MEDICINAL PROPERTIES OF SOME PLANTS USED FOR THE

TREATMENT OF SKIN DISORDERS IN THE O R TAMBO AND

AMATHOLE MUNICIPALITIES OF THE EASTERN CAPE PROVINCE,

SOUTH AFRICA

by

MAHACHI JOSIA

A dissertation submitted in fulfillment of the requirements for the degree of

MASTER OF SCIENCE (MSc): BOTANY

at

WALTER SISULU UNIVERSTY

SUPERVISOR: DR. L. KAMBIZI

SEPTEMBER 2013

ii

General Abstract

The use of medicinal plants for treatment of skin infections and improvement of skin tone

was assessed. The study covered Amathole and OR Tambo municipalities of the Eastern

Cape Province of South Africa. The study sought to identify and document some medicinal

plants which are used by the indigenous people on the skin, evaluate some biological

properties which attribute to their use for therapeutic use. This report provides

ethnobotanical data on some plant which were identified. Six medicinal plants (Kniphofia

drepanophylla, Gnidia capitata, Hypoxis hemerocallidea, Syzgium cordatum, Macaranga

capensis and Protorhus longifolia) which were implicated for treatment of skin diseases

were screened for their antibacterial and antioxidant properties.

Guided questionnaires were used to interview and gather ethnobotanical information

from the traditional healers. Members of the communities which were indicated to be

knowledgeable on use of medicinal plants in the areas were visited and interviewed. The

results revealed that a total of 45 plant species distributed in 41 Genera belonging to 28

Families are used for treatment of skin infections and improvement of skin texture. The

plant medicines were reported to be used as remedies against common skin problem

such as wounds, pimples, acnes and itches. Some were reported to have anti-

inflammatory effect on the skin while other were reported to oil dry skin and prevent skin

dryness and dry eczematous conditions. Others like Cassipourea flanaganii, and

Spirostachys africana were commonly used to enlighten skin and protect skin from ultra-

violet radiation. The most common mode of preparation of these medicinal plants was

pastes or decoctions. Sometimes crushed plant materials were put in bathing water or

iii

boiled and steamed on affected parts. It was reported that mixing pastes with oil, animal

fat and milk improve medicinal properties.

Water, methanol and acetone extracts of K. drepanophylla, G. capitata, H.

hemerocallidea, S. cordatum, M. capensis and P. longifolia were screened against five

strains of Gram negative bacteria. The results revealed that water extracts from five plant

species inhibited two or more strains of bacteria with the most common minimum

inhibitory concentrations (MICs) ranging between 5,0 to 10,0 mg/ml with the exception

of aqueous extracts of K. drepanophylla which failed to inhibit all strains of bacteria.

The screening of methanol extract of these plants for antioxidant and free radical activity

revealed a significant activity with 1, 1-diphenyl-2-picryl-hydrazyl (DPPH) free radical

(DPPH). The extracts of P. longifolia, G. capitata, M. capensis, S. cordutum and H.

hemerocallidea showed significantly higher free radical scavenging activity with IC50 of

ranging from about 11.0 to 41.2 µg/ ml while the IC50 value for K. drepanophylla could

not be determined at 100 µg/ ml.

Generally the study showed that medicinal plants still play a very important role in the

health care delivery system, especially in the O R Tambo and Amathole municipalities of

the Eastern Cape. Botanical medicine remains pivotal in the treatment of skin ailments

and improvement of the skin tone.

iv

Declaration of originality

I, Josia Mahachi, Student Number 209065494, solemnly declare that this dissertation entitled “Medicinal Properties of Some Plants Used for Treatment of Skin Disorders in the O R Tambo and Amathole Municipalities of the Eastern Cape Province, South Africa” is my original work. All sources used or quoted in the study have been

indicated and acknowledged by way of complete references.

MASTER’S CANDIDATE: MAHACHI JOSIA

SIGNATURE: ……………………………………..

DATE: ……………………………………..

SUPERVISOR: DOCTOR L. KAMBIZI

SIGNATURE: ……………………………………..

DATE: ……………………………………..

v

Plagiarism Declaration

(i) I am aware that plagiarism is defined at Walter Sisulu University (WSU) as the inclusion of another’s or other’s ideas, writing, works, discoveries and inventions from any source in an assignment or research output without the due, correct and appropriate acknowledgement to the author(s) in breach of the values, conventions, ethics and norms of different professional, academic and research disciplines and includes unacknowledged copying from intra- and internet and peers/fellow students.

(ii) I have duly and appropriately acknowledged references and confirmed to avoid plagiarism as defined by WSU.

(iii) I have made use of the citation and referencing style and stipulated by my supervisor.

(iv) This submitted work is my own. (v) I did not and will not allow anyone to copy my work and present it as his/her

own. (vi) I am committed to uphold academic integrity in the academic/ research activity. (vii) I am aware of the consequences of engaging in plagiarism.

…………………………………………… ……………………………

Signature Date

vi

Acknowledgement

Acknowledgements and thanks to:

To my supervisor Dr L. Kambizi for his expertise, excellent supervision and

mentorship which he provided during this study. Without his assistance it could

not have been possible to go through this research project;

Dr. D. Kamadyaapa and Mr. E.J. Ndebia for their technical support in performing

the antioxidant assays;

Dr. E. Immelman and Mr. E. Cleote for their assistance in the identification of

plants collected during the ethnobotanical survey;

Mr. D. Wopula for helping for social networking and conducting the ethnobotanical

survey;

Department of Physiology, Faculty of Health Science, Walter Sisisulu University for

allowing me to conduct antioxidant assays using its facilities;

Research Direcorate of Walter Sisulu University for funding this research;

National Research Foundation for funding this study;

Traditional practitioners and local people of Amathole and O R Tambo

Municipalities who provided ethnobotanical information on medicinal plants used

for treatment of skin ailments.

vii

Dedication

To my wife Tendayi Clarah Mahachi and my children Leo, Leon, Leonell and Leona who

endures the absence of their father during the period of this study and whose patience

and love is always beyond comprehension.

To my parents Leyo and Vongayi Mahachi who went through serious hardships for my

education.

To my late auntie Sosana Mahachi who took care of me during my childhood.

viii

LIST OF ABBREVIATIONS

AIDS Acquired Immune-Deficiency Syndrome

ARV Antiretroviral

DNA Deoxyribonucleic acid

DPPH 1, 1-diphenyl-2-picryl-hydazyl

HIV Human Immune-Deficiency Virus

MICs Minimum Inhibitory concentrations

S.A South Africa

UCHPP Walter Sisulu University Health Partnership Project

USA United State of America

WHO World Health Organization

WSU Walter Sisulu University

ix

Table of contents

General abstract ii

Declaration of originality iv

Plagiarism declaration v

Acknowledgements vi

Dedication vii

List of abbreviations viii

Table of contents ix

List of tables xiii

List of figures xiv

List of appendices xv

Chapter 1: Research problem 1

Introduction 1

Statement of the problem 2

Background of the problem 4

Objectives of the study 6

Significance of the study 6

Rationale of the study 9

Overview of Chapters 10

References 11

Chapter 2: Literature review 16

x

Skin disorders and infections 16

Inflammation and erythema 18

Hyperpigmentation and hypopigmentation 20

Psoriasis 21

Free radicals 22

Role of medicinal plants 23

Modern medicines from plants 25

Use of medicinal plants on the skin 27

Antimicrobial agents in plants 28

Anti-inflammatory and antierythema 30

Plant agents used against skin dryness and dry eczematous conditions 31

Antioxidant agents 31

References 33

Chapter 3: An ethnobotanical study of some medicinal plants

used for treatment of skin infection and improvement of skin

infections and improvement of skin tone in O R Tambo and

Amathole Municipalities

39

Abstract 39

Introduction 40

Materials and methodology 43

Ethnobotanical survey 44

Results 45

xi

Discussion 58

Conclusion 61

Acknowledgements 61

References 62

Chapter 4: Antibacterial activity of some plants used for

treatment of skin infections and disorders in O R Tambo and

Amathole Municipalities

66

Abstract 66

Introduction 67

Methodology 68

Results and Discussion 71

Acknowledgement 74

References 75

Chapter 5: In vitro antioxidant activity of some plants used for

treatment of skin problems in O R Tambo and Amathole

Municipalities

77

Abstract 77

Introduction 78

Materials and Methodology 80

Results and Discussion 82

Acknowledgement 86

References 87

xii

Chapter 6: General discussion 89

Discussion 89

Conclusions 93

Limitations 94

Recommendations 94

References 96

Appendices 98

Questionnaire respondent by traditional practitioners 98

Questionnaire respondent by local people 102

xiii

List of tables

Table No Title of table Page No

3.1 Ethnomedicinal plant species used for treatment and

improvement of skin in O R Tambo and Amathole

Municipalities

47

4.1 Antibacterial activity of some plants extracts used for

treatment of skin problems in O R Tambo and Amathole

Municipalities

73

5.1 1 In vitro antioxidant activity of methanol extracts of some

plants used for treatment of skin infections and disorders

84

xiv

LIST OF FIGURES

Figure No: Figure title: Page No:

2.1 Some conditions of the skin caused by infection 18

2.2 Erythema caused by mild sunburns 19

2.3 Erythema multicoforme complexes 20

2.4 Erythema multicoforme complexes 22

3.1 Map of Eastern Cape showing study area 44

3.2 Families of plant used for the treatment of skin disorders 53

3.3 Medicinal plants used for treatment and improvement 54

3.4 Type of medicinal plants used for treatment of skin

disorders

55

3.5 Mode of preparation of botanical medicines 55

3.6 M. capensis stem and leaves 56

3.7 H. hemerocallidea plant 56

3.8 K. drepanophylla underground parts 57

3.9 G. capitata plant 57

3.10 P. longifilia stem, leaves and a traditional practitioner 57

5.1 DPPH free radical activities of ascorbic acid and methanol

plant extracts

83

xv

List of Appendices

Questionnaire respondent by traditional practitioners 98

Questionnaire respondent by local people 102

1

Chapter 1: Research problem

INTRODUCTION

People on all continents have used hundreds to thousands of indigenous plants for the

treatment of ailments since prehistoric times (Acharya et al., 2008). In the Eastern Cape

Province of South Africa indigenous people have a long history of using phytotherapy for

the treatment of various diseases and ailments (Grierson and Afolayan, 1999; van Wyk,

et al., 1997) including various skin disorders. The use of medicinal plants is not something

of the past instead it is something essential for the future. Scientific literature indicated

that pathogens are increasingly becoming more resistant to antibiotics (Quave et al.,

2008). The evolution of highly resistant pathogenic microbial strains has compromised

the use of newer generation of antibiotics (Levy, 2002). The increase in resilience of

microbes to antibiotics threatens public health on global scale as it reduces the

effectiveness of treatment (Coastal et al., 1996) and increases morbidity, mortality and

health cost.

However, ethnomedicinal studies have shown that plant remedies are effective in spite

of the fact that they lack scientific justification (Jager et al., 1996; Fox, 1999; Kelmanson,

et al., 2000). Although the active phytochemicals may occur in lower concentrations,

medicinal plant extracts may be better sources of antimicrobial components than

synthetic drugs (Cox and Balick, 1994). It is believed that the phenomenon of synergism

is crucial in the efficacy of plant medicines (Kamatou et al., 2006). The development of

2

pathogenic resistance to synergistic drug combination such as those found in plants may

be slower than for single drug treatments (Quave et al., 2008).

Phytotherapy is a traditional medicinal practice based on the use of a wide variety of

plants, plant parts and plant extracts for prevention and treatment of diseases. Traditional

practitioners and herbalists use crude extracts from leaves, flowers, stems, berries, and

roots of plants to prevent, relieve, and treat illnesses. The World Health Organization

(WHO) estimates that about 80% of the population of most developing countries relies

on phytotherapy for their primary health care needs (Mukherjee and Wahil, 2006; de

Silva, 1997). It is important to note that out of the total 422,000 flowering plants reported

from the world (Govaerts, 2001) more than 50,000 are used for medicinal purposes

(Schippmann et al., 2002). That is, this great biodiversity of medicinal plants can be

utilized in scientific research for discovery of novel pharmaceuticals.

Phytotherapy depends on the ability of plants to synthesize chemical compounds that

help them defend against attack from a variety of predators such as insects, fungi and

herbivorous mammals (Wikipedia, 2010). Medicinal plants are biosynthetic factories of a

variety of chemical compounds such as phenols, aromatic substances or their oxygen

derivatives. About 11, 000 plant compounds have been isolated in recent years (Gupta,

1986). Although these compounds are toxic to plant predators and pathogens, by chance

some of these turn out to have beneficial effects when used to treat human diseases

(Wikipedia, 2010). Most of these plant compounds are taught to work in the same way

pharmaceuticals drugs used in mainstream healthcare system.

3

Statement of the Problem

Skin infections and disorders are commonly observed in local people in the O R Tambo

and Amathole Municipality Districts in the Eastern Cape Province of South Africa. They

took different forms like inflammation, erythema, ring worms, eczema, acne, insect bite

or skin pigmentation problems (hyperpigmentation and hypopigmentation). Skin

pigmentation can be a problem for all people with brown skin: people of African, Asian,

Latin and Native American background (Taylor, 2008). Hyperpigmention is caused by

ultraviolet radiation and is associated with conditions such as pregnancy, Addison’s

disease (decreased function of adrenal gland) and uses of drugs while hypopigmentation

is associated with vitiligo (an autoimmune disorder) and albinism (Levine, 2010).

Theseconditions often affect the people. In the Province, young boys undergo ritual

circumcision to be initiated into manhood. Every circumcision season the young boys

undergo advanced infections, severe blood loss and mutilation (Peltzer et al., 2008).

Plants and plant extracts have been used for the treatment of skin disorders and ailments

for centuries (Weckesser et al, 2007). As a result of increasing resistance to antibiotics of

many bacteria and fungi, plant extracts and plant compounds are of new interest as

antiseptics and antimicrobial agents in dermatology (Weckesser et al, 2007). There is an

increasing need for innovation in selecting therapeutical targets and finding leading plant

derived drugs (Bhagwandin, 2011) which are cheap and affordable to people. Most

African people still rely heavily on traditional medicine; traditional healers are often the

first and last line of defense against most diseases such as headaches, coughs, and

diarrhea, wound healing and skin diseases (Matsheta and Mulaudzi, 2008). Apart from

4

ethnobotanical property and primary health care system, medicinal plants were also the

alternate sources of income for the underprivileged communities (Dobriyal et al., 1997).

