Psoriasis

Psoriasis: Overview

Also known as plaque psoriasis, it is defined as a common inflammatory skin condition characterized by frequent episodes of redness, itching, and thick, dry, silvery scales in discrete patches on the skin.  It is most commonly seen on the trunk, elbows, knees, scalp, skin folds, or fingernails, but it may affect any or all parts of the skin.  When the patches are on the scalp and in body fold areas, the skin is often itchy, but many people with psoriasis do not feel itchy at all. It is known that the skin in psoriasis patches is growing much quicker than normal skin.  In all of us, the epidermis (the outer layer of the skin) grows continuously from its outer surface, and a new layer is reformed each month.  In psoriasis, the skin reforms a complete layer each 3-4 days – so that extra skin must shed in scales.  This process is similar to healing of the epidermis after an injury – except that normal skin 'knows when to slow down and psoriasis skin does not'.  However the actual chemical cause of psoriasis is not known.  There have been many scientific experiments performed looking for the cause, but so far changes found seem to result from the rapid growth, and not to cause it.

The main problems caused by these patches are by shedding scales and by showing on the skin where they can be seen.  Fortunately, psoriasis is unlikely to affect the face, and usually occurs on areas covered by clothes.

Most people with psoriasis find it a burden and a nuisance, but they are not stopped from enjoying life and doing their usual work.  However, the condition may involve an important area of the body such as the hands – and this does affect the person's life, and their ability to work with their hands.  The cost of caring for psoriasis can be considerable.

Psoriasis is not infectious in any way.  It does not spread on the person who has it by infecting other areas, and it cannot be transferred to other people by any form of contact.  Of course this does not stop people worrying about psoriasis if they see it, and fearing that it may infect them.

Incidence; Causes and Development

Age is not a factor, but it commonly starts between 15 to 35 years old.  The extent and activity of psoriasis varies greatly just as with any other disease.  Many people have patches on the scalp or elsewhere, but are not bothered by it and lead normal lives.  Others have wider areas of skin involved.  Studies in European communities show that about 2% of people are affected.

Psoriasis appears suddenly or gradually.  It is characterized by frequent episodes of recurrences and remissions.  It may be aggravated by injury or irritation (cuts, burns, rash, insect bites), and it may be severe in immunosuppressed people (such as with chemotherapy for cancer, or with AIDS) or those who have autoimmune disorders such as rheumatoid arthritis.

Sometimes (but certainly not always) psoriasis can run in families, and so it is likely that there are inherited properties causing a "tendency" to the condition.  If a person has this tendency, an accident or sudden/severe nervous shock, or some germ infections, can set off the condition and make it appear on the skin.

Medications, viral or bacterial infections, poor digestion, excessive alcohol consumption, obesity, lack of sunlight, overexposure to sunlight (sunburn), stress, general poor health, cold climate, and frequent friction on the skin are associated with flare-ups of psoriasis.

Signs and Symptoms

Psoriasis is described as being widespread, sharply demarcated, consisting of bright pink plaques and with overlying loose, silvery scale.  It can be located:
  • Over joints and extensor surfaces of extremities
  • On trunk, especially lower back and buttocks
  • Palms and soles
  • Scalp
  • Umbilicus
  • Nails
    • Pitting of nail surface
    • Separation of distal edge of nail from nail bed
    • Accumulation of crumbly subungual debris
    • Intergluteal: Eroded pinkness in crease between buttocks
  • Penis: Pink macules or plaques on penis
  • Large joints: Hyperkeratosis over elbows, knees, and ankles
  • Tongue: Geographic tongue (rare)
Pruritus may be present.

Diagnosis and Tests

The appearance of the skin rash is enough for a trained doctor to make the diagnosis of psoriasis, without any tests.  If there is any problem of general health, blood tests can be performed or X-rays can be taken, but these do not help the diagnosis of the condition itself.  A piece of skin can be cut out (biopsy) and sent for pathology testing to be quite sure of the diagnosis.

Treatment and Prevention

There are many different conventional treatments, and the correct treatment depends on the activity and extent of the psoriasis, whether the person has fair or dark skin, and whether there are any other exacerbating problems present as well.  Minimize flare-ups by avoiding any known aggravating factors.

A list of alternative considerations and treatments should include: Improving digestive function, improving liver function, improving bowel ecology, alcohol avoidance, fish oil and omega 3 supplementation, fasting, vegetarianism, food allergy elimination diets, sunshine exposure and vitamin D use, a high fiber diet, and stress reduction.

