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Psoriasis

MagazineApril 2009 (Vol. 20 Issue 1)Psoriasis

Q) Can you recommend any alternative treatments for moderate psoriasis? I have it on my arms and legs, and want to control it without drugs, if possible

Q) Can you recommend any alternative treatments for moderate psoriasis? I have it on my arms and legs, and want to control it without drugs, if possible. What are my options?-D.C., via e-mail

A) Psoriasis is a chronic skin condition that can affect any part of the body. Typically, it shows up as thickened red patches covered with silvery scales, usually on the scalp, elbows, knees, hands and lower back. Patches usually flare up periodically and symmetrically on both sides of the body and, as you no doubt already know, can cause considerable pain.

Precisely what causes psoriasis is not known, but experts believe that it is an immune-system malfunction, causing skin cells to replace them-selves too quickly. This results in an accumulation of dead skin cells and the formation of those characteristic thick, silvery scales.

A genetic predisposition may be the underlying cause of this auto-immune condition, but other factors can cause and contribute. In women, the most common trigger is smoking (BMJ, 1994; 308: 428-9); in men, it's alcohol. But other triggers include incomplete protein digestion, bowel toxaemia, impaired liver function, excess consumption of animal fats, nutritional factors and stress.

Psoriasis can also flare up after bacterial infections such as strep throat, skin injuries and vaccinations as well as with medicines such as lithium and beta-blockers (Altern Med Rev, 2007; 12: 319-30). But flare-ups don't always have a specific cause.

Treating psoriasis

Most conventional treatments for psoriasis only suppress symptoms-and come with a host of nasty side-effects, so you're wise to look for alternatives. Topical steroids, for instance, can thin the skin, which can make symptoms worse. Systemic drugs like methotrexate-generally prescribed for severe cases-can cause hypertension, kidney damage, anaemia and impaired immunity.

Happily, there's a wide variety of alternative treatments available. For starters, examine your diet. Psoriasis, essentially an inflammatory disorder, may benefit from an anti-inflamma-tory diet. Fasting, and diets that are low-calorie, vegetarian and/or rich in omega-3 fats can significantly improve psoriasis symptoms (Br J Dermatol, 2005; 153: 706-14). Basically, an anti-inflammatory diet emphasizes 'good fats' (cold-water fish such as trout and salmon, nuts, seeds, olive oil and other high quality oils), whole grains, beans, vegetables and fruits, while avoiding 'bad fats' (saturated animal fats, trans fats, fried and processed foods, and poor-quality oils) and refined carbohydrates. It also helps to avoid too much omega-6 (from corn, soy, safflower and sun-flower oils) in your diet.

Several herbs used as seasonings, including turmeric, red pepper, cloves, ginger, cumin, anise, fennel, basil, rosemary and garlic, can also block inflammation in the body (Ann NY Acad Sci, 2004; 1030: 434-41), so you may wish to add these to your food every day.But before changing your diet, it's best to see a nutritionist and be test-ed for food allergies or intolerances. Many psoriatic patients have an increased sensitivity to gluten, and symptoms improve on a gluten-free diet (Altern Med Rev, 2007; 12: 319-30).

Psoriasis is also associated with vitamin deficiencies, so check this out, too. Indeed, the rapid skin-cell turnover rate in psoriasis can cause increased folate uptake and its subsequent deficiency, leading to high homocysteine levels and a greater risk of cardiovascular disease (Br J Dermatol, 2006; 155: 1165-9). So, taking extra folic acid may help.

Other useful supplements include vitamins B6, B12 and D, and fish oils (Altern Med Rev, 2007; 12: 319-30). Psor-iasis patients taking high doses of fish oil (10 g/day) for eight weeks saw significant improvements in symptoms and in the amount of body surface area affected (Lancet, 1988; 1: 378-80). Taking 3.6 g/day of purified eicosapentaenoic acid (EPA; found in fish oil) reduced the severity of psoriasis after two to three months (Dermatologica, 1991; 182: 225-30).

EPA and fish oils also help when applied topically (Eur J Dermatol, 2007; 17: 284-91), and an aloe vera extract cream (0.5 per cent) and curcumin gel (1 per cent) both worked in controlled trials. Curcumin, derived from turmeric, yielded 90-per-cent resolution of skin plaques in half the patients within two to six weeks, while the remainder saw 50- to 85-per-cent improvements (Altern Med Rev, 2007; 12: 319-30). The herbal topical preparations Reli'eva (containing 10-per-cent Mahonia aquifolium) and QoolSkin were also effective in clinical trials (Am J Ther, 2006; 13: 121-6; ScientificWorldJournal, 2007; 7: 1063-9).

Finally, stress management may help. Patients who listened to a guided-imagery tape while under-going phototherapy cleared four times faster than those who received phototherapy alone (Psychosom Med, 1998; 60: 625-32). Hypnosis has also relieved symptoms (Arch Dermatol, 2000; 136: 393-9).

Also try . . .

Brief daily doses of natural sunlight, as UVB rays can improve psoriatic symptoms (Exp Dermatol, 2004; 13: 764-72). But beware: sunburn has the opposite effect.

- Homeopathy. Individualized homeopathic treatment can provoke a good response in patients with chronic skin disorders (Complement Ther Med, 2007; 15: 115-20).

- Acupuncture. Researchers at New York University treated 61 cases of psoriasis, and reported complete or near-complete clearance of lesions in 30 patients (Acupunct Electrother Res, 1992; 17: 195-208).

- Maintaining a healthy weight, as psoriasis appears to be related to a higher body mass index (Br J Dermatol, 1996; 134: 101-6).


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