In the JournalsPerspective

Acupuncture improves psoriasis

Acupuncture was one of several complementary and alternative therapies that benefited patients with psoriasis, according to a systematic review recently published in JAMA Dermatology.

“Current pharmacological treatment uses topical agents, oral agents, a growing repertoire of biologic agents and UV phototherapy. However, 52.3% of patients with psoriasis report dissatisfaction with their medical treatment because of treatment inefficacy and adverse effects,” A. Caresse Gamret, BS, of the department of dermatology and cutaneous surgery at the University of Miami, and colleagues wrote.

“Up to 51% of patients with psoriasis report the use of complementary and alternative medicine in their treatment regimen, although it is unclear which [complementary and alternative medicine] therapies are effective for treatment of psoriasis,” they added.

Researchers reviewed articles published between 1991 and 2017. Findings include:

  • one meta-analysis that concluded acupuncture improved psoriasis.
  • three randomized clinical trials that found meditation and guided imagery therapies showed modest efficacy in psoriasis treatment.
  • five randomized clinical trials that concluded topical indigo naturalis application significantly improved psoriasis treatment.
  • three randomized clinical trials that found curcumin provided statistically and clinically significant improvements in psoriasis plaques.
  • 20 studies that concluded that though fish oil treatment was not effective in randomized clinical trials in treating psoriasis, fish oil was effective when used daily.

Researchers wrote that the reviewed articles had inconsistent study designs, small sample sizes, and various primary outcomes, and thus, their findings “must be interpreted cautiously.”

Acupuncture
Acupuncture was one of several complementary and alternative therapies that benefited patients with psoriasis, according to a systematic review recently published in JAMA Dermatology.

Photo source: Adobe

“[However] because many patients are increasingly interested in [complementary and alternative medicine] treatments, the present review will help the clinician advise patients who are either uninterested in the conventional approach or who would like to incorporate one of these therapies as a complement to their current medical treatment plan.” by Janel Miller

Disclosures: The authors report no relevant financial disclosures.

Acupuncture was one of several complementary and alternative therapies that benefited patients with psoriasis, according to a systematic review recently published in JAMA Dermatology.

“Current pharmacological treatment uses topical agents, oral agents, a growing repertoire of biologic agents and UV phototherapy. However, 52.3% of patients with psoriasis report dissatisfaction with their medical treatment because of treatment inefficacy and adverse effects,” A. Caresse Gamret, BS, of the department of dermatology and cutaneous surgery at the University of Miami, and colleagues wrote.

“Up to 51% of patients with psoriasis report the use of complementary and alternative medicine in their treatment regimen, although it is unclear which [complementary and alternative medicine] therapies are effective for treatment of psoriasis,” they added.

Researchers reviewed articles published between 1991 and 2017. Findings include:

  • one meta-analysis that concluded acupuncture improved psoriasis.
  • three randomized clinical trials that found meditation and guided imagery therapies showed modest efficacy in psoriasis treatment.
  • five randomized clinical trials that concluded topical indigo naturalis application significantly improved psoriasis treatment.
  • three randomized clinical trials that found curcumin provided statistically and clinically significant improvements in psoriasis plaques.
  • 20 studies that concluded that though fish oil treatment was not effective in randomized clinical trials in treating psoriasis, fish oil was effective when used daily.

Researchers wrote that the reviewed articles had inconsistent study designs, small sample sizes, and various primary outcomes, and thus, their findings “must be interpreted cautiously.”

Acupuncture
Acupuncture was one of several complementary and alternative therapies that benefited patients with psoriasis, according to a systematic review recently published in JAMA Dermatology.

Photo source: Adobe

“[However] because many patients are increasingly interested in [complementary and alternative medicine] treatments, the present review will help the clinician advise patients who are either uninterested in the conventional approach or who would like to incorporate one of these therapies as a complement to their current medical treatment plan.” by Janel Miller

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Steve Daveluy

    Steve Daveluy

    The article by Caresse-Gamret and colleagues highlights the fact that many patients are seeking complementary and alternative treatment options for their psoriasis. This means that it’s important for physicians to be aware of the evidence that exists regarding these treatments. It’s a topic that is not often included in the traditional medical school curriculum as there’s already so much to learn with traditional medicine. 

    As the article mentions, many of the studies involving complementary and alternative medicine for psoriasis are not performed as rigorously as the more traditional medical treatments for the condition. This article summarized the evidence in support of some complementary and alternative therapies, including indigo naturalis, curcumin, dietary modification, meditation and acupuncture, which demonstrate some evidence of benefit, though the data is limited. 

    At this point, it would be difficult for physicians to change their practice. Indigo naturalis and curcumin can cause staining in the forms that are commercially available, making them too inconvenient to use. The acupuncture studies didn’t all utilize the same techniques, so there’s no way to ensure you can obtain the same results.

    Meditation is one therapy physicians can recommend now. The article contains a link to a guided meditation CD specifically used in conjunction with ultraviolet phototherapy for psoriasis. There are also many free apps for guided meditation readily available. Psoriasis is an independent risk factor for CVD and meditation has been shown to be beneficial in reducing other risk factors for cardiovascular disease, such as hypertension. So meditation may not only improve a patient’s psoriasis, it may also help extend their lifespan.

    While the other therapies discussed in the study are not quite ready for recommendation to the general population, this article shines a light on the fact that they hold potential and hopefully will lead to further study and new formulations of the topical treatments.

    • Steve Daveluy, MD, FAAD
    • Assistant professor and program director, department of dermatology
      Wayne State University

    Disclosures: Healio Family Medicine was unable to determine Daveluy’s relevant financial disclosures prior to publication.