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[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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Review
