Abstract：
BACKGROUND: Psoriasis is a chronic inflammatory skin disease. Vitamin D analogues are the first-line topical agents for the long-term management of psoriasis. Chinese herbal medicine (CHM) bath therapy is commonly employed for psoriasis. However, the effects and safety of CHM bath therapy for psoriasis vulgaris, using topical calcipotriol as the comparator, remain inconclusive. Furthermore, the combination of herbs, a distinctive feature of CHM, is essential for its therapeutic effects due to the individual and synergistic properties of the herbs involved.
OBJECTIVE: The review was conducted to evaluate the effectiveness and safety of CHM bath therapy for psoriasis vulgaris, using calcipotriol as the comparator. Potential herbs and herb combinations of CHM bath therapy were also explored for further drug discovery.
METHODS: Nine databases were searched from inception until March 05, 2024. Randomised controlled trials (RCTs) investigating CHM bath therapy, using calcipotriol as the comparator, were included. Statistical analyses were performed using RevMan 5.4, Stata 12.0 and SPSS Clementine 12.0 software. The evidence certainty for outcomes was assessed using the approach proposed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group. Moreover, association rule analysis on herbs identified in the systematic review was conducted to explore the potential herbs and herb combinations.
RESULTS: A total of 17 RCTs involving 1,379 participants were included in this systematic review. The findings of this review revealed that: 1) CHM bath therapy produced comparable effects to calcipotriol in reducing Psoriasis Area and Severity Index (PASI), Psoriasis Scalp Severity Index (PSSI), and itch visual analogue scale (VAS) at the end of the treatment phase; as well as exhibited a superior long-term effect than calcipotriol through decreasing relapse rates at the end of the follow-up phase; 2) CHM bath therapy showed an additional benefit when combined with calcipotriol in managing psoriasis vulgaris at the end of the treatment phase, in terms of PASI, PSSI, itch VAS, IL-17, IL-23, CD3+ and CD4+ T cells. The certainty of the evidence was rated as \'very low\', \'low\' or \'moderate\' based on the GRADE assessment, considering some concerns or high risk of bias of included studies, substantial heterogeneity, and existing publication bias of some outcomes. Additionally, the proportions of participants reporting adverse events were similar in both groups. Association rule analysis of all included herbs identified 23 herb combinations including Prunus persica (L.) Batsch and Carthamus tinctorius L., as well as 11 frequently used herbs, such as Kochia scoparia (L.) Schrad., Dictamnus dasycarpus Turcz. And Sophora flavescens Ait.
CONCLUSIONS: The effects of CHM bath therapy were comparable with those of topical calcipotriol but demonstrated a longer-lasting effect. Combining CHM bath therapy with calcipotriol also provided an additional benefit for adult psoriasis vulgaris. However, the certainty of the evidence was downgraded due to the methodological limitations of included studies. To confirm the findings of this review, future investigations should involve double-blinded, placebo-controlled RCTs. Importantly, it appears worthwhile to consider further research for drug development utilising the identified herbs or herb combinations.
OBJECTIVE: The review was conducted to evaluate the effectiveness and safety of CHM bath therapy for psoriasis vulgaris, using calcipotriol as the comparator. Potential herbs and herb combinations of CHM bath therapy were also explored for further drug discovery.
METHODS: Nine databases were searched from inception until March 05, 2024. Randomised controlled trials (RCTs) investigating CHM bath therapy, using calcipotriol as the comparator, were included. Statistical analyses were performed using RevMan 5.4, Stata 12.0 and SPSS Clementine 12.0 software. The evidence certainty for outcomes was assessed using the approach proposed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group. Moreover, association rule analysis on herbs identified in the systematic review was conducted to explore the potential herbs and herb combinations.
RESULTS: A total of 17 RCTs involving 1,379 participants were included in this systematic review. The findings of this review revealed that: 1) CHM bath therapy produced comparable effects to calcipotriol in reducing Psoriasis Area and Severity Index (PASI), Psoriasis Scalp Severity Index (PSSI), and itch visual analogue scale (VAS) at the end of the treatment phase; as well as exhibited a superior long-term effect than calcipotriol through decreasing relapse rates at the end of the follow-up phase; 2) CHM bath therapy showed an additional benefit when combined with calcipotriol in managing psoriasis vulgaris at the end of the treatment phase, in terms of PASI, PSSI, itch VAS, IL-17, IL-23, CD3+ and CD4+ T cells. The certainty of the evidence was rated as \'very low\', \'low\' or \'moderate\' based on the GRADE assessment, considering some concerns or high risk of bias of included studies, substantial heterogeneity, and existing publication bias of some outcomes. Additionally, the proportions of participants reporting adverse events were similar in both groups. Association rule analysis of all included herbs identified 23 herb combinations including Prunus persica (L.) Batsch and Carthamus tinctorius L., as well as 11 frequently used herbs, such as Kochia scoparia (L.) Schrad., Dictamnus dasycarpus Turcz. And Sophora flavescens Ait.
CONCLUSIONS: The effects of CHM bath therapy were comparable with those of topical calcipotriol but demonstrated a longer-lasting effect. Combining CHM bath therapy with calcipotriol also provided an additional benefit for adult psoriasis vulgaris. However, the certainty of the evidence was downgraded due to the methodological limitations of included studies. To confirm the findings of this review, future investigations should involve double-blinded, placebo-controlled RCTs. Importantly, it appears worthwhile to consider further research for drug development utilising the identified herbs or herb combinations.
