PSORIASIS

General Overview | TCM Treatment | Guttate Psoriasis | Plaque Psoriasis |
Pustular Psoriasis | Treatment Outcome

GENERAL OVERVIEW
Psoriasis is characterized by an abnormally fast rate of skin regeneration. This means psoriatic skin cells are produced 10 times faster than normal, at the same time that dead skin cells are shed at the normal rate. This causes the red, thick, inflamed plaques typical of psoriasis. Although this accurately describes what is going on, science has not been able to explain why it happens. Worldwide, psoriasis affects about 2% of the population. It is not a new condition, having been described in ancient Greek and Chinese medical texts. The name psoriasis derives from the Greek "psora", which means to itch. Still, this is a bit of a misnomer, as itch is not always a feature of the condition. Modern medicine can offer some management of symptoms for mild to moderate psoriasis, but no cure. Common medical treatments include steroids, immunosuppressive therapies, UV treatment and retinoid compounds. Many of these carry the risk of serious side effects. Psoriasis.org has excellent information on these therapies.

TCM TREATMENT
Chinese Herbs offer the chance of a lasting cure for psoriasis (treatment outcome), in most cases. The practitioner will do a TCM diagnosis, in order to assess the severity and subtleties of each individual case. This is the key to success with TCM, the recognition that while 10 patients may all have "plaque psoriasis", they may show distinct variations in the presentation of their psoriasis. Noting these variations allows the herbal formula to be tailored exactly to the case at hand.

Both patients have plaque psoriasis, although one is covered in while scale while the other is not. This would be significant for treatment, and would make the herbal formulas different for each patient. Other differences that need to be accounted for are amount of itch, severity and spread of the plaques, duration and onset of the illness, degree of redness (from pale pink to fire engine to purplish red). Additionally, accompanying and seemingly unrelated symptoms are significant for the TCM diagnosis: general thirst level of the patient, sweating or lack thereof, constipation, history of strep infections, and body type. Once all of these have been assessed, the practitioner is ready to assemble a formula composed of 10 to 16 herbs, each of which is directed at one or another of the above symptoms and signs. The herbs are administered twice daily for a period of weeks or months (treatment outcome).

GUTTATE PSORIASIS
This is an acute, sudden manifestation of psoriasis, characterized by small red lesions, and it often follows strep throat. Forty percent of guttate cases heal on their own within 6 months, while the rest go on to develop into plaque psoriasis. If it is of recent onset, and not superimposed on existing plaque psoriasis, this form is quite easy to treat with TCM. Herbs with broad antibacterial effect are used to clear any remnants of streptoccocal infection, with the addition of the usual repertoir of anti-psoriatic herbs, based on the TCM diagnosis. If guttate psoriasis develops alongside pre existing plaques, treatment will take longer.

PLAQUE PSORIASIS
This is the typical, chronic form of psoriasis, presenting with red, thickened patches, possibly covered with white or yellow scale. It usually covers the knees, elbows, trunk or scalp. It is well treated by TCM especially when it is red, rather than purplish, and has some ebb and flow of its own, i.e. it fluctuates in severity. Fluctuation is generally a good sign, whereas unchanging, fixed and very rooted lesions are always more stubborn and require more time.

PUSTULAR PSORIASIS
There are two kinds: generalized and palmo-plantar. Generalized pustular psoriasis can be a medical emergency due to great inflammation, and is best dealt with in a hospital setting. Unfortunately, however, it is sometimes a side effect of immunosuppressive treatment for plaque psoriasis, a kind of rebound reaction. Palmo-plantar pustular psoriasis shows up on the palms and soles, and is often misdiagnosed by medical doctors (see pictures), despite the fact that it presents with a very unique feature, that of yellow pustules which quickly turn brown. Any skin condition in these areas should be taken to a dermatologist for proper identification. TCM considers this type of psoriasis completely different from the others, treating it as a problem of excess moisture in the skin, whereas classic psoriasis is notoriously dry. Drying, diuretic and anti-inflammatory herbs are prescribed for this condition, with very good effects.

TREATMENT OUTCOME
There are predictable markers of improvement that one can expect once treatment has started:
Week 3 to 5: itch, if present, begins to decrease. Scales may loosen and therefore shed more, temporarily.
Week 6 to 7: a clear reduction in lesions is visible, such as in redness and size. It is not unusual for lesions to clear from the centre, or as islands of now normal skin in the middle of psoriatic plaques.
Week 7 to end: lesions continue to clear, generally not at the same rate all over the body.
Purplish lesions tend to enlarge somewhat as they fade. This is normal.

Total treatment time is anywhere from 8 weeks to 6 months or more, depending on the severity and duration of each case. Even in persistent cases, improvement becomes evident within the first few weeks, providing an incentive to stick with the treatment. The SKIN CLINIC in Brighton, England, has compiled the following survey of several thousand psoriasis patients treated with TCM: 60% of patients experienced complete clearing of psoriatic lesions. 20% had moderate to significant improvement, while the remaining 20% were not helped.