Effect of Topical Cidir leaves Extract in Reducing Skin Sensitivity in Atopic Patients

Objective: To determine the changes of Cutaneous sensations that occur after local application of cidir leaves extract in atopic patients and healthy individuals. Methods: Thirty normal individuals and 30 patients with atopic dermatitis participated in the study. The study was conducted in Najaf Teaching Hospital-Najaf in the period between October 2002 and March 2004. The square wave electrical stimulator was used to stimulate fixed spots on the volar aspect of the right forearm before and after the application of cidir leaves extract. The stimulus was increased gradually and the type of cutaneous sensation that occurred was reported. Results: Cidir leaves extract decrease the skin sensitivity both in normal and effectively in atopic patients. The mean stimulus required to induce each one of cutaneous sensation (tingling, pricking, itching and pain) was higher after the application of the cidir leaves extract. The Cutaneous sensation on other hand that induced by the stimulus was milder than before application of the extract. Conclusion: Cidir leaves extract decrease skin sensitivity both in atopic patients and healthy individuals so it can be used as a cooling agent in cases of eczema and pruritus.

Hypoglycemic and antihyperglycemic effects of Zizyphus spina-christi has been demonstrated [9].The chemical constituents confirm the fruit's beneficial use as a tonic (table 1).The seeds were rich in protein and the leaves in calcium, iron and magnesium.The food from this plant is an important source of energy, protein and minerals [2].The plant is already used in many parts of the world for the care of the skin.The chemical composition and phytochemicals present in the plant would suggest and substantiate the ethnobotanical and cultural reliance on this plant.[10].
Lipid peroxidation plays an important role in the generation of problem skin and scalp conditions by involving changes in the sebum composition leading to increases in the immune reaction of the skin.Peroxidation and other oxidative breakdowns can be caused by environmental challenges that generate free radicals (such as exhaust pollution, industrial fumes, ozone, UV light, cigarette smoke, etc.,) and by biological challenges such as micro-organisms and other detrimental conditions.An 10% Zizyphus spina-christi extract reduced lipid peroxidation by 66%.[11] Atopic dermatitis (AD) is a chronic, highly pruritic, eczematous skin disease that follows patients from early childhood into puberty and sometimes adulthood.Also referred to as eczematous dermatitis, the disease often has a remitting/flaring course, which may be exacerbated by social, environmental, and biological triggers.[12] s:

Patients and method
The study was performed in the Medical Teaching Hospital-Najaf on 30 normal individuals and 30 patients with atopic dermatitis.Their ages and sexes are illustrated on (table 2).The cidir leaves were dried, crushed and immersed in water for 24 hours..The extract was taken and applied on fixed points in the right forearm of each of normal persons as a control and atopic patients and left for five minutes.The measurement was performed by using a square wave electrical stimulator which is a non invasive technique to study the skin sensitivity.The positive electrode was a tungsten wire with a tip of 38 micrometers.While the negative electrode indifferent electrode consisted of a metal disc of 2 centimeters diameter covered with cotton gauze soaked with tap water.This electrode was applied to the abdomen.The pulse width was kept constant at 5 milliseconds while the pulse rate was fixed at 20 pulses per second.The positive electrode applied on each of the four spots which were selected on the volar aspect of each individual i.e. normal and atopic person.The voltage of the stimulator was increased gradually until the patient feels the stimulus as one type of skin sensations -tingling, pricking, itching or pain-which was recorded as the threshold voltage.The voltage was increased gradually until reaching a stimulus that can induce a second sensation , this stimulus called post threshold stimulus and the response recorded as second cutaneous sensation.

Results
The cutaneous electrical threshold was lower in atopic individuals compared to healthy controls before and after the application of cidir leaves extract (table-2).This was statistically significant (p<0.05).The mean post electrical cutaneous threshold was lower in atopic patients compared to normal individuals before and after cidir leaves extract application.After the application of cidir leaves extract, the mean post electrical cutaneous threshold was increased in both normal and atopic patients.The effectiveness of the cidir leaves extract in reducing the cutaneous sensitivity was more pronounced in atopic patients than normal individuals (table-3).This was statistically significant (p<0.05).The type of cutaneous sensations induced by skin stimulation with a square wave electrical stimulator was reported.The sensations were more irritable (pricking , iching, pain) in atopic patients than normal individuals.These sensations were changed after cidir leaves extract application and become less irritable both in atopic patients and control (table-4).Comparing atopic patients skin with that of a normal control by measuring cutaneous threshold, post cutaneous threshold and skin sensations with a square wave electrical stimulator.The cutaneous threshold was lower in atopic patients before and after using cidir leaves extract.This result was mentioned in other study.[14] The post cutaneous threshold readings were also lower in atopic patients than control before and after cidir leaves extract application.This demonstrate stastically that atopic patients skin is more sensitive to irritations as mentioned by others.
[15] After using cidir leaves extract on the skin the post threshold reading were higher than before application, this demonstrate that cidir leaves extract has cooling effect on normal and atopic persons with more efficacy in atopic patients.This result agree with what mentioned in other literatures in that, application of a 10% aqueous extract Zizyphus spina-christi powder.on UVirradiated skin showed a reduction in the skin reddening.[16] Cutaneous sensations that occurs following skin stimulations was more painful in atopic patients than control.These sensations were become less irritable after cidir leaves extract application.

Table 1 :
Age and sex of healthy control individuals and atopic patients.

Table 2 :
The mean post cutaneous electrical threshold in volts in healthy control individuals and atopic patients before and after the application of cidir leaves extract.

Table 3 :
The mean post cutaneous electrical threshold in volts in healthy control individuals and atopic patients before and after the application of cidir leaves extract.

Table 4 :
Cutaneous sensations before and after cidir leaves extracts application both in normal and atopic patients