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. 2025 May;45(5):255-270.
doi: 10.1007/s40261-025-01441-y. Epub 2025 Apr 28.

A Comprehensive Systematic Review of Natural Biomedicines for Immune-Mediated and Inflammatory Dermatologic Diseases

Promise Ufomadu  1 , Camille F Villar  2 , Stephanie Y Zhang  2 , Aileen Y Hu  2 , Oyetawa Asempa  2   3
Affiliations

A Comprehensive Systematic Review of Natural Biomedicines for Immune-Mediated and Inflammatory Dermatologic Diseases

Promise Ufomadu et al. Clin Drug Investig. 2025 May.

Abstract

Background: Natural biomedicines (NBMs) are frequently used to manage immune-mediated and inflammatory dermatologic diseases (IMIDDs). This systematic review evaluates the efficacy, safety, and clinical relevance of NBMs in IMIDDs, providing an evidence-based analysis to guide dermatologic practice.

Methods: Following PRISMA guidelines, a systematic search was conducted in PubMed, Embase, Medline, and Google Scholar for randomized controlled trials (RCTs) investigating NBMs in IMIDDs from 1990 to 2023. Studies were included if they met predefined eligibility criteria: RCT design, relevant IMIDD condition, NBM intervention, and quantitative outcome measures. Risk of bias was assessed using the Jadad scale. Results were synthesized qualitatively due to heterogeneity in study designs and outcome measures.

Results: Of 1364 records screened, 95 RCTs were included, encompassing 5265 participants across 23 countries. Indigo naturalis, fish oil (⍵-3), and aloe vera demonstrated the most consistent efficacy in managing psoriasis, systemic lupus erythematosus (SLE), atopic dermatitis (AD), and lichen planus (LP). Indigo naturalis significantly improved erythema, scaling, and PASI scores in psoriasis patients. Fish oil showed benefits in SLE disease activity indices and AD severity, while aloe vera demonstrated improvements in SCORAD and LP severity criteria. Most NBMs exhibited favorable safety profiles, although adverse event reporting was inconsistent.

Discussion: While these findings highlight the potential of NBMs in dermatologic care, methodological limitations, including small sample sizes, heterogeneity in study designs, and lack of direct comparisons to conventional therapies, limit definitive conclusions. Additionally, not all natural agents can be easily searched and captured in systematic reviews, which may have restricted the scope of included NBMs. Future research should emphasize high-quality RCTs, standardized outcome measures, and comparative studies against conventional treatments.

Trial registration: The review protocol is registered with Open Science Framework (OSF) ( https://doi.org/10.17605/OSF.IO/UH9XJ ).

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Conflict of interest statement

Declarations. Funding: No financial support was received for the conduct of this study, or for the preparation or publication of this manuscript. Conflict of interest: The authors have no conflict of interest to declare. Availability of data and material: All data generated or analyzed during this study are included in this published article (and its supplementary information files). Ethics approval: Not applicable. Consent to participate: Not applicable. Consent for publication: Not applicable. Code availability: Not applicable. Protocol registry: Open Science Framework (OSF). Protocol link: https://doi.org/10.17605/OSF.IO/UH9XJ . Author contributions: Promise Ufomadu (PU) conceptualized and designed the study, conducted the literature search, acquired and screened articles, drafted the initial manuscript, supervised the research process, and performed critical review and final editing of the manuscript. Camille F. Villar (CV), Stephanie Y. Zhang (SZ), and Aileen Y. Hu (AH) participated in article screening and selection, contributed to the write-up of immune-mediated and inflammatory dermatologic diseases (IMIDDs), and assisted in revising and refining the manuscript. Oyetawa Asempa (OA) Provided general oversight as the attending physician, contributed to manuscript revision, and was involved in the final editing and approval of the manuscript. All authors have read and approved the final version of the manuscript and agree to be accountable for the work.

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