Abstract：
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.
OBJECTIVE: 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.
CONCLUSIONS: 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.
OBJECTIVE: 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.
CONCLUSIONS: 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.
摘要：
背景：中草药（CHM）浴在中国通常用作治疗寻常型银屑病的辅助疗法。以前的系统评价表明，CHM浴疗法对寻常型银屑病是有效和安全的，然而,没有探索CHM浴疗法的细节，如最佳温度，每届会议的持续时间，和总治疗持续时间。
目的：评估CHM浴疗法对成人寻常型银屑病常规疗法的附加效果。
方法：我们从开始到2022年9月在9个医学数据库中进行了全面搜索，以确定以中文或英文发表的相关随机对照试验（RCT）。纳入的研究比较了CHM浴疗法和常规疗法的组合与仅常规疗法治疗成人寻常型银屑病。使用Cochrane偏倚风险工具2（RoB2）对纳入的RCT进行方法学质量评估。采用RevMan5.4、R4.2.3和Stata12.0软件进行统计学分析。使用建议分级评估来评估结果测量证据的确定性，发展,和评估工作组（等级）系统。
结果：本系统综述共纳入23项RCT，涉及2,183名参与者。研究结果表明，CHM浴疗法和常规疗法的组合在减少银屑病面积和严重程度指数（PASI）方面更有效，皮肤病学生活质量指数（DLQI）和瘙痒视觉模拟量表，与单独使用常规疗法相比。当CHM浴设置在38°C以上并且持续时间为20和30分钟时，这些增强的效果显着观察到。由DLQI评估。此外，与较短持续时间相比,8周的治疗持续时间对PASI产生了更好的效果.此外,纳入研究的前十种常用草药被确定。尽管有这些发现,根据等级评估，证据的确定性被评为“低”或“中等”，在亚组和敏感性分析中检测到显著的异质性。
结论：对于成人寻常型银屑病，CHM浴疗法联合常规疗法比常规疗法更有效，更安全。结果表明，治疗效果与延长治疗持续时间等因素之间存在潜在的相关性。提高浴温,和更长的洗澡时间。然而,由于纳入研究的方法学局限性,证据的确定性被降级.为了证实本系统综述的结果，双盲，未来需要安慰剂对照RCT。
目的：评估CHM浴疗法对成人寻常型银屑病常规疗法的附加效果。
方法：我们从开始到2022年9月在9个医学数据库中进行了全面搜索，以确定以中文或英文发表的相关随机对照试验（RCT）。纳入的研究比较了CHM浴疗法和常规疗法的组合与仅常规疗法治疗成人寻常型银屑病。使用Cochrane偏倚风险工具2（RoB2）对纳入的RCT进行方法学质量评估。采用RevMan5.4、R4.2.3和Stata12.0软件进行统计学分析。使用建议分级评估来评估结果测量证据的确定性，发展,和评估工作组（等级）系统。
结果：本系统综述共纳入23项RCT，涉及2,183名参与者。研究结果表明，CHM浴疗法和常规疗法的组合在减少银屑病面积和严重程度指数（PASI）方面更有效，皮肤病学生活质量指数（DLQI）和瘙痒视觉模拟量表，与单独使用常规疗法相比。当CHM浴设置在38°C以上并且持续时间为20和30分钟时，这些增强的效果显着观察到。由DLQI评估。此外，与较短持续时间相比,8周的治疗持续时间对PASI产生了更好的效果.此外,纳入研究的前十种常用草药被确定。尽管有这些发现,根据等级评估，证据的确定性被评为“低”或“中等”，在亚组和敏感性分析中检测到显著的异质性。
结论：对于成人寻常型银屑病，CHM浴疗法联合常规疗法比常规疗法更有效，更安全。结果表明，治疗效果与延长治疗持续时间等因素之间存在潜在的相关性。提高浴温,和更长的洗澡时间。然而,由于纳入研究的方法学局限性,证据的确定性被降级.为了证实本系统综述的结果，双盲，未来需要安慰剂对照RCT。
