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Psoriasis

Psoriasis is a common skin disease, affecting 1-3% of the population. The lesions of psoriasis are distinctive, starting as small, scaling bumps that typically coalesce into adherent, silvery-white plaques. These plaques can occur anywhere on the body, with a special affinity for the elbows, knees, scalp, fingernails, toenails, and gluteal cleft. In pre-disposed individuals, psoriasis can also develop at the site of physical trauma in what as known as Koebner’s phenomenon—areas of scratching, sunburn, or surgery, for example.

For hundreds of years, doctors of Chinese medicine have been prescribing medicines to be drunk as teas or applied directly to the skin, and in doing so have likely helped millions of psoriasis-sufferers. As is true of the treatment of all disease with Chinese medicine, the treatment is tailored to the individual patient. No two psoriasis patients will receive the same recipe unless their constitution and presentation are *exactly* the same--unlikely. This is one of the incredible benefits of Chinese medicine: our ability to tailor treatment specifically to you.

More detail on our approach to psoriasis can be found below in our article from the November 2014 issue of Essential Living Maine Magazine. Scroll down past the article for more before and after pictures.

Chinese Medicine and Healthy Skin: Part IV
Hello!  And welcome to our fourth and last (for now) installment on Chinese medicine and skin disease.  Glad to have you back.  We’ve covered the basics (review the August online issue), and examined both acne (September print) and eczema (October online).  To round out our triumvirate of the most common skin diseases, today we’ll look at psoriasis.  And perfect timing as we’re entering winter, a season well-known for psoriatic exacerbations.

Aside from my own struggles with acne well into my 20s and fingertip eczema well into my 30s, it was psoriasis that got me most interested in studying dermatology.  One day, years ago, in the very early stages of my health care career when I was working as a therapeutic massage therapist, I had a new client.  She was in a long skirt, and as we sat down for her intake the skirt lifted I saw that both of her lower legs were covered in thick, dense, painful looking plaques.  Not a single spot of clear skin could be found; her legs hardly looked human.  We talked about it, she said she’d struggled with the condition for decades and “tried everything” to no avail.  I remember thinking how there just had to be an answer for her, and how I wished I’d had it.

What is psoriasis?
Psoriasis is a common skin disease, affecting 1-3% of the population.  The lesions of psoriasis are distinctive, starting as small, scaling bumps that typically coalesce into adherent, silvery-white plaques.  These plaques can occur anywhere on the body, with a special affinity for the elbows, knees, scalp, fingernails, toenails, and gluteal cleft (medical-speak for your…well…your butt crack).  In pre-disposed individuals, psoriasis can also develop at the site of physical trauma in what as known as Koebner’s phenomenon—areas of scratching, sunburn, or surgery, for example.

Psoriasis is genetic, meaning if one of your parents suffers from psoriasis you have a 30% chance of developing it yourself; if both parents have psoriasis that chance increases to 60-70%.  The onset of psoriasis typically occurs between the ages of 15-30, after which development drops off for a few decades only to rise once again in the 50s and 60s.  Whatever the age, once developed, the disease is lifelong and characterized by chronic and recurrent exacerbations and remissions—meaning it will stick around for the long-term, sometimes better, sometimes worse.  In my clinic I’m clear with patients that we can’t cure psoriasis; however it is possible to treat psoriasis successfully and send it into remission, or to keep the lesions static over time.

Psoriatic exacerbations are physically debilitating, to be sure, but psoriasis is particularly notable in its emotional impact.  It’s disfiguring.  It’s not contagious, but patients with psoriasis often report that others are afraid to touch them for fear of “catching” the disease.  Many psoriasis-sufferers live a life of concealment, avoiding situations and activities that could expose them, their skin, or lead them to be “discovered” in their illness.  Skin disease doesn’t easily let you keep your disease a secret.

Psoriasis and western medicine
Psoriasis has been recognized as a disease entity in both Europe and China for at least two thousand years.  In all that time, we haven’t figured out exactly what causes it.  It appears to be an immune-mediated disease, meaning that for some reason the body’s immune system starts to attack its own skin cells.  This response triggers a more rapid than normal turnover of healthy skin cells (on the order of days instead of weeks), leading to the build-up of skin that generates psoriatic plaques and scales.

We have, over the millennia, identified some triggers for the development of psoriasis.  These include:

-bacterial or viral infections
-dry skin
-skin damage: like the Koebner phenomenon, as mentioned above
-some medications: lithium, anti-malaria meds, and steroids can all trigger a massive reaction and what we call erythrodermic psoriasis, which can be a medical emergency
-stress: which, as we all know, pretty much makes everything worse
-too much or too little sunlight: psoriasis tends to be better in the summer, but too much sun can also traumatize the skin and cause a Koebner reaction
-over-consumption of alcohol
-smoking: particularly linked to a variety known as pustular psoriasis

What are the different kinds of psoriasis?
There are a bunch of different kinds of psoriasis.  Plaque psoriasis is most common, occurring mostly on the elbows, knees, and scalp, though it can show up anywhere on the body.  Guttate psoriasis is characterized by a rapid evolution of small, red, scaly bumps on the skin that don’t tend to coalesce into larger plaques.  It often follows a sore throat or respiratory infection, and may resolve on its own in 3-4 months or, unfortunately, herald the onset of chronic plaque psoriasis.  Pustular psoriasis occurs on the palms of the hands and soles of the feet, with clearly defined, raised, pus-filled bumps.  Exacerbations can be so painful as to affect one’s ability to walk or use the hands.  And, finally, erythrodermic psoriasis: a serious progression affecting 2% of sufferers that can require hospitalization.  (Psoriatic arthritis is also worth noting; it’s a chronic, inflammatory condition affecting the joints that may precede, accompany, or follow skin manifestations of the disease.)

