Treatment of Skin Diseases is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, hair, nails, and related muscle and glands. The major function of this system is as a barrier against the external environment.[rx] Conditions of the human integumentary system constitute a broad spectrum of diseases, also known as dermatoses, as well as many nonpathologic states (like, in certain circumstances, melanonychia and racquet nails).[rx][rx] While only a small number of skin diseases account for most visits to the physician, thousands of skin conditions have been described.[rx]
Functions of Skin
Because it interfaces with the environment, skin plays a key role in protecting (the body) against pathogens.[rx,rx] and excessive water loss.[rx] Its other functions are insulation, temperature regulation, sensation, storage and synthesis of vitamin D by action of ultraviolet (UV) and the protection of vitamin B folates, absorption of oxygen and drugs[rx] and water resistance.[rx] Severely damaged skin will try to heal by forming scar tissue. This is often discolored and depigmented.
Common Skin Problems
Skin disease is a common ailment and it affects all ages from the neonate to the elderly and causes harm in a number of ways.[rx] There are more than a thousand conditions that may affect the skin but most skin diseases can be categorized into nine common types.[rx]
A rash is an area of red, inflamed skin or a group of individual spots. These can be caused by irritation, allergy, infection, an underlying disease, as well as by structural defects for example, blocked pores or malfunctioning oil glands. Examples of rashes include acne, dermatitis, eczema, hives, pityriasis rosea and psoriasis.
These occur when a virus penetrates the stratum corneum and infects the inner layers of the skin. Examples of viral skin infections include herpes simplex, shingles (herpes zoster) and warts. Some systemic viral infections, such as chickenpox and measles, may also affect the skin. Viral infections cannot be cured with antibiotics.
Such infections are caused by a variety of bacteria, the most common types being staphylococci and streptococci. Bacteria may infect the topmost layers of skin, the follicles, or the deeper layers of skin. If not treated correctly, these infections may spread throughout the body. Examples include impelling folliculitis, cellulitis and Lyme disease. Bacterial infections are better treated with antibiotics.
Harmless fungi are always present on the surface of the skin. Infection occurs when these organisms enter the body. These infections are usually superficial, affecting the skin, hair, nails and include athlete’s foot, lock itch, and ringworm. However, in people with a suppressed immune system or who have been taking antibiotics for a long period -, the fungi may spread to deep within the body, causing more serious disease.
These infections occur after exposure to parasites such as lice and scabies.
The amount of pigment in the skin is determined by the amount of melanin being produced by the body. Loss of pigment (hypopigmentation) can be caused by the absence of melanocytes, malfunctioning cells, exposure to cold or chemicals, or some types of infection. An increase in pigment (hyperpigmentation) may be caused by skin irritation, hormonal changes, aging, a metabolic disorder, or any other underlying problem. Age spots, freckles, and melasma are examples of hyperpigmentation. Vitiligo is an example of hypopigmentation.
Tumors and cancers
These growths arise when skin cells begin to multiply faster than normal. Not every skin growth is cancerous. Some tumors are harmless and will not spread. Skin cancer is the most common of all the cancers, affecting 800,000 Americans each year. It is caused, in 90% of cases, by sun exposure. The three types of skin cancers are basal cell cancer (the most curable), squamous cell cancer (which may grow and spread) and malignant melanoma (the most deadly form). Prevention involves protecting the skin against damaging ultraviolet rays. Early detection helps to improve the chances of a cure. Regular self-examinations are, therefore, recommended.
Trauma describes an injury to the skin caused by a blow, a cut, or a burn. Whenever the surface of the skin is broken, the body becomes more susceptible to infection and disease.
Wrinkles, rosacea, spider veins, and varicose veins are among those conditions that cannot be neatly categorized. Wrinkles are caused by a breakdown of the collagen and elastin within the dermis, which results in sagging skin. Rosacea is a chronic disorder in which the skin of the face becomes red and develops pimples, lesions and more rarely enlargement of the nose. Its cause is unknown. Spider veins and varicose veins become apparent when blood vessels enlarge and become visible through the surface of the skin.
