Cassia fistula: A remedy from Traditional Persian Medicine for treatment of cutaneous lesions of pemphigus vulgaris

Document Type: Mini Review Article

Authors

1 Department of Traditional Iranian Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Traditional Persian Medicine, School of Medicine, Shiraz, Iran

3 Molecular Dermatology Research Center, Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran

4 Department of Traditional Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

5 Department of Pharmacognosy, School of Pharmacy, Shaheed Beheshti University of Medical Sciences, Tehran, Iran

Abstract


Objective: Pemphigus is a rare autoimmune disease that may be fatal without proper medical intervention. It is a blistering disease that involves both the skin and mucus membranes, in which the most important causes of death comprise superimposed opportunistic infections and complications of long-term high-dose corticosteroid therapy or prolonged consumption of immune suppressant drugs. Skin lesions are the most important sources of infection, and any local treatment decreasing the healing time of lesions and reducing the total dosage of drugs is favorable.
Materials and Methods: Here, we review the probable mechanism of action of a traditional formulary of Cassia fistula (C. fistula) fruit extract in almond oil as a new topical medication for reducing the duration of treatment of pemphigus vulgaris erosions.
Result: C. fistula fruit oil has lupeol, anthraquinone compounds as rhein and flavonoids.
Previous in vitro and animal studies on C. fistula fruit have demonstrated wound healing, antioxidative, anti-leukotrienes, anti-inflammatory, antibacterial and antifungal effects of this plant.
Conclusion: It is hypothesized that C. fistula L. can be a botanical therapeutic choice for treatment of pemphigus erosions.

Keywords

Main Subjects


Abida O, Ben Mansour R, Gargouri B, Ben Ayed M, Masmoudi A, Turki H, Masmoudi H, Lassoued S. 2012. Catalase and Lipid Peroxidation Values in Serum of Tunisian Patients with Pemphigus Vulgaris and Foliaceus. Biol Trace Elem Res, 150: 74-80.

Aghili Khorasani shirazi MH. 1388. Makhzan Al-Aladvieh(The Storehouse of Medicaments), pp. 544, 545, Qum, Iran, Habl Almatin press( In Persian).

Ahmed AR. 2001. Intravenous immunoglobulin therapy in the treatment of patients with pemphigus vulgaris unresponsive to conventional immunosuppressive treatment. J  Am Acad Dermatol, 45: 679.

Almugairen N, Hospital V, Bedane C, Duvert-Lehembre S, Picard D, Tronquoy AF, Houivet E, D'Incan M, Joly P. 2013. Assessment of the rate of long-term complete remission off therapy in patients with pemphigus treated with different regimens including medium- and high-dose corticosteroids. J Am Acad Dermatol, 69: 583-588.

Anitha J, Miruthula S. 2014. Anti-inflammatory and phytochemicals analysis of Cassia fistula Linn. Fruit pulp extracts. Int J Pharmscog, 1: 207-15.

Anwikar S, Bhitre M. 2010. Study of the synergistic anti-inflammatory activity of Solanum xanthocarpum Schrad and Wendl and Cassia fistula Linn. Int J Ayurveda Res, 1: 167.

Arzani MA. 1387. Tibb al-Akbar(Akbar's Medicine), pp. 637, 578, Tehran, Iran, Jalaledin press (In Persian).

Ayyanar M, Ignacimuthu S. 2009. Herbal medicines for wound healing among tribal people in Southern India: Ethnobotanical and Scientific evidences. Int J Appl Res Nat Prod, 2: 29-42.

Azam Kan M. 1387. Exir-e-Azam( The great Elexir) , pp. 1322-1338, Tehran, Iran, Almaee press (In Persian).

Bahorun T, Neergheen VS, Aruoma OI. 2004. Phytochemical constituents of Cassia fistula. Afr J Food Agric Nutr Dev, 4: 1530-40.

Bani S, Kaul A, Khan B, Ahmad SF, Suri K, Gupta B, Satti N, Qazi G. 2006. Suppression of T lymphocyte activity by lupeol isolated from Crataeva religiosa. Phytother Res, 20: 279-287.

Bhalerao S, Kelkar T. 2012. Traditional Medicinal Uses, Phytochemical Profile and Pharmacological Activities of Cassia fistula Linn. Biological Sci, 1: 79-84.

Bhalodia NR, Nariya PB, Acharya R, Shukla V. 2012. In vitro antibacterial and antifungal activities of Cassia fistula Linn. fruit pulp extracts. Ayu, 33: 123.

Bhalodia NR, Nariya PB, Acharya R, Shukla V. 2013. In vitro antioxidant activity of hydro alcoholic extract from the fruit pulp of Cassia fistula Linn. Ayu, 34: 209.

