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A herbal cream consisting of Aloe vera, Lavandula stoechas, and Pelargonium roseum as an alternative for silver sulfadiazine in burn management

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Abstract

Background: Silver sulfadiazine (SSD) is the most used topical agent for the treatment of burn wounds. However, it has some side effects such as delayed and incomplete epithelialization, generation of black scars, and limited penetration to the depth of a wound. Objective: The present study investigated the efficacy of herbal combination cream containing Aloe vera gel and essential oils of Lavandula stoechas and Pelargonium roseum in the alleviation of symptoms in patients with superficial second-degree burns and comparison of its effects with those of SSD 1% cream. Methods: One hundred eleven patients with second-degree burns (occurring in the preceding 48 hours and affecting <50% body area) were randomized to receive either herbal cream (n = 56) or SSD 1% cream (n = 55) applied once daily for 14 days. Prevalence of skin dryness and pain severity (assessed using a visual analogue scale) and evidence of infection was determined for patients at baseline as well days 2, 7, and 14. Results: Both groups experienced a significant reduction in the pain severity at day 14 compared to baseline (p <0.001). As for the magnitude of change in pain score, there was a significantly greater reduction from baseline to the seven (p = 0.014) and 14 (p = 0.05) day in the herbal cream compared to control group. The frequency of skin dryness was not significantly different between the groups at any of the assessed time points (p >0.05). There was a single case of infection in the herbal cream group, which cleared with continuation of treatment. Conclusion: Our findings suggested that the herbal cream used here is superior to SSD 1% cream in the alleviation of pain and may serve as a natural alternative for treatment of second-degree burns.
Asian Biomedicine Vol. 6 No. 2 April 2012; 273-278
A herbal cream consisting of Aloe vera, Lavandula
stoechas, and Pelargonium roseum as an alternative for
silver sulfadiazine in burn management
Yunes Panahia, Fatemeh Beiraghdarb, Hossein Akbaric, Hossein Bekhradic, Mohsen Taghizadehc,
Amirhossein Sahebkard
aChemical Injuries Research Center, Baqiyatallah University of Medical Sciences, bNephrology and
Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran 19945-581, cJundishapur
Research Center, Barij Essence Pharmaceutical Co., Kashan 1178, dBiotechnology Research Center
and School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 91775-1365, Iran
Background: Silver sulfadiazine (SSD) is the most used topical agent for the treatment of burn wounds. However,
it has some side effects such as delayed and incomplete epithelialization, generation of black scars, and limited
penetration to the depth of a wound.
Objective: The present study investigated the efficacy of herbal combination cream containing Aloe vera gel and
essential oils of Lavandula stoechas and Pelargonium roseum in the alleviation of symptoms in patients with
superficial second-degree burns and comparison of its effects with those of SSD 1% cream.
Methods: One hundred eleven patients with second-degree burns (occurring in the preceding 48 hours and
affecting <50% body area) were randomized to receive either herbal cream (n = 56) or SSD 1% cream (n = 55)
applied once daily for 14 days. Prevalence of skin dryness and pain severity (assessed using a visual analogue
scale) and evidence of infection was determined for patients at baseline as well days 2, 7, and 14.
Results: Both groups experienced a significant reduction in the pain severity at day 14 compared to baseline
(p <0.001). As for the magnitude of change in pain score, there was a significantly greater reduction from baseline
to the seven (p = 0.014) and 14 (p = 0.05) day in the herbal cream compared to control group. The frequency of skin
dryness was not significantly different between the groups at any of the assessed time points (p >0.05). There was
a single case of infection in the herbal cream group, which cleared with continuation of treatment.
Conclusion: Our findings suggested that the herbal cream used here is superior to SSD 1% cream in the alleviation
of pain and may serve as a natural alternative for treatment of second-degree burns.
Keywords: Aloe vera, burn wound, Lavandula stoechas, Pelargonium roseum, silver sulfadiazine
Thermal burns are among the major causes of
serious injury in the United States. About 1.1 million
people are affected with burns annually, of which most
are treated as outpatient. However, 45000 of these
patients need hospital admission and another 4,500
die [1].
Because of burn injury to the skin, the first
physiologic barrier against foreign microorganisms is
impaired. Therefore, wound site infections are an
important concern in the management of burn patients.
