What to Eat When You Have Psoriasis or Psoriatic Arthritis

From healthcentral.com

The question of what to eat permeates our daily lives. It rings especially true when you’re living with a chronic disease like psoriasis. When April Armstrong, M.D., MPH, sees patients, many ask what factors they can control when it comes to managing their disease – particularly their diet.

“One of the most common things I hear is, ‘I’m trying this diet, but it’s not really working. What other diets do I try?’” she says.

To get at the heart of this question, Armstrong led an effort among fellow members of the National Psoriasis Foundation’s medical board to comb through the scientific literature on the relationship between food and psoriasis. What resulted is a paper on diet recommendations for people with psoriatic disease published in JAMA Dermatology in August 2018.
The review draws from data on more than 4,500 people living with psoriasis across 55 studies, providing the most comprehensive picture yet for what scientific evidence reveals about which foods and supplements most significantly affect disease severity.

                                                                         Unsplash

The authors are quick to point out, however, that medical treatments still lead the way in tackling psoriasis, and evidence has shown that the primary role of diet is to help mitigate disease symptoms in some patients.

“There is what’s called a reporting bias – people who try something that works for them are going to speak more loudly than if it didn’t.” Armstrong says. “That gives you a perception that it works for lots of people.”

Calorie counting can help... for some

The paper’s strongest recommendation is to reduce caloric intake if you are overweight or obese.
The link between weight and symptom severity among psoriasis patients is well established. In part because of body fat’s pro-inflammatory role, overweight or obese individuals face a host of issues – ranging from more severe symptoms to reduced treatment response – when trying to manage their disease.
The review recommends using weight loss to help mitigate these factors through what is known as a hypocaloric diet. In this case, “hypocaloric” refers to weight loss driven solely by consuming a smaller number of calories, rather than by exercise, surgery or changing nutrient portions, such as carbohydrates.

“Weight loss will undoubtedly help your heart, but we certainly know that it can help your psoriasis too,” says Mark Lebwohl, M.D., a member of the NPF medical board and co-author on the paper.

Of all the non-medical interventions overweight or obese people can receive, researchers gave evidence for hypocaloric diets their highest grade. Data on how weight loss affects people with a healthy weight, though, remains lacking.

Not quite making the grade

Gluten-free diets, originally intended for people with celiac disease or gluten sensitivity, have skyrocketed in popularity in recent years. Armstrong and Lebwohl agree that it isn’t uncommon for patients in the clinics to inquire about eliminating gluten.
While the authors strongly recommend gluten-free diets for people who face both celiac disease and psoriasis, they do not recommend the diet for anyone who has not tested positive for markers for celiac or gluten sensitivity.
Based on the lack of quality evidence for other supplements, such as selenium, fish oil and vitamin B12, the paper does not currently recommend them for psoriasis patients.
While topical vitamin D has been established as an effective treatment for psoriasis, there is little high-quality evidence to support the role of orally taking vitamin D to improve psoriasis, and the authors don’t recommend using it for prevention or treatment in adults with normal levels of vitamin D. Among patients with psoriatic arthritis, the paper suggests patients try one month of supplementation in addition to regular treatment.

Further evidence needed

In addition to offering diet recommendations, the authors highlighted some directions for future research. A hypocaloric diet in one study isn’t always the same as a hypocaloric diet in another, says Adam Ford, co-author on the paper and M.D. candidate. Diets mentioned in the study varied from 1,400 calories a day to a meagre 800 calories.
“There’s a lot of questions that still need to be answered, besides just getting to the bottom of these different supplements,” he says. “Even then, we still have a lot of work understanding the mechanisms by which improvements in psoriasis happens."

https://www.healthcentral.com/article/special-report-what-to-eat-when-you-have-psoriasis-or-psoriatic-arthritis

Vitamin D: A Little Known Remedy for Psoriasis

From prweb.com

Vitamin D deficiency is a worldwide epidemic that can lead to many diseases including tuberculosis, influenza, cancer, osteoporosis, and psoriasis. Vitamin D supplementation is inexpensive, safe and can improve the lives of many. Robin Fleck, MD at Southwest Skin & Cancer Institute in Prescott, Arizona, regularly checks for Vitamin D deficiency in psoriasis patients and supplements this vitamin when blood levels are low.

