Complementary and alternative medicine for psoriasis: what the dermatologist needs to know

The assessment of complementary and alternative medicine use in acne vulgaris patients in Turkey: A cross-sectional study

Because acne vulgaris has a chronic course, can cause cosmetic problems, and negatively affects the psychosocial functionality and quality of life of patients, patients with acne vulgaris can frequently resort to complementary medicine practices. This study aimed to examine the frequency of complementary medicine use in patients diagnosed with acne vulgaris, the methods they used, the reasons for practicing these methods, and the factors affecting these practices. In this descriptive cross-sectional study, 400 (81.4%) of 491 patients aged ≥13 years who were diagnosed with acne vulgaris and treated at the dermatology outpatient clinic at Konya Numune Hospital between February and October 2020 were enrolled. A survey consisting of 37 questions was administered to patients in face-to-face interviews. Permission to conduct the study was obtained from the Faculty of Medicine Local Ethics Committee. The mean age of the patients was 20.0 ± 5.17, and 60% of the patients were women. It was stated by 87% of the patients that they used complementary medicine methods for the treatment of acne vulgaris. The first 3 methods used, in order of frequency, were topical herbal remedies at a rate of 61%, herbal medicines at 23.5%, and cupping/leeches at 2.5%. Complementary medicine use was significantly higher among the patients aged 19 to 25 and among the single patients. While practicing complementary medicine treatments, 33.5% also used the treatment given by their doctor simultaneously. It was determined that the physicians of 73.5% of the patients did not question their use of complementary medicine when prescribing treatment. In our study, it was determined that 87% of patients with acne vulgaris used complementary and alternative medicine (CAM) methods, and the majority of these patients were young. These treatment methods may affect the treatments that their physicians will recommend. Therefore, to prevent ill-advised practices, patients should be informed about the CAM methods they use when planning their treatment. Considering the possible side effects of CAM practices, physicians need to be aware that acne vulgaris patients frequently use CAM methods and improve themselves in raising the desired awareness on this issue.

Metabolic Disorders and Psoriasis: Exploring the Role of Nutritional Interventions

(1) Background: Psoriasis is a chronic autoimmune disease with a close relationship with metabolic diseases such as obesity, diabetes, and dyslipidemia. The aim of this review was to identify the relationship between psoriasis, metabolic diseases, and dietetic therapies. According to recent findings, there is a strong association between psoriasis and obesity as well as vitamin D and micronutrient deficiencies. (2) Methods: This review was conducted via PubMed, aiming to search for studies involving psoriasis linked with metabolic disorders or with nutritional treatments. (3) Results: Our review shows that a healthy lifestyle can positively influence the course of the disease. The maintaining of a proper body weight together with physical activity and good nutritional choices are associated with an improvement in psoriasis severity. A Mediterranean diet rich in fiber, vitamins, and polyphenols may indeed be a strategy for controlling psoriasis symptoms. The effectiveness of this diet lies not only in its anti-inflammatory power, but also in its ability to favorably influence the intestinal microbiota and counteract dysbiosis, which is a risk factor for many autoimmune diseases. (4) Conclusions: In synergy with standard therapy, the adoption of an appropriate diet can be recommended to improve the clinical expression of psoriasis and reduce the incidence of comorbidities.

TCM Treatment and Drug Co-Occurrence Analysis of Psoriasis

Psoriasis is a long-term immune-mediated disease. Patients with a long history and slow progress are more common, and its treatment is difficult. This study proposes to use traditional Chinese medicine to treat psoriasis. Through the follow-up of all participants for 12 and 24 weeks, a large number of comparative experiments effectively verify the effectiveness of the method proposed in this study. The research results of this study can provide some reference ideas for follow-up research.

The effect of Melissa officinalis syrup on patients with mild to moderate psoriasis: a randomized, double-blind placebo-controlled clinical trial

Objective

Psoriasis is an immune-mediated inflammatory skin disease. It can involve any body skin area, particularly the scalp, lower back, elbows, and knees. There are several topical and systemic therapies for the treatment. Nowadays, herbal medicines are popular treatments for dermatologic conditions. This two-arm parallel, randomized placebo-controlled clinical trial was conducted to examine the hypothesis of the efficacy of Melissa officinalis syrup on patients with mild-to-moderate Plaque psoriasis.

Result

Among 100 patients, 95 participants completed the trial and five of them withdrew. The mean pruritus intensity and PASI scores decreased significantly in the intervention group compared to the placebo group (P < 0.001). The DLQI score in the intervention group increased post-treatment compared to pre-treatment (P = 0.029); however, there was no significant difference between the intervention and control group at the end of the study (0.065).

