At-home phototherapy proves effective for psoriasis treatment

From news-medical.net

For decades, people with psoriasis have been treated in clinics with narrowband ultraviolet B phototherapy, or light therapy, to reduce sores, scales, and inflammation. Now, new research from the Perelman School of Medicine at the University of Pennsylvania shows that patients can improve their psoriasis just as well at home with phototherapy devices designed to make treatment easy to self-administer. Results of the LITE study (Light Treatment Effectiveness study), published in JAMA Dermatology, found that 60% of patients who followed the recommended light therapy course twice a week at home or in a clinic had clear or mostly clear skin after 12 weeks of treatment. But patients who received at-home treatment were more likely to adhere to the prescribed treatment and were able to do so more easily than getting treatment in a doctor's office, which brings costs for both time and travel.  

Our research should influence clinical practice right away. Many insurance companies cover at home phototherapy but make it very difficult to obtain coverage causing long delays when patients need treatment immediately. Insurance companies should make the approval process easier for this treatment, and dermatology providers should prescribe home phototherapy for management of psoriasis when medically appropriate and when preferred by their patients." 

Joel Gelfand, MD, lead author, the James J. Leyden, M.D. Endowed Professor in Clinical Investigation in the Department of Dermatology at Penn and medical director of Penn's Psoriasis and Phototherapy Treatment Center

Phototherapy is provided by machines that resemble tanning beds or that can be smaller devices for hands or feet, but they emit a specific wavelength of ultraviolet light that treats psoriasis effectively without exposing patients to the cancer-causing wavelengths that are found in commercial tanning beds. Phototherapy is often used in combination with pills and biologic therapies for psoriasis (12% of patients were taking these medications during the LITE study).  

Compliance with phototherapy at clinics can be challenging

The number of sessions and the duration can vary depending on the severity of the psoriasis symptoms. Most patients need treatments lasting a few minutes each 2-3 times per week for about 12 weeks. Considering that there might be travel costs and time off work required to visit a clinic, accessing phototherapy can be a hurdle. In the study, patients spent an average of 50 minutes per treatment traveling to and from the office, with an average of $20 in travel costs for each visit. 

The study included 783 people, ages 12 and up, who had plaque or guttate psoriasis. Participants' psoriasis symptoms were assessed at regular visits with their dermatologists and then randomly assigned to receive 12 weeks of at-home nbUVB or in-clinic nbUVB treatment followed by a 12-week observation period. Those who conducted phototherapy at home were provided with machines, taught how to use them, and given specific prescriptions based on the colour of their skin and sensitivity to sunburn. After 12 weeks, 33% of home patients and 26% of in-office patients showed clear or almost clear skin. Among both at-home and in-clinic patients who were able to maintain the twice-per-week treatments, about 60% achieved clear or almost clear skin. Patients receiving home phototherapy were more than 3 times more likely than those going to a clinic to be able to maintain the recommended treatment frequency. None of the participants had to discontinue their participation in the study due to adverse side effects. 

"Medications to treat psoriasis have a risk of side effects including increased risk of infection. Some patients prefer medication-free treatment," said Gelfand. "Our study is important because it increases the options available to both clinicians and patients and gives patients the power to pursue treatment that best fits their needs and preferences." 

Representative research

People of colour have historically been left out of medical research including dermatology research, and the LITE study strived to be more representative including people of various skin types and colours. Researchers wanted to ensure they knew whether the effectiveness of at-home and in-clinic treatments differed between specific skin types.

"Whether you have very fair skin or very darkly pigmented skin, we found no difference in effectiveness of phototherapy at home or in a physician's office except that patients in general did better at home because they were able to receive treatment more consistently," said Gelfand.

 Another unique aspect of the LITE study: the research was powered by patients at all stages of the research including the design, outcome measures, and analysis. Patients served as co-authors of the study findings along with staff from the National Psoriasis Foundation who also provided input and oversight for the study.

