Clinical evaluation of a topical Unani pharmacopoeial formulation Tila-e-Kalf in the management of melasma (Kalf): A randomized controlled clinical trial

Document Type : Original Research Article

Authors

1 Department of Moalajat, SUMER, Jamia Hamdard, New Delhi, India

2 Department of Ilaj Bil Tadbeer, SUMER, Jamia Hamdard, New Delhi, India

3 Department of Dermatology, HIMSR, Jamia Hamdard, New Delhi, India

4 Department of Moalajat, School of Unani Medical Education and Research, Jamia Hamdard, New Delhi, India

5 Department of Pharmacognosy, SPER, Jamia Hamdard, New Delhi, India

Abstract

Objective: Melasma is a chronic, acquired, symmetrical hyper melanosis of skin, characterized by irregular light to dark brown patches on sun-exposed areas, with a significant effect on psychological health; melasma is termed as Kalf in Unani medicine. Conventional treatments have transitory results and often carry adverse effects like skin irritation, scarring, etc. This study was planned to evaluate the safety and efficacy of a Unani pharmacopoeial formulation Tila-e-Kalf, comprising of lentil (Lens culinaris), bitter almond (Prunus amygdalus), and fig (Ficus carica), and to compare its efficacy with standard drug hydroquinone in patients of melasma.
Materials and Methods: This was an 8-week open-label, standard controlled, randomized clinical study conducted on patients of epidermal melasma. The test group received Tila-e-Kalf while the control group received hydroquinone 4% cream for local application once daily. Efficacy was assessed by MASI (Melasma Area Severity Index), DLQI (Dermatology Life Quality Index), and PGA (Physician Global Assessment) and colored photographs.
Results: Mean MASI score decreased from10.65±0.85 to 7.07±0.74 in the test group (p<0.0001) and from 11.28±1.24 to 7.76±0.9 (p<0.0001) the in control group. Similar improvement was noticed in other parameters also. A large number of patients in the control group reported mild burning, itching, dryness, and skin rashes, while only one patient in the test group reported mild itching.
Conclusion: Tila-e-Kalf as a topical depigmenting agent was found equally effective with better tolerability and safety as compared to hydroquinone.