Tulsa Dermatologist Steven A.  Smith, M.D.  has successfully treated over 1,500 patients with Loma Psoriasis (nickel/ bromide/zinc), a non-prescription oral homeopathic-like medication.  He reports 80% received some degree of noticeable improvement.  Many have marked clearing – even in some of the more difficult cases.

Associated environmental factors
Psoriasis is suppressed by sun and humidity, and provoked by injury to skin (Koebner reaction), Streptococcal Pharyngitis or emotional upset.

Prognosis; Complications

On occasion, especially after a rapid onset which sometimes occurs in young people, it can settle or disappear.  If their skin tans well, people can be free from psoriasis every summer, even though it comes back again in winter.

Psoriasis does not cause cancer or affect the blood or the circulation.

Psoriasis

Information On This Page

Signs, symptoms & indicators of Psoriasis:

Symptoms - Head - Eyes/Ocular

Irritated eyes may be a sign or symptom of PsoriasisIrritated eyes
Eye burning, itching & discharge are possible indicators of psoriasis.
(Occasional/frequent) itchy eyes may be a sign or symptom of Psoriasis(Occasional/frequent) itchy eyes
Eye burning, itching & discharge are possible indicators of psoriasis.
Severe eye discharge may be a sign or symptom of PsoriasisMild/moderate/serious/severe eye discharge
Eye burning, itching & discharge are possible indicators of psoriasis.

Symptoms - Nails

Pitted nails is often a sign or symptom of PsoriasisPitted nails
Nail pitting may be an early sign of psoriasis.
(Very) deformed toenails may be a sign or symptom of Psoriasis(Very) deformed toenails
Nail abnormalities are a possible symptom of psoriasis.
Grooves across fingernails may be a sign or symptom of PsoriasisGrooves across fingernails
Nail abnormalities are a possible symptom of psoriasis.

Symptoms - Reproductive - General

Genital sores may be a sign or symptom of PsoriasisGenital sores
Genital lesions are a possible symptom of psoriasis in men.

Symptoms - Skin - General

Cracked skin may be a sign or symptom of PsoriasisCracked skin
Skin lesions and increased tearing are possible symptoms of psoriasis.

Conditions that suggest Psoriasis:

Aging

Premature/Signs of Aging may suggest PsoriasisPremature/Signs of Aging
Psoriasis can cause rapid skin aging.

Autoimmune

Ankylosing Spondylitis often suggests PsoriasisAnkylosing Spondylitis
Ankylosing spondylitis may be associated with psoriasis.  A study published in [J Rheumatol 1998 Jan; 25[1]: pp120-4] found that out of 939 women with ankylosing spondylitis, 18% also had psoriasis.

Symptoms - Skin - Conditions

Counter-indicators:

Tumors, Malignant

Non-Hodgkins Lymphoma may suggest PsoriasisNon-Hodgkin's Lymphoma
People who suffer from the skin disease psoriasis are at an increased risk for cancer, according to a study ending in 2003 that involved 108,000 patients.  Specifically, study authors found that patients with psoriasis had a nearly three-fold increased rate of lymphoma.

Previous research had found an association between psoriasis and lymphoma.  Doctors from the University of Pennsylvania studied whether the rate of lymphoma in patients with a history of psoriasis is different from the rate of lymphoma in patients without psoriasis.  After reviewing records, researchers found all the patients with psoriasis who had lymphoma were treated with medications consistent with psoriasis treatment.

While researchers conclude there is an association between psoriasis and lymphoma, they feel additional research needs to be done to determine if this association is related to psoriasis severity, psoriasis treatment or an interaction between these risk factors.  [Archives of Dermatology, 2003;139: pp.1425-9]

Risk factors for Psoriasis:

Digestion

Dyspepsia / Poor Digestion may increase risk of PsoriasisDyspepsia / Poor Digestion
Incomplete protein digestion or poor intestinal absorption of protein breakdown products can result in elevated levels of amino acids and polypeptides in the bowel.  These are metabolized by bowel bacteria into several toxic compounds.  The toxic metabolites of the amino acids arginine and ornithine are known as polyamines (e.g., putrescine, spermidine, and cadaverine) and have been shown to be increased in individuals with psoriasis.  Polyamines contribute to the excessive rate of cell proliferation.  Lowered skin and urinary levels of polyamines are associated with clinical improvement in psoriasis, so digestive function should be evaluated.

Infections

Yeast / Candida Infection may increase risk of PsoriasisYeast / Candida Infection
A number of gut-derived toxins are implicated in the development of psoriasis including endotoxins (cell wall components of gram-negative bacteria), streptococcal products, Candida albicans, yeast compounds, and IgE or IgA immune complexes.  These compounds increase the rate of skin cell proliferation dramatically.  Candida albicans overgrowth in the intestines (chronic candidiasis) may play a major role in many cases.

