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A growing concern over side effects of chemical-based products for enhancing ones’ beauty has resulted in the consumers’ shift to ayurvedic beauty products. Many companies have entered the beauty segment with branded products in categories such as skin care, hair care, soaps and essential oils. India is capturing the mainstream cosmetics industry and capitalizing on Ayurveda. Itincludes various high end brands creating makeup shades (based on the country’s bright colors) to skin- and hair-care segments. Indian herbs and Ayurveda products are being sourced and tested for use in the cosmetics industry and beauty parlours. Ayurvedic natural cosmetics business of India is growing at the rate of 15-20% per year- much higher than India’s overall cosmetics business that has a growth rate of 7-8%. Yoga is a mind and body practice with historical origins in ancient Indian philosophy. Various styles of yoga typically combine physical postures, breathing techniques, and meditation or relaxation.Practicing yoga might improve quality of life; reduce stress and hence improve overall physical fitness and appearance. Naturopathy includes a range of therapies based on exposure to natural elements such as sunshine, fresh air, heat, or cold, nutrition. The treatment modalities include nutrition and dietary changes (eating more whole and unprocessed foods) and use of vitamins, minerals, dietary supplements, herbal medicines. Hydrotherapy, physical medicine (therapeutic massage and joint manipulation), exercise therapy and lifestyle counseling are other aspects of naturopathy Unani and Sidha are traditional Indian medicinal systems and chiefly use herbal remedies, dietary and lifestyle modifications. There are few indexed studies demonstrating efficacy of polyherbal Unani formulations in acne vulgaris. Homeopathy was developed by Samuel Hahnemann, a German physician. It is based on the law of similars and the law of infinitesimals. The first doctrine is simili similibus curenti that is the symptoms caused by a drug in healthy person, will cure similar symptoms. The second doctrine is that the appropriate drug has to be given in high dilutions, and that the higher the dilution, the greater the effect; and is termed as potentiation. Modern physics and chemistry have shown that some of the dilutions used in homeopathy may be so high that no molecule of the original substance will remain in the preparation. However, the “essence” of the original substance is considered to remain in the preparation and a “memory of water” has been postulated. Homeopathic remedies include substances derived from plants, minerals, or animals. Examples are red onion, arnica (mountain herb), crushed whole bees, white arsenic, poison ivy, belladonna and stinging nettle. The remedies are formulated as sugar pellets to be placed under the tongue; other forms, such as ointments, gels, drops, creams, and tablets are also available.
Homeopaths generally begin with detailed examinations of their patients’ histories, including questions regarding their physical, mental and emotional states, their life circumstances and any physical or emotional illnesses. The homeopath then attempts to translate this information into a complex formula of mental and physical symptoms, including likes, dislikes, innate predispositions and even body type. There is no specific drug for disease as in case of modern medicine but collective understanding of patient’s symptom complex and the selection of drug from material medica. There are various “miASMS’ envisaged and understanding them and, the defect in constitution ultimately leads to the selection of remedy. Themiasms are as follows Psoric, sycotic, syphilitic and tubercular. The homeopathy practitioner chooses how to treat the patient based on the inner physical and mental stress, personality, the symptoms, miasms, individual constitution, personal and family history. Homeopathy is being used in various dermatological diseases including infections such as warts, abscesses; chronic conditions such as acne, psoriasis, rosacea, various forms of eczema, etc. Though homeopathy claims to be beneficial in a variety of chronic cutaneous diseases, a review of various trials of homeopathic treatment did not find evidence for any single dermatological condition. The outcome of a therapeutic measure may be due to a placebo effect, the medical intervention or by the natural course of the disease resulting in recovery by the patient. In cosmetic dermatology, homeopathy attempts to alter the patients’ mindset towards changes in beauty and appearance and its perception. In any disfigurement perceived, the cosmetic enhancement needed will be balanced by homeopathic principle of correcting mental and physical disturbances and correcting the miasms which are responsible for various cosmetic problems such as pigmentation, acne, aging, hair loss or excess body hair. Homeopathy may be considered as an effective method of communication and counseling for various chronic diseases. Traditional Chinese medicine practitioners use herbal medicines and various mind and body practices (tai chi and qi gong), and acupuncture. The fundamental treatment techniques in acupuncture are either needling, heat, moxibustion, suction or cupping, and pressure (acupressure). Acupuncture techniques have been used in various dermatological conditions including acne and melasma. Its use in cosmetology is now gaining popularity.Facial cosmetic acupuncture is applied to the head, face, and neck and showed improvement in facial elasticity in a pilot study. Aromatherapy is a subset of the biological or nature-based therapies. It consists of therapeutic use of volatile, aromatic essential oils extracted from plants. It has similarities to other forms of herbal medicines; the major difference between them is that, in the former, essential oils are extracted from parts of the plant, whereas the whole plant is used in herbal medicines. Aromatic forms of medicine have been used traditionally for spiritual, medicinal, social, and beauty purposes. The effects of aromatherapy are believed to result from the binding of chemical components in the essential oil to receptors in the olfactory bulb, impacting the brain’s emotional center, the limbic system. Topical application of aromatic oils may exert antibacterial, anti-inflammatory, and analgesic effects. The essential oils are usually diluted in carrier oils.
