Psoriasis, a chronic inflammatory skin disease that causes itchy red plaques. Chronic plaque psoriasis is frequently associated with metabolic diseases including diabetes, obesity, high blood cholesterol and lipids, metabolic syndrome and nonalcoholic fatty liver disease. It appears that shared genetic links, common environmental factors and/or common inflammatory pathways may underlie the development of psoriasis and other components of the metabolic syndrome. Psoriasis affects about 8 million people in the United States alone. In severe cases large areas of the body can be affected and it can bring arthritis, depression and other problems. A portion of people with this skin condition also have psoriatic arthritis.

Natural treatment for psoriasis
I am not aware at this time of a natural psoriasis cure. This skin condition is due to inflammation and adopting an anti-inflammatory diet could be helpful. You may consider increasing your fish intake along with fresh vegetables and reducing simple carbohydrates, trans fats, and junk foods. See suggestions for a healthy diet. Patients with psoriasis have high blood triglyceride and cholesterol levels. Basically, this skin disease is an inflammatory disorder and you would do best consuming an anti-inflammatory diet. Follow these suggestions and perhaps you may notice some improvement:

Avoid smoking since it increases the risk.
Reduce weight or eat less. Excess body fat triggers an overproduction of certain inflammatory substances in the body, which leads to a higher psoriasis risk. Those who are overweight are more likely to have a worse condition, and there is a possibility that eating less can reduce symptoms and signs. See suggestions for weight loss. Lifestyle modifications, including a low-calorie diet, may supplement the medication treatment of obese psoriasis patients.
Avoiding gluten may help some individuals.
Fish oils could be helpful. Psoriasis is an inflammatory process in the skin and omega-3 fatty acids in fish oils, such as EPA and DHA, reduce inflammation.
Chondroitin sulfate may be helpful.
Inositol supplements could be helpful in psoriasis patients who are taking lithium medication.
Topical vitamin D could be helpful.
Turmeric or curcumin may be helpful. We had an email from someone who found turmeric extract supplements helpful in reducing his psoriasis condition.
Folic acid supplementation may be helpful in patients with psoriasis who are being treated with methotrexate.
Sarsaparilla has been historically used for psoriasis but I have not seen any human research with this herb.

Psoriasis and diet
Obese patients with moderate-to-severe psoriasis increase their response to psoriasis medications if a calorie-controlled diet is included in the treatment regimen.

The significance of diet and associated factors in psoriasis.
Hautarzt. 2006.
Both the general diet and single food components have been suggested to play a role in etiology and pathogenesis of psoriasis. Fasting periods, vegetarian diets, and diets rich in omega-3 polyunsaturated fatty acids from fish oil have all been associated with improvement in some studies. The most likely explanation is the reduced amounts of arachidonic acid and the increased eicosapentaenoic acid intake resulting in a modulated eicosanoid profile. However, only one of four controlled studies showed a benefit of omega-3 fatty acids compared to placebo. Some psoriasis patients are gluten-sensitive and may benefit from a gluten free diet. The active form of vitamin D exhibits anti-proliferative and immunoregulatory effects and has been shown to be useful in the treatment.

Medical nutrition therapy as a potential complementary treatment for psoriasis--five case reports.
Altern Med Rev. 2004. Department of Human Nutrition, Food and Animal Sciences, University of Hawaii at Manoa, 1955 East West Road, Rm 216, Honolulu, HI 
This research evaluated five case studies of patients with psoriasis following a dietary regimen. There is no cure for psoriasis and the multiple treatments currently available only attempt to reduce the severity of symptoms. Treatments range from topical applications, systemic therapies, and phototherapy; while some are effective, many are associated with significant adverse effects. There is a need for effective, affordable therapies with fewer side effects that address the causes of the disorder. Evaluation consisted of a study group of five patients diagnosed with chronic plaque psoriasis (two men and three women, average age 52 years; range 40-68 years) attending a 10-day, live-in program during which a physician assessed psoriasis symptoms and bowel permeability. Subjects were then instructed on continuing the therapy protocol at home for six months. The dietary protocol, based on Edgar Cayce readings, included a diet of fresh fruits and vegetables, small amounts of protein from fish and fowl, fiber supplements, olive oil, and avoidance of red meat, processed foods, and refined carbohydrates. Saffron tea and slippery elm bark  water were consumed daily. The five psoriasis cases, ranging from mild to severe at the study onset, improved on all measured outcomes over a six-month period.

