Complementary therapies for chronic plaque psoriasis

  • Protocol
  • Intervention



This is the protocol for a review and there is no abstract. The objectives are as follows:

To assess the effects of complementary medicine for the treatment of chronic plaque psoriasis.


Description of the condition

Psoriasis is a complex skin disease that may affect any part of the body, but the most common places are the knees, elbows, and scalp. However, lesions may occur in other areas, such as the nails, joints, and mouth (Camisa 2003; Gonzaga 1996). Both men and women over a wide age range can be affected. With a worldwide prevalence, white people are more commonly seen to be at risk than any other ethnicity, and in the UK, about 2% of the population are affected (Habif 2001; Raychaudhuri 2001).

It is unknown why psoriasis occurs, but it appears that the immune system is involved (Christophers 1996; Griffiths 2007), and psoriasis is associated with markers of systemic inflammation (such as increased levels of C-reactive protein, and tumour necrosis factor), which increase the chances of heart disease, such as myocardial infarction, in affected people (Gelfand 2006). Psoriasis itself is not infectious (Roenigk Jr 1990), but some lesions may incur secondary infection, which may complicate treatment (Mallbris 2009). Psoriasis is often found in families, but may skip a generation, and many genes have been linked to it (Borska 2009; Elder 2009).

Many factors are thought to trigger the condition, including skin injury, a sore throat, chest infection, sunburn, certain drug treatments, increased intake of alcohol (Morse 1985), weather changes, and stress. Stress seems to be one of the most important factors (Farber 1993; Fortune 2002; Selye 1950; Raychaudhuri 2001; Weiss 2006; Zachariae 1973), which may also influence the clinical course of the disease. Prior psychological trauma can trigger an exacerbation of the disease (Rapp 1997; Raychaudhuri 2001; Wright 1994).

Psoriasis in any of its forms often produces physical discomfort in the form of itching, pain, and skin blemishes (Fitzpatrick 1993). Many people with psoriasis experience embarrassment, find it affects their daily life, experience anxiety and mood disorders about the uncertainty of how the disease will progress or how the condition will react to new treatments (Stein 2005), and have feelings of emotional distress at seeing their skin degenerating (Camisa 2003). However, others find it no more than a slight irritation.

Emotional distress can cover a range of experiences. Because the condition is chronic, the time needed to treat the condition may be long (Bergstrom 2003), and there may be a fear of being unable to cover the cost of treatments (Bottomley 2007; Schoffski 2007; Weiss 2006). Also, specific treatments may be needed, such as lithium for emotional disorders (Basavaraj 2010). Some people feel shame in front of other people (Savin 1970) and fear rejection. The latter is manifested by people with the condition avoiding public places, such as swimming pools, the beach, the gym, and restaurants (Ramsay 1988), and being aware that many people are trying not to touch them, e.g. suffering rejection by barbers or at beauty salons (Camisa 2003). They may be angry because they may feel discriminated against in employment (Schmitt 2006). Depression at not being sexually attractive (Bolgert 1955) may then lead to worry in a relationship about bearing children, because of the risk of genetic transmission (McEvoy 1989).

The great variability of clinical forms of the disease, the unpredictability of its progress, and the way an individual's personality can have an effect on its progression illustrate the complexities involved in treating this disease (Sato 2004). There is a global consensus that psoriasis in its more severe form is an incurable chronic condition that is difficult to treat. There is a consensus among experts that psoriasis usually does not take away the life of a person, but severely affects the quality of life (Camisa 2003; Kurd 2010; Rossi 2011). As emotional fragility can be seen in most people with psoriasis, there is a constant need to search for strategies to improve the quality of life of those with this condition (Raychaudhuri 2001).

Description of the intervention

Throughout the world, people spend large amounts of money each year on complementary medical interventions, while many questions concerning these therapies remain unanswered. Complementary and alternative medicine (CAM) consists of groups of medical and healthcare systems, practices, and products that are often considered outside conventional medical practice. According to the Cochrane Complementary and Alternative Medicine (CAM) Field, the number of those who use these therapies has been growing steadily (Cochrane CMF 2013).

The use of complementary and alternative medicines is common among people with skin diseases, specifically those with psoriasis (Schoffski 2007). Most people with psoriasis seek the opinion of their dermatologist about the existence of new treatments and complementary or alternative treatments that may provide palliative relief. Some of these therapies are able to help people achieve some relief, allowing them to cope with their condition (Feldman 1997); however, in reality, we still do not have precise information on their effectiveness, efficacy, and safety.

To help ensure consistent classification of these interventions, the USA's National Institutes of Health (NIH) has created the National Center for Complementary and Alternative Medicine (NCCAM), which has determined criteria for the definition and classification of complementary and alternative medicine. Thus, the term 'complementary medicine' refers only to the use of interventions in addition to conventional medicine. The term 'alternative medicine' refers to treatments used in place of conventional medicine, whereas the term 'integrative medicine' describes a combination of conventional medicine and complementary and alternative medicine (CAM) when there is evidence of effectiveness, efficiency, and safety (NCCAM 2013). The NCCAM has divided CAM into the following categories:

  • natural products;

  • mind and body practices; and

  • other CAM Practices (e.g. movement therapies, traditional healers, manipulation of various energy fields, and whole medical systems) (NCCAM 2013; Uman 2004).

(See a glossary of CAM interventions adapted from NLM 2013 in Table 1.)

Table 1. Glossary of CAM interventions (adapted from NLM 2013: U.S. National Library of Medicine. E02.190 - Complementary Therapies. In: MeSH Tree Structures - 2013)
MeSH (tree number) Definition and other important information
Complementary therapies (E02.190)

Therapeutic practices which are not currently considered an integral part of conventional allopathic medical practice. They may lack biomedical explanations but as they become better researched some (PHYSICAL THERAPY MODALITIES; DIET; ACUPUNCTURE) become widely accepted whereas others (humors, radium therapy) quietly fade away, yet are important historical footnotes. Therapies are termed as Complementary when used in addition to conventional treatments and as Alternative when used instead of conventional treatment

Additional tree number: none

Synonyms: Therapies, Complementary; Therapy, Complementary; Complementary Medicine; Medicine, Complementary; Alternative Medicine; Medicine, Alternative; Alternative Therapies; Therapies, Alternative; Therapy, Alternative

Acoustic stimulation (E02.190.888.030)

Use of sound to elicit a response in the nervous system

Additional tree number: E02.037, E05.723.136

Synonyms: Stimulation, Auditory; Auditory Stimulation; Stimulation, Acoustic

Acupressure (E02.190.599.092)

