Journal of Ethnopharmacology 153 (2014) 220–232

Contents lists available at ScienceDirect

Journal of Ethnopharmacology journal homepage: www.elsevier.com/locate/jep

Research paper

Ethnobotanical survey of medicinal plants used in the management of skin disorders among the Xhosa communities of the Amathole District, Eastern Cape, South Africa Anthony J. Afolayan n, Donald S. Grierson 1, Wilfred O. Mbeng 2 MPED Research Centre, Department of Botany, University of Fort Hare, Private Bag X1314, Alice 5700, South Africa

art ic l e i nf o

a b s t r a c t

Article history: Received 28 November 2013 Received in revised form 11 February 2014 Accepted 11 February 2014 Available online 28 February 2014

Ethnopharmacological relevance: Skin diseases have been of major concern recently due to the association of skin opportunistic infections and HIV/AIDS, are usually the first sign of HIV infection and conversion to AIDS. More than 90% of HIV-infected individuals develop skin and mucosal complications at some stage during the disease. Although classical medicine is undoubtedly addressing these diseases, the people of the Eastern Cape, South Africa still depend, to a large extent on traditional herbal medicine for the treatment of various diseases. The current study was undertaken to investigate the local peoples characterisation of skin diseases/disorders and to document the medicinal plants used for various skin disorders among the Xhosa-speaking communities of the Amathole District, Eastern Cape. Materials and methods: Information was obtained by interviewing 54 respondents in 7 locations. Collection of the reported medicinal plants from the wild was assisted by the informants and identification of the collected plants specimens was done with the help of floristic works of South Africa. Quantitative methods including the use-value and the informant consensus factor (ICF) were computed for determining the relative importance of species known locally and the homogeneity of the informants' knowledge respectively. Results: Twenty five skin disorders, classified under 5 categories are being treated with the listed medicinal plants in the study area. The highest ICF (0.45) was linked to bacteria-related skin disorders. This category comprised of 57 use citations, 3 skin disorders; with sore throat being the most frequently mentioned (4.2%). In this study, 106 plant species distributed in 61 families and 107 genera were identified as being used to treat one or more of the skin disorders. The species with the highest use-value was Aloe ferox Mill. (Xanthorrhoeaceae) known locally as Umhlaba. The most representative families were Solanaceae and Asteraceae with 6 species each, followed by Fabaceae, Poaceae and Rutaceae (5 species each). The leaves were the most frequently used plant part, followed by the bark (10%) and fruits (7%). Administration of the different plant parts was mostly topical (77%) on the affected area. Conclusion: A total of twenty five skin disorders/conditions, classified under 5 categories are being treated with the listed medicinal plants in the study area. 106 plant species distributed in 61 families and 107 genera were identified as being used to treat one or more of the skin disorders. The species with the highest use-value was Aloe ferox Mill. (Xanthorrhoeaceae) known locally as Umhlaba. The most representative families were Solanaceae, Asteraceae, Fabaceae, Poaceae, Rutaceae and Euphorbiaceae. Majority of the plant species were herbs and the leaves were the most frequently used, mostly applied topically as a paste, powder or sap on the affected skin area. & 2014 Elsevier Ireland Ltd. All rights reserved.

Keywords: Ethnobotanical survey Medicinal plants Skin disorders Xhosa Eastern Cape

1. Introduction

n

Corresponding author. Tel.: þ 27 406022323; mob.: þ 27 822022167; fax: þ27 86628 2295. E-mail addresses: [email protected] (A.J. Afolayan), [email protected] (D.S. Grierson), [email protected] (W.O. Mbeng). 1 Tel.: þ27 406022321; fax: þ 27 866282409. 2 Tel.: þ27 33257274; fax: þ 27 866282409. http://dx.doi.org/10.1016/j.jep.2014.02.023 0378-8741 & 2014 Elsevier Ireland Ltd. All rights reserved.

The skin is the largest organ by area in the body. It serves many important functions, including protection, percutaneous absorption, temperature regulation, fluid maintenance, sensory and disease control (Abbasi et al., 2010). The etiology of skin disorders clearly shows the close association that exists between an individual's health and his natural and sociocultural environment (Martínez and Barboza, 2010).

A.J. Afolayan et al. / Journal of Ethnopharmacology 153 (2014) 220–232

For example, household overcrowding, hot and humid climatic conditions may exacerbate or play an enormous part in the spread of skin infections. These factors are particularly problematic in Sub-Saharan Africa where it was found that over 78 million people were infected with Tinea capitis (a superficial fungal skin infection affecting the scalp) (De Wet et al., 2013). In South Africa, over 19 500 fire-related deaths are reported annually and they rank among the 15 leading causes of death in children and young adults between the age of 5–29 years (World Health Organization, 2002). Although mortality rates for skin diseases are relatively low (Njoronge and Bussmann, 2007), skin ailments present a major health concern in both developed and less-developed countries because of the following reasons: skin ailments occur worldwide and amount to approximately 34% of all occupational diseases encountered (Spiewak, 2000; Abbasi et al., 2010); skin complaints affects all ages from the neonate to the elderly (Abbasi et al., 2010; De Wet et al., 2013); due to their highly visible symptoms, they impact significantly on the quality of life, are often persistent and difficult to treat. Skin diseases have been of major concern recently due to the association of skin opportunistic infections and HIV/ AIDS. Skin manifestations are usually the first sign of HIV infection and conversion to AIDS and more than 90% of HIV-infected individuals develop skin and mucosal complications at some stage during the disease (Njoronge and Bussmann, 2007). With an HIV prevalence rate of 16.6% amongst South Africans aged between 15 and 49 years, South Africa has the largest HIV epidemic in the world (Statistics South Africa, 2011). South Africa suffers from a scarcity of dermatologists, compounded by the fact that most dermatologists are centered near urban areas and are not accessible to 70% of the rural population (Caruthers, 2013). The majority of specialist care, including dermatology, is only available in the major hospitals. There are currently 167 members in the Dermatology Society of South Africa (110 of whom are exclusively in the private sector) serving a population of about 50 million (Caruthers, 2013). Many health care centers in the Eastern Cape are often run by clinical officers or nurses, rather than physicians, who act as the primary care workers but have very limited training in diagnosing dermatologic conditions (Hay and Marks, 2004). Hence, skin diseases such as dermatitis, prurigo, scabies, and papular urticaria are either untreated or over-treated with strong topical steroids or antibiotics which have been found to cause considerable disability (Njoronge and Bussmann, 2007). Additionally, in recent years, public pressure to reduce the use of synthetic antimicrobials has increased, partly due to concerns about the environmental impact and the potential health risk related to the use of these compounds (Abad et al., 2007). These short-comings, including the appearance of drug-resistant microbial strains have resulted in increased efforts for the search for better antimicrobial agents and much attention is now being directed towards natural products (Abbasi et al., 2010). The Eastern Cape is one of the poorest regions of South Africa and it is particularly known for its richness in plant species (Phillipson, 1987). The Xhosas are the major inhabitants of this province and they live primarily in the areas called Ciskei and Transkei. They are divided into a number of subgroups with their own distinct but related heritages. One of these subgroups is called Xhosa as well. The other main subgroups are the Bhaca, Bomvana, Mfengu, Mpondo, Mpondomise, Xesibe and Thembu. The indigenous people of this province have a long history of traditional plant usage for the treatment of various diseases and ailments including the uses of plants for the treatment of wounds (Grierson and Afolayan, 1999). For many years, the Xhosas had no interaction with the Western world and they relied mainly on the traditional knowledge they had of medicinal plants to meet their requirements (Bhat, 2013). The daily activities of the Xhosa people are

