Psoriasis is an inflammatory (possibly autoimmune) skin disease that is usually found on the elbow, knees, scalp, low back and buttock fold regions. Ten to 30 percent of psoriasis patients also have inflammatory joint issues (psoriatic arthritis). While the immune system is at fault, environmental and genetic factors also play a role. Psoriasis tends to wax and wane: flares often follow life stressors and/or illness/infection. As a highly visible condition, it can greatly impact quality of life. In some with severe disease, there may be increased risk for certain chronic illness, such as kidney and heart disease.
Often following an insult to immune system (life stress, bacterial/strep/viral infection, immunization, medications, trauma, alcohol, weight gain), psoriasis may suddenly onset at any age as one or many small areas of itchy, scaly redness. It may progress with or without associated nail findings, joint pain, and/or eye or eyelid redness (some have only joint pain without rash). The same insults that trigger psoriasis onset may also cause flares. Hot weather, sunlight, sea swimming and pregnancy can ameliorate some cases. Once psoriasis is established, sunburn and other skin trauma should be avoided, as damaged areas may subsequently become psoriatic.
Psoriasis occurs when the immune system’s white blood cells (WBCs, T cells) invade the skin in large numbers for unclear reasons. The excessive WBCs produce skin cell abnormalities/overgrowth and initiate the immune system over-activity that produces inflammation. Inflammation damages cells. Damaged cells produce/release chemicals signalers (immune mediators) that signal back to the immune system to “keep fighting,” so the immune system mistakenly believes the skin area (with the extra WBCs and abnormal skin cells) is continuously under attack, as if it had ongoing infection. One of these chemicals signalers (TNF-α) also plays a role many autoimmune diseases. Medications that “soak up” this chemical signaler are now used in psoriasis. Gene locations for psoriasis have been identified (HLA-Cw6 and others).
Usually, psoriasis can be identified visually, without biopsy. There are various forms of it depending upon location, and whether or not a flare is present or joints are involved. While most blood testing is normal, blood work may help distinguish it from other conditions; fungal studies checking for infection help when feet are involved. By evaluating X-rays and/or joint fluid, a rheumatologist can help distinguish (inflammatory) psoriatic arthritis from autoimmune (rheumatoid) or other types of arthritis. Specialists should manage eye involvement.
Conventional pharmaceutical medications include topical steroids, steroid injections, coal tar, Vitamin D analogs (calcitrol), topical retinoids (tazarotene), medications that decrease cell proliferation (anthralin, methotrexate), immune modulators (tacrolimus/Protopic topical, cyclosporine, alefacept, ustekinumab) which “gear down” the immune system, and specific TNF-α inhibitors (infliximab, etanercept, adalimumab) that are more often used in autoimmune disease. The last two classes decrease immunity and increase risk for infection, requiring that risks and benefits be weighed. UV (PUVA/B) or sunlight and stress reduction are also recommended. Therapy is tailored to each patient depending upon response and other illnesses/conditions.
In Traditional Chinese Medicine (TCM), psoriasis is considered a sign of significant derangement of the body’s overall “balance” (homeostasis), and as in Western Medicine, there are various psoriasis types based on appearance and location. For example, the common form of pale, dry plaques with a thin layer of white scales may be due to “Blood Deficiency and Dryness” and/or “Liver and Kidney Yin Deficiencies”. More rapidly developing, small, bright-red lesions may be due to “Heat in the Blood Division” or “Damp Heat”. Dark purple plaques with very thick scales may be due to “Blood Stasis”. All psoriasis sufferers will likely to benefit from “calming Wind”, as “Wind” produces dryness, especially during flare-ups. Because of the multiple causes, different people require different treatments at different times to address psoriasis.
As a complex problem, multiple treatment modalities are usually used. Acupuncture starts to balance the system, while Chinese Herbal Medicine more profoundly addresses the underlying problem. Since psoriasis is considered a “deeper” problem in TCM, Chinese herbs require compliance usually for 6 to 24 months to achieve the longest lasting effects. TCM, Ayurveda and Western Medicine all link alcohol to psoriasis, and alcohol avoidance is a cornerstone of improvement without pharmaceuticals. Herbs and foods that “cool the ‘Blood’” help for the conditions caused by heat: turmeric, mint, cilantro etc are added to the diet. [2,3]
Learn more about Psoriasis
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