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ObjectiveThrough the targeted lipidomics， we explored the intervention mechanism of Kaixuan Bushen method on psoriasis vulgaris （PV） from the perspective of lipid metabolism， providing reference for the diagnosis and treatment of PV. MethodTwenty-six patients with PV admitting the outpatient clinic of the Department of Dermatology， Guang'anmen Hospital， China Academy of Chinese Medical Sciences from September 2019 to November 2020 were selected as the research object （observation group）， and 26 sex- and age-matched healthy volunteers in the same period were recruited as control group. Venous blood was collected for lipid index and targeted lipidomics detection in the control and observation groups at inclusion. After 12 weeks of continuous treatment of Kaixuan Bushen method， the psoriasis area and severity index （PASI） was measured and compared before and after treatment to assess the clinical efficacy， while venous blood was collected again in the observation group to compare the blood lipid level and lipid metabolism of patients before and after treatment. Targeted lipidomics analysis was performed by ultra performance liquid chromatography tandem mass spectrometry （UPLC-MS/MS） on an ACQUITY UPLC BEH C8 column （2.1 mm×100 mm， 1.7 μm） with mobile phase of 5 mmol∙L-1 ammonium formate in acetonitrile-water （6∶4， A）-5 mmol∙L-1 ammonium formate in acetonitrile-isopropanol （1∶9， B） for gradient elution and flow rate of 0.26 mL∙min-1. Conditions of MS were electrospray ionization （ESI）， positive and negative ion modes， and scanning range of m/z 50-1 200. Then principal component analysis （PCA） and partial least squares-discriminant analysis （PLS-DA） models were developed to screen differential metabolites， and the differential metabolites were identified and the pathways were enriched. ResultAfter 12 weeks of treatment with Kaixuan Bushen method， PASI score decreased by more than 50% in a total of 22 out of 26 patients with PV， suggesting the total effective rate was 84.62%. The serum triglyceride level of patients with PV was significantly higher than that of healthy individuals （P<0.05）， and the triglyceride level was significantly reduced after treatment （P<0.05）. Targeted lipidomics analysis screened a total of 43 potential biomarkers for PV， of which 42 were up-regulated and 1 was down-regulated， involving 7 signaling pathways such as linoleic acid metabolism， glycerophospholipid metabolism and unsaturated fatty acid biosynthesis. Moreover， there were 14 response makers for clinical efficacy of Kaixuan Bushen method on PV， of which 6 were up-regulated and 8 were down-regulated， involving five signaling pathways such as linoleic acid metabolism， glycerophospholipid metabolism and sphingolipids metabolism. In a comparison between healthy individuals and patients with PV and PV before and after treatment， the common differential metabolites were screened as phosphatidylcholine （PC） 38∶0 and ceramide （Cer） 42∶1， and the common pathways were linoleic acid and glycerophospholipid metabolic pathways. ConclusionThe disorder of lipid metabolism in PV are largely due to abnormal sphingolipid， glycerophospholipid and linoleic acid metabolic pathways， of which Kaixuan Bushen method can regulate the glycerophospholipid and linoleic acid metabolism， thereby improving psoriatic lesions.
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Objective:To analyze the medication law of external application of TCM in the treatment of psoriasis vulgaris (PV) by using data mining method.Methods:Clinical controlled trial literature about external application of TCM in the treatment of PV was retrieved from CNKI, VIP, WanFang, SinoMed, PubMed and Cochrane Library from the establishment of the databases to May 23, 2022. Prescriptions were extracted after screening. TCM inheritance computing platform V3.0 was used to analyze the property, taste, meridian, efficacy, use frequency, common medicinal pairs and the core combinations.Results:A total 186 prescriptions were included, involving 190 kinds of Chinese materia medica. The medicines were mostly bitter and cold in property and taste, mainly belonging to the liver and heart meridians. Heat-clearing drugs were mainly used, followed by blood circulation-activating and stasis-eliminating medicines, and tonic medicines. The ten most frequently used medicines were Sophorae Flavescentis Radix, Dictamni Cortex, Phellodendri Chinensis Cortex, Kochiae Fructus, Angelicae Sinensis Radix, Salviea Miltiorrhizae Radix et Rhizoma, Poria, Rehmannine Radix, and Arnebiae Radix; the 3 commonly used medicinal pairs were Sophorae Flavescentis Radix- Dictamni Cortex, Sophorae Flavescentis Radix- Cnidii Fructus, and Sophorae Flavescentis Radix- Kochiae Fructus; 4 combinations were obtained through evolution. Conclusions:External application of TCM for the treatment of PV is around the core pathogenesis of "heat toxin", mainly treating from the blood, including cooling blood and detoxifcation, activating blood circulation and removing stasis, nourishing the blood and moistening dryness. Clearing heat and drying dampness, dispelling wind and relieving itching are also valued. The treating thoughts can provide some references for clinical treatment.
