Psoriasis: Root causes, Tests, Natural Therapies

Psoriasis is a chronic autoimmune skin condition that affects the skin and, in some cases, other parts of the body. It is characterized by the rapid overproduction of skin cells, resulting in the formation of red, scaly patches or plaques on the skin's surface. Psoriasis can vary in severity, with some individuals experiencing only mild, localized symptoms, while others may have more widespread and severe manifestations.

Prevalence: Psoriasis is a common skin condition globally. Estimates of its prevalence vary, but it is generally considered to affect around 2-3% of the world's population. The prevalence can vary by region and ethnic group.

Age of Onset: Psoriasis can develop at any age, but it often first appears in young adulthood, with the majority of cases occurring before the age of 35.

Gender: Psoriasis affects both men and women, but some studies suggest a slightly higher prevalence in women.

Geographic Variation: The prevalence of psoriasis can vary significantly from one region to another. It appears to be more common in developed countries, and there can be regional differences within countries as well. Psoriasis is considered a relatively common skin condition in Greece. Estimates suggest a prevalence of approximately 2-3% in the Greek population, consistent with the global average. The Mediterranean climate in Greece, with its abundant sunshine, may have some beneficial effects on psoriasis, as exposure to sunlight can help improve symptoms for some patients. However, other environmental factors and genetics still play significant roles.

Symptoms of Psoriasis

Psoriasis is a chronic autoimmune skin condition that can manifest with a range of symptoms, which may vary in severity and appearance from person to person. The most common symptoms of psoriasis include:

Plaques: Raised, red patches of skin covered with thick, silvery-white scales are a hallmark of psoriasis. These plaques can vary in size and shape and are most commonly found on the elbows, knees, lower back, and scalp. They can also appear on other parts of the body.

Itching and Irritation: Psoriasis lesions are often itchy and can be painful or sore, especially when they crack and bleed.

Nail Changes: Psoriasis can affect the nails, causing symptoms such as:

Pitting: Small dents or depressions in the nail surface.
Discoloration: Nails may turn yellow or develop white spots.
Separation: Nails may detach from the nail bed, a condition known as onycholysis.
Thickening: Nails can become thicker and more brittle.

Inverse Psoriasis: In this form, the plaques are smooth, shiny, and found in skin folds, such as under the breasts, in the armpits, or in the groin area. Inverse psoriasis may be particularly uncomfortable due to the sensitivity of the affected areas.

Guttate Psoriasis: This type appears as small, pink, or red, drop-like spots on the skin. It is often triggered by infections, such as streptococcal throat infections.

Pustular Psoriasis: Characterized by white pustules surrounded by red skin. It can be localized to the hands and feet or become more generalized, affecting larger areas of the body.

Erythrodermic Psoriasis: This is a severe and rare form of psoriasis that can affect the entire body, leading to widespread redness, scaling, and itching. It can be life-threatening and requires immediate medical attention.

Joint Pain: Some people with psoriasis may develop a condition called psoriatic arthritis. Joint symptoms can include pain, stiffness, and swelling and can lead to joint damage over time.

Koebner Phenomenon: This refers to the development of new psoriasis lesions at the site of skin injuries or trauma, such as cuts, burns, or insect bites.

Psoriasis can affect not only the skin but also other aspects of a person's life, including their emotional well-being. The visible nature of the condition can lead to self-esteem issues and social stigma. The severity and type of psoriasis can vary among individuals, and the symptoms may come and go over time.

Causes of Psoriasis

Psoriasis is a complex and chronic autoimmune skin condition with a variety of contributing factors. While the exact cause of psoriasis is not fully understood, it is believed to result from a combination of genetic, immune system, and environmental factors.

Genetics: Family history is a significant risk factor for psoriasis. Many people with psoriasis have one or more family members with the condition, suggesting a genetic predisposition. Specific genes associated with psoriasis susceptibility have been identified, including HLA-C and various immune-related genes.