Trial registration: The trial was registered in the Iranian registry of clinical trials on November 9th, 2019 (https://www.irct.ir/trial/43434; registration number: IRCT20191104045326N1).

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-021-05667-9.

Determination of scalp hair selenium concentrations in Algerian psoriatic individuals using k 0 -standardization based on neutron activation analysis method

Psoriasis is a dermatological disease that affects 2–3% of the Algerian population. Selenium has a positive impact on psoriasis. Selenium plays an important role in protecting free radical damage as a component of the glutathione peroxidase enzyme. The objective of this investigation was to assess the status of selenium in the hair of Algerian patients suffering from psoriasis. Fifty-eight scalp hair samples were collected from Algerian patients with psoriasis, classified by gender and four age groups: 36 females and 22 males, aged between 9 and 79 years. Thirty healthy subjects aged 9–74 years were also surveyed for control purposes. Selenium content was measured for all scalp hair samples using the k 0-standardization of neutron activation analysis. The average selenium concentration for controls and patients were 0.39 ± 0.18 and 0.28 ± 0.13 μg/g respectively. Selenium concentration for female and male controls and patients, were 0.35 ± 0.17, 0.47 ± 0.19, 0.28 ± 0.14, and 0.28 ± 0.11 μg/g, respectively. There is a significant difference (p < 0.05) between selenium level in patients and in controls. Selenium concentrations in psoriatics’ scalp hair can be affected by both gender and age. Measured selenium contents have been approved by the quality assurance and quality control procedure (QA/QC).

Systems Pharmacology Approach and Experiment Evaluation Reveal Multidimensional Treatment Strategy of LiangXueJieDu Formula for Psoriasis

Clinical studies have demonstrated the anti-psoriatic effect of the LiangXueJieDu (LXJD) herbal formula. However, the systemic mechanism and the targets of the LXJD formula have not yet been elucidated. In the present study, a systems pharmacology approach, metabolomics, and experimental evaluation were employed. First, by systematic absorption-distribution-metabolism-excretion (ADME) analysis, 144 active compounds with satisfactory pharmacokinetic properties were identified from 12 herbs of LXJD formula using the TCMSP database. These active compounds could be linked to 125 target proteins involved in the pathological processes underlying psoriasis. Then, the networks constituting the active compounds, targets, and diseases were constructed to decipher the pharmacological actions of this formula, indicating its curative effects in psoriasis treatment and related complications. The psoriasis-related pathway comprising several regulatory modules demonstrated the synergistic mechanisms of LXJD formula. Furthermore, the therapeutic effect of LXJD formula was validated in a psoriasis-like mouse model. Consistent with the systems pharmacology analysis, LXJD formula ameliorated IMQ-induced psoriasis-like lesions in mice, inhibited keratinocyte proliferation, improved keratinocyte differentiation, and suppressed the infiltration of CD3+ T cells. Compared to the model group, LXJD formula treatment remarkably reduced the expression of inflammatory cytokines and factors, such as IL-1β, IL-6, TNF-α, Cox2, and inhibited the phosphorylation of p-P65, p-IқB, p-ERK, p-P38, p-PI3K, p-AKT, indicating that LXJD formula exerts its therapeutic effect by inhibiting the MAPK, PI3K/AKT, and NF-қB signaling pathways. The metabolic changes in the serum of psoriasis patients were evaluated by liquid chromatography coupled with orbitrap mass spectrometry (LC-MS). The LXJD formula improved two perturbed metabolic pathways of glycerophospholipid metabolism and steroid hormone biosynthesis. Overall, this study revealed the complicated anti-psoriatic mechanism of LXJD formula and also offered a reliable strategy to elucidate the complex therapeutic mechanism of this Chinese herbal formula in psoriasis from a holistic perspective.

Emerging Pathophysiological Targets of Psoriasis for Future Therapeutic Strategies

Psoriasis is a chronic autoimmune skin disorder which involves complex interactions between genes, keratinocytes, T-cells and inflammatory cells. It affects 2-3% population worldwide. Molecular biology and cellular immunology of psoriasis, when linked with biotechnology and genetic studies can help researchers to understand the pathophysiology of psoriasis. T-cells activation, keratinocyte hyperproliferation, and angiogenesis are the core mechanisms entailed in the development of psoriasis lesion. Investigators are trying to overcome the challenges of complex pathophysiology pathways involved in this disorder. The different possible hypotheses for its pathophysiology such as growth factors, enzymes, inflammation, and genetic factors mediated pathophysiology have been described in the present review paper in detail. Clinically available drugs only control the symptoms of psoriasis but are not effective for the treatment of the disorder completely and are also associated with some side effects such as itching, renal disorders, hematologic, nonmelanoma skin cancer, pulmonary, gastrointestinal toxicity, etc. This paper made an effort to understand the pathophysiological targets, discuss the research done so far and the treatments available for the effective management of psoriasis.

