Research continues to uncover more information on psoriasis. Scientists are exploring how nutrition, exercise, weight management, gut health, and medicines can ease symptoms and improve your overall quality of life.
How Does Exercise Affect Psoriasis?
While some researchers focus their attention on coming up with new psoriasis treatments, others look at how to best live with the disease. One promising avenue of prevention centers on fitness. Psoriasis can impact your ability to exercise. On the flip side, exercise can have an effect on your disease.
Studies find that exercise, especially when it’s intense, might help reduce the chance of getting psoriasis. People who are less fit seem to have a higher risk for the disease. Although the link needs to be explored further, it may be about how exercise can lower chronic inflammation, a hallmark of psoriasis and many other conditions.
Even if you can't exercise intensely, there are ways to fit movement into your day. You may be able to modify exercises or choose low-intensity movements.
Can Diet Improve Psoriasis Symptoms?
There's no specific diet for people with psoriasis. Some experts say avoiding foods that could cause inflammation may help. Other research shows that having certain foods could have positive effects.
The traditional Mediterranean diet can help lower inflammation, with foods like fish, fruit, vegetables, nuts, and olive oil. Researchers are looking at whether that might help make psoriasis less severe.
In one study, researchers found that diet helped psoriasis severity. But they weren't sure if it was the type of food or the weight loss that helped people. More research on the connection between nutrition and psoriasis could help people select eating plans to best suit their condition.
How Does Gut Health Impact Psoriasis?
You're far from alone in your body. You share it with trillions of bacteria, fungi, and other tiny bugs, most of which live in your gut. Scientists call this miniature community the "microbiome." This is natural, and having your inner environment in balance may be a key to good health.
Some of the bugs in your microbiome make fatty acids that control inflammation. (But not the “essential” fatty acids that you can get only from food and supplements). They also help to keep your immune system under control. Researchers are now studying whether drugs made from helpful bacteria called probiotics might prove to be an effective psoriasis treatment.
Can Losing Weight Improve Psoriasis Symptoms?
No single diet or food will treat or prevent psoriasis. And you can get this condition at any size. Still, there are some signs that nutrition and weight do affect it -- just as they affect many other conditions.
Body fat fuels inflammation. Doctors have known for a while that losing weight (if you're overweight) can reduce psoriasis symptoms and help your medicines work better at clearing your skin. The open question is: What's the best way to lose weight?
In studies, people with psoriasis who trimmed off as little as 5% of their weight by following a low-calorie diet had clearer skin.
One small study offered a very low-calorie keto diet, followed by 6 weeks of a traditional Mediterranean diet. All the people in the study were overweight or obese and had psoriasis but weren’t taking medication for it. They lost weight, and their psoriasis improved. It’s not clear if that was because of the weight loss, the types of food they ate, or both things. More research will be needed to see exactly what worked.
How Are Biologics Changing Psoriasis Treatment?
In the 1960s and '70s, new info about how the immune system -- your body's defense against germs -- plays a role in psoriasis led to several new treatments. Drugs like corticosteroids, cyclosporine, and methotrexate became mainstays for managing the disease. For the next few decades, though, advances in treatment slowed down.
Thanks to recent progress in research, that's history.
Scientists studying other autoimmune diseases found new insights about the immune system. It turns out that some of the problems in those conditions are active in psoriasis, as well.
The new info brought treatments that target specific areas of your immune system. Called biologics, these drugs launched a new era of psoriasis treatment.
They're medicines made from substances found in living things. Doctors inject these lab-made proteins or antibodies into your skin or bloodstream. Once inside the body, the drug blocks part of your altered immune system that adds to psoriasis.
In general, biologics work on psoriasis because they:
- Curb T cells (a form of white blood cell)
- Block a substance called tumor necrosis factor-alpha (TNF-alpha), one of the main messenger chemicals in the immune system
- Stop a family of your immune system's chemical messengers called interleukins
- Bind to proteins that cause inflammation
The patches and plaques of psoriasis come after an interaction between your skin cells and white blood cells. Biologics interfere with TNF-alpha or T cells, or they target interleukins. This short-circuits that unhealthy link. This will ease your inflammation. You'll have less growth of thick, scaly skin, too.
Biologic medicines approved by the FDA to treat moderate to severe psoriasis include:
- Adalimumab (Humira), a TNF-alpha-blocking antibody
- Adalimumab-adbm (Cyltezo), a biosimilar to Humira
- Brodalumab (Siliq), a human antibody against interleukins
- Certolizumab pegol (Cimzia), a TNF-alpha blocker
- Etanercept (Enbrel), a TNF-alpha blocker
- Etanercept-szzs (Erelzi), a biosimilar like Enbrel
- Guselkumab (Tremfya), an antibody against interleukins
- Infliximab (Remicade), a TNF-alpha blocker
- Ixekizumab (Taltz), an antibody that binds to inflammation-causing proteins/interleukins
- Risankizumab-rzaa (Skyrizi), an antibody against interleukins
- Secukinumab (Cosentyx), a human antibody against interleukins
- Tildrakizumab-asmn (Ilumya), an antibody against interleukins
- Ustekinumab (Stelara), a human antibody against interleukins
Biologics are good at treating psoriasis. In some clinical trials, each of the drugs lowered psoriasis activity by at least 75% in many people.
