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Psoriasis is a long-term (chronic), inflammatory skin disease that affects about 2 percent of the world population and is estimated to affect between 6 million and 8.5 million Americans. African Americans have about half the rate of psoriasis as Caucasians.
It appears most commonly on the legs, knees, arms, elbows, scalp, trunk, ears, back and nails. Toes and fingernails can lose their luster and develop ridges and pits. The joints (psoriatic arthritis), umbilicus, gluteal cleft and genitalia may also be affected.
Psoriasis appears as dry patches of thickened skin that are red to brown in color and covered with silvery-white scales, also known as plaques. The lesions vary in size and degree of inflammation from a few ranging from only a few lesions to total involvement of the skin. Psoriasis is categorized as localized or generalized, based on the severity of the disease and its overall impact on the patient's quality of life and well-being. Some people have very mild involvement with small dry patches on their elbows, knees, or scalp and may not know they have the disease because it is so mild. Others have very severe disease where virtually their entire body is fully covered with psoriasis. Localized plaque psoriasis is the most common form.
Psoriasis has a variable course with periodic ups and downs. Sometimes psoriasis may clear for years and stay in remission. Some people have worsening of their symptoms in the colder winter months. Many people report improvement in warmer months, climates, or with increased sunlight exposure. When it is severe, it can adversely affect functions of daily living including work and social activities. Psoriasis is seen worldwide, in all races, and both sexes. Although psoriasis can be seen in people of any age, from babies to seniors, most commonly patients are first diagnosed in their early adult years. People with more severe psoriasis may have social embarrassment, job stress, emotional distress, and other personal issues because of the appearance of their skin.
TYPES OF PSORIASIS
There are several types of psoriasis:
- Plaque or Vulgaris: Inflamed patches of skin topped with silvery, white scales (most common type),
- Guttate: Small dot-like or drop-like spots or lesions.
- Pustular: Weeping lesions (liquid-filled yellowish small blisters) and intense scaling.
- Inverse: In body folds (armpits, navel, buttocks, groin, under breasts).
- Erythrodermic: Intense sloughing and inflammation of the skin.
In 1990, psoriasis was the reason for more than 1 million visits to health care providers. People spend between $1.6 billion and $3.2 billion each year to treat the disease, according to the National Psoriasis Foundation (NPF). Between 150,000 and 260,000 new cases are diagnosed each year, including 20,000 in children younger than ten years.
In the past, the treatment of psoriasis was primarily managed by dermatologists. This disorder accounted for only 0.4 percent of skin-related visits to family health providers. The number of patients treated by family practitioners, however, is likely to have steadily increased as more patients seek medical care of psoriasis from their primary care practitioners.
FREQUENT SIGNS & SYMPTOMS
Psoriasis typically looks like red or pink areas of thickened, raised and rough patches of skin. Psoriasis may occur anywhere, but are commonly found on the scalp, elbows, knees, palms, and soles. Signs and symptoms include:
- Most psoriasis causes patches of thick, red skin with silvery white scales and skin swelling.
- Skin cells grow deep in the skin and slowly rise to the surface.
- Skin patches can itch or feel sore.
- Often found on elbows, knees, parts of the legs, scalp, lower back, face, palms, feet soles.
- Also found affecting fingernails, toenails, genitals, and inside the mouth.
- Pitted or dented fingernails and/or toenails.
- Red lesion in the folds of the buttock.
- Joint pain suggesting arthritis.
- Anyone can get psoriasis, but it occurs most often in adults.
- Sometimes there is a family history of psoriasis and certain genes have been linked to the disease.
PSORIASIS & DIFFERING APPEARANCES
Psoriasis has many different appearances. It may be small flattened bumps, large thick plaques of raised skin, red patches, and pink mildly dry skin to big flakes of dry skin that flake off.
Sometimes pulling of one of these small dry white flakes of skin causes a tiny blood spot on the skin. This is medically referred to as a special diagnostic sign in psoriasis called the Auspitz sign.
Genital lesions especially on the head of the penis are common. Psoriasis in moist areas like the navel or area between the buttocks (intergluteal folds) may look like flat red patches. These atypical appearances may be confused with other skin conditions like fungal infections, yeast infections, skin irritation, or bacterial Staph infections.
On the nails, it can look like very small pits (pinpoint depressions or white spots on the nail) or as larger yellowish-brown separations of the nail bed called "oil spots." Nail psoriasis may be confused with and incorrectly diagnosed as a fungal nail infection.
On the scalp, it may look like severe dandruff with dry flakes and red areas of skin. It may be difficult to tell the difference between scalp psoriasis and seborrhea (dandruff). However, the treatment is often very similar for both conditions.
PSORIASIS & JOINT PROBLEMS
Psoriasis is associated with joint problems in about 10 to 35 percent of patients. In fact, sometimes joint pains maybe the only sign of the disorder with completely clear skin. The joint disease associated with psoriasis is referred to as psoriatic arthritis, a disorder similar to rheumatoid arthritis and is difficult to treat. Patients may have inflammation of any joints (arthritis), although the joints of the hands, knees, and ankles tend to be most commonly affected.
The average age for onset of psoriatic arthritis is 30 to 40 years of age. In most cases, the skin symptoms occur before the onset of the arthritis. The diagnosis of psoriatic arthritis is typically made by a health care provider examination, medical history, and relevant family history. Sometimes, lab tests and X-rays may be used to determine the severity of the disease and to exclude other diagnoses like rheumatoid arthritis and osteoarthritis.
Patients with psoriatic arthritis fall into three groups.
- Many patients have what is called asymmetric arthritis. This means that only a few joints are involved and that it does not occur in the same joints on both sides of the body. (For example, only one wrist and one foot are affected.)
- An equal number of patients suffer from symmetric polyarthritis. This means that arthritis occurs in several corresponding joints on both sides of the body. (For example, both elbows, both knees, and both hands are affected.) The polyarthritis type of psoriatic arthritis is much like RA.
- A third group has mostly axial disease. This refers to arthritis of the spine, the sacroiliac joint (where the pelvis and bottom of the spine meet), or the hip and shoulder joints. Patients do not necessarily stay in the same category. Over time, the pattern may change. Health care providers use these categories to better understand the disease and to follow the progression of the arthritis. The treatment is basically the same.
All people who suffer from psoriatic arthritis have psoriasis (the skin rash). Some patients have very few areas of rash. Other patients have psoriasis over a large portion of their bodies. The skin lesions of psoriasis are reddish, itchy, and have silvery scales. These areas can range in size from the size of a pencil dot to the large areas the size of your palm. Psoriasis usually shows up on the elbows, knees, scalp, ears, and abdomen, but it can appear anywhere. In people with psoriatic arthritis, the psoriasis most often affects fingernails or toenails. The nails may have pits or ridges, or they may be discolored or appear to be separating from the skin.
Psoriatic arthritis can affect any joint. Symptoms often seem like those of any other type of arthritis such as joint swelling and pain. Patients generally describe less pain. Some joint symptoms are unique to psoriatic arthritis:
- The joints nearest to the fingernails and toenails are affected more. (These joints are called distal interphalangeal, or DIP, joints.)
- The affected fingers and toes take on a sausage-like appearance.
- The bones themselves become inflamed (called dactylitis).
- The tendons and ligaments become inflamed where they attach to bones. (This is called enthesitis and is especially common in the heels.)
- Bony ankylosis of the hands and feet develops. (This means that the joints stiffen and become frozen in awkward positions.)
- The joints grow inflamed where the bottom of the spine meets the pelvis. (This is called sacroiliitis.) Patients often notice no symptoms, but the inflammation can be seen on X-rays.
- The vertebrae of the spine become inflamed. (This is called spondylitis.)
- The eyes become inflamed.
About five percent of patients with psoriatic arthritis will develop a form of arthritis called arthritis mutilans. This type of arthritis affects the small joints of the hands and feet. It is especially severe and destructive. The destruction caused by arthritis mutilans can result in deformity of the hands and fingers.
Rare symptoms include problems with the aortic heart valve, extra tissue formation in the lungs, and metabolic disorders that affect the tissues.
Diagnosis of psoriatic arthritis involves a health care provider obtaining a detailed medical history, with questions about psoriasis in your family. Patients with psoriasis may have other forms of arthritis, and the symptoms of psoriatic arthritis often look like other types of joint disease. This means that your health care provider will probably do tests to rule out other diseases. Blood studies will help rule out rheumatoid arthritis (RA). (The RA test is usually not positive in patients with psoriatic arthritis.) X-rays of affected joints will be studied both to rule out other diseases and to identify characteristics of psoriatic arthritis. Psoriatic arthritis is common in people who test positive for HIV, the AIDS virus. As a precaution, your health care provider may test your blood for HIV, especially if your symptoms are severe.
Dealing with psoriatic arthritis involves treating both the skin lesions and the joint pain. Many lotions and creams are made for skin affected by psoriasis. If the skin involvement is especially severe, your health care provider will most likely prescribe a drug called methotrexate. Methotrexate can also help with the arthritis. A type of photochemotherapy called Psoralen & UVA light therapy, commonly referred to as PUVA therapy, may be helpful for both the skin and joint problems. PUVA therapy uses topical cream medications that are rubbed on the skin lesions. Following application of the cream, the skin area is placed under a lamp that emits a special ultraviolet light. The light triggers chemicals in the medication cream that treat the rash lesions.
Treatment of arthritis symptoms depends on which joints are affected and the severity of the disease. The first drugs most health care providers prescribe are non-steroidal anti-inflammatory drugs (NSAIDs). Aspirin and ibuprofen are NSAIDs, as are many prescription pain relievers. Other medications known as disease-modifying anti-rheumatic drugs (DMARDs) are used in patients with high levels of pain or especially bad arthritis. These medications work in different ways to control the arthritis.
Many other drugs can be used to treat psoriatic arthritis. Health care providers will sometimes prescribe a combination of drugs. Cortisone injections into sore joints can help relieve pain. Surgery may be called for in the rare cases of unmanageable pain or loss of joint function.
Warm water soaks and applying heat to joints gives pain relief to many patients. Your health care provider may ask you to see a physical therapist to maximize the strength and mobility of your joints. Stress does make your symptoms worse, so your health care provider may encourage you to exercise and find ways to reduce the stress of your daily life.
Your psoriatic arthritis will not go away. But there are many treatment options. Together, you and your health care provider should be able to find treatment that will work for you.
PSORIASIS & NAILS
Psoriasis may involve solely the nails in a limited number of patients. Usually, the nail symptoms accompany the skin and arthritis symptoms. Nails may have small pinpoint pits or large yellowish separations of the nail plate called "oil spots." Nail psoriasis is typically very difficult to treat. Treatment option are somewhat limited and include potent topical steroids applied at the nail-base cuticle, injection of steroids at the nail-base cuticle, and oral or systemic medications as described below for the treatment of psoriasis.
The primary cause of psoriasis remains unknown. Many factors or a combination of factors, including genetic predisposition and environmental factors seem to be involved in its development. The immune system is thought to play a major role. Despite research over the last three decades looking at many triggers, the "master switch" that turns on psoriasis is still a mystery.
This condition is linked to rapid grown of cells in the skin's outer layer. These growths on the epidermis never mature. Whereas, a normal skin cell matures and passes from the bottom layer of the skin to the epidermis in about 28 days, psoriatic cells form in about 8 days, causing scaly patches that spread to cover larger and larger areas. The result of this disorder is the production of excessive numbers of skin cells in a very short time. The condition is not contagious.
