Mediterranean diet might help ease psoriasis

From reuters.com

(Reuters Health) - The Mediterranean diet might do more than help ward off heart disease, it may also help improve psoriasis, a new study suggests.

"Psoriasis is a chronic inflammatory disease triggered by environmental factors," said lead author Dr. Celine Phan, a dermatologist at Hopital Mondor, in Creteil, France.

"The Mediterranean diet, which is characterized by a high proportion of fruits, vegetables, cereals, fish, extra-virgin olive oil, etc., could reduce chronic systemic inflammation thanks to the anti-inflammatory properties of these foods," she said in an email.

Some people seem to inherit a susceptibility to developing psoriasis, noted Dr. Laura Ferris, an associate professor of dermatology at the University of Pittsburgh, who wasn't involved in the study.

"It's a condition characterized by areas or patches of skin that is red and thickened and scaly," Ferris said in an email. "It can really impair a patient's quality of life because of discomfort and appearance. If there's red flaking, scaling skin on the face and hands it really gets in the way of life." 

About 2 percent of the U.S. population has psoriasis, Ferris said.

Phan and her colleagues tapped into a large ongoing French health study that had collected dietary information on 158,361 volunteers over two years. The researchers sent all of the study participants a link to an online psoriasis questionnaire. Of the 35,735 who filled out the questionnaire, 3,557 reported they had psoriasis, with 878 saying it was severe.

Along with information on food consumption, the original study also collected information on lifestyle and health factors, such as gender, age, smoking habits, body mass index (BMI), physical activity levels, cardiovascular disease and depression symptoms.

The researchers rated volunteers' eating habits according to how closely they followed the Mediterranean diet. Previous studies have found the diet is associated with a lower risk of chronic systemic inflammation, which has been linked to heart disease as well as conditions like psoriasis.

After taking into account other lifestyle and health factors that can raise the risk of psoriasis, researchers found that severe cases of the disease were less likely in people whose eating habits were more similar to the Mediterranean diet.

Compared to people whose eating habits scored lowest by Mediterranean diet standards, those who scored highest on Mediterranean diet adherence were 22 percent less likely to have severe psoriasis, and those whose diets were moderately Mediterranean were 29 percent less likely.

The study found no association between diet and the onset of psoriasis.

The researchers did, however, find an association between psoriasis severity and several other factors, including BMI, smoking, activity levels, heart disease, high triglycerides, high blood pressure, diabetes and depression.

While the study doesn't prove that consuming a Mediterranean diet will lessen the severity of psoriasis, "it raises some interesting questions and is provocative," said Dr. Jonathan Silverberg, an associate professor of dermatology, preventive medicine and medical social sciences at the Northwestern University Feinberg School of Medicine in Chicago and director of the Eczema Centre at Northwestern Medicine. "Other studies have suggested a connection. So this would be confirmatory of those studies."

What an observational study like this one cannot show is whether the Mediterranean diet is causing improvement or whether there's some factor shared by people who eat this way that is helping with psoriasis, said Silverberg, who was not involved in the new research.

But it takes studies like this to spur other researchers to do the randomized controlled clinical trials that could answer that question, Silverberg said. Even if it's shown that the Mediterranean diet can help improve symptoms, "I doubt it would be effective enough to replace the myriad treatment options we now use in clinical practice," Silverberg said. But doctors might be able to use it as an add-on treatment strategy, he noted.

For now though, it might make sense to steer patients toward a Mediterranean diet because there's little downside, Ferris said. Moreover, "there is an association between following the Mediterranean diet and other health benefits," she explained. "And maybe it will help with psoriasis."

https://www.reuters.com/article/amp/idUSKBN1KF26R/

How to Relieve Psoriatic Arthritis Pain

From healthcentral.com

From stretching to cooling aids, there are ways to self-soothe with this challenging joint condition 

An estimated one in five adults in the U.S. experience chronic pain. If you have psoriatic arthritis (PsA), you may be part of that statistic. For some people with psoriatic arthritis, pain is long-standing, especially during the time before an effective treatment is matched with your exact stage and set of symptoms with psoriatic arthritis. Understanding the cause of your pain and exploring the strategies to eliminate or manage it can help you take back your life.

