Truth and myths about complementary medicine in psoriasis
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Although numerous topical and pharmacological treatments exist to decrease symptoms of psoriasis, many patients with mild psoriasis may turn to complementary and alternative methods to ease their symptoms.
The complementary and alternative medicine therapies with the most robust evidence of efficacy for treatment of psoriasis include indigo naturalis, curcumin, dietary approaches, fish oil, meditation and acupuncture, according to a systematic review published in JAMA Dermatology. However, the investigators cautioned that the studies included in the review had small sample sizes, inconsistent quality of study design and differences in the measured primary outcomes.
In another study, researchers found significant associations between low vitamin D status and psoriasis. Some evidence also shows that adherence to the Mediterranean diet may slow the progression of psoriasis.
Overall, however, research on complementary and alternative treatments is lacking. Therefore, Healio spoke to Alexandra Price, MD, a board-certified dermatologist practicing in Boston, Massachusetts, whose research has focused on evidence-based complementary and integrative therapies for skin health, about the truth and myths surrounding the use of complementary and alternative treatments and home remedies to treat psoriasis.
What complementary and alternative treatments and home remedies for psoriasis are supported by the most clinical evidence?
Curcumin, indigo naturalis, acupuncture, mind body therapies and weight reduction via a hypocaloric diet have the most evidence for the treatment of psoriasis, each with randomized controlled trials supporting their use.
What myths generally surround the treatment of psoriasis with complementary and alternative medicine and home remedies? Is there any truth to these theories?
There are many misconceptions surrounding the etiology and transmissibility of psoriasis that lead patients to seek complementary and alternative treatments for their skin condition. Some of these myths are that psoriasis is a dry skin condition, that it is caused by poor hygiene, or that it is contagious. Some patients also erroneously perceive that conventional therapies do not work, or have significant adverse side effects, causing them to seek natural solutions for their skin condition.
From a clinician’s perspective, along with medication, what can patients do to lessen the severity of their symptoms at home?
Patients can engage in stress reduction techniques such as mindfulness meditation and guided imagery. There are several mobile apps such as Calm and Headspace that can be helpful as meditation and stress reduction aids. Additionally, a hypocaloric diet has been shown to be beneficial in overweight patients with psoriasis.
What does the clinical evidence say about taking dietary supplements – like vitamin D, fish oil and aloe vera – to help treat psoriasis?
An association between psoriasis and vitamin D deficiency has led to several investigations of the efficacy of oral vitamin D supplementation for plaque psoriasis. A recent randomized placebo-controlled trial found that oral vitamin D2 supplementation in patients with mild psoriasis significantly improved treatment outcomes compared with placebo, however the study sample size was small.
Oral fish oil supplements are among the most common complementary and alternative medicine modality used by dermatology patients; however, currently these supplements have conflicting efficacy data for psoriasis. While two randomized controlled trials showed benefit, seven randomized controlled trials found lack of efficacy. Most of the data showing benefit were uncontrolled trials.
The evidence for aloe vera for the treatment of psoriasis is mixed and improvements, when found, seem to be modest. Discrepancies may be due to the variability in the chemical composition of aloe preparations.
Would you recommend using a natural or alternative remedy for patients with psoriasis?
Based on available evidence, I would recommend mind-body therapies. Further, oral curcumin in a lecithin-based delivery system in combination with topical corticosteroids in patients with mild-moderate psoriasis has proven efficacy compared with topical corticosteroids alone.
Topical indigo naturalis is also recommended, however the proprietary formulation that showed benefit is not commercially available. In overweight patients with psoriasis, weight reduction through a hypocaloric diet is recommended. Acupuncture may also be beneficial, however, due to lack of blinding in most studies and the variability of the randomized controlled trial data, the most advantageous acupuncture technique for psoriasis is unclear.
What’s the take-home message for clinicians regarding using complementary medicine in psoriasis?
Complementary and alternative medicine use in the United States is increasingly common among patients with skin disease. It is therefore important for dermatologists to become familiar with both the efficacy and potential adverse effects of these therapies to effectively counsel patients.
References:
- Barrea L, et al. Rev Endocr Metab Disord. 2017;doi:10.1007/s11154-017-9411-6.
- Caresse-Gamret A, et al. JAMA Dermatol. 2018;doi:10.1001/jamadermatol.2018.2972.
- Phan C, et al. JAMA Dermatol. 2018;doi:10.1001/jamadermatol.2018.2127.