Abstract and Introduction
Complementary and alternative medicine (CAM) use is common among patients with psoriasis. CAM modalities include traditional Chinese medicine (TCM), herbal therapies, dietary supplements, climatotherapy, and mind/body interventions. In this review, evidence from clinical trials investigating the efficacy of CAM for psoriasis is reviewed. There is a large amount of evidence from controlled trials that have shown that the combination of TCM with traditional therapies for psoriasis is more efficacious than traditional therapies alone. Herbal therapies that have the most evidence for efficacy are Mahonia aquifolium and indigo naturalis, while there is a smaller amount of evidence for aloe vera, neem, and extracts of sweet whey. Dietary supplementation in patients with psoriasis demonstrates consistent evidence supporting the efficacy of fish oil supplements. Zinc supplementation has not been shown to be effective; however, some evidence is available (albeit conflicting) for vitamin D, vitamin B12, and selenium supplementation. Overwhelming evidence supports the effectiveness of Dead Sea climatotherapy. Finally, mindfulness-based stress reduction can be helpful as adjuvant treatment of psoriasis. There are potential benefits to these modalities, but also potential side issues. Concerns with CAM include, but are not limited to, contamination of TCM products with heavy metals or corticosteroids, systemic toxicity or contact dermatitis from herbal supplements, and ultraviolet light-induced carcinomas from climatotherapy. Dermatologists should be aware of these benefits and side effects to allow for informed discussions with their patients.
Complementary and alternative medicine (CAM) is defined by the National Center for Complementary and Integrative Health (NCCIH) as ''a group of diverse medical and health care systems, practices and products that are not currently considered to be part of conventional medicine''. CAM for psoriasis includes traditional Chinese medicine (TCM), herbal therapies, dietary supplements and dietary modifications, climatotherapy, and mind/body interventions. CAM use among psoriasis patients is common, with prevalence estimations varying between 42 and 69 %.[2–6] Herbal therapies seem to be the most commonly used modality.[2,3,7] Most often, patients use CAM as 'complementary' therapy, as opposed to 'alternative' therapy, i.e. rather than using CAM as monotherapy, most patients are taking CAM in combination with traditional treatment modalities in an effort to do everything possible to control their disease. Other reasons patients choose CAM include a preference for 'natural' approaches to their skin disease, a perceived lower risk of side effects, and dissatisfaction with the efficacy or toxicity of traditional medicine. Studies have shown that patients do not willingly offer information regarding CAM use to their physicians;[3,5,9,10] therefore, the onus is on the physician to ask questions regarding CAM use. Interestingly, even though patients do not frequently offer information regarding CAM use, they are willing to discuss it if asked and, in fact, expect their dermatologists to have a basic knowledge of CAM.
In the US, the demographic profile of patients who use CAM for skin disease (not specifically psoriasis) tends to be White females between the ages of 26 and 50 years, who have at least a high-school diploma.[1,12] The demographics of CAM use specifically among patients with psoriasis is not well understood and has not been investigated on a population-based level in the US.
The aims of this review are to first highlight the evidence for efficacy of CAM modalities in the treatment of psoriasis and, second, to provide the reader with clinically relevant considerations with regard to the implementation of CAM, reported drug interactions, and known side effects of CAM therapies. A PubMed search was performed using the terms 'psoriasis' and 'complementary and alternative medicine', as well as search terms for other, more specific CAM modalities such as 'fish oil' and 'traditional Chinese medicine'. Lists of references were consulted for additional articles. The discussion of efficacy was limited to randomized controlled trials (RCTs).
Am J Clin Dermatol. 2015;16(3):147-166. © 2015 Adis Springer International Publishing AG