The Analyst™

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  Psoriasis  
 
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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Other conditions that may be present | It can lead to... | It could instead be... | Recommendations

 

Also known as plaque psoriasis, it is defined as a common inflammatory skin condition characterized by frequent episodes of redness, itching, and thick, dry, silvery scales in discrete patches on the skin. It is most commonly seen on the trunk, elbows, knees, scalp, skin folds, or fingernails, but it may affect any or all parts of the skin. When the patches are on the scalp and in body fold areas, the skin is often itchy, but many people with psoriasis do not feel itchy at all. The main problems caused by these patches are by shedding scales and by showing on the skin where they can be seen. Fortunately, psoriasis is unlikely to affect the face, and usually occurs on areas covered by clothes.

Most people with psoriasis find it a burden and a nuisance, but they are not stopped from enjoying life and doing their usual work. However, the condition may involve an important area of the body such as the hands - and this does affect the person's life, and their ability to work with their hands. The cost of caring for psoriasis can be considerable.

What causes Psoriasis?
It appears suddenly or gradually. Age is not a factor, but it commonly starts between 15 to 35 years old. It is characterized by frequent episodes of recurrences and remissions. It may be aggravated by injury or irritation (cuts, burns, rash, insect bites), and it may be severe in immunosuppressed people (such as with chemotherapy for cancer, or with AIDS) or those who have autoimmune disorders such as rheumatoid arthritis.

It is known that the skin in psoriasis patches is growing much quicker than normal skin. In all of us, the epidermis (the outer layer of the skin) grows continuously from its outer surface, and a new layer is reformed each month. In psoriasis, the skin reforms a complete layer each 3-4 days - so that extra skin must shed in scales. This process is similar to healing of the epidermis after an injury - except that normal skin 'knows when to slow down and psoriasis skin does not'. However the actual chemical cause of psoriasis is not known. There have been many scientific experiments performed looking for the cause, but so far changes found seem to result from the rapid growth, and not to cause it.

Sometimes (but not certainly always) psoriasis can run in families, and so it is likely that there are inherited properties causing a "tendency" to the condition. If a person has this tendency, an accident or sudden/severe nervous shock, or some germ infections, can set off the condition and make it appear on the skin.

Medications, viral or bacterial infections, poor digestion, excessive alcohol consumption, obesity, lack of sunlight, overexposure to sunlight (sunburn), stress, general poor health, cold climate, and frequent friction on the skin are associated with flare-ups of psoriasis.

Psoriasis is not infectious in any way. It does not spread on the person who has it by infecting other areas, and it cannot be transferred to other people by any form of contact. Of course this does not stop people worrying about psoriasis if they see it, and fearing that it may infect them.

How severe is it?
The extent and activity of psoriasis varies greatly just as with any other disease. Many people have patches on the scalp or elsewhere, but are not bothered by it and lead normal lives. Others have wider areas of skin involved. Studies in European communities show that about 2% of people are affected. Psoriasis does not cause cancer or affect the blood or the circulation.

Diagnosis
The appearance of the skin rash is enough for a trained doctor to make the diagnosis of psoriasis, without any tests. If there is any problem of general health, blood tests can be performed or X-rays can be taken, but these do not help the diagnosis of the condition itself. A piece of skin can be cut out (biopsy) and sent for pathology testing to be quite sure of the diagnosis.

Treatment
On occasion, especially after a rapid onset, which sometimes occurs in young people, it can settle or disappear. If their skin tans well, people can be free from psoriasis every summer, even though it comes back again in winter.

There are many different conventional treatments, and the correct treatment depends on the activity and extent of the psoriasis, whether the person has fair or dark skin, and whether there are any other exacerbating problems present as well. Minimize flare-ups by avoiding any known aggravating factors.

A list of alternative considerations and treatments should include:
Improving digestive function, improving liver function, improving bowel ecology, alcohol avoidance, fish oil and omega 3 supplementation, fasting, vegetarianism, food allergy elimination diets, sunshine exposure and vitamin D use, a high fiber diet, and stress reduction.
 

 
 

Signs, symptoms & indicators of Psoriasis:
 
 
Symptoms - Head - Eyes/Ocular  Irritated eyes
 Eye burning, itching & discharge are possible indicators of psoriasis.

