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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5336_Библиотеки_им_академика_М_И_Перельмана
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Scientific name
(English name)
Astragalus sp.
(astragal)
Dorema ammoniacum
(dorema)
Fumaria parviflora
(fumitory)
Lawsonia inermis
(henna)
Helleborus niger
(Christmas rose)
Extract/
Arabic name Par t
Katira Gum Tragacanth gel
Oshagh Gum Gum extract
Baghlat-ol-
molk
Henna Leaves Traditional
Kharbagh Roots or
Aerial parts 4% Ethanolic
seeds
phytochemical Activity Study design Result
cushion
topical
formula
extract
cream
application
of henna dye
Extract Integrative
Prevention of
pressure ulcer
Positive effect of the
cream
formulation of
D. ammoniacum
extract on
melasma
Improvement of all
types of hand
eczema
Anti-inflammatory,
antipyretic, and
analgesic effects
anthroposophic
therapy
Triple-blind
randomized
controlled trial/
ICU patients
Randomized,
double-blind,
placebocontrolled
trial/49 patients
Randomized,
double-blind,
placebocontrolled
trial/44 patients
Case study of
capecitabineinduced
hand–foot
syndrome
Clinical case
report
Elimination of frictional
forces between the
patient’s skin and
bed and delaying
the onset of
erythema in ICU
patients
Mean melasma
severity index due to
melanin
hyperpigmentation
was significantly
decreased in the
drug group
Inhibition of
T-lymphocyte
proliferation as well
as inhibition of
pro-inflammatory
granulocyte
cytokines and
modulation of
monocyte cytokine
production
Clinical improvement
Long-term survival
with MPM
Reference
Shakibamehr
etal. (2019)
Javedan etal.
(2021)
Jowkar etal.
(2011)
Yucel and
Guzin (2008)
Werthmann
etal. (2017)
Plantago major
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(great plantain)
Portulaca oleracea
(purslane)
Quercus infectoria
(gall oak)
Viola odorata
(violet)
CTCAE-4, Common Terminology Criteria for Adverse Events, v4; ICU, intensive care unit; MPM, malignant pleural mesothelioma; VAS, visual analog scale.
Lesan-ol-
haml
Baghlat-ol-
hamgha
Afs Nutgall Topical
Benafsej Flowers Fixed oil Reduce the dryness
Leaves Gel formulation ↓ Burn, pain, and
dermatitis
Leaves Whitening
lotion and
antiaging
essence
formulation
Collagen
synthesis,free
radical
scavenging
Rapid wound
closure
score, severity,
location, and
frequency of
pruritus in
hemodialysis
patients
Randomized,
double-blind,
phase 2 clinical
trial/80 patients
Human
volunteers
(after 6 weeks,
n = 6),
application
twice daily for
6 weeks
Multicenter, open
label, pre- and
post-test
randomized
controlled trial
Randomized
controlled trial
Evaluating prevention
of acute radiation
dermatitis grade in
breast cancer
patients
Fine wrinkles
diminished
Inhibits diabetes-
induced
inflammation and
oxidative stress in
macrophages
through suppression
of the Set7/NF-κB
pathway
Massage with violet oil
was more effective in
treatment of uremic
pruritus than massage
alone
Tavakoli (2021)
Kim etal.
(2013)
Chokpaisarn
etal. (2020)
Khorsand (2019)
Treatment of Various Skin Diseases 367
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of leprosy, which is accompanied by necrosis, is similar to a cancerous state and chronic
ulcers (Avijgan etal., 2018). Avicenna relates
leprosy to cancer: “cancer, is Judham of a
single organ and is incurable, but ‘Judham’ is
a cancer of the whole body”. He clearly stated
that black baras was an early sign of judham.
Because of the popularity of Avicenna’s work
in medieval Europe, the signs that he attributed to leprosy reappeared in Western records of the disease (Dols, 1979).
Treatment
Avicenna mentioned it is most important to
accelerate the process of discharging the offending material and to purify the blood by
the opening of large veins in order to draw
the corrupt blood from the liver and spleen,
after that to pay attention to diet in order to
renormalize the unhealthy temperament.
For treating advanced leprosy, palliative care
is indicated, like moistening the drying body
and strengthening the heart and other principal organs to protect the body’s natural defensive mechanism by use of various traditional
dosage forms for minimizing deformities. In
the advancing stage of leprosy, vipers were to
be utilized in food, drink, ointments, and
“grand theriac” as a healing remedy that is
effective in antagonizing poisons. Theriac, a
word derived from ancient Greek, means
“wild animal” but according to many changes
in the original Greek formulations of theriacs by Avicenna, it is used for protection
against the many compounds that may disrupt the normal functioning of the human
body (Taghizadieh etal., 2020).
