Clinical Studies of Three Herbal Soaps in the Management of Superficial Fungal Infections
Superficial fungal infections could be worrisome in hot tropical climates; there is the need to develop affordable treatment option to stem the menace. We report the clearance effects of three (3) locally prepared herbal soaps (A, B and C) on superficial fungal infections in this study. Palm Kernel Oil (PKO) and Sodium Hydroxide (NaOH) were used to constitute the soap base. A total of 67 subjects with pronounced superficial skin lesions were recruited, prepared herbal soaps were administered randomly on the subjects, monitored for four consecutive weeks and levels of lesion clearance monitored and recorded. Microscopic examination of the skin peels reveals the presence of Cryptococcus and Epidermophyton species. Results showed that the herbal soaps completely cleared the skin lesions without visible edge in the order A (61.1%), B (52.9%), C (31.6%) and Control (0.0%). Skin infections were found to be associated with socio-economic status of the subjects and were common among the young adults. Comparative statistical analysis of the means, using paired sample student t-test showed significant differences in the herbal soaps except between A and B 0.544 (p≤0.05). The 3% w/w concentration of soap A was found to have better prospect among the three tested herbal soaps. Cultivation of Senna alata was recommended for sustainable commercial production of soap A in a resource-limiting setting like Nigeria.
to cite this article:
A.T. Oladele, A.A. Elujoba and A.O. Oyelami, 2012. Clinical Studies of Three Herbal Soaps in the Management of Superficial Fungal Infections. Research Journal of Medicinal Plants, 6: 56-64.
Received: May 03, 2011;
Accepted: June 22, 2011;
Published: September 08, 2011
Skin infections have been observed to occur frequently in warm humid climates
and common in adolescent and young adult males (El-Said,
2001; Kevin, 2008). Dermatophytes are among the most
prevalent infection-causatives in the world (Bakheshwain
et al., 2011) and millions of dollars are expended annually in their
treatment (Brooks et al., 2004). They can be persistent
and worrisome though not debilitating or life-threatening. Skin diseases however,
constitute a significant problem all over the world (Van Hees
and Naafs, 2001). Studies have shown that skin infection is a global phenomenon
(Enemuor and Amedu, 2009). Tinea versicolor is
a relatively common skin infection caused by the fungus Pityrosporum ovale
and associated with pigmentary changes on the skin. Epidemophyton flocussum
and Tinea corporis infect the skin and nails (Sanuth
and Efuntoye, 2010). The skin protects the body against pathogens and it
serves as interface with the environment. Invasion of pathogenic micro-organisms
on the skin leads to skin diseases. Fungi are of special significance in tropical
environments; this is because of the enhancement of their growth by the high
temperature and high humidity conditions which are prevalent in these regions
(Darmstadt, 2000). According to Buonanotte
(2008), 20% of the population globally has ringworm or other type of fungal
condition at any given time. Skin infections and infestations have been found
to be common in late teens and young adults worldwide and are prevalent among
the poor than the rich (Ebrahimzadeh, 2009). In a survey
of prevalence skin disorder in Ibadan and Ile-Ife, Nigeria, fungal infections
of T. capitis and T. versicolor were found to be most common (Odueko
et al., 2001; Ogunbiyi et al., 2005).
In sub-Saharan Africa, modern health care delivery is usually not affordable
due to low per capita income and its non availability in the rural areas. As
a result of cultural alignment and inability to afford cost of treatment offered
by orthodox medical practitioners, the lower strata of the population in developing
countries rely heavily on traditional medicine (Okpuzor
et al., 2008). Man has used plants to treat common skin infections
for centuries and the healing potential of plants was well accepted before microbes
were discovered (Rios and Recios, 2005). Many plants
and herbs have been found to be effective in the treatment of skin diseases
(Sati and Joshi, 2011). Large percentage of the world's
human population, especially in developing countries, depends on traditional
medicine based on medicinal and aromatic plants (WHO, 2002).
