{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:31:35Z","timestamp":1792812695744,"version":"4.5.0"},"reference-count":73,"publisher":"Elsevier BV","issue":"4","license":[{"start":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T00:00:00Z","timestamp":1617235200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T00:00:00Z","timestamp":1617235200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100015391","name":"Myositis Association","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015391","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jaad.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of the American Academy of Dermatology"],"published-print":{"date-parts":[[2021,4]]},"DOI":"10.1016\/j.jaad.2020.06.037","type":"journal-article","created":{"date-parts":[[2020,6,15]],"date-time":"2020-06-15T11:10:59Z","timestamp":1592219459000},"page":"1051-1058","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":36,"title":["The effects of immunostimulatory herbal supplements on autoimmune skin diseases"],"prefix":"10.1016","volume":"84","author":[{"given":"Christina E.","family":"Bax","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srita","family":"Chakka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef Symon S.","family":"Concha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majid","family":"Zeidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria P.","family":"Werth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.jaad.2020.06.037_bib1","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1146\/annurev-pharmtox-010617-052844","article-title":"Adverse effects of nutraceuticals and dietary supplements","volume":"58","author":"Ronis","year":"2018","journal-title":"Annu Rev Pharmacol Toxicol"},{"key":"10.1016\/j.jaad.2020.06.037_bib2","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1046\/j.1365-2133.2000.03822.x","article-title":"Adverse effects of herbal drugs in dermatology","volume":"143","author":"Ernst","year":"2000","journal-title":"Br J Dermatol"},{"key":"10.1016\/j.jaad.2020.06.037_bib3","doi-asserted-by":"crossref","first-page":"341","DOI":"10.2165\/00128071-200203050-00006","article-title":"Complementary\/alternative medicine in dermatology","volume":"3","author":"Ernst","year":"2002","journal-title":"Am J Clin Dermatol"},{"key":"10.1016\/j.jaad.2020.06.037_bib4","first-page":"62","article-title":"Herbal supplement sales in US increase by 9.4% in 2018","volume":"123","author":"Smith","year":"2019","journal-title":"HerbalGram"},{"key":"10.1016\/j.jaad.2020.06.037_bib5","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1046\/j.1529-8019.2003.01623.x","article-title":"Cutaneous side effects of alternative therapy","volume":"16","author":"Mevorah","year":"2003","journal-title":"Dermatol Ther"},{"key":"10.1016\/j.jaad.2020.06.037_bib6","doi-asserted-by":"crossref","first-page":"170","DOI":"10.5694\/j.1326-5377.1998.tb126773.x","article-title":"Echinacea-associated anaphylaxis","volume":"168","author":"Mullins","year":"1998","journal-title":"Med J Aust"},{"key":"10.1016\/j.jaad.2020.06.037_bib7","doi-asserted-by":"crossref","first-page":"331","DOI":"10.3390\/ijms17030331","article-title":"Scientific and regulatory perspectives in herbal and dietary supplement associated hepatotoxicity in the United States","volume":"17","author":"Avigan","year":"2016","journal-title":"Int J Mol Sci"},{"key":"10.1016\/j.jaad.2020.06.037_bib8","first-page":"1","article-title":"Side effects of herbal drugs used in dermatologic disorders","volume":"1","author":"Faghihi","year":"2011","journal-title":"J Cosmet Dermatol Sci Appl"},{"key":"10.1016\/j.jaad.2020.06.037_bib9","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.ajo.2004.04.072","article-title":"Ocular side effects from herbal medicines and nutritional supplements","volume":"138","author":"Fraunfelder","year":"2004","journal-title":"Am J Ophthalmol"},{"key":"10.1016\/j.jaad.2020.06.037_bib10","doi-asserted-by":"crossref","DOI":"10.1001\/archderm.140.6.723","article-title":"Activation of autoimmunity following use of immunostimulatory herbal supplements","volume":"140","author":"Lee","year":"2004","journal-title":"Arch Dermatol"},{"key":"10.1016\/j.jaad.2020.06.037_bib11","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1365-4632.2007.03388.x","article-title":"A