THE EFFECTIVENESS OF LIQUID SMOKE FOR SCABIES WOUND HEALING

THE EFFECTIVENESS OF LIQUID SMOKE FOR SCABIES WOUND HEALING 1 Ika Zulkafika Mahmudah , Nursalam1, Eka Mishbahatul Mar’ah Has. 1 1 Faculty of Nursing, Universitas Airlangga Surabaya email: [email protected] ABSTRAK Introduction. Scabies is one of skin diseases that is often experienced by santri (students) in Islamic boarding schools which can lead to inflammation, stimulate pain and emerge lesions. Liquid smoke from coconut skin has analgesic, anti-inflammatory, antimicrobial and antioxidant properties that can help wound healing process. Objective. This study aims to find out effects of liquid smoke of coconut skin toward pain and scabies to students. Method. Design of study used is Quasy Experimental. Population in this study is students of Manbaul Ulum Islamic Boarding School, Bungah, Gresik. Sample used is 60 respondents by Purposive Sampling. Independent variable is a treatment of liquid smoke to the students topically for 14 days. Meanwhile, dependent variable is reduction the level of pain, and enhancement of injury healing process. The data of the study is obtained by doing pre-test and post-test. Result. The result shows that there are effects toward reduction of pain to the treatment category (p=0,000) based on the Wilcoxon test, and difference significantly between treatment category and control category (p=0,000) based on Mann-Whitney test. Furthermore, there are the effects of liquid smoke toward injury healing of treatment category with erythema lesion, granulation, and scabies closure criteria (p=0,000) according to MannWhitney test. Discussion. Liquid smoke affects the decrease of pain levels and the process of scabies wound healing which can be used as an alternative intervention for community nurses in suppressing the incidence of scabies in Islamic boarding schools. Keywords: Liquid smoke, Pain, Scabies, Wound INTRODUCTION Scabies is one of the most common dermatological conditions in the tropical countries that have high population density, and low social economy. Scabies is caused by Sarcoptes scabei mites that live by forming tunnels on human skin (1). Then, the effort of pharmacological management has been carried out such as the use of sulfur ointment; gammaxene; benzyl-benzoas emulsion; and permethrin. In this case, there are effects of the chemical content in these drugs such as severe itchy, having different toxic, and irritation (2). Scabies prevalence in the world reaches 130 million people (1). In this circumstance, Indonesia has 5,60 – 12,95% people of scabies, and becomes one of skin diseases in which has 3rd ranks of 12 skin diseases in 2013. It is most occurred in Islamic boarding school, for instance, in Pasuruan in which has prevalence reaches 66,70%, and Lamongan is 73,3%. The number of students suffering from scabies in Manbaul Ulum Islamic Boarding School, Bungah District, Gresik Regency has always increased. There were 77% of male students and 38% of female students suffering from scabies in 2016, 81% of male students and 42% of female students suffering from scabies in 2017, and as many as 83% of male students and 48% of female students suffering from scabies in 2018. Scabies is highly contagious and affect to the psychological in which is caused by itchy constantly, and scratching that cause injury and infection (3). Liquid smoke is the result of woods pyrolysis that contain the main component such as phenol 11,68%, 4-metilfenol 4,74%, dodecanoic acid 30,02%, methyl-ester 5,16%, tetradekanoic acid 4,78%, and 2-metoksi-4-metilfenol 3,20% (4). Liquid smoke produced by coconut skin that contains lignin, cellulose, and the other substances, in case, if it is burnt, it will produce the compounds as well as phenol, carbonyl and acid category which are antioxidant, anti-inflammatory, and anti-microbial. In this case, they are able to prevent spore formation, bacteria and fungi growth, inhibit the bacteria and fungi, and viruses. The liquid smoke has thermicidal activity that can damage cell walls as well as inhibit the bacteria growth (5). The characteristic of liquid smoke is able to cure several skin diseases caused by fungi, viruses, and bacteria