|Year : 1994 | Volume
| Issue : 2 | Page : 63-67
Aqueous extract of neem leaves in treatment of Psoriasis vulgaris
SS Pandey, AK Jha, Vineet Kaur
S S Pandey
Source of Support: None, Conflict of Interest: None
A double blind clinical drug trial was conducted to see the efficacy of an indigenous drug made up of aqueous extract of Neem leaves in 50 cases of uncomplicated psoriasis taking conventional coal tar regime.
Patients taking drug in addition to coal tar had shown a quicker and better response in comparison to placebo group. No any untoward effect was noticed during the period of trial. Probable mode of action is discussed.
Keywords: Psoriasis, Therapy, Indigenous Medicine, Neem, Nimbidin
|How to cite this article:|
Pandey S S, Jha A K, Kaur V. Aqueous extract of neem leaves in treatment of Psoriasis vulgaris. Indian J Dermatol Venereol Leprol 1994;60:63-7
|How to cite this URL:|
Pandey S S, Jha A K, Kaur V. Aqueous extract of neem leaves in treatment of Psoriasis vulgaris. Indian J Dermatol Venereol Leprol [serial online] 1994 [cited 2019 Jan 21];60:63-7. Available from: http://www.ijdvl.com/text.asp?1994/60/2/63/3994
| Introduction|| |
Most, if not all, of the effective modes of therapy, old and new, apparently clear the skin of lesions by inhibiting the accelerated epidermal proliferation characteristic of psoriasis. 
Recurrent exacerbations, and unpredictable prolonged course of the disease are the main factors for dissatisfaction to various treatment regimen. Conventional coal tar therapy is still safe and widely popular but it's bad odour and colour is not accepted easily by the patients. Topical steroids, though act as wonder drug, but produce serious side effects when used for longer period. Systemic therapy with steroid, antimitotic agents, aromatic retinoids etc is advocated only in recalcitrant, extensive and complicated cases of psoriasis. These should be used with utmost care as they cause serious systemic toxicity.
The present study was conducted to assess the efficacy of a relatively non-toxic drug, capsules contain aqueous extract of Neem-leaf. Neem is the vernacular (Hindi) name of the tree Azadirachta indica A. Juss. It is a hardy, fast growing evergreen tree, grown throughout India, and has been used for a long time in agriculture and medicine . 
The major ingredient of aqueous extract of neem leaf is Nimbidin, which has hypoglycemic,  antiulcer  and antitumour  effects. Exact mode of action is not known but possible modes of action are interference with hormonal regulation, enzyme inhibition, interaction with receptors and alteration of membrane permeability and integrity. Okpako (1977)  has shown that A. Indica leaf and bark extract were more potent inhibitor of prostaglandin synthetase than acetyl salicylic acid.
| Materials and Methods|| |
A total of 50 patients (34 males and 16 females) suffering with uncomplicated psoriasis vulgaris were randomly selected from the skin out patient of Sir Sunder lal Hospital, Banaras Hindu University, Varanasi. Patients taking systemic medication were not included in the study. Detailed history of disease, previous treatment if any, was recorded and thorough clinical examination was done. The site and area of involvement, severity of erythema, scaling, and induration was recorded. Each patient was given a code numbered bottle with 90 green coloured capsules containing either active drug or placebo and a plastic container containing 5% crude coal tar and 3% salicylic acid in vaseline base. Patients were advised to take one capsule thrice per day and apply the ointment in night and next day to expose to sun for 15 minutes after taking a thorough bath. Patient was called after 4 weeks for follow-up.
At the time of follow-up, detailed examination of lesions as regards their site and area of involvement, severity of erythema, scaling and induration was recorded. History regarding any untoward effect was asked. Patient was again given the ointment and the bottle containing 90 capsules and having the same code number as in 1st visit. Patient was again called after 4 weeks for follow up. Thus the patients were followed up in similar way for 12 weeks.
Severity of the disease was assessed by calculating "Psoriasis Area and Severity Index (PASI)" score as described by Fredrikson & Pettersson (1978).  After completion of the trial the number was decoded and there were 34 bottles containing drug and 16 were having placebo capsules. All the data thus obtained were tabulated and statistical analysis of the data was done to test the level of significance.
| Results|| |
Out of the 50 patients enrolled, 6 could not complete the trial for the reasons unknown. Among the rest 44 patients, there were 32 males and 12 females. Both the groups were alike when their sex pattern was compared, (x 2 =0.017; P>0.05) [Table - 1].