mixed immunoblistering disorder exhibiting features of bullous pemphigoid and pemphigus foliaceus associated with Spirulina algae intake: immunoblistering disorder associated with Spirulina algae intake","volume":"47","author":"Kraigher","year":"2007","journal-title":"Int J Dermatol"},{"key":"10.1016\/j.jaad.2020.06.037_bib12","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1067\/mjd.2001.112219","article-title":"Recurrent erythema nodosum associated with Echinacea herbal therapy","volume":"44","author":"Soon","year":"2001","journal-title":"J Am Acad Dermatol"},{"key":"10.1016\/j.jaad.2020.06.037_bib13","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.jaad.2018.08.019","article-title":"Acute onset\/flares of dermatomyositis following ingestion of IsaLean herbal supplement: clinical and immunostimulatory findings","volume":"80","author":"Zeidi","year":"2019","journal-title":"J Am Acad Dermatol"},{"key":"10.1016\/j.jaad.2020.06.037_bib14","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1002\/art.1780281022","article-title":"The mechanism of action of L-canavanine in inducing autoimmune phenomena","volume":"28","author":"Alcocer-Varela","year":"1985","journal-title":"Arthritis Rheum"},{"issue":"4S","key":"10.1016\/j.jaad.2020.06.037_bib15","first-page":"AB196","article-title":"Echinacea-induced amyopathic dermatomyositis exacerbation in a patient well controlled on naltrexone: A case report","volume":"81","author":"Ellis","year":"2019","journal-title":"J Am Acad Dermatol"},{"key":"10.1016\/j.jaad.2020.06.037_bib16","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1038\/ni.3731","article-title":"The multiple pathways to autoimmunity","volume":"18","author":"Theofilopoulos","year":"2017","journal-title":"Nat Immunol"},{"key":"10.1016\/j.jaad.2020.06.037_bib17","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/S0192-0561(97)00061-1","article-title":"Echinacea-induced cytokine production by human macrophages","volume":"19","author":"Burger","year":"1997","journal-title":"Int J Immunopharmacol"},{"key":"10.1016\/j.jaad.2020.06.037_bib18","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1128\/iai.46.3.845-849.1984","article-title":"Macrophage activation and induction of macrophage cytotoxicity by purified polysaccharide fractions from the plant Echinacea purpurea","volume":"46","author":"Stimpel","year":"1984","journal-title":"Infect Immun"},{"key":"10.1016\/j.jaad.2020.06.037_bib19","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1093\/jnci\/81.9.669","article-title":"Macrophage activation by the polysaccharide arabinogalactan isolated from plant cell cultures of Echinacea purpurea","volume":"81","author":"Luettig","year":"1989","journal-title":"J Natl Cancer Inst"},{"key":"10.1016\/j.jaad.2020.06.037_bib20","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/S1567-5769(01)00166-7","article-title":"Activation of the human innate immune system by Spirulina: augmentation of interferon production and NK cytotoxicity by oral administration of hot water extract of Spirulina platensis","volume":"2","author":"Hirahashi","year":"2002","journal-title":"Intl Immunopharmacol"},{"key":"10.1016\/j.jaad.2020.06.037_bib21","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1089\/jmf.2000.3.135","article-title":"Effect of Spirulina on the secretion of cytokines from peripheral blood mononuclear cells","volume":"3","author":"Mao","year":"2000","journal-title":"J Med Food"},{"key":"10.1016\/j.jaad.2020.06.037_bib22","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1055\/s-2001-18358","article-title":"Isolation of three high molecular weight polysaccharide preparations with potent immunostimulatory activity from Spirulina platensis, Aphanizomenon flos-aquae and Chlorella pyrenoidosa","volume":"67","author":"Pugh","year":"2001","journal-title":"Planta Med"},{"key":"10.1016\/j.jaad.2020.06.037_bib23","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1078\/S0944-7113(04)70063-X","article-title":"Characterization of human monocyte activation by a water soluble preparation of Aphanizomenon flos-aquae","volume":"8","author":"Pugh","year":"2001","journal-title":"Phytomedicine"},{"key":"10.1016\/j.jaad.2020.06.037_bib24","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1055\/s-0030-1250043","article-title":"Enhancement of