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Fever and rash in HIV

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Related Terms
  • Acquired immune deficiency syndrome, acquired immunodeficiency syndrome, AIDS, allergic drug reaction, allergic reaction, allergy, anaphylaxis, antimicrobials, antiretroviral therapy, antiretrovirals, ART, drug reaction, epinephrine, fever, HAART, highly active antiretroviral therapy, HIV, human immunodeficiency syndrome, immune, immune defense system, immune reaction, immune response, immune system, immunocompromised, immunodeficiency, infections, rash, skin rash, viral infection, virus, weakened immune system, white blood cells.

Background
  • Nearly all patients infected with the human immunodeficiency virus (HIV) experience a fever and skin rash at some point after diagnosis.
  • A fever and rash are symptoms of an underlying medical condition. An estimated 80-90% of HIV patients develop fever and rash when they first become infected with HIV. This is because the virus is multiplying rapidly in the body and infecting immune cells. This phase generally lasts several weeks. Other common causes of fever and rash in HIV patients include allergic reactions to medications, infections, and a cancer called Kaposi's sarcoma (KS).
  • Rash is a general term that describes a change in color and texture in the skin. A rash generally causes temporary red patches or bumps in the skin, and it may be itchy and/or tender. The affected skin is often swollen.
  • A fever is an increase in normal body temperature. Healthy individuals typically have a body temperature of about 98.6 degrees Fahrenheit. The body temperature fluctuates by about one degree throughout the day. If a baby younger than 12 months old has a temperature higher than 100 degrees, a healthcare provider should be consulted immediately. Adults and children who have temperatures higher than 102 degrees that are not responding to medications, such as ibuprofen (Motrin®, Advil®), aspirin, or acetaminophen (Tylenol®), should consult their healthcare providers.
  • Once the underlying cause of fever and rash is treated, symptoms will gradually disappear. Allergic reactions to medications are usually severe and may require immediate treatment with epinephrine. Infections are treated with antimicrobials, and Kaposi's sarcoma has been treated with local and systemic therapies, such as radiation and chemotherapy.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. American Academy of Allergy Asthma & Immunology. . Accessed May 14, 2009.
  2. American Academy of Dermatology (AAD). . Accessed May 14, 2009.
  3. American Dermatological Association. . Accessed May 14, 2009.
  4. DermNet NZ. Dermatitis. . Accessed May 14, 2009.
  5. Huang ST, Lee HC, Liu KH, et al. Acute human immunodeficiency virus infection. J Microbiol Immunol Infect. 2005 Feb;38(1):65-8. .
  6. Lesho E, Gunning S, Wortmann G. An AIDS patient with fever and rash. Clin Infect Dis. 2005 Jul 1;41(1):75-6, 112-3. .
  7. Namayanja GK, Nankya JM, Byamugisha JK, et al. Stevens - Johnson syndrome due to nevirapine. Afr Health Sci. 2005 Dec;5(4):338-40. .
  8. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed May 14, 2009.
  9. Sued O, Miro JM, Alquezar A, et al. Primary human immunodeficiency virus type 1 infection: clinical, virological and immunological characteristics of 75 patients (1997-2003). Enferm Infecc Microbiol Clin. 2006 Apr;24(4):238-44. .

Causes
  • General: In addition to HIV itself, the most common causes of rash and fever in HIV patients are allergic drug reactions, infections, and a cancer called Kaposi's sarcoma (KS).
  • Acute HIV infection: The first stage of HIV, known as the primary or acute infection, may cause symptoms of fever and skin rash. This is because the virus is multiplying rapidly in the body and infecting immune cells. This phase generally lasts several weeks. An estimated 80-90% of HIV patients experience flu-like symptoms, including fever, skin rash, sore throat, enlarged lymph nodes, and cough.
  • Drug reactions: Some HIV patients may develop allergic reaction to medications. This happens when the body overreacts to a substance in the medication. During an allergic reaction, the body mistakes a substance in the medication for a harmful invader, such as bacteria, and launches an attack. While any type of medication can potentially trigger an allergic reaction, antibiotics such as penicillin are the most common trigger. Anti-HIV drugs (antiretrovirals) may also cause an allergic reaction. A skin rash and fever are symptoms of a severe and potentially life threatening allergic reaction called anaphylaxis. If not treated immediately, this reaction can lead to shock, unconsciousness, and death.
  • Some patients may develop a severe skin rash called Stevens-Johnson syndrome (SJS) as an allergic reaction to medications. SJS is potentially life threatening because, in severe cases, lesions can develop on the internal organs and cause scarring, which often leads to loss of function of the organ systems.
  • Infections: HIV patients are vulnerable to infections because the virus infects and destroys the immune system. Many types of bacteria, viruses, fungi, and parasites may cause illnesses with symptoms of skin rash and fever. Among the most common infections to cause such symptoms are staphylococcus, gonorrhea, syphilis, genital herpes virus, chicken pox, bacterial meningitis (infection of the membrane that surrounds the brain and spinal cord), a viral infection called fifth disease, human papillomavirus (HPV), hepatitis B (liver infection), cryptococcus, histoplasmosis, pneumocystis, scabies, and parasitic infections called leishmaniasis.
  • Kaposi's sarcoma: A cancer called Kaposi's sarcoma (KS) may cause fever and rash in HIV patients. This cancer develops in connective tissues, such as bone, cartilage, fat, blood vessels, muscle, or tissues related to tendons or ligaments. Patients typically suffer from lesions on the skin, which appear as raised blotches or lumps that may be purple, brown, or red.

Symptoms
  • General: The duration and severity of fever and rash in HIV patients vary, depending on the cause. Additional symptoms may also be present, depending on the cause.
  • Fever: Patients who have a fever may experience chills, increased sweating, shivering, and warm skin.
  • Rash: There are many different forms of rashes, which vary in their appearance, location, severity, and duration. Some rashes may contain blisters, flat or raised bumps, pimples, or dry or flaky skin. The skin may be red and/or itchy. If the skin itches, it is called pruritus. The amount of skin affected may be limited to an isolated area, or it may affect multiple areas of the body.

Diagnosis
  • General: A fever and rash are easily identified during a physical examination. However, because they are symptoms of an underlying medical condition, the cause must be identified in order to treat the patient. During a physical examination, a healthcare provider will take a careful medical and social history to determine the underlying cause. Medical tests may be necessary.
  • Physical examination and medical history: The healthcare provider will assess how long the patient has had the rash, as well as gather information regarding history of allergies, infections, or other skin diseases. It is important to know any change in medications, especially if the patient has taken a new drug, herb, or supplement.
