International Academy of Cosmetic Dermatology


Non-ablative fractional resurfacing has been used in Traditional Indian medicines,(1) including herbal preparations, ayurvedic, unani, and homeopathic medicines have long been in vogue. Ancient Indian texts have been quite meticulous in describing numerous dermatoses, their etiology, and therapeutics. These insights have been well-utilized by those practicing ayurveda, unani, and homeopathic medicines; however, well – researched guidelines, studies on the long term effects / side-effects, and interactions have largely been lacking, despite the encouraging responses of these therapies.

The medicinal plants, used as herbal therapy for dermatoses in vogue at that time, were studded in details in India, the outcomes of which were elucidated. Sensitization of the skin, causing irritant dermatitis (Figure 1), was a conmen denominator, warranting their limitation for future use.(2) In addition, they deem to affect the systemic organs causing damage, which might not be apparent immediately, but which might appear several months or years later.

Figure 1

Despite well-known side-effects, herbal therapy continues to be practiced by qualified and unqualified individuals (quacks). Accordingly, sporadic reports continue to appear in medical journals and newspapers, cautioning about the dangers of such medications. In addition, certain treatment medicines contain heavy metals, such as mercury and arsenic. Their long-term use could damage such vital organs as the kidneys. Other long and short term toxicity, which may appear in the form of erythema, edema and extensive scaling, or erythoderma/exfoliative dermatitis also occur(3,4) (Figure 2). Gold and silver containing agents have been much publicized preparation to maintain or restore vitality; however, their long-term use cannot be innocuous, and toxicity symptoms can be serious and life threatening.(5)

Figure 2

Table 1: Herbal preparation and their implication

Side effects Interactions
Garlic Heart burn, flatulence
Allergies and anaphylaxis
With antibiotics
– may accenuate low blood sugar
– may accenuate the action of anticoagulant drugs
Kavakava Weakness Potentiate the action of alcohol, sedatives, or sleeping pills
Interact with medication for parkinsonism and anti-psychotic drugs
Ginseng High blood pressure
Bleeding tendency
Interact with anti hypertensive and blood agents


Reduced fertility
Potentiation of cerebro-vascular disorders and cancer
May interfere with other sedatives
Gingkobiloba Restlessness, nausea, vomiting, diarrhea Interact with drugs for heart disorder, hypertension and aspirin
Ashwagandha Restlessness, excitement, gastritis Steroidal lactomes (withanolids) may have steroid like interactions

The FDA has warned many times against the use of herbal medications for obesity. Several deaths following heart attack and strokes have been reported by the prolonged use of herbal drugs available over-the-counter. Ayurvedic preparations are such easily available drugs without any restrictions on their sale for lay public. Many preparations may contain corticosteroids and other allopathic active components, potentially toxic heavy metals, and many others the nature of which may not be disclosed; moreover their dosage, method of use, and duration of treatment are never described in the enclosures.

Self-medication of such preparations by knowledge, gained through various means only compound the problem.. It is, therefore, likely that the late onset of the side-effects of the offending drugs is never suspected either by the patients or the treating physicians. It may result in mismanagement of the patient. Even topically used inocuous medicines, such as aloe vera, can cause generalized nummular dermatitis.(6) This botanical is alleged to cure/alleviate a variety of unrelated conditions, including gastric ulcers, bursitis, varicose veins, sunburn, and arthritis; yet, there is no scientific substantiations of these alleged benefits.(7)

We should recall what Hippocrates once warned:
Whoever wishes to investigate medicine properly, should proceed thus: in the first place to consider the season of the year, and what effects each of them produces for they are not at all alike, but differ much from themselves in regard to their changes. Then the winds, the hot and the cold, especially such as are common to all countries, and then such as are peculiar to each locality. In the same manner, when one comes into a city to which he is a stranger, he ought to consider its situation, how it lies as to the winds and the rising of the sun; for its influence is not the same whether it lies to the north or the south, to the rising or to the setting sun.(8)

Virendra N. Sehgal, MD
Govind Srivastava, MD
New Dehli, India

1. Behl PN Arora RB, Srivastava G. Traditional Indian Dermatology – Concepts of Past and Present. 1 ed. New Delhi: Skin Institute and School of Dermatology (SISD) Publication; 1992:1-126.
2. Behl PN, Aggarwal A, Srivastava G. Skin irritant and sensitizing plants of medicinal significance. 3 ed. New Dehli: CBS Publishers and Distributors; 2004:1-211.
3. Sehgal VN, Srivastava G. Exfoliative dermatitis: a prospective study of 80 patients. Dermatologica 1986;173:278-84.
4. Sehgal VN, Strivastava G, Sardana K. Erythroderma/exfoliative dermatitis: a synopsis. IntJ Dermatol 2004;43:39-47.
5. Behl PN, Srivastava G. Herbs useful in dermatological therapy. 2 ed. 2002:1-163.
6. Morrow DM, Rapaport MS, Strick RK. Hypersensitivity to aloe. Arch Dermatol 1980;116:1064-5.
7. Klein AD, Penneys NS. Aloe Vera. J Am Acad Dermatol 1988;18:714-20.
8. Hippocrates – Air Waters and Places (300 B.C.) quoted by Bajaj J S. Healths effects of climate change. Ann Nate Acad Med Sci (India) 2009;45:153-70.