The Dermatologists Point Of View
Patients suffering from psoriasis present a broad range of clinical phenotypes. Psoriatic lesions are classified into plaque, guttate, pustular, and erythrodermic types according to clinical features, especially regarding lesions size and distribution . Disease onset may occur at any age, including childhood, with two peak age ranges, 16 to 22 and 57 to 60 years . Psoriasis lesions are characterized by hyper-proliferation with incomplete differentiation of epidermal keratinocytes and decreased keratinocyte apoptosis, associated with inflammatory cellular infiltrate in both dermis and epidermis . Psoriasis Area and Severity Index score is currently the preferred method for the assessment of the disease severity and extent .
Tips To Help You Lose Weight
- Keep a food diary. Studies have shown that writing down everything you eat is a critical part of sustained weight loss. Noting how you feel when you eat will help you identify emotional triggers that may cause you to overeat.
- Eat slowly. If you eat too fast, you eat more than you need to satisfy your hunger. Your brain needs time to catch up with your stomach.
- Plan your meals ahead of time so you make healthy choices. When dining out, check the menu online and decide what you will order ahead of time. Ask for dressings on the side and opt for foods that are baked, broiled or steamed versus foods that are fried or in creamy sauces. Avoid the chips and bread baskets that can add unnecessary calories to a meal.
- Eat when youâre truly hungry rather than when you are tired, anxious, or stressed. Emotional eaters tend to overeat.
- Stay hydrated. Oftentimes people mistake thirst for hunger.
- Eat breakfast. If you skip this meal, youâll be starving by lunchtime and will have more difficulty making healthy choices throughout the day.
- Find resources to help you keep track of your food choices and nutritional values, and that can offer additional support when you need it. Potential resources include CalorieKing.com and MyFitnessPal.com, which offer a searchable database of foods with nutritional values.
If youâre overweight, talk to your doctor about a weight loss approach thatâs right for you.
Systemic Role For Vitamin D In The Treatment Of Psoriasis And Metabolic Syndrome
Ronald Vender
1Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON, Canada
2Dermatrials Research, Dermatology Centre, 132 Young Street, Hamilton, ON, Canada
Abstract
The novel discovery of the systemic role of vitamin D in the modulation of the immune system especially the Type 1 helper T cell pathway reveals its potential for treating Th1 inflammatory diseases. Psoriasis has been recently established to be a systemic disease centered on inflammation and involvement of cytokines of the Th1 pathway. There is an increased prevalence of metabolic syndrome in patients with psoriasis. Metabolic syndrome also involves a proinflammatory state. This paper proposes the idea of the potential use of oral vitamin D to treat psoriasis and metabolic syndrome concurrently. We propose there is merit in more clinical trials investigating the use of vitamin D to treat both psoriasis and metabolic syndrome through its anti-inflammatory effects. On application to psoriasis management and prognosis, the goal is to decrease the risk for cardiovascular disease and decrease disease morbidity and mortality.
1. Introduction
Psoriasis is a common Th1-mediated inflammatory disease characterized by scaly plaques on the skin, which can be painful and pruritic. It is also associated with psoriatic arthritis, Crohns disease, diabetes mellitus , metabolic syndrome, depression, and cancer . It affects 13% of the general population .
2. Psoriasis Pathophysiology
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Effects Of Vitamin D On The Cutaneous Immune System
Psoriasis pathogenesis implicates the innate and adaptive segments of the immune system. In particular, it is centrally controlled by T cells, in which an important role is played by T-helper 1, Th17 and Th22, interplaying with numerous cell types via different cytokines, including tumour-necrosis factor- , IL-6 and IL-17 . The activity of these cells is modulated by specific T lymphocytes, named regulatory T cells . Regulatory T cells are able to inhibit the immunological response and to preserve the cutaneous immunological homeostasis, preventing autoimmune response against self-antigens .
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How To Get More Vitamin D:
There are several ways to increase vitamin D levels in the body. The easiest way is to expose the skin to direct sunlight, which consists of both UVA and UVB rays. UVA exposure can increase the risk of skin cancer, so psoriatic patients should consult a doctor to see how much sun exposure is necessary. Vitamin D supplements are also beneficial ways to raise vitamin D levels. According to the Institute of Medicine, an upper limit of 4,000 IU per day may prevent psoriatic side effects. Lastly, there are are some food sources of vitamin D, but try to steer clear of fortified foods. Its best to focus on more natural foods that contain vitamin D.
While Were On The Topic Of Topicals What About Vitamin D Analogues
A vitamin D analogue is synthetic vitamin D that usually comes in topical form and requires a prescription.
When applied directly to affected skin, analogue vitamin D topicals help slow cell growth and thin out any plaques.
Popular vitamin D analogues include:
- tacalcitol
- calcitriol
- maxacalcitol
In more severe cases, your doc may recommend using both an analogue vitamin D option and a corticosteroid for symptom relief.