Why Does Psoriatic Arthritis Cause Pain?

Your immune system is designed to protect you from invaders. However, psoriatic arthritis can cause the immune system to become overactive and create unwanted inflammation throughout our body. This inflammation often occurs in and around the joints, especially wreaking havoc on the entheses, which is where tendons connect to bones.

Jonathan Yu, D.P.T., a doctor of physical therapy at the Hospital for Special Surgery in New York City, says that due to excessive inflammation, he often sees individuals with undertreated psoriatic arthritis experiencing pain in their spine and foot and/or ankle. Other painful areas for people with psoriatic arthritis include the joints closest to the tips of the fingers and toes (known as the distal interphalangeal joints).

Exactly how much pain you feel and where it’s located varies from one person to the next in psoriatic arthritis, which can make it challenging for doctors to identify and treat. “Especially if someone has been inactive from stiff or sore joints, this lack of movement may have caused joint pain in other areas, away from the originally affected joint,” Yu explains. “For instance, with foot issues, sometimes if one foot is in pain, a person may be off-balance in their weight bearing, which then causes other issues if it is not treated.”

Tips for Relieving Psoriatic Arthritis Pain

Because psoriatic arthritis is a whole-body condition, the solution to reducing the associated pain can required a multi-layered approach.

Reduce Stress

At the root of psoriatic arthritis pain is inflammation—and that inflammation can be triggered by numerous factors, including stress, according to Alexis del Vecchio, M.D., attending physician at Baptist Health and research appointee at the Mayo Clinic in Jacksonville, FL. “Stress can worsen inflammation and is one of the main triggers for a psoriatic flare,” says Dr. del Vecchio, who recommends managing stress through non-pharmacological means like mindfulness training. Also, “regular exercise and a varied diet that focuses on lean proteins, fruits and vegetables” can help mitigate inflammation caused by stress, he says.

Aerobic Exercise

“Aerobic exercise is really important for reducing psoriatic arthritis pain,” says Yu. Admittedly, physical activity when your joints hurt from psoriatic arthritis can be tough to accomplish. “Especially in a flared state, exercise has to be approached carefully,” Yu acknowledges. “Try more low-impact exercises such as moving in a pool, biking, or gentle walking.”

Strength Training

“We aren’t necessarily talking about body building, but weightlifting to maintain strength and support the joints can also reduce pain,” says Yu. “As an example, if you have a sore knee, more strength in your quadricep muscle can support the knee joint and help you go up the stairs with less pain.” Similarly, a stronger core may help you better manage any hip pain associated with psoriatic arthritis. The specific type of strength training that will be most beneficial will depend on which joint is flaring, Yu says.

                                                                               Getty Images/Prostock-Studio

Skin Care

Psoriasis is often a precursor to psoriatic arthritis and left untreated can be a source of pain and discomfort. People with psoriatic disease often complain that their skin burns, itches, stings, or is overall tender.

If this sounds like you, some TLC for your skin may be required, including avoiding skin care products that may be irritating and adding to your pain. The National Psoriasis Foundation has a list of over-the-counter skin products that have been created to be non-irritating and safe for those living with psoriatic disease. (Or check out HealthCentral’s expert-approved list, here.)

Heating Pad

Warming up your joints and surrounding muscles can help reduce stiffness and provide pain relief. According to the Arthritis Foundation, heat works by enlarging your blood vessels and increasing blood flow. This allows more of the good stuff—including blood, oxygen, proteins, and nutrients—to be delivered to the joint and surrounding tissues. If you have a sudden onset of swelling and redness from a flare, though, it is best to avoid heat.

Cool Down

On the flip side, sometimes cooling down a joint, also known as cryotherapy, can reduce pain in two different ways, according to Johns Hopkins Medicine. Cold therapy can reduce the swelling or inflammation that is tied to pain, and it may also reduce your sensitivity to pain. It can be as easy as applying an ice pack wrapped in a towel to protect your skin to your sore joint for 10 to 20 minutes several times a day.

