Psoriasis is a skin disorder in which your skin cells reproduce too quickly, leading to scaly skin, rashes, or blisters. With plaque psoriasis (the most common form), red, flaky patches rise on the scalp, face, knees, elbows, lower back—anywhere on the body, really. Other types present differently. Inverse psoriasis, for example, appears as smooth red blotches mostly in skin folds, while the relatively rare erythrodermic psoriasis causes skin peeling on large areas of the body. Psoriasis can also affect fingernails and toenails.
Not only is psoriasis often itchy or painful, it can take a serious emotional toll. Patients report feeling embarrassed or stigmatized because of their skin’s appearance. Although there are a number of pharmaceutical, over-the-counter, and natural treatments available, there is no cure for psoriasis. The goal of treatment is to manage symptoms and put it into remission, but flare-ups can (and for many people do) occur regularly.
For folks living with psoriasis, it can be hard to find relief. Some aspects of a Primal lifestyle may be able to help.
What Causes Psoriasis
Scientists believe that psoriasis is caused by a combination of genetic predisposition and environmental triggers. But despite its prevalence—about 3 percent of U.S. adults have psoriasis1—it’s still somewhat inscrutable.
Psoriasis is often confused with eczema, even by people making the diagnosis. Your doctor may opt for a skin biopsy to be sure. Both can present as dry, itchy, inflamed skin. And both may be triggered by stress, skin injuries, and cold, dry environments. However, they have different causes (only somewhat understood). With eczema, skin is overly sensitive due to dysregulation in the immune system, but skin cells do not turn over rapidly as with psoriasis. And whereas eczema is more common in kids, psoriasis is more common in adults.
Most experts agree that psoriasis is an autoimmune disorder. Skin issues are the outward manifestation of the disease, but under the surface lurks chronic, systemic inflammation. People with psoriasis are at greater risk for other chronic health conditions like metabolic syndrome, cardiovascular disease, Crohn’s disease, diabetes, depression, and kidney and liver diseases.23 Around one in three people with psoriasis also develop a related condition called psoriatic arthritis. The worse your psoriasis, the greater the risk of developing these comorbidities.
However, experts are unsure whether psoriasis causes inflammation, in turn leading to other problems. Another possibility is that some common factor leads to systemic inflammation which causes both psoriasis and other disorders to develop concurrently. Either way, strategies aimed at mitigating inflammation, like some of the ones I’ll mention today, are a must for psoriasis sufferers.
How to Treat Psoriasis
There are several pharmaceutical options available. Whether or not you decide to go down that route is a decision you have to make with your doctor. Some of these drugs may reduce the risk of cardiovascular disease and other serious comorbidities. But like all drugs, they also have side effects. Some common psoriasis medications (acitretin, methotrexate, tazarotene) are not safe during pregnancy. The American Academy of Dermatologists advises people who are planning to become pregnant to avoid these medications (men should also avoid methotrexate when trying to conceive).
Whatever you decide, I know a lot of my readers will also be interested in exploring nutrition, supplementation, and other behavioral options to augment their treatment. Psoriasis is notoriously stubborn. Even when someone is in remission, stress, illness, injury, certain medications, cold weather, and smoking or drinking alcohol can trigger a flare-up. It’s wise, therefore, to seek a multi-pronged approach aimed at tackling the rashes (outside) and managing inflammation (inside).
Treating psoriasis with diet interventions
Eating a diet low in foods that cause inflammation and gut issues should be a top priority for psoriasis patients. First and foremost, I’d strongly suggest that anyone with psoriasis eliminate gluten. Celiac disease is three times more prevalent among psoriasis patients than in the general population.4 Mon-celiac gluten sensitivity probably is much more common as well. Of course, I don’t think anyone needs to be eating grains, but avoidance is an especially good idea for folks with autoimmune illness.
Beyond that, you might consider trying an elimination and reintroduction diet like an autoimmune protocol, or AIP. AIP is no fun, but it might be worth it, especially if your psoriasis is poorly managed currently. Just don’t skip the reintroduction part. The idea isn’t to strictly limit your food choices forever but to identify trigger foods so you have more control over flare-ups.
And seriously moderating or avoiding alcohol is a no-brainer, both because it can intensify symptoms and due to the increased risk of liver disease.5
Supplements to try
Supplementing with fish oil, selenium, and vitamins D and B12 may help, although some people don’t notice any particular benefit.6 (B12 and D, along with vitamin A, might also be useful when applied topically.7)
There is also a lot of interest in curcumin, a compound found in turmeric. A number of small trials have yielded some success, but it’s still early. A recent meta-analysis concluded that the available data do not support using curcumin topically, but taking it as an oral supplement shows promise.8
As I’ve mentioned, stress leads to psoriasis flare-ups.9 Therefore, it’s worthwhile to moderate stress however you can manage.
Meditation and guided imagery seem to work.10 Treat yourself to a relaxing Epsom salt or oatmeal bath, then apply some of the topical treatments below.
A variety of different phototherapy options are available to treat psoriasis. The best one for you depends on the type of psoriasis you have and how severe it is. Your doctor might opt for narrowband or broadband UVB, UVA, pulsed dye laser, LED, red light therapy, or something else based on your case.11
Nature’s original phototherapy—akasunlight—can also be an effective tool. Some psoriasis meds make you more photosensitive, though, so be aware.
Your doctor might recommend creams with salicylic acid, zinc pyrithione, or coal tar. Some folks are wary of the latter due to possible carcinogenic effects. Human studies suggest coal tar is safe when applied topically in creams or shampoos, and the FDA has deemed it so. Go with your comfort level here.
If you’re interested in a more natural route, try aloe vera, apple cider vinegar (diluted 1:1 with water), tea tree oil, or mahonia (Oregon grape) cream.12
The Bottom Line
Psoriasis is an autoimmune condition where your skin cells turn over too quickly, causing red, flaky, itchy, painful rashes. You can’t cure it, but you can get symptom relief. I’ve received quite a few Success Stories over the years from readers whose psoriasis went into remission after they started following the Primal Blueprint. I chalk that up primarily to removing pro-inflammatory foods, but sun exposure and stress management surely help too.
Even with your best efforts, psoriasis flares are likely to come and go throughout your life. The best thing you can do is experiment. Find the combination of treatments that your skin responds to best to so you’re prepared next time.
Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.