**Herbal Therapy for Burns and Burn Scars**

**Herbal Therapy for Burns and Burn Scars**

#### Serap Maden, Emel Erdal Çalıkoğlu and Pertevniyal Bodamyalızade Pertevniyal Bodamyalızade Additional information is available at the end of the chapter

Serap Maden, Emel Erdal Çalıkoğlu and

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.71665

#### **Abstract**

Burn wound healing is a complex process including inflammation, epithelialization, granulation, neovascularization, and wound contraction. Modern therapies present a large number of options, while traditional therapies are promising effective choices. Plant-based products have been used in the treatment of wounds for centuries worldwide. Recently, the mechanisms behind many of these traditional therapies could be explained in detail. The most commonly found mechanisms behind the herbal source products supporting wound healing are mostly their antioxidant, anti-inflammatory, antimicrobial, cell proliferative, and angiogenic effects. However there is not much more studies demonstrated in patients except *Aloe vera* and *Avena* sp., herbal treatment still show a lot of promise in the future. It is important not to ignore possible toxic and allergic effects of plants and phytochemical agents, but the studies mostly resulted with antitoxic effects. Several herbs show efficient results with therapies of wounds also in burn wounds, which may be considered as an option for treatment. On the other hand, herbal treatment in burn wounds still needs to have more clinical and pharmaceutical studies to place in modern therapies safely.

DOI: 10.5772/intechopen.71665

**Keywords:** burn wound, herbal therapy, plant, phytochemical, wound healing

#### **1. Introduction**

Skin is the largest organ of the human body that protects the internal organs from the external environment and prevents body dehydration. It can be traumatized by burn injuries, chronic wounds, excision, tumors, and other dermatological conditions [1]. Burns are one of the most commonly seen trauma incidents and burn wounds need a meticulous care for progress, which causes major medical and economic costs [2]. Burns have extensive categories that may result from heat, cold, chemical, or radiation exposure causing acute cutaneous wounds [3]. Burn wounds are classified into three subgroups according to the depth as first

Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons

degree (superficial), second degree (partial thickness), and third degree (full thickness) [4]. Process of the wound healing has complicated pathways that do not occur in a linear way and can progress forward or backward during the phases depending on various intrinsic and extrinsic factors [5]. After the cutaneous injury, hemostasis is achieved with the activation of platelets resulting in clot formation, which essentially acts as a temporary wound closure mechanism [6]. Burn wound healing is a complex process including inflammation due to the disruption of blood vessels and extravasation of blood constituents, reepithelialization, formation of granulation tissue handled by macrophages and fibroblasts that are responsible for the recovery of the extracellular matrix (ECM), neovascularization as well as migration and mitogenic stimulation of endothelial cells and wound contraction as a result of the interaction between cells, ECM, and cytokines [7]. Neutrophils begin placing to the injury area within hours of the injury, by the effects of platelet-derived growth factors (PDGF), transforming growth factor-beta (TGF-B), and fibroblast growth factor (FGF), that are potent chemotactic agents for neutrophils [6].

substitutes [1]. In recent years, a variety of commercially available wound dressings were launched. However, they possess certain critical limitations such as addition of antimicrobial agents, which might include cytotoxic effects, especially on prolonged treatment period, causing to delay wound healing. Some of the marketed dressings lose their moisturizing effect, which makes them adhere to the surface of the wound and damage the newly formed epithelium [13]. After burn damage, the treatment of skin needs the use of several drugs adminis-

Herbal Therapy for Burns and Burn Scars http://dx.doi.org/10.5772/intechopen.71665 77

In traditional medicine, there are various phytochemicals that are used for wound healing supplying enhanced healing process via anti-inflammatory or antioxidant activity [3]. However, several herbal-sourced phytochemicals have shown some efficacy in animal models on the treatment of burn wounds; only a few herb-derived phytochemicals have been studied in human trials such as *Aloe vera* and *Avena* sp. More effective natural products are

