Skin Condition Series, Psoriasis

Are you aware that the skin is the largest organ of the body? The skin separates the inside of the body from the outside environment. It helps protect your inner organs from viruses and bacteria and also helps in regulation of the temperature of your body. Certain conditions that clog, irritate or inflame your skin can produce symptoms of swelling, redness, itching and burning. Diseases of the skin may be caused due to allergies, certain irritants, infections or may be genetic in nature.

Structure of the skin

There are 3 layers of the skin:

1. The epidermis is the outermost layer of the skin. It serves as a waterproof barrier and also creates your skin tone.
2. The dermis lies beneath the epidermis. It contains hair follicles, tough connective tissue and sweat glands.
3. The hypodermis or the deeper subcutaneous tissue is made up of connective tissue and fat.

The colour of the skin is imparted by special cells referred to as melanocytes. They synthesize the pigment melanin. Melanocytes are present in the epidermis.

What is Psoriasis?

Psoriasis is an immune-mediated disorder of the skin that produces a change in the life cycle of cells of the skin. Psoriasis results in rapid build up of cells on the skin surface. Silvery, thick scales and dry, itchy, red patches are formed of the extra skin cells. These skin patches may be painful in some cases. It typically occurs on the outside of the knees, elbows and the scalp, though it can occur on any location.

Psoriasis is a long-lasting or chronic and persistent disease. Some of the times your symptoms may become better, which alternates with times when your symptoms get worse. Psoriasis is also accompanied by other serious health disorders including heart disease, diabetes and depression.

What are the symptoms of Psoriasis?

Signs and symptoms of Psoriasis vary in different persons but may consist of one or more of the following:

• Dry, red patches on skin that are covered by silvery scales
• Small spots of scaling skin (commonly present in children)
• Cracked, dry skin from which bleeding may occur
• Burning, itching or soreness
• Pitted, thickened or ridged nails
• Stiff and swollen joints

Patches of psoriasis can range from a couple of spots of scaling similar to dandruff to major eruptions covering large areas. Most kinds of psoriasis go through phases; it flares for a couple of weeks or months and then subsides for some time. The symptoms can even go into complete remission.

What are the causes of Psoriasis?

The exact cause of psoriasis is not known, but it is believed that genetics and immune system play a role in its occurrence. A type of white blood cells, referred to as T cell or T lymphocyte abnormally attacks healthy cells in a person suffering from psoriasis. This triggers an abnormal immune response in which an increased production of healthy skin cells occurs. The dead skin isn’t removed quickly enough leading to a build up of thick, scaly patches on the surface of the skin.

There are various factors that may act as trigger for psoriasis:

• Infections including skin infections or strep throat
• Skin injury such as a scrape or a cut, a severe sunburn or bug bite
• Stress
• Smoking
• Cold weather
• Excessive consumption of alcohol
• Certain medicines such as lithium, antihypertensives (such as beta blockers), iodides and antimalarial drugs

Who is most likely to get Psoriasis?

Any person can get psoriasis but the following factors increase the risk:

• If you have a family history of psoriasis.
• If you have bacterial and viral infections. People suffering from HIV are more prone to develop psoriasis in comparison to those who have a healthy immune system. Young adults and children who have recurring infections, especially strep throat are also at increased risk.
• If you have high stress levels as stress can adversely affect your immunity.
• If you have obesity, your risk of getting psoriasis increases. Plaques of psoriasis often occur in folds and creases.
• If you are a smoker, then not only your risk of getting the disease is increased but also the severity is increased.

Dietary and lifestyle changes for Psoriasis

Taking the diet under your control is the most basic thing you can do to regain your life’s control, if you are suffering from psoriasis. Though there is little evidence to support the fact that changing diet can have major impact on the disease. But many people swear that their symptoms are relieved by changing their diet. You can approach dietary changes in four main ways:

Weight loss: According to a study published in the year 2014 in the Journal of the American Academy of Dermatology obesity is a risk factor for psoriasis. Hence, losing weight helps in relieving the severity of the symptoms. You should take the following steps:

• Eat more fruits, vegetables, fat-free and low-fat dairy products and whole grain.
• Include poultry, lean meat, beans, eggs, fish and nuts in your diet.
• Eat diet low in saturated fats, salt and sodium.
• Avoid processed foods and refined sugars.
• Maintain a food diary.
• Eat slowly.
• Remain hydrated.
• Never skip breakfast.
• Plan your meals in advance so that you can make healthy choices.

