Psoriasis: More than skin deep

Since the age of 6, I was diagnosed with the psoriasis. I had multiple flares in my life. They became progressively worse throughout my life, that none of the topical creams/lotions could help anymore and I had to switch to light therapy and in the end systemic treatments.

Since I started using Otezla, my psoriasis almost cleared up everywhere without any extra creams or lotions. But more importantly, treating psoriasis from ‘inside-out’ not just cleared up my skin, but also changed my microbiome, my mental and physical wellbeing..

I am asked a lot by people using EpiLynx skincare and cosmetics, whether the creams and serums will help their psoriasis and eczema on their face and body.

Since we are not registered and did not do any clinical trials in psoriasis, I can never advise to anyone on what to use or not to use.

However, it got me thinking whether the creams and lotion are even helpful when people have severe psoriasis and although it shows up on the skin, the real cause lays within ourselves, with our autoimmune system and microbiome.

What is the protocol that the insurance companies follow on when they decide that something will or will not be reimbursed. One might even question whether it is ethical to submit the patient for many many years of agony, depression, thinning skin while treating the psoriasis from outside and not inside?

While researching, I found this very helpful article in Harvard Medical School Publications:

The first accurate medical discussion of psoriasis dates back to 1801, but the disease itself is much older. In fact, its very name is borrowed from an ancient Greek word meaning an itchy or scaly condition. About 7 million Americans are plagued by this itching and scaling, and many of them have serious complications involving other organs. Although psoriasis is classified as a dermatologic disease, it doesn’t start in the skin, and its damage may be more than skin deep.

Beneath it all

At a basic level, psoriasis is a disorder of the immune system. White blood cells called T-helper lymphocytes become overactive, producing excess amounts of cytokines, such as tumor necrosis factor, interleukin-2, and interferon-gamma. In turn, these chemicals trigger inflammation in the skin and other organs. In the skin, the inflammation produces three characteristic findings: widened blood vessels, accumulation of white blood cells, and abnormally rapid multiplication of keratinocytes, the main cells in the outer layer of the skin. In healthy skin, keratinocytes take about a month to divide, mature, migrate to the skin surface, and slough off to make way for younger cells. But in psoriasis, the entire process is speeded up to as little as three to five days. The result is thickened, red skin that sheds silvery scales of keratinocytes that have matured before their time

Behind psoriasis

Scientists have learned that abnormal activity of the immune system gets the blame for psoriasis — but why does the immune system veer off target?

In about a third of cases, psoriasis runs in families. Multiple genetic abnormalities are associated with psoriasis. But environmental factors also play a role. Psoriasis flares have been linked to psychological stress, obesity, smoking, alcohol, strep throat, viral infections, lack of sunlight, and certain medications.

Psoriasis clinical features

Psoriasis is a chronic condition that strikes both males and females at any time from childhood to old age. It ranges from mild to severe. In general, the earlier -psoriasis starts, the more likely it is to involve large areas of skin and to have serious consequences.

Psoriasis comes in many forms. About 90% of patients have the plaque type, with sharply demarcated salmon-pink plaques of inflamed skin covered by silvery scales. In most cases, the plaques develop symmetrically on both sides of the body. Plaques are most common on the elbows, knees, and scalp, especially at the hairline. Other common locations include the genitals, the crease between the buttocks, the ear canals, and the belly button.

About half of all patients with psoriasis have nail involvement, and some people have nail psoriasis without skin inflammation. Nail problems range from tiny pits to yellowing of the nail surface and accumulation of debris under the nails. Nail psoriasis is often seen in people with psoriatic arthritis (see below).

The second most common form of psoriasis is called guttate psoriasis. Latin scholars have a head start in understanding this variety, since the name comes from “gutta,” meaning “droplet.” Patients have numerous small, red, scaly spots scattered on the arms and legs. In children and adolescents, guttate psoriasis can develop abruptly several weeks after a strep throat or viral infection. In that situation, it can resolve on its own in three to four months, but it may also convert to plaque psoriasis.

