Anti-dandruff effects of butterfly pea flowers (Clitoria ternatea)-based shampoo: A pretest-posttest control study.

Butterfly pea flower (Clitoria ternatea) may serve as an alternative anti-dandruff treatment; however, its effects on Malassezia spp. remain unexplored. The aim of this study was to explore the effects of C. ternatea as an herbal-based anti-dandruff treatment on Malassezia spp. DNA expression, plakoglobin levels, IL-8 levels, sebum levels, dandruff severity scores, adverse effects, and patient satisfaction. An experimental study with a pretest-posttest control design was conducted at the Outpatient Clinic of Dermatology and Venereology, Arifin Achmad Hospital, Pekanbaru, Indonesia, from November 2023 to January 2024. The flower of C. ternatea was used to formulate the shampoo. The study involved 70 female patients aged 18-25 with dandruff, who were divided into two groups: (a) experimental group using 20% C. ternatea shampoo and (b) control group using 2% ketoconazole shampoo. The present study found that 2% ketoconazole shampoo significantly reduced Malassezia spp. DNA expression compared to 20% C. ternatea shampooo (Clitoria ternatea: ΔCq=1.76±3.18; ketoconazole: ΔCq=3.77±2.90; p=0.008). No significant difference was observed in plakoglobin levels (C. ternatea: ΔCq=1.98±3.63; ketoconazole: ΔCq=2.50±2.36; p=0.427) or IL-8 levels (C. ternatea: ΔCq=3.46±4.00; ketoconazole: ΔCq=4.16 ± 3.62; p=0.459). C. ternatea significantly reduced sebum levels more than ketoconazole (C. ternatea: 1.16±0.98%; ketoconazole: 0.22±0.38%; p<0.001). Dandruff scores and patient satisfaction were similar for both shampoos (p=0.115 and p=0.336, respectively). Adverse effects were more common in the 2% ketoconazole shampoo group, affecting 21.2% of the patients. In conclusion, 2% ketoconazole shampoo is more effective in reducing Malassezia spp. DNA expression, while 20% C. ternatea shampoo offers better sebum control. Both shampoos are similarly effective in ameliorating dandruff severity and are well-tolerated, with fewer adverse effects reported for C. ternatea.

Phytochemical Analysis by FTIR of Zanthoxylum Acanthopodium, DC Fruit Ethanol Extract, N-hexan, Ethyl Acetate and Water Fraction.

Background: Andaliman fruit is used as spice in Batak cuisine, North Sumatera, Indonesia. The potency of andaliman fruit extract as herbal medicine is widely studied. Many studies elaborate the benefits of andaliman fruit extract as an antioxidant, antibacterial or anticancer. Objective: The aim of this study was to identify the phytochemical compounds of andaliman fruit extract and its fractions. Methods: The andaliman fruit was originated from Balige city, Tobasa Regency, North Sumatera. The extract was made by maceration within ethanol and followed by fractionation with n-hexan, ethyl acetate and water. The phytochemical screening by chemical reactions, thin layer chromatography, and Fourier Transform Infrared Spectrophotometer were performed. Results: This study found andaliman fruit ethanol extract consists of alkaloids, flavonoids, glycosides, tannins, triterpens, and steroids. The n-hexan fraction consists of triterpens and steroids, ethyl acetate fraction consists of flavonoids and glycosides, and water fraction consists of alkaloid, flavonoid, and glycosides. Andaliman fruit ethanol extract had eight color spots, n-hexan and ethyl acetate fraction had five color spots and water fraction had two color spots. Andaliman fruit ethanol extract had functional group of C-H alkanes, =C-H alkenes (aliphatic), O-H, C=C alkenes, C=C aromatics, C≡C alkynes, C-O, C=O, and NO2. The n-hexan fraction had C-H alkanes, =C-H alkenes (aliphatic), O-H, C=C alkenes, C-O, C=O, and NO2. The ethyl acetate fraction had C-H alkanes, =C-H alkenes (aliphatic), O-H, C=C alkenes, C=C aromatics, C-O, C=O, and NO2. The water fraction had C-H alkanes, =C-H alkenes (aliphatic), O-H, C=C aromatics, C≡C alkynes, and C-O. Conclusion: Phytochemical screening found that andaliman fruit ethanol extract, n-hexan, ethyl acetate and water fraction positive of phytochemical compounds. The FTIR of andaliman fruit ethanol extract, n-hexan fraction, ethyl acetate fraction, and water fraction showed the absorbance of C-H alkanes, O-H, C-O, and C=C alkenes indicating the presence of alkaloids, flavonoids, and triterpenoid saponin.