  • Allergen-specific immunoglobulin (IgE) test: An allergen-specific immunoglobulin E (IgE) test, commonly referred to as radioallergosorbent test (RAST®), may be used to determine whether the patient is allergic to particular substances, such as medications or foods. Currently, more than 550 allergens are available for determinations.
  • This test is less accurate than a skin test. It is usually performed in patients who also have severe skin diseases (such as eczema or psoriasis) that make it difficult to interpret a skin test. During the procedure, a sample of the patient's blood is sent to a laboratory for testing. The allergen is combined with the blood to determine whether the patient has immunoglobulin E (IgE) antibodies to the allergen. Antibodies are substances that identify and bind to foreign invaders in the body. If the patient has IgE antibodies, an allergy is diagnosed.
  • Biopsy: A biopsy is the only definitive diagnostic test for Kaposi's sarcoma. During the procedure, a sample of tissue is taken from the patient. The tissue sample may be taken from the skin (punch biopsy), gastrointestinal tract (endoscopic biopsy), tissue that lines the lungs and the inside of the chest wall (pleural biopsy), or lung tissue (transbronchial biopsy). The sample is then analyzed under a microscope for cancerous cells. If cancerous cells are present, Kaposi's sarcoma is diagnosed.
  • Blood test: A blood tests may be performed to determine whether the patient has a bacterial or viral infection. The patient's blood sample is analyzed under a microscope for bacteria or viruses.
  • KOH (potassium and hydroxide) preparation: A KOH (potassium and hydroxide) preparation test is used to determine whether a fungal infection is causing the symptoms. During this test, a healthcare provider will gently scrape the skin with a blunt edge (such as the edge of a microscope slide). The sample of scraped skin is then combined with a substance called potassium hydroxide (KOH). This solution allows the healthcare provider to see the fungus (if it is present) under a microscope.
  • This procedure is not usually painful because only a tiny amount of skin is needed. Patients may feel a slight pressure sensation when the skin is scraped.
  • Skin test: A skin test may be used to determine whether the rash is caused by an allergic reaction. During the test, the skin is exposed to the suspected allergens that may be triggering an allergic reaction and observed for an allergic reaction. If the allergen triggers an allergic reaction, the patient will develop reddening, swelling, or a raised, itchy red wheal (bump) that looks similar to a mosquito bite. The healthcare provider will measure the size of the wheal and record the results. The larger the wheal, the more severe the allergy.
  • Tzanck test: A tzanck test is used to determine whether a viral infection called herpes is causing the symptoms. The virus may be suspected if the patient has a rash that contains blisters. During the procedure, a small area of the skin is numbed, and a blister is opened. The healthcare provider will scrape a small sample of the fluid and skin from the blister, and it will be analyzed under a microscope for the virus. If the virus is present, a positive diagnosis for herpes is made.

Treatment
  • General: Patients should take nonsteroidal anti-inflammatory drugs (NSAIDs) and drink cool fluids to help reduce a fever. Although they do not treat the underlying cause of fever, they will minimize symptoms until treatment is started. Patients should not scratch, rub, or irritate a skin rash. If fluid-filled blisters develop, patients should not break them open.
  • If patients develop Stevens-Johnson syndrome (SJS) in response to medications, the patient should stop taking the offending drug immediately. No specific drug treatment exists for SJS. Recovery may take two to six weeks. Severe cases may require hospitalization in an intensive care unit or burn unit where the patient will receive fluids and nutrition intravenously.
  • Antimicrobials: Medications called antimicrobials are used to treat skin rashes caused by infections. Antibiotics are used for bacterial infections (such as meningitis), antifungals are used to treat fungal infections (such as cryptococcus), and antivirals are used to treat viral infections (such as herpes). Depending on the type and severity of the condition, these drugs may be applied to the skin, injected into a vein, or taken by mouth. Treatment duration and doses also depend on the type and severity of the infection, as well as the patient's overall health.
  • Chemotherapy: Chemotherapy does not cure Kaposi's sarcoma (KS), but it may help the patient achieve rapid tumor regression and may help reduce symptoms. Chemotherapy is used when the cancer involves internal organs or causes a rapidly progressive skin disease. Several chemotherapy drugs are FDA-approved for AIDS-related KS, including liposomal doxorubicin (Doxil®), liposomal daunorubicin (DaunoXome®), and paclitaxel (Taxol®).
  • Cool liquids: Drinking cool liquids may help relieve symptoms of fever. However, this does not treat the underlying cause of the fever.
  • Cool compress: A cool compress may be applied to affected areas of the skin to help alleviate itching and swelling associated with some rashes.
  • Cryotherapy: Cryotherapy has been used to treat local Kaposi's sarcoma lesions. During cryotherapy, liquid nitrogen is applied to the skin surface. This procedure may be an effective treatment for small facial lesions. Cryotherapy may cause light spots on the skin (hypopigmentation) or dark spots on the skin (hyperpigmentation), which generally lasts a few months.
  • Epinephrine: A medication called epinephrine is used to treat a severe allergic reaction called anaphylaxis. Epinephrine is injected into the skin at a hospital. Patients with a history of anaphylaxis should carry auto-injectable epinephrine (EpiPen®) with them at all times. If symptoms of anaphylaxis, including difficulty breathing, wheezing, chest pain, or loss of consciousness appear after exposure to an allergen, the patient uses the device to inject the epinephrine into his/her thigh. After using auto-injectable epinephrine, patients should visit the emergency room of a nearby hospital. Epinephrine opens the patient's airway. It also constricts the blood vessels, which increases blood pressure. Patients who experience anaphylaxis may also be admitted to the hospital to have their blood pressure monitored and possibly to receive breathing support.
  • Interferon-alfa: Interferon-alfa has been used to treat local Kaposi's sarcoma lesions. Interferon-alfa is injected under the skin daily or three times weekly. Symptoms may improve with low, intermediate, or high doses. It generally takes about four months for patients to respond to treatment. This treatment is most effective when the CD4 count (immune cells that HIV primarily infects and destroys) is higher than 150-200 cells per microliter of blood or when administered along with anti-HIV drugs (antiretrovirals). Toxicity is more common and severe with higher doses. Symptoms of toxicity include fatigue, flu-like symptoms, muscle pain, joint pain, fever, decreased bone marrow activity, and liver toxicity.
  • Intralesional vinblastine: Intralesional vinblastine, an anti-cancer drug, is commonly used to treat local Kaposi's sarcoma lesions, and it is generally well tolerated. A healthcare provider will inject the drug into the skin lesion. Side effects include skin reddening.
