Identifying immunostimulatory herbal supplements that may flare autoimmune skin diseases: a systematic scoping review

From 11,819 articles screened, 469 studies met inclusion criteria and yielded 227 distinct herbal supplements with immunostimulatory properties — 79 supported by human studies, 145 by animal models and 148 by laboratory work. Fifteen herbs had the strongest evidence across all three types (more than five single-ingredient studies or more than 25 references): alfalfa, ashwagandha, astragalus, chlorella, echinacea, garlic, ginseng, green tea extract, Indian mulberry, liquorice, mistletoe, reishi mushroom, skullcap, spirulina and tinospora. All fifteen are widely sold for "immune support" and share proinflammatory mechanisms including toll-like receptor activation, NF-kB/MAPK signalling and raised IL-1beta, IL-6, TNF-alpha, IL-12 and interferon-gamma. The authors intend this as a reference for counselling patients with autoimmune skin disease.