Discover how you can manage your psoriasis better

Psoriasis is a complex autoimmune condition belongs to a class of immune-mediated inflammatory diseases (IMID) (1, 2) and causes skin cells to grow faster than usual.

Normal skin cell turnover is usually 21-28 days, but in psoriasis skin regenerates too quickly, between 3-10 days.

The severity of psoriasis can vary from person to person, ranging from slight irritation to having a huge impact on quality of life, it can be painful and can impact sleep, concentration, and confidence.

Topical solutions and medication aren’t the only ways to treat this condition, and a Functional Medicine approach to psoriasis can work on the root cause/s.

Symptoms of psoriasis tend to go through cycles, flaring for a few weeks or even months, followed by periods of subsiding or remission.

Psoriasis is characterised by slightly raised areas of abnormal skin patches that are red (or purple on darker skin), dry, itchy and scaly.

Psoriatic skin can become three times thicker that the skin surrounding the patches.

The coverage of abnormal skin can vary in severity – it can completely cover the whole body, or just be present in localised areas on the body, for instance:

Psoriasis can also affect nails (‘nail psoriasis’) and the joints (‘psoriatic arthritis’).

Psoriasis is one of the most prevalent chronic skin conditions in the world, can appear at any time of life, and it affects females and males equally (3).

Although psoriasis can appear at any time of life, the most prevalent time when this skin condition appears is between the late teens and early adulthood, and between the ages of 55 and 60 (4).

It tends to run in families but in some cases does not.

Worldwide, 125 million people worldwide are affected by psoriasis according to the International Federation of Psoriasis Associations (5).

In the UK, it is estimated that psoriasis affects 2-3% of the population – up to 1.8 million people (6).

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Types of psoriasis

There are several types of psoriasis:

Plaque psoriasis (‘psoriasis vulgaris’)

Plaque psoriasis is the most common type, where dry skin lesions are covered in scales (called plaques = accumulation of skin cells).

Guttate psoriasis

Guttate psoriasis comprises less than 2% of cases, affecting children or young adults.

It causes small, red spots on the skin (commonly manifesting after streptococcal infections and usually associated with HLA-Cw6 gene (7)).

Inverse psoriasis

Inverse psoriasis appears in groin areas, armpits and skin folds, presenting with bright red, smooth and shiny patches that do not have scales. Sweating and rubbing make it worse.

Pustular psoriasis

Pustular psoriasis is not very common, mostly affecting adults, and presents as puss-filled pustules surrounded by red skin.

Erythrodermic psoriasis

Erythrodermic psoriasis is a very rare and serious condition; it disrupts the body’s temperature and fluid balance, with a peeling rash that covers the entire surface of the body.

The conventional medicine approach to psoriasis

The exact cause of psoriasis is not known and there is no cure for this condition yet, but there are some treatments available that can ease symptoms (itching, redness, pain, discomfort).

The type of treatment depends on the kind of psoriasis.

Topical treatments – ointments and moisturisers used in cases of mild psoriasis – to reduce scaling:

Light therapy (red light therapy and natural sunlight) and phototherapy – the light can slow down the skin cell growth speed and scaling.

Systemic medications impacting the immune system or slowing the skin cell division rate (e.g. retinoids, methotrexate, cyclosporine), prescription corticosteroids are used in flare-ups.

Biologic drugs are usually given to non-responsive psoriasis or psoriatic arthritis (Etanercept, Infliximab, Adalimumab).

Psoriasis: the root cause(s)

Psoriasis is a complex immune-mediated disease and there seems to involve a triad of factors. (8)

These factors need to be present to initiate the development of psoriasis (more on this in our autoimmune diseases article):

1/ Genetic predisposition (e.g. to autoimmunity HLA-DQ2/-DQ8 (9)).

2/ Environmental triggers, such as:

3/ Increased intestinal barrier permeability (leaky gut), associated immune dysregulation and detoxification imbalances

Gut health is very closely linked to skin health (14, 15, 16, 17).

For more details on increased intestinal permeability, what it is and how it can impact skin and immune health, head over to our leaky gut article.

The Functional Medicine approach to psoriasis

In a comprehensive Functional Medicine approach to psoriasis, the below are some of the factors our Coho practitioners will consider in each case:

Immune imbalances

Research points to Th1, Th17 and Treg immune cell imbalances in psoriasis.

These immune cells are an integral part of psoriasis and drive the inflammatory responses (18, 19).

Gut microbiota imbalances

Certain gut bacteria can contribute to inflammatory responses that exacerbate psoriasis, resulting in more severe symptoms.

