Vitamins that may be helpful
Fumaric acid, in the chemically bound form
known as fumaric acid esters, has been shown in case studies,7 preliminary
trials8 9 10 and double-blind trials11
12 13 to be effective against symptoms of psoriasis. However, because fumaric
acid esters can cause significant side effects, they should be taken only under the
supervision of a doctor familiar with their use. Nevertheless, these side effects have been
reported to decrease in frequency over the course of treatment and, if they are closely
monitored, rarely lead to significant toxicity.14
In a double-blind trial, fish oil (10 grams
per day) was found to improve the skin lesions of psoriasis.15 In another trial,
supplementing with 3.6 grams per day of purified eicosapentaenoic acid (EPA, one of the fatty
acids found in fish oil) reduced the severity of psoriasis after two to three
months.16 17 That amount of EPA is usually contained in 20 grams of fish
oil, a level that generally requires 20 pills to achieve. However, when purified EPA was used
in combination with purified docosahexaenoic acid (DHA, another fatty acid contained in fish oil), no
improvement was observed.18
Additional research is needed to determine whether fish oil itself or some of its components are more
effective for people with psoriasis. One trial showed that applying a preparation containing
10% fish oil directly to psoriatic lesions twice daily resulted in improvement after seven
weeks.19 In addition, promising results were reported from a double-blind trial in
which people with chronic plaque-type psoriasis received 4.2 g of EPA and 4.2 g of DHA or placebo intravenously each day for two weeks.
Thirty-seven percent of those receiving the essential fatty acid infusions experienced greater
than 50% reduction in the severity of their symptoms.20
Supplementing with fish oil also may help prevent the increase in blood levels of triglycerides that occurs as a side effect of certain
drugs used to treat psoriasis (e.g., etretinate and acitretin).21
Folic acid antagonist drugs have been used
to treat psoriasis. In one preliminary report, extremely high amounts of folic acid (20 mg
taken four times per day), combined with an unspecified amount of vitamin C, led to significant improvement within three
to six months in people with psoriasis who had not been taking folic acid
antagonists;those who had previously taken these drugs saw a worsening of their
Although some doctors have been impressed with the effectiveness of flaxseed oil (usually 1 to 3 tbsp per day) against
psoriasis, there have been no published trials to support that observation.
The vitamin D that is present in food or
manufactured by sunlight is converted in the body into a powerful hormone-like molecule called
1,25-dihydroxyvitamin D. That compound and a related naturally occurring molecule (1
alpha-hydroxyvitamin D3) have been found to reduce skin lesions when given orally to people
with psoriasis.23 Topical application of these compounds has also been effective in
some,24 25 26 27 but not all,28
29 trials. These activated forms of vitamin D are believed to help by preventing the
excessive proliferation of cells that occurs in the skin of people with psoriasis. Because
these potent forms of vitamin D can cause potentially dangerous increases in blood levels of
calcium, they are available only by prescription. Toxicity is usually less of a problem with
activated vitamin D applied topically than with activated vitamin D taken orally. The use of
these compounds (under the supervision of a qualified dermatologist) may be considered in
difficult cases of psoriasis. The form of vitamin D that is available without a prescription
is unlikely to be effective against psoriasis.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
Cayenne contains a resinous and pungent
substance known as capsaicin. This chemical relieves pain and itching by depleting certain
neurotransmitters from sensory nerves. In a double-blind trial, application of a capsaicin
cream to the skin relieved both the itching and the skin lesions in people with
psoriasis.30 Creams containing 0.025 to 0.075% capsaicin are generally used. There
may be a burning sensation the first several times the cream is applied, but this usually
become less pronounced with each use. The hands must be carefully and thoroughly washed after
use, or gloves should be worn, to prevent the cream from accidentally reaching the eyes, nose,
or mouth and causing a burning sensation. The cream should not be applied to areas of broken
A double-blind trial in Pakistan found that topical application of an aloe extract (0.5%) in a cream was more effective than
placebo in the treatment of adults with psoriasis.31 The aloe cream was applied
three times per day for four weeks.
