Know the medicine before you take it 皮肤用药三思而后行
The prevalence of immue system related skin disorders such as psoriasis, atopic dermatitis (AD) , and allergy has increased dramatically in industrialized countries over the past several decades. Automimmune skin diseases are a serious public health problem and demorolize the quality of life in patients, particularly in children. Conventional therapies, such as glucocorticoids, MTX, cyclosporin, are widely used in controlling inflamtory skin diseases. However, these therapies are not completely effective in all patients, and there are concerns about side effects, especially in children. In addition, the immunosuppressant is not curative treatment, it not only rescue treatment of reactions but also damage the liver or kidney function. These and other issues have led patients and their families to seek alternative herbal medicine treatments.
In the United States, in response to increased public interest and use of complementary and alternative medicines, Congress established the National Institutes of Health (NIH) Office of Alternative Medicine (OAM) in 1992. The NIH Office of Dietary Supplements was created in 1994 to conduct and coordinate research in herbs and supplements. In 1998, the NIH OAM was upgraded to the National Center for Complementary and Integrative Health (NCCIH). NCCIH has prioritized evaluating mechanisms, efficacy, and safety of botanical medicines through basic science studies, clinical research, and the establishment of dedicated botanical research centers [1].
Case Presentation
We herewith present a psoriasis patient with inflamed liver which caused by prior medication. A 40-years-old man was presented to our clinic because of hyperkeratotic psoriasis plaques on his dorsal palms (picture A). The patient had been well until three years earlier, when psoriasis was found. Then he went on his treatments journey, various GPs and dermatologist consulted, numerous topical cream and oral tablets used, he did not keep the prescription records.
With physical examination, the patient was found to be chronic fatigue with yellowish skin. No lymphadenopathy or cutaneous evidence of infection was defected. The blood chemistry, Liver function and Kidney function test were ordered. The serum Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Gamma-Glutamyltransferase (GGT), Alkaline Phosphatase (ALP), Bilirubin Direct became elevated (picture A). His liver cells damaged! Unaware of the side effects, his liver started to react dramatically, taking a toll on his overall health. Patient was advised to discontinue prior medicine immediately and wash-out side effect of previous medicine with herbal formulation. His liver function was restored within 6 months and went back to normal in 11 months. The psoriasis plaques flaked off and were replaced by healthy skin, achieved significant clearance in 19 months of herbal treatment.
病例分享
我们特此介绍一起因先前的药物治疗导致肝脏发炎的银屑病案例。一名40岁男子因其背部手掌上的角化过度牛皮癣肥厚斑快前来问诊（图A）。该男子身体健康，直到三年前发现双手掌出现牛皮癣。然后，他开始了他的治疗之旅，咨询了许多全科医生和皮肤科医生，并使用了许多外用乳膏和口服片剂，但他没有保留处方记录。
体检发现该患者皮肤发黄，体态倦怠。 但是没有发现淋巴结病或皮肤感染证据。血液生化检验，肝功能和肾功能检查显示血清丙氨酸氨基转移酶（ALT），天冬氨酸氨基转移酶（AST），γ-谷氨酰转移酶（GGT），碱性磷酸酶（ALP）和胆红素直接升高（图A）。 他的肝细胞受损！ 由于没有意识到副作用，他的肝脏开始剧烈反应，他以前服用的药对他的整体健康造成了损害。 建议患者立即停止使用先前的药物，并用中药治疗清除先前药物的副作用。 他的肝功能在6个月内恢复，并在11个月内恢复正常。 牛皮癣斑块剥落并被健康的皮肤所取代，在经过19个月的草药治疗后，皮疹显著消退。
–
Reference:
- National Center for Complementary and Integrative Health. 2016 strategic plan: Exploring the science of complementary and integrative health. US Department of Health and Human Services 2016. https://www.nccih.nih.gov/about/nccih-2016-strategic-plan (Accessed on April 2, 2020).
