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Psoriasis

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Following Up
• Special Considerations
• Supporting Research

Psoriasis is a skin disorder that appears as raised, reddish-pink areas covered with silvery scales and red borders. Psoriasis usually appears on the scalp, elbows, knees, groin, and lower back. It "comes and goes," and may appear as a few spots or involve large areas. It is not contagious, either to other body parts or other people. More than 6 million people in the United States have psoriasis, which is seen in both sexes and all age groups. It can be triggered by emotional stress and can run in families. Most cases are not painful, although severe ones can be. Approximately 5 percent of psoriasis sufferers develop psoriatic arthritis, which involves painful and swollen joints.

Signs and Symptoms

The following are symptoms of psoriasis:

• Raised skin lesions, deep pink with red borders and silvery surface scales. May be cracked and painful in severe cases
• Blisters oozing with pus (usually occurs on the palms or soles)
• Pitted, discolored, and possibly thickened fingernails or toenails
• Itchy skin in some people
• Joint pain (psoriatic arthritis) in some people

What Causes It?

The cause of psoriasis is unknown, but researchers do know that it involves a higher-than-normal rate of skin-cell production. Dead skin cells accumulate and form thick patches. Some researchers believe there is a genetic component, and that a faulty immune system may be involved. Several underlying factors may trigger the disorder or flare-ups, including the following:

• Emotional stress
• Obesity
• Skin injuries or sunburn
• Streptococcal (strep) infection (symptoms sometimes first appear 2 weeks after strep throat)
• Cold or dry air
• Certain drugs (gold, lithium, beta-blockers)
• Alcohol

What to Expect at Your Provider's Office

Your health care provider will examine your skin and ask questions about your physical and emotional health. You may need a blood test to check levels of calcium, zinc, and certain other elements.

Treatment Options

Your provider may suggest one or several different treatment options.

• Topical creams and lotions
• Medications
• Phototherapy (ultraviolet light therapy)
• Changes in your diet
• Vitamin or mineral supplements
• Exercise
• Elimination therapy (in which you discontinue taking certain medications or eating certain foods)

Drug Therapies

Prescription

Topical creams include the following:

• Corticosteroids
• Salicylic acid
• Retinols (drugs derived from vitamin A)
• Calcipotriene (a form of synthetic vitamin D3)

Systemic drugs are taken orally and are used for more severe conditions.

• Methotrexate -- an anti-metabolite that blocks rapid cell growth. Can cause serious side effects
• Cyclosporine
• Soriatane
• Biologics -- made from human and animal proteins (Amevive, Enbrel, Raptiva)

Over the Counter

• Nonsteroidal anti-inflammatory drugs (such as ibuprofen) -- Reduce inflammation and pain, especially for psoriatic arthritis
• Petroleum jelly -- Softens skin, helps it to retain moisture
• Coal tar ointments and shampoos -- Relieve symptoms. Help UV light therapy to work more effectively
• Capsaicin cream -- Pain and inflammation relief. May reduce redness, scaling. Main side effect is a brief burning sensation

Complementary and Alternative Therapies

You may benefit from mind-body therapies and stress management, including meditation and hypnosis. Some studies have shown patients who practiced meditation before receiving phototherapy had better results than patients who had phototherapy alone. Exercise can help too, as can drinking plenty of water. People with psoriasis often find symptoms are alleviated with exposure to sunlight (be sure to wear sunscreen with an SPF of 15 or higher and avoid sunburn, which makes symptoms worse).

Nutrition and Supplements

• Eliminate alcohol, simple sugars, inflammatory fats (meat, dairy). Some people show improvement on a gluten-free diet. Avoid any foods likely to trigger allergies (citrus, milk, corn, eggs). Naturally oriented doctors may use lab tests to identify hidden food allergies that can be an underlying cause of psoriasis.
• Fish oil (10 g per day). Talk to your doctor before taking such a high dose if you also take blood-thinning medication.
• Vitamins: Folate (400 mcg per day) and vitamin E (400 - 800 IU per day)
• Minerals: zinc (30 mg per day), selenium (200 mcg per day)
• Grape seed extract (100 mg two times per day). Do not take grape seed extract if you take blood-thinning medication
• Shark cartilage, 80 - 100 g per day in two to four doses. Do not take shark cartilage if you have diabetes. If you take calcium supplements, talk to your health care provider before taking shark cartilage. Shark cartilage can be expensive, and many people have equally good results with less expensive therapies.
• Avoid vitamin A and D supplements. Both are used in prescription medications in high doses. You cannot get the same benefit from the dose available in a supplement, and there is a danger of overdose if you combine prescription medication with additional supplements of these vitamins.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Milk thistle (Silybum marianum) helps regulate the immune system, which may contribute to psoriasis, and also protects the liver. Take 150 mg two times per day.
• Yellowdock (Rumex crispus), red clover (Trifolium pratense), and burdock ( Arctium lappa ) may be combined and are traditional remedies for psoriasis. Mix equal parts of the above herbs and use 1 cup tea three times per day or 30 - 60 drops tincture three times per day.
• Coleus forskohlii (50 - 100 mg two or three times a day) also has been historically used for psoriasis.
• Evening primrose oil ( Oneothera biennis ), 500 mg - 2.5 g per day. May also be applied topically.
• Oregano oil shows anecdotal evidence of helping some people with psoriasis. Take 20 - 60 drops, two times a day, diluted in water or juice.

