The bioactive compound of traditional herbal ointment accelerates wound closure, epithelialization, and angiogenesis in patients with second-degree burn wound: A randomized clinical trial

Introduction: This study endeavors to draw a comparative analysis between a traditional herbal ointment, specifically Swalin, and silver sulfadiazine ointment in the context of repairing deep second-degree burns. Methods: A randomized clinical trial was conducted at the Iran University of Medical Sciences. In this investigation, a cohort comprising eighty-two patients was stratified into two groups, namely Swalin (n = 41) and Silver sulfadiazine (SSD) (n = 41). Over 28 days, ointment applications were administered twice daily. The quantification of ointment compounds was conducted employing Gas Chromatography-Mass Spectrometry (GC-MS). The study encompassed a comprehensive assessment involving clinical examination, quantitative and qualitative histopathological evaluations, pain level determination, and scrutiny of wound closure. Statistical analyses, encompassing chi-square and Mann-Whitney U tests, were performed using SPSS software. Results: Our investigation revealed that the predominant compounds in the ointment were linoleic acid (41.37 %) and elaidic acid (37.45 %). On the 28th day, the Swalin group demonstrated a significantly higher rate of wound closure (81.52 +/- 7.76) compared to the SSD group (69.91 +/- 2.48) (p < 0.001). Furthermore, a statistically significant distinction was observed between the two groups concerning the degree of epithelialization (P = 0.048). Fibroblast density exhibited a notable discrepancy between the groups (P = 0.02). In terms of angiogenesis and collagen deposition, the Swalin group displayed a significant contrast with the SSD group (P = 0.008 and P = 0.007, respectively), while no statistical distinction was discerned in the number of immune cells (P > 0.05). Histological examination of SSD illustrated a pronounced infiltration of inflammatory cells in the dermis, predominantly lymphocytes. Conversely, the Swalin group exhibited well-formed dermal layers, minimal infiltration, and a profusion of vessels. Conclusion: In conclusion, the findings of this study highlight the potential therapeutic benefits of Swalin ointment, attributed to its rich composition of fatty acids, particularly linoleic acid, and the presence of vitamins C and E.