Incurable diseases that are poorly understood, have limited conventional therapeutic options, or have treatments with real or perceived side effects are prime candidates for alternative approaches. Psoriasis, with its long history of suffering and confusion, nicely fits into this category. Indeed, for centuries, patients with psoriasis were treated as literal lepers, and were required to carry a bell or clapper to announce their approach. The medical side of that coin is perhaps best summarized by the pithy words of Paul Bechet: “Psoriasis is an antidote for dermatologists’ ego.”
Despite the truly spectacular advances in both the pathophysiology and therapy of psoriasis, there are still many unanswered questions and there is still no cure. And, as we wade through an embarrassment of riches of conventional therapeutic options, there remains—perhaps surprisingly—significant patient dissatisfaction with their treatments. This, too, opens the door to exploration of alternatives. Further, the notion that these powerful biologic agents—which truly do appear to be safer than their predecessors—still have the potential for side effects, with one recent study reporting more than one quarter of respondents experiencing a serious adverse event secondary to a biologic agent for psoriasis, though this admittedly included a large portion of patients on infliximab.
With such an extensive armamentarium for psoriasis, many of the things we will discuss below may better serve as complementary or adjunctive therapies rather than act as alternatives. Judging by a recent survey finding that nearly 50% of psoriasis patients had used a form of alternative medicine in the preceding year, this may be happening already for many of our patients without our knowledge. This approach—taking the best of conventional medicine along with helpful unconventional remedies—is a very nice approximation of the definition of “integrative medicine.”
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