Not sure whether to use heat or cold? As a rule of thumb, use ice for acute pain (it hurts right after you exercise); use heat for longer-term aches (anything past 72 hours). And when in doubt, ask an expert. “A physical therapist can help educate on when to use heat, when to use ice, when you should push and when to back off from activity,” says Yu.

Over-the-Counter Medications

Painful psoriatic arthritis flares may respond well to a class of anti-inflammatory analgesic medications called non-steroidal anti-inflammatory drugs (NSAIDs), says Dr. del Vecchio. While these medications can be helpful for pain management, they should be used with care.

“There is a misconception that if they are sold over the counter, medications are safe to use, but that is not always the case!” says Dr. del Vecchio. “Always follow the indications on the medication bottle, and do not take NSAIDs if your doctor told you not to, and especially if you have any history of high blood pressure, cardiac problems, poor kidney function, or bleeding, which can worsen all of the above.”

Medical Devices

There are multiple medical devices that can support your joints and prevent further injury. According to the Arthritis Foundation, canes, walkers, reachers and grabbers, button hooks, jar openers, and lever door handles can help with daily life. Electronic devices, such as transcutaneous electrical nerve stimulation (TENS) units, can be placed on your skin to stimulate nerves and muscles around the area of pain. Your doctor, physical therapist, or pharmacist can help you with the best device to help your pain.

Diet

There is no one diet that can cure psoriatic arthritis or that would be right for everyone. But research suggests that there are certain foods that add to inflammation in your body and potentially make the pain worse, while other foods are known to reduce inflammation. According to a review article in Frontiers in Immunology, these include:

• Pro-Inflammatory Foods

  • Excess alcohol

  • Foods high in refined sugars such as desserts or sugary cereals

  • Fried foods

  • Packaged foods containing artificial colors and flavors

  • Processed meats

  • Soft drinks

• Anti-Inflammatory Foods

• Foods high in omega 3 fatty acids (fish and plant-based foods)

• Green tea Spices such as cinnamon, cumin, and ginger

• Legumes

• Legumes

• Nuts

• Whole grains

Hand and Foot Care

Those with psoriatic arthritis are no stranger to hand and foot pain. From fingers to toes to heels, psoriatic arthritis can be a pain. While there is no cure for psoriatic arthritis, according to the Arthritis Foundation there are things you can do in addition to treatment to manage pain in your hands and feet:

• Roll your foot across a frozen water bottle for 10 minutes at a time.

• Keep your fingernails and toenails trimmed.

• Be gentle with your nail cuticles (and ask others to be gentle as well).

• Choose shoes with a wide toe box to keep toes from excess pressure.

• Apply cold packs to your feet and hands 10 minutes at a time.

If you are seeing changes to your hands or feet, especially your fingers and toes, taking good notes to share with your doctor about the changes you are observing can be very beneficial. Psoriatic arthritis is known for causing serious inflammation in the digits—called dactylitis. If this is happening to you, it may be time to consult your rheumatologist about a possible change in your treatment.

Psoriatic Arthritis Pain Treatment

The goal of psoriatic arthritis treatment is to reduce the inflammation caused by an overactive immune system. Because the symptoms related to PsA are so varied and everyone is different, there may be some trial and error in the process of finding the best treatment that manages most of your symptoms. Your doctor may suggest one of the following:

NSAIDs

If your pain is mild or you are early in your disease course, your doctor may suggest you take nonsteroidal anti-inflammatory drugs (a.k.a NSAIDs). Available over the counter or in higher strengths by prescription, these medications can relieve pain and reduce inflammation. Aspirin, ibuprofen, and naproxen are commonly used NSAIDs to treat PsA pain.

DMARDs

This class of medication (disease-modifying antirheumatic drugs) can slow the progression of PsA and prevent further joint damage, according to the Mayo Clinic. The most commonly used DMARD for psoriatic arthritis is methotrexate. DMARDs work to suppress the body’s overall immune system, so your rheumatologist will follow you closely while taking this medication.

