Comparison between Combination of Neem, Propylene Glycol and Salicylic Acid with Salicylic Acid Alone Topically in Arsenical Palmar Keratosis.

Arsenicosis, a problem with chronic ingestion of arsenic in drinking water was first detected in 1993 in Bangladesh. Currently, 61 districts have been identified as having an arsenic concentration exceeding the maximum permissible limit of 0.05 mg/L. More than 40,000 people developed signs and symptoms of arsenicosis, manifested as skin hyperpigmentation often with hypopigmentation and later painful Keratosis on the palm and sole with fissures, cracks and warty lesions that reduce the working ability of patients. Keratosis is difficult to cure for its longer duration treatment and standard treatment is still lacking. Neem (Azadirachta Indica), a valuable source of unique natural products, has been used in various conditions, including skin care. Topical use of ethanol extract of neem has also been found to be effective. A cost-effective topical drug, in lower concentration with shorter duration and less adverse effect, is necessary. The purpose of this study was to observe the effect of the combination of neem, propylene glycol and salicylic acid for the treatment of palmar arsenical keratosis. Thirty patients of moderate palmar arsenical keratosis from an arsenic-affected area at Cumilla in Bangladesh were recruited randomly based on inclusion and exclusion criteria. One group of patients was given salicylic acid (10.0%) lotion in ethanol and another group of patients was given a combination of ethanol extract of neem (10.0%), propylene glycol (40.0%) and salicylic acid (10.0%). Clinical improvement was assessed by measurement of the palmar arsenical nodular size of both hands by slide calipers before and after the completion of treatment and perceptions of the patients about their improvement was scaled. The score (mean±SD) of the nodule of patients using neem (10.0%) plus propylene glycol (40.0%) plus salicylic acid (10.0%) before the study was 19.6±10.2 which was decreased to 8.1±6.6 after treatment. After 12 weeks of treatment, the mean perception score of improvement in neem (10%) plus propylene glycol (40.0%) plus salicylic acid (10.0%) was 4.8±0.6, improved from 2.2±1.1 in salicylic acid (10.0%) alone group. None of the patients reported any side effects rather topical use of a combination of ethanol extract of neem plus propylene glycol plus salicylic acid showed a significant effect in improving the keratotic lesion.