Psoriasis is a complex disorder involving immune attacks in skin with chronic inflammation and  exuberant overgrowth of the upper layers of skin. Psoriatic plaques are covered with thick silvery scales which shed at an alarming rate - super dandruff. The disease usually involves the extensor surfaces of the body - the opposite to eczema which prefers the flexor surfaces. Psoriasis tend to be a chronic disease lasting years to decades and in some patients follows and erratic course - flaring and subsiding in cycles lasting many months.

Psoriasis affects 1.5 % to 2.0 % of the population in western countries with Equal incidence in males and females There is genetic tendency: when one parent has psoriasis, 8 % of offspring develop psoriasis, and when both parents have psoriasis, 41 % develop psoriasis. Class I antigens associated with psoriasis are: HLA-B13, -B17, -Bw57, -CW6.

Stephen J Gislason MD

Little progress has been made in understanding and treating Psoriasis - it is one of the many immune-mediated diseases that rage-on unchecked. Medical treatments have not been very helpful and for many years psoriasis has been a target of dubious marketing practices - none of numerous creams and lotions offered to treat the disease have been  efficacious. Coal tar derivatives and peeling agents have been the most plausible treatments but offer little relief. Even the steroids - the all purpose drugs  for skin disorders -  are disappointing .

People with extensive psoriasis tend to suffer stoically and are often unwilling to bare their body in public - swimming pools and beaches are of limits for some because of embarrassment about the skin lesions which do look rather menacing to onlookers who are not familiar with the disease. Swimming in salt water and sun exposure is often helpful, however, and Ultraviolet light treatment has been used as a standard therapy. For years people have been treated with coal tar baths followed by ultraviolet light exposure with benefits. Now, of course, we are warning people against ultraviolet light exposure and have concerns about the carcinogenic potential of coal tar.

The most common form, Psoriasis vulgaris, occurs as chronic scaling papules and plaques in the scalp, elbows, forearms, lumbosacral region, knees, hands, and feet. The typical lesions are salmon pink, round, oval, papules and plaques, sharply marginated with thick silvery-white scales;  removal of scale results in the appearance of minute blood droplets (Auspitz phenomenon).

Type I:

early onset (75 %) in females (16 years) and in males (average age of onset 22 years)

Type II:

late onset (25 %) in males and females (average age of onset 56 years)

Psoriatic arthritis  occurs in 5 % to 8 % of patients with psoriasis.  There are two types:

• Mild, single joints -  involving, asymmetrically, a few distal interphalangeal joints of the hands and feet:
• Aggressive psoriatic arthritis with bone erosion and ankylosis involving the   sacroiliac, hip, and cervical areas with ankylosing spondylitis; seen especially in erythrodermic and pustular psoriasis.

Pathological Features in Skin:

• thickening and also thinning of the epi-dermis with elongation of the rete ridges
• increased mitosis of keratinocytes, fibroblasts, and endothelial cells
• parakeratotic hyperkeratosis with nuclei retained in the stratum corneum
• inflammatory cells in the dermis - lymphocytes  and monocytes- and polymorphonuclear cells in the epidermis, forming microabscesses in the stratum corneum.
• the lymphocytes are mostly CD-4 T cells with some CD-8 T cells.

Nail Abnormalities

Pitting, yellow-brown discoloration and deformation of finger and toe nails are common;  51.8% of patients suffered from pain-caused by the nail changes, and a large group of patients was restricted in their daily activities, housekeeping and/or profession  

Two of the three major pathogenic features of psoriasis--abnormal keratinocyte differentiation and hyperproliferation of keratinocytes are abnormalities of  growth and maturation  of skin cells. We think the growth disturbances are secondary to an immune cell infiltration of the skin and the release of immune mediators (cytokines) which promote cell growth and inflammation at the same time. Evidence suggests that T-lymphocytes lead the attack on the skin.  Although psoriatic plaques tend to be good breeding grounds for bacteria and fungi, there is no proof that infection is the cause of the problem.

Is Psoriasis Type IV  Pattern Food Allergy?

A good case can be made for food antigens causing psoriasis through a delayed hypersensitivity mechanisms. Food antigens may arrive in the skin as immune complexes, attach to skin cells and/or are presented by resident monocytes which trigger  lymphocytic activity. While this is just a theory, its better than no therapy at all and can lead to a  immediate therapeutic experiment.

Psoriasis responds variably to Diet Revision Therapy. In several remarkable cases, remission of psoriatic arthritis with clearing of the skin lesions has been achieved, albeit with some difficulty after several months, by rigorous application of the Alpha Nutrition Program.

For moderate to severe psoriasis, we are inclined to start diet revision with an extended food holiday on Alpha ENF and use mild topical treatment include daily  warm water baths with sea salts to soften the thickened skin and gentle scrubbing to remove skin scales.   Topical Vitamin A  gel applications to the thickest plaques is an option. Psoriatic skin is badly damaged and takes many weeks to heal. Food reintroduction must be slow and patient since it is easy to reactivate the disease with wrong food choices. This is a task for a highly motivated person with a lot of patience.

Topical Vitamin A

Synthetic vitamin A analogues can reduce the skin growth abnormalities in psoriasis. Tazarotene in an aqueous gel has been effective even on thick plaques on the knees and elbows.

Course Work Psoriasis Abstracts

Skin Center

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