The Efficacy of St. John's Wort (SJW, Hypericum Perforatum)

Posted on Authorea 2 Jun 2020 | The copyright holder is the author/funder. All rights reserved. No reuse without permission. | https://doi.org/10.22541/au.159110380.08798337 | This a preprint and has not been peer reviewed. Data may be preliminary. eae nrcal knlsosadsas n eblchoice? (IGM)- herbal mastitis Any granulomatous idiopathic scars? with and woman lesions active skin sexually intractable middle-aged related of choices wounds? the skin are event? on -What historical SJW Any of effects wort? the John’s activities? are St. anticancer -What as and antioxidant perforatum anti-inflammatory, hypericum antimicrobial, call of we are all -Why results has oil Preliminary John’s IGM. St of come traditional -How lesions a skin as evaluating intractable centuries study the clinical questions many first on Reflective over the macerates is used oil this knowledge, been SJW our promising. flowers has topical of highly the skin best from and of disappear, the extracted efficacy perforatum remedy, or to However, herbal the smaller Hypericum a healing. get is plant wound might (SJW) for the wort mass medicine John’s granulomatous of St corticosteroids the leaves treatment. systemic even after and and associated but persist mass antibiotics treatment, still solitary spectrum the can the firm broad lesions of of a drainages, with mainstay disease presents Simple the inflammatory usually are lesions. It nonspecific skin age. chronic, inflammatory child-bearing add? recurrent, of with article women a mostly this is affecting does (IGM) breast, What mastitis topic? granulomatous lesions. this Idiopathic skin about persistent the known IGM-related of with already treatment 23% patients of is in and signs) What effective mild 41% very plus 35%, mild: be clearance in to 76.4%, (total rate seems seen (clear: success massage and overall regression oil severe, The significant SJW and each). very Conclusion: for moderate were p<0.001 94%. mild, there 1.9%; was as scores, severe: 3.9%, were pre-treatment severity with moderate: Distribution was 17.6%, of compared lesions, age degree skin mini- mean When predominant the persistent the A the respectively. and with were to women, patients (28%) patients, severe. were according 21 ulcer patients of and and lesions All (52%) total moderate the induration A protocol. (61%), treatment mild, of Results: scaling standard clear, (100%), treatment. the Hyperemia six-week of as of completion years. treatment, end after 36.6 empiric or after the oil and at SJW persistent and steroid patient used with oral each before lesions patients high-dose for IGM graded in for of and filled cycles only topical also two assessed 2019, SJW of was with were and questionnaire effects Methods: mass lesions 2016 the granulomatous and between evaluating Skin of Materials recommended study regression (IGM). was antibiotic. clinical complete mastitis minutes) first after granulomatous two lesions, the idiopathic for effect skin is of antidepressive daily intractable this its lesions times knowledge, for skin (two our mainly intractable massage of use the oil medicinal best on of the macerates history to oil long However, a SJW has healing. perforatum) wound hypericum for (SJW, and wort John’s St. Purpose: Abstract 2020 2, June 1 Yuksekdag Sema results idiopathic Preliminary with (IGM): patients oil mastitis of perforatum) granulomatous lesions hypericum skin (SJW, intractable wort on John’s macerates St. of efficacy The maieTann n eerhHospital Research and Training Umraniye 1 1 Posted on Authorea 2 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159110380.08798337 — This a preprint and has not been peer reviewed. Data may be preliminary. eeiyo rtea cln,idrto n sueucrwr vlae n rdda rvosycited previously as graded and evaluated were excluded fissure/ulcer were and follow-up without induration 1). Patients treatment scaling, (Table weeks. The erythema, 6 of of side-effects. Severity end possible the any at for or study. asked disappears the were extraction), lesion from and the during intervals when as sunlight two-week stopped to at such was control exposed lesions for and skin recalled oil were olive on-going SJW ml g with 500 treatment. (280 all with (1–2.4 SJW macerates to days on oil 28 (0.1–3.3 