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Psoriasis

Psoriasis is a skin disorder that appears as raised reddish-pink areas covered with silvery scales and red borders. Psoriasis most commonly appears on the scalp elbows knees groin and lower back. It "comes and goes and may appear as a few spots or involve large areas. It is not contagious, either to other body parts or other people. More than 6 million people in the United States have psoriasis, which is seen in both sexes and all age groups. It can be triggered by emotional stress and can run in families. Severe cases can be physically painful and emotionally traumatic due to its unsightly appearance. Approximately 10 percent of psoriasis sufferers develop psoriatic arthritis, a painful arthritic condition.

Signs and Symptoms

The following are symptoms of psoriasis.

bulletRaised skin lesions deep pink with red borders and silvery surface scales; may be cracked and painful
bulletBlisters oozing with pus (usually occurs on the palms or soles)
bulletPitted discolored and possibly thickened fingernails or toenails
bulletItchy skin in some people
bulletJoint pain (psoriatic arthritis) in some people

What Causes It?

The cause of psoriasis is uncertain but researchers do know that it involves a higher-than-normal rate of skin-cell production. Dead skin cells accumulate and form thick patches. Several underlying factors may trigger the disorder or flare-ups including the following.

bulletFaulty immune system
bulletGenetics (hereditary)
bulletEmotional stress
bulletObesity
bulletSkin injuries or sunburn
bulletStreptococcal (strep) infection (symptoms sometimes first appear two weeks after strep throat)
bulletCertain drugs (gold lithium beta-blockers)
bulletAcidic foods
bulletAlcohol

What to Expect at Your Provider's Office

Your health care provider will examine your skin and ask questions about your physical and emotional health. You may need a blood test to check levels of calcium zinc and certain other elements.

Treatment Options

Treatment Plan

It is important to eat a healthy diet and avoid foods that trigger your psoriasis. Be sure to include vitamin and mineral supplements in your diet. Your provider will prescribe oral and topical medications to relieve pain and heal sores. Solar and ultraviolet (UV) light therapies also are helpful.

Drug Therapies

Prescription

Topical creams include the following.

bulletCorticosteroids—reduce inflammation and irritation; can only be used for a short period of time at the beginning of treatment
bulletSalicylic acid ointments—help the scales to shed
bulletCapsaicin ointment—blocks chemicals in the skin that cause inflammation; painful if used on open wounds
bulletCalcitriol ointment—may be as effective as corticosteroids with fewer side effects
bulletEtretinate—for severe cases that do not respond to other treatments

Systemic drugs are taken orally and are used for more severe conditions.

bulletMethotrexate—an anti-cancer drug that reduces symptoms; serious side effects
bulletPsoralen—used with UV therapy; least toxic oral medication
bulletTegison—inhibits rapid cell growth; more effective with UV therapy; numerous side effects

Over the Counter

bulletNonsteroidal anti-inflammatory drugs (such as ibuprofen)—reduces inflammation and pain especially for psoriatic arthritis; various side effects
bulletPetroleum jelly—softens skin helps it to retain moisture
bulletCoal tar ointments and shampoos—relieves symptoms; helps UV light therapy to work more effectively; possibly serious side effects

Complementary and Alternative Therapies

You may benefit from mind/body therapies and stress management. Exercise can help too as can drinking plenty of water.

Nutrition

bulletEliminate alcohol simple sugars inflammatory fats (meat dairy). Avoid acidic foods (pineapple oranges coffee tomato) and any allergic foods (wheat citrus milk corn eggs).
bulletEssential fatty acids: omega-3 and omega-6 (oily fish flaxseed oil 1 000 mg two times per day)
bulletVitamins: B12 (100 to 1 000 mcg) may need to be intramuscular injections folate (400 mcg per day) vitamin E (400 to 800 IU per day)
bulletMinerals: zinc (30 mg per day) selenium (200 mcg per day)
bulletQuercetin: 500 mg three times per day before meals
bulletDigestive enzymes help with proper protein digestion

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers and 10 to 20 minutes for roots.

bulletMilk thistle (Silybum marianum) stops breakdown of substances that contribute to psoriasis protects the liver
bulletYellow dock (Rumex crispus) red clover (Trifolium pratense) and burdock (Arctium lappa) are alternatives.
bulletSarsaparilla (Smilax sarsaparilla) can be effective in psoriasis
bulletColeus (Coleus forskohlii) has been historically used for psoriasis

Mix equal parts of the above herbs and use 1 cup tea three times per day or 30 to 60 drops tincture three times per day. This is especially effective if sipped. Take 5 to 15 minutes before meals to stimulate digestion. Coleus (Coleus forskohlii) (tincture 1 ml three times a day) has been used historically for psoriasis.

Topical creams may relieve discomfort. Chickweed (Stellaria media) relieves itching and marigold (Calendula officinalis) speeds healing of open lesions.

Homeopathy

Be aware that homeopathic treatment of skin problems can result in an initial worsening before resolution.

Following Up

See your provider regularly until your psoriasis is under control.

Special Considerations

In pregnancy oral medications can be damaging to a fetus and topical creams can be absorbed into the bloodstream.

Supporting Research

Blumenthal M ed. The Complete German Commission E Monographs. Boston Mass: Integrative Medicine Communications; 1998:169–170.

The Editors of Time-Life Books. The Medical Advisor. Alexandria Va: Time-Life Books; 1996.

Ergil KV. Medicines from the Earth: Protocols for Botanical Healing. Harvard Mass: Gaia Herbal Research Institute; 1996:207–211.

Gruenwald J Brendler T et al eds. PDR for Herbal Medicines. Montvale NJ: Medical Economics Company; 1998:903–904 114 1157.

Syed TA et al. Management of psoriasis with aloe vera extract in a hydrophilic cream: a placebo-controlled double-blind study. Trop Med Int Health. 1996;1:505–509.

Walker JP Brown EH. The Alternative Pharmacy. Paramus NJ: Prentice Hall Press; 1998.

Werbach MR. Nutritional Influences on Illness. New Canaan Conn: Keats Publishing Inc; 1988:370–373.