Mind-Body Interventions as Alternative and Complementary Therapies for Psoriasis: A Systematic Review of the English Literature

Objective: Conventional therapeutic methods for psoriasis include topical and systemic drugs, phototherapy, and biologic agents. Despite the fact that these treatment methods, and especially biologic agents, are met with a considerable reduction in disease activity, they can sometimes be costly and are nonetheless accompanied by high risks of adverse events, ranging from mild to debilitating. Therefore, complementary and alternative medicine (CAM), especially mind-and-body interventions, such as acupuncture, psychotherapy, climatotherapy, and cupping may provide a cheaper and potentially beneficial outcome for these patients. Methods: We performed a systematic review of articles pertaining to acupuncture, cupping, psychotherapy and meditation, as well climatotherapy and balneotherapy in the management of psoriasis, by using the PubMED, Medline and Google Academic research databases and reference cross-checking. Results: 12 articles on acupuncture, 9 on dry or wet cupping, 27 concerning meditation, hypnosis or psychotherapy, and 34 regarding climate therapy or balneotherapy were found. Discussion and Conclusions: Currently, there is a lack of evidence in the English literature to support acupuncture as an effective alternative therapy for psoriasis, whereas cupping has been described in the majority of instances to result in Koebner phenomenon and clinical worsening. Stress management therapies such as psychotherapy, hypnosis, and meditation have shown promising results as complementary treatment methods. Climatotherapy and balneotherapy have already been proven as effective means of achieving clinical improvement in psoriasis. Further research is still needed to verify the usefulness of the lesser studied treatment methods.

Mindfulness Practice for Glycemic Control: Could it be a New Strategy for an Old Problem? A Systematic Review and Meta-Analysis

BACKGROUND

The management of type 2 diabetes mellitus (T2DM) requires a complex and organized care that includes patient's lifestyle change. Additionally, emotional well-being is an important part of self-management, and it may impair the individual's adherence. Therefore, equipping the patients with the necessary coping and self-care techniques may be an important step in managing diabetes.

OBJECTIVE

To evaluate the effect of interventions using established mindfulness-based protocols on glycemic control of individuals with T2DM.

METHODS

Data sources: Two electronic databases (PubMed and EMBASE) were searched from inception to December 2019. We limited our search to published studies in English, Spanish and Portuguese languages.

STUDY SELECTION

Randomized clinical trials that assessed the effects of mindfulness in individuals with T2DM were selected.

DATA EXTRACTION

Two authors independently assessed the risk of bias and extracted data from the included trials. Data were pooled using inverse-variance random-effects meta-analyses. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

RESULTS

Four randomized trials were included. There were no differences in blood glucose change (mean difference between groups (MD) -0.73mg/dl; 95% CI, -10.49; 9.02; I2 =0%; very low quality of evidence) or glycated hemoglobin (MD 0.05%; 95%CI -0.22 to 0.32; I2 =29%; very low quality of evidence).

CONCLUSION

Although the quality of current evidence is very low, our findings suggest that established protocols involving mindfulness have no effect on blood glucose or glycated hemoglobin in individuals with T2DM. Indeed, large-scale trials are needed to evaluate the contribution of mindfulness to glycemic control in clinical practice. PROSPERO Registration ID: RD42020161940.

The use of complementary and alternative medicine by patients suffering from psoriasis and psoriatic arthritis

Introduction

Psoriasis is a chronic inflammatory disease, affecting 1-3% of the general population. In recent years there has been an increase in the use of complementary and alternative medicine (CAM) by psoriasis patients.

Aim

To assess the frequency of use of CAM by psoriasis patients, depending on selected demographic and clinical factors, and to examine such aspects as sources of knowledge about CAM therapies provided by patients, reasons for their use, and subjective patient satisfaction.

Material and methods

The study involved 117 psoriatic patients (female = 44, male = 73), hospitalised in the Dermatology Department of the Heliodor Swiecicki Clinical Hospital in Poznan. The research tool was the author's questionnaire, consisting of single- and multiple-choice questions about the use of CAM.

