Skin Disorders Lecture Notes PDF

Phytotherapy (PG-906 clinical, PG-907 General) Herbal therapy for CNS skin disorders. root Pharm D ninth semester students The skin is the largest organ of the body and accounts for about 16 % of a person’s body weight. It is flexible, waterproof, an...

Phytotherapy (PG-906 clinical, PG-907 General) Herbal therapy for CNS skin disorders. root Pharm D ninth semester students The skin is the largest organ of the body and accounts for about 16 % of a person’s body weight. It is flexible, waterproof, and covers the entire outside of the body. Function of skin provides a protective, external covering for the body against heat, light, injury and infection Acts as a mechanical barrier to infections and prevents microorganisms and other substances from entering the body, further enhanced by its anti-infective secretions Keratin layers in the epidermis together with sebum produced by the sebaceous glands act as a waterproof barrier Sensory organ for touch, heat, cold, socio-sexual and emotional sensations Regulates body temperature Function of skin Finger and toenails protect the extremities of the fingers and toes from damage Prevents tissue fluid loss from the body Synthesizes vitamin D in the presence of sunlight and ultraviolet radiation Excretes waste products and excess salt from the body If the skin fails in of one of these functions, there can be serious consequences for the individual. Because so much importance is attached to our appearance (and therefore the skin), any skin problems can also have a major psychological and social impact on the person affected. This makes it vitally important to support skin health on an ongoing process. Examples of diseases affecting skin: - Acne. - Psoriasis. - Eczema. - Anal Itch. - Wounds and Cuts. - Athlete's foot. - Burns. - Dandruff.  Phytotherapy to skin disorders 1-Wounds, burns 2-Inflammatory skin conditions: dermatitis, psoriasis, acne 3-Viral, bacterial infectious conditions: acne, herpes simplex.  Phytotherapy to skin disorders 1- wound healers: *centella, calendula, aloe gel, ß-sitosterol, *echinacea, hypericum 2- anti-inflammatory drugs: *chamomile, calendula, ß- sitosterol, aloe, *echinacea, 3- antibacterial, antiviral: *tea tree oil, *Melissa, hypericum  1 Uses described in pharmacopoeias Aloe Vera Gel is widely used for External treatment of minor wounds Treatment of first- and second-degree thermal burns and radiation burns.  Aloe vera gel Major chemical constituents polysaccharides (acemannan, and mannose 6-phosphate). sterols (lupeol, campesterol, and β- sitosterol), Enzymes (bradykinase) Gel must be freshly prepared because of its sensitivity to enzymatic, oxidative, or microbial degradation. Aloe Vera Gel is not approved as an internal medication Wound healing In proliferation Stimulate the activity of macrophages and fibroblasts thus increase collagen synthesis, thereby promoting tissue repair Mannose 6-phosphate: enhance fibroblasts activity Acemannan: activate macrophage  2 Constituents : The pharmacological activity of Echinacea is attributed to essential oil, , Orally in caffeic acid derivatives, polyalkynes, supportive polyalkenes, and treatment of echinacin immune system Uses supported by clinical data External uses include promotion of wound healing and treatment of inflammatory skin conditions.  Actions : Topical applications of Echinacea extracts: Antihyaluronidase activity (The polysaccharide fraction (echinacin B) promote wound healing by forming a hyaluronic acid–polysaccharide complex that inhibit hyaluronidase Stimulation of fibroblast activity, phagocytosis (alkamides) Anti- inflammatory (inhibit cyclo-oxygenase) Pressed juice of Purple Coneflower herb The ointment is used to treat inflammatory skin conditions, wounds, eczema, burns, and varicose ulcerations of the legs for no longer than 8 successive weeks. 3 Major constituents : 1-Flavonoids: isorhamnetin, quercetin 2-Triterpenes & sterols: faradiol ester 3-Polysaccharides 4-calenduloside, v.o. Uses described in pharmacopoeias External treatment of superficial cuts, minor inflammations of the skin, wounds ,acute dermatitis in patients undergoing in postoperative irradiation. Actions: 1-Wound-healing activity, (phagocytosis+epithelialization) epithelialization: extracts, faradiol ester, stimulate fibroblast proliferation 2-Antimicrobial activity, Due to: triterpene fraction, faradiol esters, isorhmnetin 3-Stimulate Phagocytosis Three polysaccharides isolated from Calendula enhanced phagocytosis in human granulocytes in vitro Clinical pharmacology (two case reports in the early medical literature support the traditional use of calendula tincture of the flowers applied on compresses to reduce inflammation and to accelerate the healing of wounds.  4 Major chemical constituents triterpenes asiatic acid madecassic acid, asiaticoside Uses supported by clinical data ▪ extracts used topically to accelerate healing, particularly in cases of chronic postsurgical and post-trauma wounds, second- and third- degree burns. ▪ treatment of ulcerous skin ailments, and prevention of scars.  Asiaticoside decrease fibrosis in wounds, thus preventing new scar formation. By: 1- increasing the synthesis of collagen, 2- inhibiting the inflammatory phase of hypertrophic scars and keloids. 