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Psoriasis is a chronic skin disease and an important health concern. Western medicine and therapies are the main treatment strategies for psoriasis vulgaris (PV); however, the overall prognosis of patients with PV is still poor. Therefore, PV prevention is especially crucial. Chinese medicine (CM) has a long history of treating psoriasis, and it has unique wisdom in different cognitive angles and treatment modes from modern medicine. In this review, we first summarized the herbs and ancient CM formulas that have therapeutic effects on PV. Second, the research status and obstacles to the current development of CM in modern medicine were reviewed. Finally, the future of CM in the context of precision medicine and integrated medicine was discussed. After a detailed reading of the abundant literature, we believe that CM, through thousands of years of continuous development and clinical practice, has achieved high effectiveness and safety for PV treatment, despite its surrounding controversy. Moreover, precise analyses and systematic research methods have provided new approaches for the modernization of CM in the future. The treatment of PV with CM is worth popularizing, and we hope it can benefit more patients.
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Humans , Medicine, Chinese Traditional , Drugs, Chinese Herbal/therapeutic use , Psoriasis/therapy , Research Design , Drug Therapy, CombinationABSTRACT
Objective@# To investigate the diagnosis and treatment for oral mucositis induced by low-dose methotrexate and to provide a reference for clinicians@*Methods @# A case of severe chemotherapy-induced oral mucositis caused by short-term use of low-dose methotrexate (the maximum cumulative dose within 1 week) was reported and reviewed in combination with the literature.@*Results@# The patient was treated with low-dose methotrexate (2.5 mg orally every other day at weeks 1, 2, and 4; the third week, 2.5 mg each time for 3 consecutive days for twice, with a maximum cumulativedose of 15 mg within a week). After irregular medication for approximately three weeks, the patient gradually developed severe erosion of the lips, pain, difficulty eating, and skin erosion on both legs. Methotrexate was stopped after admission, and local symptomatic treatments such as Kangfuxin solution were given. Recombinant human granulocyte colony-stimulating factor was used systemically when combined with neutropenia. After treatment, the chemotherapy-induced oral mucositis and skin lesions were improved. A literature review shows that chemotherapy-induced oral mucositis is a toxic reaction to high-dose methotrexate, while cases of severe chemotherapy-induced oral mucositis caused by low-dose methotrexate are rare. Studies have found that the more risk factors patients have, such as poor local oral conditions and systemic diseases such as liver and kidney dysfunction and diabetes, the higher the risk of chemotherapy-induced oral mucositis. Clinicians should cooperate with dentists to address oral diseases as much as possible before using chemotherapy drugs. In addition, when ordering patients to take methotrexate, we should pay attention to the patient's general condition and susceptibility factors, standardize the frequency and dose of administration, adopt personalized treatment plans, and give patients detailed medication education to prevent the occurrence of adverse consequences caused by medication errors. If methotrexate poisoning occurs, the drug should be stopped in time, detoxification and active symptomatic and supportive treatment should be given. Basic oral care, cryotherapy, laser therapy, nutritional support and analgesic drugs are common treatments for chemotherapy-induced oral mucositis. Systemic administration of granulocyte colony-stimulating factor may be considered when accompanied by neutropenia.@*Conclusion@# It is necessary to be alert to the occurrence of severe chemotherapy-induced oral mucositis caused by low-dose methotrexate in clinical practice.
