Herbal Products and Their Active Constituents for Diabetic Wound Healing—Preclinical and Clinical Studies: A Systematic Review

Abstract

The purpose of this review is to provide verified data on the current knowledge acquired in preclinical and clinical studies regarding topically used herbal products and their active constituents (formulations and dressings) with diabetic wound healing activity. Moreover, herbal products and their active constituents used for diabetic wound infections, and various cellular and molecular mechanisms of their actions will also be described. The electronic databases were searched for articles published from 2012 to 2022. Publications with oral or systemic administration of herbal products in diabetic wound healing, published before 2012, available only as an abstract, or in languages other than English were excluded from the study. The 59 articles comparing topically used herbal products in diabetic wound healing treatment versus control treatments (placebo or active therapy) were selected. Herbal products through different mechanisms of action, including antimicrobial, anti-inflammatory, antioxidant activity, stimulation of angiogenesis, production of cytokines and growth factors, keratinocytes, and fibroblast migration and proliferation may be considered as an important support during conventional therapy or even as a substitute for synthetic drugs used for diabetic wound treatment.

Antioxidant Activities of Natural Compounds from Caribbean Plants to Enhance Diabetic Wound Healing

“…In the literature, numerous reviews report the use of plants to improve wound healing [88][89][90] and diabetic wounds [91][92][93], but data from ethnopharmacological surveys on the traditional use of plants specifically to treat diabetic foot wounds are still rare. However, it is information on efficacy recognized by users that is generally the source of scientific work at the origin of research carried out in vitro on diabetic animals.…”

Healing of diabetic foot ulcer with topical and oral administrations of herbal products: A systematic review and meta‐analysis of randomized controlled trials

“…Also, a wide range of literature supports utilizing herbal treatments to improve DFU; however, further high‐quality appraisals on the efficacy and safety of these interventions are recommended before they can be applied on a large scale 21–26 . Systematic reviews, which are at the top of the clinical evidence hierarchy, have recently addressed the potential effect of herbal products in healing DFU; however, they either focused on metabolites and phytoconstituents of used herbs or synthesized the results of investigations with different study designs, making it difficult to draw a reliable conclusion 27–30 . On the contrary, reviews that performed a meta‐analysis or comprehensive synthesis included only studies conducted in China or evaluated Chinese Herbal Medicines (CHM), which may limit the generalizability and applicability of their findings 31–37 .…”

“… 21 , 22 , 23 , 24 , 25 , 26 Systematic reviews, which are at the top of the clinical evidence hierarchy, have recently addressed the potential effect of herbal products in healing DFU; however, they either focused on metabolites and phytoconstituents of used herbs or synthesized the results of investigations with different study designs, making it difficult to draw a reliable conclusion. 27 , 28 , 29 , 30 On the contrary, reviews that performed a meta‐analysis or comprehensive synthesis included only studies conducted in China or evaluated Chinese Herbal Medicines (CHM), which may limit the generalizability and applicability of their findings. 31 , 32 , 33 , 34 , 35 , 36 , 37 Yet, recent randomized controlled trials (RCTs) performed in different regions have reported inconsistent findings regarding the potential efficacy of herbal medications in healing DFU.…”

Biological Activity of Fermented Plant Extracts for Potential Dermal Applications

“…Wound healing is a complex inter-related biological process at the molecular level, and it occurs in four stages or phases consisting of hemostasis, inflammation, proliferation, and finally epithelialization [ 44 ]. Herbal products and their active constituents through different mechanisms of action, including antimicrobial, anti-inflammatory, and antioxidant activity, the stimulation of angiogenesis, the production of cytokines and growth factors, keratinocytes, and fibroblast migration and proliferation, may be considered as an important support during conventional therapy or even as a substitute for synthetic drugs used for wounds treatment [ 45 ]. Some research found that FPEs may stimulate wound closure.…”