From healthcentral.com
Experts break down the differences and similarities between these two autoimmune skin conditions
Psoriasis and vitiligo are both chronic, inflammatory, autoimmune diseases that may have a genetic element. But does the connection go any deeper than that? “Psoriasis and vitiligo have different disease mechanisms [or disease processes],” says Karan Lal, D.O., director of paediatric dermatology and cosmetic surgery at Affiliated Dermatology in Scottsdale, AZ. “There have been loose associations as reported by some papers, but we don’t consider these two diseases to be commonly linked.”
With that in mind, let’s take a closer look at vitiligo and psoriasis differences and similarities.
Vitiligo Causes and Symptoms
If you have an autoimmune disease, your immune system attacks parts of your own body. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), vitiligo patches develop when the body attacks and destroys melanocytes, the cells that create skin pigment (colour).
When parts of the skin lose colour, this results in spots and patches of lighter skin. Sometimes, only a few small areas are affected (known as localized vitiligo); in others, colour loss is more extensive (known as generalized vitiligo). Rarely, most of the skin colour is lost—this is known as universal vitiligo.
Another type of vitiligo is segmental vitiligo, characterized by rapid colour loss on one side of the body. After 6 to 12 months, segmental vitiligo tends to stabilize (i.e. the colour loss stops), says the AAD, and most people don’t develop new patches or spots after that.
Vitiligo can appear anywhere on the body, but in the early stages it’s most likely to affect the following areas, per the American Academy of Dermatology (AAD):
Arms
Face
Feet
Hands
Psoriasis Causes and Symptoms
Like vitiligo, psoriasis is caused by an overactive immune system. According to the NIAMS, this results in accelerated production of skin cells (they’re made in days rather than weeks) in affected parts of the body—leading to dry, thick, scaly patches or plaques on the skin.
Psoriasis can also show up on any part of the body. The most common type, plaque psoriasis (affecting around 80% of people with the condition), is most likely to affect the following areas, per the AAD:
Elbows
Knees
Lower back
Scalp
Other types of psoriasis include nail psoriasis, and inverse psoriasis (also known as flexural psoriasis), which involves areas of skin that rub together (skin folds), like the armpits, groin, and under the breasts.
Link Between Vitiligo and Psoriasis
Research published in Archives of Dermatological Research found that people with vitiligo experienced an increased risk of psoriasis. However, the odds of vitiligo were only marginally higher in people who already had psoriasis. And scientists haven’t yet been able to determine why a diagnosis of vitiligo predisposes people to develop subsequent psoriasis, meaning a lot more research is needed.
“Personally, I don’t see a lot of vitiligo and psoriasis in patients at one time,” says Dr. Lal. Radha Mikkilineni, M.D., a clinical assistant professor of dermatology at Cornell Medical School and founder and co-Medical Director of Skinsage, a national online teledermatology company, agrees that although both vitiligo and psoriasis are autoimmune disorders, there’s no scientifically proven link.
Autoimmune diseases can run in families (although having a parent with psoriasis or vitiligo is no guarantee that you’ll get it, too). According to the National Library of Medicine, about one-fifth of people with vitiligo have at least one close relative who is also affected. When it comes to psoriasis, the National Psoriasis Foundation says that if one of your parents has psoriasis, you have about a 28% chance of developing the condition. And if both of your parents have psoriasis, the risk increases to 65%.
Psoriasis aside, researchers have found that vitiligo seems to be more common in people who have a family history of the disorder or who have certain autoimmune diseases, including:
Pernicious anaemia
Rheumatoid arthritis
Systemic lupus erythematosus
Thyroid disease
Type 1 diabetes
Vitiligo and Psoriasis Treatment Options
There’s no cure for either vitiligo or psoriasis, but both conditions can be treated and managed. ”We have many treatment options for vitiligo,” says Dr. Lal. These include:
Medical tattooing helps to camouflage depigmented skin.
Melanocyte keratinocyte transplant surgery can bring pigment back to the skin on people who have stable or segmental disease, says Dr. Lal.