prescribed olive started pseudohypericin for containing was were SJW macerated lesion minutes) flowers Ready-made SJW skin two who fissure/ulceration. fresh a patients for induration, have all daily, scaling, still and times retrospectively, hyperemia/erythema, and (two interrogated treatment were massage of 2016 data May cycle oil time, all between second more but lesions a prospectively, one completed skin designed used in intractable was was tapered with study cycle Istanbul) was presenting The treatment dose AS, same patients the included. the San IGM were then cases, 2019 and All Ilac weeks, September recurrent Nevzat four and interval. IGM broad or first 4-week Mustafa persistent of a the In a diagnosis signs, mg, by for definitive following mg/day weeks. inflammatory confirmed 16 the 64 2 or was Following (Prednisolone as following infectious high-dose diagnosis corticosteroid the days. (MR) same with The oral 10 resonance the patients least with used Magnetic all treatment cases. at all In out for years. complicated obtained, employed carried 40 in drained. was was was were diagnosis antibiotic [?] (US) cm differential empiric educational ones ultrasound [?]2 spectrum and the the IGM, abscesses follow-up for from suspected All for used obtained adverse with CNB. taken was also possible patients were (MMG) was and In pictures mammography scan effects post-treatment and permission. expected and all, with the Pre- on of used macerate. explanation and oil after purposes, taken SJW also of were effects topic. consents this (SBU/21.11.2018/B.10.1.TKH.4.34.H.GP.0.01/137). Committe on written Ethics’ trial institutions’s Patients’ our first by approved the was is study IGM. The this with search, patients Pub-Med of wide-range Methods lesions a and skin after intractable Materials knowledge, on SJW our of of effectiveness best the the evaluated To we treatment. study, present after not the persist does In still surgery can since broad lesions treatment, satisfactory. drainages, skin the not Simple disappear, are of rate. or results mainstay recurrence limited cosmetic the high have and are a surgeons recurrence has corticosteroids Most prevent disease systemic nonspecific malignancy. the and exclude chronic, and to antibiotics entity a mandatory spectrum clinic is is abscess. this (CNB) an managing IGM biopsy in or needle experience prescription. fistulae core without A ul- skin women. own, inflammatory deeper common. parous also their an or middle-aged on with hyperemia mostly SJW associated unfading affecting idiopathic mass of as with breast, forms patients such the our oil of lesions now from inflammation topical skin feedback is used persistent positive and have hypericin had photosensitizer. cers who we and a when (IGM) as keratinocytes, medication mastitis cancer this of granulomatous skin about and differentiation knowledge psoriasis and had of We treatment growth the stimulate activities. in anticancer to used and intractable being shown antioxidant and increasingly anti-inflammatory, been myalgia antimicrobial, ulcers, has have burns, perforin to bruises, proven or are abrasions tradition. skin perforin), long for antidepres- a recommended its have been for wounds. also has used applications and SJW investigated dermatological of intensively overlooked rations been mostly has but perforatum) activity, hypericum sive (SJW, wort John’s St. Introduction • rtea ens ftesi rmcu ebae,cue yhprma(nrae lo o)in flow) blood (increased hyperemia by caused membranes, mucous or skin the of Redness Erythema: μ /)i ieettaemrswr sd n ainswr ret hoeoe l fteepatients these of All one. choose to free were patients and used, were trade-marks different in g/g) 2 w motn osiuns ahh-inhoe hprcn aood)adplr-lcnl (hy- phloro-glucinols and flavonoids) (hypericin, naphtho-dianthrones constituents, important Two 8 h entoso h ein r sfollowing: as are lesions the of definitions The μ /) aood(0.35-3.5 flavonoid g/g), 2 7 lhuhms ntebes ih e smaller get might breast the in mass Although μ /) yeii (0.3–6.6 hypericin g/g), 6 yeei,eyhm n elltsare cellulitis and erythema Hyperemia, 5 tmypeeta r solitary firm a as present may It μ /)adhyperforin and g/g) 3,4 1 oia prepa- Topical 1 Hy- Posted on Authorea 2 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159110380.08798337 — This a