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Background: Knowledge about cutaneous microbiota in psoriasis vulgaris and seborrheic dermatitis is limited, and a comparison of microbiota in the two diseases was not yet previously undertaken. Aims/Objectives: This study aimed to compare the scalp lesional and non-lesional microbiota in psoriasis vulgaris and seborrheic dermatitis with that in a healthy control group. Methods: Fifty samples were taken with sterile swabs from patients’ and controls’ scalps, and 16S rRNA gene sequencing analyses were performed. Results: Alpha and beta diversity analyses showed that bacterial load and diversity were significantly increased in psoriasis vulgaris and seborrheic dermatitis lesions compared to the controls. As phyla, Actinobacteria decreased and Firmicutes increased, while as genera, Propionibacterium decreased; Staphylococcus, Streptococcus, Aquabacterium, Neisseria and Azospirillum increased in lesions of both diseases. Specifically, Mycobacterium, Finegoldia, Haemophilus and Ezakiella increased in psoriasis vulgaris and Enhydrobacter, Micromonospora and Leptotrichia increased in seborrheic dermatitis lesions. Mycobacterium, Ezakiella and Peptoniphilus density were higher in psoriasis vulgaris compared to seborrheic dermatitis lesions. The bacterial diversity and load values of non-lesional scalp in psoriasis vulgaris and seborrheic dermatitis lay between those of lesional areas and controls. Limitations: The small sample size is the main limitation of this study. Conclusion: Higher bacterial diversity was detected in lesions of both psoriasis and seborrheic dermatitis compared to the controls, but similar alterations were observed when the two diseases were compared. Although these differences could be a result rather than a cause of the two diseases, there is a need to analyze all members of the microbiota and microbiota-host interactions
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SUMMARY: This study is to investigate the regulation of Notch1 and Foxp1 by miR-34a in the development of psoriasis vulgaris. RT-PCR was used to compare the levels of miR-34a in the skin lesions of 20 patients with psoriasis vulgaris and 20 normal skin tissues. Immunohistochemistry was used to detect the expression of Notch1 and Foxp1 in 51 patients with psoriasis vulgaris, which were further compared with that in 29 normal control tissues. In addition, in HaCaT cells, we used miR-34a mimics and inhibitors to overexpress and inhibit miR-34a, respectively, and detected the mRNA and protein levels of miR-34a, Notch1, and Foxp1. The level of miR-34a in the skin lesions of patients with psoriasis vulgaris was significantly higher than that in normal skin tissues (t=2.192, P<0.05). The positive rate of Notch1 in the skin lesions of patients with psoriasis vulgaris was 76.47 %, which was significantly higher than that in normal skin tissues (13.79 %) (t=29.215, P<0.01). The positive rate of FOXP1 in the psoriasis vulgaris group was 92.16 %, which was also significantly higher than that in the normal skin group (65.52 %) (t=9.087, P<0.01). In addition, overexpression of miR-34a significantly promoted the expression of Notch1 and Foxp1. However, inhibition of miR-34a significantly reduced Notch1 and Foxp1 levels. miR- 34a is highly expressed in the skin tissues of patients with psoriasis vulgaris, and may participate in the development of psoriasis vulgaris by regulating Notch1 and Foxp1.
RESUMEN: El objetivo de este estudio fue investigar la regulación de Notch1 y Foxp1 por miR-34a en el desarrollo de la psoriasis vulgar. Se utilizó RT-PCR con el fin de comparar los niveles de miR-34a en las lesiones cutáneas de 20 pacientes con psoriasis vulgar y 20 tejidos de piel normales. Se utilizó inmunohistoquímica para detectar la expresión de Notch1 y Foxp1 en 51 pacientes con psoriasis vulgar, que se compararon además con la de 29 tejidos normales control. Además, en las células HaCaT, usamos miméticos e inhibidores de miR-34a para sobreexpresar e inhibir miR-34a, respectivamente, y detectamos los niveles de ARNm y proteína de miR-34a, Notch1 y Foxp1. El nivel de miR- 34a en las lesiones cutáneas de pacientes con psoriasis vulgar fue significativamente mayor que en los tejidos normales de la piel (t=2,192, P<0,05). La tasa de positividad de Notch1 en las lesiones cutáneas de pacientes con psoriasis vulgar fue del 76,47 %, que fue significativamente mayor que la de los tejidos normales de la piel (13,79 %) (t=29,215, P<0,01). La tasa positiva de FOXP1 en el grupo de psoriasis vulgar fue del 92,16 %, que también fue significativamente mayor que la del grupo de piel normal (65,52 %) (t=9,087, P<0,01). Además, la sobreexpresión de miR-34a promovió significativamente la expresión de Notch1 y Foxp1. Sin embargo, la inhibición de miR-34a redujo de manera importante los niveles de Notch1 y Foxp1. miR-34a se expresa en gran medida en los tejidos de la piel en pacientes con psoriasis vulgar y puede participar en el desarrollo de la psoriasis vulgar mediante la regulación de Notch1 y Foxp1.
