Article

Arnica and stinging nettle for treating burns - A self-experiment

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Combudoron, composed of extracts from arnica and stinging nettle, is used for the treatment of partial thickness burns and insect bites in Europe. Because clinical investigations are lacking we wanted to investigate its efficacy in partial thickness burns. Two individuals performed a self experiment: 4 experimental grade 2 burns (each 1 cm(2)) on the back were induced respectively with an erbium YAG-laser. Wounds were treated with Combudoron gel, Combudoron liquid, placebo gel or placebo liquid in each of the subjects in a standardized, single blind manner. Outcome parameters were the photo documented duration of wound healing and visual analogue scale (VAS) pain scores. All 8 experimental burns were similar from size and depth at baseline. Eschars of the verum-treated burns fell off earlier than the placebo-treated burns (verum liquid: after 14 and 19 days compared to 17 and 27 days with placebo liquid. Verum gel: after 16 and 22 days compared to 18 and 28 days with placebo gel). Eschars of the liquid treated burns fell off earlier than of the gel treated burns. Pain scores were not applicable because they were low and differences between the lesions could not be discriminated on the back. Combudoron seems to have positive effects on healing of grade 2 laser induced burns which deserve further investigation.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Publication is rare, but of the published work, in addition to Barry Marshall's, 5 in 2010 we know of Michael Snyder's ''Snyderome'' project, 9 and Huber et al. testing of a burn ointment. 10 In 2011-2012, Gwern tested micro doses of lysergic acid diethylamide (LSD) on himself. 11 In 2014, Philip Kennedy had electrodes implanted into his speech center. ...
... Four responders said there was no regulation and no guidance on self-experimentation. Two responders indicated familiarity with self-experimenters at significant numbers, both of them top universities. One did not require an ethics review and said their primary concern is whether or not it would be a solitary selfexperiment, and not a small group experiment as in Huber et al. 10 This committee informally educates experimenters regarding possible violations of the law in their jurisdiction, and regarding gray areas of what ethics committees think a self-experiment is. The other university familiar with selfexperimenters was the one mentioned above that might assign a surrogate to obtain informed consent if the procedure was deemed risky enough. ...
... Double-blind design is not common in self-experiments, but there are examples. 10,11,57 Self-experiment value Weisse and others express the view that moving research ahead is most important, and also that the value to the many outweighs discomfort or risk for one. 3,4 Dresser and Sacks advocated the value of self-testing to further their own knowledge. ...
Article
We examine self-experimentation ethics history and practice, related law, use scenarios in universities and industry, and attitudes. We show through analysis of the historical development of medical ethics and regulation, from Hippocrates through Good Clinical Practice that there are no ethical barriers to self-experimentation. When the self-experimenter is a true investigator, there is no other party to be protected from unethical behavior. We discuss the n-of-1 issue in self-experiments, and make suggestions for improving experiment design. We discuss real-world scenarios of self-experimentation: at universities, for independent single-subject investigators, investigator/employees at pharmaceutical firms, and non-scientist self-experimenters. Our survey of ethics committees regarding policy and review for self-experimenting investigators show that approximately 1/3rd of ethics committee respondents had a policy regarding self-experimentation, and 1/3rd didn't require ethical committee review of proposed experiments. There was no relationship between having a policy and asking for review. We also surveyed member attitudes to, and experiences of, self-experimentation among members of the National Academy of Sciences, the Royal Society, and the European Academy of Sciences. To our knowledge, this survey is the first breakdown of self-experiments into impact-relevant type classifications, and represents an advance in the field. Half of our scientist respondents performed self-experiments, and roughly 1/5th had conducted a serious self-experiments. Most responders thought self-experiments were valuable, however, biologics injections, radiation exposure and surgical implants had negative ratings greater than positive. We conclude that self-experimenters should not have attempts made to terminate them, bar them from use of facilities, nor be barred from using themselves or their tissues except in exceptional circumstances. Organizational uncertainty over the ethical and regulatory status of self-experimentation, and resulting fear of consequences is unjustified and may be blocking a route to human experiments that practicing scientists widely consider appropriate, and which historical precedent had shown is valuable.
... 16 Swift eschar separation with a resulting wound-bed that appeared pink and viable suggests that kiwifruit may help in the management of patients with deep burns. 17,18 This study compared the healing effect of aloe vera extract and silver sulfadiazine in burn injuries in experimental rat model. ...
... [4][5][6][7][8] Eupolin ointment, a formulation prepared from the aqueous extract of the leaves of C. odorata (formerly Eupatorium odoratum) has been licensed for clinical use in Vietnam. 17 Most of the medicines are mixture of several plants, but none of these traditional ointments were scientifically studied. In our study, aloe vera extract was compared with silver sulfadiazine as the standard treatment for burn wounds in rat. ...