221

centered mainly on agriculture. Xhosa agriculture consists of two main sectors: cattle rearing and the production of crops and vegetables in small fields along the rivers and in home gardens. Traditionally, the Xhosas are known as cattle herders, although smaller stocks such as goats and sheep are also reared. The primary focus of their farming system is the rearing of cattle for the production of milk. In addition to agriculture the gathering of wild fruits and other edible plant parts, the collection of honey and the hunting of wildlife also contribute to their livelihood. In spite of modern civilisation and access to modern medicine, the Xhosas still believe in the efficacy of herbal medicines, hence, the practice of traditional treatment still continues. Previous ethnobotanical surveys on Xhosa medicinal plants recorded 32 plants species used to treat opportunistic fungal infections (Otang et al., 2012), 27 plants used to treat eye, nose and throat infections (Dyubeni and Buwa, 2012), 38 plants used to treat wounds (Grierson and Afolayan, 1999) and 6 plants used in traditional Xhosa cosmetics (Dold, 2005). Another survey by Bhat and Jacobs (1995) recorded the medicinal uses of 26 Xhosa medicinal plants while Bhat (2013) recorded the medicinal and other uses of 35 Xhosa medicinal plants. Together, these studies show the extensive use that the Xhosa people make of their natural resources and show that their vast natural pharmacopoeia is one of the features that greatly enriches their culture, which has attracted the attention of pharmacologists, anthropologists and scientists (Hutchings, 1989). Although different workers have documented medicinal plants from various regions of South Africa, to our knowledge no systematic investigation on the ethnopharmacological application of medicinal plants used to treat skin diseases/disorders has been carried out among the Xhosa communities of the Amathole District, Eastern Cape. Hence, the current study was undertaken to investigate the local peoples characterisation of skin diseases/ disorders and to document the medicinal plants used for the treatment of various skin conditions, in order to facilitate future scientific validation through phytochemical, antimicrobial and pharmacological studies. In addition to the use of interviews and discussions, other analytical were used to facilitate the quantification and crossverification of the ethnobotanical data. The quantification of ethnobotanical data allows the local significance of a given plant species to be estimated on the basis of various numerical indices (Cotton, 1996). For example the use-value of a species, estimates the overall usefulness of a given plant while the informant consensus factor estimates the use variability of the medicinal plants (Heinrich et al., 1998).

2. Materials and methods 2.1. Description of the study area This study was carried out in the Amatole District (Fig. 1) of the Eastern Cape Province, South Africa. The Eastern Cape Province is one of the 9 provinces of South Africa and it falls within the latitudes 301000 to 341150 S and longitudes 221450 to 301150 E (Grierson and Afolayan, 1999). It is bounded by the sea in the East and the drier Karroo (semi-desert vegetation) in the west. The elevation ranges from sea-level to approximately 2200 m in the North of the province. The Amathole District Municipality is situated within the Eastern Cape Province, between Port Alfred and Port St John, and includes the city of East London. The district stretches from the Indian Ocean coastline in the South to the Amathole Mountains in the North. The District includes the large parts of the former Ciskei and Transkei homeland areas, and it covers a land area of roughly 23 577.11 km² with a total population estimated at 1.7 million,

222

A.J. Afolayan et al. / Journal of Ethnopharmacology 153 (2014) 220–232

Fig. 1. Map of Amathole District Municipality. Source: Urban-Econ, Eastern Cape, 2011.

comprising of 91% African, 3% Coloured and 5% White. The climate is highly varied; the west is dry with sparse rain during winter or summer, with frosty winters and hot summers (Grierson and Afolayan, 1999). The area from Tsitsikamma to Grahamstown receives more precipitation, which is also relatively evenly distributed and temperatures are mild. Further east, rainfall becomes more plentiful and humidity increases, becoming more subtropical along the coast with summer rainfall. Mean maximum temperature in January has been recorded as 26 1C and mean minimum as 10 1C in July. The main tribes of the area are Xhosa-speaking peoples who are divided into several tribes with related but distinct heritages (Dyubeni and Buwa, 2012).

2.2. Ethnopharmacological investigation The present study focused on local inhabitants who use medicinal plants for the treatment of skin diseases/disorders. The study was carried out by interviewing 54 respondents in 7 locations (Guga, Gqumcashe, Ntselamanzi, Golf corse, Mzantsi, Alice and Fort beaufort) in the Amathole District of the Eastern Cape. High poverty levels, lack of modern health facilities and the extensive use of medicinal plants are characteristic of the selected locations. Study participants were selected by convenience sampling with particular focus on local people who regularly use plants for medicinal purposes and in order to ensure a sample that includes representatives of the whole community, we attempted to interview both males and females of different age groups (Singh et al., 2012). The survey was conducted from July to September

2013, through interviews and discussions with traditional healers, herbalists and village elders who use medicinal plants to treat skin infections. The interviews were conducted in Xhosa, the local language of the informants and were facilitated by a local field assistant who is fluent in both Xhosa and English. The interviews included questions that targeted the names of various skin diseases/disorders, the local names of the medicinal plants, the plant parts used, life form, the method of preparation and the mode of administration of the herbal remedy. The symptomatology and etiology of the various skin disorders were described to the informants so as to enable them state the appropriate plant species they usually use to manage the infections. The acquired data were cross-checked in different locations either by showing the plant specimen or telling the local names of plants to other informants in order to verify the authenticity of claims (Abbasi et al., 2010). Validation of the medicinal use of a plant species was made only when the answers of two or more respondents coincided to the same usage of the same part of the plant, irrespective of the preparation method (Martínez and Barboza, 2010). Unique data were included when they were supported by other ethnobotanical studies of the area and the data were tabulated to include the botanical name, family, local name, parts used, preparation and application (Table 1). 2.3. Preservation and identification of the medicinal plants Collection of the reported medicinal plants was assisted by the informants in order to ensure that the correct plants have been collected. The fresh plant materials were pressed and mounted on

A.J. Afolayan et al. / Journal of Ethnopharmacology 153 (2014) 220–232

223

Table 1 Medicinal plants used in treating skin disorders/disorders, plant parts in use and mode of administration. Botanical name/family/voucher no.

Frequency

a

Use-value (UV)

Local name/habit Part(s)/ preparations

Usage

Administration

Acacia karroo Hayne Fabaceae As1 Acalypha glabrata Thunb. Euphorbiaceae As2 Acokanthera oppositifolia (Lam.) Codd Apocynaceae As3 Agapanthus africanus (L.) Hoffmanns Amaryllidaceae As4 Agrimonia eupatoria L. Rosaceae As5 Albuca setosa Jacq. Hyacinthaceae As6 Alepidea amatymbica Eckl. & Zeyh. Apiaceae As7 Aloe ferox Mill.

3

2.8

Umnga Shrub

Bark Lotion

Ringworm, clean and soften facial skin

Topical

2

1.9

Umthombothi Tree

Bark Paste

Clean skin, rashes

Topical

3

2.8

Nthunuyembe Shrub

Leaves Decoction

Fasten hair growth, snake bite

Topical

3

2.8

Isicakathi Herb

Rhizome Decoction

Scabies and boils

Bathing

1

0.9

Inzinzinaba Herb

Leaves Decoction

Burns

Topical

1

0.9

Inqwebeba Herb

Leaves Paste

wounds

Topical

5

4.6

Iqwili Robust perennial

Rhizome Liniment

Perfume skin

Topical

29

27.1

Umhlaba

Leaves

Eczema, irritations, burns, wounds, insect bites, ringworm, boils pimples.

