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Psoriasis

Psoriasis

Description

Psoriasis is a common, chronic skin disorder characterized by round red patches and covered by thick, dry, silvery, adherent scales. The lesions are the result of excessive production of the skin cells and are most common on surfaces which receive repeated minor trauma (e.g., elbows and knees) and the scalp, ears, genitalia and perianal regions. Some individuals also develop arthritis (called psoriatic arthritis) in the fingers and toes.

Its prevalence in the U.S. is between 2-4% of the population, and it affects few blacks and is rare in Indians and blacks in tropical zones. Spontaneous remission is experienced by 29-39%.





Causes

Hyperproliferation of skin cells
Intestinal toxemia

The cell regeneration rate in psoriatic lesions is very high (1,000 times greater than in normal skin), exceeding the rate found in skin cancer. Even in uninvolved skin, the number of proliferating cells is up to 2-1/2 times greater than in non-psoriatics. This increased rate of cell proliferation is probably due to a genetic error in mitotic synthesis control, and any factor which stimulates cell proliferation will tend to aggravate the disease. Such factors include: local inflammation and trauma, candidiasis, intestinal toxemia, beta-blockers, aspirin, biotin, vitamin C, ginseng, botanicals containing inulin (such as Echinacea augustifolia, inula and Arctium lappa).

Intestinal toxemia appears to play a significant role in psoriasis. Inadequate intestinal absorption of amino acids, coupled with bacterial degradation in the colon produces putrescine as well as other toxic products. These toxic intestinal products (typically polyamines) are increased in psoriasis and promote excessive cell proliferation. Lowered skin and urinary levels of polyamines are associated with clinical improvement in psoriasis.






Signs & Symptoms

Sharply demarcated red patches or plaques covered with overlapping silvery scales
Itchiness, only if eruptive or occurs in body folds
Nail involvement results in characteristic "oil drop" stippling (tiny holes in the nails)
Possible arthritis in the small joints
Usually involves the scalp, extensor surfaces of extremities and sites of repeated trauma
There is typically family history involved (50% of cases)







Nutritional Supplements

Structure & Function:
        Immune System Support
        Essential Fatty Acids &
        Hair, Skin and Nail Support


---------------------------------
General Supplements
---------------------------------

EPO3-6 capsules, 3 times/day
Folic Acid400 mcg/d
Garlic3-6 capsules/day
Proanthocyanidins*
Quercetin1/4 tsp. 4 times/day
Rutin*
Selenium200 mcg/day
Vitamin A50,000 I.U./day
Vitamin D*
Vitamin E400 I.U./day (natural tocopherols)
Zinc25 mg/day (picolinate)



* Please refer to the respective topic for specific nutrient amounts.

Discussion:-

The basic purpose of these nutritional supplements is to decrease the inflammatory process, decrease intestinal toxemia and normalize the excessive cell proliferative response.

Zinc is a known inhibitor of excessive cell proliferation, and seems particularly indicated due to the low serum zinc:copper ratio (due to both high serum copper and low serum zinc) seen in psoriatic patients. Vitamin A and its derivatives inhibit the production of toxic amines from the intestine.

An important inflammatory pathway in psoriasis is inhibited by glutathione peroxidase, a selenium-dependent, anti-inflammatory and anti-oxidant enzyme. Glutathione peroxidase (GP) levels are low in psoriatic patients, possibly due to such factors as alcohol abuse, malnutrition, and the excessive skin loss of the hyperproliferative disease. The depressed levels of GP normalize with oral selenium and vitamin E supplementation.

Naturally occurring substances, such as quercetin or rutin (the ubiquitous plant flavonoids) and garlic, have been shown to inhibit the inflammatory process.

Another example, which is quite new on the general market but is making quite an impact is: pycnogenol™.

The use of evening primrose oil will cause an increase in fatty acid dihomogammalinolenic acid, which cannot be converted to arachidonic acid (critical for the inflammatory processes found in psoriasis), while still allowing production of important noninflammatory prostaglandins. Eicosapentaenoic acid has similar effects.

Note: All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.




Dietary Considerations

Limit sugar and animal fats. Increase fiber and cold-water fish and if necessary, bring weight to normal levels.

Dietary Oils
Control of dietary oils is important, since free fatty acid levels (FFA) are abnormal in psoriatic serum, and the levels of inflammatory fatty acids, (i.e. arachidonic acid) can be limited through careful dietary selection.

