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Complementary and Alternative Medicine Therapies for PsoriasisA Systematic Review

Educational Objective
To understand the complementary and alternative medications that are effective in treating psoriasis.
1 Credit CME
Key Points

Question  Which complementary and alternative medicine therapies are effective in treating psoriasis?

Findings  This systematic review of 57 trials and 3 meta-analyses found that indigo naturalis, curcumin, dietary modification, fish oil, meditation, and acupuncture had the most robust evidence of efficacy in the treatment of plaque psoriasis.

Meaning  Complementary and alternative medicine treatments are gaining popularity, and this review will serve as a comprehensive resource for practitioners treating patients with psoriasis.

Abstract

Importance  Up to 51% of patients with psoriasis report the use of complementary and alternative medicine (CAM) in their treatment regimen, although it is unclear which CAM therapies are effective for treatment of psoriasis.

Objective  This review compiles the evidence on the efficacy of the most studied CAM modalities for treatment of patients with plaque psoriasis and discusses those therapies with the most robust available evidence.

Evidence Review  PubMed, Embase, and ClinicalTrials.gov searches (1950-2017) were used to identify all documented CAM psoriasis interventions in the literature. The criteria were further refined to focus on those treatments identified in the first step that had the highest level of evidence for plaque psoriasis with more than 1 randomized clinical trial supporting their use. This excluded therapies lacking randomized clinical trial (RCT) data or showing consistent inefficacy.

Findings  Primary CAM therapy searches identified 457 articles, of which 107 articles were retrieved for closer examination. Of those articles, 54 were excluded because the CAM therapy did not have more than 1 RCT on the subject or showed consistent lack of efficacy. An additional 7 articles were found using references of the included studies, resulting in a total of 44 RCTs (17 double-blind, 13 single-blind, and 14 nonblind), 10 uncontrolled trials, 2 open-label nonrandomized controlled trials, 1 prospective controlled trial, and 3 meta-analyses. Compared with placebo, application of topical indigo naturalis, studied in 5 RCTs with 215 participants, showed significant improvements in the treatment of psoriasis. Treatment with curcumin, examined in 3 RCTs (with a total of 118 participants), 1 nonrandomized controlled study, and 1 uncontrolled study, conferred statistically and clinically significant improvements in psoriasis plaques. Fish oil treatment was evaluated in 20 studies (12 RCTs, 1 open-label nonrandomized controlled trial, and 7 uncontrolled studies); most of the RCTs showed no significant improvement in psoriasis, whereas most of the uncontrolled studies showed benefit when fish oil was used daily. Meditation and guided imagery therapies were studied in 3 single-blind RCTs (with a total of 112 patients) and showed modest efficacy in treatment of psoriasis. One meta-analysis of 13 RCTs examined the association of acupuncture with improvement in psoriasis and showed significant improvement with acupuncture compared with placebo.

Conclusions and Relevance  The CAM therapies with the most robust evidence of efficacy for treatment of psoriasis are indigo naturalis, curcumin, dietary modification, fish oil, meditation, and acupuncture. This review will aid practitioners in advising patients seeking unconventional approaches for treatment of psoriasis.

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Article Information

Accepted for Publication: July 10, 2018.

Corresponding Author: Ms A. Caresse Gamret, BS, Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, 1475 NW 12th Ave, Second Floor, Miami, FL 33136 (acgamret@gmail.com).

Published Online: September 5, 2018. doi:10.1001/jamadermatol.2018.2972

Author Contributions: Ms Gamret and Dr Fertig had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Gamret, Price, Fertig, Nichols.

Drafting of the manuscript: Gamret, Price, Fertig, Lev-Tov.

Critical revision of the manuscript for important intellectual content: Gamret, Price, Lev-Tov, Nichols.

Statistical analysis: Gamret.

Administrative, technical, or material support: Fertig, Nichols.

Supervision: Gamret, Price, Lev-Tov, Nichols.

Conflict of Interest Disclosures: None reported.

Additional Contributions: John E. Lewis, PhD, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, provided input on the figure but was not financially compensated for his contribution.

