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Psoriasis

Psoriasis is a long-lasting skin disease that results in patches (called plaques) of thick, red skin covered with silvery scales. It occurs because cells in the outer layer of the skin multiply faster than normal, and pile up on the skin's surface. A normal skin cell matures in 28 to 30 days and is shed from the skin's surface unnoticed. But a psoriatic skin cell takes only 3 to 4 days to mature, and moves to the surface much earlier. The surplus growth of cells piles up and forms elevated red lesions that are a common symptom in psoriasis sufferers.

Diagnosis of Psoriasis

Doctors usually diagnose psoriasis after a careful examination of the skin. However, diagnosis may be difficult because psoriasis symptoms can be similar to those of other skin diseases. A pathologist may assist with diagnosis by conducting a biopsy: that is, examining a small skin sample under a microscope.

There are several forms of psoriasis. The most common form is plaque psoriasis (its scientific name is psoriasis vulgaris). In plaque psoriasis, lesions have a reddened base covered by silvery scales. Other forms of psoriasis include

  • Guttate psoriasis - Small, drop-like lesions appear on the trunk, limbs, and scalp. Guttate psoriasis is most often triggered by bacterial infections (for example, Streptococcus).
  • Pustular psoriasis - Blisters of noninfectious pus appear on the skin. Attacks of pustular psoriasis may be triggered by medications, infections, emotional stress, or exposure to certain chemicals. Pustular psoriasis may affect either small or large areas of the body.
  • Inverse psoriasis - Large, dry, smooth, vividly red plaques occur in the folds of the skin near the genitals, under the breasts, or in the armpits. Inverse psoriasis is related to increased sensitivity to friction and sweating and may be painful or itchy.
  • Erythrodermic psoriasis - Widespread reddening and scaling of the skin is often accompanied by itching or pain. Erythrodermic psoriasis may be precipitated by severe sunburn, use of oral steroids (such as cortisone), or a drug-related rash.

Who gets Psoriasis?

Psoriasis is linked to a genetic case, where a family association exists in one out of three cases. It often appears at between the ages of 15 and 35, but it can develop at any age. About 10 percent to 15 percent of those with psoriasis get it before age 10, and occasionally it appears in infancy. Psoriasis is not contagious, so one can "catch" it from another person.

What are the most irritating locations for Psoriasis?

Scalp: Scalp psoriasis occurs in at least half of all people with psoriasis. It can range from very mild with fine scaling to very severe with thick, crusted plaques.

Genitals: Genital psoriasis acts similar to other affected parts of the body. But because of the sensitivity of the skin, this type may require special considerations.

Hands and Feet: Pustular psoriasis can impair a person's ability to work. Plaque psoriasis can dry out the skin and cause cracking and bleeding.

Nails: Nail changes occur in about half of those with psoriasis and 80 percent of those with psoriatic arthritis. The nails may have small holes (pitting), a changed shape (deformation), separation from the skin (oncholyosis) and discoloration.

 Dermatopathology

  • Marked overall thickening of the epidermis (acanthosis) and thinning of epidermis over elongated dermal papillae
  • Increased mitosis of keratinocytes, fibroblasts, and endothelial cells
  • Parakeratotic hyperkeratosis (nuclei retained in the stratum corneum)
  • Inflammatory cells in the dermis (lymphocytes and monocytes) and in the epidermis (polymorphonuclear cells), forming microabscesses of Munro in the stratum corneum

Serology – Increased antistreptolysin tier I acute guttate psoriasis with antecedent streptococcal infection. Sudden onset of psoriasis may be associated with HIV infection. Determination of HIV serostatus is indicated in at-risk individuals. Serum uric acid is increased in 50% of patients, usually correlated with the extent of the disease; there is an increased risk of gouty arthritis. The levels of uric acid decrease as therapy is effective.

Culture – Throat culture for group A beta-hemolytic streptococcus infection.

Pustular Psoriasis

  • KOH Preparations to exclude dermatophytosis.
  • Bacterial or Viral Culture to exclude staphylococcus aureus infection and HSV infection.
  • Edema and exocytosis of mononuclear cells that appear first to form a vesicle, and later myriads of neutrophils, which form a unilocular spongiform pustule.

