Efficacy and tolerability of a Chinese herbal medicine concoction for treatment of atopic dermatitis: a randomized, double-blind, placebo-controlled study

Hon, Kam Lun; Leung, Ting Fan; Ng, Pak Cheung; Lam, M. C.A.; Kam, W. Y.C.; Wong, Kin Hong; Lee, K. C.K.; Sung, Yn Tz Rita; Cheng, King-Fai; Fok, Tai Fai; Fung, Kwok‐Pui; Leung, Ping Chung

doi:10.1111/j.1365-2133.2007.07941.x

Cited by 142 publications

(97 citation statements)

References 22 publications

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“…262 No difference in the effect on severity of eczema was found between the five-herb concoction (containing F. lonicerae, H. menthae, C. moutan, R. attactylodis and C. phellodendri) and placebo. 430 The trial reported an improvement in quality of life only in the participants treated with the herbal concoction and there also appeared to be a specific steroid-sparing effect for those using mometasone furoate. The effect on quality of life deserves further scrutiny in trials of Chinese herbal medicine; however, the steroid-sparing effect does not appear to have been a prespecified outcome.…”

Section: Overall Implications For Research and Practicementioning

confidence: 99%

“…In the trial by Hon and colleagues, 430 the severity of eczema decreased in each group by around 10 points after 12 weeks, with no significant difference between the herbal treatment and the placebo. Quality of life, measured using the CDLQI, improved by > 30% in the herbal medicine group compared with hardly any improvement in the placebo group over 12 weeks of treatment, which was a statistically significant difference (p = 0.008).…”

Section: Benefitsmentioning

confidence: 99%

“…Medicinal plants of various kinds can be taken orally, usually in combination with others as a decoction by boiling them in water and drinking the 'tea' produced, or can be applied directly to the skin. Hon and colleagues 430 compared a five-herb concoction (containing Flos lonicerae, Herba menthae, Cortex moutan, Rhizoma attactylodis and Cortex phellodendri) against placebo given in capsules for 12 weeks. The placebo capsules were assessed by an expert panel to ensure that they were indistinguishable from the herbal capsules.…”

Section: Chinese Herbal Medicinementioning

confidence: 99%

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Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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BackgroundEczema is a very common chronic inflammatory skin condition.ObjectivesTo update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps.Data sourcesElectronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs).Review methodsStudies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings.ResultsOf 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; andMycobacterium vaccaevaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing.LimitationsThe large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies.ConclusionsAlthough the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Overall Implications For Research and Practicementioning

confidence: 99%

Section: Benefitsmentioning

confidence: 99%

Section: Chinese Herbal Medicinementioning

confidence: 99%

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Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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“…In a 2007 study by Hon et al of a five herb formulation (Flos lonicerae, Herba menthae, Cortex moutan, Rhizoma atractylodis, Cortex phellodendri) in a placebo controlled 12 week oral feeding trial found that while the treatment group and placebo group both improved symptoms there was no statistically significance between the two. However in the treatment group, the number of days of corticosteroids use during the month was significantly decreased, improving the quality of life of the subject (Hon et al, 2007). In a follow up study it was found the formulation suppressed brain-derived neurotrophic factor (BDNF), Thymus and activation regulated chemokine (TARC), INF-ϒ, and TNFα (Leung et al, 2008).…”

Section: Herbal Preparations -Traditional Chinese Medicinementioning

confidence: 96%

Natural Products and Dermatological Hypersensitivity Diseases

MacDonald¹,

Kulka²

2012

Allergic Diseases - Highlights in the Clinic, Mechanisms and Treatment

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“…One study introduced a new statistically significant primary outcome that was not present in the registration record (original primary outcome was not significant), 275 one study changed the scale measuring eczema severity from Severity Scoring of Atopic Dermatitis (SCORAD) index to Six Area, Six Sign Atopic Dermatitis (SASSAD), 282 and one study changed the time frame for assessment of the primary outcome from 26 weeks to 4 weeks. 289 None of these changes resulted in a significant result being reported.…”

Section: Assessment Of Outcome Reporting Bias Among Properly Registermentioning

confidence: 99%

A programme of research to set priorities and reduce uncertainties for the prevention and treatment of skin disease

Kim

Batchelor

Bath‐Hextall

et al. 2016

Programme Grants Appl Res

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Programme Grants for Applied ResearchISSN 2050-4322 (Print) ISSN 2050-4330 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full PGfAR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/pgfar. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Programme Grants for Applied Research journalReports are published in Programme Grants for Applied Research (PGfAR) if (1) they have resulted from work for the PGfAR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. Programme Grants for Applied Research programmeThe Programme Grants for Applied Research (PGfAR) programme, part of the National Institute for Health Research (NIHR), was set up in 2006 to produce independent research findings that will have practical application for the benefit of patients and the NHS in the relatively near future. The Programme is managed by the NIHR Central Commissioning Facility (CCF) with strategic input from the Programme Director.The programme is a national response mode funding scheme that aims to provide evidence to improve health outcomes in England through promotion of health, prevention of ill health, and optimal disease management (including safety and quality), with particular emphasis on conditions causing significant disease burden.For more information about the PGfAR programme please visit the website: http://www.nihr.ac.uk/funding/programme-grants-forapplied-research.htm This reportThe research reported in this issue of the journal was funded by PGfAR as project number RP-PG-0407-10177. The contractual start date was in September 2008. The final report began editorial review in April 2014 and was accepted for publication in April 2016. As the funder, the PGfAR programme agreed the research questions and study designs in advance with the investigators. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PGfAR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, CCF, NETSCC, PGfAR or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, ...

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Efficacy and tolerability of a Chinese herbal medicine concoction for treatment of atopic dermatitis: a randomized, double-blind, placebo-controlled study

Abstract: The TCHM concoction is efficacious in improving quality of life and reducing topical corticosteroid use in children with moderate-to-severe AD. The formulation was palatable and well tolerated.

Cited by 142 publications

References 22 publications

Scoping systematic review of treatments for eczema

Scoping systematic review of treatments for eczema

Natural Products and Dermatological Hypersensitivity Diseases

A programme of research to set priorities and reduce uncertainties for the prevention and treatment of skin disease

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