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.