Curcumin and fungal infection - commonly available herbs for common female infection.

Dear Editor,

We have read with great interest the clinical trial entitled “The effect of curcumin-based and clotrimazole vaginal cream in the treatment of vulvovaginal candidiasis” by Abouali et al.[1] We want to congratulate the authors for this successful clinical trial to address the most common fungal infection in women in the reproductive age group.

Herbal remedy for symptomatic treatment is a much-needed preference to currently available therapy. Although curcumin has antibacterial and antifungal activity along with antioxidant and anti-inflammatory effects, its use in a clinical setting is limited due to poor bioavailability (poor absorption, rapid metabolism, and rapid elimination). Curcuminoids have been approved by the US Food and Drug Administration (FDA) as “generally recognized as safe” (GRAS) and good tolerability and safety profiles have been demonstrated through clinical trials.

In this study, the authors tested the efficacy of commonly used azole group of the drug clotrimazole and curcumin. Overall efficacy remains the same in both the group but the local adverse events are more common in the curcumin group but are not significant. In this study, efficacy endpoints were discharge, itching, burning, and erythema. Adverse events due to curcumin are also similar such as burning, vulvolar itching, and vulvovaginal discomfort.[2] Due to overlapping of efficacy endpoints and adverse events, it appears that efficacy endpoints are difficult to be evaluated properly or authors may not be able to describe the difference between adverse events and disease-related symptoms.

In case of culture, negativity is more common in azole group than the curcumin group. Lee et al. described that curcumin's fungicidal effect is mainly because it causes fungal cell membrane damage by increasing leakage of intracellular potassium, plasma membrane damage, and disrupting membrane integrity. This nonspecific activity of curcumin may result in the dormancy of fungal cells, which had regained growth during the culture. To counter this effect, the duration of therapy extended resulted in increased culture negativity. Another important finding is that curcumin has also proven to have antibacterial effect[2] that prevented the mixed infection caused due to bacterial infection which has resulted in significant complete recovery compared to the azoles group.

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