Prevalence and Risk of Immunostimulatory Herbal Supplement Treatment Among Autoimmune Dermatology Patients

We assess the prevalence and patterns of herbal supplement treatment among patients with autoimmune skin diseases, particularly dermatomyositis (DM) and cutaneous lupus erythematosus (CLE), and identify commonly taken supplements and their associated risks.

This study screened 673 adult patients with clinicopathologic evidence of DM or CLE at the University of Pennsylvania's rheumatologic-dermatology clinic between January 2007 and February 2024. Demographic data, disease characteristics, and detailed information on herbal supplement treatment were collected. Predictors of supplement treatment were analyzed using chi-square tests and reported as odds ratios.

The prevalence of herbal supplement treatment was 32% among the cohort. The relative frequency of herbal supplement treatment was significantly higher in younger patients (44% of patients ages 18-29 years, reference; 29% ages 50-64 years, P = 0.02; 23% ages ≥65 years, P = 0.003) and in Hispanic/Latino patients (58% vs 31% White, P = 0.009). No significant difference in herbal supplement treatment was seen by sex (33% of female participants, 29% of male participants, P = 0.49), race (31% White, P = reference; 31% Black, P = 1.0; 38% Asian, P = 0.55), or disease (30% of patients with DM, 36% of patients with CLE; P = 0.12). Among patients with DM, 31% experienced a disease onset or exacerbation after supplement treatment compared with 10% of patients with CLE. Elderberry treatment was associated with the highest risk of exacerbation in both disease cohorts (62% DM, 50% CLE).

Herbal supplement treatment is prevalent among patients with autoimmune skin diseases, with immunostimulatory supplements posing a significant risk for immune dysregulation, particularly in DM. Providers should proactively screen and counsel patients regarding treatment with these supplements.