Help for Psoriasis

Types of Psoriasis

Medical Treatments

Vitamin D, Sunlight, Ultraviolet Light and Phototherapy

Treatment of Psoriasis by Traditional Medicine and Supplements

Fish Oils for Psoriasis

Nature and Nurture: Supplements, Soothing Oils, and Herbs of Value

Many Experts on Psoriasis Recommend the Following

Help for Psoriasis

It’s all Greek to me! The term, psoriasis, derives from a Greek term ‘psora’ which stands for the bran-like scaling on skin.

This unpleasant chronic skin disease, characterized by itching, scaling and inflammation, plagues all age groups. Psoriasis develops red patches of thick lesions covered with silvery scales. Not a pretty sight! The reddening of the skin, ‘erythema’, is caused by inflammation and accompanies peeling, ‘desquamation.’ Although the lesions may come and go, they are usually chronic.

Skin inflammation which extends to the upper most layer of the dermis causes the epidermis to thicken resulting in acanthosis. If immune cells penetrate inflamed skin, vesicles and pustules develop to produce scaling of the top skin layers and thereby redden the skin.

Psoriasis destroys the skin's protective skin barrier, thus allowing the skin to lose fluids and nutrients. This can also make you susceptible to infection. To some extent you can think of psoriasis as a bad sunburn that damages your skin with an overproduction of skin cells. These cells produce a thickened but dysfunctional lesion which can itch, bleed and flake off. The loss of the skin’s moisture through the lesions dries the skin. Although the lesions are thicker than normal skin they are far more porous to water and other penetrating agents. Psoriatic skin lesions contain higher levels of arachidonic acid than healthy skin. This undesirable fatty acid increases the levels of an inflammatory molecule called leukotriene (LTB4). Dietary supplements and healthy fats can help reduce inflammation. Quercetin blocks these inflammatory mediators by down regulating the 5-lipoxygenase pathway and reduces inflammation. The involvement of the fatty acid, arachidonic acid, in the biochemical pathways of skin inflammation has led to the discovery of modestly-effective dietary therapies using essential fatty acid such as gamma-linolenic acid (GLA from primrose oil and borage oil) and eicosapentenoic acid (EPA from fish oil) However, some nonsteroidal anti-inflammatory drugs such as indomethacin may worsen psoriasis.

If you suffer with psoriasis, you may notice times when your skin worsens and then suddenly improves. Conditions that may cause flare-ups include changes in climate, infections, stress, and dry skin.

Types of Psoriasis

Psoriasis often flares up on the elbows, knees, scalp, face, palms, and soles of the feet. It may also inflame fingernails, toenails, and the tissues inside the mouth and genitalia. Additionally, the skin on joints can crack. About 10 percent of psoriasis patients experience symptoms of arthritis in their joints.

There are several forms of psoriasis:

Psoriasis Vulgaris: the most common form of psoriasis (commonly referred to as Plaque Psoriasis). The markers for Psoriasis Vulgaris are lesions with a reddened base covered by silvery scales.

Guttate Psoriasis: drop-like lesions on the trunk, limbs, and scalp. Guttate Psoriasis may be triggered by viral infections or certain bacterial (streptococcal) infections.

Pustular Psoriasis: forms blisters of noninfectious pus on the skin. It may be worsened by medications, excessive sunlight, infections, pregnancy, emotional stress, or exposure to contact irritants.

Inverse Psoriasis: forms dry, smooth, red plaques that occur in the folds of skin under the breasts, in the armpits or near the genitals.

Erythrodermic Psoriasis: causes widespread reddening and scaling of the skin, itching and pain. It may be triggered by severe sunburn, use of cortisone or corticosteroids.

Medical Treatments

The following medical treatments tend to be inadequate, toxic and often rely upon simplistic research.

Mild cases of psoriasis are usually treated with lubricating creams and oils alone or with corticosteroids containing cortisone-like compounds (which actually increase skin damage), salicylic acid, crude oil tars, or anthralin synthetic vitamin D. These are often used in combination with natural sunlight. General recommendations include avoiding (1) trauma to the skin; (2) severe sunburn; (3) topical medications such as lithium and hydrochloroquine and (4) systemic corticosteroids.

