There are many studies that consider genetic and environmental factors as the primary cause of psoriasis but, on the whole, psoriasis is widely considered to be an autoimmune disease. It begins with an error in the immune system which continues like a cycle that never ends. Typically, skin cells grow, rise to the surface and fall off during a cycle of approximately one month. For psoriasis sufferers, this process occurs over just a couple of days. There is no time for the cells to fall off before new ones are created and this leads to a build-up of skin cells that itch and irritate. There are numerous diets and treatments available to help sufferers to suppress these symptoms, but there are still various ‘triggers’ that cause it to flare up – sometimes for the very first time – with devastating consequences.
The part of the body that is affected depends on the type of psoriasis that each individual has. We will cover the different types of psoriasis at a later date but, for the purposes of this blog, it is only important to know that whatever the type of psoriasis, it is chronic and cannot be cured. All that can be done is to help lessen the severity of the disease by reducing the symptoms.
So, putting aside the causes of psoriasis, there are certain factors that trigger the flare-ups and these seem to be universal.
THE KOEBNER RESPONSE
This was named after the 19th century dermatologist Heinrich Koebner, who noted that the phenomenon of skin lesions forming on parts of the body, where a person wouldn’t typically experience lesions, was occurring after an injury to the skin such as a cut, a deep wound, an insect bite or a severe sunburn. In these more modern times, it can sometimes occur after a vaccination or a tattoo.
The Koebner phenomenon is more common in people who received a diagnosis of psoriasis when they were very young. Scientists believe that the body’s inflammatory response to the injury are the precursor to a reaction or flare-up, and experts suggest that 25% – 30% of people with psoriasis will experience the Koebner Response.
Some people develop Koebner phenomenon lesions within 3 weeks after a skin injury, but symptoms can appear anywhere from 3 days to 2 years after the event which makes it very difficult to determine the cause.
If you are a psoriasis sufferer and you experience an injury of any kind, it is important to treat it with great care and attention to avoid a flare up. When bathing or showering, use lukewarm water, wash gently with the palms of the hands, and pat the skin dry after bathing. Avoid abrasive substances and sponges and try not to rub or scratch the skin around the injury. Use the products that you know are helpful for reducing psoriasis symptoms on and around the injury. Natural, chemical free products like m-folia are good for this due to the antibacterial and antifungal properties present in the herbal extract.
ALCOHOL
Studies suggest that alcohol can act as a trigger for many people diagnosed with psoriasis, particularly women. According to a study in 2011*, alcohol consumption can trigger the production of inflammatory proteins which increases the risk of infection. It is well documented that infection and inflammation contribute considerably to psoriasis symptoms.
According to another study in 2017**, the misuse of alcohol affects over 30% of people with psoriasis. Sufferers are more likely to die of alcohol-related disease than people without the condition. Alcohol consumption affects psoriasis by:
Slowing down the effects of medication
Lowering your immune function
Increasing inflammation in your body which triggers psoriasis flare-ups
Causing dehydration in the body and drying out the skin
It is important to remember that stress, which is a big contributing factor for psoriasis sufferers, is often the reason that people will turn to alcohol. Try to look for healthier ways to cope with stress such as counselling, healthy diet, exercise and meditation.
STREPTOCOCCAL INFECTION
Most people who suffer from streptococcal throat infections don’t go on to develop psoriasis, however some, usually children and young adults, can develop a form of psoriasis called guttate psoriasis. Usually this comes and goes within a few weeks. In fact, for about 80% of people, the spots will fade and never come back. But for some it can continue and go on to become long-term plaque psoriasis. Sometimes you can experience a worsening or a flare up if the streptococcus germ (bacterium) is still in your throat or tonsils.
It is not currently understood why, following streptococcal infection, only some people experience psoriatic outbreaks, but one possible explanation is that the tonsil micro-environment of these individuals promotes the generation of inflammatory T cells that drive the skin disease.
The original case report of an association between psoriasis and streptococcal infection was published in 1916 and there have been several studies since confirming that streptococcal throat infections are more common in and can cause flare ups in patients with chronic psoriasis. There is information available that demonstrates the efficacy of undergoing a tonsillectomy for the treatment of streptococcal-associated psoriasis. Tonsils can generate t-cells that recognise keratin peptides in the skin and can worsen psoriasis. Removing the tonsils can possibly decrease these skin-homing t-cells and improve the symptoms of chronic plaque psoriasis****
It is interesting to know that it is possible to have strep throat without developing any symptoms, so it would be wise to speak with your health care provider about testing for strep throat if you develop guttate psoriasis even if you don’t have a sore throat.
SMOKING
If psoriasis runs in your family then it would be a good idea to warn your children to never smoke! The genes that may cause their psoriasis could be triggered by smoking.
Psoriasis is an autoimmune disease but nicotine alters the immune system, which partially explains the link between psoriasis and smoking. By increasing the production of pro-inflammatory compounds (known as cytokines), nicotine plays an important role in the development of psoriasis. It also causes the blood vessels to widen which can irritate the skin. This occurs whether you smoke or use nicotine patches.
Additionally, smoking increases the production of free radicals which damage cells and then, conversely, decrease the antioxidants in the body that are needed to fight these free radicals!
Apart from the nicotine, studies show that the tobacco smoke may cause oxidative damage to the cells which can worsen psoriasis symptoms.
Try to reduce the risk of psoriasis flare-ups by quitting smoking and perhaps avoid being around people who smoke. Talk to the smokers around you about how the smoke may actually be making your psoriasis worse. Obviously, quitting is not easy but getting the symptoms of your psoriasis under control has to be a priority and if smoking is going to cause flares or worsening of the symptoms, then finding a way to give up is essential.
WEIGHT AND DIET
As we’ve discussed in earlier blogs, there is no definitive psoriasis diet. However, the following food groups have often been proven to be the triggers for flare ups and eliminating them has been shown to reduce, or even clear completely, the symptoms of psoriasis.
- nightshade plants, such as tomatoes, eggplant, and white potatoes
- gluten
- foods made with white flour
- dairy products
- shellfish
- pork
- red meat
- high-sugar foods and fatty foods
It’s no secret that keeping your body at a healthy weight is important if you have psoriasis. Research has proven that being overweight can raise the chances of getting psoriasis and it can make symptoms worse*****
Psoriasis is an inflammatory disease and fat cells release inflammatory chemicals known as cytokines which are known to be linked with the increase in psoriasis symptoms. Just losing a few kilos and doing a few exercises can be enough to help reduce itching and soreness on the skin and scalp – sometimes by almost 50% (and that’s without any change in medication).
Slimming is so hard, especially if you have a lot of weight to lose, but it is possible and it really does help.
Sources:
**** Case Report: The role of tonsillectomy in psoriasis treatment (nih.gov)
