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A Functional Approach to Skin Conditions: Eczema and Psoriasis

Traditional dermatological approaches target inflammation topically with steroids or internally with immune suppressing agents. While these can be effective and appear to resolve the area of inflamed skin there is often recurrence elsewhere or rebound flares when these medications are discontinued. Our goal in functional medicine is to explore what is causing an overactive immune response and take a holistic approach to address all of the body systems involved.
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In Functional Medicine a diagnosis serves as the beginning not the end of the detective process. Continuing to ask the question “why” instead of focusing on the what, allows us to get to the root cause for each individual.

While eczema and psoriasis present differently, they share some of the following commonalities: barrier disruption, inflammation, dysbiosis, leaky gut, food triggers, and nutritional deficiencies.

Traditional dermatological approaches target inflammation topically with steroids or internally with immune suppressing agents. While these can be effective and appear to resolve the area of inflamed skin there is often recurrence elsewhere or rebound flares when these medications are discontinued. Our goal in functional medicine is to explore what is causing an overactive immune response and take a holistic approach to address all of the body systems involved. Let’s walk through a functional approach to addressing these common skin conditions.

 

Defining Eczema & Psoriasis

Eczema, also known as atopic dermatitis, is the most common inflammatory skin condition in the US. It is a disease of barrier dysfunction and inflammation both externally and internally. Individuals may have a genetic predisposition that leads to an impaired skin barrier. Often people with eczema also suffer from allergies and asthma, this is referred to as the atopic triad.

Psoriasis is an autoimmune condition that accelerates the life cycle of skin cells, causing cells to build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are itchy and sometimes painful. There are many conditions that coexist with psoriasis including cardiovascular disease, metabolic syndrome, type 2 diabetes, depression, and IBD. These comorbidities share the common thread of inflammation which contributes to their pathologies.

 

What Could Be the Root Cause? 

  • Microbiome Dysbiosis: Individuals with eczema and psoriasis often have an overgrowth of problematic bacteria and yeast and an undergrowth of beneficial organisms like lactobacillus and bifidobacteria. Often, we see an overgrowth of staph aureus in patients with eczema and streptococcus in patients with psoriasis. Candida overgrowth is common in both groups and can be caused by a diet high in sugar, refined carbs, processed foods, and low in fiber.
  • Leaky gut: Also referred to as increased intestinal permeability, is another driver of inflammation for many individuals with eczema and psoriasis. 80% of our immune system surrounds our gut and is constantly surveying it’s environment. When our gut lining is impaired larger food particles and organisms can interact with the immune system. These larger particles look foreign and in order to protect us from this potential invader are immune system mounts an inflammatory response.
  • Food Triggers: Eggs, dairy, and wheat are the most common foods that trigger eczema and psoriasis. Some individuals with eczema also react to high histamine foods like tomatoes, alcohol, citrus, and vinegar. Ruling out IgE food allergies is also a reasonable area to explore in patients with eczema.
  • Nutritional Deficiencies: The standard American diet is low in essential fatty acids, antioxidants, vitamins, minerals, and fiber. Low vitamin D is also common in individuals with eczema and psoriasis and critical for a healthy immune response.
  • Environmental Factors: Toxins, pollutants, mold, and allergen exposure can all contribute to an overactive immune system.
  • Lifestyle: High Stress, poor sleep, and sedentary living contribute to the inflammatory cascade

 

What are the Treatment Approaches for Skin Conditions?

  • Elimination Diet: identifies triggers and reduce inflammation. This is followed by implementation of an anti-inflammatory diet that is rich in whole foods, balances blood sugar, and is high in protein, fiber, and healthy fats. It is also important to ensure a diverse phytonutrient diet to promote a balanced and resilient microbiome.
  • Address Lifestyle Factors: Improve Resilience to Stress, ensure a minimum of 7 hours of sleep per night, increase exercise and regular movement. UV light exposure and time spent outdoors has also shown to be therapeutic for patients with psoriasis.
  • Supplements: Omega 3s, Vitamin A, Zinc, Vitamin D, Vitamin E, etc.

 

The Role of Diagnostic Testing

Functional Medicine often employs advanced diagnostic testing to delve into the root causes of skin conditions, offering personalized treatment strategies.. These might include:

  • Food Sensitivity and Allergy Testing: To identify specific triggers.
  • Gut Microbiome Analysis: Understanding the skin-gut connection is critical when addressing the root cause of dermatologic conditions. Genova’s GI Effects® is a comprehensive assessment of your complete gut health profile.
  • SIBO Breath Test: It may be important to assess for an overgrowth of bacteria in the small intestine that could be driving the immune response.

 

Final Thoughts

Eczema and Psoriasis are complex conditions that require a multifactorial approach. As a Functional Medicine Physician, my job is to guide patients on their journey of healing, addressing the root causes, and empower them with the tools and knowledge to achieve and maintain healthy skin and a healthy body.

Our skin is a reflection of our internal health. By caring for our bodies from the inside out, we can achieve lasting health and vibrant skin.

 

Resources:

 

Alesa DI, Alshamrani HM, Alzahrani YA, Alamssi DN, Alzahrani NS, Almohammadi ME. The role of gut microbiome in the pathogenesis of psoriasis and the therapeutic effects of probiotics [retracted in: J Family Med Prim Care. 2021 Feb;10(2):1076]. J Family Med Prim Care. 2019;8(11):3496-3503. Published 2019 Nov 15. doi:10.4103/jfmpc.jfmpc_709_19

De Pessemier B, Grine L, Debaere M, Maes A, Paetzold B, Callewaert C. Gut-Skin Axis: Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions. Microorganisms. 2021;9(2):353. Published 2021 Feb 11. doi:10.3390/microorganisms9020353

Kapoor B, Gulati M, Rani P, Gupta R. Psoriasis: Interplay between dysbiosis and host immune system. Autoimmun Rev. 2022;21(11):103169. doi:10.1016/j.autrev.2022.103169

Myers B, Brownstone N, Reddy V, et al. The gut microbiome in psoriasis and psoriatic arthritis. Best Pract Res Clin Rheumatol. 2019;33(6):101494. doi:10.1016/j.berh.2020.101494

Savolainen J, Lammintausta K, Kalimo K, Viander M. Candida albicans and atopic dermatitis. Clin Exp Allergy. 1993;23(4):332-339. doi:10.1111/j.1365-2222.1993.tb00331.x

Taheri Sarvtin M, Shokohi T, Hajheydari Z, Yazdani J, Hedayati MT. Evaluation of candidal colonization and specific humoral responses against Candida albicans in patients with psoriasis. Int J Dermatol. 2014;53(12):e555-e560. doi:10.1111/ijd.12562

Wilchowski SM. The Role of the Gut Microbiome in Psoriasis: From Pathogens to Pathology. J Clin Aesthet Dermatol. 2022;15(3 Suppl 1):S25-S28.

 

 

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