References
1.
Menter  A, Korman  NJ, Elmets  CA,  et al; American Academy of Dermatology Work Group.  Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions.  J Am Acad Dermatol. 2011;65(1):137-174. doi:10.1016/j.jaad.2010.11.055PubMedGoogle ScholarCrossref
2.
Heng  MCY, Song  MK, Harker  J, Heng  MK.  Drug-induced suppression of phosphorylase kinase activity correlates with resolution of psoriasis as assessed by clinical, histological and immunohistochemical parameters.  Br J Dermatol. 2000;143(5):937-949. doi:10.1046/j.1365-2133.2000.03767.xPubMedGoogle ScholarCrossref
3.
Mason  AR, Mason  J, Cork  M, Dooley  G, Edwards  G. Topical treatments for chronic plaque psoriasis. In: Mason  AR, ed.  Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2009, doi:10.1002/14651858.CD005028.pub2.
4.
Kurd  SK, Smith  N, VanVoorhees  A,  et al.  Oral curcumin in the treatment of moderate to severe psoriasis vulgaris: a prospective clinical trial.  J Am Acad Dermatol. 2008;58(4):625-631. doi:10.1016/j.jaad.2007.12.035PubMedGoogle ScholarCrossref
5.
Armstrong  AW, Robertson  AD, Wu  J, Schupp  C, Lebwohl  MG.  Undertreatment, treatment trends, and treatment dissatisfaction among patients with psoriasis and psoriatic arthritis in the United States: findings from the National Psoriasis Foundation surveys, 2003-2011.  JAMA Dermatol. 2013;149(10):1180-1185. doi:10.1001/jamadermatol.2013.5264PubMedGoogle ScholarCrossref
6.
Fleischer  AB  Jr, Feldman  SR, Rapp  SR, Reboussin  DM, Exum  ML, Clark  AR.  Alternative therapies commonly used within a population of patients with psoriasis.  Cutis. 1996;58(3):216-220. PubMedGoogle Scholar
7.
U.S. National Library of Medicine. Collection Development Manual: complementary and alternative medicine. https://www.nlm.nih.gov/tsd/acquisitions/cdm/subjects24.html. Published 2003. Accessed October 23, 2017.
8.
Millsop  JW, Bhatia  BK, Debbaneh  M, Koo  J, Liao  W.  Diet and psoriasis, part III: role of nutritional supplements.  J Am Acad Dermatol. 2014;71(3):561-569. doi:10.1016/j.jaad.2014.03.016PubMedGoogle ScholarCrossref
9.
Yeh  M-L, Ko  S-H, Wang  M-H, Chi  C-C, Chung  Y-C.  Acupuncture-related techniques for psoriasis: a systematic review with pairwise and network meta-analyses of randomized controlled trials.  J Altern Complement Med. 2017;23(12):930-940. doi:10.1089/acm.2016.0158PubMedGoogle ScholarCrossref
10.
Upala  S, Sanguankeo  A.  Effect of lifestyle weight loss intervention on disease severity in patients with psoriasis: a systematic review and meta-analysis.  Int J Obes (Lond). 2015;39(8):1197-1202. doi:10.1038/ijo.2015.64PubMedGoogle ScholarCrossref
11.
Lin  Y-K, Wong  W-R, Chang  Y-C,  et al.  The efficacy and safety of topically applied indigo naturalis ointment in patients with plaque-type psoriasis.  Dermatology. 2007;214(2):155-161. doi:10.1159/000098576PubMedGoogle ScholarCrossref
12.
Moon  MJ, Lee  SK, Lee  J-W,  et al.  Synthesis and structure-activity relationships of novel indirubin derivatives as potent anti-proliferative agents with CDK2 inhibitory activities.  Bioorg Med Chem. 2006;14(1):237-246. doi:10.1016/j.bmc.2005.08.008PubMedGoogle ScholarCrossref
13.
Cheng  H-M, Wu  Y-C, Wang  Q,  et al.  Clinical efficacy and IL-17 targeting mechanism of Indigo naturalis as a topical agent in moderate psoriasis.  BMC Complement Altern Med. 2017;17(1):439. doi:10.1186/s12906-017-1947-1PubMedGoogle ScholarCrossref
14.
Lin  Y-K, Chang  C-J, Chang  Y-C, Wong  W-R, Chang  S-C, Pang  J-HS.  Clinical assessment of patients with recalcitrant psoriasis in a randomized, observer-blind, vehicle-controlled trial using indigo naturalis.  Arch Dermatol. 2008;144(11):1457-1464. doi:10.1001/archderm.144.11.1457PubMedGoogle ScholarCrossref