Immune System Dysfunction: Psoriasis is considered an autoimmune disorder. In a healthy immune system, T cells help protect the body from infection and other diseases. In psoriasis, T cells are mistakenly activated and trigger an inflammatory response in the skin. This leads to an overproduction of skin cells and the characteristic symptoms of psoriasis.

Environmental Triggers: Various environmental factors can trigger or exacerbate psoriasis symptoms in individuals with a genetic predisposition. Common triggers include:

Infections: Bacterial or viral infections, such as streptococcal throat infections, can lead to guttate psoriasis.
Injuries and Trauma: Skin injuries, including cuts, burns, and even tattoos, can trigger a type of psoriasis known as the Koebner phenomenon, where psoriatic lesions develop at the site of injury.
Stress: Psychological stress is associated with psoriasis flares in some individuals.
Medications: Certain medications, including lithium, antimalarial drugs, and beta-blockers, may exacerbate or trigger psoriasis.

Lifestyle Factors: Lifestyle choices can influence the severity of psoriasis. Smoking and excessive alcohol consumption have been linked to a higher risk of developing or worsening psoriasis symptoms.

Hormonal Changes: Changes in hormonal levels, such as during puberty, pregnancy, and menopause, can influence the course of psoriasis.

Obesity: There is a connection between psoriasis and obesity. Excess weight can worsen psoriasis symptoms and make treatment less effective.

It's important to note that psoriasis is a complex condition, and not all individuals with genetic susceptibility will develop the disease. Additionally, the specific triggers and risk factors can vary from person to person. Treatment and management of psoriasis typically focus on controlling the symptoms, reducing inflammation, and managing triggers to improve the quality of life for individuals with the condition.

Root Causes of Psoriasis

Functional medicine, an approach that seeks to address the underlying causes of a condition rather than merely treating its symptoms, can be applied to understanding and managing psoriasis. While the precise root causes of psoriasis can vary from person to person, functional medicine approaches aim to identify and address common underlying factors that may contribute to the development or exacerbation of psoriasis.

Dysfunctional Immune System: In functional medicine, the focus is often on restoring immune system balance. Psoriasis is an autoimmune condition, and an overactive immune response contributes to skin inflammation. Strategies may include:

Identifying and addressing food sensitivities or allergies that trigger immune responses.
Balancing gut health, as a significant portion of the immune system resides in the gut.
Reducing systemic inflammation through dietary changes and targeted supplementation.

Chronic Inflammation: Inflammation is a central feature of psoriasis. Functional medicine aims to reduce chronic inflammation through various means:

Promoting an anti-inflammatory diet, rich in fruits, vegetables, and omega-3 fatty acids.
Managing stress through techniques like meditation, yoga, or mindfulness, as stress can trigger inflammation.
Identifying and addressing chronic infections that may contribute to inflammation.

Gut Health: There is growing evidence of a connection between gut health and psoriasis. Functional medicine may involve:

Assessing and treating gut dysbiosis (imbalances in the gut microbiome) through dietary changes and probiotics.
Investigating and addressing conditions like leaky gut syndrome, which can contribute to inflammation.

Dietary Triggers: Some individuals with psoriasis find that certain dietary components can trigger or exacerbate their symptoms. Functional medicine emphasizes personalized nutrition:

Identifying and eliminating potential food triggers, such as gluten, dairy, and nightshade vegetables.
Focusing on a nutrient-dense, anti-inflammatory diet.

Toxic Exposures: Environmental toxins, such as heavy metals and chemicals, can contribute to psoriasis. Functional medicine may involve:

Detoxification protocols to reduce toxin burden.
Assessing and minimizing exposure to potential environmental triggers.

Hormonal Imbalances: Hormonal changes can influence the course of psoriasis. Functional medicine may consider:

Balancing hormonal fluctuations through dietary and lifestyle modifications.
Identifying and addressing any underlying hormonal conditions.