Topical

Perennial herb

Juice Leaves Jel

Soften hair, foster hair growth, and prevent hair loss. Skin cleansing

Topical

Xanthorrhoeaceae As8

Amaranthus caudatus L. Amarathaceae As9 Amaranthus hybridus L. Amarathaceae As10 Anagallis arvensis L. Myrsinaceae As11 Asclepias concolor (Decne.) Schltr. Asclepiadaceae As 12 Arctotis arctotoides (L.f.) O. Hoffm. Asteraceae As13 Argyrolobium argenteum Eckl. & Zeyh. Fabaceae As14 Asclepias fruticosa L. Asclepiaceae As15 Asparagus africanus L. Asparagaceae As16 Barleria obtusa Nees Acanthaceae Bs1 Behnia reticulata (Thunb.) Didr. Behniaceae Bs2 Brachylaena discolor DC. Asteraceae Bs3 Buddleja saligna Willd. Scrophulariaceae Bs4 Buxus natalensis (Oliv.) Hutch. Buxaceae

6

5.6

Utyuthu Herb

Leaves Jel Leaves Decoction

1

0.9

Imbuya Herb

1

0.9

4

Bathing Clean teeth

Bathing

Leaves Decoction

Clean facial skin

Bathing

Umsolo Herb

Leaves Decoction

Boils

Topical

3.7

Itshongwe Herb

Leaves Paste

Pimples

Topical

12

11.2

Ubushwa Herb

Leaves Juice

Ringworm, insect bite, wound, pimples, boils

Topical

1

0.9

Umfanujacile Herb

Leaves Juice

Boils

Topical

2

1.8

Igontsi Shrub

Leaves Decoction

Prevent hair loss

Topical

3

2.8

Umathunga Herb

Leaves Infusion

Eczema, wound

Topical

1

0.9

Inzinziniba Shrub

Leaves Paste

Burns

Topical

1

0.9

Isilawu Climber

Rhizome Paste

Against hair loss

Bathing

1

0.9

Isiduli Tree

Roots Infusion

Burns, wounds, clean facial skin

Topical

1

0.9

Igqange

Roots, leaves Infusion

Protect facial skin

Topical

Leaves Decoction

Ringworm, boils

Topical

Tree 12

11.2

Isixhaza Tree

224

A.J. Afolayan et al. / Journal of Ethnopharmacology 153 (2014) 220–232

Table 1 (continued ) Botanical name/family/voucher no.

Frequency

a

Use-value (UV)

Local name/habit Part(s)/ preparations

Usage

Administration

Bs5 Calodendrum capense (L.f.) Thunb.

6

5.6

Umemezi

Fruits

Soften hair, clean skin, clean teeth, rashes

Topical

Tree

Lotion

Umbethe Shrub

Leaves, roots Powder Seeds Paste Leaves Decoction

Fasten hair growth, skin irritation, rashes

Topical

Boils

Topical

Ringworm, soften facial skin, pimples Clean facial skin

Topical Bathing

Sore throat

Oral

Wounds

Topical

Sore throat

Oral

Rutaceae Cs1 Calpurnia aurea (Ait.) Benth. Fabaceae Cs2

1

0.9

Canthium inerme (L.f.) Kuntze Rubiaceae Cs3 Capparis tomentosa Lam. Capparaceae Cs4

6

5.6

Isiphingo Tree

3

2.8

Intsihlo Tree

Capsicum annuum L. Solanaceae Cs5 Carissa bispinosa (L.) Desf. ex Brenan Apocynaceae Cs6 Carpobrotus edulis L.

6

5.6

Itshilisi Herb

Roots Infusion Roots Powder Fruits Leaves

1

0.9

Isabetha Shrub

Fruits Juice

Soften facial skin

Topical

14

13.1

Unomatyumtyum Herb

Leaves

Eczema, wounds, burns and skin ulcers.

Topical

Juice

Aizoaceae Cs7 Cassipourea flanaganii (Schinz) Alston Rhizophoraceae Cs8 Catha edulis (Vahl) Forssk. ex Endl. Celastraceae Cs9 Centella asiatica (L.) Urban Apiaceae Cs10 Cheilanthes hastata (L.f.) Kunze Sinopteridaceae Cs11 Chlorophytum comosum (Thunb.) Jacques Asparagaceae Cs12 Citru limon (L.) Burm.f. Rutaceae Cs13 Clausena anisata (Willd.) Hook.f. ex Benth. Rutaceae Cs14 Clematis brachiata Thunb. Ranunculaceae Cs15 Coddia rudis (E.Mey. ex Harv.) Verdc. Rubiaceae Cs16 Commelina africana L. Commelinaceae Cs17 Cryptocarya woodii Engl. Lauraceae Cs18 Curtisia dentata C.A.Sm. Curtisiaceae Cs19 Cycnium racemosum Benth. Orobanchaceae Cs20 Cymbopogon caesius (Hook. & Arn.) Stapf

1

0.9

Umemezi Tree

Bark Powder

Soften hair, lighten skin

Topical

1

0.9

Igqwakra Small tree

Leaves Paste

Pimples

Topical

2

1.9

Imvumvu Herb

Wounds, insect bites

Topical

1

0.9

Isisefo Herb

Leaves Extracts Tinctures Leaves Decoction

Soften hair

Topical

1

0.9

Isicakathi Herb

Tubers Paste

Scabies

Topical

8

7.5

Lemon Herb

Fruits Juice

Pimples, soften facial skin, wrinkles Clean facial skin

Topical Bathing

1

0.9

Umtuto Shrub

Twig Juice

Clean teeth

Bathing

7

6.5

Ityolo Climber

Leaves Juice

Clean skin Perfume skin, wrinkles

Bathing Topical

3

2.8

Intsinde Shrub

Twig Juice Fruits Juice Roots Decoction

Clean teeth

Bathing

Soften facial skin, skin ulcer

Topical

Scabies

Bathing

1

0.9

Isicakathi Herb

1

0.9

Umnquma Shrub

Bark Infusion of powder

Eczema

Topical

1

0.9

Uzintlwa Tree

Bark Infusion of powder

Eczema

Topical

1

0.9

Injanga Herb

Leaves Paste

Skin ulcer

Topical

1

0.9

Umqungu

Leaves

Skin itch

Topical

A.J. Afolayan et al. / Journal of Ethnopharmacology 153 (2014) 220–232

225

Table 1 (continued ) Botanical name/family/voucher no.

Poaceae Cs21 Cymbopogon marginatus (Steud.) Stapf ex Burtt Davy Poaceae Cs22 Cyperus etxtilis Thunb. Cyperaceae Cs23 Datura stramonium L. Solanaceae Ds1 Dianthus thunbergii (Thunb.) S.S. Hooper. Caryophyllaceae Ds2 Digitaria eriantha Steud., Poaceae Ds3 Diospyros pubescens Pers. Ebenaceae Ds4 Dysphania ambrosioides (L.) Mosyakin & Clements Amaranthaceae Ds5 Emex australis Steinh. Polygonaceae Es2 Erythrina lysistemon Hutch. Fabaceae Es3 Euclea natalensis A.DC. Ebenaceae Es4 Euphorbia bupleurifolia Jacq. Euphorbiaceae Es5 Ficus natalensis Hochst. Moraceae Fs1 Gasteria obliqua (Aiton) Duval Asparagaceae Gs1 Gnidia kraussiana Meisn.

