Psoriasis is a disease in which the main symptom is grey or silvery flaky patches on the skin which are red and inflamed underneath. It affects around 2% of the population in the UK. Commonly affected areas include the scalp, elbows, knees, navel, palms, ears and groin. Around a quarter of people with psoriasis also suffer from psoriatic arthritis, which is similar to rheumatoid arthritis in its effects and primarily occurs in fingers and toes, but is also quite common in the spine.
It may appear for the first time at any age, although it is more likely to appear between the ages of 11 and 45. There is a genetic link and it tends to be familial. About 30% of people with at least one first degree relative with psoriasis will develop the condition. This genetic tendency can be triggered by:
- Infection
- certain medicines (including ibuprofen and lithium)
- psychological factors, including stress
- trauma to the skin
Symptoms
Normally there is a constant shedding of dead skin cells. However, psoriasis causes this replacement process to accelerate, leading to both dead and live cells accumulating on the skin surface. This then causes red, flaky, crusty patches covered with silvery scales, which are easily shed.
Psoriasis is driven by the immune system, especially involving the T cells (a type of white blood cell). Normally, T cells help to protect the body against infection and disease. In the case of psoriasis, T cells are activated inappropriately, which then triggers other immune reactions, leading to inflammation and a rapid turnover of skin cells. These cells pile up on the surface of the skin, forming itchy patches or plaques. The first outbreak of psoriasis is often triggered by emotional or mental stress or physical skin injury, but heredity is a major factor as well.
Psoriasis is a chronic disease, but patients may experience periods of remission that alternate with flare-ups lasting for several weeks or months. Conditions that may cause flare ups include infections, stress, and changes in climate that dry the skin. Also, certain medicines, including antimalarial drugs, Lithium salts and beta-blockers may trigger an outbreak or worsen the disease.
Conventional Treatment
Standard treatments for psoriasis include topically applied corticosteroids and synthetic vitamin D; light therapy; oral medications; and injections. Phototherapy using ultraviolet light can be very effective for psoriasis. Previously, UVB and PUVA (UVA exposure after ingestion of a sun-sensitizing pill) were the most common forms of light therapy. Newer treatments called narrow-band UVB (NB-UVB) seem to work at least as well as these if not better, and with fewer side effects. The latest equipment uses laser to deliver NB-UVB with pinpoint accuracy. Heliotherapy uses the sun as a source of natural ultraviolet radiation to treat psoriasis.
Lifestyle Changes
The following strategies may help to relieve psoriasis symptoms:
- daily baths (preferably with colloidal oatmeal, Epsom salts, or Dead Sea salts added to the water)
- daily use of a heavy moisturizer or ointment (preferably one that is chemical-free)
- avoidance of alcohol
- managing stress (possibly with the help of relaxing exercises like yoga, deep breathing, or meditation)
Therapies
Acupuncture – trials with psoriasis patients that did not respond to conventional medical therapies have shown that up to 50% of the patients demonstrated almost complete clearance of the lesions following a course of acupuncture.
Meditation – Stress reduction via meditation has been shown to accelerate healing of psoriatic plaques in a blinded trial.
Hypnosis both on its own and as an addition to other psoriasis treatment, has been cited as being helpful in clearing psoriasis in several published case reports.
Dietary Changes
Anecdotal evidence suggests that people with psoriasis may improve on a hypoallergenic diet. Various trials have reported that eliminating gluten improved psoriasis for some people. Other food groups can also be triggers to a flare-up and should be investigated on an individual basis. Allergy testing and food elimination diets is recommended under the guidance of a licensed healthcare professional.
Ingestion of alcohol has been reported to be a risk factor for psoriasis in men but not women. It would therefore seem prudent for men with psoriasis to restrict their intake of alcohol or avoid it entirely.
Nutritional Supplement Treatment Options
Fumaric Acid in the chemically bound form known as fumaric acid esters, has been shown in case studies and double-blind trials to be effective against symptoms of psoriasis. However, because fumaric acid esters can cause significant side effects, they should be taken only under the supervision of a practitioner familiar with their use.
Omega 3 Fish Oil –double-blind trials have shown that fish oil was found to improve the skin lesions of psoriasis and in the general severity of itching and irritation. Supplementing with fish oil also may help prevent the increase in blood levels of triglycerides that occurs as a side effect of certain drugs used to treat psoriasis.
Folic Acid levels may become depleted as a result of drugs (such as methotrexate) used to treat psoriasis. Supplementing with folic acid can lead to significant reduction in the side effects of drug therapy.
N-acetylcysteine (NAC) has an ability to decrease proliferation of skin cells. Studies indicate that use of N-AC may reduce the skin thickening and irritation associated with psoriasis.
Botanical Treatment Options
Cayenne (from chilli peppers) contains a resinous and pungent substance known as capsaicin. Capsaicin cream may help ease psoriasis symptoms when topically applied (although may produce a burning sensation with the first few applications). This chemical relieves pain and itching by depleting certain brain chemicals from nerve endings that register pain. Thorough hand washing after use is important to prevent the cream from accidentally getting into the eyes, nose, or mouth. The cream should not be applied to areas of broken skin.
Topical Aloe vera has been shown in studies to be equally effective – and in some cases more effective – than a topical corticosteroid in reducing symptoms of psoriasis.
Oregon grape (10% concentration) cream has been shown to be mildly effective against moderate psoriasis but not more severe cases. It can also be effective in reducing the inflammation associated with psoriasis.
Burdock is used by traditional herbalists both internally and externally for psoriasis. Many herbal preparations will combine burdock root with other alternative herbs, such as yellow dock, red clover, or cleavers.
Coleus is also used by some herbalists to treat people with psoriasis.
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Article contributed by Dr Tracy S Gates, DO, DIBAK, L.C.P.H., Consultant, Pure Bio Ltd. Copyright © Pure Bio Ltd 2023. All rights reserved. Pure Bio Ltd are a leading UK supplier of the highest quality PURE nutritional supplements, based in Horsham, West Sussex.
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