Anti-inflammatory effect of hamamelis lotion in a UVB erythema test

Hamamelis virginiana L. extract presents antimicrobial and antibiofilm effects, absence of cytotoxicity, anti-inflammatory action, and potential to fight infections through the nitric oxide production by macrophages

The potential of H. virginiana L. was evaluated against Candida spp. (C. albicans, C. dubliniensis, C. glabrata, C. guilliermondii, C. krusei, and C. tropicalis) and bacteria (Acinetobacter baumannii, Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus mutans). Effect on murine macrophages (RAW 264.7) was also evaluated with respect to cytotoxicity and production of cytokines (IL-1β and TNF-α) and nitric oxide (NO). The most effective concentrations of the extract were determined by microdilution broth. These concentrations were analyzed on biofilms, after 5 min or 24 h exposure. Cytotoxicity was performed by MTT assay and quantification of cytokines and NO by ELISA and Griess reagent, respectively. The extract acted against the planktonic forms and provided significant reductions of all the microbial biofilms; besides, showed no cytotoxic effect, except at 100 mg/mL, after 24 h exposure. There was cytokine production; however, a modulatory effect was observed in groups exposed to lipopolysaccharide (LPS) from E. coli. NO production was similar or higher than the control group. Thus, H. virginiana L. extract showed antimicrobial and antibiofilm effects; absence of cytotoxicity for RAW 264.7; anti-inflammatory action; and potential to fight infections through the NO production.

Applying skin protective cream and the wearing of gloves?-A randomized controlled experimental study

BACKGROUND

Glove occlusion might enhance skin sensitivity to a subsequent detergent challenge (occlusion effect). Thus, some skin protection creams (PC) claim to protect against this effect of occlusion, and are recommended to be used before wearing liquid-proof gloves.

OBJECTIVES

To evaluate the effect of PC applied prior to glove occlusion on the 'occlusion effect'-refers to increased susceptibility of the skin to a model detergent.

METHODS

One hundred and eleven volunteers were enrolled in a single-blind, randomized study. Seven PCs were applied before glove occlusion over 7 days (D1-D7). After sodium lauryl sulphate (SLS) challenge, we compared the irritation between the areas treated with PC and occlusion alone. Clinical scoring and bioengineering methods (capacitance, transepidermal water loss [TEWL], and colourimetry [erythema]) were used to quantify the irritant reactions.

RESULTS

After 1 week of occlusion and PC application, we did not observe significant changes in TEWL, nor in erythema, whereas skin hydration raised in three cream-treated areas. On day 10, after a challenge with SLS, some products significantly aggravated the skin irritation as compared to occlusion alone.

CONCLUSIONS

The 'occlusion effect'-shown as higher skin susceptibility to a model detergent-was not mitigated by PCs when applied prior to glove occlusion. On the contrary, some PCs might have negative effects on skin barrier function and augment such sensitivity.

Unveiling the Ability of Witch Hazel (Hamamelis virginiana L.) Bark Extract to Impair Keratinocyte Inflammatory Cascade Typical of Atopic Eczema

Hamamelis virginiana L. bark extract is a traditional remedy for skin affections, including atopic dermatitis/eczema (AD). Hamamelis preparations contain tannins, including hamamelitannin (HT), although their pharmacological role in AD is still unknown. This study aimed to study the rational for its topical use by considering the impact of crucial biomarkers on AD pathogenesis. A standardized extract (HVE) (0.5−125 μg/mL) was compared to hamamelitannin (HT), its main compound (0.5−5 μg/mL), in a model of human keratinocytes (HaCaTs), challenged with an AD-like cytokine milieu (TNF-α, IFN-γ, and IL-4). HVE inhibited the release of mediators involved in skin autoimmunity (IL-6 and IL-17C) and allergy (TSLP, IL-6, CCL26, and MMP-9) with a concentration-dependent fashion (IC50s < 25 μg/mL). The biological mechanism was ascribed, at least in part, to the impairment of the NF-κB-driven transcription. Moreover, HVE counteracted the proliferative effects of IL-4 and recovered K10, a marker of skin differentiation. Notably, HT showed activity on well-known targets of IL-4 pathway (CCL26, K10, cell proliferation). To the best of our knowledge, this work represents the first demonstration of the potential role of Hamamelis virginiana in the control of AD symptoms, such as itch and skin barrier impairment, supporting the relevance of the whole phytocomplex.

