Efficacy of Combination Treatment of Herbal Medicine for External Use and Western Medicine for Atopic Dermatitis: A Systematic Review and Meta Analysis

아토피 피부염에서 한약 외용제와 양약 병용 치료의 효과: 체계적 문헌고찰 및 메타분석

  • Ji Eun Lee (Department of Ophthalmology, Otolaryngology and Dermatology of Korean Medicine, College of Korean Medicine, Kyung Hee University) ;
  • Su Jin Park (Department of Ophthalmology, Otolaryngology and Dermatology of Korean Medicine, College of Korean Medicine, Kyung Hee University) ;
  • Seo Yeon Jun (Department of Ophthalmology, Otolaryngology and Dermatology of Korean Medicine, College of Korean Medicine, Kyung Hee University) ;
  • Kyuseok Kim (Department of Ophthalmology, Otolaryngology and Dermatology of Korean Medicine, College of Korean Medicine, Kyung Hee University)
  • 이지은 (경희대학교 한의과대학 안이비인후피부과 교실) ;
  • 박수진 (경희대학교 한의과대학 안이비인후피부과 교실) ;
  • 전서연 (경희대학교 한의과대학 안이비인후피부과 교실) ;
  • 김규석 (경희대학교 한의과대학 안이비인후피부과 교실)
  • Received : 2023.05.15
  • Accepted : 2023.06.28
  • Published : 2023.06.30

Abstract

Objectives: This study was conducted to evaluate the effect of combination treatment of herbal medicine for external use and western medicine for atopic dermatitis (AD). Methods: We searched randomized controlled trials (RCTs) which assess the effect of combination treatment of herbal and western medicine for AD through 8 electronic databases from the start to December 2022. The data synthesis was conducted by using Review Manager (RevMan, ver.5.4.1) and Cochrane risk-of-bias tool was used to evaluate the risk of bias. Results: 13 RCTs were included. The combination treatment group had significantly higher total efficacy rate(p<0.0001) and lower SCORAD score (p<0.00001) than the western medicine treatment group. The adverse event rate was also significantly lower in the combination treatment than the western medicine treatment group (p<0.0001). But there was no significant difference in recurrence rate (p=0.09). Conclusion: This study demonstrates that the combination treatment of herbal and western medicine could be safe and effective for AD. However, due to limits of included studies such as high heterogeneity between the literature and unclear risk of bias, further studies are warranted.

