A review of complementary and alternative medicines used by more than 51 percent of patients with psoriasis, shows that indigo naturalis, curcumin, dietary modification, fish oil, meditation, and acupuncture may be effective in some patients, but proceed cautiously investigators say.
“There have been many complimentary and alternative medicine treatments investigated for psoriasis. There is some evidence of the efficacy for these therapies in psoriasis; however, these studies must be interpreted cautiously given their small sample sizes, variability in the quality of the study design, and differences in primary outcomes measured,” wrote researchers who were led by Anna J. Nichols, M.D., Ph.D., co-director of the High Risk Skin Cancer Clinic of the University of Miami Health System.
The review, published online September 15 in JAMA Dermatology, examines the results of 57 trials and three meta-analyses. The assessment is important, said co-author Alexandra Price, M.D., a resident with the University of Miami Health System, because this is largely uncharted territory.
"For the most part, it has been uncharted territory for physicians to counsel patients on which of these alternative therapies are safe and effective. Familiarizing ourselves with the evidence behind these therapies allows us to better counsel and advise our patients on potential interactions, adverse reactions and efficacy," she said.
The review is based on a search of PubMed, Embase and www.clinicaltrials.gov for relevant studies published or conducted between 1950 and 2017. The final analysis included 44 research clinical trials, 10 uncontrolled trials, two controlled non-randomized trials, one prospective non-randomized controlled trial and three meta-analyses.
TOPICAL INDIGO NATURALIS
Indigo naturalis has long been used in traditional Chinese medicine. It, along with its active component indirubin, has been shown to have anti-inflammatory, anti-viral, anti-microbial, anti-pyretic, and anti-tumor effects.
In this review, researchers concluded there is enough evidence to recommend a trial period for indigo naturalis in psoriasis. The studies cited in the review showed that indigo naturalis may inhibit keratinocyte and repair the epidermal barrier damaged by psoriasis.
However, most of the studies cited in the review were small and the dosages were not consistent across studies. Of note, the plant’s blue tint may dissuade patients from using the product, which is not readily available.
Curcumin is a phytochemical found in turmeric, which has long been lauded for its anti-inflammatory properties. The investigators concluded that there is some preliminary evidence supporting the use of topical curcumin in adults with psoriasis. While evidence does not support the use of non-modified formulations of oral curcumin, oral curcumin in a phospholipid-based delivery system may be a beneficial adjunctive treatment for psoriasis.
“Based on the available literature, there is little evidence to support the use of topical curcumin for adults with plaque psoriasis. Because the evidence is limited regarding the effectiveness of oral nonmodified curcumin supplementation for psoriasis, a recommendation cannot be made at this time.
Still, curcumin is a “promising” treatment for psoriasis, but it has its drawbacks: a low oral bioavailability, poor topical absorption and a bright yellow pigment. Researchers are in the process of experimenting with new formulations and delivery systems.
Researchers found multiple clinical trials and meta-analyses showing that a hypocaloric diet can significantly improve psoriasis severity, dermatologic quality of life and obesity.
The review excluded studies on the Mediterranean diet, gluten-free diet, micronutrient supplementation and orange-peel extract due to a lack of statistical significance.
MEDITATION AND GUIDED IMAGERY
In a 37-patient randomized study, patients who listened to a meditation recording while undergoing phototherapy experienced four times faster skin clearance than patients who did not undergo the same procedure. Although the evidence for meditation and guided imagery is limited, investigators concluded, early research suggests that mind-body modalities may be a useful adjunctive treatment option.
The clinical trial results for the use of acupuncture for psoriasis were variable across acupuncture types included in the review. A meta-analysis of 13 clinical trials included 590 patients who received acupuncture using different techniques with acupoint stimulation appeared to be the most effective.
"We performed a systematic review, but unfortunately many of the trials are small and limited, and many of the studied formulations are not commercially available. Larger well-designed, controlled studies are needed to assess the efficacy of the therapies with the most compelling initial evidence. Our study also suggests that there are likely many other alternative therapies lacking clinical trials data that patients are using, which may or may not be effective," Dr. Price said.
A Caresse Gamret BS, Alexandra Price MD, Raymond M Fertig MD, Hadar Lev-Tov MD, Anna J Nichols MD PhD. "Complementary and Alternative Medicine Therapies for Psoriasis: a Systematic Review," JAMA Dermatology. September 2018.