Psychological and Emotional Factors: Stress, anxiety, and depression can trigger or worsen psoriasis symptoms. Functional medicine aims to address mental health:

Incorporating stress management techniques.
Counseling or therapy to address emotional factors.

Laboratory Tests for Psoriasis

Laboratory tests are not typically used to diagnose psoriasis, as it is primarily a clinical diagnosis made based on the physical examination and medical history of the patient. However, in some cases, laboratory tests may be ordered to rule out other conditions or to assess the severity of psoriasis.

Rheumatoid Factor (RF): This blood test may be ordered if your doctor suspects psoriatic arthritis, a condition often associated with psoriasis. Elevated levels of rheumatoid factor can indicate joint inflammation.

Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP): These tests measure markers of inflammation in the body. They may be elevated in people with psoriatic arthritis or in cases of severe psoriasis, indicating systemic inflammation.

Complete Blood Count (CBC): A CBC can help assess if there are any abnormalities in blood cell counts, which may be associated with severe psoriasis or complications of the disease.

Liver Function Tests: Psoriasis and certain treatments for psoriasis can affect liver function. These tests assess the health of the liver and may be monitored regularly in individuals taking certain medications.

Kidney Function Tests: Some medications used to treat psoriasis can impact kidney function, so periodic monitoring may be necessary.

Lipid Profile: Individuals with psoriasis may be at an increased risk of cardiovascular disease, and a lipid profile can help assess cholesterol levels and other cardiovascular risk factors.

Genetic Testing: Genetic tests may be used to identify specific genes associated with psoriasis susceptibility or to predict an individual's response to certain treatments, especially in the context of personalized medicine.

Skin Biopsy: While not a traditional laboratory blood test, a skin biopsy is a diagnostic procedure that may be performed to confirm the diagnosis of psoriasis and rule out other skin conditions.

It's important to emphasize that while these laboratory tests can provide valuable information, they are typically used in conjunction with a clinical assessment to manage and monitor psoriasis. The diagnosis of psoriasis is primarily based on the characteristic appearance of skin lesions and plaques.

Functional Medicine Laboratory Tests for Psoriasis

While the diagnosis of psoriasis is primarily clinical and based on the physical examination of skin lesions, these tests can help identify potential triggers or imbalances that may be addressed through a functional medicine approach.

IgG Food Sensitivity Testing (TrophoScan®): Identifying and addressing food sensitivities can be a key aspect of managing psoriasis, as certain foods may trigger or exacerbate inflammation in some individuals.

Comprehensive Stool Analysis (EnteroScan®): Assessing the gut microbiome, evaluating for conditions like leaky gut syndrome, and identifying imbalances in the gut can be important, as gut health is closely linked to autoimmune conditions and inflammation.

Nutrient Status

Vitamin D Levels: Vitamin D deficiency is common in psoriasis, and addressing this deficiency may be part of the treatment plan.
Omega-3 Fatty Acid Levels (OmegaScan®): Omega-3 fatty acids have anti-inflammatory properties and can help in reducing inflammation in the body.

Inflammatory Markers

Inflammatory Cytokines: Measuring specific cytokines, such as tumor necrosis factor-alpha (TNF-α) and some interleukins (e.g., IL-17, IL-23), can provide insights into the inflammatory response in psoriasis.

Hormone Panel: Evaluating hormone levels, including estrogen and testosterone, can be important because hormonal imbalances can influence psoriasis.

Heavy Metal Testing: Assessing for heavy metal exposure, which can be linked to inflammation and immune system dysfunction.

Genetic Polymorphisms: Some genetic variations may influence a person's susceptibility to psoriasis and their response to treatment.

These tests are part of a comprehensive evaluation, and their results are interpreted within the broader context of a patient's medical history and symptoms. The goal is to develop an individualized treatment plan that addresses the unique factors contributing to each person's psoriasis.

Conventional Therapies for Psoriasis

Conventional therapies for psoriasis are aimed at managing the symptoms, reducing inflammation, and slowing down the excessive growth of skin cells that characterize the condition. The choice of treatment depends on the type, severity, and location of psoriasis, as well as the patient's overall health.

