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Psoriasis

What is psoriasis?

Most of us make and replace our skin cells every three to four weeks, but if we have psoriasis, we do so every three to seven days. This rapid overproduction of skin cells leads to the build-up of darker patches forming on darker skin tones and red, flaky, crusty patches developing on Caucasian skin caused by the extra blood flowing to the skin to keep up with skin cell growth.`

These patches are often overlain with silvery scales and can spring up on any part of our body, including our hands and feet, in the creases of our elbows and knees as well for example, on our scalp and fingernails.

These patches are often overlain with silvery scales and can spring up on any part of our body, including our hands and feet, in the creases of our elbows and knees as well for example, on our scalp and fingernails.

What causes psoriasis?

Scientists believe the rapid skin cell growth in psoriasis begins when our immune systems, particularly our so-called ‘T cells’, start working overtime. Normally T-cells spring into action in response to say a cut, producing inflammatory chemicals that lead the skin to grow rapidly to help it heal. In psoriasis however, experts say T-cells are flicked into periods of being regularly ‘on’ even when there is not a wound to heal.
This they say, may account for the rapid growth of excess skin cells leading to the dark or red scaly patches. It is thought that this over-activity of T-cells may be triggered by stress or anxiety, hormonal changes or even certain infections or medications.

Who tends to be affected?

Usually starting before the age of 35 or in our mid-50’s, psoriasis affects around 2 per cent of the population in the UK and occurs in both women and men equally. There are different forms including plaque psoriasis, which is the most common and involves the itchy plaques described.
In addition, ‘guttate’ psoriasis, which looks like a rash of small spots, most often occurs in children, teenagers and young adults, while pustular psoriasis leads to small fluid-filled pustules, which form on top of the itchy patches. Scalp psoriasis, as the name suggests, appears on our scalp and although similar to plaque psoriasis, may cause dandruff-like flakes. Nail psoriasis meanwhile affects the nail and, in some people, psoriatic arthritis can also occur.  

How is psoriasis treated?

General practioners’ are the first port of call when it comes to both diagnosis and treatment for psoriasis, which usually begins with emollients such as creams, ointments and gels, which contain a range of active ingredients, which may include steroids.
In addition, moisturisers, which you can buy without a prescription, can help make skin more comfortable by reducing dryness, scaling, cracking and soreness and itching. Ingredients such as extracts of neem have been used for centuries in traditional medicine to treat inflammation and skin diseases while lavender essential oils are long associated with helping to relieve stress and anxiety by calming the nervous system.
Medical herbalists and increasingly, the mainstream scientific world acknowledge and appreciate the anti-inflammatory and healing properties of rosemary, rosehip and sage and the antioxidant properties of carrot and vitamin E. The latter has been used for more than 50 years in dermatology and is used in natural treatments for psoriasis, with proven beneficial effects.  
GP’s can refer us on to a specialist dermatologist for further treatments and these can include taking steroids and for example, ultra-violet radiation.
Although for some, psoriasis can be quite mild and episodes short, for others, symptoms can be severe and last for months or more at a time. This, understandably, can affect self-confidence and self-esteem and be a source of stress, anxiety, low moods and in some cases, depression. In other words, psoriasis is more than a ‘skin condition’ and when treating, it is important to follow doctors’ advice as well as thinking about our health and wellbeing from a holistic point of view, including nutrition, which appears to play a role in helping to manage the condition.

Body weight

When, over time, we accumulate stores of fat, it can be easy to think simply in terms of how this makes us look and feel. It can be helpful however to focus instead on what they are ‘doing’ inside our bodies. One effect of fat stores for example, is that they spark a low level of inflammation by churning out inflammatory chemicals into our blood.
If we are already experiencing inflammation caused by T-cells working over-time in our skin, the inflammatory response from our fat cells adds to this burden. This may help to explain why carrying extra body weight is both a risk factor for developing psoriasis, aggravating existing psoriasis and why weight reduction may improve the severity of psoriasis.
Rather than focussing on the way extra weight is making us look and feel, thinking about how reducing it may help our body to deal better with psoriasis is perhaps a more positive starting point for a positive weight loss journey.

Omega 3 Good Fats
Omega 3 ‘good’ fats found in fish like salmon and mackerel, herrings and sardines, are natural anti-inflammatories. This could explain why people with psoriasis have been reported to have lower intakes of omega 3’s. Trying to include a portion of oily fish each week or having plankton-based omega 3 or fish oil supplements daily, is another way to reap their anti-inflammatory benefits.  

