Psoriasis, my take

Psoriasis is an autoimmune disease of the skin that affects over three percent of population (that’s about five million adults), and typically involves scaling and inflammation. Psoriasis is a complex autoimmune inflammatory disease that occurs in genetically susceptible individuals and presents with the development of inflammatory plaques on the skin. It has patches of thick red silvery scales that usually itch and hurt. It can affect toe nails, fingernails, joint inflammation causing arthritis.. Some comorbid conditions occur at a higher frequency, include cardiovascular disease, malignancy, diabetes, hypertension, metabolic syndrome, inflammatory bowel disease, serious infections, and other autoimmune disorders. Altogether, it makes for an absolutely miserable experience.

Many times doctors recommend immunity suppressing drugs to calm inflammation. The problem with current medical approach is to look at this condition as a standalone, individual condition and treat as one.

One of the examples of Psoriasis
One of the examples of Psoriasis

For last many years I am looking at conditions with functional medicine principles and looking at the bigger picture. Rather than focusing on the symptoms alone and genes alone, start focusing on causes of symptoms and interactions of genes and environment (the epigenetics) . It is fundamentally a different approach.

That approach is to know the person from all aspects of and all phases of their life to create a health story line specific for that person. That gives better understanding about how that person happens to get this condition. Once you know that you can decide on specific plan for that person.

As per national psoriasis foundation- What triggers psoriasis?
Psoriasis triggers are not universal. What may cause one person’s psoriasis to become active, may not affect another. Established psoriasis triggers include:


Stress can cause psoriasis to flare for the first time or aggravate existing psoriasis. Relaxation and stress reduction may help prevent stress from impacting psoriasis.

Injury to skin</FONT COLOR>

Psoriasis can appear in areas of the skin that have been injured or traumatized. This is called the Koebner [KEB-ner] phenomenon. Vaccinations, sunburns and scratches can all trigger a Koebner response. The Koebner phenomenon can be treated if it is caught early enough.

Medications</FONT COLOR>

Certain medications are associated with triggering psoriasis, including:
Lithium:</FONT COLOR> Used to treat manic depression and other psychiatric disorders. Lithium aggravates psoriasis in about half of those with psoriasis who take it.
Antimalarials:</FONT COLOR> Plaquenil, Quinacrine, chloroquine and hydroxychloroquine may cause a flare of psoriasis, usually two to three weeks after the drug is taken. Hydroxychloroquine is the least likely to cause side effects.
Inderal:</FONT COLOR> This high blood pressure medication worsens psoriasis in about 25 percent to 30 percent of patients with psoriasis who take it. It is not known if all high blood pressure (beta blocker) medications worsen psoriasis, but they may have that potential.
Quinidine:</FONT COLOR> This heart medication has been reported to worsen some cases of psoriasis.
Indomethacin:</FONT COLOR> This is a nonsteroidal anti-inflammatory (NSAID) drug used to treat arthritis. It has worsened some cases of psoriasis. Other anti-inflammatories usually can be substituted. Indomethacin’s negative effects are usually minimal when it is taken properly. Its side effects are usually outweighed by its benefits in psoriatic arthritis.

Infection</FONT COLOR>

Anything that can affect the immune system can affect psoriasis. In particular, streptococcus infection (strep throat) is associated with psoriasis. Strep throat often triggers the first onset of psoriasis in children. You may experience a flare-up following an ear ache, bronchitis, tonsillitis or a respiratory infection, too.
It’s not unusual for someone to have an active psoriasis flare with no strep throat symptoms. Talk with your doctor about getting a strep throat test if your psoriasis flares.

One of the things psoriasis is linked to is increased intestinal permeability (leaky gut). The biggest culprits for that are:

– Heavy metal exposure,
– Dysbiosis and yeast and mold over growth in gut
– Gluten sensitivity
– Smoking,
– Some medications like non steroidal anti-inflammatory meds and antibiotics.
– bacterial, viral, parasitic infections.
– Nutritional deficiencies like vitamin D.

What can be done?</FONT COLOR>

As per Dr. Mark Hyman “take away bad and introduce good to restore body’s natural balance and improve immunity”. Following recommendations are helpful.
-To try to heal psoriasis without use of steroids, and invasive treatment products, we should try this approach first under care of someone who is well versed with this approach.
– Remove food allergy, food sensitivity (specially gluten and dairy) and follow sugar free diet.
– Remove inflammatory diet-and eat organic Non GMO whole foods, wild fish with good omega 3 sources, multi-color fruits and vegetables like berries, orange ,sweet potato, nuts.
– Seek medical help to look all the triggers mentioned above
– As you realize gut plays major role in skin condition, so fix your gut first. Work with functional/integrative physician to optimize your gut health.
– Use the right supplements at right time and right dose. For example fish oil, vitamin D, specific probiotic, anti-inflammatory products like quercetin, turmeric etc. Using anti-inflammatory meal replacement nutritional drink can help people on the go. It is important to follow this plan under physician’s guidance, as they are not free of side effect and complications.
– Regular exercise acts as anti-inflammatory. You just have to go for walks, do outdoor activity like gardening, or take up some sport and then gradually increase to structured exercise.
– Good night sleep-please follows my post on sleep.
– Rest and relaxation-Chronic stress influences inflammation. Calming techniques like meditation, abdominal breathing, yoga, massage, cognitive reflection on your feelings and practicing real gratitude can reduce anxiety and promote calm. You can refer to my post on gratitude, rest and relaxation.

Psoriasis is difficult condition to live with, but there is solution!

Author: Rekha Shah

Dr Shah practices Functional & Integrative medicine. She is Board certified by American Board of Medical Specialists in Internal Medicine and Gastroenterology. She is also a Certified Functional Medicine Practitioner.

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