Table IV.

Background information on natural ingredients studied

Ingredient	Coconut oil47, 48, 49, 50, 51	Aloe vera52, 53, 54, 55	Honey7,56,57	Turmeric23,48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62	Colloidal oatmeal63,64	Sunflower seed51,65, 66, 67, 68, 69, 70, 71	Shea butter72, 73, 74, 75	Witch hazel76, 77, 78	Tea tree oil79, 80, 81, 82, 83	Green tea37,84, 85, 86, 87
Background	VCO is an unrefined grade of coconut oil that is harvested prior to contamination with chemical processing by-products. High levels of lauric and myristic acid within VCO are known to have antibacterial and anti-inflammatory properties. VCO also reduces TEWL, therefore improving barrier function in patients with AD. VCO's reputation as a moisturizing agent, wide availability, and low evidence of allergenicity make it an attractive alternative therapy for dermatologic diseases.	AV or Aloe barbadensis Mill., derived from the Liliaceae family, has been used extensively in traditional Ayurvedic medicine and other cultures. Herbal extracts or formulations of AV gel are known for their anti-inflammatory, anti-pruritic, antibacterial, and healing properties These studies prompted researchers to test the clinical efficacy of AV as a novel treatment option for both psoriasis and acne vulgaris.	Honey is a historically used CAM, most widely known for its antibacterial and anti-inflammatory therapeutic properties in addition to its ability to promote wound healing and stimulate tissue regeneration while minimizing scar size.	Curcumin, derived from the Curcuma longa Linn plant, is a polyphenol found in turmeric, known for its strong antioxidant, anti-inflammatory, antiangiogenic, and antiproliferative properties. Various studies, including randomized control trials (RCTs), have shown that curcumin may be used medically to treat an array of dermatologic conditions.	Colloidal oatmeal (Avena sativa) has served for centuries as a topical treatment for an array of skin barrier conditions, including dry skin, rashes, burns, and AD. Colloidal oatmeal extracts have been associated with induction of gene expression, including epidermal differentiation, and genes related to skin barriers such as the zonulae occludens (tight junctions) and with downregulation of pro-inflammatory mediators in keratinocytes demonstrating the benefit of its clinical use.	SSO (Helianthus annus) has been extensively investigated in the treatment of xerosis and AD. SSO is defined consistent with the ratios of its fatty acid components: linoleic acid constitutes approximately 60%, whereas oleic acid, palmitic acid, stearic acid, and linolenic acid are also contained in SSO. Linoleic acid in SSO is a necessary fatty acid for the maintenance of normal epidermal barrier function and helps with dermatitis resolution in infants with deficiencies.	Shea butter is extracted from the Vitellaria paradoxa tree and is composed of triglycerides with oleic, stearic, linoleic, and palmitic fatty acids, in addition to the anti-inflammatory and antioxidant unsaponifiable agents including: tripterpene, tocopherol, phenols, and sterols. Furthermore, shea butter has been shown to be as effective as a ceramide-precursor in patients with AD.	Witch Hazel, derived from the plant Hamamelis virginiana, has high levels of tannins and shows antioxidative, anti-inflammatory, antimicrobial, and anti-tumoral activity. Therefore, its role in the treatment of AD and other scalp disorders has been a recent point of interest among researchers and patients who commonly use witch hazel for various dermatologic conditions.	TTO, also known as melaleuca oil, is an essential oil derived from the Australian plant Melaleuca alternifolia. It has broad spectrum antimicrobial activity and anti-inflammatory properties especially in acne. TTO is widely available in OTC products and marketed as a treatment for acne so studies evaluating its efficacy are important to answer patient queries.	Green tea extract, derived from the tea plant, Camellia sinensis and their polyphenolic catechins have natural healing, photoprotective, antioxidant, and anti-inflammatory properties. The major polyphenolic catechin present is (-)-EGCG, which has been found to inhibit two-stage carcinogenesis and UVB induced photocarcinogenesis. The topical application of green tea has had limitations because of stability and epidermal penetration challenges but has been shown to be an effective treatment for mild-to-moderate acne.

AD, Atopic dermatitis; AV, aloe vera; CAM, complementary and alternative medicine; EGCG, epigallocatechin-3-gallate; OTC, over the counter; SSO, sunflower seed oil; TEWL, transepidermal water loss; TTO, tea tree oil; UVB, ultraviolet B; VCO, virgin coconut oil.