Dermatologic Therapy, Vol. 27, 2014, 281–283 Printed in the United States · All rights reserved

© 2014 Wiley Periodicals, Inc.

DERMATOLOGIC THERAPY ISSN 1396-0296

THERAPEUTIC HOTLINE Complementary and alternative medicine use among patients with psoriasis Katerina Damevska*, Lence Neloska†, Suzana Nikolovska*, Gorgi Gocev* & Silvia Duma* *University Clinic of Dermatology, Medical Faculty, Ss. Cyril and Methodius University, and †Public Health Center “13 Noemvri”, Skopje, Republic of Macedonia

ABSTRACT: Despite the growing attention on safety and efficacy of conventional treatments, there is little information available on complementary and alternative medicine (CAM) used in psoriasis. In order to collect comprehensive information on CAM use, we conducted a face-to-face interview with 122 patients with psoriasis. All unconventional treatments for psoriasis used in the last 12 months were recorded. Fifty-seven patients (46.7%) used one of the CAM methods in the previous year, including topical and systemic antipsoriatics, dietary supplements, and diet. Forty-one different nonconventional topical treatments were used. Seven patients (5.7%) took nonconventional systemic medication, and 15.5% used dietary supplements. There were three patients who reported current adherence to a diet as treatment of psoriasis. Clinicians are often not informed that their patients are using complementary therapies. CAM may offer benefits as well as risks to patients with psoriasis. It is important to remind patient to report all ongoing and past topical and systemic treatments. The use of medications with unknown composition, efficiency, and safety should be discouraged. KEYWORDS: complementary and alternative medicine, psoriasis

Introduction Complementary and alternative medicine (CAM) is defined as a group of diverse medical systems, practices, and products that are not presently considered to be part of conventional medicine (1). Estimates of the prevalence of use of CAM in the general population vary widely, ranging from 9.8% to 76% (2). Several studies have observed an increased use of CAM in patients with psoriasis Address correspondence and reprint requests to: Katerina Damevska, MSc, PhD, University Clinic of Dermatology, Medical Faculty, University “Ss Cyrilius and Methodius”, Bul. Vodnjanska 31, Skopje 1000, Republic of Macedonia, or email: [email protected].

(3–5). Despite the growing attention on safety and efficacy of conventional treatments, there is little scientific information available on unconventional therapies used in psoriasis. The purpose of this study was to examine use of CAM in patients with psoriasis.

Methods One hundred twenty-two patients with psoriasis, 44 inpatients (36.1%) and 78 outpatients (63.9%), were recruited from the University Clinic of Dermatology, at Skopje Medical Faculty. The inclusion criteria was age >18 years and clinical diagnosis of plaque-type psoriasis. In order to collect

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comprehensive information on CAM use, we conducted a face-to-face interview with each patient. All unconventional treatments for psoriasis used in the last 12 months were recorded. All participants signed an informed consent.

Results Fifty-two male and 70 female patients, mean age 51.52 years (SD 15.56), range 19–80 years, participated in the study. The mean duration of psoriasis was 17.9 years (SD 14.21), and the mean psoriasis area severity index (PASI) score was 14.47 (SD 12.78). Fifty-seven patients (46.7%) used one of the CAM methods in the previous year, including topical and systemic antipsoriatics, dietary supplements, and diet. Forty-one different nonconventional topical treatments were used. The most mentioned agents were honey bee products and Calendula officinalis ointment, followed by St. John’s wort oils or tinctures. Eight patients (6.5%) used complex mixtures with unknown composition (Table 1). Seven patients (5.7%) took nonconventional systemic medication, of whom five took oral solutions with unclear origin and composition, one patient took megadose of vitamin D, vitamin A, and selenium, and one patient took XP-828L, a protein Table 1. Complementary and alternative medicine in patients with psoriasis (n = 122) n (%) Topical antipsoriasis agents Honey bees products Calendula officinalis ointment St. John’s wort oils/tinctures Chinese herbal creams and plasters Aloe vera gels/creams Natural tar products Colloidal silver Mixtures with unknown composition Other Systemic antipsoriasis agents Oral preparations with unknown composition XP-828L Megadoses of vit D, vit A and selenium Dietary supplements Herbal Omega-3 fatty acid supplements Vit D Weight-loss drugs Other Diets