Antibiotic therapy is among the main approaches for
the prevention and treatment of burn wounds and
statistics indicate that there was an approximately 60%
reduction in burn-related mortality following the
introduction of topical antibiotics [1].
Based on the depth of injury, burns are classified
into four degrees. First-degree burns affect only the
epidermis. Second-degree burns extend into dermis
but subcutaneous fat is not involved. In third-degree
burns, necrosis extends through the entire dermis and
affects the subcutaneous fat layer. In Forth-degree
burns, injury extends through the entire skin into
subcutaneous tissues and may involve underlying
fascia, muscle, and bone. Second-degree burns are
further classified into superficial and deep burns. The
first-degree superficial form involves papillary dermis.
Correspondence to: Dr. Yunes Panahi, Research Center of
Chemical Injuries, Baqiyatallah University of Medical Sciences,
Tehran 19945-581, Iran. E-mail: yunespanahi@yahoo.com
DOI: 10.5372/1905-7415.0602.053
Brief communication (Original)
274 Y. Panahi, et al.
It is characterized by formation of clear blisters and
fluid accumulation between epidermis and dermis. In
contrast, deep second-degree burns involve reticular
dermis and lead to complete loss of the dermis layer
and scar formation.
Silver sulfadiazine is the most used topical
antibiotic for the treatment of burn wounds. However,
it has drawbacks including delayed and incomplete
epithelialization, generation of black scars, limited
penetration to the depth of wound, hypersensitivity,
neutropenia, and thrombocytopenia [2, 3]. Other
topical antibiotics such as mafenide acetate and
silver nitrate are also associated with side effects such
as pain and hypersensitivity at the wound site, delayed
wound healing, electrolytic imbalance, and
hemoglobinemia [4, 5].
Therapeutic goals in burn management include
prevention of infections and rapid healing with the least
side effects. Given the adverse effects of currently
used topical antibiotics, introduction of novel topical
agents that could effectively and safely promote
wound healing and relieve the associated pain are
desirable. The previously reported healing, emollient,
antimicrobial, and anti-inflammatory properties
of Aloe vera gel [6-10] and the antimicrobial and
anti-inflammatory effects of Lavandula stoechas
and Pelargonium roseum essential oils [11-15],
encouraged us to carry out a study on the efficacy of
herbal combination cream containing the three
aforementioned components in patients with
superficial second-degree burns. Results were
compared with those of silver sulfadiazine 1%.
Methods
This study was a randomized and double-blinded
clinical trial among 120 patients (age range: 18 to 75
years) with superficial second-degree burns. Inclusion
criteria were thermal second-degree burns affecting
less than 5% of the body, occurrence of burn in the
preceding 48 hours, presence of no other injuries and
general physical and mental health. Exclusion criteria
were the presence of any renal, hepatic, endocrine,
cardiovascular or cerebrovascular disease, pregnancy,
history of drug or alcohol abuse, and concurrent
use (oral or topical) of antibiotics, steroids or
immunosuppressive drugs. The study protocol was
approved by the Ethics Committee of the relevant
institute and written informed consent was obtained
from participants.
Participants were randomized in a double-blind
manner to receive herbal cream (n = 60) or SSD 1%
(n = 60). The constituents of herbal cream were
A. vera gel and essential oils from L. stoechas and
P. roseum. Both creams were administered in identical
tubes and were matched in their color and volume.
Following cleansing and debridement of burn
wounds with antimicrobial solution, cream (5 g for each
10 cm2 of burn area) was applied on wounds using a
sterile spatula. After application of the creams, sterile
gauze was applied and wounds bandaged. Treatment
was continued once a day until recovery.
Patients were evaluated for the severity of pain,
frequency of skin dryness, and infection at baseline
as well as days 2, 7, and 14 following the initiation of
treatment. Pain severity was assessed using a 10-score
visual analogue scale (VAS). Patients were asked to
mark their pain severity from 0 (reflecting no pain) to
10 (reflecting unbearable pain).
Statistical analysis
Statistical analyses were performed using SPSS
software. Within-group comparisons were made using
Wilcoxon signed ranks test or paired samples t-test.
Between-group comparisons were performed by
means of Mann-Whitney U test or Chi-square test. A
two-sided p-value of <0.05 was considered as
statistically significant.