  • Radiation therapy: Radiation therapy, which is a cancer treatment that uses high-energy rays, is the most widely used and effective local therapy for Kaposi's sarcoma. Most patients have positive responses to treatment, according to researchers. Radiation therapy should be used cautiously in HIV patients because they have an increased risk of experiencing inflammation of the lining of the gastrointestinal tract.
  • Topical anesthetics: Anesthetics that are applied to the skin, such as lidocaine patches (Lidoderm®), may help relieve pain associated with SJS lesions. Anesthetics should not be applied to areas of the skin that are cut, scraped, broken, or blistered.
  • Topical retinoids: Topical retinoids, which are chemical compounds similar to vitamin A, may reduce the chance of cancer degeneration in Kaposi's sarcoma patients. A 0.1% alitretinoin gel (Panretin Gel®) has been applied to the skin two to four times daily, until the lesions are gone. This agent is generally well tolerated, but it may cause the skin to become red and irritated. Topical retinoids should not be used during pregnancy because they may cause birth defects.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Patients who have fevers may take ibuprofen (Motrin®, Advil®), aspirin, or acetaminophen (Tylenol®) to reduce a fever before treatment is started. Avoid aspirin in children because it may cause serious side effects, including Reye's syndrome, a life-threatening condition that causes brain inflammation and vomiting.

Integrative therapies
  • Strong scientific evidence:
  • Probiotics: Probiotics show promise for preventing atopic dermatitis in children. Infants benefit when their mothers take probiotics during pregnancy and breastfeeding. Direct supplementation of infants may reduce the incidence of atopic eczema by as much as half. It may also reduce cow's milk allergy and other allergic reactions during weaning. Probiotics may stabilize intestinal barrier functioning and decrease gastrointestinal symptoms in children with atopic dermatitis. Children do differ, however, in their responsiveness to specific probiotics. The effectiveness of probiotics for the treatment of eczema is still under investigation.
  • Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
  • Vitamin D: A number of different approaches are used to treat psoriasis. Mild approaches include light therapy, stress reduction, moisturizers, or salicylic acid to remove scaly skin areas. For more severe cases, treatments may include ultraviolet A (UVA) light, psoralen plus UVA light (PUVA), retinoids like isotretinoin (Accutane®), corticosteroids, or cyclosporine (Neoral®, Sandimmune®). The man-made vitamin D3 analog calcipotriene (Dovonex®) appears to control skin cell growth and it is used for moderately severe skin plaques, particularly for skin lesions resistant to other therapies or located on the face. Vitamin D3 (tacalcitol) ointment has been reported as being safe and well tolerated. High doses of becocalcidiol (a vitamin D analog) used on the skin may be beneficial in the treatment of psoriasis.
  • Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well tolerated in recommended doses. Doses higher than recommended may cause toxic effects. Individuals with overactive thyroid, kidney disease, sarcoidosis, tuberculosis, or histoplasmosis are at a higher risk of experiencing toxic effects. Vitamin D is generally considered safe for pregnant women. It may be necessary to give infants vitamin D supplements along with breast milk. The recommended intake of vitamin D for normal infants, children, and adolescents is 200 IU daily.
  • Good scientific evidence:
  • Aloe vera: Early evidence suggests that extracts from aloe in a cream or lotion may be an effective treatment for psoriasis vulgaris and seborrheic dermatitis when applied to the skin. Further study is needed in this area before a conclusion can be made.
  • Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Do not inject aloe into the skin. Do not apply to open surgical wounds or pressure ulcers. Patients should not take aloe by mouth if they have diarrhea, bowel blockage, intestinal diseases, bloody stools, hepatitis, a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease, or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
  • Evening primrose oil: Several small human studies of atopic dermatitis suggest benefits of taking evening primrose oil by mouth. Large well-designed studies are needed before a strong recommendation can be made. Evening primrose oil is approved for atopic dermatitis in several countries outside of the United States.
  • Individuals who are allergic to plants in the Onagraceae family, gamma-linolenic acid or other ingredients in evening primrose oil should avoid the substance. Individuals with seizure disorders and pregnant or breastfeeding women should also avoid evening primrose oil.
  • Unclear or conflicting scientific evidence:
  • Acupuncture: Acupuncture plus point-injection has been found beneficial for obstinate urticaria (rash), although more research is needed to confirm these findings. Further research is also needed to determine whether acupuncture can effectively treat skin disorders such as hives (itchy, red welts that form on the skin).
  • Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders or with drugs that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.
  • Agrimony: It remains unclear whether agrimony can effectively treat cutaneous disorders and rashes. Further research is needed to determine if agrimony is safe and effective.
  • Avoid if allergic or hypersensitive to agrimony or its related species. When used as recommended, agrimony is considered to be safe. Avoid with bleeding disorders, kidney or liver disease, or diabetes. Use cautiously with drugs that lower blood pressure.
  • Aromatherapy: Aromatherapy is a loosely applied term that refers to several modalities that deliver essential oils to the body. It is unclear whether aromatherapy may be of benefit in pediatric atopic eczema.
  • Essential oils should be administered in a carrier oil to avoid toxicity. Avoid if history of allergic dermatitis. Use cautiously if driving/operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
  • Avocado: Early scientific research showed promising results using avocado in a cream for psoriasis. Additional studies are needed in this area before a firm recommendation can be made.
  • Avoid if allergic or hypersensitive to avocado, banana, chestnut, or natural rubber latex. Use cautiously with anticoagulants (like warfarin). Avoid with monoamine oxidase inhibitors (MAOIs). Doses greater than found in a normal diet are not recommended if pregnant or breastfeeding. Some types of avocado may be unsafe when breastfeeding.
  • Bishop's weed: Clinical study has used 8-methoxypsoralen (8-MOP), a compound from Bishop's weed that has been identified as a treatment for psoriasis. High quality clinical studies are needed before any strong recommendation can be made.
  • Use cautiously in patients with photosensitivity. Use cautiously in patients with bleeding disorders or taking anticoagulants, NSAIDs/anti-platelet agents, or herbs/supplements that increase risk of bleeding. Use cautiously in patients taking drugs or herbs/supplements metabolized by cytochrome P450. Use cautiously in patients with eye disorders. Avoid in patients with known allergy/hypersensitivity to bishop's weed, its constituents, or members of the Apiaceae family.
  • Borage seed oil: The evidence for borage oil in the treatment of atopic dermatitis is mixed. Additional study is needed in this area. Seborrheic dermatitis is a type of inflammatory skin rash. Currently, there is insufficient evidence to support borage in the treatment of seborrheic dermatitis.
