구체적인 기전이 언급된 천연물
고추 Capsicum annuum/ Capsicum frutescens
캡사이신 성분이 Substance P를 고갈시켜 건선의 염증과 증식을 억제
실리마린 Silybum marianum
실리마린이 간의 독소를 제거하고, cAMP 분해효소를 억제하고, 류코트리엔 합성을 억제하여 염증반응을 줄일 수 있다. 이를 통해 건선의 상태를 개선시킬 수 있다.
당귀 Angelica sinensis
당귀에 들어있는 psoralen성분을 섭취시 피부 표면에서 자외선(UVA)과 만났을 때 표피의 DNA합성속도를 감소시켜 건선 각질의 과다형성을 억제할 수 있다. 1998년 연구에서 건선환자의 2/3가 당귀추출물을 경구복용한 후에 완치되었음.
캐모마일 Matricaria recutita
캐모마일 꽃의 오일 추출물에 들어있는 chamazulene 성분이 류코트리엔B4의 합성을 억제하는 항염증작용이 있다. LTB4의 증가가 건선질환에서 각질의 형성증가에 원인이 된다는 증거가 있다
강황 Curcuma longa/ Curcuma domestica
강황에 들어있는 성분이 표피에서 발견되는 PhK효소를 선택적으로 억제한다. 높은 PhK 농도는 건선의 심각도와 연관되어 있다.
강황과 calcipotriol 치료를 받은 그룹에서 각질형성세포의 transferrin 수용체 발현을 감소되어 각질의 과다형성 심각도가 줄었고, CD8+ T세포의 밀도가 감소되었다는 연구가 있다.
ALTERNATIVE NATURAL TREATMENTS FOR PSORIASIS
The herbal medicines not have more side effects as compared to synthetic drugs. The herbal medicine is easily available and easy to use in treatment. Now a day, herbal resources play a very important role in the management of the skin and inflammatory diseases. Some studies suggest that psoriasis symptoms can be relieved by change in diet and life style. Fasting food period, low energy diet and vegetarian diets have improved psoriasis symptoms. In some treatments supplemented with fish oil shows a beneficial effect due to the presence of omega - 3 Fatty Acids and Vitamin E. Cannabis is also suggested for treating psoriasis due to Anti - inflammatory properties of its canabinoids and their regulatory effect on immune system (Bhuchar et al., 2012, Brown et al., 1998, Brown et al., 2004; Farber et al., 1986; Koo et al., 1998, Mantle et al., 2001; Deng et al., 2013). Some herbal alternatives for natural psoriasis treatment and the possible rationale of their anti-psoriatic activity have been discussed below briefly on the basis of reports of some researches
Capsicum annuum/ Capsicum frutescens
It is commonly known as Cayenne, its chief component being capsaicin. One hypothesis on the pathogenesis of psoriasis suggests a neurogenic inflammatory etiology mediated through substance - P (SP). SP activates inflammatory cells and ultimately perpetuates vasodilatation, angiogenesis and keratinocyte hyperproliferation. In accordance, psoriatic lesions are known to be more densely innervated with higher SP content than control or uninvolved psoriatic skin. Capsaicin stimulates the release of SP by binding to the vanilloid receptor on slow - conducting, unmyelinated type C neurons and ultimately leads to its depletion (Joe et al., 1997, Bernstein et al., 1986, IIis et al., 1993).
고추에 들어있는 캡사이신 성분이 Substance P 를 지속 방출시켜, 고갈되게 함으로 건선의 염증과 증식을 억제한다.
Aloe vera
Aloe vera is a popular plant used in cosmetic care and first aid products in case of thermal injuries. Aloe contains anthroquinones, steroids, saponins, mucopolysaccharides and salicylic acid. Syed and colleagues (1996) conducted a double - blind, placebo – controlled study on 60 patients with psoriasis with slight to moderate plaque type psoriasis and an average 8.5 year duration of their disease. Patients self - administered topical Aloe vera extract cream or vehicle placebo three times a day without occlusion for 4 weeks to their psoriatic plaques. The aloe group showed significantly higher rates of clearing the psoriatic plaques in almost all patients. Anthraquinone and acemannan, the main active compounds in Aloe vera, have antibacterial activity against Staphylococcus and Streptococcus species and may provide a rationale for their therapeutic efficacy in psoriasis. In addition, salicylic acid, a component of Aloe vera, is a keratolytic and would contribute to its reported efficacy in the desquamation of psoriatic plaques (Syed et al., 1996, Klein et al., 1988, Robson et al., 1982, Choonhakarn et al., 2010, Paulsen et al., 2005, Dhanabal et al., 2012)
건선의 각질부위에 알로에베라 추출물 크림을 지속적으로 발랐을 때, 건선의 각질이 잘 떨어졌음. 이는 알로에 베라의 항균활성 작용때문일 수 있음. 또한 알로에 베라의 살리실산 성분은 각질용해제로 건선 치료에 기여할 수 있음.
