Chinese herbal medicine for atopic dermatitis: a systematic review.

BACKGROUND Atopic dermatitis (AD) is a chronic, itching skin disease, and conventional therapies offer inadequate symptom management. Patients with AD are increasingly turning to Chinese medicine. OBJECTIVE We systematically evaluated the clinical evidence of the efficacy and safety of oral Chinese herbal medicine for AD. METHODS Searches were conducted on major electronic databases using the following key words: "randomized controlled trials," "atopic dermatitis," "traditional Chinese medicine," "traditional East Asian medicine," "herbal medicine," "Chinese herbal drugs," "medicinal plants," "phytotherapy," "Kampo medicine," and "Korean traditional medicine." The results were screened to include English/Chinese randomized controlled trials. A metaanalysis was conducted on suitable outcome measures. RESULTS Seven randomized controlled trials were included (1 comparing Chinese herbal medicine and Western medicine with Western medicine alone; 6 comparing Chinese herbal medicine with placebo). Combined Chinese herbal medicine with Western medicine was superior to Western medicine alone. Three placebo controlled trials showed significant treatment efficacy and 2 showed significantly reduced concurrent therapy with Chinese herbal medicine. No abnormalities in safety profile or severe adverse events were reported. LIMITATIONS A metaanalysis of all included studies could not be conducted because of study heterogeneity. CONCLUSIONS Chinese herbal medicine significantly improved symptom severity of AD and was reported as well tolerated. However, the poor quality of studies did not allow for valid conclusions to support its tolerability and routine use. Additional studies addressing the methodologic issues are warranted to determine the therapeutic benefit of Chinese herbal medicine for AD.

[1]  K. Kaulback,et al.  The Socioeconomic Impact of Atopic Dermatitis in the United States: A Systematic Review , 2008, Pediatric dermatology.

[2]  D J Newell,et al.  Intention-to-treat analysis: implications for quantitative and qualitative research. , 1992, International journal of epidemiology.

[3]  M. Ishii,et al.  Efficacy and Safety of a Traditional Herbal Medicine, Hochu-ekki-to in the Long-term Management of Kikyo (Delicate Constitution) Patients with Atopic Dermatitis: A 6-month, Multicenter, Double-blind, Randomized, Placebo-controlled Study , 2008, Evidence-based complementary and alternative medicine : eCAM.

[4]  Jing-zheng Song,et al.  UPLC-PDA-TOFMS based chemical profiling approach to rapidly evaluate chemical consistency between traditional and dispensing granule decoctions of traditional medicine combinatorial formulae. , 2010, Journal of pharmaceutical and biomedical analysis.

[5]  H. Williams,et al.  WITHDRAWN: Chinese herbal medicine for atopic eczema. , 2013, The Cochrane database of systematic reviews.

[6]  M. Gershwin,et al.  Treatment of Eczema , 2007, Clinical reviews in allergy & immunology.

[7]  C. Lam,et al.  In vitro and clinical immunomodulatory effects of a novel Pentaherbs concoction for atopic dermatitis , 2008, The British journal of dermatology.

[8]  Guang-wei Chen,et al.  The Efficacy and Safety of a Chinese Herbal Product (Xiao-Feng-San) for the Treatment of Refractory Atopic Dermatitis: A Randomized, Double-Blind, Placebo-Controlled Trial , 2010, International Archives of Allergy and Immunology.

[9]  P. Shenefelt,et al.  Herbal therapy in dermatology. , 2002, Archives of dermatology.

[10]  K. Fung,et al.  Efficacy and tolerability of a Chinese herbal medicine concoction for treatment of atopic dermatitis: a randomized, double‐blind, placebo‐controlled study , 2007, The British journal of dermatology.

[11]  G H Guyatt,et al.  Intention-to-treat principle. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[12]  E. Ernst,et al.  The treatment of eczema with Chinese herbs: a systematic review of randomized clinical trials. , 1999, British journal of clinical pharmacology.

[13]  R. Prescott,et al.  The cost of atopic eczema , 1996, The British journal of dermatology.

[14]  S. B. Kayne,et al.  Traditional medicine: a global perspective. , 2010 .

[15]  R Yuan,et al.  Traditional Chinese medicine: an approach to scientific proof and clinical validation. , 2000, Pharmacology & therapeutics.

[16]  G. Varigos,et al.  Atopic eczema: its impact on the family and financial cost , 1997, Archives of disease in childhood.

[17]  H. Williams,et al.  Chinese herbal medicine for atopic eczema. , 2013, The Cochrane database of systematic reviews.

[18]  Paul Giboney,et al.  Mildly elevated liver transaminase levels in the asymptomatic patient. , 2005, American family physician.

[19]  V. Scheid,et al.  Chinese Herbal Medicine. Formulas & Strategies , 2009 .

[20]  D. Atherton,et al.  A controlled trial of traditional Chinese medicinal plants in widespread non‐exudative atopic eczema , 1992, The British journal of dermatology.

[21]  Li-Fang Wang,et al.  Emerging Treatment of Atopic Dermatitis , 2007, Clinical reviews in allergy & immunology.

[22]  J. Brostoff,et al.  Efficacy of traditional Chinese herbal therapy in adult atopic dermatitis , 1992, The Lancet.

[23]  P. But,et al.  A controlled trial of traditional Chinese herbal medicine in Chinese patients with recalcitrant atopic dermatitis , 1999, International journal of dermatology.

[24]  Jin-Ling Tang,et al.  Traditional Chinese medicine , 2008, The Lancet.

[25]  H. Williams,et al.  Systematic review of treatments for atopic eczema. , 2000, Health technology assessment.

[26]  L. Buys,et al.  Treatment options for atopic dermatitis. , 2007, American family physician.

[27]  Jianpin Liu,et al.  Comparison of effectiveness and safety between granules and decoction of Chinese herbal medicine: a systematic review of randomized clinical trials. , 2012, Journal of ethnopharmacology.