Background of the problem

The Walter Sisulu University Community Health Partnership Project (UCHPP) reported

that about 41 % diagnoses in the health centres in the Eastern Cape include injuries,

genital diseases and skin infections (Brueton et al., 2010). In this study about 10 % of

the complaints were skin infections, scabies and ascarisis. Although this significant

percentage of skin infections were reported in conventional health centres, direct

observation revealed that many cases of skin infections and disorders are not presented

to local clinics or hospitals. Instead, many people are topically using plant materials to

treat skin ailments and improve skin tone.

It is estimated that about twenty seven million South Africans use traditional medicine

because they consider pharmaceutical drugs expensive (Mander et al., 2007). Some

people live in remote locations where they do not have easy access to clinics and hospitals

and therefore, use traditional medicine as an alternative treatment (Mander et al., 1998).

It is worth to note that, about 33 % of phytotherapies in non-Western societies are used

for the treatment of skin problems (Mantle and Gok, 2001).

In the Eastern Cape Province, many people are exposed to high risks of skin infections

and skin problems. The risk factors include circumcision undertaken in non-clinical setting

5

(Peltzer et al., 2008), insect, tick, animal, and marine organism bites (Travel medicine,

2008) and exposure to ultra-violet light.

The main inhabitants of this Province, the Xhosa-speaking people, practice ritual

circumcision as a cultural institution. Every year, young abakwetha (Xhosa; initiates) are

circumcised, dressed and treated wounds using phyto-medicines. Medical circumcision

performed by health care professionals, who substitute traditional equipment and

dressing for medical ones are deemed meaningless. As a result of this cultural belief and

values many of the abakwetha go for initiation school.

In the scientific reports, there is a lot of literature depicting serious foreskin infection and

wounds from traditional circumcision generated from hospital records (Mayatula and

Mavundla, 1997; Meinjies, 1998) or circumcision/initiation school inspections. Peltzer et

al (2008) noted that pre-post intervention evaluation of 192 initiates physically examined

at the 14th day after circumcision by a trained clinical nurse 40 (20.8%) had mild delayed

wound healing, 31 (16.2%) had a mild wound infection and 22 (10.5%) mild pain. As a

result of the observed problems associated with this practice it leaves the efficacy of

botanical medicines questionable.

The districts of O R Tambo and Amathole are located along the coast and are sometimes

very hot as a result many people are observed swimming or navigating the sea shore.

This exposes them to marine hazards such as stingrays, jellyfish, and several species of

poisonous fish in the coastal waters (Travel medicine 2008). After swimming or

navigation of the sea shore many people would lay on beach sands warming themselves

6

in the sun. This exposes them to ultraviolet sun which may cause skin cancer and

hyperpigmentation. Other hazards include bites by snakes (cobras, mambas, adders,

vipers) and spiders (black and brown widow) as people camp in forests or visit game

parks (Travel Medicine, 2008).

Objectives of the study

The objectives of this study are to:

Identify and document some plant species used for the treatment of

dermatological infections and disorders in O R Tambo and Amathole

Municipality districts;

Evaluate antibacterial activities of some medicinal plants used for treatment

of skin infections and disorders;

Investigate antioxidant properties of some medicinal plants used for the

treatment of skin infections and disorders.

Significance of study

Phytotherapy has remained pivotal in the health care system of a large proportion of

people in the world. According to WHO, about 80 % of the world's population presently

uses phytotherapy for some aspect of primary health care needs. This is due to the fact

that pharmaceuticals are prohibitively expensive for most of the world's population (Edgar

7

et al., 2002), especially in South Africa where more than half of population lives below

the international established poverty datum line (Gutierrez, 2006). The Eastern Cape is

home to 6, 4 million [Statistics South Africa (SSA), 2004] and has the second highest

poverty levels in South Africa with 47 % households below the poverty line, which is

based on imputed monthly expenditure of less or equal R800 (SSA, 2004), combined with

the highest Provincial unemployment of 55 % in the country (SSA, 2004). This entails

that a significant population of the Province cannot afford the increasing pharmaceuticals

costs hence their natural resources especially medicinal plants play a very crucial role in

their health care system. This study attempts to identify and document some plant

species that are commonly used for the treatment of common skin infections and

disorders.

Documentation of ethnobotanical information is essential for understanding of human-

plant ecology. Indigenous knowledge on natural resource utilization of medicinal plants

not exceeding the resilience of the surrounding environment is an important measure of

sustainable plant biodiversity conservation (Kala, 2005). It is estimated that more than

700 hundred medicinal plants are being traded for medicinal purposes throughout the

country (Dold and Cock, 2001) resulting in the reserves and stocks of medicinal plants in

the country diminishing. In the Eastern Cape it was reported that 93 % of 116 plants are

harvested unsustainably for medicinal purposes (Cocks and MØller, 2002). A number of

these medicinal plants are endanger of extinct as a result of growing trade demands for

cheaper healthcare products and complacency to conservation. In addition, the

exploitation by the patent rights, communities and countries who invented the material

8

and the process, have been facing shortfall (Kingston et al., 2007) resulting in loss of

important information on medicinal plants and their use. Documenting the eroding plants

and associated indigenous knowledge can be used as a basis for developing management

plans for conservation and sustainable use of medicinal plants in the area.

Ethnobotanical data is very essential for discovery of novel plant derived drugs especially

where information is well evaluated. The traditional use of medicinal plants is recognized

as a way to learn more about future medicines. In 2001, researchers identified 122

compounds used as pharmaceutical drugs which are derived from “ethnomedical” plant

sources; 80 % of these compounds are used in the same way as they are used in the

traditional medicine (Fabricant and Farnsworth, 2001). There are over 750,000 plants on

earth relatively very few of them with healing properties have been studied scientifically

(Chong, 2004). The Eastern Cape Province is not an exceptional since it is endowed with

a diverse variety of medicinal plants which research has not yet translated into modern

pharmaceuticals.

Given the socio-economic standing of the people, the increasing costs of pharmaceuticals

and the great biodiversity of plant species, it is therefore, necessary to identify the some

plants and evaluate the medicinal properties of plants used for the treatment of skin

infections and disorders. This may be beneficial not only to the pharmaceutical industry

but also to the local people who are in need of the plant medicine.

9

Rationale of study

In the Eastern Cape approximately 70% of the physical related problems of an amaXhosa

family are managed using medicinal plants (Simon and Lamla, 1997). The wide spread

use of plant medicine among both urban and rural population in the Province is attributed

to cultural acceptability, efficacy against some types of diseases, physical accessibility

and economic affordability as compared to pharmaceuticals used in the mainstream

healthcare system. In addition, there are general claims that phytotherapy has no side

effects and therefore are safe to use as compared to synthetic medicines. Based on the

above arguments and low socio- economic position and inaccessibility of some health

centres to majority of people in the rural areas it is suggestive that many people use

medicinal plants to deal with health problems hence it is imperative and worth studying

the medicinal plants that are commonly used by local people.

The study of Eastern Cape medicinal plants has not been as fully realized as other

traditional communities elsewhere (Iwu, 1993). In the Province, though there has been

some organized ethnomedicinal studies, there is limited development of therapeutic

products. Generally, indigenous knowledge is getting lost owing to urbanization,

industrialization, rapid loss of natural habitats and changes in lifestyles (Teklehayamanot

and Giday, 2007). In the view of these facts documentation of the traditional medicinal

plants is of paramount importance for preservation of the indigenous knowledge and for

provision of baseline data for future pharmacological and phytochemical studies.

10

Overview of Chapters

The first chapter of this dissertation presents the research problem and its background.

The specific objectives are outlined in this chapter. In addition, the significance and

rationale for the study are described. Chapter 2 puts the problem into context by

providing the related literature. The ethnobotanical information on some plants used for

treatment of skin infections and disorders in O R Tambo and Amathole Municipalities of

Eastern Cape, South Africa are described in Chapter 3. This chapter presents an analysis

of ethnobotanical survey carried out in these two districts. From the survey six medicinal

plants namely Protorhus longifolia, Gnidia capitata, Macaranga capensis, Syzgium

cordutum and Hypoxis hemerocallidea were implicated for the treatment of skin infections

and disorders. Chapter 4 and chapter 5 report on the antibacterial activity and antioxidant

properties of these medicinal plants based on in vitro tests. The last chapter (6) provides

general discussion, limitations, and general conclusions to the study.

11

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Publications: Pretoria, South Africa.

Weckesser S, Engel K, Simon-Haarhaus B, Wittmer A, Pelz, Schempp (2007). Screening

of plant extracts for antimicrobial activity against bacteria and yeasts with dermatological

relevance. International Journal of Phytotherapy and Pharmacology.

Wikipedia (2010). Hebalism. The free encyclopaedia.

16

Chapter 2: Literature review

Skin disorders and infections

The human skin can show conditions ranging from simple dryness to severe erythema

and scaling. These indications are sometimes accompanied by pruritis, inflammation and

also may exhibit an associated oedema that further increases the discomfort (Dweck and

Dweck, 2002). In some cases binding of water in the stratum corneum can become

compromised and ineffective. This may result in skin dryness, desquamatory skin

conditions and dry eczematous conditions (Dweck and Dweck, 2002). Exposure to

ultraviolet light may present a problem of hyperpigmentation. The worst condition is when

there are injuries or damages to the skin and there are possibilities of wound infections

since this can turn even the simplest wound into a life-threatening condition (Dweck and

Dweck, 2002).

The skin is a haven for many microbes (Adeleye et al., 2003). The predominant ‘resident’

microorganisms of the skin include aerobic and anaerobic diptheroid bacilli such as

Corynebacterium, non-haemolytic aerobic staphylococci (S. epidermidis, Peptococcus),

Gram positive aerobic spore forming bacilli which are ubiquitous in the air, water and soil

namely: α-hemolytic Streptococcus (S. viridians) and Enterococci (S. faecallis), and gram

negative coliform bacilli and Acinetobacter (Jawets et al., 1978). Yeast and other forms

of fungi are often present in skin folds, while acid fast, non-pathogenic mycobacteria

occur in areas rich in sebaceous secretions (e.g. genitalia, outer ear) as normal skin flora

(Adeleye et al., 2003). These organisms are not harmful to the skin where they reside,

17

not until integrity of the skin is breached by trauma (injuries or surgical), burns, foreign

body or primary skin diseases (Badame, 1988).

The most common bacterial infections in the skin and soft tissue are Staphylococcus

aureus, Streptococcus pyogenes (Group A haemolytic Streptococcus), Clostridium

perfringes and the bacteriodes group (Adeleye et al., 2003). Others include

Mycobacterium tuberculosis, M. leprae, Neisseria gonorrhea, Pasturella tulurensis,

Bacillus antracis, Pseudomonas aeruginosa and many more factors other than trauma

and primary skin disease have been identified as contributory to skin infections (Adeleye

et al., 2003). However, some of these bacteria have evolved highly resistant strains which

have compromised the use of synthetic antibiotics (Levy, 2002). For example, many

strains of S. aureus a Gram-positive species carry resistant genes for penicillin antibiotics,

tetracyclines, methicillin and vancomycin (Quave et al., 2009). Therefore, the

development of new antiseptics and antimicrobial agents are of increasing interest.

Studies of some plant extracts and isolated plant compounds for antimicrobial activity

with dermatological relevance have shown that plant products may be essential for the

treatment of skin disorders like acne vulgaris and schorrhoic eczema (Weckesser et al.,

2007).

It was reported that biofilm-related infections caused by a staphylococci are among the

leading causes of nosocomial infections in the USA (Kong et al., 2006). Other skin

infections which are well documented are superficial fungal infection of the skin such as

18

Microsporium audounini, M. canis, M. fulum, Trychophyton tonsurans, T. scuneuleini, T.

mentagrophytes, T. rubrum, T. violaceum, Candida albicans, Epidermophyton flocossum,

Coccidiodes immitris, Cryptococcus neoformans, and Histoplasma capsulatums. Although

these infections are rare in man when they infect they may be chronic and resistant to

treatment (Adeleye et al., 2003).

Viral skin disease Disease of pigment Bacterial skin disease

Figure 2.1 Some conditions of the skin caused by infection: Adapted from

Medicine Net, 2011.

Inflammation and erythema

Inflammation and erythema are two conditions associated with the skin. Inflammation is

a protective tissue response to injury or destruction of tissues, which serves to destroy,

dilute, or wall off both the injurious agents and the injured tissues (Saunders, 2007). The

classical signs of acute inflammation are pain, heat, redness, swelling and loss of function.

The inflammatory response can be provoked by physical, chemical, and biologic agents

such as mechanical trauma, exposure to excessive amount of sunlight, X-rays, extreme

heat and cold, or by infectious agent like bacteria, viruses and other pathogenic

microorganisms (Saunders, 2003). Erythema on the other hand is a medical condition

19

which is characterized by redness or inflammation of the skin or mucous membranes that

results from dilation and congestion of superficial capillaries (Mosby’s Medical Dictionary,

2009). The condition can be as a result of any skin injury, infection, sunburn or

inflammation (Saunders, 2003). Figure 2.2 shows some erythmatic conditions of the skin

as result of mild sunburns.

Figure 2.2 Erythema caused by mild sunburns: Adapted from Medicine Net, 2011.

Other extreme cases include erythema multiforme complex. This is an acute,

inflammatory dermatologic disease of uncertain etiology (although occasionally related to

drug administration), characterized by erythematous macules, papules, vesicles, and

bullae that appear on the skin and not infrequently on the oral mucosa (Figure 2.3).

20

Figure 2.3 Erythema multiforme complex. Adapted from Mosby's Dental Dictionary, 2nd

edition. © 2008 Elsevier, Inc.

Hyperpigmentation and hypopigmentation

Pigmentation refers to the colouring of a person's skin. Complexion of a person is

attributed to the fair distribution of melanin under the epidermal layer of the skin. Melanin

is a substance in the body which is responsible for complexion. When a person is healthy,

his or her skin appears normal in colour. In the case of illness or injury, the person's skin

may change colour, becoming darker (hyperpigmentation) or lighter (hypopigmentation).

