Psoriasis

2014

A chronic and recurrent disease characterized by dry, well-circumscribed, silvery, scaling papules and plaques of various sizes. (The Merck Manual)

This is a common skin disease of unknown cause that affects up to 3 % of the American population. Onset usually occurs before age 20, but all age groups may be affected. The severity of this condition can vary from the presence of one or two cosmetically annoying lesions to a physically disabling and disfiguring affliction of the entire body surface. The condition is not contagious in any way, and general health usually is not affected. However, it is no exaggeration to say that in extreme cases, psoriasis be ruinous to the individual’s physical, emotional, and economic well-being. In addition, some cases are associated with a severe form of arthritis, called psoriatic arthritis, that affects general health in much the same way as rheumatoid arthritis does.

Psoriasis usually develops slowly, following a typical course of remission and recurrence. The characteristic psoriatic plaques, or lesions, are sharply demarcated, red and raised, covered with silvery scales, and bleed easily. These plaques do not usually itch, and will heal without leaving scar tissue or affecting hair growth. The nails may become pitted. Some patients have a tendency to develop psoriasis at the sites of physical trauma or irritation (called Koebner phenomena).

Common sites for psoriasis are:

  • • Bony protuberances (knees, elbows, sacrum)
  • • Scalp
  • • External parts of ears
  • • Nails, eyebrows
  • • Back, buttocks, and, occasionally, generalized on the trunk
  • • Skin folds, such as the umbilicus

Treatment of Psoriasis

To develop a therapeutic approach to this intransigent condition, it is important to understand the processes that underlie the turnover of cells in the skin. In normal skin, it takes about 28 days for an epidermal cell to go from creation to shedding or scaling. Psoriatic cells complete this process in three or four days, or almost nine times faster than usual. However, there appears to be no impairment of the normal regulatory mechanisms of cell division. Thus, the result is often enormous cell buildup, inadequate maturation, and finally plaque formation. Much of psoriasis therapy is directed toward removing these plaques in a non-traumatic fashion and to easing any attendant discomfort.

The underlying cause of the rapid epithelial cell turnover characteristic of psoriasis is not known. Theories abound and vary according to the practitioner’s particular belief system. Some believe the cause is primarily nutritional. Others invoke stress and psychological factors, while those with reductionist inclinations put it down to genetics.

Undoubtedly, the immune system is involved on some level, leading some authorities to describe psoriasis as an autoimmune condition. Flare-ups commonly accompany infections, especially infections of the upper respiratory tract. Environmental factors, such as injury, stress, and cold climate, are important for some patients. About one third of patients experience spontaneous remission of disease.

In short, psoriasis represents a classic example of a condition for which a holistic perspective is essential. In designing a treatment program, the practitioner must explore as many aspects of the individual’s life as is feasible.

Actions Indicated

Alteratives are important, as they are for all internally generated skin problems. In practice, the rooty hepatic alteratives often are the best choice.

Afiti-inflammatories, applied topically and taken internally, will speed the curative work of the alteratives, but not replace them. They are most helpful during flare-ups and exacerbations.

Lymphatic tonics improve the health of the internal environment.

Nervine relaxants ease the anxiety that often accompanies psoriasis. They will also soothe skin discomfort, including itching and even inflammation, due to their relaxing effects on the peripheral nerves of the autonomic nervous system.

Diuretics ensure adequate elimination via the kidneys.

Hepatics support liver function and the digestive process.

Vulneraries support the healing of skin lesions when applied topically, but are not as effective here as one might hope. Remember, there is no wound to heal.

Astringents, used topically, may help in reducing redness, heat, and itching through local vasoconstrictor effects.

Emollients assist in the process of scale removal.

Antipruritics used topically may help, but itching is not a major factor in psoriasis. Diaphoretics have been suggested as a means of increasing circulation in the skin, thus promoting elimination and, in theory, general skin health.

