In recognition of “Psoriasis Awareness Week,” we hope to shed light on a condition that goes beyond skin deep – both physiologically and emotionally. And while there are many medical treatments available to help keep symptoms of psoriasis at bay, it’s important to look at the root causes as well.
Psoriasis is a chronic skin condition with an autoimmune component. It causes red, scaly, itchy patches called “plaques” to form on (mostly) the elbows, torso, knees, and scalp. This occurs when skin formation is happening at a rate faster than skin shedding. The development and progression of psoriasis has been linked to factors such as genetics, stress, hormones, diet and gut health, and other lifestyle factors.
Although most people think of skin conditions as being fairly “benign” health issues, one must consider the social and emotional component of having visible skin lesions – particularly in more severe cases. And psoriasis stands out among skin disorders because it has been linked with immune dysfunction and systemic inflammation. Not only that, but it (along with the closely related condition, psoriatic arthritis) has been shown to be strongly associated with the development of other health conditions, such as cardiovascular disease, metabolic syndrome, hypertension, cancer, and other autoimmune diseases (ie. Crohn’s disease). And of course we know that these conditions are anything but “benign.”
Psoriasis is thought to affect 120 million people around the world. Most people will develop the condition by age 40, although for some individuals it appears between the ages of 50 and 60. Thirty percent will go on to also develop psoriatic arthritis, which includes symptoms such as generalized fatigue and swollen, painful joints (particularly the fingers and toes). Typical medical treatments include steroid creams, anti-inflammatory medications, and light therapy. These strategies can help to manage the symptoms, but don’t provide a cure for psoriasis. Let’s look at some of the underlying factors that play a role as either a risk factor or a triggering event. Identifying and addressing these modifiable factors can be key to improving the quality of life and overall health of psoriasis patients.
There is good reason to believe that hormones play a role in psoriasis. A study published in 2005 found that over 50% of pregnant women saw improvement in their psoriasis during the pregnancy (and also in subsequent pregnancies). Additionally, research has found that lower estrogen levels in menopause may be linked with flare-ups and that higher estrogen levels in other age groups may provide protection. It is important to note, however, that stress may be a confounder in these studies, since it often accompanies big life changes such as menopause. Although all the “ins and outs” of the relationship between hormones and psoriasis are still being explored, a whole-body approach would include investigating possible hormone imbalances (through proper testing) and addressing them through bioidentical hormone replacement and lifestyle changes.
Stress has also been shown to be a major risk factor in the development and exacerbation of psoriasis. This is thought to be due to inflammatory proteins and chemicals that are released in response to a stressor or physical trauma (as in wound healing) – but in the case of chronic stress the body over-responds, and this is seen in psoriasis. Stress-reducing activities such as meditation and exercise have been shown to lower one’s risk. Having a support system and engaging in healthy relationships has also been shown to be crucial for managing stress. When these strategies are not adequate, a professional counselor can be highly effective for offering additional tools and support.
The health of the gut microbiome (the different microbes that inhabit the digestive tract) is now being looked at as a key factor in many disease states and skin conditions are no exception. Since over 80% of the immune system is located within the gut, it should come as no surprise that poor gut health has been linked with this immune-mediated skin disorder. Research has even found that psoriasis patients have a decreased amount of certain bacterial strains (akkermansia, ruminococcus, and pseudobutryrivibrio). Some psoriasis patients may also have an overgrowth of Candida albicans. And the fact that Celiac disease is another risk factor for developing psoriasis further confirms the gut/skin relationship.
Dietary changes can be a powerful way to address inflammation and heal the gut. A trial period of eliminating common “trigger” foods such as gluten, dairy, other commonly allergenic foods, or meat, can be helpful in some individuals. Cutting down on sugary and processed foods is also wise, since these foods can contribute to inflammation as well. Case studies using dietary changes and nutritional supplementation have shown great promise. Vegetarian and Mediterranean-type diets, fasting periods, and diets rich in (or supplementation of) antioxidants and unsaturated fatty acids (ie. fish oil, evening primrose oil, olive oil, etc.) have all been effective is certain studies. Since everyone is a little different, trial and error may be needed to find out the best nutritional strategy for each individual.
Other lifestyle factors that can increase the risk of psoriasis or contribute to flare-ups include exposure to cold (and dry) air, trauma to the skin such as a severe sunburn, certain medications, alcohol and drug use, smoking, and strep throat infection. Since many of the medications used to treat the symptoms of psoriasis can have dangerous side effects, particularly in pregnancy, addressing some of these root causes can give psoriasis patients the best outcomes.