Anti-Inflammatory and Anti-Acne Effects of Hamamelis virginiana Bark in Human Keratinocytes

Cutibacterium acnes (C. acnes) is recognized as one of the main triggers of the cutaneous inflammatory response in acne vulgaris, a chronic skin disorder with a multifactorial origin. Witch hazel (Hamamelis virginiana L.) is a plant widely used for skin inflammatory conditions, with some preliminary anti-inflammatory evidence on the skin, but lacking data on acne conditions. This study aimed to evaluate the effect of a glycolic extract from Hamamelis virginiana bark (HVE) versus C. acnes-induced inflammation in human keratinocytes (HaCaT). Phytochemical investigations of HVE identified hamamelitannin (HT) and proanthocyanidins as the most abundant compounds (respectively, 0.29% and 0.30% w/w_extract). HVE inhibited C. acnes-induced IL-6 release (IC₅₀: 136.90 μg/mL), by partially impairing NF-κB activation; however, no antibacterial or antibiofilm activities were found. In addition, HVE showed greater anti-inflammatory activity when TNF-α was used as a proinflammatory stimulus (IC₅₀ of 38.93 μg/mL for IL-8 release), partially acting by antioxidant mechanisms, as shown for VEGF inhibition. The effects of HVE are primarily based on the proanthocyanidin content, as HT was found inactive on all the parameters tested. These results suggest further investigations of HVE in other inflammatory-based skin diseases.

An assessment of the growth inhibition profiles of Hamamelis virginiana L. extracts against Streptococcus and Staphylococcus spp

Staphylococcal and streptococcal species trigger a wide variety of infections involving epithelial tissues. Virginian witch hazel (WH; Hamamelis virginiana L.; family: Hamamelidaceae) is a plant that has been used traditionally by Native Americans to treat a variety of skin conditions. Extracts from the leaves were examined for their inhibitory effects on these bacterial species. Solvents of different polarity (water, methanol, ethyl acetate, hexane and chloroform) were used to prepare extracts from WH leaves, and the aqueous resuspensions were screened for antibacterial activities using disc diffusion and liquid dilution assays. Extract phytochemical profiles and toxicities were also examined, and combinations of extracts with conventional antibiotics were tested against each bacterial strain. The methanolic and aqueous extracts inhibited the growth of S. oralis, S. pyogenes, S. epidermidis and S. aureus, but not S. mutans. The extracts were especially active against staphylococcal species, with MIC values between 200 and 500 μg/ml. Combinations of active extracts with conventional antibiotics failed to yield beneficial interactions, except for two cases where additive interactions were observed (aqueous WH extract combined with chloramphenicol against S. oralis, and methanolic WH extract combined with ciprofloxacin against S. aureus). Phytochemical assays indicated an abundance of tannins, triterpenoids and phenolics in the water and methanol extracts, with trace amounts of these components in the ethyl acetate extract. Phytochemicals were not detected in hexane and chloroform extracts. Thus, phytochemical abundance in extracts was concordant with antibacterial activities. All extracts were found to be non-toxic in Artemia nauplii assays. These findings indicate the potential for WH leaf extracts for clinical use in treating staphylococcal and streptococcal infections, while substantiating their traditional Native American uses.

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H. virginiana extracts inhibited the growth of common bacterial skin pathogens.

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MIC values were determined and indicated strong inhibitory activity.

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The aqueous extract potentiated the antibacterial activity of chloramphenicol.

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The methanolic extracts potentiated activity of ciprofloxacin.

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All extracts were determined to be non-toxic by Artemia nauplii assays.

The Phytochemistry of Cherokee Aromatic Medicinal Plants

Background: Native Americans have had a rich ethnobotanical heritage for treating diseases, ailments, and injuries. Cherokee traditional medicine has provided numerous aromatic and medicinal plants that not only were used by the Cherokee people, but were also adopted for use by European settlers in North America. Methods: The aim of this review was to examine the Cherokee ethnobotanical literature and the published phytochemical investigations on Cherokee medicinal plants and to correlate phytochemical constituents with traditional uses and biological activities. Results: Several Cherokee medicinal plants are still in use today as herbal medicines, including, for example, yarrow (Achillea millefolium), black cohosh (Cimicifuga racemosa), American ginseng (Panax quinquefolius), and blue skullcap (Scutellaria lateriflora). This review presents a summary of the traditional uses, phytochemical constituents, and biological activities of Cherokee aromatic and medicinal plants. Conclusions: The list is not complete, however, as there is still much work needed in phytochemical investigation and pharmacological evaluation of many traditional herbal medicines.

