Using Of Topical 5% Udica Dioica Ointment In

t
Using of topical 5% Udica dioica ointm ent in
treatm ènt of psoriasis
AIi E. Al-sanafi, Ism at Y. Allawerdi, Im ad A. Jawad
Department of Pharmaqology, College of Mpdicine,
University of Tikrit.
1

d.
Using of topical 5% U/fca dioica ointm ent in
treatm ent of psoriasis
Abstract : .
Tropical urtica dioica 5% ointment was applied twice daily for 3 months
by 53 qatients with psoriasis. Patients were classified to 6 groups according to
extenslon of psoriatic lesions. The efficacy of the treatment was determ ined
folowing a 4 grades criteria, cleared, marked im provem ent , moderate
im provem ent, and m inim al or no im provement . In 3: out of 53 patients
(71.6980/4, aI psoriatic Iesions were cleared. ln 9 patients (16.981%) there
was marked improvement, and in 6 patients (11.320%) there was no
im provement. '
The best results were obtained in Iocalized Ie'ss extensive Iesions . The
electiveness of Urtica dioica treatment could be attributed to its vitam in A and
flavonoids contents. lt is a cheap, safe and effective remedy for this chronic
disabiling skin disorder.
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Introduction :
' Psoriasis is a chronic skin disorder characterized by we l dem arcated
thickened ey hematous area of skin covered by silver scales. The disease is
highly variable (1' in its extent and duration . Morphological variants are
Com m on Patients with a fam ily history tend to have an earlier onset of the
.
diseasetz) M any factors play a definite role in the developm ent of the disease #
,
.
those include traum a, stress, infection, drugs , clim ate, metabolic factors,
tSmO king , and alcohol consumptiono-o . Treatment ofysoriasis may be solely
öpical or it may be system ic, or a combination of botht )
A wide range of drugs were used in treatment of this disease . These
include, calcipotrial, vitam in A, corticosteroids , anthralin, cyclosporine A,
met h o trexate, and psoralen with Iong-wave ultra violet light (PUVA)t'6-12) . In a
previous histological experim ental study, when m ouse tail skin was used as a
model mimikinj human psoriasis, it was appeared that 40 days treatment with
5% Udica diolca ointm ent was effective in psoriasis based on epiderm al
thickness and keratinocyte number . The safety of this concentration was also
prov idetl3) , The present prospective contro led study is carried out to evaluate
the e fectiveness of topical 5% Ulica dioica ointm ent in patient volunteers
with Iocalized psoriasis.
2

Patients and Methods :
The study w as carried out on 53 patients (32 males and 21 females),
1 1-63 years in age, atending many private dermatology outpatient clinics in
Kirkuk and Qaghdad. Urtica dioica L. (Urticaceae) ointment was prepared by
mixing 5 gr. of the powder of the Ieaves of the herb with 95 gr . of vaseline
vehicle. The ointm ent was topicaly applied to the affected skin , twice daily for
6 m onths. 10 patients were topica ly treated with the vehicle vaseline by the
same m anner and for the sam e period. Patients were classified into 5 groups
according to the extension of the lesion according to the (rule of nine) stated
b Y Diette : and M orimoto and Yashikowatl4'ls) '
1St group ' The surface area of the lesion >45% of the body .
2nG group : The surface area of the Iesion 36-44% of . the body.
3rd tb group : The surface area of the Iesion 26-35% of the body.
4 group The surface area of the Iesion 21-25% of the body .
5th th group . The surface area of the Iesion 15 -20% of the body.
6 group : The su#ace area of the Iesion *15% of the body ,
The e'icacy of the topical Udica dioica treatment was determined
folowing the 4 grades criteria of W einsteintl6)
1- Cleared ' If aIl lesions were disappeared .
2- M arked im provem ent If 50-94% of the Iesions were cleared .
3-'M oderate im provement : lf 10-49% of the lesions were cleared .
4- Minimal or no improvement : If Iess than 10% of the Iesions were
cleared, or if they stated the same .
Results :
The study showed that Urtica dioica 5% ointm ent cleared a I psoriatic
lesions in 38 out of 53 patients (71.698%). Marked improvement was
recorded in '9 patients (16.981%), while minimal improvement was recorded in
6 patients (1 1.320%). The Iast six patients showed alergy to the treatment ,
and the treatment was stopped after two weeks treatment (Table 1, Fig. 1-3).
The high percentage of e fectiveness was recorded in Iocalized non extensive
Iesions.
However, in the majority of the patients, the treatment cause mild
itching in the first three days of the initiation of the treatm ent . This itching can
easily tolerated and didn't need cessation of the treatment .
3

