Vous êtes sur la page 1sur 10

Topical application of natural honey, beeswax and olive oil mixture for atopic dermatitis or psoriasis: partially controlled,

single-blinded study
Noori S. Al-Waili
Dubai Specialized Medical Center and Medical Research Laboratories, Islamic Establishment for Education, Dubai, United Arab Emirates

SUMMARY. Objectives: To investigate the effects of honey, olive oil and beeswax mixture on patients with atopic dermatitis (AD) or psoriasis vulgaris (PV). Materials and methods: Twenty-one patients with dermatitis and 18 patients with psoriasis were entered for patient-blinded, partially controlled study; 11 patients with dermatitis used topical betamethasone esters and 10 patients with psoriasis used clobetasol propionate. Honey mixture contained honey, beeswax and olive oil (1:1:1). Mixtures A, B, and C contained honey mixture with the corticosteroids ointment in a ratio of 1:1, 2:1, and 3:1 respectively. Patients with dermatitis were subjected to controlled bilateral half-body comparison to evaluate the efcacy of honey mixture against Vaseline, or mixture A against Vaselinebetamethasone esters mixture (1:1) in patients using topical corticosteroid treatment. In patients with psoriasis, the effect of honey mixture was compared with parafn in an individual right/left-sites comparison, or mixture A against parafnclobetasol propionate mixture (1:1) in patients using corticosteroid topical therapy. In dermatitis, body lesions on right or left half-body were assessed for erythema, scaling, lichenication, excoriation, indurations, oozing and itching on a 04 points scale. In psoriasis, lesions of selected site were assessed for redness, scaling, thickening and itching, on a 04 points scale. Results: In honey mixture group, 8/10 patients with dermatitis showed signicant improvement after 2 weeks, and 5/11 patients pretreated with betamethasone esters showed no deterioration upon 75% reduction of corticosteroid doses with use of mixture C. In psoriasis, 5/8 patients showed a signicant response to honey mixture. In patients using clobetasol propionate, 5/10 patients showed no deterioration upon 75% reduction of corticosteroid doses with use of mixture C. Conclusion: Honey mixture appears useful in the management of dermatitis and psoriasis vulgaris. 2003 Elsevier Ltd. All rights reserved.
Noori S. Al-Waili, Dubai Specialized Medical Center and Medical Research Laboratories, Islamic Establishment for Education, P.O. Box 19099, Dubai, United Arab Emirates. Fax: +971-4-2646025; E-mail: noori1966@ yahoo.com

INTRODUCTION
Psoriasis and atopic dermatitis (AD) represent challenging problems regarding their management and incidence. Atopic dermatitis is the most common
2003 Elsevier Ltd. All rights reserved.

inammatory skin disease in childhood,1 with a 1015% incidence. Moderate to severe AD can have a profound effect on the quality of life. Treatments include Vaseline, corticosteroids, cetirizine, antibacterial drugs and phototherapy, and there is

Complementary Therapies in Medicine (2003), 11, 226234 doi:10.1016/S0965-2299(03)00120-1

226

Topical application of natural honey, beeswax and olive oil mixture for atopic dermatitis or psoriasis

227

evidence to support the use of oral cyclosporin, topical steroids, psychological approach and ultraviolet light therapy.2 Psoriasis vulgaris (PV) is one of the commonest skin problems seen by general practitioners, affecting 12% of the population.3 Psoriasis is a chronic inammatory and proliferative disorder of skin that results in a rapid turnover of the skin cells that move rapidly up to the surface in 35 days. This leads to thickening of the supercial layers. Psoriasis is characterized by red, elevated plaques that are overlaid with thick silvery white scale. Plaque psoriasis is known as chronic stable plaque psoriasis or psoriasis vulgaris. For PV involving less than 20% of body surface area, initial treatment is topical including emollients (parafn), keratolytics (salicylic acid), coal tar, zinc, retinoids, dithranol, betamethazone and calcipotriene. Adverse effects include skin irritation, salicylate intoxication, unpleasant odor, staining of clothes, thinning of skin, steroid striae, telangiectasia, potential carcinogenic risk and tachyphylaxis with repeated use of steroids. Other treatments such as phototherapy and systemic therapy (methotrexate, cyclosporine, acitretine) are associated with toxicity. Natural remedies seem promising in the management of a wide range of dermatological diseases including PV and AD. Large number of patients with PV reported previous or current use of one or more form of alternative medicine.4,5 It was estimated that 3569% of patients with dermatological diseases used complementary/alternative medicine including herbs, diet, hypnotherapy and natural supplement.6 Intravenous administration of omega oils is safe and effective in the treatment of chronic psoriasis vulqaris.7 Topical and oral sh oil can be useful in the treatment of psoriasis.8,9 Topical application of Aloe vera was found effective in psoriasis.10 Vitamin B12 cream containing avocado oil has potential long-term topical therapy of psoriasis.11 Chamomile preparation proves to be effective in relieving associated signs and symptoms in AD and enhancing granulation and epithelization without deleterious side effect.12 Honey is one of the oldest known medicines. It has been valued highly in the Middle East and was mentioned in the Quran 1400 years ago. It has been used for treatment of respiratory diseases, urinary diseases, gastrointestinal diseases, and skin diseases including ulcers, wounds, eczema, psoriasis and dandruff.13 Honey reduces inammation, edema, and exudation, promotes healing, diminishes scar size, and stimulates tissue regeneration.1416 Olive oil, beeswax and honey are natural materials that contain favonoids, antioxidants, antibacterial ingredients and effects cytokines production by skin cells when applied topically.1721 The objective of the study is to investigate the therapeutic effect of honey mixture prepared by mixing natural honey, beeswax and olive oil on the skin lesions in patients with AD