Wholegrains
Opting for wholegrain versions of bread, breakfast cereals, pasta, wraps and pitta will help to boost your fibre intakes, as will tucking into plenty of vegetables and some fruit each day. This is important because the fibre in these plant foods feed beneficial bacteria in our colon.
In an extraordinary chain-reaction, after feasting on this fibre, these bacteria produce compounds called ‘short chain fatty acids’, that are absorbed into our blood from the colon and travel to other organs around our bodies, including our skin, where, scientists say, they have the ability to tone down over-active T cells.
It is through this complex but wonderful path that eating, for example, some porridge or a natural muesli at breakfast, some fruit mid-morning, a wholegrain wrap and salad at lunchtime and some wholegrain pasta or quinoa for example with lots of vegetables at dinner, could end up helping our bodies to dampen down the scratching and itching effects of psoriasis in our skin.  

Probiotics
As well as feeding the beneficial bacteria already present in our gut by eating a diet rich in fibre, we can also directly eat and drink ‘good’ bacteria known as ‘probiotics’ in foods and supplements and doing so, may also help our skin health. Again, it seems incredible, but some probiotics like Lactobacillus and Bifidobacterium added to yoghurts and in found in some supplements, appear to help reduce inflammation in our skin, again, probably by affecting our immune system T-cells.

Vitamin D
We make vitamin D when summer sun shines on our skin and it is found too in some limited foods such as oily fish like mackerel and to a small extent in eggs. Interestingly, levels of this vitamin have been found to be lower in people with psoriasis, possibly, say experts, because it plays a role in controlling inflammation in our bodies. This may help to explain why creams containing vitamin D seem to help improve symptoms when rubbed into psoriasis affected skin and why sunbed treatment prescribed by dermatologists, which stimulates vitamin D production in the skin, also helps symptoms.  

Selenium
This mineral is found in eggs and fish, chicken and wholegrains and is vital for our bodies to make enzymes that control inflammation. In the UK, average intakes of selenium do not reach the recommended levels and in studies, people with psoriasis have been found to have lower levels in their blood. An easy way to top up with selenium is to eat around three to four Brazil nuts a day. Including fish and wholegrains also helps or you may want to try a supplement that provides around 40 micrograms of selenium daily.

What to avoid

While some foods seem to help certain aspects of psoriasis, others appear to be less helpful because they trigger inflammation. Researchers point particularly to alcohol triggering or making symptoms of psoriasis worse. They also suggest that saturated fats found in fatty cuts of red meat, cheese, butter, cream, biscuits, cakes and puddings also increase inflammation in our bodies. These foods are often rich too in sugar, and many are high in calories and easy to overconsume, which can lead to weight gain, which itself increases inflammation.

Herbal Help

Although clinical scientific studies to prove the effectiveness of herbal remedies are not in large supply, we know from records of traditional medicine that herbs and herbal extracts have been used for hundreds if not thousands of years to treat skin conditions, including psoriasis.  
Some, herbal extracts, like that from the plant Azadirachta Indica, more usually known   of as ‘neem’, have the potential to reduce inflammation. Experts have identified many active plant nutrients in this herb, including one, of particular interest, which is called ‘nimbidin’.  
Neem extracts can be included in cream preparations and can be taken in pill form. In one 12-week study involving 50 people with psoriasis, those taking part were not aware if they were taking the active or placebo pill. Scientists discovered participants who were taking the neem extracts showed marked improvements in their symptoms of psoriasis compared with the placebo group, when taken alongside their usual topical tar treatments applied to the skin.

‘Clinical studies have shown that in cases of psoriasis neem can reduce inflammation and help heal the skin. You can use it internally or apply it externally as a cream (twice a day, combines with lyceum cream if possible)’.
Margo Marrone

Other herbs like ‘Oregon grape’ (Mahonia aquifolium), appear to slow down skin growth, which can help with symptoms of psoriasis while Qing dai (Indigo naturalis), a Chinese herb has shown proven anti-inflammatory effects that benefit psoriasis symptoms.  

Written by:  
Amanda Ursell
BSc Nutrition
Registered Nutritionist AFN
PG Dip Dietetics,  
Associateship King's College (AKC)

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