Frequency

a

Use-value (UV)

Halleria lucida L. Stillbaceae Hs2 Haplocarpha scaposa Harv. Asteraceae Hs3 Harpephyllum caffrum Bernh. Anacardiaceae Hs4 Helichrysum odoratissimum (L.) Sweet. Asteraceae Hs5 Helinus integrifolius (Lam.) Kuntze. Rhamnaceae Hs6 Hermannia geniculata Eckl. & Zeyh. Malvaceae Hs7

Herb

Paste

Usage

Administration

1

0.9

Umqungu Herb

Leaves Decoction

Skin irritation

Bathing

3

2.8

Imizi Herb

Leaves Paste

Eczema

Topical

1

0.9

Umhlabavuthwah Herb

Leaves Warmed

Boils, wounds

Topical

2

1.9

Ungcane Herb

Leave Infusion

Remove body odour

Bathing

1

0.9

Injica Herb

Leaves Decoction

Pimples

Topical

1

0.9

Umbongisa Shrub

Leaves Paste

Strengthen nail

Topical

9

8.4

Imboya

Leaves

Skin itch, eczema, pimples

Topical

Herb

Lotion

Clean skin

Bathing

2

1.9

Inkunzane Herb

Leaves Decoction

Prevent hair loss

Topical

1

0.9

Umkuwane Tree

Bark Powder

Wounds, skin irritation

Topical

2

1.9

Umtshekesane Shrub

Sore throat

Oral

3

2.8

Intsema Herb

Clean teeth Pimples, wounds, rashes

Bathing Topical

2

1.9

Umthombe Tree

Roots Decoction Wood Leaves Latex Twig Leaves Decoction

Clean teeth Clean skin

Bathing Bathing

13

12.1

Intelezi Herb

Leaves Decoction

Skin irritation, clean skin Eczema, scabies

Bathing Topical

1

0.9

Iganna

Leaves

Protect facial skin, wounds, burns, boils, rashes

Topical

Shrub

Paste Leaves Decoction Leaves Paste

Sore throat

Oral

Insect bite

Topical

Skin ulcer, burns

Topical

Remove body odour

Bathing

Scabies

Bathing

Thymelaeaceae Gs2 Gunnera perpensa L. Gunneraceae Gs3 Haemanthus albiflos Jacq. Amaryllidaceae Hs1

Local name/habit Part(s)/ preparations

1

0.9

Iphuzi Herb

7

6.5

Umathunga Herb

1

0.9

Inkobe Tree

Leaves Paste Leaves Decoction Leaves Decoction

2

1.9

Isicwe Herb

Leaves Paste

Scabies Wound

Bathing Topical

1

0.9

Umgwenye Tree

Bark Decoction

Wound, eczema, pimples

Topical

8

7.5

Impepho

Leaves

Wounds, skin ulcers, scabies, protect facial skin.

Topical

Perennial herb

Perfumes of the skin. Against hair loss

Topical Topical

Boils

Topical

1

0.9

Isilawu Shrub

Infusions Lotion Leaves Lotion

2

1.9

Impepho Herb

Leaves Paste

226

A.J. Afolayan et al. / Journal of Ethnopharmacology 153 (2014) 220–232

Table 1 (continued ) Botanical name/family/voucher no.

Frequency

a

Use-value (UV)

Local name/habit Part(s)/ preparations

Usage

Administration

Hyphaene coriacea Gaertn. Arecaceae Hs8

3

2.8

Ilala Tree

Soften hair

Topical

Clean teeth

Bathing

Hypoxis argentea Harv. ex Baker

9

Ringworm, eczema, pimples and to clean and protect facial skin.

Topical

8.4

Hypoxidaceae Hs9 Ilex mitis (L.) Radlk. Aquifoliaceae Is1 Ipomoea simplex Thunb. Convolvulaceae Is2

Lippia javanica (Burm.f.) Spreng Verbanaceae Ls1 Malva parviflora L. Malvaceae Ms1 Nicotiana tabacum L. Solanaceae Ns1 Ochna serrulata (Hochst.) Walp. Ochnaceae Os1 Olea europaea L. Oleaceae Os2 Opuntia aurantiaca Lindl. Cactaceae Os3 Pavetta lanceolata Eckl. Rubiaceae Ps1 Pelargonium peltatum (L.) L0 Hér. ex AitonGeraniaceae Ps2 Persea americana Mill. Lauraceae Ps3 Phragmites australis (Cav.) Trin. ex Steud. Poaceae Ps4 Physalis angulata L. Solanaceae Ps5 Phytolacca americana L. Phytolaccaceae Ps6 Podocarpus latifolius (Thunb.) R.Br. ex Mirb. Podocarpaceae Ps7 Pseudocrossidium crinitum (Schultz) R.H.Zander Pottiaceae Ps8 Pseudophyllanthus ovalis (E.Mey. ex Sond.) Voronts. &Petra Hoffm. Phyllanthaceae Ps9 Ptaeroxylon obliquum (Thunb.) Radlk. Rutaceae Ps10 Pterocelastrus tricuspidatus (Lam.)

Inongwe

Fruits Lotion Leaves Midrib Corm

Tuberous perennial herb

Infusion

2

1.9

Isidumo Tree

Leaves Decoction

Protect facial skin

Topical

3

2.8

Igontsi Herb

Against hair loss

Topical

Clean skin

Bathing

Protect facial skin

Topical

Boils, scabies, wounds

Topical

1

0.9

Inzinziniba Shrub

Leaves Lotion Leaves Decoction Tuber Paste Leaves Infusion

8

7.5

Ijongilanga Herb

Leaves Paste

Pimples, insect bite, wound boils

Topical

1

0.9

Icuba Herb

Leaves Paste

Wound

Topical

4

3.7

Ilitye Shrub

Leaves Paste

Soften hair, strengthen nail, soften facial skin

Topical

3

2.8

Umquma Tree

Leaves Decoction

Remove body odour

Bathing

7

6.5

Itolofiya Shrub

Leaves Jel

Soften hair, skin ulcer, protect facial skin

Topical

2

1.9

Umhleza Shrub

Leaves Paste

Skin itch

Topical

1

0.9

Ityolo perennial herb

Tubers Decoction

Clean the skin

Bathing

6

5.6

Avocado Tree

Seed Paste

Clean facial skin Protect facial skin, wrinkles

Bathing Topical

1

0.9

Ingcongolo Herb

Leaves Paste

Protect facial skin

Topical

1

0.9

Itywabotywabo Herb

Leaves Paste

Burns

Topical

1

0.9

Umsobosobo Herb

Leaves Paste

Boils

Topical

1

0.9

Umkhaba Tree

Leaves Juice

Eczema

Topical

1

0.9

Ixolo lamatye Shrub

Leaves Infusion

Skin irritation

Topical

1

0.9

Umbezo Tree

Roots Decoction

Perfume skin

Topical

2

1.9

Umthathe Tree

Bark Infusion

Remove body odour

Bathing

1

0.9

Ibholo

Leaves

Sore throat, protect facial skin

Topical

A.J. Afolayan et al. / Journal of Ethnopharmacology 153 (2014) 220–232

227

Table 1 (continued ) Botanical name/family/voucher no.

Sond. Celastraceae Ps11 Rawsonia lucida Harv. & Sond. Achariaceae Rs1 Rhus lucida L. Anacardiaceae Rs2 Rumex crispus L. Polygonaceae Rs3 Sarcostemma viminale L. Apocynaceae Ss1 Scadoxus multiflorus (Martyn) Raf. Amaryllidaceae Ss2 Schinus molle L. Anacardiaceae Ss3 Schotia afra (L.) Thunb. Fabaceae Ss4 Scilla nervosa (Burch.) Jessop Asparagaceae Ss5 Scutia myrtina (Burm.f.) Kurz Rhamnaceae Ss6 Senecio deltoideus Less. Asteraceae Ss7 Sideroxylon inerme C.A.Sm. Sapotaceae Ss8 Solanum aculeastrum Dunal. Solanaceae Ss9 Solanum nigrum L. Solanaceae Ss10 Talinum portulacifolium (Forssk.) Asch. ex Schweinf. Talinaceae Ts1 Taraxacum officinale F.H. Wigg Asteraceae Ts2 Thesium strictum P.J. Bergius Santalaceae Ts3 Tribulus terrestris L. Zygophyllaceae Ts4 Vepris undulata (Thunb.) I. Verd. Rutaceae Vs1 Zantedeschia aethiopica (L.) Spreng. Araceae Zs1 Zea mays L. Poaceae Zs2 a

