curing Fungal infections of the skin
(Superficial Mycoses) with Cassia alata leaves. By DR.S.DAMODARAN,Ph.D,INDIA
Prof. Dr.S.Damodaran Ph.d ,Tamilnadu, India.....
Superficial mycoses- Pityriasis versicolor, Tinea corporis,Tinea cruris,and Tinea pedis.
Excerpts from the doctoral thesis submitted to Dept of Pharmacology and Environmental Toxicology, Dr. A. L. Mudaliar Post – Graduate Institute of Basic Medical Sciences, University of Madras, Taramani campus, Chennai, India.600113.May 1997 and from Journal of Ethnopharmacology 42 [1994] 19-23 by Damodaran and Venkataraman © 1994.All rights reserved.
The existing medicines in the treatment of superficial fungal infections have limited therapeutic spectrum and cause several side effects besides the cost factor. Many medicinal plants have a potential role in the treatment of fungal infections. Cassia alata is one such a plant and can be used in the treatment of superficial mycoses. This information is the result of twenty five years of research and is presented here by the author for the welfare of the mankind and should not be used for commercial purposes.
CASSIA ALATA.
Cassia alata, Linn., is used in the Indian system of medicine namely Ayurveda, siddha and unani. belongs to the family Caesalpiniaceae, R.Br. and is distributed mainly in tropics and subtropics.
Sans. - Dadrughna. Eng. - Ringworm shrub. Hind. & Ben. - Dadmurdan; Dadmari. Mah. - Dadamardana. Tel. - Sheemaavisi; Sima avisl; Mettatamara. Tam. - Vendukolli; sheemai-agatti. Mal. - Seemagati. Can. - Sheemigida; Agase-gida. Kon. - Daddupana. Duk. - Dad-ka-patta; Vilayati-agati. Burm. - Maizali-gi.
EXISTING TREATMENTDrugs currently used in the treatment of pityriasis versicolor are many with diversified chemical structures. Local application of solutions containing Selenium sulphide, Sodium hyposulphite, Tolnaftate, Alcoholic solution of iodine, Propylene glycol, Zinc pyrithione, Acrisorcin and Whitefield's ointment is practiced for various lengths of time for the treatment of pityriasis versicolor. An oral antifungal agent Ketoconazole is also prescribed for several months and the disease may recur in 6-12 months.
CASSIA ALATA AND PITYRIASIS VERSICOLOR.
Three factors are taken into consideration in the treatment of pityriasis versicolor with Cassia alata leaf extract.
i. Concentration of medicinal compounds in plants and consequently their therapeutic efficacy varies according to source and handling, the part of the plant, the age of the plant and ecological factors such as neighboring plant species, seasonality, diurnal changes in light, climatic and soil conditions . These factors play a major role in the synthesis and retention of medicinal compounds in the leaves of Cassia alata.ii. Although the architecture of the skin is the same in all humans,individuals vary in skin characteristics. These factors include age, sex, genetics, occupation, race, intensity of melanin and location such as face, neck and trunk.iii. Pityriasis versicolor is a chronic fungal infection and requires long term therapy. Patients have two choices. Either to eliminate it once for all or can be free from pityriasis versicolor for some time and delay the recurrence, both require strict compliance.
A patient has to acquire enough knowledge regarding the above three factors by careful observations after each application.
TREATMENT OF PITYRIASIS VERSICOLOR WITH CASSIA ALATA LEAF EXTRACT.PREPARATION OF CASSIA ALATA LEAF EXTRACT FOR APPLICATION.
One hundred grams of fresh ,young orange green healthy leaflets collected from the leaves of CASSIA ALATA must be washed with drinking water .Using 500 ml of drinking water the leaflets must be mashed by hand in a glass vessel or stainless steel vessel for thirty minutes and the leaf extract thus obtained is filtered using [ 100 mesh ] a filter cloth or nylon filter.The filtered leaf extract is treated as 100% concentrated solution.[ hereafter referred as CASSIA ALATA leaf extract.]
APPLICATION OF CASSIA ALATA LEAF EXTRACT FOR PITYRIASIS VERSICOLOR.
Table .1 Different concentrations of Cassia alata leaf extract used at affected parts in the treatment of Pityriasis versicolor (100 gm of fresh leaves/500 ml of water.
