Psoriasis
Research
Diet &
Lifestyle
Aloe Vera
& Psoriasis
Researchers at the University of Punjab, Pakistan have
conducted a double-blind, placebo-controlled study to evaluate the efficacy and
tolerability of topical aloe Vera extract (0.5%) in an hydrophilic cream to treat patients
with psoriasis vulgaris.
Sixty patients (36 male/24 female) aged between 18 - 50
years (average age 25.6 years) with slight to moderate chronic plaque-type psoriasis
participated in the study and were randomly divided into two groups. The average duration
of the disease prior to the study was 8.5 years.
The patients were provided with a pre-coded 100g tube,
placebo or aloe Vera extract 0.5%, and they self-administered the cream topically (without
occlusion) at home 3 times daily for 5 consecutive days per week up to a maximum of 4
weeks treatment.
The patients were examined on a weekly basis and those
showing a progressive reduction of lesions, desquamation followed by decreased erythema
and lowered psoriasis area and severity index (PASI) were considered healed. The treatment
was well tolerated by all of the patients with no adverse side effects and no patients
dropped out of the study.
At the end of the 4 weeks, the Aloe Vera extract cream
resulted in significant clearing of the psoriatic plaques in 25 out of 30 patients (83.3%)
compared to the placebo cream which was successful in only 2 out of 30 patients (6.6%).
The researchers concluded that their findings suggest that
topically applied aloe Vera extract in an hydrophilic cream is more effective than a
placebo cream and has no known toxic side effects. The use of aloe Vera cream in the
treatment of mild to moderate psoriasis was considered a safe alternative treatment for
psoriasis patients.
Tanweer A, Syed S et al. Management of psoriasis with Aloe
Vera extract in a hydrophilic cream: a placebo-controlled, double-blind study. Tropical
Medicine and International Health 1996: 1, 4; 505-509.
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The Dead Sea
& Psoriasis
The Dead Sea health resort in Israel has been offering
effective treatment for a variety of skin disorders including psoriasis, vitiligo and
eczema for over 30 years. The results have been nothing short of astounding. In short, no
other health resort of this kind, has been shown to offer such effective treatment .
Whilst many 'health spas' have benefits relating to
climate, water, mud and air, very few have all of them. The Dead Sea has unique climatic
conditions which have been shown to offer excellent natural treatment for many health
problems, although the resort is best known for its treatment for psoriasis and related
skin conditions.
The Dead Sea atmosphere: - The lowest place on earth, over
400 metres below sea level, the Dead sea region has a dense air rich in bromine and other
elements which filters and limits the ultraviolet B radiation from the sun, reducing the
danger of sunburn and allowing longer exposure to the sun's rays. the thicker atmospheric
pressure is also associated with an increase in oxygen - 5 per cent richer than air at sea
level and 10 per cent higher than the air in Jerusalem, only a two hour
drive away.
The Dead Sea water: - the water in the dead sea contains
345grams of mineral salts per litre and is approximately ten times higher in saline than
ocean water and enriched by hydrogen sulfide gas. The major salts are magnesium, sodium,
potassium and calcium, although the proportion of sodium to total salts is, in fact, much
less than that of ordinary sea water.
Drinking water: - The drinking water at the Dead Sea resort
is drilled from underground aquifers or comes from fresh watersprings, some of which have
been shown to have a selenium content.
Treatment for Psoriasis: - Treatment of psoriasis at the
Dead sea is based upon a gradual increase in exposure to the sun combined with bathing in
the Dead Sea. Cortisone preparations are not used and instead the treatment relies upon
Vaseline, body oils, coal tar , sulfur and salicylic acid products. However, the main
therapeutic agent is the sun, the topical applications are used principally to lubricate
the skin.
The typical length of treatment is four weeks and the
results of studies conducted over the past twenty years are extremely impressive, the
latest study involving over 2,000 patients revealed that 60 per cent of sufferers
experienced a complete clearance and a further 36 per cent experienced virtual clearance
or significant improvement.
Although follow up research showed that the average
remission period is 5.5. months, recurrent attacks tend to less severe than originally
treated, and almost without exception, patients continue to respond well to the Dead Sea
therapy . Interestingly, the recurrence of psoriasis following hydrocortisone and other
conventional treatments is commonly more severe than before and, not infrequently the
condition becomes resistant to treatment. Furthermore, whilst there is evidence of higher
rates of skin cancer among patients who receive PUVA, there is no evidence of increased
rates of skin cancer from patients who have visited the Dead Sea region in Israel.