Full-text available
Article
Wound healing is widely discussed in the medical literature. This study compared the healing effect of aloe vera extract and silver sulfadiazine in burn injuries in experimental rat model. Sixteen rats were randomly assigned to one of two groups, each group 8 rats. A deep second-degree burn on the lower back and 3(rd) degree burn on upper back of each rat were created with a standard burning procedure. Burns were dressed daily with aloe vera extract in group 2 and silver sulfadiazine in group 1. Response to treatment was assessed by digital photography during treatment until day 32. Histological parameters (PMN, epithelialization, fibrosis and angiogenesis) were assessed after biopsy of scar at the end of research. Wound healing was more visible in aloe vera group. Also the speed of healing in aloe vera group was better than silver sulfadiazine group. Based on our findings, aloe vera can be a therapy of choice for burn injuries.
... Most notably, the eschars treated with Combudoron fell off earlier than the placebo suggesting that Combudoron has a positive effect on burn healing. 49 In a randomized, double-blind 2-week study, twice a day topical application of Arnica 13 gel on one side of the face, before or after laser treatment was compared with vehicle application on the other hemiface in 19 patients affected by facial telangiectasias without improvement in visual analog scale (VAS) bruising. 11 Contrasting results were obtained in a 2-week double-blind randomized study including 16 healthy patients who underwent creation of 7-mm standard bruises on the upper inner arms by a 595-nm pulsed-dye laser. ...
... 53 Furthermore, combined with stinging nettle, it showed promising results in 2 patients with grade 2 laser-induced burns. 49 In patients undergoing the removal of impacted wisdom teeth, Arnica was less effective for the management of pain and swelling compared with placebo suggesting that it should not be used in that clinical condition. 29 These findings suggest that Arnica can be used in the context of wound healing in selected clinical scenarios. ...
Full-text available
Article
Arnica montana has been widely used as a homeopathic remedy for the treatment of several inflammatory conditions in pain management and postoperative settings. This review gives an overview of the therapeutic use of Arnica montana in the above-mentioned fields also focusing on its mechanisms of action learned from animal models and in vitro studies. Arnica montana is more effective than placebo when used for the treatment of several conditions including post-traumatic and postoperative pain, edema, and ecchymosis. However, its dosages and preparations used have produced substantial differences in the clinical outcome. Cumulative evidence suggests that Arnica montana may represent a valid alternative to non-steroidal anti-inflammatory drugs, at least when treating some specific conditions.
... The secondary metabolites profile is generally influenced by endogenous and exogenous factors; in this particular medicinal herb, the endogenous ones are the age of the plant, while the exogenous ones are the altitude and therefore the radiation, the geographical area, the soil, the attack of parasites and others [55]. In 2011 Huber and collaborators highlighted that the sesquiterpene lactones significantly decrease inflammation by inhibiting the NF-kB complex, a mechanism of action that differs from that of non-steroidal anti-inflammatory drugs, such as indomethacin and acetylsalicylic acid [56]. All the 94 citations referred to this plant are associated with pathologies involving the musculoskeletal system, such as contractures, sprains, or strains. ...
Full-text available
Article
The Trentino-South Tyrol region is a special statute region of northeastern Italy. This territory is of particular interest for its morphology, flourishing vegetation, and history, having been a meeting area among different civilizations. Hence, Trentino is characterized by an ethnic plurality and a rich ethnobotanical knowledge, even if the available information is fragmentary, widely dispersed, and often guarded in oral popular culture. To fill this gap, in the present work 200 subjects were interviewed using an ethnobotanical survey. The resulting 817 citations referred to 64 native species, used either for human or animal health or for domestic purposes. As a second step, for each plant exploited for medicinal purposes, local importance was evaluated by calculating their relative frequency of citation. Moreover, the main traditional preparations were discussed. Among them, the most cited and exploited ones are Achillea millefolium, Arnica montana, Hypericum perforatum, Malva sylvestris, Pinus mugo, and Satureja montana, for which a deeper analysis has been performed. Lastly, the ethnobotanical knowledge of the plants growing in this territory will add a piece to the mosaic of traditional medicine in Italy and may lay the foundation for a nature-aided drug discovery process.
... In some in vitro experimental models, the production of IL-6, IL-8, and TNF-α pro-inflammatory cytokines was also measured. The secretion of IL-6, IL-8, and TNF-α in an H 2 O 2 -stressed fibroblast cell culture decreased, which indicates the cytoprotective effect against cell membrane oxidative damage and higher anti-inflammatory activity [42,44]. ...
