Alice was nine years old and had suffered from atopic eczema, An itchy, inflammatory skin condition, since she was a baby.

Transcription

1 Skin Disorders

2 Alice was nine years old and had suffered from atopic eczema, An itchy, inflammatory skin condition, since she was a baby. She had used corticosteroid creams that had helped to relieve the inflammation and itching, but the condition never went away. At the age of eight, Alice's face, neck, arms and legs were covered in dry, sore, scaly patches, which were itchy and inflamed, causing Alice to scratch her skin, resulting in bleeding.

3 Alice s assessment suggested Food sensitivities to peppers, peanuts and corn. Under-functioning immune system Staphylococcus aureus infection High histamine levels were also prevalent, which is one of the mediators causing inflammation. Alice's diet was generally low in protein and the essential vitamins and minerals from fruit and vegetables, and was high in saturated fat and sugar

4 Inherited skin condition (lack of a skin protein) More common in individuals with a personal or family history of inhalant allergies (asthma or hay fever).

5 The severity depends on the amount of moisture in the skin (less common in very humid environments and is harder to control in dry areas in the wintertime). It often begins in infancy and improves in most people as they reach adulthood.

6 Symptoms Erythematic, itchy lesions in a characteristic distribution If it is scratched, it may ooze and become crusty.

7 Common sites of eczema outbreaks

8 Genetics Irritants: soups, detergents, shampoos Allergens: house dust mites, pets (cats, dogs), pollens (seasonal), Foods: (especially before the age of one) dairy products, eggs, nuts, soy products, wheat Stress Defect in the production of a particular skin protein Dry skin What Are the Causes of Eczema? Itching during sweating, Colonization by pathogenic staphylococcus aureus Abnormal function of the immune system

9 Causes of Eczema

10 Alice s Treatment Supplementation included quercetin (anti-inflammatory and antioxidant flavonoid). Evening primrose oil was rubbed into the skin each evening (anti-inflammatory) and a cream containing liquorice was used daily to relieve the itching. By following these recommendations for eight months, with slight adjustments and fine-tuning, Alice became completely free of eczema.

11 Herbal Management As dermatitis is a typical inflammation-based disease, anti inflammatory drugs are the first line of treatment Anti-inflammatory botanicals: calendula, chamomile Humidifers: Agents that provide moisture to the skin and help prevent further water loss such as tannins containing botanicals e.g. hamamelis, quercus (high tannins precipitate protein molecules; produce a leathery, smooth coat over the skin preventing water loss). Antibacterial (if infection is detected).

12 Sekem baby: Calendula Melissa Chamomile Sesame oil Herbal Formula

13 Chamomile: Herbal Formula External use: Inflammations and irritations of the skin and mucosa (skin cracks, bruises, frostbite, and insect bites) Experimental pharmacology: In vitro, chamomile extracts inhibited both cyclooxygenase and lipoxygenase and thus the production of prostaglandins and leukotrienes, known inducers of inflammation. Topical application of either the total chamomile extract, or the flavonoid fraction only, is very effective in reducing inflammation

14 Herbal Formula Experimental pharmacology: Bisabolol, bisabolol oxide (v.o.) apigenin, luteolin and quercetin (flavonoids)inhibit cyclooxygenase and lipooxygenase enzymes (anti-inflammatory). Flavonoids also act against inflammation through their antifree radicals (antioxidant) activity. Topical application of chamomile extract and v.o. inhibited the growth of S. aureus, S. mutans, (antimicrobial). Clinical pharmacology: In clinical trials, topical application of a chamomile extract in a cream base was found to be superior to hydrocortisone 0.25% for reducing skin inflammation

15 Herbal Formula Calendula: Uses described in pharmacopoeias External treatment of superficial cuts, wounds and minor inflammations of the skin and oral mucosa Calendula is now indicated for prevention of dermatitis in patients undergoing postoperative irradiation.

16 Calendula: The essential oil, flavonoids of the flowers inhibited the growth in vitro of B. subtilis, S. aureus(antibacterial) A tincture of the flowers suppressed the replication of herpes simplex(antiviral), Herbal Formula

17 Calendula: Herbal Formula External application of a hydroalcoholic extract accelerated the rate of contraction and epithelialization of excision wounds, Faradiol esters stimulates the fibroblast proliferation,(wound healing activity). Faradiol esters and Isorhamnetin glycosides isolated from the flowers inhibit cyclo-oxygenase(antiinflammatory).

