Skip to main content
SpringerLink
Log in

Treatment of atopic eczema with evening primrose oil: rationale and clinical results

  • Clinical Pharmacology
  • Published:
The clinical investigator Aims and scope Submit manuscript

Summary

Recently a defect in the function of the enzyme delta-6-desaturase has been discussed as a major factor in the development of atopic eczema. Delta-6-desaturase is responsible for the conversion of linoleic acid to gamma linolenic acid. Several plants, including evening primrose, are known to be fairly rich in gamma linolenic acid. Hence, substitution of gamma linolenic acid in patients prone to developing atopic eczema seems like a feasible concept. During the last few years different clinical trials have been performed. Controlled trials following a parallel study design showed marked improvement in atopic eczema. Patients treated with the drug showed less inflammation, dryness, scaling and overall severity compared to controls. Although these findings have been supported by meta-analysis, there is still conflicting evidence in trials based on a crossover design alone, demonstrating a decrease in itching. At present, evening primrose oil in doses used for the treatment of atopic eczema is considered safe. However, still more trials addressing both efficacy and safety are needed to made a final decision.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

AA:

arachidonic acid

D5D:

δ-5-desaturase

D6D:

δ-6-desaturase

DGLA:

dihomogammalinolenic acid

EPO:

evening primrose oil

EFA:

essential fatty acids

GLA:

γ-linoleic acid

LA:

linoleic acid

PGE:

prostaglandin E

References

  1. Bach MA, Bach JF (1974) Effects of prostaglandins and indomethacin on rosette-forming lymphocytes: interaction with thymic hormone. In: Robinson HJ, Vane JR (eds) Prostaglandin synthetase inhibitors. Raven Press, New York, pp 241–248

    Google Scholar 

  2. Bamford JTM, Gibson RW, Renier CM (1985) Atopic eczema unresponsive to evening primrose oil (linolenic and gamma linolenic acids). J Am Acad Dermatol 3:959–965

    Google Scholar 

  3. Biagi PL, Bordoni A, Masi M, Ricci G, Fanelli C, Patrizi A, Ceccolini E (1988) A long-term study on the use of evening primrose oil (Efamol) in atopic children. Drugs Exp Clin Res 14:285–290

    Google Scholar 

  4. Bordoni A, Biagi PL, Masi M, Ricci G, Fanelli C, Patrizi A, Ceccolini E (1987) Evening primrose oil (Efamol) in the treatment of children with atopic eczema. Drugs Exper Clin Res 14:291–297

    Google Scholar 

  5. Bourne HR, Lichtenstein LM, Melmon KL (1972) Pharmacologic control of allergic histamine release in vitro: evidence for an inhibitory role of 3′5′-adenosine monophosphate in human leukocytes. J Immunol 108:695–705

    Google Scholar 

  6. Brenner RR (1974) The oxidative desaturation of unsaturated fatty acids in animals. Mol Cell Biochem 3:41–52

    Google Scholar 

  7. Brenner RR (1977) Metabolism of endogenous substrates by microsomes. Drug Metab Rev 6:155–212

    Google Scholar 

  8. Brown WR, Hansen AE (1937) Arachidonic and linoleic acid of the serum in normal and eczematous human subjects. Proc Soc Exp Biol Med 36:113–117

    Google Scholar 

  9. Burton JL (1989) Dietary fatty acids and inflammatory skin disease. Lancet 1:27–31

    Google Scholar 

  10. Cheng DS, Hanifin JM (1986) Atopic dermatitis. In: Thiers BH, Dobson RL (eds) Pathogenesis of skin disease. Churchill Livingstone, New York, pp 13–23

    Google Scholar 

  11. Everett DJ, Greenough RJ, Perry CJ, MacDonald P, Bayliss P (1988) Chronic toxicity studies of Efamol evening primrose oil in rats and dogs. Med Sci Res 16:863–864

