Botanicals in Dermatology: An Evidence-based Review

Juliane Reuter; Irmgard Merfort; Christoph M. Schempp


Am J Clin Dermatol. 2010;11(4):247-267. 

In This Article

7. Wounds, Burns, and Injuries

Widely used traditional European botanicals in wound care are chamomile (M. recutita), marigold (C. officinalis), and arnica (Arnica montana), all applied locally. Aqueous (teas, decoctions) extracts of chamomile or marigold are used as washings or wet packs for fresh wounds. Arnica should never be applied on open wounds and not as an undiluted tincture because of possible sensitization. However, arnica ointments are excellent on later stages of healing wounds for contusions and bruises. Marigold is especially recommended for wounds with bacterial infections. Small, well circumscribed lesions may be treated with the oil of St John's wort (H. perforatum), which is also believed to reduce scars by inhibition of keloid formation. All these drugs have anti-inflammatory and antimicrobial activities. Active compounds are diverse, and complex within each plant. Chamomile contains essential oil with bisabolol and chamazulen as well as saponines and other ingredients; alcoholic extraction yields the most complete blend, which may be transferred to aqueous formulations or ointments[126] [LOE-D].

Marigold (C. officinalis) has been topically used for wound treatment since ancient times. It has been shown to display bactericidal, antiseptic, and anti-inflammatory, as well as free radical scavenging properties[127] [LOE-D]. Marigold was approved by the German Commission E as a wound healing agent[128] [LOE-D]. A recent prospective, randomized trial in 254 patients who underwent surgical treatment of breast cancer and received postsurgical radiation therapy compared the effectiveness of a Calendula 10% ointment with the standard therapy (trolamine) in the prevention of radiodermatitis.[129] Twice-daily application of Calendula ointment over the whole period of radiotherapy was significantly superior to trolamine and highly effective in the prevention of acute radiodermatitis[29] [LOE-A].

Diluted alcoholic tinctures from the flowers of arnica (A. montana) are applied externally for the treatment of bruises, sprains, inflammation caused by insect bites, gingivitis, and aphthous ulcers, and for the symptomatic treatment of rheumatic complaints[130] [LOE-C]. The secondary metabolites that mediate the anti-inflammatory effects are sesquiterpene lactones of the 10α-methylpseudoguaianolide type such as helenalin, 11α,13-dihydrohelenalin, and their ester derivatives[131] [LOE-D]. It was demonstrated that these compounds mainly exert their anti-inflammatory effect by inhibiting the transcription factor, nuclear factor-κB[132,133] [LOE-D].

Although arnica has a long history in folk medicine and is widely used among consumers, up to now only a few clinical studies with arnica preparations have been carried out. In the field of dermatology, the possible synergism of vein-typical hydrotherapy according to Kneipp and topical arnica treatment was investigated in a randomized, double-blind clinical trial in 100 patients with chronic venous insufficiency[134] [LOE-A]. Both hydrotherapy and combined therapy were found to be successful. However, the combined therapy was significantly superior to the monotherapy.

The gel of aloe vera (A. barbadensis) is said to be beneficial in the treatment of chronic wounds and thermal injury[135,136] [LOE-D]. A recently conducted, systematic review of the scientific literature found four clinical trials with 371 patients (including two randomized controlled trials) that supported the efficacy of aloe vera in wound healing of first- to second-degree burns[137] [LOE-A].

Wound healing activity has been demonstrated in animal models for numerous botanical extracts. To name a few, teak (Tectona grandis)[138] [LOE-D], golden trumpet (Allamandacathartica)[139] [LOE-D], vitex (Vitex trifolia and Vitex altissima)[140] [LOE-D], madagascar periwinkle (Catharanthus roseus)[141] [LOE-D], gotu kola (C. asiatica)[142] [LOE-D], and sacred basil (Ocimum sanctum)[143] [LOE-D]. Curcumin obtained from the tumeric rhizome (C. longa)[144] [LOE-D] as well as Pycnogenol_ (Horphag Research Ltd, Geneva, Switzerland) from French maritime pine bark (Pinusmaritima)[145] [LOE-D] seem to be promising agents in the treatment of wounds. However, the efficacy of these traditional therapies has not been proven in controlled clinical trials so far.

In summary, some classical wound healing plants are still first-line treatments for trivial injuries. Marigold, arnica, and aloe have proven effective in recent controlled trials.


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