The study was supported by the Patient-Centred Outcomes Research Institute (PCORI). The Daavlin Company provided home phototherapy machines and shipped the machines to and from patients' homes at no cost to the patients.

Source:

University of Pennsylvania

Journal reference:

Gelfand, J. M., et al. (2024). Home- vs Office-Based Narrowband UV-B Phototherapy for Patients With Psoriasis. JAMA Dermatology. doi.org/10.1001/jamadermatol.2024.3897. 

https://www.news-medical.net/news/20241024/At-home-phototherapy-proves-effective-for-psoriasis-treatment.aspx

Does Alcohol Affect Psoriatic Arthritis?

From healthcentral.com

The research—and people’s individual experiences—are mixed. Here’s what you need to know 

When you have psoriatic arthritis (PsA)—an inflammatory condition of the joints linked to the skin disease psoriasis—a healthy lifestyle is a key component for managing your symptoms. That includes regular physical activity, a nutritious diet, and avoiding smoking. Does it also mean you should re-evaluate your alcohol intake? The relationship between alcohol and psoriatic arthritis isn’t completely straightforward, so if you have PsA and you also enjoy unwinding after a busy day with an adult beverage, there are a few things to consider.

Psoriatic Arthritis Symptoms

The symptoms of psoriatic arthritis vary from one person to the next but are mainly felt in the skin and joints. The disease can also affect other areas of the body, like the eyes and gastrointestinal (GI) tract. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), people with psoriatic arthritis may experience:

• Eye inflammation that causes pain, redness, and blurry vision

• Fatigue

• Inflammatory bowel disease, the symptoms of which include abdominal pain, diarrhoea or changes in bowel movements, nausea, and unexplained weight loss

• Joint stiffness, pain, and swelling, which can also affect the spine

• Nail changes

• Sausage-like swelling of a finger or toe

• Scaly, inflamed patches of skin on scalp, elbows, and knees

• Tenderness in areas where tendons and ligaments attach to bones, such as the back of the heel or sole of the foot

Alcohol and Psoriatic Arthritis Risk

The answer to the question of how alcohol intake impacts your chances of developing psoriatic arthritis isn’t cut and dry—and that’s because much of the research is conflicting, says Elena Schiopu, M.D., a professor of medicine in the division of rheumatology at the Medical College of Georgia at Augusta University.

For example, a British study of more than 90,000 people with psoriasis (about 1,400 of whom had also developed psoriatic arthritis) published in the British Journal of Dermatology found that moderate drinking (but not heavy drinking) was associated with an increased risk of PsA among those with psoriasis.

On the other hand, a study of more than 80,000 women (141 of whom developed psoriatic arthritis) published in the Journal of Rheumatology found that moderate drinkers were at a lower risk of PsA compared to non-drinkers, while those who reported excessive alcohol use (more than two drinks per day) had a four-fold greater risk of psoriatic arthritis compared to non-drinkers. That may be due to the fact that high levels of alcohol contribute to inflammation, possibly triggering the disease in some people. Still, other research has not found alcohol to be a risk factor for psoriatic arthritis.

If you have psoriasis (which often precedes a diagnosis of PsA) or you’re already living with psoriatic arthritis, where does that leave you? To start, researchers do know that increased alcohol intake is associated with more severe psoriasis symptoms and can affect treatment of the disease. Drinking also raises heart disease risk (which psoriasis also increases). The issue is so pressing that one article in the American Journal of Clinical Dermatology called on dermatologists to ask all patients about their alcohol use.

Dr. Schiopu suggests that if you currently have more than two drinks per day, it will probably benefit you to cut back. “Having alcohol socially once or twice a week and limiting yourself to one serving may not cause a big issue,” she says. (Of course, if you don’t drink now, there’s no reason to start.) You’ll also want to keep tabs on how alcohol affects your psoriasis flares, and if you already have psoriatic arthritis, your PsA flares as well.