  Itchy eyes
 Eye burning, itching & discharge are possible indicators of psoriasis.

  Discharges from eyes
 Eye burning, itching & discharge are possible indicators of psoriasis.

Symptoms - Nails

  Blue and/black/ brown fingernails
  Deformed toenails
 Nail abnormalities are a possible symptom of psoriasis.

  Grooves across fingernails
 Nail abnormalities are a possible symptom of psoriasis.

Symptoms - Reproductive - General

  Genital sores
 Genital lesions are a possible symptom of psoriasis in men.

Symptoms - Skin - General

  Cracking skin
 Skin lesions and increased tearing are possible symptoms of psoriasis.

  Itchy skin
 
 

Conditions that suggest Psoriasis:
 
 
Aging  Cataracts / Risk
 Psoriasis can cause cataracts.

  Premature/Signs of Aging
 Psoriasis can cause rapid skin aging.

Autoimmune

  Ankylosing Spondylitis
 Ankylosing spondylitis may be associated with psoriasis.

Symptoms - Skin - Conditions

  Psoriasis
 
 

Risk factors for Psoriasis:
 
 
Digestion  Dyspepsia / Poor Digestion
 Incomplete protein digestion or poor intestinal absorption of protein breakdown products can result in elevated levels of amino acids and polypeptides in the bowel. These are metabolized by bowel bacteria into several toxic compounds. The toxic metabolites of the amino acids arginine and ornithine are known as polyamines (e.g., putrescine, spermidine, and cadaverine) and have been shown to be increased in individuals with psoriasis. Polyamines contribute to the excessive rate of cell proliferation. Lowered skin and urinary levels of polyamines are associated with clinical improvement in psoriasis, so digestive function should be evaluated.

Environment / Toxicity

  Cigarette Smoke Damage
 Another disease can be added to the list of smoking-related disorders - psoriasis. Researchers have found that smoking increases the risk of developing psoriasis, heavier smoking increases the risk further, and the risk decreases only slowly after quitting. Investigators from the Massachusetts General Hospital, Brigham and Women's Hospital, the Harvard School of Public Health, all in Boston, USA, and Vancouver General Hospital, Vancouver, BC, Canada, have published the results in the November 2007 issue of The American Journal of Medicine.

Infections

  Yeast / Candida
 A number of gut-derived toxins are implicated in the development of psoriasis including endotoxins (cell wall components of gram-negative bacteria), streptococcal products, Candida albicans, yeast compounds, and IgE or IgA immune complexes. These compounds increase the rate of skin cell proliferation dramatically. Candida albicans overgrowth in the intestines (chronic candidiasis) may play a major role in many cases.

  Dysbiosis, Bacterial
  Mycoplasma Infection

Mental

  Stress
 Stress (physical, emotional and psychological) can be a trigger for psoriasis. Stress can be an initiating condition, or for worsening of existing lesions. Just the fact of having psoriasis is, in itself, psychologically and emotionally stressful.

Organ Health

  Liver Detoxification / Support Requirement
 Correcting abnormal liver function is of great benefit in the treatment of psoriasis. The connection between the liver and psoriasis relates to one of the liver's basic tasks (filtering and detoxifying the blood). Psoriasis has been linked to the presence of several microbial byproducts in the blood. If the liver is overwhelmed by excessive levels of these toxins in the bowel, or if there is a decrease in the liver's detoxification ability, the toxin level in the blood will increase and the psoriasis will get worse.

Symptoms - Nails

  History of deformed toenails
 Nail abnormalities are a possible symptom of psoriasis.

Symptoms - Skin - Conditions

Counter-indicators:
  Absence of psoriasis
 
 

Psoriasis suggests the following may be present:
 
 
Allergy  Allergy / Intolerance to Foods (Hidden)
 Psoriasis patients have benefited from gluten-free and elimination diets.

Digestion

  Dyspepsia / Poor Digestion
 Incomplete protein digestion or poor intestinal absorption of protein breakdown products can result in elevated levels of amino acids and polypeptides in the bowel. These are metabolized by bowel bacteria into several toxic compounds. The toxic metabolites of the amino acids arginine and ornithine are known as polyamines (e.g., putrescine, spermidine, and cadaverine) and have been shown to be increased in individuals with psoriasis. Polyamines contribute to the excessive rate of cell proliferation. Lowered skin and urinary levels of polyamines are associated with clinical improvement in psoriasis, so digestive function should be evaluated.