Keywords


Aggarwal K, Puri V, Goel RK, Verma D.
2016. An unusual case of facial
hyperpigmentation solved on
histopathology. J Clin Diagnostic Res, 10:
WL01-WL02.
Khan H, Akhtar N, Ali A. 2014. Effects of
cream containing ficus carica L. fruit
extract on skin parameters: in vivo
evaluation. Indian J Pharm Sci, 76: 560-
564.
Ali B, Mujeeb M, Aeria V, Mir SR,
Faiyazuddin M, Shakeel F. 2012. Antiinflammatory and antioxidant activity of
Ficu scarica Linn. Nat Prod Res, 26: 460-
465.
Baitar I. 1999. Adas. in „Al Jame' al-Mufradat
Al Aghzia wal Advia. Vol. 3, p. 242, New
Delhi, Central Council for Research in
Unani Medicine.
Ball Arefiev KL, Hantash BM. 2012.
Advances in the treatment of melasma: a
review of the recent literature. Dermatol
Surg, 38: 971-984.
Dereure O. 2001. Drug-induced skin
pigmentation. epidemiology, diagnosis
and treatment. Am J Clin Dermatol, 2:
253-262.
Finlay AY, Khan G. 1994. Dermatology life
quality index (DLQI)—a simple practical
measure for routine clinical use. Clin Exp
Dermatol, 19: 210-216.
Gupta AK, Grover MD, Nouri K, Taylor S.
2006. The treatment of melasma: A
review of clinical trials. J Am Acad
Dermatol, 55: 1048-1065.
Handel AC, Miot LD, Miot HA. 2014.
Melasma: a clinical and epidemiological
review. An Bras Dermatol, 89: 771-782.
Harumi O, Goh CL. 2016. The Effect of
melasma on the quality of life in a sample
of women living in Singapore. J Clin
Aesthet Dermatol, 9: 21-24.
Jagannathan M, Sadagopan K, Ekkarakudy J,
Anandan H. 2017. Clinicoepidemiological study of patients with
melasma in a tertiary care hospital - a
prospective study. Int J Sci Study, 4: 117-
120.
Jain DS, Balachandrudu DB. 2018. A clinical
study of melasma of face in women and
comparison of different treatment
modalities of melasma (glycolic acid -
35% and tca 15% peels). Indian J Appl
Res, 8: 39-41.
Kabiruddin M. 1951. MakhzanulMufradat,
KhawasulAdvia, Vol. I, pp.111, 543-544,
Lahore, Sheikh Mohammad Bashir &
Sons.
Kabiruddin M. 1969.TarjumaSharahAsbab,
Vol. 3, pp 344-346, New Delhi, Aijaz
Publishing House.
Kabiruddin M. 2006. Al-Qarabadeen,2nd ed.,
p.408, New Delhi, Central Council for
Research in Unani Medicine.
Khan MA. 2006. Rumooz-e-Azam, Vol. 2, p.
104, New Delhi, Central Council for
Research in Unani Medicine.
Khan MA. 2012. Muheet-e-Azam, Vol. 1, pp.
452-457, New Delhi, Central Council for
Research in Unani Medicine.
Salma et al.
AJP, Vol. 13, No. 3, May-Jun 2023 264
Khan MA. 2014. Muheet e Azam,Vol. 3, pp.
553-554, New Delhi, Central Council for
Research in Unani Medicine.
Khosravan S, Alami A, Moghadam, HM.
2017. The effect of topical use of
petroselinum crispum (parsley) versus
that of hydroquinone cream on reduction
of epidermal melasma. Holist Nurs Prac,
31: 16-20.
Kimbrough-Green CK, Griffiths CE, Finkel
LJ, Hamilton TA, Bulengo-Ransby SM,
Ellis CN, Voorhees JJ. 1994. Topical
retinoic acid (tretinoin) for melasma in
black patients: a vehicle-controlled
clinical trial. Arch Dermatol, 130: 727-
733.
Khosravan S, Alami A, MohammadzadehMoghadam H, Ramezani V, Sheikhnavesi
M, 2015. The efficacy of topical use of
petroselinum crispum (parsley) versus
hydroquinone cream for reduction of
epidermal melasma: a randomized clinical
trial. Avicenna J
Phytomed, 5(Supplement): 126-127.
Kroon MW, Wind BS, Beek JF, Veen JW.
2011. Nonablative 1550-nm fractional
laser therapy versus. J Am Acad
Dermatol, 64: 517-523.
Moradi B, Soureshjani SH, Samani MA, Yang
Q. 2017. A systematic review of
phytochemical and phytotherapeutic
characteristics of bitter almond. In J
Pharm Phytopharmacological Res, 7: 1-9.
Niwa MA, Eimpunth S, Fabi SG, Guiha I,
Groff W, Fitzpatrick R. 2013. Treatment
of melasma with the 1,927‐nm fractional
thulium fiber laser: A retrospective
analysis of 20 cases with long‐term.
Lasers Surg Med, 45: 95-101.
Razi Z. 1986. Kitabul Mansoori, pp. 198-199,
New Delhi, Central Council for Research
in Unani Medicine.
Sadeghpour M, Dover JS, Rohrer TE. 2018.
Advances in the treatment of melasma: an
evidence-based approach. Adv Cosmet
Surg, 1: 163-174.
Sarkar R, Arora P, Sonthalia S, Gokhale N.
2014. Melasma update. Indian Dermatol
Online J, 5: 426-435.
Shah JS, Patel NK, Detholia KK, Patel SK,
Varia UR. 2018. Melasma: A recurrent
hyperpigmentory disorder. Int J Curr Res
Pharm, 2: 29-36.
Sina I. 1992. Al Qanoon Fil Tibb, Vol. 4, pp.
349-351, Lahore, Sheikh Mohammad
Bashir and Sons.
Yang SH, Tsatsakis AM. Tzanakakis G. Kim
H-S, Le B, Sifaki M, Spandidos DA,
Tsukamoto Ch, Golokhvast KS, Izotov
BN, Chung G. 2017. Soyasaponin Ag
inhibits α MSH induced melanogenesis in
B16F10 melanoma cells via the
downregulation of TRP 2. Int J Mol Med,
40: 631-636.
Zubair S, Mujtaba G. 2009. Comparison of
efficacy of topical 2% liquiritin, topical
4% liquiritin and topical 4%
hydroquinone in the management of
melasma. J Pakistan Assoc
Dermatologists, 19: 158-163.