Psoriasis: Most Effective Dietary Supplements

Psoriasis is a chronic inflammatory disease affecting about 2 to 3% of the global population. It manifests as erythrodermic and scaly plaques, often uncomfortable and aesthetically troublesome. Though non-contagious, it can significantly affect patients' quality of life. Generally diagnosed between the ages of 15 and 35, it can nevertheless appear at any age.

Pathophysiology of Psoriasis

Psoriasis results from a complex immune system dysregulation, classifying this condition among autoimmune diseases. The central element of this pathology is hyperproliferation of keratinocytes due to abnormal activation of T lymphocytes. These, under the effect of activated dendritic cells, release pro-inflammatory cytokines such as interferon alpha, IL-17, and TNF-alpha. These molecules trigger persistent inflammation and stimulate the rapid proliferation of epidermal cells, migrating to the skin surface in just 7 days, compared to 28 days normally. This leads to an accumulation of immature keratinocytes, forming characteristic thick plaques. Moreover, infiltration of the dermis and epidermis by T lymphocytes and neutrophil polymorphs worsens inflammation, promoting the formation of micro-abscesses in the stratum corneum.

Symptoms and Clinical Presentation

The manifestations of psoriasis vary according to the types and severity of lesions:  Plaque Psoriasis: It is the most common form, characterized by well-defined red plaques, covered with silvery scales. These lesions primarily appear on the elbows, knees, scalp, and lower back.  Guttate Psoriasis: Small, drop-shaped lesions, often triggered by a streptococcal infection.  Pustular Psoriasis: Presence of sterile pus-filled blisters, located on the hands and feet or generalized.  Inverse Psoriasis: Red, smooth plaques appearing in skin folds like the armpits or under the breasts.  Nail Psoriasis: Involves nails, with striations, discolorations, or nail detachment. Lesions evolve in flare-ups, alternating with remission periods. Depending on the extent and impact of the lesions, psoriasis is classified as mild, moderate, or severe, the latter affecting more than 10% of body surface.

Risk Factors and Triggers

While the exact etiology of psoriasis remains unknown, several factors contribute to its onset and worsening:  Genetic Predisposition: About 30% of cases are familial. The risk for a child increases up to 60% if both parents are affected.  Environmental Factors: Emotional stress, skin trauma (Koebner phenomenon), streptococcal infections, and certain medications (beta-blockers, lithium salts) are common triggers.  Lifestyle Habits: Excessive alcohol and tobacco consumption worsen the disease and complicate its treatment.  Nutritional Deficiencies: A deficiency in folates or vitamin B12 can exacerbate symptoms.  Sun Exposure: While beneficial for the majority of patients, a minority may see their symptoms worsen under the effect of UV.

Diagnosis and Complications

The diagnosis of psoriasis is primarily based on clinical examination. Characteristic signs such as the candle phenomenon (desquamation after scratching), bloody dew (appearance of blood droplets after scratching), and the Koebner phenomenon (appearance of lesions at skin trauma sites) are often sufficient for diagnosis. In some cases, a skin biopsy may be required to confirm the diagnosis and rule out other dermatological diseases. Complications include:  Psoriatic Arthritis: An inflammatory joint condition affecting up to 30% of patients.  Metabolic Comorbidities: An increased risk of cardiovascular diseases, type 2 diabetes, and obesity.  Psychological Impact: Psoriasis, due to its visibility, can lead to emotional distress, decreased self-esteem, and reduced quality of life.

Available Treatments

The treatment goals are to reduce inflammation, slow down keratinocyte proliferation, and improve symptoms. They include:  Topical Treatments: Corticosteroids, vitamin D analogues, and moisturizing creams.  Phototherapy: Controlled exposure to UVB or PUVA therapy for moderate to severe forms.  Systemic Treatments: Methotrexate, cyclosporine, or biotherapies targeting specific cytokines such as TNF-alpha, IL-17, or IL-23.