natural killer cell activity in healthy subjects by Immulina\u00ae, a Spirulina extract enriched for Braun-type lipoproteins","volume":"76","author":"Nielsen","year":"2010","journal-title":"Planta Med"},{"key":"10.1016\/j.jaad.2020.06.037_bib25","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1007\/s00204-016-1744-5","article-title":"The antioxidant, immunomodulatory, and anti-inflammatory activities of Spirulina: an overview","volume":"90","author":"Wu","year":"2016","journal-title":"Arch Toxicol"},{"key":"10.1016\/j.jaad.2020.06.037_bib26","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1089\/acm.2006.12.429","article-title":"Immolina, a high-molecular-weight polysaccharide fraction of Spirulina, enhances chemokine expression in human monocytic THP-1 cells","volume":"12","author":"Grzanna","year":"2006","journal-title":"J Altern Complement Med"},{"key":"10.1016\/j.jaad.2020.06.037_bib27","doi-asserted-by":"crossref","first-page":"684","DOI":"10.3892\/or.2017.5346","article-title":"Spirulina lipopolysaccharides inhibit tumor growth in a Toll-like receptor 4-dependent manner by altering the cytokine milieu from interleukin-17\/interleukin-23 to interferon-gamma","volume":"37","author":"Okuyama","year":"2017","journal-title":"Oncol Rep"},{"key":"10.1016\/j.jaad.2020.06.037_bib28","first-page":"21","article-title":"The influence of Spirulina and Selen-Spirulina on some indexes of rat's immune status [in Russian]","volume":"76","author":"Trushina","year":"2007","journal-title":"Vopr Pitan"},{"key":"10.1016\/j.jaad.2020.06.037_bib29","doi-asserted-by":"crossref","DOI":"10.1186\/s12937-015-0058-4","article-title":"Impact of daily supplementation of Spirulina platensis on the immune system of na\u00efve HIV-1 patients in Cameroon: a 12-months single blind, randomized, multicenter trial","volume":"14","author":"Ngo-Matip","year":"2015","journal-title":"Nutr J"},{"key":"10.1016\/j.jaad.2020.06.037_bib30","doi-asserted-by":"crossref","first-page":"191","DOI":"10.3109\/08923979409007090","article-title":"Augmentation of the resistance against Listeria monocytogenes by oral administration of a hot water extract of Chlorella vulgaris in mice","volume":"16","author":"Hasegawa","year":"1994","journal-title":"Immunopharmacol Immunotoxicol"},{"key":"10.1016\/j.jaad.2020.06.037_bib31","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/S0162-3109(96)00125-7","article-title":"In\u00a0vitro effects of Echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients","volume":"35","author":"See","year":"1997","journal-title":"Immunopharmacology"},{"key":"10.1016\/j.jaad.2020.06.037_bib32","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.autrev.2005.12.004","article-title":"Role of non-protein amino acid l-canavanine in autoimmunity","volume":"5","author":"Akaogi","year":"2006","journal-title":"Autoimmun Rev"},{"key":"10.1016\/j.jaad.2020.06.037_bib33","doi-asserted-by":"crossref","first-page":"330","DOI":"10.5692\/clinicalneurol.51.330","article-title":"A case of inflammatory myopathy with widely skin rash following use of supplements containing Spirulina [in Japanese]","volume":"51","author":"Konno","year":"2011","journal-title":"Rinsho Shinkeigaku"},{"key":"10.1016\/j.jaad.2020.06.037_bib34","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1038\/ni0901-764","article-title":"Systemic lupus erythematosus: an autoimmune disease of B cell hyperactivity","volume":"2","author":"Lipsky","year":"2001","journal-title":"Nat Immunol"},{"key":"10.1016\/j.jaad.2020.06.037_bib35","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s40257-016-0173-9","article-title":"Cutaneous lupus erythematosus: an update on pathogenesis, diagnosis and treatment","volume":"17","author":"Hejazi","year":"2016","journal-title":"Am J Clin Dermatol"},{"key":"10.1016\/j.jaad.2020.06.037_bib36","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1186\/s13075-015-0706-2","article-title":"Pathophysiology of cutaneous lupus erythematosus","volume":"17","author":"Achtman","year":"2015","journal-title":"Arthritis Res Ther"},{"key":"10.1016\/j.jaad.2020.06.037_bib37","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1111\/j.1365-2133.2005.06784.x","article-title":"Scarring skin lesions of discoid lupus erythematosus are characterized by high numbers of skin-homing cytotoxic lymphocytes