Botanicals With Dermatologic Properties Derived From First Nations Healing: Part 2-Plants and Algae

INTRODUCTION

Plants and algae have played a central role in the treatment of skin conditions in both traditional First Nations healing and in modern dermatology. The objective of this study was to examine the evidence supporting the dermatological use of seaweed, witch hazel, bearberry, and mayapple.

METHODS

Four plants and algae used in traditional First Nations treatments of skin disease were selected based on expert recommendations. Several databases were searched to identify relevant citations without language restrictions.

RESULTS

Seaweed has potential clinical use in the treatment of acne and wrinkles and may be incorporated into biofunctional textiles. Witch hazel is an effective and well-tolerated treatment of inflammation and diaper dermatitis. Bearberry leaves contain arbutin, a skin-lightening agent that is an alternative for the treatment of hyperpigmentation. Mayapple contains podophyllotoxin, a treatment for condyloma accuminata, molluscum contagiosum, and recalcitrant palmoplantar warts.

DISCUSSION

Common plants and algae are replete with bioactive agents that may have beneficial effects on the skin. Further research will open the door to new and innovative products in the future. Limitations of this study include that the scope of our study is limited to 4 plants and algae, a small sample of the breadth of plants used by First Nations for dermatological treatments.

Evaluation of a topical treatment for the relief of sensitive skin

Background

Approximately, 50% of the population claim to have sensitive skin, which has created an important challenge for dermatologists and the cosmetic industry. This study evaluates the properties of QV Face Rescue Gel (Rescue Gel) that contains a combination of moisturizing and anti-irritant ingredients, and which is used to relieve the symptoms of sensitive facial skin.

Methods

The ability of Rescue Gel to induce collagen types I and III in cultured neonatal human foreskin fibroblasts compared to transforming growth factor beta 1, a known potent inducer of collagen types I and III, was measured using immunofluorescence staining. Furthermore, healthy volunteers were recruited to measure the potential for Rescue Gel to reduce erythema induced by solar-simulated ultraviolet radiation on the skin compared to 0.5% hydrocortisone cream (positive control) as well as it’s ability to decrease transepidermal water loss compared to baseline levels. In addition, the formulation was tested for its potential to be 1) nonstinging using a facial sting/discomfort assay performed on volunteers who reacted positively to lactic acid, 2) nonirritating as determined by repeat insult patch tests, and 3) noncomedogenic.

Results

Rescue Gel significantly induced collagen types I and III in cultured human foreskin fibroblasts similarly to transforming growth factor beta 1. In volunteers, Rescue Gel was shown to significantly reduce erythema induced by solar-simulated ultraviolet radiation similarly to 0.5% hydrocortisone, and to significantly reduce transepidermal water loss compared to baseline levels. Further, the formulation was found to be nonstinging, nonirritating, and noncomedogenic. No adverse events were observed.

Conclusion

In this study, Rescue Gel has been shown to exhibit properties that make it effective for use on sensitive or irritated facial skin, without exacerbation of the symptoms associated with sensitive skin.

Bioactive compounds from natural resources against skin aging

Skin aging involves degradation of extracellular matrix (ECM) in both the epidermal and dermal layers, it leaves visible signs on the surface of skin and the physical properties of the skin are modified. Chronological aging is due to passage of time, whereas premature aging occurred due to some environmental factors on skin produces visible signs such as irregular dryness, dark/light pigmentation, sallowness, severe atrophy, telangiectases, premalignant lesions, laxity, leathery appearance and deep wrinkling. There are several synthetic skincare cosmetics existing in the market to treat premature aging and the most common adverse reactions of those include allergic contact dermatitis, irritant contact dermatitis, phototoxic and photo-allergic reactions. Recent trends in anti-aging research projected the use of natural products derived from ancient era after scientific validation. Ample varieties of phytomolecules such as aloin, ginsenoside, curcumin, epicatechin, asiaticoside, ziyuglycoside I, magnolol, gallic acid, hydroxychavicol, hydroxycinnamic acids, hydroxybenzoic acids, etc. scavenges free radicals from skin cells, prevent trans-epidermal water loss, include a sun protection factor (SPF) of 15 or higher contribute to protect skin from wrinkles, leading to glowing and healthy younger skin. Present era of treating aging skin has become technologically more invasive; but herbal products including botanicals are still relevant and combining them with molecular techniques outlined throughout this review will help to maximize the results and maintain the desired anti-skin aging benefits.