Psoriasis is associated with vitamin D deficiency. Dr. Robin Fleck of Southwest Skin & Cancer Institute in Prescott, Arizona routinely sees very low levels of Vitamin D ranging from 6-30 ng/mL in patients presenting with psoriasis. When the patient's blood level is increased to 50-80 ng/mL, psoriasis symptoms can abate, bringing relief to psoriasis sufferers. “In my dermatology practice, I've seen a marked improvement and even clearance of psoriatic plaques on the trunk and in the scalp, in most of my patients when their blood level of vitamin D is maintained above 80 ng/mL,” states Dr. Fleck.

Much of the world's population, including in the US, has a deficiency of vitamin D due to lack of the vitamin in our present day diet. The modern custom of eating a vitamin-poor, fat-free, high-carbohydrate diet with heavily processed grains, potatoes, beans and pasteurized dairy, leads to the chronic diseases of diabetes, atherosclerosis, cancer and autoimmune conditions, including many skin disorders such as psoriasis, acne, and lupus.

Supplementation with vitamin D should be done under a doctor's care to monitor the blood level while increasing the dose of the vitamin. While vitamin D is safe in most patients, not everyone can take vitamin D due to health issues, so check with your doctor before embarking on a course of vitamin D.

Another important point is that since vitamin D is a fat-soluble vitamin, it should be taken with a fatty meal such as bacon and eggs or a hamburger to promote absorption. A study at the Cleveland Clinic Foundation showed that when vitamin D is taken with the largest meal of the day, blood levels increase over 50% compared to taking vitamin D on an empty stomach or with a light meal.

In addition, all supplements are not equal with respect to the quality of vitamin D; be sure to research your supplements to ensure they contain what they claim. Vitamin D doses of at least 5000-10000 IU per day are needed to see improvement in psoriasis.

One final point is that vitamin D is more effective when taken with vitamin K2 which assists in the formation of healthy bone. In addition, the amount of vitamin D in your blood usually drops during the winter months so check your blood level twice a year to ensure you are taking enough vitamin D.

In view of the safety and efficacy of vitamin D supplementation when properly monitored with blood testing, the use of this vitamin for treatment of psoriasis should be considered.

Other benefits of maintaining optimal blood levels of vitamin D are a decreased incidence of colds and flu seen in several worldwide studies and over 100 published studies have demonstrated vitamin D's anti-cancer effects.

Robin Fleck, M.D., is a double board certified dermatologist and internist, recognized by the American Board of Dermatology and the American Board of Internal Medicine. She is founder and medical director of Southwest Skin and Cancer Institute. Dr. Fleck is a fellow of the American College of Physicians and the American Venous Forum. She is also the medical director of Vein Specialties in Prescott, Arizona, where she treats chronic venous insufficiency, spider veins, and varicose veins.

https://www.prweb.com/releases/vitamin_d_a_little_known_remedy_for_psoriasis/prweb16142300.htm

Psoriasis on black skin: What to know

From medicalnewstoday.com

Psoriasis is a skin condition that causes some areas of skin to develop lesions. The appearance of psoriasis varies across different skin tones, and it can be more challenging to diagnose on black skin.

Psoriasis lesions tend to be thick and crusty, and they often form on the scalp, elbows, knees, and back.
In this article, learn about psoriasis on black skin, including its appearance and symptoms as well as how to treat it.

Prevalence of psoriasis in black people

Psoriasis is a common condition that affects more than 8 million people in the United States and 125 million people worldwide.
According to the National Psoriasis Foundation, it affects approximately 1.3% of African Americans compared with 2.5% of white people.
About one-third of people with psoriasis have a relative with the same condition, meaning that genetics is a risk factor.
Psoriasis usually appears between the ages of 15 and 25 years, but it can develop at any age. It is a long-term condition. While there is no cure, many treatment options are available to help manage the symptoms.