18 Herbal Formula Sesame Oil: Lignan compounds include sesamin and sesamolin acts as antioxidant for excessive ROS (inflammatory stage). Melissa Aqueous extracts of Melissae inhibited the replication in vitro of herpes simplex virus type 2, Clinical pharmacology 1% lyophilized aqueous extract of Melissae in a cream base reduced the healing time of herpetic lesions from days to 6-8 days

19 Life Style Watch your stress level to avoid eczema flare-ups Wear comfortable clothes that don't irritate skin. Moisturize dry, itchy skin often Don t scratch eczema patches. Keep sweating to a minimum to avoid eczema flare-ups.

20 Tom was a 23-year-old who suffered from low energy and whiteheads, blackheads and inflammation, his doctor had suggested steroid cream, which made the problem worse. Case discussion: Overproduction of sebum as a result of hyperactive sebaceous glands secondary to hormonal activity is the primary cause of the case.

21 How is acne developed? Abnormal build-up of skin cells causes a plug at the opening of the hair follicle, creating a clogged pore. The clogged pore accumulates keratin, oil (sebum) and bacteria until it ruptures, releasing this mixture into the skin and causing inflammation. This inflammation can lead to painful cyst/abscess formation and scarring.

22 How is acne developed?

23 Symptoms Areas of seborrhea (scaly red) Black and white heads (comedones) Causes Hormones imbalance : male- hormones, Polycystic ovary syndrome or pregnancy Medications: as prednisone, Improper diet such as deep fried food, fats, Sweets, spicy foods Emotional stress.

24 Management of Acne Herbal formula of the following: Tea tree oil Jojoba oil Aloe vera

25 Wound healing activity Aloe gel Aloe gel contains polysaccharides especially Mannose 6-phosphate Mannose 6-phosphate bind to the growth factor receptors of the fibroblasts and enhance their activity which increase both collagen and proteoglycan synthesis, thereby promoting tissue repair

26 Aloe gel Acemannan (a complex carbohydrate isolated from Aloe leaves) is a potent macrophage-activating agent and bind to growth factors prolonging their stimulation of granulation tissue Anti-inflammatory activity Lupeol, ((lupeol, campesterol, and β-sitosterol)) is the most active as anti-inflammatory (through bradykinase activity and thromboxane and prostaglandin F2 inhibition)

27 Aloe gel Uses: Aloe Vera Gel is used for The external treatment of minor wounds and inflammatory skin disorders including burns, bruises. The treatment of acne, haemorrhoids, psoriasis, seborrhoeic dermatitis, and fungal infections The treatment of radiation burns Note :Because many of the active ingredients deteriorate on storage, the use of fresh gel is recommended.

28 Tea tree oil: Essential oil (terpineol) extracted from the leaves of Melaleuca alternifolia Action: antibacterial Tea tree oil should be used only topically, swallowing tea tree oil cause severe rash, nausea, confusion, and coma because it contains erucic acid. Jojoba oil: Management of Acne Extracted from the seeds of Simmondsia chinensis Action: penetrates skin and skin oils easily (due to similar molecular structure), unclogging hair follicles (dissolve the clog) and preventing sebum build up, acts as skin moisturizer.

29 Aloe vera: Management of Acne Action: Antiseptic: prevents bacteria from infecting acne wounds and accelerates the process of healing Glucomannan, and gibberellin interacts with growth factor receptors on the fibroblast, thereby stimulating fibroblast activity and proliferation, which in turn significantly increases collagen synthesis Sterols as β- sitosterol acts as angiogenic factor Anti-inflammatory: alleviate the itching sensation caused by acne (inhibits prostaglandin production) Skin moisturizer: (mucopolysaccharides help in binding moisture into the skin)

30 A study of 24 female patients who recently had caesarean sections during childbirth examined the use of a combination oil-extract of Calendula and Hypericum oils in healing the incision site. Incisions of women in the treatment group were treated topically with an oily mixture of 70% Hypericum extract and 30% Calendula extract. All patients were treated twice daily for 16 days. Patients treated with the Hypericum/Calendula mixture exhibited a significant decrease in wound area. Explain the possible role of this ingredients in incision healing??

