Zeitschrift für Phytotherapie 2021; 42(05): 249-262
DOI: 10.1055/a-1406-4785
Forschung

Topische Anwendung von Heilpflanzen zur Unterstützung der Wundheilung

Teil 1
Karin Embacher
1   WALA Heilmittel GmbH, Bad Boll
,
Ilona Zilkowski
1   WALA Heilmittel GmbH, Bad Boll
,
Claudia Turek
1   WALA Heilmittel GmbH, Bad Boll
,
Florian C Stintzing
1   WALA Heilmittel GmbH, Bad Boll
› Author Affiliations

Zusammenfassung

Die Wundheilung ist ein komplexer Prozess, der durch eine auf den jeweiligen Wundzustand abgestimmte Versorgung unterstützt werden kann. Der Artikel betrachtet bekannte (Arnika, Johanniskraut, Ringelblume/Calendula), aber auch in Vergessenheit geratene Heilpflanzen (Beinwell, Brennnessel, Deutsche Schwertlilie, Lebensbaum/Thuja, Waldbingelkraut, Wundklee) im Hinblick auf ihr wundheilungsförderndes und antimikrobielles Potenzial bei topischer Anwendung. Auf Grundlage aktueller Literaturdaten aus In-vitro- und In-vivo-Untersuchungen sowie klinischen Studien werden die Pflanzen und ihre Wirkmechanismen den Wundheilungsphasen zugeordnet. Besonderes Augenmerk wird zudem auf die Vorteile der Kombination von Heilpflanzen gelegt, um ein breiteres Wirkspektrum über verschiedene Phasen der Wundheilung hinweg zu erhalten und eine umfassende Unterstützung dieser anzustreben.

Abstract

Topical Application of Medicinal Plants as a Support for WoundHealing – Part 1

Wound healing is a complex process with several stages, which should be supported differently by taking into account the respective state of the wound. In this publication well known (mountain arnica, St. John's wort, marigold) but also forgotten (comfrey, nettle, common iris, eastern white cedar, dog’s mercury, common kidney vetch) healing plants are presented with regard to their wound healing and antimicrobial potential in topical application. Based on published in vitro and in vivo experiments as well as clinical studies found in literature plants and their mode of action are assigned to the different phases of wound healing. Particular emphasis is put on the advantage of herbal combinations to broaden the efficacy spectrum targeting more than one phase of wound healing and thus striving for a holistic wound treatment.