Psoriasis and chondroitin
Q. I read with great interest your page on chondroitin supplements. In 2005 a small study was published:
Clinical and Histopathological Improvement Of Psoriasis With Oral Chondroitin Sulfate: A Serendipitous Finding.
Although small scale it showed extremely promising results on all but one (10 out of 11) cases of psoriasis. However psoriasis seems responsive to placebos quite regularly, yet n this case the trial was originally about osteoarthritus of the knee so arguably the placebo affect should not have affected outcome regarding psoriasis coverage. My question to add to your page is have you since seen any medical studies regarding the role of chondroitin sulfate and psoriasis treatment? And do you have any knowledge, direct or otherwise on whether this chondroitin treatment works with psoriasis.
   A. I have not seen any chondroitin psoriasis studies since the one in 2005, but it does look quite encouraging, 10 out of 11 people were helped. If a person has psoriasis, it is certainly worth a try.

Clinical and histopathological improvement of psoriasis with oral chondroitin sulfate: a serendipitous finding.
Dermatol Online J. 2005. Clinical Research Unit, Scientific Medical Department, Bioibérica, S.A., Barcelona, Spain.
We describe the clinical and histopathological results of plaque psoriasis in eleven adult patients with knee osteoarthritis and long-standing, moderate to severe psoriasis resistant to conventional therapy treated with chondroitin sulfate. Patients received 800 mg per day of chondroitin sulfate for 2 months. All patients but one presented a dramatic improvement of the condition of the skin, with a reduction of swelling, redness, flaking, and itching (clearance of psoriasis in one patient), increase in the hydration and softening of the skin, and amelioration of scaling. Histopathologically, there was a statistically significant decrease in epidermal thickness, a decrease in the thickness between the stratum basale and the stratum granulosum, a significant improvement of the degree of psoriasis activity. The confirmation of these serendipitous findings in controlled prospective studies could represent an important advance in the therapeutic armamentarium for patients with psoriasis given the excellent safety profile of chondroitin sulfate.

Inositol supplements
The effect of inositol supplements on the psoriasis of patients taking lithium: a randomized, placebo-controlled trial.
Br J Dermatol. 2004.
Lithium carbonate is the most widely used long-term treatment for bipolar affective disorders, but its ability to trigger and exacerbate psoriasis can become a major problem in patients for whom lithium is the only treatment option. Inositol depletion underlies the action of lithium in bipolar affective disorders and there are good theoretical reasons why the use of inositol supplements might be expected to help this group of patients. To determine whether inositol supplements improve the psoriasis of patients on lithium therapy. Fifteen patients with psoriasis, who were taking lithium, took part in a randomized, double-blind, placebo-controlled, crossover clinical trial comparing the effect of inositol supplements with those of a placebo (lactose). Changes in the severity of their psoriasis were measured by Psoriasis Area and Severity Index scores recorded before and after the different courses of treatment. The effect of inositol supplements on the psoriasis of 11 patients who were not taking lithium was evaluated in the same way. The inositol supplements had a significantly beneficial effect on the psoriasis of patients taking lithium. No such effect was detected on the psoriasis of patients not on lithium. The use of inositol supplements is worth considering for patients with intractable psoriasis who need to continue to take lithium for bipolar affective disorders.

Turmeric and curcumin
email - I am a 70 year old male and have had psoriasis for over 40 years. It has progresses to approximately 20 percent coverage. I began having minor arthritis symptoms in my shoulder and hands about 3 years ago. I began taking 2 grams of turmeric in capsule following one 10mg of Bioperine 3 times per day 5 months ago. My arthritis is practically non existent. I was taking 800 mg of Ibuprofen each morning to alleviate the pain. I take none now! My psoriasis has improved probably 70 percent with practically no scaling, a great reduction in redness and almost no itching.

I have suffered with psoriasis for over 30 years now and am seeking help. I have ordered curcumin and would like your opinion as to how much I should take. I am tired of taking dangerous drugs that have caused me many other health problems and the light treatments have caused me squamous cell skin cancer.
   I can't give such an answer since I have not seen studies with curcumin and psoriasis and each person has a different tolerance level to herbs. It's best to discuss with your doctor and start with one capsule a day for a week and then gradually increase the dosage over time if you can tolerate the one capsule.

Smoking, obesity, and psoriasis
Smoking appears to play a role in the risk of developing psoriasis and in the severity of the skin disease. Dr. Gerald G. Krueger, from the University of Utah School of Medicine in Salt Lake City, and colleagues compared the prevalence of smoking and obesity in 557 psoriasis patients with that seen in the three population databases. Thirty-seven percent of psoriasis patients were smokers, whereas the percentage in the other groups was significantly lower, ranging from 13 percent to 25 percent. Similarly, obesity was noted in 34 percent of psoriasis patients compared with 18 percent of subjects in the general Utah population. Further analysis of changes in body image perception over time suggested that, unlike smoking, obesity was a consequence rather than a cause of psoriasis. Overweight and obese children are at greater risk.