Alcohol and Psoriatic Arthritis Flare-ups

People who have psoriatic arthritis will notice that they have their own unique individual triggers for flares (times of active disease where you experience symptoms). You may notice that alcohol intake is one of yours. For example, Dr. Schiopu says that some patients report that wine in particular aggravates their condition. Others find that one drink on occasion is okay, but going over a certain amount brings on symptoms. “It requires some personal experimentation,” she says.

There are a few reasons why alcohol may trigger flares. The alcohol itself may be proinflammatory. In addition, the sugar in alcoholic drinks can trigger flare-ups of psoriatic arthritis, says Elizabeth Ortiz, M.D., a rheumatologist and clinical advisor at the virtual care platform WellTheory. (Sugar is also proinflammatory, she says—in research, patients with rheumatoid arthritis or psoriasis report that sugar is a common trigger.) Dr. Ortiz recommends making the lowest-sugar choice you can, which means staying away from mixers like sodas and cocktails (which often contain added sugar in syrups or juices) and instead opting for spirits mixed with no-sugar-added sparkling water, low-sugar canned alcoholic beverages, or zero sugar wines.

Dr. Ortiz points out that alcohol can also decrease your inhibitions, affecting the food choices you make—and you could end up eating foods that trigger symptoms for you. If you are drinking, “be mindful of the amount you drink, as well as how that amount affects other behaviours,” she advises.

Alcohol and Psoriatic Arthritis Medications

If you drink alcohol and are taking a medication to treat psoriatic arthritis, ask your prescriber about any potential interactions or risks associated with imbibing, advises Dr. Schiopu. One to keep in mind is methotrexate, an immunosuppressive medication that is a common treatment for psoriasis and psoriatic arthritis. Because of the potential harm to the liver, people should avoid using alcohol while taking methotrexate. “This medication is known as a liver irritant, as is alcohol. If you have one liver irritant, why add to it and press your luck with another?” says Dr. Ortiz.

Lifestyle Choices to Help Manage Psoriatic Arthritis

Identifying your personal triggers (and then avoiding them as much as possible) can go a long way to helping you manage your condition. “Knowing how someone reacts is based on trial-and-error and seeing how they feel after eating certain foods and making adjustments to their lifestyle. Everyone has their own personal threshold of what they can tolerate,” says Dr. Ortiz.

Keeping a journal can help you pinpoint the foods, drinks, or habits that may be linked to worsening symptoms. In addition, there are several lifestyle measures that are recommended across the board to help manage the disease and keep symptoms at bay. According to NIAMS, these are:

• Exercise regularly

• Maintain a healthy weight

• Quit smoking

• Seek out mental health to address the emotional toll of PsA

The Bottom Line on Alcohol and Psoriatic Arthritis

Research is conflicting on how alcohol intake affects your risk of developing psoriatic arthritis, and its impacts on symptoms can vary from one person to the next. Rheumatologists recommend moderating your alcohol intake if you choose to drink. And even more importantly, pay attention to how alcohol intake affects your symptoms and make adjustments as necessary, such as decreasing the amount or frequency that you drink, or changing the type of drinks you consume.

https://www.healthcentral.com/condition/psoriatic-arthritis/psoriatic-arthritis-and-alcohol

An Inside-Out Guide To Tackling Eczema and Psoriasis

From vogue.com 

What happens when there’s no simple fix to your flare-up of eczema or psoriasis? Sometimes, you need to bring in a team for help—like a GP, a dermatologist, a facialist, a TCM practitioner, and a nutritionist. Here's their advice on how to tackle tricky skin conditions, especially when one size does not actually fit all.

Eczema

If you have eczema you’ll be all too familiar with those cracked, dry, and scaly patches of skin that show up a bright red on paler skin tones or an ashy, almost grey on darker skin. Left untreated, eczema becomes scalier, itchier, thicker, and more hyperpigmented.