Frequency

a

Use-value (UV)

Local name/habit Part(s)/ preparations Shrub

Infusion

Usage

Administration

1

0.9

Umlongo Shrub

Leaves Paste

Ringworm

Topical

1

0.9

Intlokoshane Shrub

Bark Infusion

Scabies

Topical

1

0.9

Ubuhlunga Herb

Leaves Decoction

Against hair loss

Topical

1

0.9

Umbelebele Shrub

Leaves Decoction

Skin itch

Topical

1

0.9

Inkuphulwana Perennial herb

Bulb Infusion

Wounds, bruises

Topical

1

0.9

Ipepile Tree

Fruits Lotion

Eczema

Topical

1

0.9

Umquqoba Tree

Bark Decoction

Skin ulcers

Topical

2

1.9

Inkwitelu Perennial herb

Bulb Ointment

wounds, ringworm

Topical

1

0.9

Isiphingo Herb

Leaves Paste

Ringworm

Topical

1

0.9

Ityolo Perennial herb

Leaves Lotion

Scabies and burns

Topical

1

0.9

Unqwashu Tree

Leaves Decoction

Remove body odour

Bathing

5

4.7

Umthuma

Fruit

Insect bite, strengthen nail, perfume skin, skin ulcer

Topical

Shrub

Decoction

3

2.8

Umsobosobo Herb

Leaves Paste

Ringworm

Topical

1

0.9

Umhlabelo Herb

Leaves Paste

Skin itch

Topical

1

0.9

Ikhokhoyi Herb

Leaves Decoction

Remove body odour

Bathing

3

2.8

Umbiza Shrub

Leaves Paste

Boils, wounds

Topical

2

1.9

Inkunzane Herb

Leaves Decoction

Against hair loss, scabies

Topical

1

0.9

Ilatile lokuqhumisa Tree

Leaves

Fasten hair growth

Topical

Decoction

1

0.9

Inyibiba Herb

Rhizome Powder

Burns Sore throat

Topical Oral

2

1.9

Umbone Herb

Leaves Paste

Wound

Topical

UV¼ ΣU/n; UV¼use-value of a species; U¼ number of citations per species; n¼ number of informants.

herbarium sheets and were later transported to the University of Fort Hare's herbarium where identification of the collected plants specimens was done in the Department of Botany with the help of floristic works of South Africa (Bhat and Jacobs, 1995; Van Wyk

et al., 1997; Dold and Cocks, 2000). Voucher specimens were deposited in the Griffin Herbarium of the University of Fort Hare. Further characterisation of the plants and their previous reported usage was established by a literature search (Togola et al., 2005)

228

A.J. Afolayan et al. / Journal of Ethnopharmacology 153 (2014) 220–232

Table 2 Categories of skin disorders/conditions and their informant consensus factors (ICFs). Categories of skin disorders

No. of plant species used per skin disorder

Bacteria-related skin disorders Boils Pimples Sore throat

14 12 6

Eczema Ringworm Rashes Skin irritation

12 10 17 5

Clean facial skin Clean skin Clean teeth Perfume skin Protect facial skin Remove body odour Soften facial skin Wrinkles Lighten skin

7 9 7 7 12 6 6 3 1

Fasten hair growth Prevent hair loss Soften hair Strengthen nail

4 8 7 5

Insect bite Burns Skin ulcer Snake bite Wounds

6 12 8 1 12

Fungi-related skin disorders

Use citation per category

Informant consensus factor (ICF)

57

0.45 3.6 3.0 4.2

74

Skin hygiene/cosmetics

2.4. Data analysis In order to analyse the data obtained by the questionnaires, two analytical tools were employed: use-value and informant consensus factor (ICF). The use-value, a quantitative index that shows the relative importance of species known locally (Phillips et al., 1994) was calculated as follows: UV ¼ Σ U=n where UV¼use-value of a species; U¼number of citations per species; n ¼number of informants. The informant consensus factor (ICF) of the different categories of skin diseases/disorders (Table 2) was calculated for testing homogeneity of the informant's knowledge (Heinrich et al., 1998). ICF values range from 0 to 1 and the values will be high (near 1) if there is a well-defined selection criterion in the community and/or if information is exchanged between informants (Gazzaneo et al., 2005). The ICF was calculated as follows: ICF ¼ ðnur nt Þ=ðnur 1Þ where nur ¼number of use citations in each category; nt ¼number of species used. All citations were placed into one of 5 categories: Bacteria-related skin disorders, fungi-related skin disorders, disorders of skin keratinised tissues, breakage of skin epidermis and skin hygiene/cosmetics (Table 2).

0.08 2.4 4.2 4.8 1.8

70

within the online databases available in the library of the University of Fort Hare, namely Elsevier Science Direct, Springer link and Jstor.

0.44 3.0 5.4 4.8 3.0 6.0 3.6 3.6 1.8 0.6

26

Breakage of skin epidermis

0.41 7.2 `6.0 10.2 1.8

102

Disorders in skin keratinised tissues

Frequency of citation of skin disorder (%)

0.44 1.2 6.0 1.8 0.6 9.0

2.5. Intellectual property agreement/ethical approval The ethnobotanical survey was carried out with the full consent of all participants, with further verbal agreement and understanding that this research shall not be used for commercial purposes, but shall serve as enlightenment and as a means of preservation of the indigenous knowledge as regards the traditional management of skin diseases in the Eastern Cape, South Africa. The exact dosage of the herbal remedy used was not mentioned as such knowledge was considered to be the intellectual property of the locals. Ethical approval for the study was granted by the University of Fort Hare's Ethics Committee.

3. Results and discussion 3.1. Socio-demographic information A total of 54 informants, including traditional healers, herbalists and lay people (aged between 17 and 81years) with a mean age of 45.97 15.0 participated in the study, comprising 28 (52%) males and 26 (48%) female. The variability in terms of age, gender and user status (herbalist, traditional healer or layman) of the respondents in this study has significant implications with respect to the management of skin disorders in Xhosa traditional medicine. With respect to age, up to 33.3% of the respondents were above 50 years. However, considering the fact that a significant proportion of the respondents (22%) was below 35 years suggests that the legacy of the indigenous knowledge of Xhosa medicinal plants with respect to the treatment of skin disorders is not yet endangered in the study area. This finding deviates from the widely accepted assertion (Giday et al., 2009) that medicinal plant

A.J. Afolayan et al. / Journal of Ethnopharmacology 153 (2014) 220–232

Results of the present investigation are presented in Table 1, where the botanical names of the plants species are arranged in alphabetical order along with their local name, part used, preparation, application, popular use and number of informants. In this study, 106 plant species distributed in 61 families and 107 genera were identified as being used to treat one or more of the skin disorders. This is indicative of a considerable diversity and abundance of plant species used in the management of skin disorders in the study area. This could be attributed to South Africa's large floral biodiversity. South Africa is home to over 30 000 species of higher plants and 3000 of these species have been found to be used in traditional medicine across the country (Van Wyk et al., 1997). The most representative families were Solanaceae and Asteraceae with 6 species each, followed by Fabaceae, Poaceae and Rutaceae (5 species each) Euphorbiaceae (4 species), Rubiaceae, Apocynaceae and Amaryllidaceae (3 species each). The other families had 1 or 2 species each associated with the treatment of the reported skin disorders. In an ethnobotanical survey of plants used to treat skin disorders in Northern Maputaland in South Africa (De Wet et al., 2013), the most cited species belong to the Fabaceae (8 species), Asteraceae and Solanaceae (3 species each). In another study in which plants where surveyed for the treatment of parasitosis and skin disorders (Martínez and Barboza, 2010), the most represented families according to the number of species were Solanaceae (7 species), Asteraceae (6 species) and Fabaceae (5 species). There seems to be a tendency for a few plant families to stand out in any pharmacopoeia (Gazzaneo et al., 2005). Preference for the use of plants in these families may be related to their ready availability; these plants are normally herbaceous, can either be cultivated or occur as weeds and are common in disturbed areas (Gazzaneo et al., 2005). According to Stepp and Moerman (2001), these plants accumulate bio-active compounds as a function of their habit or of their life strategies. Hence, the selection and use of medicinal plants in local communities worldwide have been attributed to chemical and ecological factors (Stepp, 2004). The following 8 species were recorded for the first time for the management of skin diseases/disorders in South Africa: Acalypha glabrata, Albuca setosa, Capsicum annuum, Pseudocrossidium crinitum, Behnia reticulate, Buddleja saligna, Buxus natalensis, and Cymbopogon marginatus. This finding is a significant contribution to the ethnobotany of the Eastern Cape Province in the context of disease management using local pharmacopeia. In India, the leaf paste of Buddleja saligna is used for the treatment of rashes in children (Bhat et al., 2013) and the paste of Capsicum annum leaves