Subject(s)
Humans , Psoriasis/genetics , MicroRNAs/genetics , Forkhead Transcription Factors/genetics , Receptor, Notch1/genetics , Psoriasis/metabolism , Immunohistochemistry , Transfection , Blotting, Western , Reverse Transcriptase Polymerase Chain Reaction , MicroRNAs/metabolism , Forkhead Transcription Factors/metabolism , Receptor, Notch1/metabolismABSTRACT
OBJECTIVE@#To explore the efficacy and safety of Zhuang medicine medicated thread moxibustion (ZMTM) on psoriasis vulgaris.@*METHODS@#A multicenter, randomized, parallel controlled clinical trial was designed. A total of 241 outpatients with psoriasis vulgaris were randomly divided into a control group (120 cases) and a treatment group (121 cases) using a central block randomization from June 2015 to May 2018. The control group was treated with Western medicines alone including pidotimod dispersible tablets, vitamin B compound tablets, and compound cod liver oil-zinc oxide ointment. The treatment group was treated with ZMTM every 2 days combined with Western medicines. The two groups received continuous intervention for 30 days. The primary outcome was Psoriasis Area and Severity Index (PASI), and the secondary outcomes included Itch Rating Scale, Dermatology Quality of Life Index (DLQI), Hamilton Anxiety Rating Scale (HAMA), as well as PASI response rate. Meanwhile, adverse events were evaluated during the whole clinical trial. Follow-up was carried out 30 days after treatment.@*RESULTS@#There were 5 cases of shedding in this trial. In intention-to-treat analysis, 236 cases were included and each group contained 118 cases. On the 30th and 60th days, PASI scores of patients in each group were significantly lower than that at baseline (P<0.01) and the PASI score reduction of the treatment group was greater than that of the control group (P<0.01). Itch Rating Scale, DLQI, and HAMA scale were decreased in both groups after treatment, and the treatment group showed a better therapeutic effect (P<0.01). The response rates of PASI 50 and 75 were significantly higher than those in the control group [81.4% (96/118), 43.2% (51/118) vs. 41.5% (49/118), 11.0% (13/118), respectively, P<0.05]. During follow-up, the improvements in scores of PASI, Itch Rating Scale, DLQI, and HAMA of the treatment group were significantly greater than those of the control group (P<0.01). The response rates of PASI 50 and 75 in the treatment group were significantly higher than those in the control group, respectively (both P<0.05). No obvious adverse reaction was found in either group.@*CONCLUSION@#ZMTM combined with Western medicines showed a better therapeutic effect in the treatment of psoriasis vulgaris without obvious adverse reaction. (Trial Registration No. ChiCTR-IOR-16008159).
Subject(s)
Humans , Moxibustion/adverse effects , Psoriasis/drug therapy , Quality of Life , Severity of Illness Index , Treatment OutcomeABSTRACT
OBJECTIVE：To systematically evaluate the therapeutic efficacy and safety of Chinese patent medicine compound preparation combined with conventional therapy for psoriasis vulgaris ，and to provide evidence-based reference for clinical drug use. METHODS ：Retrieved from CNKI ，Wanfang database ，VIP，CBM，PubMed，the Cochrane Library and Web of Science ， RCTs about Chinese patent medicine compound preparation combined with conventional therapy versus conventional therapy in the treatment of psoriasis vulgaris were collected during the inception to Feb. 2020. After literature retrieval and data extraction ，the quality of the included studies was evaluated with risk bias assessment tool recommended by the Cochrane evaluation manual handbook 5.1. Bayesian network Meta-analysis was perfor med by using Stata 15.0 software，Addis 1.16.6 software and Markov Chain Monte Carlo method. RESULTS ：A total of 41 RCTs were included ，involving 4 122 patients. 5 kinds of interven- tion measures included Compound qingdai capsule ，Xiaoyin SF-010） granule， Keyin pill ，Yujin yinxie tablet and conventional therapy. Results of network Meta-analysis showed that in terms of improving the total effective rate ， compared with conventional therapy ，4 kinds of Chinese patent medicine compound preparations combined with conventional therapy could significantly improve the total effective rate （P＜0.05）；the results of network Meta-analysis were as follows ：Keyin pill combined with conventional therapy ＞Compound qingdai capsule combined with conventional therapy ＞Xiaoyin granule combined with conventional therapy ＞Yujin yinxie tablet combined with conventional therapy ＞conventional therapy. In terms of reducing psoriasis area and severity index （PASI）score after treatment ，compared with conventional therapy ，Keyin pill and Xiaoyin granule combined with conventional therapy could significantly reduce the PASI score （P＜0.05），while Compound qingdai capsule and Yujin yinxie tablet combined with conventional treatment had no significant difference （P＞0.05）；the results of network Meta-analysis showed that Xiaoyin granule combined with conventional therapy ＞Keyin pill combined with conventional therapy ＞ Compound qingdai capsule combined with conventional therapy ＞Yujin yinxie tablet combined with conventional therapy ＞ conventional therapy. In terms of reducing serum inflammatory factor level ，compared with conventional therapy ，Compound qingdai capsule and Xiaoyin granule combined with conventional therapy could significantly reduce the level of IL- 17（P＜0.05）， but Keyin pill and Yujin yinxie tablet combined with conventional therapy had no significant difference （P＞0.05）；the results of network Meta-analysis showed that Xiaoyin granule combined with conventional therapy ＞Compound qingdai capsule combined with conventional therapy ＞Yujin yinxie tablet combined with conventional therapy ＞Keyin pill combined with conventional therapy＞conventional therapy. In terms of safety ，there was no statistical significance in the incidence of ADR between 4 kinds of Chinese patent medicine combined with conventional therapy and conventional therapy （P＞0.05）；the results of network Meta-analysis showed that Compound qingdai capsule combined with conventional therapy ＞Xiaoyin granule combined with conventional therapy ＞Keyin pill combined with conventional therapy ＞conventional therapy ＞Yujin yinxie tablet combined with conventional therapy . CONCLUSIONS ：Compared with conventional therapy ，additional use of 4 kinds of Chinese patent medicine compound preparations can improve the curative effect of psoriasis vulgaris patients with blood heat syndrome ，and Keyin pill is the best ；Xiaoyin granule is the best in reducing the degree of skin lesions and serum inflammatory factors ；additional use of 4 kinds of Chinese patent medicine compound preparations show good safety ，and Compound qingdai capsule is the best.
