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Got itchy, scaly red or purple patches on your arms, legs, scalp — even your nether regions? It could be psoriasis.
But before you start scratching that itch, you may be wondering if this thing is a skin-deep issue, an allergy, or a legit response from your immune system 🤔.
Let’s dive in.
That’s a tricky question. Even though about 3 percent of peeps have psoriasis, scientists still don’t know its root cause. The U.S. National Library of Medicine’s take? It’s “a problem with your immune system.”
Basically, psoriasis = some combo of genetics, your environment, and your immune system mistaking your skin cells as foreign invaders.
When you have an autoimmune disease, your body mistakes normal, healthy tissues for foreign invaders. Basically, it goes to war with itself, causing damage and inflammation.
Not so fun fact: There are 100+ autoimmune diseases. Some of them, like psoriasis, only affects one body part (hello, skin wars). Others are system-wide, leaving your body exhausted and achy almost 24/7.
Regardless of your autoimmune diagnosis, your body is doing its war-waging thing because of some mysterious perfect storm of genetics and environmental factors. (Sounds like a superhero origin story, feels like death ☠️.)
TBH, experts aren’t sure why things in your environment trigger the unfortunate “Oh no, those skin cells are our enemies!” immune response. They just know that the environment plays a role in flipping the switch.
Some environmental factors that raise your risk of psoriasis?
Research is ongoing, but we *do* know that folks with certain genetic markers are 2 to 5 times more likely to get an autoimmune disease. That could mean that autoimmune issues run in your family. It also means having one autoimmune diagnosis raises your risk of being diagnosed with another one.
It’s not hard to understand why. Folks with psoriasis have overactive T cells — your immune system’s personal fighter jets — just like folks with other autoimmune diseases.
During a psoriasis flare-up, your T cells attack healthy skin cells with a special protein called cytokines. The cytokines make your skin cells multiply super fast — so much so that they start building up on top of each other. This forms those dry, scaly patches.
In 2017, researchers confirmed that cytokines are involved in triggering psoriasis, which was a major milestone in the development of treatments.
Since then, research continues to indicate that immunosuppressants (drugs that tell your immune system to chill out) help with psoriasis.
Possibly. Remember how having a genetic tendency for autoimmune disorders means you’re 2 to 5 times more likely to develop one? Well, that *might* mean you’re also more likely to develop additional autoimmune diseases on top of psoriasis.
While research linking psoriasis with other autoimmune probs is older, it’s still worth a look. A 2012 study found that peeps with psoriasis are almost twice as likely to have another autoimmune disease compared to folks without it. A small 2020 study also backed up that previous research.
The best treatment for your psoriasis depends on the severity of your skin issues, your overall health, and whether you have other conditions. Most docs recommend soothing moderate-to-severe psoriasis with treatments that target your vigilante immune system.
Two main ‘scripts have been used against psoriasis for years:
- methotrexate (Rasuvo, Otrexup [PF], Xatmep, and Trexall)
- cyclosporine (Neoral, Sandimmune, Gengraf, Restasis MultiDose, and Restasis)
Both of these meds clear your psoriasis by suppressing your immune system. They typically work, but they’re not recommended for long-term use.
These meds are made from complex, naturally derived substances rather than lab chemicals (like conventional drugs).
Anti-TNF drugs. Remember those cytokines that make your skin cells pile up? Well, TNF is a cytokine, and anti-TNF drugs crush those bad boys. Some anti-TNFs that seem to soothe or prevent psoriasis include:
- adalimumab (Humira)
- etanercept (Enbrel)
- infliximab (Remicade)
- certolizumab pegol (Cimzia)
Newer biologics. Instead of crushing cytokines, these biologics target and block certain T-cell pathways, obstructing the war on your skin cells. Some common prescriptions include:
- secukinumab (Cosentyx)
- ixekizumab (Taltz)
- brodalumab (Siliq)
- ustekinuman (Stelara) (IL-23 and IL-12)
- guselkumab (Tremfya) (IL-23)
- tildrakizumab-asmn (Ilumya) (IL-23)
- risankizumab-rzaa (Skyrizi) (IL-23)
The Psoriasis diet
Scientific proof is slim, but many folks with psoriasis recommend changing up your diet to prevent major flare-ups.
There’s no single “psoriasis diet,” but there are several meal plans that folks have found helpful:
- Mediterranean diet. Why stop at ditching inflammatory foods? The Mediterranean diet is packed with anti-inflammatory foods like olive oil, fresh fish, fruits, and veggies.
- Paleo diet. Some psoriasis patients have reported symptom improvements when they follow a Paleo meal plan.
- Dr. Pagano Diet. A chiropractor named Dr. John Pagano wrote Healing Psoriasis: The Natural Alternative, an in-depth book on diet and lifestyle changes designed to prevent psoriasis. A 2017 study did find that about 72 percent of diet participants saw improvements in their psoriasis symptoms.
- Gluten-free diet. Folks with psoriasis share genetic traits with folks with celiac disease (an autoimmune disease related to gluten-intolerance). Thus, some research has linked a gluten-free diet with relief for both.
- Vegan diet. Eating plant-based = nixing inflammatory foods like dairy and red meat. Does that mean you should go vegan? Maybe, maybe not. Definitely talk this one over with your doctor.
If you think you have psoriasis but haven’t been diagnosed yet, the first step is to see a doctor.
Your appointment should be pretty straightforward:
- discuss your medical history
- skin, hair, and nail examination
- possibly give a small skin sample (so your doc can look at things under a microscope)
The good news? The outlook for psoriasis is pretty good. Sure, it’s chronic. No, there’s no cure. But there are many treatments to help you manage your symptoms.
Researchers are also continually searching for the cause and new treatments for autoimmune disorders. It’s kind of a hot topic. You can even be part of that research by joining a clinical trial.
The National Psoriasis Foundation is full of supportive, helpful information too. Just be sure to talk to your doctor before starting any new treatments, joining a trial, or testing DIY remedies for psoriasis.