Effects of Qingre Huoxue Jiedu Formula on Nerve Growth Factor-Induced Psoriasis.

OBJECTIVE: To elucidate the mechanisms of 4 effective components from a Chinese medicine formula, namely Qingre Huoxue Jiedu Formula (QHJ heat- and toxin-clearing and blood-activating formula), in the treatment of nerve growth factor (NGF)-induced psoriasis. METHODS: Keratinocyte proliferation and T cell proliferation models were developed using NGF. An NGF solution (NGF+DMEM, 100 ng/mL) was added to all induced groups and treated groups and were cultured for 24 h, while a solution with NTRK1 antagonist (K252a+DEME, 300 nmol/L) was added and cultured for 1 h. The models were used to evaluate the effects of the treatment with each of the 4 components of QHJ, namely shikonin, paeonol, astilbin and ursolic acid. Cell apoptosis and proliferation were measured by flow cytometry analysis and CCK8 assay, respectively. The mRNA expression levels of Bax, Bcl-xl, and NGF receptor (NGFR) were assessed by quantitative real-time PCR (qRT-PCR) and Western blot analysis, respectively. RESULTS: (1) All QHJ-treated groups showed significantly increased cell apoptosis and inhibition of cell proliferation compared with the NGF-induced groups (P<0.05). In addition, treatment with QHJ plus NTRK1 significantly enhanced cell apoptosis and inhibition of cell proliferation compared with cells treated with QHJ only (P<0.05), particularly in cells treated with ursolic acid. (2) QHJ-treated groups showed higher protein expression levels of Bax, Bcl-xl compared with other groups (P<0.05). Additionally, treatment with QHJ plus NTRK1 significantly increased the protein expression levels of Bax, Bcl-xl and NGFR compared with those treated with QHJ only (all P<0.05), especially in those treated with shikonin. CONCLUSION: The action mechanism of QHJ on psoriasis might be through enhancing cell apoptosis and inhibition of cell proliferation, and upregulating the expression level of Bax, Bcl-xl and NGFR.

Factors affecting health-related quality of life in patients with skin disease: cross-sectional results from 8,789 patients with 16 skin diseases.

BACKGROUND: Many previous studies have reported factors that contribute to health-related quality of life (HRQoL) for a single skin disease. However, little is known about generalized factors associated with HRQoL across skin diseases. The objective of this study was to investigate overall HRQoL, and to identify factors related to severely impaired HRQoL among patients with 16 different skin diseases. METHODS: A cross-sectional study of 9845 patients with skin disease was conducted in 9 hospitals in China. HRQoL was assessed with the Chinese version of the Skindex-29 which measures dermatology-specific health along three domains (symptoms, emotions and functioning). With the published Skindex-29 cut-off scores for severely impaired HRQoL, logistic regression models assessed the relationship between severely impaired HRQoL and demographic/clinical characteristics, with adjustments for different skin diseases. To guarantee the models' convergence, 16 skin diseases with frequencies of at least 100 were included, and the sample size was 8789. RESULTS: Emotions was the most impaired aspect of HRQoL. Co-existing chronic diseases, 3 years or longer duration, and more severity were identified as associated factors for severely impaired HRQoL for each Skindex-29 domain, and for the aggregate. Being female, under 45 years old, and consuming alcohol were associated with a severely impaired emotion domain; Lack of exercise and smoking were associated with severely impaired symptoms and function domains, respectively. CONCLUSIONS: Skin diseases can affect many facets of HRQoL, but the emotional impairment deserves more attention. In addition to skin disease severity, this study shows that other chronic diseases and long duration are correlated with severely impaired HRQoL for patients with 16 clinical common skin diseases. This suggests the need for increased awareness in treating skin disease as a chronic disease. It also suggests that disease management decisions should consider HRQoL improvement, especially emotional conditions, when making management decisions.

Rasch Analysis of the Dermatology Life Quality Index Reveals Limited Application to Chinese Patients with Skin Disease.