associated with strong expression of the type I interferon-induced protein MxA","volume":"153","author":"Wenzel","year":"2005","journal-title":"Br J Dermatol"},{"key":"10.1016\/j.jaad.2020.06.037_bib38","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1002\/path.1721","article-title":"Enhanced type I interferon signalling promotes Th1-biased inflammation in cutaneous lupus erythematosus","volume":"205","author":"Wenzel","year":"2005","journal-title":"J Pathol"},{"key":"10.1016\/j.jaad.2020.06.037_bib39","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1046\/j.1523-1747.2000.00118.x","article-title":"Association of a promoter polymorphism of tumor necrosis factor-\u03b1 with subacute cutaneous lupus erythematosus and distinct photoregulation of transcription","volume":"115","author":"Werth","year":"2000","journal-title":"J Invest Dermatol"},{"key":"10.1016\/j.jaad.2020.06.037_bib40","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1111\/j.1365-2230.2006.02150.x","article-title":"Type\u00a0I interferon-associated skin recruitment of CXCR3+ lymphocytes in dermatomyositis","volume":"31","author":"Wenzel","year":"2006","journal-title":"Clin Exp Dermatol"},{"key":"10.1016\/j.jaad.2020.06.037_bib41","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1111\/bjd.15006","article-title":"Correlation of cutaneous disease activity with type 1 interferon gene signature and interferon \u03b2 in dermatomyositis","volume":"176","author":"Huard","year":"2017","journal-title":"Br J Dermatol"},{"key":"10.1016\/j.jaad.2020.06.037_bib42","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1111\/j.1365-2133.2004.06144.x","article-title":"Infiltrating cells, related cytokines and chemokine receptors in lesional skin of patients with dermatomyositis","volume":"151","author":"Caproni","year":"2004","journal-title":"Br J Dermatol"},{"key":"10.1016\/j.jaad.2020.06.037_bib43","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s11926-011-0166-x","article-title":"Pathogenesis of dermatomyositis: role of cytokines and interferon","volume":"13","author":"Kao","year":"2011","journal-title":"Curr Rheumatol Rep"},{"key":"10.1016\/j.jaad.2020.06.037_bib44","doi-asserted-by":"crossref","DOI":"10.1172\/jci.insight.92021","article-title":"Setting the target for pemphigus vulgaris therapy","volume":"2","author":"Ellebrecht","year":"2017","journal-title":"JCI Insight"},{"key":"10.1016\/j.jaad.2020.06.037_bib45","doi-asserted-by":"crossref","first-page":"438","DOI":"10.5021\/ad.2017.29.4.438","article-title":"Analysis of serum cytokine profile in pemphigus","volume":"29","author":"Lee","year":"2017","journal-title":"Ann Dermatol"},{"key":"10.1016\/j.jaad.2020.06.037_bib46","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1046\/j.1365-4362.2001.01083.x","article-title":"TNF\u03b1 and IL-6 are mediators in the blistering process of pemphigus","volume":"40","author":"L\u00f3pez-Robles","year":"2001","journal-title":"Int J Dermatol"},{"key":"10.1016\/j.jaad.2020.06.037_bib47","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/s10811-009-9455-4","article-title":"Quality analysis of commercial Chlorella products used as dietary supplement in human nutrition","volume":"22","author":"G\u00f6rs","year":"2010","journal-title":"J Appl Phycol"},{"key":"10.1016\/j.jaad.2020.06.037_bib48","doi-asserted-by":"crossref","first-page":"164","DOI":"10.2174\/1381612822666151112145226","article-title":"Chlorella vulgaris: a multifunctional dietary supplement with\u00a0diverse medicinal properties","volume":"22","author":"Panahi","year":"2016","journal-title":"Curr Pharm Des"},{"key":"10.1016\/j.jaad.2020.06.037_bib49","first-page":"45","article-title":"Chlorella and Spirulina microalgae as sources of functional foods","author":"Andrade","year":"2018","journal-title":"Nutr Food Suppl"},{"key":"10.1016\/j.jaad.2020.06.037_bib50","doi-asserted-by":"crossref","first-page":"e33","DOI":"10.1111\/j.1755-5922.2010.00200.x","article-title":"Hypolipidemic, Antioxidant and antiinflammatory activities of microalgae Spirulina","volume":"28","author":"Deng","year":"2010","journal-title":"Cardiovasc Ther"},{"key":"10.1016\/j.jaad.2020.06.037_bib51","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/ecam\/nen058","article-title":"Spirulina in clinical practice: evidence-based human