    Google Scholar 

  12. Everett DJ, Perry CJ, Bayliss P (1988) Carcinogenicity studies on Efamol evening primrose oil in rats and mice. Med Sci Res 16:865–866

    Google Scholar 

  13. Fischer A, Le Deist F, Durandy A (1985) Separation of a population of human T-lymphocytes that bind prostaglandin E 2 and exert a suppressor activity. J Immunol 134:815–819

    Google Scholar 

  14. Goldstein G, Scheid M, Hammerling U, Boyse EA, Schlesinger DH, Niall HD (1975) Isolation of a polypeptide that has lymphocyte differentiating properties and is probably represented universally in living cells. Proc Natl Acad Sci USA 72:11–15

    Google Scholar 

  15. Goodwin JS, Ceuppens J (1983) Regulation of the immune response by prostaglandins. J Clin Immunol 3:295–315

    Google Scholar 

  16. Hanifin JM (1983) Clinical and basic aspects of atopic dermatitis. Semin Dermatol 2:5–13

    Google Scholar 

  17. Hansen AE (1933) Serum lipid changes and therapeutic effects of various oils in infantile eczema. Proc Soc Exp Biol Med 31:160–161

    Google Scholar 

  18. Helm D von der, Ring J, Dorsch W (1987) Comparison of histamine release and prostaglandin E 2 production of human basophils in atopic and normal individuals. Arch Dermatol Res 279:536–542

    Google Scholar 

  19. Horrobin DF, Manku MS, Oka M (1979) The nutritional regulation of T-lymphocyte function. Med Hypotheses 5:723–728

    Google Scholar 

  20. Houwelingen AC von, Hennissen AH, Seyberth HW, Hornstrag G (1987) Effect of dietary fat type on prostaglandin E production in vivo. Adv Prostaglandin Thromboxane Leukotriene Res 17:871–875

    Google Scholar 

  21. Isseroff RR (1988) Fish again for dinner! The role of fish and other dietary oils in the therapy of skin disease. J Am Acad Dermatol 19:1073–1080

    Google Scholar 

  22. Kunkel SL, Ogawa H, Ward PA, Zurier RB (1981) Suppression of chronic inflammation by evening primrose oil. Prog Lipid Res 20:885–889

    Google Scholar 

  23. Leung DYM, Rhodes AR, Geha RS (1988) Atopic dermatitis. In: Fitzpatrick TB, Eisen AZ, Wolff K, et al. (eds) Dermatoloy in general medicine, 3rd edn. McGraw-Hill, New York, pp 1385–1408

    Google Scholar 

  24. Lovell CR, Burton JL, Horrobin DF (1981) Treatment of atopic eczema with evening primrose oil. Lancet 1: 278

    Google Scholar 

  25. Macdonald KJS, Green C, Raffle EJ, Kencier KJA (1985) Topical evening primrose oil and atopic eczema. Scott Med 130:267

    Google Scholar 

  26. Manku MS, Horrobin DF, Morse N, Kyte J, Jenkins K, Wright S, Burton JL (1984) Reduced levels of prostaglandin precursors in the blood of atopic patients: defective delta-6desaturase function as a biochemical basis for atopy. Prostaglandins Leukotrienes Med 9:615–628

    Google Scholar 

  27. Manku MS, Horrobin DF, Morse N, Wright S, Burton JL (1984) Essential fatty acids in the plasma phospholipids of patients with atopic eczema. Br J Dermatol 110:643–648

    Google Scholar 

  28. Meigel W, Dettke T, Meigel EM, Lenze U (1987) Additive Therapie der atopischen Dermatitis mit ungesättigten Fettsäuren. Z Hautkr 62 [Suppl 1]:100–103

    Google Scholar 

  29. Melnik BC (1990) Eine Chance zur Prevention atopischer Erkrankungen. Monatsschr Kinderheilkd 138:162–166

    Google Scholar 

  30. Melnik BC, Plewig G (1989) Ein neues Konzept zur Atiopathogenese und Prevention der Atopic. Hautarzt 40:685–692

    Google Scholar 

  31. Miller CC, Ziboh VA (1988) Gammalinolenic acid-enriched diet alters cutaneous eicosanoids. Biochem Biophys Res Commun 154:967–974

