Vitamins that may be helpful
Fumaric acid, in the chemically bound form
known as fumaric acid esters, has been shown in case studies,7 preliminary
trials8 9 10 and double-blind trials11
12 13 to be effective against symptoms of psoriasis. However, because fumaric
acid esters can cause significant side effects, they should be taken only under the
supervision of a doctor familiar with their use. Nevertheless, these side effects have been
reported to decrease in frequency over the course of treatment and, if they are closely
monitored, rarely lead to significant toxicity.14
In a double-blind trial, fish oil (10 grams
per day) was found to improve the skin lesions of psoriasis.15 In another trial,
supplementing with 3.6 grams per day of purified eicosapentaenoic acid (EPA, one of the fatty
acids found in fish oil) reduced the severity of psoriasis after two to three
months.16 17 That amount of EPA is usually contained in 20 grams of fish
oil, a level that generally requires 20 pills to achieve. However, when purified EPA was used
in combination with purified docosahexaenoic acid (DHA, another fatty acid contained in fish oil), no
improvement was observed.18
Additional research is needed to determine whether fish oil itself or some of its components are more
effective for people with psoriasis. One trial showed that applying a preparation containing
10% fish oil directly to psoriatic lesions twice daily resulted in improvement after seven
weeks.19 In addition, promising results were reported from a double-blind trial in
which people with chronic plaque-type psoriasis received 4.2 g of EPA and 4.2 g of DHA or placebo intravenously each day for two weeks.
Thirty-seven percent of those receiving the essential fatty acid infusions experienced greater
than 50% reduction in the severity of their symptoms.20
Supplementing with fish oil also may help prevent the increase in blood levels of triglycerides that occurs as a side effect of certain
drugs used to treat psoriasis (e.g., etretinate and acitretin).21
Folic acid antagonist drugs have been used
to treat psoriasis. In one preliminary report, extremely high amounts of folic acid (20 mg
taken four times per day), combined with an unspecified amount of vitamin C, led to significant improvement within three
to six months in people with psoriasis who had not been taking folic acid
antagonists;those who had previously taken these drugs saw a worsening of their
condition.22
Although some doctors have been impressed with the effectiveness of flaxseed oil (usually 1 to 3 tbsp per day) against
psoriasis, there have been no published trials to support that observation.
The vitamin D that is present in food or
manufactured by sunlight is converted in the body into a powerful hormone-like molecule called
1,25-dihydroxyvitamin D. That compound and a related naturally occurring molecule (1
alpha-hydroxyvitamin D3) have been found to reduce skin lesions when given orally to people
with psoriasis.23 Topical application of these compounds has also been effective in
some,24 25 26 27 but not all,28
29 trials. These activated forms of vitamin D are believed to help by preventing the
excessive proliferation of cells that occurs in the skin of people with psoriasis. Because
these potent forms of vitamin D can cause potentially dangerous increases in blood levels of
calcium, they are available only by prescription. Toxicity is usually less of a problem with
activated vitamin D applied topically than with activated vitamin D taken orally. The use of
these compounds (under the supervision of a qualified dermatologist) may be considered in
difficult cases of psoriasis. The form of vitamin D that is available without a prescription
is unlikely to be effective against psoriasis.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
Cayenne contains a resinous and pungent
substance known as capsaicin. This chemical relieves pain and itching by depleting certain
neurotransmitters from sensory nerves. In a double-blind trial, application of a capsaicin
cream to the skin relieved both the itching and the skin lesions in people with
psoriasis.30 Creams containing 0.025 to 0.075% capsaicin are generally used. There
may be a burning sensation the first several times the cream is applied, but this usually
become less pronounced with each use. The hands must be carefully and thoroughly washed after
use, or gloves should be worn, to prevent the cream from accidentally reaching the eyes, nose,
or mouth and causing a burning sensation. The cream should not be applied to areas of broken
skin.
A double-blind trial in Pakistan found that topical application of an aloe extract (0.5%) in a cream was more effective than
placebo in the treatment of adults with psoriasis.31 The aloe cream was applied
three times per day for four weeks.
In traditional herbal texts, burdock root
was believed to clear the bloodstream of toxins.32 It was used both internally and
externally for psoriasis. Traditional herbalists recommend 2 to 4 ml of burdock root tincture
per day. For the dried root preparation in tablet or capsule form, the common amount to take
is 1 to 2 grams three times per day. Many herbal preparations will combine burdock root with
other alterative herbs, such as yellow dock,
red clover, or cleavers. Burdock root has not been studied in
clinical trials to evaluate its efficacy in helping people with psoriasis.
Although clinical trials are lacking, some herbalists use the herb, coleus, in treating people with
psoriasis.33 Coleus extracts standardized to 18% forskolin are available, and 50 to
100 mg can be taken two to three times per day. Fluid extract can be taken in the amount of 2
to 4 ml three times per day.
An ointment containing Oregon grape (10%
concentration) has been shown in a clinical trial to be mildly effective against moderate
psoriasis but not more severe cases.34 Whole Oregon grape extracts were shown in
one laboratory study to reduce inflammation often associated with psoriasis.35 In
this study, isolated alkaloids from Oregon grape did not have this effect. This suggests that
there are other active ingredients besides alkaloids in Oregon grape. Barberry, which is very similar to Oregon grape, is
believed to have similar effects. An ointment, 10% of which contains Oregon grape or barberry
extract, can be applied topically three times per day.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
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