15.
Lin  Y-K, Leu  Y-L, Yang  S-H, Chen  H-W, Wang  C-T, Pang  J-HS.  Anti-psoriatic effects of indigo naturalis on the proliferation and differentiation of keratinocytes with indirubin as the active component.  J Dermatol Sci. 2009;54(3):168-174. doi:10.1016/j.jdermsci.2009.02.007PubMedGoogle ScholarCrossref
16.
Hsieh  W-L, Lin  Y-K, Tsai  C-N, Wang  T-M, Chen  T-Y, Pang  J-HS.  Indirubin, an acting component of indigo naturalis, inhibits EGFR activation and EGF-induced CDC25B gene expression in epidermal keratinocytes.  J Dermatol Sci. 2012;67(2):140-146. doi:10.1016/j.jdermsci.2012.05.008PubMedGoogle ScholarCrossref
17.
Lin  Y-K, See  L-C, Huang  Y-H,  et al.  Comparison of refined and crude indigo naturalis ointment in treating psoriasis: randomized, observer-blind, controlled, intrapatient trial.  Arch Dermatol. 2012;148(3):397-400. doi:10.1001/archdermatol.2011.1091PubMedGoogle ScholarCrossref
18.
Lin  Y-K, Chang  Y-C, Hui  RC-Y,  et al.  A Chinese herb, indigo naturalis, extracted in oil (Lindioil) used topically to treat psoriatic nails: a randomized clinical trial.  JAMA Dermatol. 2015;151(6):672-674. doi:10.1001/jamadermatol.2014.5460PubMedGoogle ScholarCrossref
19.
Lin  Y-K, See  L-C, Huang  Y-H,  et al.  Efficacy and safety of Indigo naturalis extract in oil (Lindioil) in treating nail psoriasis: a randomized, observer-blind, vehicle-controlled trial.  Phytomedicine. 2014;21(7):1015-1020. doi:10.1016/j.phymed.2014.02.013PubMedGoogle ScholarCrossref
20.
Lin  YK, See  LC, Huang  YH, Chi  CC, Hui  RCY.  Comparison of indirubin concentrations in indigo naturalis ointment for psoriasis treatment: a randomized, double-blind, dosage-controlled trial.  Br J Dermatol. 2018;178(1):124-131. doi:10.1111/bjd.15894PubMedGoogle Scholar
21.
Sarafian  G, Afshar  M, Mansouri  P, Asgarpanah  J, Raoufinejad  K, Rajabi  M.  Topical turmeric microemulgel in the management of plaque psoriasis: a clinical evaluation.  Iran J Pharm Res. 2015;14(3):865-876.PubMedGoogle Scholar
22.
Antiga  E, Bonciolini  V, Volpi  W, Del Bianco  E, Caproni  M.  Oral curcumin (Meriva) is effective as an adjuvant treatment and is able to reduce IL-22 serum levels in patients with psoriasis vulgaris.  Biomed Res Int. 2015;2015:283634. doi:10.1155/2015/283634PubMedGoogle ScholarCrossref
23.
Carrion-Gutierrez  M, Ramirez-Bosca  A, Navarro-Lopez  V,  et al.  Effects of Curcuma extract and visible light on adults with plaque psoriasis.  Eur J Dermatol. 2015;25(3):240-246. doi:10.1684/ejd.2015.2584PubMedGoogle Scholar
24.
Kabat-Zinn  J, Wheeler  E, Light  T,  et al.  Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA).  Psychosom Med. 1998;60(5):625-632. doi:10.1097/00006842-199809000-00020PubMedGoogle ScholarCrossref
25.
Gaston  L, Crombez  JC, Lassonde  M, Bernier-Buzzanga  J, Hodgins  S.  Psychological stress and psoriasis: experimental and prospective correlational studies.  Acta Derm Venereol Suppl (Stockh). 1991;156:37-43.PubMedGoogle Scholar
26.
Zachariae  R, Øster  H, Bjerring  P, Kragballe  K.  Effects of psychologic intervention on psoriasis: a preliminary report.  J Am Acad Dermatol. 1996;34(6):1008-1015. doi:10.1016/S0190-9622(96)90280-7PubMedGoogle ScholarCrossref
27.
Ford  AR, Siegel  M, Bagel  J,  et al.  Dietary recommendations for adults with psoriasis or psoriatic arthritis from the medical board of the National Psoriasis Foundation: a systematic review  [published online June 20, 2018].  JAMA Dermatol. doi:10.1001/jamadermatol.2018.1412PubMedGoogle Scholar
28.
Boggs  MDW. Indigo naturalis extract effective for psoriatic nails. Healthy Living Magazine. http://www.healthylivingmagazine.us/Articles/8290/. Published 2015. Accessed June 20, 2018.
29.
