Profile of Medicinal Plants Traditionally Used for the Treatment of Skin Burns

Moroccan folk healers use medicinal plants to treat several diseases including skin burns. The traditional knowledge of wound healing is not common among the general population. Only one ethnobotanical survey was carried out in Rabat, Morocco, to track the traditional use of medicinal plants in wound healing. Therefore, our report aimed to study the medicinal plants used in Taza region to treat wound healing. In total, 218 individuals participated in this survey. More than 40 medicinal plants belonging to 30 botanical families were cited as anti-burn remedies. The most commonly used medicinal plants were Agave sisalana L., Nerium oleander L., Tetraclinis articulata Benth., Lawsonia inermis L., Artemisia herba-alba Asso., and Trigonella foenum-graecum L. Most of the used medicinal plants belong to Asteraceae family. Comparing our results with the previous survey, we noted that twelve plants were reported for the first time as wound healing agents. The ethnomedicinal use showed that plants leaves are the most commonly used parts. Pulverization was the selected method of preparation. The direct application of powder to the burns was the most common way of treatment. Our study revealed, for the first time, the importance of medicinal plants to treat skin burns in Taza region. Our results could be considered as the stepping stone for creating a database of wound healing medicinal plants to promote scientific studies on these plants revealing their constituents and side effects.


Introduction
e skin is the largest organ in the body and provides many important functions including organ protection, percutaneous absorption, maintenance of body shape, fluid conservation, temperature control, and sensory and disease control [1]. Skin diseases are a major health problem worldwide. Skin burns are among the most common skin traumas in all age groups. Burns are defined as the partial or total destruction of the skin covering or underlying tissue by a thermal, electrical, or chemical agent or by ionizing radiation [2]. Most burn treatments start with a topical application of a soothing, protective, and anti-infective medication to prevent infection [3]. Since Antiquity, many plants were used by indigenous peoples in different regions of the world for the treatment of wounds and burns. Usually, ointments formulated from different medicinal plants have been used as curative agents due to their widespread diversity of medicinal ingredients such as terpenoids, tannins, alkaloids, flavonoids, essential oils, phenolic compounds, saponins, and fatty acids which exhibit abundant pharmacological potential like anticancer, antidiabetic, and antimicrobial effects as well as cosmetic properties [4][5][6][7]. Besides, it has been discovered currently that some bioactive constituents improve the curative progression of burns [8][9][10]. ese phytoconstituents are not only inexpensive but also harmless. e occurrence of many life-supporting phytoconstituents in plants has prompted scientists to scientifically evaluate these plants for potential wound healing properties [11]. e development of natural resources is a goal that is becoming more and more important in many countries. Medicinal plants are used for treatment purposes of infections. ese plants are subsidized as a foundation of stimulation for new beneficial phytoconstituents as well as color, flavor, and taste of food [12][13][14][15][16][17]. e WHO indorses the assessment of the efficacy and of plant-based medications to standardize their usage and integrate them into conventional healthcare systems [18]. Traditional medicinal practices differ greatly from country to country and region to region. ey are influenced by many factors including culture, history, generational anecdotes, and local healers' philosophies. According to the WHO, nearly 80% of the developing countries' population use traditional medicine as the primary source of therapy [18]. In Morocco, medicinal plants inhabit a significant room in medicinal systems and play an important part in the national economy [19], and numerous investigations showed recently remarkable results for future pharmaceutical applications [20][21][22][23][24][25]. Morocco is one of the Mediterranean countries with a long tradition of cultivating and using medicinal plants. In the northeastern part of Morocco, the use of traditional medicine is widespread, and several herbal remedies used individually or in combination with other agents are recommended for the treatment of burns. Despite the widespread use of medicinal plants, the scientific categorization of the local knowledge describing how to prescribe these plants is threatened with loss. e knowledge is usually transferred from generation to generation verbally, which affects the accuracy and spread of information in local populations. One scientific approach to tackle this problem is to conduct surveys among certain populations and collect as much data as possible. ese data are then categorized, analyzed, compared, scrutinized, and presented to the scientific and local communities in a clear reliable format to be preserved in a proper way for future generations. e widespread use of medicinal plants to treat skin burns in Morocco encouraged us to conduct surveys among local populations to understand and preserve local practices. After searching the literature, we found no ethnopharmacological surveys conducted on the use of medicinal plants for the treatment of skin burns in the northeast part of Morocco [26]. e purpose of this study was to record and summarize the traditional practices of using medicinal plants in the treatment of burns in the region of Taza. e results of this survey will guide scientists in their future pharmacological and clinical work aiming to provide scientific evidence on the use of certain medicinal plants to treat skin burns.