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Objective:To study the clinical efficacy of modified Shengyutang on patients with active stage psoriasis vulgaris due to Qi and blood deficiency. Method:The 134 cases were randomly divided into control group and observation group， with 67 cases in each group. The control group was given avic a capsule + Danggui Buxuewan， while the observation group was given avic a capsule + modified Shengyutang for 4 weeks， respectively. The psoriasis area and severity index （PASI）， dermatological life quality index （DLQI） and psoriasis vulgaris due to Qi and blood deficiency syndrome were observed before and after treatment. The serum growth factor ［endothelial cell specific molecule-1 （ESM-1）， transforming growth factor-<italic>β</italic><sub>1</sub>（TGF-<italic>β</italic><sub>1</sub>）， vascular endothelial cell growth factor （VEGF）］， hemorheological indicators ［high cut blood viscosity （HBV）， low cut blood viscosity （LBV）， erythrocyte sedimentation rate （ESR）］， CC cphenotype receptor（CCR）6， CC cphenotype ligand 20 （CCL20）， monocyte chemotactic protein-4 （MCP-4） in serum and tissue fluid of lesions were detected. Clinical efficacy and recurrence follow-up for 12 months were compared. The safety was evaluated between two groups. Result:Three cases in control group and one case in observation group fell off during the study period. The total effective rate was 96.97% （64/66） in observation group， which was higher than 81.25% （52/64） in control group （<italic>χ</italic><sup>2</sup>=5.064， <italic>P</italic><0.05）. During the 12-month follow-up， the recurrence rate was 20.31% （13/64） in observation group， which was lower than 51.92% （27/52） in control group （<italic>χ</italic><sup>2</sup>=6.038， <italic>P</italic><0.05）. Compared with control group after treatment， PASI， DLQI， TCM syndromes， ESM-1， TGF-<italic>β</italic><sub>1</sub>， VEGF， HBV， LBV， ESR， CCR6， CCL20 and MCP-4 in observation group were significantly reduced （<italic>P</italic><0.05）. No obvious blood and urine routine， or heart， liver and renal dysfunction was observed in the two groups. The incidence of adverse reactions was 3.03% （2/66） in observation group， which was lower than 26.56% （17/64） in control group （<italic>χ</italic><sup>2</sup>=5.764， <italic>P</italic><0.05）. Conclusion:Modified Shengyutang can significantly improve the clinical symptoms of patients with active stage psoriasis vulgaris due to Qi and blood deficiency， with a low recurrence rate and the incidence of adverse reactions.
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Background: Psoriasis is a chronic relapsing disease necessitates long-term therapy. The disease severity, comorbidities, and access to health care determine the choice of therapy for psoriasis. The main aim of the treatment of psoriasis is to induce prolonged remission and suppress the disease as there is no cure. It is only palliative and symptomatic treatment, and the choice of treatment modality is according to the type of presentation. The various modalities of treatment available include topical therapies, systemic therapies, phototherapy, and biologics. The difference includes among clinical varieties in their presenting features, severity, natural course, and response to the treatment are responsible for variation in choice of therapy.Methods: In this descriptive study, data collected from patients diagnosed with psoriasis who were admitted in a K.S. Hegde Charitable hospital from January 2017 to January 2019 were analysed for demographic features, disease pattern and drug use pattern in patients.Results: Psoriasis vulgaris/plaque type of psoriasis was commonly observed type of psoriasis in our patients with fourth and fifth decade patients getting more affected. Diabetes was the most commonly associated comorbid disorder. The patients were treated both with systemic and topical modalities of treatment, antihistaminic and methotrexate were most commonly most commonly used systemic drug and moisturizers and glucocorticoids were used topical drugs.Conclusions: Psoriasis needs a multimodality treatment with careful monitoring for the comorbid disorder. Treatment choice is individualised depending on the severity and body parts affected.