3- increasing the activity of myofibroblasts. REMODELING  5 β-sitosterol is a plant-derived angiogenic factor ; Enhance neovascularization Anti-inflammatory Contents: MEBO(Moist Exposed Burn Ointment) Beta-sitosterol 0.25%, Sesame oil 92%  *orally in depression 6 Hypericum Uses reported in traditional systems of medicine 1- Externally for minor cuts, burns and skin ulcers. 2-In viral infection of skin such as herpes hypericin simplex Major constituents: hypericin, hyperforin Actions : hypericin inactivates both viral fusion and syncytia formation External application to skin accelerate healing by stimulating fibroblasts, epithelialization.  Aloe gel *Echinacea Calendula Hypericum *Centella ß-sitosterol Echinacin Faradiol ester hypericin Asiatic acid Mannose 6-phosphate Hyperforin asiaticoside Stimulate fibroblast(alkamides,..) , antihyaluronidase activity Stimulate fibroblast Stimulate (echinacin) neovascularization + Phagocytosis Stimulate fibroblast +Phagocytosis (polysaccharides) Stimulate myofibroblast Prevent scar formation Stimulate fibroblast(Mannose 6-phosphate) + stimulate Phagocytosis (acemannan: macrophage stimulating agent) Stimulation of fibroblast increase collagen formation  ECZEMA atopic dermatitis More common in children than adults Symptoms(signs). 1- Intense itching. 2- Red rash appears later 3- Rash itches 4- If it is scratched, it may ooze and become crusty.  Psoriasis is an autoimmune disease that affects the skin. The immune system consider the skin cells as a pathogen, and sends signals that speed up the growth cycle of skin cells resulting in red, dry patches of thickened skin. Psoriasis commonly affects the skin of the elbows, knees, and scalp in intermittent attacks.  Hamamelis Leaves, bark of Hamamelis virginiana Constituents : Hamamelitannin Proanthocyanidins Gallic acid Uses supported by clinical data Topically for minor skin lesions, bruises and sprains, local inflammation of the skin and mucous membranes, Anti-inflammatory activity Hamamelitannin and proanthocyanidins are potent inhibitors of 5- lipoxygenase  Chamomile Constituents : α-bisabolol chamazulene Flavonoids  Chamomile Anti-inflammatory In vitro, chamomile extracts, bisabolol, flavonoids(luteolin, apigenin, quercetin,..) inhibit cyclooxygenase and lipoxygenase and thus the production of prostaglandins and leukotrienes. Antibacterial In vitro, chamomile extract, volatile oil inhibit S,aureus,…  Chamomile Uses supported by clinical data External use Inflammation and irritations of the skin and mucosa (skin cracks, bruises, frostbite, and insect bites), including irritations and infections of the mouth and gums, and haemorrhoids *Evening primrose oil The fixed oil obtained from the seeds of Oenothera biennis L. Major chemical constituents linoleic acid, γ-linolenic acid GLA is also found in borage and black current oils Medicinal uses supported by clinical data Internally for symptomatic treatment of atopic eczema γ-Linolenic is metabolized to di-homogamma linolenic acid (DGLA) that fights inflammation. Cream contains: Calendula officinalis, Echinacea angustifolia, Hamamelis virginica. Actions: Treat psoriasis in both acute and chronic conditions, helps to relieve inflammation, controls itching and burning. Reduces redness, dryness and scaling of skin. Uses described in pharmacopoeias Aloe Vera Gel is widely used for External treatment of …………. Treatment of first- and second-degree ……………. Inflammatory skin conditions  Anti-inflammatory Fresh Aloe Gel reduced acute inflammation: through 1- bradykinase activity 2- prostaglandin inhibition by lupeol, sitosterol 3- Aloe Vera Gel, hydrate and protect the skin. Actions : Topical applications of Echinacea extracts: Anti-inflammatory(inhibit cyclo-oxygenase) Uses supported by clinical data External uses include ………………………….and treatment of inflammatory skin conditions.  Clinical picture comedones, papules, pustules, and nodules in a sebaceous distribution (eg, face, upper chest, back). A comedone is a whitehead (closed comedone) or a blackhead (open comedone) Major chemical constituents: Volatile oil: Terpene hydrocarbons: monoterpenes, sesquiterpenes, Terpene- 4-ol. Mechanism of action: 1. Antimicrobial: Several chemical constituents of the oil (Terpene- 4- ol.), inhibited the growth in vitro of C. albicans, E. coli andS. aureus. 2. Antioxidant: Tea tree oil decreases the production of reactive oxygen species by neutrophils. Uses supported by clinical data: gel containing …??...% essential oil Topical application for symptomatic treatment of common skin disorders such as acne, tinea pedis (foot problems), TTO+Aloe gel +sulphur External application of the essential oil at concentrations of 5-100%, depending on the skin disorder being treated: 5% for acne, 10% for tenia  Aloe gel *Echinacea Calendula *Hamamelis *chamomile ß-sitosterol Bradykinase Faradiol ester, Hamamelitannin, bisabolol, Lupeole, ß-sitosterol flavonoids proanthocyanidins flavonoids Anti-inflammatory Anti-inflammatory Anti-inflammatory) Anti-inflammatory Anti-inflammatory Antioxidant astringent * Evening primrose oil Anti-inflammatory Gamma linolenic acid Anti-inflammatory Anti-inflammatory Thank you