Coal tar is applied directly to the skin, used in baths and shampoos for the scalp. Although coal tar makes skin more sensitive to ultraviolet (UV) light, it is used with phototherapy which can irritate the skin. Coal tar has fewer side effects than corticosteroids but is less effective. Anthralin, purified from coal tar, is used to treat chronic psoriasis lesions, however it often irritates the skin and is only marginally effective.

Salicylic acid helps remove scales and is often combined with topical steroids, anthralin, or coal tar.

Moisturizers have a cosmetic and soothing effect but may further loosen and damage the skin. The damaged skin barrier in the lesions rapidly exudes water and dries the skin. Moisturizers that are thick and greasy usually work best.

Retinoids include compounds similar to vitamin A (retinol) and retinoic acid (Retin-A and Renova) which are both safe effective compounds. However, psoriasis is often treated with synthetic retinoids which pose dangerous side effects. Synthetic retinoids include etretinate (Tegison) and isotretinoin (Accutane). Etretinate is most effective against pustular and erythrodermic psoriasis. Isotretinoin is also helpful against pustular psoriasis. Tazarotene (Tazorac gel) is a new topical developed for psoriasis. For women of child-bearing age, Etretinate and Acitretin, is currently available but should not be administered to women planning future pregnancies. The FDA recommends that women stop taking them three years before conceiving. Acitretin (Soriatain) is a retinoid that is quickly eliminated from the body. Many psoriasis treatments are dangerous for women and their children and pose the possibility of causing birth defects. Retinoid treatments are often combined with ultraviolet therapy1.

Vitamin D, Sunlight, Ultraviolet Light and Phototherapy

Vitamin D analogs are based on the positive effect of sunlight on psoriasis and the effects of sunlight on vitamin D synthesis and metabolism. A vitamin D derivative, vitamin D3 or 1,25 dihydroxycholecalciferol (Calcipotriol or Calcipotriene), normally produced by the liver and kidneys, appears to be useful for people with psoriasis. This is a prescription drug and over the counter vitamin D is ineffective. D3 may work by reducing cell proliferation and by suppressing immune cell activities2.

Vitamin D can act by inhibiting a cytokine cascade involved immune cells that produce the inflammatory cytokine interleukin 8. Vitamin D3, taken orally (400 mg/day) or topically (10mg/gm), decreases skin cell proliferation by decreasing the skin cells’ sensitivity to growth factors. Calcipotriene is incorporated into ointment such as Dovonex and applied twice daily. Calcipotriene may irritate the skin and is not recommended for the face or genitals. Skin improvements are seen in 60% of patients after four months.

Sunlight and ultraviolet light are used with psoralen (PUVA) for severe cases of psoriasis. Dithranol, as a pretreatment in PUVA, has shown recent therapeutic promise3. Researchers at Harvard Medical School have recently discovered that psoralen, another ultraviolet light-activated free radical generator, is an extremely efficient carcinogen. They found that the rate of squamous cell carcinoma among patients with psoriasis, who had been repeatedly treated with UVA light after a topical application of psoralen, was 83 times higher than among the general population.

UVB Phototherapy uses artificial light. This type of phototherapy is normally administered in a physician’s office. UVB phototherapy may be combined with other treatments such as a coal tar bath and an application of an anthralin-salicylic acid paste, which is left on the skin for 6 to 24 hours.

PUVA treatment combines oral or topical administration of a drug called psoralen with exposure to ultraviolet A (UVA) light. Psoralen makes the body more sensitive to UVA light. PUVA normally clears lesions more rapidly than other methods. However, it is associated with increased side effects, including nausea, headache, fatigue, burning, itching and irregular skin pigmentation. Researchers have found that PUVA is effective and relatively safe when combined with other medications such as retinoids and hydroxyurea.

Treatment of Psoriasis by Traditional Medicine and Supplements

Immunosuppressive drugs include corticosteroids, methotrexate and cyclosporin A.

Corticosteroids applied twice each day, although often effective, can lead to adverse side effects. Some physicians use high-potency corticosteroid ointments (such as Diprolene, Temovate, Ultravate, or Psorcon). Long-term use of high-potency steroids can lead to thinning of skin, internal side effects and worsening of the psoriasis.

