Skin is very precious to us as it gives the right and perfect impression of our quality of life. Normal glowing skin is the true expression of overall good health but a mild skin imperfection depicts an unusualness in physical, mental, emotional, and social health. We try our best to preserve our good skin as long as possible but sometimes unexpected and uninvited situations arise which affect the desirability of healthy skin badly. One such event is when an unknown autoimmune disease called psoriasis disturbs the body including the skin and makes life uncomfortable. It is a replacing condition, but almost all the adverse symptoms can be improved through modest changes in diet and lifestyle. Right consciousness and knowledge about this disease will increase the chances to lead a near-normal life even with psoriasis.
What is psoriasis?
It is a chronic, non-communicable, painful, disfiguring and disabling disease which negatively impacts the quality of life (QoL). It is a complex, recurrent, inflammatory disease of unknown causation, involving immune attacks in the skin with chronic inflammation and exuberant overgrowth of the outer layers of the skin. It can occur at any age and is most common in the age group 50–69. The reported prevalence ranges between 0.09% and 11.4%, making psoriasis a serious global problem.
Symptoms of psoriasis
Normally the skin constantly sheds dead cells and produces new ones in a process called cell turnover. Usually, it takes about a month for new cells that grow deep in the skin to rise to the surface, but in psoriasis, this process is accelerated and new cells rise from below the skin surface in a matter of days. Overgrowths of cells accumulate on the skin surface resulting in red, flaky, crusty patches covered with silvery lesions.
Psoriasis involves the skin and nails and is associated with several comorbidities.
- Skin lesions, mostly symmetrical, sharply demarcated, red papules and plaques, and usually covered with white or silver scales
- Lesions cause itching, stinging and pain
- Between 1.3% and 34.7% of psoriasis patients develop chronic, psoriatic arthritis that leads to joint deformations and disability
- Between 4.2% and 69% develop nail changes
- Increased risk of developing cardiovascular and non-communicable diseases
Psoriasis and quality of life
It causes a great physical, emotional and social burden. QoL, in general, is often significantly impaired. Psoriasis leads to disfiguration, disability and marked loss of productivity. Also enhances the rates of depression, social exclusion, discrimination, stigma and psychological breakdown.
Pathophysiology of psoriasis
During psoriasis, keratinocytes or skin cells divide and move more quickly from the stratum basal to the stratum corneum. Psoriasis usually varies in duration, periodicity of flair and extent. The interaction between multiple genetic factors, the immune system, and various environmental factors is responsible for psoriasis’s pathogenesis. Also, T-cell activation, which migrates from lymph nodes and the systemic circulation to the skin and triggers the release of cytokines, which drive cutaneous inflammation and epidermal hyperproliferation, resulting in erythematous, elevated plaques with overlaying scale.
Factors that trigger Psoriasis
Several triggering factors have been identified leading to the first manifestation of psoriasis or flares. Understanding and minimizing these triggers can be an important part of managing psoriasis.
- Family history of psoriasis
- Mild trauma and chronic stress
- Diet containing psoriasis trigger ingredients
- Smoking and alcohol consumption
- Systemic drugs
- Unhealthy dietary patterns and lifestyle
Nutrition and psoriasis
Nutrition is a key factor in the development and progress of psoriasis. Psoriasis patients often show unbalanced dietary habits such as a higher intake of fat and a lower intake of fresh fruits, vegetables, plant protein and dietary fibres. These unhealthy meal patterns also increase the incidence and severity of psoriasis. Patients also exhibit intestinal dysbiosis and the micronutrient deficiencies like vitamin D and selenium.
Dietary changes promote the alleviation of psoriasis, but it alone does not cause a large effect on psoriasis. It offers benefits supplementary to first-line treatments prescribed by the Doctor.
The possible dietary and lifestyle recommendation
Adequate calorie diet
- Eat a low-calorie diet in case of obesity to reduce excess weight & maintaining a healthy weight
- Opt for a balanced diet for healthy weight patients, including all the essential nutrients
- Delete saturated fats as it increases inflammation & obesity risk
- Add Omega 3 & 6 fatty acids rich sources to a regular diet
- Limit simple sugars as they exacerbate psoriasis flares
- Consume complex carbohydrates because they are anti-inflammatory and decrease psoriasis complications
- Go for low-fat protein sources, preferably plant proteins in an adequate amount
Vitamin and minerals
- Add vitamin D and selenium-rich foods to your daily diet to prevent deficiencies
- Include fresh fruits and vegetables in your daily diet, at least 2 servings a day each
Foods allowed- These can be eaten without thinking much
- Vegetables- Asparagus, Beet, Broccoli, Brussels sprouts, Cabbage, Carrots, Celery, Cucumbers, Garlic, Lettuce, Onions, Olives, Pumpkin, Spinach, Sprouts, Squash and Sweetpotatoes
- Fruits-Apples (stewed), Apricots, Berries, Cherries, Dates, Figs, Grapefruit, Grapes, Kiwi, Lemons, Limes, Mangoes, Oranges, Papayas, Peaches, Pears, Pineapples and Prunes (small)
Foods allowed in lesser quantities- These should be eaten in a limited amount
- Vegetables- Corn, dried beans, Lentils, Mushrooms and Peas
- Fruits-Avocados, Cranberries, Currants, Plums, Prunes (large), Raw apples and bananas
- Low-fat chicken, fish & eggs only 3 times a week
- Low-fat dairy products, in small quantities in case of lactose intolerance
Foods to be avoided- These should be strictly restricted
- Strawberries and citrus fruits in case of eczema or psoriatic arthritis
- Processed and red meat
- A hydrogenated product like margarine and shortening
- Nightshade vegetables such as eggplant, peppers (all types except black pepper), tomatoes (and tomato products), tobacco, white potatoes except sweet potatoes and yams
- Shellfish such as clams, crabs, lobster, shrimp, and sauces made with shellfish
- Junk food like candy, pastries, chocolate, French fries, potato chips, soda, and sweets.
- Coffee and if strongly desired only 2 cups/day can be taken
- Gluten products like wheat, barley, oats, and rye if gluten intolerance is suspected
- Refined flour & its products
- All fried foods, pizza, sugary cereals, vinegar, pickled or smoked foods, hot spices, gravies, peanut butter, and too many starchy products
- Drink adequate water at a regular interval of time
- Also, have fresh fruit juices
- Take suitable rest and handle stress in a positive way
- Do meditation, and yoga, go for 30 minutes of physical activity, listen to soft music and read books to maintain mental calmness
Smoking and alcohol consumption
- Ensure not to involve in these habits as they may deteriorate the symptoms
Presently, no specific nutritional therapy regimens for psoriasis have been established yet. Personalized diets should be proposed for individual patients based on their nutritional status, conditions of psoriasis, comorbidities and preferences. Under the guidance of an expert, a properly selected advised diet should be consistently followed by the patient. This will positively impact the course of psoriasis and the prognosis and comorbidities. Right motivation and lifestyle education on the manipulation of the disease-regulatory effects of nutrients and food will surely be useful for the management of psoriasis.
With true self-acceptance, dedication towards leading a disciplined life, unconditioned caring love from the family and the right medical support, a psoriasis patient can lead a normal healthy life beating all odds.
- Psoriasis: Targets and Therapy 2022:12 151–176
ISBN 978 92 4 156518 9, WHO
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETIC
Int. J. Mol. Sci. 2020, 21, 5405
Nutrients 2022, 14, 119