applications","volume":"2011","author":"Karkos","year":"2011","journal-title":"Evid Based Complement Alternat Med"},{"key":"10.1016\/j.jaad.2020.06.037_bib52","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2017\/3247528","article-title":"Antioxidant, immunomodulating, and microbial-modulating activities of the sustainable and ecofriendly Spirulina","volume":"2017","author":"Finamore","year":"2017","journal-title":"Oxid Med Cell Longev"},{"key":"10.1016\/j.jaad.2020.06.037_bib53","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1023\/A:1006594318633","article-title":"Inhibition of tumor invasion and metastasis by calciumspirulan (Ca-SP), a novel sulfated polysaccharide derived from a blue-green alga, Spirulina platensis","volume":"16","author":"Mishima","year":"1998","journal-title":"Clin Exp Metastasis"},{"key":"10.1016\/j.jaad.2020.06.037_bib54","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1081\/IPH-100103866","article-title":"Enhancement of chicken macrophage phagocytic function and nitrite production by dietary Spirulina platensis","volume":"23","author":"Al-Batshan","year":"2001","journal-title":"Immunopharmacol Immunotoxicol"},{"key":"10.1016\/j.jaad.2020.06.037_bib55","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1016\/j.intimp.2006.08.001","article-title":"Toll-like receptor 2-dependent activation of monocytes by Spirulina polysaccharide and its immune enhancing action in mice","volume":"6","author":"Balachandran","year":"2006","journal-title":"Intl Immunopharmacol"},{"key":"10.1016\/j.jaad.2020.06.037_bib56","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1089\/jmf.2007.564","article-title":"Enhancement of human adaptive immune responses by administration of a high-molecular-weight polysaccharide extract from the cyanobacterium Arthrospira platensis","volume":"11","author":"Lobner","year":"2008","journal-title":"J Med Food"},{"key":"10.1016\/j.jaad.2020.06.037_bib57","first-page":"73","article-title":"The beneficial effects of Spirulina focusing on its immunomodulatory and antioxidant properties","volume":"2","author":"Ravi","year":"2010","journal-title":"Nutr Diet Suppl"},{"key":"10.1016\/j.jaad.2020.06.037_bib58","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/1475-2891-5-3","article-title":"Nutrition rehabilitation of undernourished children utilizing Spiruline and Misola","volume":"5","author":"Simpore","year":"2006","journal-title":"Nutr J"},{"key":"10.1016\/j.jaad.2020.06.037_bib59","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1007\/s10811-011-9766-0","article-title":"Dietary algae and HIV\/AIDS: proof of concept clinical data","volume":"24","author":"Teas","year":"2012","journal-title":"J Appl Phycol"},{"key":"10.1016\/j.jaad.2020.06.037_bib60","doi-asserted-by":"crossref","first-page":"2973","DOI":"10.3390\/nu6072973","article-title":"The effect of Arthrospira platensis capsules on CD4 T-cells and antioxidative capacity in a randomized pilot study of adult women infected with human immunodeficiency virus not under HAART in Yaound\u00e9, Cameroon","volume":"6","author":"Winter","year":"2014","journal-title":"Nutrients"},{"key":"10.1016\/j.jaad.2020.06.037_bib61","doi-asserted-by":"crossref","first-page":"29","DOI":"10.4137\/NMI.S5862","article-title":"Potential of Spirulina platensis as a nutritional supplement in malnourished HIV-infected adults in Sub-Saharan Africa: a randomised, single-blind study","volume":"4","author":"Azabji-Kenfack","year":"2011","journal-title":"Nutr Metab Insights"},{"key":"10.1016\/j.jaad.2020.06.037_bib62","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1089\/jmf.2007.401","article-title":"Natural killer cell activation and modulation of chemokine receptor profile in\u00a0vitro by an extract from the cyanophyta Aphanizomenon flos-aquae","volume":"10","author":"Hart","year":"2007","journal-title":"J Med Food"},{"key":"10.1016\/j.jaad.2020.06.037_bib63","first-page":"79","article-title":"A review of recent clinical trials of the nutritional supplement Chlorella pyrenoidosa in the treatment of fibromyalgia, hypertension, and ulcerative colitis","volume":"7","author":"Merchant","year":"2001","journal-title":"Altern Ther Health Med"},{"key":"10.1016\/j.jaad.2020.06.037_bib64","first-page":"111","article-title":"Safety and immunoenhancing effect of a Chlorella-derived dietary supplement