{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T14:15:40Z","timestamp":1791555340041,"version":"4.3.4"},"reference-count":13,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T00:00:00Z","timestamp":1725408000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006379","name":"Office of Research and Development","doi-asserted-by":"publisher","award":["BX005921\u201001"],"award-info":[{"award-number":["BX005921\u201001"]}],"id":[{"id":"10.13039\/100006379","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AR071653"],"award-info":[{"award-number":["R01AR071653"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ACR Open Rheumatology"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study screened 673 adult patients with clinicopathologic evidence of DM or CLE at the University of Pennsylvania's rheumatologic\u2010dermatology 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\u2010square tests and reported as odds ratios.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u201329 years, reference; 29% ages 50\u201364 years, <jats:italic>P<\/jats:italic> = 0.02; 23% ages \u226565 years, <jats:italic>P<\/jats:italic> = 0.003) and in Hispanic\/Latino patients (58% vs 31% White, <jats:italic>P<\/jats:italic> = 0.009). No significant difference in herbal supplement treatment was seen by sex (33% of female participants, 29% of male participants, <jats:italic>P<\/jats:italic> = 0.49), race (31% White, <jats:italic>P<\/jats:italic> = reference; 31% Black, <jats:italic>P<\/jats:italic> = 1.0; 38% Asian, <jats:italic>P<\/jats:italic> = 0.55), or disease (30% of patients with DM, 36% of patients with CLE; <jats:italic>P<\/jats:italic> = 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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr2.11735","type":"journal-article","created":{"date-parts":[[2024,9,5]],"date-time":"2024-09-05T01:38:34Z","timestamp":1725500314000},"page":"820-825","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Prevalence and Risk of Immunostimulatory Herbal Supplement Treatment Among Autoimmune Dermatology Patients"],"prefix":"10.1002","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2712-9352","authenticated-orcid":false,"given":"Daniella F.","family":"Faden","sequence":"first","affiliation":[{"name":"Corporal Michael J. Crescenz Veterans Affairs Medical Center  Philadelphia PA USA"},{"name":"University of Pennsylvania  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline J.","family":"Stone","sequence":"additional","affiliation":[{"name":"Corporal Michael J. Crescenz Veterans Affairs Medical Center  Philadelphia PA USA"},{"name":"University of Pennsylvania  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lillian","family":"Xie","sequence":"additional","affiliation":[{"name":"Corporal Michael J. Crescenz Veterans Affairs Medical Center  Philadelphia PA USA"},{"name":"University of Pennsylvania  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5396-4362","authenticated-orcid":false,"given":"Lais","family":"Lopes Almeida Gomes","sequence":"additional","affiliation":[{"name":"Corporal Michael J. Crescenz Veterans Affairs Medical Center  Philadelphia PA USA"},{"name":"University of Pennsylvania  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3030-5369","authenticated-orcid":false,"given":"Victoria P.","family":"Werth","sequence":"additional","affiliation":[{"name":"Corporal Michael J. Crescenz Veterans Affairs Medical Center  Philadelphia PA USA"},{"name":"University of Pennsylvania  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,9,4]]},"reference":[{"issue":"131","key":"e_1_2_6_2_1","first-page":"52","article-title":"Herbal supplement sales in US increase by record\u2010breaking 17.3% in 2020","author":"Smith T","year":"2021","journal-title":"Herbalgram"},{"issue":"1","key":"e_1_2_6_3_1","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s12906-021-03283-5","article-title":"Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review","volume":"21","author":"Wieland LS","year":"2021","journal-title":"BMC Complement Med Ther"},{"issue":"7","key":"e_1_2_6_4_1","article-title":"Clinical implications of herbal supplements in conventional medical practice: a US perspective","volume":"14","author":"Hassen G","year":"2022","journal-title":"Cureus"},{"issue":"5","key":"e_1_2_6_5_1","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1016\/j.jaad.2021.12.050","article-title":"Frequency of immunostimulatory herbal supplement use among patients with autoimmune skin disease","volume":"87","author":"Ravishankar A","year":"2022","journal-title":"J Am Acad Dermatol"},{"issue":"4","key":"e_1_2_6_6_1","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1016\/j.jaad.2020.06.037","article-title":"The effects of immunostimulatory herbal supplements on autoimmune skin diseases","volume":"84","author":"Bax CE","year":"2021","journal-title":"J Am Acad Dermatol"},{"issue":"6","key":"e_1_2_6_7_1","first-page":"723","article-title":"Activation of autoimmunity following use of immunostimulatory herbal supplements","volume":"140","author":"Lee AN","year":"2004","journal-title":"Arch Dermatol"},{"issue":"3","key":"e_1_2_6_8_1","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.jaad.2018.08.019","article-title":"Acute onset\/flares of dermatomyositis following ingestion of IsaLean herbal supplement: clinical and immunostimulatory findings","volume":"80","author":"Zeidi M","year":"2019","journal-title":"J Am Acad Dermatol"},{"issue":"4","key":"e_1_2_6_9_1","article-title":"A plausible association between the use of elderberry and autoimmune hepatitis","volume":"14","author":"Ramachandran A","year":"2022","journal-title":"Cureus"},{"issue":"11","key":"e_1_2_6_10_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.isci.2023.108355","article-title":"Herbal supplement spirulina stimulates inflammatory cytokine production in patients with dermatomyositis in vitro","volume":"26","author":"Bax CE","year":"2023","journal-title":"iScience"},{"issue":"3","key":"e_1_2_6_11_1","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1177\/2374373517706612","article-title":"Prevalence and predictors of herbal medicine use among adults in the United States","volume":"4","author":"Rashrash M","year":"2017","journal-title":"J Patient Exp"},{"issue":"1","key":"e_1_2_6_12_1","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s12906-018-2160-6","article-title":"Why people use herbal medicine: insights from a focus\u2010group study in Germany","volume":"18","author":"Welz AN","year":"2018","journal-title":"BMC Complement Altern Med"},{"issue":"3","key":"e_1_2_6_13_1","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1007\/s13596-020-00469-z","article-title":"Sambucus nigra (black elder) as alternative treatment for cold and flu","volume":"21","author":"Mahboubi M.","year":"2021","journal-title":"Adv Tradit Med"},{"issue":"2","key":"e_1_2_6_14_1","first-page":"290","article-title":"The effect of Sambucol, a black elderberry\u2010based, natural product, on the production of human cytokines: I. Inflammatory cytokines","volume":"12","author":"Barak V","year":"2001","journal-title":"Eur Cytokine Netw"}],"container-title":["ACR Open Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr2.11735","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T15:50:40Z","timestamp":1759420240000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/acr2.11735"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,4]]},"references-count":13,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1002\/acr2.11735"],"URL":"https:\/\/doi.org\/10.1002\/acr2.11735","archive":["Portico"],"relation":{},"ISSN":["2578-5745","2578-5745"],"issn-type":[{"value":"2578-5745","type":"print"},{"value":"2578-5745","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,4]]},"assertion":[{"value":"2024-04-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}