Psoriasis is an autoimmune condition affecting millions of US adults. It develops "when the body makes skin cells too quickly, causing skin cells to pile up and form visible patches or spots on the skin."
Both adult males and females are affected by psoriasis similarly; children are less likely to be affected. Symptoms often appear between the ages of 20 to 30 years or 50 to 60 years.
Scientists do not know what causes psoriasis, but genetics, the immune system, diet, and lifestyle play essential roles. Researchers are also exploring the role of gut health in psoriasis.
This article addresses a functional medicine approach to psoriasis, focusing on the role of the gut.
What is Psoriasis
Psoriasis is an immune-mediated inflammatory condition of the skin and, sometimes, other organ systems. The most common visible signs of the disease are raised, scaly skin plaques on the elbows, knees, and scalp that can burn, itch, and sting.
The plaques are caused because an overactive immune system accelerates skin growth. Typically, skin cells grow and fall off in 40 to 56 days. However, in patients with psoriasis, the skin cells are not shed on time and pile up on the skin.
Those with psoriasis are at risk for other conditions, including:
- Psoriatic arthritis (PsA)
- Inflammatory bowel disease (IBD)
- Anxiety and depression
- Inflammation of the eye
- Metabolic conditions
- Insulin resistance
- Elevated lipids
- Heart disease
- Non-alcoholic fatty liver disease
What Does Psoriasis Look Like?
- The most common form of psoriasis, plaque psoriasis, is characterized by patches of thick, raised skin that are sometimes covered with a silvery-white coating called scale.
- Guttate psoriasis is characterized by an often sudden appearance of tiny skin bumps covering the torso, arms, and legs.
- Inverse psoriasis may develop in areas where skin touches skin (like the axilla, genital region, or buttock crease). The skin often looks raw and has smooth, red patches with little scale.
- Pustular psoriasis forms pus-filled bumps, usually on the feet and hands. These bumps look like an infection because of the pus, but no bacteria or infectious agents are present. Rarely, pustular psoriasis can spread over the body and cause a life-threatening illness.
- Erythrodermic psoriasis is also life-threatening. It causes itchy, burned-appearing skin. Patients develop fever, chills, a rapid heart rate, and weakness.
- The nails can be affected by psoriasis. Common features are pitted, crumbly nails with red or white spots. Sometimes, the nail separates from the underlying skin.
The Gut's Role in Psoriasis
Research is underway to investigate a healthy gut microbiome's role in preventing or treating psoriasis.
Composition of the Gut Microbiome
The gut microbiome differs between healthy controls and those with psoriatic disease. In fact, patients with psoriasis have a disrupted gut microbiome similar to patients with IBD.
The diversity of the gut microbiome may play a role in the severity of psoriasis. A recent study demonstrated that patients with more severe psoriasis had a less diverse bacterial gut flora than those with mild disease.
Damage to the Gut Barrier
A proper ratio of different species of gut bacteria is necessary to promote a healthy, intact intestinal barrier. When this ratio gets disrupted, the gut can become "leaky," leading to immune stimulation, greater levels of inflammation, and evidence of bacterial DNA in the bloodstream.
Decreased Levels of Short Chain Fatty Acids (SCFAs)
SCFAs, like butyrate, propionate, and acetate, are produced by our gut bacteria. These compounds are essential to maintain an intact gut barrier and regulate inflammation, among many other functions. Certain bacteria, like Faecalibacterium and Akkermansia species, produce SCFAs, and these particular bacteria are reduced in patients with psoriasis.
Functional Medicine Labs to Test for Psoriasis Patients
Food Allergy & Sensitivity Testing
It's good to ensure that food allergies or sensitivities are not promoting inflammation and leading to a "leaky" gut.
The food allergen test by Vibrant America measures IgE antibodies to ninety-six common foods.
Alletess Medical Laboratory has an IgG test that evaluates food sensitivity (not an IgE-mediated allergy) to ninety-six common foods. Patients can use a blood spot or serum sample for this test.
Dysbiosis, SCFAs, & Altered Intestinal Permeability
The comprehensive stool test from Great Plains Laboratory detects gut dysbiosis, inflammatory markers, SCFAs, and markers of immune function. It also provides an assessment of overall intestinal health.
A zonulin maker test can detect a leaky gut. Diagnostic Solutions offers a stool test, while the Cyrex Laboratories Array 2 test uses a blood serum sample.