Concentration of the leaf extract Areas applied
100% Trunk only90% Neck and hands80% FaceThe fresh leaf extract is generously applied only once over the affected parts as per Table.1 at bed time [4 hours before sleep] and washed off thoroughly with water in the next morning, without using soap. The effect of application of the extract is given in table.2.
Table 2: Clinical improvement after Cassia alata leaf extract treatment against Pityriasis versicolor on the human skin after one time application2nd and 3rd day - Mild irritation
4th and 5th day - Mild itching2nd week -portions of stratum corneum [topmost layer of the skin] peeled off in the areas of macules(infected Regions) and infected macules begin to disappear.3rd month - Infected macules begin to disappear. Infected regions (macules) appear
as less pigmented (Hypopigmented). Re-pigmentation begins in the hypopigmented zones.4th to 10th month-Original skin colour is restored without any signs of underlying fungus. Skin appears healthy. (Apply leaf extract to delay the recurrence)11th to 12th month-Pityriasis versicolor reappears with first signs of macules in the previously infected areas.
Table 3. Comparison of Cassia alata leaf extract with existing medicines in the treatment of Pityriasis versicolor
medicines period of application Side effects
1. Selenium sulphide ) 2-3 times a week and less frequently after improvement. sulphur odour.
[topical)
2. Propylene glycol (topical) Twice a day for 2-3 weeks3. Sodium thiosulphate (topical)Once a day for several weeksOffensive odour
4. Tolnaftate topical irritation
5. Clotrimazole topical Nightly for 7 days irritation
6. Miconazole topical Twice daily for two weeks
7. Econazole topical
8. Ketoconazole topical
9. Whitfield's ointment Nightly for 7 days irritation
10. Ketoconazole (oral) 200 mg tablets daily ranging from 5days to four weeks.hepatotoxic.11. Cassia alata leaf extract only once nil .
Therapeutic dose of Cassia alata leaf extract in the treatment of pityriasis versicolor is accompanied by a tolerable irritation on the second day after application, itching on the third day, shedding of stratum corneum in layers over the macules and the disappearance of macules and repigmentation of hypopigmented zones within 3 months. All these indicate the presence of medicines in sufficient concentrations in Cassia alata leaf extract.If irritation and itching are intolerable and the stratum corneum is shed on application of the extract even in non infected regions of the skin then the concentration of medicines in Cassia alata leaf extract is more and consequently to be reduced to the next lower concentrationin the subsequent applications.
On the contrary, absence of itching and irritation and non-shedding of layers over the macules indicate less concentration of medicines in the extract. Hence the concentration is to be increased to the next ascending order in the subsequent applications.
It is always safer to increase the concentration of Cassia alata leaf extract in the subsequent applications instead of applying higher concentrations in the beginning and experiencing intolerable irritation and itching. Table 2 can be followed for localised infections. Patients with acute infections all over the body have to find out the clinically effective but safe concentration in subsequent applications.The falling of scales from macules followed by the appearance of macules as lesspigmented zones are the first signs of the efficacy of the treatment. The macules remain hypopigmented for three weeks. It has been observed that even with existing antifungal agents, the pigmentation after treatment will take longer time and any attempt to accelerate repigmentation may not be successful. As a result of pigmentation, disappearance of macules takes place throughout the second month and the skin appears healthy from the third month onwards up to the eighth month. From nineth month onwards macules reappear resulting in recurrence. See Table 2.
Photograph of a patient showing Pityriasis versicolor infected regions before the application of Cassia alata leaf extract.
Photograph showing the clinical efficacy of Cassia alata leaf extract on the same patient after one time application.
Single application of Cassia alata leaf extract over the infected regions and protecting the individual from recurrence for a maximum period of nine months from pityriasis versicolor establishes the therapeutic supremacy of Cassia alata leaf extract over the existing medicines. It is to be noted that permanent cure of the pityriasis versicolor infection is a very difficult and time consuming process.