Opzelura (ruxolitinib) is the first topical JAK inhibitor approved by the Food and Drug Administration for non-segmental vitiligo. It works by lowering the person’s immune response to enable the development of new, healthy skin cells, with the goal of repigmenting the affected areas.
Phototherapy uses special UVB light to bring pigment back into the skin, explains Dr. Lal.
Topical steroids may be prescribed to decrease inflammation and promote repigmentation on affected areas.
According to the National Psoriasis Foundation, there are more treatment options for psoriasis than ever. These include:
Phototherapy, which exposes the skin to UVB light to slow down the growth of affected skin cells.
Systemics (including biologics and oral treatments) are prescription drugs may be taken orally, by infusion, or injected, and work throughout the body.
Topical treatments are often the first-line treatment for psoriasis, these are applied to the skin to reduce inflammation and slow down excessive cell reproduction.
When it comes to natural remedies for vitiligo, our experts don’t recommend any particular home therapies, as none have been proven to work. However, Dr. Mikkilineni advises her vitiligo patients to ensure they use proper sun protection if they have extensive involvement, including an oral antioxidant called Heliocare, which is made of polypodium leucotomos (a plant extract) that is believed to be able to help neutralize free radicals and reduce inflammation caused by sun exposure.
There’s a bit more research available on natural remedies for psoriasis. You may want to try topical aloe vera, which some studies have shown to help reduce redness and scaling. The National Psoriasis Foundation recommends looking for creams containing 0.5% aloe or applying gel directly from the aloe plant up to three times per day. The National Psoriasis Foundation also recommends applying a cream containing 10% mahonia, a powerful antimicrobial herb that plays a role in immune response, to help treat mild-to-moderate psoriasis.
Can You Prevent Vitiligo or Psoriasis?
While you can’t prevent vitiligo or psoriasis if you’re genetically predisposed to it, avoiding common triggers is a good way to reduce your risk.
Psoriasis triggers vary from person to person, but common culprits, according to the National Psoriasis Foundation, include:
Cold weather: On Citizen Pscientist, the National Psoriasis Foundation‘s global research platform, four out of 10 people with psoriasis reported winter as the season that causes the most flare ups of their disease. This may be due to less sunlight and drier indoor (heated) air.
Illness: Some people experience a psoriasis flare after an infection, such as bronchitis or tonsillitis. Streptococcus infection (strep throat) often triggers the first onset of guttate psoriasis in children.
Injury to skin: The Koebner phenomenon occurs when psoriasis develops on areas of the skin that have been injured or harmed from a cut, scrape, sunburn, bug bite, or vaccination.
Smoking: Scientists have found that smoking increases the risk of developing psoriasis, such as a study of nurses and other health professionals published in the American Journal of Epidemiology, which found that long-term smokers have almost double the risk of developing psoriasis compared with people who have never smoked.
Stress: According to the National Psoriasis Foundation, stress is one of the most common psoriasis triggers. And because a psoriasis flare itself can increase stress, this can become a vicious cycle. The AAD suggests trying yoga, deep breathing exercises, writing daily gratitude lists, and joining a support group as ways to keep your stress levels down.
Scientists have identified fewer triggers for vitiligo, but the NIAMS says the following may lead to an exacerbation of symptoms:
Emotional distress: Stress can impact the immune system and trigger immune responses, where the immune system mistakenly attacks and destroys melanocytes.
Exposure to a chemical: Allergic reactions to specific chemicals or allergens can trigger inflammatory responses in the skin.
Sunburn: Sunburn itself does not directly trigger vitiligo, but it may exacerbate the condition or worsen existing vitiligo in individuals who are already susceptible.
Whether you have psoriasis or vitiligo (or maybe both), try not to dwell on the fact that there’s no cure. Research is ongoing and there are plenty of treatment options available to you. Be open and discuss your skin concerns with your doctor, who can help you figure out the best way to manage your condition and feel good in your skin.
https://www.healthcentral.com/condition/psoriasis/vitiligo-and-psoriasis
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