Chronic papulosquamous dermatological disorder presenting as raised, reddish
pink lesions covered with silvery, opaque scales and well-defined borders.
Lesions occur predominantly on the scalp, elbows, knees, groin, and sacrum,
although not limited to these areas. May appear as a few spots or involve large
areas. Increased ratio of cyclic GMP over cyclic AMP within the dermis
stimulates a high cell production rate. Newly generated cells rise to the skin's
surface within days, accumulating in thick, crusty patches. The condition
afflicts more than six million people in the U.S. of both sexes, all ages, is
negatively affected by emotional stress, is not contagious, and has genetic
traits. (Patients with Crohn's disease have a seven fold risk increase;
chromosome 16 is implicated in both disorders.) Severe cases can be physically
painful and emotionally traumatic due to its unsightly appearance. Approximately
10% of psoriasis sufferers develop psoriatic arthritis, a phenomenon unique
among skin disorders. Although there is no cure, symptoms can be managed in most
instances. The disease may take one of several forms:
- Chronic, plaque-type (most common)
- Psoriatic erythroderma
Specific etiology uncertain; several factors are implicated:
- Immune system dysfunction (HLA antigen involvement)
- Genetic traits (portions of chromosomes 16, 17, 20,
- Emotional stress
- Skin injuries/sunburn
- Streptococcal infection (symptoms sometimes first appear two weeks
after strep throat)
- Certain drugs (chloroquine, gold, lithium, beta-blockers)
- Acidic foods
- Familial/genetic predisposition
- Race (incidence highest among Caucasians)
- Immune system diseases (including AIDS)
- Streptococcal infections elsewhere in the body
- Skin damage
- Rheumatoid arthritis
|Signs and Symptoms|
Symptoms wax and wane. Manifestations include:
- Raised skin lesions, deep pink with red borders and silvery surface
scales; may be cracked and painful
- Blisters oozing aseptic pus (pustular or guttate
type—occurs only on palms or plantars)
- Pitted, discolored, and possibly thickened fingernails and/or
toenails; may be separated from underlying skin
- Itching in some cases
- Joint pain (psoriatic arthritis) in some cases
- New lesions may appear following injuries to the
- Other skin disorders
- Squamous cell carcinoma
- Cutaneous lupus erythematosus
- Intertrigo or candidiasis
Unsightly raised dermal lesions deep pink or red in color with white or
silvery scales; pustules on palms and plantars; pitted, discolored
- Elevated cGMP relative to cAMP
- Decreased dermal keratohyalin
- Increased intracellular calcium and calmodulin levels
- Low zinc/high copper levels
- Possible B12, folate, and iron deficiencies
- Possible anemia
- Dermal surface lesions due to abnormally rapid cell growth, deposit,
- Abnormal microvasculature dermal
- Skin biopsy, if
Identifying cause of onset in relation to emotional trauma, skin injury,
viral/bacterial infection, diet, weight gain may help define treatment options.
Although blood tests will not confirm diagnosis, laboratory tests for levels of
cGMP/cAMP, HLA antigens, and levels of calcium, zinc, and certain drugs may also
help determine mode of treatment, which includes:
- Topical medications
- Systemic drugs
- Light therapy—solar and ultraviolet
- Dietary modification—avoid triggers, lose
- Vitamin/mineral supplementation
- Elimination therapy (certain medications and acidic foods)
Reduce epidermal proliferation rate and/or halt the inflammatory process.
Topical creams and lotions:
- Corticosteroids: Reduce inflammation/irritation (use only to begin
treatment; prolonged use causes skin thinning, pigment changes, and suppresses
the immune system, causing vengeful flare-ups upon cessation.)
- Petroleum jelly: Softens skin and retains moisture
- Salicylic acid ointments: Promote scale shedding
- Capsaicin ointment: Prevents blood vessel development in affected
areas; blocks inflammatory skin chemicals; should be used with care, and never
on open wounds or sores as it would be very painful
- Calcitriol (or calcipotriene) ointment (vitamin D3
analogue): May be as effective as corticosteroids with fewer side
- Coal tar ointments/shampoos: Ease discomfort, improve effectiveness
of UV light therapy (may cause folliculitis; increased squamous cell carcinoma
- Etretinate: Good response with few side effects (for severe cases
unresponsive to other treatments)
- Anthralin: Applied for 30 to 60 minutes only to affected area
(irritates healthy skin; stains last several weeks)
Ultraviolet light: Natural sunlight in short increments (sunburn
- PUVA: Artificial long-wave light therapy in combination with oral
psoralen (photosynthesizing agent), effective in recalcitrant cases (significant
carcinogenic risk in long-term treatments)
- UVB: Artificial short-wave light therapy in combination with topical
medications such as coal tar (no significant increase in carcinogenic risk
- Liquid nitrogen: freeze moderate-sized
Systemic/Oral drugs (in difficult cases):
- Methotrexate: anticancer drug (long-term use causes hepatic, renal,
hematologic toxicity; nausea; vomiting; diarrhea; significant risk of squamous
cell and increased risk of metastatic carcinoma)
- Psoralen: With UVB therapy; least toxic oral medication
- Tegison (vitamin A analogue): inhibits rapid skin cell growth,
particularly with UV therapy (numerous side effects)
- NSAIDs: for pain/inflammation of psoriatic
|Complementary and Alternative
Therapies are aimed at detoxifying the entire body and regulating cGMP/cAMP
ratios. Patients often benefit from mind-body therapies and stress management.
