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Abstract

Garlic (Allium sativum L. fam. Alliaceae) is one of the best-researched, best-selling herbal remedies and is also commonly used for treating various health problems. Garlic is widely known for its biological properties and plays an important role as an antioxidant. The purpose of this review is to gather and summarize all dermatologic-oriented in vitro and in-vivo experiments and clinical trials on garlic preparations. Extensive literatures search was carried out and twenty three studies were included. The results suggest that oral administration of garlic is effective on immunologic properties, cutaneous microcirculation, protection against UVB and cancer treatment. Additionally, topical application of garlic extract can potentially be effective on psoriasis, alopecia areata, keloid scar, wound healing, cutaneous corn, viral and fungal infection, leishmaniasis, skin aging and rejuvenation. Clinical effectiveness of oral and topical garlic extract is not sufficiently and meticulously explored as so far.
[Dermatology Reports 2011; 3:e4] [page 5]
Garlic in dermatology
N
ader Pazyar, Amir Feily
Jundishapur University of Medical
Sciences, Department of Dermatology,
A
hvaz, Iran
Abstract
Garlic (Allium sativum L. fam. Alliaceae) is
one of the best-researched, best-selling herbal
remedies and is also commonly used for treat-
ing various health problems. Garlic is widely
known for its biological properties and plays an
important role as an antioxidant. The purpose
of this review is to gather and summarize all
dermatologic-oriented in vitro and in-vivo
experiments and clinical trials on garlic prepa-
rations. Extensive literatures search was car-
ried out and twenty three studies were includ-
ed. The results suggest that oral administra-
tion of garlic is effective on immunologic prop-
erties, cutaneous microcirculation, protection
against UVB and cancer treatment. Additio -
nally, topical application of garlic extract can
potentially be effective on psoriasis, alopecia
areata, keloid scar, wound healing, cutaneous
corn, viral and fungal infection, leishmaniasis,
skin aging and rejuvenation. Clinical effective-
ness of oral and topical garlic extract is not suf-
ficiently and meticulously explored as so far.
Introduction
Garlic (Allium sativum) is one of the best-
researched, best-selling herbal remedies and
has been commonly used for treating various
health problems for centuries.
1
Garlic is a
genus of some 500 species belonging to the
family Liliaceae and Allium class of bulb-
shaped plants.
2
Its constituents include
enzymes (for example, alliinase), sulfur-con-
taining compounds such as alliin, and com-
pounds produced enzymatically from alliin (for
example, allicin).
2,3
Other constituents such as
arginine, oligosaccharides, flavonoids, and
selenium are available in garlic.
2,3
Four garlic preparations including, raw gar-
lic juice (RGJ), heated garlic juice (HGJ),
dehydrated garlic powder (DGP) and aged gar-
lic extract (AGE) are available. Different types
of garlic preparations have different pharma-
cologic properties, and among the four garlic
preparations, AGE is the most useful of them.
4
Garlic extract is made from whole or sliced gar-
lic cloves that are soaked in an alcohol solution
for different amounts of time.
5
I
ngredients
Aged garlic extract (AGE) is a complex mix-
ture. Its components include allin, cycloalliin,
S-allyl-L-cysteine, S-methyl-L-cysteine, S-eth-
ylcysteine, S-1-proponyl-L-cysteine, S-allylmer-
capto-L-cysteine, fructosyl-arginine, and beta-
chlorogenin. It also consists of L-arginine, L-
cysteine, and L-methionine.
6
Mechanism
The compounds involved in the biological
mechanisms such as flavenols, sulphur and
seleno compounds have been identified.
7
Garlic
is also characterized by more polar compounds
o
f phenolic and steroidal origin showing inter-
esting pharmacological properties.
8
Aged garlic
extract stimulate immune functions such as
proliferation of lymphocyte, cytokine release,
NK activity and phagocytosis.
9
Adverse reactions
Adverse reactions, related to garlic are poten-
tially consist of irritant contact dermatitis, aller-
gic contact dermatitis, protein contact dermati-
tis, zosteriform dermatitis,contact urtica ria and
induction of pemphigus.
1
0
The purpose of this
review is to gather and summarize all in vitro
and in vivo and clinical trials on garlic prepara-
tions and their uses in dermatology.