Extensive study results showed that herbs especially *A. vera* has an effective anti-inflammatory and wound healing effect. *A. vera* belongs to the Liliaceal family, which is a perennial succulent plant [15]. It origins from South Africa, widely used in conventional therapy and of great interest for several biomedical, pharmaceutical, and cosmetic applications [1]. Studies are mostly about the anti-inflammatory and wound healing effects. The gel form of *A. vera* has demonstrated the progress in wound, burn, and frostbite healing, showing known as anti-inflammatory effects also antifungal, hypoglycemic, and gastroprotective effects [15]. Furthermore, due to the features of *A. vera* as anti-inflammatory, antibacterial, antiseptic, and its reliability to inducing collagen synthesis during the wound healing, its gel form is thought to be used for the treatment of skin disorders [1]. *A. vera* has an analgesic effect and also been used in a host of curative purposes including treatment of skin disorders and healing of wounds [16]. *A. vera* gel has a significant effect that improves the synthesis of collagen and the degree of collagen cross-linking, after topical and systemic administration in wounds created in a diabetic rat model. Also, it is mentioned that the oral administration of *A. vera* significantly induces the proliferation of fibroblasts, the collagen deposition, and angiogenesis in

*A. vera* is a choice for treating burns because the colorless gel that comes from the leaf parenchyma is a potent moisturizing agent; it also helps in the healing process of skin lesions and alleviates pain [16, 18]. In a review, no withdrawal or serious adverse reaction was reported. The unwanted symptoms reported were only irritation, itching, discomfort, and minimal transient pain; on the other hand, these symptoms were common signs in burns, and they were found in both the *A. vera* and the control groups. Contamination with anthraquinone while using topical fresh *A. vera* has a potential cause of the irritation [19]. The polymer film

tered separately or combined, and it is a complex and painful process [14].

being studied to get over with the side effects of chemotherapeutics [8].

**2. Herbal therapies**

radiation-exposed rats [17].

**2.1.** *Aloe vera*

Several biochemicals are involved in burn healing process including matrix metalloproteinases, superoxide dismutase, catalase, reduced glutathione, malondialdehyde, myeloperoxidase, vascular endothelial growth factor, hydroxyproline, hexosamine, ascorbic acid (vitamin C) and protein content in damaged and surrounding tissue, serum levels of aspartate transaminase, alanine transaminase, lactate dehydrogenase, blood urea nitrogen, creatinine as indicators of liver and kidney damage, and tumor necrosis factor (TNF) for the evaluation of generalized tissue damage [8]. Moreover, wound repair process has also a chronic progression because of oxygen free radicals. Oxidative stress causes delay in healing and concludes with secondary tissue damage. It is assumed that antioxidant therapy may have a defense effect by decreasing free oxygen radicals and strengthening cellular antioxidant mechanisms, which supports the healing process of the wound [9]. Consequently, compounds playing roles as free-radical neutralizers that include antimicrobial properties may have an important effect in enhancing wound healing. Several traditional herbal-based therapies have been shown to possess antioxidant activity and also enhance wound healing in in vitro studies [10].

Excessive tissue growing may result with aberrant patterns of wounds. Hypertrophic scars and keloids are deviant form results of wound healing that are also seen after burn wounds. Aberrant function of fibroblasts and exaggerate accumulation of ECM during wound healing with a dysregulated response to cutaneous injuries, result in an excessive deposition of collagen. Hypertrophic scars have a raised and firm surface with red or pink in color and usually limited to wound area, while keloids have raised firm and irregular surface usually dark red and pigmented in color that extends into the neighboring skin. Keloids are tougher lesions to treat because of not regressing, also difficult to manage surgically, that do not provoke scar contractures with time, contrary to hypertrophic scars [11, 12]. There are plant-based agents that may inhibit nuclear factor κB (NF-κB) and TGF-β1 signaling in keloid fibroblasts and also decrease ECM production [3].

Various wound care products are used for the management of scars, like autografts and allografts, creams and solutions, wound dressings and alternative tissue-engineered skin substitutes [1]. In recent years, a variety of commercially available wound dressings were launched. However, they possess certain critical limitations such as addition of antimicrobial agents, which might include cytotoxic effects, especially on prolonged treatment period, causing to delay wound healing. Some of the marketed dressings lose their moisturizing effect, which makes them adhere to the surface of the wound and damage the newly formed epithelium [13]. After burn damage, the treatment of skin needs the use of several drugs administered separately or combined, and it is a complex and painful process [14].

In traditional medicine, there are various phytochemicals that are used for wound healing supplying enhanced healing process via anti-inflammatory or antioxidant activity [3]. However, several herbal-sourced phytochemicals have shown some efficacy in animal models on the treatment of burn wounds; only a few herb-derived phytochemicals have been studied in human trials such as *Aloe vera* and *Avena* sp. More effective natural products are being studied to get over with the side effects of chemotherapeutics [8].
