Psoriasis

Question 1

Psoriasis

Answer 1

A common T cell mediated inflammatory
skin condition characterised by hyperkeratosis.

Question 2

Psoriasis: Clinical presentation

Answer 2

• Symmetric salmon-coloured plaques with silvery scales.
• Characteristically involves the scalp, the extensor surfaces
• Nail pitting
• Often worse in winter; better in tropical climates.

Question 3

Psoriasis: Pathogenesis

Answer 3

Autoimmune: deregulated T cell mediated inflammatory process → keratinocyte proliferation + dysfunctional differentiation.
1. Initiation phase: Keratinocytes respond to a trigger → stimulate dendritic cells → cytokine production → T helper cell differentiation.
2. Maintenance phase: T helper cells release cytokines → keratinocyte proliferation → more inflammatory cells.

Question 4

Psoriasis: Complications

Answer 4

Psoriatic arthritis (30%), CVD, IBD,
depression, ocular disorders (e.g., uveitis).

Question 5

Psoriasis: Causes and risk factors

Answer 5

• Genetic predisposition: PSORS1
• Physical trauma
• Vaccination
• Air pollution
• Medications
• Infectious agents
• Smoking
• Alcohol
• Metabolic syndrome
• Gut dysbiosis
• Detox pathways
• Chronic high stress

Question 6

Psoriasis: Natural Approach

Answer 6

CNM Naturopathic Diet with a focus on:
* Fibre
* Antioxidants
* EPA / DHA
* Detox / support liver
AiP
* Digestive support
* Probiotics and prebiotics
Weight loss as needed
* Stress management
* Coconut oil
Neem - anti inflammatory
Aloe Vera

Question 7

Psoriasis: Avoid

Answer 7

Gluten
Red meat
Simple sugars
Toxic load

Question 8

Psoriasis: Supplements

Answer 8

Vitamin A
Vitamin D
Vitamin E
EFAs
Zinc
Milk Thistle

Question 9

Psoriasis Supplements: Vitamin A

Answer 9

Dose: 5000 iu/day

For epithelial cell differentiation, collagen synthesis

Question 10

Psoriasis Supplements: Vitamin D

Answer 10

• Downregulates cytokines eg TNF alpha
• Anti inflammatory and immunomodulatory effects.
• May help ↓ keratinocyte proliferation and cell differentiation.

Question 11

Psoriasis Supplements: Vitamin E

Answer 11

Dose: 400-800 iu/day

↓ proinflammatory cytokines

Question 12

Psoriasis Supplements: Omega - 3

Answer 12

1g of EPA

Anti-inflammatory and inhibits COX-2 and LOX pathways thus leukotrienes and PGE-2

Question 13

Psoriasis Supplements: Zinc

Answer 13

Dose: 15-30mg/day

• Downregulates keratinocyte proliferation

Question 14

Psoriasis: Milk thistle

Answer 14

Dose: 3 x 100 mg daily

Liver function: ↑ glutathione and SOD