The GP

“There are two primary causes of eczema: a leaky gut—increased intestinal permeability—which creates a low-grade inflammation in reaction to food particles leaking through your gut wall, and/or abnormal gut flora, or dysbiosis, which is when the trillions of bugs in your gut become out of balance, driving inflammation. This is caused by a high-sugar, refined-carb, low-fibre, processed diet,” says general physician Sabine Donnai, whose hi-tech diagnostic clinic in London, Viavi, prides itself on a holistic approach. “But there are other culprits, such as chemicals and other substances in creams, lotions, and detergents, as well as household cleaning products.” Her advice is to look at the whole, rather than treat the surface. “The creams, antibiotics, and other topical solutions are really just short-term solutions. You wouldn’t address every yellowing leaf of the plant if the problem is that the roots need more water!”

The dermatologist

“There are three pillars for eczema we try to tackle,” says consultant dermatologist Emma Wedgeworth. “Firstly, strengthen the skin barrier using moisturizers that can replenish. Secondly, we look at the abnormality in the skin’s immune system, treating itchy patches with medicated creams—there are more targeted creams, called phosphodiesterase inhibitors, currently in development in the US, which dampen inflammation. If these don’t work, we use light therapy, as well as immunosuppressants in the form of injections and tablets.”

The facialist

Pietro Simone, who has a clinic in London at Flemings Mayfair Hotel, says, “Avoid glycolic acid, colorants, fragrances, mineral oils, unstable vitamin C, and retinol.”

The Traditional Chinese Medicine practitioner

“Acupuncture improves skin health, restores the skin barrier, and alleviates discomfort in people with eczema,” says Traditional Chinese Medicine Doctor John Tsagaris, who practices at the Harrods Wellness Clinic. “We use herbs to complement it, including liquorice, chrysanthemum, and peony, and often use High Factor Peony Root Skin Remedy to help my patients.

The nutritionist

“Detoxification is key, as systemic toxic levels make eczema worse,” says Lucy Miller, a registered, clinically qualified nutritional therapist based in Bath and London. “A whole-food, anti-inflammatory, low-allergenic diet that contains lots of pre and probiotic foods, fibre, and good fats is vital. It needs to be low in processed foods, sugar, refined carbohydrates, and alcohol to help balance blood sugar, all of which helps to control inflammation, balance hormones, and improve immunity.”

Psoriasis

This is an autoimmune condition that causes an excess turnover of skin cells that can build up into thickened plaques. There is no quick fix, but treated correctly it can be managed well, with minimal flareups.

The GP

“Take away the things that cause the problem and add those that make it better. In the vast majority of cases, this will naturally heal psoriasis,” says Donnai. She advises her patients to focus on eight things.

1. Eat a whole-food diet.
2. Remove any food sensitivities such as gluten and dairy.
3. Test for heavy metal toxicity (mercury and other metals can trigger or exacerbate psoriasis).
4. Fix your gut (“Studies suggest intestinal permeability, or leaky gut, can contribute to psoriasis”).
5. Use the right supplements.
6. Exercise regularly.
7. Sleep for eight hours every night.
8. Practice deep relaxation.

The dermatologist

“Psoriasis can be associated with lifestyle, with sufferers having higher rates of smoking, alcohol, and higher BMIs, so sometimes making a change of this nature can help,” says Wedgeworth. Psoriasis also looks different according to ethnicity, with more redness in whiter skins and more associated problems with pigmentation in darker skins. Depending on its severity, Wedgeworth will start treatment with vitamin D creams, moving on to light therapy, “which dampens it down.”

The facialist

“Less is more. Keep it simple,” says Katharine Mackenzie Paterson, founder of KMP Skin. “Avoid heavily fragranced products and use occlusive creams to help reduce the roughness. LED—such as Dermalux Flex—can also be fantastic for psoriasis.”

The Traditional Chinese Medicine practitioner

“Psoriasis is one of the most common and well-researched conditions we treat with Chinese medicine,” says Tsagaris. “It’s triggered by an immunological response to various environmental, systemic, or psychological factors. Acupuncture effectively alleviates stress, a common trigger of psoriasis flares. It can also relieve pain, especially in cases of psoriatic arthritis.” Tsagaris also prescribes Chinese herbs, including salvia, liquorice, or ligusticum to calm the inflammation and restore a healthy skin barrier.