Assessing your patient's overall inflammatory levels can provide a helpful baseline and direct therapy.
Ferritin, ESR, and CRP are commonly used markers of inflammation.
Nutrients & Vitamins
Vitamin D and omega-3 supplementation have led to improvement in psoriasis symptoms. It's wise to determine a baseline before starting supplementation and monitor levels periodically.
Vitamin D is easily tested from a blood spot or standard blood sample.
Blood tests are used to evaluate omega-3 levels and the omega-6/omega-3 ratio.
A Functional Medicine Approach to Psoriasis
A functional medicine approach includes addressing the root cause of a condition rather than only treating symptoms. In addition to family history and genetic predisposition, root causes of psoriasis may include:
- Gut dysbiosis or leaky gut.
- Nutrient and vitamin deficiencies (like vitamin D).
- A pro-inflammatory diet low in fiber-rich plant foods.
An anti-inflammatory diet, like the Mediterranean diet, may help with psoriasis and, notably, associated conditions like diabetes and heart disease. Patients with psoriasis should avoid inflammatory foods like dairy, refined carbohydrates, gluten, saturated fat, and trans fat.
Studies have generally been favorable in the use of probiotics to treat psoriasis. However, different methodologies between studies and small numbers of robust clinical trials limit the ability to make broad recommendations. In one study, probiotics containing Bifidobacterium longum CECT 7347, B. lactis CECT 8145, and Lactobacillus rhamnosus CECT 8361 were demonstrated to reduce psoriasis severity and lower the risk of relapse.
Herbs and Supplements
Omega-3 supplements containing EPA and DHA show efficacy in improving psoriasis symptoms.
Vitamin D deficiency is associated with psoriasis. A small study demonstrated that high-dose, daily oral vitamin D intake for two to six months was associated with marked improvement of psoriasis in six individuals.
*Note: High-dose vitamin D supplementation should only be undertaken with the guidance and monitoring of a healthcare professional.
Turmeric has anti-inflammatory properties. Curcumin, a component of turmeric, was shown to prevent the production of inflammatory chemicals from cells obtained from patients having psoriatic disease.
Acupuncture is an ancient medical practice with thousands of years of use. A recent systemic review and meta-analysis showed that acupuncture techniques significantly improved psoriasis symptoms.
Infrared (IR) and visible red light therapy may effectively treat psoriasis. A small study evaluated nine patients treated with IR and red light therapy. Treatment sessions were for twenty minutes twice a week and continued for up to five weeks. Skin clearance rates were high, ranging from 60% to 100%.
Ultraviolet (UV) light therapy is also an effective psoriasis treatment and is initially performed under the care of a dermatologist.
Sunlight is an easy way to get UV exposure. It's recommended to use sunscreen (broad spectrum with SPF 15 or higher) and get around twenty to thirty minutes of afternoon sun exposure. Refrain from relying on tanning beds, however. They are not a good substitute for UV light and are associated with skin cancer, including melanoma.
Researchers compared vitamin B12 cream containing avocado oil to a calcipotriol (a vitamin D-based cream effective in treating psoriasis) in thirteen patients with plaque psoriasis. There were no significant differences in psoriasis improvement between the two creams at the end of the twelve-week study. However, the study subjects tolerated the vitamin B12 cream better than calcipotriol. Vitamin B12-avocado oil cream shows promise as a "well-tolerated, long-term topical therapy of psoriasis."
A double-blind placebo-controlled study of sixty patients compared 0.5% aloe vera cream to a placebo to treat chronic mild-to-moderate plaque psoriasis. After four weeks of treatment, the aloe vera cream cleared 82.8% of the psoriatic plaques compared to only 7.7% in the placebo group. The aloe vera treatment had no reported adverse side effects.
Psoriasis is a chronic skin condition affecting millions of adults in the US. The exact cause is unknown, but it is believed to involve genetic and environmental factors. The gut microbiome is increasingly being recognized as playing a role in the development of psoriasis, with imbalances in gut bacteria linked to inflammation and immune system activation.
Diet and functional medicine can support the treatment of psoriasis by addressing the root cause of inflammation and supporting gut health. This approach may involve reducing or eliminating certain foods, incorporating anti-inflammatory foods, and using probiotics to support a healthy gut microbiome. Additionally, functional medicine may include testing for and addressing underlying nutrient deficiencies or imbalances that can contribute to inflammation.