Evaluating Oral Glutathione Plus Ascorbic Acid, Alpha-lipoic Acid, and Zinc Aspartate as a Skin-lightening Agent: An Indonesian Multicenter, Randomized, Controlled Trial.

CLINICALTRIALSGOV IDENTIFIER: NCT04105504. BACKGROUND: For Asians, especially women with darker skin tones (Fitzpatrick Skin Types IV and V), clear, bright skin is considered highly desirable, and various topical, oral, or injection-based cosmetic skin-lightening agents with different mechanisms of action are widely available across Asia. OBJECTIVE: We sought to investigate the efficacy and safety of an oral glutathione supplement comprising L-glutathione (fermentation), ascorbic acid, alpha-lipoic acid, and zinc (as zinc aspartate) as a skin-lightening agent. METHODS: This randomized, double-blind, controlled clinical trial was carried out at three teaching hospital-based dermatovenereology clinics in Indonesia. Participants were randomized to receive either the glutathione supplement or placebo capsules and were evaluated every four weeks over a 12-week study period. Total reduction in spot ultraviolet, spot polarization, and skin tone were measured and recorded using a Janus Facial Analysis System® (PIE Co., Ltd, Suwon-si, Gyeonggi-do, Korea). RESULTS: Eighty-three participants, aged between 33 and 50 years, completed the study. Reductions in spot ultraviolet in certain subgroups, spot polarization, and skin tone were greater in the glutathione supplement group than in the placebo group, but the difference was not statistically significant. Both the glutathione supplement and placebo groups experienced only mild side effects in the first four weeks. CONCLUSION: The oral glutathione supplement was slightly beneficial for skin lightening in particular subgroups, but the results were not statistically significant. Mild and temporary side effects were reported. Further research is required to more fully evaluate the efficacy of this glutathione supplement as a skin-lightening agent.

The impact of pain intensity on quality of life of postherpetic neuralgia patients.

Aim To investigate the impact of pain intensity of postherpetic neuralgia (PHN) patients. Methods This cross sectional study included 30 PHN patients attended to the Dermatology and Venereology Department of the School of Medicine of Universitas Sumatera Utara during the period between April 2019 and October 2019. Zoster Brief Pain Inventory questionnaire including the worst pain in 24 hours and the level of interference with seven domains of quality of life (QoL) (general activity, mood, walking ability, working, relationship with other people, sleep and enjoyment of life) were used. Pearson's correlation (r) was categorized as very weak (0.0-< 0.2), weak (0.2-< 0.4), moderate (0.4-< 0.6), strong (0.6-<0.8), and very strong (0.8-1.0). Results There was a very strong correlation between worst pain intensity and mood disturbance (r=0.846) and working status (r=0.818). Worst pain intensity had a strong correlation with general activity (r=0.673), relationship with other people (r=0.653), sleep (r=0.774) and disturbance of enjoyment of life (r=0.783). Therefore, the correlation between worst pain intensity and walking ability was moderate (r=0.475). The worst pain intensity had a significant correlation with all seven domains of QoL (p<0.05). Conclusion Pain intensity influences the QoL with directly proportional correlation between pain intensity and disturbance of QoL.

Antibacterial Activity of Passion Fruit Purple Variant (Passiflora edulis Sims var. edulis) Seeds Extract Against Propionibacterium acnes.

