Journal of Clinical and Investigative Dermatology

Research Article

Topical Application of Curcumin Longa 5% Rhizome Ethyl Acetate Extract in Ointment Form versusMupirocin 2% Ointment in the Treatment of Impetigo and Folliculitis: A Double Blind, Randomized Controlled Trial

Gutierrez EMC* and Gulmatico-Flores Z

Department of Dermatology, Jose R. Reyes Memorial Medical Center, Philippines
*Address for Correspondence: Gutierrez EMC, Second year resident, Department of Dermatology, Jose R. Reyes Memorial Medical Center, Philippines; E-mail: emcgutierrez@yahoo.com
Submission: 15 January, 2019 Accepted: 27 February, 2019 Published: 29 February, 2019
Copyright: © 2020 Gutierrez EMC, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction: Impetigo is a common dermatosis of childhood commonly caused by Staphylococcus aureus and Group A Streptococcus. Antibiotics, topical or systemic, are the backbones of current treatment of impetigo. The spread of multi-drug resistant pathogens is one of the most serious threats to successful treatment of bacterial diseases. According to the World Health Organization, the use of medicinal plants is the most common form of traditional medication worldwide. Curcumin longa, commonly known as yellow ginger or turmeric or luyangdilaw, is a sterile plant from the Zingiberaceae family. Curcumin longa has been shown to possess significant antiinflammatory and anti-microbial effects. Objectives: The general objective of this study is to determine the efficacy and safety of Curcumin longa 5% rhizome ethyl acetate extract in ointment versus mupirocin 2% ointment in the clinical improvement or resolution of localized impetigo and/or folliculitis among patients seen in the JRRMMC, Department of Dermatology, and outpatient department. Methods: Patients with localized impetigo and/or folliculitis that met the inclusion criteria were recruited. Informed consent obtained, photographs taken at baseline (week 0). Similar subjects were used to compare both medications Group A (mupirocin 2% ointment) and Group B (Curcumin longa 5% rhizome ethyl acetate extract in ointment) to assure that we are dealing with the same microorganism. All patients were instructed to clean the lesions using normal saline solution using a gauze or cotton and to apply the afore mentioned medications using a cotton swab thrice daily for two weeks, or until resolution of lesions are noted. The patients were examined every week for 2 weeks and the primary investigator assessed if there is a reduction in the number of lesions and evidence of local adverse reaction (erythema, pain, itch, crusting, etc.). Photographs were taken every visit to assess improvement. Another resident physician in the same department was blinded and was assigned to distribute the ointments, in identical containers, to the recruited and qualified patients. Safety evaluation consisting of monitoring and recording all spontaneous adverse events were also noted. Results: Thirty eight patients were included in the study. 135 lesions were treated with Mupirocin, 133 with Curcumin longa. Of the 38 participants, three (7%) were considered to be dropouts owing to lost to follow up. After two weeks of treatment, 71.05% (27/38) of the mupirocin group and 52.63% (20/38) of the Curcumin longa group had resolution of the lesions; however, these differences are not statistically significant (p-value = 0.08). Female patients with age groups of 2 to 5 and 6 to 10 were noted to have the highest improvement both at 13%. Male patients ages 2 to 5 were noted to have the highest improvement at 10%. The mean Skin Infection Rating Scale (SIRS) after first week for the mupirocin group was 0.93 and 1.46 for the Curcumin longa group, and after second week for the mupirocin group was 0.37 and 0.83 for the Curcumin longa group which in both cases reflects large improvements relative to baseline (p-values < 0.001), but insignificant differences from each other (p-value = 0.063 and 0.074 respectively). Mupirocin-treated lesions recover significantly quicker than Curcumin longa-treated ones (first week, 72% and 31 %, respectively) with these proportions being significantly different at a p-value of < 0.032. There were no significant differences in the incidence of adverse effects/withdrawal rates between groups (p-values of 0.06, 0.28, and 0.09, respectively). Conclusion: Our results showed that topical application of Curcumin longa 5% rhizome ethyl acetate extract in ointment is of comparable efficacy and safety profile to mupirocin 2% in ointment in the treatment of localized impetigo and folliculitis. However, mupirocin-treated lesions recover significantly quicker than Curcumin longatreated ones. Those in the Curcumin longa group also experienced adverse reactions such as pain, erythema, blister formation, exudates, crusting and itch. Generally, the results implied that at the end of 2 weeks, both treatments had produced similar improvements on lesion counts.