Psoriasis and Chinese medicine
Okay, so after all that, what does Chinese medicine have to offer?  Patients who come to me are typically dissatisfied or frustrated with western interventions:

*They don’t want to use steroids or immuno-suppressant drugs.
*Steroids or other interventions work for only a short period of time.

*Steroids or other interventions work for a time, but symptoms worsen when the drugs are discontinued, sometimes dramatically.
*Steroids or other interventions have stopped working entirely.
*They want to get to the root of their condition, rather than continue to treat only the symptoms or simply suppress them.

If you’ve been keeping up with this series, by now you know that Chinese medicine has a distinct lens through which we view the body.  This lens gives us a unique perspective, and often provides answers where there have previously been none.  We can make sense of the body in a whole different way than your western practitioner.  Not a better or worse way, necessarily, just a whole different way.  We’re not interested in treating your psoriasis, we’re interested in treating you: the person who has psoriasis.  You also have a digestive system, a menstrual cycle (well, half of you do), sleeping patterns, urinary habits, predominant emotions, old pains, and future aspirations.  All of these things play a role in your health, so all of these things play a role in your psoriasis.  Thankfully, we’re seeing more and more western health care providers who recognize the importance of a whole-person approach.  Still, Chinese medicine provides a new, different perspective because our understanding of physiology is just, well, it’s a different understanding.  A different perspective.  A different lens.

So, we’ll ask a lot of questions and we’ll look really, really closely at your skin.  It’s not enough to know we’re treating psoriasis.  The details of your skin will help us paint a picture of your individual imbalance; once that picture is clear, we can match a treatment plan to it, execute the plan with herbal medicine and acupuncture, and watch your skin clear up.  Hurrah!  So, tell me, where are your plaques located? Are they fresh red, dark purple, or brown?  Are they thin and greasy?  Are they thick and infiltrated and tethered to your skin, or do they scrape off easily? When you scrape them off do you see slight bleeding?  Are they damp or dry?  Are they in skin crevices (like your butt crack or underneath your breasts)?  Did this exacerbation start off as a result of trauma (that Koebner phenomenon, again)?  Are your nails involved? And then the more general questions: Do you itch? Sweat? Have a sore throat?  Feel hot?  Are you especially thirsty?

Results that last
Chinese medicine is notable in its treatment of skin disease—its treatment of ALL disease—in that we’re not looking for relief because we’ve suppressed symptoms, we’re looking for relief because we’ve resolved the root of the problem.  We’ve brought your body back into right relationship with itself.  We’ve cleared things out that need to be cleared out; we’ve supplemented aspects of you that are deficient; we’ve gotten parts of your system that had stopped communicating to communicate again; all so your body can function physiologically (in a state of health) rather than pathologically (in a state of disease).  A combination of internal herbal medicine, acupuncture, and dietary and lifestyle recommendations can yield powerful, lasting results.  It’s unlikely to happen quickly, but it can happen, and it will happen over time.

OUR RESULTS:
Guttate psoriasis:
A common variant of psoriasis, frequently triggered by strep and/or other upper respiratory infection. It can resolve on its own over time, but can also evolve into chronic plaque psoriasis. This woman had come down with strep throat three times in the last year, the third of which triggered the guttate response.

Her body was covered nearly 100% by these lesions, and the before pictures below are what remained *after* a round of internal steroids. After 3.5 months of treatment we released her from care and have every expectation that her skin will be stable moving forward. I encouraged her to reach out if she again becomes susceptible to strep--if we treat her early, we should be able to avoid another deterioration into guttate.
Psoriasis - ATX Dermatology in South Portland, ME


Alexa Gilmore offers Dermatology in South Portland, ME
The discoloration you see in the above "after" pic is post-inflammatory hyperpigmentation, not active inflammation. It will resolve on its own, in time. We can also expedite its resolution with additional herbs.


psoriasis, guttate psoriasis, dermatology, maine

Plaque and scalp psoriasis:
This patient had suffered with psoriasis for 13+ years. Over that time she had been prescribed a host of conventional medications, none of which were any help. She had given up on ever resolving the issue when a new member of her health care team learned of her struggle and recommended she contact us. It was the first time in over a decade that her skin had responded positively to any intervention.

ATX Dermatology offers safe, effective Dermatology in South Portland, MEPsoriasis - ATX Dermatology in South Portland, ME
Nov 2013                                                                               March 2014

Alexa Gilmore offers Dermatology in South Portland, MEATX Dermatology offers safe, effective Dermatology in South Portland, ME
Nov 2013                                                                               March 2014

Psoriasis - ATX Dermatology in South Portland, MEAlexa Gilmore offers Dermatology in South Portland, MENov 2013                                                                               March 2014

Psoriasis - ATX Dermatology in South Portland, MEAlexa Gilmore offers Dermatology in South Portland, ME
Before/After 4 months of treatment

ATX Dermatology offers safe, effective Dermatology in South Portland, MEPsoriasis - ATX Dermatology in South Portland, ME
Before/After 4 months of treatment

Alexa Gilmore offers Dermatology in South Portland, ME
Guttate psoriasis, before/after 3.5mos herbs

ATX Dermatology offers safe, effective Dermatology in South Portland, ME
Guttate psoriasis, before/after 3.5mos herbs

psoriasis, guttate psoriasis, dermatology, skin, maine
Guttate psoriasis, before/after 3.5mos herbs

 

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Psoriasis - ATX Dermatology in South Portland, ME