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 Table of Contents  
Year : 2023  |  Volume : 8  |  Issue : 1  |  Page : 3-18

A review on the protective role of selected Ayurveda herbs against skin cancer

Department of Biophysics, Panjab University, Chandigarh, India

Date of Submission01-Apr-2022
Date of Acceptance18-Aug-2022
Date of Web Publication30-Dec-2022

Correspondence Address:
Dr. Sarvnarinder Kaur
Department of Biophysics, Panjab University, Chandigarh 160014
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdras.jdras_45_22

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Melanoma skin cancer (MSC) is considered the most aggressive among all skin cancers due to its tendency to fast growth, metastasis, and high relapse rate. Although MSC is treatable if identified early, several side effects and aesthetic issues associated with its treatment impose a psychological burden and compromise patients’ quality of life. Thus, there is a dire need for primary prevention by adopting alternative remedies, which are accessible, safe, and cost-effective. The present review emphasizes the role of selected Ayurveda herbs, viz., Azadirachta indica A. Juss, Ocimum tenuiflorum L., Phyllanthus emblica L., Santalum album L., Tinospora cordifolia (Willd.) Hook. F. and Thoms., and Withania somnifera L. Dunal, which are long being utilized in the Indian traditional system to tackle diverse health problems in preventing MSCs. PubMed and Google Scholar were used to search various research articles on the anti-oncogenic and chemopreventive roles of Ayurveda herbs. This review emphasizes the beneficial effects of Ayurveda herbs so that the ordinary public includes these herbs in their routine to prevent MSC and other cancers. The available literature clearly states that these herbs are beneficial in preventing MSCs. However, the scarcity of clinical trials on these herbs warrants extensive research in this area to obtain an efficacious drug.

Keywords: Ayurveda herbs, cancer in Ayurveda, chemoprevention, melanoma skin cancer

How to cite this article:
Aniqa A, Kaur S, Sadwal S. A review on the protective role of selected Ayurveda herbs against skin cancer. J Drug Res Ayurvedic Sci 2023;8:3-18

How to cite this URL:
Aniqa A, Kaur S, Sadwal S. A review on the protective role of selected Ayurveda herbs against skin cancer. J Drug Res Ayurvedic Sci [serial online] 2023 [cited 2023 Sep 22];8:3-18. Available from: http://www.jdrasccras.com/text.asp?2023/8/1/3/366295

  Introduction Top

A virtual environmental interface, the skin, covers almost 16% of the body mass and protects our internal organs from various assaults.[1] The skin comprises three layers epidermis, dermis, and hypodermis. The epidermis (ectodermal origin) acts as the body ’s armor, a physiochemical barrier against environmental stressors.[2],[3],[4],[5],[6],[7] Keratinocytes (tightly connected by desmosomes and tight junctions) are abundant in this layer. Dermis (mesoderm origin) underlies the epidermis and anchorages several appendages (hair follicles, nerves, sebaceous glands, and sweat glands). Immune cells and fibroblasts are abundant in this layer and are involved in many physiological responses in the skin.[2],[8] Keratinocyte stem cells in the basal layer of the epidermis divide and differentiate as they migrate outward through the skin’s surface to eventually form corneocytes (tightly linked dead but undamaged cells), constituting the principal barrier of the epidermis.[8],[9]

Because the skin is the most exposed organ of the body, UV rays, noxious agents, and toxicants can damage it. These harmful factors initiate molecular and biochemical stress, causing genomic alterations in skin cells and leading to skin carcinogenesis. The transition of human skin cells into malignant form is a multistep process involving initiation, promotion, and progression that are believed to be activated by oxidative stress in cells, causing transformation (into cancer), survival, and metastasis. Exposure to ultraviolet radiation (UVR) is considered a prominent factor for skin cancer. UVA (315 – ; 400 nm, produces reactive oxygen species), UVB (280 – 315 nm, causes DNA mutations by covalently binding the adjacent pyrimidine base pairs C-T, CC-TT transition), and the atmospheric ozone layer absorb most of the UVC (100 – 280 nm). UVB is the most potent in causing direct DNA damage, oxidative stress, and immunosuppression. The inherent DNA repair mechanism of the cell is thought to repair the UVR-induced DNA damage. However, the cell will undergo irreversible DNA mutations if DNA damage remains unrepaired due to any sporadic or genetic factor. In addition, skin cancer incidence increases significantly with age.[2]

