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Long-term sun exposure, (particularly the Ultra Violet (UV) light part of the light spectrum), has been shown to be the cause of ‘sun-induced skin damage’. This included sunspots, actinic or solar keratoses, and skin cancers. These cancers are classified in 2 groups; Non-Melanoma Skin Cancers including basal cell and squamous cell carcinomas (BCC & SCC’s) also Melanomas – (carcinoma means cancer).
Generally the more long-term sun exposure a person has, the more likely they are to develop some type of ‘sun-induced skin lesion, especially if the skin gets sunburnt. As people age their skin has a tendency to develop ‘abnormalities’ which include areas of thickened, scaly skin, these skin changes are more likely to develop on people who have had considerable exposure to sunlight.
Higher incidence of these abnormalities or lesions are found in ‘fair skinned’ people, in countries with a sunny climate or closer to the equator. And with people with outdoor occupations and those who enjoy outdoor activities. Australia has the highest skin cancer rate in the world and the greatest prevalence of actinic keratoses amongst adults older than 40 years. It has been reported that for people older than 40 years 40-60% of them will have at least one. New Zealand and the USA follow closely in numbers. This is due to the number of fair skinned inhabitants with ‘Celtic ancestry.
(Reference - Quaedvling et al reviewed are from Australian research papers. Eur J Dermatol 2006; 16 (4): 335-9)
A classification for skin colours and their response to ultraviolet light was developed in 1975 and is still used today as the standard assessment tool. Called the Fitzpatrick Scale, it classifies how differing genetic skin types react to sunlight.
(reference - Fitzpatrick TB: Soleil et peau. J Med Esthet 1975;2:33034.)
People who develop sun-induced skin lesions are more likely to have Fitzpatrick type I or II skin (fair skin, freckly and with blonde or red hair and usually burns with sun exposure and do not tan easily). They are more frequent in men than in women and this is considered to be due to the greater cumulative UV exposure as more men work in outdoor occupations than women. A high-fat diet is another factor that has been indicated in the progression in development of lesions such as actinic keratoses.
The medical treatment treatments available to treat Sun-Induced Skin Damage include destruction of the lesions with cryogens (freezing), electrodessication (burning),curettage (cutting), and chemical peeling agents and medical therapy with chemicals such as 5-Flurouracil and retinoids, Other treatments include escharotic (eroding) paints, creams and lotions. All these treatment cause varying degrees of pain and leave some scarring.
There are also commercially available products, sold as ‘cosmetic treatments’, that have a ‘bleaching action’, that is they contain chemicals that bleach the skin thereby fading skin marks, these are specifically for ‘sun and age spots’. This merely masks the abnormality. (Reference - Hardman JG, Limbird LE, Gilman AG, editors. Goodman & gilman's the pharmacological basis of therapeutics. 10th ed. New York: McGraw-Hill; 2001.)
From the very early history of mankind, plants were used to treat disease; these were referred to as herbs and some had very powerful actions.
Skin lesions were not historically recognized as a specific name, they were considered as “growths or cankers”, along with other skin lesions, including skin cancers. There is a traditional of use of herbs for such skin conditions
Some examples of these herbal treatments for abnormal skin lesions include the following:
(Reference - Fisher, C. P., G. (1996). Materia medica of western herbs for the southern hemisphere (1st ed.). Auckland: self published.)
Plants are complex chemical cocktails. Each specific chemical has a specific therapeutic action. There has been some research conducted to assess a number of the individual constituents; particular attention has been focused on a large class of phytochemicals (plant chemicals) broadly known as ‘antioxidants’. There is a group of phytochemicals called polyphenols. They have been shown to have antioxidant, anti-inflammatory and anti-tumour properties, all of which are relevant therapeutic actions for treating Actinic Keratoses’s
(Reference - Lin, J.K, Cancer chemoprevention by polyphenols including flavonoids and flavonoids through modulating signal transduction pathways, Phytochemicals: mechanism of action 2004 CRC Press New York Pgs 79-106)
To date there has been limited research to investigate the use of herbs for treating Actinic Keratoses’s and other sun-induced skin lesions. From some research there is evidence that support Polyphenols in plants do have anti-oxidative, anti-inflammatory and anti-tumour activity.
(Reference -- Epstein, Howard Cosmeceuticals and polyphenols, Clinics in Dermatology, 2009 27 (5) Pg 475-47828)
Flavonoids are another significant group of chemical compounds in plants that have been referred to as “biological stress modifiers” as they have been shown to protect cellular function against environmental stressors. They assist to stabilise cellular membranes and they have anti-oxidant and anti-inflammatory actions.