Globally the efficacy of herbal medicine is gradually being recognized and accepted
(Adodo, 2006). In Nigeria, local soaps (popularly known
as black soap) have been used as medium of administration for topical medicaments
in the treatment of skin infections and related diseases (Omobuwajo
et al., 2011). Local soaps are usually produced from the ash obtained
from husks of cocoa pods (Theobroma cacao) and palm kernel oil (i.e.,
PKO from Elaeis guinnense) (Moody et al.,
2004). This study was embarked upon to develop an affordable cheap drug
from locally available plant materials for the treatment of skin infections
among the rural populations of the developing tropical regions.
MATERIALS AND METHODS
Soap A: Fresh leaves of Senna alata (L.) Roxb (Caesalpinaceae-UHI-13918)
were collected from Ile-Ife. The leaves were oven dried at 30°C and subsequently
powdered. The powdered leaf was incorporated into the soap consisting of caustic
soda (NaOH) and Palm Kernel Oil (PKO) to make 3.0% w/w strength. The herbal
soap mixture was similarly poured and allowed to solidify and then cut into
stable 6x3x2 cm soap tablets of 65 gm each (labeled soap A).
Soap B: Fresh stem barks of Erythrophleum guineense G. Don (Leguminosae/Fabaceae-UHI-15096) and Pterocarpus osun Craib (Leguminosae/Papilionoideae-UHI-16067), root of Aristolochia ringens Vahl. (Aristolochiaceae-UHI-16305), seeds of Piper guineense Schum and Thonn. (Piperaceae-UHI-263) and Aframomum melegueta K. schum (Zingiberaceae-UHI-13296) were purchased and dried at 30°C and powdered subsequently. The powdered plant material mixture was incorporated into the soap consisting of caustic soda (NaOH) and Palm Kernel Oil (PKO) to make 5% w/w strength. The herbal soap mixture was similarly poured and allowed to solidify and then cut into stable 6x3x2 cm soap tablets of 65 gm each (labeled soap B).
Soap C: Dry seeds of Aframomum melegueta K. schum (Zingiberaceae-UHI-13296), Pipers guineense Schum and Thonn. (Piperaceae-UHI-263) and dry fruits of Xylopia aethiopica (Dunal) A. Rich (Annonaceae-UHI-14625) were obtained from a local herb market in Ile-Ife, Nigeria in March 2008. The plant materials were oven dried at 30°C and subsequently powdered. Powdered plant materials were then infused into coconut oil for one week and then filtered using Whatman No. 1 filter paper. An appropriate quantity of the filtrate (drug), enough to make 5% w/w strength was added to the NaOH-PKO soap base. The herbal-soap mixture was poured and allowed to solidify and then cut into stable 6x3x2 cm soap tablets of 65 gm each (labeled soap C).
Control soap: The control soap consists of ordinary soda-based soap tablets. No plant drug was incorporated in the control/placebo.
Plant materials: All the plant materials were identified and authenticated at University herbarium of Department of Botany, Obafemi Awolowo University, Ile-Ife, Nigeria before use. Voucher numbers were obtained for the plant specimens.
Clinical procedures: The study was carried out at the Ilesa Prison, Osun state, Nigeria between April and May 2009. An earlier visit to the prison confirmed the occurrence of different skin lesion cases and a variety of skin infections among the prison inmates. The cooperation and willingness of the inmates and their supervisors was tentatively ensured prior to the administration of the informed consent forms at the commencement of the study. The investigation was a follow up on a similar study conducted previously in which 1.5% w/w soap A was used. Open and comparative trial exercise to assess the general potential efficacy and safe concentration of different herbal soaps in the treatment of various types of skin eruptions available among the prison inmates was investigated. The inmates participation was made optional and voluntary. Ethical clearance from Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife ethical committee was obtained before the study. A total of sixty seven (67) prison inmates were recruited as subjects for the study. They were randomly distributed into four (4) groups viz: 18 (3% w/w soap A), 19 (soap C), 17 (soap B) and 13 (Control soap). Each subject was undressed and his skin was physically examined in good light noting the presence of any infection. Subjects with obvious skin infections were recruited and samples collected as skin peels from the edges of the observed lesions on the skin. Subjects were diagnosed by a Physician in the team, clerked and the soaps administered with detailed instruction on the usage. The soap was used for bathing the whole body and the lather rubbed onto the skin lesion twice daily for four (4) consecutive weeks. No other treatment/medication for the lesion was allowed throughout the period of investigation. Microscopic investigations of the samples were carried out at the laboratories of Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria where the causative organisms were identified accordingly. The subjects were examined and monitored on weekly basis for four (4) consecutive weeks to assess the effectiveness of the herbal soaps.