  • Avoid if allergic or hypersensitive to borage, its constituents, or members of the Boraginaceae family. Use cautiously in patients with bleeding disorders or taking warfarin or other anticoagulant or antiplatelet (blood thinning) agents. Use cautiously in patients with epilepsy or taking anticonvulsants. Avoid in patients with compromised immune systems or similar immunological conditions. Avoid in pregnant patients as borage oil may be contraindicated in pregnancy given the teratogenic and labor-inducing effects of prostaglandin E agonists, such as borage oil's GLA. Avoid if breastfeeding.
  • Bromelain: Bromelain has been shown to decrease inflammation, regulate the immune system, and have antiviral effects and may help treat skin rash.
  • Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or members of the Bromeliaceaefamily. Use cautiously with a history of bleeding disorders, stomach ulcers, or heart, liver, or kidney disease. Use caution before dental or surgical procedures or while driving or operating machinery. Avoid if pregnant or breastfeeding.
  • Bupleurum: Chinese studies have suggested that bupleurum may be helpful for reducing fever. However, additional study is needed to draw a firm conclusion about safety and effectiveness. In traditional Chinese medicine, bupleurum is often used in combination with other herbs.
  • Avoid if allergic or hypersensitive to bupleurum, Apiaceae or Umbelliferae (carrot) families, snakeroot, cow parsnip, or poison hemlock. Use cautiously if operating motor vehicles or hazardous machinery. Use cautiously with low blood pressure, diabetes, or edema. Use cautiously with a history of bleeding, hemostatic disorders, or drug-related hemostatic disorders. Use cautiously if taking blood thinners. Avoid if pregnant or breastfeeding.
  • Butterbur: Preliminary research suggests that butterbur may not suppress allergic skin disease reactions when compared to the prescription drug fexofenadine (Allegra®), which does suppress these reactions. Additional study is needed. Use caution if allergic or sensitive to Petasites hybridus or other plants from the Asteraceae/Compositae family (like ragweed, marigolds, daisies and chrysanthemums). Raw, unprocessed butterbur plant should not be eaten due to the risk of liver or kidney damage or cancer. Avoid if pregnant or breastfeeding.
  • Calendula: Limited early research suggests that calendula extracts may reduce skin inflammation. Human studies are lacking in this area.
  • Avoid if allergic to plants in the Aster/Compositae family such as ragweed, chrysanthemums, marigolds, and daisies. Use cautiously in patients taking sedatives, blood pressure medications, cholesterol medications, blood sugar-altering agents, and immunomodulators. Use cautiously with diabetes and in children. Avoid if pregnant or breastfeeding.
  • Chamomile: The German Commission E authorizes the use of topical chamomile for diseases of the skin. However, little research has been done on topical chamomile for eczema. Topical chamomile preparations have traditionally been used to soothe skin inflammation. The existing human evidence shows that chamomile may be of little, if any, benefit while animal studies support its anti-inflammatory action. Additional human research is needed in this area.
  • Avoid if allergic to chamomile. Anaphylaxis, throat swelling, skin allergic reactions and shortness of breath have been reported. Chamomile eyewash may cause allergic conjunctivitis (pinkeye). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
  • Chondroitin sulfate: Early research suggests that chondroitin may help treat psoriasis. Well-designed clinical trials are needed to confirm these results.
  • Use cautiously if allergic or hypersensitive to chondroitin sulfate products. Use cautiously with bleeding disorders and with blood-thinners like warfarin (like Coumadin®). Avoid if pregnant or breastfeeding.
  • Clove: Clove is commonly used as a fragrant or flavoring agent. There is a risk of blindness if it comes in contact with the eyes. Clove oil (eugenol) has been used for its analgesic (pain-relieving), local anesthetic, anti-inflammatory, and antibacterial effects. Early studies suggest that clove may lower fever, but reliable human studies are currently unavailable.
  • Avoid if allergic to clove, eugenol, or some licorice products or tobacco (clove cigarette) products. Use cautiously if allergic to Balsam of Peru. Avoid with a history of seizures, stroke, or liver damage. Use cautiously if taking medications that treat diabetes. Use cautiously with diabetes, low blood sugar levels, bleeding problems, or impotence. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
  • DHEA: DHEA (dehydroepiandrosterone) is a hormone that is produced by the adrenal glands in the body. Overall, study results suggest that DHEA likely offers no benefit to individuals with psoriasis, but some disagree. Additional research is needed before a firm conclusion can be made.
  • Avoid if allergic to DHEA. Avoid with a history of seizures. Use with caution in adrenal or thyroid disorders or anticoagulants, or drugs, herbs, or supplements for diabetes, heart disease, seizure, or stroke. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.
  • Euphorbia: Early research of Euphorbia acaulis has demonstrated an effect on patients with eczema. More trials are needed to evaluate the effect of Euphorbia acaulis for eczema.
  • Avoid if allergic or hypersensitive to pollen from Euphorbia fulgens. Use cautiously with history of Epstein Barr virus infection or stomach conditions. Avoid if pregnant or breastfeeding.
  • Gamma linolenic acid (GLA): Clinical studies have used GLA to treat atopic dermatitis in adults, children, and infants. Changes in linolenic acid metabolism have been related to eczema where conversion of linolenic acid to GLA is inhibited in persons with atopic dermatitis. However, studies in the past 20 years reveal minimal therapeutic improvements with GLA as therapy for atopic dermatitis, noted by only marginal to no improvement in inflammation and itching.
  • GLA is generally considered nontoxic and well tolerated for up to 18 months. Use cautiously with anticoagulants (blood-thinners), and avoid if pregnant or breastfeeding.
  • Gamma oryzanol: A few studies have used gamma oryzanol by mouth or applied on the skin to treat skin conditions. Although these studies seem to indicate that gamma oryzanol may be useful, additional research is needed to assess gamma oryzanol's effects.
  • Avoid if allergic/hypersensitive to gamma oryzanol, its components, or rice bran oil. Use cautiously if taking anticoagulants (blood thinners), central nervous system (CNS) suppressants, growth hormone, drugs that alter blood sugar levels, immunomodulators, luteinizing hormone or luteinizing hormone-releasing hormone, prolactin, cholesterol-lowering agents, thyroid drugs, and herbs or supplements with similar effects. Use cautiously with diabetes, hypothyroidism, hypoglycemia, hyperglycemia, or high cholesterol. Avoid if pregnant or breastfeeding.
  • Grapefruit: There is early but inconclusive evidence to support the use of grapefruit seed extract in the treatment of atopic eczema. Additional research is needed to confirm these findings.