Silybum marianum
It is commonly known as Milk Thistle. This plant is very well known for its hepatoprotective activity. Numerous changes have been detected in the liver of patients with psoriasis, including steatosis, periportal inflammation, fibrosis, necrosis and cirrhosis. A multifactorial etiology of liver disease in patients with psoriasis includes changes due to alcohol use, nutritional factors, anti – psoriatic medications and a direct effect of the psoriasis itself. Abnormally high levels of cAMP and leukotrienes have been observed in psoriatic patients and normalization of these levels may improve the condition. The importance of silymarin in the treatment of psoriasis may be due to its ability to improve endotoxin removal by the liver, inhibit cAMP phosphodiesterase and inhibit leukotriene synthesis. (Sabir et al., 2014).
실리마린이 간의 독소를 제거하고, cAMP 분해효소를 억제하고, 류코트리엔 합성을 억제하여 염증반응을 줄일 수 있다. 이를 통해 건선의 상태를 개선시킬 수 있다.
Angelica sinensis
It is commonly known as Dong quay. This Chinese herbal medicine extracts contain potent furocoumarin i.e. psoralen. Psoralens are potent photosensitizers in the presence of UVA. Exposure to UVA, following psoralen ingestion, causes epidermal DNA cross - linking and thus a decrease in the rate of epidermal DNA synthesis. Patients are self-administering a form of psoralen– UVA (PUVA) therapy by consuming dong quay and then receiving ultraviolet light therapy or natural sunlight. Koo & Arain, 1998 studied patients with psoriasis, two-thirds patients got complete relief from their disease after oral treatment with this plant extract. Another herb used in treating psoriasis hogweed (Heracleum sphondylium ), also contains a psoralen but the efficacy and side effects are not available (Bhuchar et al., 2012, Koo et al., 1998)
당귀에 들어있는 psoralen성분을 섭취시 피부 표면에서 자외선과 만났을 때 표피의 DNA합성속도를 감소시켜 건선 각질의 과다형성을 억제할 수 있다.
1998년 연구에서 건선환자의 2/3가 당귀추출물을 경구복용한 후에 완치되었음.
Matricaria recutita
It is commonly known as Chamomile. The chamomile flowers have a long therapeutic tradition in treating gastrointestinal ailments. The rationale for its use in psoriasis is that chamazulene, a by-product of the non – volatile oil extract, matricin, known to have anti – inflammatory activity by inhibition of lipoxygenase and as a result, leukotriene B4 (LTB4) formation. There is evidence supporting the role of increased LTB4 formation in psoriatic plaques; therefore, inhibition results in disease improvement. Chamomile oil has antimicrobial activity against skin pathogens, Staphylococcus and Candida. The flavonoids, quercetin and apigenin, are also active compounds of the flower. Quercetin is reported to be a potent inhibitor of lipoxygenase and to a lesser degree, cyclooxygenase. Quercetin also shows good skin penetration property (Murti et al., 2012, Safayhi et al., 1994).
캐모마일 꽃의 오일 추출물에 들어있는 chamazulene 성분이 류코트리엔B4의 합성을 억제하는 항염증작용이 있다. LTB4의 증가가 건선질환에서 각질의 형성증가에 원인이 된다는 증거가 있다.
즉, 캐모마일꽃 추출물이 LTB4의 생성을 억제하여 건선의 과다한 각질생성을 억제한다.