Results

57.26% of the respondents declared that they used or had used CAM for psoriasis. The analysis showed that the patients with psoriasis diagnosed in childhood statistically significantly more often used CAM compared to other patients (p = 0.017). The most frequent CAM therapies used by the responders were the use of topical agents (73.13%) and dietary supplements (71.64%). The main reason why psoriasis patients decided to use CAM was curiosity (34.33%), and the most commonly reported source of knowledge about CAM was the Internet (49.25%). The majority of responders monthly expenditure on CAM averaged less than PLN 100 (58.2%), and they were very dissatisfied with the effects of CAM (56.7%).

Conclusions

Psoriasis patients use complementary and alternative medicine quite frequently. Dermatologists should keep this fact in mind and should ask about the use of CAM in interviews.

Topical Delivery of Curcumin by Choline-Calix[4]arene-Based Nanohydrogel Improves Its Therapeutic Effect on a Psoriasis Mouse Model

Curcumin (CUR) has shown remarkable efficacy in the treatment of skin diseases, but its effective transdermal delivery is still a major challenge and stimulates interest in the design of novel systems for CUR dispersion, preservation, and delivery facilitation to the deeper layers of the skin. The present work aimed to investigate the potential of a nanohydrogel, formed by a micellar choline-calix[4]arene amphiphile (CALIX) and CUR, in the treatment of skin diseases through an imiquimod (IMQ)-induced psoriasis model. Psoriasis plaques are associated with aberrant keratinization, abnormal distribution of tight junctions (TJs) proteins, and enhanced expression of inflammatory markers. The nanohydrogel restored the normal distribution of TJs proteins ZO1 and occludin and reduced the expression of TNF-α and inducible nitric oxide synthetase (iNOS) compared to the untreated IMQ group. The novelty lies in the calix[4]arene-based nanohydrogel as a potential new soft material for the topical skin delivery of CUR. The nanohydrogel, due to its physicochemical and mechanical properties, enhances the drug water-solubility, preserves CUR from rapid degradation, and eases the local skin administration and penetration.

Efficacy of combined liman peloid baths and heliotherapy in the treatment of psoriasis at Cervia spa, Emilia, Italy

This study assessed the effects of liman peloid, followed by bath and heliotherapy in psoriatic patients at Cervia, Emilia, Italy. The psoriatic patients were randomized into two groups: group 1 with 56 patients, treated with liman applications, bath, and heliotherapy, and group 2 with 35 subjects, treated with mud-bath therapy using a clay peloid mixed with tap water and heliotherapy. Data was collected for the following: psoriasis area and severity index (PASI); delta-PASI (difference between post- and pre-treatment PASI); delta-PASI3 and delta-PASI6, 3 and 6 months after the end of treatment, respectively; psoriasis recurrences; and the use of both topical and systemic drugs. Although not significant, a decrease in PASI was recorded in group 1 at the end of treatment and after 3 and 6 months. Compared with group 2, there was a significant change in delta-PASI, delta-PASI3, and psoriasis recurrences in group 1 as well as a significant reduction in the topical use of drugs, both cortisone and nonsteroid drugs. This is the first and preliminary study which documented the efficacy of a specific protocol of liman bath heliotherapy in psoriatic patients as documented by a reduction in delta-PASI and delta-PASI3, a decrease in psoriasis recurrences, and use of topical drugs.

Salvianolic acid B ameliorates psoriatic changes in imiquimod-induced psoriasis on BALB/c mice by inhibiting inflammatory and keratin markers via altering phosphatidylinositol-3-kinase/protein kinase B signaling pathway

Salvianolic acid B (SAB) is an active phytocomponent of a popular Chinese herb called Radix Salvia militiorrhiza with numerous biological properties. The anti-psoriasis activity of SAB was examined by evaluating various psoriasis inflammatory and keratin markers against imiquimod (IMQ)-induced psoriasis on BALB/c mice. Totally 50 healthy BALB/c mice were evenly divided into 5 groups including control, drug control (SAB; 40 mg/kg), IMQ-induced psoriasis (5%), IMQ exposure and treated with SAB (40 mg/kg), or standard methotrexate (MTX; 1 mg/kg). Mice supplemented with either SAB or MTX significantly lowered the values of psoriasis area severity index (PASI), erythema, scaling, skin thickness, inflammatory markers (interleukin [IL]-22/23/17A/1β/6) and lipid peroxidation product (malondialdehyde). Also, IMQ exposed BALB/c mice treated with SAB or MTX display lesser histopathological changes with enhanced antioxidant activities (catalase, superoxide dismutase). Moreover, the protein expression of keratin markers (K16 and K17) and phosphatidylinositol-3-kinase (PI3K)/protein kinase B (Akt) signaling proteins (pAkt/Akt and pPI3K/PI3K) were significantly downregulated after administration with SAB and MTX as compared with IMQ induced mice. Taking together, SAB and MTX significantly ameliorate psoriatic changes by inhibiting psoriatic inflammatory and keratin markers through abolishing PI3K/Akt signaling pathway. However, further studies (clinical trials) are needed to confirm the anti-psoriatic property of SAB before recommending to psoriasis patients.