Skin cancers are the most common malignancy of humans, particularly in the Caucasian population, with over a million cases detected each year.[10],[11] However, people of color, viz., Asians, Africans, and Hispanics, also have a higher frequency and prevalence of the disease.[12] The highest skin cancer incidence rate has been reported in New Zealand and Australian individuals and the lowest in Africa. In Asia, the highest incidence of skin cancer cases is recorded in Kazakhstan, with a 23.3 / 100, 000 population.[13]

The three most familiar types are basal cell carcinomas (BCCs), squamous cell carcinomas (SCCs) (referred to as non-melanocytic skin cancer — NMSC), and cutaneous malignant melanoma (CM) [also designated as malignant melanoma (MM) or melanoma].[14],[15], [16],[17] According to a US estimate, approximately one in five Americans will develop skin cancer.[2],[18],[19] They account for nearly 15, 000 deaths and more than three billion dollars annually in medical costs in the USA.[2],[20] NMSC, also known as “ ;cancer of keratinocytes,” is among the most common human malignancies and is mainly classified as BCC and SCC, which account for about 99% of all NMSCs. Other rare forms of NMSCs include Merkel cell carcinoma, sebaceous gland carcinoma, dermatofibrosarcoma protuberans, and angiosarcoma.

Although site-specific treatments are effective in skin cancer, they have some limitations (aesthetic issues, viz., pigmentary changes, atrophy, fibrosis, and cost-burden), which compel researchers to develop novel and potential treatment strategies with minimal side effects. Moreover, the treatment available for metastatic tumors has many adverse effects such as weekend immunity, hair/weight loss, fatigue, sleep disturbances, fertility problems, and morbidity, which cause psychological problems in cancer survivors and decrease their quality of life. It is noteworthy that even after several therapy sessions, a high relapse rate (due to inevitable exposure to UV radiation, environmental toxicants, and chemoresistance) brings a financial burden along with significant morbidity to the patients. Moreover, healthy individuals are also at high risk of skin cancer due to the continuous rise in UV rays and environmental pollutants. So, considering the aforementioned pitfalls, which prove an obstacle, presses the need for alternatives to prevent skin cancer. Therefore, emphasis is on prevention strategies in professional and public education. In addition, early detection and treatment methods are becoming more critical.[21]

Rather than taking medications separately, people prefer foods with desired health benefits.

The literature survey revealed that 80% of the developing countries use alternative/traditional medicine as primary health care.[22] Moreover, alternative medicine continues to gain popularity as a complementary way of care in developed (or industrialized) countries. In countries like India and Pakistan and other eastern developing countries, we see the practice of complementary alongside allopathic medicines, where several healing traditions stand out, such as Ayurveda and Sowa-Rigpa. Notably, these traditions embark on using several therapies using a complex of herbs and plants such as Haridra, Amla, Tulsi, Guduchi, and Nimba.[23] These mixtures nowadays represent the basis for many commercial products used in cosmetics, soaps, toothpaste, and pest repellents. By tradition, they continue as treatments for chickenpox, fever, headache, leprosy, jaundice, constipation, respiratory problems, rheumatism, and gastrointestinal disorders.[23] In this review, we are discussing the preventive efficacy of Azadirachta indica A. Juss (Nimba), Ocimum tenuiflorum L. (Tulsi), Phyllanthus emblica L. (Amalaki), Santalum album L. (Chandana), Tinospora cordifolia (Willd.) Hook. F. and Thoms. (Guduchi), and Withania somnifera L. Dunal (Ashwagandha) against MSCs. The rationale behind selecting these herbs is their easy availability and their importance in Ayurveda medicine system to tackle many skin disorders.

