How Functional Medicine and Chinese Medicine Can Treat Psoriasis
Psoriasis is an extremely common inflammatory disease that affects 2-3% of the population, 60 million people worldwide, and can occur at any age, and at any site on the skin. And yet, it has little known about its etiology and is still considered incurable, despite years of research and various treatment options.
While psoriasis presents with red, itchy, dry skin plaques and lesions, could it be that our focus on this as primarily a skin disease has led us astray when it comes to understanding the correct approach to treatment?
As new research emerges it becomes increasingly clear that Psoriasis is not just a skin disease, but a disease that results from an interplay between the immune system, genetics, the environment, and the relationship between the intestinal barrier and the skin, called the gut-skin axis.
If you or someone you know suffers from Psoriasis, it’s likely that you may also experience other systemic diseases such as inflammatory bowel disease or celiac, or from metabolic disorders such as obesity, diabetes, or dyslipidemia. As the disease progresses, there is also an increased risk of stroke and heart attack. So a simple case of some lesions on the skin it is not!
As we understand more about how both the gut and the skin interact with each other and the immune and metabolic systems, we start to understand how multifactorial the development, and subsequent treatment of psoriasis must be.
In this article you will learn about the physiology behind psoriasis progression and how each person’s microbiome and concurrent symptoms will vary. This will give us important background information for understanding the various conventional Western Medicine treatments currently available, and why they have side effects or simply do not work for some psoriasis patients.
We will also discuss another promising option for treatment that takes into consideration each person’s unique presentation under the same umbrella diagnosis of psoriasis. Both functional medicine and Traditional Chinese Medicine use personalized testing or diagnostic measures to treat psoriasis in the context of the entire body, the underlying patterns, and each patient’s unique physical and emotional environmental influences and medical history. By the end of this article you will have a grasp on what is going on when you receive a psoriasis diagnosis as well as some concrete and promising next steps to get you on your way to treatment. Let’s get started!
Understanding Psoriasis, the immune system, and the gut-skin axis:
We now know that the gut and the immune system are of critical importance in the progression of psoriasis, but we aren’t totally clear on what kicks it all off in the first place. When we consider the outer, skin aspect of psoriasis we know that other than the presence of lesions and plaques, there is impaired function of the skin due to changes to the corneum hydration, increased water loss in the transepidermal layer, changes in elasticity, erythema index, temperature, and the pH.
All of these changes can lead to a degradation of the skin’s ability to do its job protecting thebody from pathogens and toxins that it encounters in the environment. This can certainly lead to responses in the immune system that affect the body systemically, especially in the other major immune-system player, the gut.
And indeed, we do find that patients with psoriasis exhibit a different bacterial composition in the gut microbiome when compared to healthy individuals without this skin disease. Psoriasis patients tend to have an abundance of certain bacteria that are linked to the development of the disease and also be lacking in other bacteria that are found in healthy guts.
So is it the case that psoriasis causes gut issues? Possibly!. But it could also be the other way around.
Diet, stress, medications and other environmental factors can disturb the delicate bacterial balance and create a disharmony of ‘good’ and ‘bad’ bacteria in the gut, known as dysbiosis. When this occurs, it disrupts the integrity of the gut lining and various gut metabolites can travel out of the gastrointestinal tract, through the blood, directly to the skin.
We already know this is a major factor when it comes to other inflammatory skin diseases such as acne. Psoriasis patients often present with comorbidities such as IBD, metabolic syndrome, colorectal cancer, arthritis, depression, non alcoholic fatty liver disease, cardiovascular disease and others that are also linked to gut dysbiosis.
What is clear is that both the gut and the skin (and their involvement in the immune and metabolic processes) are involved and affected.
What isn’t totally clear is which one was the original culprit, or if there is a consistent etiology across all psoriasis patients. Either way, understanding the interplay between these various systems not only explains the link in co-existing diseases and symptoms, but can give us options to explore for potential treatment protocols that will have a widespread effect on more than just the skin symptoms.
If you’re not interested in a little dive into the physiology of psoriasis, you can skip ahead to the next section on treatment. However! Understanding a little bit about what’s going on (promise it won’t be too jargony) will give a lot of insight into why certain treatments work, why some fail, and why there are recommendations at the end about how to proceed.
