Evaluating Complementary and Alternative Medicine to Treat Psoriasis
by Dr. Stephen Ho
Psoriasis is a common chronic skin condition that affects >2% of the population. Commonly, well-defined, red and scaly plaques (thickened skin) are noted on various parts of the body. Conventional medical treatments include prescription topical medications, oral / systemic medications that suppress or modulate the immune response, biologic drugs, and phototherapy. Unfortunately, many patients are dissatisfied with their medical treatment due to lack of efficacy, potential adverse side effects, cost, or simply a desire to seek out “natural” remedies. As a result, about half of psoriasis patients report the use of complementary and alternative medicine (CAM).
A systematic review of the medical literature on the use of CAM for psoriasis was published in JAMA Dermatology recently. CAM therapies with the most evidence to consider using in psoriasis include topical indigo naturalis, curcumin, dietary modification (weight loss in obese patients), meditation and acupuncture. Fish oil supplements are the most common CAM used by patients but studies have not proven their benefit in psoriasis.
Commentary: The problem with recommending CAM in a conventional medical practice is the lack of large-scale quality controlled studies for the majority of these modalities. This study helps to narrow down potential options to explore if CAM is to be considered. Consumers need to be cautious when choosing a CAM therapy, as not all natural products, which are sold without a prescription, display the same potency and efficacy as shown in clinical trials. For example, studies show that oral curcumin (a compound found in turmeric) in a phospholipid-based delivery system shows promise as an adjunctive treatment of psoriasis, but the oral non-modified version has low bioavailability and is thus ineffective. Topical curcumin is poorly absorbed and stains the skin yellow so is not useful. Topical indigo naturalis, used in traditional Chinese medicine and derived from indigo plants, has limited commercial sourcing and varying dosages were used in the studies hence the optimal therapeutic concentration is not yet determined. In addition, counterfeit versions of topical indigo naturalis are known to be sold, so buyer beware.
I believe if CAM is to be used, I would recommend seeing a properly licensed and reputable CAM professional (M.D. and D.O. physicians trained in CAM, naturopathic doctor, acupuncturist), who can best administer the proper CAM technique or help validate the sourcing of the natural products to be used.