Concentration Camp Cure Debunked -- Ed Anderson

It's often cited as "fact" that many WWII POW camp prisoners with psoriasis went into remission. This usually precedes speculation about the role in this disease of starvation, diet, or stress.

This claim appears to originate with a 1949 report by a Dr. Simons from Holland who was stationed in Java/Sumatra. He was treating mostly caucasians since it was formerly a Dutch colony. The Japanese imprisoned civilians there during WWII and many were put to labor. Since it's a tropical climate, it should be obvious that these victims weren't heavily dressed. This is worth noting because many people find that sun exposure improves their psoriasis. Basically, the original Dutch report results were probably worse than might be expected given the sun exposure, with only 7 of 13 reported cases showing improvement.

An excellent review of this and other concentration camp reports was done in 1971 by Dr. Herschel Zackheim and Stanford's Dr. Eugene Farber, when they published their own dietary trial and conclusions. Unfortunately, the abstract is not online. If you want to read it yourself, it may be a the nearest medical library:
Rapid Weight Reduction and Psoriasis - Arch Derm Feb 1971 v103:136-140

In this trial, they gave a 500 calorie liquid diet (15% protein, 43% carb, 42% fat) to 8 patients in a hospital environment for 3-5 weeks. Of another 8 on a regular diet, four improved, two unchanged, two got worse. Of the eight on the low calorie diet, one improved and SEVEN got worse.

Here's their summary of the various concentration camp reports:

"We are not aware of any other study in which the effect of weight loss on psoriasis has been studied under controlled conditions. In discussions of this problem the report of Simons on the course of psoriasis in Japanese concentration camps in Java in World War II is frequently cited as evidence that psoriatics do better under conditions of poor nutrition. However, a reading of that report reveals that the clinical pattern was far from uniform. Of the 13 subjects described by Simons, seven improved (two mildly), two were unchanged, two were worse throughout the internment, and two initially improved and then became worse. It is of interest that of the two patients who became worse after initial improvement, one did so when forced to go on heavy fatigue duty, and the other flared when conditions in the camp became 'miserable.' Simons also notes that the prisoners were 'obliged to perform heavy labor in the open air (usually practically naked)' so that they obviously were exposed to considerable sunlight in that tropical setting."

"Gans could not find a consistent relationship between the incidence of psoriasis and periods of poor nutrition in Germany in World Wars 1 and 2. Ottolenghi states that: 'Occurence of psoriasis has remained practically unchanged during the course of the twentieth century wars, notwithstanding nutritional scarcity and and unavailability of fat-reducing drugs.' He also cites the observation of Bonner and Jentsch to the effect that there was no perceptible decrease in the incidence of psoriasis in Europe in World War I, and those of Prakken, Sartori, and Ceccarini who noted a distinct increase in psoriasis in the first years of World War II. Simons also refers to the study of Prakken who found an acceleration of psoriasis in 1942 in 53 of 99 cases in the Netherlands despite low fat rations."

The doctors also measured cortisol levels during the rapid weight loss, and found that unlike short term stress which increases cortisol, the results were similar to starvation: Plasma cortisol levels remained normal or increased, while there was a decrease in cortisol excreted.

I'm actually a proponent of dietary regimens. I got sidetracked on the starvation claims when digging up details on what happened to the doctors whose botched turkey/tryptophan psoriasis theory turned into another urban myth. It turns out they did more studies, also reported in '71, that pointed towards the value of turkey. They determined it was not because it has any beneficial component for treating psoriasis, but that it was missing something (unknown) in their patients' normal diet. They essentially became advocates of elimination diets. (I'm all for that.)

I became curious about the weight loss aspect after reading an Italian study on dietary effects in psoriasis.

I think it still might be valuable to do a meta-study of any previous psoriasis studies that kept track of the patients' weight during the trial. It would be interesting to see a comparison of psoriasis score changes plotted against any weight changes.

One of the most impressive studies on dietary effects in psoriasis investigated the benefits of various fish related by fat content. It isn't reflected well in the abstract because the trial was stopped at six weeks, but those eating fatty fish like salmon showed remarkable steady improvement, and the benefits were lost when the fish was removed from their diet.

-- Ed Anderson 12/16/99

[with excerpts from a private email that got posted to the newsgroup]

[*] Simons, RDG: Additional studies on psoriasis in the tropics and in starvation camps.
J Invest Derm 12:285-294, 1949