Simple percentages and Paired sample t-test (SPSS) were used to analyze the data obtained from the observations.
The age distribution of the subjects recruited for the study show that the
inmates with skin lesions were mainly middle aged people between 21-30 years
(73.1%) and 31-40 years (23.9%) (Table 1) representing a sum
of 97.0% of the study population while only 3% aged above 40 years. Previous
studies have shown that skin infections are common in children, young and middle-aged
people (Nanda et al., 1988). The educational
background of the subjects in Table 2 reveals that only 13.4%
had tertiary education while the higher percentages were fairly educated both
at secondary (53.7%) and primary (26.9%) school levels, 6% have no formal education.
Skin diseases have been observed to be prevalent among the people with low socioeconomic
factors (Odueko et al., 2001), this is reflected
in the educational status of subjects.
Out of the 67 subjects diagnosed by the physician prior to treatment, T.
versicolor was 59.7%, T. corporis 14.9%, Scabies 14.9% and Acne 10.5%
(Table 3). Tinea species have been implicated to be
responsible for substantial percentage of skin infections in the tropics with
T. versicolor prevailing as reflected in the study. Microscopic examination
confirmed Cryptococcus (53.7%) and Epidermophyton (9.0%) as the
causative organisms expressed in Table 4. Dermatophytes have
been implicated among the most prevalent skin infections in the world (Brooks
et al., 2004). Results obtained after four weeks of treatment with
the herbal soaps (A, B and C) showed that the soaps effectively cleared 61.1,
52.9 and 31.6% of the fungal infections, respectively (Fig. 1).
The control soap did not show any effective clearance on the skin lesions. Paired
sample student t-test (SPSS16.0) showed significant differences between the
means of all the soaps (Table 5), only the means of soaps
A and B have no significant differences 0.544 (p≤0.05).
|| Age distribution of subjects treated with different soaps
|| Educational background of subjects treated with different
||Clinical diagnosis of subjects prior to treatment
|| Microscopic examination of skin peel samples from the treated
||Comparative effects of 3 herbal soaps on superficial skin
infections using paired samples students t-test (p≤0.05)
|The paired sample student t-test revealed significant differences
in all the pairs except between soaps A and B = 0.544 (p≤0.05)
|| Effect of herbal soaps on superficial fungal infections in
4 weeks (%)
Skin diseases are common in Nigeria and predominantly affect individuals in
the highly productive age group as reflected in Table 1; this
is similar to the findings of Onayemi et al. (2005)
in the north-western Nigeria and Nwankwo et al. (2009)
in the south-eastern Nigeria. It also corroborates the result of Ponnighaus
et al. (1996) in Malawi. This group of people is favourably disposed
to crime; hence, they constitute higher percentage of the inmates. People with
poor socio-economic status indexed by low educational status among others are
also vulnerable to skin diseases (Sanuth and Efuntoye, 2010).
Level of individual education is an index of his/her socio-economic status.