such as scabies, ringworm, and another disease (6). The effect of liquid smoke from coconut shells on scabies pain and injury have not known until now. Therefore this study aims to analyze the effect of liquid smoke from coconut shells on reducing the level of pain and scabies wound healing in students. The antioxidant, anti-inflammatory, and antimicrobial properties in liquid smoke can affect the reduction in pain levels and the process of healing scabies wounds. METHODE This study uses Quasy Experimental design accompanied by pre-test and post-test. The population used is Manbaul Ulum Islamic Boarding School students, Bungah, Gresik who anguish scabies. In this case, there are 60 respondents is taken as sample based on Purposive Sampling technique in which is divided by 30 respondents of treatment category, and the other 30 respondents of control category. The respondents are divided according to room arrangement to prevent the bland. Then, treatment category obtains an intervention namely liquid smoke in which 1ml per use of diluted water with ratio 1:10 for 2 times a day (every 12 hours) for 14 days. Evaluations are carried out by researchers every day using Wong Baker pain scale observation sheets and wound observation sheets consisting of erythema size, lesion characteristics, granulation area, and scabies hole characteristics. During intervention, both of treatment and control category are not allowed to use personal things alternately. The variable measured is the pain level and injury healing process with lesion, granulation, and scabies closure criteria. The data analysis is done by SPSS statistic test using Wilcoxon Signed Rank test and Mann-Whitney. RESULT Table 1 Distribution of pain level after giving liquid smoke intervention for 14 days to both of treatment and control category in Manbaul Ulum Islamic Boarding School, Bungah, Gresik No. 1. 2. 3. 4. Pain Level No pain Mild Medium Severe Total Mean±SD ∆ Mean (%) Wilcoxon signed rank test Mann-Whitney U-test Treatment Category Pre-test Post-test N % N % 0 16 53,3 4 13,3 14 46,7 21 70 0 5 16,7 0 - Control Category Pre-test Post-test N % N % 0 0 4 13,3 10 33,3 20 66,7 20 66,7 6 20 0 - 30 30 100 30 100 3,03 1,47 ±0,556 ±0,507 -1,56 (51,5%) (p) = 0,000 100 3,07 ±0,583 (p) = 0,000 30 100 2,67 ±0,479 -0,4 (13%) (p) = 0,001 According to Table 1, it can be found out that there are differences of pain level significantly between the result of post-test respondents toward treatment and control category after giving liquid smoke with significance value p=0,000 (α<0,05) through statistical test of Mann-Whitney U-test. Table 2 Distribution of erythema after being given the liquid smoke intervention for 14 days toward treatment and control category in Manbaul Ulum Islamic Boarding School, Bungah, Gresik No. 1. 2. 3. Erythema Category Erythema > 5 mm Erythema 1-5 mm No erythema Total Mean±SD ∆ Mean (%) Wilcoxon signed rank test Treatment Category Pre-test Post-test N % N % 2 6,7 0 28 93,3 0 0 30 100 Control Category Pre-test Post-test N % N % 2 6,7 0 28 93,3 17 56,7 0 13 43,3 30 30 100 30 100 1,93 3,00 ±0,254 ±0,000 1,07 (55,4%) (p) = 0,000 100 1,93 ±0,254 30 100 2,43 ±0,504 0,5 (25,9%) (p) = 0,000 Mann-Whitney U-test (p) = 0,000 Based on Table 2, it shows that there are differences between erythema significantly between post-test respondents result toward treatment and control category after being given the liquid smoke intervention with significance value p=0,000 (α<0,05) using Mann-Whitney U-test statistical. Table 3 Distribution of lesion after being given liquid smoke intervention for 14 days toward treatment and control category in Manbaul Ulum Islamic School, Bungah, Gresik No. 1. 2. 3. Lesion Category Purulent lesion No purulent lesion No lesion Total Mean±SD ∆ Mean (%) Wilcoxon signed rank test Treatment Category Pre-test Post-test N % N % 6 20 0 24 80 0 0 30 100 Control Category Pre-test Post-test N % N % 4 13,3 2 6,7 26 86,7 24 80 0 4 13,3 30 30 100 1,80 ±407 30 100 3,00 ±0,000 1,20 (66,7%) (p) = 0,000 100 1,87 ±0,346 30 100 2,07 ±0,450 0,2 (10,7%) (p) = 0,014 Mann-Whitney U-test (p) = 0,000 According to Table 3, it shows that there are differences scabies lesion significantly between the result of post-test respondents toward treatment and control category after being given liquid smoke intervention with significance value p=0,000 (α<0,05) using Mann-Whitney U-test statistical test. Table 4 Distribution of granulation after being given the liquid smoke intervention for 14 days toward treatment and control category in Manbaul Ulum Islamic Boarding School, Bungah, Gresik No. Granulasi Category 1. 