RINGWORM INFECTIONS [DERMATOPHYTOSES]These are caused by ringworm fungi or dermatophytes.Traditionally the diseases caused by dermatophytes have been named according to their anatomical location .Tinea capitis (scalp), tinea barbae (beard), tinea corporis (face and trunk), tinea axillaris (armpits), tinea cruris (groin), tinea pedis (feet), tinea manuum (hands) and tinea unguium (nails) ..Tinea corporis [ringworm], tinea cruris [dhobie-itch], tinea pedis [athlete’s foot] are common among the people worldwide.Microscopic examination of scrapings from the lesions (infected regions) treated in 10% Potassium hydroxide will reveal the presence of the fungus.Existing medicines.Drugs currently used in the treatment of dermatophytoses are many with diversified chemical structures. Local application in the form of creams or gels or lotions or solutions or powders containing Potassium permanganate, Gentian violet, Diiodohydroxy quinoline with hydro cortisone, Calcium or Sodium propionate, Thymol iodide, Sulphur, Salicylic acid, Ammoniated mercury, Tolnaftate, Ciclopirox olamine or Haloprogin or Naftifine hydrochloride or Undecylinic acid and its salts or Whitefield ointment or Castellani's paint, Benzimidazoles like Clormidazole, Clotrimazole, Miconazole and Econazole either alone or in combination are prescribed for various lengths of time. Oral antifungal agents like Terbinafine or Benzimidazoles like Ketoconazole or Fluconazole or Griseofulvin are also prescribed. The treatment is continued for a couple of weeks after clinical subsidence. Recurrences are common. Infections by fungi are often chronic and require prolonged treatment by antimycotic drugs that are expensive and sometimes non effective.Application of Cassia alata leaf extract for ringworm infections.For the treatment of ringworm infections, the 100% Cassia alata leaf extract is applied generously to the affected parts of infection daily at bed time [2 hours before sleep] and washed off in the next morning with water without using soap, until the subsidence of all the clinical manifestations and then once in a week for one month and then once in a month for one year.
Table 4 Application schedule and clinical improvement of Cassia alata leaf extract in the treatment of three important ringworm infections.
Cassia alata leaf extract applied daily at bed time 100gm of leaves/500 ml waterTinea pedis.
Ist week. Disappearance of painful itching and scaly fissures.
IInd week Disappearance of hyperkeratotic patches,[thickened skin]and fissures.
IIIrd week Disappearance of all clinical manifestations.
Continue once in a week for one month and once in a month for ever under continued wet and moist conditions to avoid recurrence.Tinea cruris.
Ist week. Stopping of itching and disappearance of borders.
IInd week. Disappearance of inflammation and scales.IIIrd week. Disappearance of all clinical manifestations.Continue once in a week for one month and once in a month for ever to avoid recurrence.Tinea corporis circular lesion[recent onset]Ist week. Stopping of itching and disappearance of borders.
IInd week. Disappearance of inflammation and scales.IIIrd week. Disappearance of all clinical manifestations.
Continue once in a week for one month to avoid recurrence.Tinea corporis spreading
[chronic lesion several
years old. ]Ist week. Stopping of itching.
IInd week. Disappearance of inflammation.
Continue once a week for six months.
TINEA PEDIS
Upper Photograph shows Tinea pedis [athlete’s foot] infected foot before the application of Cassia alata leaf extract. The sole shows whitish hyperkeratotic patches and blisters, with fine scales. Maceration, peeling and fissuring of the skin are observable as a result of acute infection.
The middle photograph shows Scaling and fissuring in the lateral toe web spaces
(intertrigenous type)
characteristic of tinea pedis.
The lowermost Photograph shows the curative efficacy of Cassia alata leaf extract over the affected regions of the same foot after treatment.
TINEA CORPORIS
upper Photograph shows a circular lesion[area with
disease] with raised active borders (6 months old) oft corporis [ringworm] on lateral side of the waist a male. [22 years).
Middle Photograph shows tinea corporis infected glabrous skin in the process of healing after the application of Cassia alata leaf extract.
In the lowermost photograph the lesion disappeared within 21 days The Photograph also shows hyper pigmentation [more pigmented] after healing of the lesion.
The upper Photograph shows a 5 years old chroniclesion of tinea corporis [ringworm]in the posterior scapular region of a male [30 years] spreading in all directions
The lower Photograph shows the same site of infection in the process of healing after the application of Cassia alata leaf extract. The healthy rejuvenating skin is clearly visible.
TINEA CRURIS
Upper Photograph shows an acute tinea cruris[dhobie-itch] infection on the right thigh of a male (22 years) with scales and inflammatory borders.
Middle Photograph shows hyper pigmented and eczematised skin at the infected sites of the same patient.
Lowermost Photograph shows the same region gradually in the process of healing from tinea cruris after application of Cassia alata leaf extract. The scales and inflammatory borders are disappeared. Skin became healthy with the disappearance of hyperpigmentation. The heavily dark pigmented zones are still seen near the groins.
