Use of traditional Chinese medicine reduces exposure to corticosteroid among atopic dermatitis children: A 1-year follow-up cohort study.
Atopic dermatitis is a prevalent dermatologic disease in children. Corticosteroid is an important treatment but side effects caused by long-term and excessive use heavily concern patients. Traditional Chinese medicine (TCM) is potentially an alternative treatment and might cause less adverse effects. This nationwide retrospective cohort study aimed to examine the hypothesis that TCM use is associated with lower exposure to corticosteroid.
MATERIALS AND METHODS:
Children under 12 years of age with ICD-9 codes 691.8 and 692.x were identified as atopic dermatitis patients from 2007/1/1 to 2007/12/31. Corticosteroid use was compared between TCM users and non-users for one-year follow-up by using a general estimation equation model with propensity-score matching.
A total of 9012 TCM users were identified and the use of corticosteroid after treatment was compared with matched TCM non-users. Use of TCM significantly reduced exposure to corticosteroids after 1-year follow-up. Among TCM users, the exposure to any corticosteroids was lower (42.1% reduction in TCM users versus 34.5% increase in TCM non-users, relative risk: 0.36; p-Value<0.001), the duration was shorter (relative risk for using corticosteroid more than 14 days: 0.37; p-Value<0.001), and the rate of frequent visits with steroid prescription was also lower. CHM was the most commonly used TCM modality (98.5% of all visits) and Xiao-Feng-San was the most commonly used CHM (33% of all prescriptions) with extensive coverage for pathogenesis of atopic dermatitis.
Lower use rate of corticosteroid can be found after TCM treatment, which can be considered as an integrative therapy for atopic dermatitis. Further studies are warranted on the basis of this study.
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Atopic dermatitis; Chinese herbal medicine; Corticosteroid; National Health Insurance Research Database; Pediatrics; Traditional Chinesemedicine
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The effectiveness of combined Chinese herbal medicine and acupuncture in the treatment of atopic dermatitis.
- 1Department of Dermatology, The Chaim Sheba Medical Center, Tel Hashomer, The Sackler School of Medicine, Tel Aviv University, Israel. email@example.com
Patients with atopic dermatitis increasingly use complementary medicine.
The objective of this study was to assess the effectiveness of the combination of Chinese herbal medicine and acupuncture for the treatment of atopic dermatitis.
Twenty (20) patients between the ages of 13 and 48 who had mild-to-severe atopic dermatitis were given a combined treatment of acupuncture and Chinese herbal medicine and were followed prospectively. The patients received acupuncture treatment twice a week and the Chinese herbal formula 3 times daily for a total of 12 weeks. Assessments were performed before treatment, and at weeks 3, 6, 9, and 12 of treatment. The primary outcomes were defined as the changes in the Eczema Area and Severity Index (EASI), Dermatology Life Quality Index (DLQI), and patient assessment of itch measured on a visual analogue scale (VAS).
After 12 weeks of treatment, an improvement in EASI was noted in 100% of patients, when compared with the baseline. The mean EASI fell from 4.99 to 1.81; the median percentage of decrease was 63.5%. Moreover, 78.8% of patients experienced a reduction in DLQI and VAS, as compared with the baseline. The mean DLQI decreased from 12.5 to 7.6 at the end of treatment, with 39.1% improvement. Mean VAS decreased from 6.8 to 3.7, with 44.7% improvement. No adverse effects were observed.
The results of this study suggest that the combination of acupuncture and Chinese herbal medicine have a beneficial effect on patients with atopic dermatitis and may offer better results than Chinese herbal medicine alone.
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Traditional Chinese medicine for atopic eczema: PentaHerbs formula suppresses inflammatory mediators release from mast cells.
- 1Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.
PentaHerbs formula (PHF) containing Cortex Moutan, root bark of Paeonia suffruticosa Andr. (Ranunculaceae), Cortex Phellodendri, bark of Phellodendron chinensis Schneid. (Rutaceae), Flos Lonicerae, flower of Lonicera japonica Thunb. (Capri-foliaceae), Herba Menthae, aerial part of Mentha haplocalyx Briq. (Labiatae) and Rhizoma Atractylodis, rhizome of Atractylodes lancea (Thunb.) DC. (Compositae) at the ratio of 2:2:2:1:2 was useful in the management of eczema.
AIM OF THE STUDY:
Since the mechanism of action of PHF is not known, we aimed to investigate the actions of PHF on mast cell activation.
MATERIALS AND METHODS:
Effects of aqueous extracts of PHF and individual component herb on mediator release from rat peritoneal mast cells (RPMCs) and cytokine production from HMC-1 were investigated.
PHF, Cortex Moutan and Herba Menthae significantly attenuated histamine release and prostaglandin D(2) synthesis from RPMC activated by anti-IgE and compound 48/80 (p<0.05). While Flos Lonicerae and Rhizoma Atractylodis suppressed only mediator release from compound 48/80 activated RPMC, Cortex Phellodendri potentiated only anti-IgE induced mediator release (p<0.05). However, with the exception of Cortex Moutan, PHF and the other four component herbs failed to affect cytokine production in HMC-1.
Although individual herbs demonstrated different modulating effects on mast cells, inhibition of inflammatory mediator release from mast cells would contribute to the therapeutic efficacy of PHF.
- [PubMed – indexed for MEDLINE]
Sanpao herbs inhibit development of atopic dermatitis in Balb/c mice.
