February 07, 2023
3 min read
Source/Disclosures
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Disclosures:
Gelfand reports having financial relationships with AbbVie, Amgen, BMS, Boehringer Ingelheim, GSK, Lilly (DMC), Janssen Biologics, Novartis, NeuroDerm (DMC), Pfizer and UCB (DMC); being co-patent holder of resiquimod for treatment of cutaneous T-cell lymphoma; and serving as the deputy editor of the Journal of Investigative Dermatology and board member for the International Psoriasis Council.
In this issue of Healio Psoriatic Disease we focus on complementary and alternative medicine for psoriasis.
Complementary and alternative medicine (CAM), or “complementary health approaches,” is a group of diverse medical and health care practices and products that are not presently considered to be part of conventional medicine. There are two broad subgroups: 1) natural products, including herbs, vitamins, minerals and probiotics, the latter often sold as dietary supplements; and 2) mind and body practices, including a large and diverse group of procedures or techniques administered or taught by a trained practitioner such as yoga and meditation.
There is broad interest in CAM in the United States, and the National Center for Complementary and Integrative Health at the NIH funds research studies to further understand the risks and benefits of CAM approaches.
As a common, chronic, incurable and stigmatizing disease, there is intense interest in CAM by patients with psoriasis. Complicating matters is that these patients can have prolonged spontaneous remissions and respond to placebo (PASI 75 is about 5% in patients with moderate to severe psoriasis receiving placebo) and therefore anecdotes abound about various CAM treatments improving psoriasis. A 2018 survey conducted by the National Psoriasis Foundation found that 41% of people with psoriasis reported using alternative therapies, with patients who had more severe disease being more likely to seek them out.
While interest in CAM therapy is high, it appears the interest in well conducted, rigorous trials to prove its safety and efficacy is low, as there is a dearth of data to support its use in psoriasis. So, what do patients, and their providers who recommend CAM, have to lose? A lot! First, at best, an unproven therapy may be a waste of precious time and money and may prevent patients from receiving therapies actually proven to work. At worst, patients may experience life threatening harm. Tryptophan is a CAM therapy used for disorders such as insomnia and mood disorders. Dermatologists of a certain generation will recall its association with a scleroderma-like condition called eosinophilia-myalgia syndrome. Herbs and dietary supplements promoted for their supposed weight loss or joint pain benefits, including green tea extract, may cause severe acute liver injury. Specifically turning to psoriasis,