  Materials and Methods Top

Electronic databases including PubMed, Google Scholar, and Scopus were searched using the keywords (“ Skin cancer ” OR “skin neoplasm ” OR “melanoma ” OR “malignant melanoma ”) AND (“plant” OR “extract” OR “herb” OR “phytochemical ” OR “Azadirachta indica” OR “Ocimum tenuiflorum” OR “Phyllanthus emblica” OR “Santalum album” OR “Tinospora cordifolia” OR “Withania somnifera”). To find relevant studies, articles were primarily screened on the basis of titles and abstracts. To confine the search, only English language papers were included in this review. Inclusion criteria were herbal plants assessed in in-vitro as well as in-vivo studies, which focussed on the preventive as well as metastasis-related mechanisms of MSCs. The collected data have been tabulated systematically in [Table 2]-7].

The rationale behind using A. indica A. Juss (Nimba), O. tenuiflorum L. (Tulsi), P. emblica L. (Amalaki), S. album L. (Chandana), T. cordifolia (Willd.) Hook. F. and Thoms. (Guduchi), and W. somnifera L. Dunal (Ashwagandha) is their easy accessibility, minimal or no side effects, and importance in Ayurveda medicine system to treat various skin disorders.

  Discussion Top

Melanoma skin cancer (MSC)

MSC is the most destructive form of cutaneous malignancy. MSC (arise from epidermal melanocytes) is often a treatment-refractory and metastasis-prone malignancy. As it proliferates and metastasizes to lymph nodes and other organs [as shown in [Figure 1]], it is regarded as the most lethal of all skin cancers if not diagnosed or treated early.[60] Its incidence has amplified gradually and significantly over the last several decades.[2] Most frequently, melanoma is found on the trunk of men and lower legs of women, although it can occur on the head, neck, mucosal surfaces such as gastrointestinal sites, genital mucosa, oral cavity, eyes, or elsewhere.[61]
Figure 1: Different stages of carcinogenesis: initiation, promotion, and progression. Different chemopreventive agents could interfere with these stages, such as initiation (blocking agents) or steps of promotion and progression (suppressing agents)

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Mutation (valine-to-glutamine substitution at position 600) in the v-RAF murine sarcoma viral oncogene homolog B1 (BRAF) gene encodes a serine/threonine-protein kinase, which is the driving force that triggers the RAS –RAF –mitogen-activated protein kinase (MAPK) pathway, culminating into MSC. A loss or inactivating mutations of the cyclin-dependent kinase inhibitor 2 A (CDKN2A) (mostly deleted) locus, in addition to BRAF, help in the development of MSCs. Many driver genes, viz., cyclin-dependent kinase-4 (CDK4), neuroblastoma RAS viral oncogene homolog (N-ras), KIT proto-oncogene, receptor tyrosine kinase (KIT), mitogen-activated protein kinase 1/2 (MAPK1/2), Erb-b2 receptor tyrosine kinase 4 (ERBB4), glutamate receptor ionotropic 2A (GRIN2A), glutamate metabotropic receptor 3 (GRM3), Ras-related C3 botulinum toxin substrate 1 (RAC1), phosphatidylinositol 3, 4, 5-trisphosphate-dependent Rac exchanger 2 (PREX2), p53, and phosphatase and tensin homolog (PTEN), are implicated in the melanoma pathogenesis,[62] as shown in [Figure 2].
Figure 2: Signaling pathways altered during MSC

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Diagnosis modalities available for skin cancer[63] have shown in [Figure 3]A. Clinically, the identification of MSCs is by the acronym “ ABCDE, ” which stands for asymmetry, border (irregular), color (dark or several), diameter (greater than 6 mm), and evolving (shape/size). The American Joint Committee on Cancer has proposed a TNM-based staging system, in which T describes the size of the tumor, also any spread of cancer into nearby tissue; N describes cancer spread to lymph nodes; and M describes metastasis or spread of cancer to other parts of the body. [Table 1] describes the TNM-based staging of MSCs.
Figure 3: (A): Diagnosis modalities for MSC. (B): Site-specific and systemic treatment modalities available