or psoriasis who are using either no treatment or local steroids.

MATERIALS AND METHODS Honey mixtures


Honey mixture was prepared by thorough mixing of natural honey, olive oil and beeswax (v/v/v, 1:1:1). Honey mixture with corticosteroid ointment was prepared in a v/v ratio of 1:1 (Mixture A), a ratio of 2:1 (Mixture B), and in a ratio of 3:1 (Mixture C), using the corticosteroid (betamethasone esters or clobetasol propionate) which the patient was using prior to inclusion. Natural unprocessed honey and beeswax were obtained from Lootah Farm, Al-Theed City, UAE. Honey was dark yellow in color, multioral origin, and its composition included fructose 38%, glucose 28%, acidity 13%, moisture 20%, Vitamin C 2.3 mg%, copper 0.09 mg%, zinc 0.6%, sucrose less than 0.5 mg%, pH 3.8, and glutathione reductase 0.5 mg%. Natural olive oil was prepared by cold press.

Study design
The study was patient-blind partially controlled conducted in two parallel parts among patients referred to the Dermatology Clinic, Dubai Specialized Medical Center and Medical Research Laboratories. The study was approved by Human Ethical Committee, Islamic Establishment for Education. Informed consent was obtained from the patients or their parents after thorough explanation of the procedure. The prepared mixtures and Vaseline or parafn were kept in dark containers at room temperature with special labeling to maintain patient blinding.

Atopic dermatitis
There were 21 patients with moderate to severe AD diagnosed according to Hanin-Rajka criteria for diagnosis of AD.22 The age range was 516 years, with 4 females and 17 males. Patients suffering from any other inammatory conditions, undergoing ultraviolet treatment or taking any other systemic steroid or immunosuppressive medications prior to entry were excluded. Patients either had no current treatment at time of inclusion or were treated exclusively with topical corticosteriods. Patients had skin lesions on both sides of their body mainly arms and/or legs. According to their previous treatment the patients were divided into two groups. Group 1 included 10 patients who had no treatment at time of inclusion; group 2 included 11 patients who were under current treatment with topical application of corticosteriods preparations (betamethasone esters 0.1%) during 36 months prior to time of inclusion. In group 1, lesions on the right side of the body were treated with Vaseline and lesions on the left part of the body were treated with honey mixture.

228

Complementary Therapies in Medicine

Each treatment was applied three times daily with gentle rubbing and was continued for 2 weeks with weekly follow-up. If there was no response after 2 weeks with either treatment, other management was commenced and the treatment recorded as failure. In case of response to honey mixture but not to Vaseline, Vaseline was replaced by honey mixture. In group 2, skin lesions on the right side were treated with mixture containing betamethasone esters 0.1% and Vaseline (v/v, 1:1), while lesions on the left side were treated with mixture A. In case of response to mixture of Vaseline and betamethasone esters 0.1% after 2 weeks, this treatment was continued and the patients were dropped out from further comparison. When there was no response to betamethasone esters 0.1%-Vaseline mixture after 2 weeks, a crossover trial with use of mixture A was started. In patients who responded to mixture A after 2 weeks, mixture B was used for next 2 weeks, and, provided there was a response, this was followed by mixture C for 2 weeks. At each visit, the body lesions were assessed separately by the author for signs including erythema, scaling, lichenication, excoriation, induration/papulation, oozing/crusting, and for the reported intensity of pruritis. The severity of each sign and symptom was assigned a score of 04; none = 0, mild = 1, moderate = 2, severe = 3, and very severe = 4. This simple scoring system was adapted from several others.2325 The scores of the lesions at each site were summed and the mean was calculated before and during therapy.