Publication History

Article published online:
25 October 2021

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  • Literatur

  • 1 Adams M, Berset C, Kessler M. et al Medicinal herbs for the treatment of rheumatic disorders – a survey of European herbals from the 16th and 17th century. J Ethnopharmacol 2009; 121: 343-359
  • 2 Adorjan B, Buchbauer G. Biological properties of essential oils: an updated review. Flavour Fragr J 2010; 25: 407-426
  • 3 Akaydin G, Isil S, Zekiye C. et al An ethnobotanical survey in selected towns of the Mediterranean subregion (Turkey). Turk J Biol 2013; 37: 230-247
  • 4 Alam SM, Qureshi MA, Jahan N. et al Antimicrobial screening of some medicinal plants of Pakistan. Pak J Bot 2010; 42: 4281-4284
  • 5 Barnes J, Anderson LA, Phillipson JD. St John’s wort (Hypericum perforatum L.): a review of its chemistry, pharmacology and clinical properties. J Pharm Pharmacol 2001; 53: 583-600
  • 6 Berges C, Fuchs D, Opelz G. et al Helenalin suppresses essential immune functions of activated CD4+ T cells by multiple mechanisms. Mol Immunol 2009; 46: 2892-2901
  • 7 Bhat G, Shawl AS, Shah Z. et al HPLC-DAD-ESI-MS/MS identification and characterization of major constituents of Iris crocea, Iris germanica and Iris spuria growing in Kashmir Himalayas, India. J Anal Bioanal Tech 2014; 5: 1-10
  • 8 Birt DF, Widrlechner MP, Hammer KD. et al Hypericum in infection: Identification of anti-viral and anti-inflammatory constituents. Pharm Biol 2009; 47: 774-782
  • 9 Biskup I, Zaczynska E, Krauze-Baranowska M. et al Evaluation of cytotoxicity of 5-n-alkylresorcinol homologs and fraction on mouse fibroblast cell line L929. Eur Food Res Technol 2017; 243: 1137-1148
  • 10 Blanco-Salas J, Vazquez FM, Hortigon-Vinagre MP. et al Bioactive phytochemicals from Mercurialis spp. used in traditional Spanish medicine. Plants 2019; 8: 1-15
  • 11 Blumenthal M, Busse WR, Goldberg A. et al The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Calendula flower; Calendulae flos; Ringelblumenblüten; (Calendula officinalis). 1st ed Austin: American Botanical Council; 1998: 100
  • 12 Bozyel ME, Merdamert-Bozyel E. Ethnomedicinal uses of Iridaceae taxa in Turkish traditional medicine. Int J Acad Multidiscip Res 2020; 4: 37-41
  • 13 Bussinger C, Diederich K, Laubersheimer A. Pyoderma gangraenosum mit ausgedehnten Gamaschenulcera – Eine Kasuistik. Merkurstab 2013; 66: 149-152
  • 14 Cano Sanchez M, Lancel S, Boulanger E. et al Targeting oxidative stress and mitochondrial dysfunction in the treatment of impaired wound healing: a systematic review. Antioxidants 2018; 7: 1-14
  • 15 Chadwick M, Trewin H, Gawthrop F. et al Sesquiterpenoids lactones: benefits to plants and people. Int J Mol Sci 2013; 14: 12780-12805
  • 16 Cobanoglu A, Sendir M. The effect of Hypericum perforatum oil on the healing process in the care of episiotomy wounds: A randomized controlled trial. Eur J Integr Med 2020; 34: 1-7
  • 17 Coss E, Kealey C, Brady D. et al A laboratory investigation of the antimicrobial activity of a selection of Western phytomedicinal tinctures. Eur J Integr Med 2018; 19: 80-83
  • 18 Csepregi R, Temesföi V, Das S. et al Cytotoxic, antimicrobial, antioxidant properties and effects on cell migration of phenolic compounds of selected Transylvanian medicinal plants. Antioxidants 2020; 9: 1-29
  • 19 Dar SA, Ganai FA, Yousuf AR. et al Pharmacological and toxicological evaluation of Urtica dioica. Pharm Biol 2013; 51: 170-180