Heart healthy: Decreasing inflammation and improving health of heart is important for persons suffering from psoriasis. Follow the below mentioned steps:

• Include fish in your diet; at least twice a week.
• Avoid foods containing partially hydrogenated vegetable oils as they have trans fat.
• Use low fat dairy.
• Limit your intake of alcohol.
• Limit your sodium intake to less than 1500 mg per day.
• Monitor portion sizes.

Anti-inflammatory: Since psoriasis is an inflammatory disease, following an anti-inflammatory diet may help relieve your symptoms. Avoid the following foods:

• Dairy products
• Fatty red meat
• Refined sugars
• Processed foods
• Nightshade vegetables such as tomatoes, potatoes and peppers

Foods that you should include in your diet:

• Oily ish
• Olive oil, flax seed, walnuts and pumpkin seeds
• Colourful vegetables and fruits

Gluten-free: According to new research, approximately 25% of people suffering from psoriasis may be sensitive to gluten. Moreover, various studies have demonstrated that celiac disease and psoriasis share common inflammatory and genetic pathways. The main cause of celiac disease is gluten intolerance. To eat a gluten-free diet you must read labels. Avoid wheat and its derivatives such as graham, durum, semolina, kamut and spelt. The same is for derivatives of barley including malt vinegar and malt flavouring along with rye, soy sauce and MSG.

Supplements for Psoriasis

Many persons with psoriasis have found that including supplements and vitamins in their diet has helped clear their skin and ease joint pain.

Omega Oils: Omega-3 fatty acids have been found to reduce inflammation and psoriasis is an inflammatory disease. Omega oils also have a positive effect on the immune system of the body. There are 3 kinds of omega-3 fatty acids: Eicosapentaenoic acid (EPA), Alpha-linolenic acid and Docosahexaenoic acid (DHA). According to a study published in the Journal of the American College of Nutrition, a number of clinical trials have found significant benefit of fish oil in chronic inflammatory diseases, including reduced disease activity and a decreased use of anti-inflammatory drugs.

Vitamin D: Topical ointments containing vitamin D have been used to treat psoriasis for quite some time. The main active ingredient in the two prescription topical medicines used for psoriasis (Dovonex and Vectical) is vitamin D. Vitamin D is found to change the way a cell grow and may also reduce their growth. According to a research published in the May 2011 journal Science Translational Medicine, vitamin D helps in counteracting the body’s response to inflammation that is associated with psoriasis.

Glucosamine and chondroitin: They are OTC dietary supplements, which can be taken either individually or together. Glucosamine helps in formation and repair of cartilage and possibly inhibit inflammation. Chondroitin promotes elasticity of cartilage and inhibits cartilage breakdown. Though research has been found that demonstrates that these supplements may decrease the pain and slow the progression of osteoarthritis; however, no studies have demonstrated their positive effects in psoriatic arthritis.

Persons who have an allergy to shellfish should not take glucosamine. Moreover, pregnant females and children should avoid these supplements.

MSM (Methylsulfonylmethane): It is an organic compound that contains sulfur and is found in fruits, vegetables and plants. However, it is destroyed during processing of food. Sulfur is required by body to maintain health of the connective tissue. In a 2006 study done at the Southwest College Research Institute in Tempe, Arizona, researchers have found that the symptoms of physical function and pain in patients suffering from osteoarthritis of knee was improved by taking MSM.

Turmeric: Turmeric plant and its extract are very commonly used in cooking and for medicinal use. It is extracted from the Curcuma Longa plant. The active ingredient in turmeric is Curcumin. Turmeric has antioxidant properties, which help in maintaining the health of the skin. According to an article published on skintherapyletter.com, turmeric has shown potent anti-inflammatory activity in various experimental animal models.

Vitamin A: Vitamin A is a fat soluble vitamin, which is stored in the liver. Different types of vitamin A are found in nature-retinol, which is found only in animal sources and carotenoids, which are found only in plant sources. Vitamin A helps in strengthening the immune system. According to a study, Severe Psoriasis-Oral therapy with a new Retinoid, it was found that Ro 10-9359, which is a derivative of retinoic acid, has proved to be an extremely potent antipsoriatic drug.

Psoriasis is an immune-mediated disease of the skin that produces a change in the life cycle of cells of the skin. There are various factors that can trigger the onset of psoriasis. By following certain dietary and lifestyle changes you may be able to relieve the severity of your symptoms. There are various dietary supplements such as MSM, Vitamin D, glucosamine and chondroitin, omega oils, turmeric etc. that you can take to control the disease.

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