The nutritionist

“A high level of zonulin, a protein that controls the size of the gap junctions in the gut, which can indicate if you have a leaky gut, is often associated with psoriasis, so ask for a blood test to measure it,” says Miller. Her vitamin and mineral recommendations include vitamins A, B, and D, omega-3, and quercetin. Plenty of soluble fibre will also help control blood sugar and reduce inflammation.

https://www.vogue.com/article/an-inside-out-guide-to-tackling-eczema-and-psoriasis

More than a skin-deep problem

From thestar.com.my

There’s a greater need for psoriasis awareness and more support for its patients

KUALA LUMPUR: Kenderick Lee was 24 and carving out a successful career in the corporate world when a diagnosis of the skin disease psoriasis somewhat stopped him in his tracks.

What started merely as a scalp issue ended up affecting his way of walking.

“I was diagnosed with pustular psoriasis which developed into psoriatic arthritis as I had already problems concerning arthritis, so all of these issues sort of combined and left me limping,” he said.

Psoriasis is an autoimmune disease that causes a rash with itchy, scaly patches, usually affecting the knees, elbows and scalp. It is not contagious, but there is no cure.

During the early stages after his diagnosis, Lee lost many of his friends.

“As a young person going through a chronic condition and just starting a career, it was such a chaotic time.

“There were friends who left me. I believe there should be some awareness about the condition so more people are educated about it,” he added.

Still, he has gained “gems” who stood by him.

“I found those who remained by my side,” said Lee, who is in the insurance sector.

Lee, now 35, has found refuge in a treatment called biologics.

“I have been receiving biologics for nine years,” he said, adding that it has enabled him to pursue regular, daily activities such as exercising.

Raising awareness: Sofia (left) with sponsors during the World Psoriasis Day 2024 event at KL Gateway Mall in Kuala Lumpur. — ART CHEN/The Star

Biologics are derived from natural proteins found in living cells. Commonly injected into patients every month, they work by targeting the underlying cause of psoriasis – excessive skin cell growth due to an overactive immune system.

The treatment, however, does not come cheap.

Lee pays about RM38,000 a year for the monthly injections. He hopes the government could consider subsidising the treatment for those relying on biologics.

“I am part of a programme in which my treatments are subsidised, which works well for me,” said Lee, who was present at an event on Saturday to mark World Psoriasis Day.

According to the US-based National Psoriasis Foundation, World Psoriasis Day is held annually on Oct 29 to honour “the 125 million people worldwide who face life with the challenges and frustrations of psoriasis and psoriatic arthritis”.

Dr Azura Mohd Affandi, the Health Ministry’s National Head of Dermatology Subspeciality, said biologics can ease psoriasis symptoms by as much as 90% to 100%.

Based on the Malaysian Psoriasis Registry for 2020-2022, there is a slight male predominance in psoriasis patients.

Dr Azura, who is also the head of the Dermatology Department at Hospital Kuala Lumpur, said the registry is voluntary.

From 2007-2022, it has registered 28,795 psoriasis patients, with 93.6% being adults and 6.4% under the age of 18.

“The number of affected patients is actually higher,” Dr Azura said.

Another study published based on data collected from Johor Baru revealed a prevalence rate of 0.34% of the population.

Given Malaysia’s 34 million population, she estimated that around 117,884 people in the country may be affected by the condition.

Psoriasis Association Malaysia interim president Sofia Lovi Ramasany said biologics should be made more accessible for psoriasis patients in the country.

She hopes the government would look into making biologics more available as fewer than 400 patients have access to it.

“Another pressing matter to highlight is the rare psoriasis type, which is the generalised pustular psoriasis. It can be life threatening if it’s not being treated promptly.

“People like us are not just prone to skin issues but also psoriatic arthritis where it will impact our joints and mobility.