in healthy adults undergoing influenza vaccination: randomized, double-blind, placebo-controlled trial","volume":"169","author":"Halperin","year":"2003","journal-title":"CMAJ"},{"key":"10.1016\/j.jaad.2020.06.037_bib65","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/1475-2891-10-91","article-title":"Salivary secretory immunoglobulin A secretion increases after 4-weeks ingestion of Chlorella-derived multicomponent supplement in humans: a randomized cross over study","volume":"10","author":"Otsuki","year":"2011","journal-title":"Nutr J"},{"key":"10.1016\/j.jaad.2020.06.037_bib66","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/1475-2891-11-53","article-title":"Beneficial immunostimulatory effect of short-term Chlorella supplementation: enhancement of natural killer cell activity and early inflammatory response (randomized, double-blinded, placebo-controlled trial)","volume":"11","author":"Kwak","year":"2012","journal-title":"Nutr J"},{"key":"10.1016\/j.jaad.2020.06.037_bib67","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/S0006-2952(99)00413-X","article-title":"Use of echinacea in medicine","volume":"60","author":"Percival","year":"2000","journal-title":"Biochem Pharmacol"},{"key":"10.1016\/j.jaad.2020.06.037_bib68","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1097\/00002371-200209000-00005","article-title":"Oral administration of freshly expressed juice of Echinacea purpurea herbs fail to stimulate the nonspecific immune response in healthy young men: results of a double-blind, placebo-controlled crossover study","volume":"25","author":"Schwarz","year":"2002","journal-title":"J Immunother"},{"key":"10.1016\/j.jaad.2020.06.037_bib69","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1089\/acm.1995.1.145","article-title":"Results of five randomized studies on the immunomodulatory activity of preparations of Echinacea","volume":"1","author":"Melchart","year":"1995","journal-title":"J Altern Complement Med"},{"key":"10.1016\/j.jaad.2020.06.037_bib70","doi-asserted-by":"crossref","first-page":"2061","DOI":"10.1093\/ajcn\/30.12.2061","article-title":"Effect of alfalfa saponins on intestinal cholesterol absorption in rats","volume":"30","author":"Malinow","year":"1977","journal-title":"Am J Clin Nutr"},{"key":"10.1016\/j.jaad.2020.06.037_bib71","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/0021-9150(83)90097-7","article-title":"Experimental models of atherosclerosis regression","volume":"48","author":"Malinow","year":"1983","journal-title":"Atherosclerosis"},{"key":"10.1016\/j.jaad.2020.06.037_bib72","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1016\/S0140-6736(81)92063-8","article-title":"Pancytopenia during ingestion of alfalfa seeds","volume":"317","author":"Malinow","year":"1981","journal-title":"Lancet"},{"key":"10.1016\/j.jaad.2020.06.037_bib73","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1126\/science.7071589","article-title":"Systemic lupus erythematosus-like syndrome in monkeys fed alfalfa sprouts:\u00a0role of a nonprotein amino acid","volume":"216","author":"Malinow","year":"1982","journal-title":"Science"}],"container-title":["Journal of the American Academy of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0190962220311014?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0190962220311014?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T22:59:48Z","timestamp":1759273188000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0190962220311014"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4]]},"references-count":73,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,4]]}},"alternative-id":["S0190962220311014"],"URL":"https:\/\/doi.org\/10.1016\/j.jaad.2020.06.037","relation":{},"ISSN":["0190-9622"],"issn-type":[{"value":"0190-9622","type":"print"}],"subject":[],"published":{"date-parts":[[2021,4]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"The effects of immunostimulatory herbal supplements on autoimmune skin diseases","name":"articletitle","label":"Article Title"},{"value":"Journal of the American Academy of Dermatology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jaad.2020.06.037","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Published by Elsevier on behalf of the American Academy of Dermatology, Inc.","name":"copyright","label":"Copyright"}]}}