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Successful treatment of facial vitiligo with honey bee, Allium cepa and Avena sativa combined to sun light exposure: A case clinical trial

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Objectives: To evaluate efficacy and safety of a natural formulation, completed by sun light exposure, in the management of localized vitiligo. Case summary: A 34 –year- old man was affected by facial localized vitiligo with no family history of this disease. After 17 months of treatment with conventional drugs with unsatisfactory results, the patient has adopted a new therapeutic protocol including topical application of a formulation of honey bee, Allium cepa L. juice and Avena sativa L. stem decoction. Also, a daily sun light exposure of 15-20mn was practiced. Results and discussion: A complete re-pigmentation of white patches was obtained in a period of 11 months with no adverse effects. The prolactin value was 7.06 ng/ml and cortisol was 12.36 μg/dl with 17.14 g/l of sericIgG which reflect a stabilization of stress state of the patient. Conclusions: The tested complementary therapy was safe and has successfully re-pigmented the different vitiligo lesions. Further studies are needed to confirm this stimulation of melanocyte’s proliferative activity by the present formulation.
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Available online at www.ijpcr.com
International Journal of Pharmaceutical and Clinical Research 2015; 7(1): 9-14
ISSN- 0975 1556
Research Article
*Author for Correspondence
Successful treatment of facial vitiligo with honey bee, Allium cepa and
Avena sativa combined to sun light exposure: A case clinical trial
*Zouhir Djerrou
Department of Biology, Faculty of Sciences, University of August 20th 1955 Skikda, Algeria.
Pharmacology & Toxicology Laboratory, Institute of Veterinary Sciences, University of Constantine 1, Algeria.
Available Online: 1st January, 2015
ABSTRACT
Objectives: To evaluate efficacy and safety of a natural formulation, completed by sun light exposure, in the management
of localized vitiligo.
Case summary: A 34 year- old man was affected by facial localized vitiligo with no family history of this disease. After
17 months of treatment with conventional drugs with unsatisfactory results, the patient has adopted a new therapeutic
protocol including topical application of a formulation of honey bee, Allium cepa L. juice and Avena sativa L. stem
decoction. Also, a daily sun light exposure of 15-20mn was practiced.
Results and discussion: A complete re-pigmentation of white patches was obtained in a period of 11 months with no
adverse effects. The prolactin value was 7.06 ng/ml and cortisol was 12.36 μg/dl with 17.14 g/l of sericIgG which reflect
a stabilization of stress state of the patient.
Conclusions: The tested complementary therapy was safe and has successfully re-pigmented the different vitiligo lesions.
Further studies are needed to confirm this stimulation of melanocyte’s proliferative activity by the present formulation.
Key words: facial vitiligo, re-pigmentation, honey bee, Allium cepa L., Avena sativa L., sun light.
INTRODUCTION
Vitiligo is a chronic, idiopathic, acquired pigmentary
disorder which is characterized byde-pigmented patches in
skin and mucousmembranes 1 affecting about 1-4% of the
world population 2.This disease is known since antiquity
because it has been mentioned on Papyrus Ebers 2500
years BC. It can be focal, segmental, generalized
(vulgaris), or even universal 3. Lesions are usually
symmetrically distributed on the face, neck, axillae,
elbows, knees, shins, and dorsal aspect of the hands and
feet 4. The psychological effects are an important aspect of
this disease because vitiligo is often immediately visible to
others resulting in social and emotional suffering
consequences 5. The exact etiopathogenesis of this
melanocytes activity loss is unknown and several
hypotheses were proposed viz autoimmune, cytotoxic,
biochemical, oxidant-antioxidant, growth factor,viral,
chronic pressure, neural and genetic theories 6. If the
diagnosis of vitiligo is regarded as being straightforward
in many cases, although this is not always the case, its
treatment is acknowledged as being difficult7.Medical
therapies include phototherapy radiation (narrowband
UVB), photochemotherapy, topical corticosteroids, topical
calcineurin inhibitors, vitamine D3 analogues, excimer
laser, and surgical procedures 7-14.
In the present study, the author describes a self-case of
facial vitiligo. After 17 months of treatment by
conventional drugs, and in the objective to stimulate
melanogenesis process, a natural formulation was tested
including: honey bee, red onion juice and oat stem
decoction. The treatment protocol was completed by daily
sun light exposure.