Methotrexate and Cyclosporin A4 have proven reasonably effective but are restricted to severe psoriasis because of the drugs’ toxic effects to the liver and kidney. Methotrexate can cause liver damage and decrease the production of oxygen-carrying red blood cells, infection-fighting white blood cells, and clot-enhancing platelets. Methotrexate should not be used by women who are pregnant, planning to get pregnant, or their male partners. A new drug, Novartis Pharmaceuticals Corp.’s Neoral® (a cyclosporine emulsion), is effective for severe plaque psoriasis. It relieves many symptoms such as pain, itching, scaling and irritation.

Hydroxyurea (Hydrea) is less toxic than methotrexate but also less effective. Hydroxyurea is sometimes combined with PUVA or retinoids. Side effects include anemia and decreases in white blood cells and platelets. Like methotrexate, hydroxyurea should be avoided by women who are pregnant or planning to get pregnant.

 

 

Natural sunlight can significantly improve, or clear psoriasis. Regular daily doses of sunlight taken in short exposures are recommended. UV light from the sun stimulates production of vitamin D by the skin, which slows the overproduction of skin cells that causes scaling. Avoid sunburn which may make psoriasis worse. Be aware that it can take several weeks to see improvement.This natural approach to treating psoriasis is often referred to as climatotherapy. Some people travel to Florida, Hawaii, or the Caribbean to enjoy swimming and natural sunlight as their psoriasis treatment. The most recognized site for climatotherapy, the Dead Sea in Israel, offers treatment solariums with supervised medical assistance.

While many dermatologists admonish psoriasis patients to only use prescription tanning devices combined with photosensitizing psoralens (psoralens increase skin cancers approximately 80-fold), there is evidence that commercial tanning bed therapy is effective. In a six-week study of 20 patients with stable psoriasis vulgaris, patients received three to five tanning sessions per week in commercial tanning beds without psoralens. The ultraviolet dosage was adjusted to just be below the amount required to produce erythema (redness) of the skin. All patient demonstrated benefit from the tanning beds with the average Psoriasis Area Severity Index dropping from 7.96 to 5.04.5

Fish Oils for Psoriasis

Dietary fats such as omega-3 long-chain fatty acids reduce psoriasis in some patients6. A British study controlled study found that eating 170 grams of oily fish daily for 6 weeks reduced the severity of psoriasis. Fish oil is high in the polyunsaturated omega-3 fatty acids, eicosapentanoic (EPA) and docosahexaenoic acids (DHA). EPA competes with a highly inflammatory acid, arachidonic acid (AA), for metabolism by the cyclooxygenase and lipoxygenase pathways. EPA, an anti-inflammatory fatty acid, replaces AA and there is less skin inflammation. Studies on fish oil reported some improvements after two to three months. Such studies used about 1.8 grams of EPA per day which may require taking 10 grams of salmon oil. A higher amount 3.6 grams of EPA per day was found to reduce psoriasis symptoms by 50% after five months of supplementation. Some research suggests that it may be possible to apply fish oil topically and still psoriasis improvement.

Nature and Nurture: Supplements, Soothing Oils, and Herbs of Value

Holistic medicine offers an attractive and gentle option for treating psoriasis. For example, Dr. Andrew Weil recommends using natural sunlight on the affected area, taking high levels of antioxidants such as beta carotene, Vitamin C, Vitamin E, and selenium, plus milk thistle seeds (silymarin) at 300 mg daily. Some practitioners also recommend Folic Acid, Vitamin A, B12, Selenium, Zinc, Glucosamine, Essential Fatty acids, and Lecithin.

Bathing in oil offers a luxurious approach to treating psoriasis. Many find that adding oil to a warm bath and then following up with a moisturizer soothes their skin. Scales can be removed and itching reduced by soaking 15 minutes in water containing a tar solution, oiled oatmeal, and Epsom salts.

 

Some people may recuperate on a hypoallergenic diet. One study reported that eliminating gluten (found in wheat, oats, rye, and barley) improved psoriasis.

Fumaric acid ester is occasionally taken as a supplement and has successfully treated psoriasis in some studies7.

Herbs

Cayenne contains a substance known as capsaicin that acts on sensory nerves to decrease pain and itching. Creams containing 0.025-0.075% capsaicin are generally applied. There may be a burning sensation which decreases with each use.

Burdock root has been used both internally and externally for psoriasis. Herbalists recommend 2-4 ml of burdock root tincture or 1-2 grams of dried root daily as a capsule. In large quantities, burdock root may stimulate the uterus and should not be used during pregnancy.

