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The impact of alternative medicine on dermatology has expanded greatly in recent years, with estimates that the lifetime prevalence of complementary and alternative medicine use by patients with dermatologic disease ranges between 35 and 69%, according to Ernst et al in a 2002 issue of the American Journal of Clinical Dermatology. Whether or not one is an advocate of these remedies is virtually irrelevant – if you do not have a working knowledge of what your patients are doing, your effectiveness as a physician is hampered. This dialogue is an excellent brief survey of alternative medicines in dermatology, discussing their potential uses and pitfalls. For those listeners interested in this topic, I would like to remind you of the "Adverse Effects of Herbal Remedies" dialogue in the March 2002 edition of Dialogues in Dermatology, by Dr. Jim Del Rosso. In the current dialogue, Dr. Buchness reviews the uses and complications of the more commonly used herbs such as St. John’s wort. Ginko, Ginseng, Echinacea, Feverfew, Saw Palmetto, and Ginger Root. Dr. Buchness acknowledges that there is very little evidence-based medicine to support many of the claims. With increasing use, there is a need for a reference for drug interactions with these supplements, as is available on ePocrates Rx Pro for a palm device. There were many intriguing comments in this dialogue. My favorite lesson is that the "G" herbs – ginseng, ginko, garlic, and ginger, with one exception, "f" – feverfew - have anticoagulant effects. Rather than reiterate many of the points that Dr. Buchness made during this dialogue, I will focus the rest of the commentary on one agent that many more of my patients seem to be using – tea tree oil.

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