Dermatologic applications
of systemic garlic
Antioxidant effects
Importantly, S-allylcysteine (SAC) and S-
allylmercaptocysteine (SAMC) are the major
organosulfur compounds in aged garlic extract
which prevent oxidant damage. AGE exerts
antioxidant action by scavenging reactive oxy-
gen species (ROS), enhancing the cellular
antioxidant enzymes such as superoxide dis-
mutase, catalase, glutathione peroxidase and
increasing glutathione in the cells. AGE pro-
tects DNA against free radicals and defends
against UV-induced damage. It also protects
against some forms of UV-induced immuno-
suppression.
11,12
Cutaneous microcirculation
A randomized placebo-controlled double-
blinded study show that 5 h after the adminis-
tration of garlic powder a significant increase
in capillary skin perfusion occurs by 55% in the
healthy volunteers. The increased erythrocyte
velocity results from vasodilation of precapil-
lary arterioles which increases diameter of
erythrocyte column by an average of 8.6%.
13
Immunomodulatory effect
The major immunomodulatory proteins
have been identified are known as garlic
lectins. Aged garlic extract has more potent
immunomodulatory effects than raw garlic.
14
Garlic extract potentially induces the lympho-
cytes proliferation and macrophage phagocyto-
sis, stimulates the infiltration of macrophages
and lymphocytes in transplanted tumors,
induces splenic hypertrophy, stimulates
release of interleukin-2, tumor necrosis factor-
alpha and interferon-gamma and enhances
natural killer cell and lymphokine-activated
killer cell activity. These activities reflex effec-
tive stimulation of the immune response.
1
5
Anti cancer
Two garlic-derived organosulfur compounds
such as Se-methyl selenocysteine and gamma-
glutamyl-Se-methyl selenocysteine show anti-
cancer activity.
1
6
These include the effect on
drug metabolizing enzymes, antioxidant proper-
ties, tumor growth inhibition, apoptosis, angio-
genesis and increasing of natural killer
(NK)cells.
4,17
A molecular study displays that
diallyl trisulfide (DATS) is a potential anticancer
compound for skin cancer.
18
Studies show that
diallyl disulfide (DADS) induces caspase-
dependent apoptosis through a mitochondria-
mediated by intrinsic pathway in melanoma
cells
19
and appears to be a good candidate as an
antitumor agent against melanoma.
20
UVB protection
Garlic stimulates the proliferation of
macrophages and lymphocytes and protects
against the suppression of immunity by ultra-
violet radiation.
21
Aged garlic extract contains
ingredients that protects from UVB-induced
suppression of contact hypersensitivity and
suggest that the mechanism of protection is by
antagonism of the cis-urocanic acid mediation
of this form of immunosuppression.
22
Dermatologic applications of topi-
cal garlic extract
Psoriasis
The activation of nuclear transcription fac-
Dermatology Reports 2011; volume 3:e4
Correspondence: Amir Feily, Jundishapur
University of Medical Sciences, Department of
Dermatology, Ahvaz, Iran.
E-mail: dr.feily@yahoo.com
Key words: garlic, dermatology, review.
Conflict of interest: the authors report no con-
flicts of interest.
Received for publication: 29 March 2011.
Accepted for publication: 30 March 2011.
This work is licensed under a Creative Commons
Attribution 3.0 License (by-nc 3.0).
©Copyright N. Pazyar and A. Feily et al., 2011
Licensee PAGEPress, Italy
Dermatology Reports 2011; 3:e4
doi:10.4081/dr.2011.e4
[page 6] [Dermatology Reports 2011; 3:e4]
t
or kappaB has now been linked with psoriasis.
Extensive researches in the last few years have
s
hown this pathway. This transcription factor
can be interrupted by garlic (diallyl sulfide, S-
allylmercaptocysteine, ajoene).
2
3
Alopecia areata
A double-blinded randomized controlled trial
shows that the use of garlic gel significantly
adds to the therapeutic efficacy of topical
betamethasone valerate in alopecia areata and
it can be an effective adjunctive topical thera-
py for alopecia areata.
24
K
eloid scar
Keloid scar is a chronic fibro-proliferative
disease. It is hypothesized that garlic extract is
able to inhibit nuclear factor-k B (NF-kB),
nitric oxide (NO), matrix metalloproteinase
(MMP)-2, Interleukin-6 (IL-6) and angiotensin
converting enzyme (ACE); therefore, it can be
potentially an effective treartment for keloid
scar.