Age of the patients ranged from 18 to 59 years. Mean age of the patients taking drug was 34.2±8.41 years. The difference in mean age of both the groups was not significant statistically (t=0.264; P>0.05). Similarly the mean duration of disease in patients taking drug was 7.98±6.12 years while that in patients taking placebo was 6.93±4.18 years. The difference in the two groups was statistically not significant (t=0.665; P>0.05) [Table - 2].
"PASI" score of the patients taking drug ranged from 8.4 to 32.4; mean being 18.87±7.36 at the initial stage, while that of placebo group was 19.91±6.48. Both the groups were alike when severity of the disease was compared before the starting of the drug (t=0.474; P>0.05) [Table - 3].
Both the groups had shown persistent decline in mean "PASI" score and the difference in mean was significant after 8 weeks of therapy (t=2.126; P<0.05), which became more marked after 12 weeks (t=5.261; P<0.001) [Table - 3].
On comparing the mean "PASI" score on Ist and lInd visit in drug group statistically significant difference was found (t=2.93; P<0.01) while it was not significant in placebo group (t=1.97; P>0.05). But the significant difference was seen in placebo group when the data was compared on Ist & IIIrd visit i.e. after 8 weeks (t=3.94; P<0.001). Thus showing thereby the quicker onset of response in the patients taking drug alongwith the coaltar therapy.
When the mean "PASI" score was plotted against the period of treatment, the linear diagram showed persistant decline which was more marked in the patients taking drug [Figure - 1].
No untoward side effect was noticed in any group throughout the period of the study.
| Comments|| |
Conventional crude coal tar therapy was found to be safe and effective in controlling uncomplicated psoriasis vulgaris, though the onset of action was slow.
Addition of oral aqueous extract of Neem leaf to conventional coal tar regimen has shown an excellent response and the onset of the action was quicker also.
Coal tar probably act by inhibiting the accelerated proliferation of keratinocytes, a primary alteration in psoriasis. Aqueous neem leaf extract, which contains 'Nimbidin' as a major part had shown 'Antitumour' properties . [2 ] Probably these drugs had this action in common and thus the synergistic action of the combination was responsible for quicker action.
As there were no side effect or toxic effect observed during the 12 weeks of the trial period, the combination therapy can be given safely. Probably the drug was acting as an adjuvant to coal tar therapy in patients suffering from uncomplicated psoriasis.
The capsules containing aqueous extract of Neem leaf, (Clean-N-clear capsules) and the placebo were provided by Dabur Research Foundation.
| Acknowledgement|| |
We are thankful to the Dabur Research Foundation for their financial support, supply of the drugs and constant assistant throughout the period of study as and when asked.
| References|| |
|1.||Farber EM, Abel EA, Charuworn A. Recent advances in the treatment of psoriasis. J Am Acad Dermatol 1983; 8 : 311. [PUBMED] |
|2.||Van der Nat JM, van der SluiS WG, de Silva KTD, Labadie RP. Ethnopharmacognostical survey of Azadirachta Indica A.Juss (Meliaceae). Journal of Ethnopharmacology 1991; 35:1. |
|3.||Pillai NR, Santhakumari G. Hypoglycaemic activity of Melia Azadirachta linn (Neem). Indian J Medical Research 1991; 74 : 931. |
|4.||Pillai NR, Santhakumari G. Effects of nimbidin on acute and chronic gastro-duodenal ulcer models in experimental animals. Planta Medica 1984; 50: 143. [PUBMED] |
|5.||Okpako DT. Prostaglandin synthetase inhibitory effect of Azadirachta Indica. Journal of West African Science Association 1977; 22 : 45. |
|6.||Fredriksson T, Petterssn U. Severe psoriasisoral therapy with a new retinoid. Dermatologica 1978; 157: 238. |
[Figure - 1]
[Table - 1], [Table - 2], [Table - 3]
|This article has been cited by|
||Complementary and alternative medicine for psoriasis: A qualitative review of the clinical trial literature
| ||Smith, N., Weymann, A., Tausk, F.A., Gelfand, J.M. |
| ||Journal of the American Academy of Dermatology. 2009; 61(5): 841-856 |