  • Avoid if allergic to grapefruit. Grapefruit may interact with prescription drugs, herbs, and supplements. Use cautiously if taking cytochrome P450 3A4 substrates such as anticoagulant/antiplatelets (agents that affect blood/clotting), antiarrhythmics (medications used to treat abnormal rhythms in the heart), seizure drugs, antidepressants, antihistamines, drugs that affect blood pressure, benzodiazepines (a class of psychotropic drugs that have a hypnotic and sedative action), calcium channel blockers, caffeine, corticosteroids (anti-inflammatories), erectile dysfunction drugs, estrogens, immune modulators, HMG-CoA reductase inhibitors, macrolide antibiotics, and protease inhibitors. Use cautiously if drinking red wine or tonic water. Use cautiously when smoking and with liver cirrhosis or at risk for kidney stones. Use cautiously in patients that have undergone gastric bypass surgery. Use cautiously if pregnant or breastfeeding.
  • Honey: The evidence supporting the use of honey in the treatment of dermatitis is limited. Further investigation is needed to make a firm recommendation.
  • Avoid if allergic or hypersensitive to honey, pollen, celery, or bees. Honey is generally considered safe in the recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously if taking antibiotics. Potentially harmful contaminants (e.g. C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously if pregnant or breastfeeding.
  • Hydrotherapy: There is insufficient evidence to determine whether hydrotherapy is an effective treatment for atopic dermatitis or psoriasis.
  • Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices such as pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.
  • Hypnotherapy: Further research is needed to determine whether hypnotherapy is an effective treatment for skin conditions (eczema, psoriasis, atopic dermatitis).
  • Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder, or dissociative disorders. Use cautiously with seizure disorders.
  • Jewelweed: Jewelweed has been used traditionally as a treatment for various types of contact dermatitis, including poison ivy/oak rashes and allergic dermatitis, however, human study indicates that it may not be effective for this use. Avoid if allergic or hypersensitive to jewelweed (Impatiens biflora), its constituents, or members of the Balsaminaceae family. Use cautiously if taking calcium supplements and with kidney stone disorders. Avoid consuming excess amounts of jewelweed due to reports of high mineral content, particularly calcium oxalate. Avoid if pregnant or breastfeeding.
  • Khella: Preliminary evidence suggests that khellin taken by mouth may be an effective therapy for psoriasis. However, additional study is needed to confirm these results.
  • Avoid if allergic to members of the Apiaceae family. Khella may cause liver poisoning (hepatotoxicity) in high doses. Use cautiously with liver problems or asthma. Avoid prolonged exposure to sunlight or ultraviolet radiation. Avoid if pregnant.
  • Lavender: In limited clinical study, essential oils were used in combination with massage to treat childhood atopic eczema. It was found that there was deterioration in the patient's eczema, which may have been due to possible allergic contact dermatitis provoked by the essential oils themselves. More study on the effect of lavender essential oil alone is needed before any firm conclusions can be made.
  • Avoid if allergic or hypersensitive to lavender. Avoid with a history of seizures, bleeding disorders, eating disorders (anorexia, bulimia), or anemia (low levels of iron). Avoid if pregnant or breastfeeding.
  • Licorice: Topical licorice extract gel has been shown to be effective in the treatment of atopic dermatitis in preliminary human study. Further research is needed to confirm these results.
  • Avoid with a known allergy to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid with congestive heart failure, coronary heart disease, kidney or liver disease, fluid retention, high blood pressure, hormonal abnormalities or if taking diuretics. Licorice may cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities.
  • Marshmallow: Marshmallow extracts have traditionally been used to treat inflammatory skin conditions. Several laboratory experiments, mostly in the 1960s, reported marshmallow to have anti-inflammatory activity but limited human study is available. Safety, dosing, and effectiveness compared to other anti-inflammatory agents have not been examined.
  • Historically, marshmallow is generally regarded as being safe in healthy individuals. However, since studies have not evaluated the safety of marshmallow, proper doses and duration in humans are not known. Allergic reactions may occur. There is not enough scientific evidence to support the safe use of marshmallow during pregnancy or breastfeeding.
  • Massage: Massage may be of benefit in pediatric atopic dermatitis. More studies are needed for a conclusion to be made.
  • Avoid with bleeding disorders, low platelet counts, or if on blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously if history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the patient.
  • Meditation: Meditation has been suggested to improve healing of psoriasis, when used in combination with standard treatments. More studies are needed.
  • Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professional(s) before starting a program of meditation, and should explore how meditation may or may not fit in with their current treatment plan. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.
  • Neem: Limited human data on the effect of neem on psoriasis vulgaris is available. Further research is needed before a firm conclusion can be made.
  • Avoid if allergic or hypersensitive to neem (Azadirachta indica) or members of the Meliaceae family. Use cautiously with liver disease. Avoid in children and infants. Avoid if pregnant or breastfeeding.
  • Niacin: Niacin is a B complex vitamin found in a many foods such as liver, poultry, fish, nuts, and dried beans. Niacinamide has traditionally been used in topical products for skin conditions. Preliminary research suggests benefit of a niacinamide moisturizer on dry skin in patients with rosacea. Further research is warranted.
  • Avoid niacin/vitamin B3 if allergic to niacin or niacinamide. Avoid with a history of liver disease, irregular heartbeats, heart disease, blood clotting or bleeding disorders, asthma, anxiety, panic attacks, thyroid disorders, stomach ulcers, gout, or diabetes. Avoid if pregnant or breastfeeding.
  • Omega-3 fatty acid, fish oil, alpha-linolenic acid: There is currently insufficient evidence to determine whether omega-3 fatty acid can effectively treat skin conditions, including eczema or psoriasis. Further research is warranted.
  • Avoid if allergic or hypersensitive to fish, omega-3 fatty acid products that come from fish, nuts, linolenic acid or omega-3 fatty acid products that come from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure or drugs, herbs or supplements that treat any such conditions. Use cautiously before surgery. The Environmental Protection Agency (EPA) recommends that intake be limited in pregnant/nursing women to a single 6-ounce meal per week, and in young children to less than 2 ounces per week. For farm-raised, imported, or marine fish, the U.S. Food and Drug Administration recommends that pregnant/nursing women and young children avoid eating types with higher levels of methylmercury and less than 12 ounces per week of other fish types. Women who might become pregnant are advised to eat 7 ounces or less per week of fish with higher levels of methylmercury or up to 14 ounces per week of fish types with about 0.5 parts per million (such as marlin, orange roughy, red snapper, or fresh tuna).
  • Papain: Papain has shown some benefits in reducing scaling in dry skin conditions. More high quality studies are needed to confirm these results.
  • Use cautiously in patients sensitive to papain. Use cautiously in patients being treated for prostatitis. Use Wobenzym®, which contains papain, cautiously, especially in those with bleeding disorders or taking anticoagulants or antiplatelets. Use cautiously as an adjuvant to radiation therapy. Avoid in patients with gastroesophageal reflux disease. Avoid in patients using immunosuppressive therapy.
