As interest in alternative medicine grows, patients with psoriasis weigh benefits, risks

In this issue of Healio Psoriatic Disease we focus on complementary and alternative medicine for psoriasis.

Complementary and alternative medicine (CAM), or “complementary health approaches,” is a group of diverse medical and health care practices and products that are not presently considered to be part of conventional medicine. There are two broad subgroups: 1) natural products, including herbs, vitamins, minerals and probiotics, the latter often sold as dietary supplements; and 2) mind and body practices, including a large and diverse group of procedures or techniques administered or taught by a trained practitioner such as yoga and meditation.

There is broad interest in CAM in the United States, and the National Center for Complementary and Integrative Health at the NIH funds research studies to further understand the risks and benefits of CAM approaches.

As a common, chronic, incurable and stigmatizing disease, there is intense interest in CAM by patients with psoriasis. Complicating matters is that these patients can have prolonged spontaneous remissions and respond to placebo (PASI 75 is about 5% in patients with moderate to severe psoriasis receiving placebo) and therefore anecdotes abound about various CAM treatments improving psoriasis. A 2018 survey conducted by the National Psoriasis Foundation found that 41% of people with psoriasis reported using alternative therapies, with patients who had more severe disease being more likely to seek them out.

While interest in CAM therapy is high, it appears the interest in well conducted, rigorous trials to prove its safety and efficacy is low, as there is a dearth of data to support its use in psoriasis. So, what do patients, and their providers who recommend CAM, have to lose? A lot! First, at best, an unproven therapy may be a waste of precious time and money and may prevent patients from receiving therapies actually proven to work. At worst, patients may experience life threatening harm. Tryptophan is a CAM therapy used for disorders such as insomnia and mood disorders. Dermatologists of a certain generation will recall its association with a scleroderma-like condition called eosinophilia-myalgia syndrome. Herbs and dietary supplements promoted for their supposed weight loss or joint pain benefits, including green tea extract, may cause severe acute liver injury. Specifically turning to psoriasis, a leave-on zinc-based product called Skin Cap was reported to be a miracle treatment for psoriasis with many anecdotes of its remarkable efficacy. However, the plural of anecdote is not data. Dermatologists started seeing severe psoriasis flares in patients using this product and some studies found it contained ultrapotent steroids.

So, what is a clinician to do? I will just share my approach. First, I encourage my patients to let me know about any CAM therapy they use, and I try to be nonjudgmental in receiving this information. I personally do not recommend any natural products — including herbs, vitamins, minerals or probiotics (so called dietary supplements) — for the management of psoriasis as I am unaware of any rigorous data that they offer any benefit. I also explain to patients that supplements may cause harm either due to known harmful ingredients or adulterants. For those who want to pursue CAM, I recommend mind and body practices, such as mindfulness meditation. In this issue’s cover story we discuss that there is some reasonable data that mindfulness meditation may have benefits for psoriasis, and I routinely recommend this for psoriasis. (Full disclosure, I am an avid yoga and mindfulness practitioner, or at least I try to be). Mindfulness meditation has strong data to support benefits for reducing anxiety and depression and even lowering blood pressure, which are common problems patients with psoriasis face. To paraphrase the Dalai Lama, if we want to save [a patient], we must have a plan. But no plan will work unless we meditate.

• References:
• Collection development guidelines of the National Library of Medicine: Complementary and alternative medicine. https://www.ncbi.nlm.nih.gov/books/NBK518811/. Updated March 26, 2018. Accessed Jan. 20, 2023.
• Complementary, alternative, or integrative health: What’s in a name? https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name. Updated April 2021. Accessed Jan. 20, 2023.
• Mindfulness for your health. https://newsinhealth.nih.gov/2021/06/mindfulness-your-health. Published June 2021. Accessed Jan. 20, 2023.
• Navarro VJ, et al. Hepatology. 2017;doi:10.1002/hep.28813.
• Silver RM, et al. N Engl J Med. 1990;doi:10.1056/NEJM199003293221302.
• Smith, K. Dermatol Online J. 1997;doi:10.5070/D39d81j8mf.