In traditional herbal texts, burdock root
was believed to clear the bloodstream of toxins.32 It was used both internally and
externally for psoriasis. Traditional herbalists recommend 2 to 4 ml of burdock root tincture
per day. For the dried root preparation in tablet or capsule form, the common amount to take
is 1 to 2 grams three times per day. Many herbal preparations will combine burdock root with
other alterative herbs, such as yellow dock,
red clover, or cleavers. Burdock root has not been studied in
clinical trials to evaluate its efficacy in helping people with psoriasis.
Although clinical trials are lacking, some herbalists use the herb, coleus, in treating people with
psoriasis.33 Coleus extracts standardized to 18% forskolin are available, and 50 to
100 mg can be taken two to three times per day. Fluid extract can be taken in the amount of 2
to 4 ml three times per day.
An ointment containing Oregon grape (10%
concentration) has been shown in a clinical trial to be mildly effective against moderate
psoriasis but not more severe cases.34 Whole Oregon grape extracts were shown in
one laboratory study to reduce inflammation often associated with psoriasis.35 In
this study, isolated alkaloids from Oregon grape did not have this effect. This suggests that
there are other active ingredients besides alkaloids in Oregon grape. Barberry, which is very similar to Oregon grape, is
believed to have similar effects. An ointment, 10% of which contains Oregon grape or barberry
extract, can be applied topically three times per day.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
1. Poikolainen K, Reunala T, Karvonen J, et al. Alcohol intake: a risk
factor for psoriasis in young and middle aged men? BMJ 1990;300:780–3.
2. Monk BE, Neill SM. Alcohol consumption and psoriasis.
3. Douglas JM. Psoriasis and diet. West J Med 1980;133:450
4. Michaelsson G, Gerden B. How common is gluten intolerance among
patients with psoriasis? Acta Derm Venereol 1991;71:90.
5. Bazex A, Gaillet L, Bazex J. Gluten-free diet and psoriasis. Ann
Dermatol Syphiligr 1976;103:648–50 [in French].
6. Michäelsson G, Gerdén B, Hagforsen E, et al. Psoriasis
patients with antibodies to gliadin can be improved by a gluten-free diet. Br J
7. Ameen M, Russell-Jones R. Fumaric acid esters: an alternative systemic
treatment for psoriasis. Clin Experiment Dermatol 1999;24:361–4.
8. Mrowietz U, Christophers E, Altmeyer P. Treatment of severe psoriasis
with fumaric acid esters: scientific background and guidelines for therapeutic use. Br J
9. Kolbach DN, Nieboer C. Fumaric acid therapy in psoriasis: results and
side effects of 2 years of treatment. J Am Acad Dermatol 1992;27:769–71.
10. Altmeyer PJ, Matthes U, Pawlak F, et al. Antipsoriatic effect of
fumaric acid derivatives. J Am Acad Dermatol 1994;30:977–81.
11. Nugteren-Huying WM, van der Schroeff JG, Hermans J, Suurmond D.
Fumaric acid therapy for psoriasis: a randomized, double-blind, placebo-controlled study.
J Am Acad Dermatol 1990;22:311–2.
12. Nieboer C, de Hoop D, Langendijk PN, et al. Fumaric acid therapy in
psoriasis: a double-blind comparison between fumaric acid compound therapy and monotherapy
with dimethylfumaric acid ester. Dermatologica 1990;181:33–7.
13. Mrowietz U, Christophers E, Altmeyer P. Treatment of psoriasis with
fumaric acid esters: results of a prospective multicentre study. German Multicentre Study.
Br J Dermatol 1998;138:456–60.
14. Nieboer C, de Hoop D, van Loenen AC, et al. Systemic therapy with
fumaric acid derivates: new possibilities in the treatment of psoriasis. J Am Acad
Dermatol 1989;20:601–8 [review].
15. Bittiner SB, Tucker WFG, Cartwright I, Bleehen SS. A double-blind,
randomised, placebo-controlled trial of fish oil in psoriasis. Lancet
16. Kojima T, Terano T, Tanabe E, et al. Long-term administration of
highly purified eicosapentaenoic acid provides improvement of psoriasis.