These common forms of psoriasis may be mild, but can also be very distressing. Itching is troublesome, but the unsightly skin changes can cause even more unhappiness, especially when large areas of skin are involved and scales accumulate on clothing and furniture. Other forms of the disease include erythrodermic psoriasis, which can cause severe inflammation of the entire skin surface, and pustular psoriasis, which can look as if there are innumerable small boils all over the body. Fortunately, these life-threatening forms of psoriasis are rare.

Psoriasis complications

Psoriasis shows up in the skin and nails — but immune system abnormalities cause the disease, and they can damage other parts of the body as well.

Arthritis. Up to 25% of patients with psoriasis develop joint inflammation. In some cases, the arthritis can precede the skin involvement. There is a strong link between nail psoriasis and arthritis, and some arthritis patients have nail disease without any skin inflammation.

Psoriatic arthritis, as it’s called, can strike the small joints of the fingers, one or two larger joints elsewhere in the body, or the spine. It is a painful, chronic inflammatory arthritis, but tests for rheumatoid arthritis and other forms of autoimmune arthritis are negative. Some patients improve with nonsteroidal anti-inflammatory drugs, but others require powerful medications to quiet down the immune system.

Cardiovascular disease. Research has established a link between psoriasis and heart attacks. The risk of cardiovascular complications is highest in patients with severe psoriasis that developed at a relatively young age. The association remains valid even after scientists account for risk factors that are common to both psoriasis and heart disease, such as smoking, obesity, and stress. Psoriasis patients are also at high risk for peripheral artery disease and stroke. Researchers believe that inflammation is the thread that ties psoriasis to atherosclerosis.

Psychosocial disorders. Like other chronic diseases, psoriasis can cause emotional distress and disrupt social interactions and productivity. Physical discomfort and disfigurement combine to make severe psoriasis a disabling disease.

Other conditions. Patients with psoriasis have an increased risk of diabetes, high blood pressure, Crohn’s disease, and the metabolic syndrome, a dangerous constellation of risk factors involving blood pressure, insulin resistance, obesity, and abnormal blood lipids. Patients who receive aggressive psoriasis therapy may also have a heightened risk of certain cancers.

Psoriasis treatment

People with very mild psoriasis may be able to get help from self-treatment with little more than a skin moisturizer, an antidandruff shampoo, and some sunlight. But most patients require medically supervised therapy. Although no treatment will cure psoriasis, many medications can control the disease.

Topical therapy. These ointments, gels, and lotions are the mainstay of psoriasis treatment, especially for mild-to-moderate disease. In the past, coal tar and anthralin were widely recommended; because they stain skin and clothing, they have been replaced by topical treatments that are more convenient and more effective. Many corticosteroid preparations are available; they vary in potency, but all can reduce inflammation and control itching. Corticosteroids act rapidly, but long-term use of strong steroids can produce skin thinning and damage. Newer topical therapies that are proving very effective include two forms of vitamin D, calcipotriene (Dovonex) and calcitriol (Vectical), and the vitamin A relative tazarotene (Tazorac); all are prescription drugs.

Phototherapy. At one time, it involved two to four weeks of sunbathing or, for those who could afford it, “climatotherapy” with naturally filtered sunlight at the Dead Sea. Now, though, doctors use carefully controlled exposure to ultraviolet (UV) radiation to treat moderate to severe psoriasis. UVB can be administered alone or in combination with tar or other topical agents; some patients can use UVB at home. UVA is usually reserved for extensive psoriasis that has not improved with other treatments. It is used with a photosensitizing drug in the so-called PUVA regimen.

Systemic therapy. The toughest cases of psoriasis call for the toughest treatments. Options include the oral vitamin A–like drug acitretin, the antimetabolite methotrexate, and the immunosuppressant drug cyclosporine. Today, there are many biologic agents that are very effective. They target specific steps in the immune system. All of these systemic therapies can produce serious side effects, and all require careful monitoring by experienced physicians. Still, systemic therapies offer new hope to patients who are disfigured and disabled by severe psoriasis. It demonstrates how modern science has made inroads against a disease that has plagued man for thousands of years.

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