Hyperpigmentation of the skin is caused by an increase in melanin. Certain conditions,

such as pregnancy or Addison’s disease (decreased function of the adrenal gland), may

cause a greater production of melanin and hyperpigmentation (Levine, 2010). Exposure

to sunlight is a major cause of hyperpigmentation and it can also be caused by various

drugs, including some antibiotics, antiarrhythmics, antimalarial drugs (Levine, 2010). A

typical example of hyperpigmentation is melasma (sometimes known as chloasma). This

condition is characterized by tan or brown patches, most common on the face.

Conversely, hypopigmentation of the skin is the result of a reduction in melanin

21

production. Examples of hypopigmentation include vitiligo which causes smooth, white

patches on the skin and albinism which is inherited disorder caused by the absence of an

enzyme that produces melanin (Levine, 2010).

People with albinism should use a sunscreen at all times because they are much more

likely to get sun damage and skin cancer. In addition, pigmentation loss is as a result of

skin physical damage caused by infection, blisters, burns, or other trauma to the skin.

.

Psoriasis

Psoriasis is another condition which shows hyperpigmentation. Psoriasis is a non-

contiguous common skin condition that causes rapid skin cell reproduction resulting in

red, dry patches of thickened skin (William and Shiel, 2011). The disease is characterized

by dry flakes and skin scales resulting from the rapid buildup of skin cells. Psoriasis

commonly affects the skin of the elbows, knees, and scalp. Figure 2.4 shows the

conditions on the elbow. Psoriasis has many different indications including small flattened

bumps, large thick plaques of raised skin, red patches, and pink mildly dry skin to big

flakes of dry skin that flake off.

22

Figure 2.4 Psoriasis: Adapted from MedicineNet, 2011.

Free radicals

Free radicals are atoms or groups of atoms with an odd (unpaired) number of electrons

and can be formed when oxygen interacts with certain molecules in the body (NEJM,

1994). In living systems, free radicals are generated by cells as part of normal oxidative

respiration in the mitochondria of cells (Ara and Nur, 2009). Once formed these highly

reactive radicals can start a chain reaction in the cells providing the common pathway for

cancer, aging, and a variety of other degenerative diseases. The chief danger of free

radicals comes from the damage they can do when they oxidize important cellular

components such as proteins, lipids, nucleic acids such as DNA (Prakash, 2001). The free

radicals initiate peroxidation of lipids, which in turn stimulates glycation of proteins,

inactivation of enzymes and alteration in the structure and function of collagen basement

23

and membranes (Prior, 2003: Saha et al., 2008) resulting in poor functioning cell or death

of some cells. However, the amounts of the protective antioxidant principles present

under normal physiological conditions are sufficient only to cope with the physiological

rate of free radical generation (Haripyaree et al., 2010). It is, therefore, suggested that

any additional burden of free radical, either from environment or produced within the

body can disturb the free radical and antioxidant balance resulting to oxidative stress

(Sies, 1991). This subsequently results in tissue injuries and diseases.

The skin is one of the largest organs with billions of cells that are exposed to mitochondrial

oxidative respiration hence to free radical activity. Chemical mobilization of fats under

various conditions such as lactation, fever, infection, fasting and exercises enhances free

radical activity and damage in the skin and other organs (Ara and Nur, 2009). Studies

revealed that endurance exercises can increase oxygen utilization by a factor of 10 from

the resting state (Dekker et al., 1996). This increases the generation of free radicals,

raising concerns about increased damage on the skin, muscles and other tissues in

sporting people. To prevent free radical damage the body has a defense system of

antioxidants.

Role of Medicinal Plants

Plants were once a primary source of all the medicines in the world and they still continue

to provide mankind with new medicines (van Wyk et al., 2009). This traditional practice

24

is almost universal in non-industrialized communities (Barnes et al., 1998). In Africa,

medicinal plants play an important role in the treatment of infections and diseases

(Aboaba et al., 2006). In South Africa, a large part of the day-to-day medicine is still

derived from medicinal plants and large volumes of plant-derive medicines are sold in the

informal markets and commercial sectors of economy on daily basis (van Wky et al.,

2009). In the Eastern Cape, it is observed that majority of the people in the still rely on

the medicinal plants to manage their health problems.

Some drugs commonly used in the healthcare system today are of plant origin. It is

estimated that about 25% of the prescription drugs dispensed presently by physicians

contain at least one active ingredient derived from plant material (van Wyk et al., 2009;

Chong, 2003). Many drugs occur in the leaves, fruits, seeds, barks and roots of plants

(Kerrod, 1989). Some are made from plant extracts; others are synthesized to mimic a

natural plant compound (Chong, 2003). Some well-known plant-derived pharmaceuticals

are opium, aspirin, digitalis, quinine, codeine, taxol, atropine and vincristine. In the last

century, roughly 121 pharmaceutical products were formulated based on the traditional

knowledge obtained from various sources (Anesini and Perez, 1993). In recent times,

emphasis has been put on the use of these natural products for control and treatment of

various infections and diseases as they are considered having minimal side effects as

compared to synthetic drugs (Aboaba et al., 2006). It is important to note that there is

growing interest in natural and traditional medicines as source of new commercial

products (van Wyk et al., 2009).

25

In South Africa, it is estimated that there are about 200 000 traditional practitioners who

are dispensing plant derived medicines to about 60 % of the population usually in addition

to the mainstream medicine services (van Wyk et al., 2009). In rural communities, elderly

people who are knowledgeable about the use of medicinal plants play an important role

as first-aid healers with family repertoire of plant remedies (van Wyk et al., 2009). Thus

in this view medicinal plants form the first line of treatment.

Modern medicine from plants

Indigenous knowledge has provided the pharmaceutical industry with new novel

medicines. It is estimated that about 100 plant derived drugs were introduced in the USA

drug market during the period between 1950 and 1970 (Samy and Gopalakrishnakona,

2007). These include deserpidine, reseinnamine, reserpine, vinblastine and vincristine.

The same authorities noted that other plant based drugs like ectoposide, E-

guggulsterone, teniposide, nabilone, plaunotol, Z-guggulsterone, lectinan, artemisinin

and ginkgo ides were introduced between 1971 and 1990 and about 2 % of the drugs

(including paclitaxel, toptecan, gomishin, irinotecan) were also introduced during 1991-

1995.

Plant based drugs provide outstanding contribution to modern therapeutics (Samy and

Gopalakrishnakona, 2007); for instance taxol (isolated from Taxus baccata) is a highly

effective drug against breast cancer and ovarian cancer (van Wyk et al., 2009). Quinine

isolated from Cinchona species has been used as an effective remedy for malaria for more

26

than 300 years (van Wyk et al., 2009). Morphine (isolated from Papaver somniferum) is

a powerful analgesic, used for alleviation of intense pain. It is important to note that most

plant derived drugs came into use in the modern medicine through the uses of plant

material as indigenous cure in folklore or traditional systems of medicine (Samy and

Gopalakrishnakone, 2007). This system of medicine strengthens as scientific studies

investigate more medicinal properties of plants.

Chemical compounds from plants can work as growth hormones or antibiotics, nutrients,

and toxin neutralizers (Wikipedia, 2010). Others are used as laxatives, analgesics and

anti-inflammatory and even to improve appetite in sick people. Over the years medicinal

plants have been used to cure different ailments and conditions such as mental disorders,

tuberculosis, diabetes, malaria, headache, different kinds of cancers and skin diseases.

The ability of plant compounds to treat different conditions can be attributed to their

biological properties. Studies have revealed that some plant derived compounds have

antiviral, antibacterial, antifungal and anti-helminthes properties (Engel and Cindy, 2002).

In the human body, chemical compounds from plants mediate their effects by binding to

receptor molecules present in the body; such processes are identical to those already well

understood for pharmaceutical drugs and as such herbal medicines do not differ greatly

from conventional drugs in terms of how they work (Fabricant and Farnsworth, 2001).

27

Use of medicinal plants on the skin

The use of plants for the treatment of different ailments predates written human history.

However, the recorded knowledge in the care of the skin begins some 3 000 years before

the birth of Christ, when the Egyptians recorded in hieroglyphic plants form the care of

skin on temple wall paintings (Dweck and Dweck, 2002). Through the writings of some

great historic herbalists, like Pliny (Historia Naturalis), Pedanius Dioscorides (De Materia

Medica), Claudius Galenus or Galen (De Simplicibus), Abbess Hildergarde von Bingen

(numerous works), Theophrastus Bombastus von Hohenheim or Paracelsus (The Doctrine

of Signatures), Gerard, Culpeper, Turner, and Carolus Linnaeus, it is observed that there

is a pattern emerging of plants performing certain functions in phytotherapy (Dweck and

Dweck, 2002).

The use of plants to treat skin diseases and disorders is a common practice in most

cultures, although the causes of the conditions being treated are not always understood

(Grierson and Afolayan, 1999, Srinivasan et al., 2001). It is estimated that about 33% of

phytotherapy in non-Western communities are used for treatment of skin disorders,

wounds and infections (Mantle and Gok 2001). The topical application of medicinal plants

for the treatment of different skin conditions has proven effective due to biological

activities of the plant compounds such as antimicrobial, anti-inflammatory and anti-

erythema (Quave et al., 2009).

28

Antimicrobial agents in plants

Many plants possess antimicrobial agents and provide effective remedies for the

treatment of skin and soft tissue infections (Quave et al., 2009). The antimicrobial

properties of medicinal plants are a desirable tool for controlling and treatment of

infections. A large number of antimicrobial agents derived from traditional medicinal

plants are used for the treatment of various diseases caused by micro-organisms (Jain,

1994). They are used to eliminate the infecting micro-organisms (Bruneton, 1995; Samy

and Gopalakrishnakone, 2008); as antibacterial and antifungal plant derived agents are

useful for the treatment of dermatitis (Bruneton, 1995). Although the active constituents

may occur in low concentrations, plant extracts may be a better source of antimicrobial

compounds (Cox and Balick, 1994). One study has revealed that ethanol extracts from

78 traditional medicinal plants used to treat infectious diseases in India has antibacterial

and antifungal activity at 1, 6 mg/ ml (Valsaraj et al., 1997) while some antimicrobial and

phytochemical studies revealed that 45 medicinal plants from the same country are

effective against multi-drug resistant bacteria (Ahmad and Beg, 2001). The results of

these studies suggest the presence of anti-bacterial potency. It is important to note that

as a result of multi- drug resistance strains of infectious microbe screening of medicinal

plants has become a cost effective option for novel antibiotic protypes (Afolayan, 2003).

Medicinal plants have the ability to synthesize aromatic substances; most of them are

phenols or their oxygen derivatives (Geissman, 1963). Some of these plant derived

compounds serve as plant defense mechanism against micro-organisms, insects and

herbivores (Samy and Gopalakrishnakone, 2008). Plant extracts rich in polyphenolic

29

substances such as tannins, catechins, alkaloids, steroids and polyphenolic acids have

antibacterial activity (Samy and Gopalakrishnakone, 2008). Some examples of alkaloids

with antimicrobial activity include diterpenoid alkaloids isolated from Ranunculaceae

family, alkaloids pendulamine A, pendulamine B, and diterpenoid kolavenic cid and

azafluorene alkaloid isoursuline (Wanjala et al., 2002). Pyrolizidine alkaloids were also

reported to display antimicrobial activity against both fungi and bacteria (Craig, 1998).

Flavonoids are plant synthesized compounds which are also observed to have

antimicrobial activity (Dixion et al., 1983). Flavonoid, acacetin-7-o-β-D-galactopyranoside

was found to be active towards HIV (Hu et al, 1994). A wide variety of flavonoids,

sesquiterpenoid alcohols, triterpenoids and quinic acids caffeates from plants may be

useful antimicrobials (Hu and Chen, 1997).

Other plant derived compounds with antimicrobial activity include lectins, polypeptides,

polyphenols, phenolic, essential oils, terpenoids and tannins. Peptide called cathelicidins

was reported to provide protection against necrotic skin infection caused by

Streptococcus (Nizet et al., 2001). Phenolic compounds possessing a C3 side chain,

which are sometimes known as essential oils have antimicrobial activity (Samy and

Gopalakrishnakone, 2008). Tannins are water soluble polyphenol which are present in

medicinal plants and plant foods (Scalbert, 1991). The anti-microbial activities of tannins

are well documented (Samy and Gopalakrishnakone, 2008). Studies have shown that

tannins inhibit growth of many fungi, yeasts, bacteria and virus (Samy and

Gopalakrishnakone, 2008). Studies have revealed that tannins isolated from Carpobrotus

edulis (sour fig) inhibit the growth of phagocytized multi-drug resistant Mycobacterium

30

tuberculosis and methicillin-resistant Staphylococcus aureaus (van Wyk et al, 2009).

Polyphenols and many types of tannins are known for their anticarcinogenic properties

(Scalbert, 1991). The biological properties of tannins are associated with their ability to

form complexes with proteins such as digestive enzymes and fungal or viral toxins

(Bruneton, 1995) conferring antibacterial and antifungal activity.

Anti-inflammatory and antierythematic plant agents

Inflammation and erythema are skin conditions which can be treated using medicinal

plants. Studies have shown that some plants with high levels of flavonoids; those that

are used to firm and tone the skin are rich in tannins (Dweck and Dweck, 2002) and have

anti-inflammatory and antierythematic agents. Different studies have demonstrated that

flavonoids present at interesting levels have anti-inflammatory activity (Ferrandiz and

Alcaraz, 1991; Middleton, 1996). Tannins have a vasoconstrictor effect as result they

reduce fluid loss from wounds and burns thereby enhancing tissue regeneration

(Bruneton, 1995). German Chamomile (Matricaria recutita) and Roman Chamomile

(Anthemis nobilis) both of them in the family Compositae contain a flavonoid called

apigenin which have anti-inflammatory and antierythema qualities (Dweck and Dweck,

2002). The same authority noted that the extracts from these plant species have anti-

pruritic and as a result reduce itching and improve the speed at which wounds heal.