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Psoriasis is one among the wide-spreading, chronic, frequently recurring diseases of the skin. Its worldprevalence varies between 0.09% and 11.4% in 2013 which reported in 2006 as in between 0.5% and 4.6%.In Ayurveda, the description of Kushta-roga viz. Vata-Kaphaja kushta finds similarity with psoriasis. Thecommon sites of occurrence of psoriasis are scalp, elbow, knee, earlobes and sole which are alsoconsidered as the location of Vata and Kapha.The science of Ayurveda has anecdotal accounts of success in the management of psoriasis in theactual clinical practice even though it lacks the evidence-based medical dermatology research data.It observed that the physicians adopt several treatment protocols for the cure of this disease inclinical practice, which was not rigorously evaluating in research settings. This paper/report is oneof on the ‘Thuvaraka rasayana’ is one such component that could improve treatment outcomes inPsoriasis.A pre and post test case report selected of a 36-year-old lady patient who diagnosed as having stablepsoriasis vulgaris for last seven years. She was administered with internal and external therapies alongwith Shodhana therapies (bio-cleansing procedures) and then followed by intake of Thuvaraka rasayana.The total duration of the treatment was 43 days, and the Study subject assessed before treatment, aftertreatment and on follow-up for improvement using PASI scoring, and histo-pathological study. All thesymptoms observed in the beginning were found considerably reduced, and the severity also found mild.On the follow-up, it concluded that the lesions disappeared completely and the skin set back to itsnormal texture. Even though psoriasis is an autoimmune disease where recurrence rate found moreShodhana therapy and Thuvaraka rasayana have a definite role.© 2018 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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OBJECTIVE： To evaluate the efficacy and safety of Yinxie capsules combined with Acitretin capsules in the treatment of psoriasis vulgaris in order to provide reference for clinical drug use. METHODS： Retrieved from PubMed， Embase， Cochrane Library， CBM， CNKI， VIP， Wanfang database， randomized controlled trials （RCTs） about Yinxie capsules combined with Acitretin capsules （trial group） vs. Acitretin capsules （control group） in the treatment of psoriasis vulgaris were collected. After literature screening， data extraction and quality evaluation with Cochrane 5.1.0 bias risk evaluation tool， Meta-analysis was performed by using Rev Man 5.3 software， and trial sequence analysis （TSA） was conducted with TSA 0.9 software. RESULTS： A total of 7 RCTs with 660 patients were included. Results of Meta-analysis showed that the total response rate [RR＝1.15，95％CI（1.04， 1.28）， P＝0.007]， the levels of IL-4 [SMD＝0.85，95％CI（0.02， 1.68），P＝0.04] and IL-10 [SMD＝0.56，95％CI（0.28， 0.83）， P＜0.000 1] in trial group were significantly higher than control group. The psoriasis area and severity index score [MD＝－2.34，95％CI（－2.77， －1.91），P＜0.000 01]， incidence of dry eye [RR＝0.32，95％CI（0.23， 0.45），P＜0.001]， dry skin [RR＝0.47，95％CI（0.32， 0.71），P＜0.001]， folliculitis [RR＝0.42，95％CI（0.30， 0.59），P＜0.001]， the elevation of ALT [RR＝0.18，95％CI（0.05， 0.61），P＝0.005] and hyperlipidemia [RR＝0.48，95％CI（0.35， 0.65），P＜0.001] in trial group were significantly lower than control group. There was no statistical significance in nose bleeding between 2 groups [RR＝0.46，95％CI（0.16， 0.37），P＝0.16]. TSA showed that the evidence of enhancing total response rate by Yinxie capsules combined with Acitretin capsules in the treatment of psoriasis vulgaris was reliable. CONCLUSIONS： Yinxie capsules combined with Acitretin capsules show good efficacy and safety for psoriasis vulgaris.
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Epidemiology shows that the most common psoriasis is psoriasis vulgaris. The common traditional Chinese medicine (TCM) syndrom is the blood-heat type, which is equivalent to the progressing stage of psoriasis. This article summarized the experimental research of TCM in treating psoriasis vulgaris which is considering as the blood-heat type on the basis of the differentiation of symptoms and signs. The mechanism of clinical efficacy on treating psoriasis vulgaris which is at the blood-heat type was explained in different layers such as Th lymphocytes subgroups, Notchsignalpathway, PTH and hemorheology. This study aimed to help scholars to understand the mechanism of therapeutic effect of TCM on the treatment of psoriasis vulgaris.