The medicinal compounds present in the leaf extract of Cassia alata are more effective than the existing antifungal agents in the treatment of superficial mycoses. They are very powerful against the fungi Malassezia furfur of pityriasis versicolor and Trichophyton, Epidermophyton and Microsporum of ring worm infections (dermatophytoses).It has long been suspected that a major problem in clinical practice is the lack of patient compliance causing failure of drug therapy or the reason for poor control of the disease. One of the main reasons attributable to non compliance is the cost of medicines in the treatment of superficial mycoses. Fungal infections need long term therapy involving several weeks. But the patient discontinues the application, due to cost factor, when the clinical manifestations subside resulting in the recurrence of the disease. As a result superficial fungal infections become chronic, causing enormous physical and psychological distress to the sufferers. Since Cassia alata leaf extract is totally inexpensive even for repeated applications, the cost factor as a barrier is easily overcome and the patients can get rid of the fungal infections.
Another factor observed among the patients for the poor compliance is lack of knowledge regarding fungal infections. They should be well informed that fungal infections need long term therapy and drugs used for the treatment can be successful only when the schedule is strictly followed. The medicinal compounds present in Cassia alata leaf extract deliver assured cure, only when the therapeutic schedule (Table 4) is strictly followed.The climate, migration, frequency and speed of travel, lack of sanitation, increased use of synthetic garments, use of infected garments, community life, use of common toilets and bathrooms, increased urbanization, the discharge of fungal propagules into the environment by chronic sufferers all result in increased incidences and prevalence of superficial fungal infections .
Health care systems of all types, all over the world are in crisis, predominantly in the developing countries, not least in India. The principal losers are the poor, i.e. the myriads of Indians of low socio economic status and their counterparts in other developing countries. Alleviation of the suffering and amelioration of the diseases are the ultimate aims of medicinal practice. The problems of ill health in the developing countries can only be solved by a judicious blend of various possible approaches to improve the health. The availability of suitable cost effective medicines for the treatment of diseases and the relief of symptoms are important components of any health system. One very practical approach is the optimizations of the use of already available, often inexpensive drugs.
Throughout our investigation, we came across with patients suffering from superficial fungal infections for more than 5 years. They have tried all systems of medicine, underwent all sorts of sufferings, yet, failed to get rid of the disease. Many of these patients were unaware of the therapeutic efficacy of Cassia alata leaf extract in the treatment of superficial fungal infections, some although, residing very near to Cassia alata plant never cared to apply the leaf extract either because of their disbelief over the efficacy of herbal remedies or lack of knowledge about the mode of extraction and application schedule. The present work is an effective solution to all their problems.
Note.
1.Fungal infections usually cause continuous itching.2. Tight synthetic garments, perspiration, hot environment promote fungal infections.3.Remove excess nail portions to avoid scratching and damaging the skin .4.Use Mycoderm powder for infections.5.Instead of using one or two costlier inner garments purchase more cheap garments with the same cost and discard them after sufficient use.6.Follow Cassia alata leaf extract application schedule strictly and if there is any break restart the schedule once again.7.No dietary restrictions during application schedule.8.Since Cassia alata produces beautiful flowers it can be grown in schools ,colleges, and in home gardens.9.It is easy to remove fungal infections at the outset .never allow to become chronic. 10.The medicinal compounds in Cassia alata leaf extract are more powerful in fresh leaf extract.
Our ongoing projects: Psoriasis, Dandruff, Plant cosmetics, Vitiligo.
1. Can I see the fungus causing Pityriasis versicolor?
With the help of your fingernail, remove a thin film of skin from the infected region [macule] and give it to a microbiologist or a botanist. When mounted on a slide in 10% potassium hydroxide solution and stained with 1% methylene blue for one minute and observed under the microscope, round budding cells like a bunch of grapes and short hyphal threads, characteristic ofMalassezia furfur can be seen as in the photograph. This picture may vary as a result of medication.
2. Can I see the fungus causing ringworm?
Remove the scales at the margins of the infected portions. When mounted on a slide in 10% potassium hydroxide solution and stained with 1% methylene blue for one minute and observed under the microscope, the fungus appears in the form of highly branched threads with cross walls running through the skin cells as seen in the photograph. The picture may vary as a result of medication. [For storing the skin portions use clean, dry, paper]
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