title: Is Oral Chinese Herbal Medicine Beneficial for Psoriasis Vulgaris? A Meta-Analysis of Comparisons with Acitretin.
abstract: BACKGROUND
  Psoriasis vulgaris is a chronic disease that significantly affects patient's quality of life and poses an economic burden. Acitretin is a second-generation retinoid used for psoriasis in clinical practice. Orally administered Chinese herbal medicine (CHM), alone or combined with acitretin, has been used for the clinical management of psoriasis vulgaris. This systematic review evaluates the efficacy of oral CHM in comparison with acitretin and the add-on effect of oral CHM to acitretin.
  
  
  METHODS
  Five English databases and four Chinese databases were searched from their inceptions to May 2014. Included randomized, controlled trials (RCTs) were published in English or Chinese, compared oral CHM or the combination of oral CHM and acitretin with acitretin, and used Psoriasis Area and Severity Index (PASI) as the outcome measure.
  
  
  RESULTS
  A total of 25 RCTs were included in this review: 8 studies compared oral CHM with acitretin, 12 compared the combination with acitretin alone, and 5 were three-arm studies that compared both with acitretin.
  
  
  CONCLUSIONS
  The meta-analysis indicated that oral CHM was effective for psoriasis vulgaris as follows: (1) Oral CHM is neither superior nor inferior to acitretin, and (2) oral CHM could produce add-on effects when combined with acitretin. Oral CHM itself appeared safe for treating psoriasis vulgaris and possibly could reduce the common adverse events seen with acitretin. However, the long-term effect and safety of oral CHM could not be assessed. Further research should consider including a placebo control and using outcome measures according to international guidelines to evaluate CHM, as well as include follow-ups to monitor longer-term efficacy and safety.
authors.affiliation: 1 China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University , Melbourne, Australia .
authors.forename: Claire Shuiqing
authors.initials: CS
authors.lastname: Zhang
authors.affiliation: 2 Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine , Guangzhou, People's Republic of China .
authors.forename: Lihong
authors.initials: L
authors.lastname: Yang
authors.affiliation: 1 China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University , Melbourne, Australia .
authors.forename: Anthony Lin
authors.initials: AL
authors.lastname: Zhang
authors.affiliation: 1 China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University , Melbourne, Australia .
authors.forename: Brian H
authors.initials: BH
authors.lastname: May
authors.affiliation: 2 Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine , Guangzhou, People's Republic of China .
authors.forename: Jason Jingjie
authors.initials: JJ
authors.lastname: Yu
authors.affiliation: 2 Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine , Guangzhou, People's Republic of China .
authors.forename: Xinfeng
authors.initials: X
authors.lastname: Guo
authors.affiliation: 2 Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine , Guangzhou, People's Republic of China .
authors.forename: Chuanjian
authors.initials: C
authors.lastname: Lu
authors.affiliation: 1 China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University , Melbourne, Australia .|2 Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, and The Second Clinical College, Guangzhou University of Chinese Medicine , Guangzhou, People's Republic of China .
authors.forename: Charlie Changli
authors.initials: CC
authors.lastname: Xue
mesh_terms: D017255:Acitretin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D004365:Drugs, Chinese Herbal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007641:Keratolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult
chemical_list: D004365:Drugs, Chinese Herbal; D007641:Keratolytic Agents; D017255:Acitretin