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Comparison of Refined and Crude Indigo Naturalis Ointment in Treating Psoriasis: Randomized, Observer-Blind, Controlled, Intrapatient Trial

Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital at Keelung, 222 Mai Chin Rd, Keelung 204, Taiwan. .
Archives of dermatology (Impact Factor: 4.31). 03/2012; 148(3):397-400. DOI: 10.1001/archdermatol.2011.1091
Source: PubMed
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    ABSTRACT: ETHNOPHARMACOLOGICAL RELEVANCE: Indigo naturalis is used in traditional Chinese medicine to treat various dermatoses. Our previous clinical studies showed that indigo naturalis is an effective treatment for psoriasis. Herein, the capabilities of indigo naturalis extract and its derivatives to increase claudin-1 expression and tight junction (TJ) function in human keratinocytes and psoriatic lesions were further studied. MATERIALS AND METHODS: Claudin-1 expression in psoriatic plaques with or without indigo naturalis treatment was analyzed by immunohistochemical methods. In primary human keratinocytes, the expression of claudin-1 was analyzed by fluorescent immunostaining, a real-time RT-PCR, and Western blot analysis. The effect of indigo naturalis on TJs was evaluated by measuring the transepithelial electrical resistance (TEER) and paracellular tracer flux. RESULTS: The indigo naturalis extract upregulated mRNA and protein expressions of claudin-1 and function of TJs in primary human keratinocytes in concentration-dependent manners. Its main components, indirubin, indigo, and tryptanthrin, exerted synergistic effects on upregulating TJ functions in primary human keratinocytes. In addition, indigo naturalis increased the activity of protein kinase C (PKC), and a known potent PKC inhibitor, Ro318220, attenuated the indigo naturalis-induced claudin-1 expression. Significantly, restoration of claudin-1 was observed in healed psoriatic lesions after indigo naturalis treatment. CONCLUSIONS: Indigo naturalis upregulates claudin-1 expression and restores TJ function in keratinocytes. Our data also suggest that indirubin, indigo, and tryptanthrin have a synergistic effect on TJ function.
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    ABSTRACT: Psoriasis sufferers frequently use preparations of plant extracts. Physicians need to be aware of the current evidence concerning of these products. This review evaluates the efficacy and safety of preparations of plant extracts used topically for psoriasis. Searches were conducted of PubMed, EMBASE, Cochrane library, two Chinese databases and article reference lists. Randomized Controlled Trials investigating extracts of single plants were included. Preparations of multiple plants and combinations of plant extracts plus conventional therapies were excluded. Two authors conducted searches, extracted data, and assessed Risk of Bias. Outcomes used in meta-analyses were: clinical efficacy, Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), and symptom scores. The 12 included studies investigated extracts of: Mahonia aqulifolium (n=5), Aloe vera (n=3), Indigo naturalis (n=2), Kukui nut oil (n=1), and Camptotheca acuminate nut (n=1). Methodological quality was variable. Six studies provided data suitable for meta-analysis of clinical efficacy versus placebo (RR 3.37, 95% CI: 1.36-8.33). Experimental studies indicate components of Indigo, Mahonia and Camptotheca have anti-inflammatory, anti-proliferative and other actions of relevance to psoriasis. The clinical trial evidence provides limited support for preparations containing extracts of Mahonia aquifolium, Indigo naturalis and Aloe vera for the topical management of plaque psoriasis based on multiple studies. No serious AEs were reported. Due to the small size of most studies and methodological weaknesses, strong conclusions cannot be made. The magnitudes of any effects cannot be measured with accuracy, so it is difficult to assess the clinical relevance of these preparations. This article is protected by copyright. All rights reserved.
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