• The Naturopathic Approach for Psoriasis

    Saturday, 15 January 2000 00:40
    By Michael Traub, ND & Monica Scheel, MD - Vol. 8, No. 2. Summer, 2007


    Psoriasis is thought to be the result of T-cell activation initiated by unidentified antigens. These activated T-cells release cytokines like tumor necrosis factor alpha (TNF-α) that lead to keratinocyte proliferation. This hyper-proliferative response decreases epidermal transit time from the normal 28 days to 2–4 days, ultimately leading to the erythematous scaly plaques that characterize the disease.

    There is clearly a genetic underpinning to psoriasis, and it seems to be connected with the cellular component of the immune system. Researchers have seen it in previously non-psoriatic recipients of bone marrow transplants from donors with the disease.

    In conventional medical thinking, evidence of genetic predisposition leads to a conclusion that the clinical disorder is inevitable and essentially incurable, though severity may vary. Conventional therapies are oriented toward suppressing or down-regulating the inflammatory cascade that drives the clinical signs and symptoms. This is certainly reasonable, but it may not be the whole story.

    Naturopathic thinking broadens the inquiry. Given a genetic predisposition, what can be done to reduce genetic expression besides immunosuppressive therapies? And just what are those "unidentified antigens" that seem to activate the T-cells? The naturopathic approach consists of dietary modification, therapeutic fasting, omega-3 supplementation, topical natural medicines, herbal therapies and stress management.

    Pizzorno and Murray propose that the "unidentified antigens" result from incomplete protein digestion. They also suggest a contributory role for intestinal permeability, food allergies, bowel toxemia (endotoxins), impaired liver detoxification, bile acid deficiencies, excessive alcohol and/or animal fat consumption, nutrient deficiencies (Vitamins A, D, E, zinc and selenium), and stress. All of these factors are scientifically plausible, though in the main, they have not been tested.

    Since psoriasis is essentially an inflammatory disorder, it will benefit from an anti-inflammatory diet, as well as identification, elimination and/or rotation of allergenic foods, hence the rationale for therapeutic fasting, which may slow the growth rate of keratinocytes. Several papers indicate psoriasis patients can benefit from this approach (Wolters M. Br J Dermatol. 2005 Oct; 153(4): 706–714; Brown AC, et al. Alt Med Rev. 2004 Sep; 9(3): 297–307; Lithell H, et al. Acta Derm Venereol. 1983; 63(5): 397–403).

    An anti-inflammatory diet consists basically of whole grains, legumes, vegetables and fruits, and "good fats" (cold water fish, nuts, seeds, high quality oils). Patients should do all they can to avoid "bad fats" (saturated animal fats, fried and processed foods, poor quality oils), and refined carbohydrates.

    The "reasoning for seasoning" logic—the idea that culinary use of herbs and spices began with recognition of their medicinal/hygienic value—certainly applies here. Turmeric, red pepper, cloves, ginger, cumin, anise, fennel, basil, rosemary, garlic, and pomegranate can block NFKB activation of inflammatory cytokines, and should definitely be included in an anti-inflammatory diet (Aggarwal BB, Shishodia S. Ann NY Acad Sci. 2004 Dec; 1030: 434–441).

    Fish oil, given orally and intravenously, has repeatedly proven beneficial in psoriasis (Bittiner SB, et al. Lancet. 1988 Feb 20; 1(8582): 378–380; Mayser P, et al. Br J Nutr. 2002 Jan; 87 Suppl 1: S77–S82; Mayser P, et al. J Am Acad Dermatol. 1998 Apr; 38(4): 539–547).

    Effective topical treatments include: Calcipotriene (Dovonex), a vitamin D derivative; Creams containing homeopathic preparations of Berberis aquifolium, a fruiting shrub also known as Mahonia aquifolium or Oregon Grape (Psoriaflora by Boericke & Tafel; Relieva by Apollo Pharmaceuticals); Curcumin gel 1%; Aloe vera gel; and a flavonoid-rich salve marketed as Flavsalve (New World Natural Products).

    A Canadian analysis of three separate trials using the Oregon grape preparations suggests that they are at least comparable to Dovonex, and represent a safe and effective treatment for mild to moderate psoriasis (Gulliver WP, Donsky HJ. Am J Ther. 2005 Sep–Oct; 12(5): 398–406).

    Curcumin, aka Turmeric, is proving effective, as well. Curcumin gel yielded 90% resolution of plaques in 50% of patients within 2–6 weeks; they showed 50–85% improvements. The data suggest it is twice as effective as calcipotriene cream, which generally takes 3 months to exert its full effect. Curcumin is a selective phosphorylase kinase inhibitor, which could explain the impressive clinical response (Heng MC, et al. Br J Dermatol. 2000 Nov; 143(5): 937–949).

    A controlled trial of Aloe vera extract cream in 60 patients treated for 4–12 months showed it to be 83.3% effective vs. 6.6% in the placebo-treated group; psoriasis activity severity index scores decreased by 2.2 (Syed TA, et al. Trop Med Int Health. 1996; 1: 505–509).

    It is important, when treating psoriasis, to avoid natural products that may aggravate the condition, including inulin-containing botanicals such as Echinacea, Inula, Arctium lappa, or cyclic AMP stimulators like biotin, Vitamin C, or Ginseng.

    Exercise and outdoor activities (taking precautions to not sunburn) can also be helpful, as is stress management in conjunction with other therapies (Kabat-Zinn J, et al. Psychosomatic Medicine. 1998; 60(5): 625–632).

    There are many therapeutic options beyond oral retinoids, UV, oral corticosteroids and other immunosuppressant drugs like the novel "biologics." These can all be highly effective at controlling symptoms, but carry with them a considerable risk profile. There are several proven naturopathic strategies that holistic physicians can offer patients seeking a safer, yet effective approach.


    Michael Traub, ND, past-president of the American Association of Naturopathic Physicians, is the author of Essentials of Dermatological Diagnosis and Natural Therapeutics, and practices on the Big Island of Hawaii with Monica Scheel, MD, medical director of Pacifica Integrative Skin Wellness Institute.
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