Discussion
Most of patients referring to TPM clinics were suffering from chronic diseases, which had not received appropriate treatment from modern medicine(16). The literature revealed that the most patients who referred to TPM clinics had selected traditional treatment as the end step of their therapeutic process and they hope that they would have had an acceptable therapeutic response to improve the quality of life (17, 18).
The findings of the present study showed that the majority of patients referred to TPM clinic were married, because it seems that married people tend to seek treatment and follow-up for their skin condition due to their appearance and cosmetic factors. Also, the education level of the most of the patients with dermatologic problems referring to the TPM clinic was a bachelor’s degree. This finding demonestrated that people with a higher degree of education probably had more tendency to try TPM remedies for treatment of their disease which also confirms the result of the study done by Dastgheib et al. (19, 20). The study of Hunt et al.showed that the people who were university educated were are more inclined to use complementary medicine(21). Moreover, Frass et al. showed that the more education was one of the important predictive factors for using complementary and alternative medicine, such a way that the people with higher education used complementay and alternative medicine 1.2 times more than other population (22). These results were in-line with the results of our study.
The results of the present study indicated that the most of the patients were housewives and the least were retired ones. This may be because of that the housewives often have more free time to visit TPM clinics; however, the reason for lack of follow up for skin lesions among the retirees may be because of the lower life expectancy and a lack of attention to their appearance. Kaushal et al. demonestrated that the housewives in India used allopathic medicines more than other drugs (23). This result was similar to the result of our study.
The most frequencies of patients referred to TPM clinics in our study were in spring and autumn. This may be resulted from increasing the incidence rate of many skin disorders or aggravition of skin disorders such as atopic dermatitis, eczematous disorders and other inflammatory skin conditions in spring and autumn. In addition, seasonal allergies and skin lesions are more common in these both seasons because of distribution of the pollens in the air (24, 25). Furthermore, changing in seasonal temperature and humidity of the climate of maybe the other contributing factors to differnaces distribution of patients to visit the physician because of dermatology conditions.
According to our study, acne was the most dermatologic conditions that the patients had explained in their medical chief chief complaints. Acne is an inflammatory disease with polymorphic lesions including papules, pustules, nodules and cysts that affect the face, chest, and back of the trunk commonly seen in adolescents. According to the previous studies, it is estimated that 9.4% of the global population are affected by acne, making it the eighth-most prevalent disease worldwide. This condition may affect the pscychological and social aspects of patients with acne (26). Several studies revealed that many of dermatologic conditions are multifactorial disorders. For example, seborrheic dermatitis is significantly associated with the disappearance of normal gastrointestinal flora (27). Moreover, some patients suffering from acne rosacea were found to be infected by Helicobacter pylori (28). In addition, while the exact pathogenesis of sebaceous gland diseases is unknown, some reports suggest that gastrointestinal disorders increase sebaceous gland secretions (29). Our findings showed that the most patients were also suffering from a gastrointestinal problem. Moreover, sleep disturbance, neurological and psychiatric problems were the other common comorbid complaints in patients in our study. In this regard, previose studies confirmed that the dermatological conditions were related to gastrointestinal problems, sleep disterbance, and psychiatric problems (7, 30-33).
There were a few studies around using complementary and alternative medicine in patients with sermatologic conditions. In a study done by Arye et al ., 77 patients who referred to an outpatient dermatology clinic were evaluated in the aspect of using complementary and traditional medicine in treating psoriasis. 62% used complementary medicine of which 58% of them receive such treatments from an expert in traditional medicine. Also, according to the study, the use of complementary medicine (mostly traditional medicine) among Arabs was significantly higher compared to Jews. The reason these patients used complementary medicine was they believed that it can increase their quality of life. Some also believed that the side effects and toxicity of herbal remedies were less, and even the usage of complementary medicine reduced their stress (34). All of the patients in our study were visited by one or more dermatologist but they did not have the acceptable therapeutic responses to conventional medicine, so they decided to choose TPM as their last chance. Therefore, since more than 50% of the patients in our study had moderate and good therapeutic response from TPM, it can be very promising, and it can open wide avenues for further studies.
There were some limitations in our study. First, this was a retrospective study, so for evaluating the exact effects of using TPM in patients with dermatologic conditions, we suggest that the chohort studies should be conducted and the patients are followed up, regularly. Next, some of our patients’ document were not complete, so we were faced with few missing data on some issuses, such as the therapeutic response of the patients. Therefore, designing powerful electronic systems can improve studies in this area. Finally, our project was a single-center study, so multi-center studies are recommended for future studies.