Psoriasis – It’s More Than Skin Deep

Psoriasis – It’s More Than Skin Deep

Screen shot 2013-08-07 at 4.20.59 PM

This August is Psoriasis Awareness Month, and a good time to become more familiar with this diagnosis which affects millions of Americans. Despite being a relatively common condition, many of us hold onto the false assumption that it is only skin deep. Psoriasis, in all of its forms, actually goes much deeper, to the level of the immune system. Interested in knowing more? Read on for an introduction to this autoimmune disorder, related health concerns, and how it can be treated.

 

Psoriasis – An Immune System in Distress
Like other Autoimmune (AI) diseases, Psoriasis is a chronic inflammatory condition caused by a dysfunctional immune system. Though psoriatic presentations may differ, they are caused by the same underlying imbalances that exist within all AI diseases.

Our immune systems are designed to create antibodies which tag harmful foreigners such as viruses & bacteria so that our white blood cells know where to attack. In AI disease, the body loses the ability to differentiate between a true foreigner, and our own tissues. As a result, antibodies toward our own cells are produced, directing our immune system to target tissues and organs. Inflammation develops, followed by tissue destruction and dysfunction within the body.

While there is no single cause for AI disease, there are suspected triggers that may lead to development of auto(self)-antibodies. Additionally, there can be a genetic predisposition to developing an AI disease. Common triggers that may increase the risk for autoimmune disease include:
     Chronic Infections (viral, bacterial, fungal & parasitic)
     Continuous Allergen Exposure (including food sensitivities)
     Chronic Heavy Metal Toxicity
It is especially important to limit these potential triggers in your daily life if you have a known family history of autoimmune diseases.

Psoriasis In Its Many Forms
Plaque Psoriasis
The most common form – Plaque psoriasis occurs when overactive inflammatory immune cells create cytokines (proteins that act as immune cell signals) which target keratinocytes in the skin. The result is an inflammatory, raised plaque which appears red and exhibits a silvery build up of dead cells. When removed, pinpoint bleeding known as Auspitz’s Sign is seen. Plaques tend to arise on the outer aspects of joints (knees, elbows) but can occur anywhere on the body. They may also arise in areas of recent skin trauma.

Psoriatic Arthritis
Approximately 30% of patients with Psoriasis will develop a type of Psoriatic Arthritis. This painful and debilitating condition is categorized as a spondyloarthropathy, meaning it is similar in symptoms and presentation to arthritis disorders such as Ankylosing Spondylitis, & Reactive Arthritis. The joints may become very swollen, red & extremely tender to palpate. The arthritis may develop on one or both sides of the body, and may affect the spine. Types of psoriatic arthritis include Symmetric, Asymmetric, Distal Interphalangeal predominant (joints closest to the fingertips), Spodylitis (affecting the spine) and Arthritis Mutilans (rare, but severely debilitating).

Additional Forms
Though plaque psoriasis is more commonly seen, individuals may also be diagnosed with:
Guttate Psoriasis (thinner, smaller lesions that are greater in number)
Inverse Psoriasis (red, smooth lesions that arise in body folds)
Pustular Psoriasis (red, non-infectious pustules develop on the skin)
Erythrodermic Psoriais (widespread, poorly defined red lesions with pain & peeling)

How is Psoriasis Diagnosed?
Diagnosis of psoriatic skin lesions can be based on appearance, and may include biopsy for confirmation. Additional testing for other psoriatic presentations may include X-rays or synovial fluid testing for joint symptoms, and blood tests to assess for inflammation (ESR, CRP) or a genetic component (HLA-B27). Further testing may be recommended to effectively rule out other potential causes.

Treatment – Conventional & Alternative Approaches
Conventional treatments for psoriasis are primarily suppressive, meaning they cover symptoms by blocking the activity of the inflammatory cells without addressing the underlying causes for immune dysfunction. For skin changes, these treatments usually consist of topical creams, whereas systemic immunosuppressive drugs are more commonly prescribed for arthritic symptoms. These medications can be of great value for symptom relief and interruption of tissue destruction, but it is equally important to treat the underlying imbalance.

An in-depth investigation of potential triggers is often indicated, followed by avoidance of those which are found to be significant. Even the basic removal of dietary and environmental allergens can help to decrease symptoms and decrease the number and duration of treatments needed. In addition to the chronic infections, allergens and heavy metals noted above, you should also speak with your healthcare provider about mental & emotional stressors, gastrointestinal dysbiosis, medications, and nutrient deficiencies. Each of these may contribute to auto-immune activity and aggravation of your psoriatic symptoms.