2. 3. No granulasi Granulation of partial wound Granulation of whole wound Total Treatment Category Pre-test Post-test N % N % Control Category Pre-test Post-test N % N % 30 0 0 100 30 0 0 100 30 100 1,00 3,00 ±0,000 ±0,000 2,00 (200%) (p) = 0,000 30 100 - 0 0 30 30 Mean±SD ∆ Mean (%) Wilcoxon signed rank test 100 - 0 26 4 100 1,00 ±0,000 30 86,7 13,3 100 2,13 ±0,346 1,13 (113%) (p) = 0,000 Mann-Whitney U-test (p) = 0,000 Based on Table 4, it indicates that there are differences granulation significantly between the result of post-test respondents toward treatment and control category after being given the liquid smoke intervention with significance value p=0,000 (α<0,05) through Mann-Whitney U-test statistical test. Table 5 Distribution of scabies holes closure after being given the liquid smoke for 14 days toward treatment and control category in Manbaul Ulum Islamic Boarding School, Bungah, Gresik No. 1. 2. 3. Scabies Hole Category No close Partially close Whole close Total Mean±SD ∆ Mean (%) Treatment Category Pre-test Post-test f % F % 30 100 0 0 0 0 30 100 Control Category Pre-test Post-test f % F % 30 100 6 20 0 20 66,7 0 4 13,3 30 30 100 1,00 ±0,000 30 100 3,00 ±0,000 2,00 (200%) (p) = 0,000 100 1,00 ±0,000 30 100 1,93 ±0,583 0,93 (93%) (p) = 0,000 Wilcoxon signed rank test Mann-Whitney U-test (p) = 0,000 Based on Table 5, it indicates that there are differences of the scabies hole closure significantly between the result of post-test respondents toward treatment and control category after being given the liquid smoke intervention with significance value of p=0,000 (α<0,05) through Mann-Whitney U-test statistical test. DISCUSSION Pain level of treatment category respondents before being given the liquid smoke intervention for 14 days, it is found out the range of mild, medium, severe pain. After being given the liquid smoke for 14 days, all of respondents get decreasing the pain level on the range no pain and mild pain. On the other hand, during pre-test, control category is obtained the pain level of mild, medium, and severe pain. Meanwhile, during post-test, there are the pains of range mild and medium pain. Then, there are 4 respondents of control category who do not have the change of mild pain during pre-test and post-test. And so, there are 14 respondents do not get the change of medium pain during pre-test and post-test. Phenol of the liquid smoke has analgesic that can inhibit the formation of inflammatory mediator of the cyclooxygenase and lipoxygenase through biosynthesis of eicosanoid acid way by inhibiting phospholipase C and phospholipase A2 (7). Inhibition of phospholipase C is able to block cyclooxygenase enzyme in which causes inhibition of prostaglandin so that a synthesis of prostacyclin and thromboxane (TXA2) is also inhibited. The retardation of phospholipase A2 blocks lipoxygenase enzyme so that it causes HPTE (hydroperoxy-eicosatetraenoic acid) decreasing and inhibit the formation of leukotriene in which can reduce the pain (8). In a study, the liquid smoke contains ammonia, hexane, alcohol, ketone, acid, and phenolic. Thermal decomposition of coconut skin cellulose produces anhydroglucose, carbonyl, and furan. Decomposition of hemicellulose is similar to cellulose decomposition in which produces acetic acid and carbon dioxide. Partial pyrolysis of lignin produces various types of phenolic that contribute as antibacterial (9). Phenolic liquid smoke has free radical activity and is antioxidant (10). In addition, the liquid smoke also contains carbonyl in which is antimicrobial. The carbonyl inhibits the microbial growth by penetrating the cell and deactivating enzymes in which are located in the cytoplasm and cytoplasm membrane (11). Antimicrobial of liquid smoke is able to destroy Sarcoptes scabiei lodged