a,bCHRISTINE R. TOTRI, MD; a,bCATALINA MATIZ, MD; a,bAndrew C. Krakowski, MD aUniversity of California, San Diego, La Jolla, California; bPediatric and Adolescent Dermatology, Rady Children’s Hospital, San Diego, California
Disclosure: The authors report no relevant conflicts of interest.
Complementary and alternative medicine therapies are gaining popularity among patients, aided by modern media outlets that facilitate easy and rapid dissemination of information. “Urine therapy” is one such complementary and alternative medicine and is described by its proponents as a wonder therapy for inflammatory conditions, such as acne vulgaris. As with other complementary and alternative medicines, healthcare providers should be mindful of the use of urine therapy and its potential implications for patients who may utilize it. (J Clin Aesthet Dermatol. 2015;8(10):47–48.)
A 16-year-old boy presented to the authors’ Pediatric and Adolescent Dermatology Clinic for evaluation of worsening acne vulgaris of the face. He reported severe flaring of his acne in the last several months after he began daily topical application of his own urine onto his face. The patient’s mother had seen a cable television talk show touting the values of urine therapy and pressured her son to try the technique. After “verifying” the use of urine for acne on the Internet, the patient acquiesced. He noted initial improvement with application of his own fresh urine. However, his acne worsened significantly when he began applying stored, unrefrigerated urine that he had collected in order to treat himself more conveniently. The patient denied any history of other medical or psychiatric conditions.
Physical examination revealed diffuse comedones, inflammatory papules, pustules, and scars on the face, consistent with severe acne vulgaris (<a title=”Figure 1″href=”https://jcadonline.com/wp-content/uploads/Krakowski-Figure-13.jpg”>Figure 1</a>). Skin culture grew 2+ normal skin flora. He was started on oral doxycycline 100mg twice daily, topical tretinoin, and benzyol peroxide wash and was noted to be “almost clear” at his three-month follow-up visit. The patient denied further urine treatment and, besides feeling embarrassed by the situation, he was relieved to be doing better.
In complementary and alternative medicine (CAM), urine therapy is the use of urine either topically or orally to sustain or improve one’s health. Records dating back to the ancient Egyptians and Greeks testify to the power of urine therapy, referring to urine as the “gold of the blood” and the “water of life.” Especially popular in Asia, the Middle East, and South America, urine therapy advocates cite historical use as proof of its therapeutic potential claiming urine not only as a treatment for numerous skin conditions, but also as a “free cure” for many systemic diseases.
While recycling what the body intentionally removes may seem counterintuitive to good health, it is important to consider that certain components of urine are commonly utilized as traditional medical therapies. Premarin (conjugate equine estrogens, Pfizer) is a prescription drug used to treat the symptoms of menopause; interestingly, it is isolated from pregnant mares’ urine. In dermatology, synthetic urea is an active ingredient in numerous commercial products. Urea, or carbamide, is utilized to increase water-binding capacity of the stratum corneum. In higher concentrations, it is also believed to be keratolytic and is used for conditions such as psoriasis, ichthyosis, and dermatophytosis. In a study utilizing 21 human volunteers, urea improved barrier function and enhanced antimicrobial peptide (AMP; LL-37 and ?-defensin-2) expression. Furthermore, the study showed that topical urea application normalized both barrier function and AMP expression in a murine model of atopic dermatitis.
Despite the zeal of its advocates, the clinical evidence for urine therapy remains sparse in traditional medical literature. Such practices may also be dangerous. Synthetic urea manufactured in a controlled setting may act very differently from whole urine collected and applied directly to human skin. Likewise, although initially sterile, urine left outside the body for an extended period of time becomes a growth medium for bacteria. Application to a compromised skin barrier, such as that seen in inflammatory conditions like acne and atopic dermatitis, may leave patients susceptible to both topical and systemic infections. Gram-negative bacterial infection was a specific concern for our “severely flaring” patient, prompting the wound culture, which revealed only normal skin flora.
CAM use is pervasive among dermatology patients, with a systematic review estimating a lifetime prevalence of 35 to 69 percent within this specific population. The CAM market for acne specifically is especially large—and largely unexplored—with options such as hazel (Hamamelis virginiana), tea-tree (Leptospermum spp.) oil, citrus washes, aloe vera, zinc, “tissue salt” tablets, and evening primrose oil (Oenothera biennis). Despite the overall lack of evidence supporting its role in acne management, urine therapy has emerged as one such acne CAM. Given its potential for serious side effects, unregulated nature, universal availability, and vocal constituency of supporters, providers should be educated about urine therapy’s potential use. Furthermore, better understanding of the beliefs and opinions of patients can help reduce barriers in the doctor-patient relationship, and ultimately lead to better outcomes.
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