$
Table 1 : response of patients w ith psoriasis after G ice daily treatment
w ith 5% Uiica dioica ointm ent for 3 m onths.
Treated groups
Total Response
e: of psoriatic surface area I body surface Qrade
45
3$
7 1 .693Q4
8 6 6 6 3 4 Cleared (alI Ieslons
were cleared)
9
16 .9810/0
3 2 2 1 11 1 Marked Improvement
tsc-g4v.of were cleared) the Ieslons
Mlnlmal or no
6 - 1 1 4 Improvement l (less than
cx of the Ieslons were
1 .320% cleared orthey stated
the same
4

A B
Fig. 1 -A: Psoriatic Iesions involving chest abdom en and u
B : Resolution of the Iesions after ! qper Iimbs.
G lce daily applicatlon of Udica
diok a ointm ent for 3 m onths .
5

4
A B
Fig. 2-A : P/oriàtic Iesion involving chest an'd abdom'éEn .
B : R esolution of the lesions after tw ice dailv applidation
of Urtica dioica ointm ent for 3 months.
6

A
Fig.3-A.W idely extended psoriasis
B'.Resolution of the Ietions after twice daily applications of Urtica dioica
5% ointm ent for 1 m onth .
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Discusion :
The concentration of Ulica dioica and preparation of the ointm ent used
in this study was previously recom m ended based on the efficacy and safety in
im ental anim alstlo Urljca dioica herb contains m any pharm acologica ly
exper .
active compounds, these include flavonoids (quercetin , rutin and kaempferol),
vitam in A and C , enzymes, Iecithin, amines, carbonic acids (formic and citric
ac ids) and minerals especialy calcium and potassium saIts(1&20) The
.
effectiveness of Udica dioica topical treatm ent could be attributed to its
vitam in A content. Vitam in A is involved in m aintaining differentiation of skin
cels. The retinoid is photosensitive com pound , and there are a specific
transport protein (Retinol-binding protein) which has its own receptors in
human epiderm is in stratum corneum and stratum granulosum tzl) Ja ret and
Spearman (22) stated
that the effectiveness of vitam in A in inducing a granular
Iayer in the psoriatic skin was atributed to its rectifying efect on the ruptured
Iysosomes.
On the other hand, various flavonoids were found to be relatively
selective inhibitors of arachidonate s-lipoxygenase which initiates the
biosynthesis of Ieukotrienpstz3'z4) It was known that s-lipoxygenase products
such as lz-hydroxy eicosotetraenoic acid and Ieucotriene B4 are several folds
e Ievated in psoriatic epiderm is as com pared to uninvolved skint25'26) These
Ieucotriepes cause persistent erythem atous reaction that is associated . with
enhancéd epidermopoesis , leukocyte infiltration in derm is , and the
appearance o f microabscesses in the epiderm istzs) al1 these
,
pathophysiological event mimiking the feature of psoriasis . Thus the
effectiveness of Ulica dioica ointm ent in psoriasis could be attributed to its
flavonoids l content which are potent inhibitors of arachidonate s-lipoxygenase. n conclusion J Qrtica dioica 5% ointment was recom m ended in
treatm ent of psoriasls. The best results were expected w hen the lesion is
localized. The treatm ent is cheap , safe, and e fective.
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#
References :
1- Cam p., RDR. Psoriasis. ln : Rook , W ilkinson and Ebting. Textbook of
derm atology, 6 th e d k, voI . 2 , Edited by Cham pion RH., Burton, JL., Burns,
,
DA. And Breathnach, SM . Blackwel Science Ltd. 1998 : pp 1589-1649.
2- Melski JW ., and Stern RS. The separation of susceptibility of psoriasis
from age of onset., J. Invest. Derm atol , 1981,. 77 : 474-477.
3- Henseler T. The genetics of psoriasis. J. Am . Acad. Derm atol. 1977., 37 :
