In the treatment of chronic plaque psoriasis, trial formulations of Itrifal Shahtra and Marham Ḥina may be safer, more efficacious, and more tolerable than the standard treatment of PUVAsol and petrolatum, according to study results published in the Journal of Ethnopharmacology.

Psoriasis, recurrent and incurable, and similarly described skin disordershave been treated in Greco-Arab (Unani) medicine with alternative herbal medications, although there is lacking empirical support. Researchers sought to investigate the safety and efficacy of Unani herbal medications Itrifal Shahtra and Marham Ḥina compared with standard treatment.

To accomplish this, they conducted an open-label, randomized controlled clinical trial assessing 122 individuals of whom 56 were excluded, leaving 33 participants in the Unani cohort, and 33 in the control cohort, of whom 8 from each cohort were lost to follow-up or discontinued due to the COVID-19 pandemic. In all, 25 adults remained for analysis in each cohort (Unani: 33.8±9.6 years of age, 6.6±3.0 years disease duration, 24% women; control: 34.2±10.9 years of age, 7.0±3.38 years disease duration, 40%women) who received Unani formulations: oral Itrifal Shahtra (semisolid paste) and topical Marham Ḥina (ointment) twice daily, or control medication (oral 8-methoxypsoralen and topical petroleum jelly for local application) for 12 weeks. All participants were advised to spend 5 to 15 minutes daily in sunlight. The change in psoriasis area and severity index (PASI) assessed at each visit represented the primary endpoints.


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The PASI decreased from 27.88±12.01 at baseline to 5.01±4.59 after completion of therapy for the Unani cohort, and from 23.61±9.79 to 9.85±7.16 after completion of therapy for the control cohort. Performance of the test formulations was better than that of control medications with all 25 participants in the Unani cohort achieving PASI 50, and 76% achieving PASI 75.

Study limitations include the reliance on sunlight as a source of ultraviolet radiation, underpowered sampling, most participants residing far away dropped out, and possibly participation bias and selection bias.

Researchers concluded that, “The trial formulations, Itrifal Shahtra and Marham Ḥina may be superior to control drugs PUVAsol and petrolatum in terms of safety, efficacy, and tolerability in the treatment of chronic plaque psoriasis.” They assert that Itrifal Shahtra and Marham Ḥina, “may further be evaluated in a well-designed multicentric superiority trial with an adequate sample size.”

Reference

Khatoon F, Azahar M, Jabeen A, Uddin Q, Husain N, Naikodi MAR. Treatment of chronic plaque psoriasis with herbal Unani formulations: A randomized control trial of efficacy and safety. J Ethnopharmacol. Published online June 17, 2022. doi:10.1016/j.jep.2022.115456