The Role of African Medicinal Plants in Dermatological Treatments: A Systematic Review of Antimicrobial, Wound-Healing and Melanogenesis Inhibition

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

See the reviewer report. 

Comments for author File: Comments.pdf

Author Response

The responses to the reviewers' comments have been submitted. 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The authors reviewed the African medicinal plants with wound healing, and anti-melanogenesis effects. Through this study, 46 plant species were introduced with the source references. However, some of the references are inappropriate, which needs further verification. Furthermore, although the authors aimed to review literature related to antimicrobial activity, wound-healing and melanogenesis. Only two sections (wound-healing and anti-pigmentation) were given, which made the paper rather short except for Table 1. It needs extensive revision to hold separate sections for antioxidant, antimicrobial activity, wound-healing and melanogenesis. Also, the mechanism of actions of these medicinal plants, side effects and comparison with other plants from Europe, America, Australia or Asia shall be discussed to obtain scientific significances.

 

 

1. “ The World Health Organization (WHO) reports that 80% of people in developing 36 countries rely on traditional medicine for therapy [1].” But the reference 1 is “Mabona U: Van Vuuren SF. Southern African medicinal plants used to treat skin diseases. South African Journal of Botany. 2013 Jul 255 1;87:175-93. 256”, which is not WHO report.
2. “Medicinal plants are frequently in-37 expensive and easily available, with fewer side effects than conventional medicines [2].” But the reference 2 is “Popovic, Z.; Matic, R.; Bojovic, S.; Stefanovic, M.; Vidakovic, V. Ethnobotany and herbal medicine in modern complementary and 257 alternative medicine: An overview of publications in the field of I&C medicine 2001–2013. Journal of Ethnopharmacol. 2016, 181, 258 182–192.” which is not on the economic values of medicinal plants. The authors must check the appropriateness of all the references.

 

Author Response

The responses to the reviewers' comments have been submitted.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Major Comments:

1. Risk of Bias Assessment of Included Studies:
   While the review acknowledges heterogeneity (I²) in the meta-analyses, a formal assessment of the risk of bias (RoB) for the included individual studies (n=37) is a critical component of a systematic review that is missing.  in vivo animal studies, tools like SYRCLE could be used, or for in vitro studies, a customized checklist based on relevant quality criteria (e.g., transparent methodology, appropriate controls, blinding if applicable, statistical analysis). Including this would significantly strengthen the review's conclusions about the efficacy of these plants.

   • Better to conduct and report a risk of bias assessment for the included studies and discuss how any identified biases might influence the findings.

2. Clarity in Abstract on  Synthesis Methods:
   The abstract states (lines 22-23): "All studies on antimicrobial activity, wound healing, and melanogenesis inhibition were analyzed through narrative synthesis." However, it later mentions (lines 23-25) that "Forest plots were generated using RStudio only for those studies reporting wound closure percentages or melanogenesis inhibition (IC50 values) with available standard deviations and sample sizes." This creates a slight contradiction. The methods section (lines 148-156) clarifies this well, but the abstract should be more precise.

   • Suggestion: Revise the abstract to accurately reflect that narrative synthesis was used for all antimicrobial data and some wound-healing/melanogenesis data, while quantitative synthesis (forest plots) was used for specific wound-healing and melanogenesis data where sufficient statistical information was available.

3. Interpretation of High Heterogeneity (I²):
   The forest plots (Figures 2 and 3) report very high heterogeneity (I² = 99.5% for wound healing and I² = 100% for melanogenesis inhibition). While the authors acknowledge this as "reflecting variations in species, doses, and models used" (line 187) and "reflecting variability in plant species, extract types, and experimental protocols" (lines 190-191), the implications of such extreme heterogeneity on the pooled estimates should be discussed more deeply. When I² is this high, the pooled estimate from a random-effects model can be difficult to interpret confidently as a single summary measure.

   • Suggestion: In the discussion of Figures 2 and 3, elaborate further on why a pooled estimate is still presented despite near-100% heterogeneity, or consider if focusing more on sub-group analyses (if feasible and pre-specified) or a more detailed narrative synthesis of these highly variable quantitative results might be more appropriate for these specific outcomes. Emphasize that the pooled estimate should be interpreted with extreme caution.

Minor Comments:

1. Consistency in Terminology for Controls in Tables:
   In Table 1 (Wound healing), the "Control" column lists various comparators (e.g., "0.2 % Nitrofurazone", "Vaseline®", "Untreated HaCaT cells"). This is good. Ensure such clarity is maintained across all relevant discussions or summaries.

2. Line 14: "dating back 5000 years or more." While historically true for traditional medicine, for a scientific review focused on recent literature (2018-2024), this feels slightly out of place in the abstract's background, which quickly moves to current limitations. Consider rephrasing to focus more directly on the contemporary relevance or the established traditional use as a basis for current scientific investigation

3. Figure 1 (Study Flow Chart): The figure is mentioned (line 158 and caption line 168) but not visible in the provided OCR. Assuming it's a standard PRISMA flow diagram, this is appropriate.
   
   

4. Formatting/Typos:

   • Page 9, Table 2 Header: "...(2018 -2024)." Suggest consistent spacing: "(2018–2024)."

   • Page 9, Under Pistacia atlantica: "...(MIC = 39 µg/m)L." The "L" seems extraneous or a typo. Please check.

   • Page 9, Under Parkia clappertoniana: "...(MIC = 125 µg/r..." Typo for µg/mL?

   • Page 9, Under Harpagophytum procumbens: "...(MIC = 31.25 µg/m)L..." Extraneous "L"?

   • Page 10, Line 175: Abbreviation "C. acnes = Cutibacterium acnes,". This is good, as C. acnes is the current nomenclature for what was formerly P. acnes.

   • Page 12, Line under Bauhinia rufescens: "...57.1% µg/mLat 0.1 mg/mL." The unit "µg/mLat" is unclear. Please clarify.

   • Page 13, Line 186: "...91.90% [89.04, 94.76] was found with substantial significant heterogeneity..." "Substantial significant" is a bit redundant. "Substantial heterogeneity" or "Statistically significant heterogeneity" would suffice.

Author Response

The file has been uploaded.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The authors did appropriate revisions addressing the reviewer's comments. Now it is acceptable for further process.

Author Response

No comments from the reviewer.