Frustrated in its attempt to cure this puzzling complaint, medicine reaches for ever more potent concoctions from cancer drugs to those for organ transplants.
Psoriasis is a chronic and distressing skin disease that afflicts about two million people in the US, and a further 1.12 million in the UK alone. It is most commonly found in the US and northern Europe, affecting, in all, about 2 per cent of every population in those countries.
One insight into the condition can be drawn from a social study of the Australian Aboriginals, who don't suffer from the condition while living in the bush, but develop it when moved to the city.
Another study, of the Greenland Eskimos, has led to the introduction of fish oils into the vast armament of treatments used by medicine. The study discovered a low incidence of psoriasis among the Eskimos, which has been attributed to the mainly fish diet, high in omega 3 fatty acids. As a result, clinical trials discovered that fish oils were helping the condition (Geraldine McCarthy, Medical College of Wisconsin, The Lancet, 28 September, 1991).
However, if you do not live in the bush or an igloo, the chances are you will be treated by your family doctor as dermatologists in the UK seem a rare breed. Equally possibly, you may be treated with the great new wonder drug calcipotriol (Dovonex), especially after it received a glowing report following a major test by Dr K Kragballe et al of the Marselisborg Hospital, Aarhus, Denmark (The Lancet, 26 January 1991).
It is but one of 15 possible conventional treatments available to doctors (although, at the time of going to press, WDDTY was still counting). The chosen treatment will depend on the condition, and also your doctor, who may prefer white soft paraffin to drugs. As two dermatologists from the Royal Hallamshire Hospital put it, in writing in The Lancet (31 August 1991): "The diversity of current therapies for psoriasis reflects the fact that many existing treatments are lacking efficacy, convenience of use, or freedom from adverse effects."
Other conventional treatments (see box, p 2) include mild steroid creams, ultraviolet light B (not to be confused with UVA suntan machines) and zinc. Most alarming of all are cyclosporin and methotrexate (Maxtrex). Cyclosporin is a powerful immunosuppressant, extensively used in organ transplants, while methotrexate, used since 1955 to treat psorisasis, was initially intended to treat cancer.
Calcipotriol owes much its ascendancy to the fact that it is better than the devil you know. That devil is dithranol (Cignolin in Europe and Anthralin in the US) which has been used for 65 years to treat the condition. It is applied directly on the plaques and lesions, provided they are not on the scalp, but has side effects that can only further sap the confidence of the sufferer. The cream causes a brownish staining of the skin, and bandages have to be worn as it can come off on to clothes and bedding. The stains cannot be washed out.
Calcipotriol, by comparison, is colourless and invisible on the skin, and it does not stain. However, it should be used only on certain types of people and for short periods, and long term side effects are not known, although researchers worry about its effect on the calcium levels of patients.
Amid the stampede of enthusiasm for this drug, objections raised by some doctors and researchers about study designs and proper testing has been ignored. Drs C Long and R Mack from the Department of Dermatology at the University of Wales College of Medicine wrote in to The Lancet (13 April 1991) to complain about the design of Kragballe's famous study. Long and Marks argue that the study compared calcipotriol with steroids, which "is by no means the best treatment for psoriasis". Because they didn't compare like with like or the most effective treatment (or even a non medical control ointment) it is "difficult to know how much therapeutic activity is attributable to the drug and how much to the vehicle" ie, the cream itself.
Psoriasis is an all embracing term which defines a condition that ranges from a mild itch to severe lesions covering the trunk and limbs. In simple terms, psoriasis occurs when the rate at which cells live and die is quickened, sometimes by as much as 10 times; the silvery flakes on the skin that can often be seen on sufferers are the dead cells. The most common kind is plaque psoriasis, which affects 95 per cent of all sufferers. Medicine defines the condition as generalized when there are more than five lesions on the scalp or body.
Other types include flexural (where plagues appear around joints like knee and elbows), guttate (where small spots appear all over the body, usually after a sore throat or tonsillitis), nail and palmoplantar psoriasis (which is characterized by thickened plaques on the palms and soles of feet which can become cracked and painful). Nail psoriasis often affects sufferers of psoriatic arthritis; 5 per cent of psoriasis sufferers have some form of arthritis and 5 per cent of arthritics have some form of psoriasis.