Inflammation

Psoriatic Arthritis increases risk of PsoriasisPsoriatic Arthritis
About one person in 20 suffering from psoriasis can get joint troubles, with a degree of arthritis affecting the back, or large or small joints of the body.  This arthritis is rare, but worth looking into if you have psoriasis and an aching spine or joints.

Organ Health

Liver Detoxification / Support Requirement may increase risk of PsoriasisLiver Detoxification / Support Requirement
Correcting abnormal liver function is of great benefit in the treatment of psoriasis.  The connection between the liver and psoriasis relates to one of the liver's basic tasks (filtering and detoxifying the blood).  Psoriasis has been linked to the presence of several microbial byproducts in the blood.  If the liver is overwhelmed by excessive levels of these toxins in the bowel, or if there is a decrease in the liver's detoxification ability, the toxin level in the blood will increase and the psoriasis will get worse.

Symptoms - Nails

History of deformed toenails may increase risk of PsoriasisHistory of deformed toenails
Nail abnormalities are a possible symptom of psoriasis.

Psoriasis suggests the following may be present:

Allergy

Psoriasis often suggests Allergy to Foods (Hidden)Allergy to Foods (Hidden)
Psoriasis patients have benefited from gluten-free and elimination diets: Food allergies can trigger flare-ups of psoriasis.

Digestion

Psoriasis often suggests Dyspepsia / Poor DigestionDyspepsia / Poor Digestion
Incomplete protein digestion or poor intestinal absorption of protein breakdown products can result in elevated levels of amino acids and polypeptides in the bowel.  These are metabolized by bowel bacteria into several toxic compounds.  The toxic metabolites of the amino acids arginine and ornithine are known as polyamines (e.g., putrescine, spermidine, and cadaverine) and have been shown to be increased in individuals with psoriasis.  Polyamines contribute to the excessive rate of cell proliferation.  Lowered skin and urinary levels of polyamines are associated with clinical improvement in psoriasis, so digestive function should be evaluated.

Infections

Inflammation

Psoriasis may suggest Psoriatic ArthritisPsoriatic Arthritis
About one person in 20 suffering from psoriasis can get joint troubles, with a degree of arthritis affecting the back, or large or small joints of the body.  This arthritis is rare, but worth looking into if you have psoriasis and an aching spine or joints.

Nutrients

Psoriasis may suggest EFA Type 3 RequirementEFA (Essential Fatty Acid) Type 3 Requirement
A diet low in essential fatty acids can cause various health problems, including making skin conditions such as dandruff, psoriasis and eczema worse.

Organ Health

Psoriasis often suggests Liver Detoxification / Support RequirementLiver Detoxification / Support Requirement
Correcting abnormal liver function is of great benefit in the treatment of psoriasis.  The connection between the liver and psoriasis relates to one of the liver's basic tasks (filtering and detoxifying the blood).  Psoriasis has been linked to the presence of several microbial byproducts in the blood.  If the liver is overwhelmed by excessive levels of these toxins in the bowel, or if there is a decrease in the liver's detoxification ability, the toxin level in the blood will increase and the psoriasis will get worse.

Psoriasis can lead to:

Skin-Hair-Nails

Psoriasis sometimes leads to Concern Over Wrinkled SkinConcern Over Wrinkled Skin
Psoriasis can cause rapid skin aging.

Psoriasis could instead be:

Skin-Hair-Nails

Dandruff is sometimes misdiagnosed as PsoriasisDandruff
Psoriasis is an inflammatory skin disease in which skin cells replicate at a rapid rate.  Although the symptoms of psoriasis – silvery scales covering reddened areas of the scalp – appear similar to dandruff, psoriasis is very different.  New skin cells are produced about 10 times faster than normal, but the rate at which old cells are shed is unchanged.  Live cells then accumulate and form the thick patches covered with flaking skin.

Recommendations for Psoriasis:

Animal-based

Thymic Factors may help with PsoriasisThymic Factors
Through his clinical experiences with thymic supplementation, Dr. Burgstiner said he observed 12 cases of psoriasis that were completely cured.

Botanical

Cayenne Pepper may help with PsoriasisCayenne Pepper
In a double blind study, application of a capsaicin cream to the skin helped relieve both the itching and the skin lesions in people with psoriasis.