Complementary and alternative medicine use among patients with psoriasis on different treatment regimens

The aim of this study was to explore habitudes about the use of complementary and alternative medicine (CAM) in patients with psoriasis. We conducted a face-to-face interview with 374 psoriasis patients to collect information about CAM use. All treatments for psoriasis used in the last 12 months, demographic data of patients, Dermatology Quality of Life Index (DLQI), and Psoriasis Area Severity Index (PASI) were recorded. Topical and systemic CAM, dietary supplements, and diet were investigated. Tendency to use CAM in patients using biological agents was statistically significant lower than other groups. Patients using biological agent have lower DLQI and PASI values. This situation can be the cause of low tendency in this group.

Neutrophils in Psoriasis

Neutrophils are the most abundant innate immune cells. The pathogenic roles of neutrophils are related to chronic inflammation and autoimmune diseases. Psoriasis is a chronic systemic inflammatory disease affecting ~2–3% of the world population. The abundant presence of neutrophils in the psoriatic skin lesions serves as a typical histopathologic hallmark of psoriasis. Recent reports indicated that oxidative stress, granular components, and neutrophil extracellular traps from psoriatic neutrophils are related to the initial and maintenance phases of psoriasis. This review provides an overview on the recent (up to 2019) advances in understanding the role of neutrophils in the pathophysiology of psoriasis, including the effects of respiratory burst, degranulation, and neutrophil extracellular trap formation on psoriatic immunity and the clinical relationships.

Acupuncture Needling, Electroacupuncture, and Fire Needling Improve Imiquimod-Induced Psoriasis-Like Skin Lesions through Reducing Local Inflammatory Responses

Psoriasis is a common autoimmune disease. Acupuncture-related techniques have been widely used to treat psoriasis since its ability to engage neuronal function, the immune system, and other systems is well documented. This study aimed to investigate and compare the effects of three common acupuncture-related techniques in psoriasis-like skin inflammatory responses and explore the possible involved mechanisms. Imiquimod (IMQ)-induced psoriasis-like mice were treated with acupuncture needling, electroacupuncture, or fire acupuncture. Methotrexate (MTX) was applied as a positive control. Scoring by the psoriasis area and severity index (PASI) evaluated skin lesion changes. Keratinocyte proliferation and inflammatory cell infiltration were investigated using pathological staining. The secretion levels of inflammatory cytokines were detected by enzyme-linked immunosorbent assay. The expression levels of neuropeptides were assessed by Western immunoblotting. We found that acupuncture needling, electroacupuncture, and fire acupuncture all ameliorated skin lesions, reduced epidermal thickness, inhibited keratinocyte proliferation, and reduced CD3⁺ T cell infiltration. The aforementioned acupuncture techniques also decreased inflammatory cytokine secretion, including IL-1β, IL-17A, and IL-23p40. Among them, electroacupuncture showed the best curative effects. Additionally, electroacupuncture downregulated the expression levels of Neurokinin A (NKA), which was positively associated with decreased inflammatory cytokine levels in local lesions. In conclusion, acupuncture needling, electroacupuncture, and fire acupuncture alleviated IMQ-induced psoriasis-like lesions. By contrast, electroacupuncture was more beneficial in reducing the inflammatory response, which might be related to locally dampened neuropeptide levels. Observations support the therapeutic effect of acupuncture for psoriasis and indicate a neuromodulatory mechanism in treating psoriasis by electroacupuncture.

Auricular acupressure as a complementary therapy for psoriasis vulgaris: study protocol for a multicenter randomized controlled trial

INTRODUCTION

Psoriasis vulgaris is a common skin disease characterized by persistent localized erythematous scaly plaques, typically on the elbows, knees, and scalp. It is an immune-abnormal disease that progresses slowly over a long period with frequent symptom recurrence. Current studies have shown that acupuncture is an effective therapy for psoriasis. However, the scientific evidence of the efficacy of auricular acupressure treatment for patients with psoriasis is still insufficient. Therefore, we designed a randomized controlled clinical trial to investigate the effect, safety, and cost-effectiveness of auricular acupressure in addition to medication in patients with psoriasis.

