Psoriasis, more than a skin condition

Psoriasis is a lifelong hereditary complex multisystem disorder of a chronic inflammatory nature. It is characterised by a development of red, scaly and thickened areas of skin. The exact cause is unknown.  Whilst the skin is the most visible expression of the disorder it may be associated with other conditions such as psoriatic arthritis, cardiovascular disease, obesity, insulin resistance, mental health disorders, inflammatory bowel disease and other immune-related disorders. Therefore, it should be treated not purely as a skin disease.

Psoriatic disease affects about 6.6% of the Australian population and has a significant impact on quality of life. Psoriasis is not considered a life-threatening disease though the social and psychological impact is considerable including elevated levels of anxiety, depression, and worry.

Psoriasis Facts.

·       There is no cure

·       Psoriasis increases the risk of diabetes

·       1.5 times more likely to have heart disease

·       Almost 1 in 3 people with psoriasis have depression

·       30% of people with psoriasis will develop psoriatic arthritis

·       2.5 times more likely to get Chron’s Disease

Psychological Toll

Living with a skin condition that is visible impacts heavily on a person’s mental health and emotional well-being. Psoriatic disease is exacerbated by stress, yet stress is also one of the know triggers for a new flare or worsening an existing one. Joint pain and skin itching can lead to sleep deprivation, fatigue, and the cycle of negative effects on mental health continues.

Depression has a similar relationship as stress. Psoriasis can lead to depression, and depression, in turn, exacerbates psoriasis. A study of 2,391 psoriasis patients indicated that 62% had depressive symptoms. Whilst other studies have shown that depression generally predates psoriasis onset, and patients with moderate to severe depression have a significantly increased risk of psoriasis. Science is starting to uncover the molecular mechanisms behind the association between psoriatic disease and depression and it appears the link is related to inflammation. Chronic inflammatory processes have been found to affect the pathophysiology of depression and patients with depression have high peripheral blood levels of inflammatory markers.

Studies have shown there is an increased percentage (7% to 48%) of people living with anxiety plus psoriatic disease compared to anxiety alone. Therefore, a skin lesion and joint symptom increases the frequency of anxiety. Interestingly, having anxiety as a primary condition does not increase the chance of developing a psoriatic disease. Itch, a significant symptom of psoriatic disease experienced by many, increases the levels of anxiety, consequently treating psoriatic dis­ease can improve anxiety.

The Gut-Brain-Skin Axis

The gut-brain-skin axis model has been used to explain the interrelationship of gut microbiota, emotional states as well as systemic and skin inflammation. This axis may be associated with the overlapping mechanisms of psoriasis and depression.

The gut microbiota refers to the complex community of microorganisms, including over 1000 different species of viruses, fungi, protozoa and bacteria. Disturbances in microbiome homeostasis, known as gut dysbiosis, have been linked to continuous immunological stimulation. Gut dysbiosis triggers several immune disorders and leads to inflammation.

Many inflammatory cytokines (signalling proteins that help control inflammation in your body) released in psoriasis are also released in depression, which suggests that there is a possible association between the two diseases.

The development of psoriasis is associated with alterations in the function and composition of the gut microbiota. Furthermore, the progression of psoriasis often follows gastrointestinal inflammation, such as in Inflammatory bowel disease (IBD) and the decrease in bacterial diversity in patients with psoriasis strongly resembles the pattern of dysbiosis found in IBD.

A large amount of data has shown that depression relates to alterations in gut microbiota composition and function, generally in the form of reduced diversity and richness. Moreover, irritable bowel syndrome (IBS) is an intestinal disorder characterized by chronic abdominal pain, altered bowel habits and depressive behaviour.

This communication system between the gut and the brain is named the gut-brain axis and is mediated by neuroendocrine, neuroimmune and sensory neural pathways. Psoriasis and depression lead to the dysregulation of the gut microbiota and decreases in SCFAs, which induce gut permeability and bacterial migration (leaky gut).

Family & Friends

For many people with psoriatic disease, full participation in society may be thwarted. Many people feel they are often stared at and need to cover their skin. In some cases, they exclude themselves from social interactions or places/gatherings with lots of people.

81% of respondents in a study said they felt their relationships had been impacted by their psoriasis condition. In addition, 91% of partners of people living with psoriatic disease reported their partner’s disease had an impact their family life. Areas of impact outlined included extra housework, concerns over the partner’s health, limited social engagements, restricted leisure activities or vacations.

Sex life

Some people living with psoriatic disease have genital lesions. Genital itching is common. Consequently, feeling embarrassed and withdrawn may impair fulfilling a sexual life. It is common to avoid sexual relationships and intercourse for people with psoriasis. Limited intimate relations and withdrawing from a social life implicates everyone and may re­flect poorly on mental health and quality of life.

 

Employment

People with psoriatic disease make choices about their education and career based on their disease. Lack of sleep, fatigue, physical appearance, mental health all impacts a person’s productivity and ability to perform tasks well. People working with the public noted a high level of self-consciousness and discrimination. Stable employment affects career advancements and earning potential. Some people state their psoriatic disease is the sole reason for their unemploy­ment.

Psoriasis & Skin Clinic – What makes us different

My approach is based on Prof. Tirant’s method, which has been used by practitioners around Australia and Europe for several years. The method has demonstrated very significant success rates for Psoriasis and Eczema.

Taking an incremental holistic approach.

1.       Address the triggers which activate and exacerbate episodes (diet, hormonal, stress and lifestyle-related)   

2.       Treat the symptoms with topical application to relieve physical symptoms from Professor Michael Tirants' range 

3.       Support the body internally with targeted natural-based “Practitioner Only” medicines 

4.       Establish long-term solutions to help patients manage their conditions

 

Credits / Source / Reference:

Wang, X., Li, Y., Wu, L., Xiao, S., Ji, Y., Tan, Y., Jiang, C. and Zhang, G. (2021). Dysregulation of the gut-brain-skin axis and key overlapping inflammatory and immune mechanisms of psoriasis and depression. Biomedicine & Pharmacotherapy, 137, p.111065. doi:https://doi.org/10.1016/j.biopha.2020.111065.