Psoriasis

A chronic and recurrent disease characterized by dry, well-circumscribed,
silvery, scaling papules and plaques of various sizes.



This is a common skin disease of unknown cause affecting up to 3% of the
population. Onset is usually before the age of 20, but all age groups are
affected. The severity of this condition can vary from 1 or 2 lesions to
a body-wide spread, from a benign cosmetic source of annoyance to a physically
disabling and disfiguring affliction. General health is not usually effected,
unless associated with arthritis. It is not overstating the situation to
say that in extreme cases it may be life-ruining, physically, emotionally
and economically.



Psoriasis usually develops slowly, following a typical course of remission
and recurrence. The characteristic plaques are sharply demarcated, usually
not itching, red and raised, covered with silvery scales, that easily bleed.
These lesions will heal without leaving scar tissue or effect hair growth.
The nails may develop pitting. Some patients have a tendency to develop
psoriasis at the sites of physical trauma or irritation (Koebner phenomena).
Common sites for psoriasis are:

• bony prominences (knees, elbows, sacrum),
  
• scalp
  
• external ears
  
• nails, eyebrows
  
• back, buttocks and occasionally generalized on the trunk
  
• skin folds e.g. umbilicus
  

Some cases are associated with severe arthritis, called psoriatic arthritis,
much like rheumatoid arthritis. This common skin problem is not contagious
in any way. To develop a therapeutic approach to this intransigent condition,
it is important to understand the processes that underlie the turnover of
cells in the skin.



Cell turnover in the skin.

The epidermis is entirely cellular. The innermost cells, called basal cells,
are polygonal. They have fibers fixed to small intracellular structures,
called desmosomes, that link the cells together. The basal cells divide
rapidly, forcing the daughter cells toward the skin surface. Basal cells
also synthesize keratin, an inert protein found in hair and nails. The synthesis
continues in the daughter cells, so that keratin fills the cells near the
surface. The dead surface cells are simply remnants, having lost their nucleus
and much of their internal structure. As they are shed, they are replaced
by cells from below. Although outer epidermal cells absorb water readily,
the deeper cells are watertight. The tree-like melanocyte cells in the deeper
epidermis produce a dark brown pigment called melanin. The pigment is introduced
into nearby cells through the “branch tips” of the melanocyte
cells, in units called melanosomes. A third type of epithelial cell, the
Langerhans cell, functions in immune responses of the skin. The epidermis
lacks blood vessels and obtains its nutrition by diffusion from capillaries
in the dermis. It is well supplied, however, by nerve endings that branch
between the epidermal cells.



In normal skin, the time necessary for an epidermal cell to go from creation
to shedding or scaling is about 28 days; psoriatic cells complete the process
in 3 or 4 days, almost 9 times faster than usual. However, there appears
to be no loss of normal regulatory mechanisms of cell division. Thus there
can be an enormous buildup, inadequate maturation, and finally plaque formation
from the cells so affected. Much of psoriasis therapy is directed towards
non-traumatic removal of the plaques as well as easing any attendant discomfort.



Etiology

The underlying cause of the rapid epithelial cell turnover, characteristic
of psoriasis is not known. Theories abound and vary depending upon the practitioners
particular belief system. Thus some view it as have mainly nutritional cause,
others invoke stress and psychological factors, whilst the reductionist
inclined put it down to genetics. There is undoubtedly some immune system
involvement, leading some authorities to describe psoriasis as an auto-immune
condition. It is common for a flare up or worsening to accompany infection,
especially upper respiratory. Environmental factors such as injury, stress,
climate (cold) are important in some patients. About a third of patients
have spontaneous remissions of their disease.



This is a classic example of where an holistic perspective is essential,
exploring as many aspects of the individuals life as possible.



Actions indicated for the processes behind this disease ~



Alteratives are as important here as in all internally caused skin problems.
In practice it is often the rooty `hepatic alterative’ that work best.



Anti-Inflammatories, as with eczema, if applied topically and taken
internally they will speed the curative work of the alteratives, but not
replace them. They are most helpful during periods of flare up and exacerbation



Lymphatic Tonics are important from the perspective of helping the
internal environment be as healthy as possible.



