Psoriasis – The Food Medic

This article was written by London-based GP – Dr Nirja Joshi

August is psoriasis awareness month so we are shining a light on this topic and discussing what it is, how it can be treated, and it’s impact on other aspects of our health.

What is psoriasis?

Psoriasis is an inflammatory skin condition. It can affect anyone at any age, but is more likely to affect people between 20-50 years old. In the UK it affects about 2 in 100 people (1). it is characterised by itching and flaking of the skin and often presents as raised patches around the elbows and knees and can also present in other areas such as the scalp. The patches can present as red with silver scale and sometimes white flakes. in darker skin the patches can appear darker and the scale may appear grey (1). 

There are lots of different types of psoriasis which can look different. Here are some of the main types (2):

• Plaque psoriasis – this is the most common type of psoriasis affecting 80% of sufferers with patches which could affect the whole body. This is most common around the knees, elbows and scalp.

• Guttate psoriasis – this affects about 1 in 10 sufferers of psoriasis. This appears as much smaller areas of psoriasis which can be triggered by medicines, stress or infections such as tonsillitis.

• Pustular psoriasis – pustules can develop generally on the hands and feet.

How can psoriasis be treated?

Treatment for psoriasis can help to keep symptoms under control and most patients can be managed by their GP. The treatment which is initiated will depend on the severity and location of the symptoms. 

Treatment tends to fall into three main categories (6):

• Topical – creams which can be applied to the skin
• Phototherapy – skin being exposed to specific times of UV light
• Systemic – oral medications or injections which work on the whole body

Emollients are moisturising creams which help to reduce itch and scale and improve the skin’s barrier. Emollients are best to be applied 30 minutes before applying another treatment. These types of creams may be bought over the counter, or prescribed by your GP (6).

Steroid creams of varying strengths may also be prescribed which help with the inflammation. It is important to only use steroid cream on affected skin as it can cause thinning of the skin.

Other treatments such as vitamin d analogues, coal tar and tablets such as methotrexate can also be used for the treatment.

Psoriasis and mental health

We know that having skin issues can often impact a patient’s mental health, due to appearance and some misconceptions that skin conditions may be contagious, however, there is some interesting information about how stress may be responsible for flare ups of psoriasis. 

One study showed that 68% of adults reported a stressful life event before a flare of psoriasis (3). One theory (Faber et al) suggests that a Substance P and Nerve Growth Factor, two chemicals which are thought to be related to psoriasis, increase at times of stress (3).

As well as stress and mental health playing a possible role in the presence of psoriasis, psoriasis can also increase the risk of mental health issues. Psoriasis is independently associated with depression, and those with psoriasis are twice more likely to have suicidal thoughts. This can be attributed to the physical symptoms associated with psoriasis, and the emotional burden of having a visible condition which is not well understood by others. This has been found to be more prominent amongst women, young people and minorities. This can be a difficult cycle as those with the disease may feel stressed, and then stress is a documented trigger for worsening disease (3). 

Those with psoriasis who see an improvement in their condition, also see an improvement in their psychological wellbeing (3).

Psoriasis and diet

There are no foods which cure psoriasis, however, there are foods which have been found to help with symptoms (4). Check out our article here to learn more about psoriasis and nutrition.

Psoriatic arthritis

Psoriatic arthritis can cause pain, swelling and stiffness in any joint in the body, but is most common in the hands and feet. Almost 1 in 3 people with psoriasis will have psoriatic arthritis. In most cases, people develop psoriasis 5-10 years before any joint pain occurs, however, in others the arthritis may occur before any skin changes (5).

Support available

Psoriasis could impact people who work in certain jobs(7). It is important to seek help if you are concerned about your employment; this could be in jobs such as the army or navy, or within health care or any professions that require regular hand washing. and people within food preparation need to be conscious of any open sores. Here is a useful link from The Psoriasis Association which can help with employment advice, https://www.psoriasis-association.org.uk/employment

For psoriasis action month, you can receive a kit to help guide you through your psoriasis treatment options from the National Psoriasis Foundation here: https://www.psoriasis.org/psoriasis-action-month-e-kit/

References

1. NHS. Psoriasis Overview [Internet]. 2022 [cited 2022 Aug 9]. Available from: https://www.nhs.uk/conditions/psoriasis
2. National psoriasis association. Locations and types [Internet]. 2021 [cited 2022 Aug 8]. Available from: https://www.psoriasis.org/locations-and-types//
3. T. S. Sathyanarayana Rao, K. H. Basavaraj,1 and Keya Das. Psychosomatic paradigms in psoriasis: Psoriasis, stress and mental health. Indian journal of psychiatry [Internet]. 2013 Oct [cited 2022 Aug 8];55(4). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3890931/
4. National Psoriasis association. Dietary Modifications [Internet]. 2020 [cited 2022 Aug 10]. Available from: https://www.psoriasis.org/dietary-modifications/
5. NHS. Psoriatic arthritis [Internet]. 2019 [cited 2022 Aug 10]. Available from: https://www.nhs.uk/conditions/psoriatic-arthritis/#:~:text=Psoriatic%20arthritis%20is%20a%20type,that%20can%20get%20progressively%20worse
6. NHS. Treatment Psoriasis [Internet]. 2022 [cited 2022 Aug 9]. Available from: https://www.nhs.uk/conditions/psoriasis/treatment/
7. Psoriasis association. Employment help [Internet]. 2018 [cited 2022 Aug 10]. Available from: https://www.psoriasis-association.org.uk/employment

Psoriasis was last modified: August 23rd, 2022 by Nirja Joshi