  • 20 Deutsche Gesellschaft für Wundheilung und Wundbehandlung und AWMF. S3-Leitlinie 091-001 „Lokaltherapie chronischer Wunden bei den Risiken CVI, PAVK und Diabetes mellitus” 2012; 1-279
  • 21 Diederich K. Die Arnika. Merkurstab 2003; 56: 61-76
  • 22 Dinda M, Mazumdar S, Das S. et al The water fraction of Calendula officinalis hydroethanol extract stimulates in vitro and in vivo proliferation of dermal fibroblasts in wound healing. Phytother Res 2016; 30: 1696-1707
  • 23 Dorrington MG, Fraser ID. NF-kB signaling in macrophages: dynamics, crosstalk, and signal integration. Front Immunol 2019; 10: 1-12
  • 24 Duffield JS. The inflammatory macrophage: a story of Jekyll and Hyde. Clin Sci 2003; 104: 27-38
  • 25 Ellis S, Lin EJ, Tartar D. Immunology of wound healing. Curr Dermatol Rep 2018; 7: 350-358
  • 26 ESCOP Monographs. Arnicae flos – Arnica flower. Exeter: ESCOP; Online series; 2019: 1-18
  • 27 ESCOP Monographs. Calendulae flos – Calendula flower. Exeter: ESCOP; Online series; 2019: 1-20
  • 28 Ganz C. Arzneipflanze des Jahres 2015: Johanniskraut (Hypericum perforatum). Swiss J Integr Med 2015; 27: 27-29
  • 29 Gesellschaft Anthroposophischer Ärzte in Deutschland und Medizinische Sektion der Freien Hochschule für Geisteswissenschaft (Dornach/Schweiz). Anthroposophische Arzneimittel – Vademecum. Iris germanica. Merkurstab 2017; 70: 476
  • 30 Gülcin I, Küfrevioglu ÖI, Oktay M. et al Antioxidant, antimicrobial, antiulcer and analgesic activities of nettle (Urtica dioica L.). J Ethnopharmacol 2004; 90: 205-215
  • 31 Gurtner GC, Werner S, Barrandon Y. et al Wound repair and regeneration. Nature 2008; 453: 314-321
  • 32 Hajhashemi M, Ghanbari Z, Movahedi M. et al The effect of Achillea millefolium and Hypericum perforatum ointments on episiotomy wound healing in primiparous women. J Matern-Fetal Neonatal Med 2018; 31: 63-69
  • 33 Hammer KD, Hillwig ML, Solco AK. et al Inhibition of prostaglandin E2 production by anti-inflammatory Hypericum perforatum extracts and constituents in RAW264.7 mouse macrophage cells. J Agric Food Chem 2007; 55: 7323-7331
  • 34 HMPC. Assessment report on Arnica montana L., flos. London: European Medicines Agency; 2014. EMA/HMPC/198794/2012
  • 35 HMPC. Assessment report on Calendula officinalis L., flos. London: European Medicines Agency; 2018. EMEA/HMPC/603409/2017
  • 36 HMPC. Assessment report on Hypericum perforatum L., herba. London: European Medicines Agency; 2009. EMA/HMPC/101303/2008
  • 37 HMPC. European Union herbal monograph on Calendula officinalis L., flos. London: European Medicines Agency; 2018. EMEA/HMPC/437450/2017
  • 38 HMPC. Overview of comments received on community herbal monographs on Calendula officinalis L., flos. London: European Medicines Agency; 2008. EMEA/HMPC/590044/2007
  • 39 Hoang L, Benes F, Fenclova M. et al Phytochemical composition and in vitro biological activity of Iris spp. (Iridaceae): a new source of bioactive constituents for the inhibition of oral bacterial biofilms. Antibiotics 2020; 9: 1-20
  • 40 Jäger C, Hrenn A, Zwingmann J. et al Phytomedicines prepared from Arnica flowers inhibit the transcription factors AP-1 and NF-kappaB and modulate the activity of MMP1 and MMP13 in human and bovine chondrocytes. Planta Med 2009; 75: 1319-1325
  • 41 Kim JH, Ruegger PR, Lebig EG. et al High levels of oxidative stress create a microenvironment that significantly decreases the diversity of the microbiota in diabetic chronic wounds and promotes biofilm formation. Front Cell Infect Microbiol 2020; 10: 1-20