BACKGROUND: Passion fruit is used commercially for consumption and in beverages. This plant exhibits various pharmacological properties and possesses a complex phytochemistry. In recent years, this plant has been shown to have potential antimicrobial activity. The seeds contain a high amount of piceatannol, which exhibits an inhibitory effect on Propionibacterium acnes. Therefore, the seed extract of purple variant, Passiflora edulis Sims var. edulis, may have potential antibacterial activity against P. acnes. AIM: To evaluate the antibacterial activity of P. edulis Sims var. edulis seeds extract on P. acnes. METHODS: Seed extract was prepared by maceration and dissolved in DMSO in multiple concentrations. Propionibacterium acnes was cultured in Brucella blood sheep 5% agar for 24 hours and the agar disc diffusion method was used to evaluate the inhibitory effect of each concentration (1.25%, 2.5%, 5%, 10%, 20%, and 40%), in comparison with clindamycin and erythromycin. Zones of inhibition at 24 hours were measured and documented, then analyzed to obtain the mean inhibition zone (MIZ). The Mann-Whitney test was conducted to compare the antibacterial activity of the extract, clindamycin and erythromycin. A serial dilution assay of five different concentrations (5%, 10%, 15%, 20%, and 25%) in brain-heart infusion broth was performed to determine the minimum inhibition concentration (MIC) and minimum bactericidal concentration (MBC). RESULTS: After 24 hours, all concentrations of P.edulis Sims var. edulis showed an inhibitory effect against P. acnes, with MIZs for of each concentration of 1.25% 6 mm, 2.5% 6.83 mm, 5% 8.5 mm, 10% 10.08 mm, 20% 14 mm, and 40% 16 mm. Clindamycin revealed comparable antibacterial effect to 5% seed extract, with an MIZ of 8 mm. However, erythromycin was found to be superior to the seed extract, with a 22.67 mm MIZ (p<0.05). The serial dilution assay revealed an MIC of 20% and MBC of 25%. CONCLUSION: Seed extract of P. edulis Sims var. edulis had good antibacterial activity against P. acnes, and the effect increased with the concentration.

Passion fruit purple variant (Passiflora edulis Sims var. edulis) seeds extract 10% cream in acne vulgaris treatment: an open-label pilot study.

BACKGROUND: Purple variant of passion fruit (Passiflora edulis Sims var. edulis) is a tropical plant commonly used in the beverage industry. The seeds have high content of linoleic acid and piceatannol which has been reported and showed antibacterial, anti-inflammatory, and antioxidant activities. However, there is no report regarding its effect on acne vulgaris. OBJECTIVE: To determine the efficacy of topical use of Passiflora edulis Sims var. edulis seeds extract on acne vulgaris. METHODS: In this open-label uncontrolled trial, 45 subjects with acne vulgaris were given passion fruit purple variant seeds extract 10% cream for 8 weeks. Noninflammatory, inflammatory, and total acne lesions count along with ultraviolet-induced red fluorescence (UVRF) measurement were done at weeks 0, 2, 4, 6, and 8. All reported adverse events were documented, and patient satisfaction rates were determined at week 8. Paired T-test and Wilcoxon test were done with P ≤ 0.05 indicating significance. RESULTS: There were significant reductions in noninflammatory (80.9%), inflammatory (71.1%), and total (73%) lesion count after 8 weeks of the cream application (P < 0.001). Significant reduction in UVRF spot quantity (36%) and percentage area (45.9%) were found at week 8 (P < 0.001). Only 2.2% of subjects experienced an adverse event of mild and transient peeling. Most of the subjects (77.8%) noticed significant improvement in their acne vulgaris and expressed good satisfaction rate. CONCLUSION: Topical use of passion fruit purple variant seeds extract improves acne vulgaris with reduction in lesion counts and UVRF, minimal adverse events, and good satisfaction rate. Additional prospective studies are required.

The Role of Digital Fluorescence in Acne Vulgaris: Correlation of Ultraviolet Red Fluorescence with the Severity of Acne Vulgaris.

BACKGROUND: Colonization of Propionibacterium acnes (P. acnes) and increased sebum production play important roles in the pathogenesis of acne vulgaris. Severity of acne vulgaris correlates with the lesion counts both noninflammatory and inflammatory. Digital fluorescence has been found useful in pathogenesis investigation and treatment evaluation. Ultraviolet-induced red fluorescence (UVRF) was found to be correlated with sebum and porphyrin production that can be synthesized by P. acnes. Therefore, UVRF assessment could be useful for the evaluation of the degree and extent of acne vulgaris. OBJECTIVE: To evaluate the correlation of UVRF with the severity of acne vulgaris using the digital fluorescence tool. METHODS: Forty-five patients were diagnosed with mild-to-severe acne vulgaris according to Lehmann classification. Lesion counts both noninflammatory and inflammatory and UVRF assessment using Visiopor PP34 camera were done to all participants in 5 divided facial areas (forehead, nose, right and left cheeks, and chin). Clinical assessment for each patient was done by 3 dermatologists. Determination of correlation between UVRF with acne lesion counts was done using Pearson test and with acne severity using Spearman test. RESULTS: From 45 participants, majority had moderate acne (64.4%), followed by severe (24.5%) and mild acne (11.1%). Mean number of UVRF spots was 39.98 ± 11.45 and percentage area covered with UVRF was 4.39 ± 1.72. There was no correlation found between acne lesion counts, including noninflammatory and inflammatory with the number and percentage area covered with UVRF spots. Severity grade of acne vulgaris was found to be uncorrelated with the number of UVRF spots (r = 0.27, p=0.073) and percentage area covered with UVRF spots (r = 0.173, p=0.256). CONCLUSION: The severity of acne vulgaris has no correlation with spot counts and percentage area covered with UVRF. Digital fluorescence might be helpful in investigating further of the interrelated pathogenesis factors of acne.