Psoriasis generally follows a pattern of periodic flare-ups alternating with periods of remission, most commonly beginning between the ages of 15 and 25 years. Among other things, attacks can be triggered by the following:
Often hereditary, your genes play a major role in whether or not someone develops psoriasis and psoriatic arthritis. People who are closely related to someone with psoriatic arthritis are 50 times more likely to develop the disease themselves. Recent studies have located genetic markers shared by most people who have the disease.
DEFECTIVE IMMUNE SYSTEM RESPONSE
Current research points to an immune system role in psoriasis. Signals from a defect in the immune system may result in an overgrowth of skin cells. Because the cells grow faster than they can be shed, they "pile up" on the skin's surface. The excess skin cells are thought to cause the silvery white scales that are characteristic of plaque-type psoriasis.
Psoriasis begins in the immune system, mainly with a type of white blood cell called a "T" cell. The "T" cells help protect the body against infection and disease. With psoriasis, "T" cells are put into action by mistake and then they become so active that they set off other immune responses. This leads to swelling and fast turnover of skin cells. People with psoriasis may notice that sometimes the skin gets better and sometimes it gets worse. People with HIV and AIDS often have severe psoriasis.
Things that can cause the skin to get worse include: infections, stress, changes in weather that dries the skin, and certain medications.
INJURIES & STRESS
Sometimes injuries and/or emotional or nervous stress seem to set off psoriatic skin and psoriatic arthritis flare-ups. Illness, surgery, cuts, and poison ivy can trigger psoriasis. It tends to be more common in areas of trauma, repeat rubbing, use, or abrasions.
Infections also contribute to the disease. It is known that strep infections in children can cause psoriasis. Some researchers think that the arthritis may be an immune system response to bacteria from the skin lesions. Viral or bacterial infection and sunburn can act as triggers.
Overuse of drugs or alcohol can trigger psoriasis. The use of non-steroidal anti-inflammatories drugs, lithium, chloroquine (Aralen), and beta-blockers, a type of medication frequently prescribed for heart disease and high blood pressure can be linked to psoriasis flare-ups.
OTHER POSSIBLE UNDERLYING CAUSES
Psoriasis may result from a faulty utilization of fat. Psoriasis is rare in countries where the diet is low in fat. The build up of toxins in an unhealthy colon also have been linked to the development of psoriasis.
PSORIASIS RISK FACTORS
A risk factor is something that increases your chance of getting a disease or condition. Some risk factors for psoriasis are:
- Family history of psoriasis.
- Cold climates.
- Suppression of the immune system, including AIDS.
- Certain bacterial infections.
- Certain medications, such as beta blockers and lithium.
Psoriasis can be hard to diagnose because it can look like other skin diseases; so, the health practitioner might need to look at a small skin sample under a microscope to determine its existence. Psoriasis is more than cosmetic because it is a disease which is common, chronic, and costly, both in monetary terms and in quality of life. Psoriasis can be painful and can be profoundly disruptive to a person's life. People who do not have it usually do not understand how burdensome the disease can be because there is a constant shedding of scales. There can be functional impairment, itching, and pain with health complications; such as, arthritis which accompanies some cases.
Psoriasis is not currently curable. However, it can go into remission and show no signs of disease. Ongoing research is actively making progress on finding better treatments and a possible cure in the future.
Research studies have not shown it to be contagious from person to person. You cannot catch it from anyone, and you cannot pass it to anyone else by skin-to-skin contact. You can directly touch someone with psoriasis every day and never catch the skin condition. It is possible to pass psoriasis on to your children. Although psoriasis is not contagious from person to person, there is a known genetic tendency, and it may be inherited from parents to their children. It does tend to run in some families, and a family history is helpful in making the diagnosis.
Psoriasis cannot be prevented. Avoiding physical trauma to the skin, infections, and cold, dry temperatures may help reduce flare-ups in people with the condition. Your health care provider may advise you to avoid certain foods if they appear to make your psoriasis worse.
Your health care provider will ask about your symptoms and medical history, and perform a physical exam. Your skin and nails will be examined. There are no specific blood tests or diagnostic procedures for psoriasis. Sometimes a skin biopsy will be done to confirm the diagnosis.
Psoriasis undergoes "koebnerization," manifested by the appearance of lesions at sites of cutaneous trauma. Itching is the most common symptom, and extensive scratching can often lead to superimposed lichen simplex chronicus. In some patients, burning and pain may be the only symptoms.
Psoriasis can be classified into four types: plaque-type psoriasis, guttate psoriasis, localized pustular psoriasis and generalized pustular psoriasis. The less common forms of psoriasis include pustular (localized and generalized) and erythrodermic variants (a particularly inflammatory form of psoriasis that often affects most of the body surface).
The most common form is plaque-type psoriasis. The scale itself is variable, ranging from a thick, massive scale, as is generally seen on the scalp, to no scale at all, as is generally seen in intertriginous (where two skin areas may touch or rub together) or partially treated areas.
Guttate psoriasis is characterized by numerous small, oval (teardrop-shaped) lesions that develop after an acute upper respiratory tract infection. These lesions are often not as scaly or as red as the classic lesions of plaque-type psoriasis. Usually, guttate psoriasis must be differentiated from pityriasis rosea, another condition characterized by the sudden outbreak of red scaly lesions. Compared with pityriasis rosea, psoriatic lesions are thicker and scalier, and the lesions are not usually distributed along skin creases.
The diagnosis of psoriasis can usually be made on the basis of the clinical presentation; histologic confirmation is rarely needed. If the diagnosis is uncertain, a biopsy can be performed or consultation with a dermatologist can be obtained.
POST-DIAGNOSIS PATIENT EDUCATION
Once the diagnosis of psoriasis is made, patient education about the disease should begin. Points that should be emphasized about the disease initially include its non-contagious nature and the possibility of controlling but not curing it. Patients should also be assured that psoriasis is quite common. Exacerbating factors should be discussed, including stress, infection, trauma, xerosis and use of medications such as angiotensin-converting enzyme inhibitors, beta-adrenergic blockers, lithium and the anti-malarial agent hydroxychloroquine (Plaquenil).
CONVENTIONAL MEDICAL TREATMENT
There is no known cure for psoriasis. Treatment is aimed at reducing the symptoms and includes the use of ointments and creams to soften the scales combine with gentle scrubbing to remove them. There are many effective treatment choices for psoriasis. The best treatment is individually determined by the treating health care provider and depends, in part, on the type of disease, the severity, and the total body area involved.
- For mild disease that involves only small areas of the body (like less than 10-percent of the total skin surface), topical (skin applied) creams, lotions, and sprays may be very effective and safe to use. Occasionally, a small local injection of steroids directly into a tough or resistant isolated psoriasis plaque may be helpful.
- For moderate to severe disease that involves much larger areas of the body (like 20-percent or more of the total skin surface), topical products may not be effective or practical to apply. These cases may require systemic or total body treatments such as pills, light treatments, or injections. Stronger medications usually have greater associated possible risks.
- For psoriatic arthritis, systemic medications may be required. Topical therapies are not effective.
Sometimes ultraviolet light (UVL) therapy is used to retard the production of new skin cells. UVL therapy is sometimes combined with tar therapy. Tar is applied to the scaly patches, which are then exposed to UV light. A similar treatment involves using a drug called anthralin (Drithocreme, Dritho-Scalp) instead of tar in tandem with the UV light. Only the scales and skin debris, which can be quite itchy, can be removed. Psoralen plus ultraviolet light A (PUVA) is a therapy recommended for people who have not benefited from other therapies.
It is important to keep in mind that as with any medical condition, all medications carry possible side effects. No medication is 100 percent effective for everyone, and no medication is 100 percent safe. The decision to use any medication requires thorough consideration and discussion with your health care provider. The risks and potential benefit of medications have to be considered for each type of psoriasis and the individual patient. Some patients are not bothered at all by their skin symptoms and may not want any treatment. Other patients are bothered by even small patches of psoriasis and want to keep their skin clear. Everyone is different and, therefore, treatment choices also vary depending on the patient's goals and expressed wishes.
TYPES OF PSORIASIS, ASSOCIATED FINDINGS & TREATMENT OPTIONS TYPE OF PSORIASIS CLINICAL FEATURES PRECIPITATING
Red, thick, scaly lesions with silvery scale.
- Atopic Dermatitis
- Irritant Dermatitis
- Cutaneous T-Cell Lymphoma
- Pityriasis Rubra Pilaris
- Seborrheic Dermatitis
- Topical therapy with corticosteroids
- Calcipotriene (Dovonex)
- Coal Tars
- Anthralin (Anthra-Derm)
- Tazarotene (Tazorac)
- Systemic Agents
- Combination Therapy
- Pink to salmon color
- Scaly plaques; usually on the trunk
- With sparing of palms and soles.
- Streptococcal throat infection
- Pityriasis rosea
- Secondary syphilis
- Drug eruption
- Ultraviolet-B phototherapy
- Natural sunlight
Erythematous papules or plaques studded with pustules usually on palms or soles (known as palmoplantar pustular psoriasis).
- Pustular drug eruption
- Dyshidrotic eczema
- Subcorneal pustular dermatosis>
Same as for plaque-type psoriasis.
Same as localized with a more general involvement; may be associated with systemic symptoms such as fever, malaise and diarrhea; patient may or may not have had pre-existing psoriasis.
- Pustular drug eruption
- Subcorneal pustular dermatosis
Systemic therapy and/or hospitalization usually required.
Severe, intense, generalized erythema and scaling covering entire body; often associated with systemic symptoms; may or may not have had pre-existing psoriasis.
Stress, infection, medications.
Drug eruption, eczematous dermatitis, mycosis fungoides, pityriasis rubra pilaris.
Systemic therapy and/or hospitalization usually required.
Patient education about the disease and the treatment options is important. Medical treatment for localized psoriasis begins with a combination of topical corticosteroids and coal tar or calcipotriene. For lesions that are difficult to control with initial therapy, anthralin or tazarotene may be tried. The primary goal of therapy is to maintain control of the lesions. Cure is seldom achieved. If control becomes difficult or if psoriasis is generalized, the patient may benefit from phototherapy, systemic therapy and referral to a health care provider who specializes in the treatment of psoriasis.
A particularly effective approach to psoriasis has been commonly called "rotational" therapy. This is a common practice among some dermatologists who recommend changing cycles of psoriasis treatments every six to 24 months in order to minimize the possible side effects from any one type of therapy or medication.
For example, if a patient has been using oral methotrexate for two years, then it may be reasonable to take them off of methotrexate and try light therapy or a biologic injectable medication for a while. By rotating to a medication that doesn't affect the liver, the potential of liver damage may be reduced.
In another example, a patient who has been using strong topical steroids over large areas of their body for prolonged periods may benefit from stopping the steroids for a while and rotating onto a different therapy like calcipotriene (Dovonex), light therapy, or an injectable biologic.
Treatment is based on the severity of the disease, the extent and location of the areas involved and responsiveness to the treatment
- Scalp Hair: Bearing areas are not receptive to ointment vehicles. A topical corticosteroid and/or topical calcipotriene (Dovonex) in a solution vehicle are recommended, along with daily use of a tar shampoo.
- Nails: The thick keratin of the nail blocks absorption of topical agents. For onycholysis, a topical corticosteroid in a solution vehicle may be used under the nail. Systemic therapy may be required to improve severe disease.
- Genitalia: The thin skin of the genitalia is highly sensitive to the adverse effects (atrophy) of topical corticosteroids. A low-potency topical corticosteroid ointment is recommended. Topical calcipotriene, which is not associated with a risk of atrophy, may be used.
- Palms & Soles: The thick stratum corneum of palms and soles is a barrier to penetration of topical agents. A highest-potency topical corticosteroid is recommended. Methotrexate (Rheumatrex) or acitretin (Soriatane; a systemic retinoic acid analog) may be needed.