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The epidemiology of CM is more documented than NMSC. According to Ward et al.,[64] the incidence of MSC has increased by 4 –6% annually in fair-skinned people of North America, Northern Europe, Australia, and New Zealand. According to GLOBOCAN 2020, there were 324, 635 new cases and 57, 043 deaths due to MSC.[65] The mortality rate associated with MM is 90% and has a survival rate of fewer than 10 years when getting into metastasis.[66] In Europe, in 2000, 37, 000 deaths were caused by melanoma.[67] According to an estimate, 132, 000 new cases of melanoma occur worldwide each year. Caucasians are at a higher risk than African-Americans (10 times) and Hispanics (10 times). According to the World Health Organization (WHO), worldwide, approximately 65, 000 people die from malignant skin cancers annually.[68] CM represents less than 5% of all skin cancers in the USA, but causes most skin cancer deaths.[68] CM incidence rates across Europe have changed markedly during the past five decades. Recent analyses of European data have identified up to 10-fold increases in melanoma incidence in Scandinavian countries since the 1950s, with lesser but still considerable increases in western European nations.[69] CM mortality rates in the mid-1990s were highest in Nordic countries and lowest in southern European populations such as Greece, Spain, and Portugal.[69] The highest incidence rates of melanoma are reported from (essentially European migrant populations in) Australia and New Zealand (non-Maori population), with more annual incidence.

Early detection of melanomas can be “ cured ” by surgical excision alone. Nonetheless, MSC is fast to invade and metastasize, being the long-term survival poor for advanced disease.[70] Depending on whether cancer is confined (site-specific) or metastatic (systemic), there are several treatment choices for MSC, as shown in [Figure 3](B)]. Although site-specific treatments are effective, they have some limitations (aesthetic issues, pigmentary changes, atrophy, fibrosis, and cost burden). In addition, CM is still particularly problematic to treat once it has spread from its primary site.[2] Also, the treatment of MSC is expensive.[71]

Additionally, the treatments of MM have many adverse effects, which pose psychological burden and decrease the quality of life of the survivors. All this warrants the need of prevention, and management of this dreadful disease. Considering the easy accessibility, high tolerance as well as safety margins, and effective nature of herbal remedies, botanicals are gaining more popularity amongst scientists and public worldwide. In addition, Bandaranayake[72] reported that almost 80% of the world ’s population living rely upon herbal products as primary source of health. Hence, this seems to be an attractive strategy to delay/prevent skin carcinogenesis.[73]

Ayurveda is the traditional Indian system of medicine derived from ancient Vedic civilization (dating back to 5000 BC). Ayurveda aims to improve quality of life and longevity by healing the ill, maintaining health in the healthy, and preventing illness. Ayurveda plants have well-known beneficial effects such as antioxidant, anti-inflammatory, antiviral, antimicrobial, anti-ulcerative, antidiabetic, antigenotoxic, anticarcinogenic, and so on.[74] This review has selected potential Ayurveda herbs, viz., A. indica A. Juss (Nimba), O. tenuiflorum L. (Tulsi), P. emblica L. (Amalaki), S. album L. (Chandana), T. cordifolia (Willd.) Hook. F. and Thoms. (Guduchi), and W. somnifera L. Dunal (Ashwagandha), which are long being utilized in the Indian traditional system to tackle diverse health problems. These herbs can boost innate antioxidant responses within the skin and thus prevent melanoma skin carcinogenesis. The in-vitro and in-vivo reports presented in this review will help scientists discover novel drug discoveries and clinical trials with these magic herbs.

Moreover, this review will benefit the general public interested in alternative and traditional approaches to prevent or treat MSCs. Finally, we hope this review will further help expand the research and explore these herbs and many other potential herbs, which possess immense curative properties. The subsequent sections showcase the chemoprotective role of chosen Ayurveda herbs against MSCs.

