Modulation by Chinese Herbal Therapy of immune mechanisms in the skin of patients with atopic eczema

Modulation by Chinese Herbal Therapy of immune mechanisms in the skin of patients with atopic eczema

A double-blind, but non-placebo-controlled, trial was carried out by workers from the Royal Free Hospital and School of Medicine, London. It involved a group of ten patients whose characteristics were: an age range of 16 to 65 years, and extensive (>50% of body surface area) lichenified or urticarial papules or plaques of Atopic Eczema without active exudation or infection. Exclusion factors for the study included the presence of an abnormal full blood count, liver or renal function test, concomitant serious illness or pregnancy (women of child bearing age were instructed on the use of contraceptives) as well as the use of UV phototherapy, systemic steroids, antibiotics or other immunosuppressive therapy in the two months prior to the study. The patients were instructed not to apply topical steroids to their arms, but were permitted to continue to apply it to other areas of the body without increasing their dosage.

The patients were given Chinese Herbal Therapy (CHT) consisting of a tea made from the plant extract as well as another formulation from the plant Schizonepetae tenuifolia. The patients received treatment for a period of 8 weeks and were seen at the start and at 4 and 8 weeks. A standardised quantitative assessment of disease activity was made at each visit. A 4mm biopsy specimen was taken from an excoriated active lesion of eczema and another from clinically uninvolved skin on the arms, before treatment. Following 8 weeks of treatment, biopsies were taken from adjacent sites; however, if the previously uninvolved site had become involved, another nearby uninvolved site was chosen. Immuno-histochemical studies were carried out and statistical tests were applied to the results.

The authors reported a significant decrease in erythema scores (to 40.75 ñ 24.37 from 145.8 + 32.34) and surface damage (to 27.25 ñ 7.63 from 89.75 ñ 49.06) on the completion of treatment. The authors also state that, aside from the bitter taste of the herbs, no adverse effects were noted. Immunohistochemical analysis showed an increase in the number of all cell populations in lesional as compared to non-lesional skin in the following cell groups: CD23+, Langerhan's and CD25+ cells; no differences in the ratios of cells expressing high IgE affinity or of RDF1/RDF7 and CD4/CD8 were observed.

Comment: The authors concluded from the above that the Chinese herbal therapy significantly reduced eczema activity as assessed by surface erythema and skin damage scores. They also conclude that the concomitant change in some cell populations may be evidence of their involvement in the pathogenesis of eczema. The authors conceded that a placebo controlled trial might be more definitive. However, should one conclude that the placebo effect played a very significant role in the results of this study, then placebo therapy using CHT may be a highly acceptable answer to severe atopic eczema, especially as this gives no side effects.

Also, with regard to the placebo effect, it appears that the arms were chosen as biopsy sites because of their easy accessibility. This would imply that the biopsy site does not influence the immuno-histochemical or clinical scores obtained. In this case it might have been helpful if the authors of this study had additionally assessed the sites that received uninterrupted steroid treatment during the study. We may then have had an idea of the comparative activity of the effects of CHT and corticosteroid treatment on the disease activity of atopic eczema in the same patient.

Finally, it should be noted that the immune system in Traditional Chinese Medicine (TCM) involves the Liver (reticuloendothelial system) primarily, and the Lung (skin) and Heart (psyche) secondarily. The relationship is not mentioned by the authors. This may be for one of two reasons: the authors may not be versed in TCM, or they may have chosen to exclude it in order to make the paper more acceptable. The hocus pocus of TCM is logically constructed and is the basis on which treatment I selected. Thus, those studies involving TCM that are published in medical journals should also contain a least a mention of this background as it would help to understand the reasoning behind a TCM prescription.

The British Medical Acupuncture Society.

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By Lawrence Nwabudlike

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