中草药含有类固醇和抗真菌药

StephenW

[email protected]
       
AttachmentsSun, Feb 3, 11:48 AM (13 hours ago)
       
to hiv, HCV/HIV, [email protected], Natap
www.natap.org

Chinese herbal remedy found to contain steroids and antifungals
The Lancet Feb 22, 2019

A 14-year-old boy with early-onset guttate psoriasis vulgaris presented at our clinic with several reddish-purple, horizontal streaks on the distal part of his shins. Previously, he had been treated with narrow-band ultraviolet B, topical corticosteroids ranging from mild (hydrocortisone 17-butyrate cream 1 mg/g) to moderate (mometasone furoate cream 1 mg/g and betamethasone valerate ointment 1 mg/g), and tacrolimus ointment 1 mg/g—but the response to treatment was not long lasting. The family consulted a licensed practitioner of traditional Chinese medicine who prescribed a so-called herbal cream (figure). The patient applied the cream topically on the psoriatic lesions twice a day. After 9 months of doing this, he developed a new rash on his shins that was later confirmed to be striae distensae (figure). We suspected that the cause was exposure to a corticosteroid—but the patient had not been using a corticosteroid either topically or systemically during this time. The so-called herbal cream was suspected as a possible source; however, the content label only listed herbal ingredients including Chinese sumac, Sophora flavescens, Stemona tuberosa Lour. Nevertheless, the location of the striae was very unusual, and as a simple test, the herbal cream was applied on the upper arm of the senior physician; after 12 h, a strong vasoconstriction effect was seen (figure), which further raised our suspicion that the cream contained a corticosteroid. We therefore sent it for analysis at the Department of Official Medicines Control Laboratory, Swedish Medical Products Agency, Uppsala, Sweden. The laboratory used liquid chromatography-tandem mass spectrometry and nuclear magnetic resonance, and reported that the cream contained both a potent corticosteroid (0·065% clobetasol propionate) and the antifungals ketoconazole and miconazole. We then reported this herbal product to the Danish Medicines Agency to ensure that it was dealt with appropriately.



Prolonged exposure to traditional herbal creams or ointments resulting in cutaneous striae has previously been reported, and the Medicines and Healthcare products Regulatory Agency has warned about a so-called natural Chinese herbal remedy—Yiganerjing Cream—containing the same ingredients as in our case. Furthermore, the hazards and adverse effects of herbal products are not confined to dermatology. The under-regulation of medicinal products is widespread, and the consequences of patients using such substances can be seen in clinics from all specialities. Patients who fail to respond adequately to conventional treatments often seek alternative treatment and as a result might expose themselves to potentially harmful agents. The importance of being vigilant when seeing patients taking and using herbal creams and remedies remains key to reaching the correct diagnosis. With such substances being freely available over the internet, the problem is likely to worsen.

StephenW

[email protected]

AttachmentsSun，2月3日，上午11:48（13小时前）

艾滋病毒/艾滋病毒，Natapindustry @ natap.org，Natap
www.natap.org

中草药含有类固醇和抗真菌药
柳叶刀2019年2月22日

一名14岁男孩患有早发性点滴状银屑病，在我们的诊所就诊，他的胫骨远端部分有几条红紫色水平条纹。以前，他接受过窄带紫外线B治疗，外用皮质类固醇激素从轻度（氢化可的松17-丁酸盐乳膏1 mg / g）到中度（糠酸莫米松乳膏1 mg / g和倍他米松戊酸酯软膏1 mg / g），他克莫司软膏1 mg / g-但对治疗的反应持续时间不长。这家人咨询了一位持有中药的执业医生，他开了一种所谓的草药膏（图）。患者每天两次将乳膏局部涂抹在银屑病皮损上。经过9个月的这个过程，他在他的小腿上出现了一种新的皮疹，后来被确认为皮纹（图）。我们怀疑原因是接触皮质类固醇 - 但患者在此期间没有使用局部或全身使用皮质类固醇。所谓的草药霜被怀疑是可能的来源;然而，内容标签仅列出了草药成分，包括中国漆树，苦参，Stemona tuberosa Lour。然而，皮纹的位置非常不寻常，作为一个简单的测试，草药霜涂在高级医师的上臂上; 12小时后，观察到强烈的血管收缩作用（图），这进一步加剧了我们对乳膏含有皮质类固醇的怀疑。因此，我们将其发送到瑞典乌普萨拉瑞典医疗产品局官方药品控制实验室进行分析。该实验室使用液相色谱 - 串联质谱和核磁共振，并报告该乳膏含有强效皮质类固醇（0·065％丙酸氯倍他索）和抗真菌剂酮康唑和咪康唑。然后我们向丹麦药品管理局报告了这种草药产品，以确保它得到适当的处理。



之前已经报道了长期接触传统草药膏或软膏导致皮肤纹状，药品和保健产品监管机构已经警告所谓的天然中草药 - 伊加尼精霜 - 含有与我们的情况相同的成分。此外，草药产品的危害和不利影响不仅限于皮肤病学。医药产品的监管很普遍，使用这些药物的患者的后果可以在所有专业的诊所中看到。对常规治疗没有充分反应的患者经常寻求替代治疗，因此可能使自己暴露于潜在有害的药物中。在看到患者服用和使用草药霜和补救措施时保持警惕的重要性仍然是达到正确诊断的关键。由于此类物质可通过互联网免费获得，因此问题可能会恶化。