Photo Credit: by SkyMD, Flickr.com
Psoriasis is a chronic autoimmune skin condition that affects millions of people worldwide. It causes the formation of thick, scaly patches on the skin's surface. While the exact cause is unknown, factors like genetics, infections, and environmental triggers can play a role in its development. Recent studies have also linked gut dysbiosis (an imbalance of gut microbes) to psoriasis.
PSORIASIS
Some key points one should be aware of:
● Evidence now shows that psoriasis causes your immune system to become overactive, causing skin cells to grow much faster than normal. Possible precipitating factors include disruption of the gut from either an infection or inflammation or absorption of an inflammatory substance through the skin. More specifically, psoriasis activates T cells of your immune system. T cells respond to what they believe is an “intrusion” on the body by activating inflammation. This inflammation leads to thickened, plaque-like patches seen on the skin.
● These plaques are often red or discolored, itchy, and sometimes painful. They can appear anywhere on the body but are most common on the elbows, knees, scalp, and lower back.
● Psoriasis is not contagious - you can't catch it from someone else.
● It's a long-lasting condition that tends to go through cycles, flaring up for a while and then subsiding.
● While there's no cure, various treatments can help manage symptoms and reduce flare-ups.
● The condition can affect people of all ages, but it often first appears between the ages of 15 to 25. Psoriasis
● Psoriasis is more than skin-deep - it's an immune system issue that can also affect joints (psoriatic arthritis) and increase the risk of other health problems.
FACTORS TO CONSIDER
There can be periods of remission followed by periods of flare-ups. While the exact triggers can vary from person to person, certain factors are known to commonly exacerbate symptoms.
Understanding these triggers is crucial for managing the condition effectively. Here are some of the most common triggers that can lead to psoriasis flares:
1. Stress: Emotional stress is one of the most frequent triggers for psoriatic diseases. The immune system may overreact to stress, leading to symptoms.
2. Skin injuries: Cuts, bruises, scrapes, bug bites, tattoos, sunburns, and other skin traumas can trigger flares due to the Koebner phenomenon. (Skin lesions)
3. Infections: Strep throat, respiratory infections, and other illnesses can trigger flares 2-6 weeks after the infection, especially in children.
4. Weather changes: Cold temperatures, low humidity, and dry air can affect the skin and joints, potentially causing flares.
5. Alcohol consumption: Frequent drinking or having more than 2 drinks a day can lead to flares and interfere with psoriasis treatments.
6. Smoking: Both active smoking and exposure to secondhand smoke can trigger psoriasis flares.
7. Certain medications: Some drugs like antimalarial medications, beta-blockers, and lithium may trigger or worsen psoriasis.
8. Diet: Some people report that certain foods, particularly those containing gluten, can worsen their symptoms. This is evidenced by the higher presence of Lipopolysaccharides (LPS) in the bloodstream during psoriasis flares. These are toxins released by harmful bacteria in the gut when they consume unhealthy foods.
9. Hormonal changes: Fluctuations during puberty, pregnancy, and menopause may exacerbate psoriasis symptoms.
10. Obesity: Being overweight or obese may increase the risk of developing or worsening psoriasis.
https://www.webmd.com/skin-problems-and-treatments/psoriasis/psoriatic-disease-triggers
https://www.aad.org/public/diseases/psoriasis/triggers/flares
www.medicalnewstoday.com/articles/323231
https://www.psoriasis.org/causes/
https://health.clevelandclinic.org/psoriasis-triggers
TREATMENT OPTIONS:
While there is no known cure, various treatments are available to manage symptoms, including topical treatments, light therapy, and systemic medications. Dietary measures have been shown to help especially anti-inflammatory type diets like the Mediterranean diet.
Medication options for psoriasis include:
Topical treatments:
● Corticosteroids: Available in various forms like creams, ointments, and foams to reduce inflammation and itching.
● Vitamin D analogs: Help slow skin cell growth.
● Calcineurin inhibitors: Reduce inflammation and plaque buildup.
● Coal tar: Can reduce scales, inflammation, and itchiness.
● Dithranol: Suppresses skin cell production.
● Salicylic acid: Helps remove scales.
● Tapinarof cream: A steroid-free topical treatment for plaque psoriasis.
Phototherapy:
Phototherapy is another treatment option that effectively treats psoriasis by targeting three key aspects of the condition: it lowers the abnormally fast skin cell production, dampens the exaggerated immune system activity, and alleviates skin inflammation. This triple-action approach helps to reduce the formation of psoriatic plaques and promotes healthier skin.
Systemic medications:
● Biologics: Target specific parts of the immune system.
● Otezla (Apremilast): An oral medication that controls inflammation, it is available in the strength of 10 mg/20 mg/30 mg starter kit (4 tabs/4 tabs/19 tabs) and 30 mg tablets.
● Rheumatrex (Methotrexate): Sometimes used for refractory cases, it is available in the strength of 2.5 mg, 7.5 mg, and 10 mg tablets.
● Biologics: Used for severe cases.
● Optimmune (Cyclosporine): Prescribed for extensive or disabling psoriasis, it is available in 3.5 gm and 5 mg Ointment
● Retinoids: Oral medications like Soriatane (Acetretin) for severe psoriasis, it is available in the strength of 10 mg and 25 mg capsules.
OTEZLA
Otezla (apremilast) has a relatively recent history as a treatment for psoriasis. It was approved by the FDA in 2014 for psoriatic arthritis and in 2015 for moderate to severe plaque psoriasis. As an oral medication, Otezla is a prescription pill that works from inside the body to treat inflammation associated with psoriasis. Unlike traditional creams or injections, it's an oral systemic therapy that inhibits an enzyme called phosphodiesterase 4, which helps regulate inflammation within cells.
As a newer treatment option, Otezla provides several advantages:
1. Convenient oral administration, avoiding the need for injections or topical applications.
2. Targets inflammation internally, addressing the underlying cause of psoriasis symptoms.
3. Can be used alone or in combination with other treatments like phototherapy or topicals.
4. Doesn't require routine lab monitoring, unlike some other systemic psoriasis medications.
Otezla has shown effectiveness in treating plaque psoriasis, active psoriatic arthritis, and oral ulcers associated with Behçet's disease (a rare inflammatory disorder).
https://www.otezlapro.com
It offers an alternative for patients who may not have responded well to traditional treatments or prefer an oral medication.
While Otezla can cause side effects such as diarrhea, nausea, and headaches, many patients find it to be an effective and manageable treatment option for their psoriasis symptoms
As we continue to unravel the intricate mechanisms behind psoriasis the future holds promise for even more innovative therapies. Advancements in psoriasis management have introduced various therapies, from healing the gut to topical applications to systemic treatments. Otezla (apremilast) stands out as a promising modern drug for those suffering from moderate to severe plaque psoriasis.
As always, please discuss any treatment options and medications with your doctor.This article is for information purposes only. If you’d like to read more about how your gut health affects psoriasis, my book The Gut Revolution devotes an entire chapter to the skin and the gut. It also gives dietary tips on how to decrease inflammatory flare-ups.
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