crossover trial with use of honey mixture instead of parafn was carried out. In group 2, the lesions on the left side of body were treated with mixture A and on the right side of body the lesions were treated with mixture of parafn and clobetasol propionate 0.05% (v/v, 1:1). In patients who responded to mixture A but not to steroid mixture, the steroid mixture used on the right side was replaced by mixture A. When there was response to mixture A, this was replaced with mixture B at end of third week, which in turn was replaced, in the case of a response, with mixture C at end of sixth week. After 3 weeks of using mixture C, the responders to mixture C were treated with honey mixture instead of mixture C for next 12 weeks; cases of relapse upon complete withdrawal of clobetasol application with use of honey mixture were recorded. Subsequently, mixtures A, B and C were used to allow gradual reduction of corticosteroid doses without relapse. The patients were assessed on inclusion and weekly during whole study period. Target lesions were assessed for redness, scaling, thickening, and itching; each on a 04 scale (none = 0, mild = 1, moderate = 2, severe = 3, and very severe = 4). The severity of lesions and efcacy of therapy were evaluated by the investigator on each visit, using the above simple scoring system adapted from others.26,27 The scores of the lesions at each site were summed and the mean was calculated before and during therapy.

Statistical analysis Psoriasis vulgaris


This part of the study included 18 patients aged 20 years or older (mean 32 years, range 2060), 14 males and 4 females, with plaque psoriasis. Skin lesions were symmetrical, bilateral and involving at least 10% of the body surface. Patients on systemic treatment including steroids, etretinate, methotrexate, psoralen, and ultraviolet-PUVA were excluded. According to their current treatment, the patients were divided into two groups. Group 1 included eight patients on no current treatment and group 2 included 10 patients using topical application of corticosteriod preparations (Clobetasol propionate 0.05%) for last 36 months prior to their inclusion. Pairs of comparable areas were selected, on right and left sides of the body. The site of lesions which was selected for study was 812 cm, including 23 plaques. In group 1, lesions on the right side were treated with parafn and lesions on the left side were treated with honey mixture. Both treatments were applied three times daily with gentle rubbing. Treatment continued for 3 weeks with weekly follow-up. If there was no response with any of the treatments during 3 weeks, the lesions would be treated by other means and failure of the treatment was recorded. In case of response, treatment was continued for further 3 weeks. When there was no response to parafn, Mean and standard deviation was used to express score of signs and symptoms of the lesions. ANOVA was used to compare means of scores before treatment and at each time intervals after the treatment. Students t-test was used to compare between means of scores of lesions on the left and right part of the body at same time and treatment. Clinical response was monitored using these scores, and a response in patients using steroids before inclusion was taken to mean reduction of dose of corticosteroids without deterioration in the clinical signs and symptoms and increase in symptom score.

RESULTS
All the patients with AD or PV completed the trial. The mixtures rubbed in well and did not leave the skin oily or irritated. Honey mixtures were excellently tolerated and no side effects were reported in patients with AD or PV. Table 1 illustrates the degree and extent of AD in individual patients and records the individual responses. Table 2 shows the mean score of AD lesions on the right and left parts of body and their responses to honey mixture or Vaseline. In honey mixture group, signicant improvement in signs and

Topical application of natural honey, beeswax and olive oil mixture for atopic dermatitis or psoriasis
Table 1 Severity scores for atopic dermatitis (AD) and psoriasis vulgaris (PV) lesions before and after the different therapies (see text for details of scoring) Number of patients Right side Patients with AD 1 2 3 4 5 6 7 8 9 10 Patients with PV 1 2 3 4 5 6 7 8 Total score before treatment 17 18 22 15 15 17 22 14 15 14 Total score before treatment 11 10 11 13 7 9 13 10 Total score after Vaseline treatment 7 14 15 15 12 18 19 6 14 21 Total score after parafn 10 9 10 11 3 8 10 8 Total score before treatment 16 18 20 14 14 18 22 14 14 21 Total score before treatment 11 12 10 11 13 14 8 8 Side of lesions Left side Total score after honey mixture 6 6 4 3 2 3 4 6 16 17 Total score after honey mixture 10 11 10 2 4 2 2 3

229

symptoms of the lesions was obtained in eight out of 10 patients during rst week of the treatment. The earliest and most profound improvement was obtained in pruritis, scaling and oozing. Improvement continued over time, with the lowest mean score at end of the fourth week. Two patients showed no response to honey mixture and were excluded from further comparison. On the right side of body, two patients responded well with Vaseline treatment; they continued using Vaseline treatment and dropped out from further comparison.

Eight patients showed no improvement with use of Vaseline and were given honey mixture; two of them showed no response with use of honey mixture on the right side of their body too. The remaining six patients all showed signicant improvement during the rst week of the treatment. In case of response with honey mixture, the treatment was discontinued after 4 weeks; relapse occurred within 46 weeks for lesions on left side (in four out of eight patients) and lesions on right side (in three out of six patients).

