Psoriasis - Naturopathic MedicineNaturopathic Medicine Summary

Naturopathic Medicine

Naturopathic Summary

In naturopathic medicine psoriasis is understood as a genetically-induced inflammatory and immune-mediated condition with many compounding variables, and although there is no absolute cure for psoriasis, symptom management is possible. Naturopathic modalities for the management of psoriasis include patient education to avoid triggers, diet and lifestyle modifications as well as botanical medicines and hydrotherapy.

Treatment Philosophy

There is no absolute cure for psoriasis, though control of symptoms can be achieved with a whole-person approach to treatment. Naturopathic medicine strives to treat each patient individually, rather than treating the condition in the same way. This individual treatment includes a whole-system, whole-person approach. Naturopathic modalities for the management of psoriasis include patient education to avoid triggers, diet and lifestyle modifications as well as botanical medicines and hydrotherapy.

Symptoms

Psoriasis is a chronic skin disease characterized by red and scaly skin lesions.[1,2] It can either be localized to small, concentrated areas or spread out over the entire body.[1] Psoriasis is a chronic, hyper-proliferative condition, meaning that the growth and replication of cells happens at a  higher rate than normal.[1] Studies in Australia, Europe, and the United States have estimated that psoriasis is found in 1-5% percent of the general population.[1]

 

Causes

Psoriasis is thought to be a genetic imbalance of the immune system relative to a specific immune cell and its pro-inflammatory mediators.[1] This dysregulation then causes the skin cells to grow and replicate faster than normal and contributes to the development of red skin plaques with silvery-white scales that may itch.[1]

 

Risk Factors

Medications

Some medications that can play a role in the development of psoriasis include antimalarial, angiotensin converting enzyme (ACE) inhibitors, beta-blockers, and lithium.[5] Others include the following:

  • Oral steroid withdrawal: Interestingly, while topical steroid creams are the mainstay of therapy in psoriasis, withdrawal of oral or other systemic steroids may worsen symptoms of psoriasis.[5] Therefore systemic steroid medications are typically avoided in the treatment of psoriasis and should be gradually tapered off before discontinuation.[5]
  • Non-steroidal anti-inflammatory drugs (NSAIDS): Medications like aspirin and ibuprofen can induce a psoriasis flare.[5]

Your body

  • Hormonal influence: About 36% of female patients report that hormonal changes during puberty or menopause will worsen psoriasis.[6]
  • Comorbidities: Many different conditions are associated with psoriasis. Up to 73% of patients may have at least one additional condition.[7] Though they may not necessarily be the cause, a patient with psoriasis may also have one or more of these conditions: Cardiovascular disease, osteoporosis, sleep apnea, chronic obstructive pulmonary disease (COPD),[7] erectile dysfunction,[8] cancer,[9] and gout.[10]
  • Genetics: Over 20 different genes have been correlated with psoriasis,[11] and genomic studies have linked it to genes that are also associated with other immune-mediated conditions such as rheumatoid arthritis, systemic lupus erythematosus, and Crohn’s disease.[12]
  • Infections: Infections are known to trigger flares of psoriasis.[6,11]
  • Inflammation: Psoriasis is a chronic inflammatory condition,[1] so any excess inflammation within the body could potentially cause a worsening of symptoms.

Lifestyle

  • Stress: Stress can play a significant role in psoriasis, with stress worsening psoriasis, and psoriasis worsening stress.[13] Most patients with this condition experiences some sort of self-conscious behavior.[13] Although the condition is not contagious, many people who do not understand psoriasis may view it as a contagious infection.[13] As a result, patients with psoriasis can be severely self-conscious about the lesions.[13]
  • Sleep: Poor sleep can play a role in worsening the itch of psoriasis, which could lead to productivity issues in the work environment.[2] Women with obstructive sleep apnea have increased risk of psoriasis.[14]
  • Smoking: Smoking is a known risk factor for the development of psoriasis.[15]
  • Alcohol: Alcohol is a known trigger of psoriasis, and one report stated that about 80% of male patients with psoriasis consume alcohol.[6,11]

Environment

  • Climate: Psoriasis is generally more common in colder and drier climates than it is in warmer, tropical climates.[16]

Naturopathic Therapies

Patient education through "Doctor as Teacher"

The “Doctor as Teacher” principle of naturopathic medicine is important when working with a patient who has psoriasis because it will help the patient to better understand the condition, which in turn helps with the identification and elimination of any environmental or nutritional triggers of symptom flares.