Skin Pigmentation Disorders
Baras (vitiligo)
Vitiligo is an acquired localized pigmentary
skin disorder caused by the progressive loss
of melanocytes from the epidermis and has
a huge psychosocial impact on patients.
There are depigmented macules and patches
on the skin, mucous membranes, or white
hair due to destroyed skin melanocytes. It is
characterized by milky-white sharply demarcated macules. Autoimmune, autocytotoxic,
and neural mechanisms are responsible for
vitiligo in that immune cells invade and
damage melanocytes. T cells and cytokines
such as interleukins and interferon-γ may
have a role in the vitiligo process (Haghir
et al., 2021). Many hypotheses have been
put forward but the main etiology is a few
autoimmune disorders and thyroid abnormalities that are the commonest ones. One
hypothesis suggested that melanocytes destroy themselves due to a defect in a natural
protective mechanism that removes toxic
melanin precursors. These compounds are
released at peripheral nerve endings in the
skin and have a toxic effect on melanocytes
(Van Geel and Speeckaert, 2016). Vitiligo is
named baras, and imbalanced temperament
plays a significant role in the etiology of the
disease. Temperament imbalance due to increasing wetness and coldness and increasing the condensed and viscous white phlegm
humor within the dermis causes skin surface
depression, which appears as white and
shiny patches. The metabolic power of the
body is weakened, and under these conditions, food fails to produce normal blood
transformation in the skin.
Treatment
Vitiligo treatment consists of administration of some medicinal plants to modify the
quality and quantity of the humor to produce a physiologic condition and make a
healthy internal environment and to help
drugs have appropriate effects. At first,
prior to evacuation of abnormal phlegmatic
humor, an approach named munzij (conoctive) is applied for humor maturation and
abnormal phlegm ripening, making it ready
for easy elimination by changing its consistency. Sometimes the matter is too thick or
too thin to be eliminated.
Then a laxative (mushil) such as Ayarij is
used to remove the excess impurities by inducing diarrhea, to effectively move the
waste from the vessels, membranes, and
every part of the body to the gastrointestinal tract. In this context, Ayarij-e-Faiqra is
one of the best known remedies. The main
Treatment of Various Skin Diseases 369
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ingredients are barks of cinnamon (Cinnamomum zeylanicum and Cinnamomum
cassia), rhizomes of Indian valerian (Nardostachys jatamansi), fruits of cubeb (Piper
cubeba), flowers of Persian rose, mastic (an
oleoresin of Pistacia lentiscus), and juice of
various Aloe vera subspecies. But Avicenna
recommended another version of this dosage form with C. zeylanicum and C. cassia,
rhizomes of Indian valerian, Cinnamomum
opobalsamum, Cinnamomum citriodorum,
wild ginger (Asarum sp.), saffron, and water
mint (Mentha aquatica). Topical dosage
forms containing the following herbs are
also used for skin coloring: asafoetida (Fer-
ula assa-foetida), black pepper (Piper nigrum),
common radish (Raphanus sativus), madder
(Rubia tinctorum), Indian head ginger (Cos-
tus spicatus), gentian (Gentiana lutea), and
black cumin (Nigella sativa) in various combinations. All cinnamon species contain cinnamaldehyde, which accounts for between
65 and 80% of the essential oil, and various
studies have been conducted on extracts and
isolated compounds of Cinnamomum species
investigating antibacterial, antidiabetic, antiinflammatory, antioxidant, antitumor, and
neuroprotective properties (Sharifi-Rad
etal., 2021).
Skin hyperpigmentation
Melanin, hemoglobin, and carotenoids determine the standard skin color. Most pigment
cells are melanocytes within the epidermis.
Human pigmentation is regulated by ultraviolet (UV) light as well as endocrine, paracrine, and autocrine factors. Endocrine factors and external agents like sunlight play a
significant role, which is the most common
cause of facial melanosis and manifests as
hyperpigmented macules on the face. The
etiology and pathologic mechanism of melasma are poorly understood, but the number of melanocytes is not increased; instead
they become enlarged and more dendritic,
suggesting that a hypermetabolic state leads
to increased melanin deposition in the epidermis and dermis (Van Geel and Speeckaert, 2016).