- 1College of Life Sciences, Nanjing Normal University, Nanjing 210046, Jiangsu, P. R. China.
To explore the effects of SANPAOCAO (SPC), a compound traditional Chinese folk medicine, on chronic dermatitis/eczema in mice induced by 2, 4-dinitrochlorobenzene (DNCB).
Thirty-three Balb/c mice were randomly divided into a negative control group, a positive control group, a prednisolone treatment group, an SPC ethanol extract treatment group, a Cardiospermum halicacabum ethanol extract treatment group, a Physalis minima ethanol extract treatment group, and a Jussiaea repens ethanol extract treatment group. Mice in the six treatment groups had twenty-five microliters of 0.1% DNCB in acetone/olive oil (3: 1) applied to each side of their right ears and dorsal skin three times a week, over a 5 week period. They were treated with prednisolone or the various kinds of ethanol extract after each challenge. The weight difference between the two ears, pathological changes in the right ears, dermal inflammatory cell numbers, and total serum Ig E levels were used to assess the effects of the drugs.
after the 5 weeks of challenges, the weight differences of the ears in the SPC group and the prednisolone group were significantly less than those in the other groups. There was evidence of significant suppression of the development of dermatitis, as determined by a histological examination and the serum Ig E levels.
SPC has beneficial effects when used in the treatment of chronic dermatitis-eczema in mice.
- [PubMed – indexed for MEDLINE]
Chinese herbal medicine for atopic eczema.
- 1Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, England, UK, NG5 1PB. Weiya.Zhang@nottingham.ac.uk
Traditional Chinese herbal mixtures have been used to treat atopic eczema for many years. Their efficacy has attracted public attention and recently some clinical trials have been undertaken.
To assess the effects of Chinese herbal mixtures in the treatment of atopic eczema.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) ( January 2004), the Cochrane Skin Group Specialised Register (January 2004), MEDLINE (1966 to January 2004), EMBASE (1980 to January 2004), CINHL (1980 to January 2004) and a number of complementary medicine databases. In addition, the cited references of all trials identified and key review articles were searched. Pharmaceutical companies involved in oral traditional Chinese herbs and experts in the field were contacted.
Randomised controlled trials of Chinese herbal mixtures used in the treatment of atopic eczema.
DATA COLLECTION AND ANALYSIS:
Two reviewers independently applied eligibility criteria, assessed the quality of the trials and extracted data. Any discrepancies were discussed to achieve consensus.
Four randomised controlled trials, with eight weeks for each phase, met the inclusion criteria. The trials randomised 159 participants aged from 1 to 60 years. The withdrawal rates ranged from 7.5% to 22.5% and no trial used intention to treat analysis. Three trials were randomised placebo controlled, two-phase cross-over designs assessing the same Chinese herbal mixture, Zemaphyte. In two of these three trials the reduction in erythema and surface damage was greater on Zemaphyte than on placebo, and participants slept better and expressed a preference for Zemaphyte. One trial also reported that participants itched less. The fourth trial was an open-label design comparing Zemaphyte in herbal form with Zemaphyte as a freeze dried preparation. There was a reduction in erythema and surface damage with both formulations, but no comparison between the two formulations was reported. Some adverse effects were reported in all four trials, but none were regarded as serious.
Chinese herbal mixtures may be effective in the treatment of atopic eczema. However, only four small poorly reported RCTs of the same product, Zemaphyte, were found and the results were heterogeneous. Further well-designed, larger scale trials are required, but Zemaphyte is no longer being manufactured.
- [PubMed – indexed for MEDLINE]
The Effectiveness of Acupuncture Compared to Loratadine in Patients Allergic to House Dust Mites
Background. The aim of this work was to evaluate the clinical effectiveness of acupuncture and its impact on the immune system in comparison to loratadine in the treatment of persistent allergic rhinitis caused by house dust mites. Methods. In this study, 24 patients suffering from persistent allergic rhinitis induced by house dust mites were treated either with acupuncture (n= 15) or with loratadine (n = 9). The evaluation of the data was based on the subjective and the objective rhinoconjunctivitis symptom scores, specific and total IgE, and interleukins (IL-4, IL-10, and IFN-γ) as markers for the activity of Th1 or Th2 cells. Results. The treatments with acupuncture as well as with loratadine were considered effective in the patients’ subjective assessment, whereby the effect of the acupuncture tended to be assessed as more persistent after the end of treatment. A change in the specific or the total IgE was not detectable in either group. The interleukin profile showed the tendency of an increasing IL-10 value in the acupuncture group. The results of the study show that the effectiveness of acupuncture is comparable to that of loratadine. Conclusion. Acupuncture is a clinically effective form of therapy in the treatment of patients suffering from persistent allergic rhinitis. The results indicate the probability of an immunomodulatory effect.
Acupuncture is an effective, well-tolerated form of therapy in the treatment of patients suffering from dust mite allergy with its effect being comparable to loratadine.
Although the theory that the mechanism of action of acupuncture is based on immunomodulation could not be proven significantly, it was possible to show a tendential increase of the IL-10 level in the serum under acupuncture. For a definite assessment of this issue, further studies with larger numbers of patients are necessary.
Acupuncture can function as an effective therapeutic alternative for patients having a contraindication to specific immunotherapy or to a medicinal symptomatic therapy.