To explore the clinical efficacy of Traditional Chinese Medicine bath in the treatment of psoriasis vulgaris with blood-heat syndrome and its effect on related cytokines based on different temperature and different concentration

Chinese herbal medicine bath therapy for psoriasis vulgaris using topical calcipotriol as the comparator: A systematic review with meta-analysis and association rule analysis

ETHNOPHARMACOLOGICAL RELEVANCE

Psoriasis is a chronic inflammatory skin disease. Vitamin D analogues are the first-line topical agents for the long-term management of psoriasis. Chinese herbal medicine (CHM) bath therapy is commonly employed for psoriasis. However, the effects and safety of CHM bath therapy for psoriasis vulgaris, using topical calcipotriol as the comparator, remain inconclusive. Furthermore, the combination of herbs, a distinctive feature of CHM, is essential for its therapeutic effects due to the individual and synergistic properties of the herbs involved.

AIM OF THE STUDY

The review was conducted to evaluate the effectiveness and safety of CHM bath therapy for psoriasis vulgaris, using calcipotriol as the comparator. Potential herbs and herb combinations of CHM bath therapy were also explored for further drug discovery.

MATERIALS AND METHODS

Nine databases were searched from inception until March 05, 2024. Randomised controlled trials (RCTs) investigating CHM bath therapy, using calcipotriol as the comparator, were included. Statistical analyses were performed using RevMan 5.4, Stata 12.0 and SPSS Clementine 12.0 software. The evidence certainty for outcomes was assessed using the approach proposed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group. Moreover, association rule analysis on herbs identified in the systematic review was conducted to explore the potential herbs and herb combinations.

RESULTS

A total of 17 RCTs involving 1,379 participants were included in this systematic review. The findings of this review revealed that: 1) CHM bath therapy produced comparable effects to calcipotriol in reducing Psoriasis Area and Severity Index (PASI), Psoriasis Scalp Severity Index (PSSI), and itch visual analogue scale (VAS) at the end of the treatment phase; as well as exhibited a superior long-term effect than calcipotriol through decreasing relapse rates at the end of the follow-up phase; 2) CHM bath therapy showed an additional benefit when combined with calcipotriol in managing psoriasis vulgaris at the end of the treatment phase, in terms of PASI, PSSI, itch VAS, IL-17, IL-23, CD3+ and CD4+ T cells. The certainty of the evidence was rated as 'very low', 'low' or 'moderate' based on the GRADE assessment, considering some concerns or high risk of bias of included studies, substantial heterogeneity, and existing publication bias of some outcomes. Additionally, the proportions of participants reporting adverse events were similar in both groups. Association rule analysis of all included herbs identified 23 herb combinations including Prunus persica (L.) Batsch and Carthamus tinctorius L., as well as 11 frequently used herbs, such as Kochia scoparia (L.) Schrad., Dictamnus dasycarpus Turcz. And Sophora flavescens Ait.

CONCLUSIONS

The effects of CHM bath therapy were comparable with those of topical calcipotriol but demonstrated a longer-lasting effect. Combining CHM bath therapy with calcipotriol also provided an additional benefit for adult psoriasis vulgaris. However, the certainty of the evidence was downgraded due to the methodological limitations of included studies. To confirm the findings of this review, future investigations should involve double-blinded, placebo-controlled RCTs. Importantly, it appears worthwhile to consider further research for drug development utilising the identified herbs or herb combinations.

Adding Chinese herbal medicine bath therapy to conventional therapies for psoriasis vulgaris: A systematic review with meta-analysis of randomised controlled trials

BACKGROUND

Chinese herbal medicine (CHM) bath is commonly used in China as an adjuvant therapy for managing psoriasis vulgaris. Previous systematic reviews showed that CHM bath therapy was effective and safe for psoriasis vulgaris, however, without exploration of the specifics of CHM bath therapy such as the optimal temperature, duration of each session, and the total treatment duration.

PURPOSE

To evaluate the add-on effects of CHM bath therapy to conventional therapies for adult psoriasis vulgaris.