Correlation between Serum Leptin Level with Type and Number of Lesion Skin Tag.

BACKGROUND: Skin tag is a benign tumour of connective tissue in the skin, sessile or pedunculated, skin-like to brownish coloured and often arises in the flexure area. Etiopathogenesis of skin tag is still unclear, but one of the aetiology is associated with leptin hormone. AIM: To determine the correlation between leptin serum level with type and number of the lesion skin tag. METHODS: This study is an observational analytic study with a cross-sectional design involving 33 skin tag patients. Diagnosis of skin tag was based on history and clinical examination; we conducted blood sampling and measurement of serum leptin level to the patients. RESULTS: We found the mean serum leptin level of skin tag patients were highest on the type of lesion mixed (31.54 ± 12.85 ng/ml). The mean number of skin tag lesions was 13.6 ± 5.8 lesions. There is a very high positive correlation between serum leptin level with a number of skin tag (r = 0.86) with p < 0.05 and significant correlation between serum leptin level with the type of lesions (p = 0.037). CONCLUSION: Serum leptin level has a very high positive correlation to a number of skin tag and significant correlation between serum leptin level with the type of lesion.

The Correlation between Body Mass Index with the Occurrence of Skin Tag.

BACKGROUND: Skin tag is a benign tumour of the skin with a soft consistency which commonly occurs in the flexure area. Skin tag often found in individuals with middle and old age. Until now, there are many of theories have been proposed to explain the mechanism of the skin tag, one of the theory is obesity. AIM: To determine the body mass index (BMI) in patients with skin tag. METHODS: This study is an analytic study with cross-sectional designs involving 32 subjects with skin tag and 32 controls. Diagnosis of skin tag was made based on anamnesis and clinical examination. All subjects underwent a physical examination (height and weight) to determine BMI (weight in kilogrammes divided by the square of height in meters). To analyse association between higher BMI with the occurrence of skin tag we use student t-test. RESULTS: The mean BMI in the skin tag group (28.1+ 3.9 kg/m^2) was higher compared with the control group (24.1 + 2.3 kg/m^2). Statistical analysis by Student t-test found the p-value < 0.05. CONCLUSION: We found a correlation between increased BMI with the occurrence of the skin tag.

Correlation between Serum Homocysteine and Vitiligo Area Scoring Index.

BACKGROUND: Vitiligo is a chronic skin disorder. White macules caused by melanocyte destruction is a characteristic finding that cosmetically disturbing. Until recently, pathogenesis of vitiligo is still unclear. The role of homocysteine in vitiligo is mentioned in previous studies thus it is probable that it can be a biomarker to determine vitiligo severity. AIM: To determine correlation between serum homocysteine and vitiligo area Scoring Index (VASI). SUBJECT AND METHOD: This was a cross-sectional analytic study which involved 30 vitiligo patients that were diagnosed by clinical and Wood's lamp examinations then VASI score was determined and same numbers of control. We conducted blood sampling and measurement of serum homocysteine level to the patients. RESULTS: There is no significant correlation between serum homocysteine and VASI score (p = 0.133, r = 0.281), family history (p = 0.706), and duration of vitiligo (p = 0.993, r = 0.002). There is no significant difference between serum homocysteine in vitiligo patients and controls (p = 0.905). There is a correlation between serum homocysteine with gender (p = 0.001) and age (p = 0.036; r = 0.385) in vitiligo patient. CONCLUSION: There is no significant correlation between serum homocysteine and VASI score, family history, and duration of vitiligo. There is no significant difference between serum homocysteine in vitiligo patients and controls. There is a correlation between serum homocysteine with gender and age in vitiligo patient.