AUTHOR=Wang Jiao , Liu Liu , Sun Xiao-Ying , Zhang Shuo , Zhou Ya-Qiong , Ze Kan , Chen Si-Ting , Lu Yi , Cai Xiao-Ce , Chen Jia-Le , Luo Ying , Ru Yi , Li Bin , Li Xin 

TITLE=Evidence and Potential Mechanism of Action of Lithospermum erythrorhizon and Its Active Components for Psoriasis

JOURNAL=Frontiers in Pharmacology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.781850

DOI=10.3389/fphar.2022.781850

ISSN=1663-9812

ABSTRACT=<p><bold>Background:</bold> Traditional Chinese medicine is effective in the treatment of psoriasis and can significantly reduce skin inflammation and psoriatic lesions with minimal side effects. Shikonin (SHI) and β,β-dimethylacryloyl alkannin (DMA), the main active components of <italic>Lithospermum erythrorhizon</italic>, have strong anti-inflammatory effects. This systematic review aimed to evaluate the efficacy and safety of <italic>Lithospermum erythrorhizon</italic> and its main active components and to elucidate the potential mechanisms of their action in psoriasis treatment.</p><p><bold>Methods:</bold> PubMed, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Chinese Scientific Journals, Wan Fang, and Chinese Biomedicine databases were systematically searched for articles published between 1 January 1970, and 31 February 2021. We included clinical and preclinical studies that examined the effects of <italic>Lithospermum erythrorhizon</italic> and its active components on psoriasis. All data were analyzed using RevMan 5.3 software. The Cochrane and SYRCLE’s risk-of-bias tools were used to assess the quality of all studies.</p><p><bold>Results:</bold> Eleven clinical trials including 1024 participants and 23 preclinical studies were assessed. Meta-analysis showed that when treating patients with psoriasis, the Chinese herbal medicine (CHM) formulas with <italic>Lithospermum erythrorhizon</italic> as the sovereign herb can significantly improve psoriatic dermatitis, which can significantly reduce the psoriasis area and severity index (PASI) score (mean difference [MD] = -2.00, 95% confidence interval [CI] [-3.19, -0.80], <italic>p</italic> = 0.001; I<sup>2</sup> = 85%). The incidence rates of diarrhea (risk ratio = 0.21, 95% CI [0.06, 0.81], <italic>p</italic> = 0.02) were higher in the CHM formulas group than in the control group, whereas other adverse events were not significantly different between the two groups (<italic>p</italic> &gt; 0.05). We evaluated the PASI score of mice on day 7 and found that SHI and DMA also alleviated psoriatic lesions (MD = -3.36, 95% CI [-4.67, -2.05], <italic>p</italic> &lt; 0.00001, I<sup>2</sup> = 94%). Furthermore, the epidermal thickness decreased more after SHI or DMA treatment than in the control group (MD = -34.42, 95%CI [-41.25, -27.59], <italic>p</italic> &lt; 0.00001, I<sup>2</sup> = 93%). Based on preclinical studies, we also summarized and mapped the mechanisms of SHI and DMA in the treatment of psoriasis.</p><p><bold>Conclusion:</bold> Available findings demonstrated that <italic>Lithospermum erythrorhizon</italic> combined with other conventional treatments is useful in treating psoriasis. Preclinical evidence has shown that the active components of <italic>Lithospermum erythrorhizon</italic> exhibit a potential anti-inflammatory effect, promote keratinocyte apoptosis, inhibit keratinocyte proliferation and angiogenesis, and block the cell cycle. In summary, our findings suggest that <italic>Lithospermum erythrorhizon</italic> and its active components can be used to treat psoriasis.</p>