preprint and has not been peer reviewed. Data may be preliminary. ugclymngdwt ipeitretosa h uptetcii.Snew ol o n n similar any find not could were we fistulas Since skin intractable clinic. and outpatient and 2-cm the (52%) over at induration abscesses interventions (61%), predisposing since simple scaling lesions, the with (100%), skin series, managed Hyperemia still predominant present surgically may the respectively). the lesions were 76%, In skin (28%) and ulcer disappear, (90% disease. or lactation (p recurrent smaller of antibiotics. significant or get history statistically empiric persistent and not and corticosteroids, Secondary with were present), the patients skin. factors to (if the in well of drainage especially inflammation respond abscess persist, with masses is associated the treatment often of is and most It and factors common, mass, use. predisposing contraceptive is firm other oral tender, infection and or a antidepressant age, and with child-bearing habit presents of smoking women usually diabetes, affects diseases, usually inflammatory disease lactation, are benign recurrent no a is was IGM There treatment the (100%). with satisfied instructed were as Discussion patients All topically 9.5%). SJW after (n=2, applied and sensations patients burning before (100%). except all patients effect, of that side Images revealed important results 94.1%. 2. survey was and treatment The 1 of Figures signs) in mild shown plus are treatment clearance (total rate success ersini l cer 64,ml,1.% oeae39,svr .% p 1.9%, severe significant 3.9%, very moderate were 17.6%, there scores, mild, severity severity 76.4%, pre-treatment Post-treatment with and (clear, quadrants. compared 41.1% all 19%) When (n=4, 35.2%, upper in 3. outer by in lower Table regression followed and seen in of 38%) ) shown were (n=8, degree 19% are localization symptoms the (n=4, scores common severe inner to most lower and according the 23.8%), was moderate lesions (n=5, quadrant inner Mild, the outer of Upper 2. Distributions respectively. Table 23.5%, in 28.5%). no summarized (n=6, was are fissure/ulcer indura- There severity 61.9%), and (n=13, 52.3%) respectively). scaling (n=11, 100%), 19%, (9.5%). (n=21, had tion patients and hyperemia/erythema patients two persistent (9.5% Two in revealed examination history disorders Physical (14.2%). thyroid smoking antidepressants except a diseases, using had autoimmune were four or three and endocrinologic p another mellitus 1-7, and diabetes range (n=4), controlled children, use 3 contraceptive oral (mean, them of child of one Most p p 21-42, least 21-52). (76.1%, range standard (range, at years; year the years 32.4 of 36.6 one (mean completion was over age after age reproductive history oil mean the SJW the in used and were lesions women, 90.4%) were IGM (n=19, patients recurrent or All persistent protocol. with treatment patients 21 of total A P compared test. Results were exact variables Fisher’s Continuous using compared software. significant. were 20 tically variables Statistics Categorical SPSS t-test. using using performed was analysis Statistical each for in filled was questions simple 3 including form mini-questionnaire were: a questions treatment, The the patient. of end the At • • • • • • r o aifidwt h ramn?Pes nwra e rn,i o laespecify please no, if no, or specify yes please as yes, answer if Please no, deepin- treatment? massage, or hyperemia, the yes gentle in with as with increase satisfied answer prickling, minutes no. you or Please two or burning Are for etc.? itching, yes as daily fissures as such of times answer effects ing two Please side lesion any weeks? experience skin 6 you your for Did on treatment the oil continue SJW and the apply you Did dermis. the into neoplastic extending or skin, hyperemia of inflammation, sore to cracked. or and reaction cleavage dry a linear-like appears as A skin body Fissure/ulcer: The the of epidermis. the area infiltration. of an layer of outer Hardening the Induration: of Loss (desquamation): Scaling capillaries. superficial < .0) orptet eenliaos(9)adalohr 8.% had (80.9%) others all and (19%) nulliparous were patients Four 0.001). > .5 ah,ecp en nterpoutv g n aiga having and age reproductive the in being except each), 0.05, < .0) ieenpreto h ainshdahistory a had patients the of percent Nineteen 0.001). 