Results
From the initial 120 patients with superficial
second-degree burn that were recruited into the study,
nine were excluded due to study protocol violation.
Drop-out rate was not significantly different between
the groups (p >0.05). Data from 111 completers
(n = 56 in the herbal cream and 55 in the SSD group)
were included in the final analysis. There was no
significant difference between the two groups
regarding age, gender, percent burn area, and pain
severity at baseline (p >0.05). In the same manner,
burn agents and consumption of analgesics were not
significantly different between the groups (p >0.05)
as can be seen in Table 1.
The frequency of skin dryness on days 2, 7, and
14 post-burn were 12.5%, 12.5%, and 7.1% in the
herbal cream group and 27.3%, 25.5%, and 10.9% in
the SSD group, respectively. There was no significant
difference in the frequency of skin dryness between
the groups at any of the assessed time points (p >0.05).
In addition, the rate of change in the frequency of skin
275
Vol. 6 No. 2
April 2012 A herbal combination cream for the management of burn wounds
dryness between days 2 and 7, 2 and 14, and 7 and 14
was not significantly different between herbal cream
and SSD groups (p >0.05) (Table 2).
Both groups experienced a significant reduction
in pain severity at day 14 compared to baseline
(p <0.001) as shown in Figure 1. As for the
magnitude of change in pain score, there was no
significant difference between the groups from
baseline to the second day (p = 0.059). However,
there was a significantly greater reduction from
baseline to the seventh (p = 0.014) and fourteenth
(p = 0.05) days in the herbal cream compared to control
group (Table 3). Among the study population, there
was only a single case of infection in the herbal cream
group with recovered following continuation of
treatment.
Table 1. Demographic characteristics of herbal cream and SSD groups.
Herbal cream SSD 1% p-value
Age 33.6±13.4 37.4±12.7 >0.05
Gender (F/M) 21 (37.5) 25 (45.5) >0.05
Burn % 2.48±1.45 2.38±1.42 >0.05
Burn agent
Hot water/steam 24 (42.9) 23 (41.8)
Fire 22 (39.3) 18 (32.7)
Hot liquid 5 (8.9) 10 (18.2) >0.05
Hot object 2 (3.6) 3 (5.5)
Chemical substance 3 (5.4) 1 (1.8)
Analgesic consumption 18 (32.1) 18 (32.7) >0.05
Pain severity 5.68±3.2 4.56±4.87 >0.05
SSD: silver sulfadiazine
Table 2. Prevalence of skin dryness in different time points.
Herbal cream SSD 1% p-value
Day 2 7 (12.5) 15 (27.3) 0.051
Day 7 7 (12.5) 14 (25.5) 0.081
Day 14 4 (7.1) 6 (10.9) 0.488
SSD: silver sulfadiazine.
Figure 1. Severity of pain in the herbal cream and SSD groups at different time points.
276 Y. Panahi, et al.
Discussion
Herbal cream that was used in this study is a
combination of A. vera gel and essential oils of
L. stoechas and P. roseum. The clear jelly-like
substance obtained from the inner layer of A. vera
leaves, commonly referred to as A. vera gel, is the
medicinal part of the plant that has been investigated
in relation with a number of disorders [6, 7]. A. vera
leaf gel has been reported to possess antibacterial
and antiviral properties [16]. These properties could
be attributed to the bioactive components present in
the aloe gel such as aloe-emodin, for which inhibitory
activity has been reported against strains of bacteria
(including methicillin-resistant Staphylococcus
aureus), fungi and viruses [17]. Aside from the
antimicrobial effects, A. vera has documented
anti-inflammatory activities such as inhibition of
inflammatory cell migrations, inhibition of
cyclooxygenase and blocking prostaglandin E2,
bradykinin and histamine production. These effects
could be attributed, at least in part, to the presence of
salicylates and polysaccharides such as C-glucosyl
and veracylglucans B and C in the A. vera gel
[18-20]. Finally, there is evidence supporting the
efficacy of A. vera in the healing of burn wounds,
assessed in terms of healing success rate, healing time,
and rate of epithelialization on post-skin grafting [21].