Kalaf, bahaq, and namash are the most
used terms denoting skin hyperpigmentation. Changes in skin color may be due to
homeostatic imbalances in the body, corruption of blood, or an acute mixture of temperament with blood. In people with melancholic
temperament, pathogenic black bile is congested in the epidermis (as the first place for
the accumulation of waste and the most extensive defense line), which is manifested as
itching, black and white patches, rough eruption, and dryness. Kalaf is a dark or brown to
black pigmentation patch of skin but not elevated and usually occurs on the face, with
clinical manifestations similar to melasma.
Bahaq was identical to kalaf except that bahaq was associated with sloughing and rough-
ness. Namash is equivalent to freckles and is
defined as abnormal black bile congestion in
skin layers with increased concentration that
causes dark color spots on the face.
Treatment
The systemic treatment should be taken seriously for a proper result. Appropriate nutritional programs based on temperament can
potentiate the effectiveness of topical drugs
and ease the situation, blood purification, and
pathogenic temperament relief. Medicinal
plants such as lupine seeds (Lupinus termis),
horseradish tree (Moringa olifera), common
radish, wild cucumber, pumpkin seeds (Cucurbita pepo), garden cress (Lepidium sativum),
arugula (Eruca sativa), onion (Allium cepa),
birthwort (Aristolochia bottae), and safflower
(Carthamus tinctorius) are also administered
through the skin. Today various cosmetic
companies produce different topical dosage
forms for hyperpigmentation and compete to
win the production advantage, the products
are expensive with a moderate treatment outcome (Mojtabaee etal., 2016).
Dermatitis
Diseases like hekkah and taghashofe-atraf
have been described to resemble the characteristics of dermatitis, which is currently accepted as eczema. Atopic dermatitis, atopic
eczema, and infantile eczema sufferers are
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inheritors of a chronic, relapsing, inflammatory pruritic skin disease modulated by immunity and environmental factors. Redness,
pruritus, pain, and burning sensation are
the main similarities. The wet type or exudative eczema is accompanied by pruritus and
discharge and may lead to ulcers. Itching and
erythema without any discharge are characteristics of dry type or non-exudative eczema.
Psychological factors have been recognized as
causative agents in some skin conditions.
There is evidence of the endogenous type of
depression, disturbed sleep with early waking, loss of weight and appetite, and low
mood associated with pruritis. It is generally
recognized that pruritus with skin reaction
may be due to melancholia (Eghbalian etal.,
2017). According to traditional medicine
theory, eczema is highly associated with an
imbalance in the liver temperament, as the
liver is the primary source of humoral production. Corruption of blood or an acute
mixture of humors with each other changes
the original skin and also the whole body
temperament. The abnormal humor cannot
be absorbed into the target organs and enters beneath the skin by vessels, which can
cause itching, burning, rash, and vesicles.
Melancholic type is very similar to chronic
and resistant atopic dermatitis with low
pain, pruritus, and dark rash, but bloody
and phlegmatic types are remarkably identical to childhood and adolescent atopic
dermatitis characterized by itching, white
rash, and diluted blood secretion (Edwards,
1954). Signs and symptoms of acute eczema
are redness, itching, and burning due to the
blood type. Blood and phlegmatic eczema
are of the wet type because of the wet dystemperament of the liver; safrā (yellow bile)
and black bile or melancholic eczema are of
the dry type, because of the dry dystemperament of the liver (Mansouri etal., 2016).
Atopic dermatitis
Atopic dermatitis or temperamental eczema
is a chronic, relapsing, inflammatory pruritic skin disease that develops mainly from
childhood (2–10%) to adulthood (10–30%),
it is a genetically complicated disorder
accompanied by food sensitivity, asthma,
and allergic rhinitis. Skin dryness and pruritus are characteristic features of atopic
dermatitis (Arnold etal., 1990).
Treatment
Treatment for eczema and related pruritis was
based on temperament modification, and
some preventive factors overlap in traditional
and allopathic medicines. In Avicenna’s Canon,
lifestyle modifications are essential in correcting liver temperament for correct humor production as a first and important approach.
The diet must be adjusted to avoid
mixed foods and to avoid thick, leftover,
spicy, and dry/hot foods. On the other hand,
generally easily digestible and moist/hot
foods such as chicory, watermelon, and lettuce should be consumed, because cold foods
cool down the body and slow down blood
and energy circulation. Attention should
also be paid to the process by which foods
are prepared, as sometimes this may significantly change their texture and composition
(Dashtdar etal., 2022).