CREAMS & LOTIONS - TOPICAL APPLICATIONS
Many patients respond very well to treatments applied directly to the skin. Topical treatments include:
- Corticosteroid creams and ointments (most common treatment).
- Synthetic forms of vitamin D and retinoids (calcipotriene ointment 0.005).
- Retinoids (tazarotene gel 0.05 and 0.1%).
- Coal tar preparations.
- Bath solutions and moisturizers.
- Tacrolimus and pimecrolimus (especially for inverse psoriasis).
Topical (skin applied) medications include topical corticosteroids, vitamin D analogue creams (Dovonex), topical retinoids (Tazorac), moisturizers, topical immunomodulators (tacrolimus and pimecrolimus), coal tar, anthralin, and others.
- CORTISONE CREAMS, which discourage skin cells from multiplying, are often prescribed for psoriasis, but long-term use makes the skin thin and delicate. Topical corticosteroids (steroids, such as hydrocortisone) are very useful and often the first-line treatment for limited or small areas of psoriasis. These come in many preparations, including sprays, liquid, creams, gels, ointments, and mousses. Steroids come in many different strengths, including stronger ones are used for elbows, knees, and tougher skin areas and milder ones for areas like the face, underarm, and groin. These are usually applied once or twice a day to affected skin areas. Strong steroid preparations should be limited in use. Overuse or prolonged use may cause problems including potential permanent skin thinning and damage called atrophy.
- ACTIVATED VITAMIN D-3 & RETINOID OINTMENTS, available by prescription only, has produced good results for many people with severe forms of psoriasis. A vitamin D analogue cream called calcipotriene (Dovonex) has the advantage that it is not known to overly thin the skin like topical steroids. It is important to note that this drug is not regular vitamin D and is not the same as taking regular vitamin D or rubbing it on the skin. Calcipotriene may be used in combination with topical steroids for better results. There is a newer two-in-one combination preparation of calcipotriene and a topical steroid called Taclonex. Results with calcipotriene alone may be slower and less than results achieved with typical topical steroids. Not all patients may respond to calcipotriene as well as to topical steroids. A special precaution with calcipotriene is that it should not be used on more than 20 percent of the skin in one person. Overuse may cause absorption of the drug and an abnormal rise in body calcium levels.
- A study by Boston University of a drug called calcitriol (Rocaltrol) found it resulted in improvement when applied directly to the skin. This and other related drugs have potentially serious side effects.
- The drug etretinate (Tegison), a retinoid used for stubborn cases of psoriasis, can cause bone spurs in the knees and ankles. One study found that 84 percent of those who used this drug for 5 years had bony buildups causing stiffness and restriction of movement.
- MOISTURIZERS, especially with therapeutic concentrations of salicylic acid, lactic acid, urea, and glycolic acid may be helpful in psoriasis. These moisturizers are available as prescription and non-prescription forms. These help moisten and lessen the appearance of thickened psoriasis scales. Some available preparations include Salex (salicylic acid), AmLactin (lactic acid), or Lac-Hydrin (lactic acid) lotions. These may be used one to three times a day on the body and do not generally have a risk of problematic skin thinning (atrophy). Overuse or use on broken, inflamed skin may cause stinging, burning, and more irritation. These stronger preparations should not be used over delicate skin like eyelids, face, or genitals. Other bland moisturizers including Vaseline and Crisco vegetable shortening may also be helpful in at least reducing the dry appearance of psoriasis.
- IMMUNODULATORS (tacrolimus and pimecrolimus) have also been used with some success in limited types of psoriasis. These have the advantage of not causing skin thinning. They may have other potential side effects, including skin infections and possible malignancies (cancers). The exact association of these immunomodulator creams and cancer is controversial.
- BATH SALTS or bathing in high-salt-concentration waters like the Dead Sea in the Middle East may help some psoriasis patients. Some psoriasis sufferers have tried salt water to relieve their itchy or painful skin. Some have even made pilgrimages to the world's saltiest lake, the Dead Sea. According to Lawrence C. Parish, M.D., clinical professor of dermatology and cutaneous biology at Jefferson Medical College of Thomas Jefferson University in Philadelphia, he states that the Dead Sea is excellent for psoriatic treatment, but no one knows if the water itself has merit or whether the sun is the important part. As the lowest point on the planet, the Dead Sea region has unique weather and receives a distinctive spectrum of ultraviolet light from the sun. He also states that patients need to be reasonable about combining sun with salt and advises that patients visiting the Dead Sea wear a wide-brimmed hat and apply sunscreen several times a day. Epsom Salt soaks (available over the counter) may also be helpful for a number of patients. Soaking in bath water containing Dead Sea salts or Epsom salts may have limited value, but it can help remove the scales of psoriasis and make a person feel better. Overall, these are quite safe with very few possible side effects.
- COAL TAR is available in multiple preparations, including shampoos, bath solutions, and creams. Coal tar may help reduce the appearance and decrease the flakes in psoriasis. The odor, staining, and overall messiness with coal tar may make it harder to use and less desirable than other therapies. A major advantage with tar is lack of skin thinning.
- ANTHRALIN is available for topical use as a cream, ointment, or paste. If good control of psoriasis is not achieved with topical corticosteroids, alone or in combination with calcipotriene or coal tar, consideration should be given to the addition of anthralin or tazarotene therapy. Anthralin, also known as dithranol, is an anti-psoriatic topical preparation derived from wood tar. It has been available since 1916, but it is a second-line agent because of its irritating and staining properties.
Anthralin is available in 0.1 percent to 1 percent ointments, creams and solutions. It is generally used on notably thick, large plaques of psoriasis, and therapy is initiated at low concentrations for short periods. The concentration and duration of contact with each treatment is gradually increased, up to a maximum of 30 minutes per application. Anthralin can be combined with ultraviolet phototherapy; this is known as the traditional Ingram regimen.
Patients should be warned that anthralin has a tendency to stain any surface, including the skin, clothing and bathtub. Its use should be limited to well-demarcated plaques, and it should be applied with a cotton-tipped applicator or a gloved hand. Patients should be warned that normal skin surrounding the psoriatic lesion may become irritated if it comes in contact with anthralin. The stinging, possible irritation, and skin discoloration may make this less acceptable to use. Anthralin may be applied for 10 to 30 minutes to psoriatic skin.
- TAZAROTENE is the first topical receptor-selective retinoid approved for the treatment of psoriasis. It is available only in gel form and exerts its effects through gamma and beta retinoic acid receptors. Tazarotene helps to normalize the proliferation and differentiation of keratinocytes, as well as to decrease cutaneous inflammation. Once-daily application of tazarotene gel, 0.05 percent or 0.1 percent concentration, has been shown to be as effective as twice-daily application of 0.05 percent fluocinonide cream. As monotherapy, tazarotene has been shown to significantly reduce plaque elevation in mild to moderate psoriasis. However, because of its modest efficacy, slow onset of action and high potential for causing irritation, tazarotene should usually be used in combination with corticosteroids. The primary side effect of topical tazarotene is minor skin irritation and increased photosensitivity. Tazarotene is classified as a pregnancy category X drug and its use should be avoided in women of childbearing age.
- ACTIDERM, a skin patch manufactured by ConvaTec, can be applied over most topical psoriasis medications, especially steroid (cortisone) ointments, to make them more effective. The patch allows one to achieve better results with milder steroids and fewer doses.
Oral medications include acitretin, cyclosporine, methotrexate, mycophenolate mofetil, and others. Oral prednisone (corticosteroid) is generally not used in psoriasis and may cause a disease flare if administered to many patients.
- ACITRETIN (Soriatane) is an oral retinoids drug used for certain types of psoriasis and may be prescribed for people with severe psoriasis. It is not effective in all types of the disease. It is moderately effective and best for pustular psoriasis. It may be used in males and females who are not pregnant and not planning to become pregnant for at least three years since it is a potent teratogen. The major side effects include dryness of skin and eyes and temporarily elevated levels of triglycerides and cholesterol (fatty substance) in the blood. Blood tests are generally required before starting this therapy and periodically to monitor triglyceride levels. Hyperostosis (overgrowth of bone) may occur with long-term use. Patients should not become pregnant while on this drug for at least three years after stopping this medication.
- CYCLOSPORINE is a potent immunosuppressive drug used for other medical uses including organ-transplant patients. Cyclosporin (Sandimmune) therapy has been tested with good results in the treatment of psoriasis. It may be used for severe, difficult-to-treat cases of widespread psoriasis. Improvement and results may be very rapid in onset. It may be hard to get someone off of cyclosporine without flaring their psoriasis. Although cyclosporine is highly effective, careful monitoring is required. The long-term risk of renal toxicity, which may not be detectable by blood tests, limits long-term use. Because of the potential cumulative toxicity, cyclosporine should not be used for more than one to two years for most psoriasis patients. Major possible side effects include kidney and blood-pressure problems.
- METHOTREXATE, also sold as Rheumatrex, is a common drug used in rheumatology for rheumatoid arthritis and oncology for cancer treatment. Methotrexate has been used effectively for many years for severe cases of psoriasis. It is highly effective and can be used on a long-term basis. It is usually given in small weekly doses (5 mg to 15 mg). Blood tests are required before and during therapy. The drug may cause liver damage in some patients, particularly if there is pre-existing liver (hepatic) disease or if given with long-term use. Should not be used in non-compliant patients. Can cause acute or chronic hepatotoxicity, and acute neutropenia and pancytopenia. Close health care provider monitoring and monthly to quarterly visits and labs are generally required.
INJECTIONS & INFUSIONS - BIOLOGIC DRUGS
The newest category of injectable and infusion psoriasis drugs are called biologics. All biologics modulate (adjust) and sometime suppress (quiet) the immune system. These currently available drugs include Amevive, Humira, Remicade, Enbrel, Raptiva, and ustekinumab. Newer drugs are in development and may be on the market in the near future. Some biologics are self-injections for home use while others are intramuscular injections or intravenous infusions in the health care provider's office.
- Biologics have some screening requirements such as a tuberculosis screening test (TB skin test or PPD test) and other labs prior to starting therapy.
- Currently, all of the biologics except Raptiva are dosed as "one size fits all." Raptiva has weight-adjusted dosing, so patients with higher body weights get larger doses. Future testing may support dosage adjustments for other biologics based on weight or other factors.
- The FDA has approved a biological therapy, alefacept (Amervive), for psoriasis. Because this is a drug that alters the immune system, its use should be approached with caution. The drug must be administered by a health care provider and the usual course of treatment is one dose a week given for 12 weeks.
- As with any drug, side effects are possible with all biologic drugs. Common potential side effects include mild local injection-site reactions (redness and tenderness). There is concern of serious infections and potential malignancy with nearly all biologic drugs.
- Precautions include patients with known or suspected hepatitis B or C infection, active tuberculosis, and possibly HIV/AIDS. As a general consideration, these drugs may not be an ideal choice for patients with a history of cancer and patients actively undergoing cancer therapy.
- In particular, there may be an increased association of lymphoma in patients taking biologics. It is not at all certain if this association is directly caused by these drugs. In part, this is because it is known that certain diseases like rheumatoid arthritis or psoriasis may be associated with an inherent increase in the overall risk of some infections and malignancies.
- Biologics are expensive medications ranging in price from several to tens of thousands of dollars per year per person. Their use may be limited by availability, cost, and insurance approval. Not all insurance drug plans may fully cover these drugs for all conditions. Patients need to check with their insurance and may require a prior authorization request for coverage approval. Some of the biologics manufacturers have patient-assistance programs to help with financial issues.
The choice of the right injectable medication for your condition depends on many medical factors. Additionally, convenience of receiving the medication and lifestyle may be factors in choosing the right biologic medication.