Table 2 Effect of honey mixture or Vaseline topical application on AD skin lesions on right and left side-body of the patients who had no current treatment at time of admission Time Scores (mean S.D.) Lesions on right half-body 0 (Baseline) Treatment Vaseline (10)a Week 1 Week 2 15.4 3.6 14 4.8 Honey mixture (6) Week 3 Week 4 F value Total d.f. P value
a

Lesions on left half-body 17.1 3.1 Honey mixture (10) 11.2 4.2* 6.7 5.3 ,* Honey mixture (8) 3.1 1.4 1.75 0.4 55.7 45 <0.0001

Between groups P value 0.876

16.9 2.9

0.022 0.0129

9.3 4.5 4.8 5.07 9.652 41 <0.0001

Number of patients right or left halves-body. P < 0.05 as compared to baseline mean score on the same half-body. * P < 0.05 as compared to mean score of lesions on the right halves-body.

230

Complementary Therapies in Medicine


Table 3 Effects of mixtures A, B, and C and mixtures of steroids and Vaseline on AD scores in the right and left halves of the body in patients using steroids Time 6.3 2.01 Steroids and Vaseline (11)a Week 1 Week 2 12.4 12.1 5.4 4.7 Mixture A (7) Week 3 Week 4 11.6 1.5 8.4 1.7 Mixture B (6) Week 5 Week 6 F value Total d.f. P value
a

Scores (mean S.D.) Lesions on right half-body Lesions on left half-body 6.5 1.6 Mixture A (11) 12.3 2.6 8.5 2.6 Mixture B (8) 10.75 1.8 7.87 2.1 Mixture C (6) 9 1.09 6.66 1.5 9.763 60 <0.0001

P value

0 (Baseline) Treatment

0.690

1.000 0.1256

11.6 7.5 1.2 4.98 58 0.0004

1.5

Number of patients right or left halves-body. P < 0.05 in comparison to Vaseline in the same half of the body.

In patients with AD using topical corticosteroid therapy prior to their inclusion, signicant elevation of mean score of the signs and symptoms of the lesions on the left side of body during rst week was obtained following treatment with mixture A. Scores reduced to become not signicantly different from baseline score during the second week of the treatment in eight out of 11 left halves of bodies (Table 3). Similar results were obtained with mixture B (response was obtained in six out of eight halves-body) and mixture C (response was obtained in ve out of six left halves of patients bodies). On the right half of the patients bodies, there was no response to betmethasone estersVaseline mixture (1:1) in 7/11 patients during rst 2 weeks of treatment. Upon treatment with mixture A, 6/7 right body-halves showed a response and after 2 weeks they were treated with mixture B; ve out of six patients showed response. After further 2 weeks, mixture C replaced mixture B; four out ve showed response. The mean scores reduced toward baseline values with mixtures A, B and C in spite of reduction of corticosteroid doses. The response was obtained in 8/11 left halves of patients bodies upon 50% reduction of steroid doses with use of mixture A, 6/8 upon 66% reduction in corticosteroid doses with use of mixture B, and 5/6 upon 75% reduction of topical corticosteroid doses with use of mixture C. After 6 weeks, replacement of mixture C by honey mixture (complete withdrawal of corticosteroid treatment) caused deterioration of signs and symptoms of patients with AD who had been treated with clobetasol prior to their inclusion; in lesions of four out of ve left halves of patients bodies and in three out of four right halves of patients bodies. Table 4 demonstrates the degree and extent of PV at baseline and relates this to the individual

response. Five out of eight psoriatic patients who had no treatment at time of inclusion showed signicant response on their left sides during second to third weeks of treatment by honey mixture (Table 5). The effect of honey mixture was time related; the greatest effect was obtained at end of the sixth week of treatment. On the right side of body, parafn caused insignicant response in 7/8 patients, three of whom showed no response to honey mixture on their left side. The remaining four patients received honey mixture instead of parafn; two of them showed signicant improvement. Discontinuation of treatment with honey mixture after 6 weeks caused relapse of psoriatic lesions in the left side of body (3/5) and on the right side of body (3/4). In psoriatic patients using topical clobetasol propionate therapy, no signicant deterioration in the score occurred in 7/10 patients using mixture A on the left side during 13 weeks of treatment (Table 6). A similar result was obtained in 6/7 left sides treated with mixture B and 5/6 with mixture C. With use of mixture consisting of clobetasol propionate plus parafn (1:1), lesions on 8/10 right part of bodies showed signicant deterioration in the signs and symptoms of psoriatic lesions during 13 weeks of treatment. Six patients used mixture A instead of mixture of parafn and clobetasol propionate on the right side, ve of whom showed a response during 3 weeks of treatment. Similar results were obtained in 4/5 right sides treated by mixture B, and 3/4 right sides treated with mixture C (Table 7). Replacement of mixture C by honey mixture (complete withdrawal of clobetasol) caused relapse of lesions in 2/3 right sides and in 3/4 left sides during the following 8 weeks. Only one patient out of 10 showed no relapse of psoriatic lesions on the right and left side of his body after replacement of mixture C by honey