Medicinal plants such as Ginkgo biloba and Aesculus hippocastanum were reported to

contain Ginkgoide and eucibin which have antioedema properties (Dweck and Dweck,

2002. Other flavonoids which are thought to contain some anti-inflammatory and

antierythematic properties include quercetin, kaempferol, and delphinidin and

31

hyperocide. Studies have scientifically proven that some compounds from Aloe vera or

Aloe barbadensis, have healing properties to burn, be it radiation, thermal or solar (van

Wyk and Smith, 2004).

Plant agents used against skin dryness and dry eczematous conditions

When water protective ability of stratum corneum have been compromised and become

ineffective it may be beneficial to reduce the transepidermal water loss by topically

applying occlusive films (Dweck and Dweck, 2002). It is worth noting that some medicinal

plants synthesize compounds which give the skin smooth and moisturizing qualities that

are unsurpassed. Some of these medicinal plants provide a broad spectrum of oils with

fascinating fatty acids such as ricinoleic, oleic, linoleic, linoleic, arachidonic and erucic

(Dweck and Dweck, 2002). Clinical studies of some of these oils have demonstrated

cicatrizing activity and solutions to hyperpigmentation (Dweck and Dweck, 2002). Some

of them have skin hydrating and soothing properties.

Antioxidant agents

Antioxidants are molecules which can safely interact with free radicals and terminate the

chain reaction before vital molecules are damaged. Although there are several enzyme

systems within the body that scavenge free radicals, the principle micronutrient (vitamin)

antioxidants are vitamin E, beta-carotene, and vitamin C. Additionally, selenium, a trace

metal that is required for proper function of one of the body's antioxidant enzyme

systems, is sometimes included in this category (Ara and Nur, 2009). The body cannot

32

manufacture these antioxidants so they must be supplied in the diet or in medicines when

damage has been done.

Plants are chemical factories of some of these antioxidants. Several medicinal plants have

been reported to exhibit antioxidant activity (Ara and Nur, 2009). Most of these

antioxidant compounds from plants include flavonoids, isoflavones, flavones,

anthocyanins, coumarins, lignans, catechins and isocatechins (Aqil et al., 2006; Ara and

Nur, 2009). Antioxidant-based drug formulations are used for the prevention and

treatment of complex diseases like atherosclerosis, stroke, diabetes, Alzheimer’s disease,

cancer (Hennebelle et al., 2006; Augustin et al., 2005) and dermatitis. These conditions

tend to develop when the body has low antioxidant status. Antioxidants of external source

can prevent oxidative damage by inhibiting the generation of reactive species, scavenging

free radicals or raising the level of endogenous antioxidant defense (Haripyaree et al.,

2010). The effectiveness of these antioxidant formulations against chronic conditions has

increased interest into natural antioxidant from medicinal plants (Ara and Nur, 2009).

Studies on antioxidant properties of some medicinal plants have exhibited strong

anticancer, hepato-protective, anti-viral and other healing properties (Khalaf et al., 2008).

Some antioxidant formulations are known to form a protective layer on the skin and

mucosa, thereby enhancing tissue regeneration (Bruneton, 1995).

This chapter has discussed different types of skin disorders and the effects of free radicals

in the degeneration of the skin, the role of medicinal plants in the society and in modern

medicine. It has also discussed the importance of plant derived agents on the prevention

and treatment of skin diseases.

33

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39

Chapter 3: An ethnobotanical study of some medicinal plants used

for the treatment and improvement of skin in the O R Tambo and

Amathole Municipalities, of the Eastern Cape, South Africa.

Abstract

Using ethno-direct methods, the medicinal plants used for the treatment and

improvement of skin texture were determined in O.R Tambo and Great Kei Municipal

Districts of the Eastern Cape. The ethnobotanical data were gathered from the Xhosa

speaking people using interviews, questionnaires and participatory rural appraisal from

March 2009 to November 2009. The informants were 37 local people among which 5

were tribal practitioners. They supplied consistent information concerning 45 plant

species distributed in 41 Genera belonging to 28 Families which are used for the

treatment of skin infections and improvement of its texture. Of these, 86.7 % (39 plants)

were used as remedies against common skin problem such as wounds, pimples, acnes

and itches, and 33% (15 plants) were reported to have anti-inflammatory effects on the

skin while about 28% (12) were reported to oil dry skin, enlighten skin and protect skin

from ultra-violet radiation. The medicinal plants used are listed with Latin names, local

names, parts used, uses, and mode of preparations.

Keywords: Anti-inflammatory, Ethno-direct methods, Medicinal plants, Skin problems,

Informants, Xhosa speaking people.

Introduction

40

Readily visible alterations of the skin surface have been recognized since the dawn of

history, with some being treated and some not. The use of medicinal plants against skin

infections is a common practice in many cultures, although the precise mechanism of

cure is not always understood (Grierson and Afolayan, 1999). It is estimated that about

33% of botanical therapies are used for the treatment of skin disorders and wounds

(Mantle and Gok, 2001). The topical application of many plant medicines for the treatment

of various skin conditions has proven effective due to the antimicrobial (Quave et al.,

2008) and antioxidant properties of plant secondary metabolites. The secondary

metabolites eliminate and inhibit the activity of the infecting pathogens (Samy and

Gopalakrishnakone, 2008). The plant antioxidants protect against the damaging effects

of free radicals generated under the skin by metabolic processes (Adedapo et al., 2008).

They react with these free radicals and neutralizing their damaging effect. The use of

plants with substantial antioxidants activity to afford protection against ultra-violet is

receiving attention (Katiyar et al., 2001). Some phytochemicals restrict diffusion of toxins

and lessen the adverse reaction to insect bites and stings (Finn, 2004). Furthermore, they

calm the effects of itching and irritated skin (Finn, 2004).

South Africa currently has the largest antiretroviral program in the world with half a million

people receiving antiretroviral (ARV) drugs (Avert organization, 2009). It is estimated that

about 50 000 people in the Eastern Cape are using ARV therapy (Nicolay, 2008), and the

government targets to increase the therapy by 80% of the HIV infected people by 2011

(Avert organization, 2009). The use of the first line of ARV like efavirenz, lamivudine and

stavudine has been characterized with hypersensitivity reactions resulting in skin and

41

subcutaneous tissue disorders (Ranbaxy (SA); 2006 Adcock Ingram, 2007). These

manifest as skin rashes and lesions, fungal dermatitis, eczema, itches, irritations and nail

disorders. Other adverse indicators which were reported include skin ulcer, skin nodules,

herpes simplex, herpes zoster, and pustular rash (Pharmacare limited, 2003). These

cause serious discomfort and post inflammatory hyperpigmentation in patients. In the

Eastern Cape, the amaXhosa, the inhabitants of the area use medicinal plants for the

treatment of skin diseases, ritual purposes, improvement of skin texture and complexion.

Medicinal plants like Cassipourea flanaganii were reported to be used by many people for

skin enlightening, reduction of blemishes, pimples, and increasing clarity of complexion

(Dold T, and Cocks, 2005).

Every year, young abakwetha (Xhosa initiates) are circumcised, dressed and treated

circumcision wounds using phyto-medicines. Medical circumcision performed by medical

practitioners who substitute traditional equipment and dressing of wounds for medical

ones are deemed meaningless (Stinson, undated).

People of the Eastern Cape Province have a great wealth of medicinal plants and an

ancestral tradition about their uses. The traditional knowledge of medicinal plants has

accumulated in the course of many centuries (Thirumalai et al., 2009). Local people who

include ordinary people, herbalists and traditional practitioners take advantage of this

knowledge to treat different ailments. Traditionally, this essential knowledge was passed

from generation to generation without documentation (Samy and Ignacimuthu, 2000).

The mode of transmission of knowledge could result in loss of treasure of knowledge.

42

Loss of such a treasure of knowledge may be detrimental to the healthcare system of

rural communities.

Ethnobotanical surveys have been found to be one of the reliable approaches to bio-

prospection of medicinal plants and their uses. Many plant medicines have been

incorporated in the mainstream of healthcare system. The pharmaceutical industries have

considered plant medicine as a source of bioactive agents that can be used in the

preparation of medicine (Aboaba et al., 2006). Many people believe phyto-medicines are

safe, this has been proven in the treatment of various ailments (Mitalaya et al., 2003).

Effective and inexpensive botanical remedies are gaining popularity equally among both

rural and urban areas (Katewa et al., 2004).

The objective of this study was to identify and document the medicinal plant species used

for the treatment of skin infections and improvement of skin texture by the Xhosa people.

The study is essential because it protects traditional knowledge from disappearing

(Grierson and Afolayan, 1999). This study may not be exhaustive however documenting

the indigenous knowledge through ethnobotanical studies is important for the

conservation of biological resources as well as their sustainable utilization (Igncimuthu,

et al., 2006; Revathi and Parimelazhagan, 2010).

43

Materials and methods

Study site

The Eastern Cape is a coastal province laying in the south-eastern South Africa. It is the

second largest province from Northern Cape with area of about 168 966 square

kilometres. O R Tambo and Amathole are two coastal municipal districts to the south-

east part of the province which are lined and lapped by the temperate Indian Ocean. The

coastal districts studied lay directly between Port St Johns and Cintsa East. In the North-

East along Wild Coast, towns like Port St. Johns, Mthatha, and East London experiences

long hot balmy conditions with mean summer temperatures between 16ºC and 26ºC and

mean winter temperatures between 7ºC and 20ºC and high rainfall

(southafrica.venues.com, 2009). The edapho-climatic conditions of the study area like

geographical location, topography, varied climate and fertile soils support high plant

diversity which includes temperate flora, grasslands, mangroves and dense green bushes

of the stretch.

44

Figure 3.1 Map of the Eastern Cape showing the study area. Adapted from

www.places.co.za.

Ethnobotanical survey

An ethnobotanical survey was conducted in several villages and forests around Bizana,

Port St Johns, Lusikisiki, Mt Allyff and Flagstaff areas in O R Tambo municipality district

and Cinsta, Mooiplas, and Glen Eden East Coast areas in Amathole municipality district

during March 2009 to November 2009 as phyto-medicinal wealth of the Xhosa speaking

Study Area

45

people. The study explored the traditional healthcare system of the communities for

treatment of skin problems and ailments. It included structured interviews with 37

inhabitants comprising of 21 female and 11 males of which 5 of them were traditional

practitioners (3 females and 2 males). Participatory rural appraisal was also utilized to

gather information. The participants were between the ages of 23 and 67 years. The

criteria for selection of informants were based on their knowledge of medicinal plants for

self-medication or treating others. Some informants were requested to show the plants

in the field using the local names. The species mentioned were collected and identified

taxonomically using facilities and help of staff of Walter Sisulu Herbarium. Some voucher

specimens of collected plants were prepared and deposited in the Kei Herbarium at Walter

Sisulu University.

Results

Through the survey a total of 45 plant species were recorded. These were distributed in

41 genera belonging to 28 families which are used by local people to either treat skin

ailments or improve skin texture. Thirty three percent (33 %) of the total plants are

represented by four families namely Asteraceae (5 species), Fabaceae (4 species),

Eurphobiaceae (3 species) and Solanaceae (3 species) while 22.2% is represented by 5

families which include Aloaceae, Asphodilaceae, Anacardiaceae, Asparagaceae and

Thymelaecae. The later families are each represented by 2 species. Other families which

were represented by a single species include Alliaceae, Asphodeaceae, Apiaceae,

46

Amarylliaceae, Caprifoliaceae, Curtiaceae Crussulaceae, Gunneraceae, Hypoxidaceae,

Lamiaceae, Misebembryantemaceae, Myrtaceae, Poaceae, Polygonaceae,

Plumbaginaceae, Pubiaceae, Rhizophoraceae and Verbanaceae. Figure 3.2 shows the

main families of plants used for the treatment and improvement of skin tone. Eight seven

percent (87%) of medicinal plants are used for the treatment of common skin problems

such as wounds, pimples, burns, itches, inflammations, acne and eczema, while 33% of

the plants are used as anti-inflammatory agents. About 31% of medicinal plants were

reported to improve skin texture by oiling, enlightening or protecting it from ultra-violet

rays. The main uses of medicinal plants on the skin are shown in Figure 3.3. Each use is

expressed as a percentage of the total number of the medicinal plants implicated for

treatment and improvement of the skin. Based on frequency of use by the amaXhosa

herbs are more preferred followed by trees and shrubs. Leaves, barks, roots and bulbs

are frequently used while seeds and twigs are rarely used. Figure 3.4 shows the growth

form analysis of medicinal plants used for the treatment or improvement of skin.

47

Table 3.1 Ethnomedicinal plant species used for the treatment or improvement skin

texture in O R Tambo and Amathole Municipal Districts.

Botanical name

Local name Part used Uses Mode of Preparations

Syzgium cordatum

Umswi Bark Blisters, pimples, inflammations, acne, and eczema.

Air dried bark paste is topically applied on affected part. Bark powder is mixed with cold water for 12-18 hours use to drink solution wash affected body parts.

Gnidia capitata Sisi dikili/ Umsila wengwe

Roots Wounds, burns, fractures, snake bites, sore throat, rashes, ringworm.

Decoction of air dried roots is used to wash affected parts twice daily. Burnt and ground small piece of root is applied on wound.

Gnidia anthyllides

Intozwane Roots Wounds, burns, snake bites, toothaches and earaches.

Burnt and ground small piece of root is applied on wound.

Protorhus longifolia

umhluthi/ ikhubalo

Bark Wounds, cuts, bruise and graze ringworm, acne, and eczema.

Decoction of air dried bark is used to wash affected parts twice daily.

Bulbine frutescens

Ithethe elimpofu

Leaves, or leaf gel

Wounds, herpes simplex, ringworm, insect bites, cuts and grazes, burns, sunburns, blister, itches, cracked lips, cold sores, pimples, mouth ulcers, rough skin, boils, stop bleeding.

Crush fresh leaf and apply on affected part. Apply gel from fresh leaf on affected.

48

Bulbine asphodeloide

Intelezi Leaves, or leaf gel

Wounds, itches, burns, sunburns, rough skin, insects’ bites and inflammation.

Fresh leaves are ground and paste applied on affected parts or fresh leaf is cut and gel is applied on affected parts.

Helichrysum petiolerare

Impepho Leaves Improves skin texture and beauty, wounds.

Decoction of fresh or air dried leaves are cooled and solution is used to drink and was affected parts or may steam on skin.

