Intended for healthcare professionals

Rapid response to:


Evening primrose oil for atopic dermatitis

BMJ 2003; 327 doi: (Published 11 December 2003) Cite this as: BMJ 2003;327:1358

Rapid Response:

Evening primrose oil is effective for benign mastalgia

Whilst Williams (1) may dismiss the role of evening primrose oil
(EPO) in atopic dermatitis (although in common with others, I fail to see
the relevance to this debate of the study by Takwale et al (2) of borage
oil in atopic dermatitis, since borage oil has a different pharmacokinetic
profile to EPO), it is important to remember that EPO is of considerable
use in the treatment of another common condition, benign breast pain,
which affects up to 70% of women, and is severe in 20% of women (3).

The breast tissue of women with this condition is believed to be high
in saturated fatty acids and deficient in gamma linolenic acid (GLA),
which renders the breast tissue abnormally sensitive to normal hormone
levels (4). With prolonged treatment at high dose (320 mg/day for 3-6
months), the GLA content of EPO restores the balance of fatty acids in the
breast tissue, with high efficacy and few side effects (5), and in
contrast to treatment with isoflavones such as red clover (Promensil) (6),
with no concerns regarding agonistic stimulation of breast oestrogen
receptors and the theoretical risk in relation to breast cancer.

As a breast physician, I find this simple treatment of considerable
use in this common, debilitating condition. William's dismissal of EPO for
the treatment of atopic dermatitis should not detract from its efficacy in
other common conditions.

(1) Williams HC. Evening primrose oil for atopic dermatitis. British
Medical Journal 2003; 327: 1358-1359.

(2) Takwale A, Tan E, Agrawal S, et al. Efficacy and tolerability of
borage oil in adults and children with atopic eczema: randomised, double
blind, placebo controlled, parallel group trial. British Medical Journal
2003; 327: 1385-1387.

(3) Gately CA, Miers M, Mansel RE, Hughes LE. Drug treatments for
mastalgia: 17 years experience in the Cardiff Mastalgia Clinic. J Roy Soc
Med 1992; 85: 12-15.

(4) Horrobin DF, Manku MS. Prostaglandins Leukot Essent Fatty Acids:
Reviews 1989; 37: 255-261.

(5) Pye JK, Mansel RE, Hughes LE. Clinical experience of drug
treatments for mastalgia. Lancet 1985; 2 (8451): 373-377.

(6) Ingram DM, Hickling C, West L, Mahe LJ, Dunbar PM. A double-blind
randomized controlled trial of isoflavones in the treatment of cyclical
mastalgia. The Breast 2002; 11: 170-174.

Competing interests:
None declared

Competing interests: No competing interests

17 December 2003
Anne L. Appleton
Médecin-Chef, Unité de Sénologie (Consultant Breast Physician)
Unité de Sénologie (Breast Unit), Clinique de Genolier, 1272 Genolier, Switzerland CH-1272.