Psoriasis patients turning to alternative treatments

Ronald Prussick, MD

Ronald Prussick, MD

Biologics have revolutionized the treatment of patients with psoriasis, but more than half of them still use complementary treatments, including topical and oral herbal medicines, lasers, and diet and lifestyle changes.

“Providers need an idea of what they could recommend to patients because there is so much out there. There have been studies of these products and treatments so dermatologists can make recommendations based on fact and science,” said Ronald Prussick, MD, who presented “Alternative Treatments for Psoriasis” (B012) on July 28.

Dr. Prussick, clinical assistant professor at George Washington University, Washington, D.C., discussed the efficacy of products such as aloe vera, mahonia aquifolium, indigo naturalis, vitamin D, and fish oil, as well as links between gluten sensitivity and psoriasis, and the effect of a healthy diet and exercise on psoriasis.

“If people can lose weight, stop smoking, and reduce alcohol consumption, their disease will be a lot easier to treat because biologics do not clear everyone 100 percent all the time,” he said. “These other things can still be beneficial even with the great medicines we have now.”

One of the most popular alternative products is aloe vera, which inhibits the enzyme tyrosinase and prevents dark spots from forming after psoriasis is cleared. One study showed that 83 percent of those using aloe vera had a “significant” improvement in PASI scores after one year of use compared to placebo. Patients who used 70% aloe cream reduced their PASI scores more than those using triamcinolone (0.1%) after eight weeks, Dr. Prussick said.

Another effective treatment is indigo naturalis, an anti-inflammatory that comes from a powder from an indigofera plant. One study found it decreased nail psoriasis compared with olive oil. A second study found indigo naturalis mixed with olive oil reduced nail psoriasis 51 percent, compared with a 27 percent reduction when calcipotriol was used.

Mahonia aquifolium is an Oregon grape that contains isoquinoline alkaloids that decrease inflammation and keratinocyte proliferation. Six studies showed a benefit from using it, Dr. Prussick said.

A non-medicinal approach is the use of a pulse dye laser for nail psoriasis. One study found that over three months, a pulse dye laser produced a “significant difference” in onycholysis and hyperkeratosis. A second study showed it helped clear nail psoriasis, but not as well as an excimer laser, although the pulse dye laser was more effective than the excimer laser in a subset of patients, he said.

Research has shown that patients with psoriasis have three times the risk of having celiac disease compared to the general population. General symptoms of gluten allergy are diarrhea, flatulence, fatigue, and a history of iron deficiency anemia. Patients with these symptoms should have antibody testing for IgA EMA, IgA tTG, and IgG deamidated gliadin, Dr. Prussick said. If those tests are positive, the patient should try a gluten-free diet for three months.

“When people who have antibodies to gluten and psoriasis go on a gluten-free diet, usually their psoriasis gets a lot better,” he said.

Other treatments Dr. Prussick discussed:

  • Fish oil: 12 of 15 studies showed a clinical benefit from using fish oil, but dosages differed among the studies, so no standard dose is recommended.
  • Vitamin D: Patients with psoriasis are significantly deficient in vitamin D, which is important in the regulation of the immune system. Several open-label uncontrolled studies show a clinical benefit by correcting the vitamin D deficiency, but large controlled studies are needed to confirm this.
  • Oral curcumin: The Indian spice turmeric contains oral curcumin, which is an anti-inflammatory. One study showed it had a positive benefit over 12 weeks, while another did not, but 16 percent of those who did respond had 80 percent clearance.
  • Vigorous physical activity: The long-standing Nurses Health Study showed that participating nurses with the greatest body mass index had a greater risk of developing psoriasis. Nurses who did vigorous physical activity for 100 minutes a week had a 25 to 30 percent reduced chance of developing the disease. The study also showed that smoking increases the risk of psoriasis.
  • Mindfulness meditation: Patients who used phototherapy for treatment and practiced meditation techniques responded faster to treatment than those who did not meditate.
  • Food and supplements: Studies recommend that patients with overactive immune systems and autoimmune diseases avoid/reduce consumption of garlic, alfalfa sprouts, Echinacea, golden seal, melatonin, and ramalteon.

“Because this is a systemic inflammatory disease resulting from an overactive immune system, clearly lifestyle changes can make a big difference,” Dr. Prussick said. “This should be a standard part of what we talk about with patients who have psoriasis. We know that people with moderate to severe psoriasis live about five years less than the general population because they die earlier from heart attacks and strokes. This is why lifestyle and dietary changes are very important.”

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