Helichrysum nudifolium

Indlebe zebhokwe/ Isicwe/ icholachola

Leaves and twigs

Wound and improves skin beauty.

Crushed fresh leave and twigs are used to bandage wound. Powder is topically applied on skin. Steaming of skin.

Cassipourea flanaganii

UmMemezi Bark Improves beauty and enlightens skin. Used as sunscreen.

Air dried bark powder is mixed with red oak in water. A paste is topically applied on the skin.

Spirostachys africana

Umthomb- othi

Bark Rashes on new born babies, nappy rashes, wounds and birth wounds, pimples.

Powder is allowed to stand for about 12 hours before solution is used to wash affected parts.

Sutherlandia frutescens

Unwele Leaves Wounds, inflammation of skin, herpes, cancer, chicken-pox, and eye infections.

Fresh leaves or air dried leaves are ground and are mixed with water or fresh milk and is applied on affected parts.

Aloe ferox Ikhala Leaves Wounds, dry skin, stop bleeding, removes post

Break fresh leaf and apply gel on

49

inflammatory spots, pimples and herpes.

affected part of body.

Aloe arborescens

Ingelwane Leaves or fresh gel

Pimples, dry skin, wounds, stops inflammation of skin and lighten skin.

Paste of air dried leaves is applied on affected parts.

Carpobrotus edulis

Igcukuma Leaves Sunburns, eczema, ringworms, nappy rash, dry skin, cuts and grazes, mosquito bites, stings sore throat, mouth infections.

Break leaf and rub the juice on affected part. Chew leaves and gaggle for sore throat.

Pentanisia prunelloides

Icimamlilo Roots Pains, wounds, cancer, corns.

Decoction of roots is used wash affected parts regularly.

Leonotis leonotis Umfinca- mfincane

Leaves Cancerous wounds. Air dried or fresh leaves are allowed to stand in cold water for 10 to 12 hours before drinking the solution three times a day.

Acacia karroo Umunga Bark, leaves Bumps on skin, boil, thrush.

Wet juice fibre used to tie together with splints on fracture. Boil fresh leaves and gaggle.

Miscanthus capensis

Umthala Roots Pimples, itches acne, eczema and wounds.

Decoction is used to steam the affected parts.

Gunnera perpensa

Iphuzilo- mlambo

Rhizomes Wounds, itches, eczema, inflammation and psoriasis.

Decoction of rhizomes is cool solution and drink.

Gerbera piloselloides(L) Cass

Umsa Roots Post inflammatory spots, pimples, wound hyperpigmentation, pimples and

Air dried roots are mix with oil or fresh milk and infusion is applied on affected parts.

50

improve skin texture.

Solanum incanum

Umthuma omncinci

Roots Ringworm, wounds, acne and eczema.

Air dried root are mix with water and chicken feaces. Paste is applied on affected parts.

Datura stramonium

Umhlavuthwa Leaves Wounds, boils abscesses and skin bumps.

Warm up leaf on hot plate. Apply it warm on affected part of body.

Cotyledon orbiculata

Imphewula Leaves Pimples, inflammation, genital warts, corns.

Fresh leaves crushed and rubbed on affected parts.

Kniphofia drepanophylla (Baker)

Ixonyi Rhizomes (root)

Ringworm, wounds, pimples, acne and eczema.

Dry, grind and mix with red oak or use alone in water. Apply on affected parts.

Macaranga capensis

Umpumelelo Bark Pimples, wounds eczema, and acne.

Decoction of air dried bark is allowed to cool. Solution is drunk while warm. Then induce vomit. Paste made of air dried bark and red oak is applied on affected part.

Curtisia dentana Umlahleni Roots Pimples, itches, rashes, acnes.

Decoction of roots is drunk twice a day.

Alepidea amaymbica(Ecl &Zeyh)

Umvuthuza Roots Pimples, lice on all hairy parts (head, armpits and genital area).

Decoction of roots is used to wash affected parts while cooled.

Eucomis automnalis

Umathunga Bulb Improves beauty, wounds, ulcer caused by STI and healing of fractures.

Dry or fresh bulbs are ground and mix with water and are then applied on affected part.

51

Hypoxis hemerocallidea

Inongwe/ Labatheka

Corm Pimples and improves beauty. Absorbs excess skin oils.

Dry the corm and rub it on stone, smear ground plant material on affected part.

Tulbaghia alliacea

Itswele lamlambo

Bulb Boils, wounds, pimples, eczema, herpes.

Squeeze, fresh bulb on affected part.

Euphorbia ingens

Umlonhlo Stem Skin rash, post inflammatory spots. Promote healing without hyper pigmentation.

Cut stem and apply milky fluid on affected parts.

Athrixia phylicoides

Icholocholo Leaf twigs, roots.

Wounds, boils, and septic wounds, stops bleeding.

Crush freshen parts of plant material are applied topically on affected parts.

Boobhone disticha

Icwadi/ Ishwadi

Bulb

Boils, cuts and grazes and wounds. ‘Suck’ pus from inflamed part skin.

Fresh leaf scales are used to dress circumcision cuts. Crush bulb. Apply on affected parts.

Withania somnifera

Ubuvuma Leaves Roots

Abscesses, septic wounds, cuts, bruise and inflammations. STI ulcers.

Air dried leaves or roots are mixed with animal fat then applied on affected parts.

Senecio speciosus

Ustukumbini Leaves Stems

Swellings, cuts, burns, and sores, inflamed gums.

Decoction of air dried leaves or stem are made into paste is applied on affected parts or affected parts may be steamed. Fresh leaves crushed and rubbed on affected parts.

52

Harpephyllum caffrum

Umgwenya Barks Eczema, acne, pimples, rashes, sprains, fractures and wound.

Decoction of air dried bark cool and is used to wash skin of body. Cool solution may be drink two or three times a day.

Albizia adianthofolia

Umhlandlothi Bark Improves skin beauty, acne, and eczema and eye inflammation.

Grind air dried barks. Soak them in water for 10-12 hours. Wash affected parts using solution.

Scambiosa columbaria

Makgha Leave Roots

Wounds, bruises and cuts.

Air dried leaves and roots are ground into powder. Powder is mixed oil or animal fat wounds. Mixture is regularly applied to affected parts. Fresh leaves are crushed applied.

Centaurea benedicta

Ikhatikhati Whole plant Acne, wounds, syphilis ulcers, cancer.

Powder is boiled in water for 5 to 10 minutes .Tea is drink before meals.

Elephantorrhiza elephantina

Intolwane Rhizome Rashes, acne, eczema, pimples, sprains.

Decoction of air dried rhizome is used to steam the affected parts.

Rumex lanceolatus

Dolonyana Roots ,leaves

Abscess, inflammation, sores, wounds, cancerous tumours.

Decoction of leaves or roots in water is used to wash affected parts.

Plumbago auriculata

Umabophe Roots Leaves

Warts, rashes, acne, pimples.

Roast fresh air dried leaves or roots. Grind into

53

powder. Apply to affected parts.

Lippia javanica Inzinziniba Leaves, roots

Chicken pox, scabies and lice.

Decoction of fresh or air dried leaves used wash or steam the affected parts using solution.

Trichilia emetica Umkuhlu Leaves and seed.

Bruises, acne and eczema

Paste of air dried plant material applied to affected part.

Bowiea volubilis Umagaqana Bulb Pain killing effect in skin.

Rub crushed bulb on skin.

1

0

1

2

3

4

5

Number of species

A B C D E F G H I

Plant families

Figure 3.2 Families of plants used for treatment of skin disorders.

A Asteraceae

B Fabaceae

C Euphorbiaceae

D Solanaceae

E Aloceae

F Asphodalaceae

G Anacardiaceae

H Asparagaceae

I Thymelaeceae

54

About 95% of the local people reported that they get supplies of plant medicine from the

local forests. Few local people revealed that they have some few species they grow in

their homesteads.

The indigenous people were semi-skilled in identification and processing of medicinal

plants. Very often, medicinal plants are air dried in the sun before they are made into

paste or decoctions which are applied on affected parts. Juices, solutions, or burnt

products of plant material are used. It is interesting to note that most preparations are

made into concoctions although some plants are prepared singly. Most medicine

preparations are topically applied on the skin while some are orally taken as decoctions

or solutions.

87

33 31

0

50

100

Percentage of

Plant species

A B C

Medicinal uses

A Treatment of skin infections B Anti-inflammatory

C Improvement of skin texture

Figure 3.3 Medicinal plants used for treatment and skin improvement.

55

Figure 3.4 Types of plants used for treatment of skin disorders.

Herbs 37%

Trees 24%

Shrubs 24%

Grasses 13% Climbers 2%

Herbs

Trees

Shrubs

Grasses

Climbers

Paste 38%

Juices 12%

Warming 2% Burning 8%

Dissolution 10%

Decoction 30%

Paste

Decoction

Juices

Dissolution

Burning

Warming

Figure 3.5 Mode of preparation of herbal remedies.

56

Some medicinal plants identified as used for the treatment of skin infections.

Figure 3.6 M. capensis; stem and leaves.

Figure 3.7 H. hemerocallidea plant.

57

Figure 3.8 K. drepanophylla underground parts.

Figure 3.9 G. capitata.

Figure 3.10 P. longifolia stem, leaves and berries.

58

Discussion

Documentation of ethnobotanical data is pivotal in the understanding of human-plant

relationship and human-biodiversity relations (Ramakrishnappa, 2002). Bio-prospecting

of medicinal plants is an important tool in revealing plants with useful medicinal properties

(Balandrin et al., 1993). Based on the observations made during this study, the great

biodiversity of the Province remained a vast entity of unexploited medicinal plants which

could be transformed to important dermatological medicines and cosmetics. Recently,

screening of traditional medicinal plants has been the source of innumerable therapeutic

agents (Samy and Gopalakrishnakone, 2008), and future research may lead to discovery

of more new plant derived medicines. Indigenous medicinal plants are not only used to

meet primary health care needs but also in purging and cleansing of the body (Cocks and

Dold 2009). In addition, medicinal plants had developed economic significance in both

developing and developed countries since many are being traded in the informal and

formal markets. The over-exploitation of medicinal plants for commercial trade in South

Africa poses a threat to many species (Cocks and Dold, 2009). Ethnobotanical data is

essential for implementation of conservation policies and programmes by botanists,

conservationists and other stakeholders.

People in the study area were found to be sensitive to their natural wealth, since they

harvested and leave some parts for regeneration (Cocks and Dold, 2009). They have

many traditional norms which can be interpreted as means to prevent overexploitation of

their medicinal resources (van Wyk et al., 2009). For example, barks of trees such as

Protorhus longifolia and Syzgium cordatum are only harvested in the eastern and western

59

sides. Such norms prevent death of the trees due to desiccation by complete debarking

of the plant. When roots are harvested desiccation of the remaining underground parts

is prevented by replacing the soil on the hole. However, the increasing demand for

medicinal plants has threatened the sustainability of these plants. This was even revealed

by the local people when they indicated that plant species such as Hypoxis

hemerocallidea, Macaranga capensis, Cassipourea flanaganii, and Spirostachys africana

are now rare in their locality. Although the local people noted scarcity of these medicinal

plants, 95% of the respondents indicated that they walk for long distances to search for

these medicinal plants in the forest.

Ethnobotanical information revealed that the traditional knowledge on medicinal plants

is endowed in elderly people than in younger people. The latter had some difficulties in

identifying and describing how plant species work, therefore it can be assumed that in

future this treasure of knowledge may be lost. Poonam & Singh (2009) noted that the

other contributory factor to the loss of knowledge on medicinal plants is that local people

were hesitant to disclose their knowledge because they felt it provides them with

recognition and identity of society.

Pastes, decoctions, bathing and steaming were the most common form of use of

medicinal plants on the skin. Mixing pastes with oil, animal fat and milk is believed to

improve medicinal properties of the plant medicines by the local people (Poonam and

Singh, 2009). When the medicine is topically applied the active compound are absorbed

into the underlying tissues (van Wyk et al., 2009). For example, paste of Solanum

incanum and chicken feaces is topically applied for treatment of ringworm, pimples, acne

60

and eczema. Bathing and steaming under the blanket using plant medicinal preparations

are often used to maintain general skin health, to improve the tone by opening the pores

and stimulating cetaceous circulation and make the patient sweat (van Wyk et al., 2009).

Use of concoctions such as decoctions of Kniphofia drepanophylla and Gerbera

piloselloides are used for treatment of wounds, pimples, post inflammatory spots

(hyperpigmentation) and even improve skin texture. Mixture of different plant compounds

is believed to have synergistic effect that have vital role in the treatment of disease.

Volatile phytochemicals are administered by steaming affected parts under the blanket.

Helichrysum species and Senecio species are some of the medicinal plants that are

crushed, boiled and steamed to improve skin smoothness.

The study revealed that the method of preparation of plant medicine is critical, as it

determines the effectiveness of the ultimate plant medicine. Drying of the plant material

in the sun may cause some volatile phyto-chemicals to vaporize or initiate photochemical

reactions which may cause the medicine to be ineffective (Poonam and Singh, 2009). In

addition to appropriate volume of solvents such as water or alcohol and boiling for specific

time or partial burning serve to neutralize certain toxins (van Wyk et al., 2009). The local

people commonly use water as the solvent when preparing plant medicines while in some

cases saline sea water, milk and animal fat.

Diagnosis of skin problems was indicated to be critical for administration of correct plant

medicine by local people. Traditional practitioners use signs presented by patients and

symptoms told by patients as well as their personal experience in treating the skin

problem. They give specific prescriptions which they monitor if they suspect side effects.

61

They even strongly believe that some skin infections are as a result of wrong doings

which would have been done by the patient. In the latter, treatment would be done with

the guidance of a traditional practitioner who cleanses the family using medicinal plants

following specific rituals.

Conclusion

The results of the study revealed that plant medicines still play an integral role in the

treatment of skin ailments and improvement of skin texture. Women furnished novel data

on plants used for the improvement of the skin texture while men provided novel data

on treatment of skin conditions like wounds, ringworm and acne. The study documented

45 plant species of which an in depth biochemical and ethnopharmacological evaluations

may lead to discovery of drugs which may be used for the treatment of different skin

problems and cosmetics which may be used for improvement of the skin.

