Psoriasis is a chronic skin rash characterized by scaling, patchy, or silvery-looking skin. It can affect just knees, elbows, or scalp or can spread over most of the body. It often occurs at the site of a previous injury. Psoriasis often runs in families and usually develops gradually. It has genetic, immune, and environmental aspects.

It affects 4.5 million Americans. Psoriasis occurs when skin cells mature too quickly. Skin cells build up on the surface causing red, scaly patches that often itch or are uncomfortable. Psoriasis flares up because of stress, severe sunburn, irritation, skin creams, antimalarial therapy, or from withdrawal from cortisone, or it can be brought on by other triggers.

It tends to flare up and then go into remission. Arachidonic acid and leukotrienes are elevated in the urine of people with active psoriasis, which indicates that omega-3 fatty acids may be of benefit. Psoriasis affects about 1 percent of the American population as a whole, but 2 to 4 percent of Caucasians.

Psoriasis can also occur with joint inflammation as psoriatic arthritis and is found in 3 to 7 percent of people with psoriasis. It isn’t clear whether psoriasis and psoriatic arthritis are the same disease or two almost identical diseases.

Michael Murray, N.D., and Joe Pizzorno, N.D., have documented a number of factors that influence the progression of psoriasis, including incomplete digestion of protein, bowel toxemia, food sensitivities, poor liver function, reaction to alcoholic beverages, and eating high amounts of animal fats.

Let’s look at each of these factors. When protein digestion is incomplete or proteins are poorly absorbed, bacteria can break them down and produce toxic substances. One group of these toxins is called polyamines, which have been found to be higher in people with psoriasis than in the average population.

Polyamines contribute to psoriasis by blocking production of cyclic AMP. Vitamin A and goldenseal inhibit the formation of polyamines. Because protein digestion begins in the stomach, low levels of hydrochloric acid there can also cause incomplete protein digestion.

Digestive enzymes and/or hydrochloric acid supplementation aid protein digestion. Bowel toxemia plays an important role in psoriasis. A poor balance of intestinal flora because of stress, diet, medications, or other factors often leads to bacterial and fungal infection.

In fact, many people with psoriasis have colonization of fungus in their digestive system and on their skin. In a recent study, twenty-one out of thirty-four people with psoriasis were found to have Candida albicans in the spaces between their fingers or toes, and the majority were also affected by fungi from the tinea family.

Other research found a 56 percent increase in nail fungus in people with psoriasis. Another study looked at stool samples of people with psoriasis and other skin disorders. Researchers found a high number of disease-producing microbes, predominantly yeasts, in the colon.

This may not be the cause of psoriasis, but rather an indication of poor gut ecology. Treatment for yeast infection corresponded with a decrease in skin inflammation. Elimination diets and hypersensitivity testing have also produced profound results.

People with psoriasis have high levels of IgE antibodies, which indicate an allergic component. Sixteen percent of people with psoriasis have antibodies to gliadin, the protein found in wheat, rye, and barley. Even though when tested for gliadin intolerance their endomysium antibodies were normal, a gluten-free diet for three months greatly improved the psoriasis.

Intestinal dysbiosis predisposes people to food and environmental sensitivities, so people with hypersensitivities need to heal the intestinal lining by taking appropriate bacterial supplements. Poor liver function may contribute to psoriasis as well.

Liver function profile tests and the metabolic screening questionnaire can help you determine liver function, and the metabolic screening questionnaire can also be used to follow your progress. Incorporate a detoxification program with an elimination-provocation diet to determine which foods may trigger your psoriasis.

Alcohol consumption contributes to psoriasis because it contains many toxic substances, which stress an overburdened liver. Candida albicans (yeast) thrive when beer and wine are consumed. Even one glass can provoke symptoms. Alcohol also increases intestinal permeability.

The causes and treatment of psoriasis are complex. Successful treatment must encompass several approaches reflecting its complexity. Look for underlying causes and develop a personal program based on your needs.

Healing Options

• Try the elimination-provocation diet. Explore the relationship between your psoriasis and food and environmental sensitivities through laboratory testing and the elimination-provocation diet. For best results work with a nutritionist or physician who is familiar with food sensitivity protocols.

• Take a multivitamin with minerals. Take a good-quality multivitamin with minerals every day. Look for a supplement that contains at least 25,000 IU vitamin A, 400 IU vitamin D, 400 IU vitamin E, 800 micrograms folic acid, 200 micrograms selenium, 200 micrograms chromium, and 25 to 50 milligrams zinc.

Each of these nutrients has been shown to be deficient in people with psoriasis. There are several vitamin A topical creams used by dermatologists for psoriasis. Vitamin A is a critical nutrient for healthy skin.

• Practice stress-management skills. Flare-ups of psoriasis often occur after a stressful event. Because stress has to do with our own internalization of an event, even a mildly stressful situation can trigger psoriasis. Learning stress-modification techniques can change your attitudes about stressful situations, allowing you to let them roll by more easily.

In a recent study, four out of eleven people showed significant improvement in psoriatic symptoms with meditation and guided imagery. Hypnotherapy, biofeedback, and walks in nature are other effective tools. Regular aerobic exercise is a powerful stress reducer.

• Increase consumption of fish oils and EPA/DHA. The research on fish oils is mixed. Eating fish or taking fish oils has been shown to have an anti-inflammatory effect on psoriasis for some people. Fatty acids contribute to healthy skin, hair, and nails, and fish oils promote production of anti-inflammatory prostaglandins.

It is also possible that fish oils increase the activity of vitamin D and sunlight. Eat cold-water fish—salmon, halibut, mackerel, sardines, tuna, and herring—two to four times per week or take EPA/ DHA capsules.

