Table 1.
Characteristics of included systematic reviews.
| First author (year) | First author's country | Studies (sample size) | Search duration | Control intervention | Main results (meta-analysis) | Key conclusion |
|---|---|---|---|---|---|---|
| Gong (2009) [21] | China | 11 RCTs (1,479) | Inception-2007.12. | Oral antihistamines | (I) Oral HM vs. oral antihistamines | Meta-analysis showed that HM is effective in treating AD, and its curative effect is superior to antihistamine. The conclusion of this study is credible, suggesting that HM treatment of AD has positive prospects. |
| (1) TER∗ | ||||||
| 11 RCTs, n = 1479; OR 5.64, 95% CI 4.07 to 7.81, I2 = 0% | ||||||
| (2) Recurrence rate+ | ||||||
| 11 RCTs, n = 1436; OR 0.38, 95% CI 0.29 to 0.49, I2 = 0% | ||||||
|
| ||||||
| Gu (2013) [22] | China | 28 RCTs (2,306) | Inception-2012.9. | Placebo, no treatment, or active controls | (I) Oral or external HM vs. placebo | We could not find conclusive evidence that oral or external HM could reduce the severity of eczema in children or adults. We assessed most of the studies as high risk of bias, particularly in blinding of participants and personnel, and there was substantial inconsistency between studies, so any positive effect of HM must be interpreted with caution. |
| (1) TER∗ | ||||||
| 2 RCTs, n = 85; RR 2.09, 95% CI 1.32 to 3.32, I2 = 0% | ||||||
| (2) Itching VAS+ | ||||||
| 2 RCTs, n = 94; SMD −1.53, 95% CI −2.64 to −0.41, I2 = 74% | ||||||
| (3) Overall severity+ | ||||||
| 4 RCTs, n = 239; SMD −0.88, 95% CI −1.67 to −0.09, I2 = 87% | ||||||
| (4) CDLQI score+ | ||||||
| 1 RCT, n = 85; MD −2.50, 95% CI −4.77 to −0.23 | ||||||
| (II) Oral or external HM vs. CM | ||||||
| (1) TER∗ | ||||||
| 21 RCTs, n = 1868; RR 1.43, 95% CI 1.27 to 1.61, I2 = 65% | ||||||
| (2) Itching VAS+ | ||||||
| 7 RCTs, n = 465; SMD −0.83, 95% CI −1.43 to −0.22, I2 = 89% | ||||||
| (3) Overall severity+ | ||||||
| 15 RCTs, n = 1062; SMD −0.97, 95% CI −1.23 to −0.71, I2 = 74% | ||||||
| (III) Oral or external HM vs. oral HM | ||||||
| (1) TER∗ | ||||||
| 1 RCT, n = 20; RR 1.13, 95% CI 0.78 to 1.63 | ||||||
| 2) Itching VAS+ | ||||||
| 1 RCT, n = 23; MD −1.05, 95% CI −1.75 to −0.35 | ||||||
| (3) Skin lesion score+ | ||||||
| 1 RCT, n = 23; MD −1.59, 95% CI −2.92 to −0.26 | ||||||
| (4) Overall severity+ | ||||||
| 1 RCT, n=20; MD -3.43, 95% CI -7.01 to 0.15 | ||||||
| 5) CDLQI score+ | ||||||
| 1 RCT, n = 20; MD 0.90, 95% CI −2.89 to 4.69 | ||||||
|
| ||||||
| Tan (2013) [7] | China | 6 RCTs (432) | Inception-2011. | Placebo, no treatment, or active controls | (I) Oral HM vs. placebo | HM significantly improved symptom severity of AD and it was reported as well-tolerated. The overall risk of bias assessment found that the quality of studies was poor; therefore, the results from the meta-analysis have to be interpreted with caution. |
| (1) Erythema score+ | ||||||
| 3 RCTs, n = 245; SMD −0.76, 95% CI −1.05 to −0.47, the value of I2 was not presented. | ||||||
| (2) Surface damage score+ | ||||||
| 3 RCTs, n = 245; SMD −1.08, 95% CI −1.59 to −0.56, the value of I2 was not presented. | ||||||
| (3) Itching score+ | ||||||
| 1 RCT, n = 71; MD −1.10, 95% CI −1.59 to −0.61 | ||||||
| (4) Sleep score+ | ||||||
| 1 RCT, n = 71; MD −0.80, 95% CI −1.12 to −0.48 | ||||||
| (5) CDLQI score+ | ||||||
| 1 RCT, n = 85; MD −2.50, 95% CI −4.77 to −0.23 | ||||||
| (6) Dose of topical treatment used+ | ||||||
| 1 RCT, n = 91; MD −24.50, 95% CI −27.92 to −21.08 | ||||||