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OBJECTIVE:To observe therapeutic efficacy and safety of NB-UVB combined with Total glucosides of white paeony(TGP)capsules and Urea cream in the treatment of psoriasis vulgaris. METHODS:A total of 75 patients with psoriasis vulgaris in dermatology department of our hospital during Jan. 2015-Dec. 2016 were divided into control group(37 cases)and observation group(38 cases)according to random number table. Control group was given TGP capsules 0.6 g orally,3 times a day,reducing to 0.3 g,3 times a day if diarrhea or stool increased significantly after taking the medicine+Urea cream,smearing on the skin,day and evening,for consecutive 12 weeks. Observation group was additionally given NB-UVB irradiation with initial dose of 0.36 J/cm2,2 min/time,every other day,adjusted according to skin reaction for consecutive 8 weeks,on the basis of control group. Clinical efficacies of 2 groups were observed,and PASI scores before and after treatment and the occurrence of ADR were observed. RESULTS:One patient of observation group withdrew from therapy after suffering from obvious edematous erythema with pain due to irradiation. All patients of control group completed treatment. Total response rate of observation group (86.49%)was significantly higher than that of control group(56.76%),with statistical significance(P<0.05). Before treatment, there was no statistical significance in PASI scores between 2 groups(P>0.05). After treatment,PASI scores of 2 groups were significantly lower than before treatment,and observation group was significantly lower than control group,with statistical significance(P<0.05). There was no statistical significance in total incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:NB-UVB combined with TGP capsules and Urea cream show good therapeutic efficacy and safety for psoriasis vulgaris,and can significantly decrease PASI score of patients.
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OBJECTIVE:To observe the clinical efficacy and safety of Zidan yinxie granules combined with Acitretin capsule and Compound flumetasone ointment in the treatment of psoriasis vulgaris. METHODS:A total of 97 patients with psoriasis vulgaris were divided into control group(48 cases)and observation group(49 cases)according to number random method. Control group was given Acitretin capsule 10 mg,tid,for consecutive 8 weeks,and then 10 mg,bid,for consecutive 4 weeks and Compound flumetasone ointment for external use,bid. Observation group was given Zidan yinxie granule 4 g,tid,on the basis of control group. Treatment courses of 2 groups lasted for 12 weeks. Clinical efficacy was observed in 2 groups. Psoriasis area and severity index(PASI)score,VAS score,dermatology life quality index(DLQI) score,the expression of neutrophil elastase(NE),Trappin-2 and placental calcadin(P-cad)in serum and tissue fluid of skin lesion were observed before and after treatment. Recurrence followed up for 6 months in total effective patients and the occurrence of ADR were observed. RESULTS:Two patients of observation group withdrew from the study,and 47 patients completed the study;three patients of control group withdrew from the study,and 45 patients completed the study. Total response rate of observation group was 97.87%,which was significantly higher than 84.44% of control group,with statistical significance(P<0.05). After treatment,PASI,VAS and DLQI scores,the content of NE,Trappin-2 and P-cad in serum and tissue liquid of skin lesion were significantly lower than before treatment;the observation group was significantly lower than the control group. After 6-month follow-up,recurrence rate of total effective patients in observation group(28.26%)was significantly lower than control group(47.36%),and average recurrence time of observation group [(17.91 ± 3.10)weeks]was longer than that of control group [(9.80± 3.41)weeks],with statistical significance(P<0.05). There was no statistical significance in the total incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Zidan yinxie granules combined with Acitretion capsule and compound flumetasone ointment show clinical efficacy in the treatment of psoriasis vulgaris by lowering the expression of NE, Trappin-2 and P-cad in serum and tissue liquid of skin lesion with good safety.
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A 59 year-old woman with rashes of forehead and chest visited our hospital in hope of treatment with Kampo medicine. The rashes had occurred at the age of 50 years old and gradually spread. She had been diagnosed with psoriasis vulgaris by a nearby dermatologist. Though she had been treated with the steroid ointment, the symptom had repeated exacerbation and remission for nine years. At the first examination, her exanthems were damp, concentrated on frontlet and was seen in posterior cervical region, precordial region, upper and lower limb. Jizusoippo was prescribed, and the exanthem improved significantly in 4 months. In conclusion, jizusoippo can be effective in cases of psoriasis that the exanthems are damp and concentrate on head.