BIOLOGIC DRUGS FOR PSORIASIS
Currently, the four main classes of biologic drugs for psoriasis are:
1. TNF-alpha blockers (tumor necrosis factor).
2. Drugs that block T-cell activation and the movement of T-cells.
3. Drugs that decrease the number of activated T-cells.
4. Drugs that interfere with interleukin mechanisms.
TUMOR NECROSIS FACTOR (TNF) BLOCKERS
TNF blockers include Enbrel (etanercept), Remicade (infliximab) and Humira (adalimumab). TNF-alpha blocking drugs may have an advantage of treating psoriatic arthritis and psoriasis skin disease. Their disadvantage is that some patients may notice a decrease effectiveness of TNF-alpha blocking drugs over months to years.
TNF blockers are generally not used in patients with demyelinating (neurological) diseases like multiple sclerosis, congestive heart failure, or patients with severe overall low blood counts called pancytopenia. The major side effect of these class of drugs is suppression of the immune system. Because of the increased risk of infections while on these drugs, patients should promptly report fevers or signs of infection to their health care providers. Minor side effects have included autoimmune conditions like lupus or flares in lupus. Additionally, it is best to avoid any live vaccines while using TNF blockers.
- ENBREL (etanercept) is a self-injectable medication for home use. It is injected via a small needle just under the skin, called subcutaneous injection. It is usually dosed once or twice week by patients at home after training with their health care provider or the nursing staff. Sometimes a higher loading dose is used for the first 12 weeks and then it is "stepped down" to half the dose after the first 12 weeks. Enbrel has the advantage of at least 16 years of clinical use and long-term experience.
- REMICADE (infliximab) is an intravenous (IV) medication strictly for health care provider office or special infusion medical center use. It is dosed specifically based on your weight. It is currently not for home use or self-injection. It is injected slowly over time via a small needle into a vein. It may usually be dosed once a week. There have been reports of antibodies to this drug in patients taking it for some time. These antibodies may cause a greater drug-dose requirement for achieving disease improvement or failure to improve. The IV route may be more time-consuming requiring a health care provider during the infusions. Remicade has the advantage of fast disease response and good potency.
- HUMIRA (adalimumab) is a self-injectable medication for home use. It is injected via a small needle just under the skin as a subcutaneous dose. It is usually dosed once every other week, totaling 26 injections in one year. Dosing is individualized and should be discussed with your health care provider. Sometimes a higher loading dose is used for the first dose (80 mg) and then it is continued at 40 mg every other week. It may give results as soon as one to two weeks of therapy. Humira has the advantage of at least 11 years of clinical use and long-term experience.
T-CELL BLOCKER DRUGS
T-Cell blocker drugs are drugs that block T-cell activation and the movement of T-cells.
- RAPTIVA (efalizumab) blocks both T-cell activation and the movement of T-cells into the skin. It is dosed specifically based on your weight. Labs are required before starting injections and weekly for the 12 weeks of therapy. Injections are placed just under the skin (subcutaneous) and may be given in the health care provider's office or at home. Raptiva seems to work well over several years without losing its effectiveness, therefore having the advantage of "staying power." Raptiva may cause flares of arthritis in some patients.
As with all biologics, Raptiva has been associated with possible infections and malignancy (cancer). The relative risk of these two side effects is fairly low. Raptiva may also cause a decrease or drop in the platelet (blood-clotting element) count. Platelet counts are usually checked before starting and periodically (often quarterly) while patients continue Raptiva. As with other biologics, live vaccines are not advised while patients are taking Raptiva. It is usually best to have any required vaccines weeks before starting therapy.
T-CELL DECREASING DRUGS
These are drugs that decrease the number of activated T-cells.
- AMEVIVE (alefacept) decreases the number of available activated T-cells that play a role in causing psoriasis. It is given intramuscularly (injected in the muscle) usually in the health care provider's office and given once a week for 12 weeks. Many patients may see improvement in their symptoms that lasts approximately 12 months (more or less). Amevive may not be uniformly effective for all patients, and some patients improve more than others. The average time to maximum improvement for many patients is about 14 weeks.
Amevive should generally not be used in patients with HIV infections as the drug causes a decrease in the CD4 cells (part of the immune system that HIV also attacks). Also, because of the immune-system suppression, Amevive may not be a good choice in patients with active cancer or infection.
INTERLEUKIN MECHANISM INTERFERENCE DRUGS
These are drugs that interfere with interleukin mechanisms.
- USTEKINUMAB is the newest biologic injectable medication used to modulate the immune system. It is an interleukin-12/23 human monoclonal antibody. Ustekinumab targets chemical messengers in the immune system involved in skin inflammation and skin-cell production. This drug is planned to be dosed subcutaneously (just under the skin) once a quarter (every three months). It has been very promising with very good clearance rates in the clinical trials thus far. A major advantage may be the convenience of a quarterly medication. The concerns for infection and malignancy may be similar to the other biologics.
LIGHT THERAPY (PHOTOTHERAPY)
Light therapy is also called phototherapy. There are several types of traditional medical light therapies called PUVA, UVB, and narrow band UVB. These artificial light sources have been used for decades and generally available in a health care provider's office. There are a few companies who may sell light boxes or light bulbs for prescribed home light therapy.
If psoriasis covers more than 30-percent of the body it is difficult to treat with topical medications alone. Daily, short, non-burning exposure to sunlight clears or improves psoriasis in many people. Sunlight is often included among initial treatments. Sun exposure in addition to topical therapy may be beneficial when multiple areas are affected with psoriasis. Patients should be encouraged to obtain natural sunlight exposure or tanning-bed light exposure for a few minutes a day, and then to slowly increase the duration of exposure as tolerated. Unaffected areas should be covered with a sunscreen, especially the face.
Ultraviolet light exposure can be used judiciously to prevent flare-ups during the maintenance phase of therapy.
A more controlled form of artificial light treatment (UVB phototherapy) is often used in more widespread cases. Ultraviolet B (UVB) light Used for many years, highly effective. May cause acute phototoxicity. Little to no long-term side effects. UVB can be used at home for maintenance therapy.
Alternatively, psoriasis can be treated with ultraviolet A (UVA light) and psoralen. Psoralen is an oral or topical medication that makes the body more sensitive to light. This treatment is known as PUVA. Psoralen plus ultraviolet A (PUVA) Highly effective; can be used as maintenance therapy. High risk of acute phototoxicity. Long-term risks include high risk of cutaneous malignancy.
Phototherapy can be very effective in controlling psoriasis but it requires frequent treatments. It may cause side effects such as nausea, headache, fatigue, burning, and itching. Both UVB and PUVA may increase the person's risk for squamous cell and, possibly, melanoma skin cancers. It is unclear whether UVB increases the risk of skin cancer.
- NATURAL SUNLIGHT is also used to treat psoriasis. Daily, short, controlled exposures to natural sunlight may help or clear psoriasis in some patients. Skin unaffected by psoriasis and sensitive areas such as the face and hands may need to be protected during sun exposure.
There are also multiple newer light sources like lasers and photodynamic therapy (use of a light activating medication and a special light source) that have been used to treat psoriasis.
- PUVA is a special treatment using a photosensitizing drug and timed artificial-light exposure. The photosensitizing drug in PUVA is called psoralen. These treatments are usually administered in a health care provider's office two to three times per week. Several weeks of PUVA is usually required before seeing significant results. The light exposure time is slowly and gradually increased during each subsequent treatment. Psoralens may be given orally as a pill or topically as a bath or lotion. After a short incubation period, the skin is exposed to a special wavelength of ultraviolet light called UVA. Patients using PUVA are generally sun sensitive and must avoid sun exposure for a period of time after PUVA.
Common side effects with PUVA include burning, tanning of the skin, potential skin damage, increased brown spots called lentigines, and possible increased risk of skin cancer including melanoma. The relative increase in skin cancer risk with PUVA treatment is controversial. PUVA treatments need to be closely monitored by a health care provider and discontinued when a maximum number of treatments have been reached.
- UVB PHOTOTHERAPY is an artificial light treatment using a special wavelength of light. It is frequently given daily or two to three times per week. UVB is also a component of natural sunlight. UVB dosage is based on time and exposure is gradually increased by 15 to 60 seconds per treatment or per week. Potential side effects with UVB include skin burning, skin damage, and possible increased risk of skin cancer including melanoma. The relative increase in skin cancer risk with UVB treatment needs further study.
Sometimes UVB is combined with other treatments such as tar application. Goeckerman is the name of a special psoriasis therapy using this combination. Some centers have used this therapy in a "day care" type of setting where patients are in the psoriasis treatment clinic all day for several weeks and go home each night.
- LONG-WAVE ULTRAVIOLET LIGHT has been effectively used to treat psoriasis, but it may increase the likelihood of skin cancer. exposure to the sun for 15 minutes to 30 minutes (not longer) may reduce the scaling and redness. A liquid drug called methoxsalen (Oxsoralen-Ultra) is also widely used.
COAL TAR THERAPY
Coal tar is a black viscous fluid that was first described by Goeckerman in 1925, when it was combined with ultraviolet light for the treatment of psoriasis. It is thought to suppress epidermal DNA synthesis. Coal tar is available as an ointment, cream, lotion, shampoo, bath oil and soap. Coal tar is most effective when it is used in combination with other agents, especially ultraviolet B light. Like calcipotriene, coal tar is effective when it is combined with topical corticosteroids. Coal tar shampoo can be used in combination with a corticosteroid scalp solution for the treatment of psoriasis on the scalp.
Because coal tar is messy and malodorous and can stain clothing, nighttime application is recommended. Patients should be advised to use old bed linens and to wear old pajamas when they are using coal tar. Tar products can cause folliculitis, but they otherwise are generally not associated with side effects.
If psoriasis is not controlled with topical therapy, more intensive treatment includes phototherapy, oral retinoids, methotrexate or cyclosporine.
Frequently used or well-studied combination therapies include:
- UVB plus topical calcipotriene (Dovonex).
- UVB plus topical coal tar.
- PUVA plus topical calcipotriene.
- PUVA plus retinoids.
- Acitretin plus topical calcipotriene.
- Cyclosporine plus topical calcipotriene.
Infrequently used or less well-studied therapies include:
- UVB plus methotrexate.
- PUVA plus methotrexate.
Psoriatic plaques that fail to respond to topical therapy may be improved by administration of intralesional corticosteroid injections. Triamcinolone (Kenalog) is often used for this purpose. The agent is injected directly into the dermis of a small, persistent plaque. The concentration is generally 3 to 10 mg per ml, depending on the size, thickness and area of the lesion. The dose of triamcinolone is released gradually over three to four weeks; additional injections may be needed every four to six weeks to improve the response. Disadvantages of intralesional injections include pain during the injection and potential side effects of local atrophy and systemic absorption.
The patient with refractory lesions may benefit from more advanced forms of treatment, such as phototherapy (ultraviolet B alone or psoralens plus ultraviolet A), outpatient treatment at a clinic specializing in psoriasis and systemic therapy with oral retinoids, methotrexate (Rheumatrex) or cyclosporine (Sandimmune). Combination therapy has also been shown to be effective, especially phototherapy in combination with topical anthralin, coal tar or calcipotriene.
CONSULTING A SPECIALIST
In all cases, the therapeutic goal is to maximize treatment efficacy and the patient's quality of life, while minimizing side effects. Achieving and maintaining control of psoriatic lesions is the central goal in treatment. Health care providers and patients need to understand that there is no definitive cure for psoriasis. Control of the disease may mean that lesions are not as thick or as red as they were before treatment, but some degree of erythema may remain. Most often, treatment does not result in complete clearing of the lesions.
