Evaluating the Healing Effects of Ajuga chamaecistus ssp. tomentella, on Second Grade Burn Wounds, a Double-Blind Randomized Controlled Clinical Trial

Document Type : Original paper


1 Department of Persian Medicine, Faculty of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.

2 Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran.

3 Burn’s Research Center, Iran University of Medical Sciences, Tehran, Iran.

4 Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran.

5 Dermatology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.


Background and objectives: Nowadays, the use of medicinal plants is on the rise mainly due to the fewer side effects and lower costs. Despite the traditional reports about the healing properties of Ajuga species, no clinical studies have been conducted. In this study, the effect of hydroalcoholic extract cream (3%) of Ajuga chamaecistus ssp. tomentella, one of the exclusive species of Ajuga in Iran, was compared with nitrofurazone cream (0.2%) on the second-degree burn wound healing. Methods: This clinical trial was performed at Motahhari Burns Hospital in Tehran. Fifty-two cases of second-degree burn patients were randomly assigned to two groups of 26 members, including nitrofurazone and Ajuga. We evaluated the wounds based on the onset of epithelialization, healing time, post-drug irritation, primary irritation, decreased irritation, post-drug pain, primary pain, decreased pain, allergy, infection parameters, and the Bates-Jensen Wound Assessment Tool. Results: Ajuga cream was more effective than nitrofurazone in terms of the mean day of epithelialization onset (p = 0.007), healing time (p = 0.001), post-drug irritation (p = 0.007), decreased irritation (p <0.001), post-drug pain (p = 0.018) and decreased pain (p = 0.001). Conclusion: According to the results, the Ajuga cream (3%) can be a useful remedy for burn wounds due to the reduction in the onset of epithelialization, healing time, post-drug irritation, irritation reduction, post-drug pain, and pain reduction. However, further large clinical trials are needed to confirm these results.