Bacteria such as Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, Proteus species and Streptococcus pyogenes produce small molecules that are components of the outer membrane of the bacteria, called lipopolysaccharides (LPS).

When released into the blood, these are considered to be toxic and strong stimulators of the immune system (20).

Gut bacteria can be, and at Coho routinely are, tested by using a comprehensive gut and microbiome stool test.

More importantly, any gut microbiome imbalances can then be addressed, resulting in healthy levels of beneficial bacteria and low (or no) levels of potentially pathogenic bacteria.

Microbiome retesting at Coho Health routinely demonstrates that our strategy is effective in rebalancing the gut bacteria in our clients with chronic diseases.

A healthy gut microbiome can positively influence immune system function and inflammatory processes.

Food sensitivities

Food sensitivities can result in increased levels of histamine being produced by the immune mast cells.

Higher histamine levels can exacerbate inflammation and cause the skin to become more uncomfortable and itchier (it’s the histamine that causes skin to become itchy).

In this case, food reactions in the gut are manifesting as symptoms in the skin.

Gluten (found in wheat, rye, barley and spelt) is a protein that is associated with almost all autoimmune diseases.

There is an association between psoriasis, coeliac disease and gluten sensitivity (CD, NCGS) (21, 22, 23, 24).

People with coeliac disease or non-coeliac gluten sensitivity often have high levels of antigliadin IgA antibody (in which case a gluten-free diet would be beneficial) (25).

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Infections

Several bacterial, yeast and viral infections are considered to be triggers in psoriasis.

– Streptococcus bacteria. Streptococcus throat infection has been associated with the onset or severity of psoriasis (26)

– Staphylococcus aureus is a common bacteria that can colonise the skin (as well as in the gut microbiome) and is 4-5 times more likely to be present in those with psoriasis compared to those without the condition (26)

– Candida is also more commonly a factor in psoriasis, a yeast strain that can be quite difficult to eradicate and secretes pro-inflammatory toxins (26)

– Malassezia is another fungal infection more commonly found in patients with psoriasis. Studies have noted improvements in scalp psoriasis after anti-fungal treatment (and reduced levels of Malassezia) (26)

– Helicobacter pylori (H. pylori) is a common bacterium that resides in the gastric mucosa (in the stomach) and is associated with several inflammatory skin conditions, including psoriasis.

H.pylori can cause systemic inflammation and can increase gut permeability, causing immune system imbalances (26,27).

– Viruses such as human immunodeficiency virus (HIV), hepatitis C and human papillomavirus (HPV), are also closely associated with psoriasis (26)

Detoxification pathways

If detoxification pathways are not working optimally, then this can contribute to skin conditions – skin being our largest detoxifying organ.

Simply put, the body wants to remove the build-up of toxins and waste products through the skin, and even more so when other detoxification pathways, such as the liver and kidneys, are less effective.

Optimal hydration, movement, fibre and antioxidants are foundational to supporting normal detoxification processes.

From a Functional Medicine perspective, there are many ways to assess the efficacy of detoxification pathways.

If a pathway isn’t functioning optimally, targeted nutrition and supplemental support can improve the function.

Liver detoxification involves three key processes, called phase 1 detoxification, phase 2 detoxification and phase 3 detoxification.

An abundance of whole foods including fruits and vegetables can help to increase phase 1 activity, but it is important to support phase 2 and 3 at the same time, to avoid a build up of phase 1 intermediatory products that can increase inflammation.

Phase 2 can be supported by including a good level of protein rich foods that provide key amino acids, and phase 3 can be supported with exercise and plenty of dietary fibre (and avoiding constipation).

Digestion & absorption

Another factor in psoriasis may be sub-optimal digestion and absorption, especially poor protein breakdown (optimal protein breakdown provides important building blocks, amino acids, for skin repair), and bile imbalances (bile is needed for proper detoxification) (28).

Polyamines, produced by intestinal microbiota, are essential for cell growth and differentiation.

Polyamines (putrescine, spermidine and spermine), are involved in psoriasis, and it is suggested that they play a major role in the process of keratinocyte (skin cell) proliferation, differentiation, and regulation.

It seems that an impaired metabolism of polyamines exists in psoriatic skin.

Increased polyamine biosynthesis is associated with cell proliferation in psoriasis (29).

Skin microbiome

Similarly to the gut microbiome, the skin has its own microbiome which may become imbalanced (fungi, bacteria, viruses and arthropods), and the skin microbiome may vary from person to person.

