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Phytotherapy in the management of psoriasis: a review of the efficacy and safety of oral interventions and the pharmacological actions of the main plants

Abstract

This review provides assessments of the efficacy and safety of oral forms of phytotherapy in psoriasis management and discusses the pharmacological actions of the plants that have been frequently used in clinical trials. It employed the methods described in the Cochrane Handbook. Ten randomized controlled trials that compared a plant-based intervention with placebo or a pharmacotherapy in the treatment of psoriasis vulgaris and used Psoriasis Area Severity Index (PASI) as an outcome measure were included. Superiority to placebo was found in two out of three studies. In six out of seven studies, the effect of the phytotherapy was reported as comparable to the pharmacotherapy in the short term when assessed as PASI 50. The safety of the phytotherapies was discussed. The most commonly used plants were Oldenlandia diffusa, Rehmannia glutinosa and Salvia miltiorrhiza. Experimental studies on extracts and compounds derived from these plants have reported anti-inflammatory, anti-proliferative and other actions of relevance to psoriasis management. These properties may account for the apparent actions of some of the phytotherapies used in these clinical studies. These plants and their active constituents appear to warrant further research attention in the search for future medications for psoriasis.

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Fig. 1

Abbreviations

α-SMA:

α-Smooth muscle actin

AEs:

Adverse events

AP-1:

Activating protein-1

APP:

Anti-psoriatic pharmacotherapy

Bax:

Bcl-2-associated X protein

Bcl-2 family proteins:

B cell lymphoma 2 family of apoptosis regulator proteins

BUN:

Blood urea nitrogen

CAT:

Catalase

CD:

Circular dichroism

CE:

Cornified envelope

CD4+ T cells:

T-cell surface glycoprotein CD4

CHK:

Cultured human keratinocytes

CI:

Confidence interval

COX-2:

Cyclooxygenase-2

CYP:

Cytochrome P450

DLQI:

Dermatology Life Quality Index

ERK/RSK2:

Extracellular signal-regulated protein/ribosomal S6 kinase 2 kinase

FLI:

Fos-like immunoreactive neurons

GSH-Px:

Glutathione peroxidase

GSK 3β:

Glycogen synthase kinase 3 beta

HaCaT:

Immortalized human keratinocytes cells

HeLa cells:

A cell from a sample taken from a woman called Henrietta Lacks and was named using the two initials of her first (He) and last (La) names

ICAM-1:

Intercellular adhesion molecule 1

IFN:

Interferon

IgE:

Immunoglobulin E

IκB:

IkappaB kinase

IKK:

IκBα kinase

IL:

Interleukin

iNOS:

Inducible nitric oxide synthase

JNK:

c-Jun N-terminal kinase

MCP-1:

Monocyte chemotactic protein-1

mRNA:

Messenger RNA

MD:

Mean difference

NO:

Nitric oxide

NS:

Not stated

MCP:

Monocyte chemotactic protein

NF-κB:

Nuclear factor kappa-light-chain-enhancer of activated B cells

NIK:

NF-κB-inducing kinase

PARP:

Poly(ADP-ribose) polymerase

PASI:

Psoriasis Area Severity Index

PDI:

Psoriasis Disability Index

PGA:

Physician’s Global Assessment

PGE2 :

Prostaglandin E2

PPAR:

Peroxisome proliferator-activated receptor

PT:

Phytotherapy

R-HepG2:

Human hepatoma cell line

RAGE:

Receptor for advanced glycation end products

RevMan:

Review Manager Software

RCT:

Randomized controlled trial

ROS:

Reactive oxygen species

RR:

Relative risk

THP1:

Human monocytic cell line

TNF-α:

Tumour necrosis factor-alpha

WBC:

White blood cell

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Acknowledgments

We acknowledge funding support provided by Guangdong Provincial Academy of Chinese Medical Sciences, China, Department of Innovation, Industry, Science and Research, Australian Government for the Australian Postgraduate Award (APA), the International Science and Technology Cooperation Program of China; and The Financial Industry Technology Research and Development Program of Guangdong Province, China that made this research possible.

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The authors declare that they have no conflict of interest. This article is not under submission to another journal. All authors have contributed to the paper.

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Correspondence to Chuanjian Lu or Charlie C. L. Xue.

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S. Deng and B. H. May made equal contributions to the study.

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Deng, S., May, B.H., Zhang, A.L. et al. Phytotherapy in the management of psoriasis: a review of the efficacy and safety of oral interventions and the pharmacological actions of the main plants. Arch Dermatol Res 306, 211–229 (2014). https://doi.org/10.1007/s00403-013-1428-4

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Keywords

  • Psoriasis
  • Phytotherapy
  • Herbal medicine
  • Review
  • Safety
  • Adverse events
  • Anti-inflammatory
  • Anti-proliferative
  • Oldenlandia diffusa
  • Rehmannia glutinosa
  • Salvia miltiorrhiza