Psoriasis is an inflammatory skin disease with huge negative impact on the quality of life of the patients, and has an overall prevalence of 2% to 3% in the general population. Plaques psoriasis is the most common type of the disease and presents red, well demarcated, and silvery plaques mainly localized in the umbilical and lumbosacral area as well as in the elbows, knees, and scalp. Currently, pharmacological treatments such as retinoids, corticosteroids, vitamin D analogs and biologics remain the main options for most psoriasis patients. However, side effect and high cost barred many ordinary psoriasis patients from benefiting from the treatments. A Chinese medicine formula "Shuiniujiao Dihuang Decoction with Variation (SDD)" was prescribed by Prof. Lin for many years and observed to be effective in relieving psoriasis patients' clinical manifestations. In this study, subjects with psoriasis will be randomized into treatment group of "SDD" or placebo group for 12 weeks.
Psoriasis is an inflammatory skin disease with huge negative impact on the quality of life of the patients, and has an overall prevalence of 2% to 3% in the general population. Plaques psoriasis is the most common type of the disease and presents red, well demarcated, and silvery plaques mainly localized in the umbilical and lumbosacral area as well as in the elbows, knees, and scalp. The major histological features of psoriasis include epidermal hyperplasia with aberrant keratinocyte differentiation, pronounced inflammatory cell infiltration and increased vascularization. Currently, pharmacological treatments such as retinoids, corticosteroids, and vitamin D analogs remain the main options for most psoriasis patients. However, the efficacy of conventional drugs is limited because of adverse side effects and the development of pharmacoresistance. Recently, biologics have become available for the treatment of acute and subacute plaque psoriasis with excellent response rate. However, the high costs involved with the biologics have barred many ordinary psoriasis patients from benefiting from this new class of anti-psoriatic medication. Natural products are valuable sources in novel drug development. Shuiniujiao Dihuang Decoction with Variation (SDD) is an empirical formula of the Principal Investigator (Prof. Zhi-Xiu Lin), a highly experienced Registered Chinese Medicine Practitioner and Chinese medicine dermatologist working at the School of Chinese Medicine, The Chinese University of Hong Kong. SDD has been prescribed in clinic in Hong Kong for many years and observed to be effective in relieving psoriasis patients' clinical manifestations. SDD contains 23 Chinese herbal medicines, including Rehmanniae Radix (Dihuang), Bubali Cornu (Shuiniujiao), Paeoniae Radix Rubra (Chishao), Moutan Cortex (Mudanpi), Scrophulariae Radix (Xuanshen), Ophiopogonis Radix (Maidong), etc. The formula is composed of herbal medicines that can eliminate pathogenic heat, expel blood stasis and dampness, nourish yin, and have antipruritic effect. A randomized, double-blinded, placebo-controlled trial will be conducted to evaluate the efficacy of SSD on psoriasis patients. Clinical evidence for the anti-psoriatic effects of SSD is a necessary step towards developing this Chinese medicine formula into an anti-psoriatic pharmaceutical agent.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
58
SDD formula consists of 23 herbal medicines
Placebo
Hong Kong Institute of Integrative Medicine
Hong Kong, Hong Kong
RECRUITINGPsoriasis Area and Severity Index (PASI)
The change in Psoriasis Area and Severity Index (PASI) score will be assessed. PASI scores include area involved, erythema, induration and scaling. It will be scored on a scale of 0 to 4 (0, meaning none; 1, mild; 2, moderate; 3, severe; and 4, very severe). It will be performed by 2 blinded assessors who have been trained. Four main areas were assessed for calculation of the PASI scores: the head, the trunk, the upper extremities, and the lower extremities, corresponding to 10%,20%,30%, and 40% of the total body area, respectively. The maximum score for PASI is 72.
Time frame: Week 12
Static Physician Global Assessment score (sPGA)
Participants are requested to expose their skin thoroughly before the photographs are taken at each visit. The sPGA is an investigator-rated assessment of overall disease severity to be evaluated on a 5-point scale, where 0=clear and 4=severe. The severity of erythema, scaling, and plaque are considered for assessment. It will be performed by 2 blinded assessors who have received training.
