The Impact of Herbal Medicines on Dermatologic Surgery

Abstract

Dermatologists should be aware of these herbal products and their uses. Many of these products prescribed by alternative medicine physicians or purchased over the counter should be discontinued prior to dermatologic surgery to minimize the risk of surgical complications.

Use of complementary and alternative medicine among adults with skin disease: Updated results from a national survey

“…As in 2002, the herbs used by those with skin problems included several of the supplements shown to have anticoagulant properties (fish oil/omega fatty acids/docosahexaenoic acid, ginseng, ginkgo biloba, and garlic). 20 Echinacea, one of the most commonly used herbs in our study, has been shown to cause urticaria, contact dermatitis, and erythema nodusum. [21][22][23] In this study, adults reporting skin problems in the last year were more likely to use CAM than those who did not report skin problems.…”

The Effect of Herbal Medicines on Platelet Function: An In Vivo Experiment and Review of the Literature

“…However, there remains concern about the risk of perioperative bleeding, stemming partly from anecdotal reports of catastrophic bleeding in herbal users 7-21 and partly from numerous in vitro studies that have identified inhibitors of coagulation and platelet function in herbal preparations. 7,14,15,[22][23][24][25][26][27][28][29][30][31][32] Nonetheless, neither our investigation nor the following review of the literature revealed any substantive clinical data to support this concern.…”

“…36 It is widely accepted that ginkgo inhibits platelet-activating factor through the action of its constituent ginkgolides. 1,26,31,32,37 Although platelet-activating factor is an important mediator of platelet aggregation, 33 attempts to demonstrate scientifically an in vivo effect of ginkgo on platelet or coagulation function have fallen short. For example, in a study of 50 healthy male volunteers taking ginkgo (120 mg daily) for 7 days, none of 29 platelet and coagulation parameters was abnormal.…”

“…[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] However, several herbal extracts have been identified experimentally to possess antiplatelet activity in vitro. 7,14,15,[22][23][24][25][26][27][28][29][30][31][32] The purpose of this investigation was to determine whether standard commercial preparations of commonly used herbal medicines have an effect on platelet function in vivo and, by extension, to provide clinical scientific evidence of their safety when used in the perioperative period.…”

Multiple antithrombotic agents increase the risk of postoperative hemorrhage in dermatologic surgery

“…13 Moreover, many patients undergoing dermatologic surgery take overthe-counter herbal supplements 14 that act as anticoagulants. 15 For various reasons, this may not be apparent at the time of surgery regardless of known conventional antithrombotic use. 16 Given that some patients use multiple antithrombotic agents or supplements simultaneously, it is important to assess the risk of bleeding complications in such patients.…”