25
Wound healing
According to a study conducted by Bojs et al.,
contact allergy to garlic can be effective on
wound healing.
26
Investigation on chicken skin
wounds exposed to aged garlic extract show an
increase in the re-epithelialization and pro-
fuse dose-dependent neovascularization.
27
Viral infection
Components of garlic have been shown to
have antiviral effect and inhibit cellular prolif-
eration of virally infected cells. One placebo-
controlled trial demonstrates that the applica-
tion of chloroform extracts of garlic result in
the complete resolution of cutaneous warts
without recurrence after 3-4 months.
28
Cutaneous corn
A clinical trial reveals that the application of
garlic extract on the cutaneous corns causes
the complete removal of locations. The sur-
rounding fibrin tissue of the corn capsule is
lyzed and the capsule is separated from the
main tissue .It seems due to the fibrinolytic
effect of garlic extract.
29
Fungal infection
According to a study diallyl sulphide (DAS)
and diallyl disulphide (DADS) significantly
inhibit proteinase, phospholipase secretion
and dimorphism in candida albicans. These
compounds can, therefore, act as a potent anti-
fungal in the management of candidiasis.
30
On
the other hand, ajoene (allium-derived thiosul-
finate compound) has been shown to be effec-
tive in short-term treatment of tinea pedis.
One study shows the use of ajoene as a 0.4%
(w/w) cream results in complete clinical cure
of tinea pedis. Therefore, ajoene can be an
alternative, efficient and low-cost antimycotic
drug for short-term therapy of tinea pedis and
s
uperficial mycoses. The fact that ajoene can
be easily prepared from an alcoholic extract of
garlic may make it suitable for Third World
public health care.
31-33
Leishmaniasis
Treatment of leishmaniasis potentially rele-
vant to Th1-type immune response. In vivo and
in vitro studies demonstrate that garlic extract
reduces footpad lesions in leishmania mexi-
cana-infected BALB/c mice by inducing IFN-
gamma production from T cells as a Th1
immunomodulator. In vitro, garlic extract
reduce macrophage infection through induc-
tion of nitric oxide (NO) production. It may
thus act on both T cells and macrophages to
stimulate IFN-gamma production and NO syn-
thesis for parasite killing.
3
4
On contrary, a dou-
ble blinded, placebo controlled study on 197
patients who received garlic cream 5% or
placebo demonstrated it is not effective treat-
ment for cutaneous leishmaniasis.
35
Anti-aging
According to an investigation garlic shows
beneficial effects on the maximum prolifera-
tive capacity of fibroblasts on long-term, there-
fore, garlic can play a role as an anti-aging and
rejuvenative agent.
36
Conclusions
Garlic extract can inhibit photocarcinogene-
sis and garlic extract -containing sunscrens
may be valuable in Australasian countries and
in cancer-provoking conditions, such as
Gorlin’s syndrome and xeroderma pigmento-
sum. Additionally, it can be effective on maxi-
mum proliferative capacity on fibroblasts and
garlic extract -containing creams may be of
particular value in preventing of skin aging
and as a novel addition to rejuvenation. On the
other hand, garlic extract has been reported as
a Th1 immunomodulator and the pathogenesis
of psoriasis is relevant to Th1, therefore, it
maybe effective on psoriasis in combination
with topical steroid and emollient as a new
addition to psoriasis therapy.
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... However, the former is more economical, as the ingredients are natural and available everywhere [25] . Nevertheless, using garlic directly on the skin is not recommended since it has various side effects, some of which can cause skin irritations and a notably unpleasant odor [26] . ...
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... One double-blind, randomized control study showed a significant increase in capillary skin perfusion by 55 percent in healthy volunteers. 24,25 Vasodilation of precapillary arterioles could explain therapeutic effects on hair growth by increasing blood circulation to the scalp. A randomized, double-blind, controlled clinical trial of the efficacy of 5% garlic gel in combination with betamethasone cream for three months in patients with alopecia areata showed that the use of garlic gel significantly added to the therapeutic efficacy of topical betamethasone valerate starting the second month of application as compared with in the control group. ...
