A Trial of Oolong Tea in the Management of Recalcitrant Atopic Dermatitis

Background  Mild cases of atopic dermatitis (AD) generally improve with standardtreatment. However, standard treatment fails many patients with recalcitrantAD skin lesions. Study results in animal models have demonstrated that theadministration of tea (ie, green, black, or oolong) has suppressed type Iand type IV allergic reactions.

Objective  To test the effectiveness of oolong tea in the treatment of recalcitrantAD.

Patients  Although 121 patients with recalcitrant AD were enrolled in the study,118 patients completed the open study.

Methods  Patients were asked to maintain their dermatological treatment. However,they were also instructed to drink oolong tea made from a 10-g teabag placedin 1000 mL of boiling water and steeped for 5 minutes. This amount was thendivided into 3 equal servings and 1 serving was drunk daily after 3 regularmeals. Photographs of 2 or 3 representative lesion sites were taken at baselineand at 1 and 6 months and the severity of pruritus was assessed on a 6-pointLickert-like scale ranging from markedly improved (>50% improvement) to worsened.

Results  After 1 month of treatment 74 (63%) of the 118 patients showed markedto moderate improvement of their condition. The beneficial effect was firstnoticed after 1 or 2 weeks of treatment. A good response to treatment wasstill observed in 64 patients (54%) at 6 months.

Conclusion  The therapeutic efficacy of oolong tea in recalcitrant AD may well bethe result of the antiallergic properties of tea polyphenols.

ALTHOUGH STANDARD treatment of atopic dermatitis (AD) is generally effectivein mild cases, there are many patients with recalcitrant AD skin lesions forwhom standard therapy fails to provide adequate benefit. This may warranttrials of novel treatment of AD. Recent studies^1-4in experimental animals showed that oral administration of tea (green, oolong,or black) suppressed both type I and type IV allergic reactions in the skin.We then investigated whether oolong tea has therapeutic effects in recalcitrantAD.

After obtaining informed consent, 121 patients (mean age, 24 years;age range, 16-58 years) with refractory AD were examined. They had been receivingstandard treatment (topical corticosteroids, oral antihistamines, and avoidanceof aggravating factors) for at least 6 months at our outpatient clinic. Therewere 20 mild cases of AD, 74 moderate cases, and 27 severe cases. All patientsfulfilled the diagnostic criteria of Hanifin and Rajka.⁵During the course of the study, patients were asked to maintain their dermatologicaltreatments.

Patients were enrolled in an open study of drinking oolong tea 3 timesdaily for 6 months. A commercially available teabag containing 10 g of driedoolong tea leaves (Suntory Ltd, Tokyo, Japan) was placed in 1000 mL of boilingwater and steeped for 5 minutes. The oolong tea was divided into 3 parts,and drunk after 3 regular meals. To ensure an objective evaluation of theskin lesions, 2 or 3 representative skin sites with active AD lesions werephotographed at baseline, 1 month, and 6 months. An overall assessment ofclinical symptoms was performed by comparing the photographs of the AD lesionsand the intensity of pruritus at 1 and 6 months after treatment. The assessmentwas graded as symptoms markedly improved (>50% improvement), moderately improved(25%-50% improvement), slightly improved (<25% improvement), unchanged,or worsened.

Of the 121 patients enrolled, 118 completed the study. After 1 monthof treatment, a marked or moderate improvement of skin lesions was obtainedin 74 (63%) of the 118 patients (Table 1). The severity of the disease had no influence on the clinicalresponse. The beneficial effect was first noticed after 1 or 2 weeks of treatment.A good response was still observed in 64 patients (54%) after 6 months oftreatment (Figure 1). Throughoutthe study, no patient reported clinical side effects on physical examinationor had any abnormalities on routine laboratory tests.

From these results, it seems reasonable to consider that oolong teaaffords a substantial benefit in the management of at least some patientswith recalcitrant AD.

An understanding of the pharmacological basis for the beneficial effectof oolong tea in AD is limited. Animal studies demonstrated that the polyphenolfraction of tea was mainly responsible for the suppression of passive cutaneousanaphylaxis,² and that epigallocatechin gallate,a major component of tea polyphenols, suppressed contact hypersensitivityresponse.³ Thus, we conclude that the therapeuticefficacy of oolong tea in AD may well be the result of the antiallergic propertiesof tea polyphenols.

Accepted for publication August 17, 2000.

Corresponding author: Masami Uehara, MD, Department of Dermatology,Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu 520-2193, Japan.