Symptoms

Psoriasis presents as thickened areas of skin, sometimes with an overlying scaly crust that may look shiny or silver. These lesions are usually itchy. If a person scratches them, they will bleed and scab over.
In black people, psoriasis can look violet or purple. The individual may also notice areas of darker, thicker skin. In both cases, the lesions can appear scaly. Lesions can develop anywhere on the body, including the scalp.

As psoriasis heals, it can leave areas of discoloration, which can take between 3 and 12 months to disappear.
Psoriasis tends to follow a relapsing-remitting pattern, meaning that people will experience a period of few or no symptoms and then a flare-up of more severe symptoms.
There are several different types of psoriasis, which can vary in their appearance. These are:

Chronic plaque psoriasis

Chronic plaque psoriasis is the most common form of the condition. It causes clearly defined lesions to develop on the elbows, knees, and scalp.
These red or violet lesions are between 1 and 10 centimetres (cm) in diameter and have overlying silvery scales.

Guttate psoriasis

Guttate psoriasis is more common in children or young people recovering from an infection, such as pharyngitis.
It causes small bumps less than 1 cm across to appear on the back, arms, and thighs.

Nail psoriasis

Some people with psoriasis only have symptoms on their nails. Nail psoriasis looks like tiny pinpricks on the fingernails or toenails.
The nails may also turn brown or become thick and crumbly.

Inverse psoriasis

Inverse psoriasis appears on less visible parts of the skin, such as the armpits, the buttocks, the groin, and the folds underneath the breasts. The lesions may be purple or darker than the surrounding skin.

Diagnosis

To diagnose psoriasis, a dermatologist will carry out a physical examination and ask questions about the lesions. They will probably also ask about any family history of psoriasis or related conditions, such as arthritis.
Psoriasis on black skin can be difficult to diagnose because it may resemble other skin disorders that are more common in black people.
In some cases, the doctor will also take a skin biopsy so that they can rule out other conditions.

Treatment

The treatment options for psoriasis are essentially the same regardless of skin tone, although some do carry special considerations for people with darker skin.
Standard psoriasis treatments include:

Creams and ointments

Creams and ointments are the first treatment option for most people with psoriasis.
The most commonly-used creams are steroids. Anthralin, synthetic vitamin D-3, and vitamin A products can also help manage psoriasis flare-ups. These tend to be available only with a prescription.
Over-the-counter creams for psoriasis include products containing aloe vera, jojoba, zinc pyrithione, capsaicin, or salicylic acid and coal tar.

Prescription medications

If creams and ointments do not work, a doctor may prescribe medications for psoriasis. These drugs are called systemic medications, and they may be in the form of pills, liquids, or injections.

Systemic medications include:

• acitretin
• cyclosporine
• methotrexate

The doctor may prescribe biologic drugs for moderate-to-severe psoriasis. People usually receive these drugs, which target specific parts of the immune system, as an injection or infusion.

Examples of biologic drugs include:

• TNF inhibitors, such as Enbrel (etanercept) and Humira (adalimumab)
• interleukin-12/23 inhibitors, such as Stelara (ustekinumab)
• the interleukin-17A inhibitor Cosentyx (secukinumab)
• T cell inhibitors, such as Orencia (abatacept)

Phototherapy

Phototherapy is also called light therapy. This treatment involves regularly exposing the skin to ultraviolet light under medical supervision.
Standing in a light box two or three times a week can cause the skin to tan or darken. The American Academy of Dermatology (AAD) warn that this may make dark spots on black skin more noticeable.
Learn more about phototherapy for psoriasis in this article.