L. stoechas oil constituted another component
of the herbal combination cream. The essential oil
obtained from L. stoechas has medicinal properties
including antimicrobial, anti-inflammatory, rubefacient,
and analgesic actions. There is evidence indicating
that L. stoechas oil has proper efficacy against
Gram-negative bacteria and could partially affect
Pseudomonas strains [11-13].
P. roseum oil was also included in the herbal
cream. This oil has been reported to possess antiseptic,
astringent, hemostatic, and wound healing properties
[14]. In addition, this oil has been found to be effective
against E. coli, S. aureus, P. aeruginosa, and C.
albicans infection [15]..
In spite of its painless topical application and
efficacy against a broad spectrum of Gram-positive,
Gram-negative (including most Pseudomonas
species) bacteria, and fungal strains, SSD has some
disadvantageous such as leaving black spots on skin,
lack of enough penetration to the depth of the scar,
and partial inhibition of epithelialization [2, 3].
Past animal and clinical studies have supported
the efficacy of A. vera in the healing of first to second-
degree burn wounds [21]. In a previous animal
study, Muller et al. reported the efficacy of A. vera
in shortening the healing time compared to
SSD and reversing the inhibitory effect of SSD
on wound healing [22]. In another investigation,
Hosseinimehr et al. reported a significant increase
in reepithelialization by aloe cream compared to
SSD [23]. Regarding clinical data, Visuthikosol and
colleagues reported on 27 patients with partial
thickness burn wounds where application of A. vera
gel led to early epithelialization and a significantly faster
healing compared to vaseline gauze [24]. There
are also other consistent clinical reports on the
positive impact of A. vera on the healing time and
epithelialization rate of burn wounds [25-27].
In summary, the findings of the present trial
indicated that the combination cream made of A. vera
gel and essential oils of L. stoechas and P. roseum is
superior to SSD 1% cream in alleviation of pain.
Therefore, this cream may be used as a natural and
effective alternative for SSD cream in superficial
second-degree burns.
Acknowledgements
This study was conducted with financial support
that was provided by the Baqiyatallah University of
Medical Sciences, Tehran, Iran. The authors are also
thankful to the Barij Esssence Pharmaceutical Co.
(Mashade Ardehal, Kashan, Iran) for providing the
herbal creams.
Table 3. Changes in pain severity in the herbal cream and SSD groups.
Herbal cream SSD 1% p-value
Baseline - day 2 2.61±1.55 1.91±2.25 0.059
Baseline - day 7 5.13±2.82 3.78±2.83 0.014
Baseline - day 14 5.68±3.2 4.54±2.83 0.05
SSD: silver sulfadiazine
277
Vol. 6 No. 2
April 2012 A herbal combination cream for the management of burn wounds
Conflicts of interest
Hossein Akbari, Hossein Bekhradi, and Mohsen
Taghizadeh are members of Barij Essence
Pharmaceutical Co. (Kashan, Iran).
References
1. Brunicardi F, Anderson D, Billiar T, Dunn D, Hunter J,
Pollock RE. Schwartz’s Principles of surgery. 8th ed.
USA: McGraw-Hill; 2005. p. 189-221.
2. Hussain S, Ferguson C. Best evidence topic report.
Silver sulphadiazine cream in burns. Emerg Med J.
2006; 23:929-32.
3. Malipeddi VR, Dua K, Sara UV, Malipeddi H,
Agrawal A. Comparative evaluation of transdermal
formulations of norfloxacin with silver sulfadiazine
cream, USP, for burn wound healing property. Burns.
2004; 33:836-40.
4. Ip M, Lui SL, Chau SS, Lung I, Burd A. The prevalence
of resistance to silver in a Burns unit. J Hosp Infect.
2006; 63:342-4.
5. Barillo DJ. Using mafenide acetate in acute and chronic
wounds. Ostomy Wound Manage. 2002; Suppl 5-10.
6. Hamman JH. Composition and applications of Aloe
vera leaf gel. Molecules. 2008; 13:1599-616.
7. Surjushe A, Vasani R, Saple DG. Aloe vera: a short
review. Indian J Dermatol. 2008; 53:163-6.
8. Bosley C, Smith J, Baratti P. A phase III trial comparing
an anionic phospholipid-based (APP) cream and aloe
vera-based gel in the prevention and treatment of
radiation dermatitis. Int J Radiat Oncol Biol Phys. 2003;
57:S4-38.
