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In a chemical structural study of three alkaloids isolated from Mahonia aquifolium (berberine, jatrorrhizine, and magnoflorine), the free phenolic group-bearing alkaloids (jatrorrhizine and magnoflorine) exhibited a greater capacity to scavenge peroxyl radicals, which the investigators attributed to higher lipophilicity (Bioorg. Med. Chem. 2004;12:4709–15). Nevertheless, berberine is one of the primary active ingredients in mahonia that is consistently identified for study.

Photochemical reactions and sensitivity are particularly relevant, as a recent study showed that irradiation of berberine in oxygenated dimethyl sulfoxide solvent generated the formation of superoxide anion radicals and singlet oxygen.

Other protoberberinium salts—palmatine and jatrorrhizine—were associated with significantly less photochemical generation of reactive oxygen species. Nevertheless, the investigators concluded that UVA-induced photochemical reactions of protoberberinium salts, which have been shown to exhibit antibacterial, antimalarial, and antitumor activity, warrant attention, particularly in their use for treating skin disorders (Phytother Res. 2004;18:640–6).

Psoriasis

By far, psoriasis is the dermatologic condition most associated with treatment using Mahonia aquifolium. Traditional and alternative treatments, as well as a growing body of research, bear this out.

In one study, investigators tested four protoberberine alkaloid extracts of Mahonia aquifolium (berberine, oxyberberine, jatrorrhizine, columbamine), as well as two aporphine alkaloid extracts of the herb (magnoflorine and corytuberine), for their ability to inhibit lipoxygenase, the metabolism of which contributes to psoriasis pathogenesis.

Oxyberberine, corytuberine, and columbamine were significantly better inhibitors than the remaining alkaloids. Lipoxygenase inhibition was found to be commensurate with lipid antioxidant activity. The authors concluded that the efficacy of Mahonia aquifolium for the treatment of psoriasis can be at least partially ascribed to the lipoxygenase inhibition imparted by the herb's alkaloid constituents (Planta Med. 1995;61:372–3).

In another study evaluating the capacity of Mahonia aquifolium compounds to inhibit lipoxygenase, the same team of investigators tested six bis-benzylisoquinoline (BBIQ) alkaloid constituents (oxyacanthine, armoline, baluchistine, berbamine, obamegine, and aquifoline) and found that berbamine and oxyacanthine were the most potent inhibitors, also significantly hampering lipid peroxidation. The researchers again suggested that the inhibition of lipoxygenase by these Mahonia aquifolium components may account for therapeutic effects of the plant extract, particularly when it is used to treat psoriasis (Pharmazie. 1996;51:758–61).

In a monograph published in 2005, three open-label clinical trials of Mahonia aquifolium 10% topical cream for treatment of psoriasis were discussed. The first study, which evaluated the safety of the herb in 39 patients treated for 12 weeks, revealed statistically significant increases in Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores after 4 weeks of treatment that continued up to 1 month after treatment ended.

The second study examined 32 psoriasis patients with mild to moderate bilateral presentations treated for up to 6 months with mahonia on one side of the body and a standard psoriasis formulation, i.e., calcipotriene ointment (Dovonex), on the other. The herbal treatment was considered effective, with 84% of patients reporting a good to excellent response and 63% of patients rating Mahonia aquifolium equal to or better than the standard preparation.

Similarly, the third trial, an observational study of 33 patients with mild to moderate bilateral psoriasis treated for 1 month, showed that patients improved after 1 week of therapy, with mahonia performing as well as or better than the vehicle-treated side.

The authors suggested that these findings by numerous researchers in several countries show Mahonia aquifolium to be safe and effective as a treatment for mild to moderate psoriasis (Am. J. Ther. 2005;12:398–406).

Conclusions

In addition to a long history of traditional folk use of Mahonia aquifolium, there is an expanding track record of modern use of this dynamic herb for several dermatologic indications, especially psoriasis. Mahonia's reputation as a long-time natural remedy, as well as its status in the sanctioned dermatologic armamentarium, positions this botanical as an important ingredient in a broad array of accepted medications and over-the-counter preparations.

In terms of psoriasis treatment, Mahonia aquifolium appears to belong among the various treatments considered for the mild to moderate manifestation of this recalcitrant condition.

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