Keywords

References

  1. Jang HS. Diagnosis and Treatment of Atopic Dermatitis. Korean Journal of Family Medicine. 2002;23(7);2-840.
  2. Korean Dermatological Association. Textbook of Dermatology, 7th rev. McGraw Hill. 2020;158
  3. Williams H, Robertson C, Stewart A, Ait-Khaled N, Anabwani G, Anderson R, Asher I, Beasley R, Bjorksten B, Burr M, Clayton T, Crane J, Ellwood P, Keil U, Lai C, Mallol J, Martinez F, Mitchell E, Montefort S, Pearce N, Weiland SK. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. The Journal of allergy and clinical immunology. 1999;103(1 Pt 1);125-138. https://doi.org/10.1016/S0091-6749(99)70536-1
  4. Mortz CG, Andersen, KE, Dellgren C, Barington T, Bindslev-Jensen C. Atopic dermatitis from adolescence to adulthood in the TOACS cohort: prevalence, persistence and comorbidities. Allergy. 2015;70(7);836-845 https://doi.org/10.1111/all.12619
  5. Deckers IA, McLean S, Linssen S, Mommers M, van Schayck CP, Sheikh A. Investigating international time trends in the incidence and prevalence of atopic eczema 1990-2010: a systematic review of epidemiological studies. PLOS ONE. 2012;7(7);ARTN e39803.
  6. Kim HS. Treatment for atopic dermatitis. Journal of the Korean Medical Association. 2014;57(3);226-233. https://doi.org/10.5124/jkma.2014.57.3.226
  7. Kim YH, Lee HC. The Oriental and Western Medical Study. The Journal of Pediatrics of Korean Medicine. 1993;7(1);121-133
  8. Shin SH, Kim MB, Byun SM, Lee HS, Park SG, Ko WS, Yoon HJ. A Review on External Treatment for Atopic Dermatitis in Korean Journals. The journal of Korean Medicine Ophthalmology & Otolaryngology & Dermatology. 2008;21(2);80-93.
  9. Wu Q, Ruan H, Zhao W, Mo X, Wen X, Chen D. External therapies of traditional Chinese medicine for atopic dermatitis: A Meta-Analysis. China Journal of Traditional Chinese Medicine and Pharmacy. 2015;30(12);4462-4465.
  10. Ying Z, Hiroko K, Sei K. Add-on therapy with traditional Chinese medicine: An efficacious approach for lipid metabolism disorders. Pharmacological Research. 2018;134:200-11. https://doi.org/10.1016/j.phrs.2018.06.004
  11. Kim NJ. Interaction of Co-administration with Traditional Herbal Drugs and Western Drugs. J. Kor. Soc. Hosp. Pharm. 1998;15(2):247-57.
  12. Han CY, Kim JD, Kang DW, Kim KS, Kim YB. Review about using Herbal medicine on steroid tapering and steroid overuse in Skin disease. The journal of Korean Medicine Ophthalmology & Otolaryngology & Dermatology. 2020;33(3);115-124.
  13. Lee HS. An overview of herbal medicine for atopic dermatitis. (The Korean Medicine Society for the Herbal Formula Study). 2009;17(2);99-110.
  14. Choi IH, Kim SH. Kim YC, Yoon YH. A Clinical Study of Shi Ho Cheong Gan-San on Blood Heat Pattern Atopic Dermatitis: a randomized, double-blind clinical trial. 2011;24(1);96-110. https://doi.org/10.6114/JKOOD.2011.24.1.096
  15. Lee MH, Choi YH, Han MH, Yoon JJ, Song MK, Kim MJ, Hong SH, Choi BT, Kim BW, Hwang HJ. Medicinal Herb Extracts Attenuate 1-Chl or o -2,4 dini t r obenzen e-in duce d Development of Atopic Dermatitis-like Skin Lesions. 2014;24(8);851-859. https://doi.org/10.5352/JLS.2014.24.8.851
  16. O MJ, Yoo YB., Lim SH, Kim HT. A clinical study for the effect of ointment contained Takrisodok-Eum on recovering the damaged skin barrier by Atopic dermatitis. The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology. 2011;24(3);84-107. https://doi.org/10.6114/JKOOD.2011.24.3.084
  17. Hong JH, Jung HA. Clinical Efficacy of External Application Containing Betula platyphyllae Cortex, Viticis Fructus, Agrimoniae herba in Atopic Dermatitis. The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology. 2014;27(1);1-16. https://doi.org/10.6114/jkood.2014.27.1.001
  18. Kang MS, Kim JB, Kim HT. A Clinical Study for the Effect of External Applications Containing Herbal Extracts on Mild Atopic Dermatitis Patients. 2014;27(3);40-55. https://doi.org/10.6114/jkood.2014.27.3.040
  19. Min DL, Park EJ, Kang KH. Review of Clinical and Experimental Studies on External Application Treatment for Atopic Dermatitis in the Korean Literature. The Journal of Pediatrics of Korean Medicine. 2013;27(1);36-49. https://doi.org/10.7778/jpkm.2013.27.1.036
  20. Wu Q, Ruan H, Zhao W, Mo X, Wen X, Chen D. External therapies of traditional Chinese medicine for atopic dermatitis: A Meta-Analysis. China Journal of Traditional Chinese Medicine and Pharmacy. 2015;30(12);4462-4465.
  21. Huang W. Efficacy of Chinese herbal bath combined with tacrolimus ointment in the treatment of atopic dermatitis in children. Journal of Practical Traditional Chinese Medicine. 2021;37(10);1688-1689.
  22. Xi M. Clinical Study on Emollient and Anti-Pruritus Thought in Chinese Medicine for Atopic Dermatitis. Journal of New Chinese Medicine. 2021;53(09);178-181.