Biologics

These medications are protein-based drugs that are derived from living cells cultured in a laboratory. Because they come from living cells, they can also be quite expensive. They are a great step forward in psoriatic arthritis treatment because they can zero in on certain parts of the immune system, instead of suppressing the entire immune system.

Biologic medications, frequently delivered via injection or infusion, are often divided into groups based on the part of the immune system that they help control. According to the National Psoriasis Foundation, these include:

• Interleukin 12 and 23 (IL-12/23) inhibitors

• Interleukin 17 (IL-17) inhibitors

• Interleukin 23 (IL-23) inhibitors

• T-cell inhibitors

• Tumour necrosis factor-alpha (TNF-alpha) inhibitors

PDE4 Inhibitors

Currently there is only one PDE4 inhibitor—apremilast—approved for psoriatic arthritis. This drug can be taken orally, and routine blood tests are not required. Apremilast is used for people with mild to moderate psoriatic arthritis, according to the Mayo Clinic.

JAK Inhibitors

First approved by the FDA in 2012 to treat other conditions, Janus kinase (JAK) inhibitors are not new therapies. They act similarly to biologics by interrupting inflammatory cell pathways. With an inflammatory condition, a break in inflammation signally can be very helpful to controlling pain. Some JAK inhibitors, which a typically delivered orally, come with warnings of major adverse reactions for some people, so it is important to discuss the risks and benefits with your provider.

Corticosteroids

Corticosteroids (a.k.a. steroids) are often used to reduce painful flareups while you are waiting for a longer-term therapy to start working. They are not recommended for long-term use due to a long list of potential side effects. Commonly prescribed steroids include prednisone and hydrocortisone.

Talking With Your Doctor

Not long ago, having psoriatic arthritis meant living with chronic pain in almost any joint. Thanks to many different new treatments, chronic pain is no longer the expected PsA outcome. Moreover, experts now know that exercise, diet, and mental wellness all play an important role in keeping psoriatic arthritis pain at bay.

If you are in pain, it is important to let your doctor know—this information will serve as a signal to your provider that a new treatment or plan for pain relief is needed.

https://www.healthcentral.com/condition/psoriatic-arthritis/psoriatic-arthritis-pain-relief?ap=nl2060&rhid=&mui=&lid=141093361&mkt_tok=NTQxLUdLWi0yNDMAAAGX4EN75zpsfMF9z7J5RrkmoRqLlVEhanDfW7IRIB1-b2CcsqlY0JY9TEBYw5RZsWTMGwoIzoZCxfjlkwRZ-1utHNKFlOuDltH5eN14ZcljUHN0YXo 

Psoriatic arthritis: Cold weather skin care

From mcpress.mayoclinic.org 

7 ways to protect skin and prevent flares when the temperature drops

Cold weather can make anyone’s skin feel dry and itchy. But with psoriatic arthritis, dry skin can lead to painful skin flares. Keep skin and nails healthy with these do’s and don’ts.

• Don’t take hot showers or baths. It might feel good when the weather is chilly, but hot water can make skin feel dry, tight and itchy. This can lead to a psoriasis flare. Instead, take a warm or cool shower or bath just once a day.
• 
  

Keep showers and baths short. Too much time in the water can dry skin. The American Academy of Dermatology suggests five minutes for a shower and 15 minutes for a bath.

• Do use your hands instead of a washcloth, sponge or loofah in the shower or bath. Washcloths, sponges and loofahs can scratch and cause breaks in the skin that could lead to skin psoriasis symptoms.
• 
  
• Don’t use deodorant soaps or scented soaps. What’s in these products can bother skin. Choose soaps and cleansers that add moisture and are made for sensitive skin. Also, skip facial and body scrubs. They tend to be hard on skin.
• 
  
• Do dry gently. Gently blot water from the skin with a soft towel or cloth. Rubbing can hurt the skin. Leave skin a bit damp.
• 
  
• Do use moisturizer every day. To prevent dryness, gently put a thick ointment or cream on the skin right after the bath or shower. Moisturize often during the day and again before bedtime. Choose products with no smell made for sensitive skin.

