Chinese Herbal Medicine Improves EASI Scores in Patients with Atopic Dermatitis

Oral and topical Chinese herbal medicine (CHM) improves Eczema Area and Severity Index (EASI) scores in those with atopic dermatitis when combined with conventional medicine, new data suggest, although further data may be needed due to a limited number of studies.1

Meaghan E. Coyle, PhD—from the China-Australia International Research Centre for Chinese Medicine in Australia—led a team of investigators in this analysis, assessing the few randomized controlled trials available to assess CHM’s impact on atopic dermatitis.

Recently developed clinical guidelines considering CHM recommend against its use, but these recommendations were based upon systematic reviews that had been published in 2013 and 2014.2,3 This new analysis by Coyle et al sought to explore CHM’s use further in dermatology.

“New evidence has emerged that necessitates an update of the evidence,” Coyle and colleagues wrote.1 “Therefore, this systematic review of randomised controlled trials (RCTs) sought to evaluate the efficacy, effectiveness and safety of CHM for atopic dermatitis”

Trial Design and Findings

The investigators sourced RCTs through the World Health Organization’s International Clinical Trials Registry Platform. Research deemed as eligible for inclusion included RCTs that evaluated CHM against placebo, waitlist control, or standard conventional therapies. They were only considered eligible provided they reported outcomes such as signs assessed by clinicians, patient-reported symptoms, safety, long-term atopic dermatitis control, or health-related quality of life.

Screening was carried out by exporting search results into Microsoft Excel, with titles then being reviewed to exclude any irrelevant studies. Study data and characteristics were extracted by Coyle and coauthors, with the team appraising the risk of bias of these RCTs and rating the certainty of evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. When appropriate, data were synthesized via meta-analysis.

Their search of the International Clinical Trials Registry Platform concluded with around 3000 records being identified. Most of these studies were excluded by the investigative team following a review of the registration titles. Among the analysis's full-text articles, the team noted that 7 met their inclusion criteria, with 862 participants being included in total.

Overall, Coyle and colleagues found that topical CHM did not significantly differ from placebo in reducing severity of pruritus on the visual analogue scale (mean difference [MD] −2.15, 95% CI −5.64 to 1.34; I² = 95%; evidence not graded).1 However, they did find CHM led to greater improvement than placebo in the reduction of patients' EASI scores (MD −2.75, 95% CI −4.07 to −1.44; I² = 0%; low-certainty evidence).

There was no significant difference observed by the investigators between CHM and placebo in terms of health-related quality of life outcomes (MD −2.20, 95% CI −5.27 to 0.88; I² = 0%; moderate-certainty evidence). They also highlighted, however, that adverse events appeared more frequently in the CHM cohorts versus the controls.

“This review contributes to informing clinicians and patients about the available evidence on CHM for atopic dermatitis,” Coyle et al wrote.1 “Patients who wish to use CHM for atopic dermatitis are encouraged to discuss the potential benefits and risks in light of the limited available evidence with an appropriately qualified and registered health practitioner.”

References

1. Coyle Meaghan E, Liu Junfeng, Charlie C, et al. Chinese Herbal Medicine for Atopic Dermatitis: A Systematic Review of Registered Randomised Controlled Trials, Dermatologic Therapy, 2025, 9920370, 9 pages, 2025. https://doi.org/10.1155/dth/9920370.

2. Tan H. Y., Zhang A. L., Lenon G. B., et al. Chinese Herbal Medicine for Atopic Dermatitis: a Systematic Review, Journal of the American Academy of Dermatology. (2013) 69, no. 2, 295–304, https://doi.org/10.1016/j.jaad.2013.01.019, 2-s2.0-84880325363.

3. Gu S., Yang A. W., Xue C. C, et al. Topical Application of Chinese Herbal Medicine for Atopic Eczema: a Systematic Review with a Meta-Analysis, Dermatology. (2014) 228, no. 4, 294–302, https://doi.org/10.1159/000360526, 2-s2.0-84905028522.