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Guttate Psoriasis

Skin Conditions, Immune | June 24, 2020 | Author: Naturopath

Immune, Skin conditions, autoimmune

Guttate Psoriasis

Guttate psoriasis is a form of psoriasis which occurs more often in young people. It can appear suddenly usually after an infection - most commonly group-A streptococcal infections of the tonsils. Children or adolescents are most usually affected.

What is psoriasis

Psoriasis is a chronic inflammatory disease which affects the skin - where skin cells accelerate their lifecycle in an abnormally rapid rate. This results in a build-up of immature skin cells in patches of raised, scaly, red, dry and flaky appearance which may shed and itch. It commonly occurs on elbows, knees and the scalp. The condition is considered due to an over-active immune system; has a strong genetic component and association with auto-immune pathogenesis. It mainly affects young children and adolescents and is often accompanied by another type of psoriasis, psoriatic arthritis, causing swelling in the joints.

Inflammation associated with psoriasis can also affect different organ system, which strongly suggest psoriasis as a systemic disease rather than a disease of the skin.

What is psoriasisTo summarize: Psoriasis is a chronic, inflammatory systemic disease with its development related to interactions between – genetic susceptibility, immune response and environmental influences.

Guttate psoriasis is a subtype of psoriasis. It is a variant with an acute onset of lesions which is thought triggered by superantigens from streptococcal infections which stimulate an increase of T cells in the skin.

Symptoms of guttate psoriasis

With guttate psoriasis, lesions appear as small, round spots - known as papules, which are raised and may be scaly. It presents usually on the limbs and torso but may occur on scalp, ears and face.

Psoriasis triggers

Conditions which may trigger guttate psoriasis include:

  • Upper respiratory infection
  • Streptococcal infection
  • Tonsillitis
  • Stress
  • Skin injury
  • Medication – such as beta blockers and antimalarials

There is a connection with bacteria of the skin and gut, and the development of auto-immune disease. 

The skin microbiome plays an active role in immune regulation and defence. The production of antibacterial components and biofilm formation help protect against invasion of pathogens. The microbiome of skin in several diseases such as atopic dermatitis, acne vulgaris and psoriasis showed a differential colonization of microbes than that of healthy skin. It is hypothesized this microbiota triggers an abnormal immune system response and is responsible for activation of autoimmune diseases. The skin is intrinsically related to the gut in what is termed the gut-skin axis and, with psoriasis, the gut microbiota is also considerably altered from that of normal pathogens. Interactions between the microbiota and the immune system are important for establishing and maintaining balance. 

Treatment strategies

Psoriasis is a chronic condition with no known cure. It resolves and relapses and may require a long-term strategy in reducing the triggers and symptom control. The disorder can be mild, moderate to severe depending on lesions and total surface area of the body affected. Medical treatment will often involve glucocorticoids, vitamin D analogues and phototherapy. With guttate psoriasis, tonsillectomy has shown to have a therapeutic effect, but is not considered a recommendation. 

Supporting the immune system

Guttate psoriasis is a psoriatic condition associated with the immune system. A healthy immune response is important when faced with any disease. Stress, lack of sleep, reduced nutritional intake and deficiencies can compromise the immune system making its defences vulnerable.

Chronic, non-immune and auto-immune conditions can occur when the immune system responds to perceived attacks from microbes in an excessive or inappropriate way which can result in damage to tissues of the body.  

Supporting the immune systemModulating the complex immune system to respond in a healthy an appropriate manner is important in the prevention and treatment of any infection and is a preferred course of action. 

Encouraging healthy immunity always begins with a nourishing diet, exercise for a healthy body and stress release, and good quality and quantity of sleep.
 

Nutrients which support immunity 

Probiotics and prebiotics taken orally not only help modify the terrain of the gut but also apply immunomodulatory effects on skin and can strengthen its barrier function. They do this by decreasing skin bacterial load and opposing aggressive disease-causing pathogens. Lactobacillus paracasei NCC2461 is one strain of probiotics which was found to help psoriasis by decreasing skin sensitivity, helping repair skin barrier function and preserving the skin's moisturizing content. 

Resveratrol, quercetin and curcumin are immune modulating compounds found in many plants and available as supplements. They offer anti-inflammatory and antioxidant actions and a reduction in pro-inflammatory mediators.