The objective of this study was to examine the psychometric properties of the Chinese version of the Dermatology Life Quality Index (DLQI) and to assess the invariance of its items with respect to several patient parameters via Rasch analysis. Data were aggregated from 9,845 patients with various skin diseases across 9 hospitals in different regions of China. The response structure, local independence, and reliability of the DLQI scale were analysed in a partial credit model, and differential item functioning (DIF) across region, disease, sex, and age were assessed with a Mantel-Haenszel procedure. Although acceptable scale reliability (Person Separation Index=2.3) was obtained, several problems were revealed, including disordered response thresholds, misfitting items, DIF by geogra-phical region and disease, and mis-targeting patients with mild impairment regarding health-related quality of life (HRQL). In conclusion, the DLQI provides inadequate information on patients' impairments in HRQL, and the application of the DLQI in Chinese patients with skin disease is limited.

Chinese herbal Pulian ointment in treating psoriasis vulgaris of blood-heat syndrome: a multi-center, double-blind, randomized, placebo-controlled trial.

BACKGROUND: Traditional Chinese medicine (TCM) has a long history in the treatment of psoriasis vulgaris. We aimed to evaluate the clinical efficacy and safety of Chinese herbal Pulian ointment in treating psoriasis vulgaris of blood-heat syndrome. METHODS: A multicenter, randomized, double-blind, placebo-controlled trial was conducted. Participants with psoriasis vulgaris of blood-heat syndrome were blinded and randomized to receive Pulian ointment or placebo ointment twice daily for 4 weeks, with follow-up 8 weeks after treatment. Psoriasis Area Severity Index (PASI) scores, severity of each symptom and area of skin lesion and quality of life were assessed at baseline, 2 weeks, and 4 weeks. Adverse events were recorded during the study. SAS 9.4 software and SPSS 17.0 software was applied for data analysis. RESULTS: A total of 300 participants with psoriasis vulgaris of blood-heat syndrome were assessed for eligibility, and 294 were randomly assigned to the Pulian ointment and placebo group from six study centers. Full analysis set (FAS): after 4 weeks of treatment, there were significant differences between groups in PASI score and the separate score of skin lesion area, favoring Pulian ointment group (P < 0.05). However, no significant differences were observed in scores of scaling, erythema and induration/thickness (P > 0.05). Per protocol set (PPS): There was no statistically significant difference in PASI score and separate score of each symptom and area of skin lesion between two groups (P > 0.05). Quality of life measured by Hamilton Anxiety Rating Scale (HAMA) and 36-Item Short Form Health Survey (SF-36) improved after treatment in both groups, but there was no significant difference between the two groups (P > 0.05). After being followed up for 8 weeks, the total relapse rates of the Pulian Ointment group and placebo group were 5.88 and 8.45%, respectively, and the difference was not statistically significant between the two groups (P > 0.05). No adverse event was observed in both groups throughout the study. CONCLUSIONS: Pulian Ointment seems effective and well tolerated in improving the PASI score and separate score of skin lesion area for patients with psoriasis vulgaris of blood-heat syndrome. Further research could build on the current study to explore whether other preparation forms and greater intervention intensity are necessary for better therapeutic effects. TRIAL REGISTRATION: Chictr.org.cn Identifier ChiCTR-TRC-12002054 .

PageRank analysis reveals topologically expressed genes correspond to psoriasis and their functions are associated with apoptosis resistance.