  23. Xu S, Ding Y, Yi X, Huang Q. Efficacy of Chinese herbal medicine Huanglian paste wet pack combined with glucocorticoid ointment topical treatment of moderate and severe atopic dermatitis in adults. Chinese Journal of Dermatovenereology of Integrated Traditional and Western Medicine. 2020;19(06);575-576.
  24. Li P, Li B, Liu H. Clinical Observation of Ebastine Combined with Portulacae Herba in the Treatment of Atopic Dermatitis. Chinese Journal of Modern Applied Pharmacy. 2020;37(06);736-740.
  25. Xu J, Chen S. Clinical observation on the treatment of pediatric atopic dermatitis with damp-heat encapsulation by combining traditional Chinese and Western medicine with external treatment. Journal of North Pharmacy. 2017;14(08);9-10.
  26. Chen J, He X. Therapeutic Effect of Jin Yu Waixi Recipe for Pediatric Atopic Dermatitis Children with Different Traditional Chinese Medical Constitutions. Journal of Guangzhou University of Traditional Chinese Medicine. 2017;34(01); 35-39.
  27. Huang W, Wang C. Curative effect of TCM medicated bath combined with tacrolimus on moderate to severe atopic dermatitis in children and influence on serum LTB4 on LTC4. Chinese Journal of General Practice. 2016;14(04);604-606, 685.
  28. Han H, Guo F, Liu H. A randomized single-blind clinical trial on the efficacy and safety of using herbal baths in combination with tacrolimus ointment in the treatment of atopic dermatitis in children, Guide of China Medicine. 2013;11(06);606-608.
  29. Li P, Wu L, Zhou F, Zhang S. Clinical Observation on Dafengzi Ointment Combined with Chinese Medication Decoction for 30 Cases of Atopic Dermatitis. Journal of Traditional Chinese Medicine. 2012;53(08);678-680.
  30. Wu D. Liang Y. Li Y. A Comparative Study of adjuvant treatment for atopic Dermatitis in infants with natural indigo. Public Medical Forum Magazine. 2007;19;869-870.
  31. Yu Q. Effect Observation and Quality of Life Analysis of Traditional Chinese Medicine Bath on Atopic Dermatitis. Xinjiang Medical University. 2019.
  32. Xue X. Therapeutic effect of traditional Chinese medicine bath combined with tacrolimus on atopic dermatitis and serum inflammatory mediators. 2018;6(2).
  33. Wu Q, Jing H, Zhang F, Wang W, Wang X. Clinical effect of JIANG Shujing Zhitong Xiaoyan ointment on atopic dermatitis. 2020;5(22);117-119.
  34. Korean Dermatological Association. Textbook of Dermatology, 7th rev. McGraw Hill. 2020;163-164.
  35. Saraswat A. Topical corticosteroid use in children: adverse effects and how to minimize them. Indian journal of dermatology, venereology and leprology. 2010;76(3);225-8. https://doi.org/10.4103/0378-6323.62959
  36. Annie C. Nicholas VN. The Use of Topical Calcineurin Inhibitors in Atopic Dermatitis. The Open Dermatology Journal. 2014;8;12-17. https://doi.org/10.2174/1874372201408010012
  37. The Society of Korean Medicine Ophthalmology, Otolaryngology & Dermatology. Text of Traditional Korean Dermatology & Surgery. GB. 2022;24
  38. Shin SH, Kim MB, Byun SM, Lee HS, Park SG, Ko WS, Yoon HJ. A Review on External Treatment for Atopic Dermatitis in Korean Journals. The journal of Korean Medicine Ophthalmology & Otolaryngology & Dermatology. 2008;21(2);80-93.
  39. Guo Z, Li Y, Hou Y, Wang Y, Liang Y, Si X, Pan G, Wang Y, Hu Q. Chinese herbal bath therapy for the treatment of Atopic dermatitis in children: A meta-analysis and systematic review. 2022;101(47);e31923.
  40. Yoon JM, Kim DB, Park YC. Effect of Taeyeol-go on Atopic Dermatitis. 2006;15(2);187-192.
  41. Ahn JH, Yun YH, Kim MH, Ko SG, Kim KS, Choi IH. Efficacy and safety of topical Jaungo application in patients with atopic dermatitis : a randomized, double-blind, placebo-controlled study. Complementary therapies in medicine. 2018;40;22-28. https://doi.org/10.1016/j.ctim.2018.07.007
  42. Kim AN, Kim SK, Seo JS, Kim SH, Kim YE, Jang HC. Analysis on the herbal combinations in Korean medicine for atopic dermatitis. The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology. 2016;29(2);82-97. https://doi.org/10.6114/jkood.2016.29.2.082
  43. Andoh T, Yoshihisa Y, Rehman M, Tabuchi Y, Shimizu T. Berberine induces anti-atopic dermatitis effects through the downregulation of cutaneous EIF3F and MALT1 in NC/Nga mice with atopy-like dermatitis. Biochemical pharmacology, 2021;185;114439
  44. Joo JK, Han HS, Lee YJ. Anti-inflammatory Effect of Portulacae Herba Water Extract on Lipopolysaccharide-activated RAW 264.7 Macrophages. The Korea Journal of Herbology. 2016;31(1);61-67. https://doi.org/10.6116/kjh.2016.31.1.61.
  45. Lim YY, Kim HM, Park WS, Kim JH, Shin HJ, Kim MN, Kim BJ. Anti-inflammatory and Anti-pruritic Effects of Portulaca oleracea L. Extract Using In Vitro and In Vivo Inflammation Model: LPS-treated Raw264.7 Cells, Keratinocytes, NC/Nga Mice and Hairless SKH-1 Mice. Allergy, Asthma & Immunology Research. 2011;31(3);199-206.
  46. Wei-Jie L, Huang J, Li S, Gong X, Sun J, Mao W, Guo S. Portulaca oleracea L. extracts alleviate 2,4-dinitrochlorobenzene-induced atopic dermatitis in mice. Frontiers in nutrition, 2022;9;986943.