In the involved skin, the cellular content of free arachidonic acid (AA) is 250 times greater than in uninvolved skin tissue. This elevation appears to be due to the presence in the plaques of a yet to be defined inhibitor of normal AA breakdown.

Trauma also induces the release of free AA and may account for the common clinical observation of plaques at the sites of repeated trauma. This is significant, since the increase in arachidonic acid stimulates the inflammatory pathways, thus promoting the proliferative process. The only significant source of arachidonic acid in humans is through the animal fats in the diet.

Low dietary fiber is associated with diverticular disease and increased levels of gram-negative rods in the bowel, both of which contribute to intestinal toxemia.

Psoriatic patients improved on a fasting and a vegetarian diet at a Swedish hospital where the effect of such diets on chronic inflammation disease was being studied. The improvement was probably due to decreased levels of arachidonic acid and endotoxins.

Patients have also benefited from a gluten free diet.






Homeopathic Remedy

Long term treatment

1. Lycopodium Clavatum - 30C
2. Petroleum - 30C (especially for hands types)
3. Borax tinct. - 3 to 15C long term

Treatment Schedule

Doses cited are to be administered on a 3X daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.

Legend

X = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
X or C underlined means it is most useful potency

Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one remedy - if so, use all of them.

References

Boericke, D.E., 1988. Homeopathic Materia Medica.

Coulter, C.R., 1986. Portraits of Homeopathic Medicines.

Kent, J.T., 1989. Repertory of the Homeopathic Materia Medica.

Koehler, G., 1989. Handbook of Homeopathy.

Shingale, J.N., 1992. Bedside Prescriber.

Smith, Trevor, 1989. Homeopathic Medicine.

Ullman, Dana, 1991. The One Minute (or so) Healer.

Herbal Approaches

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Herbs
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Aloe vera
Burdock
Cayenne
Flax seed oil
Licorice Root
Milk thistle (Silybum)
Momordica Charantia (bitter melon)
Sarsaparilla

Note: The misdirected use of an herb can produce severely adverse effects, especially in combination with prescription drugs. This Herbal information is for educational purposes and is not intended as a replacement for medical advice.

Discussion:

Aloe vera gel has always been a favorite for skin problems, especially on acute areas. More palatable forms have become available to encourage its use internally, as well.

Cayenne is often useful against itching. It appears to inhibit the release of substance P from cutaneous sensory neurons.

Licorice Root (specifically glycyrrhetinic acid) acts like hydrocortisone, indeed, in some trials it proved superior! 93% reported benefit compared to 83% using cortisone. In combination, the licorice derivative potentiates the benefit of cortisone.

Many other topical applications are resorted to, including: Burdock, Calendula, Chamomile and Chickweed ointments.

German Chamomile flower is an approved herb by the German Commisssion E and a major phytomedicine on the German market, accounting for sales of over $8 million (1996). It is classified as a dermatological preparation.

Detoxification may be helpful, for which, Milk thistle (Silymarin) and Sarsaparilla are effective.

Milk thistle (Silybum) is often recommended, although therapy may take from 6 - 12 months.

Diuretics may also be resorted to as well, again for detoxification purposes. Cleavers and Figwort have been used.

The aqueous extract of the ripe fruit of Momardica charantia (balsam pear, bitter melon) inhibits rapid cell proliferation. The therapeutic protocol is only 3 weeks in this case.

An aqueous extract of Honduran sarsaparilla, sarsasaponn, has been found to be effective in psoriasis, particularly the more chronic, large plaque forming variety. This is apparently due to its ability to normalize lipid metabolism or its potential ability to bind endotoxins. Similar efficacy has been achieved with two Chinese varieties.

Flax seed oil is often recommended as an adjunctive therapy.

References:

Evans, FQ: The rational use of glycyrrhetinic acid in dermatology. Br. J. Clin. Pract. 1958, 12:269-279.

Hikino, H. "Recent Research on Oriental Medicinal Plants." In Economic and Medicinal Plant Research. Edited by Wagner, H., Hikino, H., and Farnsworth, N.R. Vol. 1. London: Academic Press, 1985.

Kurkcuoglu, N & Alaybeyi, F: Topical capsaicin for psoriasis. Br. J. of Dermatology, 1990, 123(4):549-550.

Teelucksingh, S et al., Potentiation of hydrocortisone activity in skin by glycyrrhetinic acid. Lancet, 1990, 335:1,060-1,063.

Thurman, FM: The treatment of psoriasis with sarsaparilla compound. NEJM. 1942, 227:128-133.