9. Visuthikosol V, Chowchuen B, Sukwanarat Y,
Sriurairatana S, Boonpucknavig V. Effect of aloe vera
gel to healing of burn wound a clinical and historic
study. J Med Assoc Thai. 1995; 78:403-9.
10. West DP, Zhu YF. Evaluation of aloe vera gel gloves
in the treatment of dry skin associated with
occupational exposure. Am J Infect Control. 2003; 31:
40-2.
11. Hajhashemi V, Ghannadi A, Sharif B. Anti-inflammatory
and analgesic properties of the leaf extracts and
essential oil of Lavandula angustifolia Mill. J
Ethnopharmacol. 2003; 89:67-71.
12. D’Auria FD, Tecca M, Strippoli V, Salvatore G,
Battinelli L, Mazzanti G. Antifungal activity of
Lavandula angustifolia essential oil against
Candida albicans yeast and mycelial form. Med
Mycol. 2005; 43:391-6.
13. Dadalioglu I, Evrendilek GA. Chemical compositions
and antibacterial effects of essential oils of Turkish
oregano (Origanum minutiflorum), bay laurel (Laurus
nobilis), Spanish lavender (Lavandula stoechas L.),
and fennel (Foeniculum vulgare) on common
foodborne pathogens. J Agric Food Chem. 2004; 52:
8255-60.
14. Baghernejad MR, Abedi D, Ghannadi A, Jalali M.
Antimicrobial Activity of Essential Oils of Pelargonium
roseum and Vitex agnuscostus. APV, International
meeting on pharmaceutics, Biopharmaceutics and
Pharmaceutical Technology; 2004 March 15-18;
Nuremberg, Germany.
15. Galea C, Csedo C. Testing the antibacterial and
antifungic activity of the species Pelargonium roseum
and Pelargonium graveolens. 19th European Congress
of Clinical Microbiology and Infectious Diseases;
2009 May 16 -19 May; Helsinki, Finland.
16. Greenwald J, Brendler T, Jaenicke C. PDR for Herbal
medicines. 3rd ed. Montvale, NJ: Thomson PDR; 2004.
17. Mohammad Abu-Darwish S, Mazen Ateyyat A.
The Pharmacological and Pesticidal Actions of
Naturally Occurring 1, 8-dihydroxyanthraquinones
Derivatives. World journal of Agricultural Sciences.
2008; 4:495-505.
18. Esua MF, Rauwald JW. Novel bioactive maloyl glucans
from Aloe vera gel: isolation, structure elucidation and
in vitro bioassays. Carbohydr Res. 2006; 341:355-64.
19. Langmead L, Makins RJ, Rampton DS. Anti-
inflammatory effects of aloe vera gel in human colorectal
mucosa in vitro. Aliment Pharmacol Ther. 2004; 19:
521-7.
20. Vzquez B, Avila G, Segura D, Escalante B.
Antiinflammatory activity of extracts from aloe vera
gel. J Ethnopharmacol. 1996; 55:69-75.
21. Maenthaisong R, Chaiyakunapruk N, Niruntraporn S,
Kongkaew C. The efficacy of aloe vera used for burn
wound healing: a systematic review. Burns. 2007; 33:
713-8.
22. Muller MJ, Hollyoak MA, Moaveni Z, Brown TL,
Herndon DN, Heggers JP. Retardation of wound healing
by silver sulfadiazine is reversed by Aloe vera and
nystatin. Burns. 2003; 29:834-6.
23. Hosseinimehr SJ, Khorasani G, Azadbakht M, Zamani
P, Ghasemi M, Ahmadi A. Effect of aloe cream versus
silver sulfadiazine for healing burn wounds in rats. Acta
Dermatovenerol Croat. 2010; 18:2-7.
24. Visuthikosol V, Chowchuen B, Sukwanarat Y,
Sriurairatana S, Boonpucknavig V. Effect of aloe vera
gel to healing of burn wound a clinical and histologic
study. J Med Assoc Thai. 1995; 78:403-9.