S1-S11.
4- Gonalez S., Diaz F., Rius F., and Vargas 1 . Study of cedain clinical
variables in patients with psoriasis and their relation to DNA content
keratinoc/es. J, Am. Acad. Dermatol. 1995., 22 . 218-222.
5- Baker BS., Bokth S,, Powiks A ., Garioch JJt, Lewis H., and Valdimarsson
H . Group A streptococcal antigen specific T-lym phocyte in gutate psoriatic
Iesion. Br. J. Derm atol. 1993; 128 : 493-499 .
6 Arnold HL., Odorn RB., and Jam es W D . Disease of the skin. 8th ed . W .B.
Saunders Co. 1990 ; 1-12 198-212 .
7- Kragbale K., Fogh K., and Sogaard H . Long term e#icacy and tolerability
of topical calcipotriol in psoriasis , results of open study. Acta. Derm .
Venereol. 1991 ; 71 475-478.
8- Culen SI. Long term effectiveness and safety to topical calcipotriene for
psoriasis. South Med. J. 1996., 89 1053-1056 .
9- Langer A. A Iong-term multicenter assessment of the safety and tolerability
of calcipotriol ointm ent in the treatment of chronic plaque psoriasis . Br. J.
Derm atol. 1996., 135 385-389.
10- Cunliffe W J. and Bedh-lones J. Com parative study of calcipotriol
ointm ent and betam ethasone l7-valerate ointm ent in patients with
psoriasis vulgaris, J. Am . Acad. Derm atol. 1992* 26 : 736-743.
,
1 1 - Honeyman JF , Sanchez L., and Valdes P . Low dose calosporine
A .im proves sever disabiling psoriasis in Latin America . Latin American
m ulticenter study. Int. J. Dermatol . 1995., 34 583-588.
12- Ashton RE., Andre P., Lowe NJ ., and W hitefield M .Anthralin ' historical
and current perspectives. J. Am . Acad. Dermatol . 1983., 9 : 173-192.
13- Al-sam arrae AJ. The e#ect of Urtica dioica herb on the m ouse tail skin
as a model m im iking hum an psoriasis : a histological study . Ph.D. thesis,
Colege of M edicine Tikrit University , 1999.
14- Die te T Psora lne and UV-A and UV-B twice weekly for the treatment
of psoriasis, Arch. Derm atol. 1984,' 120 116-123.
15- Morim oto S., and Yashikawa K . Psoriasis and vitam in Da. Arch.
Dermatol. 1989*, 125 . 227-230 .
16- W einstein E. Methotrexate therapy . Arch. Dermatol. 1989*, 125 277-
280.
17- Monk T. Anthralin-corticosteroid com bination therapy in the treatm ent
of chronic plaque psoriasis . Arch. Derm atol. 1988., 124 : 548-450.
18- British herbal pharm acopeia . British herbal m edical association,
London 1996 : p 224.
19- Mabey R., Mslntyre M ., M ichael P., Duff G ., and Stevens J . The new
age herbalist. How to use herbs for healing , nutrition, body care and
relaxation. A fireside book . Sim on and Schuster INC . New York 1988 : pp
121,124.
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20- W att JM. and Gerdian MB. The medicinal and poisonous plant of
S outhern
and Eastern Africa. 2nd ed . E. and S. Livingstone Ltd. London
1962 : p 1042-1045.
21- G oldsm ith LA. Biochem istry and physiology of the skin. Oxford
University Press. New York 1978 : p 352-360.
22- Jorett A. and Spearman RIC. Histochem istry of the skin psoriasis. The
English University Press. London 1961 : p 34-52.
23- Yoshim ato T., M asayuki F., and Yam amoto S. Flavonoids : potent
inhibitors of arachidonate s-lipoxygenase. Biochem . Biophys. Res. Com m .
1983., 1 16 : 612-618.
24- Havsteen B. Flavonoids, a class of natural products of high
pharmacological potency. Biochem. Pharmacol. 1983., 32 : 1 141-1 148.
25- Brain, et aI. Psoriasis and Ieucotriene B. Lancet 1982., 2 : 262-263.
26- Grabbe et aI. Identification of chemotactic Iipoxygenase products of
arachidonate m etabolism in psoriatic skin.J.Invest.Derm atoI.,1984,82:477-
479.
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