Efficacy and safety of Chinese herbal medicine in the treatment of chronic pruritus: A systematic review and meta-analysis of randomized controlled trials

Background: Chronic pruritus (CP) is a common and aggravating symptom associated with skin and systemic diseases. Although clinical reports suggest that Chinese herbal medicine (CHM) is safe and effective in Chronic pruritus treatment, evidence to prove it is lacking. Therefore, in this review, we evaluated the therapeutic effects and safety of Chinese herbal medicine for the treatment of Chronic pruritus. Methods: Nine databases were searched for relevant randomized controlled trials (RCTs) from the inception of the database to 20 April 2022. The randomized controlled trials that compared the treatment of Chinese herbal medicine or a combination of Chinese herbal medicine and conventional western medicine treatment (WM) with western medicine treatment intervention for patients with Chronic pruritus were selected. We evaluated the effects of treatment with Chinese herbal medicine on the degree of pruritus, the Dermatology Life Quality Index (DLQI) score, response rate, recurrence rate, and incidence of adverse events in patients with Chronic pruritus. The risk of bias in each trial was evaluated using the Cochrane Collaboration tool. The RevMan software (version 5.3) was used for performing meta-analyses to determine the comparative effects. Results: Twenty-four randomized controlled trials were included, compared with placebo, moderate-quality evidence from one study showed that Chinese herbal medicine was associated with reduced visual analogue scale (VAS) (MD: −2.08; 95% CI = −2.34 to −1.82). Compared with western medicine treatment, low-to moderate-quality evidence from 8 studies indicated that Chinese herbal medicine was associated with reduced visual analogue scale, 4 studies indicated that Chinese herbal medicine was associated with reduced Dermatology Life Quality Index (MD = −1.80, 95% CI = −2.98 to −.62), and 7 studies indicated that Chinese herbal medicine was associated with improved Effective rate (RR: 1.26; 95% CI = 1.19–1.34). Compared with combination of Chinese herbal medicine and western medicine treatment, 16 studies indicated that Chinese herbal medicine was associated with reduced visual analogue scale, 4 studies indicated that Chinese herbal medicine was associated with reduced Dermatology Life Quality Index (MD = −2.37, 95% CI = −2.61 to −2.13), and 13 studies indicated that Chinese herbal medicine was associated with improved Effective rate (RR: 1.28; 95% CI = 1.21–1.36). No significant difference in the occurrence of adverse events in using Chinese herbal medicine or western medicine treatment was reported. Conclusion: The efficacy of Chinese herbal medicine used with or without western medicine treatment was better than western medicine treatment in treating chronic pruritus. However, only a few good studies are available regarding Chronic pruritus, and thus, high-quality studies are necessary to validate the conclusions of this study.