Elsevier

Wound Medicine

Volume 26, Issue 1, September 2019, 100163
Wound Medicine

Review article
Healing activity of Stryphnodendron adstringens (Mart.), a Brazilian tannin-rich species: A review of the literature and a case series

https://doi.org/10.1016/j.wndm.2019.100163Get rights and content

Abstract

Introduction

Stryphnodendron adstringens,commonly known as “barbatimão”, is a Brazilian savannah plant that has been long used in folk medicine due to its wound healing properties. However, there is a lack of integrated analyses of its healing activity based on scientific evidence.

Methods

The present study provides a literature review based on articles published in journals indexed in PUBMED and SCIELO databases. Moreover, a case series of four patients treated with a commercial barbatimão bark extract ointment is described.

Results and discussion

Forty-two publications on barbatimão were included in this review, most of which were published in English. From these studies, several biological and clinical actions of barbatimão were identified including anti-inflammatory, antioxidant, anti-ulcer, antimicrobial, and anti-parasitic effects, in addition to healing properties. The healing ability of barbatimão is scientifically described using evidence mainly obtained from animal experimental studies, and only one clinical trial exists that describes its healing effect on decubitus ulcers. Therefore, it was considered relevant to report a case series of patients subjected to barbatimão treatment for wounds caused by intense involuntary physical trauma (external accidents) or surgery. Considering all cases, the complete wound healing duration was 3.6 ± 0.8 months. Barbatimão is a tannin-rich plant, and chemical matrix analysis suggests that its wound healing effect is mainly due to high levels of epigallocatechin-gallate (EGCG) and gallic acid molecules.

Conclusion

Considering the difficulty in treating chronic or extensive wounds, barbatimão could be an effective, low-cost phytotherapy formulation with low levels of toxicity.

Introduction

Wound healing is a biological process that involves four distinct and subsequent phases (haemostasis, inflammation, proliferation, and tissue remodelling) in order to restore injured tissues [1]. Due to the complexity of this process, searching for natural products with effective and safe healing activities could be considered beneficial [2]. Brazil is a megadiverse country in terms of plant species, with some species long being used as wound healing treatments by several indigenous and mixed-race traditional communities (caboclo, caiçara, and descendants of enslaved Africans, named quilombolas) [3]. This is the case for Stryphnodendron adstringens (Mart.) Coville, a tannin-rich species commonly known as barbatimão (Fig. 1). Barbatimão is native to the Brazilian Cerrado biome, and is considered an endemic species as is distributed in all Brazilian geographic regions [4].

The name “barbatimão’ originated from the indigenous Tupi-Guarani language and means “the tree that tightens” [5]. The traditional curative properties of barbatimão were recognized long ago by Auguste de Saint-Hilaire and other European naturalists that travelled inner Brazil in the 19th century [6]. Prior studies have been performed using barbatimão bark in order to verify its efficacy in the treatment of wounds and existing some evidences related with its clinical action [7,8]. Due its important wound healing effects, the purpose of this report is to review the literature relating to the wound healing properties of this plant, and to present a case series of wound healing using barbatimão extract for voluntary (surgery) and involuntary (physical injures) trauma.

Section snippets

Selection of papers

The papers analyzed in the present review were selected from two electronic databases, PUBMED and SCIELO, accessed on May 01, 2017 using the following search filters: “Stryphnodendron adstringens”; “Stryphnodendron adstringens wound healing”; “barbatimão”; and “barbatimão wound healing”. Studies describing information potentially associated with the wound healing activity of barbatimão were also considered, such as those focusing on the chemical characterization of bioactive molecules present

Results and discussion

In the present review a total of 39 articles were identified using “Stryphnodendron adstringens” as a filter, and 21 using “barbatimão” as a filter in the PUBMED database. In this database, just nine articles were identified using “Stryphnodendron adstringensand wound healing” as a filter. From the SCIELO database, a total of 29 articles were identified using “Stryphnodendron adstringens”, and 67 were identified using “barbatimão” as filter words. The “Barbatimão and healing” filter identified

Conclusions

Considering the difficulty of treating chronic or extensive wounds, barbatimão could be an effective, low-cost, and low-toxicity phytotherapy formulation. Barbatimão seems to possess wound healing activity due to its chemical matrix being rich in tannins, especially EGCG and gallic acid. It is probable that the antioxidant, anti-inflammatory, and proliferative effects of barbatimão extract could contribute to the healing activity of this plant. However, complementary studies on the causal

Ethical Statement

The study was part of a project previously approved by the Ethics Committee of the Universidade Federal de Santa Maria and was conducted according to Resolution # 1/88 of the National Health Council. However, patients did not sign their consent because a retrospective case series was performed based on clinical information and photographs found in the medical records of the Public and Free Service of Nursing School of Universidade Federal de Santa Maria, Palmeira das Missões, Brazil.

Financial disclosure

No financial statement, since the project did not have funding, besides the researchers themselves, to contribute with the necessary materials.

Declaration of Competing Interest

All authors declare no conflict of interest.

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