Psoriasis is an inflammatory skin disease. Deceleration in keratinocyte apoptosis is the most significant pathological change observed in psoriasis. To detect a meaningful correlation between the genes and gene functions associated with the mechanism underlying psoriasis, 927 differentially expressed genes (DEGs) were identified using the Gene Expression Omnibus database, GSE13355 [false discovery rate (FDR) <0.01; |log fold change >1] with the package in R langue. The selected DEGs were further constructed using the search tool for the retrieval of interacting genes, in order to analyze the interaction network between the DEGs. Subsequent to PageRank analysis, 14 topological hub genes were identified, and the functions and pathways in the hub genes network were analyzed. The top­ranked hub gene, estrogen receptor­1 (ESR1) is downregulated in psoriasis, exhibited binding sites enriched with genes possessing anti­apoptotic functions. The ESR1 gene encodes estrogen receptor α (ERα); a reduced level of ERα expression provides a crucial foundation in response to the anti­apoptotic activity of psoriatic keratinocytes by activating the expression of anti­apoptotic genes. Furthermore, it was detected that the pathway that is associated most significantly with psoriasis is the pathways in cancer. Pathways in cancer may protect psoriatic cells from apoptosis by inhibition of ESR1 expression. The present study provides support towards the investigation of ESR1 gene function and elucidates that the interaction with anti­apoptotic genes is involved in the underlying biological mechanisms of resistance to apoptosis in psoriasis. However, further investigation is required to confirm the present results.

[A randomized, placebo controlled study on Fangfeng Tongsheng granule in treatment of sub-acute eczema].

The clinical study was conducted to further evaluation the effectiveness and safety of Fangfeng Tongsheng granule in the treatment of sub-acute eczema (superficial cold and interior heat syndrome, exterior and interior sthenic syndrome). In the block randomized, multi-centered study, totally 108 patients were enrolled and assigned to two groups: 72 patients in the test group and 36 patients in the placebo control group. Those in the test group took Fangfeng Tongsheng granule with the dose of 3 g, twice a day, while those in the control group were give simulated agent granules with the same dose. The therapeutic course lasted for 14 days. Their efficacies in TCM syndrome, dermal symptoms and adverse events were observed. According to the test results, except for the one exit case, all of the remaining 108 cases, including 71 in the test group, and 36 in the control group, completed the clinical trial. As for the efficacy of TCM syndrome, after the medication for 2 weeks, the cure rate was 33.81% (24/71) in the test group and 0% (0/36) in the control group (P < 0.01), with a statistical difference between the two groups. Regarding the TCM score, after the medication for 2 weeks, the test group decreased by (12.82 +/- 7.96), while the control group decreased by (3.67 +/- 4.12), indicating a statistical difference between the two groups. As for the efficacy of dermal symptoms, after the medication for 2 weeks, the cure rate was 25.35% (18/71) in the test group and 0% (0/36) in the control group, with a statistical difference between the two groups. Regarding the dermal symptom score, after the medication for 2 weeks., the test group decreased by (10.04 +/- 7.17), while the control group decreased by (2.33 +/- 3.57), indicating a statistical difference between the two groups. There was no significant adverse event caused by Fangfeng Tongsheng granule. In conclusion, Fangfeng Tongsheng granule was effective and safe in treating subcute eczema (superficial cold and interior heat syndrome, exterior and interior sthenic syndrome).

Exploratory clinical trial to evaluate the efficacy of a topical traditional chinese herbal medicine in psoriasis vulgaris.

Objective. To evaluate the efficacy and safety of herbal ointment, Shi Du Ruan Gao, in patients with plaque-type psoriasis. Design. Single-center, randomized, investigator-blinded, parallel group, placebo-controlled study. Participants. One hundred outpatients with mild to moderate chronic plaque-type psoriasis were enrolled. Intervention. The patients applied either Shi Du Ruan Gao ointment or vehicle ointment topically to for 8 weeks. Main Outcome Measures. The outcomes were assessed using the following criteria: Total Severity Score (TSS, sum of erythema, scaling, and plaque elevation/induration, on a 0 to 4 scale), Investigator Global Assessment (IGA) evaluated on a 0 (Clear) to 4 (s to very severe) scale, and Global Subjects' Assessment of treatment response on a 7-point scale from -1 (worse) to 5 (Cleared). Results. Significant reductions in the Total Severity Score (P < 0.001) (mean score: 2.7 after Shi Du Ruan Gao treatment versus 5.1 in control subjects). Both Investigator Global Assessment (IGA) and Global Subjects' Assessment of treatment are better in the Shi Du Ruan Gao group than the control group (P < 0.001). Conclusion. Shi Du Ruan Gao ointment was a safe, and effective therapy for plaque-type psoriasis.

