Psoriasis, Autoimmunity, Inflammation and the Gut – what natural things can you do to heal?

Dr Carrie Decker ND, explores some practical interventions and provides a brief overview on the role of your gut and the development and progression of psoriasis.

If you or a loved one has psoriasis, you probably are familiar with the struggles of waxing and waning symptoms of dry, flaking skin, possibly accompanied by itching and pain as the skin repeatedly cracks in regions, while it goes through various phases of healing and shedding. For some people the issue is rather mild, and only presents as a somewhat unsightly patch which may be uncomfortable for others to see as they may fear it is contagious.  For others, the pain and symptoms are more severe, and may be accompanied by arthritis (known as psoriatic arthritis), which causes progressive damage to the joints and often requires medications and management by a rheumatologist to prevent irreversible joint destruction.

As more people experience this it is appropriate to take time to learn more about this condition, to understand why it is important to be treated, as well as to learn more about holistic approaches to healing the disease.

1. Psoriasis is an autoimmune disease. In autoimmune diseases, the body’s immune system becomes dysregulated and responds and reacts to proteins that are normal to the body, but seen as invaders. Inflammation associated with the immune response further promotes oxidative stress and immune activation. Autoimmune diseases often coexist, and psoriasis is no different.[1] Individuals with psoriasis have approximately twice the risk of a normal population to have two other autoimmune diseases, and are about 3.5 times more likely to have rheumatoid arthritis. [2]
2. In addition to the aforementioned autoimmune diseases, individuals with psoriasis have an increased frequency of other health complications including: inflammatory bowel disease, diabetes, cardiovascular disease, hypertension, metabolic syndrome, hepatitis, serious infections, and malignancy.[3]^,[4],[5] There are various reasons that these diseases may be associated, and overall, they are not well known. Some of these diseases may be associated because of the systemic effects of chronic, immune-mediated inflammation associated with psoriasis. Other associations may be due to lifestyle factors or adverse effects of systemic medications used to treat psoriasis.
3. Psoriatic arthritis affects approximately 1/3 of people with psoriasis at some point in their lives, many of which are undiagnosed.[6] Psoriatic arthritis often involves multiple joints which may be symmetric or asymmetric, and commonly includes the distal joints of the fingers, and/or the lower back and hips. There also may be soft tissue inflammation at the insertion of a tendon into the joint, or painful swelling of one or multiple fingers. Pitting of the nails or other fingernail changes such as separation from the nail bed are also common with psoriatic arthritis, occurring in 80 to 90 percent of individuals affected by psoriatic arthritis.[7] Psoriatic arthritis usually occurs after the skin lesions of psoriasis, but this is not always the case.
4. Psoriasis is associated with gastrointestinal dysbiosis, and a low level of gastrointestinal bacteria that are known to be beneficial.[8] There are many ways the gastrointestinal microbial population may be connected with a variety of systemic disease, and autoimmune disease is a common focus of research on this topic.[9] Assessing for poor gastrointestinal flora balance including the presence of parasites, bacteria imbalance, and fungal overgrowth, followed by appropriate treatment and restoration of the healthy bowel flora and intestinal health can improve systemic inflammation, immune dysregulation, and therefore support the body in healing from psoriasis. Dietary changes, such as the avoidance of gluten, also may improve digestive health and reduce systemic inflammation and immune activation, particularly as celiac disease is more common in individuals with psoriasis.[10]
5. Essential fatty acids such as eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and gamma-linolenic acid (GLA) can reduce inflammation and have been shown to improve symptoms of psoriasis including the number of lesions, pruritus, erythema, and scaling.[11]^{,[12],[13],[14]} EPA and DHA, known as omega-3 fatty acids, are found at high levels in fish oil and are considered “essential fatty acids” because the body is very poor at converting alpha-linolenic acid (ALA), a precursor to EPA and DHA. That is why alternative oils or sources of fatty acids such as flax, hemp, walnuts, and chia which contain high levels of ALA are poor alternatives to fish oil. GLA, an omega-6 fatty acid, also has anti-inflammatory actions and can be found in borage, evening primrose, and black currant oils. Like EPA and DHA, the body may poorly convert the precursor linoleic acid (LA) into GLA.[15]
6. Other natural substances with anti-inflammatory, immune modulating, or antioxidant actions which also have been studied for the treatment of psoriasis include curcuminoids,[16]^,[17] (the therapeutic compounds found in turmeric) a pine bark extract known as Pycnogenol® that has a high level of antioxidant potential,[18] vitamin A,[19]^,[20]  and vitamin D. [21] Low levels of vitamin D are common population-wide and are even more prevalent in individuals with chronic psoriasis.  Because of the important role that vitamin D plays in the growth and maturation of the cells of the skin, supplementation may play a role in the treatment of psoriasis. Topical application of products such as aloe vera in a cream or alternate liquid form can be soothing to the skin, increase moisture, and have been shown to be equally effective for the treatment of psoriasis as the topical steroid cream 0.1% triamcinolone acetonide, yet do not have the adverse side effects of the topical steroid including skin thinning.[22]^,[23]

In conclusion, learning more about a disease which you or a loved one may face is important to take preventative measures proactively, to support your healing and avoid or minimise risks of possible disease complications. Please consider the information you find here as a starting point on your healing journey, and seek out a qualified holistic health provider such as a naturopathic doctor, integrative physician, or functional medicine practitioner who has experience working with this condition to help you in resolving the symptoms and working towards overall improved health. National or international organisations such as the National Psoriasis Foundation, International Psoriasis Council, and the Psoriasis International Network are some websites of many, that have resources you may find useful in your healing journey.