Figure 1: Schematic presentation of lesions
localization in face and neck.
CASE REPORT
A 34 year- old man was suffering from localized vitiligo
on the face and neck in November 2010. There was no
family history of vitiligo. Any chronic disease has been
diagnosed in the patient such as diabetes or thyroid
dysfunction. This patient occupying a university teaching
position, and he lived an interesting social pressure in the
Zouhir Djerrou / Successful treatment of facial vitiligo
IJPCR, January 2015 February 2015, Volume 7, Issue 1, 9-14
Page10
months preceding the appearance of the first lesions in the
left cheek. At the peak of the disease evolution, the patient
had lesions of de-pigmentation at the left cheek (the
largest) and a smaller one at the right cheek. A rectangular
white patches in both maxillae (left and right) and frontal
lesions appeared later. In the end, seven months after the
outbreak of de-pigmentation appeared two small spots at
the neck (Fig. 1).
Twenty days after the outbreak of the first lesion, the
patient has consulted a dermatologist which has diagnosed
the disease and recommended a continuous application of
some conventional drugs (Fig. 2). A treatment was started
but the disease has continued to spread, giving other
lesions. Noting that hair color (black) was preserved which
suppose that a melanocyte’s reservoir was preserved at
these areas. After 8 months of treatment (Locapred®,
Vitix® gel and physiblock®), the frontal lesion which has
appeared after the start of treatment was re-pigmented
perfectly with appearance of some brown points at the left
cheek, this development occurred during the months of
May- June. Thereafter, in the following 3 months the
frontal healed lesion has de-pigmented again and other
small frontal spots appeared. At the end of the 17th month
of medication with conventional drugs, a slight re-
pigmentation was obtained especially in the two spots left
and right cheeks, but the evolution has been very slow. It
should also be noted that two small white spots appeared
at the neck.
At the term of this period, and because of unsatisfactory
results, the patient decided to adopt a natural remedy
formed from honey bee, red onion juice and decoction of
dry oat stems (10 g of stems were boiled in 150 ml of water
for 12-15min). This natural mixture has been practiced
every evening. Exposure to the sunlight for a period of 15-
20mn/day was performed permanently in the sunny days
(1h before midday). The natural remedy has been applied
for a period of 20 days followed by 4 days off, so that sun
Figure 2: Treatment protocol
Zouhir Djerrou / Successful treatment of facial vitiligo
IJPCR, January 2015 February 2015, Volume 7, Issue 1, 9-14
Page11
exposure was permanent (except non-sunny days ) until
complete re-pigmentation of all lesions. We mention that
during the 28 months of disease, the patient has also
applied the Citrus lemon fruit’s juice, for a few times
(limed use).
Table 1: Hemato-biochemical profile one month
before complete re-pigmentation.
Hematological
profile
Val
ues
Biochemical
profile
Blood Red cells
(1012/l)
Hemoglobin
(g/dl)
Hematocrit (%)
MCV (fl)
MCH (pg)
MCHC (g/dl)
Platelets (109/l)
White blood
cells (109/l)
Granulocytes
(%)
Lymphocytes
(%)
Monocytes (%)
SS: 1h
2h
5.31
16.4
51.8
97
30.9
31.7
231
6.7
44.2
46
9.8
05
10
Glycemia (g/l)
Total proteins
(mg/l)
Urea (g/l)
Cholesterol (g/l)
Triglycerides (g/l)
HDL (g/l)
LDL (g/l)
TGO (g/l)
TGP (g/l)
Ca++ (mg/l)
CRP
67
0.26
1.41
1.44
0.49
0.63
38
45
84
(-)
During 9 months of application of the natural formulation
under sun exposure, all the lesions were perfectly re-
pigmented (Fig. 3). We mention that the white spots on the
right cheek and that of maxillae (left and right) were re-
pigmented one month before the great patch of the left
cheek. Small brownish points appeared first in all de-
pigmented surfaces at the same time and due to the growth
of these, perfect re-pigmentation was installed. The large
frontal lesion showed a slow and centripetal re-
pigmentation. This lesion, which was healed and de-
pigmented again, scored a late re-pigmentation of 4
months compared to the great left cheek lesion. In the 2
small neck spots, which were treated only 5 months after
the application of the natural mixture, treatment response
was very quick and complete re-pigmentation took place
only one month later.