in scabies lesion by damaging cell. The destruction of the mites can stop the mites that activate the pain response so that it can decrease. The injury phase of both treatment and control category during pre-test is in the inflammatory that is characterized by erythema or papules, and lesion. The lesion of each respondent is different, however, each treatment and control category has respondent who have purulent lesion character. After being given the liquid smoke of coconut skin for 14 days, the injury inflammatory phase of treatment category is shorter that is characterized by reducing the size of erythema and lesion in which get the granulation faster, and the scabies hole that has closed during post-test. Meanwhile, the respondents of control category still have lesion that has not experienced the granulation and scabies hole that is still opened on 14th day, and there are two respondents who has purulent lesion. It indicates that the inflammatory phase of treatment category is shorter and more quickly getting into proliferation phase. The scabies sore of the patients are began with erythema or papules in which becomes primary lesion. Besides, another indication is found white distinctive lines as an indication of mites. If the primary lesion is scratched, it can expand the scratched and it is called as secondary lesion. In more severe condition, it can cause the pus (12). The contents of liquid smoke are able to increase fibroblast production and injury contraction. The mechanism can help to quicken the injury healing process. Besides that, it is found flavonoid in which can increase the collagen and protein, as well as reduce peroxidase fat in the granulation of the wound (13). The other chemical components identified are phenol compound, carbonyl, carboxylic acid, furan, hydrocarbon, alcohol, and lactone. In case, the quality and quantity of them are influenced by the ingredients and pyrolysis process of the coconut skin (14). Meanwhile, organic acids in which are antibacterial of the liquid smoke including acetic acid, format, propionate, butyric, and another acid. In bacterial test conducted by a study, it uses two bacteria categories namely B. subtilia and S. aureus in which represent gram positive, and E. coli and P. fluorescens in which is gram negative. Based on the four bacteria strains used, the addition of liquid smoke shows the retardation of the four bacteria growth (15). The antioxidant, anti-inflammatory, and antimicrobial of the substance are able to inhibit lipid peroxidation, degradation tissue, and increase injury contraction (16). Besides, those characteristics can destroy the mites through thermicides activity of liquid smoke, and prevent the bacterial growth. Moreover, they also inhibit lipid peroxidase so that it prevents degradation tissue, and affect to increasing injury contraction in which can increase fibroblast (5). In case, the process helps to optimize the injury proliferation phase so that it increases the healing process. The liquid some used as the antimicrobial and antioxidant is the second class of liquid smoke in which has yellowish, and is clearer than the third class. Then, the second liquid smoke has been tested that it is able to inhibit S. aureus, E. coli, and Candida sp. microbe growth. In this circumstance, it is caused that phenolic of liquid some that has been proven microscopically causes a damage to the microbial cell walls(17). SIMPULAN DAN SARAN The pain level of scabies to the respondents given the liquid smoke of coconut skin is lower during post-test in which is the range mild pain and no pain. On the other hand, the pain level of control category is in the range of mild and moderate pain. The injury healing process on inflammatory phase and respondents’ proliferation given the liquid smoke of coconut skin is faster in which is characterized by absence of erythema and lesion, granulation process, and scabies holes closure are more quickly. However, the control category is still found erythema, lesion, granulation that have not optimal, and scabies holes closure. Scabies patients are able to utilize the liquid smoke of coconut skin to contribute the injury healing process without