| (II) Oral HM + CM vs. CM | ||||||
| (1) Overall severity score+ | ||||||
| 1 RCT, n = 98; MD −2.56, 95% CI −3.46 to −1.66 | ||||||
|
| ||||||
| Yang (2016) [23] | China | 13 RCTs (1,232) | 2000.01.01-2015.10.31 | CM | (I) Oral HM (or oral HM + CM) vs. CM | The current clinical evidence showed that HM treatment for AD has better clinical effect. Due to poor methodological quality of existing trials, the future need more high quality, large-sample RCTs to get more reliable clinical conclusions. |
| (1) TER∗ | ||||||
| 13 RCTs, n = 1232; OR 4.86, 95% CI 3.44 to 6.87, I2 = 0% | ||||||
| (2) SCORAD score+ | ||||||
| 4 RCTs, n = 390; MD −15.51, 95% CI −20.15 to −10.87, I2 = 73% | ||||||
| (3) Serum IgE+ | ||||||
| 2 RCTs, n = 181; MD −67.10, 95% CI −179.63 to 45.43, I2 = 87% | ||||||
| (4) Recurrence rate+ | ||||||
| 4 RCTs, n = 326; OR 0.21, 95% CI 0.07 to 0.60, I2 = 58% | ||||||
|
| ||||||
| Ma (2017) [24] | China | 14 RCTs (976) | Inception-2016.9. | CM | (I) Oral or external HM + CM vs. CM | The present study suggests that combination of HM and CM has curative effect with lower incidence of adverse reactions in the treatment of AD. The search results are limited to domestic literature, the clinical evidence level is low, and there is a lack of high-quality, standardized RCT. Further RCTs are required to confirm it. |
| (1) Cure rate∗ | ||||||
| 11 RCTs, n = 757; OR 2.94, 95% CI 2.08 to 4.16, I2 = 0% | ||||||
| (2) TER∗ | ||||||
| 12 RCTs, n = 733; OR 4.86, 95% CI 3.13 to 7.56, I2 = 0% | ||||||
| (3) Recurrence rate+ | ||||||
| 3 RCTs, n = 251; OR 0.74, 95% CI 0.36 to 1.53, I2 = 0% | ||||||
|
| ||||||
| Shi (2017) [25] | China | 24 RCTs (1,618) | Inception-2016.12. | Placebo or CM | (I) Oral HM, acupuncture, moxibustion, etc. vs. placebo or CM | We need to make conclusion cautiously for the efficacy and safety of HM and related treatment on AD. Articles having good quality based on the Cochrane Collaboration's risk of bias tool were included ensuring the results trustworthy. |
| (1) TER∗ | ||||||
| 8 RCTs, n = 667; RR 1.10, 95% CI 0.99 to 1.21, I2 = 65% | ||||||
| (2) SCORAD score+ | ||||||
| 4 RCTs, n = 173; SMD 0.89, 95% CI −0.24 to 2.02, I2 = 86% | ||||||
| (3) decrease of EASI score∗ | ||||||
| 2 RCTs, n = 50; MD 3.22, 95% CI 0.41 to 6.03, I2 = 0% | ||||||
| (4) decrease of SSRI score∗ | ||||||
| 2 RCTs, n = 105; SMD −0.36, 95% CI −1.16 to 0.45, I2 = 76% | ||||||
|
| ||||||
| Liu 2018 [26] | China | 37 RCTs (2,973) | Inception-2017.12. | CM | (1) Oral Jinpi HM (or oral Jinpi HM + CM) vs. CM | Studies have shown that HM Jianpi therapy had significantly higher clinical efficacy than CM in the treatment of AD. Due to the publication bias and low quality of included RCTs in this study, more multicenter, high quality, large-sample, randomized double-blind controlled trials are needed to further demonstrate the conclusion. |
| (1) TER∗ | ||||||
| 30 RCTs, n = 2333; OR 4.05, 95% CI 3.27 to 5.03, I2 = 0% | ||||||
| (2) SCORAD score+ | ||||||
| 15 RCTs, n = 1282; MD −9.82, 95% CI −13.31 to −6.33, I2 = 90% | ||||||
| (3) EASI score+ | ||||||
| 3 RCTs, n = 232; MD −2.80, 95% CI −3.54 to −2.07, I2 = 0% | ||||||
| (4) Itching VAS+ | ||||||
| 7 RCTs, n = 448; MD −0.79, 95% CI −1.10 to −0.47, I2 = 24% | ||||||
| (5) Serum IgE+ | ||||||
| 6 RCTs, n = 534; MD −34.92, 95% CI −86.07 to 16.22, I2 = 97% | ||||||
| (6) Serum IFN-γ∗ | ||||||
| 4 RCTs, n = 346; MD 1.75, 95% CI 1.14 to 2.35, I2 = 0% | ||||||
| (7) Serum IL-4+ | ||||||