  • Para-aminobenzoic acid: Para-aminomethylbenzoic acid (PABA) may be useful in the treatment of lichen slerosus, a benign, progressive dermatologic condition characterized by inflammation, pruritus (itching), and pain, especially in the anogenital region (involving the anus and genitals). Additional investigations are needed regarding the use of PABA for inflammatory skin disorders.
  • Avoid with known hypersensitivity to PABA or its derivatives. Discontinue use if rash, nausea, or anorexia occurs. Avoid oral use in children and pregnant or nursing women. Use cautiously in patients with renal or liver disease. PABA should not be given concurrently with sulfonamides. Use cautiously in patients with bleeding disorders or taking anticoagulants. Use cautiously in patients with diabetes or hypoglycemia.
  • Peony: Peony root may have beneficial effects on immune function. These effects may help decrease inflammation associated with allergic skin reactions such as allergic dermatitis. There is currently not enough evidence to recommend for or against the use of peony in allergic skin conditions.
  • Avoid if allergic or sensitive to peony. Avoid with bleeding disorders or if taking drugs, herbs, or supplements that increase bleeding risk. Use cautiously with estrogen-sensitive cancers or if taking drugs, herbs, or supplements with hormonal activity. Avoid if pregnant or breastfeeding.
  • Polypodium: Laboratory and animal studies report that Polypodium leucotomos extract (anapsos) may reduce inflammation. However, there is clinical little information about the effectiveness of anapsos taken by mouth in people with atopic dermatitis or psoriasis. Poor-quality human studies report that anapsos may improve skin appearance. More research is needed in this area before a recommendation can be made.
  • Avoid if allergic to ferns (family Polypodiaceae) or if pregnant or breastfeeding.
  • Psychotherapy: Atopic dermatitis is a skin disease associated with an increased anxiety level. Psychotherapy may be helpful for atopic dermatitis patients with high levels of anxiety. However, more research is needed before recommendation can be made.
  • Psychotherapy is not always sufficient to resolve mental or emotional conditions. Psychiatric medication is sometimes needed. The reluctance to seek and use appropriate medication may contribute to worsening of symptoms or increased risk for poor outcomes. The client or patient should seek referrals from trusted sources and should also inquire of the practitioner's training and background before committing to work with a particular therapist.
  • Rose hip: Rose hips are reputed to have antibacterial and antifungal properties and have traditionally been used as an anti-inflammatory agent for dermatoses. In addition, rose hips contain several vitamins and minerals, including vitamin C, vitamin B1,vitamin E, calcium, zinc, and carotenoids that may have therapeutic effects when applied to the skin. High quality clinical trials are needed to establish the therapeutic efficacy of rose hips and rose oil preparations in the topical treatment of dermatological disorders.
  • Use cautiously in patients taking immune system stimulants, anticoagulant or anti-platelet aggregating agents, or laxatives. Avoid in patients who are allergic to rose hips, rose pollen, its constituents, or members of the Rosaceae family.
  • Rutin: In clinical study, O-(beta-hydroxyethyl)-rutoside (a form of rutin) offered benefit for skin irritation in individuals with breast cancer undergoing radiation treatment. More well-designed clinical trials are required to better determine the effectiveness of rutin for skin conditions.
  • Avoid if allergic/hypersensitive to O-(beta-hydroxyethyl)-rutosides or plants that rutin is commonly found in, such as rue, tobacco, or buckwheat. Use cautiously in elderly patients. Use cautiously with skin conditions. Use cautiously if taking medications for edema, diuretics, or anti-coagulation medications. Use cautiously if pregnant or breastfeeding.
  • Safflower: Preliminary evidence looks promising for the use of safflower oil in the treatment of phrynoderma, a rough, dry skin condition generally associated with a vitamin A deficiency. Additional study is warranted to better determine the effectiveness of safflower for skin conditions.
  • Avoid if allergic/hypersensitive to safflower, Carthamus tinctorius, safflower oil, daisies, ragweed, chrysanthemums, marigolds or any related constituents. Use parenteral safflower oil emulsions cautiously in newborns. Use cautiously with diabetes, hypotension, inadequate liver function, hypercoagulability, and skin pigmentation conditions. Use cautiously if pregnant or breastfeeding.
  • Sanicle: Sanicle (Sanicula europaea, Sanicula europa) has been studied for use in atopic eczema. More studies are needed.
  • Avoid if allergic or sensitive to sanicle. Use cautiously with stomach problems. Use cautiously if taking blood pressure-lowering or diuretic drugs. Avoid if pregnant or breastfeeding.
  • Schisandra: There is a currently a lack of available sufficient evidence to determine if schisandra is an efficacious treatment for eczema. Results from limited study, which investigated the effect of schisandra in combination with other herbs, suggested a potential benefit. Further study is required before conclusions can be drawn.
  • Use cautiously during pregnancy or lactation due to insufficient available evidence. Use cautiously in patients with bleeding disorders, seizure disorders, high intracranial pressure, high blood pressure, gastoeseophageal reflux or peptic ulcer disease, neurological disorders, and diabetes. Avoid in patients allergic to schisandra, any of its constituents, or other members of the Schisandraceae family. Allergic skin rashes and urticaria has been reported in some patients.
  • Sea buckthorn: Study results on the effectiveness of sea buckthorn for atopic dermatitis are mixed. More study is needed in this area before a conclusion can be made.
  • Avoid if allergic or hypersensitive to sea buckthorn, its constituents, or members of the Elaeagnaceae family. Use cautiously if taking angiotensin converting enzyme (ACE) inhibitors, anticoagulants and antiplatelet agents (blood thinners), antineoplastics (anticancer agents), or cyclophosphamide or farmorubicin. Avoid higher doses than food amounts if pregnant or breastfeeding.
  • Selenium: Further research is necessary to determine whether selenium can be used to effectively treat psoriasis and other skin disorders.
  • Avoid if allergic or sensitive to products containing selenium. Avoid with history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
  • Shark cartilage: Shark cartilage products have been tested by mouth or on the skin in people with psoriasis. However, no clear benefits have been shown. More research is needed before a conclusion can be drawn.
  • Avoid if allergic to shark cartilage or any of its ingredients (including chondroitin sulfate and glucosamine). Use cautiously with sulfur allergy. Avoid with history of heart attack, vascular disease, heart rhythm abnormalities, or heart disease. Use cautiously with history of liver or kidney disorders, tendency to form kidney stones, breast cancer, prostate cancer, multiple myeloma, breathing disorders (like asthma), cancers that raise calcium levels (like breast, prostate, multiple myeloma, or squamous cell lung cancer), or diabetes. Avoid if pregnant or breastfeeding.
