Phytotherapy and psoriasis: Complementary and alternative medications

Abstract

Psoriasis comprises severe skin problems affects on
quality of patient’s life. It affects 2% of the general
population with age before 35 years old. Most potent
and cheap psoriatic drugs are still largely unavailable.
Recently, as aresult of the apparent side effects of
chemical drugs, treatments of herbal origin gains the
popularity among patients with skin disorders especially
those for psoriasis. In this review, the uses of complementary
and alternative medications of various topical
herbal formulae with different potency against psoriasis
was greatly assessed. Modified Psoriasis scoring systems
were performed as evident of improvement when
various topical herbal formula including traditional chinese
medicine ingredients such as Camptotheca acuminate,
Oleum horwathiensis, Capsaicin, furocoumarins,
Curcumin, and Tars were used against psoriasis. Also,
plant extracts of Aleo Vera, and green tea were reported
in topical form for the treatment of psoriasis. Most
studies indicated a variety of biological activities of
used herbs depending on their chemical constituents.
This versatile range of biological activities explaining,the apparent benefits of these herbs in monitoring of
psoriasis.

Full text

Published by Baishideng Publishing Group Inc
World Journal of
Dermatology
World J Dermatol 2014 November 2; 3(4): 76-91
ISSN 2218-6190
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76
Psoriasis: Biologic treatment and liver disease
Vilarrasa E, Puig L
86
Phytotherapy and psoriasis: Complementary and alternative medications
Gabr SA, Alghadir AH
Contents
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INDEXING/ABSTRACTING

Phytotherapy and psoriasis: Complementary and alternative
medications
Sami A Gabr, Ahmad H Alghadir
Sami A Gabr,
Department of Anatomy, Faculty of Medicine,
Mansoura University, Mansoura 35516, Egypt
Sami A Gabr, Ahmad H Alghadir,
Rehabilitation Research
Chair, King Saud University, Riyadh 11433, Kingdom of Saudi
Arabia
Ahmad H Alghadir,
Department of Rehabilitation Science, Col-
lege of Applied Medical Sciences, King Saud University, Riyadh
11433, Kingdom of Saudi Arabia
Author contributions:
Gabr SA and Alghadir AH contributed to
this paper.
Correspondence to:
Dr. Sami A Gabr,
Rehabilitation Research
Chair, King Saud University, 2454, Riyadh 11433,
Kingdom of Saudi Arabia. nadalab2009@hotmail.com
Telephone:
+966-56-2060018
Fax:
+966-14-698541
Received:
December 23, 2013
Revised:
September 8, 2014
Accepted:
October 14, 2014
Published online:
November 2, 2014
Abstract
Psoriasis comprises severe skin problems affects on
quality of patient’s life. It affects 2% of the general
population with age before 35 years old. Most potent
and cheap psoriatic drugs are still largely unavailable.
Recently, as aresult of the apparent side effects of