Factors relating to the success of Dead sea treatment for
psoriasis: - The successful results of the Dead Sea treatment
of psoriasis may be due to a
combination of the sun, the water and the climate. Undoubtedly the most important factor
is exposure to the sun's rays. A recent study compared the results of sunbathing only with
Dead Sea water bathing only and sunbathing and water bathing combined. Water bathing only
produced an average improvement of 20 per cent; sun bathing only produced an average
improvement of 72.8%, and sun bathing and water bathing produced 83.4%.
The amount of time patients should be exposed to the sun at
the Dead sea has also been investigated. During July and August 1994, 45 psoriatic
patients were treated at the Dead sea for 28 days using one of three sun-exposure
schedules - 3 hours per day, 4.5 hours per day and 6 hours per day.
The results of that study revealed that those patients
exposed to the sun for 3 hours a day experienced 91% improvement, those who were exposed
for 4.5 hours experienced 87% improvement and those exposed for 6 hours experienced 88%
improvement. These figures indicate that patients who visit the dead Sea during July and
August only need to spend 3 hours
in the sun each day.
In a further study conducted in Belgium, patients being
treated with artificial UV radiation whilst being showered with water which contained 20%
of mineral salts similar to those in the Dead Sea improved significantly more than the
patients showered with plain water only, although the studies at the dead sea indicate
that the additional improvement is only in the region of 10 per cent.
Psychological factors: - During a patient's stay at the
Dead sea, it is thought that psychological factors may have an important influence.
Patients tend to form mutually supportive groups and lose much of the shame and
embarrassment, and are able to socialise freely and not worry about covering up their
lesions. The patients also tend to become hopeful and optimistic after seeing their skin
and others' improve.
Miscellaneous factors: -One or two other factors may also
contribute to the success of the treatment of psoriasis at the Dead sea. The air is very
high in bromine - ten to twenty times higher than that found in Jerusalem . Bromine tends
to help relax patients and as the condition is well acknowledged as being stress-related,
this may help alleviate the psoriasis.
One other factor is, as mentioned above, the high amount of
oxygen in the air at the Dead sea. Oxygen is a vital nutrient to help cleanse and nourish
the body's tissues.
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Essential fatty
acids & Psoriasis
One of the first studies indicating the relationship of essential
fatty acids with psoriasis was an eight-week pilot study conducted at the
Department of Dermatology, School of Medicine, University of California,
USA in 1986 (1). Results obtained from 13 psoriatic patients demonstrated
that eicosapentaenoic acid (20:5,n3 (EPA)) and docosahexaenoic acid
(22:6,n3 (DCHA)) were rapidly incorporated into the sera, neutrophils, and
epidermis of the patients, and that the incorporation of EPA and DCHA into
epidermal lipids increased with weeks of supplementation with minimal
alteration of arachidonic acid (an inflammatory acid found in animal
proteins) in the epidermal lipids. Clinical evaluations showed that eight
of the patients (61%) experienced mild to moderate improvement in their
psoriatic lesions.
The improvements in the
patients’ skin lesions correlated with high EPA/DCHA ratios attained in
epidermal tissue specimens. The results demonstrated the need for further
investigations into the role of dietary Omega 3 fatty acids as a potential
protective agent and/or therapeutic adjunct for the clinical management of
psoriasis
(1) Ziboh VA.: Cohen K.A.;
Ellis C.N.; et a). Effects of dietary supplementation of fish oil on
neutrophil and epidermal fatty adds: Modulation of clinical course of
psoria[ic subjects. ARCH. DERMATOL. (USA), 1986, 122/11 (1277-1282);
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Fish oil
versus corn oil & Psoriasis
Researchers at the Institute for Nutrition Research, University of Oslo,
Norway conducted a four-month double-blind, multi centre trial, where they
randomly assigned 145 patients with moderate-to-severe psoriasis to
receive in their diet either highly purified ethyl esters of n-3 fatty
acids (fish oil 6 g of oil per day, containing 5 g of eicosapentaenoic and
docosahexaenoic acid) or an isoenergetic amount of corn oil containing
mainly n-6 fatty acids.
All of the patients were
advised to reduce their intake of saturated fatty acids (i.e. meats,
cheese, dairy food, chocolate, etc). A 48-hour dietary recall was
performed, and the fatty-acid pattern in the serum phospholipids was
monitored in a sub-group of patients.
