Psoriasis: What it is and what to do about it

by Kristen McElveen, ND

Image courtesy of iStock.

Image courtesy of iStock.

What is Psoriasis?

Psoriasis is an inflammatory skin condition that typically presents with itchy and/or painful, red, scaly patches on the elbows, knees, and scalp and may or may not include arthritis. It currently affects about 7.4 million adults in the US (1), twice as common in white populations compared to black populations (1) and affects women and men equally(2).

The cause is technically unknown, but can depend on genetics, the state of the person's immune system and history of infection.

What are the symptoms?

There are 6 classifications of psoriasis (3):

  • Plaque psoriasis - the most common presentation and what is pictured above - raised, inflamed and red skin with silvery-white scales (called "plaques") that usually show pinpoint bleeding when scratched off (like you poked the skin with a needle)
  • Guttate psoriasis - a widespread eruption of red, scaly bumps (water drop appearance) usually after infection like an upper respiratory infection or vaccination
  • Pustular psoriasis - redness with small puss-filled bumps (like acne), usually on hands and feet, but can be anywhere
  • Erythroderma (erythrodermic psoriasis) - generalized redness with fine scales, often with severe itching and pain or irritation
  • Psoriatic arthritis - arthritis that affects people with the skin lesions (this can affect about 10% of people with psoriasis), usually affecting the hands and feet more than the large joints and can be only on one side in 50% of cases (people who develop psoriatic arthritis tend to also have psoriasis on the fingernails, which can look pitted or flaky)
  • Keratoderma biennorrhagicum (reactive arthritis) - a reactive immune condition that characterized by psoriatic plaques, urinary/pelvic inflammation, conjunctivitis and arthritis - can have painful, scalloped plaques on feet and toes

Is there testing available?

Psoriasis is a clinical diagnosis, which means that a qualified health professional will likely diagnose it based on your history and physical exam. Sometimes, it can be very difficult to tell between eczema, psoriasis and seborrheic dermatitis, so you can do a skin biopsy to confirm. 

What about treatment?

Treatments vary.

Allopathic treatment usually consists of a topical corticosteroid to control the inflammation and itch. Topical vitamin D or tar preparations may also be recommended, though the tar preparations are becoming a treatment of the past due to cancer risk and compliance (staining and terrible odor). 

For more severe disease, phototherapy (medically supervised UV light therapy) or oral systemic therapy may be recommended. Oral medications typically suppress the immune system (like methotrexate or cyclosporine) or uses a retinoid (which are related to vitamin A) and can help to slow down the growth of the cells - the plaques build up because skin cell growth is happening too fast for the natural skin-sloughing to remove the previous layer.

Naturopathic and integrative treatments have also proven to be very successful. A naturopathic approach treats the person and not just the symptoms and often involves a mind-body approach as many people who have psoriasis may also suffer from depression and anxiety because the plaques are often very noticeable. 

In my naturopathic practice, symptoms of psoriasis would significantly improve with: 

  • stress management with counseling, EFT (tapping) and/or flower essences
  • addressing leaky gut and removing food allergens by sticking to a customized anti-inflammatory diet such as a modified Paleo diet with some grains (as tolerated) with individualized probiotic support (dairy and gluten are common sensitivities in people with skin issues)
  • exercise (supporting the body's natural detox, stress relief and endorphins to fight depression)
  • immune system balancing (NOT immune BOOSTING, as that can make psoriasis worse)
  • proper nutrition - essential fatty acid balance and correction of vitamin/mineral deficiencies, including vitamin D optimization
  • topical treatments using phototherapy, topical vitamin D, coconut oil or other compounded preparations

It's good to remember that psoriasis is a chronic condition and will never be totally "cured," but it can stay in remission with a healthy lifestyle and proper treatment.

I have suffered from psoriasis since I was a child and when I first eliminated dairy from my diet in my teens, it disappeared for years, only to re-emerge during periods of high stress (or too much ice cream). 

Psoriasis can be triggered by:

  • stress
  • other infections
  • certain medications (lithium, beta blockers) or supplements (vitamin C and ginseng)
  • alcohol and/or poor diet

The more we can identify and eliminate the triggers, the better the chance for remission, which is why, from a naturopathic perspective, we work from the inside out, focus on the gut and treat the whole person.

You can slather as much topical treatments on as you like, but if you don't address the entire system, it will only be a bandaid and will not treat the root cause. In changing your lifestyle and reducing inflammation as much as possible by changing the things we can control, there IS hope to not experience as many symptoms. 

If you would like to see a licensed naturopathic physician about your psoriasis or other skin conditions, you can find one here or Google "[your state} associate of naturopathic physicians" (and be sure to read my article on the difference between a licensed ND and and un-licensable ND).

 

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References:

  1. Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70:512-516.
  2. Gelfand JM, Stern RS, Nijsten T, et al. The prevalence of psoriasis in African Americans: results from a population-based. J Am Acad Dermatol. 2005;52:23-26.
  3. Griffiths CE, Christophers E, Barker JN, et al. A classification of psoriasis vulgarism according to phenotype. Br J Dermatol. 2007;156:258-262.