Topical Herbal Formulae in the Management of Psoriasis: Systematic Review with Meta-Analysis of Clinical Studies and Investigation of the Pharmacological Actions of the Main Herbs

School of Health Sciences, and Traditional and Complementary Medicine Research Program, Health Innovations Research Institute, RMIT University, Bundoora, VIC, 3083, Australia.
Phytotherapy Research (Impact Factor: 2.66). 04/2014; 28(4). DOI: 10.1002/ptr.5028
Source: PubMed


This systematic review and meta-analysis of randomized controlled trials (RCTs) examined the topical use of multi-herbal formulations for the management of psoriasis vulgaris. Studies were identified from PubMed, Cochrane library, EMBASE, and the Chinese databases CNKI and CQVIP. Methods were according to the Cochrane Handbook and meta-analyses used RevMan 5.1. Nine studies met the inclusion/exclusion criteria. The comparisons were with placebo and/or anti-psoriatic pharmacotherapy (APP) with two studies having three arms. The pooled meta-analysis data indicated the topical herbal formulae improved overall clinical efficacy (defined as 50% improvement or greater) when compared with: topical placebo (plus oral herbal co-intervention); topical APP alone; and topical APP (plus pharmaceutical co-intervention). Improvement was evident in Modified Psoriasis Area and Severity Index (PASI) score when topical herbal formula was compared to placebo (plus oral herbal co-intervention). No serious adverse events were reported. The most commonly used herbs were Sophora flavescens root and Lithospermum erythrorhizon root. Experimental studies reported that these herbs and/or their constituents have anti-inflammatory, anti-proliferative, anti-angiogenic, and tissue repair actions. These actions may at least partially explain the apparent benefits of the topical multi-herbal formulations in psoriasis. Copyright © 2013 John Wiley & Sons, Ltd.

Download full-text


Available from: Shiqiang Deng, Mar 22, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This review provides assessments of the efficacy and safety of oral forms of phytotherapy in psoriasis management and discusses the pharmacological actions of the plants that have been frequently used in clinical trials. It employed the methods described in the Cochrane Handbook. Ten randomized controlled trials that compared a plant-based intervention with placebo or a pharmacotherapy in the treatment of psoriasis vulgaris and used Psoriasis Area Severity Index (PASI) as an outcome measure were included. Superiority to placebo was found in two out of three studies. In six out of seven studies, the effect of the phytotherapy was reported as comparable to the pharmacotherapy in the short term when assessed as PASI 50. The safety of the phytotherapies was discussed. The most commonly used plants were Oldenlandia diffusa, Rehmannia glutinosa and Salvia miltiorrhiza. Experimental studies on extracts and compounds derived from these plants have reported anti-inflammatory, anti-proliferative and other actions of relevance to psoriasis management. These properties may account for the apparent actions of some of the phytotherapies used in these clinical studies. These plants and their active constituents appear to warrant further research attention in the search for future medications for psoriasis.
    Full-text · Article · Nov 2013 · Archives for Dermatological Research
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Psoriasis is a chronic inflammatory skin disease, with an important impact on the patient's quality of life. Its incidence and prevalence are continuously increasing. The complex ethiopathology of this disorder is only partially known; there is a clear genetic predisposition, which associates a number of environmental triggering factors such as an unbalanced diet and lifestyle. The conventional therapeutic options are not always satisfactory in terms of efficiency and safety, therefore, complementary and alternative medicine approaches are frequently chosen by patients, mostly as self-medication. This review, based on recent literature flow data, outlines the pharmacological benefits of herbal formulations with antipsoriatic activity. It also reveals the molecules responsible for their effects, as well as their interference with the metabolic and immunopathogenic mechanisms of this disease. An important number of plants have been proved to act as antipsoriatic agents, many botanical-based preparations containing keyphytochemical molecules (belonging mainly to phenolics, triterpenoids and phytosterols or unsaturated fatty acids, as mentioned in pecific phyto-pharmaceutical databases). Specific mechanisms of action, which can explain their activity (such as lipoxygenase inhibition, antioxidant, anti-inflammatory, anti prostaglandin), were recently described. Only some of these formulations have been actively tested in vitro or in vivo. Most publications in the field agree on the need for more in vitro and in vivo studies, especially clinical assessment on patients with Psoriasis vulgaris. These would provide more accurate data on the efficacy and safety of such herbal formulations for this disease.
    Full-text · Article · Jun 2014 · Notulae Botanicae Horti Agrobotanici Cluj-Napoca
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Psoriasis causes worldwide concern because of its high-prevalence, as well as its harmful, and incurable characteristics. Topical therapy is a conventional treatment for psoriasis vulgaris. Chinese medicine (CM) has been commonly used in an integrative way for psoriasis patients for many years. Some CM therapies have shown therapeutic effects for psoriasis vulgaris (PV), including relieving symptoms and improving quality of life, and may reduce the relapse rate. However, explicit evidence has not yet been obtained. The purpose of the present trial is to examine the efficacy and safety of the YXBCM01 granule, a compound Chinese herbal medicine, with a combination of topical therapy for PV patients. Methods/design: Using an add-on design, the trial is to evaluate whether the YXBCM01 granule combined topical therapy is more effective than topical therapy alone for the treatment of PV. The study design is a double-blind, parallel, randomized controlled trial comparing the YXBCM01 granule (5.5 g twice daily) to a placebo. The duration of treatment is 12 weeks. A total of 600 participants will be randomly allocated into two groups, YXBCM01 granule group and placebo group, from 11 general or dermatological hospitals in China. Topical use of calcipotriol betamethasone for the first 4 weeks and calcipotriol ointment for the remaining 8 weeks will be the same standard therapy for the two groups. Patients will be enrolled if they have a clinical diagnosis of PV, a psoriasis area severe index (PASI) of more than 10 or body surface area (BSA) of more than 10%, but PASI of less than 30 and BSA of less than 30%, are aged between 18 and 65-years-old, and provide signed informed consent. The primary outcome, relapse rate, is based on PASI assessed blindly during the treatment. Secondary outcomes include: (i) relapse time interval, (ii) time to onset, (iii) rebound rate, (iv) PASI score, (v) cumulative consumption of medicine, (vi) the dermatology quality life index (DLQI), and (vii) the medical outcomes study (MOS) item short form health survey (SF-36). Analysis will be on intention-to-treat and per-protocol subject analysis principles. Discussion: To address the effectual remission of the YXBCM01 granule for PV, this trial may provide a novel regimen for PV patients if the granule can decrease relapse rate without more adverse effects. Trial registration: Chinese Clinical Trial Registry ( ChiCTR-TRC-13003233, registered 26 May 2013.
    Full-text · Article · Jul 2014 · Trials
Show more