It is important to be aware that while they may be helpful, diaphoretics may also aggravate psoriasis in some people. They may cause local overstimulation, with an end result of increasing cell replication rates and thus desquamation. This is not a major contraindication, but keep it in mind.

Specific Remedies

Many different herbs have been described as specific for psoriasis, depending upon local botany and cultural preferences. However, there are probably no true specifics. This is to be expected in light of the multifactorial, systemic nature of psoriasis. Some people respond incredibly well to one herb, while others show no response at all. This can prove both challenging and frustrating for the practitioner, let alone the patient.

The woody, hepatic alteratives are the herbs that come closest to being specifics for psoriasis. Herbs in this group include:

  • Arctium lappa (burdock)
  • Mahonia aquifolium (Oregon grape)
  • Rumex crispus (yellow dock)
  • Smilax spp. (sarsaparilla)

Of course, any of the other alteratives may prove to be specific for a given individual. Important leafy alteratives to consider include:

Numerous herbs are relevant for topical application. An important goal is to lift and remove psoriatic scales while reducing local inflammation. This often means that the form of the topical application is as important as any remedies it contains. Choice of topical application will be governed to some extent by the personal preferences of the patient, so experimentation may be necessary. Widely used plants include:

  • Calendula officinalis (calendula)
  • Plantago spp. (plantain)
  • Populus bakamifera var. balsamifera (balm of Gilead)
  • Stellaria media (chickweed)
  • Thuja occidentalis (thuja)

A Prescription for Psoriasis

  • Arctium lappa 1 part
  • Rumex crispus 1 part
  • Galium aparine 1 part
  • Scutellaria lateriflora 1 part

Dosage: up to 5 ml of tincture three times a day. In addition, the patient should drink an infusion of fresh Urtica dioica or Galium aparine two or three times a day.

Table Actions Supplied by Prescription for Psoriasis

ACTION HERBS
Alterative Arctium lappa, Galium aparine, Rumex crispus, Urtica dioica
Lymphatic tonic Galium aparine, Urtica dioica
Nervine relaxant Scutellaria lateriflora
Anti-inflammatory Galium aparine
Diuretic Arctium lappa, Galium aparine, Urtica dioica
Hepatic Arctium lappa, Galium aparine, Rumex crispus

A Prescription for Psoriasis with Anxiety and Tension

Dosage: up to 5 ml of tincture three times a day. The patient also should drink an infusion of Matricaria recutita as desired.

Table Actions Supplied by Prescription for Psoriasis with Anxiety

ACTION HERBS
Alterative Arctium lappa, Galium aparine, Rumex crispus, Urtica dioica
Lymphatic tonic Galium aparine, Urtica dioica
Nervine relaxant Valeriana officinalis, Verbena officinalis
Anti-inflammatory Calium aparine
Diuretic Arctium lappa, Calium aparine, Urtica dioica
Hepatic Arctium lappa, Calium aparine, Rumex crispus, Verbena officinalis

A Prescription for Intransigent, Unresponsive Psoriasis

  • Arctium lappa 2 parts
  • Rumex crispus 2 parts
  • Smilax spp. 2 parts
  • Phytolacca americana 1 part
  • Valeriana officinalis 1 part

Dosage: 5 ml of tincture three times a day. In addition, the patient should drink an infusion of fresh Urtica dioica or Galium aparine two or three times a day.

Care must be taken with this combination, and it is not advisable for children because of the inclusion of Phytolacca americana (poke root).

Table Actions Supplied by Prescription for Unresponsive Psoriasis

ACTION HERBS
Alterative Arctium lappa, Galium aparine, Phytolacca americana, Rumex crispus, Smilax spp., Urtica dioica
Lymphatic tonic Calium aparine, Phytolacca americana, Urtica dioica
Nervine relaxant Valeriana officinalis
Anti-inflammatory Calium aparine
Diuretic Arctium lappa, Calium aparine, Urtica dioica
Hepatic Arctium lappa, Galium aparine, Rumex crispus, Smilax spp.