Full-text available
Article
Skin disorders of different etiology, such as dermatitis, atopic dermatitis, eczema, psoriasis, wounds, burns, and others, are widely spread in the population. In severe cases, they require the topical application of drugs, such as antibiotics, steroids, and calcineurin inhibitors. With milder symptoms, which do not require acute pharmacological interventions, medications, dietary supplements, and cosmetic products of plant material origin are gaining greater popularity among professionals and patients. They are applied in various pharmaceutical forms, such as raw infusions, tinctures, creams, and ointments. Although plant-based formulations have been used by humankind since ancient times, it is often unclear what the mechanisms of the observed beneficial effects are. Recent advances in the contribution of the skin microbiota in maintaining skin homeostasis can shed new light on understanding the activity of topically applied plant-based products. Although the influence of various plants on skin-related ailments are well documented in vivo and in vitro, little is known about the interaction with the network of the skin microbial ecosystem. The review aims to summarize the hitherto scientific data on plant-based topical preparations used in Poland and Ukraine and indicate future directions of the studies respecting recent developments in understanding the etiology of skin diseases. The current knowledge on investigations of interactions of plant materials/extracts with skin microbiome was reviewed for the first time.
... These lactones significantly decrease NFkap-paB-mediated inflammation as they pass through the skin easily. [40] Phosphorylation and degeneration of IkappaB, NF-kappaB's inhibitory subunit, stimulates NF-kappaB. NFkappaB activation by T cells, B cells and epithelial cells is inhibited by helenalin which in turn blocks kappaB-driven gene expression. ...
Full-text available
Article
Objectives: Arnica montana is a widely used therapeutic plant used traditionally to treat various ailments. The objective of this study was to evaluate the botany, phytochemistry and ethnopharmacology along with special emphasis given on pharmacological activity of plant A. montana. Key findings: The plant extracts have been reported to possess antibacterial, antitumor, antioxidant, anti-inflammatory, antifungal and immunomodulatory activity. A wide range of chemical compounds including sesquiterpene lactones and their short-chain carbonic acid esters, flavonoids, carotenoids, essential oils, diterpenes, arnidiol, pyrrolizidine alkaloids, coumarins, phenolic acids, lignans and oligosaccharides, etc., are found in different parts of the plant. Summary: It has been scrutinized that extensive research has been carried out to explore the therapeutic potential of flowers of the plant. Therefore, investigations should be carried out to explore the therapeutic potential of other parts of the plant for better therapeutic utilization.
... Combudoron seems to have positive effects on healing of grade 2 laser induced burns, which needs further investigation. 16,17 This study assessed the effect of nettle extract on second-degree burns wound healing in rats in comparison with silver sulfadiazine and vaseline. ...
Full-text available
Article
Numerous studies were carried out to develop more sophisticated dressings to expedite healing processes and diminish the bacterial burden in burn wounds. This study assessed the healing effect of nettle extract on second degree burns wound in rats in comparison with silver sulfadiazine and vaseline. Forty rats were randomly assigned to four equal groups. A deep second-degree burn was created on the back of each rat using a standard burning procedure. The burns were dressed daily with nettle extract in group 1, silver sulfadiazine in group 2, vaseline in group 3 and without any medication in group 4 as control group. The response to treatment was assessed by digital photography during the treatment until day 42. Histological scoring was undertaken for scar tissue samples on days 10 and 42. A statistically significant difference was observed in group 1 compared with other groups regarding 4 scoring parameters after 10 days. A statistically significant difference was seen for fibrosis parameter after 42 days. In terms of difference of wound surface area, maximal healing was noticed at the same time in nettle group and minimal repair in the control group. Our findings showed maximal rate of healing in the nettle group. So it may be a suitable substitute for silver sulfadiazine and vaseline when available.
... Combudoron also seems to have positive effects on healing grade 2 laser induced burns which deserve further investigation [13]. ...
Article
Introduction: Assessing effect of three herbal medicines on healing of deep second and third degree burns in rats and their comparison with silver sulfadiazine group. Methods and materials: 40 rats were randomly assigned to one of the four groups, each group 10 rats. A deep second degree burn and a third degree burn were induced on the lower back and upper back of each rat under standard burning procedure, respectively. The burns were daily dressed with Robacin in group 1, silver sulfadiazine in group 2, aloe vera extract in group 3, and Rimojen in group 4. Responses to the treatment were assessed by digital photography during the treatment until day 32. Histological parameters (PMN, epithelialization, fibrosis, and angiogenesis) were assessed after the scar biopsy at the end of the research. Results: On the basis of the taken photos, the wound had better healing in Robacin group. Also, speed of healing was better in aloe vera group than silver sulfadiazine and Rimojen groups. In terms of wound surface area maximal improvement was observed at the same time in the second and third degree burn wounds in Robacin group, in the second degree wound of aloe vera and Rimojen groups, and in the third degree wound of aloe vera and silver sulfadiazine groups. In pathological respects, epithelialization was more evident in both wounds of aloe vera group and third degree burn of Robacin group. In both wounds of Robacin group (second and third degree), the extend of angiogenesis and fibrosis was significantly less than other groups; but, inflammation was at a less level in third degree of silver, second degree of Rimogen and aloe vera, and third degree of aloe vera groups. Conclusion: In histological survey, minimal rate of angiogenesis and fibrosis was seen in Robacin group, which indicated less wound scar in this group. Healing speed of the burn wound was also higher in Robacin group.
