Oral and Topical Centella asiatica in Type 2 Diabetes Mellitus Patients with Dry Skin: A Three-Arm Prospective Randomized Double-Blind Controlled Trial

Introduction. Uncontrolled diabetes mellitus (DM) is related to skin disorders, particularly dry skin. Pathogenesis of dry skin in
type 2 diabetes mellitus (T2DM) rises from the chronic hyperglycemia causing an increase in advanced glycation end-products
(AGEs), proinflammatory cytokines, and oxidative stress. Combination of oral and topical Centella asiatica (CA) is expected to
treat dry skin in T2DM patients more effectively through decreasing N(6)-carboxymethyl-lysine (CML) and interleukin-1α (IL-
1α) and increasing superoxide dismutase (SOD) activity. Methods. A three-arm prospective, double-blind, randomized, controlled
study was performed to evaluate the efficacy of the oral and topical CA extract in 159 T2DM patients with dry skin. (e subjects
were divided into the CA oral (CAo) 2 × 1.100 mg + CA topical (CAt) 1% ointment group, oral placebo (Plo) + CAt group, and Plo
and topical placebo (Plt) group. Dry skin assessment was performed on day 1, 15, and 29, while evaluation of CML, IL-1α, and
SOD activity was on day 1 and 29. Result. Effectivity of CAo + CAt combination was assessed based on HbA1c and random blood
glucose (RBG). In well-controlled blood glucose, on day 29, the percentage of SRRC decrement was greater in the CAo + CAt
group compared to the control group (p � 0.04). SCap value in the CAo + CAt group was greater than that in the control group
(p � 0.01). In the partially controlled blood glucose, increment of SOD activity in the CAo + CAt group was greater than that in
the control group (p � 0.01). (ere were medium-to-strong correlation between CML with SOD (r = 0.58, p < 0.05) and IL-1α
with SOD (r = 0.70, p < 0.05) in well-controlled blood glucose. Systemic and topical adverse events were not significantly different
between groups. Conclusion. CAo and CAt combination can be used to significantly improve dry skin condition through in-
creasing SOD activity in T2DM patients with controlled blood glucose.