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Psoriasis
Description
Psoriasis is a common disease that produces silvery, scaly plaques on the skin. A dermatologist should be consulted to confirm the diagnosis of psoriasis.

Dietary changes that may be helpful: Ingestion of alcohol appears to be a risk factor for psoriasis in men but not women.1 2 It would therefore be prudent for men with psoriasis to drink moderately, if at all.

Anecdotal evidence suggests that people with psoriasis may improve on a hypoallergenic diet.3 One study reported that eliminating gluten (found in wheat, oats, rye, and barley) improved psoriasis for some people.4 A nutritionally oriented doctor can help individuals with psoriasis determine whether gluten or other foods are contributing to their skin condition.

Nutritional supplements that may be helpful: In a double blind study, fish oil (10 grams per day) was found to improve the skin lesions of psoriasis.5 In another study, supplementing with 3.6 grams per day of purified eicosapentaenoic acid (EPA, one of the fatty acids found in fish oil) reduced the severity of psoriasis after two to three months.6 7 That amount of EPA is contained in about 20 grams of fish oil. However, when purified EPA was used in combination with purified docosahexaenoic acid (DHA, another fatty acid contained in fish oil), no improvement was observed.8 Additional research is needed to determine whether fish oil itself or some of its components are more effective for individuals with psoriasis. One study showed that applying a preparation containing 10% fish oil directly to psoriatic lesions twice daily resulted in improvement after seven weeks.9

Supplementing with fish oil also may help prevent the increase in blood levels of triglycerides that occurs as a side effect of certain drugs used to treat psoriasis (e.g., etretinate and acitretin).10 Some nutritionally oriented doctors have been impressed with the effectiveness of flaxseed oil (usually 1-3 tablespoons per day) against psoriasis, although there have been no published studies to support that observation.

The vitamin D that is present in food or manufactured by sunlight is converted in the body into a powerful hormone-like molecule called 1,25-dihydroxyvitamin D. That compound and a related naturally occurring molecule (1 alpha-hydroxyvitamin D3) have been found to be helpful when given orally to people with psoriasis.11 Topical application of these compounds has worked well in some,12 13 14 15 but not all, studies.16 17 These activated forms of vitamin D are believed to work by preventing the excessive proliferation of cells that occurs in the skin of people with psoriasis. Because these potent forms of vitamin D can cause potentially dangerous increases in blood levels of calcium, they are available only by prescription. The use of these compounds (under the supervision of a qualified dermatologist) may be considered in difficult cases of psoriasis. The form of vitamin D that is available without a prescription is unlikely to be effective against psoriasis.

Fumaric acid, in the chemically bound form known as fumaric acid esters, has been shown in some studies to be effective against psoriasis.18 19 However, because fumaric acid esters can cause significant side effects, they should be taken only under the supervision of a doctor familiar with their use.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Cayenne contains a resinous and pungent substance known as capsaicin. This chemical relieves pain and itching by depleting certain neurotransmitters from sensory nerves. In a double blind study, application of a capsaicin cream to the skin relieved both the itching and the skin lesions in people with psoriasis.20

Creams containing 0.025-0.075% capsaicin are generally used. There may be a burning sensation the first several times the cream is applied, but this should gradually become less pronounced with each use. The hands must be carefully and thoroughly washed after use, or gloves should be worn, to prevent the cream from accidentally reaching the eyes, nose, or mouth and causing a burning sensation. Do not apply the cream to areas of broken skin.

In traditional herbal texts, burdock root is described as a blood purifier or alterative.21 Burdock root was believed to clear the bloodstream of toxins. It was used both internally and externally for psoriasis. Traditional herbalists recommend 2-4 ml of burdock root tincture per day. For the dried root preparation in tablet or capsule form, the common amount to take is 1-2 grams three times per day. Many herbal preparations will combine burdock root with other alterative herbs, such as yellow dock, red clover, or cleavers.

Some nutritionally oriented doctors believe that "sluggish" liver function is a contributing factor in psoriasis, possibly explaining why milk thistle seeds, which promote normal liver function, can be beneficial. Milk thistle can be taken in an amount that provides 420 mg of silymarin per day. Milk thistle is available in capsules, tablets, or an extract that is standardized to contain 70-80% silymarin. Once improvement occurs, intake is often reduced to 280 mg of silymarin per day. This lower amount may also be used for preventive purposes.

Psyllium husk powder is sometimes used by psoriasis sufferers, since maintaining normal bowel health is believed to be important for managing psoriasis. Psyllium acts as a bulk-forming laxative to cleanse the bowel and encourage normal elimination. Some doctors of natural medicine suggest 7.5 grams of the seeds or 5 grams of the husks to be taken one to two times per day, with water or juice. It's important to maintain adequate fluid intake when using psyllium.