Topical application of natural honey, beeswax and olive oil mixture for atopic dermatitis or psoriasis
Table 4 Severity of AD and PV lesions in patients treated with topical application of corticosteroid prior to their inclusion Number of patients Right side Patients with AD 1 2 3 4 5 6 7 8 9 10 11 Patients with PV 1 2 3 4 5 6 7 8 9 10 Total score before treatment 8 10 8 8 6 4 6 4 5 7 4 Total score before treatment 4 4 5 4 3 4 7 7 7 7 Total score after betamethasone and Vaseline 12 13 19 21 17 14 13 8 6 7 5 Total score after clobetasol parafn 10 9 9 10 4 4 11 12 12 12 Total score before treatment 6 7 7 6 7 4 7 6 4 5 7 Total score before treatment 5 4 6 4 3 4 6 7 6 7 Side of lesions Left side Total score after mixture A 8 9 8 8 7 4 7 6 11 12 13 Total score after mixture A 5 5 4 3 4 3 6 12 11 12 Total score after mixture B 8 8 7 8 7 4 10 11

231

Total score after mixture C 6 11 7 7 6 4

Total score after mixture B 5 5 3 4 4 4 12

Total score after mixture C 6 4 4 3 5 10

Table 5 Effects of parafn or honey mixture on psoriatic lesions on right and left part of body in patients who had no current treatment at time of inclusion Time 10.88 1.9 Parafn (8)a Week 1 Week 2 Week 3 10.38 2.26 9.37 2.26 8.6 2.5 Honey mixture (4) Week 4 Week 5 Week 6 F value Total d.f. P value
a

Scores (mean S.D.) Lesions on right side of body Lesions on left side of body 10.8 2.16 Honey mixture (8) 8.75 3.65 6.87 4.12 5.5 4.07 Honey mixture (5) 2.4 0.89 2 0.7 1.8 0.4 8.917 46 <0.0001

Between groups P value 1.000

0 (Baseline) Treatment

0.3214 0.163 0.0821

7.7 3.3 6.2 3.8 5.7 3.3 3.026 43 0.0153

Number of patients right or left side-body with psoriatic lesions. P<0.05 as compared to baseline mean score on the same part of body.

mixture, viz. honey mixture could replace clobetasol treatment in 1/10 patients with psoriasis after gradual reduction of clobetasol doses with use of mixtures A, B and C.

DISCUSSION
Results showed that topical application of honey mixture containing natural honey, beeswax and olive

oil was associated with signicant improvement of signs and symptoms of AD in 80% of patients who had no treatment at time of inclusion. In patients who were under current corticosteroid therapy at time of their inclusion, honey mixture enabled them to reduce the dose of corticosteroid without deterioration in the condition. Regarding PV, there were marked improvements in 50% of patients with honey, and a great reduction in dose of corticosteroid in those who were under corticosteroid therapy. This study

232

Complementary Therapies in Medicine

Table 6 Effects of mixtures A, B, and C and steroid plus parafn mixture on psoriatic scores in patients using topical steroids preparation Time Scores (mean S.D.) Lesions on right side of body 0 (Baseline) Treatment Steroids plus parafn (10)a Week 1 Week 2 Week 3 10 10.4 1.3 9.4 1.8 2 Mixture A (6) Week 4 Week 5 Week 6 7.8 1.12 5.7 2.3 4.5 2.3 Mixture B (5) Week 7 Week 8 Week 9 F value Total d.f. P value
a

Lesions on left side of body 5.2 1.3 Mixture A (10) 7.8 3.7 7.1 3.7 ,* 6.7 3.5 Mixture B (7) 6.4 2.8 5.8 2.5 5.2 3.0 Mixture C (6) 72 5.8 1.6 4.5 1.04 1.017 78 0.0222

Between groups P value

5.4 1.7

0.3434

0.0751 0.0235 0.082

8.8 6.2 2.6 6 2.8 9.561 72 <0.0001

1.6

Number of right or left side of body with psoriatic lesions subjected for treatment. P < 0.05 as compared to baseline mean score on the same part of body. * P < 0.05 as compared to mean score of lesions on the right side of body.