    Google Scholar 

  32. Morse PF, Horrobin DF, Manku MS, Stewart JCM, Allen R, Littlewood S, Wright S, Burton J, Gould DJ, Holt PJ, Jamsen CT, Mattila L, Meigel W, Dettke T, Wexler D, Guenther L, Bordoni A, Patrizi A (1989) Metaanalysis of placebo controlled studies of the efficacy of Epogam in the treatment of atopic eczema. Relationship between plasma essential fatty acid changes and clinical response. Br J Dermatol 121:75–90

    Google Scholar 

  33. Rocklin RE, Thistle L (1986) Reduced prostaglandin E 2 (PGE 2) receptors on atopic T-lymphocytes. Cell Immunol 99:294–299

    Google Scholar 

  34. Ruzicka T (1988) Eicosanoide bei atopischer Dermatitis. Hautarzt [Suppl 8] 39:38–39

    Google Scholar 

  35. Ruzicka T, Ring J (1987) Enhanced releasibility of prostaglandin E2 and leukotrienes B4 and C4 from leucocytes of patients with atopic eczema. Acta Derm Venereol (Stockh) 67:469–475

    Google Scholar 

  36. Samuelsson B, Goldyne M, Granström E (1978) Prostaglandins and thromboxanes. Ann Rev Biochem 47:997–1029

    Google Scholar 

  37. Schalin-Karrila M Mattila L Jansen CT Uotila P (1987) Evening primrose oil in the treatment of atopic eczema: effect on clinical status, plasma phospholipid fatty acids and circulating blood prostaglandins. Br J Dermatol 117:11–19

    Google Scholar 

  38. Skogh M (1986) Atopic eczema unresponsive to evening primrose oil (linolenic and gamma-linolenic acids). J Am Acad Dermatol 15:114–115

    Google Scholar 

  39. Strannegard IL, Svennerholm L, Strannegard Ö (1987) Essential fatty acids in serum lecithin of children with atopic dermatitis and in umbilical cord serum of infants with high or low IgE levels. Int Arch Allergy Appl Immunol 82:422423

    Google Scholar 

  40. Traitler H, Winter H, Richli U (1984) Characterization of gamma-linolenic acids in ribes seed. Lipids 19:923–928

    Google Scholar 

  41. Wehrmann W, Niedecken H, Bauer R (1987) Klinische und immunmodulatorische Effekte bei einer Behandlung mit ungesättigten Fettsäuren bei atopischer Dermatitis. Z Hautkr 62 [Suppl 1]: 111–115

    Google Scholar 

  42. Willis AL (ed) (1987) Handbook of eicosanoids: prostaglandins and related lipids, vol 1, part A and B. CRC, Boca Raton

    Google Scholar 

  43. Wright S, Burton JL (1982) Oral evening primrose-seed oil improves atopic eczema. Lancet 11:1120–1122

    Google Scholar 

  44. Ziboh VA, Chapkins RS (1987) Biologic significance of polyunsaturated fatty acids in the skin. Arch Dermatol 123:686–690

    Google Scholar 

  45. Zurier RB, Sayadoff DM, Torrey SB (1977) Prostaglandin E1 treatment of NZB/NZW mice. I. Prolonged survival of female mice. Arthr Rheum 20:723–728

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dermatologische Klinik and Poliklinik der Ludwig-Maximilians, Universität München, Frauenlobstrasse 9-11, W-8000, München 2, Germany

    M.J. Kerscher & H.C. Korting

Authors
  1. M.J. Kerscher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H.C. Korting
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kerscher, M., Korting, H. Treatment of atopic eczema with evening primrose oil: rationale and clinical results. Clin Investig 70, 167–171 (1992). https://doi.org/10.1007/BF00227362

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00227362

Key words

Search

Navigation