• Enjoy some sunlight and get your vitamin D. Sunlight stimulates our bodies to manufacture vitamin D, which has been shown to be an effective treatment for psoriasis. Ask your doctor to test your vitamin D levels. If low, supplement.

Cod liver oil is a good source of vitamin D because it also contains fish oil and vitamin A, both of benefit in psoriasis. A good multivitamin usually has 400 IU vitamin D. An additional 400 IU of vitamin D could be beneficial.

In general, slow tanning improves psoriasis, with sunshine and sunlamps prescribed as part of standard therapy. A recent study done in Israel at the Dead Sea, long renowned for its treatment of psoriasis, showed that natural sunlight stimulated significant improvement in disease activity.

One group was just given sunlight therapy, and the other received additional therapy in mud packs and sulfur baths. Both groups showed significant improvement in skin symptoms and with psoriatic arthritis, where present. Sunlight and ultraviolet light therapy are regular therapies for psoriasis.

• Use aloe vera cream. A placebo-controlled study of sixty people with psoriasis found that a 0.5 percent aloe vera cream cured 86 percent of the subjects. Each person used the aloe vera cream three times each day for a period of one year, and the researchers concluded that aloe vera cream is a safe and effective cure for psoriasis.

• Try glucosamine. A new hypothesis is that glucosamine, a component of connective tissue widely used for arthritic conditions, may benefit people with psoriasis. There is no human research as yet, but glucosamine has little risk.

• Try milk thistle (silymarin). Extracts of the herb milk thistle have been used since the fifteenth century for ailments of the liver and gallbladder. Milk thistle, also known as silymarin, contains antiinflammatory flavonoid complexes that promote the flow of bile and help tone the spleen, gallbladder, and liver.

An excellent liver detoxifier, milk thistle has also been shown to have a positive effect on psoriasis. Take 3 to 6 capsules of 175 milligrams standardized 80 percent milk thistle extract daily with water before meals.

• Take zinc. Zinc is necessary for maintenance and repair of skin, immune function, and healing. Copper and zinc compete for the same receptor sites during absorption. When zinc is deficient, copper is usually elevated. This is true for people with psoriasis.

Many studies have determined that people with psoriasis have lower levels of zinc than people in control groups. However, studies using oral zinc supplementation haven’t always shown a clear improvement in psoriasis, though such studies have been of short duration—only six to ten weeks.

Even though they didn’t show improvement in the skin, they did show improvement in immune function and dramatic improvement in joint symptoms. It’s possible that either zinc needs to be used along with other nutrients, or the time frame of these studies was too brief to see improvement. Take 50 milligrams zinc picolinate (an easily absorbed form) daily.

• Take selenium. Many studies have shown that people with psoriasis are deficient in selenium. Selenium is part of a molecule called glutathione peroxidase that protects against oxidative damage (free radicals). Giving supplemental selenium to people with psoriasis showed an increase in glutathione peroxidase levels and improvement in immune function, though not an improvement in skin condition.

However, they were studies of short duration with selenium the only supplement. This underscores the concepts of patience when using natural therapies and of using more than one nutrient or approach at a time. Take 200 micrograms daily, which you can get in a good multivitamin. Selenium can be toxic, so more is not necessarily better.

• Try Saccharomyces boulardii. Saccharomyces boulardii is a cousin to baker’s yeast. It has been shown to raise levels of secretory IgA, which are low in psoriatic arthritis and psoriasis. Take 6 capsules daily.

• Try topical creams. Many topical creams, oils, and ointments help psoriasis. Capsaicin, a cayenne pepper cream, helped 66 to 70 percent of the people who used it in a recent trial. The main side effect was that of a burning feeling associated with chili peppers, which quickly subsided.

Vitamins A and E have also been used topically with success; one physician alternates them, one each day. Creams containing zinc are also effective, as are salves containing sarsaparilla. Goldenseal ointment or oral supplements can also be helpful.

• Try Honduran sarsaparilla. Sarsaparilla, a flavoring in root beers and confections, has proven to be effective in psoriasis, especially the more chronic, large-plaque forming type. Sarsaparilla binds bacterial endotoxins. Take 2 to 4 teaspoons liquid extract daily; 250 to 500 milligrams solid extract daily.

• Try lecithin and phosphatidylcholine. Lecithin was used in a ten-year study from 1940 to 1950. People consumed 4 to 8 tablespoons of lecithin daily, along with small amounts of vitamins A, B1, B2, B5, B6, D, thyroid and liver preparations, and creams.

Out of 155 patients, 118 people responded positively. Lecithin-rich foods include soybeans, wheat germ, nuts, seeds, whole grains, eggs, and oils from soy, nuts, and seeds. Lecithin granules can be purchased in health-food stores and added to foods as a cooking ingredient.

Lecithin can also be purchased in capsule form, as can the active ingredient in lecithin, phosphatidylcholine. Take 4 to 8 tablespoons daily or 1 to 4 capsules of phosphatidylcholine.

• Take folic acid. There is much research on folate deficiency caused by the drug methotrexate, which is a folate antagonist medication often used for psoriasis. This seems ironic, because folic acid is one of the primary nutrients needed for proper skin formation.

Jonathan Wright, M.D., recommends extremely high-dose folic acid therapy for psoriasis—50 to 100 milligrams daily. Although I have never used dosages in such high ranges, a dose of 10 to 15 milligrams daily is considered safe.

Be aware that if folic acid is taken by someone with a vitamin B12 deficiency, nerve damage can go undetected. If you are going to use high levels of folic acid, have your doctor test your vitamin B12 status with homocysteine or methylmalonic acid testing.