Although a therapy plan serves as a guide to the treatment of localized psoriasis, various paths can be taken to achieve control of localized disease. The treatment path should be decided on a patient-to-patient basis. As mentioned previously, generalized psoriasis may require more complex forms of therapy. Consultation with a dermatologist may be beneficial for patients who require such therapy.
Outbreaks of psoriasis seem to lessen during the summer months. It may even go away on its own, but once you have had psoriasis, it is always possible that it will return.
Resent research has led some to believe that rapid growth of psoriatic cells can be attributed to problems with prostaglandin regulation and a deficiency of sulfur and fatty acids. Dr. Knud Kragballe used a mixture of omega-3 and omega-6 essential fatty acids to treat people with psoriasis. At the end of the 12-week test there was a moderate improvement of the skin condition in most cases. Some researchers disagree, but others have found fatty acids supplements to benefit skin disorders.
The freezing of moderately sized psoriatic lesions using liquid nitrogen has been tested with good results.
LONG-TERM PSORIASIS PROGNOSIS
Overall, the prognosis for most people with psoriasis is good. While it is not curable, it is controllable. There have been a few studies showing a possible association of psoriasis and other medical conditions, including obesity and heart disease.
Psoriasis research is heavily funded and holds great promise for the future. Just the last five to ten years have brought great strides forward in treatment of the disease with self-injectable medications called biologics. New biologics are in the pipeline including quarterly subcutaneous injections that modulate the immune system at different levels.
Researchers and health care providers are striving to learn more about psoriasis by studying genetics and new treatments that help the skin not to react to the immune system, and laser light treatment on thick patches. There is no cure for psoriasis, but a broad range of treatments is available to reduce the symptoms, clear up the skin, and send the disease into remission by using treatments that range from creams rubbed into the skin, to lasers that aim ultraviolet rays at the skin, to the newest treatments such as injectable drugs made from living cells.
Researchers continue to look for reasons why immune cells overreact and what genes may be responsible for psoriasis; hoping to find better treatments, and eventually a cure. Psoriasis research is aided by the visibility of the symptoms on the skin.
There are many ongoing clinical trials for psoriasis all over the United States and in the world. Many of these clinical trials are ongoing at academic or university medical centers and are frequently open to patients without cost.
Clinical trials frequently have specific requirements for types and severity of psoriasis that may be enrolled into a specific trial. Patients need to contact these centers and inquire regarding the specific study requirements. Some studies have restrictions on what recent medications have been used for psoriasis, current medication, and overall health.
Some of the many medical centers in the U.S. offering clinical trials for psoriasis include the University of California, San Francisco Department of Dermatology, the University of California, Irvine Department of Dermatology, and the St. Louis University Medical School.
Multiple sclerosis, Crohn's disease, rheumatoid arthritis, and type 1 diabetes are just a few of the diseases that may also benefit from psoriasis research.
National Institutes of Health National Psoriasis Foundation American Academy of Dermatology
Canadian Dermatology Association Psoriasis Society of Canada
PSORIASIS SUPPORT GROUP
The National Psoriasis Foundation (NPF) is an organization dedicated to helping patients with psoriasis and furthering research in this field. They hold national and local chapter meetings. The NPF website shares up-to-date reliable medical information and statistics on the condition.
DIETARY, NUTRITIONAL & HOLISTIC RECOMMENDATIONS
Eat a diet that is composed of 50-percent raw foods and includes plenty of fruits, vegetables and whole grains. Include fish in the diet as well.
Eat foods high in Sulfur, which helps to keep the skin smooth and youthful. Good sources include Garlic, Onions, Eggs, and Asparagus.
Consume plenty of yellow and orange vegetables. These are high in Beta-Carotene, a precursor of Vitamin A.
Drink at least 2 quarts of quality Water every day to keep the skin well hydrated.
Get plenty of dietary Fiber. Fiber is critical for maintaining a healthy colon. Many fiber compounds, such as Apple Pectin and Psyllium Husks, are able to bind to bowel toxins and promote their excretion in the feces. Also follow a program for colon cleansing. A clean, regularly functioning colon is very important for good health.
MoonDragon's Health Therapy: Colon Cleansing
Follow Essential Fatty Acids rich diet. Chronic dryness of the skin can indicate a lack of oils in the entire body. Ironically, it is possible to eat a very high-fat diet and still not provider your body with the type of essential fatty acids it needs. Use Fish Oils and Flaxseed, Black Currant, Borage, Avocado, Olive and Evening Primrose oils help to provide an abundance of beneficial fatty acids beneficial to skin health. Fish oil, flaxseed oil, and Primrose oil contain ingredients that interfere with the production and storage 'of arachidonic acid (AA), a natural substance that promotes the inflammatory response and makes the lesions of psoriasis turn red and swell. Red meat and dairy products contain AA, so you should avoid these foods.
Fresh, raw and unprocessed seeds and nuts are also rich in fatty acids. Take 1 tablespoon of oil or nuts daily; you may see an improvement in your skin in as little as 4 to 6 weeks.
Use cold-pressed Flaxseed, Sesame Seed, or Soybean oils.
Avoid fried foods, animal fats, and heat-processed vegetable oils such as those sold in supermarkets. Use cold-pressed oils only. Beware of any oils that have been subjected to heat, whether in processing or cooking. Heating oils leads to the production of free radicals, which may have a destructive effect on the skin. Do take supplemental Essential Fatty Acids. This may be the best supplement available for dry skin, but be patient; it may take a month or more to see results.
Do not consume citrus fruits, processed foods, saturated fats (found in meat and dairy products), sugar, or white flour.
Do not drink soft drinks or eat chocolate, potato chips or other junk foods.
Avoid alcohol and caffeine. These substances have a diuretic effect, causing the body - including the skin cells - to lose fluids and essential minerals.
For psoriatic outbreaks, apply seawater to the affected area with cotton several times a day.
LIFESTYLE RECOMMENDATIONS FOR TREATING GENERAL DRY SKIN PROBLEMS
Consult with your health care provider about these recommendations and make sure they are suitable for you and should be followed for your specific psoriatic skin problems. They are, however, recommended for general dry skin problems. For more information about dry skin, see the link below.
MoonDragon's Health & Wellness: Dry Skin
Do not smoke, and avoid secondhand smoke. Smoking has a harmful effect on the skin for several reasons. First, nicotine constricts the blood vessels, including the tiny capillaries that serve the skin. This deprives the skin of the oxygen and nutrients it needs for good health. Second, smoking involves the frequent repetition of certain facial postures, which eventually become etched in the skin in the form of wrinkles. The characteristic "smoker's face" has wrinkles radiating in a circle outward from the mouth. Smoking also can make the skin dry and leathery.
Do not use harsh soaps, cold cream, or cleansing creams on your skin. Cleansing creams are made from hydrogenated oils, which can cause free radical damage to your skin, resulting in dryness and wrinkles. Instead, use pure Olive, Avocado, or Almond oil to cleanse the skin. Pat the oil on, then wash it off with warm water and a soft cloth.
Twice weekly, use a loofah sponge for the face and warm water to boost circulation and remove dead skin cells. Avoid using the loofah around your eyes, however.
Always moisturize your skin after cleansing, and at other times throughout the day, if necessary, to keep it from drying out. Use a liquid moisturizer or facial oil that contains nutrients and other natural ingredients. Do not use solid, waxy moisturizing creams. Wrinkle Treatment Oil and Vitamin A Moisturizing Gel from Derma-E Products are both good for dry age lines caused by the sun and the skin's natural aging. The Wrinkle Treatment Oil is also good for cleansing the skin. The moisturizing gel is non-oily and fast-absorbing.
Look for skin care products that contain humectants. Humectants are substances that attract water to the skin to hold in moisture. Natural humectants include Vegetable Glycerine, Vitamin E, and Panthenol, a form of Pantothenic Acid (Vitamin B-5).
Humidifiers moisten the air. When the moisture in the room is too low, natural moisture is removed from skin (hands and entire body). You can avoid chapped, irritated skin by using an air humidifier.
Use a Humidifier (or even a pan of water placed near a radiator) to humidify your environment, especially in winter. This helps to reduce the amount of moisture lost from the skin through evaporation.
Once a week, use a facial mask to clarify the skin and remove dull, dry surface skin cells. (This can be done immediately after the facial sauna described under HERBS below.) Blend together well 1 teaspoon Green Clay powder and 1 teaspoon raw Honey. Apply the mixture to your face, avoiding the eye area. Leave it on for 15 minutes, then rinse well with lukewarm water. While your skin is still slightly damp, apply a natural skin oil or liquid moisturizer.
If your skin is chapped or cracked, increase your consumption of water and essential fatty acids. Keep any chapped areas well lubricated and protected from the elements.
For cracked, dry skin on the fingers, use Calendula cream or oil with Comfrey, Vitamin E oil, and Aloe Vera. Apply the mixture to hands at bedtime, then wear plastic gloves overnight.
Soaking your hands daily in Apricot-Kernal or Sweet Almond oil makes the hands soft and supple. Warm up 1 cup of the oil and soak your hands in it for 10 minutes. Then massage in the oil well.
Wear gloves while washing the dishes and doing housework to protect hands from harsh cleansers and detergents. For those with sensitive skin, cool temperatures and wind can dry and chap the hands, so wear gloves outside in the fall, winter and spring. Avoid using very hot water, and moisturize the hands frequently.
Hot water dries the skin. Hot water severely dries out the skin on your hands and your body and causes itching. If your hands are chapped, always wash them in lukewarm or cool water. Instead of regular soap, try using a mild Castile Soap, pH-Balanced Soap, or soap containing certain ingredients such as Calendula and Oatmeal. These products are readily available at health food stores or online and in body-care shops.
To care for combination skin, simply treat the dry areas as dry skin and the oily areas as oily skin. See Oily Skin for more information.
Allergies are often the culprit. Chronic dermatitis, severe itching, chapping, or blisters can be the result of allergies or extreme sensitivities. Eliminate the potential sources of allergens that might be present in lotions and soaps. These include coloring agents, synthetic oils, mineral oils, lanolin and fragrances.
Take 5 mg daily the skin protecting Biotin Vitamin in supplement form. Biotin is also contained in such foods as liver, soy flour, mushrooms, egg yolk, nuts, sardines, and almonds.
Take 1 tablespoon of Flaxseed Oil daily.
Take 30 to 60 mg Zinc 1 to 2 times daily.
Take 25,000-50,000 IU of Beta-Carotene every day.
See SUPPLEMENTS below for more recommendations.
OTHER SKIN-RELATED LINKS
MoonDragon's Health & Wellness Disorders: Acne
MoonDragon's Health & Wellness Disorders: Age Spots
MoonDragon's Health & Wellness Disorders: Dandruff
MoonDragon's Health & Wellness Disorders: Dermatitis
MoonDragon's Health & Wellness Disorders: Dry Skin
MoonDragon's Health & Wellness Disorders: Hives
MoonDragon's Health & Wellness Disorders: Intertrigo
MoonDragon's Health & Wellness Disorders: Nails
MoonDragon's Health & Wellness Disorders: Oily Skin
MoonDragon's Health & Wellness Disorders: Rosacea
MoonDragon's Health & Wellness Disorders: Seborrhea
MoonDragon's Health & Wellness Disorders: Skin Cancer
MoonDragon's Health & Wellness Disorders: Skin Rash
MoonDragon's Health & Wellness Disorders: Sunburn
MoonDragon's Health & Wellness Disorders: Wrinkles
HERBS FOR PSORIASIS PROBLEMS
Burdock Root and Red Clover cleanse the blood.
Poultice made from Chaparral, Dandelion, and Yellow Dock can help psoriasis.