Anti-inflammatory potential of a lipolotion containing coriander oil in the ultraviolet erythema test

SUMMARY BACKGROUND

Coriander oil is used as an antimicrobial agent and as a natural fragrance. The present study investigated the anti-inflammatory potency of coriander oil in the ultraviolet (UV) erythema test in vivo.

METHODS

40 volunteers were enrolled in this monocentric,randomized,placebo-controlled double-blind study.Test areas on the back were irradiated with the 1.5 fold minimal erythema dose UV-B. Subsequently, the test areas were treated under occlusion for 47 hours with a lipolotion containing 0.5% or 1.0% essential coriander oil. Hydrocortisone (1.0%) and betamethasone valerate (0.1%) in the vehicle served as positive controls.The vehicle was used as place-bo.The effect of the test substances on the UV-induced erythema was measured photometrically after 48 hours.Additionally,the skin tolerance of the test preparations was assessed on non-irradiated skin.

RESULTS

Compared to placebo, the lipolotion with 0.5% coriander oil significantly reduced the UV-induced erythema, but it was not as effective as hydrocortisone. The skin tolerance of both coriander oil concentrations was excellent.

CONCLUSIONS

The lipolotion containing coriander oil displayed a mild antiinflammatory effect in this study. It could be useful in the concomitant treatment of inflammatory skin diseases.

Hamamelis in children with skin disorders and skin injuries: results of an observational study

Published clinical experience with hamamelis ointment in children is limited. This observational study included children (age 27 days to 11 years) with minor skin injuries, diaper dermatitis, or localized inflammation of skin. The children received either hamamelis ointment or dexpanthenol ointment in groups at a 3-to-1 ratio. Baseline and post-treatment assessments compared the total scores of predefined signs and symptoms for each condition. Physicians and parents were asked for a global assessment of efficacy and tolerability of the respective treatments at the end of therapy. A total of 309 children were treated (hamamelis n = 231; dexpanthenol n = 78). The treatment groups were comparable regarding demographic data and baseline total scores of signs and symptoms. In all three diagnosis groups, the efficacy of hamamelis and dexpanthenol was shown by a statistically significant and clinically relevant decrease of total scores from baseline to endpoint (p < 0.0001 for each group, Wilcoxon signed-rank test). Overall, the results for the hamamelis and the dexpanthenol groups were similar. Descriptive advantages for the hamamelis group were observed for a number of parameters and diagnosis groups. Both treatments were well tolerated. Ratings of the tolerability of hamamelis were "excellent" or "good" in 99.1% (physicians) and 98.2% (parents) of cases, respectively. The corresponding ratings for dexpanthenol were 97.4 and 92.3%. In conclusion, hamamelis ointment is an effective and safe treatment for certain skin disorders in children up to the age of 11 years. The observed effects are similar to dexpanthenol.

Rat models of acute inflammation: a randomized controlled study on the effects of homeopathic remedies

Background

One of the cardinal principles of homeopathy is the "law of similarities", according to which patients can be treated by administering substances which, when tested in healthy subjects, cause symptoms that are similar to those presented by the patients themselves. Over the last few years, there has been an increase in the number of pre-clinical (in vitro and animal) studies aimed at evaluating the pharmacological activity or efficacy of some homeopathic remedies under potentially reproducible conditions. However, in addition to some contradictory results, these studies have also highlighted a series of methodological difficulties.

The present study was designed to explore the possibility to test in a controlled way the effects of homeopathic remedies on two known experimental models of acute inflammation in the rat. To this aim, the study considered six different remedies indicated by homeopathic practice for this type of symptom in two experimental edema models (carrageenan- and autologous blood-induced edema), using two treatment administration routes (sub-plantar injection and oral administration).

Methods

In a first phase, the different remedies were tested in the four experimental conditions, following a single-blind (measurement) procedure. In a second phase, some of the remedies (in the same and in different dilutions) were tested by oral administration in the carrageenan-induced edema, under double-blind (treatment administration and measurement) and fully randomized conditions. Seven-hundred-twenty male Sprague Dawley rats weighing 170–180 g were used. Six homeopathic remedies (Arnica montana D4, Apis mellifica D4, D30, Atropa belladonna D4, Hamamelis virginiana D4, Lachesis D6, D30, Phosphorus D6, D30), saline and indomethacin were tested. Edema was measured using a water-based plethysmometer, before and at different times after edema induction. Data were analyzed by ANOVA and Student t test.