  • 42 Kim SY, Nair MG. Macrophages in wound healing: activation and plasticity. Immun Cell Biol 2019; 97: 258-267
  • 43 Koh TJ, DiPietro LA. Inflammation and wound healing: the role of the macrophage. Expert Rev Mol Med 2011; 13: 1-14
  • 44 Kommission C. Anthroposophische Arzneimittel. Aufbereitungsmonographien der Kommission C. Arnica, Planta tota. 1999; Veröffentlicht im Bundesanzeiger Nr. 99a vom 04.06.1986: 125-126
  • 45 Kommission C. Anthroposophische Arzneimittel. Aufbereitungsmonographien der Kommission C. Calendula. Bundesanzeiger Nr. 85 1999; Veröffentlicht im Bundesanzeiger Nr. 99a vom 04.06.1986. Korrektur: Veröffentlicht im Bundesanzeiger Nr. 85 vom 08.05.1991: 287-288
  • 46 Kommission C. Anthroposophische Arzneimittel. Aufbereitungsmonographien der Kommission C. Hypericum. 1999; Veröffentlicht im Bundesanzeiger Nr. 162a vom 02.09.1987. Korrektur: Bundesanzeiger Nr. 85 vom 08.05.1991: 584-585
  • 47 Kommission C. Anthroposophische Arzneimittel. Aufbereitungsmonographien der Kommission C. Mercurialis perennis. 1999; Veröffentlicht im Bundesanzeiger Nr. 43a vom 02.03.1991: 680
  • 48 Kos O. Phytochemische und pharmakologisch-biologische Untersuchungen von Arnica montana und Vernonia triflosculosa [Dissertation]. Freiburg i. Br.: Universität Freiburg; 2005: 175-176
  • 49 Kraft K. Phytotherapie in der Wundheilung. Z Phytother 2016; 37: 48-53
  • 50 Kriplani P, Guarve K, Baghael US. Arnica montana L. – a plant of healing: review. J Pharm Pharmacol 2017; 69: 925-945
  • 51 Lass C, Vocanson M, Wagner S. et al Anti-inflammatory and immune-regulatory mechanisms prevent contact hypersensitivity to Arnica montana L. Exp Dermatol 2008; 17: 849-857
  • 52 Linde K. St. John’s Wort - an overview. Forsch Komplemen-tärmed 2009; 16: 146-155
  • 53 Lorenz P, Beckmann C, Felenda J. et al Das Waldbingelkraut (Mercurialis perennis L.). Pharmakognosie einer alten Arzneipflanze. Z Phytother 2013; 34: 40-46
  • 54 Lorenz P, Bunse M, Klaiber I. et al Comprehensive phytochemical characterization of herbal parts from kidney vetch (Anthyllis vulneraria L.) by LC/MSn and GC/MS. Chem Biodivers 2020; 17: 1-23
  • 55 Lorenz P, Knödler M, Bertrams J. et al n-Alkylresorcinol occurrence in Mercurialis perennis L. (Euphorbiaceae). Z Naturforsch C, J Biosci 2010; 65c: 174-179
  • 56 Lyss G, Knorre A, Schmidt TJ. et al The anti-inflammatory sesquiterpene lactone helenalin inhibits the transcription factor NF-κB by directly targeting p65. J Biol Chem 1998; 273: 33508-33516
  • 57 Lyss G, Schmidt TJ, Merfort I. et al Helenalin, an anti-inflammatory sesquiterpene lactone from Arnica, selectively inhibits transcription factor NF-κB. Biol Chem 1997; 378: 951-961
  • 58 Mandera R, Roemer F. Anthyllis vulneraria – Wundklee und Wundheilung. Merkurstab 1998; 51: 337-347
  • 59 Marzotto M, Arruda-Silva F, Bellavite P. Fibronectin gene up-regulation by Arnica montana in human macrophages: Validation by real-time polymerase chain reaction assay. Homeopathy 2020; 109: 140-145
  • 60 Merfort I. Arnica. In: Hagers Enzyklopädie der Arzneistoffe und Drogen; Programmversion 10.2. Heidelberg: Springer Medizin Verlag; 2010: 1-23
  • 61 Merfort I. Arnika – aktueller Stand hinsichtlich Wirksamkeit, Pharmakokinetik und Nebenwirkungen. Z Phytother 2010; 31: 188-192
  • 62 Mirmalek SA, Parsa T, Parsa Y. et al The wound healing effect of Iris forentina on full thickness excisional skin wounds: A histomorphometrical study. Bangladesh J Pharmacol 2016; 11: 86-90