Before complete healing (95% of re-pigmentation), a
haemato-biochemical and hormonal assessment was
performed to look for possible adverse effects from the
application of different products and to control certain
hormones reflecting the state of stress. The results have
shown that all parameters were within the physiological
range (Table1), confirming that after a period of 17 months
of treatment with conventional drugs and 10 months of
natural remedy application; there was no detectable
physiological disturbance. The values of the prolactin and
cortisol (Table 2) indicate a tendency for stabilization and
less stress in the patient
Table 2: Prolactine, cortisol and IGg values
Parameters
Values
Prolactine (ng/ml)
Cortisol (μg/dl)
IgG seric (g/l)
7.06
12.36
17.14
DISCUSSION
In the present case there was no family history of vitiligo;
the disease was occurred after a particular stress conditions
happened in the patient’s life. He was safe from
chronically disease ordinarily implicated in this disease as
diabetes and thyroid dysfunction. Only the frontal patch
was visibly responded positively to conventional drugs
after several months of treatment. However, the lesion was
reappeared with other small lesions. We mention here that
the patient was strongly psychologically affected which
Figure 3: Evolution of frontal and cheek lesions.
Zouhir Djerrou / Successful treatment of facial vitiligo
IJPCR, January 2015 February 2015, Volume 7, Issue 1, 9-14
Page12
may affect negatively the physiological response to drugs.
After 17 months, the disease seemed to be stabilized but
also the re-pigmentation process was very slow.The
application of the natural formulation has resulted in
complete re-pigmentation with no adverse effects.
It has been reported by Kahramanet al. 15 that honey
contains approximately 80% carbohydrates (40% fructose,
35% glucose, and 5% sucrose) and 20% water. In addition,
it contains more than 180 substances, including amino
acids, vitamins, minerals, enzymes, organic acids and
phenolic compounds. This natural complex has been
shown to possess antimicrobial, antiviral, anti-parasitory,
anti-inflammatory, antioxidant, anti-mutagenic and
antitumor effects 16. The honey bee from Algerian country
has been reported to possess high antioxidant potential 17
and know a large implication in Algerian traditional
medicine as cicatrizing agent used alone or in combination
18.
Green oats contain mainly pectin and SiO2, esters with
polyphenols and mono- or oligosaccharides 19. The
chemical composition of the dry stems of Avena sativa L.
is not documented for our knowledge. Traditionally, the
oat was used as a remedy in different therapeutic areas:
Sedative, external use (cutaneous disorders), nervous
system, and endocrinology, gastrointestinal, respiratory
and urinary tracts and also for general condition19. Several
studies have focused the evaluation of A. sativa L.
pharmacological properties, among them topical anti-
inflammatory activity. Aries et al. 20 has reported that
colloidal extract of A. sativa L. stimulated the production
of the anti-inflammatory TGFβ1 by keratinocytes and
inhibited the production of interleukins. In addition to this,
Aries et al. 21, 22 have founded an inhibition by colloidal
extract of A. sativaL. of Ca-ionophore A23187 on the
liberation of arachidonic acid from phospholipids and the
subsequent metabolism into prostaglandins and
leukotriene. The expression of phospholipase and COX2
was tempered. In a study of Boisnic et al. 23, treatment with
oatmeal extract oligomer has decreased significantly skin
inflammation with decrease of TNF-alpha. Avena flour
preparation has inhibited the expression of Nitric oxide
synthase which appears when neuro-immunocutaneous
system is destabilized during cutaneous inflammation 24. In
experimental wound healing model, this Avena flour
preparation has induced the expression of VEGF by
keratinocytes and has increased keratinocytes migration
and collagen fibercontraction 25. A study of Liu et al. 26 has
shown that oat avenanthramides, phenolic antioxidants
present in oat, exhibit a high capacity to inhibit adhesive
interaction between endothelial cells through inhibition of
adhesion molecule expression and to inhibit pro-
inflammatory cytokines and chemokines. The authors
concluded that their data provide evidence for the anti-
inflammatory potential and anti-atherogenic effects of oat
avenanthramides antioxidants.
