Radiation therapy (RT) is an important part of many different cancer treatments, but damage to the skin around the site of radiation can be significant. RT using dose fractionation makes use of the fact that normal and cancer tissues have different recovery rates and allows for therapies where the goal is the preservation of breast tissue. However, all forms of RT are also associated with declines in quality of life measures as well as with increases in pain, nausea and insomnia. RT is also associated with declines in cognitive and social functions as well as increased financial costs and difficulties.
One of the primary concerns in RT are the common (~10-31%) severe skin reactions experienced by breast cancer patients. These reactions include loss of skin (dry/moist desquamation), scarring, loss of pigmentation, loss of elasticity and poor healing. The risk of severe skin reactions increases with increasing weight, increased breast size, higher doses of RT, the type of radiation given and the size of the treated area.
Despite the serious consequences of skin reactions to RT, there is no set treatment or protocol to protect irradiated normal skin. Approaches that have shown some promise include treatments with various lotions that may or may not contain medications including steroids, sucralfate, urea and others.
In this article, the researchers propose the use of wheatgrass extract on the skin of breast cancer patients. Their rationale is based on various studies in animals, wheatgrass’ extremely low level of toxicity, it’s anti-inflammatory and immune-boosting properties. They also propose that, based on previous studies, wheatgrass could be useful promoting healing, acting as an anti-inflammatory, reducing pain and the risk of infections. In addition, the authors proposed that the use of wheatgrass on irradiated skin during RT could reduce the risks of scarring, swelling, blistering and redness, and could improve skin elasticity.
We might not think much about the process that takes place when we have a small cut or burn. A healthy body will heal itself in a few days. But many people who have poor wound healing (e.g. type 2 diabetes, immunocompromised) or major wounds or burns need to receive additional support to healing quickly and properly. Therefore, researchers are constantly looking for ways to augment or speed up the body’s natural wound healing process. Previous reports have suggested that the juice from wheatgrass (Triticum aestivum) can help. The current study examined this in a laboratory setting.
Researchers created two types of experimental wounds in anesthetized rats, namely surgical incisions and thermal burns (hot wax). The wounds were created in such a way as to carefully control the size and extent of the wound. The wounds were then treated in one of three ways: No additional treatment (control), wheatgrass juice applied to the wound, or an antibiotic ointment called Framycetin. The wounds were then measured for 9 days after the initial burn. Surgical wounds showed signs of healing in all cases (smaller wound size) but healing was significantly faster in the groups treated with wheatgrass juice or the antibiotic ointment compared to control. Likewise, granulation tissue (the tissue that needs to form during normal healing) was thicker and healthier looking (under microscope) in the treated animals compared to control. In the animals that sustained burn wounds, two untreated animals developed severe blood infections and died. This did not occur in the wheatgrass juice or the antibiotic ointment groups. The speed of wound healing was faster in the wheatgrass juice and the antibiotic ointment groups compared to control animals.
Wheatgrass juice, when applied directly to surgical or burn wounds, can speed the healing process. This may be of special relevance in patients who are allergic to antibiotic ointments or in countries where antibiotics are too expensive for routine use. Wheatgrass juice may provide an equally effective alternative to topical antibiotics.
Fitostimoline is a topically applied agent whose main active ingredient is a water extract of Triticum vulgare, a species of wheat. Citrizan Gel is a product that contains an enzyme (catalase) derived from horses. Both of these agents have been reported to improve wound healing. The current study compared them to determine if one was superior.
Researchers enrolled 227 patients with medium-sized, second degree (blistering) burns to participate in this clinical trial. Volunteers received one of three possible treatments, a wheatgrass extract (Fitostimoline) cream, Fitostimoline-soaked gauze, or Citrizan Gel. These treatments were applied as directed and patients were followed for up to 20 days. More patients treated with Fitostimoline had complete wound healing by the end of the trial than those treated with Citrizan Gel. Specifically, 97.3% of patients treated with Fitostimoline gauze and 91.5% of those treated with Fitostimoline cream healed in the study period. Only 84.5 of patients treated with Citrizan Gel were fully healed in that time. The difference is made even more impressive by the fact that, on average, the wounds were slightly smaller in the Citrizan Gel group at start (not statistically significant, however). Interestingly, the overall speed of burn wound healing was not significantly different between treatment groups. Combined Fitostimoline-treated groups reported slightly but significantly fewer overall symptoms, pain, and burning than catalase gel at end of study.
The wheat product, Fitostimoline, facilitated healing of a moderate second degree burn in human patients. This product was more effective than a catalase gel in the number of people who fully healed and was better at reducing symptoms of pain and burning sensation. Wheat grass extract soaked in gauzes are nominally more helpful than the extract used as a cream.
In addition to being exceptionally painful, second and third degree burns disrupt the skin’s natural protective barrier and make sufferers vulnerable to various infections. Modern burn therapy includes keeping the wound clean and as sterile as possible, minimizing pain, and assuring the patient gets adequate hydration. The key is to promote skin closure and healing as quickly as possible, though this can take months depending on the severity of the burn.
A man suffered extensive 2nd and 3rd degree burns to his face and upper body after falling into a fire. Conventional treatment plus penicillin was used. Four days later his condition improved although his eyes exuded pus. A week later the burns were discharging pus and were malodorous and no healing was apparent.
Two weeks after the accident the burns were debrided and the surface covered with chlorophyll-soaked gauze. The following day, malodour had improved and extensive new skin and tissue had formed over the wounds so that the dressings could be removed.
After 4 days, much of the neck and face had healed, and even allowed shaving. There was no scarring, and almost no contraction or stiffening of the skin, but one eyelid required some surgical treatment. Healing was complete about a month and a half after the accident and a month after the first chlorophyll dressing. It is unusual for severe burns to heal so quickly.