Ayurveda for prevention of melanoma

The three basics of Ayurveda, which are very important for normal body function, are vata, pitta, and kapha (three basic humors of the body). Tridoshas is the condition in which all these three systems lose coordination and cause excessive cell proliferation.

In Ayurveda, cancer is represented either as “Granthi” (minor neoplasm) or as “Arbuda” (primary neoplasm, which is a significant, painful, immobile, deep-seated, and slow-growing tumor).[75] The stages of development of cancer in Ayurveda are (a) Sopha—swelling/inflammation; (b) Granthi— glandular swelling; (c) Arbuda—tumor; (d) Karkatarbuda—malignant tumor; (e) Adhyarbuda—metastasis in primary sites; (f) Dwirarbuda—distant metastasis; and (g) Vranarbuda—suppurating tumors. These stages also require other biofactors such as the Agni (digestive/metabolic factors), Srotas (body channels), and Dhatus (body organs) to achieve a disease. Ayurveda also believes that “Ama” (“incompletely digested,” a toxic, heavy, and sticky juice that originates as a waste product of digestion and metabolism) is the leading cause of several diseases, including cancer.[76] It is conjugated with Doshas or Dhatus and can circulate and interact with other excretory products to produce a reactive/toxic form, potentially disrupting the immune system and increasing the severity of the disease.

In Ayurveda, Kushta chikitsa deals with causes, types, symptoms, and treatment of skin diseases. According to Ayurveda, melanoma includes the violation of tridosha (Vata, Pitta, and Kapha). The main involvement of the skin is a disturbance of Pitta along with raktadosh (toxification of blood) effecting the Agni (digestive/metabolic factors), Sapta dhatu (body tissues), Satkriyakala (involvement of generic sequence), and Srotamsi (channels of the body). The main treatment that can be done is Jaloka Avacharana, known as leech therapy or bloodletting and it will help in removing toxins from the blood and, along with this herbal medicine, will help in stopping the melanoma from spreading.

Kushta roga is the broad term used in Ayurveda for various skin disorders, which are believed to be caused by vitiation of mostly pitta and rakta doshas. Melanoma is considered to be formed by vitiation of tridoshas and is known as kaaknak kushta (a subtype of maha kushta). The skin lesion has blackish/no fixed color in the middle and reddish at the periphery or vice versa and mostly asymmetrical.

Herbs are called “ Adaptogens” (in Ayurveda), which help the body cope with stress, and have immense potential to boost the body ’s antioxidant activity. Herbs can help in healing, as well as in combating the side effects and cancer-associated/chemotherapy-associated complications. Each herb contains multiple active components which act synergistically producing benefits and attenuates the adverse effects or toxicity. Thus, these days, it is crucial to raise awareness and encourage implementation of Ayurvedic therapies for combating cancer and use of integrated approach for tumor management.

Many Ayurveda herbs have played a significant role in treating different cancers. Instead of using targeted therapies for the destruction of the tumors, Ayurvedic herbs restore normal tissue functions (“Sama Dhatu Parampara”)[77] via boosting intrinsic antioxidant activity. Ayurveda herbs help reduce the side effects and cancer-associated complications. It is also helpful in post-surgery care.[78] These herbs improve the patient’s quality of life, who have no other choice. Therefore, herbs have been considered a robust chemopreventive strategy for skin cancer and developing skin cancer therapeutics. The present review summarizes some potential Ayurveda herbs (A. indica, O. tenuiflorum, P. emblica, S. album, T. cordifolia, and W. somnifera) in regulating oxidative stress, which can prevent skin cancer. It is crucial to raise awareness and to encourage the inclusion of these Ayurveda herbs in the daily routine for preventing skin cancer. [Figure 4] depicts the antioxidant mechanism of these Ayurveda herbs in skin cancer prevention.
Figure 4: Activation of ARE/EpRE pathway by potential Ayurvedic herbs to prevent oxidative stress-induced cellular damage in the skin

