The Collison Newsletter July 2010

  

PSORIASIS - A Non-Drug Approach to Management*  

  

Psoriasis is a chronic, non-contagious autoimmune disease that affects the skin and joints. Typically, there are red, scaly patches on the skin, often called plaques. These represent areas of inflammation with excessive skin production. Skin accumulates at these sites and thus gives a silvery-white appearance, especially when rubbed or scratched. Plaques frequently occur on the elbows and knees, but can be found anywhere on the skin. Fingernails and toenails and joints may also be affected.

 

The cause of psoriasis is not known. It is most likely an autoimmune disorder, and just why the body becomes allergic to itself is unknown. Stress is often a factor and there may be a genetic component.

Clinical Types / Classification 

There are several classifications of psoriasis, and the following is a brief clinical overview.

·       Plaque psoriasis or psoriasis vulgaris. This is the most common form, affecting up to 90% of people with psoriasis. The plaques are raised areas of inflamed skin covered with silvery white scaly skin.

·       Pustular psoriasis. In this form there are raised areas that are filled with non-infectious (sterile) pus (pustules). The surrounding skin, and that under the lesion, is red and tender. It can be localised or generalised.

·       Flexural psoriasis or inverse psoriasis. This form appears as smooth inflamed patches of skin, especially in the skin folds, particularly around the genitals, the armpits, under pendulous breasts and under an overweight stomach. It is aggravated by friction and sweat, and is prone to fungal infections.

·       Guttate psoriasis. This is characterised by numerous small round spots which appear over large areas of the body and generally occurs after a streptococcal infection.

·       Nail psoriasis. This causes the following changes to occur in the nails: discolouring under the nail plate, pitting of the nails, horizontal lines on the nails, thickening of the skin under the nails and loosening and crumbling of the nail. (See my November 2009 newsletter Nails as Signs of Health Problems).

·       Psoriatic arthritis. This results in joint and surrounding tissue inflammation. It can affect any joint but is most common in the joints of the fingers and toes. Psoriatic arthritis can also affect the hips, knees and spine. Up to 15% of people with psoriasis suffer from this form of arthritis.

·       Erythrodermic psoriasis. This is rare and involves widespread inflammation and exfoliation of the skin over most of the body, generally accompanied by severe itching, swelling and pain. It can be fatal.

Diagnosis 

A diagnosis of psoriasis is usually based on the appearance of the skin. There are no special blood tests or diagnostic procedures. A skin biopsy, or scrapings, may be needed to exclude or rule out other possible diagnoses and to confirm the diagnosis.

 

It is graded as mild when less than 3% of the body is affected, moderate when 3-10% of the body is affected, and severe when more than 10% of the body is involved. In extreme cases, almost the whole of the skin can be covered by the psoriasis.

 

Psoriasis occurs more commonly in dry skin than oily skin or well-moisturised skin, and especially after an external skin injury such as a scratch or cut.

Treatment 

The orthodox approach generally involves a variety of drugs, and briefly is as follows:

·       Topical treatments

As a first step, medicated ointments or creams are applied to the skin. These will help reduce inflammation, remove the build-up of scale, and clear the affected skin of plaques. There are many different medications in the various ointments and creams and these include coal tar, dithranol, various corticosteroids, vitamin D3 analogues and retinoid. The mechanism of each is different, but they all help to normalise skin cell production and reduce inflammation.

·       Phototherapy

If topical treatment fails to achieve the desired goal then the next step would be to expose the skin to ultraviolet (UV) radiation. This is why sunlight exposure is so beneficial in the management of psoriasis and is the best way to gain exposure to UV radiation.

·       Systemic treatment

This third step involves the use of medications that are taken internally, either orally or by injection. These include corticosteroids and drugs such as the antimetabolite (anticancer or chemotherapy) methotrexate and the immunomodifier cyclosporine, both being immunosuppressant drugs and retinoids, synthetic forms of vitamin A.

 

Needless to say, going from topical treatments to systemic treatment is going from least to most toxicity. Systemic treatment must be reserved for the most severe and resistant cases.

 COMPLEMENTARY THERAPIES

1)      Diet 

It is clear that what we eat has a tremendous impact on our overall health.

 

A healthy diet is essential for health and the importance of alkali-forming foods has been set out in detail in my September 2005 newsletter Acid / Alkaline Balance – The Ideal Diet. Another guideline to the correct diet is my March 2009 newsletter Foods for Health.

 

The Essential Omega-3 fatty acids may be beneficial in the management of psoriasis. Another study has shown that there is an inverse association between psoriasis and the intake of carrots, tomatoes and fresh fruit.

 

If anti-gliadin antibodies (reflecting gluten sensitivity) are present, a gluten-free diet would be worthwhile trying. There are more people with psoriasis who have anti-gliadin antibodies than the general population.

