Add-On Effect of Chinese Herbal Medicine Bath to Phototherapy for Psoriasis Vulgaris: A Systematic Review

Table 1

Characteristics of thirteen studies of Chinese herbal medicine bath combined with phototherapy for psoriasis.

Author, year; setting; location	Participant (T/C); average age (T/C)	Treatment interventions	Control interventions	Treatment and followup duration	Total treatment sessions	Outcome measures	Results	Number of participant reported adverse events (n=); SAE
Cui et al., 2008 [5]; hospital; Beijing and Anshan, China	62/57; 45.82 ± 13.89/38.72 ± 12.17 years	CHM bath: 20 min, qod; NB-UVB: consistent with control intervention	NB-UVB: 50% of MED as initial dosage, increased by 0.1 J/cm^2 each time, maximum dosage 2.5 J/cm^2, twice a week	56 days; no information	16 sessions	TER based on PASI (90-60-25); PASI score	TER (T: 96.77%; C: 71.93%, 𝜒^2=27.755, 𝑃<0.01); PASI score (T: 4.16 ± 7.40; C: 11.40 ± 11.64); NB-UVB average dosage; T: (9.95 ± 4.76) J/cm^2; C: (12.77 ± 5.05) J/cm^2 (𝑃<0.01)	Adverse events (redness, pruritus) rate: T: 4.84% (3/62); C: 31.58% (18/57) (𝜒^2=119, 𝑃<0.01); no SAE
Gu et al., 2009 [6]; hospital; Urumqi, China	89/96; 31.15/32.84 years	CHM bath: 30 min, qod; NB-UVB: consistent with control intervention; Pu Lian ointment, bid	NB-UVB (311 nm): 0.3 J/cm^2 as initial dosage, increased by 0.1 J/cm^2 each time, qod; Pu Lian ointment, bid	28 days; 6 months	14 sessions	TER based on PASI (90-60-25); relapse rate during followup	TER (T: 94.38%; C: 84.38%, 𝜒^2=4.8, 𝑃<0.05); relapse rate during followup (T: 10.81%; C: 30.30%, 𝑃<0.05)	Mild redness, pruritus, and skin dryness (T: 10/89; C: 23/96) (𝜒^2=5.10, 𝑃<0.05); skin pigmentation in all (resolved without medical assistance within 2 months); no SAE
Lin et al., 2010 [7]; hospital; Hefei, China	95/90; 29.52 ± 6.38/; 27.42 ± 6.28 years	CHM bath: 20–30 min, three times a week; NB-UVB: consistent with control intervention; Bing  Huang Fu Le ointment after NB-UVB, qd	NB-UVB (311 nm): 0.3–0.5 J/cm^2 as initial dosage, increased by 0.1 J/cm^2each time, 110 seconds, three times a week; Bing Huang Fu Le ointment after NB-UVB, qd	49 days; no information	20 sessions	TER based on PASI (90-60-25); PASI score	TER (T: 96.7%; C: 70%, 𝜒^2=17.69, 𝑃<0.01); PASI score (T: 11.15 ± 8.11; C: 14.74 ± 9.05)	Redness (T: 9/95; C: 22/90; 𝜒^2=4.44, 𝑃<0.05); pruritus (T: 11/95; C: 26/90; 𝜒^2=4.94, 𝑃<0.05); skin dryness (T: 15/95; C: 17/90; 𝑃>0.05); no SAE
Liu et al., 2005 [8]; hospital; Shijiazhuang, China	40/40; 36.2/35 years	CHM bath: 30 min, qod; NB-UVB: consistent with control intervention	NB-UVB (311–313 nm): 0.08 or 0.1 J/cm^2 as initial dosage, increased by 0.01–0.03 J/cm^2 each time, qod	40 days; no information	20 sessions	TER based on PASI (90-60-25)	TER (T: 95.0%; C: 82.5%, 𝑃<0.01)	No information
Liu et al., 2004 [9]; hospital; Dalian, China	151/179; no information	CHM bath: 20 min, qod; UVA and UVB: consistent with control intervention	UVA (5400 μW/cm^2): 0.16 J/cm^2 as initial dosage, qod; UVB (350–460 μW/cm^2): 20.0 J/cm^2 as initial, qod; increased by 10%–20% each time	No information; 12 months	No information	TER based on PASI (90-60-25); relapse rate during followup	TER (T: 90.07%; C: 88.83%, 𝑃>0.05); relapse rate during followup (T: 15.23%; C: 35.19%, 𝑃<0.05)	Redness, pruritus (T: 10/151; C: 10/179); no SAE
Shi et al., 2011 [10]; hospital; Beijing, China	170/168; no information	CHM bath: 20 min, qod: NB-UVB: consistent with control intervention	NB-UVB (310–315 nm): 0.2–0.4 J/cm^2 as initial dosage, increased by 0.1 J/cm^2each time, qod	56 days; no information	28 sessions	TER based on PASI (90-60-20)	TER (T: 84.7%; C: 70.2%, 𝑃<0.01)	Mild redness, pruritus (T: 11/170; C: 29/168); skin pigmentation in all (resolved without medical assistance within 3 months); no SAE
Wang et al., 2010 [11]; hospital; Nanchong, China	70/70; no information	Acitretin capsules for one-week pretrial treatment: 20 mg/qd; CHM bath: 30 min, 3 times a week: NB-UVB: consistent with control intervention	Acitretin capsules: consistent with treatment intervention; NB-UVB: 0.5 J/cm^2 as initial dosage, increased by 10%–20% each time, 3 times a week, or 1-2 times a week (if lesions reduced)	21 days; no information	9 sessions	TER based on lesion score (90-70-30)	TER (T: 77.14%; C: 58.57%, 𝜒^2=5.534, 𝑃<0.05)	Redness, pruritus (T: 6/70; C: 5/70); no SAE