Management

There is no cure for psoriasis. Anything that irritates the skin can cause the condition to flare up. The AAD offer the following advice to avoid flare-ups wherever possible:

• avoid skin injuries, such as nicks, cuts, and bug bites
• protect the skin from sunburn
• use a cold compress and moisturize regularly to alleviate the itching
• avoid scratching itchy skin

People should also learn to recognize the triggers that lead to their flare-ups. These differ among individuals but can include:

• stress
• bug bites
• summer heat and cold winter weather

Some people with psoriasis develop lesions on their scalp so doctors may also recommend frequent shampooing with a medicated shampoo.

Summary

Psoriasis is a common skin condition that affects fewer African Americans than white people in the U.S.
In black people, psoriasis may look darker than the surrounding skin or might appear purple. In both cases, it tends to have a scaly overlay. Psoriasis lesions can appear anywhere on the body, including the scalp.
Anyone with symptoms of psoriasis should speak to a doctor about diagnosis and appropriate treatment options.

https://www.medicalnewstoday.com/articles/325068.php

Higher weight increases risk of psoriasis

From medicalxpress.com/news

Studies have linked psoriasis and higher weight, but the causal relationship between the two has been unclear. What triggers what? Or could other underlying reasons explain the connection?

"Higher BMI may contribute to increased inflammation of the skin, which can exacerbate psoriasis, but it could also be that psoriasis leads to a person being less physically active and thus gaining weight," explains Mari Løset.
She is a medical doctor at the Department of Dermatology at St. Olavs Hospital and a postdoctoral fellow at the Norwegian University of Science and Technology's (NTNU) K.G. Jebsen Center for Genetic Epidemiology.
Løset is part of a team that been involved in a study of the causal relationship between BMI and psoriasis.
BMI stands for body mass index and is a measure of body fat content. It is calculated from a person's height and weight.
The observational study is a large collaboration among researchers from NTNU, England and North America. Some of the data being used are from the Health Survey in Nord-Trøndelag (HUNT) and the UK Biobank. Together, the analyses include data from 750 000 individuals.

Psoriasis is a chronic inflammatory condition of the skin, which causes a red, scaly rash. The cause of the disorder is probably multifactorial, involving both heredity and the environment.
Worldwide, two to four per cent of the population is affected by psoriasis. The incidence is particularly high in Norway.
"Self-reported data from two large population surveys in Norway indicate that six to eleven per cent of the population may be affected in this country," says Løset.
A study in the city of Tromsø has shown that the incidence of psoriasis was 4.8 per cent in 1980, but had increased to 11.4 per cent in 2008.
"Similar studies from other parts of the world substantiate the fact that the condition is increasing," says the postdoctoral fellow.
To investigate the causal relationship between BMI and psoriasis, the researchers used a method called Mendelian randomization. It is named after Gregor Mendel, who is known as the father of genetics.

According to Mendel's principles of inheritance, whether we inherit a certain variant of genes from our mother or our father is random. Genetic variants are randomly distributed, or randomized, between individuals.
"Mendelian randomization means that nature itself distributes individuals randomly into groups based on genes. This way, we can avoid the results being influenced by external factors," says Løset.
"Our understanding of how genes are related to disease is increasing at record speed, and in this study we used known genetic variants as markers for BMI and psoriasis," she adds.
By using Mendelian randomization, the researchers found that higher weight is a contributing factor to psoriasis. They observed that greater BMI increased the chance of getting the disease.
"We calculated that the risk increased by nine per cent for each higher whole number on the BMI scale," Løset says.

But the researchers are still uncertain about just how higher weight can lead to psoriasis.
"We still don't know enough about the mechanisms behind this connection. Fatty tissue is an organ that produces hormones and inflammatory signalling molecules, which could be a contributing factor," says Løset.
So far, not much research has been done on whether weight loss can cause psoriasis to disappear, although a few clinical studies suggest the possibility.
"Psoriasis is a very complex disease and we hope to study subgroups, especially individuals with severe psoriasis. The hypothesis is that we will be able to observe even greater links with higher weight," says Mari Løset.

https://medicalxpress.com/news/2019-04-higher-weight-psoriasis.html