Topical Treatments

Topical Corticosteroids: These anti-inflammatory creams or ointments are commonly used to reduce redness, itching, and inflammation in mild to moderate psoriasis.
Topical Calcineurin Inhibitors: Medications like tacrolimus and pimecrolimus can be used for sensitive areas such as the face and genitals.
Vitamin D Analogs: Topical creams containing vitamin D analogs like calcipotriene can help slow down the growth of skin cells.
Coal Tar Preparations: Coal tar products can help relieve itching, scaling, and inflammation.
Salicylic Acid: These products help remove scales and are often used in combination with other treatments.
Tazarotene: This synthetic retinoid is used for mild to moderate plaque psoriasis.

Phototherapy (Light Therapy)

Ultraviolet B (UVB) Therapy: Controlled exposure to UVB light can help slow the growth of skin cells and reduce symptoms. Both broad and narrow-band UVB are used.
Psoralen plus Ultraviolet A (PUVA): This involves a combination of a light-sensitizing drug (psoralen) and UVA light exposure. It is effective but carries potential side effects.
Laser: Targeted laser therapy is used for localized psoriasis plaques.

Systemic Medications

Oral Retinoids: These synthetic forms of vitamin A can be used for severe psoriasis but may have side effects that require close monitoring.
Methotrexate: An immunosuppressant drug that helps slow skin cell growth and reduce inflammation.
Cyclosporine: An immunosuppressant used for severe psoriasis, particularly for short-term relief.
Biologics: These are advanced, targeted therapies that suppress specific parts of the immune system involved in psoriasis. Biologics are typically used for moderate to severe psoriasis, especially if other treatments have failed. Examples include drugs like etanercept, adalimumab, and infliximab.
Apremilast: A newer oral medication that inhibits an enzyme involved in inflammation.

Other Treatments

Intralesional Steroids: Injecting corticosteroids directly into stubborn psoriasis plaques can be effective.
Retinoid Creams: Topical retinoids like tazarotene can be used in combination with other treatments.
Salon-Based UV Therapy: Some individuals may use commercial tanning beds as a form of UV therapy, but this should be done under medical supervision to avoid overexposure and skin damage.

Treatment plans are typically personalized, and the choice of therapy depends on the type and severity of psoriasis, the patient's overall health, and their response to previous treatments. Additionally, lifestyle modifications, including stress management, a healthy diet, and avoiding triggers, can complement conventional therapies and improve the overall management of psoriasis.

Natural Therapies for Psoriasis

Many people with psoriasis explore natural therapies and lifestyle modifications to complement conventional medical treatments. While these approaches may help manage psoriasis symptoms, it's essential to consult with a healthcare provider or dermatologist before trying any natural remedies, as they can interact with medications or have contraindications.

Dietary Changes

Anti-Inflammatory Diet: Focus on a diet rich in fruits, vegetables, whole grains, and lean proteins. Omega-3 fatty acids, found in fatty fish like salmon, walnuts, and flaxseeds, can help reduce inflammation.
Gluten-Free Diet: Some people with psoriasis may have gluten sensitivity, and eliminating gluten from the diet may improve their symptoms.
Nightshade-Free Diet: Avoiding nightshade vegetables like tomatoes, eggplants, and peppers may benefit some individuals, as these foods can exacerbate psoriasis for certain people.

Supplements

Fish Oil: Omega-3 fatty acids in fish oil supplements can help reduce inflammation and may improve psoriasis symptoms.
Vitamin D: Ensuring adequate vitamin D levels, either through supplements or sensible sun exposure, may help reduce psoriasis symptoms.
Probiotics: A healthy gut microbiome is essential, so probiotics may be helpful in some cases.
Turmeric: The active compound in turmeric, curcumin, has anti-inflammatory properties and may benefit individuals with psoriasis.
Oregon Grape (Berberine): Oregon grape extract has been studied for its potential in improving psoriasis symptoms.