Time frame: Week 12
Constitution in Chinese Medicine Questionnaire (Hong Kong Version)
The 60-item Constitution in Chinese Medicine Questionnaire (CCMQ) Hong Kong version will be used to assess the body constitution (BC) in Chinese medicine of subjects. According to Chinese medicine theory, there are 9-type of BC: gentleness (8 Items), Qi-deficiency (8 Items), Yang-deficiency (7 Items), Yin-deficiency (8 Items), phlegm-wetness (8 Items), wetness-heat (6 Items), blood-stasis (7 Items), Qi-depression (7 Items), and special diathesis (7 Items). Subjects will have to score on a 5-point Likert scale for each item where 1=never and 5=for most of the time. A final score for each BC will be calculated according to the scoring algorithm. A higher score in the CCMQ BC scale indicates a higher likelihood of the specific BC type, and a score of 30 is set as threshold for case definition. Coexistence of multiple imbalanced BC types is possible which is consistent with the Chinese medicine theories.
Time frame: Week 12
Chinese Medicine symptom pattern
A structural designed record form will be completed by Chinese medicine practitioner (CMP) to record the signs and symptoms of the subjects, which includes but not limited to spirit, skin condition, joints condition, sleep condition, tongue and pulse condition. A final symptom pattern will be decided by the CMP according to the form by Chinese medicine theory.
Time frame: Week 6
Chinese Medicine symptom pattern
A structural designed record form will be completed by Chinese medicine practitioner (CMP) to record the signs and symptoms of the subjects, which includes but not limited to spirit, skin condition, joints condition, sleep condition, tongue and pulse condition. A final symptom pattern will be decided by the CMP according to the form by Chinese medicine theory.
Time frame: Week 12
Chinese Medicine symptom pattern
A structural designed record form will be completed by Chinese medicine practitioner (CMP) to record the signs and symptoms of the subjects, which includes but not limited to spirit, skin condition, joints condition, sleep condition, tongue and pulse condition. A final symptom pattern will be decided by the CMP according to the form by Chinese medicine theory.
Time frame: Week 18
Psoriasis Area and Severity Index (PASI)
The change in Psoriasis Area and Severity Index (PASI) score will be assessed. PASI scores include area involved, erythema, induration and scaling. It will be scored on a scale of 0 to 4 (0, meaning none; 1, mild; 2, moderate; 3, severe; and 4, very severe). It will be performed by 2 blinded assessors who have been trained. Four main areas were assessed for calculation of the PASI scores: the head, the trunk, the upper extremities, and the lower extremities, corresponding to 10%,20%,30%, and 40% of the total body area, respectively. The maximum score for PASI is 72.
Time frame: Week 6
Psoriasis Area and Severity Index (PASI)
The change in Psoriasis Area and Severity Index (PASI) score will be assessed. PASI scores include area involved, erythema, induration and scaling. It will be scored on a scale of 0 to 4 (0, meaning none; 1, mild; 2, moderate; 3, severe; and 4, very severe). It will be performed by 2 blinded assessors who have been trained. Four main areas were assessed for calculation of the PASI scores: the head, the trunk, the upper extremities, and the lower extremities, corresponding to 10%,20%,30%, and 40% of the total body area, respectively. The maximum score for PASI is 72.
Time frame: Week 18
Static Physician Global Assessment score (sPGA)
Participants are requested to expose their skin thoroughly before the photographs are taken at each visit. The sPGA is an investigator-rated assessment of overall disease severity to be evaluated on a 5-point scale, where 0=clear and 4=severe. The severity of erythema, scaling, and plaque are considered for assessment. It will be performed by 2 blinded assessors who have received training.
Time frame: Week 6
Static Physician Global Assessment score (sPGA)
Participants are requested to expose their skin thoroughly before the photographs are taken at each visit. The sPGA is an investigator-rated assessment of overall disease severity to be evaluated on a 5-point scale, where 0=clear and 4=severe. The severity of erythema, scaling, and plaque are considered for assessment. It will be performed by 2 blinded assessors who have received training.
Time frame: Week 18
Psoriasis-involved body surface area (BSA)
BSA represents the affected skin surface. It is an objective measure of psoriasis severity. The head, the upper extremities, the trunk, and the lower extremities, corresponding to 10%,20%,30%, and 40% of the total body area, respectively. The range of BSA is 0-100. It will be performed by 2 blinded assessors who have received training by Dr Steven Loo.
