Effect of topical application of Hypericum perforatum extract (St. John's wort) on skin sensitivity to solar simulated radiation.

St. John's wort (Hypericum perforatum) is a tradional folk remedy that is used for the topical treatment of superficial wounds, scars and burns. A characteristic metabolite of St. John's wort is the photodynamic active plant pigment hypericin. It is known that hypericin may cause a severe photodermatitis called hypericism when higher amounts of St. John's wort are ingested orally. To date, no reports on the photosensitizing capacity of topical application of St. John's wort are available. Here, we investigated the effects of Hypericum oil (hypericin 110 microg/mL) and Hypericum ointment (hypericin 30 microg/mL) on skin sensitivity to solar simulated radiation. Sixteen volunteers of the skin types II and III were tested on their volar forearms with solar simulated radiation for photosensitizing effects of Hypericum oil (n=8) and Hypericum ointment (n=8). The minimal erythema dose (MED) was determined by visual assessment, and skin erythema was evaluated photometrically. With the visual erythema score, no change of the MED could be detected after application of either Hypericum oil or Hypericum ointment (P>0.05). With the more sensitive photometric measurement, an increase of the erythema-index after treatment with the Hypericum oil could be detected (P< or =0.01). The results do not provide evidence for a severe phototoxic potential of Hypericum oil and Hypericum ointment, detectable by the clinically relevant visual erythema score. However, the trend towards increased photosensitivity detected with the more sensitive photometric measurement could become relevant in fair-skinned individuals, in diseased skin or after extended solar irradiation.