To reduce swelling and redness, lightly brush of scales with a loofah and apply alcohol-free Goldenseal decoction or extract.
Lavender is good to use in a sauna or steam bath. It fights inflammation and soothes and heals irritated skin. Note: If you are pregnant or have heart disease or high blood pressure, do not use heat treatments. Lavender Essential Oil is strong antimicrobial and antibacterial and helps to heal wounds. As aromatherapy, lavender essential oil helps to calm anxiety and stress.
Sarsaparilla and Yellow Dock are good detoxifiers.
Silymarin (Milk Thistle) extract increases bile flow and protects the liver, which is important in keeping the blood clean. After medical research on the medicinal effects of Milk Thistle Seed, Germany's Commission E approved an oral extract of Milk Thistle as a treatment for liver disease which includes alcoholic hepatitis, fatty liver, mild liver cirrhosis, liver poisoning and acute viral hepatitis. Take 300 mg 3 times daily (adult dosage).
Wild Pansy is used to treat psoriasis.
Turmeric (Curcumin) has been found to be beneficial in treating psoriasis and other skin disorders.
SPICE SHOWS PROMISE AS POWERFUL SKIN DISEASE TREATMENT
Sep 1, 2005
By Lisette Hilton
Los Angeles - Curcumin - the potent yellow spice found in turmeric and curry powders - is effective in treating psoriasis as well as many other skin conditions, according to Madalene Heng, M.D.
Dr. Heng, professor of medicine/dermatology at the University of California, Los Angeles, School of Medicine, has developed curcumin psoriasis and antiaging products sold under the names Psoria-Gold and Re-Juven (OmniCure). Results of a recent University of Texas study indicate that curcumin effectively halts the growth of, and eventually kills, melanoma cells in culture. Clinical trials also are under way to test the spice's effects on colon cancer, pancreatic cancer, multiple myeloma and breast cancer.
Dr. Heng has already incorporated curcumin treatment into her practice as a treatment for all kinds of wounds, burns, sun-damaged skin, psoriasis, eczema and other inflammatory skin conditions. According to Dr. Heng, who has published many studies on the topic, it makes sense that curcumin would work on psoriasis.
The trigger for psoriasis is an injurious stimulus, which may be a wound, sunburn, allergic reaction or infection (bacterial, fungal or viral). The injury stimulus, usually together with a superimposed bacterial infection, triggers a wound healing response, leading to the generation of T lymphocytes, which generates tumor necrosis factor-alpha, new blood vessels, scar tissue and epidermal proliferation. These healing processes require a source of energy - namely, adenosine triphosphate, or ATP - which is generated from glycogen stores in the cells by phosphorylase kinase, an enzyme secreted five minutes after injury.
According to Dr. Heng, in normal non-psoriatic individuals, there is a switch-off mechanism for phosphorylase kinase, and after the wound is healed, phosphorylase kinase levels return to normal and the energy supply to the inflammatory process is curtailed. This returns the skin to normal except for some post-inflammatory changes such as erythema, scarring and pigmentation. In psoriatic individuals, the switch-off mechanism for phosphorylase kinase is defective due to a defective Type II cAMP protein kinase linked to a defective gene on the distal end of the 17th chromosome (17q) (Tomfohrde J et al. Science 1994;264:1141-1145; Tournier S et al. J Cell Physiol 1996; 167:196-203; Sozzi G et al. Genes Chromosomes Cancer 1994;9:244-250). Increased phosphorylase kinase levels results in increased phosphorylation reactions, leading to the increased breakdown of glycogen stores to ATP, correlating with an increased epidermal proliferation and psoriatic activity (Heng MCY et al. Br J Dermatol 1994;130:298-306).
"Curcumin, by lowering phosphorylase kinase levels in psoriatic epidermis, has been shown to result in resolution of psoriasis, and achieves this through decreasing the population of Ki-67 cells, i.e., cells capable of dividing, within the epidermis. (Heng MCY et al. Br J Dermatol 2000;143:937-949)," she says. "While curcumin-untreated psoriatic controls possess numerous Ki-67 cells, curcumin-treated psoriatic epidermis possess few Ki-67 cells (Heng MCY et al. Br J Dermatol 2000;143:937-949). The rapid epidermal turnover associated with numerous Ki-67 cells results in generation of stratum corneum in four days in untreated psoriatic controls, compared to 60 days in curcumin-treated psoriatics, suggesting that a major defect in psoriatic controls is loss of the epidermal barrier (resembling that of a jellyfish), compared to curcumin-treated psoriatics."
"In our patients, when the epidermal barrier is completely reformed (as shown by the skin appearance returning to normal), it has been observed that all treatment (including curcumin) may be stopped without recurrence of the psoriatic disease."
At this point, Dr. Heng says, there is plenty of preclinical anecdotal evidence showing curcumin's benefits and that it is safe; clinical data is now needed to make the spice a part of mainstream treatment.
SKIN CARE HERBS
Acne & Skin Disorders Formulas are herbal products used for acne and skin disorders containing herbs that are helpful for eczema and psoriasis as well.
Aloe Vera Gel from organically grown, unprocessed whole raw Aloe Vera can keep your skin looking clean, clear, smooth, toned, hydrated and glowing with health. Can also reduce the appearance of fine lines, wrinkles and sun damage.
Barberry is used for treating gallbladder disease, heartburn and indigestion and diarrhea. This herb can also be used to treat infections, parasites, psoriasis, and vaginitis.
Black Seed Oil is an excellent healer, and its areas of application range from external skin care (psoriasis, eczema, dry skin, joints & scalp massage) and to internal use as a treatment for various complaints (asthma, arthritis, immune system). Research shows that Black Seed contains more than 100 components, some of which are still unidentified, that work together synergistically. Suitable natural alternative for all types of allergic and infectious disorders of the respiratory tract, such as asthma, allergies, chronic bronchitis, emphysema, hacking cough, and other cold-like symptoms.
Black Seed with Garlic promotes healthy circulation, useful for arthritis and cardiovascular & respiratory support. It also supports digestion and is a natural remedy for ulcers. Garlic is known to lower cholesterol naturally.
Blood Cleanse is a blend of five powerful blood purifiers that remove toxins from the blood, lymphatics and liver, leading to vibrant, healthy skin. According to Ayurveda, most inflammatory skin conditions are a result of high pitta in the blood. Blood cleanse is formulated to remove this excess pitta, hus relieving skin irritations. It increases circulation and promotes healing as it clears out foreign tissues, obstructions and stagnant blood. Blood Cleanse also helps calm pitta emotions such as anger and aggression.
Burdock Root is used is traditionally used for skin disorders associated with adolescence. It is also one of the most effective herbs for cleansing the blood without the side effect of nausea. Burdock Root tincture is an herbal treatment for psoriasis and a promising HIV herb, Burdock is also a blood purifier.
A naturally therapeutic hand creme that combines Honey, a natural humectant, and vitamin rich Grapeseed oil to moisturize and rebalance dry, damaged hands.
Hand Salve made from Sweet Almond Oil, Olive Oil and Beeswax, with Vitamin E, Comfrey Root extract, Rosemary, Lavender, Eucalyptus essential oils added for their healing and soothing properties. It is perfect for those who work outdoors in gardens or on farms.
Cocoa Butter is used in confections and in the manufacture of tobacco, soap, and cosmetics. By itself, it is used to improve skin elasticity and to reduce wrinkles.
Colloidal Silver is effective for minor skin irritations, rashes hives, insect bites, sores, burns, inflammation, skin swelling and dry, itchy, cracked skin.
Comfrey Leaf is one of the most well-known healing plants, especially for its ability to heal tissue and bone.
Dandelion root is known as a blood purifier used for liver and kidney disorders. Dandelion root also contains nutritive salts to build up the blood.
Boericke & Tafel Florasone Cream is a homeopathic eczema cream is fast acting, pleasant to use, non-greasy and absorbs quickly.
Unscented Emu Oil Soap Bar is moisturizing, condition, non-irritating, and accompanied with all the benefits of emu oil. Emu Oil is a natural skin softener and protector. This pure Emu Oil supports skin hydration and elasticity and improves skin surface blood flow & healing.
Flaxseed Oil is a rich, vegetarian source of omega-3 and omega-6 essential fatty acids beneficial for many ailments.
Hyaluronic Acid Hydraplenish With MSM & BioCell Collagen is a vegetarian product. Hyaluronic Acid Hydraplenish contains the patented BioCell Collagen II complex for healthy connective tissue and synovial fluid plus Opti MSM to support healthy hair.
Jojoba Oil is a chemically waxy ester that is derived from the desert plant Simmondsia chinensis and is great for skin and hair.
Kombucha is well known for its health-supporting properties. People from all over the world claim drinking Kombucha Tea provides relief from many physical ailments. Kombucha Tea Extract drops are very convenient and portable. Take them anytime, anyplace; work, traveling or at home. Kombucha's benefits to the physical body vary widely. It is said to enhance the immune system. By detoxifying the body, kombucha makes it unlikely for disease causing bacteria and viruses to find a suitable growth environment. This results in a healthier physical body.
Pure Lanolin can be used like petroleum jelly on chapped skin and as a moisturizer When rough, troubled, chapped patches of skin. Pure lanolin is considered a heavy duty moisturizer.
MSM (Methylsulfonylmethane) helps moisturize the scalp and hair. Great for itchy scalp, dandruff, dermatitis and psoriasis. MSM is a special biological sulfur needed by the body to maintain beautiful, strong and healthy hair. MSM shampoo is thick, concentrated and adds body and life to all types of hair.
Neem leaf exrract & Aloe Vera gel have been used for centuries in the treatment of skin disorders. Neem Leaf & Oil Lotion is great for irritated, itchy and sensitive skin. Neem leaf enhances overall health, improves immune system response and supports healthy bowel function. Neem Leaf Extract utilizes pure, natural grain alcohol. One to three times per day take 5 to 20 drops. May be taken in water, juice, undiluted or sublingually. May be used topically. Neem Oil for the Garden is used for organic gardening as an insect-repelling. Neem Oil Hair Conditioner is the perfect companion to our Neem Oil Shampoo. Therapeutic Neem Shampoo has been specially formulated to clean gently, with no harsh chemicals, soaps or synthetic, waxy thickeners. Whole Neem Oil, Leaf & Bark Soap is the ultimate neem experience! For super sensitive skin.
Nutribiotic Skin Care ointment with GSE can be used topically for such things as scrapes, scratches and cuts. NutriBiotic Skin Ointment with GSE can also be used on the lips and in the mouth on cold sores and canker sores.
Oatmeal, Lavender & Neem Oil soap made with saponified oils of Olive Oil and/or high oleic Safflower Oil, Palm Oil, Coconut Oil, Avocado Oil, Shea Butter and Jojoba Oil, Lavender Essential Oil and Rosemary Extract is recommended for sensitive skin.
Bee Propolis & Tea Tree ointment is especially helpful in assisting tissue repair after burns. It can be applied directly to the skin to help the healing process.
Psorzema Cremes and other related products by Derma-e, is a safe and an effective blend of herbal extracts and vitamins that provide natural relief from symptoms of scaling, flaking, itching and irritated dry skin associated with these conditions. Neem, Vitamin A, Vitamin E, and Bearberry are among the many healing natural ingredients that are used in this pleasant moisturizing creme. Does not contain steroids or coal or pine tars.
Psoriaflora Psoriasis Cream is a homeopathic preparation by Boericke & Tafel. A topical cream that helps provide relief and is a natural alternative for psoriasis.
Pure Shea Butter is derived from the seeds of the Karite Nut of the Mangifolia Tree in Africa. A powerful emollient, pure Shea Butter can be used alone as a moisturizer or as a lip balm.