Time frame: Week 6
Psoriasis-involved body surface area (BSA)
BSA represents the affected skin surface. It is an objective measure of psoriasis severity. The head, the upper extremities, the trunk, and the lower extremities, corresponding to 10%,20%,30%, and 40% of the total body area, respectively. The range of BSA is 0-100. It will be performed by 2 blinded assessors who have received training by Dr Steven Loo.
Time frame: Week 12
Psoriasis-involved body surface area (BSA)
BSA represents the affected skin surface. It is an objective measure of psoriasis severity. The head, the upper extremities, the trunk, and the lower extremities, corresponding to 10%,20%,30%, and 40% of the total body area, respectively. The range of BSA is 0-100. It will be performed by 2 blinded assessors who have received training by Dr Steven Loo.
Time frame: Week 18
Impact of Psoriasis Questionnaire (IPSO)
The change in Impact of Psoriasis Questionnaire (IPSO) score will be assessed. IPSO is a validated 16-item psoriasis-specific instrument for quality of life of psoriasis patients. The IPSO is intended predominantly to assess the psychosocial impact of psoriasis on patient's lives. The IPSO uses an ordinal rating scale, with responses of 'none', 'some', 'moderately', 'quite a bit' and 'extremely' scored 1, 2, 3, 4 and 5, respectively. The scores for item 4 were reversed. The higher the summed score, the greater the impact experienced due to psoriasis.
Time frame: Week 12
Short Form 36 survey (SF36)
The change in the score of quality of life using Short Form 36 survey (SF36) will be assessed. SF36 is generic instrument to measure general health status that is complementary to those derived from dermatological questionnaires. It will be used to assess the patient's health status using 8 different dimensions including vitality, physical functioning, bodily pain, general health perceptions, role limitations due to physical health, role limitations due to emotional health, social role functioning and mental health. The possible score ranges from 0 to 100 points whereby 0 points represent the greatest possible limitation of health, while 100 points represent the absence of health restrictions.
Time frame: Week 12
Psoriasis Itch Visual Analog Scale (Itch VAS)
Psoriasis itch VAS is a validated tool to assess treatment benefit of plaque psoriasis. It was developed to measure itch intensity within the last 24 hours. A horizontal line with a length of 100mm is to be used to represented the range of itch intensity from 0 (no itch at all) to 100 (worst itch you can imagine). Subjects rated the maximal intensity of itch during the previous 24 hours by putting a vertical mark through the horizontal line at the the spot he/she felt best reflected their maximal itch intensity.
Time frame: Week 12
Use of rescue therapy
The frequent use of rescue therapy during study period
Time frame: Day 0 to Week 18
Adverse events
Adverse events related to study treatment
Time frame: Day 0 to Week 18
Serum markers (IL-17, IL-22)
The changes in levels of serum markers IL-17, IL-22
Time frame: Week 6
Serum markers (CRP )
The changes in levels of serum markers C-reactive protein (CRP)
Time frame: Week 6
Serum markes (BD2)
The changes in levels of serum marker Beta-Defensin 2 (BD2).
Time frame: Week 6
Serum markers (IL-17, IL-22)
The changes in levels of serum markers IL-17, IL-22
Time frame: Week 12
Serum markers (CRP)
The changes in levels of serum markers C-reactive protein (CRP)
Time frame: Week 12
Serum markers (BD2)
The changes in levels of serum marker Beta-Defensin 2 (BD2).
Time frame: Week 12
Oral and Gut microbiota composition in saliva and stools
Saliva and stool specimen will be collected at baseline and week 12 (+/-4 days) for gut microbiota assessments.
Time frame: Week 12
Gene expression of serum inflammatory factors
The changes in gene expression of serum inflammatory factors will be assessed by using the blood sample taken on baseline, week 6 and week 12. Analysis of such item could help to explore the effect mechanism of investigating medicinal product on gene expression of serum inflammatory factors on psoriasis patients.
Time frame: Week 6
Gene expression of serum inflammatory factors
The changes in gene expression of serum inflammatory factors will be assessed by using the blood sample taken on baseline, week 6 and week 12. Analysis of such item could help to explore the effect mechanism of investigating medicinal product on gene expression of serum inflammatory factors on psoriasis patients.
Time frame: Week 12
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.