Treatment of Skin Diseases
The common medications for topical use include[rx]:
- Antibacterials – These medicines, like Bactroban or Cleocin, are often used to treat or prevent infection
- Anthralin – Although not often used, these help to reduce inflammation and can help treat psoriasis
- Antifungal agents – Lamisil, Lotrimin, and Nizoral are a few examples of common topical antifungal drugs used to treat skin conditions such as ringworm and athlete’s foot
- Benzoyl peroxide – creams and other products containing benzoyl peroxide are used to treat acne
- Coal tar – This topical treatment is available with and without a prescription, in strengths ranging from 0.5% to 5%. Coal tar is used to treat conditions including seborrheic dermatitis (usually in shampoos) or psoriasis. Currently, coal tar is seldom used because it can be slow-acting and can cause severe staining of personal clothing and bedding
- Corticosteroids – These are used to treat skin conditions including eczema and come in many forms including foams, lotions, ointments, and creams
- Retinoids – These medications (such as Retin-A and Tazorac) are gels or creams derived from vitamin A and are used to treat conditions including acne
- Salicylic acid – This medication is available in the form of lotions, gels, soaps, shampoos, and patches. It should be used sparingly as putting too much on one’s body at once can cause toxicity. Salicylic acid is the active ingredient in many skin care products for the treatment of acne and warts.
Oral treatments for skin conditions include:
- Antibiotics – Oral antibiotics like erythromycin, tetracycline, and dicloxacillin are used to treat many skin conditions
- Antifungal agents – Common oral antifungal drugs such as ketoconazole and Diflucan can be used to treat more severe fungal infections
- Antiviral agents – Common antiviral agents include Valtrex, acyclovir, and familiar. Antiviral treatments are used for skin conditions including those related to herpes
- Corticosteroids – These medications, including prednisone, can be helpful in treating skin conditions linked to autoimmune diseases including vasculitis and inflammatory diseases such as eczema and psoriasis. Dermatologists prefer topical steroids to avoid side-effects; however, short-term use of prednisone is sometimes necessary
- Immunosuppressants – Immunosuppressants, such as azathioprine and methotrexate, can be used to treat conditions including severe cases of psoriasis and eczema
- Biologics – These new therapies are the latest methods being utilized to treat psoriasis and other conditions. Examples of biologics include Enbrel, Humira, Remicade, stelae, and amevive.
Herbal Drugs For Skin Diseases
Natural drugs from the plants are gaining popularity because of several advantages such as often having fewer side-effects, better patient tolerance, being relatively less expensive and acceptable due to a long history of use. Besides herbal medicines provide rational means for the treatment of many diseases that are obstinate and incurable in other systems of medicine. For these reasons, several plants have been investigated for the treatment of skin diseases ranging from itching to skin cancer.
Achyranthes Aspera (Common name: Prickly chaff flower, Devil’s horsewhip; Family: Amaranthaceae)
Traditionally, the plant is used in boils, scabies, and eruptions of skin and other skin diseases. The MeOH extract, alkaloid, non-alkaloid and saponin fractions obtained from the leaves of A. Aspera exhibited significant inhibitory effects (concentration 100 μg) on the Epstein-Barr virus early antigen (EBV-EA) activation induced by the tumor promotor 12-O-tetradecanoylphorbol-13-acetate (TPA) in Raji cells. The results revealed that leaf extract and the non-alkaloid fraction are valuable antitumor promotors in carcinogenesis.[rx]
Allium cepa (Common name: Onion; Family: Liliaceae)
A study undertaken in patients with seborrheic keratoses to evaluate the ability of onion extract gel to improve the appearance of scars following excision has shown that this extract gel improved scar softness, redness, texture and global appearance at the excision site at study weeks 4, 6 and 10 as assessed by the blinded investigator.[rx][rx]