METHODS AND ANALYSIS

This on-going study is a two-arm parallel, assessor-blinded, randomized controlled trial in which 180 participants with psoriasis will be recruited and then randomly allocated into two groups in a 1:1 ratio. Equal randomization will be conducted using a computer-generated random allocation sequence. Participants in the intervention group will receive auricular acupressure treatment once per week for 4 weeks, and calcipotriol betamethasone ointment for topical use once daily for 4 weeks. Participants in the control group will receive only calcipotriol betamethasone ointment treatment once daily for 4 weeks. All patients will be followed up for 12 weeks. The primary outcome is relapse rate. The secondary outcomes include time to relapse, rebound rate, time to new onset, Psoriasis Area and Severity Index score improvement rate, body surface area affected, a visual analogue scale, and Dermatology Life Quality Index. Cost-effectiveness analysis will be carried out from a health and community care provider perspective.

DISCUSSION

This multicenter randomized controlled trial will provide important clinical evidence for the effect and safety of auricular acupressure as a complementary therapy in patients with psoriasis.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR-TRC-14004916 . Registered on 20 May 2014. This protocol is version 3.0 which was updated on 24 September 2016.

Apoptotic or Antiproliferative Activity of Natural Products against Keratinocytes for the Treatment of Psoriasis

Natural products or herbs can be used as an effective therapy for treating psoriasis, an autoimmune skin disease that involves keratinocyte overproliferation. It has been demonstrated that phytomedicine, which is used for psoriasis patients, provides some advantages, including natural sources, a lower risk of adverse effects, and the avoidance of dissatisfaction with conventional therapy. The herbal products’ structural diversity and multiple mechanisms of action have enabled the synergistic activity to mitigate psoriasis. In recent years, the concept of using natural products as antiproliferative agents in psoriasis treatment has attracted increasing attention in basic and clinical investigations. This review highlights the development of an apoptotic or antiproliferatic strategy for natural-product management in the treatment of psoriasis. We systematically introduce the concepts and molecular mechanisms of keratinocyte-proliferation inhibition by crude extracts or natural compounds that were isolated from natural resources, especially plants. Most of these studies focus on evaluation through an in vitro keratinocyte model and an in vivo psoriasis-like animal model. Topical delivery is the major route for the in vivo or clinical administration of these natural products. The potential use of antiproliferative phytomedicine on hyperproliferative keratinocytes suggests a way forward for generating advances in the field of psoriasis therapy.

Do recent research studies validate the medicinal plants used in British Columbia, Canada for pet diseases and wild animals taken into temporary care?

ETHNOPHARMACOLOGICAL RELEVANCE

There are insufficient safe and effective treatments for chronic pain in pets. In cases such as osteoarthritis there is no commercially available cure and veterinarians use NSAIDs to manage pain. Pet owners may have to plan for a lifetime of plant-based treatment for the conditions that lead to chronic pain in pets. Phytopharmacotherapies have the advantage of being less toxic, cheap or free, readily available, are more likely to be safe for long-term use and have the potential to reset the immune system to normal functioning.

AIM OF THE STUDY

To examine the recently published medicinal plant research that matches unpublished data on ethnoveterinary medicines (EVM) used for pets in Canada (British Columbia) to see if the EVM data can provide a lead to the development of necessary drugs.

MATERIALS AND METHODS

In 2003 semi-structured interviews were conducted with 60 participants who were organic farmers or holisitic medicinal/veterinary practitioners obtained using a purposive sample. A draft manual prepared from the data was then evaluated by participants at a participatory workshop that discussed the plant-based treatments. A copy of the final version of the manual was given to all research participants. In 2018, the recently published research matching the EVM data was reviewed to see if the EVM practices could serve as a lead for further research.