3 < < .0) ite a lactation a had Sixteen 0.001). < .0 o ah.Teoverall The each). for 0.001 .5wscniee statis- considered was 0.05 6,9 Although Posted on Authorea 2 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159110380.08798337 — This a preprint and has not been peer reviewed. Data may be preliminary. knlsos oee,frhrsuiswt ihrvlm fptet r eddt aeafia decision. final a make to needed IGM-related are persistent patients with of patients volume in higher promising with and well effective studies tolerated be further they However, to but seems lesions. weeks. patients, massage skin enzyme sixth oil the of P450 SJW of end conclusion, liver two the In in the to sensations drug on the burning effect using mild its continued encountered and on just we depending study, reported, present generally been drugs immunosuppressive are also statins, effects have warfarin, isotypes. these barbiturates, agents but with mouth, chemotherapeutic interactions the drug and of Certain safe dryness transient. considered and and generally headache mild is restlessness, SJW (100%). dizziness, doses. that treatment reactions, appropriate shown the allergic have in patients with respectively. orally depressive satisfied used in patients, were 76.4%, use when patients the SJW all of including (clear: and studies 23% 94%, regression p Previous was and significant 1.9%; treatment 41% very severity of severe: 35%, were signs) of 3.9%, mild in degree there plus extracts seen the moderate: scores, oil and to 17.6%, severity (61%), according severe, SJW pre-treatment mild: lesions scaling and with topical the (100%), moderate compared recommend of hyperemia/erythema mild, When to Distributions revealed as started examination graded (28%). we physical were fissure/ulcer intractable, beginning, and or (52%) the induration persistent In lesions, mass, skin become the with 2016. presents reducing them usually in from IGM of effective Since very disappointing. some is was treatment pomads and steroid corticosteroid containing with oral formulation experience high-dose previous topical although our lipid a series, reduce present of the to activity In antimicrobial known vascularity. and improving and SJW. are flavonoids and healing of flavonoids of necrosis extract wound addition, oil cell presence demonstrated olive of In al the onset et SJW. in the Suntar of slowing increased of constituents or were preventing the rate by among the peroxidation proliferation al. are including density, et cell fibroblast which Ozturk findings, compounds, epithelial their xanthones, to Other use. and According medical synthesis, fibroblasts. have activity. embryonic collagen experimental to medical on process SJW appear healing of greatest also activity wound healing the kaempferol, the and have helps as quercetin hyperforin it reported flavonoids, and already how were effect. hypericin SJW, activities inducing of although antimicrobial proliferation properties and fibroblast antioxidant the as anti-inflammatory, on well its However, published studies detail. many in not are (TNF model. alpha There its rat factor that diabetic necrosis suggested in tumor authors wounds including The excisional cytokines lowering al. full-thickness psoriasis. on et of effect Mansouri flares al. study, its clinical et another to Yadollah-Damavand the an related decrease In probably help is cells. trig- of can efficacy mammalian that ointment induction in proteases involves SJW occurrences cysteine mechanism cleavage that are with other which proteolytic showed combined that caspases, of with of suggested was cascade together activation been a effects the extract ger also through antioxidant the has death) of cell and It (programmed activity Hyper- cells, production. apoptosis biological melanoma oxide light. nitric This malignant (UV) of human ultraviolet phototoxicity. inhibition under of enhanced cells proliferation irradiation melanoma suppress human UV be to in can able phototoxicity which was enhanced photosensitizer icin and a cancer. radicals is skin free hypericin of of and treatment keratinocytes, selective of for differentiation activities. used anticancer and and growth anti-inflammatory stimulates antioxidant, burns also antimicrobial, psoriasis, have hyperforin literature. egzema, English-written and