Smoking and the risk of psoriasis in women: Nurses' Health Study II.
Am J Med. 2007.
We prospectively examined over a 14-year time period (1991-2005) the relation between smoking status, duration, intensity, cessation, and exposure to secondhand smoke, and incident psoriasis in 78,532 women from the Nurses Health Study II. In this prospective analysis, current and past smoking, and cumulative measures of smoking were associated with the incidence of psoriasis. The risk of incident psoriasis among former smokers decreases nearly to that of never smokers 20 years after cessation.

Relation to diabetes, high blood pressure and inflammation
Women with psoriasis have a higher risk of diabetes and high blood pressure, perhaps because of the underlying inflammation that causes the skin condition. Dr. Abrar Qureshi of Brigham and Women's Hospital and Harvard Medical School in Boston thinks psoriasis should be considered a systemic disorder, rather than simply a skin disease. Having psoriasis increases the risk that a person will also have a dangerous clustering of risk factors for heart disease and diabetes known as metabolic syndrome. People with psoriasis are at increased risk for strokes, heart disease, and circulatory problems in the legs. People with severe forms of this inflammatory skin disease psoriasis are more likely to die of heart-related causes and stroke than those without the condition. European Heart Journal, online December 27, 2009.
   Comments: Perhaps adopting an anti-inflammatory diet with high amounts of vegetables and fish and low amounts of simple carbohydrates and trans fats could reduce the risk or severity of psoriasis.

Heart attack risk
Psoriasis may be an independent risk factor for heart attack, particularly in young individuals with severe cases. Psoriatics should be encouraged to aggressively address their modifiable cardiovascular risk factors. Psoriasis is a "T-helper cell disease" and heart attack has been linked to such diseases, Dr. Joel M. Gelfand, from the University of Pennsylvania in Philadelphia, and colleagues explain in the Journal of the American Medical Association.

Natural ointments and creams
Topical application of natural honey, beeswax and olive oil mixture for atopic dermatitis or psoriasis: partially controlled, single-blinded study.
Complement Ther Med. 2003.
Dubai Specialized Medical Center and Medical Research Laboratories, Islamic Establishment for Education, Dubai, United Arab Emirates.
To investigate the effects of honey, olive oil and beeswax mixture on patients with atopic dermatitis (AD) or psoriasis vulgaris (PV). Twenty-one patients with dermatitis and 18 patients with psoriasis were entered for patient-blinded, partially controlled study; 11 patients with dermatitis used topical betamethasone esters and 10 patients with psoriasis used clobetasol propionate. Honey mixture contained honey, beeswax and olive oil (1:1:1). Mixtures A, B, and C contained honey mixture with the corticosteroids ointment in a ratio of 1:1, 2:1, and 3:1 respectively. Patients with dermatitis were subjected to controlled bilateral half-body comparison to evaluate the efficacy of honey mixture against Vaseline, or mixture A against Vaseline-betamethasone esters mixture (1:1) in patients using topical corticosteroid treatment. In patients with psoriasis, the effect of honey mixture was compared with paraffin in an individual right/left-sites comparison, or mixture A against paraffin-clobetasol propionate mixture (1:1) in patients using corticosteroid topical therapy. In dermatitis, body lesions on right or left half-body were assessed for erythema, scaling, lichenification, excoriation, indurations, oozing and itching on a 0-4 points scale. In psoriasis, lesions of selected site were assessed for redness, scaling, thickening and itching, on a 0-4 points scale. In honey mixture group, 8/10 patients with dermatitis showed significant improvement after 2 weeks, and 5/11 patients pretreated with betamethasone esters showed no deterioration upon 75% reduction of corticosteroid doses with use of mixture C. In psoriasis, 5/8 patients showed a significant response to honey mixture. In patients using clobetasol propionate, 5/10 patients showed no deterioration upon 75% reduction of corticosteroid doses with use of mixture C. Honey mixture appears useful in the management of dermatitis and psoriasis vulgaris.

Aloe vera not of benefit
A double-blind, placebo-controlled study of a commercial Aloe vera gel in the treatment of slight to moderate psoriasis vulgaris.
J Eur Acad Dermatol Venereol. 2005.
The effect of this commercial aloe vera gel on stable plaque psoriasis was modest and not better than placebo.