... Huber 42 utilizó Arnica en forma de gel tópico para picadas de insectos y quemaduras en piel por aplicación de YAG-laser y obtuvo resultados excelentes. ...
Full-text available
Article
Introduction: Arnica montana is a plant native to Central and Southern Europe of proven effectiveness to relieve posttraumatic pain and other conditions. However, knowledge about this plant and its beneficial effects is scant among health professionals. Objectives: contribute to the professional development of those involved in alternative treatments by gathering updated information about Arnica montana. Methods: a search strategy was developed based on the following terms: homeopathy, clinical trial, meta-analysis, systematic review, effectiveness and safety, as combined with Arnica montana. Use was made of the databases MEDLINE and CUMED, as well as the Cochrane Central Register of Controlled Trials and the Cochrane Complementary Medicine Specialized Register, limited to articles published from January 2002 to June 2012. Conclusions: based on the evaluation of the information available, it may be stated that this natural product may be used both safely and effectively to relieve pain and reduce posttraumatic and postsurgical inflammation in humans.
Article
Abstract BACKGROUND: Osteoarthritis (OA) ranks fifth among all forms of disability affecting 10% of the world population. Current treatments available are associated with multiple side effects and do not slow down the progression of disease. Moreover no such effective treatment is available till date in various systems of medicine to treat osteoarthritis. Curcumin and Arnica have shown evident clinical advances in the treatment of osteoarthritis. OBJECTIVE: The aim of the present study was to design, optimize and characterize novel herbal transdermal patches of curcumin and Arnica montana using factorial design. METHODS: A multiple factorial design was employed to investigate the effect of hydroxypropyl methyl cellulose, ethyl cellulose and jojoba oil on elongation and drug release. Transdermal patches were evaluated by FTIR, DSC, FESEM, ex vivo drug permeation, anti oateoarthritic activity and analgesic activity. RESULTS: Independent variables exhibited significant effect on the physicochemical properties of the prepared formulations. The higher values of drug release and elongation were observed with the higher concentration of hydroxypropyl methyl cellulose and jojoba oil. Anti osteoarthritic activity was assessed by complete freund's adjuvant arthritis model and analgesic activity by eddy's hot plate method. Combination patch exhibited good anti oateoarthritic and analgesic activity as compare to individual drug patches. CONCLUSION: The design results revealed that the combination patch exhibited good physicochemical, anti osteoarthric and analgesic activity for the treatment of osteoarthritis. More plants and their combinations should be explored to get reliable, safe and effective formulations that can compete with synthetic drugs.
Chapter
Laser efficacy is now recognized in the treatment of several diseases and in the field of esthetic dermatology. Although there are various types of laser, the most commonly used lasers in dermatology are erbium and carbon dioxide (CO2), and laser resurfacing is one of the most widely used lasers. Despite the development of CO2 laser technology, some side effects still occur and sometimes may be severe. The first attempts of the treatment of laser skin complications amid patient-tested synthetic drugs which have been the subject of many studies. According to several published works, the use of antibiotic prophylaxis for post-laser resurfacing care is still controversial. Since the last few years, the interest to the natural post-laser care has rapidly increased, and the second attempt in the treatment was focused on the use of medicinal plants. Yet, only few studies have been recently carried out to assess the healing effect of medicinal plants on post-laser wound treatment. The studies initiated in this field are inconclusive mainly for methodological reasons.
Article
Poly(vinyl alcohol) (PVA) hydrogels are biocompatible materials that retain relatively high amounts of aqueous fluids in their network. The incorporation of antimicrobial natural products, such as pomegranate and arnica, is a strategy for coupling their bactericidal effects with the favorable properties of the gels for wound healing treatment. The goal of this work was to investigate the microstructural, mechanical, and release properties of PVA-pomegranate and PVA-arnica samples. Physical interactions were observed by Fourier transform infrared spectra in PVA-pomegranate samples. The addition of pomegranate to PVA led to high Tg, probably related to the physical interactions, and low Tm and Xc, possibly due to the pomegranate location between PVA chains. Increased levels of arnica were associated with a slight decrease in samples' Xc, probably due to a physical barrier imposed by arnica to the interaction of PVA chains. PVA samples presented higher swelling than the samples containing natural products. High amounts of pomegranate in the samples led to high weight loss and high phenols and flavonoids delivery. Arnica release seemed to be more difficult than the pomegranate release. All samples presented relative high mechanical properties. In addition, pomegranate samples present higher potential to deliver active compounds than arnica samples.