Tea Tree cream has a antiseptic soothing and cooling effect on inflamed skin. It can be used as diaper change lotion. Tea Tree Liquid Castile Soap is great for acne and other skin conditions. Dr Bronner's Tea Tree Soap is a true castile soap in a bar form or liquid soap made with organic oils.
Unkers Medicated Salve has been providing healing and relief for over 60 years. It works great for arthritis, sore muscles and joints, cuts, burns, bruises, throat congestion, sinus problems, psoriasis, and much more.
Urea Cream contains between 20 to 40 percent urea, dermatologist recommended, which has been medically proven in various clinical studies to have extraordinary moisturizing, anti-fungal and anti-microbial properties. It is helpful for dry, cracked, calloused skin, providing needed moisturizing, softening hardened skin tissues and providing healing and pain relief. It promotes smooth, beautiful, wrinkle-free, younger-looking skin.
Yellow Dock root is one of the best blood cleansing herbs for chronic skin diseases, purges lymph glands, liver ailments, psoriasis, anemia, rheumatism, coughs and helps with Iron deficiency. Yellow Dock is an excellent blood-builder as its iron content is easily digestible and it contains up to 40% iron compounds.
HERBS FOR DRY SKIN PROBLEMS
Used topically, Aloe Vera has excellent soothing, healing, and moisturizing properties. It also helps to slough off dead skin cells. Apply aloe vera gel topically on affected areas as directed on the product label.
Calendula and Comfrey have skin-softening properties. They can be sued in a facial sauna or to make herbal or floral waters. Comfrey also reduces redness and soothes irritated skin. Allantoin, an ingredient in many skin care products, is derived from comfrey. Note: Comfrey is recommended for external use only.
Calendula Oil for chapped hands. Calendula is a type of marigold that's very easy to grow and has skin-healing properties. Pick a handful of the barely opened flowers on a dry day and put them in a blender. Add enough olive oil to cover the flowers and purée. Store in a glass jar away from direct heat, and shake daily for several weeks. You can add more blossoms and Olive Oil over the weeks. When the oil has taken on a deep orange color, strain it a few times. Apply to chapped skin as needed.
Olive Oil moisturizer for supple skin. The fatty compounds in olive oil soothe chapped hands, promote the regeneration of skin cells and help to seal in the skin's natural moisture. Each night before you go to sleep, coat your hands with a thick layer of olive oil. Put on a pair of light, cotton gloves. In the morning, rinse your hands.
Spray an herbal or floral water mist on your skin throughout the day to replenish lost moisture. Almost all skin types, but particularly dry skin, benefit from lavender. You can purchase Lavender Water (Hydrosol) already made, or you can make your own by adding a few drops of Lavender Essential Oil to 4 ounces of distilled Water, or by making an infusion of fresh Lavender leaves and flowers.
A weekly facial sauna using the herbs Chamomile, Lavender, and Peppermint is good for dry skin. Using a glass or enameled pot, simmer a total of 2 to 4 tablespoons of dried or fresh herbs in 2 quarts of water. When the pot is steaming, place it on top of a trivet or thick potholder on a table, and sit with your face at a comfortable distance over the steam for 15 minutes, splash your face with cold water and allow your skin to air dry or pat it dry with a towel. Then either apply a good natural moisturizer or facial oil, or apply a Clay mask. After the sauna, you can allow the herbal water to cool and save it for use as a toning lotion to be dabbed on your face with a cotton ball after cleansing.
ALL-PURPOSE HEALING SALVE
To make an all-purpose healing salve for dry, irritated or inflamed skin, mix in a pot:
4 tablespoons Calendula Oil
4 tablespoons Comfrey Oil
4 tablespoons Arnica Oil
4 tablespoons Vitamin E Oil
Gently warm the oils on the stove or in a microwave oven. Melt 1/3 ounce of Beeswax in a double boiler. Mix the herbal oil and beeswax together, pour into glass jars and cool.
MoonDragon's Health Therapy: Herbal Preparations - Making Your Own Preparations
PSORIASIS & SKIN CARE NUTRITIONAL SUPPLEMENTS
Unless otherwise specified, the dosages recommended in this section are for adults. For a child between the ages of 12 and 17 years, reduce the dose to 3/4 the recommended amount. For a child between 6 and 12, use 1/2 the recommended dose, and for a child under the age of 6, use 1/4 the recommended amount.
NUTRIENTS Supplement Suggested Dosage Comments
Essential Fatty Acids As directed on label. 3 times daily. Important for all skin disorders. Aids in preventing dryness. Vitamin A 25,000 IU daily. Caution: If you are pregnant, do not exceed 10,000 IU daily. Helps prevent dry skin. Strengthens and protects the skin tissue. Beta Carotene & Natural Carotenoid Complex 15,000 IU daily. Helps prevent dry skin and aids in healing of tissue. Potent antioxidant and precursor of Vitamin A. Vitamin D-3 400 to 1,000 IU daily, or as directed by health care provider. Aids in healing of tissues. Essential for hormones vital for healthy skin. Zinc 50 to 100 mg daily. Do not exceed a total of 100 mg daily from all supplements. Protein metabolism depends on zinc. The skin is composed primarily of protein and protein is needed for healing. Use zinc gluconate lozenges or OptiZinc for best absroption. Copper 3 mg daily. Needed to balance with Zinc. ACES Plus Zinc As directed on label. Contains antioxidants that protect the skin by neutralizing free radicals.
Proteolytic Multi-Enzymes As directed on label. Keeps down inflammation and destroys free radicals. Stimulates protein synthesis and repair. Selenium 200 mcg daily. Do not exceed this amount. If you are pregnant, do not exceed 40 mcg daily. Has powerful antioxidant properties. Shark Cartilage 1 gram per 15 lbs of body weight daily, divided into 3 doses. If you cannot tolerate taking it orally, it can be administered in a retention enema. Inhibits the growth of blood vessels to stop the spread of psoriasis. Itching and scaling clear first, then redness fades. Allow 2 to 3 months to see results. Vitamin B Complex 50 to 100 mg of each major B vitamin 3 times daily, with meals (amounts of individual vitamins in a complex will vary). B vitamins are needed for healthy skin and hair. Anti-stress and anti-aging vitamins. Aids in reproduction of all cells. Use a high-stress formula, yeast free formula. Vitamin B-1
50 mg 3 times daily in addition to B-Complex. B vitamins are needed for repair and healing of skin tissue and healthy skin. Vitamin B-5
(Pantothenic Acid / Panthenol)
100 mg 3 times daily in addition to B-Complex. Aids in proper adrenal function, relieving stress on this organ. Plus Extra
50 mg 3 times daily. Deficiency has been linked to skin disorders. Aids in reducing fluid retention, keeping down infections. Plus
2,000 mcg daily. Aids in cell formation and cellular longevity. B-Vitamins are needed for healthy skin. Use a lozenge or sublingual form. Folic Acid 400 to 800 mcg daily. Affects the repair of DNA. Vitamin C With Bioflavonoids 2,000 to 10,000 mg daily, in divided doses. Necessary for collagen production and formation of skin tissue, and for enhancing the immune system. Inhibits inflammation and stabilizes cell membranes. An important antioxidant to prevent tissue damage to the skin and to aid in healing and improve health of skin. Vitamin E 200 to 1,200 IU daily. A potent antioxidant. Neutralizes free radicals that damage skin. Use emulsion form for easier assimilation. Use D-Alpha-Tocopherol form.
Kelp 1,000 to 1,500 mg daily. Supplies balanced minerals. Needed for good healthy skin. A good source of Iodine and other minerals needed for tissue repair and healing. MSM
As directed on label. Needed for tissue repair. Often deficient in people with this disorder.
Glutathione 500 mg twice daily, on an empty stomach. A powerful antioxidant that inhibits the growth of psoratic cells. Herpanacine As directed on label. Contains antioxidants, amino acids, and herbs that promote overall skin health. Lecithin Granules: 1 tablespoon 3 times daily, before meals.
Capsules: 1,200 mg 3 times daily, before meals.
Fat emulsifiers. Lecithin also protects the cells. Needed for better absorption of the essential fatty acids. Or
200 to 500 mg daily.< Fat emulsifiers. Protects the cells. MultiVitamin Complex As directed on label. All nutrients are needed in balance for healing and for immune response. Calcium 1,500 mg daily. Essential for normal cell division and function. Magnesium 750 mg daily. Essential for normal cell division and cell function. Helps uptake of calcium. Bovine Cartilage As directed on label. Use pure bovine. Has been shown to be useful in improving psoriasis. Aloe Vera As directed on label. Has excellent soothing, healing, and moisturizing properties. Helps to slough off dead skin cells. Apply aloe vera gel topically on affected areas. Collagen Apply topically as directed on label. Good for very dry skin. A nourishing cream that can restore a healthy tone to damaged skin. Pycnogenol
As directed on label. Powerful antioxidants and anti-inflammatory that also strengthens collagen.
NOTIFY YOUR HEALTH CARE PROVIDER
If you or a family member are or have symptoms of dry skin with flaking and inflammation and need evaluation or if you have been diagnosed with psoriasis and feel you need to have medical assistance to help alleviate the problem.
If you or a family member experiences severe chapping, cracking and/or bleeding of broken skin.
If you or a family member experience symptoms of infection from broken skin.
If You have any unexpected or unusual symptoms. Some people may have sensitivity, allergies, or other health conditions which would prevent them from using certain medications, herbs, or other treatments. Some medications used may produce side effects.
QUALITY PRODUCTS & SUPPLEMENTS
SKIN CARE-RELATED PRODUCTS
Supplements and products for Psoriasis, Skin Rash, Eczema and Dermatitis, a group of skin conditions that causes inflammation of the skin.
Acidophilus Products Alfalfa Herbal Products AlkaMax Supplement Products Almond (Sweet) Herbal Oil Products Aloe Vera Herbal Products Alpha-Hydroxy Acids Products Apple Cider Vinegar Products Barberry Herbal Products Barley Grass Herbal Products Bee Propolis Products Bergamot Essential Oil Products Beta Carotene Supplement Products Bifidus Supplement Products Bioflavonoid Supplement Products Biotin Supplement Products Black Salve Herbal Products Blood Cleanse Detox Products >Bringraj-Bhringaraj Herbal Products Burdock Herbal Products Calendula Herbal Products Carotenoid Complex Products Cayenne Herbal Products Chamomile Herbal Products Chamomile Essential Oil Products Chaparral Herbal Products Chaste Tree (Vitex) Herbal Products Chlorella Herbal Products Chlorophyll Supplement Products Chromium Supplement Products Clay Cosmetic Products CoEnzyme A Supplement Products Colloidal Silver Products Comfrey Herbal Products Coptis Herbal Products Cysteine & NAC Products Dandelion Herbal Products dioxychlor">Dioxychlor Supplement Products Dimethylsulfoxide (DMSO) Products Echinacea Herbal Products EFA Complex Products Eucalyptus Herbal Products Evening Primrose Herbal Oil Products Fennel Seed Herbal Products Fiber Supplement Products Flaxseed Herbal Products Flaxseed Herbal Oil Products Garlic (Kyolic) Supplement Products Germanium Supplement Products Goldenseal Herbal Products Greens Supplement Products Guggul Herbal Products HCl Betaine Supplement Products Herbal Detox Products Herpanacine Supplement Products Honey Products Horsetail Herbal Products InflaZyme Forte Products Jojoba Herbal Oil Products
Kombucha Herbal Products Kyo-Green Supplement Products Lavender Essential Oil Products Lavender Herbal Products Lavender Hydrosol Products Lecithin Supplement Products Lemon Balm Essential Oil Products Licorice Herbal Products Lime Essential Oil Products Milk Thistle Herbal Products MSM Supplement Products Multi-Enzyme Supplement Products Neem Herbal Products Neem Herbal Oil Products Olive Leaf Herbal Products Oregon Grape Herbal Products Oxy Supplement Products Peppermint Essential Oil Products Potassium Supplement Products Psoriasis Relief Products Red Clover Herbal Products Rose Essential Oil Products Rose Herbal Products Rosewater Hydrosol Products Rosewood Essential Oil Products Royal Jelly Bee Products Rutin Supplement Products Saw Palmetto Herbal Products Selenium Supplement Products Shark Cartilage Supplemet Products Skin Care Products Skin Rash Relief Products Speedwell (Veronica) Herbal Products Spirulina Supplement Products Strawberry Leaf Herbal Products Surakta Herbal Products Tamanu Herbal Oil Products Tea Tree Essential Oil Products Thyme Essential Oil Products Thyme Herbal Products Ultimate Oil Supplement Products Violet Leaf (Wild Pansy) Herbal Products Vitamin A Supplement Products Vitamin B-Complex Supplement Products Vitamin B-3 Supplement Products Vitamin B-5 Supplement Products Vitamin B-6 Supplement Products Vitamin C Supplement Products Vitamin D Supplement Products Vitamin E Supplement Products Walnut (Black) Herbal Products Watercress Herbal Products Wheat Germ Herbal Oil Products Wheatgrass Herbal Products Witch Hazel Herbal Products Yarrow Essential Oil Products Yellow Dock Herbal Products Zinc Supplement Products
PSORIASIS RELIEF PRODUCTS
HerbsPro: Psoriasis Cream, Home Health, 2 fl oz.