25. Thamlikitkul V, Bunyapraphatsara N, Riewpaiboon W,
278 Y. Panahi, et al.
Theerapong S, Chantrakul C, Thanaveerasuwan T,
et al. Clinical trial of aloe vera Linn. for treatment of
minor burns. Siriraj Hosp Gaz. 1991; 43:313-6.
26. Akhtar MA, Hatwar SK. Efficacy of aloe vera extract
cream in management of burn wound. J Clin Epidemiol.
1996; 49 (Suppl. 1):24.
27. Sun JH, Chen XG, Jin RT, Li TN, Bian YX. People’s
Liberation Army medicine information. Med J Chin
Army. 1994; 8:191-2.
... Of these 30 articles, 22 were excluded because they were not related to AV or SSD, and/or there was no direct comparison in regards to efficacy between AV and SSD for the treatment of burns. Of the seven studies included, four of them were conducted in Iran [6,7,25,28], one in Pakistan [14], one in Turkey [23], and one in Puerto Rico ( Table 2) [25]. When analyzing the number of days it took for the burn wound to heal, we observed that AV expedited healing in comparison to SSD (RR: -1.34, 95% CI: -1.8 to 0.9, p < 0.001, I2 = 0.0%) ( Figure 2 2. Effectiveness of Aloe vera gel compared with 1% silver sulphadiazine cream as burn wound dressing in second degree burns [14]. ...
... A randomized double-blinded clinical trial was conducted by Yunes et al. in 2012, which compared the efficacy of an AV-based herbal cream with 1% SSD on the pain reduction of second-degree burns [28]. The herbal cream consisted of AV gel and the essential oils of Lavandula stoechas and Pelargonium roseum. ...
... To the best of our knowledge, this is the first systematic review conducted that compares the efficacy of AV gel and SSD for burn wound healing. Existing literature demonstrates that AV gel seems to be efficacious in the treatment of second-degree burns with no or less toxicity than SSD [6,7,14,23,25,28]. Moreover, AV is a less expensive and more accessible option than SSD, making it a more cost-effective and convenient treatment option. ...
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Burn wounds remain a prevalent problem in the developed and developing world. A multitude of remedies has been tested. This study evaluated the healing time of second- and third-degree burn wounds between silver sulfadiazine (SSD) and Aloe vera (AV). In July 2020, a systematic review of MEDLINE (Ovid) and PubMed (National Library of Medicine) was performed to identify studies that reported healing of second- and third-degree burns using either SSD or AV. Articles meeting the inclusion criteria were screened and carefully analyzed. Our goal was to report the healing time for these burns using SSD and AV. A total of eight studies published between 1988 and 2018 reporting healing of second- and third-degree burns using SSD and AV were included in this review. Six were cohort studies and two were randomized controlled trials. The studies included both animal and human subjects. The meta-analysis demonstrated that the mean time to wound healing favored AV (RR: -1.34, 95% CI: -1.8 to 0.9, p < 0.001). It would seem that time to healing benefitted those burns in which AV was utilized. In conclusion, increased consideration and emphasis should be placed on using AV to aid the healing of second- and third-degree burns.
... The three randomized controlled trials chosen were those conducted by Khosarani et al. [13], Shahzad and Ahmed [11], and Panahi et al. [14]. Table 2 critiques those three articles in terms of validity, importance, and applicability. ...
... Table 2 critiques those three articles in terms of validity, importance, and applicability. The study by Panahi et al. [14] is not included in table 2 because their Aloe vera formulation and assessment outcome were significantly different those of the other two selected studies. RCT: randomized controlled trial; RR: risk reduction; ARR: absolute risk reduction; NNT: number needed to treat. ...
... The third study was a randomized double-blinded clinical trial study conducted by Panahi et al. [14] in Iran. This study included 120 second-degree burn patients with a total burn area of<50%. ...
