Psoriasis: the most effective dietary supplements

Psoriasis is a chronic inflammatory disease affecting approximately 2 to 3% of the world’s population. It presents as erythematous, scaly plaques that are often uncomfortable and cosmetically bothersome. Although not contagious, it can significantly impair patients' quality of life. It is generally diagnosed between ages 15 and 35, but it can occur at any age.

Pathophysiology of psoriasis

Psoriasis results from a complex dysregulation of the immune system, placing this condition among autoimmune diseases. The central element of this pathology is hyperproliferation of keratinocytes due to abnormal activation of T lymphocytes. The latter, under the influence 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, which migrate to the skin surface in only 7 days, compared with 28 days under normal conditions. This leads to an accumulation of immature keratinocytes, forming the characteristic thick plaques. Furthermore, infiltration of the dermis and epidermis by T lymphocytes and neutrophils worsens the inflammation, promoting the formation of microabscesses in the stratum corneum.

Symptoms and clinical presentation

The manifestations of psoriasis vary according to type and lesion severity: • Plaque psoriasis: This is the most common form, characterized by well-demarcated red plaques covered with silvery scales. These lesions mainly 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 pustules filled with sterile pus, localized on the hands and feet or generalized. • Inverse psoriasis: Red, smooth plaques appearing in skin folds such as the armpits or under the breasts. • Nail psoriasis: Nail involvement, with pitting, discoloration or nail detachment. Lesions occur in flares alternating with periods of remission. Depending on the extent and impact of the lesions, psoriasis is classified as mild, moderate or severe, the latter affecting more than 10% of the body surface area.

Risk factors and triggers

Although 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 consumption and smoking worsen the disease and complicate its treatment. • Nutritional deficiencies: A deficiency in folate or vitamin B12 can exacerbate symptoms. • Sun exposure: While it is beneficial for the majority of patients, a minority may experience worsening of their symptoms due to UV exposure.

Diagnosis and complications

The diagnosis of psoriasis is mainly based on clinical examination. Characteristic signs such as the candle sign (scaling after scratching), the bleeding dew (appearance of drops of blood after scratching) and the Koebner phenomenon (appearance of lesions at sites of skin trauma) are often sufficient to make the diagnosis. In some cases, a skin biopsy may be necessary to confirm the diagnosis and rule out other dermatological diseases. Complications include: • Psoriatic arthritis: An inflammatory joint involvement that affects up to 30% of patients. • Metabolic comorbidities: An increased risk of cardiovascular disease, type 2 diabetes and obesity. • Psychological impact: Because of its visibility, psoriasis can lead to emotional distress, lowered self-esteem and reduced quality of life.

Treatments available

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