Darija Mahović

Fanika Mršić

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221ACTA DERMATOVENEROLOGICA CROATICAAcupuncture as a Complementary Method of  Traditional Psoriasis Treatment: Myth or Reality?Acta Dermatovenerol Croat                                 2016;24(3):221-222                            LETTER TO THE EDITORDear Editor,the practitioners of traditional Chinese medicine described psoriasis some 2000 years ago (1). Psoriasis vulgaris is a common, chronic inflammatory skin dis-ease whose worldwide prevalence ranges from 0.1-3% (2,3). Understanding the role of the immune system in psoriasis and the interplay between the innate and adaptive immune system has helped to manage this complex disease, which affects patients far beyond the skin changes themselves (2). In addition to the usual and widely accepted methods of treatment of pso-riasis, including topical therapies, phototherapy, and conventional and biological systemic therapies, data can be found in the literature that suggest a favorable effect of acupuncture on the course of psoriasis (4,5). Despite that, this complementary method of tradi-tional treatment of various diseases is not yet widely accepted worldwide. According to the World Health Organization (WHO), acupuncture has been an offi-cially recognized method of treatment for more than 50 diseases from 1979 (5). At the Department of Neu-rology at the University Hospital Center Zagreb, acu-puncture has been used since 2011 for the treatment of various types of headaches, trigeminal neuralgia, and spinal pain syndromes. We report the case of  a pa-tient with a known history of psoriasis who was treated for chronic migraines with acupuncture.The 49-year-old female patient was examined for headache of a pulsating character that she had had for 16 years. The headache was mainly located on the left side of head and accompanied by nausea, vomit-ing, and both photophobia and phonophobia, and there was a worsening of symptoms upon exertion. The headaches were occurring once a week with an average duration of 2-3 continuous days.  The patient also had frequent mild headaches. Additionally, the pa-tient was diagnosed with psoriasis at the age of 29 and was occasionally treated with phototherapy. Systemic therapy for psoriasis had not been given to the patient thus far. After the clinical evaluation and considering the medical history and clinical findings, the diagnosis of chronic migraine was established and prophylactic therapy with dual antidepressant was introduced. On follow-up examinations, a reduction in the frequency and intensity of migraine headaches was observed. Af-ter one year there was a progression of symptoms, and treatments with acupuncture were started. Stainless steel filiform needles of 25 mm in length were inserted perpendicularly into points on the head, arm, and legs and retained for 30 minutes. The treatment was admin-istered once a day for 10 days with an interval of 2-3 days between treatments.  The patient showed signifi-cant improvement for a period of 6 months after the acupuncture treatment, which is why the treatment with acupuncture was repeated. The patient stated that very soon after the beginning of each acupuncture treatment, she had noticed a significant improvement regarding psoriatic lesions as a “side effect”. On the first day of acupuncture, extensive erythematosquamous plaques were noticed on the skin of the dorsum of the feet (Figure 1), palms, and elbows. It is important to emphasize that the patient did not use any specific topical antipsoriatic therapies during the acupuncture treatment, but only bland emollients. During the third week of treatment, a significant improvement was ob-served, or according to the patient, “she has not had such a good skin for a long time” (Figure 2).The improvement of the clinical status can be ex-plained by overlapping acupuncture points used in the treatment of pain syndromes and psoriasis or to the holistic effect of acupuncture.Figure 1. Psoriatic changes on the feet before acupunc-ture.Letter to the editor  Acta Dermatovenerol Croat   2016;24(3):221-222In recent years, several high-quality evidence-based Western medicine guidelines have been devel-oped for the treatment of psoriasis (6,7). In addition to that modern approach, several studies confirmed the effectiveness of acupuncture in the treatment of psoriasis. The recent review by Coyle et al. (4) indicates promising evidence of the efficacy of acupuncture for psoriasis treatment with an increasing number of people achieving clinical and statistical improvements. Furthermore, Wang et al. (8) have recently published the protocol for a systematic review which aims to as-sess the effectiveness and safety of acupuncture for patients with psoriasis.  In acupuncture, hair-thin needles are inserted into the skin, releasing  natural pain killers such as ad-enosine, endorphins, and serotonin into the body. It is known that patients with psoriatic arthritis can benefit from the treatment. Some patients may be concerned that acupuncture needles could worsen a skin flare-up but an acupuncturist uses sterile needles to prevent any risk to flaring skin. The advantage of acupuncture is that it is a very safe alternative medicine treatment and is not likely to interfere with any existing psoriasis treatment. It is important to note that acupuncture is a 5000-year-old alternative medicine treatment and that it has been officially recognized by the WHO for more than three decades (5). After achieving clinical improvement and regres-sion of psoriatic plaques during the acupuncture for headache, the authors reviewed the literature and found reports about possible benefits of treating pso-riasis with acupuncture. Therefore, the purpose of this letter and case study is to raise awareness and inform dermatologists about the different and until now un-der-explored possibilities of acupuncture in treating psoriasis.References1. Wu JN. A short history of acupuncture. J Altern Complement Med 1996;2:19-21.2. Boehncke WH, Schöon MP. Psoriasis. Lancet 2015;386:983-94.3. Li L, Chen H. Research progress of acupunc-ture to treat psoriasis. Shanxi J Tradit Chin Med 2013;29:57-8.4. Coyle M, Deng J, Zhang AL, Yu J, Guo X, Xue CC, et al. Acupuncture therapies for psoriasis vulgaris: a systematic review of randomized controlled trials. Forsch Komplementmed 2015;22:102-9. 5. http://www.evidencebasedacupuncture.org/who-official-position/6. Nast A, Boehncke WH, Mrowietz U, Ockenfels HM, Philipp S, Reich K, et al. S3 - Guidelines on the treatment of psoriasis vulgaris (English version). Update. J Dtsch Dermatol Ges 2012;10 Suppl. 2:S1-95.7. National Psoriasis Foundation Medical Board; Hsu S, Papp KA, Lebwohl MG, Bagel J, Blauvelt A, Duffin KC, et al. Consensus guidelines for the management of plaque psoriasis. Arch Dermatol 2012;148:95-102.8. Wang L, Yang H, Li N, Wang W, Bai Y. Acupuncture for psoriasis: protocol for a systemic review. BMJ Open 2015;5:e007526.Darija Mahović1,2, Fanika Mrsić1 1School of Medicine Zagreb, University of Zagreb, 2Department of Neurology, University Hospital Center Zagreb Corresponding author: Assist. Prof. Darija Mahović, MD, PhDSchool of Medicine Zagreb, University of ZagrebDepartment of Neurology, University Hospital Center ZagrebKispaticeva 121000 ZagrebCroatiadarija.mahovic@zg.t-com.hr Received: August 21, 2015Accepted: May 11, 2016Figure 2. Psoriatic changes on the feet during acupunc-ture.222 ACTA DERMATOVENEROLOGICA CROATICA

Acupuncture as a Complementary Method of Traditional Psoriasis Treatment: Myth or Reality?

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