Phytotherapy in Diabetic Foot Ulcers: A Promising Strategy for Effective Wound Healing

Miraj, Sonal Sekhar; Kurian, Shilia Jacob; Rodrigues, Gabriel; Saravu, Kavitha; Rao, Mahadev; Raychaudhury, Siba Prasad; Downs, Bernard W.; Bagchi, Debasis

doi:10.1080/07315724.2022.2034069

Cited by 4 publications

(7 citation statements)

References 115 publications

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“…Recent studies have suggested that herbal medicines could be an inexpensive complementary therapy with few adverse reactions for managing DFU complications 19,20 . Also, a wide range of literature supports utilizing herbal treatments to improve DFU; however, further high‐quality appraisals on the efficacy and safety of these interventions are recommended before they can be applied on a large scale 21–26 . Systematic reviews, which are at the top of the clinical evidence hierarchy, have recently addressed the potential effect of herbal products in healing DFU; however, they either focused on metabolites and phytoconstituents of used herbs or synthesized the results of investigations with different study designs, making it difficult to draw a reliable conclusion 27–30 .…”

Section: Introductionmentioning

confidence: 99%

Healing of diabetic foot ulcer with topical and oral administrations of herbal products: A systematic review and meta‐analysis of randomized controlled trials

Zamanifard,

Nasiri,

Yarahmadi

et al. 2024

International Wound Journal

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This systematic review aimed to qualitatively synthesize recent randomized controlled trials (RCTs) regarding the effect of topical application and oral intake of herbal products on the healing of diabetic foot ulcer (DFU). Also, we sought to pool the obtained findings in a meta‐analysis using a random‐effects model, if RCTs were relatively comparable and homogenous. A comprehensive search was performed on five electronic data sources from their inception through 23 January 2024. The RCTs, without restriction on the country of origin, were included if they compared the effect of administering standard treatments and/or placebo (i.e. control condition) to applying standard treatments and/or herbal products in topical or oral routes (i.e. experimental condition). Out of 1166 retrieved records, 28 RCTs were included. Studies used different poly and single herbal formulations. Based on the meta‐analysis, administration of standard care plus daily dressing of the ulcer site with olive oil for 28 days significantly increased the total ulcer healing score (3 RCTs; weighted mean difference [WMD] = 89.30; p < 0.001), raised frequency of complete ulcer healing (2 RCTs; risk ratio [RR] = 12.44; p = 0.039) and declined ulcer degree (3 RCTs; WMD = −22.28; p = 0.002). Also, daily use of the bitter melon leaf extract in oral form for 28 days significantly increased the total ulcer healing score (2 RCTs; WMD = 0.40; p = 0.001). Additionally, based on qualitative synthesis, the adjuvant use of herbal agents seems an intriguing choice to manage DFU. Nonetheless, considering the undesirable methodological quality of most studies and the high heterogeneity in administered herbal formulations, more robust trials are required to build a solid conclusion regarding the use of herbal products for healing DFU.

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Section: Introductionmentioning

confidence: 99%

Healing of diabetic foot ulcer with topical and oral administrations of herbal products: A systematic review and meta‐analysis of randomized controlled trials

Zamanifard,

Nasiri,

Yarahmadi

et al. 2024

International Wound Journal

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“…Moreover, systematic reviews emphasize the potential of topical and natural herbal agents as cost‐effective, adjunctive nonpharmacological measures, demonstrating favorable outcomes with minimal adverse reactions in DFU healing 9,10 . The bioactive molecules derived from therapeutic herbs are believed to exert multiple pharmacological effects, contributing to DFU control with minimal adverse consequences 11 . Dermaheal, an ointment comprising therapeutic herbs, including those studied in diabetic rats, has shown promising results in healing cutaneous wounds.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 The bioactive molecules derived from therapeutic herbs are believed to exert multiple pharmacological effects, contributing to DFU control with minimal adverse consequences. 11 Dermaheal, an ointment comprising therapeutic herbs, including those studied in diabetic rats, has shown promising results in healing cutaneous wounds.…”

Section: Introductionmentioning

confidence: 99%

Short‐term effect of dressing with Dermaheal ointment in the treatment of diabetic foot ulcer: A double‐blinded randomized controlled clinical trial