Diet

Weight Loss may help with PsoriasisWeight Loss
Being overweight can make psoriasis more likely.  During WWII, people who were on protein-deficient, calorie-deficient diets lost their psoriasis, which they regained when they went back on a normal diet.  You can starve the psoriasis before you yourself suffer from starvation.
Low/Decreased Fat Diet may help with PsoriasisLow/Decreased Fat Diet
A "moderate" diet is best in coping with psoriasis, without an excess of rich, fatty, starchy or spicy foods, or alcohol.
Alcohol Avoidance may help with PsoriasisAlcohol Avoidance
A "moderate" diet is best in coping with psoriasis, without an excess of rich, fatty, starchy or spicy foods, or alcohol.
Spicy Foods Avoidance may help with PsoriasisSpicy Foods Avoidance
A "moderate" diet is best in coping with psoriasis, without an excess of rich, fatty, starchy or spicy foods, or alcohol.

Drug

Environmental

Sunlight Exposure often helps with PsoriasisSunlight Exposure
Summer sun is the best source of ultra-violet light, and many people find psoriasis settles very well in summer.  Treatment in winter can be aided by artificial lamps: smaller lamps are usually not strong enough, but impulse type lamps, wall mounted "fluorescent lamp type" lamps, and larger "solarium" lamps are suitable.  Unfortunately, some psoriasis sufferers are rather sensitive to sun light, and may not be improved with this treatment.

It is usually best to apply a tar or drithanol preparation daily, to be followed later by ultra-violet light treatment.

Mineral

Zinc may help with PsoriasisZinc
Zinc orally or topically may be useful in the treatment of psoriasis.
Crude Coal Tar may help with PsoriasisCrude Coal Tar
It has been known for a long time that coal tar (2-5%) helps psoriasis and it is available as crude coal tar coal, tar lotion, and in refined forms incorporated into ready made creams, lotions and shampoos.  In general, the more messy and smelly the tar preparation is, the better it is likely to work – so please be prepared to persevere with it.

The use of coal tar is declining as newer compounds effective against the different forms of psoriasis are replacing it.  However, it still has the advantages of being low cost and causing less systemic toxicity as compared with more modern therapies.

A chemical similar to those found in tar may be used on its own – known as Dithranol or Anthralin.  This must be used cautiously as it can irritate, but a strength and base can usually be found to suit and help the individual person's psoriasis.  Tar treatments can lead to steady and effective control.  It is usually best to apply a tar or drithanol preparation daily, to be followed later by ultra-violet light treatment.

Nutrient

EPA (eicosapentanoic acid) often helps with PsoriasisEPA (eicosapentanoic acid)
Several double-blind clinical studies have demonstrated that supplementing the diet with 10 to 12gm of EPA results in significant improvement.  This would be equivalent to the amount of EPA in about 150gm of mackerel or herring.  It must be kept in mind that the presence of DHA in fish oil may reduce the effectiveness of the EPA.  A high EPA fish oil is recommended.

Vitamins

Vitamin D often helps with PsoriasisVitamin D
Vitamin D has been recognised for many years to improve some of the important abnormalities present in psoriasis skin, but ingestion of even only slightly above the daily recommended amount of Vitamin D can lead to problems with calcium metabolism in the body (possible kidney stones and irregular heart beats).

For this reason calcipotriol, a synthetic form of vitamin D, is used instead in ointment form.  Calcipotriol has been found to also have the ability to improve psoriasis, but with minimum effects on internal calcium metabolism.  It is available in a very greasy, ointment base for twice daily application.  There is a risk of facial dermatitis if the ointment is used on the face or neck, so application is only recommended for the trunk and limbs, and it is important that the hands are thoroughly washed after application to avoid inadvertent transfer to the skin of the face.  Comparative studies have shown that calcipotriol ointment is at least as effective as topical cortisones and dithranol in the treatment of stable plaque psoriasis.

KEY

Weak or unproven link: may be a sign or symptom of; may suggest; may increase risk of; sometimes leads to
Weak or unproven link:
may be a sign or symptom of; may suggest; may increase risk of; sometimes leads to
Strong or generally accepted link: is often a sign or symptom of; often suggests; is sometimes misdiagnosed as
Strong or generally accepted link:
is often a sign or symptom of; often suggests; is sometimes misdiagnosed as
Definite or direct link: strongly suggests; increases risk of
Definite or direct link:
strongly suggests; increases risk of
Definitely or absolutely counter-indicates: strongly contraindicates
Definitely or absolutely counter-indicates:
strongly contraindicates
May be useful: may help with
May be useful:
may help with
Moderately useful: often helps with
Moderately useful:
often helps with