chemical drugs, treatments of herbal origin gains the
popularity among patients with skin disorders especially
those for psoriasis. In this review, the uses of comple-
mentary and alternative medications of various topical
herbal formulae with different potency against psoriasis
was greatly assessed. Modified Psoriasis scoring sys-
tems were performed as evident of improvement when
various topical herbal formula including traditional chi-
nese medicine ingredients such as Camptotheca acumi-
nate, Oleum horwathiensis, Capsaicin, furocoumarins,
Curcumin, and Tars were used against psoriasis. Also,
plant extracts of Aleo Vera, and green tea were report-
ed in topical form for the treatment of psoriasis. Most
studies indicated a variety of biological activities of
used herbs depending on their chemical constituents.
This versatile range of biological activities explaining,
the apparent benefits of these herbs in monitoring of
psoriasis.
© 2014 Baishideng Publishing Group Inc. All rights reserved.
Key words:
Psoriasis; Herbal medicine; Skin disorders;
Chinese herbal medicine; Traditional chinese medicine
Core tip:
Herbal medicine plays a significant role in the
treatment of psoriasis; this review gives a shed of light
on some herbal medicine formulae and extracts includ-
ing Aleo Vera, and green tea. These plants extracts
and its formulae exhibited efficiency as anti-psoriasis
agents. This may relate to the varying biological activi-
ties especially tissue repair actions.
Gabr SA, Alghadir AH. Phytotherapy and psoriasis: Complemen-
tary and alternative medications. World J Dermatol 2014; 3(4):
86-91 Available from: URL: http://www.wjgnet.com/2218-6190/
full/v3/i4/86.htm DOI: http://dx.doi.org/10.5314/wjd.v3.i4.86
INTRODUCTION
Psoriasis occurs in most populations with a range of
1%-3%
[1,2]
. As usual, synthesized drugs are more potent in
psoriases, however severe unexpected binary effects will
appeare with long period of drug use. Under advice of
dermatologists, about 50% of psoriatic patients around
the world used complementary interventions
[3-8]
. These
include herbal medicine
[9,10]
; which applied to psoriatic
patients with different formulae, topically
[11]
; internally
[12]
;
and in combination with other forms like acitretin
[13]
. The
biological activities of these constituents were discussed
in most literatures
[14,15]
. Whereas these interventions were
prescribed to patients alone or in combinations with dif-
ferent forms
[16,17]
, to perform the targeted therapeutic ef-
fect with limited side effects.
Due to the benecial prospects of traditional chinese
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DOI: 10.5314/wjd.v3.i4.86
World Journal of
Dermatology
W J
D
World J Dermatol 2014 November 2; 3(4): 86-91
ISSN 2218-6190 (online)
© 2014 Baishideng Publishing Group Inc. All rights reserved.V