Conventional and herbal immunosuppressants are commonly used for the treatment of psoriasis. Doctors generally treat psoriasis in ‘steps’, based on the severity of the disease, size of the skin areas involved, type of psoriasis, and the patient's response to initial treatment. This is sometimes called the "1-2-3" approach. In step 1, medication is applied to the skin (topical treatment). Step 2 employs light treatment (phototherapy). Step 3 involves the ingestion of medication by mouth or injection: a process that addresses the whole immune system (called systemic therapy).

In this approach, affected skin can, over a period of time, become resistant to treatment, especially when topical corticosteroids are used. Also, a treatment that works very well in one person may have little effect in another. Thus, doctors often use a trial-and-error approach to find a treatment that works. If a treatment does not work, or if adverse reactions to the treatment occur, doctors may switch between treatments periodically (for example, every 12 to 24 months).

Immnunosuppressants List (conventional and herbal):

1. Topical Corticosteroid, 外用皮质类固醇(激素)

1.1 Betamethasone 倍他米松1.12 Clocortolone 氯可托龙
1.2 Clobetasol 丙酸氯倍他索1.13 Fluocinolone 氟轻松
1.3 Diflorasone 醋酸双氟拉松1.14 Hydrocortisone 氢化可的松
1.4 Fluocinonide 醋酸氟轻松1.15 Prednicarbate 泼尼卡酯
1.5 Flurandrenolide 丙酮缩氟氢羟龙1.16 Triamcinolone 醋酸曲安奈德
1.6 Halobetasol 卤贝他索丙酸酯1.17 Alclometasone 阿氯米松
1.7 Amcinonide 安西奈德1.18 Desonide 地索奈德
1.8 Desoximetasone 去羟米松1.19 Flumethasone 氟米松
1.9 Halcinonide 氯氟舒松1.20 Methylprednisolone 甲基泼尼松龙
1.10 Mometasone 莫米松;莫美达松1.21 Prednisolone 泼尼松龙
1.11 Fluticasone 沙美特罗替卡松

 

2. Topical Retinoid, 外用维A酸

  1. Adapalene, 阿达帕林(达芙文凝胶)
  2. Tazarotene, 他扎罗汀(乙炔维A酸)

 

3. Topical and Intralesional Cytotoxic Agents, 外用细胞毒性药物

  1. Topical 5-fluorouracil (5-FU), 5-氟尿嘧啶(5-Fu)
  2. Mechlorethamine (nitrogen mustard), 氮芥
  3. Carmustine (nitrosourea), 卡莫司汀(亚硝基脲)
  4. Vinblastine, 长春碱(抗肿瘤药)
  5. Bleomycin, 博来霉素(争光霉素)
  6. Methotrexate, 甲氨蝶呤,氨甲蝶呤,氨甲叶酸(抗肿瘤药)
  7. Podophyllin (pPodophyllotoxin), 盾叶鬼臼树脂(足叶草毒素, 鬼臼毒素)
  8. Miltefosine (hexadecylphosphocholine), 米替福新(十六烷基磷酸胆碱)

 

4. Topical Immunomodulator, 局部免疫调节剂

  1. Tacrolimus (Protopic), 他克莫司软膏(普特彼)
  2. Pimecrolimus (Elidel), 吡美莫司(爱宁达)
  3. Imiquimod, 咪奎莫特(治疗生殖器疣)

 

5. Phototherapy, 光疗法

  1. Narrowband (311nm) ultraviolet B (UVB),窄谱中波紫外线照射
  2. Broadband (280-320nm) UVB, 宽谱中波紫外线照射
  3. UVAI (340-400nm) phototherapy, 长波紫外线I照射
  4. UVAII (320-340nm) phototherapy, 长波紫外线II照射
  5. Combined UVA/UVB, 联合中波长波紫外线照射

 

6. Photochemotherapy, 光化学疗法

  1. PUVA (oral/topical psoralens and ultraviolet A radiation)补骨脂素(Methoxsalen or 8-MOP)加长波紫外线

 