Table 2 indicate that subjects with lower level of education
are mostly infected with skin infections. This is similar to a study in Iraq
where people of low level educated parents are more susceptible to fungal skin
infections (Fathi and Al-Samarai, 2000). Improved educational
policy that will dispose the teeming population in the rural and urban areas
to good education is important to stem the spread of skin infections as recommended
by Onayemi et al. (2005). The clinical diagnosis
of the skin infections (Table 3), Tinea versicolor
(59.7%) and Corporis (14.9%) were confirmed by the microscopic investigations
in the laboratory (Table 4), revealing the presence of Cryptococcus
and Epidermophyton which spread easily among the subjects. This study supports
the findings of Nanda et al. (1988) that T.
versicolor is a common skin disorder among adults. The characteristic hot
humid weather condition of tropical region, overcrowding of the prison cells,
inadequate/poor personal hygiene and sharing of personal effects by the inmates
and malnutrition also predispose the inmates to superficial fungal infections
(Ogunledun et al., 2010). The skin lesions on
the subjects were completely cleared with the edges no longer visible within
four weeks of herbal soap treatment as seen in Fig. 1 for
A (61.1%), B (52.9%), C (31.6%) and Control (0%). Both A and B soaps demonstrated
good activity against superficial fungal infections on the skin, confirming
the folkloric uses of the plant components as antifungal agents.
Leaves of Senna alata at 1.5%w/w of local soap has been found to clear
47.06% of the subjects infected with T. versicolor (Oladele
et al., 2010). A substantial improvement of 61.1% clearance was observed
with increased concentration (3%w/w) of S. alata leaves in this present
study. E. guineense stem bark, used in the preparation of soap B, is
claimed for the treatment of skin infections throughout the dry zones of West
Africa (Arbonnier, 2004; Burkill, 1985)
which is supported by the findings from this study (52.9% clearance, Fig.
1). Some of the alkaloids in the stem bark of E. guineense have been
implicated for this antimicrobial activity by other workers Manfouo
et al. (2005) and Ngounou et al. (2005)
while the seed oil has also been reported as a broad spectrum antifungal agent
against dermatophytes (Adedotun et al., 2006).
Ethanolic extract of P. guineense seeds (used in soaps B and C) have
shown significant antifungal effect on filamentous fungi (Ngane
et al., 2003) while monoacylglycerols made from coconut oil have
demonstrated antifungal activity against Aspergilus niger DMF 0801.
The seed extract of A. melegueta showed some antimicrobial activity by
inhibiting the growth of E. coli and Salmonella spp. at concentration
of 50 mg mL-1 (Doherty et al., 2010).
Leaves and stem bark of P. osun are medicinally useful for superficial
skin infections such as eczema (Gill, 1992) while the
extracts from stem bark showed significant antimicrobial activities due to different
classes of isolated chemical compounds (Ebi and Ofodile,
Comparative statistical analysis of the herbal soaps (Table 5)
in clearing superficial fungal infections was carried out using paired sample
student t-test of SPSS16.0 (2007); it showed significant differences between
the means of all the soaps except the means of A and B soaps that have no significant
differences 0.544 (p≤0.05). Lack of significant differences between A and
B soaps showed that they possess higher clearance effect over soap C and the
control in the treatment of superficial fungal infections. However, the efficacy
of A and B soaps are similar statistically. The only advantage soap A has over
soap B is that it contains only one (1) plant material against five (5) for
soap B which will reduce production cost as well as difficulties in collection
and conservation while ensuring sustainable supply. Senna alata is a
perennial shrub that grows easily from seed and stem cuttings. It is easily
cultivated in plantations with a short rotation age compared to E. guineense
tree with long gestation period. Only leaves are harvested from Senna alata
which supports surer sustainability than the stem barks E. guineense
and P. osun which may not be sustainable when harvested for commercial
production. Cultivation of important medicinal plants such as S. alata is
required for sustainable supply (Malik et al., 2011)
to prevent overexploitation.
Results from the study showed that herbal soaps A and B, sourced from locally available materials, have great potentials for treating superficial fungal infections common in the hot humid regions of sub Saharan West Africa. Cultivation of these important and frequently used medicinal plants is required for sustainable supply. Economic studies of the conservation of plants used for the herbal preparations are also required in order to tap the potentials offered by these plants.
Adedotun, A.A., E.L. Aya and O.O. Dabiri, 2006.