is the rst to report therapeutic effects of honey mixture on patients with AD and psoriasis. Many scoring system are available for AD or psoriasis, but none has been uniformly accepted and none allows quick and reliable assessment of patients in busy clinic.2427 We therefore devised a simple scoring system for estimating local signs and symptoms, but not extension of the lesions since we used local application. Lichenication and drying were the most difcult feature to assess because they respond slowly to treatment. The most pronounced changes with use of honey mixture we found for itching, erythema, scaling and oozing. The pathogenic aspects of AD include imbalanced T-helper 1/T-helper 2 response, altered prosta-

glandin metabolism, defect in keratinocyte function, delayed eosinophil apoptosis and IgE-mediated facilitated antigen presentation by epidermal dendritic cell.34 Current treatment is directed to the reduction of cutaneous inammation and infection and to the elimination of exacerbating agents. It is shown that elevated concentrations of prostaglandin and Leukotriene B4 are important in skin lesion of AD.28 Moreover, increased oxidative stress is important in the pathophysiology of AD.29 . Olive oil is a source of at least 30 phenolic compounds such as hydroxytyrosol and oleuropein which have bactericidal activity.30 Phenolic acid in olive oil has protective effect against cytotoxic effect of reactive oxygen species.31 Olive oil inhibits

Table 7 Number of right or left halves of body with AD or PV lesions, which showed signicant response to treatment Types of treatment in the study Groups of patients No active treatment at time of inclusion Right part-body Honey mixture Mixture A Mixture B Mixture C Vaseline Vaseline corticosteroid mixture Parafn Parafn corticosteroid mixture 2/10 (AD) 3/11 (AD) 1/8 (PV) 2/10 5/6 (AD) 2/4 (PV) Left part-body 8/10 (AD) 5/8 (PV) 6/7 (AD) 5/6 (PV) 5/6 (AD) 4/5 (PV) 4/5 (AD) 3/4 (PV) 8/11 (AD) 7/10 (PV) 6/8 (AD) 6/7 (PV) 5/6 (AD) 5/6 (PV) Corticosteroid treatment at time of inclusion Right part-body Left part-body

Topical application of natural honey, beeswax and olive oil mixture for atopic dermatitis or psoriasis

233

platelet aggregation and prostaglandin.32 Hydroxytyrosol in olive oil inhibited in a dose-related manner the production of leukotriene B4.18 Olive oil diet increased nitric oxide and decreased arachidonic acid production.19 Olive oil appeared to be protective against cutaneous actinic damage.33 A natural mixture of high molecular weight alcohol (D-002) isolated and puried from beeswax, produces a signicant reduction of exudate volume in carrageenan-induced pleuritic inammation.34 D-002 reduced leukotriene B4 and thromboxane B2 and diminished granuloma weight.20 In a mixture with a boric acid and zinc oxide ointment, beeswax has been used on patients with chronic eczema and psoriasis with improvement.35 Beeswax was used as ointment for skin burn care.21 Honey reduces pain, oedema, exudates and scar formation.36 Honey seems to accelerate wound healing as measured by the thickness of granulation tissue, epithelialisation from the periphery of the wound and the size of the open wound.37 Pure honey inhibited fungal growth and diluted honey appears capable of inhibiting toxin production.38 In an earlier study, we found that conjunctival application of honey could eradicate acute bacterial conjunctivitis due to Staphylococcus aureus.39 In comparison with antibiotics, honey eradicated bacterial conjunctivitis in rats due to Pseudomonas aerogenosae as effectively as antibiotics.40 . In vitro studies, 3050% of honey in liquid broth inhibited growth of many human pathogenic bacteria including Candida albicans.41 In patients with postoperative wound infections topical honey application causes faster eradication of bacterial infections, reduces antibiotic used and hospital stay, accelerates wound healing, and results in minimal scar formation.17 In addition, we have used honey to treat seborrheic dermatitis and dandruff.42 More recently, we have found that honey lowers plasma concentrations of prostaglandin E2, prostagalndin F2 alpha and thromboxane B2 in healthy subjects.43 The mechanism of action of honey has not been denitely known though acidity, osmolality, and hydrogen peroxide production have been proposed as an important factors.16 Recently we found that honey increased nitric oxide in saliva taken from normal individuals.44 In addition, it was found that various honeys contained different amount of nitric oxide metabolites and intravenous honey could increase urinary nitrite excretion in the animals.45 Flavonoids, rich in olive oil and honey, have potent antioxidant, cytoprotective and anti-inammatory activities and inhibited histamine, IL 6 and IL 8.46 Nitric oxide reduced incidence of skin infection in psoriasis.47 Nitric oxide donors signicantly reduced the number of CD14 and CD3 cells inltrating the epidermis in psoriatic skin.48 We and others have shown that non-steroidal anti-inammatory drugs may be an important therapy in the treatment of acne, psoriasis, urticaria and others.49,50

The mechanism of therapeutic effects of honey mixture on AD or psoriastic skin lesions might be attributed to reduction in the prostaglandin synthesis at site of application, elevation of nitric oxide in the lesions, inhibition of fungal or bacterial growth, inhibition of leukotriene B4, and to its antioxidant and anti-inammatory activities. Further studies are needed to substantiate the results of this study. In spite of considerable limitation of the present study including small number of participants, short duration of follow-up, simple method of scoring, and single blinding, the results obtained provide evidence to justify proceeding to a denitive randomized trial.