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BACKGROUND: Central centrifugal cicatricial alopecia (CCCA), a scarring alopecia that commonly affects women of African descent, can be challenging to manage, and there are limited treatment modalities available. The use of natural ingredients for nonscarring hair loss has gained popularity among patients, but has not been previously studied for CCCA. OBJECTIVE: We sought to review clinical studies evaluating the use of natural ingredients in the treatment of CCCA. METHODS: Systematic searches of the PubMed and SCOPUS databases were performed in March 2018 using various ingredient names and the terms alopecia, scarring alopecia, Central Centrifugal Cicatricial alopecia, and CCCA. Specific ingredients included azelaic acid, peppermint oil, pumpkin seed oil, garlic supplements/shampoo, Black castor oil, jojoba oil, argan oil, olive oil, horsetail plant oil, lavender oil, coconut oil, chamomile oil, thyme oil, tea tree oil, sulfur oil, menthol, and rosemary oil. Two reviewers independently screened titles, leading to the selection of eight clinical studies. RESULTS: A review of the literature revealed no clinical trials that evaluated the treatment of CCCA with natural ingredients. Despite limited evidence-based research for CCCA, several natural ingredients showed efficacy in alopecia areata, androgenetic alopecia, and psoriatic alopecia. CONCLUSION: Upon review of the literature, there were no randomized, controlled studies evaluating the use of natural ingredients or aromatherapy in the management of CCCA. Despite this, several botanical and natural ingredients do show promise in treating androgenetic alopecia and alopecia areata. More clinical studies need to be performed to evaluate treatment options as a whole, including natural modalities, to better serve these patients.
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Garlic is an herb which has been used by many cultures for treating various health problems for centuries. Uncontrolled use of herbal remedies, known as alternative treatment methods, may lead to side effects and serious treatment complications. This study aimed to draw attention to complications related to alternative treatment methods and to review the literature in the light of this case. A female patient who had been treated for trigeminal neuralgia was admitted to our clinic complaining of severe pain on the left side of her face. In anamnesis, the patient reported that she had applied garlic topically to this region. Extraoral examination revealed a broad cutaneous burn on the same region. According to a dermatology consultation, a treatment for cutaneous burns was applied and severe trigeminal neuralgia pain was eliminated with glycerol injection by an oral and maxillofacial surgeon.
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Diallyl sulfide (DAS), diallyl disulfide (DADS), and diallyl trisulfide (DATS), extracted from crushed garlic by steam-distillation, have been reported to provide the anticancer activity in several cancer types. However, their mechanisms of effects on skin cancer cells remain unclear. Therefore, we used human melanoma A375 cells and basal cell carcinoma cells as the models to elucidate the effects of these three allyl sulfides. Basal cell carcinoma (BCC) is known to be the most prevalent type of skin cancer, and melanoma is the most lethal form. We found that DATS revealed better growth inhibition of A375 and BCC cells than DADS and DAS did. We further demonstrated that DATS increased intracellular reactive oxygen species (ROS) generation, induced cytosolic Ca(2+) mobilization, and decreased mitochondrial membrane potential (DeltaPsim). Western blot results showed the concordance for the expression of molecules involved in G(2)/M arrest and apoptosis observed by cell cycle and cell viability analysis. Moreover, we detected the activation of p53 pathway in response to the oxidative DNA damage. DATS also displayed selective target of growth inhibition between skin cancer cells and normal keratinocyte HaCaT cells. Taken together, these results suggest that DATS is a potential anticancer compound for skin cancer.
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Cutaneous cancers are among the most common forms of cancer. Melanoma is an aggressive malignancy which is poor in prognosis. Despite of many years of researches, the treatment of melanoma is still a problem. Historically, plants have been main resources in traditional medicine and natural products are considered as important sources of antitumor drugs. Meanwhile, garlic for a long time has been used in man's food as a medicinal plant. In this study, the garlic extract was prepared and fractionated by ultra-filtration method with Amicon system. Garlic extract and its fractions including residue (R) 100, R50, R30, R10, R5, and filtrate (F) 5 were investigated for their cytotoxic activities on Sk-mel3 cell line of melanoma. The results show that garlic extract induced a significant cytotoxic activity on Sk-mel3 cell line. Among fractions R100 and R10 have more potential in cytotoxic activities against Sk-mel3 melanoma cells. In conclusion, garlic appears to be a good candidate as an antitumor agent against melanoma. To clarify the effective molecules and their mechanisms more studies should be applied on animal models and humans.