摘要：
背景：银屑病是一种慢性炎症性皮肤病。维生素D类似物是长期治疗银屑病的一线外用药物。中草药（CHM）浴疗法通常用于牛皮癣。然而,与外用卡泊三醇治疗寻常型银屑病相比,CHM浸浴疗法的疗效和安全性尚不确定.此外，草药的组合，CHM的一个显著特征，由于所涉及的草药的个体和协同特性，对其治疗效果至关重要。
目的：本综述旨在评价CHM浴疗法与卡泊三醇治疗寻常型银屑病的有效性和安全性。还探索了CHM浴疗法的潜在草药和草药组合，以进一步发现药物。
方法：从开始到2024年3月5日检索了9个数据库。研究CHM浴疗法的随机对照试验（RCT），使用卡泊三醇作为比较物，包括在内。采用RevMan5.4、Stata12.0和SPSSClementine12.0软件进行统计分析。使用建议分级评估提出的方法评估结果的证据确定性，发展,和评价(等级)工作组。此外，对系统评价中确定的草药进行关联规则分析，以探索潜在的草药和草药组合。
结果：本系统综述共纳入17项RCT，涉及1,379名参与者。这篇综述的结果表明：1）CHM浴疗法在减少牛皮癣面积和严重程度指数（PASI）方面产生了与卡泊三醇相当的效果，银屑病头皮严重程度指数（PSSI），治疗阶段结束时的瘙痒视觉模拟量表（VAS）；通过在随访阶段结束时降低复发率，与卡泊三醇相比，显示出优于卡泊三醇的长期效果；2）CHM浴疗法在治疗阶段结束时与卡泊三醇联合治疗寻常型银屑病时显示出额外的益处，就PASI而言，PSSI,itchVAS,IL-17、IL-23、CD3+和CD4+T细胞。证据的确定性被评为“非常低”，根据等级评估，\'低\'或\'中等\'，考虑到纳入研究的一些担忧或高风险偏倚，实质性异质性，以及现有的一些结果的发表偏差。此外,两组报告不良事件的参与者比例相似.对所有包含的草药进行关联规则分析，确定了35种草药组合，包括李子（L.)巴奇和红花L.，以及11种常用的草药，如Kochiasoparia(L.)施拉德。,DictamnusdasycarpusTurcz.和苦参。.
结论：CHM浴疗法的效果与局部卡泊三醇疗法的效果相当，但显示出更持久的效果。将CHM浴疗法与卡泊三醇结合还为成人寻常型银屑病提供了额外的益处。然而,由于纳入研究的方法学局限性,证据的确定性被降级.为了证实本次审查的结果，未来的调查应该涉及双盲，安慰剂对照随机对照试验。重要的是,似乎值得考虑进一步研究利用已确定的草药或草药组合进行药物开发。
目的：本综述旨在评价CHM浴疗法与卡泊三醇治疗寻常型银屑病的有效性和安全性。还探索了CHM浴疗法的潜在草药和草药组合，以进一步发现药物。
方法：从开始到2024年3月5日检索了9个数据库。研究CHM浴疗法的随机对照试验（RCT），使用卡泊三醇作为比较物，包括在内。采用RevMan5.4、Stata12.0和SPSSClementine12.0软件进行统计分析。使用建议分级评估提出的方法评估结果的证据确定性，发展,和评价(等级)工作组。此外，对系统评价中确定的草药进行关联规则分析，以探索潜在的草药和草药组合。
结果：本系统综述共纳入17项RCT，涉及1,379名参与者。这篇综述的结果表明：1）CHM浴疗法在减少牛皮癣面积和严重程度指数（PASI）方面产生了与卡泊三醇相当的效果，银屑病头皮严重程度指数（PSSI），治疗阶段结束时的瘙痒视觉模拟量表（VAS）；通过在随访阶段结束时降低复发率，与卡泊三醇相比，显示出优于卡泊三醇的长期效果；2）CHM浴疗法在治疗阶段结束时与卡泊三醇联合治疗寻常型银屑病时显示出额外的益处，就PASI而言，PSSI,itchVAS,IL-17、IL-23、CD3+和CD4+T细胞。证据的确定性被评为“非常低”，根据等级评估，\'低\'或\'中等\'，考虑到纳入研究的一些担忧或高风险偏倚，实质性异质性，以及现有的一些结果的发表偏差。此外,两组报告不良事件的参与者比例相似.对所有包含的草药进行关联规则分析，确定了35种草药组合，包括李子（L.)巴奇和红花L.，以及11种常用的草药，如Kochiasoparia(L.)施拉德。,DictamnusdasycarpusTurcz.和苦参。.
结论：CHM浴疗法的效果与局部卡泊三醇疗法的效果相当，但显示出更持久的效果。将CHM浴疗法与卡泊三醇结合还为成人寻常型银屑病提供了额外的益处。然而,由于纳入研究的方法学局限性,证据的确定性被降级.为了证实本次审查的结果，未来的调查应该涉及双盲，安慰剂对照随机对照试验。重要的是,似乎值得考虑进一步研究利用已确定的草药或草药组合进行药物开发。