7. Systemic Glucocorticoids, 全身应用糖皮质激素

  1. Dexamethasone, 地塞米松(氟美松)
  2. Triamcinolone, 去炎松(氟羟氢化泼尼松,氟羟强的松龙)
  3. Methylprednisolone, 甲强龙(甲基强的松龙)
  4. Prednisolone, 氢化泼尼松,(去氢氢化可的松, 强的松龙)
  5. Prednisone, 泼尼松(强的松)
  6. Cortisone, 可的松
  7. Hydrocortisone, 氢化可的松

 

8. Cytotoxic and Antimetabolic Agents, 细胞毒性药物抗代谢药物

  1. Methotrexate, 甲氨蝶呤,氨甲蝶呤,氨甲叶酸(抗肿瘤药)
  2. Azathioprine, 硫唑嘌呤
  3. Mycophenolic Acid (MPA), 霉酚酸(麦考酚酸)
  4. Mycophenolate Mofetil (MMF), 霉酚酸酯
  5. Thioguanine, 硫鸟嘌呤(抗肿瘤药)
  6. Hydroxyurea, 羟基脲
  7. Cyclophosphamide, 环磷酰胺(癌得星,安道生)
  8. Chlorambucil, 苯丁酸氮芥(瘤可宁)
  9. Doxorubicin, 亚德里亚霉素(阿霉素)
  10. Colchicine, 秋水仙碱

 

9. Retinoids, 口服维A酸

  1. Tretinoin, (All-trans retinoic acid, ATRA), 全反式维甲酸
  2. Isotretinoin, 异维A酸
  3. Etretinate (Tigason), 依曲替酯(阿维A酯,体卡松,银屑灵)
  4. Acitretin (Neotigason), 新体卡松,(依曲替酸, 新银屑灵)
  5. Bexarotene (Targretin), 蓓萨罗丁

 

10. Immunomodulator, 免疫调节剂

  1. Cyclosporine A (CsA), 环孢霉素
  2. Tacrolimus (Prograf, FK506), 他克莫司FK-506
  3. Pimecrolimus (ASM 981), 吡美莫司
  4. Sirolimus (SRL), 西罗莫司
  5. Everolimus (EVL), 依维莫司
  6. Leflunomide (Arava), 来氟米特

 

11. More Than 50 Types of Herbal Immunosuppressants
      免疫抑制剂草药约五十多味

  1. 甘草,Glycyrrhiza (Licorice)
  2. 金银花,Lonicera (Honeysuckle)
  3. 白鲜皮,Dictamnus (Burnet Saxifrage)
  4. 蝉蜕,Cryptotympana (cicada slough)
  5. 大黄,Rheum (Rhubarb)
  6. 雷公藤,Triperygium (Threewingnut)
  7. 苦参,Sophora  (Flavescent Sophora Root)
  8. 夏枯草,Prunella (Self Heal)
  9. 郁金,Curcum
  10. 柴胡,Bupleurum (Thorowax)

 

The Herose® Psoria Capsule is approved as a Chinese Proprietary Medicine in Singapore, developed by a group of doctors headed by military surgeon/dermatologist, Dr Tang Jinghua, who has over 30 years of experience in practising Chinese medicine. Based on his rich clinical experience, Dr Tang believes that what is commonly known as a variety of ‘cold syndromes’ (insufficiency of both the Pi and the Shen) causes anomalies in the immune system function. To address this in the case of psoriasis, he adopts the therapeutic method of warming the yang and promoting blood circulation to enhance and balance the immune system. This treatment concept is diametrically opposed to Western-style therapies that employ drugs to suppress the immune system. Immunosuppression provides only temporary symptomatic relief, does not correct the root problem, and can be accompanied by many undesirable side effects over long term use.

Therefore, in the Herose treatment protocol, ALL immunosuppressants must be AVOIDED during treatment. The formulation of Herose® Psoria Capsules is the result of extensive modern experimental research, and is an exclusive combination of 100% natural herbal ingredients which have no known toxicity and adverse effects.

Differentiation between Group A and Group B Patients

The prognosis of healing Herose® Psoria Capsules is dependent on whether a patient has ever undergone immunosuppression before. Those who have never had their immune system suppressed with drugs belong to Group A. Those with a history of immunosuppression therapy (from either western or herbal therapies) are classified as Group B patients.