  • Spiritual healing: There is limited research on the use of spiritual healing for eczema. Further research is needed.
  • Spiritual healing should not be used as the only treatment approach for medical or psychiatric conditions, and should not delay the time it takes to consider more proven therapies.
  • St. John's wort: Early research of Hypericum cream for the topical (applied to the skin) treatment of mild to moderate atopic dermatitis shows positive results. Further studies are needed before a firm conclusion can be made.
  • Avoid if allergic or hypersensitive to plants in the Hypericaceaefamily. Rare allergic skin reactions like itchy rash have been reported. Avoid with HIV/AIDS drugs (protease inhibitors) like indinavir (Crixivan®), or non-nucleoside reverse transcriptase inhibitors, like nevirapine (Viramune®). Avoid with immunosuppressant drugs (like cyclosporine, tacrolimus or myophenic acid). Avoid with organ transplants, suicidal symptoms, or before surgery. Use cautiously with history of thyroid disorders. Use cautiously with drugs that are broken down by the liver, with monoamine oxidase inhibitors (MAOI) or selective serotonin reuptake inhibitors (SSRIS), digoxin, or birth control pills. Use cautiously with diabetes or with history of mania, hypomania (as in Bipolar Disorder), or affective illness. Avoid if pregnant or breastfeeding.
  • Sweet marjoram: Limited available human study showed that massage with essential oils, including marjoram, was not more effective in alleviating childhood atopic eczema than massage without essential oils. More long term high-quality studies with sweet marjoram alone are needed.
  • Use cautiously in patients with bleeding disorders or in those taking anticoagulants, in patients with diabetes or in those taking antidiabetic agents, or in pregnant patients. Avoid in patients with known allergy/hypersensitivity to marjoram, its constituents, or to members of the Lamiaceae family.
  • Tea tree oil: Small studies show that tea tree oil applied to the skin may reduce allergic skin reactions caused by histamine-induced inflammation.
  • Avoid allergic or hypersensitive to tea tree oil (Melaleuca alternifolia), any of its constituents, balsam of Peru, benzoin, colophony (rosin) tinctures, eucalyptol, or members of the Myrtle (Myrtaceae) family. Avoid taking tea tree oil by mouth. Avoid if taking antineoplastic agents. Use tea tree oil applied to the skin cautiously in patients with previous tea tree oil use. Avoid if pregnant or breastfeeding.
  • Thyme: Historically, thyme has been used topically for a number of inflammatory skin disorders. Results are mixed. Additional study is needed in this area.
  • Avoid with known allergy/hypersensitivity to members of the Lamiaceae (mint) family or to any component of thyme, or to rosemary (Rosmarinus officinalis). Avoid oral ingestion or non-diluted topical application of thyme oil due to potential toxicity. Avoid topical preparations in areas of skin breakdown or injury, or in atopic patients, due to multiple reports of contact dermatitis. Use cautiously in patients with gastrointestinal irritation or peptic ulcer disease due to anecdotal reports of gastrointestinal irritation. Use cautiously in patients with thyroid disorders due to observed anti-thyrotropic effects in animal research of the related species Thymus serpyllum. Avoid if pregnant or breastfeeding.
  • Thymus extract: It remains unclear whether thymus extract can effectively treat skin conditions such as psoriasis or eczema. Early research results are inconclusive. Further research is needed.
  • Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid if receiving immunosuppressive therapy, with thymic tumors, myasthenia gravis (neuromuscular disorder), untreated hypothyroidism, or if taking hormonal therapy. Avoid if pregnant or breastfeeding; thymic extract increases human sperm motility and progression.
  • Witch hazel: Based on human study, witch hazel was less effective than hydrocortisone cream, and no more effective than placebo in relieving inflammation associated with atopic eczema. Although witch hazel has been commonly used to relieve minor skin irritations, there are few human studies evaluating its use for this purpose, especially in children. High quality clinical study is needed in this area.
  • Avoid if allergic or sensitive to witch hazel. Avoid if pregnant or breastfeeding. Use cautiously in patients with liver or kidney disorders, diabetes, and in children.
  • Zinc: Preliminary research on the effectiveness of zinc to treat skin conditions, including psoriasis and eczema are inconclusive. Further research is necessary before a firm conclusion can be made.
  • Zinc is regarded as relatively safe and generally well tolerated when taken at recommended doses and few studies report side effects. Zinc should only be given to pregnant or breastfeeding women under the supervision of their qualified healthcare providers.
  • Fair negative scientific evidence:
  • Boron: Preliminary human research of a topical ointment containing boric acid does not report significant benefits in patients with psoriasis.
  • Avoid if allergic or sensitive to boron, boric acid, borax, citrate, aspartate, or glycinate. Avoid with history of diabetes, seizure disorder, kidney disease, liver disease, depression, anxiety, high blood pressure, skin rash, anemia, asthma, or chronic obstructive pulmonary disease (COPD). Avoid with hormone-sensitive conditions like breast cancer or prostate cancer. Avoid if pregnant or breastfeeding.
  • Evening primrose oil: Initial research does not show a benefit of evening primrose oil in the treatment of psoriasis.
  • Individuals who are allergic to plants in the Onagraceae family, gamma-linolenic acid, or other ingredients in evening primrose oil should avoid the substance. Individuals with seizure disorders and pregnant or breastfeeding women should also avoid evening primrose oil.
  • Traditional or theoretical uses lacking sufficient evidence:
  • Aconite: The aconite plant grows in rocky areas. It is often found in the mountainous woodlands of many parts of Europe, especially France, Austria, Germany, and Denmark. Although aconite has been suggested as a potential treatment for skin rash, human studies are lacking.
  • It has also been suggested that aconite may help reduce the symptoms of fevers. Homeopaths often prescribe aconite preparations at the start of a fever. However, studies are currently lacking in this area.
  • Aconite is highly toxic and is not safe for human consumption. Avoid with heart disease, heart dysfunction, irregular heartbeat, hemodynamic instability (abnormal blood flow), gastrointestinal disorders, ulcers, reflux esophagitis, ulcerative colitis, spastic colitis, or diverticulosis. Use cautiously with diabetes or suicidal tendencies. Avoid if younger than 18 years old. Avoid if pregnant or breastfeeding.
  • Amaranth oil: Amaranth is grown in Asia and the Americas and harvested primarily for its grain, which is used as a food source for bread, pasta, and infant food. Amaranth has been suggested as a potential treatment for skin rash. However, human studies are lacking.
