Psoriasis is a chronic inflammatory skin disease characterized by thickened, silvery-scaled patches. It has been associated with inflammatory and immune mechanisms probably associated with a genetic predisposition that can be triggered by stress (1,2). Psoriasis is one of the most common chronic inflammatory skin disorders, affecting ~2% of the general population (3). Psoriasis can substantially affect quality of life of patients. Numerous different treatments are available, which may allow short-term improvement and long-term control of the disease, but these measures do not cure psoriasis (4). Treatments include topical applications, systemic therapies and phototherapy; while they can be effective, a number of treatments are associated with significant adverse effects. Thus, there is a requirement for effective affordable therapies with fewer side effects that address the causes of the disorder.

Psoriasis is considered to be a T-cell-mediated inflammatory skin disease, which is characterized by hyperproliferation and poor differentiation of epidermal keratinocytes. While susceptibility to psoriasis is inherited, the disease is influenced by environmental factors, such as infections and stress (5). Diet has been suggested to be involved in the aetiology and pathogenesis of psoriasis (6,7). Fasting periods, low-energy diets and vegetarian diets have been shown to improve psoriasis symptoms in certain studies (6), and diets rich in polyunsaturated fatty acids from fish oil have also shown beneficial effects (7). These diets modify the polyunsaturated fatty acid metabolism and influence the eicosanoid profile, so that inflammatory processes are suppressed (6,7).

Written informed consent was obtained from the patient. A 36-year old female presented to the clinic with psoriasis since the age of 22. She stated that her outbreak of psoriasis originated on the scalp and slowly descended downward towards her feet. Eventually the psoriatic lesions covered a large extent of her body, with the exception of her face (Fig. 1). She had been prescribed topical steroid cream for the past 14 years. Possible cause could be due to usage of anti-dandruff shampoo (which contains coal tar) since teenage years. The patient stopped using the anti-dandruff shampoo upon the first consultation. Stopping the shampoo would not alleviate psoriasis in the time limits of the present study, but may help hasten the recovery.

At the start of treatment, the patient was advised to consume a healthy diet with abundant vegetables, minimal meat, no junk food, and to avoid taking any forms of sugar in food or drinks. The following supplements were prescribed: Vitacor Plus-1 tablet 3 times daily, ProLysinC-2 tablets 3 times daily, VitaCforte-2 tablet 3 times daily, and LysinC Drink mix-1 scoop 4 times daily. Table I shows the list of components in these supplements. The patient was advised to stop using the steroid cream immediately at the beginning of treatment. Return appointments were scheduled once per month.

During the first month the patient experienced flaring of the skin condition with shedding of the dead skin. From the second month onwards, the psoriasis patches appeared thinner. Patches on the upper part of body (neck, shoulder, upper arms) appeared to heal faster than the lower parts of the body. This healing process continued and the psoriatic patches on the legs were the last to heal. At the end of 6 months the patient's psoriasis had completely disappeared (Fig. 2). The patient reported aggravation of itching and soreness in the first month, followed by gradual improvement of these symptoms over the 6 months. The patient had no complaints/side effects associated with the nutritional regimen.

As there is no cure for psoriasis, the multiple treatment options currently available only attempt to reduce the severity of symptoms. Therapeutic approaches include natural modalities, such as sunlight, diet and stress avoidance, and pharmacological treatments, either topically applied in the form of creams or lotions, orally ingested or injected. Standard topical treatments and their side effects are as follows: Anthralin, skin irritation; calcipotriol, elevation of serum calcium; corticosteroids, skin thinning, hair follicle infections, facial redness, rosacea, a worsening of diabetes mellitus, and reduced endogenous steroid production; topical retinoids, skin reddening and irritation; and non-steroidal immunomodulators, burning sensation (5). Epidemiological studies have shown that increased intake of fresh fruits and vegetables is associated with a decreased prevalence of psoriasis (8,9). In his review of the literature, Wolters cites evidence of a potential benefit of dietary factors in psoriasis (9); it was reported that fasting periods, low-energy diets, vegetarian diets, and diets rich in n-3 polyunsaturated fatty acids from fish, improved the symptoms of psoriasis, as these diets were able to suppress inflammatory processes. In an Italian case-control study of 316 patients with psoriasis and 366 controls, the risk of psoriasis was found to be significantly inversely associated with the intake of carrots, tomatoes and fresh fruit, as well as with the β-carotene intake (7). The consumption of vegetables and fruits may be beneficial in psoriasis due to their high content of various antioxidants, such as carotenoids, flavonoids and vitamin C. Frei (10) reports that increasing intake of antioxidants, such as vitamin C, vitamin E, β-carotene and selenium may aid in preventing an imbalance between oxidative stress and antioxidant defence in psoriasis.

The present case had presented with severe psoriasis showed complete clearing of patches after six months on the prescribed dietary and nutritional supplement treatment. In addition to the changes made to the diet, including increased vegetable and fruit intake, the added supplements also provided support against oxidative stress (with vitamins E, C, B2 and zinc and selenium), aided normal energy metabolism (with vitamins B1, B2, B3, B5, B6, B12 and biotin, magnesium and vitamin C), maintained normal function of the immune system (with folic acid, vitamins A, D, and C, and selenium and copper); and optimized collagen formation (with vitamin C, lysine and proline). In addition, the major components of the supplements, ascorbic acid, lysine and proline, have been shown to be important in collagen integrity (11,12). Optimal collagen structure depends upon adequate supplies of ascorbic acid and the amino acids lysine and proline (11,12). In addition, lysine contributes to extracellular matrix stability as a natural inhibitor of plasmin-induced proteolysis (11). Since the human body cannot synthesize vitamin C or the amino acid lysine, they are required in the diet.

In conclusion, the nutritional dietary change and supplementation with specific nutrients resolved the patient's psoriasis in six months. In contrast to the current treatments, which are associated with various side effects that only attempt to reduce the severity of symptoms, non-toxic nutritional dietary intervention was shown to be effective in resolving the patient's psoriasis, suggesting that this treatment should approach be considered for patients with psoriasis.