METHODS

We conducted a comprehensive search in nine medical databases from inception to September 2022 to identify relevant randomised controlled trials (RCTs) published in Chinese or English. The included studies compared the combination of CHM bath therapy and conventional therapies to conventional therapies alone for adult psoriasis vulgaris. Methodological quality assessment of the included RCTs was performed using the Cochrane risk-of-bias tool 2 (RoB 2). Statistical analysis was carried out using RevMan 5.4, R 4.2.3 and Stata 12.0 software. The certainty of evidence of outcome measures was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation Working Group (GRADE) system.

RESULTS

A total of 23 RCTs involving 2,183 participants were included in this systematic review. Findings suggested that the combination of CHM bath therapy and conventional therapies was more effective in reducing Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI) and itch visual analogue scale, compared to using conventional therapies alone. These enhanced effects were notably observed when the CHM bath was set above 38 °C and had a duration of 20 and 30 min, as assessed by DLQI. Moreover, an eight-week treatment duration resulted in better effects for PASI compared to shorter durations. Additionally, the top ten frequently used herbs in the included studies were identified. Despite the findings, the certainty of evidence was rated as 'low' or 'moderate' based on the GRADE assessment, and significant heterogeneity was detected in subgroup and sensitivity analyses.

CONCLUSION

The CHM bath therapy combined with conventional therapies is more effective and safer than conventional therapies alone for adult psoriasis vulgaris. The results suggest a potential correlation between treatment effects and factors such as extended treatment duration, increased bath temperature, and longer bath sessions. However, the certainty of evidence was downgraded due to methodological limitations of the included studies. To confirm the findings of this systematic review, a double-blinded, placebo-controlled RCT is needed in the future.

A network pharmacology and molecular docking investigation on the mechanisms of Shanyaotianhua decoction (STT) as a therapy for psoriasis

Psoriasis is an immune-mediated inflammatory skin disease with a complex etiology involving environmental and genetic factors. Psoriasis patients often require long-term treatment. Shanyaotianua decoction (STT), a typical traditional Chinese medicine prescription, positively affects psoriasis, although its molecular targets remain unknown. To elucidate its molecular mechanisms, a combination of network pharmacology, bioinformatics analysis, and drug similarity comparisons were employed. Participants were separated into 3 groups: non-lesional (NL), lesions after medication (LM), and psoriasis lesion groups (LS). Based on the Gene Ontology/kyoto encyclopedia of genes and genomes enrichment analyses, the key targets were mainly enriched for biological processes (immuno-inflammatory responses, leukocyte differentiation, lipid metabolic disorders, and viral infection) with the relevant pathways (Janus kinase/signal transducers and activators of transcription and adipocytokine signaling and T-helper 17 cell differentiation), thus identifying the possible action mechanism of STT against psoriasis. Target prediction for 18 STT compounds that matched the screening criteria was performed. Then, the STT compounds were intersected with the differentially expressed genes of the psoriatic process, and 5 proteins were potential targets for STT. Based on the open-source toolkit RDKit and DrugBank database, and through molecular docking and drug similarity comparisons, spinasterol, diosgenin, and 24-Methylcholest-5-enyl-3belta-O-glucopyranoside_qt may be potential drugs for psoriasis.

Liangxue Jiedu Runzhi ointment in the treatment of mild and moderate psoriasis with blood-heat syndrome: A double-blind randomized controlled trial

INTRODUCTION

Psoriasis is a kind of chronic inflammatory skin disease characterized by erythema, skin hyperplasia, scales and keratinocyte hyperproliferation. Psoriasis Vulgaris, the most common kind of psoriasis, severely deteriorates the life quality of patients. Traditional Chinese Medicine (TCM) is a good choice for the treatment of psoriasis, which has been proved to be safe and effective, and may reduce the recurrence rate. In clinical practice, Liangxue Jiedu Runzhi (LJR) ointment can effectively treat mild and moderate psoriasis with blood-heat syndrome, but there is a lack of evidence-based medical evidence. This trial aims to evaluate the efficacy and safety of LJR ointment for the treatment of mild and moderate psoriasis with blood-heat syndrome.