[Effects of Chinese medical facial mask comprehensive therapy in treating acne vulgaris].

OBJECTIVE: To evaluate the clinical effectiveness and safety of Chinese medical facial mask comprehensive therapy in treating acne vulgaris. METHODS: Totally 233 acne vulgaris patients (FAS set) in I -III degree were randomly assigned to the facial mask group (113 cases) and the Western medicine group (120 cases). They were respectively treated with external application of Chinese medical facial mask (twice a week) and 5% benzoyl peroxide gel (Benzine, once in the evening). The treatment lasted for four successive weeks. The integrals of lesions and the improvement of Chinese medicine syndrome integrals were observed 1 week, 2 weeks and 4 weeks after treatment respectively. The occurrence of adverse reactions was recorded. The subjects' evaluation on using the Chinese medical facial mask comprehensive therapy was also recorded. RESULTS: Totally 228 of the 233 patients completed the therapeutic course (7 cases of overtime, 221 cases of PPS set, 105 cases in the facial mask group and 116 cases in the Western medicine group). After 4 weeks of treatment, the lesions and the total effective rate of CM symptoms were obviously higher in the facial mask group than in the control group (46.9% vs 30.0%, 70.8% vs 55.8%, P < 0.05). The statistical results of FAS set and PPS set showed no difference. After 4 weeks of treatment, the integrals of PPS lesions and the CM syndrome integrals in the facial mask group were lower than in the Western medicine group, showing statistical difference (P < or = 0.05). After 2 weeks and 4 weeks of treatment, the integrals of lesions and the CM syndrome integrals of FAS set and PPS set were all higher in the facial mask group than in the control group (P < 0.05). The occurrence of adverse reactions was 1.8% (2/113) in the facial mask group and 2.5% (3/120) in the control group without statistical difference (P > 0.05). CONCLUSIONS: Chinese medical facial mask comprehensive therapy is safe and effective in treating acne vulgaris of I - III degree. The occurrence of adverse reactions is very low. It is easy to operate and spread.

Expression of the psoriasis-associated antigen, Pso p27, is inhibited by traditional Chinese medicine.

AIM OF THE STUDY: Pso p27 is shown to be an autoantigen in psoriasis and the objective of the present study was to investigate whether Traditional Chinese Medicine (TCM) would influence the expression of Pso p27. MATERIALS AND METHODS: Skin biopsies obtained from psoriatic patients before and after treatment with TCM were analyzed for the presence of Pso p27 antigen by indirect immunofluorescence using murine monoclonal antibodies against Pso p27. RESULTS: A significant reduction in the amount of Pso p27 in the psoriatic skin was obtained after treatment with TCM for 3 months. CONCLUSIONS: The presence of Pso p27 in psoriatic skin is reduced when psoriatic patients are treated with TCM.

Distribution and development of the TCM syndromes in psoriasis vulgaris.

OBJECTIVE: To study the distribution and development rules of the TCM syndromes in psoriasis vulgaris. METHODS: Based on the clinical epidemiologic mass survey, the study was carried out by means of a status survey, multi-center and large-sample research. The data base was set up by EPIINFO6.0. The SPSS was used to do the statistical analyses in 2651 cases of psoriasis vulgaris to study the correlations among the distribution and development of the TCM syndromes, the stages of the disease, nationality, psoriasis history, family history, smoking history, alcohol drinking history, and severity of the disease. RESULTS: The TCM syndromes in psoriasis vulgaris mainly include the blood-heat syndrome (53.8%), blood-dryness syndrome (27.4%), and blood-stasis syndrome (18.1%). Other syndromes were rarely seen, covering 0.6%. The concurrent syndromes mainly involve dampness, heat, blood stasis and toxin. The distribution differences of the main syndromes at different stages of the disease had statistical significance (P < 0.01). The syndrome distribution is not related with nationality and family history (P > 0.05), but it was closely related with the psoriasis history, smoking history, alcohol drinking history, and severity of the disease (P < 0.01). CONCLUSION: At the initial stage, psoriasis vulgaris usually manifests itself as the blood-heat syndrome, and later it may be improved or turn into the blood-dryness or blood-stasis syndrome. Smoking, alcohol consumption, and severity of the disease may play a role in the syndrome's transformation.