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Potential Ayurveda herbs for preventing melanoma

(a) A. indica A. Juss (Nimba)

A. indica, also known as “Nimba,” in Ayurveda is an evergreen tree that belongs to the Meliaceae family native to India, Burma, Pakistan, Bangladesh, and Nepal. Various parts of the neem plant cure illnesses such as blood disorders, eye diseases, persistent fever, malarial fever, leprosy, skin diseases, ulcers, and wounds in Ayurveda, Unani, and homoeopathy systems of medicine, and this “ divine tree ” is now used in western medicine to treat various metabolic disorders. Due to numerous alkaloids, flavonoids, glycosides, and amino acids, neem has antifungal, anthelmintic, antibacterial, antiviral, antidiabetic, contraceptive, and sedative effects.[79] Two bioactive neem compounds, nimbolide and azadirachtin, have been researched extensively and found to aid cancer management through antitumor and antioxidant activity.[80] According to the literature review, A. indica defends the skin from the harmful effect of UV rays, other chemical contaminants, skin infections, and wounds.[81],[82],[83] Furthermore, the vitamins and fatty acids found in neem help minimize wrinkles and fine lines on the skin and provide an anti-aging benefit. The antioxidant and anti-oncogenic ability of neem against MSC has been summarized in this article, as shown in [Table 2].
Table 1: TNM staging of melanoma

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(b) O. tenuiflorum L. (Tulsi)

O. tenuiflorum, also famous as “Holy basil” or “Queen of Herbs,” is a member of the Labiatae family that originated in north-central India and now grown throughout eastern Asia, Africa, China, America, and other parts of the world. Tulsi has an important religious and social significance in Hinduism. Tulsi is known as “The Incomparable One,” “Mother Medicine of Nature,” and “Elixir of Immortality” in Ayurveda because of its medicinal and spiritual properties.[84] In Ayurveda, basil tackles various ailments such as anxiety, cough, asthma, diarrhea, malaria, fever, arthritis, eye diseases, urinary tract infections (UTIs), indigestion, vomiting, back pain, gastrointestinal disorders, skin diseases, and insect bites.[85]Tulsi is high in nutrients and other chemicals, including fatty acids, sitosterol, eugenol, methyl eugenol, anthocyanidins, carotene, ascorbic acid, vitamin K, certain levels of sugars, flavonoids, saponins, tannins, and triterpenoids. Some of the isolated active components of the O. tenuiflorum are eugenol, ursolic acid, linalool, and isoeugenol. Research has shown that eugenol, apigenin, and luteolin reduce the dermatoxic effects of xenobiotics and UV exposure. Traditionally, it was topically applied on the skin to treat acne and other infections.[86]Tulsi also protects the skin by avoiding blackheads and treating fungal infections and wounds.[87] This article summarizes Tulsis antioxidant and anti-oncogenic ability against MSCs, as shown in [Table 3].
Table 2: Various in-vitro and in-vivo studies on the anticancer effects of A. indica

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Table 3: Various in-vitro and in-vivo studies on the anticancer effects of O. tenuiflorum

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(c) P. emblica L. (Amalaki)

P. emblica, or “Indian gooseberry” and ‘Amalaki’ in Ayurveda, belongs to the Euphorbiaceae family and is widely cultivated in Nepal, India, Sri Lanka, South-East Asia, and China.[88] It is also known as “the King of Rasayana.” In traditional Chinese and Indian Ayurveda systems, its fruit treats diarrhea, jaundice, inflammation of the lungs and eyes, asthma, bronchitis, hemorrhage, dysentery anemia, jaundice, and dyspepsia. “Chyvanaprash,” a popular preparation comprising Amla along with other herbs, is very useful in anemia, asthma, inflammations of the lungs, and eye diseases. Amla has an abundance of phenolics, tannins, flavonoids, vitamins, amino acids, minerals, and vitamin c. Amla also possesses various medicinal benefits such as antidiabetic, hypolipidemic, antibacterial, antioxidant, anti-ulcerogenic, hepatoprotective, gastroprotective, antimutagenic, and chemopreventive effects.[88]P. emblica lessens the UV-induced erythema and reduces free radicals, thus acting as an anti-aging agent.[89] Its roasted crushed seeds mixed with oil can be used to cure itches and scabies. Epidermis lightening retailers in Europe, the Middle East, and Asia use Amla to treat freckles and age spots.[90],[91],[92]Amla’s antioxidant and anti-oncogenic ability against MSCs has been summarized in this article, as shown in [Table 4].
Table 4: Various in-vitro and in-vivo studies on the anticancer effects of P. emblica

