By Lisa Rapaport

(Reuters Health) – Complementary and alternative medicine approaches might help relieve psoriasis symptoms, a research review suggests.

Such approaches included acupuncture, meditation, and herbal remedies like indigo naturals or curcumin, according to the authors of the review.

Raised patches of dry, scaly, itchy skin are a hallmark of psoriasis. The inflammatory skin condition can be made worse by exposure to stress, cold, and infections. Symptoms may be eased by topical ointments and medications, but there is no cure.

Even though up to half of psoriasis patients use complementary and alternative medicine to get relief, research to date hasn’t offered a clear picture of what approaches might be most effective at clearing up skin or making it less uncomfortable, researchers note in JAMA Dermatology.

For the current study, researchers examined data from 60 studies of a wide variety of complementary and alternative medicine approaches to relieving psoriasis. While these studies were too varied in quality, design and outcomes measured to draw firm conclusions about the effectiveness of different types of non-traditional therapies, the results suggest that at least some complementary and alternative medicine interventions might help some people with psoriasis feel better, said study co-author Dr. Alexandra Price of the University of Miami in Florida.

“Certain complementary and alternative medicine therapies, such as indigo naturalis, curcumin, fish oil, meditation, acupuncture, and hypocaloric diets, have been shown to be safe and effective treatments for psoriasis in randomized controlled trials, although fish oil had conflicting results,” Price said by email.

Patients should still be cautious, however.

“While there are a number of natural therapies available over the counter, only a few of them have been studied in trials,” Price said.

Even when studies have been done, results may not be definitive, Price noted.

The formulations and doses of curcumin and indigo naturalis that have been effective in clinical trials are not widely available for patients to buy, Price said. That means when patients buy these products, they may get untested versions.

Fish oil, the most common alternative therapy for psoriasis, has been effective in some studies but not in others, making it unclear how much it helps, Price added.

In the current analysis, fish oil showed no meaningful improvements in psoriasis in 12 controlled experiments that randomly assigned some people to use this product and others to use a placebo or alternative remedy. But other less rigorous types of studies found daily fish oil did appear to help improve symptoms.

“Traditional treatments for psoriasis, such as topical corticosteroids, topical vitamin D analogues, retinoids, and biologic therapies, currently have the most data supporting their use, and therefore, should remain first treatments for psoriasis,” Price advised.

When patients do want to explore other options, they should consider the relative risk associated with different types of complementary and alternative medicine, said Dr. Steve Xu of the Northwestern University Feinberg School of Medicine in Chicago.

“With topical and oral complementary and alternative medicines, there is a greater potential for harm for adverse events, lesser clinical evidence for efficacy, and unclear manufacturing processes for ingredient purity and consistency,” Xu, who wasn’t involved in the study, said by email.

At the same time, there may be little harm in trying low-risk things like meditation or other stress reduction techniques in combination with traditional medicine, even if trials don’t decisively prove that these alternatives help, Xu added.

“If it works for my patient and they feel like they derive a benefit from it – who am I to discourage it or be a naysayer,” Xu said.

SOURCE: JAMA Dermatology, online September 5, 2018.