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24
Jun

First-line therapeutic options for patient with psoriasis vulgaris in initial stage

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Case Presentation

A 12-year-old girl began to suffer from psoriasis vulgaris (guttate type) in February of 2005. She presented at Tang Jinghua Clinic on 9th March, 2005. The discrete, erythematous scaling, small papules and plaques were distributed mainly on the trunk (Fig.1-A). Patient blood pressure, pulse and temperature were all normal, she had no backache, no history of any drug used, and no history of syphilis.

KOH examination was negative. TANGS capsules three times a day were administrated to her. After about 10 weeks of treatments, the patient’s psoriasis had cleared completely (Fig.1-B). The psoriatic lesions appeared on the trunk areas of the patient (Fig.1-A) at the initial stage , thus TANGS herbal therapy was given as the firstline therapy in placed of the topical steroids and calcipotriene, which is the common practice among dermatologists per evidence-based guidelines.

During the treatment, no other conventional medication was used. Through the periodic follow-up consultations, the condition was observed to be without recurrence up to and beyond the date this case report was written.

case11_a

case11_b

Discussions

Today, psoriasis is recognized as the most prevalent autoimmune disease caused by inappropriate activation of the cellular immune system—for example, the role of tumor necrosis factor (TNF)-alpha, T cell proliferation and T cell activation, and migration to the epidermis. This advancement in knowledge, combined with development in recombinant technologies, has led to the development of target-specific biological-agent therapies.

The topical or systemic immunosuppressants may elicit few side effects with normal use, but continued use may lead to tachyphylaxis. Moreover, the gold standard for psoriasis care is to palliate the disease safely and effectively in the long term. For the above case, the patient was at the initial stage of psoriasis without any history of treatment with systemic immunosuppressant. Three patients who were given Tangs Psoria as the first-line therapy showed remarkable improvement resulting in total disease clearance in 10 weeks (Fig.1-B). Herbal medicine such as TANGS, uses plants to treat disease, either a single herb or as a mixture of different herbs. Unlike conventional drugs, in which the active substance is extracted from the chemicals, herbal medicines usually makes use of the herb in its whole form. This makes it difficult to determine which ingredient or ingredients should be considered as the active agent, and thus, subjecting such therapy to standardization can be difficult.

TCM researchers believe that the causes of psoriasis are "blood heat and deficiency of blood, which are internal igniters interacting with dryness-heat and pathogenic wind". Therefore, herbs that clean and remove heat from the blood are used to treat psoriasis, such as the Xiao Yin Pian compiled in China Pharmacopoeia that is formulated from the cooling herbs named Ku Sen (Redix Sophorae Flavescentis), Jin Yin Hua (Flos Lonicerae), Chan Tui (Periostracum Cicadae), etc. However, TANGS' herbal formulation adopts the therapeutic method, which is in contrast to the classical TCM approach. TANGS herbal drugs stimulate yang (of the Chinese concept of Yin & Yang) component of the human body’s immune system, stimulating blood circulation, and facilitating in the detoxification processes. The patients will experience some adjustment to their bodies, at the same time as the normalization of their immune responses, and this will cause a wave-like healing progress. Although the mechanism of action for the positive clinical response to TANGS, as well as the modulation of pathologic cellular and inflammatory pathways in skin lesions, need to be investigated further, the treatment results and previous clinical findings suggest that TANGS' formulation may play an important part in the management of immune system cells (T-cell) to avoid misfiring and inappropriate targeting of the skin cells. It may also be that pharmacogenomics is an important variable: there may be groups of people who show a better response to one or the other of therapeutic agents, perhaps because of polymorphisms in genes that control the expression of the relevant molecules. These case report may provide the impetus for patients to consider an alternative to conventional immunosuppressive therapy.

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