J Wound Care. 2026 Jan 2;35(1):100-109. doi: 10.12968/jowc.2024.0452.
ABSTRACT
OBJECTIVE: This study aimed to evaluate the effects of the interleukin (IL)-17A inhibitor secukinumab in conjunction with a modified nourishing blood and moisturising decoction (NBMD) on superficial fungal infections in patients with psoriasis with blood-dryness pattern (a traditional Chinese medicine (TCM) subtype characterised by dry, scaly skin and pruritus; the approximate Western clinical equivalent being mild-to-moderate chronic plaque psoriasis with xerotic (dry-type) features).
METHOD: A cohort of patients diagnosed with psoriasis with blood-dryness pattern were enrolled and randomised into three treatment groups: one receiving secukinumab monotherapy (control group); a matched group receiving tumour necrosis factor (TNF)-α inhibitor (etanercept) plus NBMD therapy (match group), and a third group receiving combination therapy with secukinumab and NBMD therapy (study group). Clinical efficacy was assessed using the Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI). Peripheral blood Th17 cells and serum levels of IL-17A and IL-22 were measured before and after 12 weeks of treatment. The incidence of superficial fungal infections was recorded at three, six and 12 months. Statistical analysis was performed using SPSS version 22.0, employing Chi-squared tests and repeated measures analysis of variance. Absolute risk reduction was calculated to quantify infection risk differences.
RESULTS: A total of 216 patients were included in the study, 72 in each of the three groups. Compared with the control group, both the study group and the match group demonstrated superior clinical outcomes. At the 12-month follow-up, PASI 90 (≥90% reduction) response rates were significantly higher in the study group (76.39%) and match group (73.61%) than in the control group (51.39%). Quality of life measures (DLQI) and TCM symptom scores also showed significantly greater improvements in the combination groups (Cohen’s d=0.85 for DLQI and 0.76 for TCM symptom scores, representing large and medium-to-large effects, respectively; p<0.001). Immunological analyses revealed that both the study group and match group exhibited more pronounced reductions in Th17 cells, IL-17A and IL-22 levels compared with the control group, indicating enhanced modulation of the IL-17 inflammatory pathway. Notably, the 12-month incidence of superficial fungal infections was markedly lower in the study group (12.5%) and match group (13.9%) than in the control group (30.6%). The adjusted hazard ratios were 0.41 (p<0.01) for the study group and 0.45 (p<0.01) for the match group, demonstrating a significantly reduced risk with combination therapy.
CONCLUSION: In this study, combining secukinumab with a modified nourishing and moisturising TCM regimen yielded superior clinical outcomes, including greater symptom relief, improved quality of life, and a reduced risk of superficial fungal infections compared with biologic monotherapy.
PMID:41528783 | DOI:10.12968/jowc.2024.0452
