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Sir, ing condition, we decided to treat this patient by an alternative approach. Acitretin was discontinued on Chinese herbal therapy is part of traditional Chinese medicine (TCM) and has been reported in TCM literat9 March 2000, and 2 weeks later treatment with Chinese herbs was initiated whilst continuing topical ure to be eVective in the treatment of psoriasis (1). In the past few decades, several non-controlled studies have therapy. Chinese herbal therapy consisted of a herbal mixture been reported in Chinese language literature showing eYcacy of several single herb preparations in the treatcontaining 15 herbs, including RAD. The crude herbs were cooked for 20min and the resulting decoction was ment of psoriasis (2–6). Recent investigations in chemical constituents of herbs taken twice a day. Crude herbs instead of a patent medicine were chosen to prevent contamination with have shown that Radix Angelica Dahuricae (RAD) contains angelicin, which is a psoralen-like molecule. It possible chemicals, such as corticoids or other immunomodulatory agents, as has been reported previously (9, has been reported that angelicin and its derivatives have photochemical properties comparable to 8-methoxy10). During therapy, several herbs were changed according to TCM practice to follow the patient’s condition. psoralen (3, 7, 8). It is attractive to hypothesize that Chinese herbal mixtures, containing RAD in combinaLiver enzymes and creatinine levels were monitored. As her condition continued to relapse, narrow-band tion with phototherapy, might be more eVective compared to Chinese herbs without this addition or without UVB was reinstalled at a continuous low dose of 0.10 J/cm2 on 17 April 2000 (week 4). The relapse phototherapy. We report a patient successfully treated with this combination. continued to aggravate up to week 5 (Fig. 1a). At week 6, a remarkable amelioration of the lesions was observed for the  rst time. Topical therapy and phototherapy CASE REPORT were discontinued in week 7, and therapy was continued with Chinese herbs as monotherapy. A 45-year-old woman with a 19-year history of severe Psoriasis Area and Severity Index (PASI ) was recorded recalcitrant plaque psoriasis presented at our departat several visits. Two weeks’ combination therapy of ment. Previous treatments consisted of topical corticoChinese herbs and low-dose narrow-band UVB without steroids, calcipotriol, dithranol, photo(chemo)therapy, dose increments induced a 75% improvement of PASI. including narrow-band UVB, retinoids, methotrexate, Maximal improvement (95% reduction of PASI ) was fumaric acid derivatives and several combinations of reached after 14 weeks’ treatment (Fig. 1b). these treatments, which usually improved the conditions initially but failed to induce a long-term satisfactory response. Both methotrexate and fumaric acid DISCUSSION derivatives resulted in a rise of liver enzymes. Between November 1999 and February 2000, the The present case report illustrates a remarkable improvement of psoriasis after treatment with Chinese herbs. patient was treated with a combination of narrow-band UVB (3 /week) and acitretin (20 mg/day). In this Although several reports on successful therapeutic eVects in psoriasis have been reported in the scienti c and period, she was also treated with a combination of calcipotriol ointment twice a day, and clobetasol propiChinese language literature (2–6, 11), evidence from placebo-controlled trials is not yet available for Chinese onate ointment twice a day. Again, this combination resulted in some improvement; however, no satisfactory herbs in the treatment of psoriasis. The innovation of using the herb RAD, which has response occurred. Phototherapy was discontinued on 24 February 2000 after 16 weeks’ treatment and acitretin photochemical properties, in combination with low-dose narrow-band UVB is intriguing (12). Reports in the was continued at an alternating dose of 10–20mg/day, as well as topical therapy. Within one week, an unstable Chinese literature on the combination of this single herb with UVA phototherapy conclude that this therapy was relapsing psoriasis was observed of multiple pinpoint papules rapidly coalescing to expanding plaques, as eVective in psoriasis as 8-MOP UVA phototherapy but had fewer side eVects (3, 4, 13). Western scienti c although acitretin and topical clobetasol and calcipotriol were continued. As almost all established antipsoriatic research mainly focused on the photochemical properties of the constituent angelicin and its derivatives in treatments proved to be insuYcient to control her relaps-

acta dermato-venereologica

Remarkable Success of Chinese Herbs in Combination with a Short Course of Low-Dose Narrow-Band UVB Phototherapy in Severe Recalcitrant Plaque Psoriasis