as the icin such in will well-documented disorders, been we dermatologic has reported. disease, ulcers some were results IGM in promising used of and been lesions etc., have skin applications intractable SJW results. on Topical our application compare SJW to topical able of be not effects the reporting study, 23-25 oee,teei o nuhifrainaottesft fuigSWtpcly nthe In topically. SJW using of safety the about information enough not is there However, 22 17 aesonta oia yeiu efrtmipoe isergnrto in regeneration tissue improves perforatum hypericum topical that shown have 23 10,11 h otcmo des ffcsaegsritsia symptoms, gastrointestinal are effects adverse common most The 3 eihn tal. et Menichini 18-20 utemr,isuea eeyfrwud,bussadskin and bruises wounds, for remedy a as use its Furthermore, < .0 o ah.Teoealscesrt ttlclearance (total rate success overall The each). for 0.001 J nldsmn oebooial ciesubstances, active biologically more many includes SJW 4 15 aesgetdta J nue inhibition induces SJW that suggested have 12-14 ftecnttet,flvnis hyper- flavonoids, constituents, the Of 21 tde h wound the studied 17 oe study novel A 1 Hyperforin α 16 ). Posted on Authorea 2 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159110380.08798337 — This a preprint and has not been peer reviewed. Data may be preliminary. au mrvstsu eeeaini ultikesecsoa onsi ibtcrtmdl vdBased Evid model. rat perfo- diabetic hypericum in Topical 245328. wounds 2015: al. excisional 2015; et full-thickness Med N, in Alternat Nekouyian Complement regeneration E, tissue Jangholi improves M, A ratum Chavoshi-Nejad Wort psoriasis: S, John’s 215–220. Yadollah-Damavandi plaque-type Saint 63(4): in topical 17. 2017; levels of Med impact factor-alpha The Postgrad necrosis perforatum J al. tumor study. et tissue subsp. Z, pilot on ultraviolet Safaei-Naraghi L. treatment P, under perforatum) Najafizadeh perforatum cells S, (Hypericum Hypericum melanoma Mirafzal P, human Mansouri al. its in 193–202. 16. et phototoxicity of 46(2): C, enhanced review 2013; Toniolo and Prolif A M, Cell radicals L.): Marrelli free light. perforatum C, of 583–600. inhibition (Hypericum Alfano 53(5): induces wort G, 2001; John’s Menichini Pharmacol St Pharm dressing 15. J JD. wound Phillipson properties. for clinical 1404–1415. LA, membranes and 47(1): Anderson pharmacology oil-loaded 2019; chemistry, J, Biotechnol perforatum Barnes Nanomed Hypericum Cells of 14. Artif Production tests. vitro N. in 30(4): Erdemir and 2019; O, material potentially Med Egri as Environ plants Wilderness American 13. conditions. North scarce Endemic resource FR. under Champlin in cleaning 401–406. LS, wounds wound Brame burn for NW, on agents Nelson curcumin suitable 6462956. AJ, and 2020: Whitehead perforatum 2020; hypericum 12. Med of Alternat treatment effects Complement topical healing Based the the Evid of for rats. Evaluation biomedicines N. herbal 27. Seyhan Invest New 8(2): J 11. U. 2020; Wolfle mastitis. CM, Biomedicines. granulomatous Schempp disorders. F, lobular dermatological Gendrisch idiopathic of J, with Hoffmann patients 75 10. palmoplantar of of 414–420. treatment treatment 40–43. 32(5): and the 56(1): 2019; Diagnosis in 2011; Surg J. cream Dermatol Li tazarotene J Indian 0.1% e6895. 9. study. topical 12(2): controlled of 2020; randomized Evaluation Cureus observer-blinded ST. an literature. Mmystery Amladi of mastitis-A psoriasis: BH, review granulomatous Mehta and Idiopathic series 1–6. J. 8. case 2019; Vredenburgh A P, Surg unraveled: Invest Bindal retrospective J be A SA, to treatment. Alexander rupture: yet nonsurgical skin VM, with and Thomas mastitis surgical granulomatous underwent Idiopathic 7. who al. Diagnostic patients et 200 C, disease? Xi autoimmune of X, an study Lu it cohort Y, is a Zhang 729–733. by mastitis: J, Wang Granulomatous infrared 42(8): 6. and al. 2012; Today 354-357. et visible M, Surg the 22: Kara dilemmas. in 2013; E, Dermatol Unal protection therapeutic A, Exp and Radical Unal methods. L, al. vivo Ozel et ex 5. J, versus Lademann vivo A, in 2012; Kleemann – Biopharm SF, cream Pharm Haag hyperforin-rich J effect Eur S, anti-inflammatory Arndt vivo. and ex photoprotective 4. and vivo vitro In in al. activity antioxidant et 346-350. high F, with 81: Casetti associated SF, with is Haag creams hyperforin of S, of application Schanzer :275–294. dermatological MC, 17(1) of Meinke 2011; Estimation Molecules 3. perforatum). al. extracts. et (Hypericum oil M, wort Tasic-Kostov Wort V, John’s John’s Tadic A, St. St. Zugic I, of Arsic application 2. Topical 109–120. CM. 80(2-3): Schempp 2014; G, Med Seelinger Planta U, Wolfle 1. References interest. of conflict no is There interest of Conflicts 5 Posted on Authorea 2 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159110380.08798337 — This a preprint and has not been peer reviewed. Data may be preliminary. n2,10)(=3 19)(=1 23)(=,2.