The effect of topical herbal lipogel containing extracts of Ziziphus jujube and Echium amoenum on pruritus in hemodialysis patients: A double-blind randomized placebo trial

Document Type : Original Article


1 Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran

2 Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran AND World Federation of Acupuncture-Moxibustion Societies (WFAS), Beijing, China

3 Department of Pharmacognosy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran

4 Department of Biostatics, Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran

5 Department of Internal Medicine, Diabetes Research Center, Mazandaran University of medical sciences, Sari, Iran

6 Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran

7 Student Research Committee, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran



Background: Pruritus is a troublesome symptom in patients with chronic kidney failure (CKF). Topical treatment is the first choice for many skin conditions including pruritus.
Objectives: This study examined the effect of topical lipogel containing Ziziphus jujube and Echium amoenum extracts on pruritus in hemodialysis (HD) patients.
Methods: A double-blind crossover trial was conducted with 50 HD patients. A demographic and medical information form and the 12-item Pruritus Severity Scale were used to collect data. Participants were randomly assigned into a placebo group and an intervention group. The intervention was carried out for four weeks. The groups were then switched after a 2-week washout period and followed for the next four weeks. The severity of pruritus was measured before and once a week after the intervention for 4 weeks. The independent samples t-test, the Mann-Whitney U test, the chi-square test, and repeat measures analysis of variance (RMANOVA) were used to analyze the data.
Results: The mean baseline pruritus scores were 15.14±2.59 and 14.34±2.6 in the intervention and placebo groups, respectively (P=0.581). The mean pruritus score decreased by three points in the intervention group and one point in the placebo group at the end of the intervention. The results of the RMANOVA also showed that over time, the herbal lipogel significantly reduced the mean pruritus scores in the intervention group (P<0.0001), while it remained relatively unchanged in the placebo group.
Conclusion: The use of a topical lipogel containing extracts of Ziziphus jujube and Echium amoenum can effectively reduce pruritus in HD patients. Therefore, this lipogel may safely be used to relieve pruritus in patients receiving HD.


Masoumeh Bagheri-Nesami [Pubmed] [Google Scholar]