A. sativum (Common name: Garlic; Family: Liliaceae)
In a study conducted on Swiss albino mice in whom cancer was induced by 7,12-dimethylbenz(a)anthracene (DMBA) revealed that best chemopreventive action of garlic was observed in mice in which garlic treatment was performed before and after the induction of skin carcinogenesis. The protective effect against skin cancer elicited by garlic in mice is believed to be due at least in part to the induction of cellular defense systems.[rx]
Aloe vera (Common name: Barbados aloe; Family: Xanthorrhoeaceae)
One of the studies conducted on mice to investigate the effects of Scutellariae radix and Aloe vera gel (AV), in spontaneous atopic dermatitis (AD)-like skin lesions revealed that the group receiving only AV in a dose of 0.8 mg/kg p.o provided relief in AD due to the reduction of interleukin (IL)-5 and IL-10 levels.[rx]
The gel has properties that are harmful to certain types of bacteria and fungi. A cream containing 0.5% aloe for 4 weeks reduced the skin “plaques” associated with psoriasis.[rx] Application of gel helped in the improvement of partial thickness burns.[rx] When applied to the skin, the gel seems to help skin survive frostbite injury.[rx] It might delay the appearance of skin damage during and after radiation treatment.[rx]
Azadirachta indica (Common name: Neem; Family: Meliaceae)
Leaf extract is applied externally on boils and blisters.[rx] In one study, skin tumors were induced in mice by topical application of DMBA (500 nmol/100 μl for 2 weeks) followed by TPA (1.7 nmol/100 μl of acetone, twice weekly) as a promoter. The test group received aqueous Azadirachta indica leaf extract (AAILE) orally at a dose level of 300 mg/kg body weight three times a week for 20 weeks. The results of this study revealed the chemopreventive potential of A. indica against murine skin carcinogenesis.[rx][rx]
Bauhinia variegata (Common name: Kachanar, Orchid tree, Camel’s Foot Tree, Mountain Ebony; Family: Fabaceae)
In the skin papilloma model, significant prevention, with delayed appearance and reduction in the cumulative number of papillomas was observed in the DMBA + Kachanar + croton oil-treated the group as compared to the DMBA + croton oil group. In anti-mutagenic studies, a single application of Kachanar extract at doses of 300, 600 and 900 mg/kg dry weight, 24 h prior to the i.p. administration of cyclophosphamide (at 50 mg/kg) significantly prevented micronucleus formation and chromosomal aberrations in bone marrow cells of mice, in a dose-dependent manner.[rx]
Beta vulgaris (Common name: Beetroot; Family: Brassicaceae)
The in vitro inhibitory effect of beetroot extract on EBV-EA induction using Raji cells revealed a high order of activity compared to capsanthin, cranberry, red onion skin, and short and long red bell peppers. An in vivo anti-tumor promoting activity evaluation against the mice skin and lung bioassays also revealed a significant tumor inhibitory effect. The combined findings suggest that beetroot ingestion can be one of the useful means to prevent cancer.[rx]
Brassica oleraceae (Common name: Red Cabbage; Family: Brassicaceae)
Significant reduction of tumors was observed in mice in whom skin cancer was induced by a single topical application of 200 nmol of the initiator DMBA to their backs, followed 1 week later by promotion with 10 nmol of TPA twice weekly for 30 weeks followed by 0.1 g/L of aqueous extract of B. oleraceae 1 week after administration of initiator.[rx]
Calendula officinalis (Common name: Marigold; Family: Asteraceae)
The flowers of marigold have long been employed in folk therapy and more than 35 properties have been attributed to decoctions and tinctures from the flowers. The main uses are as remedies for burns (including sunburns), bruises and cutaneous and internal inflammatory diseases of several origins. Topical formulations containing marigold extract (ME), evaluated in hairless mice against UV-B irradiation-induced photodamage, revealed that application of ME in gel formulation, containing 0.21 μg/cm of narcissism and as 0.07 μg/cm of the rutin in the viable epidermis, were associated with a possible improvement in the collagen synthesis in the subepidermal connective tissue.[rx]