medicine (TCM), it was applied in management of vari-
ous dermatological conditions
[18]
. However, much con-
cerns should performed regarding the safety of Chinese
herbal treatment. Whereas, a bnormal actions as liver tox-
icity was reported during treatment
[19-21]
. So, the biological
activities of some plant extracts used alone or in different
combination forms against psoriasis were greatly report-
ed in this review.
PSORIASIS
According to the type of diagnosis, it was reported as
dermal disorders with varying shapes and severe lesions.
This disease prevails a mong people with age ranges from
15-45 years. The extant of disease usually appears with
chronic symptoms
[22]
. Many factors ranged between ge-
netic, apoptotic, cellular, and immunological parameters
were attributed with the pathological severity of the dis-
ease
[23-25]
. The diagnosis of the disease depends manily
up on the type, location, and area of lesions or plaques.
These parameters were included in many disease scoring
systems. The most useful one is psoriasis area and sever-
ity index score which evaluated to measure disease sever-
ity especially during treatment trials
[26-32]
.
HERBAL MEDICINE AND PSORIASIS
Traditional Chinese medicine and psoriasis
For most dermatologic disorders, TCM with different
formulations were used as an alternative method of
therapy
[33]
. Each part of the palnt can be used as source
for herbal remedies to words many diseases
[34,35]
. The di-
versity of both function and plant parts used, promotes
specialists developing new forms of biologically active
constituents with minimum hazards
[7,36]
. Whereas, natu-
ral plants provide the essential requirements for human
safty. It was reported that TCM is special good choice for
many patients which in turn requires a well experienced
dermatologists to select the more convenient TCM
[37]
.
So, with TCM patients can be treated safely with little
side effects
[38]
. The use of TCM in various forms to treat
psoriasis depend mainly on the type of disease. Whereas
each type has the recommended and denite mixture of
herbs for treatment
[39]
.
Local formulae of indigo plant was efciently used to
treat patients with severe psoriasis. However, recent ideas
were discussed to enhance the potency of this crude
herb by preparing extracts with better convenience and
absorption
[40]
. Camptotheca acuminata decne is another
example of active topical agents in china
[41]
. The biologi-
cal activities of this herb mainly due to its alkaloids con-
tent with antineoplastic activities
[42]
. In open clinical trials,
the efciency of this topical agent was applied for many
cases with psoriasis. The data showed that Camptotheca
acuminate decne was signicantly more effective with no-
ticed possible enhancement of post inammatory hyper-
pigmentation
[43]
. Whereas, in another study a hazard ef-
fect like dermal allergy was reported against camptotheca
acuminate decne which depends mainly on the type
and disease intinisty
[44-47]
. Besides of local trials, some
injectable forms of TCMs like Radix macrotomiae seu
Lithospermi was used with better potent and minimum
side effects against psoriasis compared to other forms of
therapeutic modalities
[7]
. Similar to Western medications,
another type of TCMs were used in capsules or tablets
forms for monotherapies or in groups of herbs with
higher safty and efciency. It was found that, three years
follow-up of psoriatic cases treated orally with TCM
showed convenient results with no hematological or bio-
chemical abnormalities compared to chemotherapeutic
agents
[19,48]
.
Extensive growing evidence was reported for using
natural plant forms to treat psoriatic patients. Comple-
mentary and alternative medicine (CAM) was used by
most patients as a complementary treatment along with
conventional treatment. So, teaching of CAM should be
integrated into the dermatology residency curriculum,
and dermatologists need to increase their awareness of
CAM use by their patients in order to improve therapeu-
tic communication
[49]
.
Some medicinal plants formulations with probable anti-
psoriatic activity
Aloe vera extract:
The plant characterized by its suc-
culent pulpy leaves which contain clear gel. This plant
was used since ancient times as potent remedy for many
diseases
[47,48]
. The versatile range of its active constituents
as analgesic, antipruritic, wound healing and anti-inam-
matory promotes its use as good anti-psoriatic agent
[50]
.
In double-blind, placebo-controlled study, 0.5% of
local forms of Aloe vera extract were subjected for the
treatment of psoriasis with diagnostic scores between 4.8
and 16.7 (mean 9.3). The data concluded that 0.5% of the
extract has higher efciency with no hazards, and could
be used as successful herbal treatment against psoriasis
[51]
.
However, in other study a commercial Aloe vera gel form
showed modest effective treatment against psoriasis
[52]
.
Oleum horwathiensis formula:
Oleum horwathiensis
formula contains many herbal constituents which showed
higher potency in local forms against psoriasis. These
constituents are; Achillaea herba, allium sativum, Ca-
lendula os, Taraxaci radix, Urtica folium and Veronica
ofcinalis. This herb was applied locally to treat psoriasis
with varying severity. The results showed a promising ef-
fect against disease severity after 12 wk
[53]
.
Capsaicin formula:
It is the most popular active con-
stituent present in cayenne pepper (C. frutescens) showed
a probable activity towords psoriasis
[54]
, through activa-
tion of cellular apoptotic factors
[55]
. Zero point zero two
ve percent of this formula was applied as local cream
to enhance the psoriatic status of patients with varying
disease intinisty. The data obtained showed an obvious
decrease in disease severity within short period of time,
however a minimum hazard effect like local site burning
87
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Gabr SA
et al
. Herbal medicine as anti-psoriatic agents

