Educational Series: Psoriasis – Going beyond the surface | Part 1

by | 1 September 2023

Psoriasis is an autoimmune condition that causes cells to develop rapidly on the skin. This overgrowth can lead to thick, scaly plaques that may itch or cause discomfort. There are several different types of psoriasis. These vary depending on the appearance of the scales and their location on the body. Between 2.3% and 6.6% of the Australian population have psoriasis, and while the skin is the most visibly affected organ, there is increasing evidence to support the recognition of many associated disorders, including:  

  • Psoriatic arthritis  
  • Cardiovascular disease  
  • Obesity  
  • Insulin resistance  
  • Mental health disorders  
  • Certain types of malignancy i.e., the tendency of a medical condition to become progressively worse  
  • Inflammatory bowel disease and other immune-related disorders  

Psoriasis affects 2-4% of males and females, and can persist lifelong, fluctuating in extent and severity. Psoriasis is considered a non-curable, long-term (chronic) skin disorder. Family history will show that others within the family may also have psoriasis, and there is a common link of asthma, dermatitis and rheumatoid arthritis. Some family members will have one or the other, and others may have several of these conditions (everyone is different). 

The immune system is the body’s defence against infection and diseases, and consists of two major arms – the innate immune system and the adaptive immune system. Both parts are comprised of many cell types; each with its own specialty that work together to fight off disease and help maintain the body’s health.  

In psoriasis, the immune system is compromised, resulting in overstimulation of the immune system resulting in cellular inflammation.  

Here is an image of psoriasis on a cellular level. What are we seeing here? Let’s explore…  

Keratinocytes (epidermal skin cells of the basal layer), proliferate at ten times the rate of non-diseased keratinocytes and fail to mature properly, resulting in raised, inflamed, scaly red skin lesions known as plaques, which can be itchy. T cells (immune cells) are over-proliferated in the psoriasis skin, and these cells are responsible for destroying viruses, bacteria and infections. Increased production and recruitment of T-cells creates more inflammation resulting in further skin barrier impairment. 

A structural filaggrin gene defect is an aggravating factor of psoriasis. Any abnormalities in this gene cause the epidermal barrier defence systems to become compromised; negatively influencing the keratinocyte lifecycle and corneocyte compaction processes. As a result, there are many challenges in achieving balance within the epidermis when the innate/adaptive immune systems are constantly being activated triggering cellular inflammation.   

 

Treating Psoriasis

 

Different types of Psoriasis 

Psoriasis differs in variations, symptoms & characteristics:  

Plaque psoriasis 
This is the most common form of psoriasis characterised by red, raised inflamed skin with white scales and plaques that may become itchy or burning. This form may occur anywhere on the body.  

Nail psoriasis
This form of psoriasis affects the fingers and toenails causing pitting, discolouration, abnormal nail growth, separation, crumbling, or looseness of nails.  

Guttate psoriasis
This form of psoriasis mainly affects children and young adults, often triggered by strep throat, leading to small, water-drop shaped, scaling lesions that may appear on the arms, legs, trunk, or scalp. It may appear as a single outbreak or may reoccur.  

Inverse psoriasis:
This form of psoriasis occurs around the armpits, groin region, under the breast, and around the genitals, and is characterised by red, inflamed skin and is worsened by sweating or friction.  

Pustular psoriasis
This form of psoriasis is rather uncommon. It’s characterised by widespread patches and blisters on the hands, fingertips, and feet.  

Erythrodermic psoriasis
This is the least common type of psoriasis characterised by red, peeling, itchy, and a burning rash covering the entire body.  

Psoriatic arthritis
In addition to inflamed, scaly skin, many people with arthritis develop psoriatic arthritis characterised by swollen and painful joints.  

In Part 2, we will explore how to treat psoriasis following a Corneotherapeutic approach while implementing internal recommendations to support psoriasis from the inside-out. Stay tuned!   

Written by Kai Atkinson