Of all of the skin problems people experience, psoriasis can be one of the most frustrating. It often starts with a terrible itchy scalp that keeps you awake nights…you try many skin products, only to find it can come right back with a vengeance. What starts out as being very itchy, turns into red bumps, then larger thicker ‘plaques’ of it, often with a white silvery scale. Needless to say, it can be quite embarrassing at work when you get an uncontrollable itch, or in public when you go swimming and people wonder if the red patches on your knees and elbows are contagious (it’s not). It is especially hard on kids at school where they can be teased about it. In this article I will discuss a few new ways of understanding the problem and its causes, and some fundamental and effective naturopathic treatment strategies.
Skin Cell Growth
In normal skin, there is a balance of skin cells that form and skin cells that die – it takes about 28 days for skin cells to fully form. However, when the skin is damaged, there are more skin cells formed, which also draws more blood into the area causing redness and swelling (inflammation). Similarly, in psoriasis, this process also occurs, although the process of skin cell development is accelerated to take only 4 days, with thirty times more new skin cells. What causes this rapid piling up of skin cells in people with psoriasis?
Triggers and Causes of Psoriasis
About one-third of people with psoriasis have other family members with it as well. Despite the genetic predisposition, there must be a specific trigger to start the process. Recent research has found that the problem is not in the skin cells themselves, but is a reaction of the immune system. Some of the immune-related triggers of psoriasis include any infection, such as from strep throat, viruses, or yeast; physical injury (even a cut or scrape); pregnancy; an emotional crisis or stress; and medications (eg: lithium, blood pressure drugs). From a naturopathic perspective, we also know that our immunity is dramatically affected by nutritional deficiencies, a liver overwhelmed with toxins, and by what is happening in the digestive tract – with psoriasis what happens on the inside can have profound effects to the outside. Other factors that are associated with psoriasis include obesity, type 2 diabetes, alcohol consumption, smoking, and excessive animal fats in the diet. Most underlying factors tend to fall in four categories – nutrition, toxicity, digestion, and stress & lifestyle. In my experience, these are the basic components to address in all patients with psoriasis.
The conventional treatment of the most common forms of psoriasis include topical skin treatments like coal tar, corticosteroids, synthetic vitamin A and D ointments, and ultraviolet phototherapy. For moderate to severe cases, immunosuppressive medications may be used such as methotrexate or cyclosporine. Newer ‘biological agents’ have been developed that block specific parts of the immune system. Most of these treatments have significant adverse effects, and can be costly, it’s no wonder that more psoriasis sufferers are looking to natural solutions.
Basic Naturopathic Treatment
From the naturopathic perspective, some of the important basics to ensure positive results are to improve the diet, detoxify, improve digestive health, and balance stress. Note that topical treatment can help, but full resolution will only come from the inside out. From the dietary perspective, it is fundamental to eliminate the foods that trigger the immune system. I recommend doing an elimination diet where suspect foods are cut out for 3 weeks to see if symptoms improve – common culprits are wheat, dairy, eggs, and soy. An alternative to this is a blood test checking for immune system antibodies to common foods. It is interesting to note that 16% of psoriasis sufferers have an immune reaction to the gluten protein found in grains (wheat, barley, kamut, spelt, oats, rye, triticale). For these people, eliminating gluten in the diet usually solves the psoriasis, amazing!
We are all biochemically unique, with slightly different nutritional needs. Some common nutritional deficiencies amongst people with psoriasis include vitamins A, D, E, B12 and folic acid; selenium, zinc, and omega-3 fats. Patients with widespread psoriasis were found to have very low levels of vitamin D. Vitamin D is not just for strong bones; it also helps control cell replication in the skin and even has antimicrobial effects there too. It’s no wonder that there are much fewer cases of psoriasis in the tropics, where lots of sun allows the body to produce its own vitamin D. For us Canadians, I usually recommend 2000 I.U. of supplemental vitamin D3 per day, and more based on blood tests. I often recommend the use of ultraviolet-B light (UVB) to encourage the body’s own production of vitamin D, and to generate healing effects from this light that we get so little of in Canada. I have also found that vitamin B12 injections have been helpful for my patients with psoriasis since it has immune antibody regulating benefits. Another essential nutrient for psoriasis patients is omega-3 fat. These are the ‘good fats’ and they help strengthen cell membranes and regulate immune functions. Numerous studies have shown the benefit of fish oils in helping reduce the skin thickness, itching, redness, and scaling of psoriasis. I recommend 5-10grams of fish or flax oil per day, or 3-5 servings of cold water fish each week.
Toxicity of various sorts can overwhelm the body – clogging up the liver and slowing down its detoxification processes. Ultimately, if the liver is backed up, then unprocessed toxins spill into the circulation, affecting the immune balance in the skin. Signs of toxicity include headaches, fatigue, aches, digestive problems, skin rashes, allergy symptoms, and being uncomfortable with scents such as perfumes and cleaning chemicals. Also realize that when we do not exercise regularly, we allow these toxins to just sit around, increasing the chance of triggering the skin’s immune cells. Simple approaches to detoxification include an organic diet, 4-6 glasses of water and 25-35grams of fiber per day, and using liver-assisting herbs and spices such as milk thistle, dandelion, burdock, and turmeric. In regards to promoting effective skin circulation, I have found that my patients with psoriasis who used the far-infrared sauna received the best resolution of their psoriasis symptoms, since it penetrates the skin so well, drawing out the toxins.
Digestive factors are extremely important to investigate. Do you have imbalanced intestinal bacteria and yeast from antibiotics? Are you digesting well – any bloating, constipation, heartburn or excess gas? It is important to resolve these symptoms, and to ensure regular, daily, easy bowel movements. Consider if there is enough stomach acid, digestive enzymes, and healthy bacteria in the intestines. If you’re not digesting and absorbing your food, then something else will! If there is poor protein digestion and absorption, then bacteria will digest this ‘second helping’ and overproduce their toxic byproducts which have been shown to actually increase skin cell growth. Strengthening your digestion, and clearing debris from your digestive tract can be of significant benefit.
Identifying and reducing your sources and perceptions of stress are crucial. Regular meditation, deep belly breathing, and other stress management techniques promote body-mind-immunity balance. Reassessing your lifestyle can also be very important. By addressing the above factors, and putting it all together with consistency and patience, I have found that psoriasis can be resolved with a naturopathic approach.
Rahim B. Habib BSc, ND