Some skin reactions are acute and readily present themselves after a change in your immediate environment. Maybe you tried a new soap or detergent that was too harsh for your skin, or were affected by severe weather conditions. Or perhaps your line of work creates calloused skin on your joints from repetitive movements. But when scaly, itchy patches of skin appear and you can’t pin down the source, there may be more complicated factors at play.

If scaly, raised patches of irritated skin sound familiar to you, you may have heard of psoriasis. It’s a skin disease that affects as much as 3% of the U.S. population, which is more than 7.5 million American adults. It causes different levels of discomfort, depending on the size and location of affected skin areas and intensity of sensations. Psoriasis is cited as a public health concern not only because people with the disease suffer more frequent mental distress than those without, but also because it is strongly associated with obesity and prior smoking status. (Source, Source)

What causes psoriasis is not yet fully understood, but there are treatments available to successfully manage symptoms. The unknown cause, paired with its manifestation through different triggers, at different stages in life, and with a hyperactive immune response, makes psoriasis commonly lumped into the category of autoimmune diseases. However, there are more specific and helpful ways to describe and understand psoriasis. (Source)

In this article, we’ll take a look at the types, causes, triggers, and common symptoms of psoriasis, along with how this condition is diagnosed and treated. Spoiler alert: Your lifestyle has a big impact on successful symptom management!

What Is Psoriasis?

Psoriasis is a chronic skin disorder that typically appears without warning and causes various reactions on the surface of the skin. Reactions include white patches of scaly skin that most commonly affect the elbows and knees, as well as redness, swelling, itching, or pain. Nails can be affected as well, turning thick, pitted, or ridged. There are 5 types of psoriasis:

• plaque psoriasis
• guttate psoriasis
• inverse psoriasis (also known as intertriginous or flexural psoriasis)
• pustular psoriasis
• erythrodermic psoriasis

It is possible for more than one type to occur simultaneously, and each type varies in severity. Some types, namely erythrodermic and some instances of general pustular psoriasis, require medical intervention because of their serious and life-threatening effects. (Source, Source)

Scientists cannot fully explain what causes psoriasis, but the current research looks towards genetics and environmental factors as the major determinants of developing the disease. Of the 5 types, plaque psoriasis is the most common and often occurs in the presence of other autoimmune diseases. It may even be an autoimmune disorder itself, although this hasn’t been entirely proven. (Source, Source)

Three Common Misconceptions About Psoriasis

It’s important to dispel some common misconceptions about psoriasis before we explore the disease in more detail.

• First and foremost, psoriasis is not contagious. You can’t get it from being in contact with someone who has psoriasis, whether via physical touch, swimming in a pool, or more intimate forms of contact. It isn’t like a common cold, flu, or chickenpox and can’t be transmitted from person to person through any type of contact. (Source)
• Psoriasis is not a disease that’s restricted to the skin. The inflammation it causes can affect internal tissues and joints as well. In some cases, chronic inflammation resulting from psoriasis acts as a precursor to psoriatic arthritis, which is why it’s critical to manage inflammation through treatment and a supportive diet and lifestyle. (Source, Source)
• Psoriasis is not caused by a singular external factor such as gluten-containing ingredients or harsh laundry soap. Its origins involve your unique and complex biology and cannot be reduced down to a single trigger or event. (Source)

What Is Plaque Psoriasis?

Plaque psoriasis, the most common form of this inflammatory condition, is characterized by thick, scaly patches of dry skin, called plaques, created from rapid skin growth and inflammation. You’re most likely to find them on the knees, elbows, lower back, or scalp. And regardless of plaque size — they can be a single patch or multiple patches growing together to form a larger area — they are itchy and can burn, sting, or feel tight and painful. Plaque psoriasis affects more than 85 percent of people diagnosed with psoriasis. (Source)

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What Causes Plaque Psoriasis?

Genetics

Studies on the genetics of people with psoriasis have shown different gene variations that affect the function of the immune system and skin barrier. Chromosomes, gene mutations, overstimulated cytokines (which are small proteins that control both growth and activity of immune system cells and blood cells), and single nucleotide polymorphisms, or SNPs, are all pieces of the genetic puzzle that may predispose a person to psoriasis. (Source, Source, Source)

Family History

The American Academy of Dermatology states that if you have a grandparent, parent, or sibling who has psoriasis, your personal risk for getting psoriasis is increased. However, this familial association does not create a direct link to you also getting the disease. Some people with a genetic predisposition based on family history never develop psoriasis because those genes are never activated. (Source)

Conversely, those without certain genetic traits can still get psoriasis. That’s why the root cause of psoriasis has yet to truly be identified; the variables for presentation are different from person to person and are triggered through different circumstances. (Source)

Immune System

What is known for certain is that plaques appear because T cells, a type of white blood cell, flood to the areas where the disease is present on the skin, react, and cause inflammation. This leads to rapid skin cell division and turnover, creating the buildup of dead skin cells on the skin’s surface. (Source)

Though it is unknown why the T cells start this process in the first place, the reaction persists for life because there is no safe way to inhibit T cells without damaging overall immune system function. Psoriasis often manifests in people already living with other autoimmune diseases. There is evidence of an association between psoriasis and Crohn’s disease, celiac disease, multiple sclerosis, and lupus because of the underlying immune system dysfunction shared among these conditions. (Source, Source)

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Is Psoriasis an Autoimmune Disease?