Contains 2-percent salicylic acid in a base of allantoin, beeswax, cetyl alcohol, grapefruit extract, cod liver oil, cymbopogon schoenanthus oil, echinacea angustifolia extract, rosa canina fruit oil, rumex crispus root extract, jojoba seed oil, similax aristolochifolia root extract, and vitamin e. Absorbs quickly, paraben-free without preservatives, mineral oils, petroleums, artificial color, artifical fragrance and no gluten.
HerbsPro: Eczema & Psoriasis Cream, Natralia, 2 oz.
Natralia Nourish Eczema & Psoriasis Cream has been formulated with natural ingredients for the management of the symptoms of Eczema, Psoriasis and Dermatitis. It does not contain gluten or milk derivative, yeast, artificial colours, SLS, parabens, nut oils and artificial flavor. Is a balanced blend of natural herbs, essential oils and homoeopathic ingredients. It is a mild soothing moisturising cream for the relief of dry, itchy or sensitive skin due to extreme dryness. Formulated with natural ingredients to provide topical relief with emollient and therapeutic properties. Formulated with specifically chosen homoeopathic ingredients, herbal extracts and essential oils for the symptomatic relief of eczema and psoriasis. Gentle formula. Suitable to use on the face and body.
HerbsPro: Natural Psoriasis & Dermatitis Cream, Grahams Natural Alternatives, 2 oz
HerbsPro: Oxipor Psoriasis Lotion, 4 oz.
Coal Tar solution used to control itching, relieve redness and scaling.
HerbsPro: Psoria-derm Psoriasis Cream, Dr. Zhang's Formula, 4 oz.
Homeopathic formula, non-greasy, does not stain.
HerbsPro: Dermarest Psoriasis Medicated Skin Treatment, 4 oz.
With skin soothing zinc complex, relieves itchy and irritated skin, restores moisture, reduces redness, removes scales, fragrance free and dermatologist tested formula.
HerbsPro: Dermazinc Zinc Therapy Spray Drops For Psoriasis, 4 oz
For relief of itching, redness, irritation, scaling and flaking associated with seborrheic dermatitis and dandruff. Relief in 7 to 10 days. Dermatologist recommended and prescribed. Formerly available through physicians only.
HerbsPro: Sal Shampoo, DML, 4 oz.
Shampoo with 3-percent salicylic acid. Relieves symptoms of psoriasis and seborrheic dermatitis.
HerbsPro: Eczema & Psoriasis Wash, Natralia, 7 fl. oz.
Concentrated bath and shower formula containing 0.2-percent ethanol w/w, for the relief of skin irritation, itching, flaking & dryness. Natural homeopathic alternative. Naturally Australian, new non-steroidal. Suitable for use on children.
HerbsPro: Pine Tar Shampoo, Grandpa's Brands Company, 8 fl. oz.
Since 1878, helps to remove flakes of dandruff, seborrhea & psoriasis.
Amazon: Psoriasis Products
Amazon: Skin Rash Relief Products
Amazon: Diaper Skin Rash Relief Products
Amazon: Itching & Rash Relief Products
Amazon: Eczema, Psoriasis & Rosacea Care Products
SKIN RASH RELIEF PRODUCTS
Amazon: Skin Rash Relief Products
Amazon: Diaper Skin Rash Relief Products
Amazon: Itching & Rash Relief Products
Amazon: Eczema, Psoriasis & Rosacea Care Products
AROMATHERAPY: ESSENTIAL OILS DESCRIPTIONS & USES
Allspice Leaf Oil Angelica Oil Anise Oil Baobab Oil Basil Oil Bay Laurel Oil Bay Oil Benzoin Oil Bergamot Oil Black Pepper Oil Chamomile (German) Oil Cajuput Oil Calamus Oil Camphor (White) Oil Caraway Oil Cardamom Oil Carrot Seed Oil Catnip Oil Cedarwood Oil Chamomile Oil Cinnamon Oil Citronella Oil Clary-Sage Oil Clove Oil Coriander Oil Cypress Oil Dill Oil Eucalyptus Oil Fennel Oil Fir Needle Oil Frankincense Oil Geranium Oil German Chamomile Oil Ginger Oil Grapefruit Oil Helichrysum Oil Hyssop Oil Iris-Root Oil Jasmine Oil Juniper Oil Labdanum Oil Lavender Oil Lemon-Balm Oil Lemongrass Oil Lemon Oil Lime Oil Longleaf-Pine Oil Mandarin Oil Marjoram Oil Mimosa Oil Myrrh Oil Myrtle Oil Neroli Oil Niaouli Oil Nutmeg Oil Orange Oil Oregano Oil Palmarosa Oil Patchouli Oil Peppermint Oil Peru-Balsam Oil Petitgrain Oil Pine-Long Leaf Oil Pine-Needle Oil Pine-Swiss Oil Rosemary Oil Rose Oil Rosewood Oil Sage Oil Sandalwood Oil Savory Oil Spearmint Oil Spikenard Oil Swiss-Pine Oil Tangerine Oil Tea-Tree Oil Thyme Oil Vanilla Oil Verbena Oil Vetiver Oil Violet Oil White-Camphor Oil Yarrow Oil Ylang-Ylang Oil Aromatherapy
Healing Baths For Colds
Using Essential Oils
AROMATHERAPY: HERBAL & CARRIER OILS DESCRIPTIONS & USES
Almond, Sweet Oil Apricot Kernel Oil Argan Oil Arnica Oil Avocado Oil Baobab Oil Black Cumin Oil Black Currant Oil Black Seed Oil Borage Seed Oil Calendula Oil Camelina Oil Castor Oil Coconut Oil Comfrey Oil Evening Primrose Oil Flaxseed Oil Grapeseed Oil Hazelnut Oil Hemp Seed Oil Jojoba Oil Kukui Nut Oil Macadamia Nut Oil Meadowfoam Seed Oil Mullein Oil Neem Oil Olive Oil Palm Oil Plantain Oil Plum Kernel Oil Poke Root Oil Pomegranate Seed Oil Pumpkin Seed Oil Rosehip Seed Oil Safflower Oil Sea Buckthorn Oil Sesame Seed Oil Shea Nut Oil Soybean Oil St. Johns Wort Oil Sunflower Oil Tamanu Oil Vitamin E Oil Wheat Germ Oil
HELPFUL RELATED MOONDRAGON NUTRITION BASICS LINKS
MoonDragon's Nutrition Basics Index MoonDragon's Nutrition Basics: Amino Acids Index MoonDragon's Nutrition Basics: Antioxidants Index MoonDragon's Nutrition Basics: Enzymes Information MoonDragon's Nutrition Basics: Herbs Index MoonDragon's Nutrition Basics: Homeopathics Index MoonDragon's Nutrition Basics: Hydrosols Index MoonDragon's Nutrition Basics: Minerals Index MoonDragon's Nutrition Basics: Mineral Introduction MoonDragon's Nutrition Basics: Dietary & Cosmetic Supplements Index MoonDragon's Nutrition Basics: Dietary Supplements Introduction MoonDragon's Nutrition Basics: Specialty Supplements MoonDragon's Nutrition Basics: Vitamins Index MoonDragon's Nutrition Basics: Vitamins Introduction
NUTRITION BASICS ARTICLES
MoonDragon's Nutrition Basics: 4 Basic Nutrients MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute? MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods MoonDragon's Nutrition Basics: Foods That Destroy MoonDragon's Nutrition Basics: Foods That Heal MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods MoonDragon's Nutrition Basics: Phytochemicals MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce MoonDragon's Nutrition Basics: Limit Your Use of Salt MoonDragon's Nutrition Basics: Use Proper Cooking Utensils MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water
RELATED MOONDRAGON HEALTH LINKS & INFORMATION
MoonDragon's Nutrition Information Index MoonDragon's Nutritional Therapy Index MoonDragon's Nutritional Analysis Index MoonDragon's Nutritional Diet Index MoonDragon's Nutritional Recipe Index MoonDragon's Nutrition Therapy: Preparing Produce for Juicing MoonDragon's Nutrition Information: Food Additives Index MoonDragon's Nutrition Information: Food Safety Links MoonDragon's Aromatherapy Index MoonDragon's Aromatherapy Articles MoonDragon's Aromatherapy For Back Pain MoonDragon's Aromatherapy For Labor & Birth MoonDragon's Aromatherapy Blending Chart MoonDragon's Aromatherapy Essential Oil Details MoonDragon's Aromatherapy Links MoonDragon's Aromatherapy For Miscarriage MoonDragon's Aromatherapy For Post Partum MoonDragon's Aromatherapy For Childbearing MoonDragon's Aromatherapy For Problems in Pregnancy & Birthing MoonDragon's Aromatherapy Chart of Essential Oils #1 MoonDragon's Aromatherapy Chart of Essential Oils #2 MoonDragon's Aromatherapy Tips MoonDragon's Aromatherapy Uses MoonDragon's Alternative Health Index MoonDragon's Alternative Health Information Overview MoonDragon's Alternative Health Therapy Index MoonDragon's Alternative Health: Touch & Movement Therapies Index MoonDragon's Alternative Health Therapy: Touch & Movement: Aromatherapy MoonDragon's Alternative Therapy: Touch & Movement - Massage Therapy MoonDragon's Alternative Health: Therapeutic Massage MoonDragon's Holistic Health Links Page 1 MoonDragon's Holistic Health Links Page 2 MoonDragon's Health & Wellness: Nutrition Basics Index MoonDragon's Health & Wellness: Therapy Index MoonDragon's Health & Wellness: Massage Therapy MoonDragon's Health & Wellness: Hydrotherapy MoonDragon's Health & Wellness: Pain Control Therapy MoonDragon's Health & Wellness: Relaxation Therapy MoonDragon's Health & Wellness: Steam Inhalation Therapy MoonDragon's Health & Wellness: Therapy - Herbal Oils Index
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MOONDRAGON'S REALM - WEBSITE DIRECTORY
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