Daily bowel movements are necessary
for the elimination of harmful substances to
achieve an overall balanced state. First of all,
it is better to eliminate the “bile melancholy”
caused by the burning of yellow bile and/or
abnormal salty or alkaline mucus that tends
to heat and dryness. Recommended for this
purpose are different Terminalia species
known as myrobalans and a combination
with dodder, fumitory (Fumaria parviflora),
senna (Cassia angustifolia), Persian rose, and
common wormwood (Artemisia absinthium).
Stress and anxiety were found to raise the
strange temperature in the body and reduce
the instinctive heat, and the effect of emotional aspects was greater and faster than
that of other factors (Eghbalian etal., 2017).
Mental relaxation and strengthening of the
brain by a variety of local and systemic traditional formulations according to body temperament are mentioned in the Canon of
Medicine. Natural mineral waters with sulfate improved skin lesions in scabies, and
traditional formulations had an advantage
via restoring the epidermal barrier’s balance
(Jedkareh etal., 2016).
Treatment of Various Skin Diseases 371
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Qoobā (Psoriasis)
Avicenna believes that ghoobaye moteghasher
or “flaky qoobā” is very similar to sʿafah-yābes
and treatment approaches are the same. Bar-
as aswad, sʿafah-yābes, and qoobā have simi-
lar symptoms (Mohammadian Rasanan
et al., 2022). Sheqaqe poosti and taqshofe
atraf are also skin scaling, or roughness, and
increased thickness of the skin due to abnor
mal melancholic humor that has occurred in
the hands, feet, face, lips, and anus, and the
main reason is dry skin. Hakkah is the general term for pruritis without any skin lesion. The dryness of skin may be the result
of exposure to extreme hot or cold weather
and wind, and many other systemic diseases.
Avicenna has defined ghooba as redness,
itching, desquamation, and localized scaly
patches mostly on the head. Some kinds of
ghooba have pruritis and autumn is an exacerbating factor for the disease. Psoriasis is
similar to ghooba due to salty phlegm or
blood mixed with black bile humor.
Baras aswad
Baras aswad is a severe itching, dry skin disorder with rough and black flakes due to accumulation of abnormal black bile humor in the
skin that can spread all over the body surface.
Sʿafah
Sʿafah (favus) is a skin condition that causes a
scattered rash with mild itching that can develop into an ulcerative, crusty plaque with
scales. Favus is typically a childhood disease,
yet adult cases are not uncommon. In tinea
capitis favosa, a chronic inflammatory dermatophyte infection of the scalp, over 90% of
patients are affected with Trichophyton schoen-
leinii. Trichophyton violaceum, Trichophyton
verrucosum, zoophilic Trichophyton mentagrophytes, Microsporum canis, and geophilic Microsporum gypseum have also been recovered
from favic lesions. T. schoenleinii fungus can be
isolated from tinea capitis lesions appearing
as gray patches, but can also colonize the scalp
without causing any symptoms (Ilkit, 2010).
Sʿafah-yābes is a skin condition that
causes dry, crusted plaque with scales. It occurs all over the skin surface but mainly on
the head/face. It manifests as two types: dry
and wet, due to the combination of soda with
salty phlegm or the combination of burned
yellow bile humor for which winter is an exacerbating factor; shirinaj or moist favus has
plasma discharge that decreases rapidly.
Psoriasis treatment
Lifestyle modifications, known as the six essential measures or Settehe–Darurieah, are
important external factors. Expelling waste
humor and balancing dry temperament is
the essential treatment protocol.
Black-bile-producing foods such as canned
foodstuffs, frozen meat that is kept for a
long time in the freezer, all precooked and
processed meats, fast foods, the meat of old
animals, salted or smoked fish, old cheese,
eggplant, dense and leftover foods can produce excessive black bile humor in the body.
Excessive activity, extreme cold, hot weather, and astringent baths should be avoided.
A short-duration bath moisturizes the body,
and humid air needs more consideration.
Dry and polluted air is also a negative external factor, dry weather exacerbates disease
symptoms, and stress or anxiety can trigger
or worsen psoriasis symptoms. Healthy and
adequate sleep, vomiting to eliminate abnormal bodily fluids, and methods of defecation are also important and should be considered accordingly. Internal factors such as
a healthy stomach, liver, and spleen for
proper digestion produce normal humor and
generate usual black bile. Systemic and local
herbal medicines and physical manipulations like wet cupping and/or venesection
are also recommended. Wetting is stimulated by the consumption of moist food and
whey powder (Walzem et al., 2002). Some
local treatment examples are gum arabic,
almond tree (Prunus amygdalus) and plum
tree (Prunus domestica) gums combined with
vinegar, fixed oils of wheat, viola (Viola odo-
rata) and chickpea (Cicer arietinum), a decoc-
tion of barley (H. vulgare) and citron seeds
(Citrus medica).