There are some drawbacks, though. Biologics can be expensive. Though biologics are safe for most people, these medicines they could raise your chances of infection, cancer, and other complications. Your doctor will need to keep close tabs on you to make sure you stay healthy.
What Are Some Medications to Treat Psoriasis?
These are some of the newer medicines used to treat psoriasis.
- Apremilast (Otezla) is a drug you take by mouth that's approved to treat psoriatic arthritis and plaque psoriasis in adults. It curbs phosphodiesterase-4 (PDE4), an enzyme that controls inflammation. Side effects include diarrhea, nausea, and headache. Some people in studies who took the drug lost weight. If you use the medicine, it's recommended that you check your weight regularly and watch out for signs of depression.
- Deucravacitinib (Sotyktu) stops the protein allosteric tyrosine kinase 2 (TYK2), which is found in immune cells and shown to be central to what causes psoriasis. Side effects include serious allergic reactions, skin rash, tightness in the chest, feeling faint, and trouble breathing.
- Roflumilast (Zoryve) is a steroid-free cream that'sFDA-approved to treat plaque psoriasis in people over the age of 12. This drug targets the phosphodiesterase-4 (PDE4) enzyme to reduce inflammation. Possible side effects include headache, diarrhea, nausea, and upper respiratory and urinary tract infections.
- Tapinarof (Vtama) is another steroid-free cream that you apply daily. Side effects may include headache, bumps around hair follicles, rash, itching, stuffy or runny nose, and throat or nose pain.
- Tofacitinib (Xeljanz) is a pill that blocks Janus kinase (JAK) enzymes to ease inflammation. Common side effects include diarrhea, headache, and stuffy or runny nose. It's FDA-approved for psoriatic arthritis, and sometimes used off-label for psoriasis. An off-label use means it's not FDA-approved to treat psoriasis, but doctors prescribe it to people because they find it helps.
Show Sources
Photo Credit: omgimages / Getty Images
SOURCES:
American Academy of Dermatology Association: "What Should I Eat If I Have Psoriasis?"
FDA: "FDA approves new psoriasis drug Taltz,” "FDA approves Amjevita, a biosimilar to Humira," "Understanding Unapproved Use of Approved Drugs "Off Label,"" "Prescribing Information: Zoryve," "Prescribing Information: VTAMA."
Harvard Medical School: "Preventing psoriasis with exercise."
International Journal of Molecular Sciences: "Recent Advances in Psoriasis Research; The Clue to Mysterious Relation to Gut Microbiome," "The Role of Gut Microbiome in Psoriasis: Oral Administration of Staphylococcus aureus and Streptococcus danieliae Exacerbates Skin Inflammation of Imiquimod-Induced Psoriasis-Like Dermatitis."
Journal of the American Academy of Dermatology: “New psoriasis treatments based upon a deeper understanding of the pathogenesis of psoriasis vulgaris and psoriatic arthritis: a personal appraisal of their use in practice.”
Nature: “Pathogenesis and therapy of psoriasis.”
Medicine (Baltimore): "Association between physical activity and risk of prevalent psoriasis."
Journal of Clinical Investigation: “Recent insights into the immunopathogenesis of psoriasis provide new therapeutic opportunities.”
Nutrition: "Aggressive weight-loss program with a ketogenic induction phase for the treatment of chronic plaque psoriasis: A proof-of-concept, single-arm, open-label clinical trial."
PLoS One: "Cardiorespiratory fitness in late adolescence and long-term risk of psoriasis and psoriatic arthritis among Swedish men."
Current Pharmaceutical Design: “Advances in Therapy for Psoriasis: An Overview of Infliximab, Etanercept, Efalizumab, Alefacept, Adalimumab, Tazarotene, and Pimecrolimus.”
University of Washington: "The Human Microbiome."
Medline Plus: "Tapinarof Topical."
Johns Hopkins Medicine: "Psoriasis Diet: Foods to Eat and Avoid If You Have Psoriasis."
National Psoriasis Foundation: "The Little Things Count."
Psoriasis Targets and Therapy: "Psoriasis and Exercise: A Review," "The Effect of Lifestyle Changes on Disease Severity and Quality of Life in Patients with Plaque Psoriasis: A Narrative Review."
Drug Design, Development and Therapy: "Profile of tofacitinib citrate and its potential in the treatment of moderate-to-severe chronic plaque psoriasis."
Nutrients: "Nutritional Therapy in Persons Suffering from Psoriasis."
Journal of Clinical Medicine: "Role of Janus Kinase Inhibitors in Therapy of Psoriasis."
The New England Journal of Medicine: "Trial of Roflumilast Cream for Chronic Plaque Psoriasis."
American Journal of Managed Care: "Dr Patrick Burnett Explains Mechanism of Action for Roflumilast Cream in Psoriasis."