Nervine Relaxants help with the commonly associated problem of anxiety,
and will ease discomfort in the skin because of the relaxing effect upon
the peripheral nerves of the autonomic nervous system. This will reduce
itching, and even inflammation to some extent.



Diuretics are important in ensuring adequate elimination through
the kidneys.



Hepatics will contribute their special support for liver function
and the digestive process.



Vulnerary herbs will support the healing of skin lesions when applied
topically, but are not as effective as one might think. Remember that there
is no wound to heal.



Astringents, used topically, may help in reducing redness, heat and
itching through a local vaso-constrictive effect.



Emollients help in the process of scale removal.



Anti-Pruritics may help used topically, but itching is not a major
factor in psoriasis.



Diaphoretics have been suggested as a way of increase circulation
in the skin, thus promoting elimination and, in theory, general skin health.
However, they can aggravated the problem in some people because of local
over stimulation, increasing cell replication rates and thus desquamation.




This is not a major contra-indication, but be aware of it.



Specific remedies ~

Many different herbs have been described as specific for the common skin
problem, depending upon local botany and cultural preferences. However,
it must be said that there are probably no true specifics here. This is
only to expected if the multi-factorial, systemic roots of psoriasis are
considered. Some people respond incredibly well to one herbs whilst others
show non at all. This can prove both challenging and frustrating for the
practitioner, let along the patient!



As opposed to eczema, the woody, hepatic alteratives are the closest we
have to specifics for here. Herbs that would be included in this group include:



Arctium lappa — Berberis aquifolium

Rumex crispus — Smilax spp.



Of course, any of the other alteratives may prove specific in any one individual.
Of the leafy alteratives, remember:



Galium aparine — Larrea divaricata — Scrophularia nodosa

Trifolium pratense — Viola tricolor — Urtica dioica



There are an abundance of relevant herbs for topical application. An important
factor is the lifting and removal of scales, whilst reducing local inflammation.
This often means that the form of the application is as important as any
remedies it contains. Choice of topical form should be governed to some
extent by the personal preference of the patient, often necessitating experimentation.
Plants that are widely used include:



Calendula officinalis — Stellaria media T– huja occidentalis

Plantago spp. — Populus candicans



For details of herbs and considerations about the appropriate form of topical
applications, please refer to the relevant section.



One possible prescription for psoriasis ~

Arctium lappa

Rumex crispus

Galium aparine

Scutellaria spp. equal parts to 5ml of tincture three times a day

Urtica dioica or Galium aparine

an infusion of the fresh herb drunk 2 or 3 times a day.

This combination for internal use supplies the following actions:

• Alterative ~ Arctium lappa, Galium aparine, Rumex crispus,
  Urtica dioica
  
• Lymphatic Tonic ~ Galium aparine, Urtica dioica
  
• Nervine Relaxant ~ Scutellaria spp.
  
• Anti-Inflammatory ~ Galium aparine
  
• Diuretic ~ Arctium lappa, Galium aparine, Urtica dioica
  
• Hepatic ~ Arctium lappa, Galium aparine, Rumex crispus
  

One possible prescription for psoriasis with much anxiety and tension
~

Arctium lappa

Rumex crispus

Galium aparine

Valeriana officinalis

Verbena officinalis equal parts to 5ml of tincture three times a day

Matricaria recutita an infusion of drunk as desired

Note the inclusion of Vervain as part of the nervine component. Why? This
combination for internal use supplies the following actions:

• Alterative ~ Arctium lappa, Galium aparine, Rumex crispus,
  Urtica dioica
  
• Lymphatic Tonic ~ Galium aparine, Urtica dioica
  
• Nervine Relaxant ~ Valeriana officinalis, Verbena officinalis
  
• Anti-Inflammatory ~ Galium aparine
  
• Diuretic ~ Arctium lappa, Galium aparine, Urtica dioica
  
• Hepatic ~ Arctium lappa, Galium aparine, Rumex crispus,
  Verbena officinalis
  

One possible prescription for intransigent, unresponsive psoriasis ~

Arctium lappa 2 parts

Rumex crispus 2 parts

Smilax spp. 2 parts

Phytolacca decandra 1 part

Valeriana officinalis 1 part 5ml of combined tinctures 3 times a
day

Urtica dioica or Galium aparine

an infusion of the fresh herb drunk 2 or 3 times a day.

