Abstract

Objective: Conventional therapeutic methods for psoriasis include topical and systemic drugs, phototherapy, and biologic agents. Despite the fact that these treatment methods, and especially biologic agents, are met with a considerable reduction in disease activity, they can sometimes be costly and are nonetheless accompanied by high risks of adverse events, ranging from mild to debilitating. Therefore, complementary and alternative medicine (CAM), especially mind-and-body interventions, such as acupuncture, psychotherapy, climatotherapy, and cupping may provide a cheaper and potentially beneficial outcome for these patients. Methods: We performed a systematic review of articles pertaining to acupuncture, cupping, psychotherapy and meditation, as well climatotherapy and balneotherapy in the management of psoriasis, by using the PubMED, Medline and Google Academic research databases and reference cross-checking. Results: 12 articles on acupuncture, 9 on dry or wet cupping, 27 concerning meditation, hypnosis or psychotherapy, and 34 regarding climate therapy or balneotherapy were found. Discussion and Conclusions: Currently, there is a lack of evidence in the English literature to support acupuncture as an effective alternative therapy for psoriasis, whereas cupping has been described in the majority of instances to result in Koebner phenomenon and clinical worsening. Stress management therapies such as psychotherapy, hypnosis, and meditation have shown promising results as complementary treatment methods. Climatotherapy and balneotherapy have already been proven as effective means of achieving clinical improvement in psoriasis. Further research is still needed to verify the usefulness of the lesser studied treatment methods.

Highlights

  • Psoriasis is a chronic inflammatory disorder that possesses decisive immunological and genetic elements, upon which several environmental factors may act, triggering the pathological cascade

  • After the initial search and title screening, we obtained a total of 90 articles regarding acupuncture, 58 referring to cupping therapy, 146 pertaining to meditation and psychotherapy, and 298 related to climatotherapy

  • Full-text screening led to the removal of a further 24 acupuncture articles, which were animal studies, protocols for systematic reviews and prospective studies, systematic and non-systematic reviews, aside from articles written in Chinese or Korean that only had the abstract in English

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Summary

Introduction

Psoriasis is a chronic inflammatory disorder that possesses decisive immunological and genetic elements, upon which several environmental factors may act, triggering the pathological cascade. Until recently, PASI responses of 50 or 75 (denoting a 50% or 75% reduction in disease severity, respectively) were the primary aims for treatment, current methods strive for PASI 100, meaning a complete remission of cutaneous lesions [6,7,8] These therapies include topically applied drugs such as dithranol, salicylic acid, corticosteroids, vitamin D analogues, or calcineurin inhibitors; phototherapy typically using either ultraviolet B (UVB), or a combination between psoralen and ultraviolet A (PUVA); systemic non-biologic therapies such as methotrexate (MTX), cyclosporin A, acitretin, apremilast, 6-thioguanine, or tofacitinib; and biologic agents that interfere with the pathological cascade of psoriasis near its outstart, these being TNF-α inhibitors (Adalimumab, Etanercept, Certolizumab, and Infliximab), the IL-12/23 inhibitor Ustekinumab, specific IL-23 inhibitors (Guselkumab, Risankizumab, and Tildrakizumab), and the IL-17 inhibitors (Brodalumab, Ixekizumab, and Secukinumab) [6,7,8,9,10]. As practitioners, should always be informed and aware of recent developments, so that our selected treatment modality is optimal for each patient

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