Topical applications of some substances may relieve discomfort.

• Aloe ( Aloe vera )
• Apple cider vinegar
• Capsaicin creams
• Evening primrose oil ( Oneothera biennis )
• Oats or oatmeal baths
• Tea tree oil ( Melaleuca alternifolia ). Note: Tea tree oil is toxic if ingested
• Oregon grape ( Mahonia aquifolium ), 10% in a cream

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for psoriasis based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Apis mellifica -- for skin rashes that feel hot and dry and are sensitive to touch. Symptoms are relieved by cool baths and worsened by heat. This remedy is most appropriate for individuals who often feel sad, disappointed, or even depressed. They tend to cry easily but may also be irritable and envious by nature.
• Calendula -- used topically, particularly if the affected area becomes inflamed. This remedy will soothe but not cure the skin condition.
• Rhus toxicodendron -- used for psoriatic arthritis and for skin disorders accompanied by intense itching that worsens at night and improves with the application of heat. This remedy is most appropriate for individuals who are generally restless and unable to get comfortable at night.
• Sulphur -- for skin disorders that are accompanied by intense itching. This remedy is most appropriate for individuals who are thirsty, irritable when not feeling well, uninspired and messy under ordinary circumstances, and who describe a sensation of internal heat and burning. Symptoms tend to improve with open, cold air and worsen with warmth

Chiropractic

No well-designed studies have evaluated the effect of chiropractic on individuals with psoriasis, but a few case studies have reported that spinal manipulation may reduce skin lesions in some individuals. Researchers are still not clear whether chiropractic care is helpful for all people with psoriasis.

Acupuncture

Acupuncture may help some people with psoriasis, possibly due to the relaxation effect of the therapy combined with traditional Chinese medicine approaches of eliminating the "heat" and "dampness" in the meridians (energy pathways in the body) associated with psoriasis.

Following Up

See your provider regularly until your psoriasis is under control.

Special Considerations

In pregnancy, oral medications can be damaging to a fetus, and topical creams can be absorbed into the bloodstream.

Supporting Research

Behrendt M. Reduction of psoriasis in a patient under network spinal analysis care: a case report. J Vertebr Sublux Res . 1998; 2(4):196-200.

Bittner SB, Tucker WFG, Cartwright I, Bleehen SS. A double-blind, randomised, placebo-controlled trial of fish oil in psoriasis. Lancet . 1988;i:378-80.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:169-170.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3 ^rd ed. New York, NY: Penguin Putnam; 1997: 227, 319-320, 345-346.

Ellis CN, Berberian B, Sulica VI, et al. A double-blind evaluation of topical capsaicin in pruritic psoriasis. J Am Acad Dermatol . 1993;29:438-42.

Gruenwald J, Brendler T, Jaenicke C, et al., eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Co; 1998:903-904, 114, 1157.

Hoffman D. The Herbal Handbook: A User's Guide to Medical Herbalism . Rochester, VT: Healing Arts Press; 1988:23-4.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996:263-265.

Liao, SJ. Acupuncture treatment for psoriasis: a retrospective case report. Acupunct Electrother Res. 1992;17:195-208.

The National Psoriasis Foundation. Alternative approaches. Accessed online July 2006 at www.psoriasis.org.

Shenefelt PD. Hypnosis in dermatology. Arch Dermatol . 2000;136:393-9.

Syed TA, et al. Management of psoriasis with aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study. Trop Med Int Health. 1996;1:505-509.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995.

Walker JP, Brown EH. The Alternative Pharmacy. Paramus, NJ: Prentice Hall Press; 1998.

Weisenauer M, Ludtke R. Mahonia aquifolium in patients with psoriasis vulgaris -- an intraindividual study. Phytomed . 1996;3:231-5.

Werbach MR. Nutritional Influences on Illness. New Canaan, Conn: Keats Publishing Inc; 1988:370-373.

• Review Date: 9/1/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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