Article
Palliative care approaches that effectively manage distressful symptoms associated with wounds at the end of life remain elusive. This 4-week study examined a topical wound powder RGN107 for reducing pain, odor, and exudate in 50 patients with pressure ulcers, skin tears, and malignant/fungating and vascular wounds receiving hospice or palliative care and explored quality of life for the caregiver. Through an observational design, the outcomes were measured with visual analog scales, 2 pain questionnaires, and a caregiver quality-of-life instrument. Intent-to-treat analyses were used. Statistically significant reductions in pain (P =.001), odor (P =.04), and exudate (P =.00003) were observed. Caregiver quality of life remained unchanged (P =.28); however, improvements were noted in 3 subscales. Findings suggest topical RGN107 reduced pain, odor, and exudate in a highly challenged population with wounds at the end of life. A larger comparative effectiveness trial should be conducted with other wound powder comparators and usual care approaches and should include cost benefits.
Article
BACKGROUND Wound healing is widely discussed in the medical literature. This study compared the healing effect of aloe vera extract and silver sulfadiazine in burn injuries in experimental rat model. METHODS Sixteen rats were randomly assigned to one of two groups, each group 8 rats. A deep second-degree burn on the lower back and 3 rd degree burn on upper back of each rat were created with a standard burning procedure. Burns were dressed daily with aloe vera extract in group 2 and silver sulfadiazine in group 1. Response to treatment was assessed by digital photography during treatment until day 32. Histological parameters (PMN, epithelialization, fibrosis and angiogenesis) were assessed after biopsy of scar at the end of research. RESULTS Wound healing was more visible in aloe vera group. Also the speed of healing in aloe vera group was better than silver sulfadiazine group. CONCLUSIONS Based on our findings, aloe vera can be a therapy of choice for burn injuries.
Full-text available
Article
Inflammatory joint diseases are characterized by enhanced extracellular matrix degradation which is predominantly mediated by cytokine-stimulated upregulation of matrix metalloproteinase (MMP) expression. Besides tumour necrosis factor-alpha (TNF-alpha), Interleukin-1beta (IL-1beta) produced by articular chondrocytes and synovial macrophages, is the most important cytokine stimulating MMP expression under inflammatory conditions. Blockade of these two cytokines and their downstream effectors are suitable molecular targets of antirheumatic therapy. Hox alpha is a novel stinging nettle (Urtica dioica/Urtica urens) leaf extract used for treatment of rheumatic diseases. The aim of the present study was to clarify the effects of Hox alpha and the monosubstance 13-HOTrE (13-Hydroxyoctadecatrienic acid) on the expression of matrix metalloproteinase-1, -3 and -9 proteins (MMP-1, -3, -9). Human chondrocytes were cultured on collagen type-II-coated petri dishes, exposed to IL-1beta and treated with or without Hox alpha and 13-HOTrE. A close analysis by immunofluorescence microscopy and western blot analysis showed that Hox alpha and 13-HOTrE significantly suppressed IL-1beta-induced expression of matrix metalloproteinase-1, -3 and -9 proteins on the chondrocytes in vitro. The potential of Hox alpha and 13-HOTrE to suppress the expression of matrix metalloproteinases may explain the clinical efficacy of stinging nettle leaf extracts in treatment of rheumatoid arthritis. These results suggest that the monosubstance 13-HOTrE is one of the more active antiinflammatory substances in Hox alpha and that Hox alpha may be a promising remedy for therapy of inflammatory joint diseases.
Article
Alcoholic extracts prepared form Arnicae flos, the collective name for flowerheads from Arnica montana and A. chamissonis ssp. foliosa, are used therapeutically as anti-inflammatory remedies. The active ingredients mediating the pharmacological effect are mainly sesquiterpene lactones, such as helenalin, 11 alpha,13-dihydrohelenalin, chamissonolid and their ester derivatives. While these compounds affect various cellular processes, current data do not fully explain how sesquiterpene lactones exert their anti-inflammatory effect. We show here that helenalin, and, to a much lesser degree, 11 alpha,13-dihydrohelenalin and chamissonolid, inhibit activation of transcription factor NF-kappa B. This difference in efficacy, which correlates with the compounds' anti-inflammatory potency in vivo, may be explained by differences in structure and conformation. NF-kappa B, which resides in an inactive, cytoplasmic complex in unstimulated cells, is activated by phosphorylation and degradation of its inhibitory subunit, I kappa B. Helenalin inhibits NF-kappa B activation in response to four different stimuli in T-cells, B-cells and epithelial cells and abrogates kappa B-driven gene expression. This inhibition is selective, as the activity of four other transcription factors, Oct-1, TBP, Spl and STAT 5 was not affected. We show that inhibition is not due to a direct modification of the active NF-kappa B heterodimer. Rather, helenalin modifies the NF-kappa B/I kappa B complex, preventing the release of I kappa B. These data suggest a molecular mechanism for the anti-inflammatory effect of sesquiterpene lactones, which differs from that of other nonsteroidal anti-inflammatory drugs (NSAIDs), indomethacin and acetyl salicylic acid.