A type of massage in which finger pressure on specific body sites is used to promote healing, relieve fatigue, etc. Although the anatomical locations are the same as the ACUPUNCTURE POINTS used in ACUPUNCTURE THERAPY (hence acu-), no needle or other acupuncture technique is employed in acupressure. Shiatsu is a modern outgrowth that focuses more on prevention than healing

Additional tree number: E02.779.867.171

Synonyms: Shiatsu; Shiatzu; Zhi Ya; Chih Ya

Acupuncture analgesia (E02.190.044.105)

Analgesia produced by the insertion of ACUPUNCTURE needles at certain ACUPUNCTURE POINTS on the body. This activates small myelinated nerve fibers in the muscle which transmit impulses to the spinal cord and then activate three centers - the spinal cord, midbrain and pituitary/hypothalamus - to produce analgesia

Additional tree number: E03.091.048

Synonyms: Analgesia, Acupuncture; Acupuncture Anesthesia; Anesthesia, Acupuncture

Acupuncture points (E02.190.044.555.035)

Designated locations along nerves or organ meridians for inserting acupuncture needles

Additional tree number: none

Synonyms: Acupuncture Point; Point, Acupuncture; Points, Acupuncture; Acupoints; Acupoint

Acupuncture therapy (E02.190.044)

Treatment of disease by inserting needles along specific pathways or meridians. The placement varies with the disease being treated. It is sometimes used in conjunction with heat, moxibustion, acupressure, or electric stimulation

Additional tree number: none

Synonyms: Therapy, Acupuncture

Acupuncture, ear (E02.190.044.133, E02.190.204.500)

Acupuncture therapy by inserting needles in the ear. It is used to control pain and for treating various ailments

Additional tree number: none

Synonyms: Acupunctures, Ear; Ear Acupunctures; Auricular Acupuncture; Ear Acupuncture; Acupuncture, Auricular; Acupunctures, Auricular; Auricular Acupunctures

Anthroposophy (E02.190.088)

Knowledge of the nature of man. A spiritual and mystical doctrine that grew out of theosophy and derives mainly from the philosophy of Rudolph Steiner, Austrian social philosopher (1861-1925)

Additional tree number: K01.844.058

Synonyms: none

Aromatherapy (E02.190.525.061, E02.190.755.100, E02.190.888.061)

The use of fragrances and essences from plants to affect or alter a person's mood or behavior and to facilitate physical, mental, and emotional well-being. The chemicals comprising essential oils in plants has a host of therapeutic properties and has been used historically in Africa, Asia, and India. Its greatest application is in the field of alternative medicine

Additional tree number: F04.754.035

Synonyms: Aromatherapies; Aroma Therapy; Aroma Therapies; Therapies, Aroma; Therapy, Aroma

Art therapy (E02.190.888.124)

The use of art as an adjunctive therapy in the treatment of neurological, mental, or behavioral disorders

Additional tree number: E02.831.100, F04.754.070

Synonyms: Therapy, Art; Art Therapies; Therapies, Art

Auriculotherapy (E02.190.204)

Treatment of pain, drug addictions, or other ailments by stimulating the various points on the external ear (EAR AURICLES). It is based on the ancient Chinese practices of EAR ACUPUNCTURE, but sometimes magnets and other modes of stimulation are used

Additional tree number: none

Synonyms: Auriculotherapies

Autogenic training (E02.190.525.217.100)

Technique based on muscle relaxation during self-hypnotic exercises. It is used in conjunction with psychotherapy

Additional tree number: F04.754.103

Synonyms: Autogenic Trainings; Training, Autogenic; Trainings, Autogenic

Autosuggestion (E02.190.525.217.771.100)

Suggestion coming from the subject himself

Additional tree number: F04.754.424.771.299

Synonyms: Autosuggestions

Biofeedback, psychology (E02.190.525.123)

The therapy technique of providing the status of one's own AUTONOMIC NERVOUS SYSTEM function (e.g., skin temperature, heartbeats, brain waves) as visual or auditory feedback in order to self-control related conditions (e.g., hypertension, migraine headaches)

Additional tree number: F02.830.131, F04.754.137.301, F04.754.308.500, L01.143.283.425.624.500

Synonyms: Biofeedbacks, Psychology; Psychology Biofeedback; Psychology Biofeedbacks; Psychophysiologic Feedback; Feedback, Psychophysiologic; Feedback, Psychophysiological; Biofeedback; Biofeedbacks; Biofeedback (Psychology); Biofeedbacks (Psychology); Myofeedback; Myofeedbacks; False Physiological Feedback; False Physiological Feedbacks; Feedback, False Physiological; Feedbacks, False Physiological; Physiological Feedback, False; Physiological Feedbacks, False; Bogus Physiological Feedback; Bogus Physiological Feedbacks; Feedback, Bogus Physiological; Feedbacks, Bogus Physiological; Physiological Feedback, Bogus; Physiological Feedbacks, Bogus

Breathing exercises (E02.190.525.186)

Therapeutic exercises aimed to deepen inspiration or expiration or even to alter the rate and rhythm of respiration

Additional tree number: E02.779.474.124

Synonyms: Exercise, Breathing; Respiratory Muscle Training; Muscle Training, Respiratory; Training, Respiratory Muscle; Qigong; Qi Gong; Gong, Qi; Ch'i Kung; Kung, Ch'i

Color therapy (E02.190.888.249)

A form of phototherapy using color to influence health and to treat various physical or mental disorders. The color rays may be in the visible or invisible spectrum and can be administered through colored lights or applied mentally through suggestion

Additional tree number: E02.774.215, F04.754.215

Synonyms: Therapy, Color; Chromatotherapy; Chromotherapy

Dance therapy (E02.190.888.374)

The use of dancing for therapeutic purposes

Additional tree number: E02.779.474.186, E02.831.230, F04.754.278

Synonyms: Therapy, Dance; Dance Therapies; Therapies, Dance

Diffuse noxious inhibitory Control (E02.190.262)

A physiological process by which the perception of pain at a local area of the body is inhibited by a second painful stimulus administered at a distal body site

Additional tree number: E03.091.322

Synonyms: none

Eclecticism, historical (E02.190.755.624)

A system of medicine, most popular in the 19th century, that advocates the use of indigenous plants in the treatment of specific signs and symptoms

Additional tree number: E03.091.322

Synonyms: Historical Eclecticism

Electroacupuncture (E02.190.044.244)

A form of acupuncture with electrical impulses passing through the needles to stimulate NERVE TISSUE. It can be used for ANALGESIA; ANESTHESIA; REHABILITATION; and treatment for diseases

