title: The efficacy and safety of topically applied indigo naturalis ointment in patients with plaque-type psoriasis.
abstract: BACKGROUND
  It has been reported in the Chinese literature that indigo naturalis exhibits potential antipsoriatic effects in systemic therapy.
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of topically applied indigo naturalis on treating plaque-type psoriasis and to analyze the histological change in skin tissues.
  
  
  METHODS
  Fourteen patients with chronic plaque psoriasis were enrolled. The patients were topically applied with either indigo naturalis ointment or vehicle ointment on contralateral skin lesions daily for 8 weeks. Efficacy was evaluated on the basis of the clinical scores, including induration, scaling, erythema and clearing percentage. At the end of treatment, skin punch biopsies were taken and prepared for the immunohistochemical analysis.
  
  
  RESULTS
  A significant reduction in clinical scores was achieved with topically applied indigo naturalis ointment. Analysis of biopsies showed a marked improvement of skin histology. The expressions of proliferating marker Ki-67 and inflammatory marker CD3 were decreased, but the differentiation marker such as filaggrin was increased in the epidermis after indigo naturalis ointment treatment.
  
  
  CONCLUSIONS
  The results suggest that topical application of indigo naturalis ointment may be a novel, safe and effective therapy for psoriasis that is mediated, at least in part, by modulating the proliferation and differentiation of keratinocytes in epidermis, as well as by inhibiting the infiltration of T lymphocytes and therefore the subsequent inflammatory reactions in psoriatic lesions.
authors.affiliation: Department of Traditional Chinese Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.
authors.forename: Yin-Ku
authors.initials: YK
authors.lastname: Lin
authors.forename: Wen-Rou
authors.initials: WR
authors.lastname: Wong
authors.forename: Ya-Ching
authors.initials: YC
authors.lastname: Chang
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
authors.forename: Pei-Kwei
authors.initials: PK
authors.lastname: Tsay
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Chang
authors.forename: Jong-Hwei Su
authors.initials: JH
authors.lastname: Pang
mesh_terms: D000287:Administration, Topical; D000328:Adult; D001706:Biopsy; D049109:Cell Proliferation; D002908:Chronic Disease; D004396:Coloring Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D000091344:Filaggrin Proteins; D006801:Humans; D007203:Indigo Carmine; D007211:Indoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015603:Keratinocytes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009824:Ointments / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology*; D012867:Skin / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents; C000717249:FLG protein, human; D000091344:Filaggrin Proteins; D007211:Indoles; D009824:Ointments; D007203:Indigo Carmine