Camellia sinensis (Common name: Green tea, Chaay; Family: Theaceae)
Green tea comes from the tea plant C. Sinensis and may play a beneficial role in the treatment of skin tumors and cancer. It contains polyphenols, which act as antioxidants in the body. A specific polyphenol in Green tea called epigallocatechin gallate, according to the National Center for Complementary and Alternative Medicine, has been reported to prevent the onset of further growth of skin tumor in the body. It can rejuvenate old skin cells to start reproducing again, keeping the skin younger looking.[rx]
Cannabis Sativa (Common name: Charas, Ganja; Family: Cannabinaceae)
The powder of the leaves serves as a dressing for wounds and sores. Ganja is externally applied to relieve pain in itchy skin diseases. Hemp seed oil is useful for the treatment of eczema and host of other skin diseases like dermatitis, seborrhoeic dermatitis/cradle cap, varicose eczema, psoriasis, lichen planus, and acne rosacea. By using hemp seed oil, the skin is strengthened and made better able to resist bacterial, viral and fungal infections. Crushed leaves are rubbed on the affected areas to control scabies.[rx]
Crocus sativus (Common name: Saffron; Family: Iridaceae)
Saffron is a naturally derived plant product that acts as an antispasmodic, diaphoretic, carminative, emmenagogic and sedative. The chemopreventive effect of aqueous saffron on chemically induced skin carcinogenesis using a histopathological approach was studied. Its ingestion inhibited the formation of skin papillomas in animals and simultaneously reduced their size. Saffron inhibited DMBA-induced skin carcinoma in mice when treated early. This may be due, at least in part, to the induction of cellular defense systems.[rx] It has also been found useful in the treatment of psoriasis.[rx]
Curcuma longa (Common name: Turmeric; Family: Zingiberaceae)
A study conducted on male Swiss albino mice in whom skin cancer was induced by topical application of DMBA, revealed a significant reduction in a number of tumors per mouse in the group receiving 1% curcumin obtained from rhizomes of C. longa.[rx]
Daucus carota (Common name: Carrot; Family: Apiaceae)
A study, conducted to investigate the chemopreventive effects of oil extract of D. carota umbels on DMBA-induced skin cancer in mice for 20 weeks, revealed significant reduction in tumor incidence following administration via intraperitoneal (0.3 ml of 2% oil) and topical (0.2 ml of 5, 50 and 100% oil) but least with gavage (0.02 ml of 100% oil).[rx]
Echinacea Angustifolia, Echinacea purpurea (Common name: Purple coneflower; Family: Asteraceae)
Echinacea has been applied to and used to treat skin problems such as skin boils, wounds, ulcers, burns, herpes, hemorrhoids, and psoriasis. Forms of Echinacea include tablets, juice, and tea.[rx] A study conducted on patients to determine the effect of oral supplementation with a nutraceutical, containing methionine, Echinacea, zinc, probiotics, and other antioxidant and immunostimulating compounds, on the response of cutaneous warts, revealed a significant reduction of warts in such patients.[rx]
Eucalyptus globulus (Common name: Blue gum, Camphor oil; Family: Myrtaceae)
In a study conducted on humans, it was revealed that human facial demodicosis, when treated with freshly prepared camphor oil with or without glycerol dilutions, gave complete cure with concentrations of 100%, 75%, and 50% respectively.[rx] A study conducted on humans revealed that camphor oil with or without glycerol dilutions completely cured zoonotic scabies with concentrations of 100%, 75% and 50% within 5-10 days.[rx]
Euphorbia Walachia, Euphorbia hirta, Euphorbia tirucalli (Common name: Wallich spurge; Fam. Euphorbiaceae)
Juice of E. Walachia is used to treat warts and skin infections.[rx] A study, conducted on various species of Euphorbia, E. hirta, exhibited best antioxidant activity. The plant extracts showed more activity against Gram-positive bacteria and fungi. The best antimicrobial activity was shown by E. tirucalli. The study supported the folkloric use of E. hirta and E. tirucalli against some skin diseases caused by oxidative stress or by microorganisms.