Main Subjects

  1. Combs SA, Teixeira JP, Germain MJ. Pruritus in Kidney Disease. Semin Nephrol 2015 ;35(4):383-91. doi: 10.1016/j.semnephrol.2015.06.009 PMID: 26355256 PMCID: PMC5497472
  2. Hu X, Sang Y, Yang M, Chen X, Tang W. Prevalence of chronic kidney disease-associated pruritus among adult dialysis patients: A meta-analysis of cross-sectional studies. Medicine (Baltimore) 2018; 97(21):e10633. doi: 10.1097/MD.0000000000010633 PMID: 29794739 PMCID: PMC6392722
  3. Karimi S, Heydari Seraj M, Afshar R. Evaluation of uremic pruritus and its relevant factors in hemodialysis patients. Med Scholar 2020;22(4):29-36.
  4. Ozen N, Cinar FI, Askin D, Mut D. Uremic pruritus and associated factors in hemodialysis patients: A multi-center study. Kidney Res Clin Pract 2018;37(2):138-147. doi: 10.23876/j.krcp.2018.37.2.138 PMID: 29971209 PMCID: PMC6027816
  5. Swarna SS, Aziz K, Zubair T, Qadir N, Khan M. Pruritus associated with chronic kidney disease: A comprehensive literature review. Cureus 2019;11(7):e5256. doi: 10.7759/cureus.5256 PMID: 31572641 PMCID: PMC6760874
  6. Yahya BA, Hashim AM. Effect of freezing and heating white bread on the glycemic response of healthy individuals. Novel Clin Med 2023; 2(4): 196-201. doi: 10.22034/ncm.2023.409805.1106
  7. Moncrieff G, Cork M, Lawton S, Kokiet S, Daly C, Clark C. Use of emollients in dry-skin conditions: consensus statement. Clin Exp Dermatol 2013;38(3):231-8. doi: 10.1111/ced.12104 PMID: 23517354.
  8. San B, Yildirim AN. Phenolic, alpha-tocopherol, beta-carotene and fatty acid composition of four promising jujube (Ziziphus jujuba Miller) selections. J Food Compost Anal 2010;23(7):706-10.
  9. Moghadam GT, Hosseini-Zijoud SM, Shayesteh TH, Ghasemi H, Ranjbar A. Attenuation of cisplathin-induced toxic oxidative stress by propofol. Anesthesiol Pain Med. 2014; 4(4). doi: 5812/aapm.14221
  10. Zhao J, Li SP, Yang FQ, Li P, Wang YT. Simultaneous determination of saponins and fatty acids in Ziziphus jujuba (Suanzaoren) by high performance liquid chromatography-evaporative light scattering detection and pressurized liquid extraction. J Chromatogr A 2006; 1108(2):188-94. doi: 10.1016/j.chroma.2005.12.104 PMID: 16458908
  11. Jabbar Imani N, Saeedi M, Hajheydari Z, Ebrahimzadeh MA, Morteza-Semnani K. Effect of Sambucus ebulus topical preparation on uremic pruritus. Pharm Biomed Res 2017;3(2):26-32.
  12. Khorsand A, Salari R, Noras MR, Saki A, Jamali J, Sharifipour F, et al. The effect of massage and topical violet oil on the severity of pruritus and dry skin in hemodialysis patients: A randomized controlled trial. Complement Ther Med 2019;45:248-253. doi: 10.1016/j.ctim.2019.06.015 PMID: 31331569
  13. Abdi S, Abdi S. Effect of Aloe Vera gel on relief of hemodialysis patients' pruritus. Complement Med J 2019;9(2):3707-17.
  14. Afrasiabifar A, Mehri Z, Hosseini N. Efficacy of topical application of sweet almond oil on reducing uremic pruritus in hemodialysis patients: A randomized clinical trial study. Iran Red Crescent Med J 2017;19(2):e34695.
  15. Jameson JL. Harrison's principles of internal medicine: McGraw-Hill Education; 2018.
  16. Muszer K, Reich A, editors. Creation and validation of the questionnaire for assessment of itch severity. Proceedings of the 2nd International Students’ Conference of Young Medical Researchers; 2012.
  17. Reich A, Bożek A, Janiszewska K, Szepietowski JC. 12-Item Pruritus Severity Scale: Development and Validation of New Itch Severity Questionnaire. Biomed Res Int 2017;2017:3896423. doi: 10.1155/2017/3896423 PMID: 29098154 PMCID: PMC5642880
  18. Baharvand P, Esmaeili A, Abbasi MR, Namazi S. Validity and reliability of Persian Version of 12-Item Pruritus Severity Score Questionnaire in the Hemodialysis Patients with Uremic Pruritus. Iran J Dermatol 2021;24(2):73-9.
  19. Shahgholian N, Dehghan M, Mortazev M, Gholami F, Valiani M. Effect of massage with aromatic oils on pruritus relief in hemodialysis patients. Complement Med J 2013;2(4):291-302.
  20. Gad SC. Pharmaceutical manufacturing handbook: production and processes: John Wiley & Sons; 2008.
  21. Dekio I, Morita E. The weight of a finger-tip unit of ointment in 5-gram tubes. J Dermatolog Treat 2011;22(5):302-3. doi: 10.3109/09546631003797098 PMID: 20673156
  22. Vafaee S, Shorofi A, Kamali M, Asgarirad H, Mousavinasab S N, Azadbakht M, et al. The Effect of Topical Application of Lavender Lipogel on Sleep Quality and Well-being in Patients Undergoing Maintenance Hemodialysis: A Randomized Clinical Trial. Jundishapur J Chronic Dis Care 2023;12(4):e138628. doi:10.5812/jjcdc-138628
  23. Boaz M, Shtendik L, Oron M, Portugal-Cohen M, Kohen R, Biro A, et al. A randomized controlled clinical trial comparing the efficacy of dead sea mineral-enriched body lotion versus two types of placebo in the treatment of cutaneous dryness, itching, peeling and tightness in hemodialysis patients (EDIT). Nephron Clin Pract 2009;113(3):c169-76. doi: 10.1159/000232598 PMID: 19672115
  24. Karadag E, Kilic SP, Karatay G, Metin O. Effect of baby oil on pruritus, sleep quality, and quality of life in hemodialysis patients: pretest-post-test model with control groups. Jpn J Nurs Sci 2014;11(3):180-9. doi: 10.1111/jjns.12019 PMID: 25065964
  25. Balaskas E, Szepietowski JC, Bessis D, Ioannides D, Ponticelli C, Ghienne C, et al. Randomized, double-blind study with glycerol and paraffin in uremic xerosis. Clin J Am Soc Nephrol 2011;6(4):748-52. doi: 10.2215/CJN.05490610 PMID: 21258039 PMCID: PMC3069365
  26. Forouhari A, Moghtaderi M, Raeisi S, Shahidi S, Parin Hedayati Z, Zaboliyan J, et al.Pruritus-reducing effects of omega-3 fatty acids in hemodialysis patients: A cross-over randomized clinical trial. Hemodial Int 2022;26(3):408-414. doi: 10.1111/hdi.13007 PMID: 35112475
  27. Soleimani M, Nabavi R, Karimi N, Ebrahimian A. Effect of hydroxyzine on pruritus of hemodialysis patients. Tehran Univ Med J 2020;78(3):171-7.