Hydrotherapy

Extended inpatient treatment at a specialized hydrotherapy center can improve symptoms,[20] and quality of life for patients with psoriasis.[21]

Botanicals and Herbs

  • Quing Dai (Indigo naturalis): Quing Dai is an herb that has been used for generations in China and has been found to be a useful topical therapy for skin and nail psoriasis.[17]
  • Turmeric (Curcuma longa): Turmeric, along with Greater Galangal (Alpinia galangal), and Sugar Apple (Annona squamosal) have shown reductions in some of the signaling biomarkers found in patients with psoriasis.[18]
  • Aloe (Aloe vera): Aloe can be an effective and moisturizing topical therapy for psoriasis, and it may also serve as a vehicle for the delivery of other topical treatments.[19]

Diet and Lifestyle

Nutrition and diet

A diet that avoids common immune system triggers and inflammatory foods may offer benefits to patients with immune and inflammatory conditions such as psoriasis.[22]

  • Foods to avoid: Foods like refined sugars, dairy, legumes, grains, processed food chemicals, artificial sweeteners, alcohol, nightshade foods, nuts and seeds can increase inflammation in the body and worsen inflammatory conditions.[22]
  • Foods to include: Vegetables, hormone & preservative-free meats, healthy oils such as avocado and coconut oil similar to the diet make-up of the Mediterranean diet.[23]
  • Dietary fasting: Fasting was reported to improve joint pain in some patients, and a vegan diet was reported to be beneficial for symptoms in patients with psoriasis.[24]
  • Alcohol reduction: is significantly associated with psoriasis, so removal of alcohol from the diet will improve symptoms for patients living with the condition.[25]
  • Gluten-free diet: Studies relating psoriasis and celiac disease have conflicting results. Although patients with psoriasis do not always have the same biomarkers of those with celiac disease,[26] patients with psoriasis who have celiac biomarkers may benefit from a gluten-free diet.[25]

Supplements

  • Vitamin D: The use of vitamin D may work well as a topical treatment for psoriasis,[25] but the benefits of psoriasis treatment using oral vitamin D are unclear. Some studies have shown no difference between patients taking oral vitamin D and controls,[25] although some patients with psoriatic arthritis report benefits after taking an oral vitamin D supplement.[27]
  • Vitamin B12: Vitamin B12 in avocado oil as a topical treatment may be beneficial for long-term management for psoriasis.[28]
  • Omega-3 Fatty Acids: Although several studies have failed to show beneficial effects of supplementation with OFAs, several trials, including double-blind studies, have shown modest improvements in psoriasis.[29]