A young man spilt boiling water into his boot, causing 2nd-degree scalding of his calf. The wound was cleaned carefully, and a 5% chlorophyll pack was applied. Two days later, the wound was already dry, and healing had already taken place over most of the area. A soft, non-adhesive antiseptic dressing was then applied to the healed portion, while a chlorophyll dressing was used to cover the unhealed parts. A week after the accident, only a protective dressing was needed. Thus, a mere 7 days were required for healing. Scar tissue was minimal and the skin’s appearance subsequently returned to normal.
1.The rate of healing when chlorophyll is used is so rapid that its inclusion in the armamentarium of burns treatment is suggested.
2. Chlorophyll completely supersedes the sulphonamide compounds as a primary dressing for clean and potentially infected wounds.
3. Chlorophyll is a powerful deodorant.
Chlorophyll is generally regarded as a photosynthetic pigment present in green plants. This article reviews the anti-inflammatory, wound healing and malodour reducing properties of chlorophyll.
In a study on embryonic hearts in mice, it was noted that growth occurred at a faster rate when chlorophyllin was introduced into the heart cells. In other animal experiments, wounds treated with chlorophyll derivatives healed faster when compared to other agents. Chlorophyll acted on different aspects of wound healing and resulted in faster healing. Furthermore, chlorophyll derivatives had an antibacterial effect considered beneficial in wounds that tend to get re-infected.
Another animal study reported that chlorophyll enhanced the formation of blood cells in anemic animals. A 70-83% increase in the number of red blood cells and haemoglobin concentration was noted within 10-16 days of regular administration of chlorophyll derivatives. Induction of the formation of other blood cells was also noted.
Significantly, none of these studies reported any signs of toxicity from administration of chlorophyll derivatives even over a prolonged period of time.
Clinical investigations of the uses of chlorophyll derivatives actively started in the US in 1940. Numerous chlorophyll derivatives including chlorophyll copper complex (CCC) were used in the form of ointments and solutions to promote healing of wounds at various hospitals. Remarkable improvement was noted in the wound healing process, even in wounds that did not respond to other therapies. In more than 400 cases of suppurative disease, CCC stimulated granulation tissue and epithelialisation better than other agents. Chronic refractory skin ulcers were also treated successfully. In addition, the itching and burning sensation generally associated with most skin wounds and burns was also significantly reduced. Chlorophyll derivatives were successful in resolving numerous skin disorders, burns and even gum diseases.
Both local application and oral consumption of chlorophyll derivatives significantly reduced the malodour associated with colostomy. There were no reports of toxicity.
Although the exact mechanism of action of chlorophyll is not known, it is thought to exert its action via:
1. stimulation of protein synthesis
2. antimicrobial effects
3. neutralising effects on wound-healing retarding compounds in exudate
4. tight binding of microbial indolic compounds.
Other clinical studies have shown positive results using chlorophyll derivatives for treating pancreatitis, cancer and psoriasis. Further research is required to prove these beneficial effects on a larger scale.
The introduction of anti-inflammatory steroids and antimicrobial drugs during the 1940s overshadowed the therapeutic effects of chlorophyll. However, management of slow healing wounds with these agents remains a time consuming and expensive process. Further studies are required to explore the therapeutic potential of chlorophyll.
In practical terms, CCC led to:
1. Increased growth rate in mouse embryo heart cells (40%).
2. Increased healing rates.
3. Wound healing acceleration without inflammation.
4. 25% increased healing rate in 70% of traumatic & thermal wounds.
5. Fibroblast activation.
6. Marked increase in cell mitotic indices.
7. Increase in number of blood vessels and circulation.
8. Bacteriostasis in vitro. Staph. aureus neutralised.
9. Abolition of hemagglutination in wounds.
10. Reversal of X-ray induced leukopenia in animals.
11. Antiulcer activity in animals.
12. Protection against CCl4 – induced hepatitis.
13. Increased O2 consumption indicating cell regeneration.
Lieutenant Colonel Bowers of the US Army reports on the use of water-soluble derivatives of chlorophyll in over 400 cases over a period of nine months. He (and colleagues) noted several major effects, notably: loss of odour associated with infected wounds; a stimulating effect on tissue formation (granulation tissue) when used as a dressing particularly for burns; and a drying effect in the case of abscesses, sinus tracts, surface lesions and osteomyelitis. Mention is made of chlorophyll efficacy in treatment of cyst wounds, fistula-in-ano (6 cases), sarcoma/carcinoma (4 cases), ulcerative colitis (1 case), thoracic empyema (several cases, 2 particularly effective), gunshot wound sinus tracts (17 cases), decubitis ulcer (4 cases) and burns (4 patients). In 119 cases of compound fractures to limbs chlorophyll reduced odour and enhanced healing, in some cases with exceptional results, e.g. legs saved from seemingly inevitable amputation. Numerous other cases and conditions are mentioned. Chlorophyll was comfortable as a wet dressing and was easily tolerated by patients. The author is convinced that chlorophyll is the best agent known for use in the treatment of suppurative diseases, indolent ulcers or wherever stimulation of tissue repair is desired, although it is not presented as a cure-all.
Wound healing involves an inflammatory (exudative) phase and a proliferative tissue growth and repair phase that presumably involves growth stimulating factors. This study tested various water soluble chlorophyll preparations and other agents including vitamin ointments and sulfathiazole on wounds created by excising portions of skin from rats, guinea pigs, rabbits and dogs. Response in rate of healing tended to be greater for chlorophyll than with other agents tested (the data is summarized in several tables not reproducible here).
On the basis of these observations it is suggested that chlorophyll preparations should be used much more extensively in the treatment of wounds and burns.