A few key observations on psoriasis patients:
- They tend to have less bacteria that produce short chain fatty acids (SCFAs) and less SCFAs themselves, especially those like butyrate and propionate that help in fermenting dietary fiber. SCFAs are known to be anti-inflammatory through the process of reducing the inflammatory cytokine production, like TH17. SCFAs reduce certain immune cell’s proliferation.
- TH17 (the inflammatory cytokine mentioned above), Interleukin (IL) 23, and tumor necrosis factor (TNF) alpha are all involved in the upregulation of psoriasis inflammation.
- These cytokines and chemokines and immune cells circulate systemically, not just in the skin, and so involve many tissues and organs. These, when activated and excessive, will create inflammation in multiple sites.
- Basically, the gut does indeed affect the skin through these measures, but inflammation in the dermis/skin also directly affects cells in the gut.
- Interestingly, when children were reported to have had skin infections early in life- viral, bacteria, or fungal- they were also significantly correlated with the development of psoriasis.
- Other issues that enhance the TH17 response (mentioned above) such as Candida albicans, also worsen existing psoriasis symptoms, along with other immune responses.
- There is also a major link between our metabolism and the immune responses of the body. Diets rich in inflammatory oils can alter the gut composition and exacerbate psoriasis symptoms.
To summarize the above points, it is clear that when someone has psoriasis they have less beneficial factors such as SCFAs, and they have more detrimental factors such as IL-23/TH17, TNF alpha, and other inflammatory communication molecules. The diet and our metabolism also play a role in the immune response, and the immune response can negatively affect the gut lining. As stated before, the gut and the skin are also directly connected, and they affect each other bidirectionally. So again, while we don’t really know which one was disturbed first, we know it all affects each other, and this gives us options for treatment.
What are the beneficial western approaches to Psoriasis Treatment and what are the shortcomings:
With the brief scientific overview we did above, some of the conventional western treatments will make sense in theory, and we will go over these. The main issue to keep in mind is that although there is a logical basis for the treatment approaches, many psoriasis patients have adverse side effects, or the treatments simply do not work for them.
This is because even though treatments are based on a relevant factor (such as inhibiting TNF since TNF is aggravating), they don’t take into consideration the unique manifestation of the various mechanisms at play, the patient’s personal medical history, and the individual environmental and dietary factors that contribute to their gut and skin microbiota.
One treatment that has gained a bit of popularity is to address the skin microbiome directly and alter it using transplantation and bacteriotherapy. So far these haven’t been extremely successful. This is likely because there are different microenvironments in the skin between sebaceous, dry and moist sites and the profile of microbiota isn’t consistent. It is also somewhat difficult to determine whether certain harmful microbes may be transferred along with a bacterial substitution, which could lead to more issues.
Another treatment is the IL-17 inhibitors which seem to have a beneficial effect on the epithelial barriers. However, the downside is that they tend to negatively affect the intestinal barrier leading to inflammation there. As we learned above, this can eventually lead to an exacerbation of skin diseases so it is not an ideal long term solution.
On the flipside, Anti-TNFa therapies for bowel diseases tend to lead to side effects such as mucosal and cutaneous lesions. As we learned earlier, disrupting the skin barrier may also then lead to further gut disruptions in turn, which eventually would go against the point of the original treatment intention, as well as the additional negative effects to the skin.
The positive side of all this is that when something does treat the gut or the skin, it also has the potential to benefit the other, depending on how the microbiota is altered. For instance, prebiotics and probiotics have had lots of research done in recent years and seem to have potential in restoring the bacterial balance in the gut as well as preventing dysbiosis.
While probiotics have not been studied with psoriasis as the main diagnosis of the research participants, our knowledge of the gut-skin axis allows us to infer that there may be a therapeutic use in this instance, and with less side effects. Fecal transplants may also be considered for the same reason.
There are some newer studies on using immunoglobulin (such as IgY) to benefit the gut microbiome without causing adverse side effects. More research needs to be done to determine the extent of the effects and how personalized this approach can be.