(Reference - Pengelly A, The constituents of medicinal plants Publisher Sunflower Herbals Muswellbrook, NSW 1996)
These actions assist to counter the UVR (Ultra Violet Radiation) damage on human skin. A review by Degner & Romagnolo reviewed and assessed research on groups of plant chemicals that have therapeutic modes of actions relevant to treating cancers (including polyphenols and flavonoids). They concluded that phytochemicals target multiple pathways with cancer and therefore have potential as ‘effective agents’ for treating and protecting against cancers. Another important comment they make is about the ‘Synergy between Phytochemicals’, they consider that “it is reasonable to expect that the combination of several phytochemicals would be more efficacious than one alone.”
(Reference - Degner, SC., Romagnolo DF. (University of Arizona, Tucson, Arizona, USA), Chapter 40, Professor RR Watson, Professor VR Preedy, Botanical Medicine in Clinical Practice: CABI International, England)
When discussing herbal approaches to ‘treating pathological states of the skin’, Mills and Bone, state from their observations and research that the therapeutic actions of plants are now being tested by scientific research to validate their therapeutic actions. Unfortunately most research into antiseptic, anti-inflammatory and anti-tumour effects relating to skin conditions are conducted as in vitro (test tube or laboratory) experiments, rather than on active human subjects.
(Reference - Mills S, Bone K. Principles and practice of phytotherapy. 1st ed. London: Churchill Livingstone; 2000.)
Kerry Bone is an Australian Pharmacist and Herbalist, specialising in manufacturing, research and production of Herbal Medicines. He has generously given me time to discuss formulations and research.
It is important that more research is conducted to verify the effectiveness of Herbal Medicine. LHP has this commitment.
The principles involved in formulating effective herbal treatments include being aware of the underlying cause of the condition being treated, the disease process and what therapeutic actions are required to counter them, returning the body systems to improved wellbeing.
When considering the choice of which herbs to blend in a formulation for treating sun-induced skin conditions, reflection is made on the therapeutic actions that are required to treat the condition. For Actinic Keratoses’s the main requirement is to ‘normalise’ the aberrant cell formation in the dermal layer. For this herbs would be chosen with alterative and anti-neoplastic actions, while adding ‘healing’ actions such as vulnerary and demulcent, which assist reducing inflammation and nourishing the dermal layer.
There will be a certain amount of overlap of actions when combining herbs. It is for the discernment of the Herbalist to find a definitive blend that maximises benefit to the user of the treatment. For example; there are a number of herbs that have therapeutic actions that cover a range of these required actions. For example:
Echinacea spp have the following therapeutic actions: alterative, vulnerary, anti-inflammatory, collagenic, anti-viral and antiseptic.
Calendula officinalis has these actions: vulnerary, anti-inflammatory, lymphatic, antiseptic, astringent and anti-fungal.
Phytolacca decandra has depurative, anti-inflammatory, analgesic, lymphatic, anti-neoplastic, anti-viral and anti-fungal as actions.
Herbs are chosen with the desired therapeutic actions, with the least negative side effects, as opposed to such herbs as; Sanguinaria canadensis, or Euphorbia peplus – that have some of the desired actions, but have known negative side effects (the escharotic or eroding action when used on healthy skin can cause irritation, including blistering), thereby negating the efficacy and usefulness of the product. Often called ‘black salves’ are herbal based eroding creams or ointments based on the herb known as Bloodroot (Sanguinaria canadensis)
(Reference - Fisher, C. P., G. (1996). Materia medica of western herbs for the southern hemisphere (1st ed.). Auckland: self published)
These creams/ointments are available from naturopaths, ‘health’ shops and internet websites. It must be used with care as it has an escharotic action, which erodes the tissue it is applied to, often causing irritation and blistering.
There may be a lot of pain and discomfort throughout the treatment process and post treatment there may be some degree of scarring to the treatment area, which in turn leaves the area more photosensitive.
Euphorbia peplus is the source of the product known as PEP005 or Peplin (ingenol mebutate) which in gel form is currently in Phase 3 clinical trials are being conducted to asses the effectiveness for treating actinic keratoses. Ogbourne et al assessed the Antitumor activity of 3-Ingenyl angelate in pre-clinical research, both invitro and invivo with mice.
(Reference - Ogbourne SM et al Antitumor activity of 3-Ingenyl angelate(peplin)Cancer Research 64, 2833-2839, April 15, 2004)
· Scar tissue is more photosensitive therefore more prone to development of future sun induced skin abnormalities.
In my practice as a Medical Herbalist and I noticed that most of my patients over the age of 50 had varying degrees of sun-induced skin damage. Many had experienced quite invasive and painful procedures to remove lesions. Scar tissue that develops with the wound healing is even more photo-sensitive than normal skin. With my knowledge of herbal therapeutics, I developed a cream to ‘normalise’ abnormal skin cell development. This product has been used within my clinical practice for over ten years, with very positive results to my patients.
· The herbal formulation is non-escharotic (non-irritant and non-eroding).
During this period there have been no reported negative adverse reactions.