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Author: Dr David Lim, Dermatology Registrar, Middlemore Hospital, Auckland, New Zealand, 2012.
Feverfew (Tanacetum parthenium, alternative names: Chrysanthemum parthenium and Pyrethrum parthenium) is a flowering plant originating from Europe, that is now found in many regions of the world. It has been used for centuries for its believed medicinal properties such as treating fevers, headaches, arthritis and other ailments. The name ‘feverfew’ originates from its property as a ‘fever reducer’ and has previously been referred to as the ‘medieval aspirin’.
While feverfew has been used for centuries in the treatment of a number of conditions, modern studies have come to mixed conclusions regarding many of the claimed benefits. Specifically, it appears that feverfew has limited (if any) benefit for the treatment of headaches and rheumatoid arthritis. However, there is growing evidence that it may be beneficial as a topical treatment for skin conditions such as atopic eczema and allergic contact dermatitis. Its activity for these conditions appears comparable to weak topical steroids.
Feverfew contains several biologically active components that have beneficial anti-inflammatory and antioxidant activity. It appears to inhibit a number of pro-inflammatory cytokines and impairs prostaglandin production as well as the action of neutrophils. These actions help reduce inflammation and are helpful for inflammatory and auto-immune conditions.
Laboratory studies have also demonstrated other effects such as an anti-spasmodic and blood vessel relaxant. It appears to impair platelet activity, inhibit histamine release and slow the growth of bacteria. Many of these laboratory studies have not translated to beneficial effects when used by people.
Feverfew is usually well tolerated however side effects can occur in up to 18% of people using it. Side effects include mouth ulceration and inflammation of the oral mucosa (stomatitis). Parthenolide (a component of feverfew) is a potent cause of contact allergic dermatitis in some people, and can arise when used topically (on the skin). Parthenolide is one of the main causes of compositae allergy.
Products that exclude parthenolide are widely available and often referred to as ‘Purified Feverfew Extract’. These purified products do not appear to cause significant skin sensitisation.
Stopping feverfew after long-term oral ingestion can precipitate a ‘post-feverfew syndrome’. Symptoms include muscle and joint aches and stiffness, headaches and difficulty sleeping.
Feverfew impairs the action of platelets, so care should be taken with oral use of feverfew for people who take “blood-thinners” or anticoagulants such as aspirin, clopidogrel, dipyridamole, warfarin or dabigatran. Those with a history of significant bleeds, such as internal bleeding of the head or stomach, should also take care.
Skin care products containing feverfew are widely available in pharmacies and supermarkets without a prescription. Care should be taken to obtain products labelled as ‘Purified Feverfew Extract’ or ‘Parthenolide free’, as parthenolide commonly causes skin irritation. Products available include moisturisers and cleansers. Instructions for use are individualised to the specific products.
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