References

[1] Bazsó A, et al. Systemic Autoimmune, Rheumatic Diseases and Coinciding Psoriasis: Data from a Large Single-Centre Registry and Review of the Literature. Mediators Inflamm. 2015;2015:657907.  View Full Paper

[2] Wu JJ, et al. The association of psoriasis with autoimmune diseases. J Am Acad Dermatol. 2012 Nov;67(5):924-30. View Abstract

[3] Neimann AL, et al. Prevalence of cardiovascular risk factors in patients with psoriasis. J Am Acad Dermatol. 2006 Nov;55(5):829-35. View Abstract

[4] Pearce DJ, et al. The comorbid state of psoriasis patients in a university dermatology practice. J Dermatolog Treat. 2005;16(5-6):319-23. View Abstract

[5] Wakkee M, et al. Increased risk of infectious disease requiring hospitalization among patients with psoriasis: a population-based cohort. J Am Acad Dermatol. 2011 Dec;65(6):1135-44. View Abstract

[6] Mease PJ, et al. Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol. 2013 Nov;69(5):729-35. View Abstract

[7] Cohen MR, et al. Baseline relationships between psoriasis and psoriatic arthritis: analysis of 221 patients with active psoriatic arthritis. Department of Veterans Affairs Cooperative Study Group on Seronegative Spondyloarthropathies. J Rheumatol. 1999 Aug;26(8):1752-6. View Abstract

[8] Scher JU, et al. Decreased bacterial diversity characterizes the altered gut microbiota in patients with psoriatic arthritis, resembling dysbiosis in inflammatory bowel disease. Arthritis Rheumatol. 2015 Jan;67(1):128-39. View Full Paper

[9] Leavitt, M. Microbiome: How your bacteria affects psoriasis, psoriatic arthritis. National Psoriasis Foundation. Updated May 6, 2015. Accessed July 17, 2016. View Full Paper

[10] Bhatia BK, et al. Diet and psoriasis, part II: celiac disease and role of a gluten-free diet. J Am Acad Dermatol. 2014 Aug;71(2):350-8. View Full Paper

[11] Maurice PD, et al. The effects of dietary supplementation with fish oil in patients with psoriasis. Br J Dermatol. 1987 Nov;117(5):599-606. View Abstract

[12] Mayser P, et al. n-3 fatty acids in psoriasis. Br J Nutr. 2002 Jan;87 Suppl 1:S77-82. View Abstract

[13] Miller CC, et al. Dietary supplementation with ethyl ester concentrates of fish oil (n-3) and borage oil (n-6) polyunsaturated fatty acids induces epidermal generation of local putative anti-inflammatory metabolites. J Invest Dermatol. 1991 Jan;96(1):98-103. View Abstract

[14] Balbás GM, et al. Study on the use of omega-3 fatty acids as a therapeutic supplement in treatment of psoriasis. Clin Cosmet Investig Dermatol. 2011;4:73-7. View Full Paper

[15] Horrobin DF. Fatty acid metabolism in health and disease: the role of delta-6-desaturase. Am J Clin Nutr. 1993 May;57(5 Suppl):732S-737S. View Abstract

[16] Gupta SC, et al. Therapeutic roles of curcumin: lessons learned from clinical trials. AAPS J. 2013 Jan;15(1):195-218. View Full Paper

[17] Aggarwal BB, et al. Potential therapeutic effects of curcumin, the anti-inflammatory agent, against neurodegenerative, cardiovascular, pulmonary, metabolic, autoimmune and neoplastic diseases. Int J Biochem Cell Biol. 2009 Jan;41(1):40-59. View Full Paper

[18] Belcaro G, et al. Improvement in signs and symptoms in psoriasis patients with Pycnogenol® supplementation. Panminerva Med. 2014 Mar;56(1):41-8. View Abstract

[19] Marghescu S, et al. [Psoriasis therapy with retinoid]. Z Hautkr. 1982 Oct 1;57(19):1410-20. View Abstract

[20] Orfanos CE, et al. [Treatment of psoriasis using vitamin A, vitamin A acid and oral retinoids]. Hautarzt. 1979 Mar;30(3):124-33. View Abstract

[21] Gisondi P, et al. Vitamin D status in patients with chronic plaque psoriasis. Br J Dermatol. 2012 Mar;166(3):505-10. View Abstract

[22] Choonhakarn C, et al. A prospective, randomized clinical trial comparing topical aloe vera with 0.1% triamcinolone acetonide in mild to moderate plaque psoriasis. J Eur Acad Dermatol Venereol. 2010 Feb;24(2):168-72. View Abstract

[23] Syed TA, et al. Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study. Trop Med Int Health. 1996 Aug;1(4):505-9. View Abstract