Results

In the first phase of experiments, some statistically significant effects of homeopathic remedies (Apis, Lachesis and Phosporus) were observed (the reduction in paw volume increase ranging from 10% to 28% at different times since edema induction). In the second phase of experiments, the effects of homeopathic remedies were not confirmed. On the contrary, the unblinded standard allopathic drug indomethacin exhibited its anti-inflammatory effect in both experimental phases (the reduction in paw volume increase ranging from 14% to 40% in the first phase, and from 18% to 38% in the second phase of experiments).

Conclusion

The discrepancies between single-blind and double-blind methods in animal pharmacological research are noteworthy and should be better investigated, also in non-homeopathic research.

Anti-Inflammatory and Skin-Hydrating Properties of a Dietary Supplement and Topical Formulations Containing Oligomeric Proanthocyanidins

BACKGROUND

Anti-inflammatory and skin hydration properties of a dietary supplement and 2 topical formulations (Anthogenol) with oligomeric proanthocyanidins were investigated.

METHODS

Forty-two subjects were randomized into 2 groups: one taking the dietary supplement (100 mg/day) and the other without supplement. After 4 weeks, erythema was induced using UV radiation followed by treatment with topical cream or lotion. Erythema was measured for up to 72 h after irradiation. Skin hydration after 1 and 2 weeks of application of the cream and lotion was also measured in separate test fields.

RESULTS

Both topical formulations led to a significant suppression of erythema formation and the dietary supplement led to an additional slightly stronger suppression. Thus 72 h after UV exposure and compared to the control fields of patients that had not taken a dietary supplement, erythema was slightly (13.2%) lower in the subjects that had taken a dietary supplement. The cream resulted in a maximal reduction of erythema of 45.9% (p = 0.0015), while the lotion resulted in a maximal reduction of 53.1% (p = 0.0002). Both topical formulations also increased skin hydration (by nearly 20%; p < 0.002 for all combinations of dietary supplementation and topical treatment) and the hydration was higher in the group taking the dietary supplement.

CONCLUSION

The regular use of Anthogenol products may help to protect from free-radical-mediated skin inflammation and to increase skin hydration.

The UV Erythema Test as a Model to Investigate the Anti-Inflammatory Potency of Topical Preparations – Reevaluation and Optimization of the Method

BACKGROUND

The ultraviolet (UV) erythema test is one of the most frequently used methods to investigate the anti-inflammatory potency of topical dermatological preparations in vivo.

METHODS

The following questions were addressed in four separate studies with healthy persons (skin types 2 and 3): (1) the optimal localization was determined by comparing light scales on the back, buttocks and volar forearms; (2) the optimal UV-B dose was determined by comparing the 1-fold, 1.5-fold and 2-fold minimal erythema doses (MEDs); (3) hydrocortisone and prednicarbate were evaluated as positive controls, and a sample size calculation was performed, and (4) betamethasone valerate and pimecrolimus were tested as further positive controls in the optimized study model.

RESULTS

The back proved to be the best localization for the UV erythema test. It showed a good correlation between the light scale and the test areas. The 1.5-fold MED was the best irradiation dose. In contrast to prednicarbate and betamethasone valerate, hydrocortisone was a rather weak positive control. However, when the sample size was > or = 40 subjects, significant results were also obtained with hydrocortisone. Pimecrolimus was not effective in the UV erythema test.

CONCLUSIONS

The UV erythema test should be performed on the back with at least 40 subjects using the 1.5-fold MED. It may be useful to include a potent corticosteroid, such as prednicarbate or betamethasone valerate, in addition to hydrocortisone. The UV erythema test seems to be suitable only for substances with corticosteroid-like effects, since in this test model the calcineurin inhibitor pimecrolimus was not effective.

Accidental Sodium Hypochlorite-Induced Skin Injury During Endodontic Treatment

A case of accidental skin injury caused by leakage of sodium hypochlorite solution from the rubber dam during root canal preparation is reported. After placement of a rubber dam and initiation of root canal treatment, the patient complained of a burning sensation with sodium hypochlorite irrigation. The complaints were ignored by the practitioner, and a skin rash developed on and around the patient's chin, followed by scab formation. The patient required medical treatment with topical Hamamelis virginiana extract for 2 weeks, with full recovery.