3.3. Growth form, plant parts used, preparation and administration methods Of the 106 plant species that were recorded for the treatment of the skin diseases/disorders in the study area, herbs constituted 49%, trees 25% and shrubs 22% (Fig. 2). The leaves were the most frequently used plant part for the treatment of the skin diseases, followed by the bark (10%) and fruits (7%) (Fig. 3). The leaves were mostly applied topically as a paste, powder or sap on the affected skin area. The leaves have also been shown to be the most frequently used plant part in similar studies where medicinal plants are used for treating skin diseases (Saikia et al., 2006). This is encouraging for sustainable development purposes as the traditional use favours plant parts that can be regrown with ease (De Wet et al., 2013). In a few cases, different parts of the same plant were used to treat different disorders, for example, the latex of the leaves of Euphorbia bupleurifolia are used in topical application for the treatment of pimples, rashes and wounds, while the twig of the same plant is used to clean the teeth (Table 1). Twelve methods of preparations were mentioned in the present study, among which decoction (28%) was the most frequently mentioned, followed by paste (26%) and infusion (13%) (Fig. 4). Administration of the different plant parts was mostly topical (77%) on the affected area. Baths (20%) were commonly used for treating rashes and irritations of the skin, followed by preparations that were orally administered (3%).

Herb (succulent perennial)

Habit of medicinal plants

3.2. Diversity of medicinal plants used to treat skin disorders

is externally applied for the treatment of rheumatism, lumbago and neuralgia (Sunil et al., 2012).

Herb (robust perennial Herb (climber) Herb Tree Shrub 0

10

20

30

40

50

60

Frequency of occurrence (%) Fig. 2. Growth form of plants used for treating skin diseases/disorders.

Twig Tuber

Plant parts used

knowledge in rural areas is declining. Gender-wise, the females who constituted a significant proportion (48%) of the informants also utilise local traditional herbal remedies in managing skin disorders. This is significant, especially for women in rural communities, who have had to cope with common diseases in the family (De Wet et al., 2013). Previously, Xhosa medicinal practices have been considered as highly specialised; with diviners (Sangomas) and herbalists taking the lead. Appeasing the ancestral spirits (amathongo) through various rituals and chanting of incantations is an important component of Xhosa traditional medicine (Hammond-Tooke, 1962), thus associating the knowledge and use of traditional medicines with supernatural powers (Bhat et al., 1985). Hence, the knowledge of herbal remedies for managing life-threatening ailments like diabetes, hypertension and cancer is still confined to the diviners, while minor ailments like skin disorders could be conveniently managed with the use of herbs prescribed by the laymen as well.

229

Seed Fruit Root Rhizome Leaf Bark 0

20

40 Frequency (%)

60

Fig. 3. Plant parts used for treating skin diseases/disorders.

80

230

A.J. Afolayan et al. / Journal of Ethnopharmacology 153 (2014) 220–232

demonstrated strong hydrogen peroxide scavenging activity (Omoruyi et al., 2012). The antibacterial activity and the freeradical scavenging reported for the leaf extract of Carpobrotus edulis could partially justify its ethnomedical use. Gasteria obliqua, use-value of 12.1 (Table 1), known locally as Intelezi is widely distributed in the Eastern Cape (Dold and Cocks, 2000). Decoction of the leaves is locally used as a bath to cleanse the skin and for the treatment of skin irritation in the study area. Apart from its medicinal value, the plant is believed to be capable of banishing evil spirits and to prevent lightning from striking the houses (Dold and Cocks, 2000). Hence, it is common to see some plants of the genus Gasteria, placed on the roofs and walls of houses in the Eastern Cape.

Latex Fresh part Tinctures Extract

Methods

Powder Infusion

Gel Juice Liniment Decoction Paste Lotion 0

5

10

15

20

25

30

Percentage Fig. 4. Methods of preparation of the medicinal plants.

3.4. Use-values of the medicinal plant species In addition to the use of questionnaires, analytical tools were employed so that it could be possible to do quantification and cross verification of the ethnobotanical information for the management of skin disorders in the study area. For example, the overall usefulness of the mentioned medicinal plants in the context of treating skin disorders was estimated on the basis of the computed index called use-value (Phillips and Gentry, 1993). The species with the highest use-value was Aloe ferox Mill. (Xanthorrhoeaceae) known locally as Umhlaba, with a use-value of 27.1 (Table 1). The bitter yellow juice which exudes from just below the surface of the leaf when cut is externally applied for the treatment of eczema, skin irritations, burns, insect bites, ringworm, boils, pimples and wounds. Healing occurs through temporary repair by fibrin clot and granulation of collagen, elastin, proteoglycans and other connective fibres by fibroblasts. Heggers et al. (1996) showed the stimulation of fibroblast activity and collagen proliferation with Aloe ferox gel. The gel reduced wound diameter, seemed to reduce scarring and inhibited acute inflammation, collagenase and metalloproteases activity, which can degrade collagen connective tissue when unchecked. Wounds treated with Aloe ferox showed rapid granulation and increased oxygen supply as a result of the increased blood flow (Davis and Agnew, 1986). In another study, Choi et al. (2001) isolated a glycoprotein from Aloe that stimulated the formation of epidermal tissue. These studies support the traditional use of Aloe ferox in the treatment of chronic wounds, burns and ulcers. Aloe gel, unlike the juice is derived from the inner fleshy part of the leaf and it is used as bath for skin cleansing and also in topical application to soften hair, foster hair growth and to prevent hair loss (Table 1). More recently the cosmetic industry has started including the leaf gel of Aloe ferox in cosmetic formulations because of its moisturising properties. Since Aloe is approximately 99% water, it penetrates through the surface of the skin (stratum corneum) to the vascular dermal area, thus contributing to soft and smooth skin that is hydrated, nourished and rejuvenated. Aloesin, a constituent of the leaf exudate also shows promise as a pigmentation-altering agent for cosmetic applications (Loots et al., 2007). The medicinal plant with the second highest use-value (13.1) was Carpobrotus edulis, known locally as Unomatyum-tyum (Table 1). The leaf juice is mildly antiseptic, hence it is topically applied for treatment of eczema, wounds, burns and skin ulcers by the locals in the study area. The in vitro antibacterial activity of Carpobrotus edulis against Escherichia coli, Enterococcus faecalis, Pseudomonas aeruginosa and Staphylococcus aureus has been reported (Chokoe et al., 2008). The leaf extracts of this plant also

