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Current Drug Discovery Technologies


ISSN (Print): 1570-1638
ISSN (Online): 1875-6220

Clinical Trial

Efficacy of Aloe vera/ Plantago Major Gel in Diabetic Foot Ulcer: A Randomized Double-Blind Clinical Trial

Author(s): Younes Najafian, Zahra M. Khorasani, Mona N. Najafi, Shokouh S. Hamedi, Marjan Mahjour and Zohre Feyzabadi*

Volume 16 , Issue 2 , 2019

Page: [223 - 231] Pages: 9

DOI: 10.2174/1570163815666180115093007

Price: $65


Background: Diabetic foot ulcer (DFU) is one of the most common complications of diabetic patients. Mostly, non-healing DFU leads to infection, gangrene, amputation and even death. High costs and poor healing of the wounds need a new treatment such as alternative medicine. So, the aim of this study was to evaluate the efficacy of Aloe vera/ Plantago major gel (Plantavera gel) in healing of DFU.

Methods: Forty patients with DFU enrolled in a double-blind randomized clinical trial. The patients who were randomly assigned into the intervention group (n = 20), received topical Plantavera gel in addition to the routine cares, whereas the patients in the control group (n = 20), received topical Placebo gel in addition to the routine cares. Intervention was done twice a day for 4 weeks in the both groups. Photography and an evaluation of DFU healing were conducted by a checklist and then were scored at baseline and at the end of each week. The collected data was analyzed by SPSS software.

Results: At the end of the study, there was a significant difference between the two groups in terms of total ulcer score (P<0.001) and Plantavera gel significantly reduced the ulcer surface comparing with the control group (P=0.039). However, there was not a significant difference between the two groups (P=0.263) in terms of the ulcer depth. During this study, no side effect was observed for Plantavera gel in the intervention group.

Conclusion: Topical Plantavera gel seems to be an effective, cheap and safe treatment. Of course, further studies are required to confirm the properties of the wound healing of this gel.

Keywords: Diabetic foot ulcer, ulcer healing, Plantago major, Aloe vera, plantain, plantavera gel.