Main Subjects

  • Gosain A, Di Pietro LA. Aging and wound healing. World J Surg. 2004; 28(3): 321–326.
  • Mohammadi AA, Bakhshaeekia A, Alibeigi P, Hasheminasab MJ, Tolide-ei HR, Tavakkolian AR, Mohammadi MK. Efficacy of propranolol in wound healing for hospitalized burn patients. J Burn Care Res. 2009; 30(6): 1013–1017.
  • Rahzani K, Taleghani F, Nikbakht Nasrabadi A. Qualitative approach on social problems in burned disfigurement individuals. J Arak Uni Med Sci. 2008; 11(3): 37–48.
  • Aramwit P, Palapinyo S, Srichana T, Chottanapund S, Muangman P. Silk sericin ameliorates wound healing and its clinical efficacy in burn wounds. Arch Dermatol Res. 2013; 305(7): 585–594.
  • Gomez R, Cancio LC. Management of burn wounds in the emergency department. Emerg Med Clin North Am. 2007; 25(1): 135–146.
  • Hosseini SN, Karimian A, Mousavinasab SN, Rahmanpour H, Yamini M, Zahmatkesh SH. Xenoderm versus 1% silver sulfadiazine in partial-thickness burns. Asian J Surg. 2009; 32(4): 234–239.
  • Saeidinia A, Keihanian F, Lashkari AP. Partial-thickness burn wounds healing by topical treatment: a randomized controlled comparison between silver sulfadiazine and centiderm. Medicine. 2017; 96(9): 1–9.
  • Ribeiro MP, Espiga A, Silva D, Baptista P, Henriques J, Ferreira C, Silva JC, Borges JP, Pires E, Chaves P, Correia IJ. Development of a new chitosan hydrogel for wound dressing. Wound Repair Regen. 2009; 17(6): 817–824.
  • Zadeh A, Mahzooni T, Emami SA, Akbari H, Fatemi MJ, Saberi M, Bagheri T, Niazi M, Araghi S. The effect of coriander cream on healing of superficial second degree burn wound. Tehran Univ Medical J. 2015; 73(9): 646–652.
  • Bagheri T, Fatemi MJ, Hosseini SA, Saberi M, Niazi M, Momeni M, Masoumi Z. Comparing the effects of topical application of honey and nitrofurazone ointment on the treatment of second-degree burns with limited area: a randomized clinical trial. Med Surg Nurs J. 2017; 5(4): 22–30.
  • Ghannadi A, Zolfaghari B, Shamashian S. Necessity, importance, and applications of traditional medicine knowledge in different nations. J Islam Iran Trad Med. 2011; 2(2): 161–176.
  • Khanavi M, Najafi B, Sadati SN, Abai MR, Vatandoost H. Chemical constitute and larvicidal activity of fractions of Ajuga chamaecistus tomentella plant against malaria vector Anopheles stephensi. J Arthropod Borne Dis. 2017; 11(1): 116 –123.
  • Mozaffarian V. A dictionary of Iranian plant names. Tehran: Farhang-e-moaser, 2007.
  • Lamardi SN, Tahroodi S, Khanavi M, Doust RH. Antibacterial activity of aerial part extracts and fractions of Ajuga chamaecistus tomentella. Tradit Integr Med. 2017; 2(2): 61–66.
  • Nawaz HR, Malik A, Khan PM, Ahmed S. Ajugin E and F: two withanolides from Ajuga parviflora. Phytochemistry. 1999; 52(7): 1357–1360.
  • El Hilaly J, Israili ZH, Lyoussi B. Acute and chronic toxicological studies of Ajuga iva in experimental animals. J Ethnopharmacol. 2004; 91(1): 43–50.
  • El Hilaly J, Lyoussi B. Hypoglycaemic effect of the lyophilised aqueous extract of Ajuga iva in normal and streptozotocin diabetic rats. J Ethnopharmacol. 2002; 80(2-3): 109–113.
  • Gautam R, Jachak SM, Saklani A. Anti-inflammatory effect of Ajuga bracteosa Wall Ex Benth. mediated through cyclooxygenase (COX) inhibition. J 2011; 133(2): 928–930.
  • Kuria K, De Coster S, Muriuki G, Masengo W, Kibwage I, Hoogmartens J, Laekeman GM. Antimalarial activity of Ajuga remota Benth (Labiatae) and Caesalpinia volkensii Harms (Caesalpiniaceae): in vitro confirmation of ethnopharmacological use. J Ethnopharmacol. 2001; 74(2): 141–148.
  • Sadati Lamardi SN, Majidi Z, Alipour C, Farajzadeh S, Gohari A, Shafaroodi H, Vazirian M, Ostad SN. Antioxidant potential, hypoglycemic effect and safety of Ajuga chamaecistus ssp. tomentella (Boiss.) Rech. f. aerial parts. Res J Pharmacogn. 2018; 5(4): 53–63.
  • Turkoglu S, Turkoglu I, Kahyaoglu M, Celık S. Determination of antimicrobial and antioxidant activities of Turkish endemic Ajuga chamaepitys (L.) Schreber subsp. euphratica PH Davis (Lamiaceae). J Med Plant Res. 2010; 4(13): 1260–1268.
  • Khanavi M, Davoodipoor AM, Sadati SN, Ardekani MRS, Sharifzadeh M. Antinociceptive effect of some extracts from Ajuga chamaecistus ssp. tomentella (Boiss.) Rech. f. aerial parts. DARU J Pharm Sci. 2014; 22(1): 1–6.
  • Aghili Khorasani MH. Makhzan-al-advia. Rahimi R, Shams Ardekani MR, Farjadmand F, Eds. Tehran: Tehran University of Medical Sciences, 2009.
  • Israili ZH, Lyoussi B. Ethnopharmacology of the plants of genus Ajuga. Pak J Pharm Sci. 2009; 22(4): 425–462.
  • Khalil EA, Afifi FU, Al-Hussaini M. Evaluation of the wound healing effect of some Jordanian traditional medicinal plants formulated in Pluronic F127 using mice (Mus musculus). J Ethnopharmacol. 2007; 109(1): 104–112.
  • Hosseinkhani A, Falahatzadeh M, Raoofi E, Zarshenas MM. An evidence-based review on wound healing herbal remedies from reports of traditional Persian medicine. J Evid Based Complement Altern Med. 2017; 22(2): 334–343.
  • Ghahraman A, Okhovvat AR. Matching the old medicinal plant names with scientific terminology. Vol. 1. Tehran: Tehran University Press, 2004.
  • Lamardi SNS, Jahantab S, Ziyarati P, Khanavi M, Shams-Ardekani MR. Quantification of 20-hydroxyecdysone, a major phytoecdysteroid, in Ajuga chamaecistus tomentella using high-performance liquid chromatography. Tradit Integr Med. 2016; 1(3): 96–100.
  • World Health Organization (WHO). Supplementary information, S.3.7 Microbiological quality of non-sterile products: recommended acceptance criteria for pharmaceutical preparations: Final test for revision of the international pharmacopoeia. [Accessed 2020]. Available from: https://www.who.int/medicines/publications/pharmacopoeia/2012-04-03MicrobialPurity_QAS11-41_FINAL.pdf
  • Sadati N, Ostad SN, Karimian Z, Shams Ardekani MR, Akbarzadeh T, Hadjiakhoondi A, Khanavi M. Phytochemical study and in vitro cytotoxic effect of Ajuga chamaecistus tomentella. Asian J Chem. 2012; 24(7): 2871–2874.
  • Sadati N, Jenett-Siems K, Siems K, Shams Ardekani MR, Hadjiakhoondi A, Akbarzadeh T, Ostad SN, Khanavi M. Major constituents and cytotoxic effects of Ajuga chamaecistus tomentella. Z Naturforsch. 2012; 67(5-6): 275–281.
  • Akbay P, Çalιş IH, Heilmann J, Sticher O. Ionone, iridoid and phenylethanoid glycosides from Ajuga salicifolia. 2003; 58(3-4): 177–180.
  • Mamadalieva NZ, El Readi MZ, Ovidi E, Ashour ML, Hamoud R, Sagdullaev SS, Azimova SS, Tiezzi A, Wink M. Antiproliferative, antimicrobial and antioxidant activities of the chemical constituents of Ajuga turkestanica. Phytopharmacol. 2013; 4(1): 1–18.
  • Dinan L. The Karlson lecture. Phytoecdysteroids: what use are they? Arch Insect Biochem Physiol. 2009; 72(3): 126–141.