Description of the Study Area.
is study was carried out in the province of Taza. is city is administratively part of the Region of Fes-Meknes. Taza is a town located in the northeast of Morocco in the Taza corridor, a mountain pass where the Rif and Middle Atlas Mountains meet. e city is the capital of its province. It is located 220 km west of Oujda and 316 km east of Rabat ( Figure 1). is city covers an area of 37 km 2 with a population of 152,678 inhabitants in 2020.
is city was selected because we observed the widespread use of medicinal plants to treat wound healing. Moreover, no ethnopharmacological study was conducted in this region to collect information about the use of medicinal plants in wound healing.

Collection of Data.
e study was carried out from January 2021 to April 2021. Ethnobotanical knowledge was obtained through semi-assembled discussions. Interviews were carried out, and plant names in local dialect were recorded when cited. A total of 218 participants were interviewed for this survey (Table 1). e interviews were planned to register data about plants used for healing purposes of skin burns and their homegrown names, methods of preparation, parts of the plant used, drug management, and demographic characteristics of the study participants (Table 1).

Sociodemographic Characteristics of Herbalists.
Ethnobotanical surveys require questioning herbalists, traditional healers, and/or people with long experience in medicinal plants.
e data obtained from questionnaires highlight the sociodemographic characteristics of herbalists and traditional healers. In this work, the number of participants was 218 individuals practicing traditional medicine in Taza. e age of these traditional practitioners ranged between 30 and 90 years with a high rate for the age group of 50 and 70 years (Table 1). It was also noted that women actively participated in this survey (83.49%) compared with men (16.51%). is is in line with previous studies carried out in Morocco, where women were more interested in traditional medicine [27,28]. Unfortunately, most participants did not have formal education (75.69%). However, only 16.97% have primary level, 5.5% have secondary level, and 1.83% have university level education. Most participants declared that their knowledge was inherited from older family members (92.66%), while 7.34% acquired their knowledge from traditional practices (traditional initiation). e transmission of this traditional knowledge was carried out exclusively by families, and this can lead to the disappearance of certain information (plants not yet known) because new generations became less interested in traditional knowledge.

e Diversity of Medicinal Plants Used to Treat Burns.
e survey revealed the importance of medicinal plants in treating burns. As listed in Table 2, [47] medicinal plants were used to treat burns. ese species belong to 30 different botanical families. Different species were recognized by their vernacular names, which showed the diversity of the regional language, and the information was collected by analyzing and categorizing the location of the population. In our previous work, we showed that the region of Taza is rich in medicinal plants such as Agave sisalana L., Nerium oleander L., Tetraclinis articulata Benth., Lawsonia inermis L., Artemisia herba-alba Asso., and Trigonella foenum-graecum L. which are used not only for skin burns but also for other pathologies such as diabetes and diseases related to the digestive system [27]. Despite the richness of Taza with medicinal plants, a comparison of the diversity of medicinal plants between Taza and other regions was never conducted. Only Salhi et al. [3] carried out a study including six cities in the Rabat region (Rabat, Sale, Temara, Skhirat, Khemisset, and Tiflet). In the study of Salhi et al. [3], thirty-six species belonging to 35 genera and 23 botanical families were identified.

Medicinal Plants Previously Reported for Dermatology
Uses.

ND
Our data showed that the leaves were the most used parts (41%) of medicinal plants, followed by seeds (17%), flowers (13%), roots (11%), bark and latex (4% each), fruits, bulbs, stems, pericarp, and mucilage (2% each) (Figure 2). Our results were similar to the only work carried out in Morocco by Salhi et al. [3] on plants used against skin burns. Other work carried out in Morocco on medicinal plants against different pathologies showed that the leaves were the most commonly used parts [19,27,28,30,68]. e results demonstrated that the powder was the main and simplest traditional application method used in the treatment of skin burns either alone or in combination with adjuvants such as honey, olive oil, and rose oil. Similar results were reported by Salhi et al. [3].

Conclusion and Perspectives
We surveyed and summarized the medicinal plants used to treat skin diseases in the Taza region. e traditional knowledge demonstrated in this work showed that ethnobotanical surveys can play a decisive role in screening plants with biological properties such as wound healing activity. e results of our work can guide scientists in their selection of plants to be studied experimentally to treat burns. Other surveys should also be carried out in other regions of Morocco to highlight all the medicinal species treating skin burns in Moroccan folk medicine and thus preserve such valuable knowledge for future generations. In addition, medicinal plants that revealed healing effects in our study should be studied for their in vivo properties. In addition, powders of these species could be prepared as formulations for their applications against skin burns.

Data Availability
All the available data used to support the findings of the study are included within the article.  Evidence-Based Complementary and Alternative Medicine 7