Graphical Abstract
Abu-Qamar MeZ,Wilson A. Qualitative content analysis of complementary topical therapies used to manage diabetic foot in Jordan. Afr J Tradit Complement Altern Med 2012; 9(3): 440-8.
Zhang P, Lu J, Jing Y, et al. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med 2017; 49(2): 106-16.
Bakri FG, Allan AH, Khader YS, Younes NA, Ajlouni KM. Prevalence of diabetic foot ulcer and its associated risk factors among diabetic patients in Jordan. Jordan Med J 2012; 46(2): 118-25.
Rice JB, Desai U, Cummings AKG, et al. Burden of diabetic foot ulcers for medicare and private insurers. Diabetes Care 2014; 37(3): 651-8.
Shahi SK, Kumar A, Kumar S, Singh SK. Prevalence of diabetic foot ulcer and associated risk factors in diabetic patients from North India. J Diabetes Complications 2012; 4(4): 83-91.
Moura LI, Dias AM, Carvalho E, de Sousa HC. Recent advances on the development of wound dressings for diabetic foot ulcer treatment—a review. Acta Biomater 2013; 9(7): 7093-114.
Nole KLB, Kirsner RS. Advanced wound care therapies in non-healing lower extremity ulcers: high expectations, low evidence. Evid Based Med 2014; 19(3): 91.
Jagadish M, McNally MM, Heidel RE, et al. Diabetic foot ulcers: the importance of patient comorbidity recognition and total contact casting in successful wound care. Am Surg 2016; 82(8): 733-6.
Rajagopalan C, Viswanathan V, Rajsekar S, Selvaraj B, Daniel L. Diabetic foot ulcers—comparison of performance of ankle-brachial index and transcutaneous partial oxygen pressure in predicting outcome. Int J Diabetes Dev Ctries 2017; 1-6.
Rinkel WD, Luiten J, van Dongen J, et al. In-hospital costs of diabetic foot disease treated by a multidisciplinary foot team. Diabetes research and clinical practice 2017; 132: 68-78.
Yekta Z, Pourali R, Aghassi MR, et al. Assessment of self-care practice and its associated factors among diabetic patients in urban area of Urmia, northwest of Iran. J Res Health Sci 2011; 11(1): 33-8.
Baillie C, Rahman S, Youssief A, Khaleel A, Bargery C. Multidisciplinary approach to the management of diabetic foot complications: Impact on hospital admissions, limb salvage and amputation rates. Int J Endocrinol Metab 2017; 5(2): 00119.
Navarro T, Dardik A, Junqueira D, Cisneros L. Vascular diseases for the non-specialist.In Costa RHR, de Loiola Cisneros L, Luz AR, Eds.Diabetic Foot. Switzerland: Springer 2017; pp. 151-65.
Widgerow AD. Bioengineered skin substitute considerations in the diabetic foot ulcer. Ann Plast Surg 2014; 73(2): 239-44.
Zhang J, Hu Z-C, Chen D, et al. Effectiveness and safety of negative-pressure wound therapy for diabetic foot ulcers: A meta-analysis. Plast Reconstr Surg 2014; 134(1): 141-51.
Sharma D, Singh B, Jaswal K, et al. Effectiveness of negative pressure wound therapy in the management of chronic diabetic ulcers: a prospective study. Int J Surg 2017; 4(4): 1313-8.
O’Reilly D, Pasricha A, Campbell K, et al. Hyperbaric oxygen therapy for diabetic ulcers: Systematic review and meta-analysis. Int J Technol Assess Health Care 2013; 29(3): 269-81.
Barnes R, Shahin Y, Gohil R, Chetter I. Electrical stimulation vs. standard care for chronic ulcer healing: A systematic review and meta‐analysis of randomised controlled trials. Eur J Clin Invest 2014; 44(4): 429-40.
Kirsner RS, Warriner R, Michela M, Stasik L, Freeman K. Advanced biological therapies for diabetic foot ulcers. Arch Dermatol 2010; 146(8): 857-62.
Fani D. Plantago major and Aloe vera mixture, improves the wound healing process in rats with excisional full thickness skin wounds based on stereological parameters. Shiraz: Shiraz University of Medical Sciences 2015.
Aqili M. Makhzan-al-Adwiah, Shams Ardakani MR. editor.Sabz Arang and Tehran University of Medical Sciences:: Tehran 2008.
Adom MB, Taher M, Mutalabisin MF, et al. Chemical constituents and medical benefits of Plantago major. Biomed Pharmacother 2017; 96: 348-60.
Attah MO, Jacks TW, Jacob A, Eduitem O, John B. The Effect of Aloe vera (Linn) On Cutaneous Wound Healing and Wound Contraction Rate in Adult Rabbits. Nova J Med Biolog Sci 2016; 5(3): 1-8.
Mozaffarian V. Indentification of medicinal and aromatic plants of Iran Farhang moaser: Tehran. 2012.
Aqili M. Gharabadin-e-kabir. Safir-e-ardehal Publisher: Tehran 2013.
Avicenna H. The Canon of medicine Alaalami Library: Beirout 2005.
Daburkar M, Lohar V, Rathore AS, Bhutada P, Tangadpaliwar S. An in vivo and in vitro investigation of the effect of Aloe vera gel ethanolic extract using animal model with diabetic foot ulcer. J Pharm Bioallied Sci 2014; 6(3): 205-12.
Oliveira SHdS,Soares MJGO, Rocha PdS. Use of collagen and aloe vera in ischemic wound treatment: Study case. Revista da Escola de Enfermagem da USP 2010; 44(2): 346-51.
Akram M, Hamid A, Khalil A, et al. Review on medicinal uses, pharmacological, phytochemistry and immunomodulatory activity of plants. SAGE Publications 2014.
Jamilah J, Sharifa A, Sharifah N. GC-MS analysis of various extracts from leaf of Plantago major used as traditional medicine. World Appl Sci J 2012; 17: 67-70.
Matsuura N, Aradate T, Kurosaka C, et al. Potent protein glycation inhibition of plantagoside in Plantago major seeds. BioMed Research International 2014; 2014: 208539.
Kartini SP, Thongpraditchote S, Siripong P, Vallisuta O. Effects of Plantago major extracts and its chemical compounds on proliferation of cancer cells and cytokines production of lipopolysaccharide-activated THP-1 macrophages. Pharmacogn Mag 2017; 13(51): 393.
Mahmood A, Phipps M. Wound healing activities of Plantago major leaf extract in rats. Int J Trop Med 2006; 1(1): 33-5.
Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Williams textbook of endocrinology. Elsevier Health Sciences: Philadelphia 2015.
Arunkumar S, Muthuselvam M. Analysis of phytochemical constituents and antimicrobial activities of Aloe vera L. against clinical pathogens. World J Agricultural Sci 2009; 5(5): 572-6.
Chaibakhsh N, Ahmadi N, Zanjanchi MA. Use of Plantago major L. as a natural coagulant for optimized decolorization of dye-containing wastewater. Ind Crops Prod 2014; 61: 169-75.
Araújo LU, Grabe-Guimarães A, Mosqueira VCF, Carneiro CM, Silva-Barcellos NM. Profile of wound healing process induced by allantoin. Acta cirurgica brasileira 2010; 25(5): 460-1.
Kimura Y, Sumiyoshi M, Kawahira K, Sakanaka M. Effects of ginseng saponins isolated from Red Ginseng roots on burn wound healing in mice. Br J Pharmacol 2006; 148(6): 860-70.
Nasiri M, Fayazi S, Jahani S, Yazdanpanah L, Haghighizadeh MH. The effect of topical olive oil on the healing of foot ulcer in patients with type 2 diabetes: A double-blind randomized clinical trial study in Iran. J Diabetes Metab Disord 2015; 14(1): 38.
Mohajeri G, Safaee M, Sanei MH. Effects of topical Kiwifruit on healing of neuropathic diabetic foot ulcer. J Res Med Sci 2014; 19(6): 520.
Suksomboon N, Poolsup N, Punthanitisarn S. Effect of Aloe vera on glycaemic control in prediabetes and type 2 diabetes: A systematic review and meta‐analysis. J Clin Pharm Ther 2016; 41(2): 180-8.
Samuelsen AB. The traditional uses, chemical constituents and biological activities of Plantago major L. A review. J Ethnopharmacol 2000; 71(1): 1-21.

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