Other treatments such as methotrexate and infliximab have variable outcomes. This seems to be due to the gut’s ability to clear and metabolize the drugs which may prevent the therapeutic effect from taking place. The composition of each of our gut’s bacteria will change the response to drugs that we ingest.
To summarize what we’ve just looked at, there are several treatment options in conventional medicine but many of them are either based on a general theory or a partial mechanism of the disease and are not personalized to suit the individual’s microbiome, often leading to ineffectiveness or negative side effects, or simply temporary symptomatic relief rather than root cause cure.
Conventional medicine tends to use protocols based on general diagnosis, but it is really important that multifactorial diseases such as psoriasis are taken on a case by case basis. There is no single drug that is going to be successful for everyone.
So what can you do if you have psoriasis and the conventional treatments aren’t working for you?
The Functional Medicine and Chinese Medicine Approach
Functional Medicine and Chinese Medicine are two completely different systems, developed from different theories, using different substances and treatment protocols to address diagnoses. However, there are some similarities between these two medicines that make them compelling options for treating a complex disease such as psoriasis, whether they are used on their own or in combination.
- Both medicines use diagnostic methods that are personalized to each patient based on testing, observation and pattern differentiation rather than a few symptoms that qualify them for a generalized diagnosis.
- Treatment is tailored to the individual and is not purely symptom based
- The protocol is not based on the single western diagnosis of Psoriasis but rather all underlying patterns/the root cause, as well as alleviation of symptoms, ideally without causing side effects.
- The goal is not to allow patients to temporarily feel better, but to deeply heal in such a way that the body is able to clear the disease and maintain real and lasting change and overall better health (rather than simply a lack of disease).
If you work with a functional medicine or Chinese medicine practitioner for your psoriasis, it is likely that they will do specific testing or other diagnostic measures to determine which systems are out of balance and where the symptoms are coming from.
Treatment will not be only a prescription for a medication but rather a multi-faceted plan that considers all aspects of your life including anything that influences you physically and emotionally. You will likely be advised on beneficial changes to make with the foods you eat and cooking methods as well as any number of lifestyle changes you can make such as exercise, time outside, how to engage with stressors, sleep hygiene, and interpersonal relationships. Even your greatest hopes and dreams for your life will come into play as those are ultimately involved in a life in which you are healthy and thriving and psoriasis-free.
In Functional Medicine you will also likely be prescribed some supplements once you are able to digest them, or potentially enzymes or other botanicals if they are relevant to your test results.
In Chinese Medicine a similar approach will be taken using herbal formulas that are not single ingredients that address individual symptoms but rather a complex synergy of herbs that are combined to balance the whole system and correct pathological patterns while also accounting for potential side effects of certain herbs by balancing them with others. Ideally the side effects would be very low or non-existent when the right diagnosis is made and the appropriate treatment is given. It may take longer to see Psoriasis symptoms disappear using these approaches (but not necessarily!) because you are not just masking the manifestations of the disease or dampening them down.
When a disease has become chronic it may take some time to get to the very bottom of it and will involve participation on the side of the patient as they will effectively be changing their life as they heal. That said, when the right treatment is found for the individual, relief can come quite quickly, and is more likely to last after the treatment is completed.
As an example, when a chinese formula (shen ling bai zhu san) was studied for its use in treating psoriasis, it was found that the herbs worked together to modulate the gut microbiota, lipid metabolism and the immune system. Considering everything we’ve just learned this is probably no surprise to you at all. But before reading this article, it may have seemed unrelated that a formula that is successful in treating a specific skin condition would have a primary mechanism in the digestive system and immune response. But it all makes sense!
So if you are experiencing Psoriasis symptoms and you have tried conventional approaches with unsatisfactory results, or you’re just looking for a different option, the best move is to book in for a one-on-one consultation with a practitioner and get your testing and diagnostics done personally for you and your individual presentation. You are now equipped with a greater understanding of the incredibly complex nature of Psoriasis, but also with a pathway to find relief and resolution. Get started today
Dr. Jenny Bisset
Founder of The Bisset Method
JB Wellness
Chinese + Functional Medicine
Sources:
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