Additional tree number: E02.186.250, E02.342.543, E02.779.468.399, E03.091.823.500, E03.155.519

Synonyms: none

Faith healing (E02.190.901.155)

The use of faith and spirit to cure disease

Additional tree number: none

Synonyms: Healing, Faith; Prayer Healing; Healing, Prayer

Holistic health (E02.190.321)

Health as viewed from the perspective that humans and other organisms function as complete, integrated units rather than as aggregates of separate parts

Additional tree number: K01.752.667.710, N01.400.350

Synonyms: Health, Holistic; Wholistic Health; Health, Wholistic; Medicine, Holistic; Medicine, Wholistic; Wholistic Medicine; Holistic Medicine; Holistic Therapies; Wholistic Therapies

Homeopathy (E02.190.388, E02.190.901.249)

A system of therapeutics founded by Samuel Hahnemann (1755-1843), based on the Law of Similars where "like cures like". Diseases are treated by highly diluted substances that cause, in healthy persons, symptoms like those of the disease to be treated

Additional tree number: none

Synonyms: Homoeopathy

Horticultural therapy (E02.190.438)

A therapeutic approach in which horticultural artefacts are utilized in improving an individual's social, emotional, educational, psychological, and physical well-being

Additional tree number: F04.754.392

Synonyms: Horticultural Therapies; Therapies, Horticultural; Therapy, Horticultural

Hypnosis (E02.190.525.217)

A state of increased receptivity to suggestion and direction, initially induced by the influence of another person

Additional tree number: F04.754.424

Synonyms: Hypnoses; Mesmerism

Imagery (psychotherapy) (E02.190.525.249)

The use of mental images produced by the imagination as a form of psychotherapy. It can be classified by the modality of its content: visual, verbal, auditory, olfactory, tactile, gustatory, or kinesthetic. Common themes derive from nature imagery (e.g., forests and mountains), water imagery (e.g., brooks and oceans), travel imagery, etc. Imagery is used in the treatment of mental disorders and in helping patients cope with other diseases. Imagery often forms a part of HYPNOSIS, of AUTOGENIC TRAINING, of RELAXATION TECHNIQUES, and of BEHAVIOR THERAPY

Additional tree number: F04.754.462

Synonyms: Imageries (Psychotherapy); Imagery; Guided Imagery; Imagery, Guided; Directed Reverie Therapy; Directed Reverie Therapies; Reverie Therapies, Directed; Reverie Therapy, Directed; Therapies, Directed Reverie; Therapy, Directed Reverie

Kinesiology, applied (E02.190.599.186)

The study of muscles and the movement of the human body. In holistic medicine it is the balance of movement and the interaction of a person's energy systems. Applied kinesiology is the name given by its inventor, Dr. George Goodheart, to the system of applying muscle testing diagnostically and therapeutically to different aspects of health care

Additional tree number: E02.779.867.344

Synonyms: Applied Kinesiology

Laughter therapy (E02.190.525.311)

Therapeutic use of humor and laughter to improve emotional well being in order to facilitate improvement in health

Additional tree number: none

Synonyms: Therapy, Laughter

Magic (E02.190.901.411)

Beliefs and practices concerned with producing desired results through supernatural forces or agents as with the manipulation of fetishes or rituals

Additional tree number: I01.076.201.450.897.439

Synonyms: Magics

Manipulation, chiropractic (E02.190.599.233)

Procedures used by chiropractors to treat neuromusculoskeletal complaints

Additional tree number: none

Synonyms: Chiropractic Manipulation; Spinal Adjustment, Chiropractic; Adjustment, Chiropractic Spinal; Adjustments, Chiropractic Spinal; Chiropractic Spinal Adjustment; Chiropractic Spinal Adjustments; Spinal Adjustments, Chiropractic; Chiropractic Adjustment; Adjustment, Chiropractic

Manipulation, osteopathic (E02.190.599.280)

Musculoskeletal manipulation based on the principles of OSTEOPATHIC MEDICINE developed in 1874 by Dr Andrew Taylor Still

Additional tree number: E02.779.867.444

Synonyms: Osteopathic Manipulative Treatment; Osteopathic Manipulative Treatments; Treatment, Osteopathic Manipulative; Treatments, Osteopathic Manipulative; Osteopathic Manipulation

Massage (E02.190.599.500)

Group of systematic and scientific manipulations of body tissues best performed with the hands for the purpose of affecting the nervous and muscular systems and the general circulation

Additional tree number: E02.779.867.522

Synonyms: Zone Therapy; Therapies, Zone; Zone Therapies; Therapy, Zone; Reflexology; Rolfing; Bodywork; Bodyworks; Craniosacral Massage; Massage, Craniosacral

Medicine, African traditional (E02.190.488.505, E02.190.901.433)

A system of traditional medicine which is based on the beliefs and practices of the African peoples. It includes treatment by medicinal plants and other materia medica as well as by the ministrations of diviners, medicine men, witch doctors, and sorcerers

Additional tree number: I01.076.201.450.654.505

Synonyms: Traditional Medicine, African; Medicine, Traditional African; Traditional African Medicine; African Medicine, Traditional; African Traditional Medicine; Medicine, African; African Medicine; African Witch Doctor; African Witch Doctors; Doctor, African Witch; Doctors, African Witch; Witch Doctors, African; Witch Doctor, African

Medicine, Arabic (E02.190.488.510)

Traditional Arabic and Islamic Medicine (TAIM) is one of complete systems of herbalist medicine of ancient world, and uses plant species from Mediterranean region. The remedies are administered in forms of standard decoction prepared by boiling plant parts in hot water, infusion in water or oil or inhalation of essential oils. It is also taken as juice, syrup, roasted material, fresh salad or fruit, macerated plant parts, oil, milky sap, poultice and paste

Additional tree number: I01.076.201.450.654.510, K01.400.552.643

Synonyms: Arabic Medicine

Medicine, Ayurvedic (E02.190.488.515)

The traditional Hindu system of medicine which is based on customs, beliefs, and practices of the Hindu culture. Ayurveda means "the science of Life": veda - science, ayur - life

Additional tree number: I01.076.201.450.654.515

Synonyms: Ayurvedic Medicine; Siddha Medicine; Medicine, Siddha; Hindu Medicine; Medicine, Hindu

Medicine, Chinese traditional (E02.190.488.585.520)

A system of traditional medicine which is based on the beliefs and practices of the Chinese culture