31 A wound is a type of injury that result in an opening or breaking of the skin (an open wound), or where trauma causes bruises (a closed wound). Wound-healing includes three phases: Inflammation Proliferation Remodeling Wounds

32 Phases of Wound 1. The inflammatory stage: Neutrophils and macrophages produce proteolytic enzymes and reactive oxygen species (ROS) to get rid of dead tissues and as defense against invading bacteria. High concentrations of ROS can induce severe tissue damage, neoplastic transformation and decreasing the healing process by damages in cellular membranes. Anti-oxidant plants (with high radical-scavenging capacity) decreases the conc. of ROS and consequently enhances wound healing. Herbs act on the inflammatory stage: calendula, hypericum

33 Phases of Wound 2. Proliferation phase It is characterized by formation of new tissues and new blood vessels (angiogenesis) β-sitosterol (angiogenic factor) may act in this stage.

34 Phases of Wound 3. The remodeling stage It begins about 21 days after the injury. It is characterized by collagen remodeling. Type I collagen, which is a stronger type of collagen, replaces type III (which is formed during proliferation phase) and the collagen becomes more organized. Cardiac glycosides of digitalis thought to increase collagen remodeling.

35 Herbal Treatment Hypericum Calendula

36 Herbal Treatment Hypericum (St. John Wort): Contains volatile oil, anthraquinones (hypercin, hyperforin) and flavonoids Inflammatory stage Antibacterial activity due to volatile oil, hyperforin. Anti-inflammatory: flavonoids, phenolic acids Proliferation stage Stimulation of fibroblast, increases number of fibroblasts and collagen production (hypericin)

37 Herbal Treatment Calendula (Marigold flower) Marigold flower contains volatile oil, flavonoids (quercetin, ), carotenoids Volatile oil act as antimicrobial so promote wound healing, Flavonoids, other phenolics act as anti-oxidant so help getting rid of excess free oxygen species involved in the inflammatory stage.

38 Herbal Treatment Calendula (Marigold flower) Mode of administration Wound Dressing : soak a compress in calendula tea and apply to the affected area. Ointment: mixing a few drops of calendula oil with skin lotion.

39 Mebo ointment: β-sitosterol in sesame oil β-sitosterol: Inhibits cyclooxygenase Stimulates the growth of new capillaries from preexisting ones(angiogenic factor). Sesame oil Acts as antioxidant. Herbal Formula Indications: burns and wounds healing.

40 A dermatologist advice his Herpes zoster patient to use a herbal remedy formed of capsaicin and licorice root to alleviate the pain. Comment on the mode of action of each component???

41 Shingles (Herpes zoster) is a disease that causes the outbreak of fluid-filled blisters on the skin. The condition can last one to 14 days, and is caused by the Varicella-zoster virus. Symptoms: begin as a burning or tingling sensation in a specific area on one side of the body and progress to a region of blisters that cause itching and pain that can range from mild to intense.

42 Herbal Treatment Capsaicin Glycyrrhizen

43 Herbal Treatment CNS Pain sensation Substance P Substance P is an important element in pain perception and through transmission of pain information into the central nervous system. Capsaicin binds to a receptor called (TRPV1) from which substance P is released. Prolonged exposure to capsaicin depletes substance P in the regional peripheral nerves and decreases TRPV1 activity leading to desensitization (reduction in pain sensation)

44 Herbal Treatment Glycyrrhizen Inhibit the replication of virus. Anti-Inflammatory.

45 Skin formula 100 g Ointment contains: Pressed juice of Purple Coneflower herb A large-scale longitudinal trial (4598 patients) studied the effects of an ointment containing a lyophylisate of the expressed juice of Echinaceae purpureae. Therapeutic benefit from the ointment was observed in 85.5% of the cases. Indications :The ointment is used to treat inflammatory skin conditions, wounds, eczema, burns, herpes simplex, and varicose ulcerations of the legs.

46 Skin formula The polysaccharide fraction (echinacin B) promote wound healing by forming a hyaluronic acid polysaccharide complex that indirectly leads to the inhibition of hyaluronidase. Inhibition of tissue and bacterial hyaluronidase is thought to localize the infection and prevent the spread of causative agents to other parts of the body.

47 1g cream contains: Grape seed extract. Aloe vera. Tea tree oil. Rose hips oil. Acne fighting formula

48 Proanthocyanidins in grape seed extract trigger the release of vascular endothelial growth factor and promote production of collagen fibres by fibroblasts The polyphenols present in grape seed oil inhibit the release of arachidonic acid responsible for the production of leukotrienes and prostaglandins and exerts antimicrobial activity in addition to oil components. Therefore its topical application causes wound contraction and closure.

49 Rosehip oil has a high fatty acid content (about 80%), especially linoleic acid and linolenic acid it acts as anti-inflammatory and antimicrobial