Lifestyle

  • Moisturizers: Also called emollients, moisturizers can improve symptoms and quality of life for patients with psoriasis,[30] and they can also improve the efficacy of topical corticosteroid creams in the treatment of psoriasis.[31] Castor oil has been proposed as an anti-inflammatory emollient in patients with psoriasis[32] although there are no clinical studies to support this use for castor oil. Some patients may have a negative reaction to topical castor oil, so care should be taken with anyone using castor oil.
  • Weight loss: Obese or overweight patients with psoriasis who lose weight through eating nutritiously and actively moving their bodies can achieve a 75% reduction in severity of symptoms.[33]
  • Stress reduction: Stress reduction practices such as yoga and meditation may help improve quality of life for patients with psoriasis.[34]
  • Smoking cessation: Due to the strong correlation between smoking and increased severity of psoriasis symptoms, smoking cessation will improve not only psoriasis, but a number of other health concerns.[15]
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  2. Kimball AB, Edson-Heredia E, Zhu B, et al. Understanding the Relationship Between Pruritus Severity and Work Productivity in Patients With Moderate-to-Severe Psoriasis: Sleep Problems Are a Mediating Factor. J Drugs Dermatol.2016;15(2):183-188; PMID: 26885786 Link to research.
  3. Truong B, Rich-Garg N, Ehst BD, et al. Demographics, clinical disease characteristics, and quality of life in a large cohort of psoriasis patients with and without psoriatic arthritis. Clin Cosmet Investig Dermatol.2015;8:563-569; PMID: 26622188 Link to research.
  4. Ogdie A, Yu Y, Haynes K, et al. Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a population-based cohort study. Ann Rheum Dis.2015;74(2):326-332; PMID: 25351522 Link to research.
  5. Balak DM, Hajdarbegovic E. Drug-induced psoriasis: clinical perspectives. Psoriasis (Auckl).2017;7:87-94; PMID: 29387611 Link to research.
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  7. Machado-Pinto J, Diniz Mdos S, Bavoso NC. Psoriasis: new comorbidities. An Bras Dermatol.2016;91(1):8-14; PMID: 26982772 Link to research.
  8. Bardazzi F, Odorici G, Ferrara F, et al. Sex and the PASI: patients affected by a mild form of psoriasis are more predisposed to have a more severe form of erectile dysfunction. J Eur Acad Dermatol Venereol.2016;30(8):1342-1348; PMID: 26990837 Link to research.
  9. Chiesa Fuxench ZC, Shin DB, Ogdie Beatty A, et al. The Risk of Cancer in Patients With Psoriasis: A Population-Based Cohort Study in the Health Improvement Network. JAMA Dermatol.2016;152(3):282-290; PMID: 26676102 Link to research.
  10. Lai YC, Yew YW. Psoriasis and uric acid: a population-based cross-sectional study. Clin Exp Dermatol.2016;41(3):260-266; PMID: 26643816 Link to research.
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  15. Armstrong AW, Harskamp CT, Dhillon JS, et al. Psoriasis and smoking: a systematic review and meta-analysis. Br J Dermatol.2014;170(2):304-314; PMID: 24117435 Link to research.
  16. Chandran V, Raychaudhuri SP. Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis. J Autoimmun.2010;34(3):J314-321; PMID: 20034760 Link to research.
  17. McDermott L, Madan R, Rupani R, et al. A Review of Indigo Naturalis as an Alternative Treatment for Nail Psoriasis. J Drugs Dermatol.2016;15(3):319-323; PMID: 26954317 Link to research.
  18. Saelee C, Thongrakard V, Tencomnao T. Effects of Thai medicinal herb extracts with anti-psoriatic activity on the expression on NF-kappaB signaling biomarkers in HaCaT keratinocytes. Molecules.2011;16(5):3908-3932; PMID: 21555979 Link to research.
  19. Feily A, Namazi MR. Aloe vera in dermatology: a brief review. G Ital Dermatol Venereol.2009;144(1):85-91; PMID: 19218914 Link to research.
  20. Merial-Kieny C, Mengual X, Guerrero D, et al. Clinical efficacy of Avene hydrotherapy measured in a large cohort of more than 10,000 atopic or psoriatic patients. J Eur Acad Dermatol Venereol.2011;25 Suppl 1:30-34; PMID: 21175872 Link to research.
  21. Taieb C, Sibaud V, Merial-Kieny C. Impact of Avene hydrotherapy on the quality of life of atopic and psoriatic patients. J Eur Acad Dermatol Venereol.2011;25 Suppl 1:24-29; PMID: 21175871 Link to research.
  22. Afifi L, Danesh MJ, Lee KM, et al. Dietary Behaviors in Psoriasis: Patient-Reported Outcomes from a U.S. National Survey. Dermatol Ther (Heidelb).2017;7(2):227-242; PMID: 28526915 Link to research.
  23. Barrea L, Balato N, Di Somma C, et al. Nutrition and psoriasis: is there any association between the severity of the disease and adherence to the Mediterranean diet? J Transl Med.2015;13:18; PMID: 25622660 Link to research.
  24. Lithell H, Bruce A, Gustafsson IB, et al. A fasting and vegetarian diet treatment trial on chronic inflammatory disorders. Acta Derm Venereol.1983;63(5):397-403; PMID: 6197838 Link to research.
  25. Murzaku EC, Bronsnick T, Rao BK. Diet in dermatology: Part II. Melanoma, chronic urticaria, and psoriasis. J Am Acad Dermatol.2014;71(6):1053 e1051-1053 e1016; PMID: 25454037 Link to research.
  26. Sultan SJ, Ahmad QM, Sultan ST. Antigliadin antibodies in psoriasis. Australas J Dermatol.2010;51(4):238-242; PMID: 21198518 Link to research.
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  28. Stucker M, Memmel U, Hoffmann M, et al. Vitamin B(12) cream containing avocado oil in the therapy of plaque psoriasis. Dermatology.2001;203(2):141-147; PMID: 11586013 Link to research.
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  30. Gelmetti C. Therapeutic moisturizers as adjuvant therapy for psoriasis patients. Am J Clin Dermatol.2009;10 Suppl 1:7-12; PMID: 19209948 Link to research.
  31. Seite S, Khemis A, Rougier A, et al. Emollient for maintenance therapy after topical corticotherapy in mild psoriasis. Exp Dermatol.2009;18(12):1076-1078; PMID: 19453736 Link to research.
  32. Vieira C, Evangelista S, Cirillo R, et al. Effect of ricinoleic acid in acute and subchronic experimental models of inflammation. Mediators Inflamm.2000;9(5):223-228; PMID: 11200362 Link to research.
  33. Upala S, Sanguankeo A. Effect of lifestyle weight loss intervention on disease severity in patients with psoriasis: a systematic review and meta-analysis. Int J Obes (Lond).2015;39(8):1197-1202; PMID: 25920774 Link to research.
  34. Basavaraj KH, Navya MA, Rashmi R. Stress and quality of life in psoriasis: an update. Int J Dermatol.2011;50(7):783-792; PMID: 21699511 Link to research.