RESULTS AND CONCLUSION

Medicinal plants are used to treat a range of conditions. The injuries treated in pets in British Columbia included abscesses (resulting from an initial injury), sprains and abrasions. Dogs were also treated with medicinal plants for rheumatoid arthritis, joint pain and articular cartilage injuries. More than 40 plants were used. Anal gland problems were treated with Allium sativum L., Aloe vera L., Calendula officinalis L., Plantago major L., Ulmus fulva Michx., Urtica dioica L. and Usnea longissima Ach. Arctium lappa, Hydrangea arborescens and Lactuca muralis were used for rheumatoid arthritis and joint pain in pets. Asthma was treated with: Linum usitatissimum L., Borago officinalis L., Verbascum thapsus L., Cucurbita pepo L., Lobelia inflata L., and Zingiber officinale Roscoe. Pets with heart problems were treated with Crataegus oxyacantha L., Cedronella canariensis (L.) Willd. ex Webb & Berth, Equisetum palustre L., Cypripedium calceolus L., Pinus ponderosa Douglas ex Lawson, Humulus lupulus L., Valeriana officinalis L., Lobelia inflata L., Stachys officinalis (L.) Trev., and Viscum album L. The following plants were used for epilepsy, motion sickness and anxiety- Avena sativa L., Valeriana officinalis, Lactuca muralis (L.) Fresen., Scutellaria lateriflora L., Satureja hortensis L., and Passiflora incarnata L. Plants used for cancer treatment included Phytolacca decandra, Ganoderma lucidum, Lentinula edodes, Rumex acetosella, Arctium lappa, Ulmus fulva, Rheum palmatum, Frangula purshiana, Zingiber officinale, Glycyrrhiza glabra, Ulmus fulva, Althea officinalis, Rheum palmatum, Rumex crispus and Plantago psyllium. Trifolium pratense was used for tumours in the prostate gland. Also used were Artemisia annua, Taraxacum officinale and Rumex crispus. This review of plants used in EVM was possible because phytotherapy research of the plants described in this paper has continued because few new pharmaceutical drugs have been developed for chronic pain and because treatments like glucocorticoid therapy do not heal. Phytotherapuetic products are also being investigated to address the overuse of antibiotics. There have also been recent studies conducted on plant-based functional foods and health supplements for pets, however there are still gaps in the knowledge base for the plants Stillingia sylvatica, Verbascum thapsus, Yucca schidigera and Iris versicolor and these need further investigation.

Patient experiences of using Chinese herbal medicine for psoriasis vulgaris and chronic urticaria: a qualitative study

Background: Psoriasis vulgaris and chronic urticaria are common skin conditions with a significant health burden. Achieving long-term control remains a challenge, and some patients choose Chinese herbal medicine (CHM) to meet this need. Little is known about the motivators and experiences of using CHM for these skin conditions.Objectives: To determine the motivators for choosing CHM, and experience of using CHM for psoriasis vulgaris and chronic urticaria.Methods: We conducted semi-structured interviews with participants who had previously used CHM for these conditions. Interviews were transcribed for data analysis.Results: Twenty participants completed the interviews in Guangzhou (n = 16), China, and Melbourne (n = 4), Australia. Motivators included wanting an alternative to conventional medicine, beliefs about CHM and previous experience. Participants expected that CHM would be safer and could prevent relapse; this expectation was met for some participants. Preparing CHM decoctions was onerous, and CHM granules were more convenient.Conclusion: Beliefs, previous experience of using CHM, desire to prevent relapse, and safety are important motivators for choosing CHM in people with psoriasis vulgaris and chronic urticaria. Further clinical evidence is required to enable patients to make informed clinical decisions. Patient preferences should be considered in the context of available evidence when prescribing CHM.

Effect of Korean medicine as add-on therapy to phototherapy for psoriasis: Two case reports

RATIONALE

Psoriasis is a common chronic, immune-mediated inflammatory skin disease. Here, we describe 2 patients who presented with psoriasis to illustrate the potential efficacy of Korean medicine treatment combined with phototherapy.

PATIENT CONCERNS

A 33-year-old female (Case 1) and a 37-year-old male (Case 2) presented at the clinic with symptoms of itching, erythema, and scaliness.

DIAGNOSIS

Both patients were diagnosed with psoriasis based on the locations of erythema, as well as the appearance of circumscribed scaly papules and plaques.

INTERVENTIONS

Patients underwent 5 months (Case 1) and 8 months (Case 2) of treatments with acupuncture, herbal medicine, probiotics, and phototherapy.

OUTCOMES

After treatment, the patients improved in Psoriasis Area and Severity Index score from 7 to 1.2 (Case 1), and 23.2 to 2.2 (Case 2).

LESSONS

These outcomes suggest that Korean medicine therapies combined with phototherapy may be effective for resolution of psoriasis; however, further research is needed to confirm these findings.

Sleep disorders and atopic dermatitis: A 2-way street?

Sleep disturbance is very common in patients with atopic dermatitis (AD) and is a major factor leading to impaired quality of life. Sleep disturbance is often viewed as one of the symptoms of AD and one of the measures of disease severity. In this review we describe a variety of sleep disorders associated with AD and a wide range of effect that sleep disorders have on patients with AD. We also discuss our current understanding of the mechanism of sleep disturbance in patients with AD. The relationship between sleep disorders and AD might be bidirectional and could form a vicious cycle. Therefore we suggest viewing sleep disorders as a comorbidity of AD for which regular screening and bidirectional management strategies are indicated, with equal focus on maintaining disease control and implementing specific strategies to improve sleep.