Article
The skin of Yorkshire pigs was irradiated with various doses of argon and copper-vapor laser and evaluated for effects on healing time of pretreatment with topical or intramuscular vitamin E or the Op-Site wound dressing. Incident irradiance for both lasers was between 3.5 and 4.5 W/cm2 for a 10-14-mm beam diameter with a nearly uniform intensity profile. Minimal erythemic dose for the copper-vapor laser was 35 ± 2 J/cm2 (10 s exposure) and 22.4 ± 0.1 J/cm2 (6-s exposure) for the argon laser. Three dose levels were administered: a low dose causing light erythema, an intermediate dose, and a high dose causing dermal stasis. The radiant exposures for low, intermediate, and high doses were 35, 70, and 138 J/cm2 for the copper-vapor laser and 22.4, 55, and 129 J/cm2 for the argon laser. Exposure to argon and copper-vapor lasers generally caused wounds with similar healing times. Healing time was significantly decreased for wounds caused by intermediate exposure of the copper-vapor laser and either pretreated with vitamin E or treated with the wound dressing. Healing times for corresponding argon-laser exposure were significantly decreased with pretreatment of intramuscular vitamin E only or after treatment with the wound dressing. These findings may be valuable in selecting treatment for accidental laser skin injuries in man.
Article
First-degree burns are the most common type of burn, but are often inadequately treated. The methods of treatment and the course of healing are poorly documented owing to the fact that first-degree burns are generally not considered to be a serious injury. First-degree burns can be caused by thermal injury or UV irradiation (sunburn). The pathophysiology and the therapeutic approach are similar, although the damage follows a different time course for each injury – immediate damage after contact with hot objects, liquids or fire, delayed damage after sun exposure. After initial cooling with water, aqueous emulsions with small amounts of well-tolerated lipids (O/W emulsions) are best suited for treating first-degree burns or sunburn. Water evaporates producing cooling and reducing inflammation; the lipids accelerate the repair of the damaged skin barrier and reduce drying. Foam sprays and lotions are ideal because they are easy and painless to apply. The use of topical corticosteroids is not recommended, as superiority to the vehicle has not been shown.
Article
The purpose of this randomised comparative study was to evaluate the use of silver sulphadiazine (SSD) 1% cream (Group A) with the use of Procutase (Group B) in treating burns with a TBSA <10% and a depth not greater than 2nd degree burns and thus suitable for outpatient management. The two groups were similar in age, gender, race, and extent of burn. Procutase is an ionic hydrogel composed of natural hydrophilic polymers in an active ionic solution with an inhibitor of matrix metalloproteinases MMP-1, -3 and -9 (collagenase/gelatinase). Subjects were seen in follow-up biweekly, and wounds of patients in SSD group were compared with those of Procutase group for healing time, pain score at dressing change, compliance with therapy and complication rate. The result of this study showed that Procutase treated patients had statistically significantly less pain and shorter wound healing time. Procutase can be used successfully in patients with burns that do not require hospital admission.
Article
Wound-healing complications following body contouring for massive weight loss patients are significant, with rates exceeding 40 percent. To better understand aberrant healing in this population, the authors have performed a comparative analysis of the wound milieu literature for patient populations with similar complication rates. PubMed and Ovid databases were reviewed from January of 1985 to January of 2009 for key terms, including wound healing, obesity, cancer, burn, transplant, and body contouring. Serum and wound levels of multiple factors, including matrix metalloproteinases (MMPs) and cytokines, were assessed. Complication rates in body contouring surgery range from 31 to 66 percent. Sixty-five studies were reviewed, and wound-healing complication rates were identified for cancer (45.8 percent), burn (30.4 percent), posttransplant (36 percent), and obese (43 percent) populations. In these groups, matrix metalloproteinases and tissue inhibitors of metalloproteinase (TIMPs) help regulate wound repair. Matrix metalloproteinase levels were elevated in cancer (4-fold increase in MMP-2), burn (20- to 30-fold increase in MMP-9), transplant (1.4-fold increase in MMP-2), and obese/chronic (79-fold increase) populations. TIMPs were increased in cancer (1.9-fold increase in TIMP-2) and burn (1.4-fold increase in TIMP-1) patients but decreased in chronic wound (55-fold decrease in TIMP-1) populations. Alterations to these regulatory proteins lead to prolonged matrix degradation, up-regulation of inflammatory mediators, and decreased growth factors, delaying the wound-healing process. Complications after body contouring surgery are likely multifactorial; however, molecular imbalances to the massive weight loss wound milieu may contribute to poor surgical outcomes. Examining wound regulatory proteins including transforming growth factor-beta, vascular endothelial growth factor, and matrix metalloproteinases could aid in understanding the healing difficulties observed clinically.
