Plaques, Flares, and Goose Oil: Psoriasis Through the Ages

According to the National Psoriasis Foundation, ancient Egyptians treated skin afflictions like psoriasis with everything, including cat and dog feces, goose oil, onions mixed with sea salt, and urine (yes, really). However, present-day dermatologists are perplexed by these odd and archaic remedies. Case in point: Adam Friedman, M.D., a professor of dermatology at The George Washington University School of Medicine, says he “truly can’t think of a reason” why these things would've been used to treat psoriasis. “Goose oil is similar to olive oil and could be moisturizing for the skin, but that’s about it,” he says.

Hippocrates, who is widely recognized as the Greek “Father of Medicine,” described dry, flaky skin patches as “lopoi,” meaning epidermis, and was believed to include psoriasis and leprosy. Back then, psoriasis was often confused for other ailments, namely leprosy, which is where the label stemmed from. However, there are some key differences between the two diseases—for starters, leprosy is a contagious bacterial infection that attacks the nervous system and can lead to a lack of nerve sensation. Additionally, skin lesions caused by leprosy appear lighter than normal skin and don’t typically have flaking scales like psoriasis lesions do.

Galen, a famed Greek physician, first used the word “psora,” which meant “desquamative ailment” to define a skin disorder that involved itchy scaliness of the eyelids, corners of the eyes, and scrotum. While we now know that psoriasis can affect skin anywhere on the body, these areas were likely where doctors saw the condition present itself most often back then.

Leprosy and psoriasis continued to be confused for centuries to come. As a result, many psoriatic patients were diagnosed with leprosy and received the same type of “treatments,” which back then, included social isolation, declaration of death by the Church, and starting in 1313, burning at the stake ordered by Philip de Fair—a.k.a. the King of France. Needless to say, it was not a great time to have psoriasis (or leprosy for that matter).

Robert Willan, an English doctor who founded dermatology as a medical specialty (so, he was basically the “grandfather of dermatology”), was the first physician to offer a clearly defined description of psoriasis lesions. He illustrated what different types of psoriasis, including guttate (which appears as small red, dotty patches), look like in drawings. This was huge as it helped to introduce a new way to classify and diagnose the disease.

Ferdinand Von Hebra was an Austrian dermatologist who founded the New Vienna School of Dermatology, which was made up of an important group of doctors who laid the foundations for modern dermatology. What set Von Hebra’s work apart is he was the first physician to apply modern research methods to dermatology and create an extensive interest in the subject. He’s also famous for permanently shedding the term “lepra” from the description of psoriasis, which ultimately separated the two diseases from one another once and for all.

French physician Pierre Bazin was the first person to coin the term “psoriasis arthritique” or “arthritic psoriasis” after the association between the two ailments was founded by fellow famed French dermatologist, Jean Louis Alibert, in 1818. Alibert is often known as the “father of French dermatology” and specialized in patients with chronic disorders, including skin conditions like syphilis and leprosy.

Yep, it really took 90 years before the next leap in treatment. Topical corticosteroids, which are now used to treat a variety of skin disorders, became the first staple treatment for psoriasis, as physicians found that their anti-inflammatory properties can be beneficial at alleviating symptoms. The long-term risks had not been identified at this point, and dermatologists saw significant success in patients who tried the therapy. Before then, coal tar was a common treatment, as was Goeckerman therapy, which was developed by dermatologist William Goeckerman and involved combining coal tar with an early form of ultraviolet light phototherapy.

Phototherapy—specifically ultraviolet B, which is present in natural sunlight—was found to be an effective approach to treating psoriasis, as it slowed the growth of affected skin cells. The treatment involves exposing the skin to an artificial UVB light source for a set amount of time and on a consistent basis. Systemic medications, which work inside the body by attacking the physiological processes that cause psoriasis, were also introduced. These treatments were used dependent upon the degree of severity, how much of the body was covered, and whether patients had responded to topicals.

Researchers John M. Moll and Verna Wright—the latter of whom was a rheumatologist — studied the association between psoriasis and arthritis rigorously, and eventually published a paper called “Psoriatic Arthritis,” which detailed their knowledge of the disease and has since been cited thousands of times. This paper was a major milestone in the history of psoriasis as it specifically described the characteristics and uniqueness of psoriatic arthritis. It also helped distinguish the disease from rheumatoid arthritis.

Biologic therapies, or “biologics,” were first introduced for the treatment of psoriasis and psoriatic arthritis. Biologics are a type of protein-based systemic drug that work by blocking the action of a specific immune cell, called the T-cell, as well as certain proteins in the immune system, like tumor necrosis factor-alpha, as these both play a role in the development of psoriasis and psoriatic arthritis. Unlike prior treatments, biologics are taken via injection or through IV infusion. This was a huge turning point as some physicians started to see complete clearance in their psoriasis patients, rather than just improvement.

A new biologic injectable treatment called bimekizumab is currently being studied in clinical trials and is expected to be released in the next couple of years. It shows promise to be even more effective at clearing psoriasis than currently available treatments because of its ability to target specific parts of the immune system that cause the inflammatory condition. JAK inhibitors, which are medications that work by blocking a different part of the inflammatory pathway than most traditional treatments, are also on the horizon. They will likely be available in one-to-two years in both oral and topical form, notes Jeremy Fenton, M.D., a clinical instructor of dermatology at Mt. Sinai Hospital in New York City.