Vallianou  NG, Evangelopoulos  A, Schizas  N, Kazazis  C.  Potential anticancer properties and mechanisms of action of curcumin.  Anticancer Res. 2015;35(2):645-651. http://www.ncbi.nlm.nih.gov/pubmed/25667441. Accessed October 19, 2017.PubMedGoogle Scholar
30.
National Psoriasis Foundation. Natural therapies for psoriatic disease. https://www.psoriasis.org/advance/natural-therapies. Published 2016. Accessed September 20, 2017.
31.
The People’s Pharmacy. Turmeric eases suffering from psoriasis. https://www.peoplespharmacy.com/2011/10/13/turmeric-eases-suffering-from-psoriasis/. Published 2011. Accessed September 20, 2017.
32.
Psoriasis Self Management. Benefits of turmeric for psoriasis. http://www.psoriasisselfmanagement.com/natural-herbs-supplements/benefits-of-turmeric-for-psoriasis/. Published 2014. Accessed September 20, 2017.
33.
Varma  SR, Sivaprakasam  TO, Mishra  A, Prabhu  S, M  R, P  R.  Imiquimod-induced psoriasis-like inflammation in differentiated human keratinocytes: its evaluation using curcumin.  Eur J Pharmacol. 2017;813:33-41. doi:10.1016/j.ejphar.2017.07.040PubMedGoogle ScholarCrossref
34.
Prasad  S, Tyagi  AK, Aggarwal  BB.  Recent developments in delivery, bioavailability, absorption and metabolism of curcumin: the golden pigment from golden spice.  Cancer Res Treat. 2014;46(1):2-18. doi:10.4143/crt.2014.46.1.2PubMedGoogle ScholarCrossref
35.
Landis  ET, Davis  SA, Feldman  SR, Taylor  S.  Complementary and alternative medicine use in dermatology in the United States.  J Altern Complement Med. 2014;20(5):392-398. doi:10.1089/acm.2013.0327PubMedGoogle ScholarCrossref
36.
Bittiner  SB, Tucker  WF, Cartwright  I, Bleehen  SS.  A double-blind, randomised, placebo-controlled trial of fish oil in psoriasis.  Lancet. 1988;1(8582):378-380. doi:10.1016/S0140-6736(88)91181-6PubMedGoogle ScholarCrossref
37.
Gupta  AK, Ellis  CN, Tellner  DC, Anderson  TF, Voorhees  JJ.  Double-blind, placebo-controlled study to evaluate the efficacy of fish oil and low-dose UVB in the treatment of psoriasis.  Br J Dermatol. 1989;120(6):801-807. doi:10.1111/j.1365-2133.1989.tb01378.xPubMedGoogle ScholarCrossref
38.
Danno  K, Sugie  N.  Combination therapy with low-dose etretinate and eicosapentaenoic acid for psoriasis vulgaris.  J Dermatol. 1998;25(11):703-705. doi:10.1111/j.1346-8138.1998.tb02487.xPubMedGoogle ScholarCrossref
39.
Balbás  GM, Regaña  MS, Millet  PU.  Study on the use of omega-3 fatty acids as a therapeutic supplement in treatment of psoriasis.  Clin Cosmet Investig Dermatol. 2011;4:73-77. doi:10.2147/CCID.S17220PubMedGoogle ScholarCrossref
40.
Kristensen  S, Schmidt  EB, Schlemmer  A, Rasmussen  C, Johansen  MB, Christensen  JH.  Beneficial effect of n-3 polyunsaturated fatty acids on inflammation and analgesic use in psoriatic arthritis: a randomized, double blind, placebo-controlled trial.  Scand J Rheumatol. 2018;47(1):27-36. doi:10.1080/03009742.2017.1287304PubMedGoogle ScholarCrossref
41.
Søyland  E, Funk  J, Rajka  G,  et al.  Effect of dietary supplementation with very-long-chain n-3 fatty acids in patients with psoriasis.  N Engl J Med. 1993;328(25):1812-1816. doi:10.1056/NEJM199306243282504PubMedGoogle ScholarCrossref
42.
Strong  AMM, Hamill  E.  The effect of combined fish oil and evening primrose oil (Efamol Marine) on the remission phase of psoriasis: a 7-month double-blind randomized placebo-controlled trial.  J Dermatolog Treat. 1993;4(1):33-36. doi:10.3109/09546639309088234Google ScholarCrossref
43.
Gupta  AK, Ellis  CN, Goldfarb  MT, Hamilton  TA, Voorhees  JJ.  The role of fish oil in psoriasis. A randomized, double-blind, placebo-controlled study to evaluate the effect of fish oil and topical corticosteroid therapy in psoriasis.  Int J Dermatol. 1990;29(8):591-595. doi:10.1111/j.1365-4362.1990.tb03477.xPubMedGoogle ScholarCrossref
