Herbal Remedies for Psoriasis: What Are Our Patients Taking?

Tace Steele, MD; Cindy J. Rogers, MD; Sharon E. Jacob, MD

Disclosures

Dermatology Nursing. 2007;19(5):448-463. 

In This Article

Abstract and Introduction

Abstract

The objective of this study was to review and explore the top 15 currently used and the historically used herbal remedies in the treatment of psoriasis. Articles, press releases, message boards, product marketing sites, and patient education lines through the National Library of Medicine (www.pubmed.gov), National Psoriasis Foundation (www.psoriasis.org), Google (www.google.com), and Yahoo (www.yahoo.com) were reviewed. Despite widespread use of complementary and alternative medications, specifically herbals, there is limited scientific data regarding their benefits and interactions. Studies on the efficacy and side effect profiles of these remedies are needed. Additionally, both providers and patients need to be cognizant of both potential benefit distortion and adulteration of the herbal products.

Introduction

Herbal and supplement aisles abound in supermarkets and local health food stores nationwide, providing evidence of the booming market for "Complementary and Alternative Medicine" (CAM) products. In 1997, retail sales of bottled herbs at neighborhood pharmacies alone reached over $70 million a year, up more than 22-fold from 1991 (Podolsky, 1997). Moreover, of the $27 billion per year industry in out-of-pocket expenditures for CAM products, over $700 million is estimated to be spent on herbal supplementation. Despite this widespread use, it is remarkable that only 40% of patients disclosed their use of CAM products to their providers (Eisenberg et al., 1998; Helwig, 2000; Stein, 2000).

Psoriasis affects 2% of the U.S. population, accounting for 10% of outpatient visits to dermatologists (Thompson, Feldman, & Fleischer, 1998). In a university clinic, 62% of 578 psoriatic patients acknowledged the use CAM therapies, defined as herbal (ranked highest) and vitamin treatments, homeopathy, non-prescription tanning, and other non-traditional modalities (Fleischer et al., 1996). The CAM-using group had greater psoriasis severity, but did not correlate with increased utilization of conventional medical therapies. It was theorized that those patients using CAM may have been less inclined to utilize conventional medical treatments. However, in a Norwegian study, 42% of patients with psoriasis had pursued previous or current use of CAM products because they were dissatisfied with conventional therapies (Jensen, 1990b). When patients were interviewed, the main reason for CAM use was "to do everything to heal the disease," followed by a desire for improved quality of life (Ben-Arye, Ziv, Frenkel, Lavi, & Rosenman, 2003). Patients report primarily re ceiving information related to CAM from lay persons and the mass media. Furthermore, 55% of patients reported aggravation or no improvement of their psoriasis when CAM modalities were used (Jensen, 1990a).

The large number of CAM therapeutic armament parallels the wide range of conventional Western medical therapies that have been prescribed to treat psoriasis, from topical therapies (for example: steroids, vitamin D analogues, retinoids, salicylates, fumaric acid esters, and anthralins) to systemic medications (for example, phototherapy, metho trex ate, cyclosporine, retinoids, 6-thioguanine, mycophenolate mofetil, troglitazone, and the newer biologic agents, such as adalimumab, alefacept, efalizumab, etanercept, and infliximab). In a recent Japanese Society for Psoriasis Research analysis of 28,628 cases, herbal medicines (14.5%) ranked highest among systemic therapies used. This was followed by etretinate (7.6%), NSAIDs (4.4%), oral corticosteroids (4.1%), methotrexate (2.8%), and cyclo spor ine (1.6%) (Kawada et al., 2003).

The range of herbal remedies used worldwide in the treatment of psoriasis either alone or in combination is broad (see Table 1 ). As an all-inclusive review is beyond the scope of this review article, the reader is directed to the following key sources (Aug-Le, 2002; Canadian College of Naturopathic Medicine, 2004). The purpose of this article is to (a) highlight the current use of herbal remedies in the treatment of psoriasis; (b) review the existing supporting scientific data and adverse complications, if known; (c) provide a useful reference table on current and historical herbs used in the treatment of psoriasis; and (d) increase clinician awareness of herbal remedy utilization to ultimately allow for better comprehensive care of our patients.

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