Wang et al., 2011 [12]; hospital; Kaifeng, China	50/50; 38.2/37.5 years	CHM bath: 30 min, qod; NB-UVB: consistent with control intervention; urea emollient after NB-UVB, qd	NB-UVB (310–315 nm): 0.3–0.5 J/cm^2as initial dosage, increased by 10%–20% each time, qod; urea emollient after NB-UVB, qd	28 days; no information	14 sessions	TER based on PASI (90-60-20)	TER (T: 86.0%; C: 72.0%, 𝑃<0.05)	Mild skin dryness, burning pain after NB-UVB (T: 4/50; C: 5/50); no SAE
Wang et al., 2012 [13]; hospital; Kaifeng, China	60/60; 38.3/37.1 years	CHM bath: 30 min, qod; NB-UVB: consistent with control intervention; urea emollient after NB-UVB, qod; glycyrrhizin tablets: 2 tablets/tid	NB-UVB (310–315 nm): 0.3–0.5 J/cm^2 as initial dosage, increased by 10%–20% each time, qod; urea emollient after NB-UVB, qod; glycyrrhizin tablets, 2 tablets/tid	28 days; no information	14 sessions	TER	TER (T: 91.7%; C: 77.7%, 𝜒^2=8.239, 𝑃<0.05)	Skin dryness, burning pain after NB-UVB (T: 4/60; C: 5/60); no SAE
Wu et al., 2011 [14]; hospital; Chengdu, China	75/65; 32.5/34.8 years	Halometasone emollient for one-week pre-trial treatment: qd; CHM bath: 15–20 min, qod; NB-UVB: consistent with control intervention; urea emollient, qd	Halometasone emollient: consistent with treatment intervention; NB-UVB (310–315 nm): 0.5–0.6 J/cm^2 as initial dosage, increased by 0.1 J/cm^2 each time, qod; urea emollient, qd	40 days; no information	20 sessions	TER based on PASI (95-60-20); PASI score	TER (T: 78.67%; C: 56.92%, 𝜒^2=10.54, 𝑃<0.01); PASI score (T: 9.24 ± 2.17; C: 5.46 ± 1.86)	Slight light skin dryness, burning pain after NB-UVB (T: 2/75; C: 3/65); no SAE
Wu et al., 2010 [15]; hospital; Guangzhou, China	40/39; 36.45 ± 8.52/36.67 ± 8.36 years	CHM bath: 15–20 min, qod; NB-UVB: consistent with control intervention	NB-UVB (311–315 nm): 0.3–0.5 J/cm^2 as initial dosage, increased by 0.1 J/cm^2each time, qod	90 days; no information	45 sessions	TER based on PASI (90-60-30); PASI score	TER (T: 75.00%; C: 51.28%, 𝜒^2=4.78, 𝑃=0.029); PASI score (T: 4.21 ± 1.22; C: 6.45 ± 2.27)	Skin dryness, pruritus (T: 5/40; C: 5/39); skin pigmentation in all; no SAE
Yan and Zhang, 2009 [16]; hospital; Xi’an, China	42/38; no information	CHM bath: 30 min, qod; NB-UVB: consistent with control intervention	NB-UVB: 0.3 J/cm^2 as initial dosage, increased by 0.2 J/cm^2, qod	80 days; no information	40 sessions	TER based on lesion elimination	TER (T: 88.0%; C: 42.1%, 𝑃<0.05)	No information
Zhou and Huang, 2005 [17]; hospital; Nanning, China	143/129; 35/36.2 years	CHM bath: 30 min, qod; UVA: consistent with control intervention	UVA: 4 J/cm^2 as initial dosage, increased by 1 J/cm^2, qod	28 days; no information	14 sessions	TER based on PASI (90-60-25)	TER (T: 80.42%; C: 64.0%, 𝑃<0.01)	No information

Qd: once a day, bid: twice a day, tid: three times a day, and qod: once in every two days; CHM: Chinese herbal medicine; NB-UVB: narrowband ultraviolet B; UVA: ultraviolet A; MED: minimal erythema dose, the minimum dose of radiation that produces skin erythema; TER: total effective rate, calculated as the percentage of “cured and remarkably effective” cases; PASI (95-60-20): “Clinically cured”-PASI score reduction of 95 to 100%; “remarkably effective”-PASI score reduction of 60 to 94%; “effective”-PASI score reduction of 20 to 59%; and “ineffective”-PASI score reduction of 0 to 19%; PASI (90-60-20), PASI (90-60-25), and PASI (90-60-30) refer to effectiveness levels using different proportions of PASI score reduction; lesion score (90-70-30): effectiveness levels based on the reduction of psoriatic lesions area and severity; lesion elimination: effectiveness levels based on the elimination of lesion (90–100%, 30–59%, or 0–29% refer to clinically cured, remarkably effective, and ineffective accordingly); SAE: serious adverse event.