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Objective: Current treatment for second-degree burn wounds, including silver sulfadiazine (SSD) application, may cause side effects such as delayed and incomplete wound healing, leaving a scar. Traditional plants empirically used for burn wounds, such as Aloe vera, seem to be a promising option with good safety profiles. Methods: We therefore compared Aloe vera to SSD for second-degree burn wounds based on a review of clinical trials obtained by an organized search through the Cochrane, PubMed, and DynaMed databases. Three randomized clinical trials studies were selected, two of which were critically appraised. The third study, with a different outcome assessment, was analyzed separately. Results: Two studies showed that Aloe vera was more effective in treating second-degree burn wounds than SSD 1% with an absolute risk reduction of 0.2, relative risk reduction of 0.83–1.0, and number needed to treat five patients. The Aloe vera group showed faster healing, earlier epithelialization, and earlier pain alleviation. The third study combined Aloe vera with other herbs, which showed better healing ability and restored skin hydration than those with SSD. Conclusion: Each of the three articles stated that Aloe vera was more effective than SSD for treating second-degree burn wounds. Nevertheless, each of the studies lacked methodology and comprehensive data reporting.
... 23 • Aloe vera gel appears to be an effective treatment for reducing pain in people with burns. 9,10 In RCTs, people with second and third degree burns who received aloe vera gel reported statistically significantly lower rating of pain measured on a on visual analogue scale than people who were treated with 1% silver sulfadiazine cream. Aloe vera gel was superior for pain management after seven days of treatment (n=120 people, p = 0.014) and after 14 days of treatment (n = 120 people, p =0.05). ...
... Aloe vera gel was superior for pain management after seven days of treatment (n=120 people, p = 0.014) and after 14 days of treatment (n = 120 people, p =0.05). 10 Aloe vera was also associated with faster achievement of a pain-free status in people with second degree burns (n = 50 people, p = 0.01). 9 The soothing characteristics of aloe vera are potentially related to its high water content. ...
... Numerous medicines are available in market to cure hypertension, as their extended use and extra-ordinary price produces several adverse effects and results patients' poor compliance and unaffordability [3]. In this situation, herbal medicines are getting more attention as they are safe, affordable, easily accessible and durable because of the existence of dual opposing mechanisms i.e. inhibitory and excitatory constituents inbuilt in same herb, which advantages the remedy with less side effects [4,5]. Many medicinal plants ameliorate the hypertension as a decoction of stem bark of Rhaptopetalum coriaceum oliver has been used in folk to treat hypertension [6], Rauwolfia serpentine with active agent reserpine has been widely used to treat the hypertension [7], other herbs include Zingiber officinale, Uncaria rhynchophylla, Solanum sisymbriifolium, Moringa oleifera, Hibiscus sabdariffa and many other plants [8]. ...
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Objective: This study determines the efficacy and probable underlying mode of action to the folk usage of Euphorbia hirta, Fagonia indica and Capparis decidua in hypertension. Methods: The aqueous-methanol extracts of E. hirta (EH.Cr), F. indica (FI.Cr) and C. decidua (CD.Cr) were tested for antihypertensive effects in rats using non-invasive and in-vasive blood pressure measuring apparatus. In-vitro assays were carried out using isolated rat aortae using PowerLab station. Results: EH.Cr, FI.Cr and CD.Cr at 500 mg/kg (orally) caused a fall in the mean systolic blood pressure in arsenic-induced hypertensive and normotensive rats, similar to nifedipine. In rat aortae, EH.Cr, CD.Cr and FI.Cr reversed low (20 mM), high (80 mM) K+ and phenylephrine (P.E)-driven contractions, while F. indica partially inhibited high K+ contractions. In the presence of TEA, F. indica remained unable to relax low K+ contractions. EH.Cr and CD.Cr moved Ca++ concentrations response curves to the right, like nifedipine. All fractions of EH.Cr and CD.Cr except aqueous, pet-ether and chloroform fractions of FI.Cr displayed Ca++ antagonistic activity. FI.Cr, its ethyl acetate and aqueous fraction exhibited TEA-sensitive potassium channel activation. On baseline tension, test materials also produced phentolamine-sensitive vasospasm. Conclusion: E. hirta, F. indica and C. decidua possess antihypertensive activity in arsenic-induced hypertensive rats possibly mediated via endothelium-dependent vasorelaxation. In normotensive rats, E. hirta and C. decidua showed antihypertensive activities through endothelium-dependent and Ca++ antagonistic pathways, while F. indica exhibited potassium channel activation and Ca++ antagonistic like effects in its vasorelaxation. Additional weaker vasospastic effects were derived through α-adrenergic like pathways. Keywords: Euphorbia hirta, Fagonia indica, Capparis decidua, antihypertensive, Ca++ antagonist, potassium channel activation.