Walji, H: Skin Conditions. Natural Health Series, Kian Press, 1997.



Aromatherapy - Essential Oils

Benzoin Essence,Bergamot Essence,
Cajeput Essence,Calendula Essence,
Geranium Essence,Juniper Essence,
Lavender Essence,Tea Tree Essence,
Thuja Essence.


Related Health Conditions

Arthritis
Candidiasis
Intestinal toxemia
Seborrheic dermatitis




Abstracts

References

Anonymous: Psoriasis Rx: A Plus E Plus Zinc. Cortlandt Forum, May 1993;123/63-31.

Bazex, A. Diet without gluten and psoriasis. Ann Derm Symp, 1976: 103;64

Bech-Thomsen N & Wulf HC: Photoprotection due to pigmentation and epidermal thickness after repeated exposure to ultraviolet light and psoralen plus ultraviolet A therapy. Photodermatol Photoimmunol Photomed, 1996 Oct-Dec, 11:5-6, 213-8.

Boer, J., J. Hermans, A. Schotorst, & D. Suurmond. Comparison of photochemotherapy (PUVA) for clearing and maintenance therapy of psoriasis. Arch Dermatol, 1984: 120; 52-7.

Brewer, G, et al: Chromium Supplementation and Insulin Sensitivity in Psoriasis. Journal of the American College of Nutrition, 1993;12(5):588/Abstract 35.

Calzavara-Pinton PG et al., Photodynamic therapy with systemic administration of photosensitizers in dermatology. J Photochem Photobiol B, 1996 Nov, 36:2, 225-31.

Chafin, A., D. Vesley, D. J. Hudson, et. al. Inhibition of grown and guanylate cyclase activity of undifferentiated prostate adenocarcinoma by an extract of balsam pear (Momardica charntia abbreviata). Proc Natl Acad Sci Usa, 1978: 75; 989-3.

Donadini, A., A. Dazzaglia & G. Desirello. Plasma levels of Zn, Cu and Ni in healthy controls and in psoriatic patients. Acta Vitamin Enzymol, 1980: 1; 9-16.

Donadini, A. et al: Selenium Plasma Levels in Psoriasis. Clinical and Experimental Dermatology, 1992;17:214-216.

Editorial - Polyamines and psoriasis. Arch Dermatol, 1979: 115; 943-4.

Editorial - Polyamines in psoriasis. J Invest Dermatol, 1983: 81; 385-7.

Editorial - Leukotrienes and other lipoxygenase products in the pathogenesis and therapy of psoriasis and other dermatoses. Arch Dermatol, 1983: 119; 541-7.

Even-Paz Z: Dermatology at the Dead Sea spas. Isr J Med Sci, 1996 Jul, 32 Suppl:, S11-5.

Feldman SR et al., An assessment of potential problems of home phototherapy treatment of psoriasis. Cutis, 1996 Jul, 58:1, 71-3.

Fergin P: Photodynamic therapy for psoriasis? Australas J Dermatol, 1996 May, 37:2, 87-8.

Fleischer AB Jr et al., Alternative therapies commonly used within a population of patients with psoriasis. Cutis, 1996 Sep, 58:3, 216-20.

Fleischer AB Jr et al., Commercial tanning bed treatment is an effective psoriasis treatment: results from an uncontrolled clinical trial. J Invest Dermatol, 1997 Aug, 109:2, 170-4.

Gollnick HP: Oral retinoids--efficacy and toxicity in psoriasis. Br J Dermatol, 1996 Oct, 135 Suppl 49:, 6-17.

Gonzalez S et al., Development of cutaneous tolerance to ultraviolet B during ultraviolet B phototherapy for psoriasis. Photodermatol Photoimmunol Photomed, 1996 Apr, 12:2, 73-8.

Gupta, A. K. et al: The Role of Fish Oil in Psoriasis: A Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Effect of Fish Oil and Topical Steroid Therapy in Psoriasis. International Journal of Dermatology, October 1990;29 (28): 591-595.

Guzzo C: Recent advances in the treatment of psoriasis. Dermatol Clin, 1997 Jan, 15:1, 59-68.

Haddox, M., J. Stephenson & M. Moser., et. al. Ascorbic acid modulation of splenic cell cyclic GMP metabolism. Life Sciences, 1979: 24; 1555-6.

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Jerner B et al., A controlled trial of acupuncture in psoriasis: no convincing effect. Acta Derm Venereol, 1997 Mar, 77:2, 154-6.

