Introduction
St. John’s wort (SJW, hypericum perforatum) has been intensively
investigated and used for its antidepressive activity, but mostly
overlooked dermatological applications also have a long
tradition.1 Topical preparations of SJW has been
recommended for skin abrasions or bruises, burns, ulcers, myalgia and
intractable wounds.2 Two important constituents,
naphtho-dianthrones (hypericin, flavonoids) and phloro-glucinols
(hyperforin), are proven to have antimicrobial, anti-inflammatory,
antioxidant and anticancer activities.1 Hyperforin has
been shown to stimulate growth and differentiation of keratinocytes, and
hypericin is now increasingly being used in the treatment of psoriasis
and skin cancer as a photosensitizer.3,4
We had knowledge about this medication when we had positive feedback
from our patients with idiopathic granulomatous mastitis (IGM) who have
persistent skin lesions such as unfading hyperemia or deeper ulcers and
used topical oil forms of SJW on their own, without prescription. IGM is
a chronic, nonspecific inflammation of the breast, affecting mostly
middle-aged parous women.5 It may present as a firm
solitary mass associated with an inflammatory skin fistulae or an
abscess.6 Hyperemia, erythema and cellulitis are also
common. A core needle biopsy (CNB) is mandatory to exclude malignancy.
Most surgeons have limited experience in managing this clinic entity and
the disease has a high recurrence rate. Simple drainages, broad spectrum
antibiotics and systemic corticosteroids are the mainstay of the
treatment, since surgery does not prevent recurrence and cosmetic
results are not satisfactory.7 Although mass in the
breast might get smaller or disappear, skin lesions can still persist
after treatment.
In the present study, we evaluated the effectiveness of SJW on
intractable skin lesions of patients with IGM. To the best of our
knowledge, after a wide-range Pub-Med search, this is the first trial on
this topic.