Oregon Grape (Mahonia aquifolium) as a tool for helping with Psoriasis

Background: Due to the emerging trend of alternative medicine, patients inquire about natural remedies to alleviate their symptoms. Dermatologists should be aware of the efficacy and safety of topical botanical treatments available on the market. Mahonia aquifolium, native to the United States, has been recently shown to have anti-inflammatory properties useful in cutaneous disorders. Objective: Our aim was to review clinical trials that assess the efficacy and safety of Mahonia aquifolium in cutaneous disorders. Design: We searched PubMed, MEDLINE, and the Web of Science databases and performed a manual search of clinical trials in the references. We excluded in vivo and in vitro animal trials. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Results: Of the 502 articles identified, eight met the inclusion criteria. Specifically, seven trials studied the effects of Mahonia aquifolium in psoriasis and one studied that in atopic dermatitis. Clinical trials have not been identified in any other cutaneous disorder using this plant extract. Risk of bias of included trials were either unclear or low risk. Five of seven studies showed a statistically significant improvement with Mahonia aquifolium in psoriasis, while one study showed efficacy in the treatment of atopic dermatitis. Conclusion: Several studies have shown that Mahonia aquifolium leads to a statistically significant improvement of symptoms in psoriasis and atopic dermatitis with minimal side effects.

Psoriasis is usually treated with local and systemic medications that have varying degrees of efficacy and safety profiles. We investigated the efficacy and safety of an alternative treatment from natural sources, Mahonia aquifolium, for the management of mild to moderate psoriasis. Two hundred subjects participated in a randomized, double-blind, placebo-controlled study using either the topical cream Reliéva (a homeopathic product containing a proprietary M. aquifolium extract) or control (placebo) twice a day for 12 weeks. Efficacy and safety were assessed using the Psoriasis Area Severity Index (PASI) and the Quality of Life Index (QLI) questionnaires at different times throughout the 12-week study. The PASI was evaluated by the physician at the beginning (week 0) and end (week 12) of the study. The QLI was assessed by patients at weeks 0, 4, 8, and 12. The results indicate statistically significant (P < 0.05) improvements in PASI and QLI in the Mahonia-treated group, compared with the control group. The side effects reported were infrequent, < 1% and minor; the most frequent side effects were rash, a burning sensation when applying the cream, and clothing stain. These data indicate that Reliéva, a proprietary form of M. aquifolium, is effective and well tolerated in patients with mild to moderate psoriasis.

This report on three clinical trials and the worldwide experience with Mahonia aquifolium 10% topical cream concluded that Oregon grape is a safe and effective treatment for mild-to-moderate plaque psoriasis, improving PASI and quality-of-life scores.

The antipsoriatic Mahonia aquifolium extract inhibited 5-lipoxygenase and lipid peroxidation, an anti-inflammatory/antioxidant mechanism relevant to the treatment of psoriasis with Oregon grape.