Now that we understand the significance of genetics, family history, and immune system function as potential contributors to psoriasis, can we prove with conviction that it is an autoimmune disease? The frustrating answer is no. The National Psoriasis Foundation calls psoriasis, sometimes considered a skin disease or chronic skin condition, an “immune-mediated disease,” meaning that while the disease has an unclear cause, it is inflammatory in nature due to an impaired immune response. But so far, scientific research has not given psoriasis the firm classification of autoimmune disease. (Source, Source)

One major difference between plaque psoriasis and known autoimmune diseases is that with psoriasis the immune system sends out T cells and triggers overgrowth of new cells. Skin cells are overproduced, as opposed to what’s seen in other autoimmune conditions such as rheumatoid arthritis, where healthy cells are attacked.  

As with many diseases and chronic inflammatory conditions that have a basis in immune system dysfunction, more research is needed to classify with certainty whether or not psoriasis is in fact an autoimmune disease.

What Triggers Plaque Psoriasis?

When psoriasis arises, it can be difficult to pinpoint the initial trigger that caused the disease. But once you’re living with psoriasis, it becomes easier to recognize what produces symptoms in your unique case. Common psoriasis triggers include:

• stress: Stress can trigger psoriasis, and a psoriasis flare-up can also cause stress. This cycle can be broken with healthy lifestyle habits, which we’ll discuss later.
• skin injury: Scratches, bug bites, vaccinations, and sunburns contribute to psoriasis flare-ups.
• weather: Both extreme cold and extreme hot temperatures take a toll on psoriatic skin.
• illness: Allergic reactions, common colds, the flu, or other strains on your health that kick the immune system into gear have the potential to cause psoriasis flares.
• other external triggers: Food sensitivities, alcohol use, and various environmental impacts on health can also trigger psoriasis symptoms.

(Source)

Diagnosing and Treating Plaque Psoriasis

A board-certified dermatologist is your best bet at receiving a psoriasis diagnosis. They will take into account your symptoms, family history, recent life stressors, and joint pain or swelling when determining whether or not you have the disease.

After the initial relief of being able to give your pain a name, more relief comes in the form of treatment. There is no cure, but different interventions can produce positive changes depending on symptom severity. Some of these treatments include:

• topical steroids
• anti-inflammatory or nonsteroidal topical medications
• medicinal plant salves (like milk thistle)
• phototherapy
• oral medications
• biologics (injectable medications)
• lifestyle modifications

(Source, Source)

The right treatment options all depend on your individual case of psoriasis, but one thing is for sure: Lifestyle modifications play a major part in successful management. Having psoriasis carries the risk of developing other serious conditions, some of which include psoriatic arthritis, heart attacks, mental health problems, Crohn’s disease, diabetes, and obesity. Creating a lifestyle that supports a healthy immune system can help you manage your psoriasis for the long haul, and lower your risk for other associated ailments. (Source)

Living With Plaque Psoriasis

People with psoriasis report having feelings of anger, depression, anxiety, and social isolation that they directly attribute to their skin condition. Their perception of the severity of the disease can affect their quality of life, and stressing over the appearance of plaques can worsen psoriasis flare-ups. Because of this slew of psychological factors, stress management and relaxation techniques can improve how you relate to your symptoms. (Source, Source)

Additionally, lifestyle habits such as smoking and alcohol use can predispose you to psoriasis, especially if certain genetic components for the disease already exist. These substances can also exacerbate symptoms when the disease is present. The bottom line here is that smoking and alcohol only make it more challenging to manage psoriasis. (Source)

Nutrition is also a factor in living well with psoriasis. One study points out that people with the disease often have an unbalanced diet that’s lower in fish and fiber intake and higher in saturated fats, compared to controls. (Source)  

All this to say, your mental health and dietary habits have a big influence on keeping psoriasis in check!

Managing Plaque Psoriasis With Lifestyle Interventions

Since plaque psoriasis has mysterious origins, crops up with other autoimmune diseases, and usually has its onset later in life, there are definite barriers to overcome in order to live your healthiest life after diagnosis. But because lifestyle changes can curb psoriasis symptoms, you may want to consider turning to integrative care to bolster the treatments recommended by your health care provider when creating a holistic management plan.

Psoriasis is no stranger to our Nutritional Therapy Practitioners here at WellTheory. They are here to help you identify potential triggers and, taking your individual nutrient needs into account, support you through targeted dietary changes and/or a therapeutic diet such as the AIP elimination diet.

The Bottom Line on Psoriasis and Autoimmunity

Psoriasis is a chronic inflammatory skin condition that varies in severity. Plaque psoriasis is the most common form and involves immune system dysfunction, but we can’t yet say it’s definitely an autoimmune disease. Currently, there is no cure for psoriasis, but it can be managed through changes to your diet and lifestyle.

Living with psoriasis can be burdensome, both physically and mentally, so it’s essential to be your own best advocate while consulting with your health care providers to receive the care you deserve. Feeling your best is possible when you have the right treatment and support for managing your psoriasis diagnosis.

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