% n5,100%) (n=51, 28.5%) (n=6, 52.3%) (n=11, 61.9%) (n=13, Total 100%) Fissure/ulcer (n=21, Induration Scaling Erythema Score Severity (23.5%) 12 0 3. (18.1%) (41.1%) Table 2 21 4(30.7%) (50%) (28.5.2%) 3 6 (27.2%) 3 3 (35.2%) Severe (46.1%) 18 6 (50%) (42.8%) 3 9 (54.5%) 2 6 Moderate (23%) 3 (28.5%) 6 1 0 Mild 0 100%) 0 (n=51, 0 28.5%) 0 (n=6, 0 52.3%) Clear (n=11, 61.9%) (n=13, Total 100%) Fissure/ulcer (n=21, Induration Scaling Erythema Score Severity lesions deep mm) 2. 1 Table least Numerous/ (at height covered Noticable lesions coverage, all thick purple Very to red Deep 3 Severe mm) (0.75 covered partly fissures multiple depth, elevation Intermediate definitive Moderate lesions thick, most Diffuse, dark) (not Red 2 Moderate few Superficial, palpable (0.5mm) Light elevation white pink Fine, dark sign to No Light sign 1 No Mild sign No sign No 0 Fissure/ulcer Clear wort. Induration John’s Scaling St Erythema with Score drugs Severity of interactions Pharmacokinetic drug al. perforatum): 1. et Table (Hypericum M, 262–276. wort Huang SQ, 18(2): John’s Pan 2004; St 349–356. Psychopharmacol E, 54(4): J Chan al. 2002; S, et Pharmacol Zhou B, Clin 25. J Gerden Br C, outcomes. Bergquist 2nd clinical QY, perfora- Aspects. and 2011. Yue interactions (Hypericum Clinical 11, L, wort and Chapter Henderson Francis; John’s Biomolecular & St. 24. Press/Taylor Medicine: of CRC Herbal attributes (FL): Editors. Medical Raton S, Boca al. Wachtel-Galor et edition. IFF, potential J, Benzie healing Crawford wound In: A, vivo tum) Bartlow in 468–477. KM, the 127: on Klemow 2010; Investigations 23. Ethnopharmacol al. J et perforatum L. T, (Hypericum Baykal perforatum Wort D, Hypericum Yılmazer John’s 33-39. of EK, Akkol St. 111: IP, 2007; of Suntar on Ethnopharmacol activity L. 22. J Wound-healing 237-241. perforatum Y. fibroblasts. Hypericum 31(4): embryonic Ozturk 2007; of chicken S, Biol on extract Korkmaz J L.) ethanolic Turk N, of Ozturk fungi. study and vitro 2003; 21. bacteria In Drugs some S. CNS of Sukdolak known? sporulation S, is and Solujic what growth quality T, depression: and Milosevic in action wort 20. of John’s St modes of constituents, action 539-562. active of 17(8): Mechanism products: V. Butterweck Herbal 47–77. 19. M. 13(1): 2000; Morgan Rev K, Res Bone Nutrition RBH, control. Wills 18. eeiysoe flsosatrtreatment. after lesions of scores Severity treatment. before lesions of scores Severity severity. of degree the to according lesions the of Distribution 6 Posted on Authorea 2 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159110380.08798337 — This a preprint and has not been peer reviewed. Data may be preliminary. opeino w ylso ihds rlcriotri oehrwt ra pcrmatboi (Informed antibiotic spectrum M.U.) broad patient with the together from corticosteroid taken oral permission high-dose and of consent cycles two of completion 1. Figure (1.9%)** 1 0 *P (9%)* 1 (3.9%)** 0** 2 0** (16.6%)** 3 1 Severe 0** (17.6%)** 0** 9 (4.7%)** 0** 1 (27..2%)** 2 3 (76.4%)** Moderate (15.3%)* 39 2 (83.3%)** (19%)* 5 4 (63.6%)** 1 7 Mild (84.6%)** 11 (76.1%)** 16 0 Clear < .5 ttsial infiat p significant, statistically 0.05: esseteyhmtu nuaino h pe ue udato etbes,ee after even breast, left of quadrant outer upper the on induration erythematous persistent A < .0:saitclyhgl significant highly statistically 0.001: 7 Posted on Authorea 2 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159110380.08798337 — This a preprint and has not been peer reviewed. Data may be preliminary. Ifre osn n emsintknfo h ain M.U.) patient the from taken permission and consent (Informed 2. Figure h einfddaddsperdatrtpclapiaino J i aeaefr6weeks 6 for macerate oil SJW of application topical after disappeared and faded lesion The 8