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Psoriasis
29th Mar, 2022

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An overview of psoriasis

Psoriasis is a chronic, immune-mediated, inflammatory skin disease characterised by the development of red scaly patches (psoriasis plaques) with thick silvery scales. These plaques can appear anywhere on the body, particularly the elbows, knees, back, buttocks and scalp. In addition, many people with psoriasis develop pitted or flaking and deformed nails.

Globally, 125 million people are affected by psoriasis, which begins most often in people aged 16 to 22 years and aged 55 to 65 years. Up to 40% of psoriasis patients develop psoriatic arthritis, an autoimmune arthritis that affects the joints and the areas where the tissue attaches to the bone.

Individuals with psoriasis are also at higher risk of developing cardiovascular disease, metabolic syndrome, diabetes mellitus, depression, anxiety, and other autoimmune conditions. In addition, raised serum antibodies to gliadin (found in wheat and some grains) and coeliac disease is more prevalent in people with psoriasis.

Psoriasis is an autoimmune condition where immune cells become overactive and attack active skin cell, releasing inflammatory molecules and stimulating skin cells resulting in the abnormally high rate of growth of skin cells.

Risk factors include genetic, environmental, and behavioural factors. Alterations in the skin and intestinalmicrobiome also play an important role in developing psoriasis.

Currently, there is no cure for psoriasis. Treatments for mild to moderate psoriasis involve topical treatments and phototherapy. Moderate to severe psoriasis often requires systemic drugs.

 

Potential triggers

  • Genetic predisposition
  • Physical factors (e.g. X-rays, injections, tattoos, insect bites)
  • Chemical factors (e.g. chemical burns, topical treatments)
  • Infections (mainly streptococcal pharyngitis, viral infections)
  • Emotional stress
  • Tobacco smoking
  • Alcohol consumption
  • B12, folate, zinc, and iron deficiencies
  • Medications (beta-blockers, chloroquine, lithium, angiotensin-converting enzyme inhibitors, nonsteroidal anti-inflammatory drugs, anti-malarial drugs, rapid withdrawal of systemic corticosteroids).

Psoriasis subtypes

Plaque psoriasis (psoriasis vulgaris)

The most common type (90% of cases), characterised by red, inflamed patches covered with thick, silvery scales that may come and go spontaneously or with the appearance and resolution of triggers.

Guttate psoriasis

Common in childhood and often triggered by upper respiratory tract infections such as streptococcal infection. It causes small pink spots, which often resolve spontaneously in weeks to months.

Pustular psoriasis

Characterised by white, pus-filled blisters and red, inflamed skin areas. It can be widespread or localised to palms and soles.

Inverse psoriasis

Causes patches of red, inflamed skin under the armpit or breasts, in the groin or around the genitals.

Erythrodermic psoriasis

A severe and rare type of psoriasis. The scales cover more than 75% of the body, and the and the skin appears sunburned. It can be life threatening and should be treated as a medical emergency.

 

Long term holistic treatment aims

  • Reduce skin inflammation, improve skin integrity, and facilitate wound healing to alleviate psoriasis symptoms and improve quality of life.
  • Modulate the immune response and reduce chronic inflammation.
  • Improve gut health and support the nervous system if ongoing stress is contributing.
  • Address co-morbidities such as metabolic syndrome, diabetes, anxiety, depression and cardiovascular disease.

Herbal & Nutritional recommendations

* Please contact your health professional for the prescription of herbal and nutritional remedies.

Vitamin A
  • Topical and oral retinoids can reduce inflammation and severity of psoriasis plaques.

Vitamin D
  • Deficiency is common in psoriasis; Topical vitamin D combined with vitamin A may be beneficial

Vitamin B12
  • Topical B12 and avocado oil cream reduces the severity of psoriasis.

Selenium
  • Low levels are associated with disease severity. May reduce oxidative stress and inflammation.

Zinc
  • Zinc sulphate (220 mg three times per day) reduces joint pain and swelling in psoriatic arthritis.
  • 0.25% zinc pyrithione cream, applied twice daily, reduced localised plaque psoriasis.