372 Maryam Nikoosokhan
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A Brief Review of Some Common
Modern Dermatologic Treatments
Vitiligo
There are different approaches for vitiligo
treatment that aim to prevent the spread of
the disease and facilitate repigmentation of
affected lesions. The mainstay of treatment
has been topical steroids, calcineurin inhibitors, phototherapy, cosmetic products, immunomodulators, and surgery. However,
systemic treatments are increasingly being
shown to have a significant impact on the
course of the disease as monotherapy or adjunctive therapy. Oral mini-pulsed corticosteroid therapy, methotrexate, minocycline,
ciclosporin, Janus kinase inhibitors, and
certain supplements have been used in the
systemic treatment of vitiligo. Selenium,
zinc, polyphenols, and vitamins A, C, and E
induced visible repigmentation in mouse
studies (Searle etal., 2021).
Atopic dermatitis
General management of atopic dermatitis
in allopathic medicine involves eliminating
irritant factors, controlling emotional
stress, restoring the skin barrier function
by using hydrophilic creams and lotions for
hydration of xerotic skin, patient education,
and pharmacologic treatment of skin inflammation, including oral antihistamine,
topical and oral corticosteroids that can
cause side effects in long-term use (Howe,
2022). Physical activity like jogging and a
brisk walk is recommended, a change of environment every 2–3 months is beneficial,
and meditation is helpful in most melancholic psychological problems (Rafieian Kopaei etal., 2016).
Acne
Compliance to acne vulgaris treatment is
poor because of numerous factors. Topical
and oral antibiotic monotherapy is not
recommended because of increasing worldwide bacterial resistance. There was even use
of topical antibiotics as a monotherapy that
have additional anti-inflammatory effects.
Topical retinoids and four combination oral
contraceptives (COCs) are approved by the
US Food and Drug Administration (FDA).
Isotretinoin, which is generally safe and well
tolerated, is FDA approved for the treatment
of severe recalcitrant acne vulgaris and is also
recommended for moderate acne that is
treatment-resistant, leads to scarring, or
causes significant psychosocial distress.
There is increasing evidence regarding the
role of diet in acne, high-glycemic-index
diets, dairy especially skim milk, and whey
protein consumption should be avoided.
Dietary modifications and natural treat
ments will likely play an increasing role in
acne treatment as further evidence accrues.
In general, high-quality randomized controlled trials and analytical studies are
needed regarding the safety and comparative efficacy of various acne treatments
(Habeshian and Cohen, 2020).
Psoriasis
At present, there is no cure and no alteration
in the overall course of the disease. All treatments are suppressive. Mild psoriasis affects
less than 3 to 5% of the body surface area.
The treatment approach begins with evaluation for psoriatic arthritis, and treatment
options include topical corticosteroids, vitamin D analogs, calcineurin inhibitors, and
keratolytic and targeted phototherapy. The
moderate form covers 3 to 10% of the body
surface area, and severe psoriasis is typically
considered with a body surface area coverage of 10% or greater. The American Academy of Dermatology–National Psoriasis
Foundation guidelines recommend the consideration of prescribing biologics, oral
agents, and phototherapy concurrently for
patients with moderate to severe psoriasis.
Biologics have higher efficacy compared to
oral medications or phototherapy, and topical therapies can be used as adjunct treatments but not as monotherapy in treating
Treatment of Various Skin Diseases 373
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moderate to severe psoriasis. Physical and
mental rest help to back up the specific management of acute episodes. Anxiety and depression should be treated concomitantly
(Armstrong and Read, 2020).
definite relationship between high estrogen
levels and melasma. Because of sun-induced
pigment darkening and the important
role of UV-A radiation, advice is to use
broad-spectrum sunblock, especially outdoors. First-line therapy with hydroquinone
as whitening agent, tretinoin, corticoster-
Melasma
oids, and triple combination, because of bet-
ter efficacy, and second-line therapy with
Melasma, also known as chloasma, often occurs predominantly in women. There is a
azelaic acid and liquiritin is recommended
(Griffiths, 2006).
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