Determination of hamamelitannin, catechins and gallic acid in witch hazel bark, twig and leaf by HPLC

An HPLC method for the determination of hamamelitannin, catechins and gallic acid in witch hazel bark, twig and leaf has been developed. The separation system consisted of a C18 reversed-phase column, a gradient elution system of methanol/water and orthophosphoric acid, and a photodiode array detector. The concentrations of hamamelitannin, gallic acid, (+)-gallocatechin and (+)-catechin were 4.77, 0.59, 0.22 and 0.39% (w/w), respectively, in the bark. Hamamelitannin and catechins were also detected in the leaves at concentration less than 0.04% (w/w). This method is simple, sensitive and reproducible, ideally suited for rapid, routine analysis.

Anti-inflammatory efficacy of topical preparations with 10% hamamelis distillate in a UV erythema test

In 40 volunteers the efficacy of three lotions with 10% hamamelis distillates from different suppliers, two vehicles, dimethindene maleate 0.1% gel, hydrocortisone 1% cream and hydrocortisone 0.25% lotion were investigated in a modified UV erythema test with three UV dosages (1.2, 1.4 and 1.7 MED). The test preparations were applied occlusively over a 48-hour period following irradiation. Chromametric measurement of redness and visual assessment were performed 24, 48 and 72 h after induction of erythema. The hydrocortisone formulations were most effective in erythema suppression. An anti- inflammatory effect was noted for all three hamamelis lotions as well as for the vehicles. A significantly greater suppression of erythema than seen with the vehicles was noted for one of the hamamelis lotions at 1.4 MED. The efficacy of the antihistamine dimethindene maleate did not surpass the hamamelis lotions or the vehicles. Even though the differences between the hamamelis lotions were slight, it was possible to make an objective selection of the best hamamelis distillate for aftersun purposes.

Antioxidant and photoprotective activity of a crude extract of Culcitium reflexum H.B.K. leaves and their major flavonoids

The aim of the present study was to evaluate the in vitro antioxidant and in vivo photoprotective activities of an ethanolic extract of Culcitium reflexum H.B.K. leaves (ECR extract). The antioxidant activity of the extract was assessed by means of three different in vitro tests: (1) bleaching of the stable 1,1-diphenyl-2-picrylhydrazyl radical; (2) peroxidation, induced by the water-soluble radical initiator 2,2'-azobis(2-amidinopropane)hydrochloride, on mixed dipalmitoylphosphatidylcholine/linoleic acid unilamellar vesicles; (3) UV radiation-induced peroxidation in phosphatidylcholine multilamellar vesicles. In all in vitro tests used the ECR extract showed a significant antioxidant effect. Furthermore, a gel formulation containing this extract proved, when topically applied, to afford a significant in vivo protection against UV-B-induced skin erythema in healthy human volunteers. Then, by chromatographic fractionation and spectroscopic methods, we identified some cinnamic acid derivatives and the major flavonoid constituents of the ECR extract, viz. the flavonols rutin, quercetin-3-O-beta-D-galactopyranoside-4'-O-beta-D-glucopyranoside, quercetin-3-O-beta-D-glucopyranoside, isorhamnetin-3-O-beta-D-galactopyranoside, quercetin and kaempferol.

Topical metronidazole does not abate UVB-induced erythema

BACKGROUND

The capacity of topical metronidazole to reduce erythema severity scores in rosacea has been attributed to its anti-inflammatory activity.

METHODS

Nine healthy subjects were irradiated on three 1-cm(2) areas on their volar forearm with 2 MEDs of UVB. Twenty-four hours later, one of the irradiated areas was treated daily with metronidazole 1% vanishing cream, one with the vehicle only and the third was left untreated (control). The intensity of erythema was measured, at 24, 48, 72 and 96 h after irradiation, by a Chromameter CR200 (Minolta, Japan) and expressed in the L*a*b* system. The a* parameter was taken as the measure of redness.

RESULTS

Overall, redness diminished over time in a linear way, but treatments did not influence it significantly.

CONCLUSION

In our vehicle, metronidazole 1% cream failed to abate the UVB-induced erythema. An activity other than the anti-inflammatory one should be suggested to explain the topical metronidazole efficacy in rosacea.

