Potential Effects and Mechanisms of Action of Topical Wallflower (Erysimum cheiri (L.) Cranz) Administration in Anal Fissure

Anal fissure is an ischemic ulcer that occurs in anoderm and it has no obvious etiology and pathophysiology in current medicine. Anal fissure has a profound history in Persian and Persian medicine and wallflower (Erysimum cheiri (L.) Crantz) has been a common medication in this case. Traditional oil and/or dilute decoction of wallflower has been introduced as an effective topical medicine for anal fissure in Persian medicine.The aim of this study was to demystify the ancient wisdom in administration of low-dose wallflower for anal fissure, via the view point of modern pharmacological mechanisms. The basic idea and source of information was according to Persian and Arabic medicine manuscripts of the medieval Islamic era. Electronic literature was searched for related phytochemical and pharmacological studies available in Scopus, Google scholar, Pubmed and ScienceDirect databases from 1900 to 2018. The results showed that different parts of wallflower contain several types of cardiotonic steroids, isothiocyanates and flavonoids. Low-dose topical cardiotonic steroids, below their IC50, could have potential effects on the ischemic condition of anal fissure ulcer and collagen synthesis in the local fibroblasts, by stimulation of Na+/K+ ATPase pump. Furthermore, other active compounds in wallflower are isothiocyanates that could be responsible for tissue protective effects by induction of NRf2 expression and activating TRPA1 channels. Also wallflower flavonoids are responsible for anti-inflammatory, analgesic and wound healing properties. To the best of our knowledge, this is the first time that low-dose topical wallflower administration is hypothesized to have anal fissure healing potential in conventional medicine. This study has introduced a novel mechanistic approach for anal fissure treatment.