[Effect of combined herbal medicine therapy on the expression of psoriasis-associated antigen-Pso p27 in patients with psoriasis vulgaris].

OBJECTIVE: To evaluate the effect of combined herbal medicine therapy on the expression of psoriasis-associated antigen (Pso p27) in patients with psoriasis vulgaris. METHODS: Fifteen psoriasis vulgaris patients were included in the study and they were all treated with combined herbal medicine therapy for 12 weeks. Both psoriasis area and severity index (PASI) score and plaque index (PI) score were evaluated before and after treatment, while skin biopsies from selected lesions and uninvolved skin near the lesions were performed. Expression of Pso p27 in the target skin and surrounding uninjured skins were analysed using immunofluorescence method. RESULTS: The PASI score and PI score decreased after the combined herbal medicine therapy in both acute and silent stages (P < 0.01), so did the positive cells of Pso p27 and the intensity of fluorescein stain (P < 0.05). CONCLUSION: The combined herbal medicine therapy is effective in treating psoriasis vulgaris in both acute and silent stages, which may be resulted from its inhibition of the expression of Pso p27.

[Clinical efficacy of narrow band ultraviolet bin combined with yuyin recipe in treating psoriasis vulgaris].

OBJECTIVE: To observe the clinical efficacy of narrow band ultraviolet bin (NB-UVB) combined with Yuyin Recipe (YYR) in treating psoriasis vulgaris (PV). METHODS: One hundred and nineteen patients with PV were randomly assigned to 2 groups by envelop method, the 62 patients in the treated group were treated with NB-UVB and YYR bathing, and the 57 in the control group were treated with NB-UVB alone. The course of treatment for both groups was 8 weeks. PASI scoring was performed before treatment and at the 2nd, 4th, 6th and 8th week of treatment respectively, and the treatment effect was evaluated depending on the decreasing rate of PASI score. The accumulated dose and side-effect of NB-UVB applied was observed. RESULTS: The PASI scores in the treated group measured at various time points after treatment were significantly different to that of baseline (P < 0.05). The cure rate in the treated group and the control group was 69.35% and 24.56% while the total effective rate in them 96.77% and 71.93%, respectively, showing significant difference between the two groups (chi2 = 27.755, P <0.01). The difference of PASI decreasing rate between groups showed statistical significant from the 4th week (P <0.01). The total dose of NB-UVB applied in the treated group (9.95 +/- 4.76) was less than that in the control group (12.77 +/- 5.05) with the difference of statistical significance (t = 3.141, P <0.01). The adverse reaction occurrence in them was 4.84% (3/62) and 31.58% (18/57) respectively, also showing significant difference (chi2 = 119, P <0.01). CCONCLUSION: The combined use of TCM medicated bath with NB-UVB can enhance the curative effect, reduce the accumulated dosage and lessen the adverse reactions of ultraviolet radiation.

Clinical observation in 86 cases of acne vulgaris treated with Compound Oldenlandis Mixture.

86 cases of acne vulgaris were treated with Fu Fang She She Cao He Ji ([symbol: see text] Compound Oldenlandis Mixture), with the other 34 cases treated with Dang Gui Ku Shen Wan ([symbol: see text] Pills Prepared from Chinese Angelica and Flavescent Sophora Root) as the controls, to observe the therapeutic effect of the former. The results showed that the cure plus markedly effective rate was 73.26% in the treatment group, and 47.06% in the control group, with a significant difference in the cure plus markedly effective rate between the two groups (P < 0.01), and also in the total effective rate between the two groups significant (P < 0.05). It may be concluded that the Compound Oldenlandis Mixture is a better agent for the illness.