Complementary and alternative medicine for glaucoma

Given the recent interest in complementary and alternative medicine (CAM), some patients may seek such treatments to supplement their traditional glaucoma management. The prevalence of CAM use for glaucoma is approximately 5%. We reviewed the literature to determine the potential benefit of various alternative treatments. Aside from a temporary osmotic effect from high dose intravenous ascorbic acid, there is no evidence that megavitamin supplementation has a beneficial effect on glaucoma. During exercise, autoregulation in healthy eyes seems to maintain a consistent blood flow rate to the optic nerve despite fluctuations in intraocular pressure (IOP). In a glaucomatous eye, the very modest IOP-lowering that follows exercise may be offset by the initial elevation in IOP that occurs when one first initiates exercise. At this time, there is no evidence to encourage or discourage the use of special diets, acupuncture, relaxation techniques, or therapeutic touch specifically for the treatment of glaucoma. Very little research has been done on the majority of herbal remedies with regard to their treatment of glaucoma. Marijuana can cause a profound lowering of IOP, but the high nonresponse rate, short half life, and significant toxicity are strong indicators that it is not an appropriate therapeutic agent. Ginkgo biloba and some other Chinese herbal remedies do not affect IOP, but may improve blood flow to the optic nerve and, as such, may have a beneficial effect on glaucoma. These agents have recognized toxicities. Although there are some well-designed studies of alternative treatments, many of the recommendations for using alternative treatments are currently unsupported by the data provided.

In-vitro antioxidant and in-vivo photoprotective effect of three lyophilized extracts of Sedum telephium L. leaves

Sedum telephium L. is a medicinal plant used in antiquity to cure many types of inflammatory skin diseases. The leaves (without the external cuticle), are used to promote healing and reduce skin inflammation and pain, and contain various components. We found two major components: flavonol glycosides and polysaccharides, with molecular weight between 13,000 and 13,500 Da. We evaluated the in-vitro antioxidant and in-vivo skin photoprotective effects of three lyophilized extracts obtained from the juice of S. telephium L. leaves: a total lyophilized juice, a lyophilized flavonolic fraction, and a lyophilized polysaccharidic fraction. Two in-vitro models were used: the bleaching of the stable 2,2-diphenyl-1-picrylhydrazyl (DPPH*) radical, and the protective effect against UV-induced peroxidation on phosphatidylcholine multilamellar vesicles, as model membranes. The antioxidant/radical scavenging activity of each lyophilized extract was also assessed in-vivo by determining their ability to reduce UVB-induced skin erythema (monitored by reflectance spectrophotometry) in healthy human volunteers. The findings of the in-vitro experiments clearly demonstrated that, unlike the lyophilized polysaccharidic fraction, the lyophilized flavonolic fraction and total lyophilized juice possess strong antioxidant/free radical scavenging properties, which are likely due to phenolic compounds. Consistent with these findings, gel formulations of both the total lyophilized juice and, to a greater degree, the lyophilized flavonolic fraction appeared to possess a strong protective effect against UV-induced skin erythema in-vivo, whereas the lyophilized polysaccharidic fraction was completely ineffective. The in-vitro and in-vivo results suggest that, both the total lyophilized juice and, in particular, the lyophilized flavonolic fraction, but not the lyophilized polysaccharidic fraction of S. telephium L. leaves, have photoprotective effects against UVB-induced skin damage.

Inflammation and Native American medicine: the role of botanicals

There is a growing interest in medicinal botanicals as part of complementary medicine in the United States. In particular, both physicians and consumers are becoming aware of the use of herbals by Native American societies; many botanicals sold today as dietary supplements in the United States were used by Native Americans for similar purposes. Yet, these supplements represent only a small number of the >2500 different plant species from vascular taxa, and >2800 species from all taxa, known to have been prized for their medicinal properties by the indigenous inhabitants of the North American continent. We review some of the studies of the immunomodulatory activities of botanicals used by native peoples of North America, the bioactive constituents responsible for those activities, and the mechanisms by which these constituents might modulate the immune system. We focus particularly on 3 species of purple coneflower (ECHINACEA:) because of the widespread use of purple coneflower in the United States to boost immunity and prevent upper respiratory infections. Seven of the 10 most common botanicals sold in the United States were used extensively by Native Americans. However, there are very few data to support such use and even less information about drug toxicity or interactions.