Additional tree number: I01.076.201.450.654.558.520

Synonyms: Traditional Chinese Medicine; Chinese Medicine, Traditional; Chung I Hsueh; Hsueh, Chung I; Zhong Yi Xue; Chinese Traditional Medicine; Traditional Medicine, Chinese

Medicine, East Asian traditional (E02.190.488.585)

Medical practice or discipline that is based on the knowledge, cultures, and beliefs of the people in EAST ASIA

Additional tree number: I01.076.201.450.654.558

Synonyms: Medicine, Oriental Traditional; Oriental Traditional Medicine; Medicine, Traditional, East Asia; Traditional Medicine, Oriental; Traditional East Asian Medicine; Traditional Far Eastern Medicine; Traditional Medicine, East Asia; East Asian Traditional Medicine; Oriental Medicine, Traditional; Medicine, Traditional Oriental; Traditional Oriental Medicine; Traditional Oriental Medicines; East Asian Medicine; East Asian Medicines; Medicine, East Asian; Oriental Medicine; Medicine, Oriental; Medicine, East Asia; Asia Medicines, East; East Asia Medicine; East Asia Medicines; Medicines, East Asia; Medicine, Far East; East Medicine, Far; East Medicines, Far; Far East Medicine; Far East Medicines; Medicines, Far East

Medicine, Kampo (E02.190.488.585.600)

System of herbal medicine practiced in Japan by both herbalists and practitioners of modern medicine. Kampo originated in China and is based on Chinese herbal medicine (MEDICINE, CHINESE TRADITIONAL)

Additional tree number: I01.076.201.450.654.558.600

Synonyms: Kanpo Medicine; Medicine, Kanpo; Kanpo; Kampo; Kampo Medicine

Medicine, Korean traditional (E02.190.488.585.700)

Medical practice or discipline that is based on the knowledge, cultures, and beliefs of the people of KOREA

Additional tree number: I01.076.201.450.654.558.700

Synonyms: Korean Traditional Medicine; Traditional Medicine, Korea

Medicine, Mongolian traditional (E02.190.488.585.850)

Medical practice indigenous to the peoples of Mongolia, developed over many years according to their culture, beliefs, and traditions

Additional tree number: I01.076.201.450.654.558.750

Synonyms: Medicines, Mongolian Traditional; Mongolian Traditional Medicine; Mongolian Traditional Medicines; Traditional Medicine, Mongolian; Traditional Medicines, Mongolian; Mongolian Medicine; Medicine, Mongolian; Medicines, Mongolian; Mongolian Medicines; Mongolian Folk Medicine; Folk Medicine, Mongolian; Folk Medicines, Mongolian; Medicine, Mongolian Folk; Medicines, Mongolian Folk; Mongolian Folk Medicines

Medicine, traditional (E02.190.488)

Systems of medicine based on cultural beliefs and practices handed down from generation to generation. The concept includes mystical and magical rituals (SPIRITUAL THERAPIES); PHYTOTHERAPY; and other treatments which may not be explained by modern medicine

Additional tree number: I01.076.201.450.654

Synonyms: Traditional Medicine; Folk Remedies; Folk Remedy; Remedies, Folk; Remedy, Folk; Home Remedies; Home Remedy; Remedies, Home; Remedy, Home; Medicine, Primitive; Primitive Medicine; Medicine, Folk; Folk Medicine; Medicine, Indigenous; Indigenous Medicine; Ethnomedicine

Medicine, Unani (E02.190.488.510.500)

A modified Greco-Arabic medical system flourishing today as unani medicine. It was the product of Arab physicians and scholars captivated by Greek philosophy, science, and medicine. It is practiced today in India and Pakistan, largely as a type of herbal medicine

Additional tree number: I01.076.201.450.654.510.500, I01.076.201.450.654.745, K01.400.552.643.500

Synonyms: Unani Medicine

Meditation (E02.190.525.374, E02.190.901.455)

A state of consciousness in which the individual eliminates environmental stimuli from awareness so that the mind can focus on a single thing, producing a state of relaxation and relief from stress. A wide variety of techniques are used to clear the mind of stressful outside interferences. It includes meditation therapy

Additional tree number: F04.754.137.750.500

Synonyms: Transcendental Meditation; Meditation, Transcendental

Mental healing (E02.190.525.500, E02.190.901.500)

The use of mind to cure disease, particularly physical illness

Additional tree number: none

Synonyms: Healing, Mental

Meridians (E02.190.044.555)

Classical loci in ACUPUNCTURE. They are main and collateral channels, regarded as a network of passages, through which vital energy (Qi) circulates and along which acupoints (ACUPUNCTURE POINTS) are distributed. The meridians are a series of 14 lines upon which more than 400 acupoints are located on the body

Additional tree number: I01.076.201.450.654.558.520.300.500

Synonyms: Ching Lo; Jing Luo; Luo, Jing; Jingluo

Mesotherapy (E02.190.506)

The application of medicine, vitamins, extracts, or other bioactive substances for a localized effect via multiple subcutaneous injections or perfusion of substances into the various layers of the skin below the EPIDERMIS

Additional tree number: E02.218.660, E02.319.267.530.620.785

Synonyms: none

Mind-body therapies (E02.190.525)

Treatment methods or techniques which are based on the knowledge of mind and body interactions. These techniques can be used to reduce the feeling of tension and effect of stress, and to enhance the physiological and psychological well-being of an individual

Additional tree number: none

Synonyms: Mind Body Therapies; Mind-Body Therapy; Therapies, Mind-Body; Therapy, Mind-Body; Mind-Body Medicine; Mind Body Medicine

Moxibustion (E02.190.044.588)

The burning of a small, thimble sized, smoldering plug of dried leaves on the SKIN at an ACUPUNCTURE point. Usually the plugs contain leaves of MUGWORT or moxa

Additional tree number: none

Synonyms: Moxabustion

Musculoskeletal manipulations (E02.190.599)

Various manipulations of body tissues, muscles and bones by hands or equipment to improve health and circulation, relieve fatigue, promote healing

Additional tree number: E02.779.867

Synonyms: Manipulations, Musculoskeletal; Manual Therapies; Manual Therapy; Therapies, Manual; Therapy, Manual; Manipulation Therapy; Manipulation Therapies; Therapies, Manipulation; Manipulative Therapies; Manipulative Therapy; Therapies, Manipulative; Therapy, Manipulative; Therapy, Manipulation

Music therapy (E02.190.888.500)

The use of music as an adjunctive therapy in the treatment of neurological, mental, or behavioral disorders

Additional tree number: E02.831.440, F04.754.549

Synonyms: Therapy, Music

Naturopathy (E02.190.655)