was reported, so the formulae was advised to be applied
for only 2 successive days
[56,57]
.
Furocoumarins formula:
This formula contains many
active agents obtained from different herbal plants in-
cluding Ammi majus. The anti psoriatic activity of this
formula depends mainly on photoactivation of furocou-
marins
via
ultraviolet A (UV-A, 320-400 nm) when ap-
plied either locally or in oral forms. The activity mainly
depend up on activation of skin cell apoptosis
via
pho-
tochemical linkage with DNA strands and in turn DNA
fragmentation. Consequently, a reduction in overexpres-
sion of inflammatory and proliferative proteins was re-
ported within psoriatic lesions
[58]
. These activity was fur-
ther investigated in relation to standard therapy, the data
obtained showed similar enhancement of disease prole
with minimum side effects
[59,60]
.
Curcumin formula of turmeric (Curcuma longa):
This
active formula is extracted from the rhizome of Curcuma
longa plant, it is the most potent polyphenolic compound
present as fumaric acid
[61]
. The extract is characterized by
its versatile activities ranged between anti-inflammatory,
antioxidant, antitumor, and anti microbial activities
[33]
, the
mode of action against tumor is through regulation of
the role of some cellular and immunological parameters
during cell cycle and apoptosis
[62]
. For centuries, it was
reported that Turmeric was applied to heal wounds and
reduce scare formation
[63]
. Similary, curcumin showed a
signicant enhancement of psoriatic lesions when applied
locally on diseased skin or orally through capsules. The
extract worked
via
induction of skin cell apoptosis
[64-67]
.
Tars formula:
It is one of the most efcient herbal for-
mula applied since past times to treat skin disorders. This
active ingredient was extracted from many herbal plants
like birch (Betula spp.), beech (Fagus spp.), or juniper
(Juniperus spp.) trees. The extract was applied as anti-
psoriatic agent in different forms with 5%-10% concen-
tration. The improvement capacity of extract depends
on photoactivation mechanism using UV-B with varying
light intinisty
[68]
.
Green tea potential benefits for psoriasis:
Tea con-
sidered the second worldwide beverage next to water. It
consumed as green, black, or Oolong tea. It was reported
that green tea is the most important agent targeting hu-
man health
[69]
. This may be related to its higher content
of polyphenolic compounds, like avanols and catechins,
whereas dried green tea leaves produce more than 30%
of these active constituents. Most studies indicated that
green tea constituents have awide range of medical uses
as antioxidant, antimicrobial, anti-tumor, anti-inamma-
tory, and thermogenic agents
[70,71]
. The vriable actions of
green tea constituents along with its photo suppression
action promotes dermatologists to use it as conventional
treatment for skin diseases, especially psoriasis
[72-75]
.
The treatment of skin with green tea extracts protect
the skin from developing skin cancer through damaging
DNA
via
photochemical action of ultraviolet A radia-
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Topical application
GTP or EGCG
GTP or EGCG act as
Growth regulator Differentiation inducer Apoptosis inhibitor
EGF
EGF-R
Epiregulin
VEGF-R2
FGF2
EPS8
ODC
AMD1
p57/KIP2
Keratins
Filaggrin
Involucrin
Transglutaminase
Caspase 14
HSP70
GADD45
β
Rb/E2F1, p21
p53, TRADD
c-myc, COX2
Ref-1, TNF-R
DEFCAP, CARD9
CARD10
Differentiation and barrier formation
Figure 1 Green tea effects on human epidermal keratinocytes in molecular and immune response levels
[85-87]
. EGCG: Epigallocatechin-3-gallate; GTP: Green
tea polyphenols; AMD1: Adenosylmethionine decarboxylase 1; CARD: Caspase recruitment domain; COX2: Cyclooxygenase-2; EGF-R: Epidermal growth factor
receptor; EPS8: A substrate for the epidermal growth factor receptor kinase; GADD45
β
: Growth arrest and DNA damage 45
β
; HSP70: Heat-shock protein 70; ODC:
Ornithine decarboxylase; Rb: Retinoblastoma; TNF-R: Tumor necrosis factor receptor; TRADD: Tumor necrosis factor receptor 1 associated death domain protein;
VEGF-R2: Vascular epithelial growth factor-receptor 2; FGF2: Fibroblast growth factor 2; DEFCAP: Death-effector lament-forming caspase protein.
Gabr SA
et al
. Herbal medicine as anti-psoriatic agents

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[76]
. It was reported that green tea or its active con-
stituents when applied in psoriatic skin, promotes the
formation of skin cell apoptosis
via
activation of certain
apoptotic biological enzymes included in epidermal dif-
ferentiation, cornication of the epidermal keratinocytes
and skin barrier formation
[77-82]
. Finally, the activity of
green tea against psoriasis summarized in, activation of a
set of apoptotic genes which promotes epidermal differ-
entiation and skin barrier formation along with enhance-
ment of the healing process as in Figure 1
[83-87]
.
CONCLUSION
Clinical trials proved a significant potential benefits of
herbs against psoriasis which appeared relatively safe. The
varied biological activities of these topical herbal formu-
lae may relate to its apparent benets in psoriasis. Most
advanced trials like molecular screening were needed for
discovering new leads and drug safe candidates from
plant natural products against psoriasis.
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P- Reviewer
: Manolache L, Naldi L
S- Editor
:
Ji FF
L- Editor
: A
E- Editor
:
Liu SQ
Gabr SA
et al
. Herbal medicine as anti-psoriatic agents

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