3.5. Consensus factor among informants The categories of skin disorders/conditions and the informant consensus factors (ICFs) are shown in Table 2. A total of twenty five skin disorders/conditions are being treated with the listed medicinal plants in the study area. The skin disorders/conditions were classified under 5 categories: Bacteria-related skin disorders, fungirelated skin disorders, disorders of skin keratinised tissues, breakage of skin epidermis and skin hygiene/cosmetics. The ICF of the various categories of the skin disorders ranged from 0.45 to 0.08. The highest ICF (0.45) was linked to bacteria-related skin disorders. This category comprised of 57 use citations, 3 skin disorders; with sore throat being the most frequently mentioned (4.2%). The ICF for skin hygiene/cosmetics was 0.44. This category comprised of 9 different skin usages related to cleanliness and beauty and protect facial skin was the most frequently cited usage (6%). Also included in this category were the highest number of use citations (102, 31% of the total) and plant species (58, 55% of the total). This shows that there is a high preference of traditional Xhosa cosmetics (imbhola yesiXhosa) amidst the widespread advertising campaigns in the media for new and advanced cosmetic formulations. The most important plant species in this category are Persea americana (avocado), Citrus limon (lemon) and Cassipurea flanagii (ummemezi). Xhosa men and women still use and indeed prefer their traditional cosmetics for beauty, well being and as social status indicators in the Eastern Cape today (Dold, 2005). For example, the juice of lemon fruits are topically applied to soften facial skin and to treat pimples and wrinkles and also as a bath to cleanse facial skin. The powdered seed of avocado is mixed with a little water to form a paste to treat wrinkles and to protect facial skin against the scorching heat of the sun during summer. The paste derived from the bark of Cassipurea flanagii is used by Xhosa women to lighten the complexion of the face. In Xhosa tradition, a lighter complexion of the skin is perceived as an index of beauty and ummemezi achieve this (Dold, 2005). An ICF of 0.41, 74 use citations from 41 plant species were recorded for the fungi-related skin diseases category (Table 2). This category consisted of 4 skin disorders and skin rash was the most frequently mentioned (10.2%). The plant species with highest use values in this category were Arctotis arctotoides (ubushwa), Aloe ferox (umhlaba) and Buxus natalensis (Isixhaza). Arctotis arctotoides is a decumbent herb commonly found as a roadside weed in most coastal districts of South Africa. The juice of the leaves of Arctotis arctototides is used by the Xhosa people in topical application for the treatment of ringworm, insect bite and wounds (Table 1). Previous reports have shown that the aqueous extract of Arctotis arctotoides was inhibitory against a panel of pathogenic fungi (Afolayan, 2003) and fungicidal against a panel of opportunistic fungi associated with HIV/AIDS (Otang et al., 2012). Buxus natalensis is a slow-growing, much branched evergreen small tree that is native to South Africa. Decoction of the leaves of this plant is used as a topical formulation for the treatment of

A.J. Afolayan et al. / Journal of Ethnopharmacology 153 (2014) 220–232

ringworm by the Xhosa people. The genus Buxus is a rich source of alkaloids and over 200 triterpenoidal alkaloids have been isolated from various plants of this genus, including Buxus Sempervirens, Buxus papillosa and Buxus microphylla. Some of the alkaloids have been reported to treat skin infections, rheumatism, and heart disorders (Choudhary et al., 2003). The lowest ICF (0.08) was recorded in the disorders in skin keratinised tissues category (Table 2). Within this category were 26 use citations, 24 plant species and 4 skin disorders. The most frequently cited usage in this category was soften hair (4.8%). ICF values ranges from 0 to 1 and low values (near 0) are expected if informants disagree on the taxa to be used in the treatment within a category of illness (Gazzaneo et al., 2005). Hence, the low ICFs observed in this study suggest a lower degree of agreement among the informants on the taxa used in the treatment of skin diseases/ disorders in the study area. This low correlation emphasises the richness and diversity of unrecorded indigenous knowledge for the management of skin diseases/disorders in the study area. The diversity of the information obtained for the management of skin diseases is a reflection of the inherent diversity among the informants. The prevalence and the mildness of skin disorders make their treatment easy with different plant remedies. Current traditional medicinal practices of the Xhosa people can be divided under four categories (Bhat and Jacobs, 1995): 1. Common remedies not followed by rituals, mostly practiced by common people. 2. Medicinal knowledge, considered to be family secrets handed down from generation to generation 3. Knowledge of medicinal plants acquired by traditional doctors or diviners (known as ‘amgaqirha’ in the Xhosa language) from the ancestors in their dreams 4. Traditional doctors (known as ‘amaxwhele’ in the Xhosa language) who physically diagnose prescribe and sell the medicine for various diseases but do not divine the causes of diseases.

4. Conclusions The current study was undertaken to investigate the local peoples characterisation of skin diseases/disorders and to document the medicinal plants used for various skin conditions for future scientific validation through phytochemical, antimicrobial and pharmacological studies. In this study, 106 plant species distributed in 61 families and 107 genera were identified as being used to treat one or more of the skin disorders, indicative of a considerable diversity and abundance of plant species used in the management of skin disorders in the study area. The following 8 species were recorded for the first time for the management of skin diseases/disorders in South Africa: Acalypha glabrata, Albuca setosa, Capsicum annuum, Pseudocrossidium crinitum, Behnia reticulate, Buddleja saligna, Buxus natalensis, and Cymbopogon marginatus. This finding is a significant contribution to the ethnobotany of the Eastern Cape Province in the context of disease management using local pharmacopeia. The species with the highest use-value was Aloe ferox Mill. (Xanthorrhoeaceae) known locally as Umhlaba. The most representative families were Solanaceae, Asteraceae, Fabaceae, Poaceae, Rutaceae and Euphorbiaceae. Majority of the plant species were herbs and the leaves were the most frequently used, mostly applied topically as a paste, powder or sap on the affected skin area. A total of twenty five skin disorders/conditions, classified under 5 categories are being treated with the listed medicinal plants in the study area. Further studies are in progress to investigate the antimicrobial activity of the extracts of the most cited plants against bacterial and fungal pathogens implicated in skin diseases. Scientific validation of the bio-activity of the selected medicinal plants will justify the incorporation and use of these natural remedies for the primary health care of local inhabitants.

231

Acknowledgements Authors greatly appreciate the National Research Foundation (NRF), Govan Mbeki Research and Development Centre (GMRDC) of the University of Fort Hare, South Africa and the Medicinal Plant and Economic Development Research Centre (MPED) for financing this study.