Bystryn JC, Rudolph JL. 2005. Pemphigus. Lancet, 366: 61-73.

Chams‐Davatchi C, Valikhani M, Daneshpazhooh M, Esmaili N, Balighi K, Hallaji Z, Barzegari M, Akhiani M, Ghodsi Z, Mortazavi H. 2005. Pemphigus: analysis of 1209 cases. Int J Dermatol, 44: 470-476.

D’Auria L, Bonifati C, Mussi A, D’Agosto G, De Simone C, Giacalone B, Ferraro C, Ameglio F. 1997. Cytokines in the sera of patients with pemphigus vulgaris: interleukin-6 and tumour necrosis factor-alpha levels are significantly increased as compared to healthy subjects and correlate with disease activity. Eur cytokine Netw, 8: 383-387.

Danish M, Singh P, Mishra G, Srivastava S, Jha K, Khosa R. 2011. Cassia fistula Linn.(Amulthus)—an important medicinal plant: a review of its traditional uses, phytochemistry and pharmacological properties. J Nat Prod Plant Resour, 1: 101-118.

Farzaei MH, Abbasabadi Z, Shams-Ardekani MR, Abdollahi M, Rahimi R. 2014. A Comprehensive Review of Plants and Their Active Constituents With Wound Healing Activity in Traditional Iranian Medicine. Wounds, 26: 197-206.

Feliciani C, Toto P, Amerio P, Pour SM, Coscione G, Amerio P, Shivji G, Wang B, Sauder DN. 2000. In vitro and in vivo expression of interleukin-1α and tumor necrosis factor-α mRNA in pemphigus vulgaris: interleukin-1α and tumor necrosis factor-α are involved in acantholysis. J Invest Dermatol, 114: 71-77.

Fernández MA, Heras B, Garcia MD, Sáenz MT, Villar A. 2001. New insights into the mechanism of action of the anti‐inflammatory triterpene lupeol. J Pharm Pharmacol, 53: 1533-1539.

Geetha T, Maralakshmi P. 1999. Effect of lupeol and lupeol linoleate on lysosomal enzymes and collagen in adjuvant-induced arthritis in rats. Mol Cell Biochem, 201: 83-87.

Guo M-Z, Li X-S, Xu H-R, Mei Z-C, Shen W, Ye X-F. 2002. Rhein inhibits liver fibrosis induced by carbon tetrachloride in rats. Acta Pharmacol Sin, 23: 739-744.

Harman K, Albert S, Black M. 2003. Guidelines for the management of pemphigus vulgaris. Br J Dermatol, 149: 926-937.

IbnSina (avecinna) H. 1037. Al-Qanoon Fit-Tib (Principles in medicine), pp. 978, Vol. 3,Tehran, Iran, Tehran press (in Arabic).

Iraji F, Asilian A, Siadat AH. 2010a. Pimecrolimus 1% cream in the treatment of cutaneous lesions of pemphigus vulgaris: A double-blind, placebo-controlled clinical trial. J Drugs Dermatol, 9: 684-686.

Iraji F, Banan L. 2010b. The efficacy of nicotinamide gel 4% as an adjuvant therapy in the treatment of cutaneous erosions of pemphigus vulgaris. Dermatol Ther, 23: 308-311.

Irshad M, Shreaz S, Manzoor N, Khan LA, Rizvi MMA. 2011. Anticandidal activity of Cassia fistula and its effect on ergosterol biosynthesis. Pharm Biol, 49: 727-733.

Kasperkiewicz M, Schmidt E, Zillikens D. 2012. Current therapy of the pemphigus group. Clin Dermatol, 30: 84-94.

Kermani NI. 1387. sharh-ol-asbab va Alamat, pp. 641-644, Qom, Jalaledin press.

Kershenovich R, Hodak E, Mimouni D. 2014. Diagnosis and classification of pemphigus and bullous pemphigoid. Autoimmun Rev, 13: 477-81.

Lee CK, Lee PH, Kuo YH. 2001. The chemical constituents from the aril of Cassia fistula L. Journal of the Chinese Chemical Society, 48: 1053-1058.

Martin LK, Werth VP, Villaneuva EV, Murrell DF. 2011. A systematic review of randomized controlled trials for pemphigus vulgaris and pemphigus foliaceus. J Am Acad Dermatol, 64: 903-908.

Mozaffarpur SA, Naseri M, Esmaeilidooki MR, Kamalinejad M, Bijani A. 2012. The effect of cassia fistula emulsion on pediatric functional constipation in comparison with mineral oil: a randomized, clinical trial. DARU, 20: 83.

