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Topical herbal medicine for psoriasis.

Deng, S et al 2013. Topical herbal medicine combined with pharmacotherapy for psoriasis: a systematic review and meta-analysis. Arch Dermatol Res Jan 26 [Epub ahead of print]

Psoriasis is a chronic inflammatory condition that affects approximately 2% of the global population. Not all patients respond well to therapy and long-term management can present a clinical challenge. Herbal medicines, in conjunction with conventional pharmacotherapy, are used by a large percentage of psoriasis patients and a number of topical herbal preparations have been evaluated in clinical trials.

This systematic review and meta-analysis examined the current evidence for the efficacy and safety of topical herbal medicines, together with anti-psoriatic pharmacotherapy, in the treatment of psoriasis. Concurrent pharmacotherapies could include: emollients, corticosteroids, vitamin D3 analogues, tazarotene, coal tar, dithranol, methotrexate (MTX), cyclosporine, retinoids, fumarates and/or biological agents. Herbal medicine applications varied between studies. Randomised control trials (RCTs) published up until September 2012 were considered for the review.

Database searches provided a final total of 1,139 articles on the topic, with eight RCTs satisfying all inclusion criteria. All of the eight RCTS were conducted in China. In total, 1,449 participants were enrolled and 1,446 completed these eight studies. The herbal interventions were baths (4), ointments (3) and steam (1). The following herbs were used in three studies: Sophora flavescens root, Cnidium monnieri seed, Dictamnus dasycarpus bark and borneol. The following herbs were used in two studies: Scutellaria baicalensis root, Rheum palmatum root, Rehmannia glutinosa root, Salvia miltiorrhiza root and Carthamus tinctorius flower.

Each of the eight RCTs reported benefits for combination therapy, with six studies demonstrating increased clinical efficacy in the patient groups using herbal treatment together with pharmacotherapy. Adverse effects were not associated with use of herbal combinations.

The reviewers concluded that adding certain herbal medicines to anti-psoriatic pharmacotherapy resulted in additional therapeutic benefits when compared to pharmacotherapy alone. Previous experimental studies have found that some of the herbs possess anti-inflammatory, immunomodulatory, anti-proliferative, wound healing and/or anti-pruritic properties which may explain the reported clinical effects. One reason proposed for the combination was to address the side effects of long-term pharmacotherapy use. Oftentimes, clinical options are limited to reducing medication dose or replacing one drug with another.

While positive results were observed in this systematic review, the wide variation between herbal interventions used and lack of replicated studies warrants further research in this area.

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Publication:Australian Journal of Herbal Medicine
Article Type:Report
Geographic Code:8AUST
Date:Jan 1, 2013
Words:394
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