44.
Madland  TM, Björkkjaer  T, Brunborg  LA, Fröyland  L, Berstad  A, Brun  JG.  Subjective improvement in patients with psoriatic arthritis after short-term oral treatment with seal oil. A pilot study with double blind comparison to soy oil.  J Rheumatol. 2006;33(2):307-310.PubMedGoogle Scholar
45.
Veale  DJ, Torley  HI, Richards  IM,  et al.  A double-blind placebo controlled trial of Efamol Marine on skin and joint symptoms of psoriatic arthritis.  Br J Rheumatol. 1994;33(10):954-958. doi:10.1093/rheumatology/33.10.954PubMedGoogle ScholarCrossref
46.
Bjørneboe  A, Smith  AK, Bjørneboe  GE, Thune  PO, Drevon  CA.  Effect of dietary supplementation with n-3 fatty acids on clinical manifestations of psoriasis.  Br J Dermatol. 1988;118(1):77-83. doi:10.1111/j.1365-2133.1988.tb01753.xPubMedGoogle ScholarCrossref
47.
Lassus  A, Dahlgren  AL, Halpern  MJ, Santalahti  J, Happonen  HP.  Effects of dietary supplementation with polyunsaturated ethyl ester lipids (Angiosan) in patients with psoriasis and psoriatic arthritis.  J Int Med Res. 1990;18(1):68-73. doi:10.1177/030006059001800109PubMedGoogle ScholarCrossref
48.
Kragballe  K, Fogh  K.  A low-fat diet supplemented with dietary fish oil (Max-EPA) results in improvement of psoriasis and in formation of leukotriene B5.  Acta Derm Venereol. 1989;69(1):23-28.PubMedGoogle Scholar
49.
Kragballe  K.  Dietary supplementation with a combination of n-3 and n-6 fatty acids (super gamma-oil marine) improves psoriasis.  Acta Derm Venereol. 1989;69(3):265-268.PubMedGoogle Scholar
50.
Ziboh  VA, Cohen  KA, Ellis  CN,  et al.  Effects of dietary supplementation of fish oil on neutrophil and epidermal fatty acids. Modulation of clinical course of psoriatic subjects.  Arch Dermatol. 1986;122(11):1277-1282. doi:10.1001/archderm.1986.01660230069013PubMedGoogle ScholarCrossref
51.
Maurice  PD, Allen  BR, Barkley  AS, Cockbill  SR, Stammers  J, Bather  PC.  The effects of dietary supplementation with fish oil in patients with psoriasis.  Br J Dermatol. 1987;117(5):599-606. doi:10.1111/j.1365-2133.1987.tb07492.xPubMedGoogle ScholarCrossref
52.
Kojima  T, Terano  T, Tanabe  E, Okamoto  S, Tamura  Y, Yoshida  S.  Effect of highly purified eicosapentaenoic acid on psoriasis.  J Am Acad Dermatol. 1989;21(1):150-151. doi:10.1016/S0190-9622(89)80363-9PubMedGoogle ScholarCrossref
53.
Kettler  AH, Baughn  RE, Orengo  IF, Black  H, Wolf  JE  Jr.  The effect of dietary fish oil supplementation on psoriasis. Improvement in a patient with pustular psoriasis.  J Am Acad Dermatol. 1988;18(6):1267-1273. doi:10.1016/S0190-9622(88)70133-4PubMedGoogle ScholarCrossref
54.
Mayser  P, Mrowietz  U, Arenberger  P,  et al.  Omega-3 fatty acid-based lipid infusion in patients with chronic plaque psoriasis: results of a double-blind, randomized, placebo-controlled, multicenter trial.  J Am Acad Dermatol. 1998;38(4):539-547. doi:10.1016/S0190-9622(98)70114-8PubMedGoogle ScholarCrossref
55.
Grimminger  F, Mayser  P, Papavassilis  C,  et al.  A double-blind, randomized, placebo-controlled trial of n-3 fatty acid based lipid infusion in acute, extended guttate psoriasis. Rapid improvement of clinical manifestations and changes in neutrophil leukotriene profile.  Clin Investig. 1993;71(8):634-643. doi:10.1007/BF00184491PubMedGoogle ScholarCrossref
56.
Farber  EM, Nall  L.  Psoriasis: a stress-related disease.  Cutis. 1993;51(5):322-326.PubMedGoogle Scholar
57.
Sounds True. Mindfulness meditation for people with psoriasis. https://www.soundstrue.com/store/mindfulness-meditation-for-people-with-psoriasis.html?___SID=U. Accessed June 21, 2018.
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