Advances in Skin & Wound Care:
Richard “Sal” Salcido, MD, EdD, is the Editor-in-Chief of Advances in Skin & Wound Care and the Course Director for the Annual Clinical Symposium on Advances in Skin & Wound Care. He is the William Erdman Professor, Department of Rehabilitation Medicine; Senior Fellow, Institute on Aging; and Associate, Institute of Medicine and Bioengineering, at the University of Pennsylvania Health System, Philadelphia.
This month’s continuing medical education (CME) activity focuses on the application of naturally occurring or modified plants, also known as “medicinal plants” or phytochemicals. Theoretically, phytochemicals possess many wound-healing properties. In humans, they are nonessential nutrients for life sustainment, but they may have a defensive role in protecting the healing function. Plants produce phytochemicals to protect and repair themselves against the environment, diseases, fungi, and parasites. Research also demonstrates that phytochemical products may be useful to protect humans against similar threats to homeostasis. There are more than a thousand known phytochemicals (lycopene in tomatoes, isoflavones in soy, and flavonoids in fruits). In addition, there are nonnutritive plant chemicals with protective and anti-inflammatory properties that may have utility in wound healing: the ubiquitous aloe vera1 and honey, which is a by-product of interaction between plants and bees. Honey from bees has recently been ascribed as possessing “immunomodulatory” activity in the wound healing trajectory.2
In this month’s CME article (page 328), “Topical Phytochemicals: Applications for Wound Healing,” the author explores concepts of using phytochemicals to decrease the tissue adhesion properties of potentially harmful bacteria on the wound surface, among other mechanisms. Flavonoids (phytochemicals) are found in abundance in the human diet, in vegetables, fruits, nuts, seeds, wine, and coffee.3 Flavonoids possess anti-inflammatory and antibacterial properties that work through a mechanism known to inhibit endothelial leukocyte adhesion molecules responsible for inflammation in vivo.3 The use of phytochemicals as therapeutics falls under the generalized category of complementary and alternative medicine (CAM). The practice of CAM includes a spectrum of healing philosophies, approaches, and therapies, including acupuncture, naturopathy, and herbal medicine. These strategies are rooted in the traditions of non-Western cultures and are often considered standard practice, such as in Chinese medicine. In 1998, The US Congress mandated the establishment of the National Center for Complementary and Alternative Medicine as part of the National Institutes of Health.
The concept of CAM certainly is not new to wound care practitioners. There is a plethora of global wound care literature citing examples of alternative practices and the use of plant-based therapies. Numerous case reports in the literature, for example, describe wound treatment with various substances such as honey, sugar, iodine, meat tenderizer, seaweed, and aloe vera.4 Over the years, phytochemicals have become standard ingredients impregnated into various wound dressings, which are approved for use by the Food and Drug Administration. Paradoxically, FDA approval is not required when these substances are sold over-the-counter, as they are not considered to be pharmaceuticals.
The number of unproven CAM strategies and options for wound healing provides us with a tremendous opportunity to reexamine old treatments and apply them in the current environment.
1. Dat AD, Poon F, Pham KB, Doust J. Aloe vera for treating acute and chronic wounds. Cochrane Database Syst Rev 2. 2012; 2: CD008762
2. Majtan J. Honey: an immunomodulator in wound healing. Wound Repair Regen. 2014; 22: 187–92.
3. Gerritsen ME, Carley WW, Ranges GE, et al. Flavonoids inhibit cytokine-induced endothelial cell adhesion protein gene expression. Am J Pathol. 1995; 147: 278–92.
4. Salcido R. Complementary and alternative medicine in wound healing. Adv Skin Wound Care. 1999; 12: 438
Higdon J. An evidence-based approach to dietary phytochemicals. New York, NY:Thieme, 2007 .