Andrographis (Andrographis paniculata) is a herb which offers numerous immunomodulatory activity along with antimicrobial, antioxidant and anti-inflammatory actions.

Vitamin D – deficiency is linked to the ability of the skin to remain healthy, and to flares of psoriasis activation. It has been used successfully to treat psoriasis topically reducing differentiation and inflammation and can play a role in decreasing the risk of many chronic illnesses such as autoimmune diseases and infectious diseases.

As an immune regulatory hormone, vitamin D has shown a beneficial action towards many inflammatory diseases which are mediated by helper T-lymphocytes type 1 (Th1) cells. These include diabetes, Crohn's disease, multiple sclerosis and psoriasis.

Zinc and copper are thought to play a role in the aetiology and pathogeneses of psoriasis. Trace mineral evaluation may help with any imbalances.

Vitamin A may help reduce the over-production of skin cells and reduce inflammation when applied topically.

Fish oil (omega-3 fatty acids) taken orally benefit skin health as an anti-inflammatory and support barrier function of the skin.

Herbal medicine as alternatives to hydrocortisone. Licorice (Glycyrrhiza glabra) and Chamomile (Matricaria chamomilla) offer anti-inflammatory action.

Herbal medicine as alternatives to hydrocortisoneCalendula Officinalis extracts offers an anti-inflammatory action, inhibits oxidative stress and reduces endothelial growth factor (VEGF) -  a signal protein produced by cells that stimulates the formation of blood vessels. Calendula can be taken orally as a herbal preparation and applied externally.

Melaleuca alternifolia (tea tree oil) – topical application suppresses inflammatory mediator production and offers antimicrobial activity.

Centella Asiatica (Gotu Kola). Oral supplement offers potent antipyretic, anti-pruritic, and anti-inflammatory activity.

Topical creams

Topical application of emollient products (moisturisers), applied at least twice daily and especially after bathing, can help reduce irritation and scaling. Choose products which contains calendula, gotu kola, tea tree, licorice and chamomile for best results.

Could gluten be an issue? Some studies have shown a significant higher mean IgA anti-gliadin antibodies (AGA) have been associated with psoriasis, and reduction of symptoms was shown on the elimination of gluten from the diet. Celiac disease is an autoimmune condition triggered by ingestion of gluten in genetically predisposed people.

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References

https://www.msdmanuals.com/professional/dermatologic-disorders/psoriasis-and-scaling-diseases/psoriasis

https://www.psoriasis.org/about-psoriasis/types/guttate#:~:text=Guttate%20psoriasis%20appears%20as%20small,an%20infection%20like%20strep%20throat.

https://skinhospital.edu.au/psoriasis-treatment/

Psoriasis Pathogenesis and Treatment https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471628/

Systemic Role for Vitamin D in the Treatment of Psoriasis and Metabolic Syndrome https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130965/

Vitamin D and its role in psoriasis: An overview of the dermatologist and nutritionist https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486909/

Dietary compounds as potential modulators of microRNA expression in psoriasis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686315/

Comparison of levels of serum copper, zinc, albumin, globulin and alkaline phosphatase in psoriatic patients and controls: A hospital based casecontrol study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375770/

Gut microbiota and nutrient interactions with skin in psoriasis: A comprehensive review of animal and human studies https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103976/#B33

Psoriasis and Microbiota: A Systematic Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023392/#:~:text=T%2Dcell%20activation%20in%20guttate,pathogenesis%20of%20chronic%20plaque%20psoriasis.

Digestive system in psoriasis: an update https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5648743/

Integrative Dermatology – The Use of Herbals and Nutritional Supplements to Treat Dermatological Conditions https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816298/

Psoriasis and Microbiota: A Systematic Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023392/#B70-diseases-06-00047

Plant-derived immunomodulators: an insight on their preclinical evaluation and clinical trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548092/

Harnessing the medicinal properties of Andrographis paniculata for diseases and beyond: a review of its phytochemistry and pharmacology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032030/

Glycyrrhizin combined with acitretin improve clinical symptom of psoriasis via reducing Th17 cell differentiation and related serum cytokine concentrations https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4659031/

The Pharmacological Activities of Glycyrrhizinic Acid (“Glycyrrhizin”) and Glycyrrhetinic Acid https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7123798/

https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/glycyrrhetinic-acid

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