“We need support from the government and community to have a transformation where the condition is understood and supported.“Patients who are diagnosed with psoriasis are also likely shunned from society and this could negatively impact their mental health as well,” she said.

https://www.thestar.com.my/news/nation/2024/11/11/more-than-a-skin-deep-problem 

10-20 pc women experience psoriasis during pregnancy

From sambadenglish.com

Hormonal changes caused during pregnancy can trigger the risk of psoriasis in about 10-20 per cent of women, said health experts 

New Delhi: Hormonal changes caused during pregnancy can trigger the risk of psoriasis in about 10-20 per cent of women, said health experts on Saturday.

Psoriasis is a commonly seen chronic autoimmune condition that causes skin inflammation, with thick, itchy, scaly patches, most commonly on the knees, elbows, trunk, and even the scalp. The common symptoms are red patches, rashes, scaling of the skin, dry and cracked skin, itching, and soreness. It is caused due to an overactive immune system that causes inflammation.

“Pregnancy is an exciting and life-changing phase for women. Though, it can often bring about various challenges for expectant mothers and one concerning problem is psoriasis. The hormonal fluctuations during pregnancy often lead to variations in immune response, which can trigger flare-ups,” said Dr Jisha Pillai, Dermatologist, Lilavati Hospital Mumbai. “Around 10-20 per cent of women may suffer from psoriasis during pregnancy. However, there will be no risk to the foetus due to psoriasis,” added Pillai.

Pillai noted that stress during pregnancy can also aggravate existing psoriasis and lead to the new onset of this condition. Moreover, changes in skincare routine and sensitivity to environmental triggers might position pregnant individuals at greater risk for outbreaks. Other trigger factors include smoking, secondhand smoke, alcohol, skin infections, cold weather, and certain medications.

Besides pregnancy hormones that can affect the immune system and skin, potentially altering psoriasis severity, changes in medicines can also work as potential triggers for psoriasis.

“Many psoriasis treatments are not recommended during pregnancy due to potential risks to the foetus. Women may need to discontinue certain medications, which can lead to flare-ups,” said Dr. Parinita Kalita, Associate Director, Obstetrics And Gynaecology, Robotic Surgery, Max Super Speciality Hospital. Women with more severe psoriasis before pregnancy may also have a higher risk of exacerbation, the doctor noted.

The health experts stressed the need to consult a dermatologist and an obstetrician to help manage psoriasis effectively during pregnancy. They must use products suggested by dermatologists only and avoid self-medication for managing symptoms of this condition.

“Women must report symptoms of psoriasis such as red patches, scaling of the skin, and itchiness without any delay for seeking timely intervention,” Pillai said. (IANS)

https://sambadenglish.com/miscellany/health/10-20-pc-women-experience-psoriasis-during-pregnancy-experts-7380099

How to get psoriasis under control

From krone.at

It's hard to imagine how much psoriasis affects patients' quality of life - especially if you are not affected yourself. But those affected should not despair, because the chronic skin disease and the associated symptoms can now be treated effectively 

There are many sad stories of fathers whose children are reluctant to hug them or of people who don't invite anyone home spontaneously because they can't vacuum up the flakes of skin scattered around their home so quickly. "Suffering from psoriasis is a huge burden on life," confirms Dr. Katharina Wippel-Slupetzky, a dermatology specialist in Vienna. "So it's all the more important to know that you don't have to put up with it. Although there is no cure for the skin condition, with the right treatment it is now possible to be symptom-free - and not have to be satisfied with a slight improvement in symptoms."

However, there is still a lack of knowledge about this non-contagious skin disease - even among young patients, the expert is surprised to learn. At first, they often know little about the unpleasant, itchy, rough and scaly patches on their bodies. These are often found on mechanically stressed areas such as the knees and elbows, but also on the scalp and sometimes on the palms of the hands, soles of the feet and in so-called inverse areas such as the genital area, armpits and anal folds. The joints are involved in up to 30% of cases.