Juhlin, L., L. Bedquist, G. Echman, et. al. Blood glutathione-peroxide levels in skin diseases - Effect of selenium and vitamin E treatment. Acta Dermat Vener (StockH), 1982: 62; 211-4.

Katayama, H. & H. Hori. The influence of UVB irradiation on the excretion of the main urinary metabolite of prostaglandin F1a and F2a in psoriatic and normal subjects. Acta Dermatol Vener (StockH), 1984: 64; 1-4.

Kirschmann, J.D. 1990. Nutrition Almanac: Nutrition Search. McGrew-Hill: New York.

Kishimoto Y et al., Transfer of autoimmune thyroiditis and resolution of palmoplantar pustular psoriasis following allogeneic bone marrow transplantation. Bone Marrow Transplant, 1997 May, 19:10, 1041-3.

Kumar B et al., Coal tar therapy in palmoplantar psoriasis: old wine in an old bottle? Int J Dermatol, 1997 Apr, 36:4, 309-12.

Kurkcuoglu, N. & Alaybeyi, F: Topical Capsaicin For Psoriasis. British Journal of Dermatology, October 1990;123(4):549-550.

Larko, O. & G. Swanbeck. Is UVB treatment of psoriasis safe? Acta Dermat Vener (Stock H), 1982: 62; 507-12.

Lithell, H., A. Bruce, B. Gustafsson, et. al. A fasting and vegetarian diet treatment trial on chronic inflammatory disorders. Acta Derm Vener (StockH), 1983: 63; 397-403.

Man MQ M et al., Optimization of physiological lipid mixtures for barrier repair. J Invest Dermatol, 1996 May, 106:5, 1096-101.

McCarty MF: Glucosamine for psoriasis? Med Hypotheses, 1997 May, 48:5, 437-41.

McKenna KE & Stern RS: The outcomes movement and new measures of the severity of psoriasis. J Am Acad Dermatol, 1996 Mar, 34:3, 534-8.

Morison WL: PUVA therapy is preferable to UVB phototherapy in the management of HIV-associated dermatoses. Photochem Photobiol, 1996 Aug, 64:2, 267-8.

Murray, Michael T. Endotoxins and alternative complement pathway activation, an underlying factor in many diseases. Townsend Newsletter. Porttownsend, WA. June 1984, pp. 1-3.

Murray, M.T., & J.E. Pizzorno. 1991. Encyclopedia of Natural Medicine. Rocklin, Ca; Prima Publishing.

Nettelblad H et al., Psoralens used for cosmetic sun tanning: an unusual cause of extensive burn injury. Burns, 1996 Dec, 22:8, 633-5.

Noronha PA & Zubkov B: Nails and nail disorders in children and adults. Am Fam Physician, 1997 May 1, 55:6, 2129-40.

Olafsson JH et al., Psoriasis treatment: bathing in a thermal lagoon combined with UVB, versus UVB treatment only. Acta Derm Venereol, 1996 May, 76:3, 228-30.

Orenberg, Deneau & Farber. Response of chronic psoriatic plaques to localized heating induced by ultrasound. Arch Dermatol, 1980: 116; 893-7.

Orfanos CE et al., Current use and future potential role of retinoids in dermatology. Drugs, 1997 Mar, 53:3, 358-88.

Ormerod AD: A comparison of subjective and objective measures of reduction of psoriasis with the use of ultrasound, reflectance colorimetry, computerized video image analysis, and nitric oxide production. J Am Acad Dermatol, 1997 Jul, 37:1, 51-7.

Parrish, J. Phototherapy and photochemotherapy of skin diseases. J Incest Dermatol, 1981: 77; 167-71.

Perez A et al., Safety and efficacy of oral calcitriol (1,25-dihydroxyvitamin D3) for the treatment of psoriasis. Br J Dermatol, 1996 Jun, 134:6, 1070-8.

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Prystowsky JH et al., Effect of UVB phototherapy and oral calcitriol (1,25-dihydroxyvitamin D3) on vitamin D photosynthesis in patients with psoriasis. J Am Acad Dermatol, 1996 Nov, 35:5 Pt 1, 690-5.

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Said A et al., Psoralens percutaneous permeation across the human whole skin and the epidermis in respect to their polarity (in vitro study). J Dermatol Sci, 1997 Feb, 14:2, 136-44.

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Thurmon. NEJM 227: 4; 128-33.

Urabe, H., K. Nishitani & H. Kohda. Hyperthermia in the treatment of psoriasis. Arch Dermatol, 1981: 117; 770-4.

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