The composition and antifungal properties of the E. suaveolens
seeds and oil. Life Sci., 3: 61-64.
Adodo, A., 2006.
Herbs for Healing: Receiving God's Healing Through Nature. Revised Edn., PAX Publications, Nigeria, ISBN-13: 978-8018-48-3
Arbonnier, M., 2004.
Trees, Shrubs and Lianas of West African Dry Zones. 1st Edn., CIRAD, Margraf Publishers GMBH MNHN, USA., ISBN: 2876145790, Pages: 574Direct Link |
Bakheshwain, S., N. El-Khizzi, A.M. Al-Rasheed, A. Al-Ajlan and S. Parvez, 2011.
Isolation of opportunistic fungi from dermatophytic samples. Asian J. Dermatol., 3: 13-19.CrossRef |
Brooks, G.F., J.S. Butel and S.A. Morse, 2004.
Jawetz, Melnickand Adelberg's Medical Microbiology. 23th Edn., McGraw Hill, USA
Buonanotte, F., 2008.
Treating ringworm and other fungal conditions. http://www.associatedcontent.com/article/725971/treating_ringworm_and_other_fungal.html?cat=68
Burkill, H.M., 1985.
The Useful Plants of Tropical West Africa. Vol. 1, Royal Botanic Gardens Kew, Sydney, pp: 604
Darmstadt, G.L., 2000.
Cutaneous Fungal Infection. In: Nelson Textbook of Paediatrics, Behrman, R.E. (Ed.). 16th Edn., W.B. Saunders Publisher, Philadelphia, PA., USA., pp: 2036
Doherty, V.F., O.O. Olaniran and U.C. Kanife, 2010.
Antimicrobial activities of Aframomum melegueta
(Alligator pepper). Int. J. Biol., 2: 126-131.Direct Link |
Ebi, G.C. and S.I. Ofodile, 2000.
Antimicrobial activity of Pterocarpus
stems. Fitoterapia, 71: 433-435.CrossRef |
Ebrahimzadeh, A., 2009.
A survey on pityriasis versicolor in the university students in Southeast of Iran. Asian J. Dermatol., 1: 1-5.CrossRef | Direct Link |
El-Said, A.H.M., 2001.
Mycological and physiological studies on fungi, isolated from skin diseases. Pak. J. Biol. Sci., 4: 1432-1436.CrossRef | Direct Link |
Enemuor, S.C. and A.S. Amedu, 2009.
Prevalence of superficial mycoses in primary school children in Anyigba, Kogi State, Nigeria. Afr. J. Microbiol. Res., 3: 062-065.Direct Link |
Fathi, H.I. and A.G. Al-Samarai, 2000.
Prevalence of tinea capitis among schoolchildren in Iraq. East. Mediterr. Health J., 6: 128-137.PubMed | Direct Link |
Gill, L.S., 1992.
Ethnomedical Uses of Plants in Nigeria. Uniben Press, Nigeria, Pages: 212
Kevin, B., 2008.
Medical Encyclopedia. Drug Information Online. Drugs.com. http://www.drugs.com/medical_encyclopedia.html.
Malik, A.R., M.A.A. Siddique, P.A. Sofi and J.S. Butola, 2011.
Ethnomedicinal practices and conservation status of medicinal plants of North Kashmir Himalayas. Res. J. Med. Plant, 5: 515-530.CrossRef |
Manfouo, R.N., F.N. Ngounou, B.T. Ngadjui and B.L. Sondengam, 2005.
Erythrosuavine, a new diterpenic alkaloid from E. suaveolens
(Guil. and Per) Brenan. Bull. Chem. Soc. Ethi., 19: 69-74.
Moody, J.O., O.A. Adebiyi and B.A. Adeniyi, 2004.