A drugless system of therapy, making use of physical forces such as air, light, water, heat, massage. Treatments are often diet- and nutrition-oriented with attention given to the patient's personal history and lifestyle

Additional tree number: none

Synonyms: Medicine, Naturopathic; Naturopathic Medicine

Neurofeedback (E02.190.525.123.500)

A technique to self-regulate brain activities provided as a feedback in order to better control or enhance one's own performance, control or function. This is done by trying to bring brain activities into a range associated with a desired brain function or status

Additional tree number: F02.830.131.500, F04.754.137.301.750, F04.754.308.500.750, L01.143.283.425.624.500.500

Synonyms: Neurofeedbacks; Brainwave Biofeedback; Biofeedback, Brainwave; Biofeedbacks, Brainwave; Brainwave Biofeedbacks; Alpha Feedback; Alpha Feedbacks; Feedback, Alpha; Feedbacks, Alpha; Electromyography Feedback; EEG Feedback; EEG Feedbacks; Feedback, EEG; Feedbacks, EEG; Electroencephalography Biofeedback; Biofeedback, Electroencephalography; Biofeedbacks, Electroencephalography; Electroencephalography Biofeedbacks; Alpha Biofeedback; Alpha Biofeedbacks; Biofeedback, Alpha; Biofeedbacks, Alpha; Brainwave Feedback; Brainwave Feedbacks; Feedback, Brainwave; Feedbacks, Brainwave

Occultism (E02.190.901.650)

From the Latin word occultus meaning "clandestine", "hidden", "secret", "knowledge of the hidden". In common English usage, occult refers to "knowledge of the paranormal", as opposed to "knowledge of the measurable", usually referred to as science. Occultism is the study of occult practices, including (but not limited to) magic, alchemy, extra-sensory perception, astrology, spiritualism, and divination and is conceived of as the study of the inner nature of things. Interpretation of occultism and its concepts can be found in the belief structures of religions such as Gnosticism, Hermeticism, Theosophy, Wicca, Thelema, Satanism, and neopaganism (Mircea 1976)

Additional tree number: K01.672

Synonyms: Occultisms

Organotherapy (E02.190.701)

Historically, the treatment of disease by the administration of animal organs or their extracts (after Brown-Sequard). At present synthetic preparations substitute for the extracts of a gland

Additional tree number: E02.095.682

Synonyms: Organotherapies

Phytotherapy (E02.190.755)

Use of plants or herbs to treat diseases or to alleviate pain

Additional tree number: none

Synonyms: Herb Therapy; Herbal Therapy

Play therapy (E02.190.888.625)

A treatment technique utilizing play as a medium for expression and communication between patient and therapist

Additional tree number: F04.754.664

Synonyms: Play Therapies; Therapies, Play; Therapy, Play; Sandplay Therapy; Sandplay Therapies; Therapies, Sandplay; Therapy, Sandplay; Sandplay; Sandplays

Psychodrama (E02.190.525.781)

Primarily a technique of group psychotherapy which involves a structured, directed, and dramatized acting out of the patient's personal and emotional problems

Additional tree number: F04.754.864.581.679

Synonyms: Drama Therapy; Therapy, Drama; Dramatherapy

Psychophysiology (E02.190.525.812)

The study of the physiological basis of human and animal behavior

Additional tree number: F02.830, F04.096.795, H01.158.782.795

Synonyms: Physiological Psychology; Psychology, Physiological; Physiologic Psychology; Physiologic Psychologies; Psychologies, Physiologic; Psychology, Physiologic; Mind-Body Relations (Physiology); Mind Body Relations (Physiology); Mind-Body Relation (Physiology); Relation, Mind-Body (Physiology); Relations, Mind-Body (Physiology); Mind-Body Relationship (Physiology); Mind Body Relationship (Physiology); Mind-Body Relationships (Physiology); Relationship, Mind-Body (Physiology); Relationships, Mind-Body (Physiology)

Radiesthesia (E02.190.901.740)

Therapeutic cult concerned with intangible energies surrounding the living body and based on the detection of these intrinsic radiations by dowsing, or divining, or the use of more elaborate instruments (radionics)

Additional tree number: none

Synonyms: none

Reflexotherapy (E02.190.799)

Treatment of some morbid condition by producing a reflex action, as in the household treatment of nosebleed by a piece of ice applied to the cervical spine

Additional tree number: none

Synonyms: Reflex Therapy; Therapy, Reflex

Rejuvenation (E02.190.822)

The phenomenon of youthfulness, vitality, and freshness being restored. This can apply to appearance, TISSUES, organ functions, or other areas

Additional tree number: E02.849

Synonyms: none

Relaxation therapy (E02.190.525.875)

Treatment to improve one's health condition by using techniques that can reduce PHYSIOLOGICAL STRESS; PSYCHOLOGICAL STRESS; or both

Additional tree number: F04.754.137.750

Synonyms: Therapy, Relaxation; Relaxation Techniques; Relaxation Technics

Role playing (E02.190.525.781.653)

The adopting or performing the role of another significant individual in order to gain insight into the behavior of that person

Additional tree number: F04.754.864.581.679.653

Synonyms: Playing, Role; Playings, Role; Role Playings

Sensory art therapies (E02.190.888)

Therapies using arts or directed at the senses

Additional tree number: none

Synonyms: Art Therapies, Sensory; Therapies, Sensory Art

Shamanism (E02.190.488.830, E02.190.901.788)

An intermediate stage between polytheism and monotheism, which assumes a "Great Spirit", with lesser deities subordinated. With the beginnings of shamanism there was the advent of the medicine man or witch doctor, who assumed a supervisory relation to disease and its cure. Formally, shamanism is a religion of Ural-Altaic peoples of Northern Asia and Europe, characterized by the belief that the unseen world of gods, demons, ancestral spirits is responsive only to shamans. The Indians of North and South America entertain religious practices similar to the Ural-Altaic shamanism. The word shaman comes from the Tungusic (Manchuria and Siberia) saman, meaning Buddhist monk. The shaman handles disease almost entirely by psychotherapeutic means; he frightens away the demons of disease by assuming a terrifying mien

Additional tree number: I01.076.201.450.654.830

Synonyms: none

Speleotherapy (E02.190.894)

The use of CAVES, mines, or other subterranean environments in treatment of diseases. Speleotherapy is used in some Central and Eastern European countries to treat CHRONIC OBSTRUCTIVE AIRWAY DISEASE

Additional tree number: none

Synonyms: Speleotherapies

Spiritual therapies (E02.190.901)

Mystical, religious, or spiritual practices performed for health benefit

Additional tree number: none

Synonyms: Therapies, Spiritual; Spiritual Healing

Suggestion (E02.190.525.217.771)