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(d) S. album L. (Chandana)

S. album, also known as “ Royal Tree,” is a member of the Santalaceae genus, found in tropical Asia, Australia, the Pacific Islands, and Hawaii.[93] Sandalwood and agarwood are the most common and widely used incense among Chinese and Japanese people.[94] The Egyptians used its wood for embalming the deceased to venerate the god.[95] In Buddhism, sandalwoods are considered the Padma (lotus) group and attributed to the Bodhisattva Amitabha. Sandalwood is one of the most often used scents in incense offerings to the Buddha.[94] It is also used in many industries to make perfumes, soaps, detergents, cosmetics, and insect repellents. Its wood has a strong fragrance and is the world’s second most costly wood.[95] It was classified as “vulnerable” in 1997 according to the International Union for Conservation of Nature (IUCN).[95]S. album can also cure skin diseases such as pimples, scars, and eczema. Sandalwood essential oil, which is expensive in its pure form, is mainly used in Ayurvedic medicine to relieve anxiety. The essential oil derived from sandalwood is good for toning the skin and treating skin problems. It also has anti-aging and anti-tanning properties.[96],[97] Alpha-santalol, one of the active constituents of sandalwood oil, has been investigated extensively for its anticancer, anti-inflammatory, and antifungal properties.[98],[99] Sandalwood&# 8217;s antioxidant and anti-oncogenic ability against MSC has been summarized in this article, as shown in [Table 5].
Table 5: Various in-vitro and in-vivo studies on the anticancer effects of S. album

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(e) T. cordifolia (Willd.) Miers (Guduchi)

T. cordifolia, or “Amrita” or ‘Guduchi’ in Ayurveda, also known as “heavenly elixir,” belongs to the Menispermaceae family and is abundant in South Asia, Indonesia, the Philippines, Bangladesh, Thailand, Myanmar, China, and Sri Lanka.[100] Due to its high therapeutic value and rejuvenating ability, Ayurvedic and Chinese systems have traditionally used T. cordifolia to treat fever, asthma, dysentery, leprosy, malnutrition, jaundice, skin diseases, and diabetes. Its watery extract, Indian quinine, is very effective in fever, indigestion, rheumatism, urinary diseases, dyspepsia, general debility, syphilis, skin diseases, bronchitis, spermatorrhea, and impotence.[101],[102],[103] It contains different constituents such as alkaloids (berberine, palmatine, tembetarine, isocolumbin), diterpenoid lactones, glycosides, hormones, sesquiterpenoid, phenolics, aliphatic compounds, and polysaccharides.[104] Pharmacological research revealed its antibacterial, antioxidant, anti-inflammatory, immunomodulatory, antistress, antispasmodic, chemoprotective, radioprotective, neuroprotective, and hypoglycemic effects.[105] It is the best remedy for skin problems such as black spots, pimples, fine lines, wrinkles, acne, and it also slows down the aging process.[106] The antioxidant and anti-oncogenic ability of Giloy against MSCs has been summarized in this article, as shown in [Table 6].
Table 6: Various in-vitro and in-vivo studies on the anticancer effects of T. cordifolia

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(f) W. somnifera (L.) Dunal (Ashwagandha)