Other herbal treatment
2 years personal experience in anapsos treatment of psoriasis in various clinical forms
Med Cutan Ibero Lat Am. 1983.
A personal experience on 495 patients affected by several forms of psoriasis and its answer to the treatment with anapsos (Polypodium Leucotomos extract) is presented. The whitenings between 80% and 100% of the affected skin were achieved on 304 patients (61.41%); 46 patients whitened between 30% and 80% of their lesions, 15 obtained null results and only 11 had relapses. It is remarkable the high number of abandonments to treatment which came at 119 patients (24.04%) due to slowness of process and other reasons probably. The association with PUVA which shortens the treatment and gives other advantages is pointed out as positive. The average time of treatment was 6 months, and daily doses were from 80 mg. and 720 mg. depending on age, weight and treatment phase. Side effects appeared in two patients only: one with intense pruritus and the other one with gastric disturbances. In both cases, these side effects disappeared when the treatment was interrupted.

Estrogen
For women with psoriasis, high levels of estrogen during pregnancy seem to improve their skin condition.

Psoriasis from medications
TNF-blockers used to treat rheumatoid arthritis may lead to psoriasis.

Standard Psoriasis treatment - medication
Topical psoriasis treatment includes tar, topical corticosteroids, topical calcipotriene, topical tazarotene, anthralin, and corticosteroid tape (Cordran tape). Systemic therapy includes UVB phototherapy, psoralen, acitretin, methotrexate, and cyclosporine.
   A long list of treatments has been available for patients. Topical therapies such as corticosteroids, vitamin D analogues, and retinoids are used for localized disease. Phototherapy including broadband ultraviolet B (UVB), narrowband UVB, PUVA, and climatotherapy are effective for more extensive disease. Systemic therapies such as methotrexate, retinoids, and cyclosporine are for patients with refractory or extensive cutaneous disease.

Topical ointments and creams, including salicylic acid and topical steroids.
Lotions, bath solutions and other nonprescription topical preparations to help soothe symptoms and reduce scaliness.
Light therapy, including UVB and lasers.
Prescription oral medications are reserved for people with moderate-to-severe cases. Treatment with methotrexate or ciclosporin for chronic plaque psoriasis brings satisfactory disease control. Ciclosporin appears to be more effective than methotrexate in the short-term.

Psoriasis treatment side effects
Patients with moderate or severe symptoms and signs frequently require systemic treatment and these medications may be associated with side effects. Little is known about the frequency of these side effects when systemic agents are used in true clinical practice. Methotrexate is the most prescribed psoriasis medication. Oral retinoids cause the highest psoriasis treatment side effects, although most are minor side effects. Cyclosporine has the highest serious side effect.

Treatment risks include cancer
Long-term treatment with so-called PUVA therapy is associated with increased risks of deadly malignant melanoma as well as a less deadly non-melanoma skin cancer called cutaneous squamous cell carcinoma. During PUVA therapy, patients are given the photosensitizing drug psoralen and exposed to ultraviolet A light.
Treatment with ultraviolet B (UVB) radiation does not appear to increase melanoma or non-melanoma skin cancer risk. Dr. Jeffrey M. Weinberg, of St. Luke's-Roosevelt Hospital Center, New York, says taking methotrexate, cyclosporine or mycophenolate mofetil, may increase the risk of lymphoproliferative disorders involiving increased production of lymphocytes, which is normally seen as a response to infection. TNF blockers may cause a slightly increased risk of cancer, including non-melanoma skin cancer and blood cancers. The newer biologics include infliximab (Remicade), etanercept (Enbrel) and adalimumab (Humira). Journal of the American Academy of Dermatology, June 2009.

Types
Guttate
Pustular
Psoriasis of the liver
Arthritic

Non-blistering skin diseases, such as alopecia areata, vitiligo and psoriasis are increasingly believed to be directly mediated by the activities of autoreactive T cells.

Questions
Can MSM be useful in psoriasis treatment?
   We have not seen research regarding the relationship of a MSM supplement to this skin disorder.

Is there any natural drug free way to deal with psoriasis? Is gamma oryzanol of any benefit in healing psoriasis?
   A Medline search in February 2010 did not reveal any studies with the use of gamma oryzanol supplements as a treatment for psoriasis.

I came across an article that said, "Tinefcon is a mono herbal extract of a plant called Sphaeranthus Indicus. This plant—whose Sanskrit name actually translates to “cuts off” or “wards off”—has been used in Ayurvedic medicine for over a thousand years to alleviate a wide variety of conditions, from fever to rheumatoid arthritis to skin conditions and more. Tinefcon is similar to the biologics in that it works to treat psoriasis from the inside out by affecting a certain type of immune cell (specifically, the TNF-Alpha." Can you comment on this?
   I have not seen any human studies with is product in relation to herbal psoriasis treatment.