Individual skin microbiome can be affected by factors such as:

The general composition of healthy skin microbiota includes bacterial phyla like Actinobacteria, Brevibacterium, Propionibacterium and Staphylococcus epidermidis, which help to modulate the immune response (30).

Staphylococcus epidermidis can inhibit skin pathogens such as staphylococcus aureus and streptococcus (as mentioned above – these are pathogenic bacteria that can colonise the skin and contribute to psoriasis) (30).

Nutritional deficiencies

Fat-soluble nutrients are important for skin and immune health:

Vitamin D. There is a significant association between low vitamin D levels and psoriasis (31)

Vitamin A. Topical treatment of vitamin A has been helpful for some people with psoriasis, and optimal vitamin A levels can help regulate skin cell turnover rate (32)

Vitamin E (vitamin A and E being powerful antioxidants that protect against free radical damage). Research has demonstrated the benefits of vitamin E in psoriasis, when combined with other antioxidants (33).

Magnesium is one of our major minerals (the other being calcium), and magnesium is a common mineral insufficiency / deficiency around the world.

Magnesium is a go-to mineral for supporting the nervous system and modulating the stress response.

As many people with psoriasis will observe, stress can exacerbate symptoms and optimising magnesium (as well as B vitamins) can help modulate the stress response, thereby reducing the negative impact of stress on the immune system.

And these are just a few examples.

Functional Medicine approach to psoriasis: lifestyle factors

Psoriasis is a complex autoimmune condition.

Introducing some lifestyle changes along with dietary changes is a must in addressing psoriasis (despite many people finding this the most challenging area to change!).

– Sleep and circadian rhythm optimisation.

Optimising the sleep promoting hormone, melatonin, is important and research shows that levels of melatonin are lower in people with psoriasis (34, 35, 36).

Avoid blue lights, artificial light, in the evening, stay off your screens for 1-2 hours prior to bed, implement a sleep routine that helps to downregulate the stress hormones and optimise melatonin production.

– Baths in Dead Sea salts

Dead Sea salts are rich in minerals, and magnesium sulphate can be extremely helpful for some people with psoriasis.

As well as supporting skin health directly, it’s also great for the nervous system.

– Nervous system support

Relaxation, mental health support, stress support, engaging in hobbies or activities that are fun, can all be helpful.

Studies have demonstrated that relaxation, hypnosis, biofeedback and behavioural and cognitive stress management therapies, have been helpful for people with psoriasis (37).

These are all essentially ways to reduce stress and/or have a healthier response to stress.

Functional Medicine approach to psoriasis: functional testing

As you can see, there are many potential factors involved in psoriasis, and testing helps us to pinpoint exactly which factors are at play for you.

While we have a huge range of tests available to us, we carefully recommend the right test for you based on your specific case:

– Routine conventional tests such as the full blood count, liver function tests, inflammatory markers, homocysteine and uric acid, can provide some key foundational information.

– Micronutrients – for example assessing levels of vitamin D and red blood cell mineral levels

– Comprehensive Stool Testing to assess digestive function and the microbiome (for example the Genova Diagnostics GI Effects, Invivo Clinical’s GI Ecologix or Diagnostic Solutions GI-MAP stool test)

– Infections (H. Pylori, SIBO breath test, Cyrex Array 12 – Pathogen Associated Immunity)

– Barrier Assessment (Cyrex Array 2 – Intestinal Antigenic Permeability Screen)

– Food sensitivities and allergies (Cyrex Array 10 – Multiple Food Reactivity Screen, Cyrex Array 4 – Gluten Associated Cross Reactivity Screen, Cyrex Array 3 – Wheat/Gluten Reactivity Screen, Precision Diagnostics P88 Dietary Antigen Test)

– Detoxification (Cyrex Array 11 – Chemical Immune Reactivity Screen, mycotoxins, heavy metal testing, Hepatic Detox Profile)

Having precise information on the factors that are involved in your psoriasis means we can put the right treatment plan in place for you.

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The wrap...

Psoriasis is a complex autoimmune condition that can have a significant impact on your life – not just physically but psychologically and emotionally too.

Because it’s a complex condition, there are a number of factors that can be involved, and this is where the Coho Functional Medicine approach can really help.

While we know that there’s no complete cure for psoriasis, by assessing all of the root cause factors at play, we can drastically improve your quality of life in the short, medium, and long term.

If you think the Coho Functional Medicine approach to psoriasis can help you, you can book a free 15 minute discovery call with us here.

We offer Functional Medicine consultations in the UK, in Mallorca, and to clients around the World through our virtual Functional Medicine clinic.

To your optimised, healthy future,

Aga & the Coho Health team