Ficus carica, Ficus racemose, Ficus bengaalensis (Common name: Fig; Family: Moraceae)
In some rural areas of Iran, a traditional method for the treatment of warts comprises the use of fig tree (F. carica) latex. A study conducted in patients with warts has revealed that this therapy of warts offers several beneficial effects including short-duration therapy, no reports of any side-effects, ease-of-use, patient compliance, and a low recurrence rate. Although, the exact mechanism of the antiwart activity of fig tree latex is unclear it is likely to be the result of the proteolytic activity of the latex enzymes.[rx] F. racemose L. bark powder is used externally in case of pimples, itches, and scabies and F. bengaalensis L. bark powder are also used externally to cure scabies.[rx]
Lavendula Officinalis (Common name: Lavender; Family: Labiatae)
The effects of lavender oil on mast cell-mediated immediate-type allergic reactions in mice and rats have been studied. It has been reported to inhibit concentration-dependently the histamine release from the peritoneal mast cells. It also inhibits immediate-type allergic reactions by inhibition of mast cell degranulation in vivo and in vitro when tested on mice and rats.[rx]
Lawsonia inermis (Common name: Henna; Family: Lythraceae)
Henna is a traditionally used plant of Middle-East that is applied on hands and feet. In the traditional system of medicine, leaf paste is applied twice a day, on the affected parts to cure impetigo.[rx] In a study, clinical improvement in the patients suffering from hand and foot disease due to use of capecitabine, an anti-cancer drug, with the use of henna revealed anti-inflammatory, antipyretic and analgesic effects of henna.[rx]
Lycopersicon esculentum (Common name: Tomato; Family: Solanaceae)
A study conducted on healthy human volunteers using tomato paste (40 g), providing approximately 16 mg/d of lycopene, ingested with 10 g of olive oil over a period of 10 weeks has revealed that it is feasible to achieve protection against UV light-induced erythema by ingestion of a commonly consumed dietary source of lycopene.[rx][rx]
Mangifera indica (Common name: Mango; Family: Anacardiaceae)
The gum is used in dressings for cracked feet and for scabies. Latex is applied to cure ulcers.[rx] Aqueous extract of stem-bark (MIE, 50-800 mg/kg i.p.) produced a dose-dependent and significant (P < 0.05-0.001) anti-inflammatory effect against fresh egg albumin-induced paw edema in rats.[rx]
Matricaria chamomile, Matricaria recutita or Chamomilla Recutita (Common name: Chamomile; Family: Asteraceae)
It aids in skin cell regeneration and acts as an antioxidant, fighting free radical damage on the skin. Free radicals are a dangerous oxygen by-product of cellular metabolism. There have been allergies reported and those with daisy allergies may find themselves allergic to chamomile.[rx] A controlled study of 161 individuals found chamomile cream equally effective as 0.25% hydrocortisone cream for the treatment of eczema.[rx] In a double-blind study, chamomile cream proved less effective for reducing inflammation of the skin than hydrocortisone cream or witch hazel cream.[rx][rx]
Mirabilis jalapa (Common name: Four o’clock flower, Marvel of Peru; Family: Nyctaginaceae)
M. Jalapa is used traditionally in allergic skin disorders and asthma. A study, employing ethanol: acetone (1:1) extract of the roots of M. Jalapa, revealed that the extract (0.5 mL of 100 mg mL[-1]) inhibited histamine-induced guinea pig tracheal chain contractions non-competitively. The extract (100 or 200 mg kg[-1] i.p.) inhibited milk-induced eosinophilia, albumin-induced paw edema and protected mast cells against clonidine-induced granulation justifying the folkloric use of M. jalapa in the treatment of allergic diseases and asthma.[rx]
Momordica charantia (Common name: Bitter gourd; Family: Cucurbitaceae)
Topical application of the fruit extract of (100 μl/animal/day) during the peri-initiation stage (1 week before and 2 weeks after initiation) by DMBA and/or during the tumor promotion stage reduced the
- (i) tumor burden to 4.26, 3.72 and 3.11 (positive control value: 5.42);
- (ii) a cumulative number of papillomas to 81, 67 and 53 (positive control value: 103); and
