ABSTRACT
Chronic distal symmetric polyneuropathy [CDP] is the most common form of diabetic neuropathy. In chronic [lasting>12 months] painful CDP, the patient suffers from paresthesia and pain, that may lead to disability with daily activities and even sleep. In this work, evaluation of the efficacy of topical application of a curcumin cream formula [0.05%], as a novel indication for treatment of CDP, was guarantied. The efficacy of a capsaicin-curcumin combination [CCC] cream was also tested. Subjects and This study included 120 known diabetic patients coming for follow up, aged 23-63 years, 37 with type 1 and 83 with type 2 DM. The patients were randomly allocated into 4 groups: group 1 applied topical cream base and served as controls. Group 2 applied topical 0.075% capsaicin cream. Group 3 applied topical 0.05% curcumin cream and group 4 applied topical cream containing 0.075% capsaicin plus 0.05% curcumin [combination]. All groups were given the medication as water washable cream, applied topically, 4 times daily for 2 months. The two cream formulas showed a remarkable relief of CDP associated symptoms. As compared to a standard capsaicin cream [0.075%] and a cream base that served as placebo. At the end of study period of 2 months, the overall percentage of patients showing improved and 89.3% for placebo, capsaicin, curcumin and neuropathic symptoms was 20.7%, 70%, 78.5% curcumin-capsaicin combination, respectively [P<0.0001]. The percentage of patients without neuropathic symptoms was 3.4%, 20%, 26% and 42.9% for the four groups, respectively [P<0.0001]. Moreover, pain score declined from 4.2 +/- 0.5, 4. 3 +/- 0.3, 3.9 +/- 0.6 and 4.2 +/- 0.4 [P>0.05] before treatment to 4.0 +/- 0.5, 3.1 +/- 0.3, 2.9 +/- 0.5 and 1.2 +/- 0.3 [P<0.0001] after treatment with placebo, capsaicin, curcumin or their combination, respectively. The onset of gaining pain relief was evident from the first week of treatment, with the highest number of patients reporting pain relief with the combination therapy. Conclusions: Our clinical observations report, for the first time, that topical application of curcumin cream [0.05%] has a beneficial effect in alleviating symptoms associated with CDP. The clinical observations also suggest that a cream containing a combination of 0.075% capsaicin plus 0.05% curcumin is an effective, noninvasive treatment modality for the management of CDP