Complementary and integrative therapies for psoriasis: Looking forward

Despite the great advances in our understanding of disease pathogenesis and a rich variety of therapeutic options, including the availability of newer biologic agents, there is still no cure for psoriasis. Based on low levels of satisfaction in the treatment they receive and their overall care, it is not surprising that a substantial part of patients turn to complementary and alternative therapies. Integrative medicine is an exciting new approach to health care. The dermatologist should recognize this growing trend and become familiar with the current literature on integrative therapies for psoriasis. Several complementary therapies, those that have been found to be safe and effective, can be recommended as part of an integrative treatment plan.

Italian guidelines on the systemic treatments of moderate-to-severe plaque psoriasis

Psoriasis is a common disease, which has a considerable impact on the healthcare system. Therefore, appropriate use of therapeutic resources is very important. Management of psoriasis in daily clinical practice is highly variable because many issues are still debated and not definitely addressed by the evidence-based medicine. Moreover, the different availability and reimbursability of drugs in each country justifies national guidelines. Expert consensus can provide helpful guidelines for optimizing patient care. A total of 20 dermatologists from different areas of Italy and with large experience in the treatment of psoriasis agreed to participate in the guidelines expert panel who aimed to reach consensus on the factors influencing psoriasis severity, the indications for systemic treatments, the parameters to be considered in the choice of treatment, and the factors to be considered in the choice of biological treatment. The recommendations for the use, screening and monitoring of systemic therapies were based on the 2015 S3 European Dermatology Forum/European Academy of Dermatology and Venereology psoriasis guidelines. Recommendations on the treatment of psoriasis in special patient populations were also agreed. The final document was discussed in a meeting moderated by a facilitator with participation of the entire group and adopting a nominal group technique to reach consensus. A statement was regarded as consented when agreement was achieved by at least 75% of the voting experts according to the Delphi procedure.

Gas chromatography-mass spectrometry analysis of effects of dietary fish oil on total fatty acid composition in mouse skin

Altering the fatty acid (FA) composition in the skin by dietary fish oil could provide therapeutic benefits. Although it has been shown that fish oil supplementation enhances EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) abundance in the skin, comprehensive skin FA profiling is needed. We established a gas chromatography-mass spectrometry method, which allows precise quantification of FA profile using small (<24 mm² for mice and <12 mm² for humans) skin specimens that can be readily obtained from live mice and humans. We determined mouse skin FA composition after 2, 4 and 8 weeks of consuming a control diet or a diet supplemented with fish oil. Fish oil markedly enhanced EPA and DHA in mouse skin within 2 weeks, and this increase plateaued after 4 weeks. The FA composition in mouse skin was different from that of serum, indicating that skin has homeostatic control of FA metabolism. Mice fed the control diet designed to simulate Western human diet displayed similar skin FA composition as that of humans. The present study presents a validated method for FA quantification that is needed to investigate the mechanisms of actions of dietary treatments in both mouse and human skin.

The welcoming attitude of dermatologists towards complementary and alternative medicine despite their lack of knowledge and training

Background/aim: Although complementary and alternative medicine (CAM) use is highly prevalent, there is very limited information on dermatologists' attitudes and knowledge about CAM. In this survey, we aimed to study the knowledge and attitude of dermatologists in Saudi Arabia towards CAM. Furthermore, we assessed dermatologists' intention to receive CAM education and training. Methods and design: We collected data through an online cross-sectional survey sent to email addresses of dermatologists in Saudi Arabia. Questions included socio-demographic data, knowledge and attitudes towards CAM practice. Results: A total of 93 questionnaires were returned from dermatologists in various regions of Saudi Arabia. The mean age was 41.7 ± 10.3 (range, 25-63) years. A total of 67% of dermatologists had welcoming attitudes towards CAM. We did not find any significant relationship between age, gender, experience or any other factor and positive attitudes towards CAM. More than 70% of participants reported an interest in learning about CAM. However, only 9 (9.7%) dermatologists had attended CAM courses. Sixty-one participants (65.6%) were eager to receive CAM-specific education, and 66% of dermatologists acknowledged having previously discussed CAM with their patients. The most important reason that dermatologists did not discuss CAM with their patients was a lack of studies supporting CAM (66.7%) and the belief that doctors' knowledge on CAM is insufficient (58.1%). Conclusion: A greater number of dermatologists have an affirmative attitude towards CAM. The willingness to improve knowledge and training indicates that the CAM field could potentially grow in dermatology.