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Review
. 2013 Sep 10;2013(9):CD008642.
doi: 10.1002/14651858.CD008642.pub2.

Chinese herbal medicine for atopic eczema

Sherman Gu  1 , Angela W H Yang, Charlie C L Xue, Chun G Li, Carmen Pang, Weiya Zhang, Hywel C Williams
Affiliations
Review

Chinese herbal medicine for atopic eczema

Sherman Gu et al. Cochrane Database Syst Rev. .

Abstract

Background: Chinese herbal medicine (CHM) has been increasingly used for atopic eczema. A previous version of this Cochrane review published in 2004 found some evidence of a possible benefit for oral ingestion of CHM for eczema, but the results were inconclusive and the evidence needs to be updated. We have expanded the scope of this review to include an assessment of the topical and oral effects of CHM for eczema.

Objectives: To assess the effects of oral ingestion and topical applications of CHM for the management of eczema in children and adults.

Search methods: We searched the following databases up to September 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, Issue 8), MEDLINE (from 1946), EMBASE (from 1974), AMED (from 1985), LILACS (from 1982), and CINAHL (from 1981). We searched the following from inception: SCOPUS, HERBMED, ProQuest, CQVIP, CNKI, and Wanfang Data. We also searched trials registers, handsearched conference proceedings, checked the reference lists of all included and excluded studies and review articles for further references to relevant trials, and contacted experts in Chinese medicine for unpublished studies.

Selection criteria: All randomised controlled trials (RCTs) in children and adults with eczema comparing CHM to placebo; no intervention; active controls, including acupuncture; or conventional medicines.

Data collection and analysis: Two authors selected the RCTs, extracted data, and assessed quality independently. We contacted study authors for missing data. We collected adverse events from the included studies.

Main results: We included 28 studies, with a total of 2306 participants. We assessed most of the studies at high 'risk of bias', particularly in blinding of participants and personnel, and there was substantial inconsistency between studies, so any positive effect of CHM must be treated with caution. We did not include the four studies from the previous version in this review, because they investigated a CHM product that has been withdrawn from the market since 2004.Four studies (three oral and one topical) compared CHM to placebo. Pooled data from 2 studies showed the total effectiveness rate in the CHM group was higher (by risk ratio (RR) 2.09, 95% confidence interval (CI) 1.32 to 3.32; 2 studies; n = 85), and the itching visual analogue score (VAS) in the CHM group was 1.53 lower (by standardised mean difference (SMD), 95% CI 2.64 to 0.41; 2 Studies; n = 94) than the placebo group, where a lower VAS score indicates reduced itch. One study of 85 participants with moderate to severe eczema who received an oral CHM formula for 12 weeks reported a quality of life (QoL) score 2.5 lower in the CHM group (by difference in means (MD), 95% CI 4.77 to 0.23; 1 study; n = 85) than the placebo group, where a lower score indicates better QoL. Twenty-two studies and 1 arm from a study with a 4-arm parallel controlled design compared CHM (5 oral, 6 topical, and 12 mixed oral and topical) to conventional medicines. The total effectiveness rate in the CHM groups was superior (RR 1.43, 95% CI 1.27 to 1.61; 21 studies; n = 1868; very low quality evidence), and the itching VAS in the CHM groups was 0.83 lower (SMD, 95% CI 1.43 to 0.22; 7 studies; n = 465) than the comparators.Two studies compared combined oral and topical CHM to the same oral CHM formula alone. The total effectiveness rate in 1 study was not statistically significant (RR 1.13, 95% CI 0.78 to 1.63; 1 study; n = 20). In the other study, the itching VAS in the CHM group was 1.05 lower (MD, 95% CI 1.75 to 0.35; 1 study; n = 23) than the control group.With regard to side-effects, four studies did not give any report of adverse events. The other 24 studies reported minor adverse events, which were reversed soon after stopping CHM. One participant withdrew from one trial because of exacerbation of their condition after using the CHM intervention.Eight studies received government funding.