17. Kojima T, Ternao T, Tanabe E, et al. Effect of highly purified
eicosapentaenoic acid on psoriasis. J Am Acad Dermatol 1989;21:150–1.
18. Soyland E, Funk J, Rajka G, et al. Effect of dietary supplementation
with very-long-chain n-3 fatty acids in patients with psoriasis. N Engl J Med
19. Dewsbury CE, Graham P, Darley CR. Topical eicosapentaenoic acid (EPA)
in the treatment of psoriasis. Br J Dermatol 1989;120:581–4.
20. Mayser P, Mrowietz U, Arenberger P, et al. W-3 Fatty acid-based lipid
infusion in patients with chronic plaque psoriasis: results of a double-blind, randomized,
placebo-controlled, multicenter trial. J Am Acad Dermatol 1998;38:539–47.
21. Ashley JM, Lowe NJ, Borok ME, Alfin-Slater RB. Fish oil
supplementation results in decreased hypertriglyceridemia in patients with psoriasis
undergoing etretinate or acitretin therapy. J Am Acad Dermatol
22. Oster KA. A cardiologist considers psoriasis Cutis
23. Morimoto S, Yoshikawa K, Kozuka T, et al. An open study of vitamin D3
treatment in psoriasis vulgaris. Br J Dermatol 1986;115:421–9.
24. Morimoto S, Yoshikawa K. Psoriasis and vitamin D3. Arch
25. Kragballe K. Treatment of psoriasis by the topical application of the
novel cholecalciferol analogue calcipotriol. Arch Dermatol
26. Smith EL, Pincus SH, Donovan L, Holick MF. A novel approach for the
evaluation and treatment of psoriasis. J Am Acad Dermatol 1988;19:516–28.
27. Kragballe K, Beck HI, Sogaard H. Improvement of psoriasis by a
topical vitamin D3 analogue (MC 903) in a double-blind study. Br J Dermatol
28. Henderson CA, Papworth-Smith J, Cunliffe WJ, et al. A double-blind,
placebo-controlled trial of topical 1,25-dihydroxycholecalciferol in psoriasis. Br J
29. Van de Kerkhof PCM, Van Bokhoven M, Zultak M, Czarnetzki BM. A
double-blind study of topical 1 alpha,25-dihydroxyvitamin D3 in psoriasis. Br J
30. Ellis CN, Berberian B, Sulica VI, et al. A double-blind evaluation of
topical capsaicin in pruritic psoriasis. J Am Acad Dermatol 1993;29:438–42.
31. Syed TA, Ahmed SA, Holt AH, et al. Management of psoriasis with
Aloe vera extract in a hydrophilic cream: A placebo-controlled, double-blind study.
Tropical Med Inter Health 1996;1:505–9.
32. Hoffman D. The Herbal Handbook: A User’s Guide to Medical
Herbalism. Rochester, VT: Healing Arts Press, 1988, 23–4 [review].
33. Bone K. Clinical Applications of Ayurvedic and Chinese
Herbs. Warwick, Queensland, Australia: Phytotherapy Press, 1996, 103–7.
34. Wiesenauer M, Lüdtke R. Mahonia aquifolium in patients
with psoriasis vulgaris—an intraindividual study. Phytomed
35. Galle K, Müller-Jakic B, Proebstle A, et al. Analytical and
pharmacological studies on Mahonia aquifolium. Phytomed
36. Liao, SJ. Acupuncture treatment for psoriasis: a retrospective case
report. Acupunct Electrother Res 1992;17:195–208.
37. Jerner B, Skogh M, Vahlquist A. A controlled trial of acupuncture in
psoriasis: no convincing effect. Acta Derm Venereol (Stockh) 1997;77:154–6.
38. Kabat-Zinn J, Wheeler E, Light T, et al. Influence of a mindfulness
meditation-based stress reduction intervention on rates of skin clearing in patients with
moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA).
Psychosom Med 1998;60:625–32.
39. Shenefelt PD. Hypnosis in dermatology. Arch Dermatol
40. Kline MV. Psoriasis and hypnotherapy: a case report. Int J Clin
Exp Hypn 1954;2:318–22.