Melaleuca alternifolia
It is traditionally known as Tea Tree Oil and is popular for its wound healing property. The oil contains terpin – 4-ol, alpha - terpineol and alpha – pinene which confer antimicrobial activity against Propionibacterium acnes and Staphylococcus epidermidis. No studies have investigated the use of tea tree oil in psoriasis; however, its role in urticarial reactions and control of whale and flare has been reported. Hence, study can be made to evaluate its anti – psoriatic efficacy. Although there is reported efficacy in the treatment of acne, dandruff and cold sores, tea tree oil can produce allergic dermatitis in individuals sensitized to the sesquiterpenoid fractions. Oral ingestion can lead to the detrimental effects of cognitive disorientation, systemic contact dermatitis and coma (Carson et al., 2001, Carson et al., 1998, Koh et al., 2002, May et al., 2000).
티트리 오일을 외용제로 사용하면, 항균작용이 있다. 건선치료에 사용된 연구는 없지만, 티트리 오일은 두드러기 반응을 완화시킬 수 있다.
Gaultheria procumbens
It is commonly known as Wintergreen. Wintergreen is a plant native to the Eastern United States and historically was used by Native Americans as an analgesic. It contains 118 Singh and Tripathy / Journal of Applied Pharmaceutical Science 4 (11); 2014: 114-121 methyl salicylate, which is having anti – inflammatory properties. Although used topically for psoriasis, wintergreen can cause systemic effects like tinnitus, vomiting, tachypnea and acid – base disturbances. Patients using aspirin or a prescribed salicylic acid compound in conjunction with a salicylate herbal (for example, wintergreen, aloe vera, or red clover) are more susceptible for systemic toxicities. Additionally, oil of wintergreen can increase prothrombin time and international normalized ratio (INR) of clotting, creating problems for patients on warfarin. There are no investigations on its effectiveness in psoriasis, but have potential anti – inflammatory effect and needs further scientific investigations for its use in psoriasis (Sahu et al., 2011).
Ulmus rubra
It is commonly known as Slippery elm, named so for its mucilage component, derived from the inner bark of the elm. Historically, Native Americans used this extract as a poultice for boils and wounds. It is currently marketed as a treatment for irritable bowel syndrome, reflux and cystitis. Brown and colleagues (2004) evaluated a study group of five patients with chronic plaque-type psoriasis on a home based six month medical nutritional therapeutic regimen. They assessed psoriasis symptoms and bowel permeability over the experimentation period and reported an improvement in all studied parameters. Psoriasis area and Severity Index averaged post test scores showed significant improvement (Buchar et al., 2012, Brown et al., 2004).
여기서 언급된 2004년 논문 내용중
Subjects were then instructed on continuing the therapy protocol at home for six months. The dietary protocol, based on Edgar Cayce readings, included a diet of fresh fruits and vegetables, small amounts of protein from fish and fowl, fiber supplements, olive oil, and avoidance of red meat, processed foods, and refined carbohydrates. Saffron tea and slippery elm bark water were consumed daily.
Ulmus rubra = 느릅나무
느릅나무 추출물을 매일 먹으면서 동시에 건강한 식단과 사프란 차를 6개월동안 먹었을 때
건선과 장투과성이 개선되었다.
Curcuma longa/ Curcuma domestica
Turmeric has a long history of being used for infections and kidney stones. The use in psoriasis is a relatively new adjunct. The anti-inflammatory components are thought to be contained in the curcuminoids and volatile oils which function through selective inhibition of phosphorylase kinase (PhK). PhK is an enzyme found in the epidermis. Significantly higher levels have been noted to correlate with clinical activity of psoriasis. It is also reported decreased PhK activity in the curcumin and calcipotriol treated groups corresponded to severity of parakeratosis, decreases in keratinocyte transferrin receptor expression and density of epidermal CD8 + T cells. The study did not report any adverse effects, although contact dermatitis is a reported adverse effect (Joe et al., 1997).
강황에 들어있는 성분이 표피에서 발견되는 PhK효소를 선택적으로 억제한다. 높은 PhK 농도는 건선의 심각도와 연관되어 있다.
강황과 calcipotriol 치료를 받은 그룹에서 각질형성세포의 transferrin 수용체 발현을 감소되어 각질의 과다형성 심각도가 줄었고, CD8+ T세포의 밀도가 감소되었다는 연구가 있다.
Mahonia aquifolium
It is a very popular plant used in skin disorders, especially in psoriatic plaques. Muller et al (Muller et al., 1994), reported the effect of bark extract of Mahonia aquifolium and its main constituents (berberine, berbamine, oxyacanthine) on 5-lipoxygenase and lipid peroxidation. He also reported the extract of bark of Mahonia aquifolium is an inhibitor of keratinocytes growth. The benzylisoquinoline alkaloid berbamine and oxyacanthine were more potent inhibitors (Muller et al., 1994, Misik et al., 1995, Gulliver et al., 2005, Galle et al., 1994).