Infections

  Dysbiosis, Bacterial
  Mycoplasma Infection

Inflammation

  Psoriatic Arthritis
 About one person in 10 suffering from psoriasis can get joint troubles, with a degree of arthritis affecting the back, or large or small joints of the body. This arthritis is rare, but worth looking into if you have psoriasis and an aching spine or joints. Patients who have inflammatory arthritis and psoriasis are diagnosed as having psoriatic arthritis.

Nutrients

  Zinc Requirement
  EFA (Essential Fatty Acid) Type 3 Requirement

Organ Health

  Liver Detoxification / Support Requirement
 Correcting abnormal liver function is of great benefit in the treatment of psoriasis. The connection between the liver and psoriasis relates to one of the liver's basic tasks (filtering and detoxifying the blood). Psoriasis has been linked to the presence of several microbial byproducts in the blood. If the liver is overwhelmed by excessive levels of these toxins in the bowel, or if there is a decrease in the liver's detoxification ability, the toxin level in the blood will increase and the psoriasis will get worse.
 
 

Psoriasis can lead to:
 
 
Skin-Hair-Nails  Concern Over Wrinkled Skin
 Psoriasis can cause rapid skin aging.

  Pruritus Ani
 
 

Psoriasis could instead be:
 
 
Skin-Hair-Nails  Dandruff
 Psoriasis is an inflammatory skin disease in which skin cells replicate at a rapid rate. Although the symptoms of psoriasis - silvery scales covering reddened areas of the scalp - appear similar to dandruff, psoriasis is very different. New skin cells are
produced about 10 times faster than normal, but the rate at which old cells are shed is unchanged. Live cells then accumulate and form the thick patches covered with flaking skin.
 
 

Recommendations for Psoriasis:
 
 
Animal-based  Urine Therapy
  Thymic Factors
 Through his clinical experiences with thymic supplementation, Dr. Burgstiner said he observed 12 cases of psoriasis that were completely cured.

Botanical

  Cayenne Pepper (Capsicum frutescens)
 In a double blind study, application of a capsaicin cream to the skin helped relieve both the itching and the skin lesions in people with psoriasis.

  Glycolic Acid
  Neem
 Sheryll Zenganeh, the publisher of "Empress Press", a national newsletter for people with psoriasis and other serious skin conditions, has promoted the effectiveness of Neem. Sheryll suffered from psoriasis for seventeen years before she came in contact with neem. She stated in her newsletter that "today, thanks to the Neem tree and the products from NeemAura Naturals, my psoriasis is virtually gone and I now has soft, supple, youthful, gorgeous skin."

In clinical studies, neem extracts and oil were found to be as effective as coal tar and cortisone in treating psoriasis. However, there were none of the usual side effects accompanying the use of neem as there were with Coal tar and cortisone. When applied to the skin, Neem extracts and oil removed the redness and itching while improving the condition of the skin for the duration of the treatment.

Chemical

  Glycerin / Glycerol

Diet

  Therapeutic Fasting
  Weight Loss
 Being overweight can make psoriasis more likely. During WWII, people who were on protein-deficient, calorie-deficient diets lost their psoriasis, which they regained when they went back on a normal diet. You can starve the psoriasis before you yourself suffer from starvation.

  Low Fat Diet
 A "moderate" diet is best in coping with psoriasis, without an excess of rich, fatty, starchy or spicy foods, or alcohol.

  Alcohol Avoidance
 A "moderate" diet is best in coping with psoriasis, without an excess of rich, fatty, starchy or spicy foods, or alcohol.

  High/Increased Fiber Diet
  Vegetarian/Vegan Diet
  Spicy Foods Avoidance
 A "moderate" diet is best in coping with psoriasis, without an excess of rich, fatty, starchy or spicy foods, or alcohol.

Drug

  LDN - Low Dose Naltrexone
 One party reported: "Although the response to low-dose naltrexone (LDN) may sometimes be slower in psoriasis than some other auto-immune conditions, it is effective in the long-term and, once the response is firmly established, it will remain stable as long as the treatment is continued.".