| 4 RCTs, n = 346; MD −3.15, 95% CI −4.16 to −2.15, I2 = 75% | ||||||
| (8) Serum EOS+ | ||||||
| 5 RCTs, n = 410; MD −0.11, 95% CI −0.20 to −0.02, I2 = 0% | ||||||
| (9) Recurrence rate+ | ||||||
| 4 RCTs, n = 283; OR 0.36, 95% CI 0.21 to 0.60, I2 = 0% | ||||||
| (II) Oral Jinpi HM vs. CM | ||||||
| (1) TER∗ | ||||||
| 21 RCTs, n = 1355; OR 4.81, 95% CI 3.63 to 6.36, I2 = 0% | ||||||
| (III) Oral Jinpi HM + CM vs. CM | ||||||
| (1) TER∗ | ||||||
| 9 RCTs, n = 832; OR 2.94, 95% CI 2.11 to 4.11, I2 = 0% | ||||||
|
| ||||||
| Liu (2019) [27] | China | 13 RCTs (1385) | Inception-2018.10.2. | CM | (I) Tripterygium agents (or Tripterygium agents + CM) vs. CM | Tripterygium agents appear to be effective when treating patients with atopic eczema, but with apparent side effects. It cannot be concluded that Tripterygium agents can be generally used for eczema in the clinic because of the small sample size. Further multi-center studies with large samples, and high-quality should be conducted to clarify the efficacy and safety of Tripterygium agents for treating eczema. |
| (1) TER∗ | ||||||
| 13 RCTs, n = 1361; RR 1.59, 95% CI 1.26 to 2.00, I2 = 93% | ||||||
| (2) Serum IL-2∗ | ||||||
| 2 RCTs, n = 178; SMD 11.09, 95% CI −13.41 to 35.58, I2 = 99% | ||||||
| (3) Serum IL-4+ | ||||||
| 1 RCT, n = 160; SMD −0.64, 95% CI −0.96 to −0.33 | ||||||
| (4) Serum IFN-γ∗ | ||||||
| 1 RCT, n = 160; SMD 0.69, 95% CI 0.37 to 1.01 | ||||||
| (5) Serum CRP+ | ||||||
| 1 RCT, n = 118; SMD −20.01, 95% CI −22.64 to −17.39 | ||||||
| (6) Serum IgE+ | ||||||
| 1 RCT, n = 220; SMD −0.57, 95% CI −1.11 to −0.03 | ||||||
| (7) Recurrence rate+ | ||||||
| 2 RCTs, n = 149; RR 0.44, 95% CI 0.06 to 3.00, I2 = 89% | ||||||
| (II) Tripterygium agents vs. CM | ||||||
| (1) TER∗ | ||||||
| 4 RCTs, n = 367; RR 1.19, 95% CI 0.96 to 1.48, I2 = 85% | ||||||
| (III) Tripterygium agents + CM vs. CM | ||||||
| (1) TER∗ | ||||||
| 9 RCTs, n = 994; RR 1.78, 95% CI 1.40 to 2.25, I2 = 84% | ||||||
|
| ||||||
| Wang (2019) [28] | China | 19 RCTs (2178) | 1980.1.1.-2019.3.31. | Placebo or active controls | (I) Oral or external HM vs. CM | HM have certain advantages in treating atopic dermatitis and have relatively lower incidents of adverse reaction. |
| (1) Cure rate∗ | ||||||
| 16 RCTs, n = 1727; RR 1.79, 95% CI 1.35 to 2.39, I2 = 60% | ||||||
| (2) TER∗ | ||||||
| 16 RCTs, n = 1727; RR 1.19, 95% CI 1.08 to 1.31, I2 = 90% | ||||||
| (3) SCORAD score+ | ||||||
| 4 RCTs, n = 292; MD −14.67, 95% CI −19.52 to −9.82, I2 = 77% | ||||||
| (4) Recurrence rate+ | ||||||
| 7 RCTs, n = 906; RR 0.57, 95% CI 0.32 to 1.02, I2 = 76% | ||||||
| (5) Adverse events rate+ | ||||||
| 14 RCTs, n = 1735; RR 0.49, 95% CI 0.36 to 0.66, I2 = 42% | ||||||
| (II) Oral or external HM vs. CM or Placebo | ||||||
| (1) Serum IgE+ | ||||||
| 5 RCTs, n = 464; MD −119.19, 95% CI −177.93 to −60.45, I2 = 0% | ||||||
∗Higher score indicates better results, +lower score indicates better results. AD, atopic dermatitis; CDLQI, children's dermatology life quality index; CI, confidence interval; CM, conventional medication; CRP, C-reactive protein; EASI, eczema area and severity index; EOS, eosinophil count; HM, herbal medicine; IFN, inteferon; IL, interleukin; IgE, immunoglobulin E; MD, mean difference; OR, odds ratio; RCT, randomized controlled trial; RR, risk ratio; SCORAD, scoring atopic dermatitis; SMD, standardized mean difference; SSRI, symptom score reducing index; TER, total effective rate; VAS, visual analogue scale.