Hypericum and wound healing.
Article Type: Report
Subject: Wound healing (Research)
Wound healing (Management)
St. John's wort (Health aspects)
St. John's wort (Research)
St. John's wort (Usage)
Surgical wound infections (Prevention)
Author: Finney-Brown, Tessa
Pub Date: 03/22/2010
Publication: Name: Australian Journal of Medical Herbalism Publisher: National Herbalists Association of Australia Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 National Herbalists Association of Australia ISSN: 1033-8330
Issue: Date: Spring, 2010 Source Volume: 22 Source Issue: 1
Topic: Event Code: 310 Science & research; 200 Management dynamics Computer Subject: Company business management
Accession Number: 223823995
Full Text: Samadi S, Khadivzadeh T, Emami A, Moosavi N, Tafaghodi M, Behnam HR. 2010. The effect of Hypericum perforatum on the wound healing and scar of cesarean. JACM 16:1;113-17.

After a cesarean section, delays in wound healing and the formation of visible scars are common complications. The scars are not only cosmetic deformities, which are potentially psychologically stressful, but may also cause pruritis, pain, contractures and hinder movement.

At present hypertrophic scars are difficult to treat with allopathic medicine and the best strategy still seems to be prevention of their formation. Hypericum perforatum, commonly known as St John's wort (SJW), is recommended both topically and orally for the healing of wounds in many folk medicine traditions.

In order to clinically assess the use of SJW for prevention of hypertophic scarring and promotion of post cesarean wound healing, Iranian researchers completed a randomised double blind clinical trial of 144 women with surgical childbirth (by the same two obstetricians). The women were randomly allocated into three groups: a control non intervention group, a placebo group and an active group. The latter two applied placebo or SJW ointment (macerated 1:3 in oil then clarified and mixed into petroleum jelly at 20% oil extract and 80% petroleum jelly) three times a day for 16 days beginning 24 hours after the operation.

Wound healing was assessed via the REEDA scale (redness, edema, ecchymosis, discharge and approximation) on day 10, giving each criteria a score out of three with 0 being normal skin. On the fourtieth day an experienced plastic surgeon assessed the degree of scarring using the Vancouver Scar Scale (VSS), consisting of a range from 0 to 14 in four categories: pigmentation, height, pliability and vascularity. The women were asked to rate their pain on the fourtieth day using a visual analogue scale, whether they experienced pruritis and whether they were satisfied with the results of healing.

On the tenth day the SJW treated group showed significantly better wound healing than either placebo or control groups. The total score of the REEDA was lower, as were all of the criteria bar ecchymosis. At day 40 there was a significantly lower VSS score in the active group compared with placebo and controls. Women using the Hypericum ointment experienced significantly less pruritis, greater satisfaction with healing (90% compared with 76% for placebo and 68% for control) and lower pain scores. Only one patient experienced an adverse effect of irritation at the surgical site, which resolved without medical intervention on cessation of the active treatment.

The trial demonstrated the clinical efficacy of using Hypericum perforatum oil extracts to aid wound healing and prevent hypertrophic scar formation. Constituents that may be responsible for the results include amentoflavone and hypericine (anti-inflammatory) and hyperforin which inhibits gram positive bacteria. The flavonoids and xanothones in the extract probably caused an increase in the percentage of polygonal fibroblasts, stimulated collagen synthesis and influence epithelial cell proliferation and migration. The authors suggest that further studies may be useful in comparing the efficacy of this treatment with other complementary medicine approaches.

Tessa Finney-Brown MNHAA

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