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Heal With Vitamin D Medication For Psoriasis
Very often, treatment starts with topical creams and ointmentsproducts you put on your skin. Studies show that vitamin D ointment works as well as strong anti-inflammatory topical medications called corticosteroids. In fact, a combination of the two types of prescription medications is even more effective. One example of a vitamin D ointment is calcipotriene . Its usually applied twice a day to psoriasis plaques, the red areas of skin covered by silvery scales.
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Other Vitamins And Supplements For Psoriasis
There is not much evidence to suggest that vitamins or dietary supplements help reduce symptoms of psoriasis.
However, oily fish are a good source of vitamin D, and some people with psoriasis believe that omega-3 fatty acid supplements help ease their psoriasis.
Omega-3 fatty acids may reduce inflammation, and psoriasis is an inflammatory disease.
However, there are not enough long-term clinical trials to show whether these supplements are effective for treating psoriasis.
Other Nutrients For Psoriasis
Vitamins are not the only types of nutrient that might help reduce psoriasis symptoms.
Omega-3 fatty acids, commonly found in fish and flax seeds, glucosamine and chondroitin, and methylsulfonylmethane may help to reduce inflammation and assist skin health.
While people often recommend the above vitamins to treat psoriasis, the most reliable solution is to eat a nutritious, balanced diet, free from processed food, alongside conventional treatments.
The United States Food and Drug Administration does not regulate dietary supplements. It can be difficult to make sure that all ingredients in a supplement are both of a high quality and mentioned on the packaging.
Ask a doctor to recommend reliable brands that include the ingredients on the label.
Supplements that contain unnamed ingredients may interfere with other medications a person is taking.
The cornerstone of psoriasis treatment is prevention. Avoiding certain triggers can prevent psoriasis from flaring up. This can help to reduce reliance on over-the-counter and pharmaceutical medications.
Some prevention tips to keep in mind include:
- minimizing stress levels
- keeping the skin moisturized, as outbreaks are more likely to occur on dry skin
- staying inside as much as possible during the winter, as cold weather can dry the skin
- using a humidifier during the colder months to help keep the skin moist and prevent outbreaks
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Why Vitamin D For Psoriasis Works
Here is a more in depth view of how Vitamin D for psoriasis works, with several reasons illuminating why Vitamin D is the go-to vitamin for treating psoriasis.
For starters, Vitamin D3
Prevents Inflammation
In psoriasis, the nasty skin legions, scales and rashes are caused by an auto-immune reaction that results in excessive inflammation. Vitamin D3 has proven time and time again to prevent and reduce this inflammation.
Vitamin D works by preventing inflammation cascades. In several studies, it lowered markers of inflammation in psoriasis and other inflammatory diseases. Vitamin D3 goes a step further, however, upregulating the genes involved in creating anti-inflammatory compounds.
That means that it switches on your bodys ability to make the guys that counteract the inflammation, empowering your body to auto-heal itself!
Regulates Dendritic Cell Formation and Rapid Skin Cell Growth
A more in-depth view of the auto-immune reaction involved in psoriasis revealed that the skin legions are a result of over functioning T-cells as well as Dendritic Cells.
Dendritic Cells are what signal the body to produce T-cells in response to an infection. Both T-cells and Dendritic Cells have been found in vast quantities in the skin of psoriasis patients in areas with and without skin rashes.
Its a huge dose, to be sure, so the patients were under regular doctor supervision side note: it is not advised you do this by yourself at home.
Boosts Immune Function
When And Why Should You Check Vitamin D Levels With A Blood Test
Okay, so nobody loves running to the doctor for a blood test, but hear me out: Getting your levels checked is the most surefire way to supplement appropriately and safely, and there are lots of good reasons for doing it.
âIf youâre experiencing a flaky scalp, I would recommend that you first get vitamin D levels checked to determine whatâs going on before running out and relying on any single course of treatment, like a dandruff shampoo,â says Dr. Simmons-OâBrien. She recommends a âvillage approachâ that utilizes multiple methods of prevention and treatment working in tandem together: supplementing with vitamin D to set a healthy internal foundation, using quality topical products to manage the yeast or bacteria overgrowth, and then possibly seeing a dermatologist for prescription treatment if needed.
Itâs especially important to get a blood test if you have risk factors or signs of vitamin D deficiency. Depending on your levels, your doctor may recommend a dosage beyond the standard supplementation protocol.
And on the other side, accidentally overcompensating with vitamin D can be dangerous. According to Harvardâs T.H. Chan School of Public Health, vitamin D toxicity most often occurs from taking supplementswhich is why itâs not recommended to take more than 4,000 IU daily unless monitored by a doctor. By knowing your true vitamin D level, youâll be able to supplement in the safest way possible.
