Psoriasis treatment mythbusters

| Sarah L. Stewart

For people dealing with the chronic itch, pain and frustration of psoriasis, sometimes any treatment that promises relief can seem like it’s worth a try — no matter how obscure or outlandish. “[Patients] will try anything just in sheer desperation,” said Dr. Caitriona Ryan, vice chair of dermatology at Baylor University Medical Center, Dallas, and member of the NPF Medical Board.

But that desperation can make patients vulnerable to bogus treatments that are, at best, an ineffective waste of money and, at worst, a danger to their health. Here, our team of experts identifies some over-the-counter and alternative treatments that they advise their patients to avoid. Consider their guidance carefully, but remember: “The best person to dictate your therapy is your psoriasis doctor,” Ryan said.

Fad diets

“Fad diets are one of the things I hate hearing about,” Ryan said. Not only are they typically expensive and difficult to adhere to, she said, but for the most part, they don’t work.

Although many patients swear by elimination diets, such as going gluten-free, studies haven’t shown a widespread improvement in psoriasis among people who eliminate gluten.

“Everybody tries different diets for psoriasis,” said Dr. Alan Menter, chair of dermatology, Baylor University Medical Center, Dallas, and winner of an NPF Lifetime Achievement Award. “The vast majority make no difference, except for a tiny portion of patients who are gluten-sensitive. Probably less than 5 percent benefit from a gluten-free diet.” Instead, the perceived benefit of eliminating gluten in many cases may simply be a result of losing weight, Ryan said.

Urine therapy

In some cultures, drinking or applying one’s own urine to the skin is purported to improve or cure chronic conditions including cancer, paralysis and psoriasis. Prior to entering her care, one of Ryan’s patients, a man from India, tried drinking his urine to help his psoriasis.

“He did it for three months,” Ryan said. “I couldn’t believe it.”

It didn’t work for the man, and the broader medical community does not recommend it.

Tanning beds

Some psoriasis patients mistakenly believe that sessions at a tanning salon can serve as a replacement for light therapy administered by their dermatologist.

But tanning beds are not only far less effective at treating psoriasis, they’re also dangerous.

That’s because tanning beds emit both UVA and UVB rays, which are known to cause skin cancer; studies show tanning bed use before the age of 35 can increase the risk of developing deadly melanoma by 59 percent, according to the American Academy of Dermatology.

In contrast, dermatologists use narrow band UVB rays, a small segment of the ultraviolet spectrum that is safer and provides more therapeutic benefit. “Tanning beds are not nearly as effective as narrow band UVB or even home light units,” Menter said.

‘Kitchen sink’ creams

Before trying a “natural” psoriasis cream, check the ingredient list. You’ll find that many products on the market contain dozens of botanical ingredients — and more isn’t necessarily better.

“A lot of the ‘magic’ creams have the kitchen sink in them,” said Dr. Richard Fried, M.D., Ph.D., dermatologist, licensed clinical psychologist and clinical director, Yardley Dermatology and Yardley Clinical Research Associates in Pennsylvania. “Sometimes they can confuse the picture a little bit.”

Instead, he advises his patients to look for products that are purer, both to help pinpoint which ingredients are actually beneficial and to reduce the likelihood of an allergic reaction.

“Sometimes putting strange things on angry skin can make skin angrier,” he said.

Fumaric acid

An oral prescription drug called Fumaderm, which contains fumaric acid esters, has been used for decades in Europe to treat severe plaque psoriasis.

In the United States, however, the U.S. Food and Drug Administration (FDA) has not approved Fumaderm or any other fumaric acid ester drugs, but that hasn’t stopped some psoriasis patients from obtaining them with potentially serious consequences.

The drug works by inhibiting the immune system’s T cells. Taking it without a doctor’s supervision can lead to dangerously low T cell counts, as well as side effects including gastrointestinal problems, Ryan said.

Vics VapoRub

Some patients believe that this over-the-counter topical containing camphor, eucalyptus oil, menthol and other oils in a petroleum jelly base can be helpful when applied to their psoriasis. But while it may be just what the doctor ordered for relieving cold symptoms, Ryan doesn’t recommend applying Vicks VapoRub to psoriasis plaques.

“It won’t help,” she said.

‘Cures’

When considering an alternative treatment, first research if it’s been endorsed by dermatologists; if it hasn’t, there’s a good chance it’s not worth your time or money, Ryan said. “If a treatment works, we have done research on it,” she said.

Also beware of any product that claims it will “cure” your psoriasis.

Certain treatments might alleviate the itch and reduce the appearance of plaques, but psoriasis is a disease for which there is no cure — yet.

“Be cautious about listening to somebody who says this is the most amazing thing that’s ever happened in the world of psoriasis,” Menter advised. “Be moderate, be sensible and discuss it with your dermatologist.”

Worth a shot

Not all dermatologists agree on the effectiveness of psoriasis treatments that fall outside of the traditional pharmaceutical realm. But there are some complementary and alternative therapies that many doctors believe may be beneficial, and when used correctly, don’t have the potential to cause any harm.

“Embracing some adjunctive [treatments], statistically speaking, will make patients flare less often, make their flares less severe and extensive, and make them feel better in general,” said Fried.

Here are a few treatments that are widely accepted as potentially helpful for psoriasis. But, as always, consult with a dermatologist you trust before trying them out yourself.

Ceramide creams

“Psoriasis is much more prone to happen in dry skin,” said Ryan.

She recommends keeping skin hydrated with unscented lotions that contain ceramides, the same lipids that belong to the outer layer of the skin. Brands containing ceramides include CeraVe and some types of Cetaphil.

Turmeric

Studies have shown that curcumin, the naturally occurring chemical found in the spice turmeric, can be beneficial in treating a variety of inflammatory diseases, including psoriasis, according to the 2007 study “Beneficial role of curcumin in skin diseases,” published in Advances in Experimental Medicine and Biology.

“Turmeric has definitely been shown to have a positive effect,” said Dr. Menter.

Consult with your doctor about adding the spice to your food, taking it as a supplement or applying a topical turmeric cream.

Vitamin D

In recent years, vitamin D deficiency has been linked to a wide range of ailments from diabetes to cancer. Research has also emerged showing vitamin D may be beneficial in treating disorders such as psoriasis, according to a report in the May 2011 Science Translational Medicine Journal.

“Vitamin D-3 seems to have an immune-stabilizing effect,” said Fried. “It’s controversial as to whether or not it works reliably, but in dosages of 2,000 international units (IU) or less, we know it’s safe.”

Meditation

For many patients, one of the most frustrating aspects of psoriasis can be its unpredictability, never knowing when the next flare is going to strike.

“That unpredictability leaves people constantly feeling at risk,” Fried said.

For some, meditation can help restore a sense of power over their psoriasis.

“There’s a good amount of data that proven techniques, such as mindfulness meditation, can improve psoriasis overall in terms of its clinical severity and also improve the symptoms of psoriasis,” Fried said. “We know it enhances a sense of personal control or mastery.”

 

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