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Background: Atopic eczema (AE) is a common skin disease with an increasing worldwide prevalence, which has almost doubled over the last decade in South Africa. Many patients commonly explore complementary and alternative medicines (CAM) for AE and often initially seek advice from their local pharmacists.Aim: To explore the knowledge, attitude and practices amongst community pharmacists regarding CAM. Setting:The study was conducted amongst pharmacists working in community pharmacies in Durban, South Africa.Methods: During 2016, a cross-sectional study was conducted amongst 158 randomly selected pharmacists, of which 82 responded. Respondents were sent an email with a link to the questionnaire. Where logistically possible, questionnaires were hand-delivered. Results:The majority of respondents were male (n = 46; 56%), aged between 31 and 40 years. Despite most pharmacists not being familiar with various CAMs for AE, many (43%) recommend them, and 50% were amenable to referring patients to CAM practitioners. Despite 51% reporting that patients do ask about CAM for AE, 54% are not confident discussing or initiating discussions with patients. More than half of the pharmacists (55%) had no CAM training but believed it is essential for inclusion in the undergraduate pharmacy curriculum. Most were interested in broadening their knowledge on CAM and felt it would better prepare them in counselling their patients. Conclusions:The study demonstrated poor knowledge and communication about CAM for AE between pharmacists and patients, although pharmacists exhibited strong interests in learning more about CAM. There is a continuing need for education programmes and inclusion into undergraduate curricula that would assist pharmacists to advise patients on different types of CAMs.

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Despite the availability of medicines with proven efficacy, many patients use complementary or alternative medicines (CAMs) to manage atopic eczema (AE). Due to the lack of objective information on topical CAMs, this systematic review evaluates the current evidence for the efficacy and safety of topical herbal preparations in AE. Using Cochrane systematic review methodology, PubMed, the Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (via EBSCO), MEDLINE (via EBSCO), Proquest Health and Medical Complete, GREAT and CAM-QUEST were searched from inception until June 2014. Bibliographies of retrieved studies were hand searched for further relevant trials. All controlled clinical trials of topical herbal medicines for AE in humans of any age were included regardless of the control intervention or randomization. Only English-language publications were considered. Eight studies met the inclusion criteria. Seven investigated extracts of single plants and one an extract from multiple plants. Only two studies that showed a positive effect were considered to have a low risk of bias across all domains (those of liquorice gel and Hypericum perforatum). In these two, the test product was reported to be superior to placebo. Despite variations in diagnostic criteria and lack of validated tools for outcome assessments in one of these, the promising results may warrant continued research in better-designed studies. No meta-analysis was performed due to heterogeneity in all studies. There is currently insufficient evidence of efficacy for any topical herbal extract in AE. Many studies had methodological flaws and even those showing efficacy were single trials with small patient cohorts.

Complementary and alternative medicines (CAM) are widely used for atopic eczema (AE) with user estimates as high as 63%. Despite the availability of effective conventional therapies, the chronic nature of AE and concerns about long-term steroid use lead many patients to seek alternative treatment. Evidence of the efficacy of these alternative therapies is inconsistent and available published data have shortcomings, making it difficult for clinicians to assess their role, if any, in management. To assess the evidence, systematic reviews of controlled studies have been undertaken for Chinese herbal medicines, homeopathy, evening primrose oil, borage oil, probiotics and certain dietary supplements. This overview summarises the findings from the most recent systematic reviews. Taken together, none of the alternative therapies evaluated demonstrated obvious and indisputable evidence of efficacy. Further studies are warranted with some therapies (Chinese herbal medicines, certain probiotic strains and fish oil), whereas homeopathy failed to show any treatment effect. Further studies on homeopathy, or evening primrose oil and borage oil, are difficult to justify. It must also be remembered that CAM products are currently under-regulated and may not meet the stringent quality standards of conventional medicines.

Background: Complementary and alternative medicines (CAM) are increasingly popular globally with frequent use amongst patients with atopic eczema (AE). Despite increased AE prevalence in South Africa (SA), no local data on CAM-use for this disease exists. Methods: A cross-sectional study utilizing a comprehensive questionnaire qualifying and quantifying CAM use in patients with AE. We interviewed 206 AE patients; 106 from a public hospital dermatology clinic and 100 from private dermatology practices in central Durban. One-way analysis of variance (ANOVA) compared means of continuous predictors across 3 or more groups. Differences in frequencies of categorical explanatory variables by CAM and AE were assessed using Pearson chi-square (χ 2) test or Fishers exact test. Results: There were 143 children, 63 adults; 163 females and 43 males. Races represented were Black (56%), Indian (33%), Coloured (6%) and White (4%). 135(66%) reported current or previous CAM use. Common reasons were family/friends' recommendations (42%) and media-influence (23%). Frequently used CAMs were vitamins (35%), aromatherapy oils (27%), herbal creams (26%), traditional African medicines (23%) and homeopathy (19%). Nondisclosure to the dermatologist was high (59%). Almost half (48%) said they were not questioned about CAM use. More Indian patients used CAM (p=0.001) and Muslims were most frequent CAM users (p=0.044). Although not statistically significant, the more educated and higher income bracket used CAM more. 28% felt CAM had fewer sideeffects, 28% felt it was safer than conventional medicine and 35% felt CAM was more natural. Conclusion: The detailed trends of CAM use by South Africans for AE is an important addition to the current literature. Dermatologists and healthcare professionals addressing patients with AE need to be more familiar with CAM types that patients may explore as this could impact on the overall clinical outcome.

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