Complementary and Alternative Medicine for Psoriasis: What the Dermatologist Needs to Know

Abstract

Complementary and alternative medicine (CAM) use is common among patients with psoriasis. CAM modalities include traditional Chinese medicine (TCM), herbal therapies, dietary supplements, climatotherapy, and mind/body interventions. In this review, evidence from clinical trials investigating the efficacy of CAM for psoriasis is reviewed. There is a large amount of evidence from controlled trials that have shown that the combination of TCM with traditional therapies for psoriasis is more efficacious than traditional therapies alone. Herbal therapies that have the most evidence for efficacy are Mahonia aquifolium and indigo naturalis, while there is a smaller amount of evidence for aloe vera, neem, and extracts of sweet whey. Dietary supplementation in patients with psoriasis demonstrates consistent evidence supporting the efficacy of fish oil supplements. Zinc supplementation has not been shown to be effective; however, some evidence is available (albeit conflicting) for vitamin D, vitamin B12, and selenium supplementation. Overwhelming evidence supports the effectiveness of Dead Sea climatotherapy. Finally, mindfulness-based stress reduction can be helpful as adjuvant treatment of psoriasis. There are potential benefits to these modalities, but also potential side issues. Concerns with CAM include, but are not limited to, contamination of TCM products with heavy metals or corticosteroids, systemic toxicity or contact dermatitis from herbal supplements, and ultraviolet light-induced carcinomas from climatotherapy. Dermatologists should be aware of these benefits and side effects to allow for informed discussions with their patients.

Complementary and integrative therapies for psoriasis: Looking forward

“…Vitamin D, vitamin B12, and selenium supplementation have been shown to be useful in the treatment of psoriasis (Brazzelli et al, 2010). Zinc supplementation has not been shown to be effective (Talbott & Duffy, 2015).…”

Dietary habits in Japanese patients with psoriasis and psoriatic arthritis: Low intake of meat in psoriasis and high intake of vitamin A in psoriatic arthritis

“…Thus, the intake of fish containing n ‐3 PUFA and soybean containing isoflavones, and minimizing the consumption of red meat containing SFA and dietary sulfur, are recommended to improve psoriasis . The supplementation of vitamin D or vitamin B 12 is also encouraged for psoriatic patients . Topical vitamin D is effective for psoriasis: it suppresses hyperproliferation in keratinocytes, and suppresses Th17 activity while inducing regulatory T cells .…”

“…The effects of topical vitamin B 12 on psoriasis are also reported: it scavenges nitric oxides and reactive oxygen species . Several controlled and uncontrolled trials of systemic vitamin D or B 12 for psoriasis have been performed though the results are not conclusive …”

Allergic contact dermatitis caused by argan oil, neem oil, and Mimosa tenuiflora

“…Patients with psoriasis frequently consider complementary and alternative medicines, including herbal therapies, traditional Chinese medicine, homeopathy, and dietary supplements, to be remedies with a perceived lack of side‐effects . Several herbal preparations (i.e.…”

“…therapies, traditional Chinese medicine, homeopathy, and dietary supplements, to be remedies with a perceived lack of side-effects (1). Several herbal preparations (i.e.…”