Various triggers trigger the condition

"There is often a genetic background, even if only distant relatives are affected. This mainly affects psoriasis that occurs before the age of 40; in a third of cases, the disease develops before the age of 16. There is a second peak from the age of 40, usually in the 5th to 6th decade of life," explains the expert. Infections such as streptococci, but also smoking, alcohol, stress or some medications (certain drugs for high blood pressure) can trigger the outbreak of psoriasis.

The appropriate treatment for this unpleasant skin condition is discussed with the doctor.

(Bild: stock.adobe.com/B. BOISSONNET)

Sometimes very emotional or stressful phases of life also cause the condition. "A great deal has improved in terms of treatment in recent years," says Dr. Wippel-Slupetzky. "There are now various good local therapies such as creams and sprays. Irradiation with UV light, some immunosuppressive tablets such as methotrexate and those that block inflammatory messengers also help. However, drugs called biologics have revolutionized therapy. These inhibit inflammatory messengers in the body."

The way these drugs are administered is also advantageous, explains the expert: "Depending on the active ingredient, injections or infusions are administered. The frequency ranges from every few days to several times a year. This makes everyday life easier, as the application takes less time. However, basic skin care should be maintained." Of course, the doctors discuss which therapy would be best together with those affected.

"The rough rule of thumb is that if more than 10 percent of the skin is affected, systemic therapy is recommended, i.e. the entire organism is treated, be it with UV radiation, tablets, injections or infusions. If so-called 'upgrade criteria' are present, such as the infestation of visible areas such as the face, hands, severe nail infestation, but also involvement of the genital area, these therapies are also used for skin involvement of less than 10 percent." It is also important to consider the patient's individual circumstances in order to select the most suitable therapy for them.

Psoriasis often affects more than just the skin

Psoriasis is much more than just a skin disease, as it affects the entire body. Those affected have a higher risk of cardiovascular disease, for example. Sometimes the joints are also affected, which is referred to as psoriatic arthritis. "30 percent of psoriasis patients develop this disease, but the skin does not necessarily have to be affected first," says Dr. Wippel-Slupetzky. "In general, nail, scalp and intimate areas are strong warning signs for the possible development of psoriatic arthritis. Skin symptoms and joint complaints that occur together should therefore always be linked and shown to a specialist."

According to the expert, patients should: "Take care of your health: go for a check-up, don't smoke and ideally don't drink alcohol or only drink a little. It is also important to aim for a normal weight, as abdominal fat in particular produces inflammatory messengers that fuel psoriasis. You should eat a Mediterranean diet with fish, olive oil and lots of vegetables."

https://www.krone.at/3577493

Can Vitamin D Help With Psoriatic Arthritis? Here’s What Experts Say

From healthcentral.com 

Research has found people with psoriatic arthritis tend to be low in this essential vitamin—but the jury is out on whether a supplement can help

Psoriatic arthritis, an autoimmune disease fuelled by out-of-control inflammation, can cause symptoms like joint pain, fatigue, and swelling from head to toe, so it's no surprise that people might be looking for ways to get relief. And one option that has gotten some attention is vitamin D, which some consider to be one of the best supplements for psoriatic arthritis.

But in reality, the relationship between psoriatic arthritis and vitamin D is—as with a lot of supplements —a tricky one to figure out, since the science behind it is still unclear. What might be driving the correlation? Vitamin D is one of the most promising vitamins for psoriasis (a related but still separate condition that appears on the skin), so there’s reason to be optimistic. So, do psoriatic arthritis supplements like vitamin D merit a spot in your medicine cabinet? Here’s what the experts say.

The Relationship Between Vitamin D and Psoriatic Arthritis

The connection between vitamin D and psoriatic arthritis is more complicated than it seems. Vitamin D, for reference, benefits your body on several fronts. “It’s important for bone health and has roles in the immune system and in maintaining skin health,” says S. Louis Bridges, Jr., M.D., a rheumatologist and physician-in-chief and chair of the Department of Medicine at the Hospital for Special Surgery in New York City.