METHODS

A multicenter, randomized, double-blind, placebo-controlled, and self-controlled clinical trial was carried out according to this paper. The symmetrical rashes of each subject were regarded as the target lesions and were randomly divided into a treatment group (LJR ointment group) and a control group (placebo group). The LJR ointment or placebo ointment were externally administered on bilateral symmetric rashes, twice a day for eight weeks. The follow-up examination was made for subjects every two weeks. The primary research finding was conveyed by Psoriasis Area and Severity Index (PASI) in 8 weeks. The secondary research finding includes adverse events.

RESULTS

46 subjects undergo this research project. The difference between PASI scores of the target lesions in the treatment group and control group is statistically significant were in 8 weeks (P < .001). The percentage of PASI 75 in treatment group and control group were 48% and 15% in week 8, respectively (x2 = 11.33, P < .05). No severe adverse events were reported.

CONCLUSIONS

LJR ointment was proved to have efficacy in the treatment of mild and moderate psoriasis with the blood-heat syndrome.

Reconstruction Algorithm-Based Computed Tomography Image Feature for Evaluating the Effect of Internal Administration and Medicated Bath of Liangxue Xiaoyin Decoction on Psoriasis Vulgaris

Skin computed tomography (CT) image based on improved marching cubes (MC) algorithm was explored to evaluate the therapeutic effect of internal administration of Liangxue Xiaoyin decoction combined with medicated bath in the treatment of psoriasis vulgaris. 712 patients with psoriasis vulgaris blood heat syndrome in hospital were recruited as the research object, which were randomly divided into observation group (TCM oral therapy combined with medicinal bath) and control group (TCM oral therapy), each with 356 cases. Psoriasis area and severity index (PASI), pruritus degree, and clinical treatment effect were compared. The results showed that the reconstruction time of median method was greatly shorter, and the algorithm efficiency was improved by 40.6290%. After treatment, the psoriasis area and severity index (PASI) score of the observation group was 5.61 ± 1.15, ΔPASI = (22.64 ± 2.15). ΔPASI% = 80.14%, which were greatly higher than the control group ((9.41 + 1.56) points, ΔPASI = (18.84 + 1.65) points, ΔPASI% = 66.69%) (P < 0.05). After treatment, the itching degree of the observation group was 3.03 ± 1.01 points, which was lower than that of the control group ((3.71 ± 1.06) points), and the itching degree of the observation group was greater than that of the control group, with substantial difference (P < 0.05). The total effective rate of observation group (88.76%) was higher than that of control group (71.07%) (P < 0.05). Therefore, skin CT image based on the improved MC algorithm can evaluate the therapeutic effect of internal administration of Liangxue Xiaoyin decoction combined with medicated bath in the treatment of psoriasis vulgaris. The internal administration of Liangxue Xiaoyin decoction combined with medicated bath had a good effect on the treatment of psoriasis vulgaris and was of certain clinical application value.

TCM Treatment and Drug Co-Occurrence Analysis of Psoriasis

Psoriasis is a long-term immune-mediated disease. Patients with a long history and slow progress are more common, and its treatment is difficult. This study proposes to use traditional Chinese medicine to treat psoriasis. Through the follow-up of all participants for 12 and 24 weeks, a large number of comparative experiments effectively verify the effectiveness of the method proposed in this study. The research results of this study can provide some reference ideas for follow-up research.

Clinical application of compound Glycyrrhizin tablets in the treatment of patients with Simplex Henoch-Schonlein Purpura and its effect on immune function

Objectives:

To investigate the curative effect of Compound Glycyrrhizin Tablets in the adjuvant treatment of simplex Henoch-Schonlein purpura and its influence in improving immune function.

Methods:

In this retrospective study design was used in this study. Eighty newly diagnosed patients with purpura simplex who visited the outpatient department of Baoding First Central Hospital from June 2017 to February 2020 were included. They were randomly divided into treatment group and control group. The two groups were provided with the same conventional comprehensive treatment. Patients in the treatment group received oral administration of Compound Glycyrrhizin Tablets on the basis of conventional treatment. The clinical efficacy of the treatment group and the control group were compared according to the time and effect of purpura regression, followed by the comparison of changes of T cell subsets before and after treatment.