The essential oils may be extracted from different part of plants such as the leaves (eucalyptus, peppermint), flowers (lavender, rose), twigs (juniper), wood (sandalwood), roots (vetivert, calamus), sap (benzoin, frankincense), and grasses (palmarosa grass, lemongrass). The major chemical components of essential oils include terpenes, esters, aldehydes, ketones, alcohols, phenols, and oxides. Oils high in ketones are known for their wound-healing properties, such as Helichrysmitalicum (everlasting flower) whereas oils high in alcohols are renowned for their antimicrobial and anti-infectious properties (e.g., Melaleucaalternifolia terpinen-4-ol, tea tree). Two lavenders, Lavandula angustifoliaand Lavandula latifolia are high in alcohols, terpenes, and oxides and are noted for their effects in the rapid healing of burns, without scarring or infections. The carrier oils, such as avocado oil, wheat germ oil, sweet almond oil, evening primrose oil, and coconut oil, also have some pharmacologic activities. The oils may be applied externally in the following ways: therapeutic massage, mixed with a plain vegetable oil, via a compress , as a topical wound dressing, mixed in a gel or paste , as a spray , in a bath , or as an inhalation therapy. Essential oil may be ingredient of gargles and mouthwashes. The internal use of essential oils is very rare. The cosmetic and perfume industry are the largest users of essential oils. Although high-quality evidence of effectiveness and safety for aromatherapy in the cosmetic dermatology field is lacking, few studies are now being reported. Plant-derived essential oils may be a biologically plausible treatment for acne and is being researched. Lavender aromatherapy’s potential to ease anxiety in patients undergoing minimally invasive facial cosmetic procedures has been demonstrated. Positive biologic effect on hair loss and hair regrowth of a pulsed electromagnetic field in combination with essential oils in cases of androgenic alopecia has been demonstrated. Skin appearance affects the self-image via the central nervous system, whereas autonomic, psychoneuro-immunologic, and behavioral factors interact to affect the skin appearance. Psychological counseling and various techniques such as meditation, relaxation, hypnosis, biofeedback and other methods of stress management benefit cosmetic problems such as hair loss, rosacea, aging signs and acne. These techniques also help to reduce anxiety, needle phobia, and pain during various cosmetic and dermatosurgical procedures. The medical spa concept is new and gradually capturing the beauty and wellness market in India. In a medical or dermatology spa (spa environment within a cosmetic set up), the clients avail of treatments and services which have medicinal value and long lasting aesthetic benefits. It can be considered as a blend of medical and aesthetic services offered at a one stop shopping environment. CAM practices such as nutrition/ dietary supplements, massage therapy, aromatherapy are employed for skin rejuvenation and integrated within a cosmetic dermatology set up. Though CAM methods are considered safe and free from side- effects, these can cause adverse reactions. As there are no molecular targets available for most of the traditional medicine, it is difficult to assure their safety. The alternate or traditional medicines may contain heavy metals, toxins, allergens which can cause damage to the skin and/or internal organs.Oral herbal medications may be adulterated with steroids, heavy metals, nonsteroidal anti-inflammatory drugs, antihistamines, diuretics, etc. Chinese herbal creams may be adulterated with corticosteroids. Allergic contact dermatitis and photosensitization are common.
Both type I and Type IV hypersensitivity reactions have been documented with Ayurvedic oil (Dhanwantaratailam) application. Hepatotoxicity may be seen with commonly used herbal products, such as Ayurvedic and Chinese herbs, green tea, etc. There is a high use of CAM among cosmetic surgery patients along with increasing reports of hematomas associated with herbal and homeopathic medicines. The most common adverse effects with homeopathy were allergic reactions and intoxications. Heavy metals such as arsenic, cadmium, mercury and iron which are used in homeopathy can be toxic. Rhus toxidendron was a frequent cause of adverse reactions. Essential oils used in aromatherapy may be toxic if used inappropriately in the hands of unqualified personnel. Potential hazards from essential oils exist due to their chemical constituents. High proportions of aldehydes and phenols can cause irritant dermatitis; ketones can cause neurotoxicity; potentially carcinogenic components include safrole in sassafras oil or beta-asarone in calamus oil. Phototoxicity, allergic contact dermatitis and airborne contact dermatitis have been reported with aromatherapy. Adulteration in oils can cause dermocaustic reactions, neurotoxicity or have an abortive potential. In the field of CAM, it is difficult for science to catch up to practice due to the lack of funding for appropriate studies. In contrast, it also becomes difficult for practice to catch up to science as new information is discovered. It is also difficult to conduct randomized control trials to demonstrate the efficacy since most CAM therapies are individualized. However, qualitative research is gaining momentum in the field of CAM. The scientific evidence for a CAM product or practice (with respect to safety and efficacy) can be accessed by the literature reviews published in last 5 years in the form of systematic reviews or meta-analysis or randomized controlled trials; and has been made accessible by NCCAM. The Department of Health Research, Government of India has also developed a policy for studies on Ayurveda and other traditional medicines. CAM methods are commonly used in our population. Herbal medicines and natural products are an integral part of CAM and the use of botanicals, nutraceuticals and cosmeceuticals are an integral part of cosmetic dermatology practice. Thus a cosmetic dermatologist can be inclined to incorporate CAM in clinical practice to address the patient care needs. However, he/she should have a proper knowledge and experience with specific CAM treatments. In addition, further research into the efficacy, benefits, and risks of CAM methods should be undertaken for a better insight. CAM methods are popular and are commonly used by aesthetic patients to enhance their skin health, beauty and youth. Hence a cosmetic dermatologist needs to be aware of the various CAM practices.The major traditional Indian healthcare system includes AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy).
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