... Viola odorata [58], Piper longum and Piper nigrum [59]. These observed effects also help the statement that herbal medicine retain the synergistic and / or side effects abolishing mixtures [4,5]. ...
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Objective This study determines the efficacy and probable underlying mode of action to the folk usage of Euphorbia hirta, Fagonia indica and Capparis decidua in hypertension. Methods The aqueous-methanol extracts of E. hirta (EH.Cr), F. indica (FI.Cr) and C. decidua (CD.Cr) were tested for antihypertensive effects in rats using non-invasive and in-vasive blood pressure measuring apparatus. In-vitro assays were carried out using isolated rat aortae using PowerLab station. Results EH.Cr, FI.Cr and CD.Cr at 500 mg/kg (orally) caused a fall in the mean systolic blood pressure in arsenic-induced hypertensive and normotensive rats, similar to nifedipine. In rat aortae, EH.Cr, CD.Cr and FI.Cr reversed low (20 mM), high (80 mM) K⁺ and phenylephrine (P.E)-driven contractions, while F. indica partially inhibited high K⁺ contractions. In the presence of TEA, F. indica remained unable to relax low K⁺ contractions. EH.Cr and CD.Cr moved Ca⁺⁺ concentrations response curves to the right, like nifedipine. All fractions of EH.Cr and CD.Cr except aqueous, pet-ether and chloroform fractions of FI.Cr displayed Ca⁺⁺ antagonistic activity. FI.Cr, its ethyl acetate and aqueous fraction exhibited TEA-sensitive potassium channel activation. On baseline tension, test materials also produced phentolamine-sensitive vasospasm. Conclusion E. hirta, F. indica and C. decidua possess antihypertensive activity in arsenic-induced hypertensive rats possibly mediated via endothelium-dependent vasorelaxation. In normotensive rats, E. hirta and C. decidua showed antihypertensive activities through endothelium-dependent and Ca⁺⁺ antagonistic pathways, while F. indica exhibited potassium channel activation and Ca⁺⁺ antagonistic like effects in its vasorelaxation. Additional weaker vasospastic effects were derived through α-adrenergic like pathways.
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Aloe vera is a natural product that is now a day frequently used in the field of cosmetology. Though there are various indications for its use, controlled trials are needed to determine its real efficacy. The aloe vera plant, its properties, mechanism of action and clinical uses are briefly reviewed in this article.
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Many of the health benefits associated with Aloe vera have been attributed to the polysaccharides contained in the gel of the leaves. These biological activities include promotion of wound healing, antifungal activity, hypoglycemic or antidiabetic effects antiinflammatory, anticancer, immunomodulatory and gastroprotective properties. While the known biological activities of A. vera will be briefly discussed, it is the aim of this review to further highlight recently discovered effects and applications of the leaf gel. These effects include the potential of whole leaf or inner fillet gel liquid preparations of A. vera to enhance the intestinal absorption and bioavailability of co-administered compounds as well as enhancement of skin permeation. In addition, important pharmaceutical applications such as the use of the dried A. vera gel powder as an excipient in sustained release pharmaceutical dosage forms will be outlined.
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Aloe vera has been traditionally used for burn healing but clinical evidence remains unclear. We conducted a systematic review to determine the efficacy of topical aloe vera for the treatment of burn wounds. We electronically searched relevant studies in MEDLINE, CINAHL, Cochrane Library, HealthSTAR, DARE, South-East Asia Database, Chinese Databases, and several Thai local Databases (1918–June 2004). Only controlled clinical trials for burn healing were included. There were no restrictions on any language of publication. Two reviewers independently extracted data on study characteristics, patient characteristics, intervention, and outcome measure.Four studies with a total of 371 patients were included in this review. Based on a meta-analysis using duration of wound healing as an outcome measure, the summary weighted mean difference in healing time of the aloe vera group was 8.79 days shorter than those in the control group (P = 0.006). Due to the differences of products and outcome measures, there is paucity to draw a specific conclusion regarding the effect of aloe vera for burn wound healing. However, cumulative evidence tends to support that aloe vera might be an effective interventions used in burn wound healing for first to second degree burns. Further, well-designed trials with sufficient details of the contents of aloe vera products should be carried out to determine the effectiveness of aloe vera.
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