Effect of the Compound Extracted From Azadirachta Indica Leaves in the Treatment of Arsenical Keratosis

Prepare an ointment from Azadirachta indica leaves extract and its apply on palmer arsenical keratosis patient, for 12 weeks. After intervention, effect of the ointment will be observed by measuring the nodule (before and after apply the ointment)

Study Overview

• Status: Unknown
• Conditions: Keratotic Nodular Size
• Intervention / Treatment: Drug: Azadirachta indica leaves extract containing ointment intervention.

Detailed Description

Arsenicosis or arsenic toxicity caused by prolong ingestion of contaminated groundwater by inorganic arsenic (more than 0.05 mg/liter). It is the severest natural calamity widespread specially in Bangladesh where 61 districts out of 64 are affected. The commonest and earliest feature of arsenicosis is skin involvement like keratosis, melanosis and skin carcinoma. Keratosis of the palm and soles reduce the working ability of the patient's and affect their socio-economic condition. There is no specific treatment for keratosis. Short-term improvement may occur by using some topical keratolytic like salicylic acid, propylene glycol, eating some dietary supplementation like vitamin A, C, E, zinc, folic acid and foodstuffs like corn, spinach but symptoms recure after stoppage of these treatments. Also, these treatments require longer duration which ultimately affects patient adherence. Azadirachta indica leaves contain flavonoids, quercetin, azadirachtin, nimbin, steroids, alkaloids, phenolic compounds and other biologically active compounds that have anti-proliferative, anticarcinogenic, antioxidative and immunostimulant effects. For this reason, a study named "Effect of ethanol extract of leaves of Azadirachta indica on palmer arsenical keratosis: A single-blind trial" was done in the Department of Pharmacology, Bangabandhu Sheikh Mujib Medical University, which was found effective . So, the purpose of this study is to evaluate the effectiveness of the identified compound on moderate to severe arsenical keratosis which will be isolated from A. indica leaves extract. After IRB clearance, 35 patients with moderate to severe arsenical keratosis will be collected based on inclusion and exclusion criteria from the arsenic affected area, located at Kamalla Union of Muradnagar Upazilla, Comilla. The study will be quasi-experimental study. Included patients will be informed about the purpose of this study, as well as harmful and beneficial effects. Informed written consent, detail history, clinical examination, photographs of the palm and sole and nail samples will be collected before starting recruitment to confirm arsenicosis. For identification of isolated compounds present in the A. indica leaves, thin layer chromatography, nuclear magnetic resonance, and infrared spectrometry will be done. Cytotoxic effects of the A. indica leaves extract will be assessed by using brine shrimp bioassay. The ointment will be prepared from A. indica leaves extract and supplied to the patient at an interval of 2 weeks. Each patient will be advised to apply the ointment, with a clean fingertip by rubbing gently in the morning and night for 12 weeks. Regular monitoring will be done through phone calls and during a follow-up visit at the field level, about improvement and side effects of the ointment. Clinical improvement will be assessed by measuring the keratotic nodular size with the help of slide calipers. Statistical analysis will be done by paired t-test.

• Study Type: Interventional
• Enrollment (Anticipated): 35
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Israt Zahan Zarin, MBBS; Phone Number: 01729181559; Email: drisratzahan34@gmail.com

Study Locations

• Bangladesh
  • Comilla, Bangladesh
    • Recruiting
    • Muradnagar Upazilla
    • Contact: Israt Zahan Zarin, MBBS; Phone Number: 01729181559; Email: drisratzahan34@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 19 years to 65 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. 19 to 65 years of age
2. Male and female both were included
3. Presence of palmar arsenical keratosis which nature was moderate to severe (2 to >5)
4. Used water at least more than 6 months which was contaminated with arsenic (>50 µg/L) especially for drinking purpose
5. Any drug like topical application did not received by the patient for at least last three month

Exclusion Criteria:

1. <19 and >65 years of age
2. Pregnant and breast feeding mother
3. Accept any treatment at least last three months for arsenicosis
4. Any type of skin disease like drug allergy, atopic dermatitis, psoriasis, eczema and other keratosis
5. Various systemic disease like diabetes mellitus, hepatitis, rheumatoid arthritis and others that affected the skin

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Azadirachta indica leaves extract containing ointment intervention.; Azadirachta indica leaves extract containing ointment will be used twice daily for 12 weeks	Drug: Azadirachta indica leaves extract containing ointment intervention.; Azadirachta indica leaves extract containing ointment, white petroleum, bee wax, stearyl alcohol

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Keratotic nodular size	Lesion size will be measured by slide calipers	12 weeks

Collaborators and Investigators

• Sponsor: Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
• Investigators: Principal Investigator: Bangladesh Muradnagar Upazilla.Comilla, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Study record dates

Study Major Dates

• Study Start (ACTUAL): October 20, 2019
• Primary Completion (ANTICIPATED): January 20, 2021
• Study Completion (ANTICIPATED): February 20, 2021

Study Registration Dates

• First Submitted: December 23, 2020
• First Submitted That Met QC Criteria: December 23, 2020
• First Posted (ACTUAL): December 28, 2020

Study Record Updates

• Last Update Posted (ACTUAL): January 8, 2021
• Last Update Submitted That Met QC Criteria: January 7, 2021
• Last Verified: January 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Skin Diseases; Keratosis
• Other Study ID Numbers: BSMMU/2020/1643

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No