  • 63 Mzid M, Khedir SB, Salem MB. et al Antioxidant and antimicrobial activities of ethanol and aqueous extracts from Urtica urens. Pharm Biol 2017; 55: 775-781
  • 64 Negut I, Grumezescu V, Grumezescu AM. Treatment strategies for infected wounds. Molecules 2018; 23: 2392-2415
  • 65 Nicolaus C, Junghanns S, Hartmann A. et al In vitro studies to evaluate the wound healing properties of Calendula officinalis extracts. J Ethnopharmacol 2017; 196: 94-103
  • 66 Okmen G, Balpinar N. The biological activities of Hypericum perforatum L. Afr J Tradit Complement Altern Med 2017; 14: 213-218
  • 67 Parente LM, Lino Júnior Rde S, Tresvenzol LM. et al Wound healing and anti-inflammatory effect in animal models of Calendula officinalis L. growing in Brazil. Evid Based Complement Alternat Med 2012; 2012: 375671
  • 68 Patten J, Wang K. Fibronectin in development and wound healing. Adv Drug Deliv Rev 2021; 170: 353-368
  • 69 Prisacaru AI, Andritoiu CV, Andriescu C. et al Evaluation of the wound-healing effect of a novel Hypericum perforatum ointment in skin injury. Rom J Morphol Embryol 2013; 54: 1053-1059
  • 70 Rahman AU, Nasim S, Baig I. et al Anti-inflammatory isoflavonoids from the rhizomes of Iris germanica. J Ethnopharmacol 2003; 86: 177-180
  • 71 Rancic A, Sokovic M, Vukojevic M. et al Chemical composition and antimicrobial activities of essential oils of Myrrhis odorata (L.) Scop, Hypericum perforatum L and Helichrysum arenarium (L.) Moench. J Essent Oil Res 2005; 17: 341-345
  • 72 Samadi S, Khadivzadeh T, Emami A. et al The effect of Hypericum perforatum on the wound healing and scar of cesarean. J Altern Complement Med 2010; 16: 113-117
  • 73 Saroglou V, Marin PD, Rancic A. et al Composition and antimicrobial activity of the essential oil of six Hypericum species from Serbia. Biochem Syst Ecol 2007; 35: 146-152
  • 74 Schempp CM, Wölfle U, Meyer U. et al Johanniskraut (Hypericum perforatum L.) – heilkräftige Lichtpflanze der Sommersonnwende. Merkurstab 2011; 64: 596-606
  • 75 Schepetkin IA, Özek G, Özek T. et al Chemical composition and immunomodulatory activity of Hypericum perforatum essential oils. Biomolecules 2020; 10: 1-20
  • 76 Seyhan N. Evaluation of the healing effects of Hypericum perforatum and Curcumin on burn wounds in rats. Evid Based Complement Alternat Med 2020; 2020: 1-5
  • 77 Shah PJ, Williamson MT. Synergistic activity of Calendula officinalis petal extract with cefotaxime on ESBL producing Escherichia coli. Int J Pharm Biol Sci 2018; 8: 419-425
  • 78 Stanciuc AM, Gaspar A, Moldovan L. et al In vitro antimicrobial activity of Romanian medicinal plants hydroalcoholic extracts on planktonic and adhered cells. Roum Arch Microbiol Immunol 2011; 70: 11-14
  • 79 Stockert K. Lipidmediatoren und ihre Rolle bei Entzündungen und Allergien. In: Stocker K. Allergieprävention. Berlin, Heidelberg: Springer; 2020: 185-245
  • 80 Suganda AG, Amoros M, Girre L. et al Inhibitory effects of some crude and semi-purified extracts of indigenous French plants on the multiplication of human herpesvirus 1 and poliovirus 2 in cell culture. J Nat Prod 1983; 46: 626-632
  • 81 Süntar IP, Akkol EK, Yilmazer D. et al Investigations on the in vivo wound healing potential of Hypericum perforatum L. J Ethnopharmacol 2010; 127: 468-477
  • 82 Thibane VS. Ethnopharmacological study on plants used for skincare and beauty by some Xhosa communities [Dissertation]. Pietermaritzburg: University of KwaZulu-Natal; 2018: 53-59
