{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T15:56:55Z","timestamp":1764172615032,"version":"3.40.5"},"reference-count":101,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T00:00:00Z","timestamp":1710979200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"2022 TCM Innovation Team and Talent Support Program of the State Administration of Traditional Chinese Medicine","award":["ZYYCXTD-C-202204"],"award-info":[{"award-number":["ZYYCXTD-C-202204"]}]},{"name":"Guangzhou Science and Technology Planning Project","award":["202206080006"],"award-info":[{"award-number":["202206080006"]}]},{"DOI":"10.13039\/501100007162","name":"Department of Science and Technology of Guangdong Province","doi-asserted-by":"crossref","award":["2020B1111170012"],"award-info":[{"award-number":["2020B1111170012"]}],"id":[{"id":"10.13039\/501100007162","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Guangdong Provincial Hospital of Chinese Medicine","award":["YN2019QL11"],"award-info":[{"award-number":["YN2019QL11"]}]},{"name":"China\u2013Australia International Research Centre for Chinese Medicine"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Psoriasis vulgaris is a chronic dermatological disease with a high global prevalence. It significantly reduces patients\u2019 quality of life and is associated with a substantial economic burden. Conventional therapies for mild-to-moderate psoriasis are often associated with insufficient long-term symptomatic relief and side effects. Chinese herbal medicine (CHM) is commonly used for psoriasis management. A CHM formula, namely <jats:italic>Fu zheng he fu zhi yang<\/jats:italic> (FZHFZY), has shown promising treatment effects in clinical practice when used as a bath therapy. However, its efficacy and safety has not been evaluated by a rigorous randomized controlled trial (RCT). Therefore, we designed a double-blinded pilot RCT embedded with a qualitative study on CHM formula FZHFZY plus topical urea for mild-to-moderate psoriasis vulgaris to advance the evidence development and practice of CHM external application for psoriasis. This will be a mixed-method design consisting of a pilot RCT and a qualitative study. The pilot RCT is a two-arm, parallel, placebo-controlled, double-blinded trial. Sixty eligible participants will be randomized at a 1:1 ratio to receive eight weeks\u2019 treatment of either FZHFZY plus 10% urea cream, or placebo plus 10% urea cream, with 12-week follow-up visits after the treatment phase. The CHM or placebo will be administered externally as a bath therapy. Outcome measures include trial feasibility, efficacy and safety. The primary efficacy outcome will be Psoriasis Area Severity Index (PASI). Secondary efficacy outcomes include Physician Global Assessment, PASI-75, PASI-50, Body Surface Area, Dermatology Life Quality Index, Skindex-16, itch visual analogue scale and relapse. The qualitative study will be conducted to collect participants\u2019 feedback on CHM external application and their experience with the pilot RCT. This study will advance the evidence-based clinical practice of using CHM for psoriasis vulgaris and then to support translation of findings into clinical practice in the future.<\/jats:p>\n<jats:p><jats:bold>Trial registration number:<\/jats:bold> <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.chictr.org.cn\/showprojEN.html?proj=176262\" xlink:type=\"simple\">ChiCTR2200064092<\/jats:ext-link>.<\/jats:p>","DOI":"10.1371\/journal.pone.0297834","type":"journal-article","created":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T17:44:32Z","timestamp":1711043072000},"page":"e0297834","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Add-on effects of Chinese herbal medicine external application (FZHFZY) to topical urea for mild-to-moderate psoriasis vulgaris: Protocol for a double-blinded randomized controlled pilot trial embedded with a qualitative study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5211-151X","authenticated-orcid":true,"given":"Junyue","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire Shuiqing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony Lin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingjie","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Deng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haiming","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6937-9088","authenticated-orcid":true,"given":"Charlie Changli","family":"Xue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chuanjian","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,3,21]]},"reference":[{"issue":"5","key":"pone.0297834.ref001","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1056\/NEJMra0804595","article-title":"Psoriasis","volume":"361","author":"FO Nestle","year":"2009","journal-title":"N Engl J Med"},{"volume-title":"Global report on psoriasis","year":"2016","author":"World Health Organization","key":"pone.0297834.ref002"},{"issue":"1","key":"pone.0297834.ref003","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.jaad.2019.09.066","article-title":"Identifying the prevalence and disability-adjusted life years of the most common dermatoses worldwide","volume":"82","author":"S Mehrmal","year":"2020","journal-title":"J Am Acad 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