The number of letters and inquiries received on the subject of the skin eruption named psoriasis is equal to, if not greater than about any other single disease. There are two reasons for thisone is that the disease is very chronic and prone to recurrence (the patient, there-fore, is constantly reminded of its existence), and the other is that when the patient consults a physician, the latter’s report is likely to be very discouraging.
It is a pleasure, therefore, to call attention to a remonstrance about this attitude from one of the best known of American dermatologists. He protests, first, against the universal note of pessimism that pervades medical discussion of the subject, and, second, against the indifference to the established value of diet in the control of the disease.
Research performed 20 years ago indicated very definitely that there was a nutritional factor in psoriasis and that this could be con-trolled by diet. Yet this research has largely gone unnoticed and its lessons unheeded.
An instance is afforded by the case of a patient with psoriasis, who consulted a dermatologist in Paris, two in London, and five eminent American specialists in skin diseases, without any benefit. After all of this discouraging experience a fairly simple change in diet resulted in such striking changes for the better, that local treatment which could not before be tolerated was administered without discomfort. All of the dermatologists previously consulted had ignored the possibility of dietary control.
Most patients who have lived with the disease any length of time will, I believe, heartily endorse this attitude. They know by countless observations that dietary indiscretions will influence the severity of the eruption. Alcohol in any form they cannot tolerate. And, in general, they are most comfortable on a vegetable regimen.
Diet, alone, is not claimed to be completely curative for psoriasis. But it is claimed that diet will bring the skin to such a state of quiescence that methods of treatment previously too severe to be tolerated can be used to accomplish the clearing up of the eruption.
The nature of the fundamental nutritional change in psoriasis which points the way to the logic of the diet is an unbalanced protein metabolism.
For this reason, the diet should be rigidly restricted in the matter of proteins. In many cases the elimination of meat, fish, fowl, eggs, soups with meat stocks, and especially visceral food, such as kidneys and liver, is sufficient to keep the disease within bounds. In severe and selected cases, a weighed diet keeping the nitrogen intake below 5 grams a day and the total calories below 2,000, is necessary.