Research has found that vitamin D deficiency was especially common among people with PsA—and that the lower their vitamin D levels were, the more disease activity, indicated by a higher DAPSA (Disease Activity in Psoriatic Arthritis) score, they experienced. DAPSA is a measurement of PsA severity that takes into account the joints affected, pain levels, and levels of C-reactive protein, which is an inflammation marker.

But it’s unclear whether low vitamin D levels are the cause or the result of inflammation, according to Dr. Bridges. “When there is inflammation, serum levels of vitamin D decrease,” says Dr. Bridges. “Low levels of vitamin D are associated with a variety of inflammatory states.” In other words, it’s like which came first—low vitamin D, which contributes to the uptick in inflammation and DAPSA, or the inflammation, which stifles the levels of vitamin D? It’s hard to say.

Should You Take Vitamin D to Treat Your Psoriatic Arthritis?

Taking vitamin D could be helpful if you have psoriasis alongside your PsA. “Oral vitamin D supplementation may have some benefits in psoriasis,” says Dr. Bridges, though he notes that most research focuses on the efficacy of topical creams applied to plaques (versus oral supplements). “They work by slowing down the rapid skin cell turnover associated with psoriasis and have immunomodulatory effects.”

As for psoriatic arthritis, vitamin D may help ease symptoms—in theory. But “there are no studies that definitively show this, and much more work is needed,” says Dr. Bridges. “We also need studies to understand the role of vitamin D in the development and treatment of PsA, and the differences in vitamin D metabolism between patients with PsA compared to psoriasis without arthritis.”

What are the Best Sources of Vitamin D?

Sunlight is the primary source of vitamin D. “Vitamin D is made or synthesized in the skin from its precursor, a type of cholesterol,” says Shailendra Singh, M.D., a rheumatologist at White County Medical Center in Searcy, AK. “When you're exposed to the sunlight, that vitamin D precursor is formed in the skin—and once that is formed, that is converted into its active form in the liver and the kidneys.” But if you don’t spend a lot of time outside, then sunlight alone might not be enough to make the amount of vitamin D you need.

If that’s the case, you’ll need to get it from your diet—and, ideally, you should be eating your vitamin D rather than taking it through a supplement, according to Dr. Singh. “There are several foods which are enriched in vitamin D,” he says. “Most of the milk available in the market is enriched with vitamin D, as are yogurt and cheese.” You can also find vitamin D in fatty fish and fish liver oil.

How Much Vitamin D You Need With Psoriatic Arthritis

Besides infants, most people need 15 micrograms (mcg) of vitamin D a day, according to the National Institutes of Health (NIH). (A cup of milk has 2.9 mcg, while three ounces of salmon and trout each have over 14 mcg.) Even if you have psoriatic arthritis, that’s all our experts recommended. “I do not recommend routine vitamin D supplementation to treat psoriatic arthritis,” says Dr. Bridges.

The Risks of Too Much Vitamin D

Because it can increase calcium absorption, taking too much vitamin D can lead to hypercalcemia—literally, excessive calcium—which in turn leads to nausea, vomiting, and kidney stones. And while too much vitamin D alone can lead to kidney failure, it's extremely rare, according to the NIH. Really, it only tends to become a problem if you’re taking a lot of different vitamins, according to Dr. Singh. “Overdosing on vitamin D is very, very difficult,” he says.

And, even when you take it in an over-the-counter supplement, “that vitamin D needs to be activated inside the kidneys and in the liver to become active vitamin D—and our body will only produce as much active vitamin D as it needs,” he says. The rest gets excreted out.

Talk With Your Doctor

If you’re curious about supplementing with vitamin D, talk to your doctor—but manage your expectations accordingly. If your doctor checks your vitamin D levels and they’re low, they might recommend a supplement, says Dr. Singh. And if they’re normal, then supplementing with vitamin D won’t add any extra benefit for your psoriatic arthritis. And remember, it’s not a cure-all, and should at most be part of an overarching treatment plan overseen by your doctor.

https://www.healthcentral.com/condition/psoriatic-arthritis/psoriatic-arthritis-and-vitamin-d