Allium cepa L. (Alliaceae family) has a long history of
medicinal use. The Sulfur- and non-sulfur-containing
components have been isolated from bulbus of this plant;
the organic sulfur compoundsinclude the thiosulfinates,
thiosulfonates, cepaenes, S-oxides, S,S_-dioxides,
monosulfides, disulfides, trisulfides, and zwiebelanes 27.
European Medicines Agency (EMA) has published an
assessment report about A. cepa L. bulbs, a lot of
pharmacological properties of this plant were reviewed
and discussed (Anti-allergic / allergic, anti-inflammatory,
antimicrobial, antifungal, antiprotozoal, anti-
nematodicidal, anti-carcinogenic and anti-mutagenic, anti-
hyperglycemic, anti-aggregatory, cardiovascular and lipid-
lowering effects, neuroprotective and effects on skin) 28.
According to a study of Arunget al. 29, the dried skin extract
of this plant inhibited melanin formation in B16 melanoma
cells in dose dependent manner. In contrast, the extract of
the flesh of the onion did not lead to melanin inhibition.
However, an opposite result was reported by Kubo et al. 30
previously. According to these authors, quercetin of onion
enhanced the total melanin content in B16 melanoma cells.
A study of Khalifa and and Al-Obaidi 31 has shown a highly
therapeutic effect of crude onion juice in the treatment of
patchy alopecia areata by topical application. In a study of
Al Masaudi& AlBureikan 32, when testing the effects of the
onion- honey mixture with different concentrations (v/v:
1/1, 1/4, 4/1), the authors have found that the mixture (1/1)
had a very noticeable effect on all species of examined
microbes. Their data has also shown that the tested mixture
was significantly more effective comparing with onion or
honey alone.
In view of these literature reports, we can affirm that the
present formulation is very rich in antioxidant components
with anti-inflammatory activity. The inhibition of pro
inflammatory cytokines and chemokines by some
molecules as avenanthramides, and the total melanin
enhancement by other components as quercetin were
scientifically accepted. Furthermore, the formulation is a
good source of nutritional elements to nourish the damaged
skin. In addition, the sun light role in the stimulation of
melanogenesis process was well investigated. In a study
published in 2003, three vitiligo cases were treated
successfully (follow-up of 6 to 9 months) with twice
topical application of 0.1% Tacrolimus ointment. These
patients were allowed unprotected (no sunscreen) natural
sunlight exposure at midday: 5 minutes in the summer and
10 minutes in fall, winter, and spring 33. Finally, a synergic
effect between the honey bee, A. cepajuice and A. sativa
decoction (v/v/v: 1/1/1) is possible in term of
melanogenesis stimulation. As a limitation for the current
study, we mention that the evaluation of re-pigmentation
process, during disease evolution, adopted non-
quantitative visual examination and the interpretation of
each natural product’s role remains difficult.
CONCLUSION
In summary, a facial localized vitiligo case was followed-
up. After 17 month of conventional treatment with
unsatisfactory results, a new therapeutic protocol was
tested. A formulation of honey bee, Allium cepa L. juice
and Avena sativa stem decoction was applied topically
each evening. Also, a daily sun light exposure was
practiced. A complete re-pigmentation had taken place
during 11 months of remediation with any adverse effects.
Further studies are recommended with large number of
Zouhir Djerrou / Successful treatment of facial vitiligo
IJPCR, January 2015 February 2015, Volume 7, Issue 1, 9-14
Page13
patients to confirm the efficacy of this treatment protocol
in the management of localized vitiligo.
CONFLICT OF INTEREST: None
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574.
... Diyabette ise adjuvan tedavi olarak kullanılmaktadır. [1][2][3][4][5][6][7][8][9] 50-100 mg soğanın serum kolesterol ve plazma fibrinojen düzeyini düşürdüğü bildirilmektedir. 10 Klinik çalışmalar, Bulbus allii cepae'nın anti-hiperglisemik aktiviteye sahip olduğunu ortaya koymaktadır. ...