ACKNOWLEDGEMENTS The author would like to thanks Haj Saeed Lootah, Chairman of trustee, Dubai College of Medicine and Islamic Establishment for Education for his kind support. Prof Najeem Al-deen, Chairman, Lootah University, and Mr. Amjed Ali, Miss Jaya David and Anni Koshi, nursing staff, provided assistant.

REFERENCES 1. Schultz-Larsen F, Hanin J. Secular changes in the occurrence of atopic dermatitis. Acta Derm Venereol 1992; 176: 712. 2. Hoare C, Li Wan Po A, Willaims H. Systematic review of treatment for atopic eczema. Health Technol Assess 2000; 4: 1191. 3. Greaves M, Weinstein G. Treatment of psoriasis. N Engl J Med 1995; 332: 581588. 4. Fleischer A, Feldman S, Rapp S. Alternative therapies commonly used within a population of patients with psoriasis. Cutis 1996; 58: 216220. 5. Jensen P. Alternative medicine and chronic skin diseases. Use of alternative treatments among patients with atopic eczema and psoriasis. Tidssk Nor Laegeforen 1990; 110: 28692872. 6. Ernst E, Pittler M, Stevinson C. Complementary/ alternative medicine in dermatology: evidence-assessed efcacy of two diseases and two treatments. Dermatology 2000; 201: 191195. 7. Mayser P. Omega-3 fatty acid-based lipid infusion in patients with chronic plaque psoriasis: results of a double-blind, randomized, placebo-controlled, multicenter trial. J Am Acad Dermatol 1998; 38: 539547. 8. Escober S. Topical sh oil in psoriasis: a controlled and blind study. Clin Exp Dermatol 1992; 17: 159162. 9. Bittiner S. A double-blind, randomized, placebo-controlled trial of sh oil in psoriasis. Lancet 1988; 20: 378380. 10. Vogler B, Ernst E. Aloe vera: a systematic review of its clinical effectiveness. Br J Gen Pract 1999; 49: 823828. 11. Stucker M, Memmel U, Hoffmann M, Hartung J, Altmeyer P. Vitamin B 12 cream containing avocado oil in the therapy of plaque psoriasis. Dermatology 2001; 203: 141147. 12. Ross S. An integrative approach to eczema (atopic dermatitis). Holist Nurs Pract 2003; 17: 5662. 13. Zaghloul A, El-Shattawy H, Kassem A. Honey, a prospective antibiotic: extraction, formulation, and stability. Pharmazie 2001; 56: 643647.

234

Complementary Therapies in Medicine


phenolic components of olive oil. Thromb Res 1995; 78: 15111560. Purba M, Kouris-Blazos A. Skin wrinkling: can food make a difference? J Am Coll Nutr 2001; 20: 7180. Carbajal D, Molina V , Valdes S, Arruzazbala L, Mas R. Anti-ulcer activity of higher primary alcohols of beeswax. J Pharm Pharmacol 1995; 47: 731733. Kubota K, Kumakiri M, Miura Y, Hine K. Clinical studies on zinc oxide ointment replacing boric acid and zinc oxide ointment. Hokkaido Igaku Zasshi 1983; 58: 400405. Molan P. Re-introducing honey in the management of wounds and ulcer-theory and practice. Ostomy Wound Manage 2002; 48: 2840. Bergman A, Yanai J, Weiss J, Bell D, David P. Acceleration of wound healing by topical application of honey. An animal model. Am J Surg 1983; 145: 374376. Wellford E, Eadie T, Liewellyn C. Evaluation the inhibitory action of honey on fungal growth, sporulation and aatoxin production. Z Lebensm Uters Forsch 1994; 166: 280283. Al-Waili N, Jafari S, Ali A. Effects of natural honey on acute bacterial conjunctivitis due to staphylococcus aureus. FASEB J 2001; 15: A561. Al-Waili N, Jafari S. Effects of honey and cloves extract on bacterial conjunctivitis due to Pseudomonas aerogenosae: compared with antibiotics. FASEB J 2001; 15: A586. Al-Waili N, Al-Alak J, Haq A, Shabani M, Akmal M. Effects of honey on gram positive and gram negative bacterial growth in vitro. FASEB J 2001; 15: A586. AL-Waili N. Therapeutic and prophylactic effects of crude honey on chronic seborrheic dermatitis and dandruff. Eur J Med Res 2001; 6: 306308. AL-Waili N, Boni N. Natural honey lowers plasma concentrations of prostaglandin in healthy individuals. J Med Food 2003; 6: 129133. Al-Waili N, Boni N. Effects of honey ingestion on nitric oxide in saliva. FASEB J 2003; 17: A1250. Al-Waili N. Identication of nitric oxide metabolites in various honeys and effects of honey on plasma and urinary nitrite/nitrate concentration. J Med Food 2003. Theoharides T, Alexandrakis M, Kempuraj D. Anti-inammatory actions of avonoids and structural requirements for new design. Int J Immunopath Pharmacol 2001; 14: 119127. Weller R, Dykhuizen R, Leifert C, Ormerod A. Nitric oixde release accounts for the reduced incidence of cutaneous infections in psoriasis. J Am Acad Dermatol 1997; 36: 218282. Giustizier M, Albanesi C, Scarponi C. Nitric oxide donors chemokine production by keratinocytes in vitro and in vivo. Am J Pathol 2002; 161: 14091418. Friedman E, LaNatra N, Stiller M. NSAIDs in dermatologic therapy: review and preview. J Cutan Med Surg 2002; 6: 449459. Al-Waili N. Two cases of psoriasis and high doses of indomethacin. Emirates Med J 1987; 5: 6163.

