The plaques of psoriasis may signal heart-threatening inflammation within.
by Lisa James
It started as an advertising tagline and wound up as a lame quip. “The heartbreak of psoriasis,” which first appeared decades ago in ads for skin lotion, became a type of shorthand for any overly dramatic reaction to a less-than-disastrous problem.
It’s true that many cases of psoriasis fall more into the category of annoyance than heartbreak, at least in terms of symptoms. (People with severe cases of this unsightly, itchy disorder may beg to disagree.) But the phrase might actually be closer to the mark than the original ad writers thought: Research suggests there is a potential link between psoriasis and increased cardiovascular risk.
“I think the word is slowly getting out that psoriasis is not just a skin disease,” says Lawrence J. Green, MD, a Washington, DC-area dermatologist and chair of the research committee for the National Psoriasis Foundation (www.psoriasis.org).
According to the NPF, as many as 7.5 million Americans have psoriasis. The disorder, in which an immune system malfunction leads to the overproduction of skin cells, comes in different forms. The most common is plaque psoriasis, marked by red, raised patches of skin covered with a silvery-white buildup known as scale. Up to 30% of patients develop psoriatic arthritis, which causes joint pain and stiffness.
Researchers have seen connections between psoriasis, particularly more severe cases, and other disorders. NPF surveys of more than 5,600 patients found that those with severe psoriasis were more likely to have diabetes and cardiovascular disease (Dermatology 11/12). In a paper presented at an American College of Cardiology meeting, University of Pennsylvania researchers reported that people with severe cases had a 53% increased incidence of “major adverse cardiac events,” including heart attacks and strokes. In addition, the NPF says, associations have been made between psoriasis and Crohn’s disease, depression, high blood pressure and obesity.
While more studies are needed to solidify the links among psoriasis and other ailments, scientists see inflammation as a prime suspect. The thickened, red skin caused by psoriasis “means the blood vessels in the skin have multiplied and are also full of inflammatory cells,” says Green. “Scientists have shown how inflammatory cells triggered by psoriasis show up in every organ system in the body.”
What does this mean in terms of cardiovascular risk? Green says, “Research strongly suggests that the inflammation caused by psoriasis adds to the body’s total inflammatory burden, increasing the risk of plaque buildup within arteries.”
“Most chronic diseases have inflammation in common. When you treat the inflammation, there’s a reduction in a wide variety of symptoms, including skin flares,” says Brittany Kolluru, ND, of the National College of Natural Medicine Clinic in Portland, Oregon.
Kolluru says many patients come to her for help with their psoriasis because “they’re tired of having to wear long-sleeved tops or long pants. Makeup and other cover-up products don’t really work.” She notes that because psoriasis is “one of the more stubborn chronic conditions, it really requires a multifaceted approach.”
As with most disorders, a key weapon in the war against psoriasis is the fork. “The most important thing is to reduce or stop eating processed foods and start focusing on a whole-foods diet,” says Kolluru. “Such a diet is nutrient-dense and the body needs this higher level of nutrients to heal itself. Whole foods also contain more fiber, which helps eliminate toxins from the body.”
One of the advantages of eating whole foods lies in the antioxidants, compounds that neutralize the free radicals associated with inflammation, they contain. For example, the berry family—including wild blueberries, cranberries, tart cherries, raspberries and strawberries—contain substances that fight not just one or two types of free radicals but entire classes of these cell-damaging substances. And eating cold-water fish such as salmon provides omega-3 fatty acids, which also help reduce inflammation.
What a whole-foods diet subtracts is as important as what it adds. “When you eat whole food you’re avoiding additives and processing agents that tend to have a exacerbating effect on symptoms,” Kolluru explains. She notes that because such a diet does not disallow any specific food group, it is easier for patients to live with.
While Kolluru chooses supplements based on each patient’s needs, “one I use a lot is Coleus forskohlii; it works by helping to slow down one of the pathways that affect cell replication rates.” (Coleus, a remedy from India, is best known in this country as the source of forskolin, a natural weight loss aid.) Some practitioners recommend milk thistle, which supports the liver as it does its job of clearing toxins from the body, and red clover as a blood cleanser. Using a sauna (drinking water before and after) can also help the body sweat out toxins.
Getting extra time in the sun may help. Kolluru says, “Exposure to the sun’s UV rays and increased vitamin D [which is manufactured in sun-exposed skin] helps slow down the rate at which the skin makes new cells.”
Kolluru also recommends topical remedies. “In the winter months the key thing is using a good emollient when the heaters are going and the air is dry”; jojoba oil is one of her favorites because “it doesn’t leave that greasy feeling on your skin.” In addition, “capsaicin cream can be helpful for people who have a lot of itching.” Other useful topicals include soothing aloe, licorice extract and chamomile (don’t use chamomile if you are allergic to ragweed.) Apple cider vinegar in water may provide temporary relief from itching and scaling.
Despite the disorder’s itchy persistence, you can keep psoriasis at bay. Kolluru says patients “who make a commitment to changing lifestyle factors can usually find a good level of symptom relief.”