Milk thistle seeds are considered very safe. Herbalists recommend 420 mg of silymarin daily from capsules. Once improvement is noticed at about two months, lower the dosage to 280 mg per day. If taking raw seeds, eat 12-15 grams of milk thistle seeds daily or drink them in a tea. Sarsaparilla has been used as an anti-inflammatory and the dosage is at least 9 grams of the dried root daily, usually divided between morning and evening.

Sarsaparilla can cause nausea and kidney damage and large doses for long periods of time should be avoided.

Bitter melon inhibits the enzyme guanylate cyclase, which may benefit people with psoriasis. Small children or anyone with hypoglycemia should not take bitter melon since it may lower blood sugar. Diabetics taking hypoglycemic drugs (such as chlorpropamide, glyburide, or phenformin) or insulin should use bitter melon only under medical supervision.

Whole Oregon grape extracts were shown in one study to reduce the inflammation associated with psoriasis. Barberry, similar to the Oregon grape, is also used. Ointments containing these extracts are applied about three times per day. Oregon grape, barberry, and other berberine-containing plants should be used with caution during pregnancy and while breast-feeding.

Quercetin, a plant flavinoid, blocks the 5-lipoxygenase pathway and reduces inflammation. It is very safe and the average daily intake is 25 mg in the United States.

Many Experts on Psoriasis Recommend the Following

1. Keep the skin supple and enjoy regular oil baths, e.g., one teaspoon of GLA/EFA oil, or apply GLA/EFA to the lesion.

2. Apply anti-inflammatory cream, e.g., MPS Exfolia, to the lesion. This cream contains mucopolysaccharide, vitamin A, E, B6, biotin and essential fatty acids. The topical application of these nutrients will increase the rate of healing as well as decrease inflammatory responses. The application of GLA/EFA will also increase healing.

3. Take linseed oil (1-2 tablespoons per day) or supplement with GLA/EFA (3 teaspoons per day).

4. Improve the absorption of nutrients by supplementing with digestive enzymes at each meal (DEF or Hydrozyme).

5. Increase intake of fish oils, particularly those rich in EPA, e.g., wild salmon, sardines, or mackerel, as well as onions and garlic.

6. Avoid smoking or being passively exposed to cigarette smoke, as the nicotine in the smoke can initiate seborrheic dermatitis and thus complicate the psoriasis in some sensitive individuals.

7. Check for drug sensitivity, particularly to beta-adrenergic blocking drugs that are used in the treatment of blood pressure.

8. Avoid stressful situations, fatigue, environmental change (such as exposure to cold) and trauma to the skin as these can initiate new skin lesions.

9. Many drugs can initiate or aggravate psoriasis in susceptible individuals. These are alpha interferon, cortisone, lithium, phenylbutazone, aspirin, progesterone, iodide, nystatin, indomethacin and beta-blockers. Care must be taken when taking these drugs.

10. Inhibitors of phosphodiesterase (eg. Quercetin, theophylline) which increase cAMP levels can improve psoriasis.

11. Vitamin A inhibits ornithine decarboxylase and thus reduces the formation of polyamines. This reduction results in decreased cellular proliferation.

12. Taking the enzymes, trypsin, chymotrypsin and pancreatin (DEF), one hour before meals can reduce circulatory kinins or inflammatory mediators.

Other supplements that are often used:

Lymphodran (Regulates Calmodulin Leukotrienes)	3 - 4/day
GLA/EFA (Anti-inflammatory) apply to the skin lesion as well	1 - 2 tsp/day
BACE (Anti-oxidant)	3 - 8/day, depending on severity
DEF (Reduces Allergen load\ Improves digestion)	1/2 / 1hr prior to meal
Hydrozyme (Improves digestion)	1 tablet with meal
Kelamin (B complex)	2/day
Heme 100 (Folic Acid, B12 supplement)	2/day
C powder with Bioflavonoids (Improves wound healing)	1 - 3 teaspoons/day
Glucosamine (Improves ground substance viscosity)	4 - 6/day
Lecithin Granules (Inositol pathway regulation)	1 dessertspoon/day
D alpha tocopheryl succinate (Regulator of inflammatory cycle)	632 mg 1 - 2/day
SAD (Decrease anxiety and tension)	1 - 4/day, empty stomach
SFM (Reduces stress)	1 - 3/day, empty stomach
MPS Exfolia	Apply to the skin morning and night.
Vitamin D	400 - 800 I.U./day