The National Psoriasis Foundation suggests using products made for psoriasis from CeraVe, Curel and Gold Bond, among others.

• 
  
• Don’t forget hands and nails. Most people with psoriatic arthritis have nail symptoms. Keep nails short. Always moisturize your hands and nails, especially after washing hands. When doing dishes, wear cotton gloves under vinyl or nitrile ones.
• 
  
• Do use a machine that adds moisture to the air, known as a humidifier, when the heat’s on. This can help keep skin from drying out.

https://mcpress.mayoclinic.org/psoriatic-arthritis/psoriatic-arthritis-cold-weather-skin-care/

Psoriasis and Alcohol: 4 Reasons to Drink Less

From everydayhealth.com

If you have psoriasis, you’ve likely experienced itchy, scaly, discoloured patches on your skin that can be annoying and uncomfortable. Psoriasis symptoms can disrupt sleep, and the condition is linked with psoriatic arthritis, which can cause pain and joint stiffness.

Because of its symptoms, psoriasis can impact how you feel not only physically but also emotionally. Research suggests this challenge has led many people with the chronic autoimmune disorder to turn to alcohol.

“There is no question people with psoriasis drink more than others — there are many epidemiological studies showing that,” says Mark G. Lebwohl, MD, a dermatologist and the chairman emeritus of the Kimberly and Eric J. Waldman Department of Dermatology at the Icahn School of Medicine at Mount Sinai in New York City.

“Does alcohol make psoriasis worse, or does psoriasis make people consume more alcohol? It’s much easier to demonstrate the latter than the former,” he adds.

Indeed, although some research has shown that alcohol worsens psoriasis symptoms, and may even trigger flares, other studies suggest otherwise.

“Studies to date have been mixed, but it’s been observed by many dermatologists who treat psoriasis that people with the condition become fairly ill after binge drinking, and part of that is that their psoriasis symptoms worsen,” Dr. Lebwohl notes.

In addition, many people with psoriasis also have other health problems — from overweight or obesity to high blood pressure or heart disease — and “drinking alcohol doesn’t make any of those things better,” he adds.

Here are four reasons to limit alcohol consumption if you have psoriasis. 

Increased Severity of Symptoms

Although the exact cause of psoriasis remains a mystery, what is known is that the condition involves problems with the immune system and inflammation.

Normally, the immune system uses inflammation to fight off infections or recover from injury. If you have psoriasis, however, your immune system uses inflammation in error, resulting in the symptoms of the condition.

Alcohol affects the function of brain chemicals called neurotransmitters, which impact your behaviour and body’s responses, including the immune response. 

It’s possible that neurotransmitters also trigger the body’s response in psoriasis. Research suggests that the chemical messengers may also play a role in the inflammation process with psoriasis. That’s just one theory, though.

Meanwhile, recent studies have shown that alcohol may negatively impact the skin barrier, the outermost layer of the skin that functions like a brick wall around the inner layers, preventing moisture from escaping and allergens and viruses from entering.

The skin barrier is made up of skin cells called keratinocytes. Alcohol may cause these cells to proliferate, disrupting the function of the skin barrier and making it easier for allergens and viruses to enter it, studies have found.

This could worsen the symptoms of psoriasis, research suggests.

                                                         Excessive drinking can worsen psoriasis symptoms and interfere with treatment.
                                                                                                                             Martí Sans/Stocksy; Everyday Health

Impaired Effectiveness of Treatments

Alcohol may also limit the effectiveness of certain psoriasis treatments and reduce a person’s adherence to their treatment regimen.

A 2021 analysis found that excessive alcohol consumption was associated with reduced response to both conventional and biologic systemic treatments.

“[Biologics] are the newer and better drugs we have to treat psoriasis,” Lebwohl says.

Furthermore, a study published in 2022 found that any alcohol use at all was associated with a higher risk for treatment failure among people with psoriasis on biologic therapy.