Potential treatments worth investigating for longer-lasting relief and healing include:
Heavy metal testing & Chelation therapy (when indicated)
Food allergy elimination diets (based on diagnostic test findings)
Anti-inflammatory protocols
Essential macro & micro nutrient supplementation (to reverse deficiencies)
Diagnosis & treatment for chronic infections
Gastrointestinal support (including diagnostic testing for SIBO, leaky gut syndrome, & more)
Ozonotherapy IV’s & topicals (to modulate inflammation & decrease immune dysfunction)
Low Dose Naltrexone (to modulate inflammation & decrease autoimmune activity)

 

Questions about treatments for Psoriasis and other autoimmune disorders? Contact Dr. Kaley at Restorative Health Clinic (503) 747-2021.

 

Dr. Kaley Bourgeois

 

References:

National psoriasis foundation. (n.d.). Retrieved from https://www.psoriasis.org/

Blauvelt, MD, A. (July). Pathophysiology of psoriasis. Retrieved from http://www.uptodate.com/contents/pathophysiology-of-psoriasis

Eating to Erase Eczema

Eating to Erase Eczema

Screen shot 2013-02-13 at 9.07.30 PM

A friend recently asked me what she could do to treat her eczema. After finding minimal help with prescription corticosteroid creams and antihistamines, she was hoping for an affordable, lasting treatment approach that she could manage at home.

Is there a home treatment worth trying? “Yes,” I told her. “You can find relief by eating to erase eczema.”

Eczema, also known as Atopic Dermatitis, is by no means a simple condition with one simple solution. The rash is an outward sign of inward dysfunction in the immune system, involving over-reactive inflammatory cells, often accompanied by a history of hay fever and asthma. Causes of inflammation and specific triggers vary from person to person, but most of us can get considerable relief by avoiding the most common dietary allergens and inflammatory foods. This gives the immune system a chance to calm down, and allows the rash an opportunity to heal.

By following a few strict, but straightforward dietary recommendations, my friend saw her eczema begin to resolve after 2 days. Another friend, this one suffering from Phompholyx (a form of eczema on the hands and feet) watched the itchy, painful bumps disappear after 1 week.

Below are the recommendations that worked for them.

For at least 2 weeks, remove the following top allergens:
1. Zero dairy (this includes foods with added whey or casein).
2. Zero grains (this includes corn, gluten free products such as rice, and items thickened with flour).
For at least 2 weeks, remove foods that promote inflammation:
3. Zero cane sugar (use stevia, or honey or palm sugar in moderation).
4. Limit red meat & eat only grass-fed, free-range animal products (animals fed grains and corn produce higher levels of inflammatory proteins that you then ingest).
Additional Recommendations:
5  Eat healthy fats in abundance (olive oil, coconut oil, fish oil, avocado, nuts & seeds).
6. Avoid already-known food allergens (such as eggs, soy, so on).

In my experience, most people report symptom relief, better energy and an increased sense of well-being after following steps 1-6. These patients often choose to stay on a grain-free, dairy-free diet. For those that hope to regularly enjoy a tasty rice pilaf or a thick wedge of gouda cheese, I recommend trying the following steps:

After at least 2 weeks, once the rash has significantly improved:
1. Add back 1 food per week (for example, cheese week 1, rice week 2, so on)
2. If the eczema begins to return, the most recently re-introduced food is likely a trigger for you. Avoid it.
3. Continue to minimize sugar–it will exaggerate any inflammatory response, regardless of the trigger.

Why does this work?
Picture your over-reactive immune system as a well built fire. The kindling is made up of various allergens (foods, dust, mold, pollen, etc.), and the lighter fluid is sugar and other inflammatory foods. With enough allergens, the fire will keep burning. Add some sugar, and you’ve got a bonfire.

If you can remove enough of the kindling, the fire will start to die down. A little lighter fluid may string it along, but the size and heat of the fire will begin to fade. This is exactly what you do by removing dairy and grains, and limiting sugar.

An estimated 80% of your immune system lives in your gut, meaning that your inflammatory cells and overall state of inflammation are especially sensitive to the foods you eat. For most people with food sensitivities, milk and gluten proteins are at the top of the list; I’ve found that many of these individuals are reactive to the proteins in other grains, too. Removing dairy and grains may not eliminate all of your allergen exposure, but it may be enough to put out the fire.

 

For additional information on eczema, allergies, and naturopathic treatment options,  please contact us at (503) 747-2021. Diagnostic testing and effective therapies are available, including allergy panels, immune system support, and gastrointestinal medicine.

Yours in health,
Dr. Kaley Bourgeois

References:
Allam, JP, Novak, N. “The pathophysiology of atopic eczema. .” Clin Exp Dermatol. 31.1 (2006): 89-93. Web. 13 Feb. 2013.
Furness, J, Kunze, W. “Nutrient Tasting and Signaling Mechanisms in the Gut, II. The intestine as a sensory organ: neural, endocrine & immune responses.” Am J Physiol. 277.5 (1999): G922-G928. Web. 13 Feb. 2013. <http://ajpgi.physiology.org/content/277/5/G922.full>.