Acknowledgements

The research was supported by the Walter Sisulu University Research Centre. The author

is grateful for the assistances offered by the systematic personnel of the Department of

Biological Department of Walter Sisulu University. In addition, the provision of traditional

knowledge on plant medicine used to treat skin infections and improve skin by the people

of O R Tambo and Amathole districts is greatly appreciated.

62

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66

Chapter 4: Antibacterial activity of some medicinal plants used

for the treatment of skin infections and disorders in the O R

Tambo and Amathole of Municipalities of the Eastern Cape

Province, South Africa.

Abstract

The study aimed at evaluating the in vitro antibacterial activity of six medicinal plants

(Kniphofia drepanophylla, Gnidia capitata, Hypoxis hemerocallidea, Syzgium cordatum,

Macaranga capensis and Protorhus longifolia) used in O R Tambo and Amathole Municipal

Districts for the treatment of skin infections. Water, methanol and acetone extracts of

these medicinal plants were screened against five strains of Gram negative bacteria. The

results revealed that water extracts from five plant species inhibited two or more strains

of bacteria with the most common minimum inhibitory concentrations (MICs) ranging

between 5,0 to 10,0 mg/ml with the exception of aqueous extracts of K. drepanophylla

which did not inhibit all strains of bacteria. All methanol plant extracts were significantly

active against all strains of bacteria with MICs ranging from 0, 5 to 5, 0 mg/ml. Acetone

plant extracts were significantly active with most of them being able to inhibit at least

two or more strains of bacteria. However, all acetone extracts failed to inhibit Klebsiella

pneumoniae.

Keywords; antibacterial, gram negative bacteria, medicinal plants, Minimum inhibitory

concentration.

67

Introduction

Use of medicinal plants to treat diseases and complaints is universal among developing

nations (Edgar et al., 2002). In the Eastern Cape, plants have long played a pivotal role

in the lives of amaXhosa people, the inhabitants of the area (Keirungi and Fabricius,

2005). Approximately 70% of the physical related problems of an amaXhosa family are

managed using medicinal plants (Simon and Lamla, 1997). They use medicinal plants as

antiseptics, anti-inflammatory, blood clotting agents, to enlighten the skin or for

treatment of skin infections and to protect themselves from sun’s rays damaging effects.

In South Africa half the population lives below the international established poverty line

(Gutierrez, 2006). In the Eastern Cape, 49% of the population is unemployed and 41%

of the people dwell in the rural areas (South African Institute of Race Relations, 1999)

and are significantly poorer (Cock and MØller, 2002) and could not afford western

medicines. In recent years medical costs have generally increased beyond the rich of

many people. In some cases rural people live far away from clinics and hospitals for them

to easily access the needed medication. Their proximity of the forests and their richness

of medicinal plants and their vast experience in the use of use of medicinal plants enable

them to access readily available medicines.

The province’s plant biodiversity gives it a great potential to develop cheap and easily

accessible plant medicine, especially the coastal areas. Apparently plant resources are

the source of traditional medicines to about 80% of the continent’s population (Chibale,

68

2010). However, there is need to correct the perceived weaknesses of traditional plant

medicines by scientifically testing their efficacy and potency.

Amongst the plants used for treatment of skin infections and problems in O R Tambo and

Amathole municipal districts are Kniphofia drepanophylla, Gnidia capitata, Hypoxis

hemerocallidea, Syzgium cordatum, Macaranga capensis and Protorhus longifolia.

Ethnobotanical data collected from study area revealed that local people use these plants

for self-medication or are prescribed by either herbalists or traditional healers for the

treatment of skin diseases and other ailments. Therefore, this paper presents findings of

the antibacterial activities of these medicinal plants.

Materials and Methodology

Collection of plants and preparation of extracts

K. drepanophylla (rhizome), M. capensis (bark) and P. longifolia (bark) were collected in

Dimfi village near Lusikisiki, Mtambalala forest and Ntafufu village near Port St Johns in

O.R.Tambo districts while H. hemerocallidea (corm), G. capitata (roots) and S. cordatum

(bark) were collected in Glen Eden Far Resort Area and Ngxingxolo village respectively

during the period March 2009 and November 2009. They were air dried at room

temperature. Voucher specimens were prepared and deposited in the Kei Herbarium,

Walter Sisilu University.

Plant materials were crushed using a blender and were shaken in water, methanol, and

acetone for 24 to 36 hours. The extract solutions were decanted and filtered using

Whitman No.1 filter paper. Water filtrates were concentrated to dryness using a freeze

69

drier at reduced pressure and temperature. Methanol and acetone filtrates were

concentrated to dryness using a rotary evaporator at 40°C and 35°C, respectively. The

extracts were packed and closed in small sterile bottles under refrigerated conditions until

use.

Bacteria used in the study

The bacteria used in this study are not directly implicated to skin infections but they have

similar characteristics to those that cause skin infections (Masika and Afolayan, 2002).

The bacteria were selected on the basis of availability. Gram negative bacteria were used;

it was worth screening plant extracts against these bacteria because they may be

resistant to a wide range of antibiotics. The pathogenic capacity of Gram negative bacteria

is often associated with certain components of their cell wall particularly

lipopolysaccharides (Salton and Kim, 1996). One of the unique characteristics of the cell

wall being the ability to protect the bacteria from several antibiotics, dyes and detergents

that would damage the inner membrane or cell wall.

Preparation of agar plates

The dry plant extracts were re-dissolved in their respective solvents of extraction (water,

methanol and acetone) to make stock solutions of 50 mg/ml. Bio-kanamycin was also de-

ionized water to make a stock solution of 50 mg/ml. Nutrient agar (Oxoid) was prepared

70

in the usual way by autoclaving (Masika and Afolayan, 2002) and was allowed to cool to

45°C before mixing it with specific quantities of plant extracts drawn from stock solutions.

Nutrient agar was poured and plant extracts and bio-kanamycin were pipette and mixed

to make final concentrations of 0.5, 5.0, 7.0, and 10.0 mg/ml of respective plant extracts

in triplicate Petri dishes. Each mixture was swirled to spread evenly until it began to set.

Control plate containing 1.0 ml of water, methanol, acetone and bio-kanamycin were also

prepared in triplicate. Prepared plates were left for 12 hours to allow solvent to evaporate

before streaking with bacteria.

Antibacterial testing

Five Gram negative bacteria strains (Citrabacter freundii, Escherichia coli, Enterobacter

cloacae, Klebsiella pneumoniae, and Proteus mirabilis) obtained from the Nation of Health

Laboratory Services were used. Bacteria species were recovered for testing by growing

them in separate sterile Nutrient Broth (Oxoid) for 24 hours. Then each culture was

diluted hundred times in fresh nutrient broth. The bacteria were streaked in radial pattern

on the agar plates (Afolayan and Meyer, 1997). Radial pattern streaking enabled

management of more than one strain of organism in the same medium. The prepared

plates were incubated at 35°C for 24 hours before observation could be done.

71

Results and Discussion

Methanol extracts of all the plants in this study effectively inhibited all strains of bacteria

used with most common minimum inhibitory concentrations (MIC) ranging between 0, 5

and 10 mg/ml as revealed in the table 4.1. Inhibition of bacteria by methanol extracts

was observed in similar studies by (Rabe and van Staden, 1997; Grierson and Afolayan,

1999; Masika and Afolayan, 2002). Methanol extracts of K. drepanophylla was relatively

weak to K. pnuemoniae and E. coli. These strains of bacteria were inhibited at 7 mg/ml

and 10 mg/ml respectively.

The antibacterial assays of water extracts from five plant extracts in this study showed

inhibition of two or more strains of bacteria except of the extracts of K. drepanophylla

which was not active to all strains of bacteria. Both M. capensis and P. longifolia water

extracts inhibited K. pneumoniae at MIC of 5 mg/ml while other water extracts were

inactive to the same strain of bacteria. G. capitata, M. capensis and P. longifolia aqueous

extracts inhibited E. coli but the same strain of the bacteria was not inhibited by aqueous

extracts from the other plants. H. hemerocallidea corm aqueous extract only inhibited C.

freundii and P. mirabilis at 10 mg/ml.

Acetone extracts of all plants showed a significant inhibition of C. freundii and P. mirabilis

with MIC of 0, 5 mg/ml while they were inactive against E. cloaceae. M. capensis

consistently inhibited E. coli and K. pnuemoniae at 5 mg/ml while other five plant acetone

extracts were not active against the same strains of bacteria.

72

Traditionally, the local people prepared the plant medicines with water infusions or

decoctions. Based on the observation that some water and acetone extracts are inactive

it may be argued that traditional practitioners are unlikely to extract active components

of the medicinal plants; therefore it is recommendable to use methanol for extraction.

The ability of some water extracts to inhibit some strains justifies the use of the water

extracts by traditional practitioners.

Like bio-kanamycyin, some plant extracts inhibited some strains of bacteria tested at 0.5

mg/ml. Therefore, it can be argued that some of these plants extracts can be good

candidates for development of novel drugs. Bearing in mind that only crude preparation

showed a significant inhibition to some bacteria. If the active components are isolated,

purified and/ or modified they can go a long way in dealing with the health problems of

the local people and the world at large.

73

Table 4.1 Antibacterial activity of some plant extracts used for the treatment of skin

problems in O R Tambo and Amathole Districts.

Plant extracts (MIC or Na)

Solvents Bacteria Kd Gc Hh Sc Mc Pl Bio-K Control

Water

C.f Na 7.0 10.0 0.5 7.0 5.0 0.5 Na

E.c Na 5.0 Na Na 5.0 5.0 0.5 Na

E.cl Na 7.0 Na 5.0 5.0 5.0 0.5 Na

K.p Na Na Na Na 5.0 5.0 0.5 Na

P.m Na 7.0 10.0 1.0 5.0 5.0 0.5 Na

Methanol

C.f 5.0 0.5 5.0 0.5 0.5 0.5 Na

E.c 10.0 5.0 5.0 1.0 1.0 1.0 Na

E.cl 5.0 5.0 5.0 0.5 0.5 1.0 Na

K.p 7.0 5.0 5.0 1.0 0.5 1.0 Na

P.m 1.0 0.5 1.0 0.5 0.5 0.5 Na

Acetone

C.f 0.5 0.5 0.5 0.5 0.5 0.5 Na

E.c Na Na Na Na 5.0 Na Na

E.cl Na Na Na Na Na Na Na

K.p Na Na Na Na 5.0 Na Na

P.m 0.5 5.0 5.0 0.5 0.5 0.5 Na

Key Plants from which extracts were extracted; MIC: minimum inhibitory concentration (mg/ml) Kd: Kniphofia drepannophylla Na: Not active Gc: Gnidia capitata Bio-K: Bio-kanamycin Hh: Hypoxis hemerocallidea Sc: Syzgium cordatum Mc: Macaranga capensis Pl: Protorhus longifolia Bacteria on which extracts were tested; C.f: Citrabacter freundii

74

E.c: Escherichia coli E.cl: Enterobacter cloaceae K.p: Klebsiella pneumonia P.m: Proteus mirabilis

Acknowledgements

Great appreciation to National Research Foundation for funding this study, National

Health Laboratory Services for providing the bacteria used in this study, Department of

Health for providing bio-kanamycin, Mr. D. Wopula for his assistance in ethnobotanical

survey, Dr. K. L. Immelman and Mrs. E. Cloete for assistance offered in identification of

plants and the local people of the two districts studied for providing ethnobobatanical

information.

75

References

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isolated from the shoots of Helichrysum aureonitenens. Journal of Ethnopharmacology.

57: 177-181.

Chibale K (2010). Discovery Africa’s drug potential Health. Integrating Modern and

traditional Medicines.

Cock ML, MØller V. (2002). Uses of and indigenized medicines to enhance personal

wellbeing: South African case study. Social Science Medicine. 54.387-397.

Edgar J, da Silva, Baydoun E, Badran A (2002). Biotechnology and the developing world.

Electronic J. of Biotechnology. 5:1.

Grierson DS, Afolayan AJ (1999). Antibacterial activity of some indigenous plants used for

treatment of wounds in the Eastern Cape, South Africa. Journal of Ethnopharmacology.

66: 103-106.

Gutierrez E (2006). Ecotourism and Biodiversity Conservation. 597-602 in Groom MJ,

Meffe GK, Carroll, CR. (Ed.). Principles of Conservation.

Keirungi J, Fabricius C (2005). Selecting medicinal plants for cultivation at Nqabara on

the Eastern Cape Wild Coast, South Africa. South African Journal of Science 101.

Masika PJ, Afolayan, AJ (2002). Antimicrobial activity of some plants used for the

treatment of livestocks in the Eastern Cape, South Africa. Journal of Ethnopharmacology.

83: 12.

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Rabe T, van Stadens, J (1997). Antibacterial activity of Southern African plants used for

medicinal purposes. Journal of Ethnopharmacology. 56: 81-87.

Salton MJR, Kim, KS (1996). Structure in: Baron’s Medical Microbiology (Baron, S et al.,

Eds) (4th Ed). University of Texas Medical Branch.

Simon C, Lamla M (1997). Merging pharmacopoeia; Understanding the origins of

incorporative pharmacopoeial processes among Xhosa healers in Southern Africa. Journal

Ethnopharmacology. 33: 237-247.

South Africa Institute of Race Relations (1999). Fact 1, 1-2 Johannesburg.

77

Chapter 5: In Vitro Antioxidant activity of some plants used for

treatment of skin problems in O R Tambo and Amathole Districts

of the Eastern Cape Province, South Africa.

Abstract

The methanol extracts of some commonly used medicinal plants against skin infections

and disorders were screened for their antioxidant activity using ascorbic acid as standard

antioxidant. The free radical scavenging activity was evaluated using 1, 1-diphenyl-2-

picryl-hydrazyl (DPPH) free radical. The analysis was performed using a Phoenix-2000v

UV-VIS spectrophotometer. The methanol extracts of Protorhus longifolia, Gnidia

capitata, Macaranga capensis, Syzgium cordutum and Hypoxis hemerocallidea showed

significantly higher free radical scavenging activity than that of ascorbic acid while

Kniphofia drepanophylla showed very weak antioxidant activity. The IC50 of former plant

extracts were 11.5, 14.4, 14.6, 40.0, 41.2 and 44.0 µg/ml respectively while the IC50

value for K. drepanophylla could not be determined at 100µg/ml. The DPPH free radical

scavenging activity of the plant extracts increased with increasing concentration i.e. the

free radical activity was dose dependent. Generally, results revealed that these medicinal

plants are potential sources of natural antioxidant.