Article
Background: An acute burn wound is a complex and evolving injury. Extensive burns produce systemic consequences, in addition to local tissue damage. Treatment of partial thickness burn wounds is directed towards promoting healing and a wide variety of dressings are currently available. Improvements in technology and advances in understanding of wound healing have driven the development of new dressings. Dressing selection should be based on their effects on healing, but ease of application and removal, dressing change requirements, cost and patient comfort should also be considered. Objectives: To assess the effects of burn wound dressings on superficial and partial thickness burns. Search methods: For this first update we searched The Cochrane Wounds Group Specialised Register (searched 8 November 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10); Ovid MEDLINE (2008 to October Week 4 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, November 07, 2012); Ovid EMBASE (2008 to 2012 Week 44); AND EBSCO CINAHL (1982 to 2 November 2012). Selection criteria: All randomised controlled trials (RCTs) that evaluated the effects of burn wound dressings on the healing of superficial and partial thickness burns. Data collection and analysis: Two authors extracted the data independently using standardised forms. We assessed each trial for internal validity and resolved differences by discussion. Main results: A total of 30 RCTs are included in this review. Overall both the quality of trial reporting and trial conduct were generally poor and meta analysis was largely precluded due to study heterogeneity or poor data reporting. In the context of this poor quality evidence, silver sulphadiazine (SSD) was consistently associated with poorer healing outcomes than biosynthetic (skin substitute) dressings, silver-containing dressings and silicon-coated dressings. Burns treated with hydrogel dressings appear to heal more quickly than those treated with usual care. Authors' conclusions: There is a paucity of high-quality evidence regarding the effect of different dressings on the healing of superficial and partial thickness burn injuries. The studies summarised in this review evaluated a variety of interventions, comparators and clinical endpoints and all were at risk of bias. It is impossible to draw firm and confident conclusions about the effectiveness of specific dressings, however silver sulphadiazine was consistently associated with poorer healing outcomes than biosynthetic, silicon-coated and silver dressings whilst hydrogel-treated burns had better healing outcomes than those treated with usual care.
Article
Healing time, infection rate, and residual scar formation were compared in carbon dioxide laser burns in rats treated in four ways: Spandra composite dressing, OpSite composite dressing, Petrolatum Gauze (USP), and no treatment. There were no infections and no differences in scar formation among the treatment groups. The mean healing times were ten days for the polyurethane dressings (Spandra and OpSite), 13 days for Petrolatum Gauze, and 16 days for the untreated group. Spandra was easier to apply and handle than OpSite. These findings suggest that synthetic gas-permeable dressings promote healing after cutaneous carbon dioxide laser surgery more effectively than conventional treatments of ointment-impregnated gauze or leaving the wound exposed to the air.
Article
An extract of Urtica dioica folium (IDS 23, Rheuma-Hek), monographed positively for adjuvant therapy of rheumatic diseases and with known effects in partial inhibition of prostaglandin and leukotriene synthesis in vitro, was investigated with respect to effects of the extract on the lipopolysaccharide (LPS) stimulated secretion of proinflammatory cytokines in human whole blood of healthy volunteers. In the assay system used, LPS stimulated human whole blood showed a straight increase of tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) secretion reaching maximum concentrations within 24 h following a plateau and slight decrease up to 65 h, respectively. The concentrations of these cytokines was strongly positively correlated with the number of monocytes/macrophages of each volunteer. TNF-alpha and IL-1 beta concentration after LPS stimulation was significantly reduced by simultaneously given IDS 23 in a strictly dose dependent manner. At time 24 h these cytokine concentrations were reduced by 50.8% and 99.7%, respectively, using the highest test IDS 23 assay concentration of 5 mg/ml (p < 0.001). After 65 h the corresponding inhibition was 38.9% and 99.9%, respectively (p < 0.001). On the other hand IDS 23 showed no inhibition but stimulated IL-6 secretion in absence of LPS alone. Simultaneously given LPS and IDS 23 resulted in no further increase. In contrast to described effects on arachidonic acid cascade in vitro, tested Urtica dioica phenol carbon acid derivates and flavonoides such as caffeic malic acid, caffeic acid, chlorogenic acid, quercetin and rutin did not influence LPS stimulated TNF-alpha, IL-1 beta and IL-6 secretion in tested concentrations up to 5 x 10(-5) mol/l. These further findings on the pharmacological mechanism of action of Urticae dioica folia may explain the positive effects of this extract in the treatment of rheumatic diseases.
Article
Stinging nettle leaf extracts are registered in Germany for adjuvant therapy of rheumatic diseases. In a whole blood culture system the nettle extract IDS 23 (Rheuma-Hek) inhibited lipopolysaccharide stimulated monocyte cytokine expression, indicating an immunomodulating effect. We investigated the immunomodulating effects of IDS 23 on phytohemagglutinin (PHA) stimulated peripheral blood mononuclear cells (PBMC) in vitro. Using commercial immunoassays the distinct cytokine patterns of Th1 and Th2 cells were determined. Interleukin 2 (IL-2) and interferon-gamma (IFN-gamma) mRNA expression was evaluated by reverse transcription-polymerase chain reaction (RT-PCR) with PHA stimulated PBMC. IDS 23 inhibited PHA stimulated production of Th1-specific IL-2 and IFN-gamma in PBMC culture (n = 10) in a dose dependent manner up to 50+/-32% and 77+/-14%, respectively. In contrast, IDS 23 stimulated the secretion of Th2-specific IL-4. The dose dependent inhibiting effect on IL-2 and IFN-gamma expression was also detected with RT-PCR, while the amount of actin-specific mRNA transcript was not modified by IDS 23. Our results suggest the effective ingredient of IDS 23 acts by mediating a switch in T helper cell derived cytokine patterns. IDS 23 may inhibit the inflammatory cascade in autoimmune diseases like rheumatoid arthritis.