Ashwagandha, also known as “Indian ginseng,” belongs to the Solanaceae family in Ayurveda, is grown in India, Nepal, China, Baluchistan, Afghanistan, Sri Lanka, Congo, South Africa, Egypt, Morocco, Jordan, and Yemen.[107]W. somnifera is an Ayurvedic herb graded as a “Rasayana” (the most revered Ayurvedic herb). Its roots treat obstinate ulcers and rheumatic swelling, and its root decoction to pregnant and older adults is a nutrient and health restorative tonic. Its root is also helpful in alleviating inflammation, pain, constipation, and backache.[108],[109] In addition, its roots can serve as a nerve tonic, aphrodisiac, and sedative. Its powdered root is beneficial with equal parts of ghee and honey for impotence or seminal debility. Because of the presence of steroidal alkaloids and steroidal lactones, it has immunomodulatory, anti-inflammatory, anti-arthritis, antibacterial, antioxidant, antidiabetic, antitumor, and neuroprotective properties.[107] Several studies have showed the anticancer activity of W. somnifera against cancers of colon, prostate, blood, lung, breast, pancreas, kidney, head, and neck in humans,[110] whereas stomach and skin in mice.[111] Withaferin A and withanolide D, two main withanolides, are responsible for much of Ashwagandha’s pharmacological effects. However, few studies have advocated the clinical uses of W. somnifera to manage different cancers.[112]Ashwagandha also benefits the skin by replenishing natural oils and creating skin-enriching compounds such as hyaluronan, elastin, and collagen, giving the skin hydration, suppleness, and strength.[113],[114] Ashwagandha’s antioxidant and anti-oncogenic ability against MSC have been summarized in this article, as shown in [Table 7].
Table 7: Various in-vitro and in-vivo studies on the anticancer effects of W. somnifera

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  Conclusion Top

The literature survey revealed that these Ayurveda herbs contain numerous active components which prevent MSC by adopting unique mechanisms, as seen in [Figure 4]. Their beneficial effect is due to their ability to target multiple pathways in skin carcinogenesis, such as oxidative stress, inflammation, apoptosis, angiogenesis, and so on. However, there is a need for extensive research and clinical trials to investigate the antiskin cancer efficacy of these herbs in humans. Another loophole in the studies reported is the lack of pharmacokinetic profiles (absorption, distribution, metabolism, and excretion) of these herbs, which is crucial for further drug development. Nevertheless, exploring these herbs would be an inexpensive and straightforward way to improve health worldwide, supremely in developing countries.

In conclusion, these herbs showed a protective effect on MSC. A. indica showed chemoprevention via enhancing the immune system, decreasing the tumor growth, and decreasing the melanin production. O. tenuiflorum showed protective effects via increasing the apoptosis of tumor cells, decreasing the growth of tumors, and increasing the antioxidant potential. P. emblica showed protection via decreasing the modulation of extracellular matrix and decreasing the oxidative stress. S. album showed protection via decreasing the tumor growth, increasing the apoptosis of tumor cells, and cell-cycle arrest. T. cordifolia protected against skin cancer via decreasing angiogenesis and modulation in extracellular matrix. W. somnifera showed protection via decreasing tumor growth and increasing apoptosis of tumor cells. These herbs protect or reverse the damaging effects caused by UV radiation and other noxious environmental carcinogens. As these herbs are cost-effective and selectively cytotoxic, their individual use or combinatorial use will be more effective in preventing/treating MSC. However, these herbs warrant extensive investigations to obtain efficacious drugs in defeating melanoma skin carcinogenesis. This review draws scientists’ worldwide attention to exploring the Ayurveda medicinal system to discover new medicines. We believe that this approach could lead to new, less expensive, potentially successful anticancer drugs.



Financial support and sponsorship


Conflicts of interest

The authors have no potential conflicts of interest.

Authors’ contributions

SK, AA: Conceptualization, data curation, formal analysis, investigation, methodology; AA: roles/writing—original draft, writing; SK, AA: review and editing.

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]


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