Exercise increases cAMP and improves overall health. Proper hydration aids in
elimination. Herbs and nutrition may be helpful by themselves or as adjunctive
- Limit alcohol, refined foods, simple sugars, and saturated fats found
in meat and dairy as these foods tend to exacerbate this condition. Avoid acidic
foods (pineapple, oranges, coffee, tomato) and any allergic foods (wheat,
citrus, milk, corn, eggs are the most common).
- Essential fatty acids: omega-3 and omega-6 (oily fish, flaxseed oil,
1,000 mg bid)
- Vitamins: B12 (100 to 1,000 mcg) may need to be intramuscular
injections, folate (400 mcg/day), vitamin E (400 to 800 IU/day)
- Minerals: found to be low in patients with psoriasis; zinc (30
mg/day), selenium (200 mcg/day)
- Quercetin: 500 mg tid before meals, decreases cAMP, decreases gut
- Digestive enzymes facilitate proper protein digestion and should be
taken with each meal. This is particularly important as incomplete protein
digestion inhibits the formation of cAMP, thus contributing to the cell
proliferation which characterizes
Herbs are generally a safe way to strengthen and tone the body's systems. As
with any therapy, it is important to ascertain a diagnosis before pursuing
treatment. Herbs may be used as dried extracts (capsules, powders, teas),
glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless
otherwise indicated, 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. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as
- Topical creams may alleviate discomfort. Chickweed (Stellaria
media) relieves itching, and marigold (Calendula officinalis) speeds
healing of open lesions.
- Milk thistle (Silybum marianum) decreases cAMP breakdown,
- Yellowdock (Rumex crispus), red clover (Trifolium
pratense), and burdock (Arctium lappa) are alteratives.
- Sarsaparilla (Smilax sarsaparilla) binds endotoxins, shown in
studies to be effective in psoriasis.
- Coleus forskohlii (tincture, 1 ml tid) increases cAMP,
and has been used historically for psoriasis.
Mix equal parts of the above herbs and use 1 cup tea tid or 30 to 60 drops
tincture tid. This is especially effective if sipped or taken 5 to 15 minutes
before meals to stimulate digestion.
In homeopathic philosophy, treating a skin condition is not beneficial.
Constitutional treatment by a homeopathic prescriber who will address the whole
person may help. Homeopathic treatment of skin problems can result in an initial
worsening of any skin condition before resolution.
Sunlight/ultraviolet light is a beneficial treatment for those with
psoriasis. Exposure to the sun or UVB for half an hour daily is a helpful
Follow-up is important in severe cases, particularly when treatment includes
Prevention may not be possible, but avoid triggering drugs (lithium, NSAIDs,
salicylates, white willow [Salix alba], penicillin, and others).
Treatment aims at avoiding flare-ups and lengthening periods of remission. A
stressful event often precedes the initial episode, thus stress management
techniques often help with successful treatment.
- Secondary infections
- Serious bowel involvement
- Exfoliate erythrodermatitis
- Rebound after
Aggressive control and treatment usually beget a benign
Oral medications and topical creams absorbed into the bloodstream can be
damaging to the fetus. Use caution when treating
Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic
Guide to Herbal Medicines. Boston, Mass: Integrative Medicine
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, Jaenicke C, et al., eds. PDR for Herbal
Medicines. Montvale, NJ: Medical Economics Co; 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
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.
Copyright © 2000 Integrative Medicine
CommunicationsThis publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
responsibility for the accuracy of the information or the consequences arising
from the application, use, or misuse of any of the information contained herein,
including any injury and/or damage to any person or property as a matter of
product liability, negligence, or otherwise. No warranty, expressed or implied,
is made in regard to the contents of this material. No claims or endorsements
are made for any drugs or compounds currently marketed or in investigative use.
The reader is advised to check product information (including package inserts)
for changes and new information regarding dosage, precautions, warnings,
interactions, and contraindications before administering any drug, herb, or
supplement discussed herein.