  • Amaranth is generally considered safe. Avoid if allergic or sensitive to amaranth. Use cautiously with diabetes, low blood sugar levels, low blood pressure, immune system disorders, or kidney disorders. Use cautiously if pregnant or breastfeeding.
  • Feverfew: It is unclear if feverfew (Tanacetum parthenium) is an effective treatment for skin rash because human studies are currently lacking.
  • Avoid if allergic to feverfew or other plants of the Compositaefamily (chrysanthemums, daisies, marigolds, ragweed). Stop use before surgery and dental or diagnostic procedures. Avoid with drugs that increase bleeding risk. Avoid stopping feverfew use all at once. Instead, slowly take less and less over several days. Avoid with a history of heart disease, anxiety, or bleeding disorders. Caution is advised with history of mental illness, depression, or headaches. Avoid if pregnant or breastfeeding.
  • Rhubarb: Rhubarb is an herb that is commonly used in traditional Chinese medicine (TCM). Traditionally, rhubarb has been used to treat fever. Until studies are performed, it remains unknown if rhubarb can help reduce fevers in humans.
  • Avoid if allergic to rhubarb, its constituents, or related plants from the Polygonaceae family. Avoid using rhubarb for more than two weeks. Avoid with atony (lack of muscle tone), colitis, Crohn's disease, dehydration with electrolyte depletion, diarrhea, hemorrhoids, insufficient liver function, intestinal obstruction, ileus, irritable bowel syndrome, menstruation, pre-eclampsia, renal disorders, ulcerative colitis, and urinary problems. Avoid handling rhubarb leaves, as they may cause contact dermatitis. Avoid rhubarb in children younger than 12 years old due to water depletion. Use cautiously with bleeding disorders, cardiac conditions, constipation, history of kidney stones, or thin or brittle bones. Use cautiously if taking anticoagulants, anti-psychotic drugs, or oral drugs, herbs, or supplements (including calcium, iron, and zinc). Avoid if pregnant or breastfeeding.
  • Stinging nettle: Stinging nettle is found in Africa, Europe, the United States, and Canada. It is a perennial plant that has been used as a medical treatment since ancient times. Although stinging nettle has been suggested as a potential treatment for skin rash, human studies are lacking.
  • Avoid if allergic or hypersensitive to nettle, members of the Urticaceae family, or any ingredient of nettle products. Use cautiously with diabetes, bleeding disorders, or low sodium levels in the blood. Use cautiously if taking diuretics or anti-inflammatory drugs. Use cautiously in older adults. Avoid if pregnant or breastfeeding.
  • Valerian: Valerian is an herb native to Europe and Asia. Today, the herb grows in most parts of the world. It is unclear if valerian can help treat fevers. Studies have not been performed to determine if this is a safe and effective fever treatment.
  • Use cautiously if allergic to valerian or other members of the Valerianaceaefamily. Use cautiously with livers disorders. Use cautiously two weeks before surgery. Avoid if driving or operating heavy machinery, as it may cause drowsiness. Avoid if pregnant or breastfeeding.

Prevention
  • Auto-injectable epinephrine: Individuals who have experienced anaphylactic reactions should avoid allergy-causing food, medications, or substances. Individuals with a history of anaphylaxis should carry an autoinjectable epinephrine device (known as an EpiPen®) with them at all times. A trained family member or friend may help the patient administer the epinephrine, if necessary.
  • Discuss history of allergies: Patients should tell their healthcare providers if they are allergic to any drugs (prescription or over-the-counter), herbs, or supplements. Patients should not take a drug, herb, or supplement that has caused an allergic reaction in the past.
  • Good hygiene: Patients can take precautions to avoid contracting infections that may cause fever and rash. Patients should thoroughly wash their hands with soap and water. Patients should talk to their healthcare providers about recommended immunizations. Patients should minimize or avoid close contact with individuals who have contagious illnesses.
  • Highly active antiretroviral therapy (HAART): HIV patients should receive highly active antiretroviral therapy (HAART), which is a combination of anti-HIV drugs (antiretrovirals). This treatment suppresses the virus and boost's the immune system. Therefore, patients who receive HAART are less likely to develop infections that may cause fever and rash.

Complications
  • Anaphylaxis: A skin rash and fever may be symptoms of a severe and potentially life-threatening reaction called anaphylaxis. The most serious symptoms of anaphylaxis include chest pain, difficulty breathing, shock, and loss of consciousness, all of which can be fatal. Patients should seek immediate medical treatment if these symptoms develop.
  • Febrile seizure: A febrile seizure occurs when an infant or young child develops a seizure or convulsions when he/she has a fever higher than 102 degrees Fahrenheit. Symptoms may include shaking or jerking of the arms or legs, fixed stare, eyes rolling back, heavy breathing, drooling, and bluish skin. Patients who experience these symptoms should be taken to the emergency department of a nearby hospital immediately.
  • Infection: Some infections that cause fever and rash may spread to multiple parts of the body and cause organ damage. For instance, a liver infection called hepatitis can potentially lead to liver failure. Therefore, HIV patients who experience symptoms of fever and rash should consult their healthcare providers to diagnose and treat the underlying cause.
  • Kaposi's sarcoma: Kaposi's sarcoma (KS) is a cancer that usually causes tumors to form in the tissues below the skin or face or in the mucous membranes of the nose, mouth, or anus. Patients typically suffer from lesions on the skin, which appear as raised blotches or lumps that may be purple, brown, or red. While the skin lesions may be disfiguring, they are not usually life threatening. In some cases, the lesions may be painful or cause swelling. However, if KS develops in the lungs, liver, or gastrointestinal tract, the disease may be life threatening because internal bleeding or difficulty breathing may develop. Patients should consult their healthcare providers if they experience symptoms of KS.
  • Stevens-Johnson syndrome: A skin rash and fever may be symptoms of a severe allergic reaction to medications, called Stevens-Johnson syndrome (SJS). This condition is potentially life threatening because, in severe cases, the lesions can cause significant scarring of the involved organs, which often leads to loss of function of the organ systems.
  • The reaction typically starts with a nonspecific upper respiratory tract infection. During the first stage of SJS, patients may experience flu-like symptoms, including, fever, sore throat, chills, headache, and a general feeling of discomfort for one to 14 days. Some patients also develop diarrhea and vomiting. As the disease progresses, skin lesions quickly develop. Skin lesions may occur anywhere, but they are most common on the soles of the feet, palms of the hands, and back of the hands. The skin may become red, swollen, or blistered and may contain open sores and/or blisters. Patients may experience extensive shedding of the skin. Patients who experience symptoms of SJS should seek immediate medical treatment.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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