Apple Cider Vinegar: Some people use diluted apple cider vinegar topically to help alleviate itching and inflammation. Be cautious with undiluted vinegar, as it can be irritating.

Oats and Epsom Salt Baths: Adding colloidal oatmeal or Epsom salts to warm baths can provide relief from itching and soften psoriasis plaques.

Moisturizing: Regularly applying a hypoallergenic moisturizer can help prevent dryness and reduce itching and scaling.

Stress Reduction: Stress can trigger or worsen psoriasis symptoms. Stress management techniques such as meditation, yoga, deep breathing exercises, and progressive muscle relaxation may be beneficial.

Avoiding Triggers: Identifying and avoiding factors that exacerbate psoriasis, such as alcohol, smoking, and certain medications, can be helpful.

Sunlight Exposure: Controlled exposure to natural sunlight can improve psoriasis symptoms for some individuals. It's essential to use sunscreen on unaffected areas to avoid sunburn.

Acupuncture and Traditional Chinese Medicine: Some people find relief through acupuncture or traditional Chinese medicine practices.

Dead Sea Salt Baths: Soaking in warm baths with Dead Sea salt may help soften psoriasis plaques and reduce inflammation.

It's important to remember that natural therapies may not work for everyone, and results can vary. Additionally, the safety and effectiveness of these remedies can depend on individual factors and the specific type and severity of psoriasis. Always consult with a dermatologist before incorporating any natural treatments into your psoriasis management plan and be prepared to discuss any potential interactions with existing medications.

Herbal remedies are often sought by individuals with psoriasis as complementary or alternative treatments. Herbal remedies should be used with caution, as they can have side effects or interact with other medications.

Aloe Vera: Aloe vera gel, when applied topically, can help soothe and moisturize the skin, reducing itching and redness. It is widely used for its anti-inflammatory and skin-soothing properties.
Mahonia Aquifolium (Oregon Grape): The extract of the root of this plant, particularly berberine, has been studied for its potential to reduce psoriasis symptoms. It's available in various forms, including creams and ointments.
Turmeric: Curcumin, the active compound in turmeric, has strong anti-inflammatory properties. It can be taken orally as a supplement or applied topically as a paste. Some individuals find it helpful in reducing psoriasis symptoms.
Tea Tree Oil: Diluted tea tree oil may help soothe psoriasis plaques when applied topically. However, it should not be used undiluted, as it can be irritating to the skin.
Neem Oil: Neem oil, derived from the neem tree, has been used in traditional medicine for its anti-inflammatory and antibacterial properties. It can be applied topically to reduce itching and inflammation.
Chickweed (Stellaria media): This herb is sometimes used as a topical ointment to alleviate itching and redness associated with psoriasis.
Oregano Oil: Oregano oil contains carvacrol, which has antibacterial and anti-inflammatory properties. It can be diluted and applied topically.
Licorice (Glycyrrhiza glabra): Topical creams or gels containing licorice extract have been explored for their potential anti-inflammatory effects in managing psoriasis.
Barberry (Berberis vulgaris): Berberine, a compound found in barberry, may have anti-inflammatory and antimicrobial properties. It can be used topically or as a supplement.
Capsaicin: Capsaicin, derived from chili peppers, can be used topically in creams or ointments to reduce itching and inflammation associated with psoriasis.
Salicylic Acid: Salicylic acid is derived from willow bark and can be used topically to help remove scales and reduce inflammation.

It's important to use herbal remedies cautiously, especially if you are pregnant, breastfeeding, or have underlying health conditions. Some herbs may have side effects or contraindications, and their safety and efficacy can vary among individuals. Always consult with your dermatologist before trying herbal remedies for psoriasis and ensure that they do not interact with any prescribed medications you may be taking.

Vasilis J. Sideris
Biologist
Medical Doctor, Biopathologist (Microbiologist)
Certified Functional Medicine Practitioner, CFMP^®