오리건 포도나무 껍질의 추출물이 각질형성세포의 성장을 억제했다는 연구결과가 있음.
Alpinia galangal and Annoa squamosa
Chanachai et al (2009) reported the plant Alpinia galanga, Curcuma longa and Annona squamosa for their anti-psoriatic effect. They reported the molecular role of the extracts in supressing psoriasis via regulation of NF-kB signaling biomarkers. They used semi-quantitative RT-PCR and reported gene assay in ten different genes of NF-kB signaling network in HaCaT cells (Saelee et al., 2011).
두 식물의 추출물이 NF-kB 신호전달경로를 억제함으로써 항염증, 항건선 효과가 있다.
Thespesia populnea
Shrivastava et al (2009) reported anti-psoriatic effect of Thespesia populnea bark extract on Perry’s Scientific Mouse tail model. They reported a 25% increased orthokeratosis. Plant has been reported to contain carbohydrates, glycosides, tannins, flavonoids, triterpenoids, phytosterols, proteins and lipid/fixed oil (Shrivastava et al., 2009).
Thespesia populnea 식물의 껍질 추출물이 피부의 정상적인 각질 형성패턴을 증가시킴으로 비정상 각질형성 과정인 건선에 대한 항건선 작용이 있다.
Smilax china
Vijaylakshmi et al (2012), reported the anti-psoriatic activity of Smilax china. They isolated the flavonoid quercetin from the methanolic extract of the rhizome. They performed anti-psoriatic effect on HaCaT cell lines. They reported a significant reduction of epidermal thickness, with reduction of leucocyte migration. This was the first report of flavonoid quercetin to have an anti-psoriatic activity (Vijayalakhsmi et al., 2012).
청미래덩굴에서 추출한 플라보노이드인 quercetin이 사람의 각질세포 실험연구에서 피부의 두께를 감소시키고, 백혈구의 이동을 줄였다.
Nigella sativa
Dwarampudi et al (2012) reported the 95% of ethanolic extract of Nigella sativa Linn (Ranunculaceae) seeds, commonly known as Black cumin, produced a significant epidermal differentiation, from its degree of orthokeratosis. This was equivalent to the effect of the standard positive control, tazarotene (0.1%) gel. The ethanolic extract of Nigella sativa seeds also showed increase in relative epidermal thickness when compared to control group by confirming its traditional use in psoriasis treatment. They worked on screening of antipsoriatic activity of 95% of ethanolic extract of Nigella sativa seeds by using mouse tail model for psoriasis and in vitro antipsoriatic activity was carried out by SRB Assay using HaCaT human keratinocyte cell lines (Dwarampudi et al., 2012).
흑쿠민의 에탄올 추출물이 정상적인 표피의 각질 생성분화 (정상각질화)를 촉진시켜서
정상적인 표피층의 두께를 증가시켰다.
Wrightia tinctoria
Dhanabal et al., (2012) reported the hydroalcoholic extract of Wrightia tinctoria leaves showed significant antipsoriatic effect on mouse tell test model, as compared to isoretinoic acid as standard. They found the extract to produce significant orthokeratosis, prominent antioxidant activity in DPPH, Nitric oxide and hydrogen peroxide scavenging assay (Dhanabal et al., 2012).
Wrightia tinctoria 식물의 잎 추출물이 정상적인 각질생성과정=orthokeratosis 증가시키고, 항산화효과가 있었음
Some other traditionally known plants for Anti-psoriatic activity
Subbaiah et al (2012), reported some traditional local medicinal plants of Kurnool district of Andhra Pradesh (India) for their potential anti-psoriatic affect. The documented plants include Olax scandens, Pedalium murex, Phyllanthus reticulatus, Rhinacanthus nasutus, Rhus mysorensis, Solanum pubescens, Camptotheca accuminata, Indigo naturalis etc. These plants need more focus for investigations of their Anti-psoriatic activity (Subbaiah et al., 2012, Lin et al., 2007, Wang et al., 1998, Lin et al., 2009, Sampson et al., 2001, Lin et al., 1996).