The uncritical acceptance of an idea or plan of action

Additional tree number: F04.754.424.771

Synonyms: Suggestions

Tai Ji (E02.190.525.890)

One of the MARTIAL ARTS and also a form of meditative exercise using methodically slow circular stretching movements and positions of body balance

Additional tree number: E02.779.474.913, I03.450.642.845.560.500

Synonyms: Tai-ji; Tai Chi; Chi, Tai; Tai Ji Quan; Ji Quan, Tai; Quan, Tai Ji; Taiji; Taijiquan; T'ai Chi; Tai Chi Chuan

Therapeutic touch (E02.190.525.906, E02.190.901.830)

Placing of the hands of the healer upon the person to be cured with the intent of spiritual energetic healing

Additional tree number: none

Synonyms: Touch, Therapeutic; Reiki; Laying-on-of-Hands

Tissue therapy (E02.190.701.884)

Historically, tissue transplantation, especially of refrigerated tissue (after Filatov). It was theorized that nonspecific substances, capable of initiating restorative processes, formed in tissues when refrigerated. Cell therapy (after Niehans) refers to implantation of tissue by injection. Originally this involved fresh cells but later frozen or lyophilized cells

Additional tree number: E02.095.682.884

Synonyms: Therapy, Tissue; Biogenic Stimulators; Biogenic Stimulator; Stimulator, Biogenic; Stimulators, Biogenic; Cell Therapy; Therapy, Cell

Witchcraft (E02.190.901.968)

An act of employing sorcery (the use of power gained from the assistance or control of spirits), especially with malevolent intent, and the exercise of supernatural powers and alleged intercourse with the devil or a familiar

Additional tree number: I01.076.201.450.897.439.925

Synonyms: Sorcery; Sorceries

Yoga (E02.190.525.937, E02.190.901.984)

A major orthodox system of Hindu philosophy based on Sankhya (metaphysical dualism) but differing from it in being theistic and characterized by the teaching of raja-yoga as a practical method of liberating the self. It includes a system of exercises for attaining bodily or mental control and well-being with liberation of the self and union with the universal spirit

Additional tree number: E02.779.474.937, K01.844.799.867

Synonyms: none

Additionally, many practitioners are not medically qualified and have little knowledge of the biomedical sciences, although some do take diplomas in their area of treatment. Some are medically qualified practitioners who have studied, for example, in hypnotherapy, acupuncture, and homeopathy. The selection of a competent healthcare practitioner is an important decision and can be essential to ensuring the best possible care (NCCAM 2013).

How the intervention might work

Studies have shown that stress management has helped to increase the efficacy of treatments in many people with psoriasis (Kabat-Zinn 1998), because stress appears to play an important part in a vicious circle of interactions that lead to worsening psoriatic skin (Mohum 2006; Zachariae 1996). Although the intrinsic mechanisms of action of the CAM systems are not well understood, improvement in mental health may help (Bonadonna 2003), because when added to conventional treatments, results have been acceptable (NCCAM 2013; Tierney Jr 2007).

Complementary and alternative medicines are mistakenly considered to be innocuous because they are regarded as 'natural products'. However, they are complex substances with active chemical ingredients and therefore have pharmacokinetic and pharmacodynamic effects like any other drug. These effects, which may often be unknown, may turn out to be dangerous and unsafe (Kabat-Zinn 1998).

The concept of what complementary or alternative practice means is often completely dependent upon the cultural context of different countries. The definition of complementary and alternative practices includes all such practices and ideas that are outside the domain of conventional medicine in most countries and considered by its users as preventing or treating illness, or promoting health or well-being (Gaston 1991).

Why it is important to do this review

Although there are many publications on CAMs, important knowledge about their effectiveness, efficiency, and safety have not been fully mapped. The body of clinical trial literature surrounding the use of complementary and alternative medicine for psoriasis is large, but has several limitations (Smith 2009).

We plan to review the evidence for the possible potential benefits of complementary interventions, classified according to the criteria of the National Center for Complementary and Alternative Medicine (NCCAM 2013), which is aimed at treating chronic plaque psoriasis.


To assess the effects of complementary medicine for the treatment of chronic plaque psoriasis.


Criteria for considering studies for this review

Types of studies

All randomised controlled trials (RCTs) evaluating the effects of complementary and alternative medicine, classified according to the National Center for Complementary and Alternative Medicine/National Institutes of Health (NCCAM/NIH) (NCCAM 2013), for the treatment of chronic plaque psoriasis.

Types of participants

We will include people of any age with a diagnosis of chronic plaque psoriasis.

Types of interventions

We will consider complementary medicine interventions in any form used in conjunction with conventional treatments for chronic plaque psoriasis. We will also include studies that apply alternative medicine, especially with regard to studies conducted within the criteria for categorisation of NCCAM/NIH (NCCAM 2013). Chinese medicines will make the present review as comprehensive as possible.

We might include the following possible general comparisons.

  1. complementary medicine interventions versus conventional medical practice, e.g. meditation plus PUVA (a combination of psoralen and ultraviolet A) versus PUVA;

  2. complementary medicine interventions versus alternative medicine interventions, e.g. acupressure plus PUVA versus acupressure herbal Chinese medicine;

  3. complementary medicine interventions versus complementary medicine interventions, e.g. acupressure plus PUVA versus meditation plus PUVA;

  4. alternative medicine interventions versus conventional medical practice, e.g. homeopathy versus PUVA; or

  5. alternative medicine interventions versus alternative medicine interventions, e.g. Tai Ji versus hypnosis.

For inclusion in the review, at least one arm of the RCT will need to include a CAM intervention.

A glossary of potential CAM interventions, adapted from NLM 2013, is available in Table 1.

Types of outcome measures

Primary outcomes
  1. Changes in disease status assessed by signs (e.g. planimetric method, Camisa 2003; Psoriasis Area and Severity Index (PASI), Fredriksson 1978) and symptoms (e.g. Symptom Severity Scale (SSS), Hughes 1981; Self Administered Psoriasis Area and Severity Index (SAPASI), Feldman 1996) of disease or any tool available.

  2. Adverse effects or events (e.g. life-threatening adverse events (LTAE), Naranjo 1981).

Secondary outcomes
  1. Changes in conventional medicine interventions assessed by lower doses of drug, reduced ultraviolet light exposures, or increased intervals between relapses.