Results:

The total effective rate of the treatment group was 92.5%, which was higher than that of the control group (77.5%) (P < 0.05). The purpura subsidence time of effective patients in treatment group was shorter than that in control group (P < 0.05). There was no significant difference in lymphocyte subsets between the treatment group and the control group before treatment. After treatment, the proportion of CD4+ cells and CD4+/CD8+ cells in the treatment group were obviously higher than that in the control group, and the count of CD8+ cells was evidently lower than that in the control group (P < 0.05).

Conclusions:

Compound Glycyrrhizin is effective in the adjuvant treatment of simplex Henoch-Schonlein purpura without obvious adverse reactions, which is valuable for clinical application as an adjuvant.

Cinnamaldehyde inhibits psoriasis‑like inflammation by suppressing proliferation and inflammatory response of keratinocytes via inhibition of NF‑κB and JNK signaling pathways

Psoriasis is a systemic immune-mediated inflammatory disease characterized by uncontrolled keratinocyte proliferation and poor differentiation. Cinnamaldehyde (CIN) has been shown to inhibit the proliferation and inflammatory response of primary and immortalized immune cells. However, to the best of our knowledge, the role of CIN in the progression of psoriasis remains unclear. Therefore, the present study aimed to investigate the biological role of CIN in psoriasis. To mimic abnormal proliferation and differentiation in keratinocytes in vitro, normal human epidermal keratinocytes (NHEKs) were stimulated with M5 (IL-1α, IL-17A, IL-22, oncostatin M and TNF-α). The viability and proliferation of NHEKs were analyzed using Cell Counting Kit-8 and 5-Ethynyl-2′-deoxyuridine assays, respectively. Western blotting was used to analyze the expression levels of keratin 1, filaggrin and loricrin in NHEKs. The results of the present study revealed that CIN significantly inhibited the proliferation and cell cycle progression, and promoted the differentiation of M5-stimulated NHEKs. CIN also markedly attenuated the extent of oxidative stress-induced damage in M5-stimulated NHEKs. Moreover, CIN ameliorated M5-induced inflammatory injury in NHEKs, as evidenced by the decreased levels of multiple inflammatory factors. Furthermore, CIN notably downregulated the expression levels of phosphorylated (p)-inhibitor of NF-κB, p-p65 and p-JNK in M5-stimulated NHEKs. In conclusion, the present data suggested that CIN may protect NHEKs against M5-induced hyperproliferation and inflammatory injury via inhibition of NF-κB and JNK signaling pathways. These results provide a novel insight on the role of CIN in psoriasis.

Network Pharmacology-Based Analysis on the Mechanism of Action of Ephedrae Herba-Cinnamomi Ramulus Couplet Medicines in the Treatment for Psoriasis

Background

This study explored the mechanism of action of Ephedrae Herba-Cinnamomi Ramulus couplet medicine (MGCM) at the pharmacological level in the treatment of psoriasis.

Material/Methods

The active ingredients in MGCM were mined through literature retrieval and the BATMAN-TCM database, and potential targets were predicted. In addition, targets associated with psoriasis were acquired using multiple disease-related databases. Thereafter, an interaction network between candidate MGCM targets and the known psoriasis-associated targets was constructed based on the protein–protein interaction (PPI) data, using the STRING database. Then, the topological parameter degree was determined for mining the core targets for MGCM in the treatment of psoriasis, which also represented the major hubs within the PPI network. In addition, the core networks of targets and ingredients were constructed using Cytoscape software to apply MGCM in the treatment for psoriasis. These core targets were then analyzed for Gene Ontology biological processes and Kyoto Encyclopedia of Genes and Genomes pathway enrichment using OmicShare.

Results

The ingredient-target core network of MGCM for treating psoriasis was constructed; it contained 52 active ingredients and corresponded to 19 core targets. In addition, based on enrichment analysis, these core targets were majorly enriched for several biological processes (immuno-inflammatory responses, leukocyte differentiation, energy metabolism, angiogenesis, and programmed cell death) together with the relevant pathways (Janus kinase-signal transducer and activator of transcription, toll-like receptors, nuclear factor κB, vascular endothelial growth factor, and peroxisome proliferator-activated receptor), thus identifying the possible mechanism of action of MGCM in treating psoriasis.

Conclusions

The present network pharmacology study indicated that MGCM alleviates various pathological factors of psoriasis through multiple compounds, multiple targets, and multiple pathways.