Sarsaparilla may be beneficial as an anti-inflammatory agent. Capsules or tablets should provide at least 9 grams of the dried root per day, usually taken in divided doses. Tincture is used in the amount of 3 ml three times per day.

An ointment containing Oregon grape has been shown in a double blind study to be effective against psoriasis.22 Whole Oregon grape extracts were shown in one laboratory study to reduce inflammation (often associated with psoriasis) and to stimulate the white blood cells known as macrophages.23 In this study, isolated alkaloids from Oregon grape did not have these effects. This suggests that there are other active ingredients besides alkaloids in Oregon grape. Barberry, which is very similar to Oregon grape, is believed to have similar effects. An ointment made from a 10% extract of Oregon grape or barberry can be applied topically three times per day.

References:
1. Poikolainen K, Reunala T, Karvonen J, et al. Alcohol intake: a risk factor for psoriasis in young and middle aged men? BMJ 1990;300:780-83.
2. Monk BE, Neill SM. Alcohol consumption and psoriasis. Dermatologica 1986;173:57-60.
3. Douglas JM. Psoriasis and diet. West J Med 1980;133:450 [letter].
4. Michaelsson G, Gerden B. How common is gluten intolerance among patients with psoriasis? Acta Derm Venereol 1991;71:90.
5. Bittiner SB, Tucker WFG, Cartwright I, Bleehen SS. A double-blind, randomised, placebo-controlled trial of fish oil in psoriasis. Lancet 1988;i:378-80.
6. Kojima T, Terano T, Tanabe E, et al. Long-term administration of highly purified eicosapentaenoic acid provides improvement of psoriasis. Dermatologica 1991;182:225-30.
7. Kojima T, Ternao T, Tanabe E, et al. Effect of highly purified eicosapentaenoic acid on psoriasis. J Am Acad Dermatol 1989;21:150-51.
8. Soyland E, Funk J, Rajka G, et al. Effect of dietary supplementation with very-long-chain n-3 fatty acids in patients with psoriasis. N Engl J Med 1993;328:1812-16.
9. Dewsbury CE, Graham P, Darley CR. Topical eicosapentaenoic acid (EPA) in the treatment of psoriasis. Br J Dermatol 1989;120:581-84.
10. Ashley JM, Lowe NJ, Borok ME, Alfin-Slater RB. Fish oil supplementation results in decreased hypertriglyceridemia in patients with psoriasis undergoing etretinate or acitretin therapy. J Am Acad Dermatol 1988;19:76-82.
11. Morimoto S, Yoshikawa K, Kozuka T, et al. An open study of vitamin D3 treatment in psoriasis vulgaris. Br J Dermatol 1986;115:421-29.
12. Morimoto S, Yoshikawa K. Psoriasis and vitamin D3. Arch Dermatol 1989;125:231-34.
13. Kragballe K. Treatment of psoriasis by the topical application of the novel cholecalciferol analogue calcipotriol. Arch Dermatol 1989;125:1647-52.
14. Smith EL, Pincus SH, Donovan L, Holick MF. A novel approach for the evaluation and treatment of psoriasis. J Am Acad Dermatol 1988;19:516-28.
15. Kragballe K,. Beck HI, Sogaard H. Improvement of psoriasis by a topical vitamin D3 analogue (MC 903) in a double-blind study. Br J Dermatol 1988;119:223-30.
16. Henderson CA, Papworth-Smith J, Cunliffe WJ, et al. A double-blind, placebo-controlled trial of topical 1,25-dihydroxycholecalciferol in psoriasis. Br J Dermatol 1989;121:493-96.
17. Van de Kerkhof PCM, Van Bokhoven M, Zultak M, Czarnetzki BM. A double-blind study of topical 1 alpha,25-dihydroxyvitamin D3 in psoriasis. Br J Dermatol 1989;120:661-64.
18. Kolbach DN, Nieboer C. Fumaric acid therapy in psoriasis: results and side effects of 2 years of treatment. J Am Acad Dermatol 1992;27:769-71.
19. Altmeyer PJ, Matthes U, Pawlak F, et al. Antipsoriatic effect of fumaric acid derivatives. J Am Acad Dermatol 1994;30:977-81.
20. 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.
21. Hoffman D. The Herbal Handbook: A User's Guide to Medical Herbalism. Rochester, VT: Healing Arts Press, 1988, 23-24 [review].
22. Wiesenauer M, Ldtke R. Mahonia aquifolium in patients with psoriasis vulgaris_an intraindividual study. Phytomedicine 1996;3:231-35.
23. Galle K, Mller-Jakic B, Proebstle A, et al. Analytical and pharmacological studies on Mahonia aquifolium. Phytomedicine 1994;1:59-62.

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Psoriasis - Symptoms, Indications and Actions

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