Atopic dermatitis (AD) is a chronic inflammatory skin disorder that most commonly occurs in children. The aims of this project are: 1. To evaluate the efficacy of indigo naturalis ointment in treating AD topically; 2. To evaluate the safety of indigo naturalis ointment in treating AD topically; 3. To investigate whether indigo naturalis ointment treatment is associated with a change in total IgE, cytokines, eosinophils, and CRP in patients with AD; 4. To evaluate whether indigo naturalis ointment treatment improves the quality of life in patients with AD.
Atopic dermatitis (AD) is a chronic inflammatory skin disorder that most commonly occurs in children. AD is characterized by itchy and dry skin that affects approximately 5 to 20% of children in the world. Currently, corticosteroids are the most widely prescribed medication in treating AD; however, there are concerns regarding the side effects such as skin atrophy, telangiectasia, striae, folliculitis and adrenocortical suppression that inhibits growth in children. Many patients and families seek complementary and alternative medications such as traditional Chinese medicine (TCM). In TCM, indigo naturalis has been used to treat various infectious and inflammatory skin diseases for hundreds of years. Ancient TCM literature has recorded that indigo naturalis is also effective in treating facial eczema (AD) in infants. The aims of this project are: (1) To evaluate the efficacy of indigo naturalis ointment in treating AD topically; (2) To evaluate the safety of indigo naturalis ointment in treating AD topically; (3) To investigate whether indigo naturalis ointment treatment is associated with a change in total IgE, cytokines, eosinophils, and CRP in patients with AD; (4) To evaluate whether indigo naturalis ointment treatment improves the quality of life in patients with AD.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
Every 10 x 10 cm area of lesion requires 0.5 g of ointment, applied twice daily (morning and evening, separated by approximately 12±2 hours) for 6 weeks.
Every 10 x 10 cm area of lesion requires 0.5 g of ointment, applied twice daily (morning and evening, separated by approximately 12±2 hours) for 6 weeks.
Chang Gung Memorial Hospital at Keelung
Kelung, Taiwan, Taiwan
Chang Gung Memorial Hospital at Taipei
Taipei, Taiwan, Taiwan
Chang Gung Memorial Hospital at Linkou
Taoyuan, Taiwan, Taiwan
Percentage change in Eczema Area Severity Index (EASI) scores from baseline to week 6
The Eczema Area and Severity Index (EASI) is used to measure the disease severity of erythema, infiltration/papulation, excoriation, and lichenification each on a scale of 0 to 3 (none to severe) as well as the percentage of disease area on a scale of 0 to 6 for the head ⁄ neck, upper limb, trunk and lower limb body regions. Each body region score is calculated by multiplying the disease severity score by the disease area score and by the multiplier. The scores are summed to give the total EASI score, ranging from 0 to a maximum 72. The mean percentage change in EASI = (EASI baseline-EASI post-treat) / EASI baseline x 100%
Time frame: 6 weeks
Proportion of subjects who have achieved EASI-50, EASI-75, and EASI-90 after 6 weeks of treatment
It is defined as at least 50%, 75%, and 90% reduction in EASI score relative to the baseline.
Time frame: 6 weeks
Proportion of subjects with a change in Investigator's Global Assessment (IGA, range 0-5) from baseline to week 6.
1. Proportion of subjects with an IGA score of 0 (clear) or 1 (almost clear) at week 6. 2. Proportion of subjects with ≥ 2 point improvement in IGA at week 6.
Time frame: 6 weeks
The mean percentage change in Total Body Surface Area involved with AD (BSA, range 0%-100%) from baseline to week 6.
BSA is total Body Surface Area involved, ranging from 0% (none) to 100% (total body surface involved)
Time frame: 6 weeks
The mean change in pruritus score (10-cm visual analogue scale) from baseline to week 6.
Visual Analogue Scale (VAS) for pruritus severity rates from 0 (no itching) to 10 (very severe itching)
Time frame: 6 weeks
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Clinical-immunological correlation between the treatment outcome and the changes in the level of immunoglobin E (IgE), cytokines, eosinophil count, and C-reactive protein (CRP) in the peripheral blood from baseline to week 6.
Measuring the correlations of treatment by EASI score and BSA, with the changes in IgE, eosinophils, cytokines (IL-1β, IL-6, TNF-α…) from baseline to week 6.
Time frame: 6 weeks
The mean change in Dermatology Life Quality Index (DLQI)from baseline to week 6
The DLQI is a self-administered 10-item questionnaire, ranges from 0 (best) to 30 (worst); the higher the score, the more quality of life is impaired. For subjects from age 6 to age 16, children's DLQI (CDLQI) will used.
Time frame: 6 weeks
Physician's Global Assessment (PGA ) at week 6.
0 = Symptoms cleared or excellent improvement of 90-100%; 1 = Marked improvement of 75-89%; 2 = Moderate improvement of 50-74%; 3 = Slight improvement of 3049%; 4 = No appreciable improvement of 029%; 5 = Worsening of the condition
Time frame: 6 weeks
Subject's Global Assessment (SGA) at week 6.
0 = Symptoms cleared or excellent improvement of 90-100%; 1 = Marked improvement of 75-89%; 2 = Moderate improvement of 50-74%; 3 = Slight improvement of 3049%; 4 = No appreciable improvement of 029%; 5 = Worsening of the condition
Time frame: 6 weeks