- (iii) percent incidence of mice bearing papillomas to 100, 94 and 94, respectively (positive control value: 100). In a comparison of the anticarcinogenic efficacy of Momordica peel, pulp, seed and whole fruit extract (100 μl/animal/day), after topical treatment during the peri-initiation and during the tumor promotion stage, revealed the modulation of the
- (i) tumor burden (tumors/mouse) to 3.06, 3.61, 3.17 and 3.11;
- (ii) a cumulative number of papillomas to 49, 65, 54 and 53; and
- (iii) percent incidence of mice bearing papillomas to 84, 100, 94 and 94, respectively.[rx]
Plumbago zeylanica (Common name: Doctor Bush; Family: Plumbaginaceae)
The whole plant is crushed with a pinch of salt and the paste is applied externally in case of ringworm.[rx] A study conducted on plumbagin (5-hydroxy-2-methyl-1,4-naphthoquinone), a medicinal plant-derived naphthoquinone, isolated from the roots of the P. zeylanica revealed that topical application of plumbagin in mice inhibited UV induced development of squamous cell carcinomas.[rx]
Portulaca oleraceae (Common name: Purslane, Pigweed, Little Hogweed; Family: Portulacaceae)
The herb possesses natural cooling properties that soothe the skin, relieving it of skin inflammations and rashes during scorching heat. Burns and skin eruptions like boils and carbuncles can be treated with an effective concoction of the leaves. Topical application of the aqueous extract on to the skin is effective as antibacterial and antifungal.[rx] Externally it is used to treat burns, earache, insect stings, inflammations, skin sores, ulcers, pruritis (itching skin), eczema and abscesses which are usually treated with the fresh herb as a poultice or the expressed juice is used.[rx] In Ghana, the leaves are ground, mixed with oil and tied on boils.[rx] Sometimes in combination, the leaves are also eaten with tiger nuts (Cyperus esculentus) as a remedy for skin diseases and chancres. Extract of this plant was also found to be effective in the treatment of AD using hairless mice.[rx]
Prunus persica (Common name: Peach; Family: Rosaceae)
Ethanolic extract of the flowers (Ku-35) (50-200 μg/ml) were found to inhibit UVB and UVC induced deoxyribonucleic acid (DNA) damage by the COMET assay in the skin fibroblast cell (NIH/3T3). In addition, Ku-35 inhibited UVB-or UVC-induced lipid peroxidation, especially against UVB-induced peroxidation at higher than 10 μg/ml.[rx]
Rosmarinus officinalis (Common name: Rosemary; Family: Labiatae)
Rosemary is a common household plant grown in many parts of the world. It is used for flavoring food, a beverage drink, as well as in cosmetics. The most important constituents of rosemary are caffeic acid and its derivatives such as rosmarinic acid. These compounds have an antioxidant effect. Chronic UV exposure is responsible for long term clinical manifestations such as photoaging and photo-cancers. Aqueous extract of R. officinalis has been reported to be effective in preventing cutaneous photodamage induced by UV radiations.[rx]
Sarco asoca (Common name: Ashoka; Family: Caesalpinaceae)
A paste of the roots is useful in freckles and external inflammations, ulcers and skin diseases. It is used for itching in eczema, psoriasis, dermatitis, and herpes-kush ta/visarpa by rubbing the crushed flower on the skin. It is a favorite herb to relieve pruritis, scabies and tinea pedis. A significant reduction in the expression of ornithine decarboxylase, a key enzyme in the promotion stage of 2-stage skin cancer, in the plant-treated group was also observed suggesting the chemopreventive activity of flavonoids from S. asoca on 2-stage skin carcinogenesis.[rx]
Thyme Vulgaris (Common name: Thyme; Family: Lamiaceae)
It may relieve the symptoms of cellulitis, an infection of the skin caused by bacteria which can lead to pain, tenderness, edema, fever, chills, and reddening of the skin. It may also offer anti-fungal and antibacterial benefits. However, the University of Maryland Medical Center cautions that thyme has not been proven to specifically benefit cellulitis. In addition, this herb may raise the risk of bleeding.[rx]
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