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45 (36.8) 11(9.0) 11 (9.0) 9 (7.3) 7 (5.7) 7 (5.7) 4 (3.2) 3 (2.4) 8 (6.5) 7 (5.7) 7 (5.7) 5 (4.1) 1 (0.8) 1 (0.8) 19 (15.5) 7 (5.7) 2 (1.6) 1 (0.8) 2 (1.6) 7 (5.7) 3 (2.4)

extract obtained from sweet whey. One participant reported taking two nonconventional systemic treatments in the last 12 months. There were two patients who reported current adherence to a gluten-free diet and one patient on low-lipid diet as treatment of psoriasis. Nineteen patients (15.5%) used dietary supplements, most of them omega fatty acids and vitamins. CAM treatments for health problems other than psoriasis were registered in eight patients: herbal remedies in treatment of depressive symptoms and urinary infections (4), weight loss treatment (2), homeopathic remedies for Helicobacter pylori (1), and herbal anti-asthmatic preparation (1).

Discussion The results of our study show a high prevalence of CAM usage in patients with psoriasis. The majority had used different topical preparations of variable quality and potency, generally harmless, but with unproven therapeutic benefit. A small percentage of the patients (5.8%) took oral herbal mixtures of an unclear composition. Such practice may result in the use of potentially toxic species and drug– herb interactions. Therefore, St. John’s wort extract (Hypericum perforatum) is commonly used in herbal medications in our region; it increases the activity of cytochrome P450 3A4 enzyme and reduces plasma concentrations of certain drugs (6). Topical or oral administration of Hypericum causes photosensitivity, and marigold (Calendula officinalis), propolis, and aloe vera products may cause contact allergy (7). Another problem is contamination and adulteration of herbal medicinal products with other herbs, microbes, pesticides, heavy metals, hormones, stimulants, and drugs (8). The true prevalence of the use of CAM remains uncertain. Patients usually do not inform the physician about this consumption. This may be a result of a fear of getting a negative reaction by the physician, or because the patient’s belief that his habit of using plants or herbal medicine is irrelevant. In our region, herbal products are considered to be natural, healthy, and harmless. However, most dermatologists are not trained on composition and pharmacological activities of these products, especially those that are not part of the local traditional medicine.

Conclusion Considering the wide and growing use of CAM among patients with psoriasis, it is important to

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remind patient to report all ongoing and past topical and systemic treatments. The use of medications with unknown composition, efficiency, and safety should be discouraged.

References 1. NIH Consensus Conference. Acupuncture. JAMA 1998: 280: 1518–1524. 2. Harris PE, Cooper KL, Relton C, Thomas KJ. Prevalence of complementary and alternative medicine (CAM) use by the general population: a systematic review and update. Int J Clin Pract 2012: 66 (10): 924–939. 3. Ben-Arye E, Ziv M, Frenkel M, Lavi I, Rosenman D. Complementary medicine and psoriasis: linking the patient’s outlook with evidence-based medicine. Dermatology 2003: 207 (3): 302–307.

4. Magin PJ, Adams J, Heading GS, Pond DC, Smith W. Complementary and alternative medicine therapies in acne, psoriasis, and atopic eczema: results of a qualitative study of patients’ experiences and perceptions. J Altern Complement Med 2006: 12 (5): 451–457. 5. May BH, Zhang AL, Zhou W, Lu CJ, Deng S, Xue CC. Oral herbal medicines for psoriasis: a review of clinical studies. Chin J Integr Med 2012: 18 (3): 172–178. 6. Komoroski BJ, Zhang S, Cai H, et al. Induction and inhibition of cytochromes P450 by the St. John’s wort constituent hyperforin in human hepatocyte cultures. Drug Metab Dispos 2004: 32 (5): 512–518. 7. Schempp CM. Effect of topical application of Hypericum perforatum extract (St. John’s wort) on skin sensitivity to solar simulated radiation. Photodermatol Photoimmunol Photomed 2000: 16 (3): 125–128. 8. Posadzki P, Watson L, Ernst E. Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic reviews. Eur J Clin Pharmacol 2013: 69 (3): 295– 307.

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Complementary and alternative medicine use among patients with psoriasis.

Despite the growing attention on safety and efficacy of conventional treatments, there is little information available on complementary and alternativ...
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