  2. Changes in participant status assessed by psychosocial changes (e.g. Psoriasis Disability Index (PDI), Finlay 1987; happiness, anxiety, emotional distress, behavioural changes, sexuality, or intimacy); quality of life (e.g. Dermatology Life Quality Index (DLQI), Mazzotti 2003; 36-item short-form health survey (SF-36), Tasai 1997; UK Sickness Impact Profile (SIP), Finlay 1990); and treatment satisfaction (through using any tool available).

Search methods for identification of studies

We aim to identify all relevant RCTs, regardless of language or publication status (published, unpublished, in press, or in progress).

Electronic searches

We will search the following databases for relevant trials:

  • the Cochrane Skin Group Specialised Register;

  • the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library;

  • PubMed using the CAM subset;

  • MEDLINE via OVID (from 1946);

  • Embase via OVID (from 1974);

  • AMED via OVID (Allied and Complementary Medicine Database, from 1985);

  • PsycInfo via OVID (from 1806);

  • CINAHL (Cumulative Index to Nursing and Allied Health Literature) via EBSCO (from 1981);

  • Salford Database of Psoriasis trials;

  • ISI Web of Science; and

  • HealthSTAR.

We have devised a search strategy for RCTs for PubMed, which is displayed in Appendix 1. This will be used as the basis for search strategies for the other databases listed.

Trials registers

We will search the following trials registers.

Searching other resources

References from published studies

We will check the bibliographies of included studies and review articles for additional references to relevant trials.

Unpublished literature

We will contact the authors of included studies and ask them about other published and unpublished RCTs.

Conference proceedings

We will handsearch the following conference proceedings from 2011 to date when they have not already been handsearched by the Cochrane Skin Group.

  • World Psoriasis & Psoriatic Arthritis Conference

  • Annual Meeting of the American Academy of Dermatology

  • Annual Meeting of the European Society for Dermatological Research

  • World Congress of Dermatology

  • Annual Meeting of the British Society for Investigative Dermatology

  • Annual Meeting of the Society for Investigative Dermatology

Adverse effects

We will not perform a separate search for adverse effects of complementary therapies for chronic plaque psoriasis. However, we will examine data on adverse effects from the included studies we identify.

Data collection and analysis

We plan to include at least one 'Summary of findings' table in our review. In this, we will summarise the primary outcomes for the most important comparison. If we feel there are several major comparisons or that our findings need to be summarised for different populations, we will include further 'Summary of findings' tables.

We will perform the data collection and analysis according to the recommendations in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011).

Selection of studies

Two review authors (CM and EK) will independently screen titles and abstracts of trials from literature searches for inclusion in the review and code them as "retrieve" (eligible, potentially eligible, or unclear) or "do not retrieve". We will obtain full text of those coded "retrieve", and two review authors (CM and EK) will independently screen the full text to identify studies for inclusion. We will resolve disagreements by discussion; however, if we do not reach consensus, a third author (CS) will make the judgment.

We will record reasons for the exclusion of any ineligible studies in the 'Characteristics of excluded studies' tables.

We will carry out the selection process in sufficient detail to complete a flow diagram.

Data extraction and management

Two review authors (CM and EK) will independently conduct data extraction from the primary studies, and if necessary, they will consult a third reviewer (CS or VS) to resolve any disagreements. We will modify the standard Cochrane Skin Group data extraction form to meet the needs of this systematic review.

Assessment of risk of bias in included studies

Two authors (CM and EK) will independently assess the risk of bias for each included trial using the criteria described in the Cochrane Handbook for Systematic Reviews of Interventions (Chan 2005; Higgins 2011). A third author (CS or VS) will resolve any disagreement. We will assess the risk of bias according to the following domains:

  1. random sequence generation (selection bias);

  2. allocation concealment (selection bias);

  3. blinding of participants and personnel (performance bias);

  4. blinding of outcome assessment (detection bias);

  5. incomplete outcome data (attrition bias);

  6. selective reporting (reporting bias); and

  7. other bias (other sources of bias related to a particular trial design, e.g. cross-over or cluster-randomised, or specific circumstances, e.g. interventions mixed).

We will classify the risk of bias as low risk of bias, high risk of bias, or unclear risk of bias.

Measures of treatment effect

Considering the objective, criteria for considering studies, outcomes for this review, and also the recommendation in the Cochrane Handbook for Systematic Reviews of Interventions (Chan 2005; Higgins 2011), we plan to use the following types of measurements of treatment effect.

Continuous data: outcome measures evaluated by numerical quantity

We will combine the results using the mean difference (MD) for measures using the same scale or the standardised mean difference (SMD) when different scales are used to evaluate the same outcome. This type of measure may be found for signs assessed by PASI, for example.

Dichotomous data: outcome measures evaluated as binary responses

We will show the summarised results as risk ratios (RR) considering the types of included studies criteria, i.e. RCTs. We will calculate the number needed to treat (NNT) from the RR if estimated effects are statistically significant. These type of data may be found for changes in conventional medicine interventions assessed by lower doses of drug, for example.

Ordinal data: outcome measures evaluated by several ordered categories, e.g. trichotomous (mild, moderate, or severe)

If a shorter ordinal scale is used, we will analyse in meta-analyses as dichotomous data, but if a longer scale is used, we will analyse as continuous data in meta-analyses. These type of data may be found for psychosocial changes, such as depression, for example.

Counts and rates: outcome measures based on the number of events experienced by each individual

If a meta-analysis is appropriate, we may use the rate ratio, i.e. rate of events in the two groups by dividing one by the other. This type of data may be found for adverse effects or events, for example.

Time-to-event data: measures the time until an event occurs

We may use the hazard ratio (HR) to measure this type of time-to-event outcome. This type of data may be found for increased interval between relapses, for example.

If we find more than one study that analyses the same outcome, we will conduct a meta-analysis. All statistical parameters will use 95% confidence intervals (CI). However, where data are not available for meta-analysis or are considered inappropriate, we will assess the evidence systematically and describe it.

Unit of analysis issues

Given the nature of the disease and variety of interventions, we can expect the following units of analysis.

  • Parallel RCTs: The unit of analysis will be based on the individual participant (unit to be randomly assigned for interventions to be compared).

  • Cross-over RCTs: In cross-over designs, we will only include the phase one data to avoid a carry-over effect.

  • Cluster RCTs: If we include cluster-randomised trials, the unit of analysis will be the group that was allocated the intervention.

  • Multiple treatment: If we include multiple intervention groups within a RCT and more than two groups are relevant, we will create single pair-wise comparisons to analyse it as a parallel RCT where possible.

  • Multiple body parts receiving different interventions: If we include RCTs where chronic plaque psoriasis or body parts are randomised to the allocated intervention, which have similarities to a cross-over RCT, we will extract and analyse all relevant data if possible.

