Deeper Than The Skin: Psoriasis 101

Although classified as a skin disease, the physiological aspects of psoriasis (PsO) and psoriatic arthritis (PsA) are seldom as easy to diagnose as the visual symptoms we see and feel are. Twin studies indicate that even though there’s a definite genetic predisposition to the condition, genetics alone don’t necessarily or conclusively dictate whether we will have psoriasis at some point in our lives.

While topical treatments and home remedies may well help to treat the symptoms locally or offer some comfort and give a protective barrier around the affected area, they won’t and can’t affect our underlying bio-chemistry that’s causing it.

Deeper Than The Skin: The Physiological Aspects Of Psoriasis |
Copyright © 2021 | Adapted from American Academy of Family Physicians(4)

So the environment, diet and nutrition, lifestyle, antibiotics history, and medical history (such as streptococcal infections associated with PsA) are significant.

The internal physiological aspects of psoriasis – and any other autoimmune disease, really – can influence and affect the inflammatory cascade that leads to skin lesions and links to all the other comorbid conditions that are associated with PsO and PsA.

Methods that can heal the gut microbiome and improve our insulin resistance, and dietary components that can help reduce inflammation or help regulate angiogenesis may lead to a remission or “cure” of sorts, but this then begs the question: Is remission a cure or simply a brief pause on a certain way of life?

What triggers remission in Pso and PsA?

Psoriasis remission occurs when symptoms of PsO or PsA disappear altogether, albeit briefly. As these conditions are incurable, the primary goal of treatment for both is remission.

Remission is an ideal state of health, where the immune system gives the skin time to heal, or joints are no longer affected.

A review of available literature regarding studies on remission in PsO and PsA patients over the past 20 years highlights the fact that remission is a spontaneous act that currently has no known trigger or reason.

An often-ignored, under-recognized, undertreated, or overlooked factor that affects quality of life for PsA patients is comorbidity, where a large proportion of PsA patients have comorbidities, which influence their treatment, prognosis, and outcomes.

These comorbidities need to be considered when setting realistic expectations of disease remission. Although these PsA comorbidities may include the obvious PsO skin condition, they could also extend to:

  • cardiovascular disease
  • obesity or metabolic syndromes
  • depression
  • uveitis
  • and cancer

Expectations are an important factor in disease management.

59% of surveyed PsA patients in a 2018 study(1) were either receiving no treatment or only topical treatment. In this study, the decision to not treat was influenced by:

  • environmental and lifestyle factors
  • ongoing stigmatic attitudes towards people with either PsO or PsA
  • increased feelings of isolation and a “differentness” to others
  • and the burden of treatment options, which often includes a lack of time to enjoy own activities.

Treatment options and methods clearly impact quality of life and result in very low expectations that dermatologists or rheumatologists will be able to effectively treat PsO or PsA.

However, treatment options and lifestyle changes are able to bring about remission in some cases and under certain circumstances, but this differs from person to person(2).

Flare-remission cycles are common in autoimmune diseases and psoriatic diseases, specifically. In addition to this, autoimmune diseases seem to be more prevalent in the female gender(3), although psoriatic disease affects men and women almost equally.

Misdiagnosis plays a large role in treatment and resulting remission occurrences. Even so, there is no “one size fits all” treatment option for psoriatic disease because we are all unique and respond to different treatments in different ways(4).

Spontaneous remission – that is, without any apparent trigger or reason – could result in a marked reduction in arthritic symptoms or skin that clears up completely. Remission may be short, extended, or lifelong, with no way to predict onset or repeated flares.

This inability to predict flares and onset of symptoms extends to the possibility of becoming a psoriatic patient. If one in three patients have a close family relative, two-thirds do not.

Scientists believe(5) that a combination of genetic factors and external triggers cause psoriasis. These factors include:

  • stress or anxiety
  • trauma or depression
  • illness (particularly in viral or bacterial coccus infections)
  • skin injuries in flare spots
  • medications for other conditions
  • allergic reactions to almost any allergen
  • foods and their nutritional values
  • lifestyle choices or substance abuse
  • environmental factors
  • and lack of sleep

Being born with specific psoriasis-causing genes is also not a guarantee that you will have psoriatic disease, either. It stands to reason that avoiding triggers is key to delaying the onset of psoriasis, preventing the development of non-hereditary psoriatic disease, and limiting flare-ups to initiate long-term or lifetime remission.

Getting your immune system to turn off its faulty attacks(6) against your body is vital to creating an ideal environment to trigger remission.

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