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OBJECTIVE:To observe therapeutic efficacy and safety of modified Longdan xiegan tang in the treatment of psoria-sis vulgaris(blood heat type). METHODS:A total of 80 patients with psoriasis vulgaris(blood heat type)were randomly divided into control group(38 cases)and observation group(42 cases),other 30 healthy volunteers were included in healthy control group. Control group was given Xiaoyin tablet 1.6 g orally,3 times a day for 4 weeks. Observation group was given modified Longdan xiegan tang,400 mL after detected with water,1 h after breakfast and supper,7 d as a treatment course,for 4 courses. Clinical ef-ficacies and PASI score were observed before and after treatment. The levels of inflammatory factors(IL-1,IL-6,IL-8,TNF-α), the expression of NF-κB protein and NF-κB gene were observed in observation group before and after treatment,and then were compared with healthy control group. The relationship of inflammatory factor levels with NF-κB protein expression in observation group before treatment,the relationship of PASI score with inflammatory factor and NF-κB expression were observed in observa-tion group before and after treatment,and the occurrence of ADR was recorded. RESULTS:Total response rate of observation group(85.7%)was significantly higher than that of control group(52.6%),with statistical significance(P<0.05). Before treat-ment,there was no statistical significance in PASI score between 2 groups (P>0.05). After treatment,PASI score of 2 groups were significantly lower than before treatment,and the observation group was significantly lower than the control group,with statis-tical significance (P<0.05). After treatment,The levels of IL-1,IL-6,IL-8 and TNF-α in observation group were significantly lower than before treatment,but there was no statistical significance with healthy control group(P>0.05);the expression of NF-κB protein and NF-κB gene in observation group were significantly higher than healthy control group,with statistical significance(P<0.01 or P<0.05). The levels of IL-1, IL-6, IL-8 and TNF-α were positively associated with the expression of NF-κB protein in observation group before treatment. The levels of IL-1,IL-6,IL-8 and TNF-α and the expression of NF-κB pro-tein were both positively associated with PASI score in observa-tion group before and after treatment. CONCLUSIONS:Modified Longdan xiegan tang show significant therapeutic efficacy for psoriasis vulgaris(blood heat type),can reduce PASI score,the levels of NF-κB protein expression and inflammatory factors.
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Objective To investigate the effect of calcipotriol in the treatment of psoriasis vulgaris.Methods 306 patients with stable psoriasis vulgaris were randomly divided into control group (n =153) and experimental group (n =153).Patients received in 2 groups received Vitamin C,folic acid and narrow-band UVB treatment.The control group was treated with clobetasol propionate ointment,those and in the experimental group was treated with topical ointment of calcipotriol.Scores of PASI and dermatological quality of life (DLQI)were measured,and the therapeutic effect,the serum levels of inflammatory cytokines,T lymphocyte subpopulations and skin barrier function were compared between the two groups.Results Compared with before treatment,levels of IFN-γ,IL-2,IL-17 and IL-18 in the two groups decreased (P ＜ 0.01),levels of CD3 +,CD4 + and CD4 +/CD8 + increased (P ＜ 0.01),levels of CD8 + decreased (P ＜0.01),levels of sebum content,water content of cuticle increased (P ＜ 0.01),levels of PH value decreased (P ＜ 0.01),PASI score,DLQI score decreased (P ＜ 0.01).Compared with the control group,the levels of IFN-γ,IL-2,IL-17 and IL-18 were lower (P ＜ 0.01),levels of CD3 +,CD4 + and CD4 +/CD8 + were higher (P ＜0.01),levels of CD8 + was lower(P ＜0.01),sebum content,water content of cuticle were higher (P ＜ 0.01),PH value was lower(P ＜0.01),PASI score and DLQI score were lower(P ＜0.01).Conclusion The efficacy of calcipotriol in treating psoriasis vulgaris is significant,worth of clinical promotion.
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Objective To investigate the characteristics and the clinical significance of relevant parame-ters of blood in psoriasis vulgaris(PV). Methods A retrospective analysis among 38 PV patients and 40 normal controls was done. The comparing parameters contained NLR,CRP,total cholesterol,triglyceride,serum uric acid.Pearson correlation analysis was used to detect the correlations.Results NLR,total cholesterol,triglyceride, serum uric acid in psoriasis vulgaris patients were significantly higher than in the normal controls(P < 0.05). There was a statistically significant correlation between NLR and PASI in the PV patients,but no correlation of CRP with NLR and PASI(P > 0.05). In the patients with PASI ≥ 7,the serum uric acid level was significantly higher than in those with PASI < 7. Conclusions NLR is indicateive of the severity and state of inflammation. The severer PV,the higher the level of serum uric acid.
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Objective To analyse the clinical effect of Yinxie capsule combined with compound flumetasone ointment in the treatment of psoriasis vulgaris. Methods 110 patients with psoriasis vulgaris who were treated in our hospital from June 2015 to June 2017 were selected and divided into control group (n=55) and observation group (n=55) according to their admission order and double order. The control group was treated by compound flumetasone ointment, the observation group on the basis of the increase of Yinxie capsule treatment, compared two groups of patients with clinical curative effect. Results Two groups of patients before treatment, the PASI score, DLQI score was not significantly different, were decreased after treatment, and the observation group in the decrease of higher than the control group, the difference was statistically significant (P<0.05). In the effective rate of clinical treatment, the control group was far less than the observation group (83.64 %<98.18 %), the difference was statistically significant (P<0.05). In the incidence of adverse reactions, there was no significant difference between the control group and the observation group. Conclusion Yinxie capsule combined with compound flumetasone ointment in the treatment of psoriasis vulgaris not only has excellent clinical effect, and has high safety, can be popularized in clinical treatment.