The results revealed that
the score on the Psoriasis Area and Severity Index, as evaluated by the
physicians, did not change significantly during the trial in either group.
The patients’ own subjective appraisals also found no significant
improvement. However, in the corn oil group there was found to be a
significant correlation between clinical improvement and an increase in
eicosapentaenoic acid and total n-3 fatty acids.
The researchers concluded
that dietary supplementation with fish oil was no bet-ter than corn-oil
supplementation in treating psoriasis. Clinical improvement was not
correlated with an increase in the concentration of n-3 fatty acids in
serum phospholipids among the patients in the fish-oil group, whereas
there was a significant correlation between clinical improvement and an
increase in eicosapentaenotc acid and total n-3 fatty acids in the
corn-oil group.
Source: - Alternative in Health V2 I4,
May/June 1997
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PUVA
& Psoriasis
OBJECTIVE: To
compare the therapeutic efficacy of narrowband (TL-01) UV-B
phototherapy vs photochemotherapy (psoralen-UV-A [PUVA]) in patients
with chronic plaque-type psoriasis. DESIGN: Open, nonrandomized,
intraindividually controlled paired comparison study.
SETTING: Phototherapeutic unit in a university hospital.
PATIENTS: Twenty-five patients with chronic plaque-type psoriasis.
INTERVENTIONS: Paired irradiations with threshold erythemogenic
doses of narrowband UV-B and PUVA were given to the patients' dorsal
aspect including the arms and legs. Treatment was performed 3 times
weekly until complete or almost complete clearing with one or both
regimens or over a maximum period of 18 exposures.
MAIN OUTCOME MEASURES: Assessment of the Psoriasis Area and Severity
Index (PASI) in each half of the patient's dorsal aspect before and
after treatment with the 2 regimens.
RESULTS: The median pretreatment PASI score of 16 (range, 6.2-23.4)
was reduced by 84% to 2.5 (range, 0-12.6) by the narrowband UV-B
treatment and by 89% to 1.8 (range, 0-8.2) by the PUVA treatment.
Statistical analysis of these data showed a tendency for PUVA being
superior to narrowband UV-B although the difference remained below
the level of significance (P = .17). However, a clear effect of the
pretreatment PASI score on the therapeutic outcome was found.
Patients with higher baseline PASI scores responded significantly
better to PUVA than to narrowband UV-B (P = .03).
CONCLUSIONS: Our data demonstrate that in many patients with
plaque-type psoriasis, narrowband UV-B is comparably as effective as
PUVA and, given the lack of photosensitizer-related adverse
reactions and the possibly lower long-term cancer risk, can be
considered as first-line treatment. Treatment with PUVA, on the
other hand, remains the mainstay for patients with high PASI scores
who do not respond or whose psoriasis cannot be controlled
adequately by narrowband UV-B.
Tanew A,
Radakovic-Fijan S, Schemper M, Honigsmann H Department of
Dermatology, University of Vienna Medical School, Austria. a.tanew @
akh-wien.ac.at Arch Dermatol 1999 May;135(5):519-24
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Psoriasis
& salt solutions
The
combination of saltwater baths and subsequent ultraviolet irradiation
is an effective treatment for psoriasis and atopic dermatitis. The aim
of the present study was to determine the photosensitizing properties
of two commercially available bath salts, original salt from the Dead
Sea and sodium chloride. To address this issue, test areas on the
volar aspects of the forearms were soaked with salt solutions for 15
minutes prior to ultraviolet-B (UVB) irradiation. The salt
concentrations tested were 1%, 3% 5% and 15%. Tap water followed by
UVB and UVB alone served as controls. Erythema was determined by
visual and photometric measurement, and delayed tanning was assessed
by colorimetry. Erythema obtained by wetting the skin prior to UVB
irradiation was more pronounced than erythema induced by UVB alone.
The most prominent erythema was yielded by tap water + UVB. The salts
had a differing photosensitizing capacity and the strongest erythema
was produced by the 5% solutions. There was only a moderate influence
on delayed tanning by bathing the skin prior to irradiation. The
results from the present study indicate that soaking the skin with
salt solutions or tap water increases skin sensitivity to subsequent
UVB irradiation. This may contribute to the effectiveness of salt
water baths followed by UV irradiation and may account for an
increased sunburn risk after bathing.
Schempp CM, Blumke C, Schulte-Monting J,
Schopf E, Simon JC, Funktionsbereich Photodermatologie,
Universitats-Hautklinik Freiburg. Hautarzt 1998 Jun;49(6):482-6
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