Senna Alata Leaf Decoction as a Treatment for Tinea Imbricata in an Indigenous Tribe in Southern Philippines :a Pilot Study

Introduction:

Tinea imbricata is a rare form of tinea corporis caused by Trichophyton concentricum, an anthropophilic dermatophyte. Its lesions would present embossed "maze-like" or lace-like pattern of embosed concentric rings mainly on the trunk and extensor surfaces of both extremities, sparing the palms, soles, hair and nails. Due to the rarity of the disease, limited epidemiologic and prevalence studies exist. (Halickova, 2008) Tine imbricata is known to be endemic in places such as the Pacific Islands of Oceana, South East Asia, India, Sri-Lanka, North, Central and South America. (Halickova, 2008 and Pihet, 2008) The first case was discovered in the southern Philippines by William Dampier in 1789. (Fernandez, 1962) In 2010, cases of tinea imbricata were found to still exist among T'boli tribe who live in the mountainous areas of Kiamba in Sarangani through the University of the Philippines- Department of Science and Technology (UP-DOST) telemedicine project. (Carpio, 2010) The inherited susceptibility of T.concentricum infection may explain why the disease affects only specific group of people. The most accepted inheritance pattern is autosomal recessive attributing to the inherited defect in cell-mediated immunity, which results to failure of the T-lymphocytes to become sensitized to the fungi and mount an immune response. Majority of the patients are blood-related individuals and rarely infect unrelated individuals even after close contact or cohabitation., Other risk factors are isolated and primitive living conditions especially in humid areas, widespread poverty, poor hygienic conditions and overcrowding. (Bonifaz, 2003 and Bonifaz, 2004) Antifungals are the mainstay treatment against Trichophyton concentricum. Griseofulvin, 500 mg/tab twice daily, and terbinafine, 250 mg once daily, for at least 4 weeks result to complete resolution. (Wingfield, 2004) However, these commercial antifungal preparations are costly and not readily available in the health centers of Sarangani. Furthermore, even with systemic antifungal intake, disease remission would only last for at least 8 weeks post-treatment. Alternative treatment options that will promote clearance of the infection that are accessible, inexpensive and practical to use should be explored.

Antifungals from local plant sources are one of the potential alternatives. Among these, Senna alata has validated efficacy on superficial dermatophytic infections and is included in the Philippine National Drug Formulary. It is a tropical ornamental shrub, also known as candle bush and locally as "Akapulko, which grows throughout the low and medium altitude areas of the country including Sarangani.

Chemical screening of the leaves and roots of S. alata revealed the anthraquinones and its derivatives such as aloe, emodin, chrysophanol, and rhein, are the major components responsible for its antifungal activity. These are naturally occurring phenolic compounds are readily oxidized to form a phenolate ion or quinone, which aids in the scavenging and entrapment of microorganisms. Furthermore, phenols impair a variety of enzyme systems that are involved in the microorganism's energy production. They also disrupt the integrity of the cell membrane and interfere with the synthesis of its structural components. (Hemen and Ledwani,2012) There were anecdotal reports on the efficacy of akapulko decoction against tinea imbricata. A decoction is the liquid resulting from concentrating the essence of the substance by heating or boiling, especially a medicinal preparation made from a plant. Plant parts such as leaves can be used in decoctions. The first anecdotal report was published by Dofitas and Non last 2010. Senna alata leaf decoction was used as leave-on body wash in a T'boli woman resulting in complete clearance of the lesions. In the case series by Carpio et. al., S. alata leaf decoction resulted to partial improvement of the skin lesions. (Dofitas and Non, 2010 and Caprio, 2010) At present there are no existing clinical trials about the use of akapulko as an alternative or complementary treatment to tinea imbricata. The favorable results from the anecdotal and case series studies pave the way for the consideration of akapulko decoction as a part of an accessible and affordable treatment regimen for tinea imbricata.

II Objectives: