Topical Herbal Products as Adjuncts to Standard Care for the Management of Diabetic Foot Ulcers

Background and Aim: Diabetic foot ulcers (DFUs) constitute one of the most debilitating complications of diabetes mellitus (DM). The use of topical herbal products as adjuvant agents in wound dressing is one of the most widely used practices worldwide. The present review aimed to provide a detailed and comprehensive systematic review focusing on randomized clinical studies and critically analyze not only the clinical outcomes but also the methodological approaches used by these studies. Methods: The present systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. For the extraction of relevant studies, three databases were searched: Pubmed, Web of Science Core Collection, and Scopus by two independent researchers. Results: A search of the three databases resulted in the identification of 5528 records which were reduced to 3224 after removal of duplicates. The application of inclusion and exclusion criteria left 35 full-text articles assessed for eligibility. Finally, 13 articles were excluded and only 22 articles were advanced to the final analysis. Most studies reported details of local ulcer management only while others reported the additional systemic/surgical measures used for management. The present review identified 18 botanical agents/preparations used alone or in combination with other agents as adjuvant agents in treatment of DFUs. In most situations, these agents proved to be effective. Conclusion: The present review reported the methodological approaches and clinical outcomes of botanical extracts used topically for the treatment of diabetic foot ulcers in randomized controlled studies. These agents proved to be generally effective. However, many gaps existed in the study designs which may limit the evidence-based value of these studies.