Keywords: Antioxidant, ascorbic acid, DPPH, free radical, scavenging activity.

78

Introduction

Many people worldwide are exposed to different stresses which result in the generation

of free radicals in biological systems. These include stresses from food toxins and food

adulteration, atmospheric pollution, exposure to ultraviolet radiation from the sun,

unhealthy lifestyles such as smoking and alcoholism. In addition, chemical mobilization

of fats under various conditions such as lactation, exercise, fever and infection can result

in high production of free radicals (Ara and Nur, 2009). Free radicals are molecule

fragments having one or more unpaired electrons; they are usually short-lived and highly

reactive (Chang and Cruickshank, 2005). Under both normal and pathological conditions

free radicals are produced in all cells by mitochondrial oxidative chain reaction (Ko and

Leung, 2007; Ara and Nur, 2009). Although oxidation reactions are crucial for life, they

can also be damaging; hence both plants and animals maintain complex systems of

multiple types of antioxidants, such as glutathione, ascorbic acid (vitamin C), tocopherol

(vitamin E) and antioxidant enzymes such as catalase, superoxide dismutase and various

peroxidases (Davies, 1995). Low levels of antioxidants, or inhibition of the antioxidant

enzymes, cause oxidative stress and may damage or kill cells resulting in development of

degenerative conditions such as heart diseases, ischemia, anemia, asthma, arthritis,

inflammation, neuro-degeneration, Parkinson’s disease, mongolism, cancer, aging and

dementias (Prakash, 2001; Ara and Nur, 2009).

Antioxidants are a diverse group of chemical compounds that are synthesized by plants.

As part of their adaptation from marine life, terrestrial plants began producing non-marine

antioxidants such as ascorbic acid (Vitamin C), polyphenols, flavonoids and tocopherols

79

(U.S. National Institute of Health, 2010). The main purpose of antioxidant in biological

systems is to scavenge and trap free radicals (Adedapo et al., 2008). They terminate

chain reactions which are responsible for oxidative stress by removing free radical

intermediates, and inhibit other oxidation reactions. Tutour (1990) noted that they have

an important role in protecting oxidative damage induced by highly reactive oxygen

species (ROS), in the cells and tissues. Thus an increase in the antioxidant reserves of

any organism can reduce oxidative stress (Ara and Nur, 2009). Furthermore, antioxidants

have been implicated in having a role in the proper functioning of the immune system,

which help to keep the body health including the skin. A significant number of plant

species have been reported to have extracts with antioxidant activity (Nooman et al.,

2008). The antioxidant and anti-radical properties of these plant products can be ascribed

to widely distributed secondary metabolites such as flavonoids, isoflavones, athocyanins,

coumarin, lignans, catechins and isocatechins (Ara and Nur, 2009). Most of these

antioxidants from plants are phenol and polyphenolic compounds (Prakash, 2001).

According to Hanson (2001) stratum corneum, the skins main protective barrier against

environmental assaults generates tremendous amounts of free radicals. This high

production of ROS increases the risk of oxidation of skin tissue resulting in dermatological

disorders. The ROS can initiate peroxidation of lipids, which in turn stimulates glycation

of proteins and alteration in structure and functions of collagen basement and other

membranes (Prior, 2003; Polterait, 1997; Saha et al., 2008;) and this play a role in the

development of long term complications (Lee et al., 2003; Prior, 2003) such as dementias,

quick aging of the skin, skin cancer, and skin inflammation. Therefore, it can be argued

80

that if these free radicals are left unchecked they can increase the risk for chronic and

oxidative diseases. Scientific evidence suggests that antioxidants reduce the risk for

diseases that are as a result of oxidative stress (Miller et al., 2000) and chronic diseases.

Over the past three decades antioxidant based formulations have played a major role in

chemo-prevention and treatment of pathological conditions caused by oxidative stress

(Prior, 2003; Khalaf et al., 2008; Hennebella, 2008). This resulted in a great deal of study

in natural antioxidant (Ara and Nur, 2009) in other parts of the world. In the Eastern

Cape, there is limited research in the field of antioxidants. Therefore, the present study;

evaluate the antioxidant activity of some plants used for the treatment of skin problems.

Medicinal plants which were investigated are Kniphofia drepanophylla, Gnidia capitata,

Hypoxis hemerocallidea, Syzgium cordatum, Macaranga capensis and Protorhus

longifolia.

Materials and methods

Collection of plant materials

Six plant species which were commonly implicated in the treatment of skin infections from

ethnobotanical data were selected for antioxidant evaluation. K. drepanophylla (rhizome),

M. capensis (bark) and P. longifolia were collected from O. R. Tambo district, at Dimfi

village near Lusikisiki, Mtambala forest and Ntafufu village near Port St Johns respectively.

H. hemerocallidea (corm), G. capitata (roots) and S. cordatum (bark) were collected from

Amathole District. The plant materials were collected between March 2009 and November

81

2009). They were air dried at room temperature. Voucher specimens were prepared and

deposited at Kei Herbarium, Walter Sisulu University.

Extraction of plant materials

Air dried plant materials were crushed using a blender and were extracted separately by

shaking approximately 100 g of each plant species in 95 % methanol for 24 to 36 hours.

The extracts were filtered using Whatman No.1 filter paper. The extract solutions were

concentrated to dryness using a rotary evaporator at 40 ⁰C under reduced pressure. The

extracts were packed and closed in sterile bottles and were refrigerated until use.

DPPH Radical Scavenging Activity

The free radical scavenging activity was evaluated in vitro using 1, 1-diphenyl-2-picryl

hydrazyl (DPPH) a known free radical. Both DPPH and methanol used were of analytical

grade. The method used by Ara and Nur (2009) and Khalaf et al. (2009) was adopted. A

0,004% w/v of DPPH was prepared in 99% methanol. Methanol stock solutions of 100

µg/ml of different plant extracts were prepared by dissolving 10 mg of each dry plant

extract in 100 ml of 99% methanol. From each stock solution 2 ml, 4 ml, 6 ml, 8 ml and

10 ml of solution were taken and poured into five test tubes. Each test tube was serially

diluted by topping up to 10 ml using 99 % methanol. As a result of this serial dilution

working solutions of concentrations 20 µg/ml, 40 µg/ ml, 60 µg/ ml, 80 µg/ ml and 100

82

µg/ ml established. From each of the working solution 2 ml of plant extract were added

to covet and to each covet 2 ml of DPPH was added. A control was made by adding 2 ml

of DPPH and 99 % methanol. A blank of 4 ml of methanol was used. They were prepared

in triplicates and were allowed to react in the dark for 15 minutes at room temperature.

The absorbance of mixtures was measured at 517 nm using a Phoenix-2000v UV-VIS

spectrophotometer. The mean absorbance of the triplicates was determined and the

scavenging of DPPH free radical was determined using the equation;

% DPPH radical scavenging = [(A –B)/A] x100

Where A =Absorbance of control and B =Absorbance of test sample.

Results and Discussion

DPPH is widely used to test the ability of plants extracts to act as free radical scavengers

or hydrogen donors (Prakash, 2001) and evaluate antioxidant activity of medicinal plants

extracts. The reaction of DPPH with numerous antioxidants has been reported (Miller et

al., 2000). The DPPH free radical scavenging activity of six indigenous plant species of

the Eastern Cape and ascorbic acid are presented in Figure 5.1. Availability of antioxidants

for reaction with DPPH depends on various factors such as solubility in the solvent of

extraction or whether antioxidants are bound to cell wall during extraction of plant

material. Based on these factors plant extracts may react with DPPH at different rates i.e.

differing kinetics and the reaction would sometimes not go into completion in some

reasonable assay time (Miller et al., 2000). Therefore, the sample size that scavenges

83

DPPH by 50 % (IC50 value) was chosen as the end-point for measuring the antioxidant

activity of the extracts. The in vitro antioxidant activities of methanol extracts are shown

in Table 5.1. Ascorbic acid was used as a frame of reference since it is a known antioxidant

which can scavenge DPPH and other free radicals.

0

20

40

60

80

100

120

0 20 40 60 80 100

% S

caven

gin

g o

f D

PP

H

Concentration (µ g/ ml)

Figure 5.1 DPPH free radical activity of Ascorbic Acid and Methanol Plant Extracts of some plants used for treatment

of skin infections and disorders.

Ascorbic acid

S. cordatum

H. hemerocallidea

M. capensis

P. longifolia

G. capitata

K. drepanophylla

84

Table 5.1 In vitro antioxidant activity of methanol extracts of some plants used for the

treatment of skin infections and disorders in the Eastern Cape.

Methanol plant extracts IC50 (µg/ml)

G. capitata 11.5

P. longifolia 14.4

M. capensis 14.6

S. cordatum 40.0

H. hemerocallidea 41.2

K.drepanophylla ***

Ascorbic acid 44.0

*** IC50 value not determined

As indicated in Figure 5.1, P. longifolia, G. capitata, M. capensis, S. cordutum and H.

hemerocallidea have proven to be effective antioxidant containing extracts compared to

the reference standard ascorbic acid. All these plant species extracts were observed to

have higher IC50 value as compared to Ascorbic acid as shown in Table 5.1. The IC50

values of these plant species were 11.5, 14.4, 14.6, 40.0, and 41.2 µg/ml respectively

while that of ascorbic acid was 44.0 µg/ml. The antioxidant activities of these medicinal

plants were dose dependent (Figure 5.1). As the concentration of these plants extracts

increases the antioxidant activity increased exponentially. The high scavenging activity of

85

these plant extracts against DPPH is of interests. As antioxidant-based formulations are

used for chemo-prevent and treatments of degenerative diseases like arthritis,

inflammation, neuro-degeneration, mongolism, aging process and dementias (Ara and

Nur, 2009). An antioxidant of external source can prevent oxidative damage by inhibiting

the generation of reactive species, scavenging free radicals or raising level of endogenous

antioxidant defense (Haripyaree et al., 2010). This result justifies the continual uses of

the medicinal plants for curing dermatological conditions by herbalist and traditional

healers. In addition, this explains why the local people of O R Tambo and Amathole

Districts still have strong belief in the efficacy and usefulness of the medicinal plants.

In contrary, to high antioxidant activity of the other five plant species K. drepanophlla

revealed a weak antioxidant activity as shown on Figure 5.1. This plant species could not

even achieve its IC50 value at the highest concentration of 100 µg/ ml used in this study.

The use of this plant species by herbalists and traditional practitioners for curing of

oxidative stresses is not justifiable. Perhaps if the use of this plant is justifiable the IC50

value of K. drepanophlla would be recognized at a higher concentration since increase in

concentration of the plant extract tend to increase the free radical activity of the plant

extracts.

Although these plant extracts revealed high antioxidant activity, there is need to

investigate the chemical constituents which are responsible for the antioxidant activity.

The possible constituents are flavones, isoflavones, flavonoids, tannins, glycosides and

many others. Many of these are potential antioxidant compounds synthesized by plants

(Lee et al., 2004). Some of them have been already isolated from plants and have been

86

tested in models for combating chronic diseases and their results revealed great potential

in controlling the conditions due to oxidative stresses (Prakash, 2001). This free radical

scavenging activity potential could be ascribed to natural antioxidant present in medicinal

plants. Isolation of the constituents could be critical in the development of antioxidant

therapy (Hasan et al, 2006; Erdemoglu et al., 2006).

Scientific evidence suggests that antioxidants reduce risk of oxidative conditions due to

free radicals (Prakash, 2001; Ara and Nur, 2009) and endogenous defense mechanisms

have evolved to offer protection against these conditions (Ara and Nur 2009). An increase

in the amount of the antioxidant reserves of an organism can be of great importance in

reduction of oxidative stress such as aging (Ara and Nur, 2009), inflammation, dementias

and other chronic diseases and treatment of these conditions. As revealed by this study,

G. capitata, P. longifolia, M. capensis, S. cordatum and H. hemerocallidea may be

considered as natural sources for antioxidant therapy and it is imperative to identify the

antioxidant molecules.

Acknowledgements

This research was supported by the Research Directorate of Walter Sisulu University and

the National Research Foundation of South Africa. Authors would like to thank Mr. E.J.

Ndebia and Dr. D. Kamadyaapa from Department of Physiology, Faculty of Health

Sciences, Walter Sisulu University for their technical support in the analysis of the results.

87

References

Adedapo AA, Jumoh FO, Koduro S, Afolayan AJ, Masika (2008). Antibacterial and

antioxidant properties of methanol extracts of leaves and stem of Calpurnia aurea.

Complementary and Alternative medicine.

Ara N, Nur H (2009). In Vitro Activity of Methanolic Leaves and Flowers Extracts of Lippia

alba. Res. J. of Med. and Med. Sc. 4(1):107-110.

Chang R, Cruickhank B (2005). Chemistry (8thed.). McGraw-Hill; New York; 968.

Davies K (1995). Oxidative stress; the paradox of aerobic life. Biochem. Soc. Symp. 61:1-

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Erdemoglu N, Taran NN, Cikici I, Sener BB, Aydin A (2006). Antioxidant Activities of Some

Lamiaceae Plant extracts. Phytotherapy research. 20:63-70.

Handson FG (2001). http//Iwouldbuy.com/manuka-oil.html.

Hasan MS, Ahmed MI, Mondal S, Uddin SJ, Masud MM, Sadhu SK, Ishibashi M (2006).

Antioxidant, antinociceptive activity and general toxicity study of Dendrophthoe falcate

and isolation of quertctrin as the major component. OPEM. 6: 355-60.

Haripyaree A, Guneshwor K, Damayanti M (2010). Evaluation of antioxidant properties

of some sulfur free radicals reactivity with curcumin as reference. EJEAFChe 9 (2): 337-

344.

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Khalaf AN, Shakya AK, Al-othman A, El-agbar Z, Farah, H (2008). Antioxidant Activity of

Some Common Plants. Turkish Journal Biology 32:51-55.

Lee SE, Hwang HJ, Ha SJ (2003). Screening of medicinal plant extracts for antioxidant

activity. Life Sci. 73: 167-179.

