Psoriasis is a systemic inflammatory disorder that generally comprises excessive production of skin cells leading to patches of thick, scaly, inflamed, often itchy skin. The systemic inflammation underlying psoriasis can also manifest as psoriatic arthritis, a potentially severe arthritic joint condition. About 7.4 million US adults aged 20 or older have psoriasis.
Those with psoriasis have a markedly increased risk of developing other major inflammatory disorders, particularly:
- cardiovascular disease
- metabolic syndrome
Note: This link between psoriasis and systemic health is underscored by a 5-year diminished life expectancy among those with the disease, largely attributable to increased cardiovascular disease risk. All people with moderate-to-severe psoriasis should review Life Extension’s protocols on cardiovascular disease and chronic inflammation, and be screened for cardiovascular risk factors.
Integrative interventions like fish oil, vitamin D, and pycnogenol have potent anti-inflammatory properties and have been shown to alleviate symptoms of psoriasis.
Causes and Risk Factors
- Genetics is an important contributor in up to 90% of cases, with a variant gene HLA-Cw6 conferring the greatest risk
- There are also many triggers including injury, sunburn, infection, obesity, certain medications, emotional stress, alcohol, and tobacco
Signs and Symptoms
While psoriasis can appear anywhere on the skin, it most often affects the elbows, knees, scalp, lower back, and genitals. Potential signs and symptoms include:
- Raised, reddish patches covered with thick, silvery-white, shiny scales, which may be itchy
- Pinpoint bleeding spots appear when scales are scraped off (Auspitz sign)
- Fever, dehydration, and elevated white blood cell count may occur in severe cases
- Joint stiffness or pain, including inflammation or damage in psoriatic arthritis
The diagnosis of psoriasis is based on a physical examination of the skin, scalp, and nails. Skin biopsy and blood testing are rarely necessary.
- Topical (eg, corticosteroids and vitamin D analogs): first-line treatment for mild psoriasis
- Systemic medications: affect the whole body; used for more severe forms of psoriasis
- Phototherapy: light therapy for moderate-to-severe psoriasis
Novel and Emerging Strategies
- Fumaric acid esters, which have been shown to lead to complete clinical remission in up to 82.5% of participants, may also ameliorate cardiovascular risk by improving endothelial function.
- Several small molecule drugs and biologics are emerging as therapeutic options for treating psoriasis.
Dietary and Lifestyle Considerations
- A Mediterranean-style diet reduces the severity of psoriasis, with higher consumption of olive oil and fish associated with lower psoriasis severity.
- Climatotherapy and balneotherapy, the medical use of mineral water and mud baths, are shown to be beneficial in psoriasis.
- Good sleep hygiene is helpful, as nighttime melatonin levels are significantly lower in psoriasis patients.
- Fish oil: Fish oil supplements given to psoriasis patients for up to six months resulted in clinical improvement in skin redness, hardening, scaling, and itching.
- Vitamin D: In a 2013 study, psoriasis symptoms significantly improved in patients receiving high daily doses of vitamin D3 in combination with a low-calcium diet.
- Pycnogenol: In a study in psoriasis patients, the addition of pycnogenol to standard treatment resulted in significant improvement in skin redness, hardening, and scaling compared with standard treatment alone.
- White peony extract: A 2014 study showed substantial clinical improvement, along with a significant drop in inflammatory cytokines, in 32% of patients treated exclusively with peony glucosides.
- Whey protein: In one study, administration of whey protein isolate resulted in clinical improvement in patients with psoriasis, regardless of whether the whey protein was given alone or in addition to topical or light therapies.