Essential fatty
acids
  • May improve psoriasis severity and reduce risk factors for its comorbidities including cardiovascular disease, obesity, and metabolic disease.

Probiotics
  • Probiotic mixtures including strains of Lactobacillus and Bifidobacterium can reduce psoriasis severity.

Aloe barbadensis
(Aloe)
  • Wound healing, anti-inflammatory, immunostimulant, and antibacterial; topical application may reduce severity, redness, and number of plaques.

Boswellia serrata

(Boswellia)
  • Contains active ingredients that target inflammatory pathways exacerbated in psoriasis.
  • Topical application may reduce redness and scales.

Capsaicin
  • Topical application can reduce pain, scaling and itching in psoriasis.

Centella asiatica
(Gotu kola)
  • Anti-inflammatory, wound healing, and anti-psoriatic herb.
  • May inhibit excess skin cell formation.

Curcuma longa
(Turmeric)
  • Oral and topical application beneficial as adjunct to conventional treatment for improving plaques and reducing inflammation.

Mahonia
aquifolium
(Oregon grape)
  • Anti-psoriatic herb.
  • Reduces excessive skin cell production and significantly improves symptoms and quality of life (topical).

Salix alba (White
willow)
  • Topical application can break down psoriatic plaques.
  • Contains salicylic acid, prescribed for removing excess skin.

 

Diet & Lifestyle recommendations

General dietary advice
  • Limit alcohol, sugar, highly processed and fatty foods.
  • Increase antioxidant rich foods, high fibre foods and low GI foods e.g. whole grain cereals, unprocessed vegetables and selected fruits, tea, herbs, spices, legumes, nuts, seeds.
  • Drink at least eight cups of fluid per day, preferably water or herbal teas.
  • Increase omega-3 polyunsaturated fatty acids (especially DHA and EPA) e.g. marine fish.
  • A gluten free diet may be beneficial for coeliac disease or in those with gliadin antibodies.

Stress reduction
  • Yoga, tai chi, deep breathing, vagal nerve stimulation, counselling/psychology and adequate sleep.

Exercise
  • 30 minutes of exercise daily, or at least 150 minutes per week.
  • Wear loose, moisture wicking clothing to avoid skin irritation.
  • Apply sunscreen when exercising outdoors and stay well hydrated.

Sunlight exposure
  • Start by exposing affected areas for 5-10 minutes a day; apply sunscreen to on non-affected areas.
  • Be mindful that overexposure can induce psoriasis flares.

Skin care
  • Moisturise skin regularly and use a home humidifier to help retain skin moisture.
  • Regularly bathe in warm water and Epsom salts to remove dry skin and soothe itchy skin.
  • Choose hypoallergenic, alcohol-free, fragrance-free cosmetics and personal care products.

 

Seek Medical Care

This is not an all-inclusive comprehensive list of information. Consult a qualified healthcare provider before starting any therapy. Application of clinical judgement is necessary.