Its cause is not so easily defined. Medicine claims not to understand why the condition occurs, although one study suggests that interferon (a cell protein that induces immunity to infection) could be a trigger (Dietmar Fuchs, Institute of Medical Chemistry, University of Innsbruck, Austria, The Lancet, 21 September 1991). Some scientists believe it to be genetic, while others say it can be caused by too much cholesterol in the blood, by hormonal changes or by an allergic reaction to certain drugs or foods. Yet others say it can be triggered by a respiratory infection, by physical or chemical damage to the skin, or by psychological stress. It has been noted that the condition can take up to two years to develop after the trauma. One study in the British Journal of Dermatology (1990; 123, 319-323) found a marked zinc deficiency in 16 patients with psoriasis compared to normal controls. Indeed, it's too early to know how this drug wrks and whether it is the wonder cure it is being touted as.
On a more personal note, former psoriasis sufferer Sandra Gibbons, who went on to write Beat Psoriasis (Thorsons, 1992), and to set up the Alternative Centre in London which has treated 10,000 sufferers, had her own way of describing the condition. "Psoriasis sufferers are victims of not letting anything in or out. The horny layer of skin becomes like a suit of armour, acting as a protection from anyone we perceive may hurt us."
>From that, it would seem there are almost as many triggers or causes as there are treatments. It is probably safe to say that psoriasis is the result of a natural predisposition coupled by an environmental trigger. In other words, while nothing can be done with our genetic coding, much can be done to avoid the trigger or at least understand what the trigger is.
For Sandra Gibbons, the trigger seemed to be either diet related or, more accurately, the trigger was squeezed by diet. After suffering from psoriasis for 14 years, and religiously trying the latest cream treatments, she consulted a naturopath who recommended a regime of salads, fruit and mineral water with dried apricots and almonds. Within 10 weeks, her psoriasis had cleared. "It proved to be a simple case of raw foods eliminating the toxins from the body, as with the process of fasting," she recounts in her book, although she emphasizes that none of the diets should be undertaken without professional advice. "The next task was to readjust the diet to suit my personal needs and lifestyle and remain clear of psoriasis. I succeeded six years later just by eliminating dairy foods from my normal, less restrictive diet. It was that simple."
Naturopath Harald Gaier reports similar success with his recommended daily diet of oily fish, such as herring and mackerel, melon and zinc supplements. He also approves of several herbal or homoeopathic combination products (see Alternatives, p 9).
Contrary to Gaier's findings, candida specialist Dr John Mansfield said that his food sensitivity programme was having no success with psoriasis sufferers. After an admittedly limited trial with 10 patients, he stopped treating the condition.
His interest was reawakened in 1982 when he attended a conference in Atlanta. There, for the first time, a link between psoriasis and candida was mooted. Pioneering this line of research are E William Rosenberg, Professor of Dermatology at the University of Tennessee College of Medicine in Memphis, and Dr Sidney Baker, medical director of the Gesell Institute of Human Development in New Haven, Connecticut.
Rosenberg maintains that psoriasis is an inherited fault in the body's antigen antibody response to foreign organisms, particularly candida albicans, which can bring on psoriasis. Both have published studies on their success in treating psoriasis with an anti candida approach.
Dr Mansfield returned to England and began treating his psoriasis sufferers as if they had candida. They were given fungicide such as Nystatin, Fungizone or a newer preparation such as Sporanox, while recommending a diet free of sugar, all refined carbohydrates (those made with white flour) and all yeasted foods.
He claims a 75 per cent success rate, and looks for a complete clearance of the condition within four months, and an improvement after four to five weeks. He believes the remaining 25 per cent could have been treated successfully had he attacked the condition more aggressively. Dr Baker, for example, claims great success from applying very large doses of fungicide; however, this would cost about lb120 a week, and with no guarantees of success.