14. Molan P. The role of honey in the management of wounds. J Wound Care 1999; 8: 415418. 15. Molan P. Why honey is effective as a medicine. 1. Its use in modern medicine. Bee World 1999; 80: 8092. 16. Al-Waili N, Saloom K. Honey to treat post-operative wound infections due to gram positive and gram negative bacteria following caesarian section and hysterectomies. Eur J Med Res 1999; 4: 126141. 17. Tuck K, Hayball P. Major phenolic compounds in olive oil. J Nutr Biochem 2002; 13: 636644. 18. Petroni A, Blasevich M, Papini N. Inhibition of leukocytes leukotriene B4 production by an olive oil-dervied phenol indetied by mass-spectrometry. Throm Res 1997; 87: 315322. 19. Moreno J, Carbonell T, Sanchez T. Olive oil decrease both oxidative stress and the production of arachidonic acid metabolites by the prostaglandin G/H synthase pathway. J Nutr 2001; 13: 21452149. 20. Noa M, Mas R. Effect of D-002 on the pre-ulcerative phase of carrageenan-induced colonic ulceration in the guinea pig. J Pharma Pharmacol 1998; 50: 549553. 21. Zanoschi C, Ciobanu C, Verbuta A. The efciency of some natural drugs in the treatment of burn. Rev Med Chir Soc Med Nat Lsai 1991; 95: 6365. 22. Hanin J, Rajka G. Diagnostic feature of atopic dermatitis. Acta Derm Venerol 1980; 92: 4447. 23. Maloney J, Morman M, Stewart D, Tharp M. Clobetasol prpionate emollient 0.05% in the treatemtn of atopic dermatitis. Int J Dermatol 1998; 37: 142144. 24. Bahmer F. Quantication of extent and severity of atopic dermatitis: the ADASI score. Arch Dermatol 1991; 127: 12391240. 25. Stalder F, Atherton D. Consensus report of the European Task Force on atopic dermatitis: severity scoring of atopic dermatitis, the SCORAD index. Dermatology 1993; 186: 2331. 26. Kibby B, Fortune D, Bhushan M, Chalmers R. The Salford psoriasis index: an holistic measure of psoriasis severity. Br J Dermatol 2000; 142: 728732. 27. van de Kerkhof M. The psoriasis area and severity index and alternative approaches for the assessment of severity: persisting areas of confusion. Br J Dermatol 1997; 137: 661663. 28. Raskovic S, Bogic M, Peric-Popadic A, Arandjeloveic S. The role of prostaglandins in allergic inammation. Srp Arh Celok Lek 1998; 126: 388393. 29. Omata N, Tsukahara H, Ito S. Increased oxidative stress in childhood atopic dermatitis. Life Sci 2001; 69: 223228. 30. Sudina F, Mirzoeva K, Pushkareva A, Korshunova K. Caffeic acid phenethyl ester as a lipoxygenase inhibitor with antioxidant properties. FEBS Lett 1993; 329: 2124. 31. Manna C, Angelo S, Migliard V . Protective effect of the phenolic fraction from virgin olive oil against oxidative stress in human cells. J Agric Food Chem 2002; 50: 65216526. 32. Petroni A, Blasevich M, Salami M, Papini N. Inhibition of platelet aggregation and eicosanoid production by

33. 34. 35.

36. 37.

38.

39. 40.

41. 42. 43. 44. 45. 46.

47.

48. 49. 50.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Vous aimerez peut-être aussi