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References
1Afridi HI, Kazi TG, Kazi N, Kandhro GA, Baig JA, Shah AQ, Khan S, Kolachi NF, Wadhwa SK, Shah F, Jamali MK. Evaluation of cadmium, chromium, nickel, and zinc in biological samples of psoriasis patients living in Pakistani cement factory area. Biological trace element research. 2011 Sep;142(3):284-301.
2Algahtani MS, Ahmad MZ, Ahmad J. Nanoemulsion loaded polymeric hydrogel for topical delivery of curcumin in psoriasis. Journal of Drug Delivery Science and Technology. 2020 Oct 1;59:101847.
3Antiga E, Bonciolini V, Volpi W, Del Bianco E, Caproni M. Oral curcumin (Meriva) is effective as an adjuvant treatment and is able to reduce IL-22 serum levels in patients with psoriasis vulgaris. BioMed research international. 2015 Oct;2015.
4Armstrong AW, Read C. Pathophysiology, clinical presentation, and treatment of psoriasis: a review. Jama. 2020 May 19;323(19):1945-60.
5Bernstein JE, Parish LC, Rapaport M, Rosenbaum MM, Roenigk Jr HH. Effects of topically applied capsaicin on moderate and severe psoriasis vulgaris. Journal of the American Academy of Dermatology. 1986 Sep 1;15(3):504-7.
6Bernstein S, Donsky H, Gulliver W, Hamilton D, Nobel S, Norman R. Treatment of mild to moderate psoriasis with Relieva, a Mahonia Aquifolium extract—a double-blind, placebo-controlled study. American journal of therapeutics. 2006 Mar 1;13(2):121-6.
7Bilia AR, Bergonzi MC, Isacchi B, Antiga E, Caproni M. Curcumin nanoparticles potentiate therapeutic effectiveness of acitrein in moderate-to-severe psoriasis patients and control serum cholesterol levels. Journal of Pharmacy and Pharmacology. 2018 Jul;70(7):919-28.
8Chen X, Hong S, Sun X, Xu W, Li H, Ma T, Zheng Q, Zhao H, Zhou Y, Qiang Y, Li B. Efficacy of fish oil and its components in the management of psoriasis: a systematic review of 18 randomized controlled trials. Nutrition Reviews. 2020 Oct;78(10):827-40.
9Clemmensen OJ, SIGGAARD‐ANDERSEN J, Worm AM, Stahl D, Frost F, Bloch I. Psoriatic arthritis treated with oral zinc sulphate. British Journal of Dermatology. 1980 Oct;103(4):411-5.
10Dabholkar N, Rapalli VK, Singhvi G. Potential herbal constituents for psoriasis treatment as protective and effective therapy. Phytotherapy Research. 2021 May;35(5):2429-44.
11Del Duca E, Farnetani F, De Carvalho N, Bottoni U, Pellacani G, Nisticò SP. Superiority of a vitamin B12-containing emollient compared to a standard emollient in the maintenance treatment of mild-to-moderate plaque psoriasis. Int J Immunopathol Pharmacol. 2017 Dec;30(4):439-444.
12Ellis CN, Berberian B, Sulica VI, Dodd WA, Jarratt MT, Katz HI, Prawer S, Krueger G, Rex Jr IH, Wolf JE. A double-blind evaluation of topical capsaicin in pruritic psoriasis. Journal of the American Academy of Dermatology. 1993 Sep 1;29(3):438-42.
13Fu H, Tang Z, Wang Y, Ding X, Rinaldi G, Rahmani J, Xing F. Relationship between vitamin D level and mortality in adults with psoriasis: A retrospective cohort study of NHANES data. Clinical Therapeutics. 2021 Feb 1;43(2):e33-8.
14Furue K, Ito T, Tsuji G, Kadono T, Nakahara T, Furue M. Autoimmunity and autoimmune co‐morbidities in psoriasis. Immunology. 2018 May;154(1):21-7.
15Garbicz J, Całyniuk B, Górski M, Buczkowska M, Piecuch M, Kulik A, Rozentryt P. Nutritional Therapy in Persons Suffering from Psoriasis. Nutrients. 2022 Jan;14(1):119.
16Grän F, Kerstan A, Serfling E, Goebeler M, Muhammad K. Focus: Skin: Current Developments in the Immunology of Psoriasis. The Yale Journal of Biology and Medicine. 2020 Mar;93(1):97.
17Gulliver WP, Donsky HJ. A report on three recent clinical trials using Mahonia aquifolium 10% topical cream and a review of the worldwide clinical experience with Mahonia aquifolium for the treatment of plaque psoriasis. American journal of therapeutics. 2005 Sep 1;12(5):398-406.