A Prescription for a Patient with Psoriasis and Hypertension

  • Arctium lappa 2 parts
  • Rumex crispus 2 parts
  • Galium aparine 2 parts
  • Valeriana officinalis 1 part
  • Crataegus spp. 1 part
  • Tilia platyphyllos 1 part
  • Achillea millefolium 1 part

Dosage: 5 ml of tincture three times a day. The patient should also drink an infusion of Matricaha recutita, Tilia platyphyllos, or Trifolium pratense as desired. Allium sativum should be added to the diet or used as a dietary supplement: 1 clove of fresh garlic or 200 to 300 mg of standardized extract three times a day.

The last prescriptior. is designed for a case in which hypertension is not the primary concern. Thus, the bulk of the dose consists of alterative herbs, rather than hypotensive remedies.

Table Actions Supplied by Prescription for Psoriasis with Hypertension

ACTION HERBS
Alterative Arctium lappa, Galium aparine, Phytolacca americana, Rumex crispus, Smilax spp., Urtica dioica
Lymphatic tonic Galium aparine, Phytolacca americana, Urtica dioica
Nervine relaxant Tilia platyphyllos, Valeriana officinalis
Anti-inflammatory Galium aparine
Diuretic Achillea millefolium, Arctium lappa, Crataegus spp., Galium aparine, Tilia platyphyllos, Urtica dioica
Hepatic Allium sativum, Arctium lappa, Galium aparine, Rumex crispus, Smilax spp.
Hypotensive Achillea millefolium, Allium sativum, Crataegus spp., Tilia platyphyllos, Valeriana officinalis

Broader Context of Treatment

Both practitioner and patient should be aware of the many non-herbal treatment and coping options for psoriasis. Psoriasis is a condition in which patient empowerment becomes vital. Patients bear the burden of the label “psoriasis sufferer,” and so they suffer. They are often told little about the range of simple nursing techniques that could make their negative skin experience easier to live with.

The skin is an interface between the person and his or her world. It senses and expresses. Psoriasis impacts the individual’s experience of the world in two broad ways:

The physical distress makes it difficult for the patient to feel at ease.

The psychological trauma of feeling “disfigured” may lead to social isolation and depression.

The therapist must be prepared to help and advise in these areas as well as with the purely herbal issues. Stress management is critically important, and will ideally be part of an overall reevaluation by the patient of lifestyle, personal goals, and life vision.

For most people with psoriasis, exposure to sunlight helps alleviate and sometimes even clear the condition. Unfortunately, we have disrupted our environment so greatly that this can no longer be generally recommended, as UV light entering through the depleted ozone layer is potentially more damaging than helpful. However, the Dead Sea may be safer, because it is so far below sea level. Here occurs a quality of UV light not found anywhere else on the planet. Because the light passes through additional layers of air on its way to this area, more of the harmful spectrum may be filtered out. The salts of the Dead Sea itself are also beneficial for psoriasis. (Of course, none of this takes into account possible human dangers, such as war!)

Much of the nutritional advice available for psoriasis is contradictory. In my therapeutic experience, I have seen success with both a grapefruit fast and a no-citrus diet! Psoriasis is the epitome of a “holistic” disease, it being almost impossible to generalize about recommendations. Specifics of diet must be based upon the individual, not the pathology.

Supplements suggested for inclusion in a broad therapeutic approach to the treatment of psoriasis by Pizzorno and Murray in Textbook of Natural Medicine are:

  • High-potency multiple vitamin and mineral formula
  • Flaxseed oil: 1 tablespoon/day
  • Vitamin A: 50,000 IU/day (do not use in pregnancy or for women planning to become pregnant)
  • Vitamin E: 400 IU/day
  • Chromium: 400 IU/day
  • Selenium: 200 meg/day
  • Zinc: 30 mg/day