  • Multiple body parts receiving the same intervention: If we include RCTs where participants are randomised to receive the same intervention, but multiple chronic plaque psoriasis or body parts receive the same intervention, and a separate judgement is made for each body part, which have similarities to a cluster RCT, the unit of analysis will be the group of multiple chronic psoriasis or body parts that was allocated the intervention.

Dealing with missing data

If the included studies have missing data, we will manage this by following the strategies detailed in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011).

  1. As a first step, we will try to contact the authors by sending at least two emails to request additional information (e.g. incomplete reporting, lack of intention-to-treat analysis, summary data missing for an outcome, randomisation process not described, or any other necessary data). If we obtain no answer, we will report and discuss this in the text.

  2. We will describe any methods used to cope with missing data.

  3. We will perform sensitivity analyses to test the robustness of these assumptions.

  4. We will discuss the impact of missing data on the results of the review.

  5. We will use available case analysis as our primary analysis. The available case analysis will use data on known results for a particular outcome. A potential source of heterogeneity may be the variation in the amount of missing data.

  6. We will use intention-to-treat analysis (ITT) with imputation as our secondary analysis: ITT assessment will use analysis of the total number of randomised participants whether or not the original authors analysed them in this way. It may be necessary to impute dichotomous outcome data. The most common way is to assume that all the missing participants experienced the event or all did not. An alternative is to impute data according to the event rate in a control group or according to event rates in the participants who complete in the groups. We will base the choice of methodology on clinical judgment in some cases.

Assessment of heterogeneity

We will assess the level of diversity among studies using I² statistic. We will describe this as percentage of variability in effect estimates resulting from heterogeneity. We will consider heterogeneity substantial if the I² statistic is > 50%, considering, in addition, magnitude and direction of effects and strength of evidence for heterogeneity (e.g. P value from the Chi² test).

If substantial heterogeneity exists among studies, our strategies for addressing it will follow the recommendations in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011). Considering the complexities and degree of incompleteness in CAM interventions, where it makes sense, we will try to explore this with subgroup analysis of study characteristics and advise caution in the interpretation of our results.

Assessment of reporting biases

We will try to contact the authors by email if there is insufficient information to assess report bias. We will also contact the trial authors to clarify the information if there are mismatches between study protocols and reports.

We will perform a funnel plot asymmetry test if we include 10 or more RCTs in the meta-analysis to have power in the test to distinguish chance from real asymmetry.

Data synthesis

We will meta-analyse RCTs if the pooled estimates for the outcomes is possible. When the heterogeneity is not substantial (I² statistic < 50%), we will use a fixed-effect meta-analysis. Whenever heterogeneity is substantial (I² statistic > 50%), we will use a random-effects meta-analysis.

In cases where the combination of data is not possible to perform meta-analyses, we will present a description of individual studies.

Subgroup analysis and investigation of heterogeneity

If possible and whenever it makes sense, we will conduct subgroup analyses to explore possible sources of heterogeneity due to participants, interventions, or methods:

Participant characteristics
  • Severity of psoriasis (e.g. light, moderate, severe)

  • Age groups (e.g. children (until 18 years old), adults (between 18 to 65 years old), and the elderly (more than 65 years old))

  • Setting (e.g. hospital, home care)

  • Ethnicity

  • Associated chronic conditions

Type and characteristics of CAM interventions
  • Natural products

  • Mind and body practices

  • Other CAM practice

We will also assess duration of the treatments.

We will assess statistical differences in subgroup analyses by overlap of confidence intervals and by performing the test for subgroup differences available in Review Manager (RevMan).

Sensitivity analysis

We plan to explore how the results of the meta-analysis change under different assumptions by conducting sensitivity analyses to assess the robustness of the results, describing and comparing them with the overall findings. Moreover, we will conduct sensitivity analyses looking at the following aspects of methods:

  1. study design (e.g. parallel, cross-over, cluster); and

  2. methodological quality (e.g. effects of missing data; blinding; intention-to-treat; risk of bias: low, high, or unclear).


We would like to thank Finola Delamere and Laura Prescott from the Cochrane Skin Group for their support when writing this protocol, and we are grateful for peer review comments made by Bob Dellavalle, Juping Chen, Matthew Grainge, and Philippa Middleton. We would also like to thank Liz Doney for the search strategy development.

The Cochrane Skin Group editorial base wishes to thank Robert Dellavalle who was the Cochrane Dermatology Editor for this protocol; Matthew Grainge and Philippa Middleton who were the Statistical and Methods Editors, respectively; the clinical referee, Juping Chen; and the consumer referee, Maria Grogan.


Appendix 1. PubMed (draft) search strategy

#7Search #6 Limits: Complementary Medicine
#6Search #1 and #5
#5Search #2 or #3 or #4
#4Search "palmoplantar* pustulosis"
#3Search "pustulosis palmaris et plantaris"
#2Search ("Arthritis, Psoriatic"[Mesh]) OR "Psoriasis"[Mesh] or psoria*
#1Search ((randomized controlled trial[Publication Type] OR controlled clinical trial[Publication Type]) OR randomized[Title/Abstract]) OR placebo[Title/Abstract] OR "clinical trials as topic"[MeSH Terms:noexp] OR randomly[Title/Abstract] OR trial[Title] NOT (animals[MeSH Terms] NOT (humans[MeSH Terms]) AND animals[MeSH Terms])

Contributions of authors

CM was the contact person with the editorial base.
CM co-ordinated the contributions from the co-authors and wrote the final draft of the protocol.
CM, VS, and RA worked on the methods sections.
CM, EK, CS, VT, and VS drafted the clinical sections of the background and responded to the clinical comments of the referees.
VS and RA responded to the methodological and statistical comments of the referees.
JT contributed to writing the protocol.
CP was the consumer co-author and checked the protocol for readability and clarity. He also ensured that the outcomes are relevant to consumers.
CM is the guarantor of the final review.


The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS, or the Department of Health, UK.

Declarations of interest

Carlos Alberto Monson: Nothing to declare.
Valter Silva: Nothing to declare.
Régis B Andriolo: Nothing to declare.
Elisa Harumi Kozasa: Nothing to declare.
Cid Yazigi Sabbag: Nothing to declare.
Carlos Alberto de Paula: Nothing to declare.
John A Tweed: Nothing to declare.
Virginia Fernandes Moça Trevisani: Nothing to declare.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • The National Institute for Health Research (NIHR), UK.

    The NIHR, UK, is the largest single funder of the Cochrane Skin Group.