Effectiveness and Tolerability of a Standardized Extract from Ageratina pichinchensis on Patients with Tinea Pedis: An Explorative Pilot Study Controlled with Ketoconazole

Abstract

Ageratina pichinchensis has been used for many years in Mexican traditional medicine for the treatment of superficial mycosis. Previous studies have demonstrated the antifungal effectiveness of a hexane extract from aerial parts of this plant on in vitro cultures of Candida albicans, Aspergillium niger, Trichophyton mentagrophytes, and Trichophyton rubrum. To compare the effectiveness and tolerability of A. pichinchensis with ketoconazole in patients with the clinical and mycological diagnosis of tinea pedis, we carried out a double-blind pilot study. The experimental group was treated topically with a cream containing A. pichinchensis standardized extract (10 %), while the control group was administered a similarly colored cream containing 2 % ketoconazole. All patients were clinically followed weekly for 4 weeks. By means of a mycological examination (direct microscopic detection), the mycological diagnosis of tinea pedis was performed. This technique was also used for evaluating the mycological effectiveness at the end of treatment. A total of 120 patients were included, 60 in each treatment group. Of these, 97 patients were included in the statistical analysis, 51 from the experimental group and 46 controls. The remainder of the patients withdrew from the study due to non-medical causes. Clinical effectiveness was reached in 80.3 and 76 %, while therapeutic success was achieved in 80.3 and 71.7 % of the experimental and control groups, respectively. There were no statistical differences between groups (p = 0.31). Our results suggest the effectiveness and tolerability of a standardized extract from A. pichinchensis in treatment of patients with tinea pedis.

Abbreviations

MIC:Minimal inhibitory concentration

PII:Primary irritation index

HPLC:High performance liquid chromatography

Asteraceae - Ageratina pichinchensis - axihuitl - benzofurans - superficial mycosis - tinea pedis - dermatophyte - dermatomycosis - complementary and alternative medicine

References

• 1 Zurita E M, Zolla C. Enfermedades dermatológicas en la medicina tradicional de México.  Bol Oficina Sanit Pan. 1986;  101 339-44
• 2 Argueta A, Cano L, Rodarte M. Atlas de la medicina tradicional Mexicana, tomo1 - 3. Instituto Nacional Indigenista; México D.F 1994: 1786
• 3 Aviles M, Suárez G. Catalogo de plantas medicinales. Jardín Etnobotánico Centro INAH, Cuernavaca, Morelos, México; 1994: 47
• 4 Monroy-Ortiz C, Castillo-España P. Plantas medicinales utilizadas en Morelos. México; Centro de Investigaciones Biológicas Universidad Autónoma del Estado de Morelos 2000: 61-2
• 5 Rzedowski G C, Rzedowsky J. Flora fanerogámica del Valle de México. Centro Regional del Bajío. Comisión Nacional para el Conocimiento y Uso de la Biodiversidad. Patzcuaro, Michoacán.; Instituto de Ecología A.C. 2nd Edition. 2001: 797
• 6 Gómez F, Quijano L, Calderón J S, Perales A, Rios T. 2, 2-Dimethylchromenes from Eupatorium aschembornianum .  Phytochemistry. 1982;  21 2095-7
• 7 Navarro V M, García A, González M, Fuentes A, Aviles M, Rios Y. et al . Antifungal activities of nine traditional Mexican medicinal plants.  J Ethnopharmacol. 2003;  87 85-8
• 8 Rios M Y, Aguilar-Guadarrama B, Navarro V M. Two new benzofurans from Eupatorium aschenbornianum and their antimicrobial activity.  Planta Med. 2003;  69 967-70
• 9 Porta-Aponte T, Olivera-Fernández A, Palma-Mora S, Monteaguado G L, González-Pérez D. Pruebas dérmicas y oftálmicas a un extracto etanólico de Bixa orellana .  Medicentro. 2001;  5 1-5
• 10 Wade-Foster K, Ghannoum M A, Eleweski B E. Epidemiologic surveillance of cutaneous fungal infection in the United States from 1999 to 2002.  J Am Acad Dermatol. 2004;  50 748-52
• 11 Cordeiro R A, Brilhante R S, Rocha M F, Rabenhorsch S H, Moreira J L, Grangeiro T B. et al . Antifungal susceptibility and genetic similarity of sequential isolates of Trichophyton rubrum from an immunocompetent patient whit chronic dermatophytosis.  Clin Exp Dermatol. 2006;  31 122-4
• 12 Ghannoum M A, Hossain M A, Long L, Mohamed S, Reyes G, Hukherjee P K. Evaluation of antifungal efficacy in an optimized animal model of trichophyton mentagrophytes-dermatophytosis.  J Chemother. 2004;  16 139-44
• 13 Gupta A K. The treatment of chronic interdigital tinea pedis infection using imiquimod cream 5 %.  J Am Acad Dermatol. 2004;  50 (Suppl. 1) 104
• 14 Porche D J. Tinea pedis: a common male foot problem.  J Nurse Pract. 2006;  2 152-3
• 15 Gupta A K, Ryder J E, Chow M, Cooper E A. Dermatophytosis: the management of fungal infections.  Skinmed. 2005;  4 305-10
• 16 Hoharitanon S, Chaichalotornkul J, Sindhupak W. A comparison of the efficacy between two itraconazole generic products and the innovative utraconazole in the treatment of tinea pedis .  J Med Assoc Thai. 2005;  88 ( (Suppl. 4)) 167-72
• 17 Herrera-Arellano A, Rodríguez-Soberanes A, Martinez-Rivera M A, Martinez-Cruz E, Zamilpa A, Alvarez L. et al . Effectiveness and tolerability of standardized prhytodrug derived from Solanum chrysotrichhum on tinea pedis: a controlled and randomized clinical trial.  Planta Med. 2003;  69 390-5
• 18 Menendez S, Falcon L, Simon D R, Landa N. Efficacy of ozonized sunflower oil in the treatment of tinea pedis.  Mycoses. 2002;  45 329-32
• 19 Puiatti P, Cervetti O, Forte M, Zina G. Ketokonazole treatment in superficial mycosis.  Drugs Exp Clin Res. 1986;  12 405-7
• 20 Greer D L. Topical treatment for mocasín-type tinea pedis.  J Am Acad Dermatol. 1987;  16 554-8
• 21 Greer D, Jolly H W. Comparative trial of a two-dosage schedule of ketoconazole 2 % cream for the treatment of tinea pedis.  J Am Acad Dermatol. 1987;  17 53-6
• 22 Lester M. Ketoconazole 2 percent cream in the treatment of tinea pedis, tinea cruris and tinea corporis.  Cutis. 1995;  55 181-3