Salahi,

Nasiri,

Yazdanpanah

et al. 2024

Health Science Reports

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Background and AimsDiabetic foot ulcers, a major cause of amputations in diabetics, could benefit from natural products as adjuncts to standard care, given the costs and adverse effects of typical therapies. This study aims to evaluate the short‐term effects of dressing with Dermaheal ointment in the treatment of DFUs through a double‐blinded randomized controlled clinical trial.MethodsThis double‐blinded, placebo‐controlled trial included 50 patients with Wagner's ulcer grade I or II, randomly assigned to Dermaheal and placebo groups (received standard treatment and placebo ointment). The ulcer site was dressed daily for four consecutive weeks with either Dermaheal or placebo ointment. Ulcer healing score (using DFU healing checklist), ulcer size with transparent ruler and largest dimension of ulcer, and pain severity using numerical pain rating score (were recorded at five‐time points, including baseline, and on weeks 1, 2, 3, and 4). Also, ulcer healing status was investigated at the trial ended in November 2021.ResultsBoth groups showed significant improvement in ulcer healing over 4 weeks (ptime < 0.001), with more remarkable progress in the Dermaheal group (pgroup = 0.03). At the trial end, complete ulcer healing was also significantly higher in the Dermaheal group compared to the placebo group (56% vs. 12%, p = 0.002). Both groups exhibited a decrease in ulcer size (ptime < 0.001). Considering the baseline ulcer size as a covariate, substantial changes in mean ulcer size were noted in the initial (p = 0.01), second (p = 0.001), third (p = 0.002), and fourth (p = 0.002) weeks of the intervention, showing a preference for the Dermaheal group. However, no significant between‐group difference was observed in pain severity levels.ConclusionDressing with Dermaheal as a topical treatment shows promise in improving healing and reducing the size of diabetic foot ulcers. Further research is needed to confirm these findings' long‐term efficacy.

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“…It is preferable that the use of phytochemicals alone or as an adjunct to standard therapy has shown promising results in the management of DFU complications. Phytotherapy is generally thought to be less toxic than synthetic therapeutic agents, making it an excellent choice for DFU management 4 . Numerous plant compounds, including resveratrol, curcumin, sesamol, and naringin, have been chemically synthesized and tested with promising results for accelerating the healing of foot ulcers through a variety of mechanisms 5 …”

Section: Introductionmentioning

confidence: 99%

“…Phytotherapy is generally thought to be less toxic than synthetic therapeutic agents, making it an excellent choice for DFU management. 4 Numerous plant compounds, including resveratrol, curcumin, sesamol, and naringin, have been chemically synthesized and tested with promising results for accelerating the healing of foot ulcers through a variety of mechanisms. 5 One such plant-based substance is KMP (3,5,7-trihydroxy-2-[4-hydroxyphenyl]-4H-1-benzopyran-4-one) has a low molecular weight (286.2 g/mol).…”

mentioning

confidence: 99%

Development and optimization of kaempferol loaded ethosomes using Box–Behnken statistical design: In vitro and ex‐vivo assessments

Raghav,

Kumar,

Sethiya

et al. 2024

J Biomed Mater Res

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Kaempferol (KMP) belong to flavonoid class have developed in ethosomal formulation and were evaluated for their potential to treat diabetic foot ulcers. Even though ethosomes are highly deformable, they can pass through human skin intact. KMP ethosomes were formulated using the cold method and optimized by Box–Behnken design (BBD) (three‐factor, three‐level (33)). The formulation variables used for optimization are drug concentration of KMP, soylecithin content, and ethanol percentage. The optimized formulation was examined using transmission electronic microscopy (TEM), differential scanning calorimetry (DSC), Fourier transform infrared (FTIR) spectroscopy, in‐vitro release, ex‐vivo permeation studies, and storage stability. The optimized KMP ethosomes was found to have vesicle size (VS) of 283 ± 0.3 nm and zeta potential (ZP) of −29.67 ± 0.3 mV, polydispersity index (PDI) of 0.36, % entrapment efficiency (%EE) of 91.02 ± 0.21%, drug loading (%) of 46.23 ± 2.5% followed by good storage stability at 4°C/60 ± 5% RH. In vitro drug release of optimized KMP ethosomes was 88.2 ± 2.75%, which was approximately double when compared with pure KMP release, that is 49.9 ± 1.89%. The release kinetics for optimized KMP ethosomes follows the Korsmeyer–Peppas model. An apparent permeation coefficient of 356.25 ± 0.5 μg/cm2 was determined and compared with pure KMP (118.46 ± 0.3 μg/cm2) for 24 h. According to the study, ethosomes can be a cutting‐edge strategy that offers a new delivery method for prolonged and targeted distribution of KMP in a variety of dosage forms including oral, topical, transdermal, and so forth.

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Phytotherapy in Diabetic Foot Ulcers: A Promising Strategy for Effective Wound Healing

Cited by 4 publications

References 115 publications

Healing of diabetic foot ulcer with topical and oral administrations of herbal products: A systematic review and meta‐analysis of randomized controlled trials

Healing of diabetic foot ulcer with topical and oral administrations of herbal products: A systematic review and meta‐analysis of randomized controlled trials

Short‐term effect of dressing with Dermaheal ointment in the treatment of diabetic foot ulcer: A double‐blinded randomized controlled clinical trial

Development and optimization of kaempferol loaded ethosomes using Box–Behnken statistical design: In vitro and ex‐vivo assessments

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