Authors' conclusions: We could not find conclusive evidence that CHM taken by mouth or applied topically to the skin could reduce the severity of eczema in children or adults.Well-designed, adequately powered RCTs are needed to evaluate the efficacy and safety of CHM for managing eczema.

PubMed Disclaimer

Conflict of interest statement

Kam‐Lun Ellis Hon, who peer‐reviewed this review as a clinical referee, was also the Principal Investigator in the following included study:

Hon KL, Leung TF, Ng PC, Lam MCA, Kam WYC, Wong KY, et al. Efficacy and tolerability of a Chinese herbal medicine concoction for treatment of atopic dermatitis: a randomized, double‐blind, placebo‐controlled study. British Journal of Dermatology 2007;157(2):357‐63. [MEDLINE: 17501956]

Figures

1
1
Study selection flow diagram
2
2
'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies
3
3
'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study
4
4
Forest plot of comparison: 1 CHM versus placebo, outcome: 1.3 Overall severity score
5
5
Forest plot of comparison: 2 CHM versus drugs, outcome: 2.1 Total effectiveness rate (number of participants recovered and significantly improved) with subgroup analysis
6
6
Funnel plot of comparison: 2 CHM vs drugs, outcome: 2.4 Overall severity score
1.1
1.1. Analysis
Comparison 1 CHM versus placebo, Outcome 1 Total effectiveness rate (number of participants recovered and significantly improved).
1.2
1.2. Analysis
Comparison 1 CHM versus placebo, Outcome 2 Itching VAS.
1.3
1.3. Analysis
Comparison 1 CHM versus placebo, Outcome 3 Overall severity score.
1.4
1.4. Analysis
Comparison 1 CHM versus placebo, Outcome 4 Overall severity score (short‐term improvement).
1.5
1.5. Analysis
Comparison 1 CHM versus placebo, Outcome 5 QoL.
1.6
1.6. Analysis
Comparison 1 CHM versus placebo, Outcome 6 QoL (short‐term improvement).
1.7
1.7. Analysis
Comparison 1 CHM versus placebo, Outcome 7 Adverse events.
1.8
1.8. Analysis
Comparison 1 CHM versus placebo, Outcome 8 Adverse events in one study.
2.1
2.1. Analysis
Comparison 2 CHM versus drugs, Outcome 1 Total effectiveness rate (number of participants recovered and significantly improved) with subgroup analysis.
2.2
2.2. Analysis
Comparison 2 CHM versus drugs, Outcome 2 Total effectiveness rate (long‐term improvement).
2.3
2.3. Analysis
Comparison 2 CHM versus drugs, Outcome 3 Itching VAS.
2.4
2.4. Analysis
Comparison 2 CHM versus drugs, Outcome 4 Overall severity score.
2.5
2.5. Analysis
Comparison 2 CHM versus drugs, Outcome 5 Overall severity score (long‐term improvement).
2.6
2.6. Analysis
Comparison 2 CHM versus drugs, Outcome 6 Adverse events.
2.7
2.7. Analysis
Comparison 2 CHM versus drugs, Outcome 7 Total effectiveness rate with posthoc subgroup analysis.
3.1
3.1. Analysis
Comparison 3 Combination of oral and topical CHM versus same oral CHM, Outcome 1 Total effectiveness rate (number of participants recovered and significantly improved).
3.2
3.2. Analysis
Comparison 3 Combination of oral and topical CHM versus same oral CHM, Outcome 2 Total effectiveness rate (long‐term improvement).
3.3
3.3. Analysis
Comparison 3 Combination of oral and topical CHM versus same oral CHM, Outcome 3 Itching VAS.
3.4
3.4. Analysis
Comparison 3 Combination of oral and topical CHM versus same oral CHM, Outcome 4 Skin lesion score.
3.5
3.5. Analysis
Comparison 3 Combination of oral and topical CHM versus same oral CHM, Outcome 5 Overall severity score.
3.6
3.6. Analysis
Comparison 3 Combination of oral and topical CHM versus same oral CHM, Outcome 6 QoL.
3.7
3.7. Analysis
Comparison 3 Combination of oral and topical CHM versus same oral CHM, Outcome 7 Adverse events.
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References

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