Miller HE, Rigelhof F, Marquart L, Prakash A, Kanter M (2000). Cereal Foods World. 45(2):

59-63.

Polterait O (1997). Antioxidants and free radical Scavengers of Natural origin. Current

Org. Chem. 1: 415- 440.

Prakash A (2001). Antioxidant Activity. 19(2): 1-4.

Prior RL (2003). Fruits and vegetables in the prevention of cellular oxidative damage.

American Journal of Clinical Nutrition.78; 570S-578S.

Saha MN, Alam MA, Aktar R, Jahangir R (2008). In vitro free radical scavenging activity

of Ioxra coccinea L. Bang. Journal Pharmacology. 3: 90-93.

Tutour BL (1990). Antioxidant activities of algal extracts Synergistic effect with Vitamin

E. Phytochemistry. 29: 3759-3765.

U.S. National Institute of Health, Office of Dietary Supplements (2010). Antioxidant.

Wikimedia.

89

Chapter 6: General Discussion and Conclusions

DISCUSSION

The skin is frequently affected by diseases, whether as primary disease of the skin itself

or as a secondary effect of other conditions (DHB, 2011). The severity of the skin condition

varies enormously. At one extreme, there may be nothing more than a patch of redness

on the finger resulting from sensitivity to a particular metal in a ring. At the other extreme,

weeping blisters may cover an individual from head to foot, resulting in fluid loss to a

degree, which may be life threatening (DHB, 2011). Ethnobotanical information reveals

that bites, ringworm, boils, septic sores and burns were more common to children of less

than 15 years of age while other skin problems such as dryness eczema, acne, cancer,

hyperpigmentation and hypopigmentaion were reported in people of all age group

(Chapter 3). During the early 1990s the health transition in South Africa was characterized

by a very high in injury burden (Bradshaw et al., 2002).

The skin disorders were commonly reported in the rural area (Chapter 3) where the

majority of the population of Eastern Cape resides and where clinic and hospitals are

sparsely distributed (Cocks and Dold, 2000). In rural parts of the Eastern Cape, self-

medication is a common practice (Chapter 3) and wild medicinal plants are harvested and

used as initial response to illness (Dold and Cocks, 1997) including dermatological

problems (Chapter 3). In the case of severe skin disorders and other illness rural people

consult traditional herbalists and other knowledgeable people who live in their locality

(Chapter 3). It is of paramount importance to note that during both self-medication and

90

consultation of traditional practitioners, people take advantage of great biodiversity of

plant species in their proximity to cure disease and ailments (Ndubani and Hojer 1999).

For this reason, it was important to document information on the plant taxa that are used

to cure skin disorders before it is lost since it is transmitted from generation to generation

by unreliable oral means and in most cases the information is confined to traditional

practitioners and clan elderly people (Chapter 3).

Poor wound healing capacity in elderly and those with chronic skin diseases often makes

minor skin injuries or common skin diseases the precipitating event costly interventions.

In addition to adults and elderly people, many children suffer from inherited and acquired

skin diseases (Society for Investigative Dermatology, 2005). Chronic diseases of the skin,

hair and nail need fairly good treatment to maintain their functionality and to decrease

pain, severe itch and dependency. In the absences of complications, affected adults in the

study area are able to cope with skin diseases by topically applying botanical medicines

(Chapter 3). This study found that the use of juicy leaf medicinal plants such as Aloe

species, Bulbine species and Carpobrotus species for self-medication to treat minor skin

problems such as bruises, small wounds, itchy rash and corns is a common practice in

amaXhosa people in the study area (Chapter 3). This may be due to availability of

enormous knowledge on the use of plant preparations in traditional medicine and strong

belief in the effectiveness of these plant preparations (Chapter 3).

Ethnobotanical data obtained in this study can be very important to conservationist and

botanist who are interested in conversation of potentially useful plant species (Chapter 3).

While the in vitro antibacterial activity (Chapter 4) and in vitro antioxidant studies can be

91

used as baseline investigations by biologist, chemists and pharmacologist who may be

interested in the active ingredients of plants. There is growing interest in natural and

traditional plant medicine as a source of new commercial products (van Wyk, 2008).

Based on ethnobotanical data obtained in chapter 3, a judicious choice of 6 (Hypoxis

hemerocallidea, Gnidia capitata, macaranga capensis, Syziguim cordatum, Protorhus

longifolia and Kniphofia drepanophylla) out of 45 medicinal plants used for treatment of

skin disorders in O.R. Tambo and Amathole municipalities was done for further

investigation of medicinal properties of these plants. These plant species were selected

for further study because they were frequently implicated for use of treatment of skin

disorders in the study area (Chapter 3).

The in vitro antibacterial (Chapter 4) and antioxidant (Chapter 5) activities of these

medicinal plants (H. hemerocallidea, G. capitata, M. capensis, S. cordatum, P. longifilla)

were regarded effective in combating dermatological problems by most respondents.

Considering that some of these plant medicinal preparations were taken orally, traditional

practitioners and the local people ruled out any side effects when using these medicinal

plants (Nkomo, 2009).

Methanol, acetone and water extracts from H. hemerocallidae, G. capitata, M. capensis,

S. cordatum, and P. longifilia had significant antibacterial activity against Gram negative

bacteria used in this study. Conversely, methanol, acetone and water extract from K.

drepanophylla did not inhabit all strains of bacteria. However, there was a significant

difference in the antibacterial activity between extracts from different solvents (methanol,

92

acetone and water extracts). The methanol plant extracts were highly active against all

strains of bacteria with MICs raging from 0, 5 to 5, 0 mg/ml while other extracts were

less active. It can be argued that the type of solvent used for extraction is critical for

effective extraction of phytochemicals from the plant materials.

Despite the fact that water extracts have lesser activity than methanol extracts, their

significant antibacterial activity was of interest since water is the most common solvent

in the preparation of traditional botanical medicine. In most traditional preparations plant

materials are either crushed and mixed with water and boiled with water for a specific

length of time or macerated and allowed to stand for a specific length of time (Chapter

3). The antibacterial activity of the water extracts justifies their continual use in the

treatment of skin disorders and traditional practices (Chapter 3).

An antioxidant evaluation of the six medicinal plants based on ability of plants extract to

scavenge a standard free radical 1, 1-diphenyl-2-picryl-hydrazyl (DPPH) depicts that H.

hemerocallidea, G. capitata, M. capensis, S. cordatum, and P. longifilia have antioxidant

properties comparable to ascorbic acid except K. drepanophylla (Chapter 5). These plant

extracts had IC50 value less than that of ascorbic acid (IC50 value =44, 0 µg/ml) implying

that they have a higher antioxidant properties than that of ascorbic acid (Chapter 5). The

use of these external sources of antioxidants derived from medicinal plants can prevent

oxidative damage of free radicals in the body. This probably explains why plant derived

products are orally administered or topically applied to the body to combat skin diseases,

other diseases and ailments in traditional medicine (Chapter 3).

93

Participants in this study ranked the efficacy and effectiveness of medicinal plants very

high (Chapter 3). Based on both antibacterial and antioxidant properties of the

investigated medicinal plants (Chapter 4 and Chapter 5) it can be deduced that there are

phyto-chemicals in these plants responsible for healing process. It can be argued that if

these active ingredients are isolated and their toxicity is studied they can go a long way

in the treatment of skin diseases. Botanical medicines contain phyto-chemicals that act

directly or indirectly to prevent or treat diseases and maintain health (van Wyk et al,

2009).

CONCLUSION

From this study, it can be concluded that:

The usage of medicinal plants for the treatment of skin disorders and other

ailments among the amaXhosa in the O R Tambo and Amathole municipalities is

still pivotal for the primary health delivery system.

A variety of plants which include trees, shrubs, herbs, and grasses are used as

medicinal plants by amaXhosa in the study area.

Herbal medicines are cheaper than the mainstream drugs and can be afforded

easily and accessed by the majority of people in O R Tambo and Amathole

municipalities.

The people in O R Tambo and Amathole municipalities’ particularly in rural areas

still have a strong belief in the effectiveness and efficacy of their herbal remedies.

94

H. hemerocallidea, P. longifolia and K. drepanophylla are becoming scarce in the

natural forests.

Extracts of H. hemerocallidea, G. capitata, M. capensis, S. cordatum, and P.

longifilla have significantly high in vitro antibacterial activity against some Gram

negative bacteria and in vitro antioxidant activity on DPPH.

Methanol extracts of these plants have higher antibacterial and antioxidant

properties than water and acetone extracts.

Limitations

Gathering ethnobotanical information was a challenge since the local people were

conservative as regarding to their indigenous knowledge and most of them were reluctant

to give out information. However, persistence and patience of negotiating with the

intended respondents enable findings in this study. It was also a challenge to gather

information in sparsely populated and mountainous areas in the study area, but this meant

frequent trips and endurance.

RECOMMENDATIONS

Plants may be considered as good sources of natural antimicrobial and antioxidant for use

against diseases.

Further investigation on isolation and purification of active ingredients responsible for

the antimicrobial and antioxidant activities is recommended.

Further studies are suggested on the toxicity of these medicinal plants.

95

Based on the results of ethnobotanical studies there is need to establish medicinal

plant gardens for the propagation of much sought plant species yet under pressure

from harvesters as a conservation measure.

96

References

Bradshaw D, Schneider M, Dorrington R, Bourne D, Laubscher R (2002). South African

cause of death profile in transition – 1996 and future trends. South African Medicinal

Journal 92: 618-623.

Dold AP, Cocks M (1997). AmaYeza esiXhosa –an insight into Xhosa medicine. The

Phoenix, Eastern Cape Museum Magazine. 9, 2 & 3:4-5. Albany Museum, Graham’s town.

Cock ML, Dold AP (2000). The medicinal plants traded in the Eastern Cape Province.

Unpublished report, Department of Water Affairs and Forestry, Pretoria.

Disability Handbook (2011). DHB.

Ndubani P and Hojer B (1999). The traditional healers and treatment of sexually

transmitted illnesses in rural Zambia. Journal of Ethnopharmacology 67: 15-25.

Nkomo M (2009). Phytomedicinal studies of plants used in the treatment of dysmenorrhea

on O R Tambo Municipality. Unpublished report, Submitted in fulfiment of the requirement

of a Master degree of Science: Botany. Botany Department, Walter Sisisulu University:

Mthatha. 118-119.

Society for Investigative Dermatology (2005). Priority for Skin Biology and Disease

Research.

van Wky B-E (2008). Abroad review of commercially important South African medicinal

plants. Journal of Ehnopharmacol. 119: 342-355.

97

van Wky B-E, van Oudtshoorn B, Gericke N (2009). Medicinal plant of South Africa. Briza

Publications: Pretoria.

98

APPENDICES

Questionnaire respondent by traditional practitioners

ETHNOMEDICINAL OF STUDY OF SOME PLANTS USED FOR TREATMENT OF

SKIN INFECTIONS AND DISORDERS

Mahachi J is a student of Walter Sisulu University. He is carrying out a study to assess

and identify some medicinal plants used for treatment of skin infections and disorders

and improve the skin in the OR Tambo and Amathole Municipalities of the Eastern Cape.

This study will cover areas around Lusikisi, Flagstaff, Bizana and Port St. Johns in OR

Tambo and Mooiplas, Cinsta and Glen Eden Far Resort Area in the Great Kei sub- district

of Amathole Municipality. The results of this study will be made known to local people

and authorities as well to other interested parties. The purpose of this study is to find

enthomedical information of plants used for treatment of skin infections and improve the

skin.

1. Do you have people coming to consult you concerning treatment for skin diseases?

Yes No

2. What kind of skin problems do you normally have clients coming for treatment?

Wounds Ringworm itches Skin rashes psoriasis eczema Pigmentation

problems

99

3. Which plants do you use to use to prepare your medicines?

4. Which plant parts do you use to prepare the medicine?

5. How do you prepare you plant medicines?

6. How much of the plant material would need for each preparation?

7. What do you consider most important to prepare an effective medicine?

8. How do you know which plant species to use for treatment of a particular ailment

of the skin?

100

9. How is the medicine used by the patients?

Topical application Oral taken Steaming on affected

parts

10. How would you rank the efficacy of your plant medicines (Tick where appropriate).

Poor Fair Good Very good Excellent

11. Where do you get plant material which use to prepare your medicines?

12. How far are these plant materials from the place where you live?

13. Are the plants still in abundances?

Yes No

101

14. If yes: Which plant species are abundant?

15. If no: Which plants are rare?

16. May you assist by showing some plants which you use for medicines?

102

Questionnaire respondent by local people

ETHNOMEDICINAL OF STUDY OF SOME PLANTS USED FOR TREATMENT OF

SKIN INFECTIONS AND DISORDERS

Mahachi J is a student of Walter Sisulu University. He is carrying out a study to assess

and identify some medicinal plants used for treatment of skin infections and disorders

and improve the skin in the OR Tambo and Amathole Municipalities of the Eastern Cape.

This study will cover areas around Lusikisi, Flagstaff, Bizana and Port St. Johns in OR

Tambo and Mooiplas, Cinsta and Glen Eden Far Resort Area in the Great Kei sub- district

of Amathole Municipality. The results of this study will be made known to local people

and authorities as well to other interested parties. The purpose of this study is to find

enthomedical information of plants used for treatment of skin infections and improve the

skin.

1. Do you often use plant material as medicines on the skin?

Yes No

2. For what reasons do you use the plant material on the skin?

3. Which plants do you often use on the skin use on the skin?

103

4. Which plant parts do you use?

5. How do you prepare you medicine?

6. Where do you get plant material to prepare you medicines?

7. Do you still have these plants in abundances?

Yes No

8. If yes; which ones are still available easily?

9. If no; which ones are now rare?

104

10. Do you sometimes consult with the traditional practitioner for you to get the

plant medicines to use on the skin?

11. Which condition do you consult with traditional practitioner?

12. How do you rank the efficacy of the plant medicines? (Tick where appropriate).

Poor Fair Good Very good Excellent

13. Do you any plant materials that are used for treatment of skin problems or

improve the skin tone?

Yes No

14. If yes, which ones do you know?

15. What are these plants used for?

16. How are these plants prepared into medicine?

105

17. May you help me by showing me some of the plants which are used to treat

skin problems?

106