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Psoriasis - Pamela Smith, MD, MS (2021 Conference) (LDN, low dose naltrexone)
LDN Research Trust 2021 Conference - Friday Morning
Dr. Pamela Smith, an internationally known nutritionist/energy coach, radio host, best-selling author, and The SMART Weigh Strategy creator, presents using LDN and other therapies to treat psoriasis.
Psoriasis is a chronic inflammatory skin disease that causes redness and scaling. It affects 2% of the general population in the world. In the US, the annual outlay of outpatient cost for those living with psoriasis is $1.6 to $3.2 billion a year. In fact, about 400 people die each year of psoriasis-related causes.
Psoriasis is an autoimmune process, driven by abnormally activated helper T cells. Once activated, psoriatic T cells produce cytokines which act to attract and activate neutrophils which cause inflammation. Psoriasis has a genetic component. If both parents have psoriasis, the risk of the child having the disease is 41%. In addition, the environment plays a role in the development of psoriasis: physical trauma, infections, stress, rapid weight loss, alcohol consumption, tobacco use, and even some medications.
There are two subtypes of psoriasis: chronic plaque psoriasis (most common - 90%), and guttate (2nd most common - 2%) which is the pustular form and can be life-threatening.
Dr. Smith reviews some of the conventional therapies. Skin care does matter when it comes to psoriasis: bathing in cool to tepid water, using gentle cleansers, and using oatmeal products such as Aveeno or oatmeal flour baths. She also shares that natural oils on the skin can be helpful: avocado, almond, and olive. Because psoriasis improves in the summer due to exposure to UV light, UVB therapy is still used. However, this can decrease DNA synthesis and has some immunosuppressive effects. Long-term exposure to ultraviolet light can lead to herpes simplex outbreaks, aging of the skin; and may increase the risk of skin cancers. However, it is one of the oldest therapeutic modalities for psoriasis. Vital therapy does remain a mainstay and has promised for advancement.
Medications used to treat psoriasis are methotrexate, cyclosporine, acetretin (which has some anti-inflammatory effects and is used for rapid control of pustular psoriasis), and biological immune response modifiers (the most commonly used). Due to the severe side effects, each of these drugs requires a thorough baseline evaluation and then constant monitoring of the patient.
Topical pharmaceuticals are commonly used to decrease the thickness of the plaques of psoriasis.
- Salicylic acid, urea, and alpha hydroxy acid are the most common keratolytic agents.
- Coal tar has been used for a long time. It's created from the gases produced during the distillation of coal that are condensed and undergo ammonia extraction. This results in a dark liquid; it contains 10,000 different chemical compounds. It does have side effects and can even cause the patient to develop an allergic reaction.
- Anthralin is another topical that inhibits cell growth and promotes cell differentiation; however, it’s very messy.
- Calcipotriene is a bioactive topical form of vitamin D, and it promotes keratocyte differentiation, is metabolized very quickly, so that has less interference with calcium metabolism.
- Tazaroten gel is topically applied retinoid as well (a vitamin A derivative).
- Topical steroids are anti-inflammatory but also, immunosuppressive and anti-proliferative. Gets less effective the longer one uses it. So, with long-term use, this is almost as bad as using topical steroids or taking steroids by mouth.
- A combination of vitamin D analog and a steroid is commonly being used now.
Dr. Smith promotes having the patient remove pro-inflammatory foods from their diet. Because psoriasis is an autoimmune disease, removing pro-inflammatory foods is recommended. She also recommends avoiding acidic foods, nightshades, sugar, alcohol, and any patient allergy foods. She suggests a comprehensive allergy test. In addition, she recommends pharmaceutical-grade fish oil, zinc, vitamin D, and lecithin.
Dr. Smith also includes environmental things like animal dander, trees, grasses, etc. as things considered antagonists. She presents a research article that states that obesity has been associated with the pro-inflammatory state, and several studies have demonstrated a relationship between body mass index and psoriasis severity.
Dr. Smith reviews a few topical botanical agents for psoriasis. The most studied and most efficacious topical botanical therapeutics are mahonia, indigo naturalis, aloe vera, and capsaicin (an extract made from chili peppers). Most commonly reported adverse side effects - of course it's put on the skin, so you can have this local skin irritation erythema and burning and pain. The treatment group in research of capsaicin on psoriasis had better overall improvement, greater relief of itching, and a decrease in severity scores. In addition, she goes on to review several others such as licorice, curcumin, milk thistle, and some Chinese medicine herbal preparations.
Other non-conventional therapies she shares are acupuncture, climatotherapy (moving to sunny, dry climates), Balneophototherapy (exposer to sun and water, like the Dead Sea), and treatment for alleviating stress. Improving stress levels may increase the positive effects of therapy, whether it's conventional, or a more metabolic personalized medicine approach. Several controlled studies have demonstrated that relaxation, hypnosis, biofeedback, homeopathy, behavioral cognitive stress management therapies have been effective.
LDN for psoriasis
Low dose naltrexone, used for all autoimmune diseases, is effective including for psoriasis, especially after fixing the gut. For milder cases, you can use topical naltrexone 1% cream for itching, so 1% cream of LDN. For severe cases, use orally. Dr. Smith tends to prescribe LDN orally of 1.5mg capsule one hour before bedtime for the first week, the second week two 1.5mg, and the third week, three 1.5mg, and after that 4.5mg once a day.
- LDN is an off-label usage of LDN for psoriasis.
- Studies revealed that the compounded drug is efficacious, and downregulates molecular markers associated with the pathogenesis of psoriasis.
- In a 2019 trial, a clinical case demonstrated that a patient with a history of psoriasis was treated with 4.5mg of LDN. During a flare-up, she showed significant improvement, and psoriasis remission, after only three months of 4.5mg of LDN.
- In another case report from 2018, a 60-year-old white female was successfully treated with LDN for her moderate plaque psoriasis over a six-month period of time.
KEYWORDS: psoriasis, LDN, low dose Naltrexone, topical, oral, chronic plaque psoriasis, guttate, chronic inflammatory skin disease, inflammatory, inflammation, anti-inflammatory, therapies