Psoriasis - Naturopathic Therapies

Psoriasis is a chronic skin condition that may have varying levels of symptom intensity. It causes skin cells to grow very quickly, which results in thick silvery or red patches of skin ^[1]. Usually, skin cells grow and turn over once a month and new skin grows to replace the old skin. However, in the pathological processes involved in psoriasis, new skin cells move to the exterior surface faster (sometimes in days, rather than in weeks). They end up building plaques, which range in size. The most common areas affected are extensor surfaces (knees and elbows), as well as the scalp and extremities like hands and feet. Psoriasis is more common in adulthood, as oppose to eczema which is more common in children ^[1]. These plaques may or may not be itchy.

Much of the underlying process in psoriasis occurs because the immune system is over-active when it shouldn’t be, resulting in inflammation ^[2]. In this study, the authors found that the psoriatic skin lesions had a significantly lower expression of many negative immune regulators, including interleukin-10, cytotoxic T lymphocyte-associated 4, programmed cell death 1, programmed cell death 1 ligand 1 and 2, and indoleamine 2,3-dioxygenase. These immune regulators should normally keep things in check, but in psoriasis they are found to be deficient. Psoriasis likely has an underlying genetic component and may be triggered by environmental factors. Psoriasis is usually diagnosed based on the skin’s appearance. Often a referral to a dermatologist may be made for confirmation or further evaluation. If the diagnosis is unclear, further testing may be performed, such as a skin biopsy. Severe psoriasis is easier to diagnose than mild psoriasis, which can often be confused with other skin conditions due to its inflammatory nature. Symptoms are usually worsened by the cold, certain medications, infections, and psychological stress. Psoriasis can also be worsened by smoking and alcohol consumption, as well as obesity. There are also various subtypes of psoriasis. This article will focus on plaque psoriasis, but many of the potential treatments discussed might also be useful in other types of psoriasis (such as pustular psoriasis, or psoriatic arthritis – which is a condition where psoriasis and arthritis occur together).

Conventional Treatments

The conventional treatments for psoriasis aim to decrease the rate at which skin cells grow, reduce inflammation, and remove scales if they are present ^[3]. There exist topical treatments, which when used can sometimes be quite effective for mild psoriasis. When the psoriasis is more severe, it is standard to combine topical treatments (like creams) with oral medications or additional therapies. The mainstay of topical treatments is corticosteroids ^[3]. These are anti-inflammatory and can slow skin cell turnover by suppressing the immune system. There are a variety of strengths of steroids. If psoriasis is more severe, then higher potency steroids can be used. Usually low-potency steroids are used for sensitive areas (like the face, or on skin folds). One concern with long-term use of steroids is that they can cause the skin to thin. For this reason, it is often suggested that topical steroids are used only as-needed and for temporary lengths of time. Another common topical therapy is synthetic vitamin D (called an analogue). These treatments also slow down the rate that the skin cells grow. If scales are present, there are medications that specifically help to decrease scales and smooth the skin. These can sometimes be irritating and stain clothing. Finally, there are other topical therapies like salicylic acid, coal tar, and moisturizing creams. These are topical therapies that can be used in many skin conditions and can help combat dryness, reduce itching, and decrease inflammation.

Light therapy, also known as phototherapy, is a non-pharmacological treatment for psoriasis. It involves the use of light that is exposed to the skin ^[3]. The use of ultraviolet light seems to help with mild to moderate psoriasis symptoms, including decreasing itchiness. Oral medications for psoriasis include retinoids, which are a group of drugs that are structurally related to vitamin A. These drugs are quite harsh on the body and typically considered for severe psoriasis. They can cause birth defects and so are contraindicated in pregnant women. Methotrexate is an agent that is used orally to treat psoriasis. It is generally tolerated at low-doses, but can cause gastro-instestinal issues and fatigue ^[4]. If used long-term, it can cause issues with platelets and liver function.

Naturopathic Treatments

Addressing Deficiencies

The first thing to consider from a naturopathic perspective is nutrient deficiencies. People with psoriasis can be deficient in chromium, vitamin D, and antioxidants like selenium and vitamin A. Chromium is useful in regulating blood sugar levels. Vitamin D, as mentioned earlier, plays a role in normalizing cell proliferation and differentiation. People with psoriasis appear to have low vitamin D levels compared to the rest of the population. Vitamin D can be replenished orally (this produces a regular, steady, and measurable intake) or by being exposed to adequate amounts of sunlight. Selenium is a precursor to glutathione, which is a potent antioxidant. Low concentrations of selenium are seen in patients with psoriasis. Finally, vitamin A and zinc are other nutrients that are commonly deficient and restoring their status can be helpful in decreasing the symptoms of psoriasis.

Botanical Therapies

There are many herbs that can be used in the treatment of plaque psoriasis. Some act as anti-inflammatories, while others have a larger effect on regulating the immune system. For example, a number of herbs help to decrease cGMP levels. The proliferation of skin cells is partly caused by an imbalance of cyclic AMP (or cAMP) to cyclic GMP (or cGMP). Cell division is controlled by the balance of these two components. In people with psoriasis, there is often a decrease amount of cAMP and an increased cGMP ^[5]. So using herbs that decrease cGMP can restore the balance. Examples include the herbs goldenseal, bitter melon, and milk thistle. Silymarin, one of the active constituents in milk thistle can also help treat psoriasis by improving liver function and decreasing inflammation.

Omega-3 Fatty Acids

Omega-3 fatty acids are a mainstay for natural dermatological conditions. This is because they contain potent anti-inflammatory components, EPA and DHA. EPA in particular is an effective anti-inflammatory. In addition, omega-3 fatty acids can help to decrease the production of arachidonic acid (which is inflammatory and found in animal fats), as well as reducing leukotriene production.

Diet Options

One common natural approach for psoriasis is an elimination diet. This is where more allergenic foods are removed for a period of at least 2 weeks. At the end of the elimination phase, foods are re-introduced gradually to see if symptoms worsen. If the skin gets worse, that food is likely an offending food and should be avoided in the long-term. This allows for an individualized approach for each patient. Alternatively, healthy diet options include limiting sugar, animal meats, and alcohol (which as mentioned can aggravate psoriasis). It is recommended that patients increase their fiber intake. Since obesity is also an aggravating factor, it is suggested that overweight individuals consider losing weight until their body mass index is in the normal range.

Acupuncture

Acupuncture and/or Traditional Chinese Medicine has been used as a whole-systems approach to treating psoriasis. Although difficult to explain, some positive findings have been published in the literature ^[6]. Treatments are generally recommended on an individualized basis and usually require several sessions over several weeks. Acupuncture may be a good option for those who also wish to work on other aspects of their health and can also be a good method for reducing stress and anxiety in those prone to it.

Conclusion

Psoriasis is a chronic health issue that is caused by a highly complex pathological process involving the immune system. The skin proliferates at a much higher rate than it normally should, causing patches and plaques. The conventional approaches include topical therapies, light therapies, and drug therapies. All can be effective and can be used in combination if the disease is severe. Effective naturopathic options exist. They include diet and lifestyle modifications that can help to decrease aggravating factors and reduce inflammation. There are also herbal options that reduce cell proliferation. Acupuncture has also been studied and has shown promise in some of the trials conducted. We recommend you seek the services of your naturopathic doctor to determine which course of action might be most appropriate for your specific situation.