Article
Investigation of an ethanolic extract prepared from fresh Arnica montana flowers afforded three new 1,5- trans-guaianolides, of which 11alpha,13-dihydro-2-O-tigloylflorilenalin and the respective 2-O-isovaleryl derivative are reported for the first time. Additionally, three new and one known 2beta-ethoxy-2,3-dihydrohelenalin esters were isolated. GC/MS studies of the extract after a two year storage at 4 degrees C demonstrated that the latter were artefacts that had been formed by addition of ethanol to the cyclopentenone structure of helenalin. Formation of these adducts gave compounds possessing an inhibitory activity comparable to that of 11alpha,13-dihydrohelenalin derivatives in the NF-kappaB EMSA and the IL-8 ELISA in vitro assays as well as in the in vivo croton oil-induced mouse ear edema test for one adduct, namely 2beta-ethoxy-6-O-acetyl-2,3-dihydrohelenalin. As expected, 6-O-(2-methylbutyryl)- and 6-O-methacryloyl-helenalin exhibited a stronger activity in the NF-kappaB EMSA and IL-8 ELISA. Sesquiterpene lactones seem to be the most important NF-kappaB inhibiting compounds in the Arnica extract. Bioguided fractionation using the luciferase reporter gene assay resulted in the isolation of only moderately active compounds, such as 6-acetoxy-2,2-dimethylchroman-4-one and 10-acetoxy-8,9-epoxythymol isobutyrate.
Article
The best treatment for burns and scalds depends on the depth of the skin necrosis. Epidermal and superficial dermal burn injuries (IIa) can heal spontaneously with conservative treatment without scar development, but deep dermal or full-thickness burns constitute an absolute indication for surgery. Full-thickness or split-thickness skin grafts are used for wound closure. In the case of extensive burn injuries allografts are used for temporary wound closure. In certain licensed laboratories autologous keratinocytes can be cultured for transplantation. In circumferential burn injuries affecting the extremities or the trunk the rigid eschar has to be incised to relieve the pressure behind it. Following a debridement conservative treatment of superficial dermal burns involving wound coverage with biosynthetic dressings or nanocristalline silver gauze dressings or use of special disinfecting ointments can be implemented.
Article
Preparations of Arnica montana L. are widely used for the topical treatment of inflammatory diseases. The anti-inflammatory activity is mainly attributed to their sesquiterpene lactones (SLs) from the helenalin and 11alpha,13-dihydrohelenalin type. To study the penetration kinetics of SLs in Arnica preparations, a stripping method with adhesive tape and pig skin as a model was used. For the determination of SLs in the stripped layers of the stratum corneum (SC), a gas chromatography/mass spectrometry method was developed and validated. Thereby the amount of helenalin derivatives was calculated as helenalin isobutyrate, and 11alpha,13-dihydrohelenalin derivatives as 11alpha,13-dihydrohelenalin methacrylate. This GC-MSD method is suitable also to determine low amounts of SLs in Arnica preparations. The penetration behaviour of one gel preparation and two ointment preparations was investigated. The SLs of all preparations show a comparable penetration in and a permeation through the stratum corneum, the uppermost part of the skin. Interestingly, the gel preparation showed a decrease of the penetration rate over 4h, whereas the penetration rate of ointments kept constant over time. Moreover, we could demonstrate that the totally penetrated amount of SLs only depends on the kind of the formulation and of the SLs-content in the formulation but not on the SLs composition or on the used extraction agent.
Article
First-degree burns are the most common type of burn, but are often inadequately treated. The methods of treatment and the course of healing are poorly documented owing to the fact that first-degree burns are generally not considered to be a serious injury. First-degree burns can be caused by thermal injury or UV irradiation (sunburn). The pathophysiology and the therapeutic approach are similar, although the damage follows a different time course for each injury--immediate damage after contact with hot objects, liquids or fire, delayed damage after sun exposure. After initial cooling with water, aqueous emulsions with small amounts of well-tolerated lipids (O/W emulsions) are best suited for treating first-degree burns or sunburn. Water evaporates producing cooling and reducing inflammation; the lipids accelerate the repair of the damaged skin barrier and reduce drying. Foam sprays and lotions are ideal because they are easy and painless to apply. The use of topical corticosteroids is not recommended, as superiority to the vehicle has not been shown.