Psoriasis is an extremely common skin disorder. Rate of occurrence is between 2-4%. A diagnostic summary describes a sharply bordered reddened rash or plaques covered with overlapping silvery scales. It characteristically involves the scalp, the extensor surfaces (backside of the wrists, elbows, knees, and ankles), and sites of repeated trauma. Family history involvement is in 50% of cases and there are links to possible arthritis.

• Classic hyperproliferative skin disorder – rate of cell division very high (1,000 times > normal skin), exceeding rate in squamous cell carcinoma; even uninvolved skin is 2.5 times greater than in non-psoriatics.

• Basic defect is within the skin cells; incidence increased in HLA-B13, HLA-B16, and HLA-B17 – genetic error in mitotic control; 36% of patients have a family member with psoriasis; cell division rate controlled by delicate balance between cyclic AMP and cyclic GMP; increased cGMP is linked to increased proliferation; increased camp is linked to enhanced cell maturation and decreased proliferation; decreased camp and increased cGMP measured in skin of psoriatics.

Therapeutic Considerations

Rebalancing camp ;cGMP ratio achievable via natural medicine; controllable factors contributing to psoriasis are described below:

Incomplete protein digestion

Incomplete digestion or poor absorption increases amino acids/polypeptides in bowel-metabolised by bowel bacteria into toxins; toxic metabolites of arginine and ornithine are ‘polyamines’ (putrescine, spermidine, cadaverine) – increased in psoriatics; polyamines inhabit formation of camp; inducing excess cell proliferation; lowered skin and urinary polyamines are linked to clinical improvement; natural compounds inhibit formation of polyamines – vitamin A and berberine alkaloids of Hydrastis Canadensis (goldenseal)inhibit bacterial decarboxylase enzyme which converts amino acids into polyamines; evaluate digestive function with Heidelberg Gastric Analysis and/or Comprehensive Digestive Stool Analysis; reinforce digestion (HCL, pancreatic enzymes).

Bowel toxemia

Gut derived toxins implicated – endotoxins (compounds from cell walls of Gram-negative bacteria), streptococci, Candida albicans, yeast, and IgE and IgA immune complexes); increase cGMP, promoting proliferation; chronic candidiasis may play major in many cases.

• Low-fiber diet linked to increased gut-derived toxins; fiber of fruits, vegetables, whole grains, and legumes bind toxins and promote their excretion.

• Aqueous extract of Similax sarsaparilla is effective in psoriasis, particularly chronic, large plaque-forming variety – improved psoriasis in 62% of patients and completely cleared another 18% (80% benefited); benefit due to sarsaparilla components binding and excretion endotoxins; severity and response correlate well with level of circulating endotoxins – control of gut-derived toxins is critical; support fecal excretion and proper handling of absorbed endotoxins by liver.

Liver function

Correcting abnormal liver function is beneficial; liver filters and detoxifies portal blood from bowels; if liver is overwhelmed by excess bowel toxins or if there is a decrease in liver’s detox ability, systemic toxin level increases and psoriasis worsens; ETOH worsens psoriasis – increases toxin absorption by damaging gut mucosa and impairs liver function; eliminate ETOH; silymarin, flavonoid of Silybum marianum, is valuable in treating psoriasis by improving liver function, inhibiting inflammation, and reducing excess cellular proliferation.

Nutrition

• Diet, fasting, and food allergy control: psoriasis is positively linked to body mass index and inversely related to intake of carrots, tomatoes, fresh fruits, and index of beta-carotene intake; fasting and vegetarian regimens help psoriatics – probably due to decreased gut-derived toxins and polyamines; gluten-free and elimination diets are beneficial.

Individual nutrients
• Decreased vitamin A and zinc is common in psoriasis; A and Zn are critical to skin health of skin.

• Fumaric acid: oral dimethylfumaric acid or monoethylfumaric acid and topical 1-3% of monoethylfumaric acid are useful, but side-effects (flushing of skin, nausea, diarrhea, malaise, gastric pain, mild liver and kidney disturbances) can occur; use only if other natural therapies fail.

Psychological aspects

Thirty nine per cent of psoriatics report specific stressful event within 1month prior to initial episode; such patients have a better prognosis; a few cases are successfully treated with hypnosis and biofeedback alone.

Physical therapeutics

Sunlight (ultraviolet light) is extremely beneficial (standard medical treatment is drug psoralen plus ultraviolet A – PUVA therapy); ultraviolet B (UVB) alone inhibits cell proliferation and is as effective as PUVA with fewer side-effects; UV may benefit via induction of skin vitamin D; induction of localised elevation of temperature (42-45 degrees) in affected area by ultrasound and heating pads is effective.

Topical treatments

Botanical alternatives to hydrocortisone ; glycyrrhetinic acid from licorice (glycyrrhiza glabra), chamomile (Matricaria chamomilla), and capsaicin from cayenne pepper (Capsicum frutescens).

• Glycyrrhiza glabra (licorice root): glycyrrhetinic acid effect is similar to topical hydrocortisone; superior to topical cortisone, especially in chronic cases; can potentiate effects of topical hydrocortisone by inhibiting 11-beta-hydroxy-steroid dehydrogenase with catalyses conversion of hydrocortisone to inactive form.
• Matricaria chamomilla (chamomile): flavonoid and essential oil components are anti-inflammatory and anti-allergic.

• Aloe vera: topical extract in hydrophilic cream is highly effective in psoriasis vulgaris: well tolerated by all patients studied, with no adverse drug-related symptoms and no drop-outs.

The Therapeutic approach at the Irish Centre of Integrated Medicine is to decrease bowel toxemia, rebalance fatty acid and inflammatory processes in the skin, use therapeutic regimen to further balance abnormal cell proliferation:

• Diet: limit sugar, meat, animal fats, and alcohol; increase dietary fiber and cold-water fish; normalise weight, eliminate gluten; identify and address food allergies.

• Topical treatment: preparations containing one or more of the ingredients described above; apply to affected areas of skin b.i.d.-t.i.d.