Chinese medicine does hold promise for eczema therapies. (Tiger penis and rhino horn, not so much.) There are real drugs hiding in there. Artemisinin, for example, is a scientifically verified antimalarial isolated from a traditional Chinese herb. But I won't believe in the efficacy or safety of any Chinese therapy until it has been verified by the full spectrum of clinical trials. In short--when it's not alternative anymore, but mainstream. And if a drug works, it is going to have side effects and interactions with other medications. So there's definitely the potential for Chinese herbs to produce some good therapies in the future--the pharma company Glaxo Smith Kline now has a traditional Chinese medicine division. There are also other storeholds of incredible biodiversity, such as marine compounds from the Malaysian coastline. But it could be decades before we see any drugs hit the market from these sources.

My plot is too simple to make clear that I think it's possible that some drugs isolated from Chinese herbs might be more effective than low-potency steroids such as hydrocortisone. They could be better. But on average I'd be surprised if they were. And if it's true (according to Wikipedia) that a typical herbal treatment from a traditional Chinese practitioner is decocted from 9-18 herbs, I have to wonder what exactly the active ingredients are and how sure the practitioner is of the dose and proportions.

I also worry that we just don't know what some of these herbal compounds are doing. What are the side effects? And where were the herbs harvested? Do they contain arsenic and heavy metals? China's not famous for its environmental policies.

The Chinese multi-component treatment does have a parallel with Western pharma approaches such as the "triple cocktail" antiretroviral for HIV, or combination chemotherapy. The Chinese herbal compounds just haven't been rigorously identified, categorized, and tested in the way that they need to be.

I clearly find Chinese herbal medicine intriguing. You can expect me to investigate Chinese herbal eczema therapies in this blog. I'll also consider vitamin D and probiotics, although from what I've seen, they do not promise anything but slight improvement for the average patient.