  Conventional Drugs / Information
 Apollo Pharmaceutical Inc., recognizing the need for improved dermatological treatments, has taken a natural plant source and, through rigorous scientific development, produced Relieva, our first new medication for the effective treatment of plaque psoriasis. Relieva has shown its efficacy and excellent tolerability a 200 patient Double Blinded Placebo Controlled Study recently published in the American Journal of Therapeutics (13, 121-126, 2006)

Through a long line of firsts in the biotechnology industry, the history of REMICADE includes 15 FDA indications spanning across inflammatory diseases that include Crohn's disease (adult and pediatric), ulcerative colitis, rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis and psoriasis. (2007)

Habits

  Sunlight / Light Exposure
 Summer sun is the best source of ultra-violet light, and many people find psoriasis settles very well in summer. Treatment in winter can be aided by artificial lamps: smaller lamps are usually not strong enough, but impulse type lamps, wall mounted "fluorescent lamp type" lamps, and larger "solarium" lamps are suitable. Unfortunately, some psoriasis sufferers are rather sensitive to sun light, and may not be improved with this treatment.

It is usually best to apply a tar or drithanol preparation daily, to be followed later by ultra-violet light treatment.

  Personal Hygiene Changes
 Please see the description of a new soap being used to treat facial skin problems under "Personal Hygiene Changes".

Homeopathy

  Homeopathic Remedies / Vaccines
 Tulsa Dermatologist Steven A. Smith, M.D. has successfully treated over 1,500 patients with Loma Psoriasis (nickel/ bromide/zinc), or Loma Lux Psoriasis, a non-prescription oral homeopathic-like medication. He reports 80% received some degree of noticeable improvement. Many have marked clearing - even in some of the more difficult cases.

As labeling and product changes occur, you should go tohis website and see the latest information, including the story of how he discovered this approach.

Mineral

  Zinc
 Conventional systemic treatments for psoriasis have significant side effect considerations. Consequently, any effective and safe topical agent is a welcomed addition to the therapeutic armamentarium.

The effectiveness of zinc pyrithione topically to treat seborrheic dermatitis and psoriasis has been well documented. The mechanism of action of zinc pyrithione on psoriasis and seborrheic dermatitis has been reported to be anti-proliferative via "DNA interactions", anti-yeast, antiseptic, and keratinolytic mechanisms.

A report describes the use of a preparation containing zinc pyrithione (0.25% - which is also recognized as the active ingredient in a major anti-dandruff shampoo) in a vehicle containing isopropyl myristate to treat a case of psoriasis. Solution was sprayed on one elbow, but not the other, twice daily for 3 weeks. Itching disappeared in 3 days and there was obvious improvement at 3 weeks. [Dermatology Online Journal: 3(1) : 3]

There are OTC preparations available containing zinc pyrithione, sometimes referred to as zinc omadine, such as Skin Cure.

  Boron
  Crude Coal Tar
 It has been known for a long time that coal tar (2-5%) helps psoriasis and it is available as crude coal tar coal, tar lotion, and in refined forms incorporated into ready made creams, lotions and shampoos. In general, the more messy and smelly the tar preparation is, the better it is likely to work - so please be prepared to persevere with it.

A chemical similar to those found in tar may be used on its own - known as Dithranol or Anthralin. This must be used cautiously as it can irritate, but a strength and base can usually be found to suit and help the individual person's psoriasis. Tar treatments can lead to steady and effective control. It is usually best to apply a tar or drithanol preparation daily, to be followed later by ultra-violet light treatment.

  Colloidal Silver

Nutrient

  EPA (eicosapentanoic acid)
 Several double-blind clinical studies have demonstrated that supplementing the diet with 10 to 12gm of EPA results in significant improvement. This would be equivalent to the amount of EPA in about 150gm of mackerel or herring. It must be kept in mind that the presence of DHA in fish oil may reduce the effectiveness of the EPA. A high EPA fish oil is recommended.

  TMG (Tri-methyl-glycine) / SAMe

Oxygen / Oxidative Therapies

  Ozone / Oxidative Therapy
 There have been a few reports of psoriasis improvement with the use of ozonated oil applied topically. Further evidence to support this claim could not be found.