As mentioned in Dr. Tang JingHua Clinical Research and Findings & Herose Treatment Flow Chart and References:

Group A patients who have never been placed on any corticosteroids or immunosuppressants will usually experience the recovery process as detailed below:

  • Improvement begins in the upper part of the body and gradually progress downwards, towards the feet, and
  • The affected areas should become paler than normal skin, as in the case of vitiligo

Group B patients who had previously taken corticosteroids or immunosuppressants will recover in the following way:

  • Improvement begins in the lower part of the body and gradually progresses upwards, or starts in all parts of the body concurrently, and
  • The affected areas turn grayish.

If patients’ medical records are not available, the characteristics of the healing process resulting from treatment with Herose® Psoria Capsules can help to differentiate patients into Group A and Group B.

Time Required for Full Recovery

  1. Approximately 120 days for Group A patients (non-Immunosuppressant users).
  2. For Group B patients (ex Immunosuppressants User): the healing time is 7 times the duration of previous immunotherapy (PO, IM, IV), plus 120 days.

*The above estimate is based on the information supplied by the patient’s medical records that indicate the correct dosage of medications and length of treatment previously received. If such information is unavailable, the time needed for full recovery under Herose therapy cannot be reliably established, because results are determined by the amount and strength of topical corticosteroids or phototherapy formerly applied.

Important Notes During Treatment

1. Wavelike Process (Immunosuppressants withdraw syndrome)

Patients who had previously taken immunosuppressive drugs will recover gradually in a wavelike process due to the side effects of withdrawal from immunosuppression, especially on the skin areas where the corticosteroid cream was frequently applied. The initial wavelike situation may occur within 20 days after treatment with Herose® Psoria Capsules, as shown in the diagram below for Group B Patients. Each peak of the wave represents a relapse/flare-up. However, the severity and frequency of relapses will reduce progressively with continued treatment.

wavelike process

2. Bowel Movement

During the treatment, some patients will experience thirst and feel dryness in their mouth. The color of patients’ excretion will be darker, and the odor of excretion and urine will be of smelly cacosmia. These are normal signs to indicate that the body is expelling toxins.

3. Swelling & Pain in the limbs

If more than 70% of the skin area of a limb is affected by psoriasis, swelling and pain will incur on the limb’s lesions because the rashes block respiration and perspiration of the skin. This is a normal reaction. Consult your own doctor for treatment with antibiotics: eg, Penicillin, Ciprofloxacin, Clindamycin, etc.

4. Partial Dry Fissure

If the lesion size is larger than 3cm x 3cm, dry fissures and painful bleeding will occur on the recovering lesion, as blood circulation improves. Apply vaseline on the affected skin area. DO NOT apply corticosteroid or immunomodulator creams.

5. Infections by Microorganisms

Bacterial/viral/fungal/parasitic infections cause symptoms such as stomach pain, headache, fever and chills that will worsen psoriatic lesions. Consult your doctors immediately for proper treatment, but meanwhile, please continue treatment with Herose® Psoria Capsule.

6. Menstrual Effects

Psoriasis symptoms may be exacerbated during menstruation, when a patient is taking Herose® Psoria Capsules. This is a normal situation, please continue treatment.

7. Hair Perming, Colorings and Detergents

The chemicals in hair perming or coloring lotions or detergents may irritate the skin and exacerbate psoriasis. Avoid any hair perming or coloring, and do wear latex gloves when performing domestic chores during the entire treatment period.

8. Hypertensive Patients and Diabetic Patients

During treatment with Herose® Psoria Capsules, hypertensive patients and/or diabetic patients must check their blood pressure and/or urine glucose index. If the blood pressure and/or urine glucose index become low, the dosage of hypertension and/or diabetes drugs must be reduced accordingly.

9. Arteriosclerosis Patients

If arteriosclerosis patients feel dizzy during Herose treatment, they should reduce the dosage of Herose® Psoria Capsules accordingly.

10. Avoid immunosuppressants or oral contraceptives

After full recovery, be aware that immunosuppressant or corticosteroid or anti-cancer drugs taken internally or externally may suppress your immune system and trigger psoriasis again.

Herose User Reference & Treatment Flow Charts

English Version in pdf | Chinese Version in pdf