Navanath M.S, Naikwade N, Mule S, Krishna PP. 2009. Evaluation of anti-inflammatory activity of Cassia fistula and Ficus benghalensis. J Pharm Res, 2: 1304-06.

Neelam C, Ranjan B, Komal S, Nootan C. 2011. Review on Cassia fistula. Int J Res Ayurveda Pharm, 2: 426-430.

Okon L, Werth V. 2014. Bullous Pemphigoid, Mucous Membrane Pemphigoid and Pemphigus Vulgaris: An Update on Pathobiology. Curr Oral Health Rep, 1-10.

Paradisi A, Sampogna F, Di Pietro C, Cianchini G, Didona B, Ferri R, Abeni D, Tabolli S. 2009. Quality-of-life assessment in patients with pemphigus using a minimum set of evaluation tools. J Am Acad Dermatol, 60: 261-269.

Poulin Y, Perry HO, Muller SA. 1984. Pemphigus vulgaris: results of treatment with gold as a steroid-sparing agent in a series of thirteen patients. J Am Acad Dermatol, 11: 851-857.

Rajagopal P, Premaletha K, Kiron S, Sreejith K. 2013. Phytochemical and pharmacological review on Cassia fistula Linn. Int J Pharm Chem Biol Sci, 3: 672-79.

 Rizvi MMA, Irshad M, Hassadi GE, Younis SB. 2009. Bioefficacies of Cassia fistula: an Indian labrum. Afr J Pharm Pharmacol, 3: 287-292.

Ruocco E, Wolf R, Ruocco V, Brunetti G, Romano F, Lo Schiavo A. 2013a. Pemphigus: Associations and management guidelines: Facts and controversies. Clin Dermatol, 31: 382-390.

Ruocco V, Ruocco E, Lo Schiavo A, Brunetti G, Guerrera LP, Wolf R. 2013b. Pemphigus: Etiology, pathogenesis, and inducing or triggering factors: Facts and controversies. Clin Dermatol, 31: 374-381.

Sadik CD, Sezin T, Kim ND. 2013. Leukotrienes orchestrating allergic skin inflammation. Exp Dermatol, 22: 705-709.

Saleem M. 2009. Lupeol, a novel anti-inflammatory and anti-cancer dietary triterpene. Cancer lett, 285: 109-115.

Shailajan S, Yeragi M, Matani A, Gurjar D. 2013. Variation in β-sitosterol content from different geographical regions. Int J Pharm Sci Res, 4: 4392-96.

Siddique HR, Saleem M. 2011. Beneficial health effects of lupeol triterpene: a review of preclinical studies. Life Sci, 88: 285-293.

Tabrizi M, Chams‐Davatchi C, Esmaeeli N, Noormohammadpoor P, Safar F, Etemadzadeh H, Ettehadi H, Gorouhi F. 2006. Accelerating effects of epidermal growth factor on skin lesions of pemphigus vulgaris: a double‐blind, randomized, controlled trial. J Eur Acad Dermatol Venereol, 21: 79-84.

Thirumal M, Srimanthula S, Kishore G. 2012. Cassia fistula Linn-Pharmacognostical, phytochemical and pharmacological review. Crit Rev Pharm Sci, 1: 43-65.

Tonekaboni H. 2007. Tohfat ol momenin( Present for the faithful), pp. 1160, Tehran, Nashre shahr press.

Tsang SW, Zhang H, Lin C, Xiao H, Wong M, Shang H, Yang Z-J, Lu A, Yung KK-L, Bian Z. 2013. Rhein, a Natural Anthraquinone Derivative, Attenuates the Activation of Pancreatic Stellate Cells and Ameliorates Pancreatic Fibrosis in Mice with Experimental Chronic Pancreatitis. PloS one, 8: e82201.

Veldman C, Stauber A, Wassmuth R, Uter W, Schuler G, Hertl M. 2003. Dichotomy of autoreactive Th1 and Th2 cell responses to desmoglein 3 in patients with pemphigus vulgaris (PV) and healthy carriers of PV-associated HLA class II alleles. J Immunol, 170: 635-642.

Veldman C, Höhne A, Dieckmann D, Schuler G, Hertl M. 2004. Type I regulatory T cells specific for desmoglein 3 are more frequently detected in healthy individuals than in patients with pemphigus vulgaris.  J Immunol, 172: 6468-6475.

Yesilova Y, Ucmak D, Selek S, Dertlioğlu SB, Sula B, Bozkus F, Turan E. 2013. Oxidative stress index may play a key role in patients with pemphigus vulgaris. J Eur Acad Dermatol Venereol, 27: 465-467.

Zargaran A, Zarshenas MM, Mehdizadeh A, Mohagheghzadeh A. 2013. Management of tremor in medieval Persia. J Hist Neurosci, 22: 53-61.