Vitamins

  Vitamin Folic Acid
 A small study demonstrated that 20mg folic acid given 4 times a day over a 3-6 month course produced marked improvements in patients with long standing psoriasis. Two additional patients experienced worsening of the condition with folic acid use, but they had at some time in the past been treated with methotrexate. Previous methotrexate exposure may make some, but not all, cases of psoriasis worse when being treated with high doses of folic acid. [Cutis 1977;20: pp.39-41]

  Vitamin D
 Vitamin D has been recognised for many years to improve some of the important abnormalities present in psoriasis skin, but ingestion of even only slightly above the daily recommended amount of Vitamin D can lead to problems with calcium metabolism in the body (possible kidney stones and irregular heart beats).

For this reason calcipotriol, a synthetic form of vitamin D, is used instead in ointment form. Calcipotriol has been found to also have the ability to improve psoriasis, but with minimum effects on internal calcium metabolism. It is available in a very greasy, ointment base for twice daily application. There is a risk of facial dermatitis if the ointment is used on the face or neck, so application is only recommended for the trunk and limbs, and it is important that the hands are thoroughly washed after application to avoid inadvertent transfer to the skin of the face. Comparative studies have shown that calcipotriol ointment is at least as effective as topical cortisones and dithranol in the treatment of stable plaque psoriasis.
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Very strongly or absolutely counter-indicative
May do some good
Likely to help







GLOSSARY

AIDS:  Acquired Immune Deficiency Syndrome. An immune system deficiency disorder that suddenly alters the body's ability to defend itself. The AIDS virus invades the T4 helper/inducer lymphocytes and multiplies, causing a breakdown in the body's immune system, eventually leading to overwhelming infection and/or cancer, with ultimate death.

Allergy:  Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.

Arginine:  A nonessential amino acid but may be essential for individuals with certain diseases or nutritional concerns. May promote the release of growth hormone. Involved in creatine synthesis, a compound that stores energy in muscle. Helps to remove ammonia from the body as part of the urea cycle.

Arthritis:  Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.

Autoimmune Disease:  One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.

Bacteria:  Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.

Biopsy:  Excision of tissue from a living being for diagnosis.

Cancer:  Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

Candidiasis:  Infection of the skin or mucous membrane with any species of candida, usually Candida albicans. The infection is usually localized to the skin, nails, mouth, vagina, bronchi, or lungs, but may invade the bloodstream. It is a common inhabitant of the GI tract, only becoming a problem when it multiplies excessively and invades local tissues. Growth is encouraged by a weakened immune system, as in AIDS, or with the prolonged administration of antibiotics. Vaginal symptoms include itching in the genital area, pain when urinating, and a thick odorless vaginal discharge.

Cataract:  A steadily worsening disease of the eye in which the lens becomes cloudy as a result of the precipitation of proteins. Most cataracts are caused by the functions of the body breaking down. Eye trauma, such as from a puncture wound, may also result in cataracts.

Chemotherapy:  A treatment of disease by any chemicals. Used most often to refer to the chemical treatments used to combat cancer cells.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Epidermis:  The outer layers of the skin, made up of an outer, dead portion and a deeper, living portion. Epidermal cells gradually move outward to the skin surface, changing as they go, until they become flakes.

IgA:  Immunoglobulin A. Supports mucosal immunity.

Metabolite:  Any product (foodstuff, intermediate, waste product) of metabolism.

Ornithine:  A nonessential amino acid but may be essential for individuals with certain diseases or nutritional concerns. Manufactured from arginine and functions similarly to arginine, it stimulates the human growth hormone and is made by the digestion of proteins and some compounds made from arginine. The major difference between the two is that ornithine enters cell mitochondria. Arginine does not.

Protein:  Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.

Psoriasis:  An inherited skin disorder in which there are red patches with thick, dry silvery scales. It is caused by the body making too-many skin cells. Sores may be anywhere on the body but are more common on the arms, scalp, ears, and the pubic area. A swelling of small joints may go along with the skin disease.

Rheumatoid Arthritis:  A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).

Spondylitis:  Inflammation of one or more vertebrae.

Vitamin D:  A fat-soluble vitamin essential to one's health. Regulates the amount of calcium and phosphorus in the blood by improving their absorption and utilization. Necessary for normal growth and formation of bones and teeth. For Vitamin D only, 1mcg translates to 40 IU.

Yeast:  A single-cell organism that may cause infection in the mouth, vagina, gastrointestinal tract, and any or all bodily parts. Common yeast infections include candidiasis and thrush.