Is saw palmetto (Serenoa repens) topical safe in patients with Multiple Sclerosis (MS)?

Safety of Topical Saw Palmetto in Multiple Sclerosis Patients

Topical saw palmetto (Serenoa repens) is likely safe for patients with multiple sclerosis as there is no evidence of systemic absorption or interactions that would exacerbate MS symptoms or interfere with MS treatments.

Safety Profile of Saw Palmetto

Saw palmetto is primarily used for treating lower urinary tract symptoms and benign prostatic hyperplasia. When evaluating its safety in MS patients, several factors should be considered:

General Safety Profile

• Saw palmetto is generally well-tolerated with mild adverse effects when used orally 1
• Most common side effects from oral use include:
  • Abdominal pain
  • Diarrhea
  • Nausea
  • Fatigue
  • Headache
  • Decreased libido
  • Rhinitis

Topical Application Considerations

• Topical applications typically have lower systemic absorption than oral formulations
• No specific contraindications for topical use in MS patients have been reported in the literature
• The American Academy of Dermatology guidelines do not list saw palmetto among contraindicated topical treatments for patients with neurological conditions 2

Multiple Sclerosis Treatment Considerations

When evaluating any treatment in MS patients, potential interactions with disease-modifying therapies must be considered:

• MS patients may be on various medications including:

  • Glatiramer acetate
  • Beta-interferons
  • Sphingosine-1-phosphate receptor modulators
  • Anti-CD20 therapies (ocrelizumab, rituximab)
  • Natalizumab
  • Dimethyl fumarate
  • Teriflunomide 2

• No drug interactions between saw palmetto and MS medications have been reported 1

Decision-Making Algorithm for Topical Saw Palmetto in MS Patients

1. Assess MS status:

   • Determine current disease activity
   • Review current MS medications
   • Evaluate for any recent exacerbations

2. Evaluate risk factors:

   • Check for history of allergic reactions to botanicals
   • Review current skin condition at application site
   • Consider any history of hormone-sensitive conditions (saw palmetto has mild hormonal effects)

3. Application recommendations:

   • Start with a small test area to check for local reactions
   • Apply to intact skin only
   • Avoid application near eyes or mucous membranes
   • Discontinue if local irritation occurs

Important Caveats and Precautions

• While topical application likely minimizes systemic absorption, patients should be monitored for any new or worsening MS symptoms after initiating use
• There is one case report of hormonal effects (hot flashes and early menarche) in a young girl using saw palmetto supplements, suggesting potential endocrine activity 3
• Patients with MS who experience sensitivity to cosmetic products or have compromised skin barriers may be at higher risk for irritation

Conclusion

Based on available evidence, topical saw palmetto appears to be safe for MS patients. The lack of reported interactions with MS medications and the generally favorable safety profile of saw palmetto suggest that topical applications pose minimal risk. However, as with any complementary treatment, patients should inform their neurologist about its use, particularly if they notice any changes in their MS symptoms.