Part of the reason for this is that people with psoriasis who drink are less likely to adhere to their treatment as prescribed.

At least one study has found that drinking alcohol is a key reason many people with psoriasis don’t follow their treatment course as recommended by their doctor, which ultimately influences how well these drugs work to control symptoms.

Raised Risk of Comorbidities

Comorbidities are medical conditions that coexist with another diagnosis and may affect your health and treatment as a result.

Because of psoriasis’s effect on the immune system, people who have it are at an increased risk for certain comorbidities.

Here are the most common comorbidities associated with psoriasis and their potential relationship with alcohol consumption.

Psoriatic Arthritis If you have psoriasis, you’re at high risk for psoriatic arthritis, which occurs when the inflammation caused by the condition affects your joints. About 30 percent of people with psoriasis develop psoriatic arthritis, research shows.

Most studies assessing the relationship between alcohol use and psoriatic arthritis risk among people with psoriasis have found little if any correlation. But a 2020 analysis observed that people with psoriasis who consumed one to three alcoholic drinks per day had a 57 percent higher risk for psoriatic arthritis.

Heart Disease People with psoriasis are already at increased risk for heart disease. Alcohol use is also a known risk factor for heart problems, as it has been shown to increase blood pressure, and it has been linked with conditions such as coronary heart disease, stroke, peripheral arterial disease, and cardiomyopathy.

Liver Disease Alcohol use can cause liver disease, and an analysis of data from multiple studies published in 2022 found that people with chronic plaque psoriasis are nearly twice as likely to develop metabolic dysfunction–associated steatotic liver disease (MASLD) (formerly known as non-alcoholic fatty liver disease), as people who don’t have psoriasis.

“People with psoriasis tend to be overweight or obese, which means their lipid levels tend to be higher,” Lebwohl says. “That’s why they are at higher risk for fatty liver disease.”

Lipids are organic compounds in the body that include fats and cholesterols.

Because both alcohol use and psoriasis can increase a person’s risk of liver problems, dermatologists writing in the American Journal of Clinical Dermatology recommend that people with psoriasis be discouraged from “excess” alcohol consumption.

In addition, several of the newer biologic therapies for psoriasis carry U.S. Food and Drug Administration (FDA) warnings concerning potential harm to the liver, according to Lebwohl, much like the drug methotrexate, which, though older, is still often used to treat psoriasis (at least in small doses).

“By themselves, these drugs are no more harmful for the liver than many others we use all the time,” Lebwohl says.

But some drugs, including methotrexate, can lead to hepatic fibrosis when used in combination with alcohol.

This could lead to serious health complications, including cirrhosis.

Possible Increase in Mental Health Issues

Numerous studies have shown that people with psoriasis often have depression, and a significant percentage have anxiety, sometimes along with depression. Depression and anxiety are often related and are themselves comorbidities for each other.

One study found that people with psoriasis had a 21 percent higher risk of depression and a 17 percent higher risk of anxiety than the general population.

Although some studies have found that excessive alcohol use among people with psoriasis is associated with higher rates of depression or anxiety, that’s not always the case.

Still, rates of depression and anxiety are higher among people with alcohol use disorder, according to the National Institute on Alcohol Abuse and Alcoholism, and alcohol use is known to worsen symptoms of anxiety, while reduced consumption may lead to “substantial reductions” in depression symptoms.

If you’re concerned that your alcohol intake is affecting your mood, your psoriasis, or any other part of your life negatively, talk to your doctor about alcohol use disorder treatments. Options include therapy programs, support groups, medication, and, often, a combination of these.

The Takeaway

• If you have psoriasis, cutting back on alcohol can benefit your skin and your overall health.
• Alcohol can interact with some commonly used psoriasis treatments and lower the chances you’ll follow your treatment regimen.
• Alcohol raises the risk of heart and liver disease and may raise your risk of psoriatic arthritis.

https://www.everydayhealth.com/skin-conditions/psoriasis-and-alcohol-reasons-to-drink-less/