providing side effects. Antimicrobial, antiinflammatory, and antioxidant of the liquid smoke may be as the intervention for another disease. For the next researchers, they can present the liquid smoke in the dosage in which can minimize the liquid smoke aroma so that it increases the client comfort. UCAPAN TERIMAKASIH Delivering thank you for the students and Manbaul Ulum Islamic Boarding School staffs who have been the respondents in this study. The gratitude is also delivered to the deans, lecturer, and staffs of Nursing Faculty Universitas Airlangga who have provided supports and facilities in the study process. REFERENCES 1. WHO. Scabies. 2015; Available http://www.who.int/lymphatic_filariasis/epidemiology/scabies/en/ from: 2. Djuanda A. Ilmu Penyakit Kulit dan Kelamin. Jakarta: Fakultas Kedokteran Universitas Indonesia; 2010. 3. Lydeamore MJ, Campbell PT, Regan DG, Tong SYC, Andrews RM, Steer AC, et al. A biological model of scabies infection dynamics and treatment informs mass drug administration strategies to increase the likelihood of elimination. Math Biosci [Internet]. 2018; Available from: https://doi.org/10.1016/j.mbs.2018.08.007 4. J.Z. L, Setiaji B, Trisunaryanti W, Wijaya K. Identification of antibacterial compound from extract coconut shell liquid smoke. Int J Appl Chem. 2019;10(2):141–51. 5. Kadang L, Heliawati L, Darmakusuma D, Tuhehay AM. The grade 2 of liquid smoke of some agricultural waste as a natural termiticide. Asian J Microbiol Biotechnol Environ Sci. 2019;19(4):1030–3. 6. Umboh DDRW, Wanto STME. Pemanfaatan dan pemasaran biobriket dan asap cair. Huda NSTMP, editor. Bandung: Pusat Pengembangan Pemberdayaan Pendidik dan Tenaga Kependidikan Bidang Mesin dan Teknik Industri/TEDC Bandung; 2014. 7. Lima G, Montenegro C, Almeida C, Athayde-Filho P, Barbosa-Filho J, Batista L. Database Survey of Antiinflammatory Plants in South America. Int J Mol. 2011;Sci 12: 26. 8. Anwar Y, Sabir JSM, Qureshi MI, Saini KS. 5-Lipoxygenase: A Promising Drug Target Against Inflammatory Diseases-Biochemical and Pharmacological Regulation. Curr Drug Targets. 2014;15(4). http://dx.doi.org/10.2174/1389450114666131209110745 9. Mashuni, Jahiding M, Kurniasih I, Zulkaidah. Characterization of preservative and pesticide as potential of bio oil compound from pyrolisis of cocoa shell using gas chromatography. 2017;020008. http://dx.doi.org/10.1063/1.4978081 10. Kusrini D, Fachriyah E, Prinanda GR. Isolation of phenolic acid in Acalypha indica l plants and test total phenol also antioxidant test using DPPH method. IOP Conf Ser Mater Sci Eng. 2019; http://dx.doi.org/10.1088/1757899X/509/1/012033 11. Lingbeck JM, Cordero P, Bryan CAO, Johnson MG, Ricke SC, Crandall PG. Functionality of liquid smoke as an all-natural antimicrobial in food preservation. MESC [Internet]. 2014;97(2):197–206. Available from: http://dx.doi.org/10.1016/j.meatsci.2014.02.003 12. El-aal AAA, Hassan MA, Ismail H, Ali MA, Barakat M. Immunomodulatory impression of anti and pro-inflammatory cytokines in relation to humoral immunity in human scabies. 2016; http://dx.doi.org/ 10.1177/0394632015627464 13. Tarawan VM, Mantilidewi KI, Dhini IM, Radhiyanti PT, Sutedja E. Coconut Shell Liquid Smoke Promotes Burn Wound Healing. 2017;22(38):436–40. http://dx.doi.org/10.1177/2156587216674313 14. Jahiding M, Mashuni, Ilmawati W, Ermawati, Rahmat, Arsyad J, et al. Characterization of Coconut Shell Liquid Volatile Matter ( CS-LVM ) by Using Gas Chomatroghaphy. 2017;(Lvm). http://dx.doi.org/10.1088/17426596/846/1/012025 15. Saloko S, Darmadji P, Setiaji B, Pranoto Y. Antioxidative and antimicrobial activities of liquid smoke nanocapsules using chitosan and maltodextrin and its application on tuna fi sh preservation. Food Biosci [Internet]. 2014;7:71–9. Available from: http://dx.doi.org/10.1016/j.fbio.2014.05.008 16. Rosa SA, Adi S, Achadiyani, Khairani AF, Lantika UA. The Effect of Yellow Potato (Solanum tuberosum L.) Gel on Wound Healing Process in Mice (Mus musculus). Glob Med Heal Commun. 2018;6(38):21–7. http://dx.doi.org/10.29313/gmhc.v6i1.2417 17. Kailaku S, Syakir M, Mulyawanti I, Syah A. Antimicrobial activity of coconut shell liquid smoke. 2017; http://dx.doi.org/10.1088/1757-899X/206/1/012050