  • 83 Tsiri D, Graikou K, Poblocka-Olech L. et al Chemosystematic value of the essential oil composition of Thuja species cultivated in Poland - Antimicrobial activity. Molecules 2009; 14: 4707-4715
  • 84 Velnar T, Bailey T, Smrkolj V. The wound healing process: an overview of the cellular and molecular mechanisms. J Int Med Res 2009; 37: 1528-1542
  • 85 Verma N, Tripathi SK, Sahu D. et al Evaluation of inhibitory activities of plant extracts on production of LPS-stimulated pro-inflammatory mediators in J774 murine macrophages. Mol Cell Biochem 2009; 336: 127-135
  • 86 Wagner S, Merfort I. Skin penetration behaviour of sesquiterpene lactones from different Arnica preparations using a validated GC-MSD method. J Pharm Biomed Anal 2007; 43: 32-38
  • 87 Wang S-H, Hu Y-L, Liu T-X. Plant distribution and pharmacological activity of flavonoids. Tradit Med Res 2019; 4: 269-287
  • 88 Wölfle U, Seelinger G, Schempp CM. Topical application of St. John's wort (Hypericum perforatum). Planta Med 2014; 80: 109-120
  • 89 Yadollah-Damavandi S, Chavoshi-Nejad M, Jangholi E. et al Topical Hypericum perforatum improves tissue regeneration in full-thickness excisional wounds in diabetic rat model. Evid Based Complement Alternat Med 2015; 1-4
  • 90 Zerm R. Integrative Behandlung chronischer Wunden unter besonderer Berücksichtigung des Honigs. Merkurstab 2012; 65: 4-11
  • 91 Zwicker P, Schultze N, Niehs S. et al Differential effects of Helenalin, an anti-inflammatory sesquiterpene lactone, on the proteome, metabolome and the oxidative stress response in several immune cell types. Toxicol In Vitro 2017; 40: 45-54
  • 92 Araujo LU, Reis PG, Barbosa LC. et al. In vivo wound healing effects of Symphytum officinale L. leaves extract in different topical formulations Pharmazie - Int J Pharm Sci Res. 2012; 67: 355-360
  • 93 Babaei E, Asghari MH, Mehdikhani F. et al. The healing effects of herbal preparations from Sambucus ebulus and Urtica dioica in full-thickness wound models Asian Pac J Trop Biomed. 2017; 7: 421-427
  • 94 Dähnhardt D, Dähnhardt-Pfeiffer S, Groeber-Becker F. et al. Epidermal regeneration induced by comfrey extract: a study by light and electron microscopy Skin Pharmacol Physiol. 2020; 33: 189-197
  • 95 Hammer KD, Birt DF. Evidence for contributions of interactions of constituents to the anti-inflammatory activity of Hypericum perforatum Crit Rev Food Sci Nutr. 2014; 54: 781-789
  • 96 Joshi BC, Mukhija M, Kalia AN. Pharmacognostical review of Urtica dioica L Int J Green Pharm. 2014; 8(4): 201-209
  • 97 Naser B, Bodinet C, Tegtmeier M. et al. Thuja occidentalis (Arbor vitae): a review of its pharmaceutical, pharmacological and clinical properties Evid Based Complement Alternat Med. 2005; 2: 69-78
  • 98 Seigner J, Junker-Samek M, Plaza A. et al. Symphytum officinale root extract exerts anti-inflammatory properties by affecting two distinct steps of NF-κB signaling Front Pharmacol. 2019; 10: 289-301
  • 99 Stan M, Voicu SS, Caruntu SN. et al. Antioxidant and anti-inflammatory properties of a Thuja occidentalis mother tincture for the treatment of ulcerative colitis Antioxidants. 2019; 8: 416-435
  • 100 Vogl S, Picker P, Mihaly-Bison J. et al. Ethnopharmacological in vitro studies on Austria's folk medicine – An unexplored lore in vitro anti-inflammatory activities of 71 Austrian traditional herbal drugs J Ethnopharmacol. 2013; 149: 750-771
  • 101 Zouari Bouassida K, Bardaa S, Khimiri M. et al. Exploring the Urtica dioica leaves hemostatic and wound-healing potential BioMed Res Int. 2017; 1-10