18Halim SA, Khan A, Csuk R, Al-Rawahi A, Al-Harrasi A. Diterpenoids and triterpenoids from frankincense are excellent anti-psoriatic agents: an in silico approach. Frontiers in chemistry. 2020:486.
19Hill H, Anderson N, Malakouti M, Jacob SE. Herbals in the holistic treatment of psoriasis. J Clin Dermatol. 2015;16:147-65.
20Jadhav P, Jiang Y, Jarr K, Layton C, Ashouri JF, Sinha SR. Efficacy of dietary supplements in inflammatory bowel disease and related autoimmune diseases. Nutrients. 2020 Jul;12(7):2156.
21Janeczek M, Moy L, Lake EP, Swan J. Review of the efficacy and safety of topical mahonia aquifolium for the treatment of psoriasis and atopic dermatitis. The Journal of Clinical and Aesthetic Dermatology. 2018 Dec;11(12):42.
22Kharaeva Z, Gostova E, De Luca C, Raskovic D, Korkina L. Clinical and biochemical effects of coenzyme Q10, vitamin E, and selenium supplementation to psoriasis patients. Nutrition. 2009 Mar 1;25(3):295-302.
23Lei L, Su J, Chen J, Chen W, Chen X, Peng C. Abnormal Serum Copper and Zinc Levels in Patients with Psoriasis: A Meta-Analysis. Indian J Dermatol. 2019 May-Jun;64(3):224-230.
24Megna M, Ferrillo M, Barrea L, Patruno C, Muscogiuri G, Savastano S, Fabbrocini G, Napolitano M. Vitamin D and psoriasis: an update for dermatologists and nutritionists. Minerva endocrinologica. 2020 Apr 27;45(2):138-47.
25Millsop JW, Bhatia BK, Debbaneh M, Koo J, Liao W. Diet and psoriasis, part III: role of nutritional supplements. J Am Acad Dermatol. 2014 Sep;71(3):561-9.
26Raut G, Wairkar S. Management of psoriasis with nutraceuticals: An update. Complementary therapies in clinical practice. 2018 May 1;31:25-30.
27Rendon A, Schäkel K. Psoriasis pathogenesis and treatment. International journal of molecular sciences. 2019 Jan;20(6):1475.
28Sadeghian G, Ziaei H, Nilforoushzadeh MA. Treatment of localized psoriasis with a topical formulation of zinc pyrithione. Acta Dermatoven APA. 2011;20(4):187-90.
29Salihbegovic EM, Kurtalic N, Omerkic E. Smoking Cigarettes and Consuming Alcohol in Patients with Psoriasis. Materia Socio-Medica. 2021 Mar;33(1):30.
30Sampson JH, Raman A, Karlsen G, Navsaria H, Leigh IM. In vitro keratinocyte antiproliferant effect of Centella asiatica extract and triterpenoid saponins. Phytomedicine. 2001 Jan 1;8(3):230-5.
31Søyland E, Heier I, Rodríguez‐Gallego C, Mollnes TE, Johansen FE, Holven KB, Halvorsen B, Aukrust P, Jahnsen FL, De La Rosa Carrillo D, Krogstad AL. Sun exposure induces rapid immunological changes in skin and peripheral blood in patients with psoriasis. British Journal of Dermatology. 2011 Feb;164(2):344-55.
32Stanescu AM, Simionescu AA, Diaconu CC. Oral vitamin D therapy in patients with psoriasis. Nutrients. 2021 Jan;13(1):163.
33Syed TA, Ahmad SA, Holt AH, Ahmad SA, Ahmad SH, Afzal M. Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo‐controlled, double‐blind study. Tropical Medicine & International Health. 1996 Aug;1(4):505-9.
34Togni S, Maramaldi G, Di Pierro F, Biondi M. A cosmeceutical formulation based on boswellic acids for the treatment of erythematous eczema and psoriasis. Clinical, cosmetic and investigational dermatology. 2014;7:321.
35Tripathi P, Bhardwaj P. Psoriasis: An autoimmune disorder. Journal of Drug Delivery and Therapeutics. 2020 Sep 15;10(5):316-24.
36Usedom E, Neidig L, Allen HB. Psoriasis and Fat-soluble Vitamins: A Review. J. Clin. Exp. Dermatol. Res. 2017;8(5).
37Wacewicz-Muczyńska M, Socha K, Soroczyńska J, Niczyporuk M, Borawska MH. Cadmium, lead and mercury in the blood of psoriatic and vitiligo patients and their possible associations with dietary habits. Science of The Total Environment. 2021 Feb 25;757:143967.
38Waller JM, Dreher F, Behnam S, Ford C, Lee C, Tiet T, Weinstein GD, Maibach HI. ‘Keratolytic’properties of benzoyl peroxide and retinoic acid resemble salicylic acid in man. Skin Pharmacology and Physiology. 2006;19(5):283-9.
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