Do Aloe vera
and Ageratum conyzoides
enhance the anti-microbial activity of traditional medicinal soft soaps (Osedudu)? J. Ethnopharmacol., 92: 57-60.PubMed |
Nanda, A., S. Kaur, O.N. Bhakoo, I. Kaur and C. Vaishnari, 1988. Pityriasis
in infancy. Pediatr. Dermatol., 5: 260-262.PubMed |
Ngane, A.N., L. Biyiti, P. Bouchet, A. Nkengfack and P.H. Amvam Zollo, 2003.
Antifungal activity of Piper guineense
of Cameroon. Fitoterapia, 74: 464-468.CrossRef | PubMed | Direct Link |
Ngounou, F.N., R.N. Manfouo, L.A. Tapondjou, D. Lontsi and V. Kuete et al
Antimicrobial diterpenoid alkaloids from Erythrophleum suaveolens
(Guill and Perr) Brenan. Bull. Chem. Soc. Eth., 19: 221-226.Direct Link |
Nwankwo, O.B., N.A. Amadi, S.K., M.U. Chukwuocha, A.E. Nwoke, C.N. Oguejiofor and O. Uchechukwu, 2009.
Common skin infections among secondary school students in Mbaise, Imo State, Nigeria: Proxy predictor of environmental hygiene standards. The Social Sci., 4: 223-228.Direct Link |
Odueko, O.M., O. Onayemi and G.A. Oyedeji, 2001.
A Prevalence survey of skin diseases in Nigerian Children. Nig. J. Med., 10: 64-67.PubMed |
Ogunbiyi, A.O., E. Owoaje and A. Ndahi, 2005.
Pediatric Dermatology. Blackwell Publishing, Nigeria, pp: 6-10
Ogunledun, A., H.I. Effedua, A.A. Ambali, F.A. Oluwole, P. McLoone, A.A. Salako and K.S. Oritogun, 2010.
Incidence of Malassezia fungemia
in School Children with Pityriasis versicolor
in Ogun State, Nigeria. Academic Arena, 2: 1-5.Direct Link |
Okpuzor, J., O. Adebesin, H. Ogbunugafor and I. Amadi, 2008.
The potential of medicinal plants in sickle cell disease control: A review. Int. J. Biomed. Health Sci., 4: 47-55.Direct Link |
Omobuwajo, O.R., A. Abdu, O.A. Igbeneghu, I.O. Agboola and G.O. Alade, 2011.
Preliminary investigation of a herbal soap incorporating Cassia alata
(L.) roxb leaves and Ageratum conyzoides
Linn. whole plant powders. Continental J. Pharm. Sci., 5: 1-10.
Onayemi, O., S.A. Isezuo and C.H. Njoku, 2005.
Prevalence of different skin conditions in an outpatients setting in North-Western Nigeria. Int. J. Dermatol., 44: 7-11.CrossRef | PubMed |
Oladele, A.T., B.A. Dairo, A.A. Elujoba and A.O. Oyelami, 2010.
Management of superficial fungal infections with Senna alata
(Alata) soap: A preliminary report. Afr. J. Pharm. Pharmacol., 4: 098-103.Direct Link |
Ponnighaus, J.M., P.E. Fine and J. Saul, 1996.
The epidemiology of Pityriasis versicolor
in Malawi, Africa. Mycoses, 39: 467-470.PubMed |
Rios, J.L. and M.C. Recio, 2005.
Medicinal plants and antimicrobial activity. J. Ethnopharmacol., 100: 80-84.CrossRef | PubMed | Direct Link |
Sanuth, H.A. and M.O. Efuntoye, 2010.
Distribution and microbiological characterization of dermatophytes infection among Primary School Children in Ago Iwoye, Ogun State, Nigeria. Res., 2: 95-99.
Sati, S.C. and S. Joshi, 2011.
Aspects of antifungal potential of ethnobotanically known medicinal plants. Res. J. Med. Plant, 5: 377-391.CrossRef | Direct Link |
Van Hees, C. and B. Naafs, 2001.
Common skin Diseases in Africa: An Illustrated Guide. Stichting Troderma van Hees Publishers, Africa
WHO Traditional Medicine Strategy 2002-2005. World Health Organization, Geneva, Direct Link |