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ABSTRA ABSTRA ABSTRA ABSTRA ABSTRACT CT CT CT CT Vitiligo is chronic idiopathic disorder of skin pigmentation that plays havocs with the social livings of patients. Its major symptom is the occurrence of white patches/lesions on human skin. It affects 1-2 % of general population. A 15 years juvenile patient was affected by generalized Vitiligo with no familial history of the ailment. The patient was asked to take two table spoonful of honey per oral mixed with one cup of boiled milk of cow early in the morning daily. White de-pigmented skin was observed to be partially re-pigmented after 4 months with the reversal of disease progression.
Article
Full-text available
ABSTRA ABSTRA ABSTRA ABSTRA ABSTRACT CT CT CT CT Vitiligo is chronic idiopathic disorder of skin pigmentation that plays havocs with the social livings of patients. Its major symptom is the occurrence of white patches/lesions on human skin. It affects 1-2 % of general population. A 15 years juvenile patient was affected by generalized Vitiligo with no familial history of the ailment. The patient was asked to take two table spoonful of honey per oral mixed with one cup of boiled milk of cow early in the morning daily. White de-pigmented skin was observed to be partially re-pigmented after 4 months with the reversal of disease progression.
Article
Objectives: To evaluate efficacy and safety of a natural formulation, completed by sun light exposure, in the management of localized vitiligo. Case summary: A 34 –year- old man was affected by facial localized vitiligo with no family history of this disease. After 17 months of treatment with conventional drugs with unsatisfactory results, the patient has adopted a new therapeutic protocol including topical application of a formulation of honey bee, Allium cepa L. juice and Avena sativa L. stem decoction. Also, a daily sun light exposure of 15-20mn was practiced. Results and discussion: A complete re-pigmentation of white patches was obtained in a period of 11 months with no adverse effects. The prolactin value was 7.06 ng/ml and cortisol was 12.36 μg/dl with 17.14 g/l of sericIgG which reflect a stabilization of stress state of the patient. Conclusions: The tested complementary therapy was safe and has successfully re-pigmented the different vitiligo lesions. Further studies are needed to confirm this stimulation of melanocyte’s proliferative activity by the present formulation.
Article
Full-text available
Background: Vitiligo is a chronic, idiopathic, acquired pigmentary disorder which is characterized by depigmented patches on skin and mucous membranes. It affects approximately % 0.1-8.8 of the population. Different hypotheses are concerning to explain etiopathogenesis. Nowadays several studies have been keeping up about oxidative stress in vitiligo etiology. Oxidative stress is the result of overproduction or inadequate removal of reactive oxygen species. Recent studies are mainly major on antioxidants levels and lipid peroxidation product levels in blood. There is not enough evidence about the levels of protein and DNA peroxidation product levels in vitiligo patients. At this point multicentric more studies on larger population are needed to be made to prove the certain affects of these markers in vitiligo etiology.
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The aim of the present study was to characterize the physical, biochemical and antioxidant properties of Algerian honey samples (n = 4). Physical parameters, such as pH, moisture content, electrical conductivity (EC), total dissolved solids (TDS), color intensity, total sugar and sucrose content were measured. Several biochemical and antioxidant tests were performed to determine the antioxidant properties of the honey samples. The mean pH was 3.84 ± 0.01, and moisture the content was 13.21 ± 0.16%. The mean EC was 0.636 ± 0.001, and the mean TDS was 316.92 ± 0.92. The mean color was 120.58 ± 0.64 mm Pfund, and the mean 5-hydroxymethylfurfural (HMF) content was 21.49 mg/kg. The mean total sugar and reducing sugar contents were 67.03 ± 0.68 g/mL and 64.72 ± 0.52 g/g, respectively. The mean sucrose content was 2.29 ± 0.65%. High mean values of phenolic (459.83 ± 1.92 mg gallic acid/kg), flavonoid (54.23 ± 0.62 mg catechin/kg), ascorbic acid (159.70 ± 0.78 mg/kg), AEAC (278.15 ± 4.34 mg/kg), protein (3381.83 ± 6.19 mg/kg) and proline (2131.47 ± 0.90) contents, as well as DPPH (39.57% ± 4.18) and FRAP activities [337.77 ± 1.01 µM Fe (II)/100 g], were also detected, indicating that Algerian honey has a high antioxidant potential. Strong positive correlations were found between flavonoid, proline and ascorbic acid contents and color intensity with DPPH and FRAP values. Thus, the present study revealed that Algerian honey is a good source of antioxidants.
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