 

The possibility of food intolerance being a contributory factor in psoriasis, especially in severe and chronic cases, should be considered. Once identified, the food(s) to which there is an intolerance should be excluded from the diet. How to identify food intolerance is described in detail in my book How to Stop Feeling So Awful (see home page).

2)      Exercise 

Eating well is not the only way to boost overall health. Physical activity is also important. Engage in, and commit to, a regular exercise program. Built into this should also be a plan to achieve ideal weight, the Body Mass Index (BMI) should ideally be in the region of 21.

3)      Dietary Supplements 

A dietary supplement is a product taken by mouth that contains a dietary ingredient that is intended to supplement the diet. These products include vitamins, minerals, herbs or other botanicals, amino acids and substances such as enzymes.

 

A variety of supplements have been used to control psoriasis. Many of these are unproven, but individual case reports suggest benefit.

 

Apart from the vitamin supplements as recommended in my book (see homepage) How to Live to 100+ Years Free from Symptoms and Disease (pages 97-102), the following have shown promise in the management of psoriasis:

·       Vitamin A and Zinc (both essential for skin health)

·       Vitamin E

·       Selenium

·       Evening primrose oil

·       Milk thistle

·       Oregano oil

·       Grape seed extract

4)      Sunlight 

Sunlight is very beneficial for psoriasis. The importance of sunlight is set out in my November 2007 newsletter Sunlight and Health.

5)      Detoxification

Detoxification can help get the cumulated toxins from the body (see my June 2009 newsletter Detoxification).

6)      Autoimmune Protocol 

Psoriasis is considered to be an autoimmune disorder. Appropriate care of the immune system is therefore relevant in the management of psoriasis. This has been set out in my October 2008 newsletter Autoimmune Protocol.

7)      Stress Management 

There is a correlation between stress and psoriasis and especially psoriatic arthritis. Hence some form of stress management, including activities that help to reduce stress, is an important part of the treatment of psoriasis. These can include Cognitive Behaviour Therapy, supportive counselling (see my August 2006 newsletter Supportive Counselling), hypnotherapy, meditation, yoga, relaxation techniques and, as indicated above, regular exercise.

 

Positive thinking is also essential. See my December 2009 newsletter Positive Thinking for the New Decade.

 

Dealing with the symptoms of, and treatments for, psoriasis can put your mind and body under stress, and the disease may be getting worse as a result. It is okay to be angry, sad and frustrated and to show your ‘pain’ to others. Psoriasis is an unfortunate reality, but it is important that it does not take control of your emotions.

 

There is a term linked to this: ‘The Heartbreak of Psoriasis’. This is used to describe the emotional impact of the disease, the effect of having a chronic uncomfortable disorder and the social effects of being self conscious of one’s appearance.

 

Stress management is essential.

8)      Prevention of Dry Skin 

Psoriasis is more likely to occur in people who have dry skin than in those with an oily or well-moisturised skin. To prevent dry skin and reduce psoriatic symptoms, do not use shower scrubs, as they not only damage skin by leaving tiny scratches, they also scrape off the naturally-occurring skin oil. Moisturizers can be applied to moisturize the skin, and lotions used to promote skin oil gland functions.

9)      Other Helpful Therapies 

Herbal shampoos can help scalp psoriasis.

 

Climatotherapy involves the notion that some diseases can be successfully treated by living in a particular climate. The Dead Sea is one of the most popular locations for this type of treatment, in particular for the treatment of psoriasis. Dead Sea salts are available commercially, and these may be added to bath water to help the skin to heal. Another location is the Blue Lagoon in Iceland, near Reykjavik, a geothermal spa at 39°Celcius. It contains pure minerals, algae (of a healthy sort) and silica, and is recommended for the treatment of psoriasis.

Conclusion 

Psoriasis is a lifelong condition. Once it has developed, it is likely that flare-ups will continue throughout life. Although there is currently no cure, various treatments can help to control the symptoms, and may reduce the expression to virtually zero.

 

A combination of the various orthodox and alternate types of treatments, as set out above, can generally give good control. If at all possible, systemic treatments should be avoided except in severe and resistant cases. Patients undergoing systemic treatment should have regular blood and liver function tests because of the toxicity of the medications.

 

As already mentioned above, stress management is essential, and this author has found excellent results using hypnotherapy. Supportive counselling is also useful to help the coping process.

 

Take control of your life now and do not let your psoriasis win.

  

*Copyright 2010: The Huntly Centre.

Disclaimer: All material in the Huntlycentre.com.au website is provided for informational or educational purposes only. Consult a health professional regarding the applicability of any opinions or recommendations expressed herein, with respect to your symptoms or medical condition.

     

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