Care must be taken with this combination, and is not advisable for children,
because of the inclusion of Poke. This combination for internal use supplies
the following actions:

• Alterative ~ Arctium lappa, Galium aparine, Phytolacca decandra,
  Rumex crispus, Smilax spp, Urtica dioica
  
• Lymphatic Tonic ~ Galium aparine, Phytolacca decandra,
  Urtica dioica
  
• Nervine Relaxant ~ Valeriana officinalis
  
• Anti-Inflammatory ~ Galium aparine
  
• Diuretic ~ Arctium lappa, Galium aparine, Urtica dioica
  
• Hepatic ~ Arctium lappa, Galium aparine, Rumex crispus,
  Smilax spp.
  

One possible prescription for a patient with psoriasis & hypertension
~

Arctium lappa 2 parts

Rumex crispus 2 parts

Galium aparine 2 parts

Valeriana officinalis 1 part

Crataegus spp. 1 part

Tilia spp. 1 part

Achillea millefolium 1 part 5ml of combined tincture 3 times a day

Matricaria recutita, Tilia spp. or Trifolium pratense

an infusion drunk as desired

Allium sativum should be used as a dietary supplement.

This is designed for a case where the hypertension is not the primary concern,
thus the main bulk of the dose is alterative rather than hypotensive.. This
combination for internal use supplies the following actions:

• Alterative ~ Arctium lappa, Galium aparine, Phytolacca decandra,
  Rumex crispus, Smilax spp, Urtica dioica
  
• Lymphatic Tonic ~ Galium aparine, Phytolacca decandra,
  Urtica dioica
  
• Nervine Relaxant ~ Tilia spp., Valeriana officinalis
  
• Anti-Inflammatory ~ Galium aparine
  
• Diuretic ~ Achillea millefolium, Arctium lappa, Crataegus
  spp., Galium aparine, Tilia spp., Urtica dioica
  
• Hepatic ~ Allium sativum, Arctium lappa, Galium aparine,
  Rumex crispus, Smilax spp.
  
• Hypotensive ~ Achillea millefolium, Allium sativum, Crataegus
  spp., Tilia spp., Valeriana officinalis
  

Broader Context of Treatment

There are many non-herbal factors for the practitioner to be aware of, and
be ready to inform the patient about. This is a condition where empowerment
becomes vital. The patient carries around the label psoriasis `sufferer’,
so they suffer. They are often told little about the range of simple nursing
techniques that would make their skin experience easier.



The skin is an interface between the person and their world. It senses and
expresses. Psoriasis impacts the individuals experience of being in their
world in two broad ways, physically and psychologically:

• The physical distress makes being at ease difficult.
  
• The psychological trauma of feeling `disfigured’ may lead to social
  isolation and depression.
  

The therapist must be prepared to help and advise with these areas as well
as the purely herbal issues. Stress management is crucial, and will ideally
be part of a re-evaluation by the patient of their life-style, personal
goals and vision.



For the majority of people with psoriasis, exposure to sun-light can alleviate
the conditions and sometimes clear it. Unfortunately we have disrupted our
environment so much it is no longer to be recommended due to potential damage
from UV light let through by the depleted ozone layer.



The Dead Sea is still environmentally safe because it is so far below sea
level. Here a quality of UV light occurs, not found anywhere else on the
planet. The additional air that the light passes through has the effect
of filtering more of the harmful spectrum out. Additionally there are the
salts of the sea itself. (This does not take into account possible human
dangers, such as war!)



Much of the nutritional advice available for this condition is contradictory.
With different patients I have seen success with both a grapefruit fast
and a no citrus diet! Psoriasis is the epitome of the `holistic’ disease,
it being almost impossible to generalize and where specifics of diet must
be based upon the individual, not the pathology.