References Abad, M.J., Ansuategui, M., Bermejo, P., 2007. Active antifungal substances from natural sources. Arch. Org. Chem. 7, 116–145. Abbasi, A.M., Khan, M.A., Ahmad, M., Zafar, M., Jahan, S., Sultana, S., 2010. Ethnopharmacological application of medicinal plants to cure skin diseases and in folk cosmetics among the tribal communities of North-West Frontier Province, Pakistan. J. Ethnopharmacol. 128, 322–335. Afolayan, A.J., 2003. Extracts from the shoots of Arctotis arctotoides inhibit the growth of bacteria and fungi. Pharm. Biol. 41, 22–25. Bhat, J.A., Kumar, M., Bussmann, R.W., 2013. Ecological status and traditional knowledge of medicinal plants in Kedarnath Wildlife Sanctuary of Garhwal Himalaya, India. J. Ethnobiol. Ethnomed. 9, 1. Bhat, R.B., 2013. Plants of Xhosa people in the Transkei region of Eastern Cape (South Africa) with major pharmacological and therapeutic properties. J. Med. Plants Res. 7, 1474–1480. Bhat, R.B., Adeloye, A.A., Etejere, E.O., 1985. Some medicinal plants of Nigeria. J. Econ. Taxonomic Botany 6, 161–165. Bhat, R.B., Jacobs, T.V., 1995. Traditional herbal medicine in Transkei. J. Ethnopharmacol. 48, 7–12. Caruthers, J., 2013. Dermatology in South Africa. Dermatology world. Retrieved 12/ 10/2013 at 〈http://www.aad.org/dw/monthly/2013/april/dermatology-in-southafrica#page7〉. Choi, S.W., Son, B.W., Son, Y.S., Park, Y.I., Lee, S.K., Chung, M.H., 2001. The woundhealing effect of a glycoprotein fraction isolated from Aloe vera. Br. J. Dermatol. 145, 535–545. Chokoe, P.K., Masoko, P., Matlou, P.M., Rachmond, L., 2008. Does seasonal variation influence the phytochemical and antibacterial properties of Carpobrotus edulis? Afr. J. Biotechnol. 7, 4164–4171. Choudhary, M.I., Shahnaz, S., Parveen, S., Khalid, A., Ayatollahi, A.M., Atta-urRahman, Parvez, M., 2003. New triterpenoid alkaloid cholinesterase inhibitors from Buxus hyrcana. J. Nat. Prod. 66, 739–742. Cotton, C.M., 1996. Ethnobotany: Priniciples and Applications. John Wiley and Sons Ltd, England p. 424 Davis, R.H., Agnew, P.S., 1986. Antiarthritic activity of anthraquinones found in Aloe for podiatric medicine. J. Am. Podiatric Med. Assoc. 76, 61–66. De Wet, H., Nciki, S., van Vuuren, S.F., 2013. Medicinal plants used for the treatment of various skin disorders by a rural community in northern Maputaland, South Africa. J. Ethnobiol. Ethnomed. 9, 51. Dold, A.P., Cocks, M.L., 2000. Indigenous Plant Use of the amaXhosa People on the Eastern Border of the Great Fish River Reserve, Eastern Cape. Annals of the Eastern Cape Museum 1, 26–53. Dold, T., 2005. Imbhola yesixhosa—Traditional Xhosa Cosmetics. Veld & Flora 91, 123–125. Dyubeni, L., Buwa, L.V., 2012. An ethnobotanical study of plants used for the treatment of ear, nose and throat (ENT) infections in Nkonkobe Municipality. South Afr. J. Med. Plants Res. 6, 2721–2726. Gazzaneo, L.R.S., Lucena, R.F.P., Albuquerque, U.P., 2005. Knowledge and use of medicinal plants by local specialists in a region of Atlantic Forest in the state of Pernambuco (Northeast Brazil). J. Ethnobiol. Ethnomed. 1, 1–9. Giday, M., Asfaw, Z., Woldu, Z., 2009. Medicinal plants of the Meinit ethnic group of Ethiopia: an ethnobotanical study. J. Ethnopharmacol. 124, 513–521. Grierson, D.S., Afolayan, A.J., 1999. Antibacterial activity of some indigenous plants used for the treatment of wounds in the Eastern Cape, South Africa. J. Ethnopharmacol. 66, 103–106. Hammond-Tooke, W.D., 1962. Bhaca Society. Oxford University Press, Cape Town p. 325 Hay, R., Marks, R., 2004. The international foundation for dermatology: an exemplar of the increasingly diverse activities of the International League of Dermatological Societies. Br. J. Dermatol. 150, 747–749. Heggers, J.P., Kucukcelebi, A., Listengarten, D., Stanbenau, J., Ko, F., Broemeling, L.D., Robson, M.C., Winters, W.D., 1996. Beneficial effect of Aloe on wound healing in an excisional wound model. J. Altern. Comp. Med. 2, 271–277. Heinrich, M., Ankli, A., Frei, B., Weimann, C., Sticher, O., 1998. Medicinal plants in Mexico: Healers' consencus and cultural importance. Social Sci. Med. 47, 1863–1875. Hutchings, A., 1989. Observations on plant usage in Xhosa and Zulu medicine. Bothalia 19, 225–235. Loots, Du T., Van der Westhuizen, F.H., Botes, L., 2007. Aloe ferox leaf gel phytochemical content, antioxidant capacity and possible health benefits. J. Agric. Food Chem. 55, 6891–6896. Martínez, G.J., Barboza, G.E., 2010. Natural pharmacopoeia used in traditional Toba medicine for the treatment of parasitosis and skin disorders (Central Chaco, Argentina). J. Ethnopharmacol. 132, 86–100. Njoronge, G.N., Bussmann, R.W., 2007. Ethnotherapeutic management of skin diseases among the Kikuyus of Central Kenya. J. Ethnopharmocol. 111, 303–307.

232

A.J. Afolayan et al. / Journal of Ethnopharmacology 153 (2014) 220–232

Omoruyi, B.E., Bradley, G., Afolayan, A.J., 2012. Antioxidant and phytochemical properties of Carpobrotus edulis (L.) bolus leaf used for the management of common infections in HIV/AIDS patients in Eastern Cape Province. BMC Comp. Altern. Med. 12, 215. Otang, W.M., Grierson, D.S., Ndip, R.N., 2012. Ethnobotanical survey of medicinal plants used in the management of opportunistic fungal infections in HIV/AIDS patients in the Amathole District of the Eastern Cape Province, South Africa. J. Med. Plants Res. 6, 2071–2080. Phillips, O., Gentry, A., 1993. The useful plants of Tambopata, Peru: I. Statistical hypotheses tests with a new quantitative technique. Econ. Botany 47, 15–32. Phillips, O., Gentry, A.H., Reynel, C., Wilkin, P., Gálvez- Durand, C., 1994. Quantitative ethnobotany and Amazonian conservation. Conserv. Biol. 8, 225–248. Phillipson, P.B., 1987. A checklist of vascular plants of the Amatole Mountains, Eastern Cape Province: Ciskei. Bothalia 17, 237–256. Saikia, A.P., Ryakala, V.K., Sharma, P., Goswami, P., Bora, U., 2006. Ethnobotany of medicinal plants used by Assamese people for various skin ailments and cosmetics. J. Ethnopharmocol. 106, 149–157. Singh, A.G., Kumar, A., Tewari, D.D., 2012. An ethnobotanical survey of medicinal plants used in Terai forest of western Nepal. J. Ethnobiol. Ethnomed. 10, 8–19.

Spiewak, R., 2000. Occupational skin diseases among formers. In: Zagorski, J. (Ed.), Occupational and Para-Occupational Diseases in Agriculture.. Institute of Agriculture Medicine, Lublin, Poland, pp. 142–152. Statistics South Africa., 2011. Mid Year Population Estimates Accessed 3/01/2013. Retrieved 13/05/2013 at: 〈http://www.statssa.gov.za/Publications/statsdown load.asp?PPN=P0302〉. Stepp, J.R., 2004. The role of weeds as sources of pharmaceuticals. J. Ethnopharmacol. 92, 163–166. Stepp, J.R., Moerman, D.E., 2001. The importance of weeds in ethnopharmacology. J. Ethnopharmacol. 75, 19–23. Sunil, P., Sanjay, Y., Vinod, S., 2012. Pharmacognostical investigation and standardization of Capsicum annum roots. Int. J. Pharmacogn. Phytochem. Res. 4, 21–24. Togola, A., Diallo, D., Dembele, S., Barsett, H., Paulsen, B.S., 2005. Ethnopharmacological survey of different uses of medicinal plants from Mali, (West Africa) in the regions Doila, Kolokani and Siby. J. Ethnobiol. Ethnomed. 1, 1–7. Van Wyk, B.E., van Oudtshoorn, B., Gericke, N., 1997. Medicinal Plants of South Africa, first ed. Briza, Pretoria, pp. 1–304 (isbn: 1-875093-09–5) World Health Organization, 2002. Traditional and Alternative Medicine. Fact sheet No 271. Retrieved October 4, 2013, from /www.who.int/medicines/organiza tion/trm/orgtrmmain.shtmlS.