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You May Also Opt For A Limited Option You May Use The Following Method
However, it must be noted that a high dosage of vitamin D supplements can cause serious side effects. Patients may experience excessive urination and weight loss. There are chances of anorexia, irregular heartbeats, and high blood calcium levels. High calcium may result in kidney stones.
Application of the cream may also result in severe itching, skin pain, or inflammation. Thus, before adhering to this regime, it is recommended that you consult your doctor before starting any regular treatment.
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How Vitamin D Deficiency Contributes To Psoriasis
If you live with psoriasis then you know how difficult it can be to plan your day around your flare-ups. When your skin becomes inflamed with itchy, scaly plaques, you may not feel like leaving the house.
Luckily, you have options, one of which may be as simple as diagnosing and treating a vitamin D deficiency. At Skinworks Dermatology, with three New York City locations, dermatologist Javier Zelaya, MD, and our team are dedicated to caring for your skin.
If psoriasis is affecting your quality of life, dont hesitate to contact Dr. Zelaya. He can help you determine what might be causing your psoriasis or making your symptoms worse. One of those factors could be a vitamin D deficiency.
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How Should Vitamin D Analogue Be Used
Vitamin D analogues are available as cream, solution, ointment, or foam. You can directly apply it on psoriasis-affected skin. You can use it on your skin twice daily — morning and evening. Gently rub on the cream until no medication is visible. Itâs best to wash your hands with soap and water after each time.
Hereâs what you need to know before you apply vitamin D analogues:
- Itâs important to use it exactly as your doctor directs you to
- Apply it at the same time each day
- For children between ages 2 and 6, donât use more than one tube per week
- For people aged 7 and above, donât use more than two tubes per week
- Only apply it to areas affected by psoriasis
- Donât swallow or eat the medicine
Treatment Of Face And Flexures
In general, the use of calcipotriol ointment on face and flexures is not recommended due to irritancy. Nevertheless, most patients tolerate calcitriol or analogs on these sites. Calcitriol ointment was found to be better tolerated and more effective than calcipotriol ointment in the treatment of psoriasis in sensitive areas.
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Role Of Vitamin D In Skin Physiology
Vitamin D plays a vital role in the skin: the keratinocytes are not only a source of vitamin D, but also a responder to its active form . They are the only cells in the body that can synthesize vitamin D from its precursor 7-DHC, and which are equipped with the entire enzymatic machinery necessary to metabolize vitamin D into its active metabolite 1,252D. Keratinocytes also express VDR, thus they respond in an autocrine and paracrine manner to the active form of vitamin D. The entire pathway of vitamin D3 in human skin is shown in Figure 1.
Fig. 1
Summary of vitamin D3 pathway and functions in the human skin. Vitamin D3 is synthesized in the skin from its precursor 7-DHC under the influence of UVB and metabolized to its active form, 1,252D3 through 2 subsequent hydroxylation reactions by CYP27A1 and CYP27B1 enzymes. It is rendered inactive through the catabolic enzyme CYP24A1. 7-DHC, 7-dehydrocholesterol 25D3, 25-hydroxyvitamin D3 1,252D3, 1,25-dihydroxyvitamin D3 24,252D3, 24,25-dihydroxycholecalciferol 1,24,253D3, 1,24,25-trihydroxycholecalciferol CYP27A1, 25-hydroxylase CYP27B1, 1-hydroxylase CYP24A1, 24-hydroxylase AMP, antimicrobial peptide Ag, antigen UVB, ultraviolet radiation B.
Vitamins And Psoriatic Disease
There is no direct link between vitamins and dietary supplements and psoriatic disease. However, many with psoriatic disease find that including vitamins and supplements in their diet helps their skin clear and may ease joint pain.
Dietary supplements can be extracts or concentrates, and they can occur in many forms, such as tablets, capsules, softgels, gelcaps, liquids or powders.
The U.S. Food and Drug Administration does not regulate dietary supplements for safety or effectiveness. This can also lead to an inconsistency when it comes to active ingredients. Itâs important that you talk to your doctor before adding any vitamins or supplements to your treatment plan, as some may interfere with your medications.
Here are some of the more popular vitamins and supplements used to combat psoriatic disease.
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Bioavailability And Influence Of Processing And Cooking
The vitamin D, like other fat-soluble vitamins , is absorbed incorporated in mixed micelles from the intestine into the enterocytes by non-saturable passive diffusion. Subsequently, the vitamin D is transported in the chylomicrons via lymph to the circulation . The more polar metabolite 25D is absorbed better and faster than vitamin D because it is also taken up directly from the proximal jejunum into the portal vein . There are few data on its availability from natural sources. The absorption of vitamin D from supplements may differ depending on the used vehicle substance, such as oils, powders, ethanol . For example, it has been reported that the bioavailability of vitamin D from fortified hard cheese is equivalent to supplements and that vitamin D bioavailability is not influenced by the fat content of the fortified milk .