Skin Trouble: Is it eczema or psoriasis?

Q: I have bad psoriasis but don’t want to take prescription medication.  What else can I do to clear up my skin?  Thank you!
Julia M, Florida
A: Hi, I’m going to talk first about the difference between eczema and psoriasis, because sometimes patients get those mixed up.  Eczema is an adjective – not a diagnosis.  Eczematous skin is red, flaky, often itchy – in general, skin that’s irritated.  The diagnosis is “atopic dermatitis.”  What that means is skin reacting to some kind of offending substance.  “Derm” is the root word for skin, in Greek, and “itis” means inflammation.  The “atopic” part refers to an inappropriate immune response.
The challenge with almost all skin concerns is to find out what creates irritation to the skin, and then avoid the offending substance.
 The vast majority of skin complaints are not cancer, and not life threatening.  But they can be severely compromising.
If you have eczema, or atopic dermatitis, you have a sensitive immune system and you’ll have to manage this condition life long.  Drugs are not the answer, because they suppress the natural urge to engage the immune system and heal the “lesion” caused by the offending substance.  And almost all drugs have side effects, which can sometimes be worse than the disease itself.  Drugs are hardly ever the best approach to chronic, not life-threatening problems.  The answer is to identify, and remove as best as possible, the irritants.
The first order of business with eczema (or any skin condition) is to closely examine your diet.  The “big 9” of food irritants are: wheat, dairy, soy, corn, eggs, caffeine, tomatoes, peanuts and shellfish.  Often eliminating these foods completely (elimination diet) for 2 (minimum) to 6 weeks will clear up your skin beautifully.  If you can work with someone experienced with liquid fasting, a short liquid diet (I like the Master Cleanse) for 3-10 days can help your body shed a backlog of stored “toxins.”  Before reacting too strongly to the word “toxin” please consider the world we live in today.  There are hundreds of thousands more chemicals in our water, air and food supply than 100 years ago.  All of us, no matter how conscientious, have consumed food and drink that has touched plastic.  We all have breathed in fake perfumes and chemical-laden cleaning products or spent time in a smoggy city.  The “toxic” burden of everyday life is at an all-time high despite relentless efforts by environmentalists.  Our oceans have been used as a sewer for several hundred years and this situation is unlikely to be reversed.  Humans have never before lived with the current levels of man-made compounds, which our bodies are incapable of processing.  So if you are serious about protecting your health, you will engage in every way possible to offset the pollution that is unavoidable.  Don’t drink liquid that comes out of plastic.  Just start there.  It may take a year to really, completely take on that imperative.  It would be worth it.  Don’t eat food that is highly processed, made with GMO ingredients, or has been stored in plastic.  Whew!  That’s a tall order.  Do your best.  And your health will improve.  Often atopic people (react to the environment readily) are slow detoxifiers and are helped by eating vegetables high in sulfur, like the cruciferous veggies cauliflower, broccoli, kale, boy choy and Brussels sprouts (which are delicious baked).  These folks will also likely react to nickel and so should avoid wearing cheap jewelry.
Julia says she has psoriasis.  That is a deeper problem than atopic dermatitis, because it’s actually a type of auto-immune disease in which surface skin cells turn over with excessive rapidity.  Usually it takes skin cells about 3 weeks to move from the “basement membrane” (lower level of the epidermis) to the surface.  With psoriasis, this turn-over happens in 2-3 days.  Therefore a lot of skin cells build up and create the characteristic silvery scales on elbows, knees, scalp and groin.  Sometimes the nail bed is involved, creating yellow discoloration and thick, pitting nails.  Sometimes the psoriatic patches are scattered all over the body.  Sometimes the joints are affected too (psoriatic arthritis).  All forms of psoriasis tend to worsen with alcohol consumption, smoking tobacco, eating lots of animal fat and protein (red meat), and with lack of Vitamins A, D (especially important), E,  Zinc, Selenium.  These nutritional deficiencies are caused by “leaky gut” or other types of irritable bowel syndrome (IBS).  Psoriasis is typically worsened by stress, constipation and poor digestion.  Some common drugs worsen psoriasis: non-steroidal anti-inflammatories like Aleve and Ibuprofen, antimalarial medicines, ACE inhibitors, beta blockers, Lithium and withdrawing from steroids.
In general, the first order of business with any skin complaint is to check the diet.  Anything that goes into the mouth should be optimally digested, and assimilated, without the help of the immune system.  However, very often, we put things into our mouths that the digestive system rejects, requiring an engagement of the immune system to promote clearance, or detoxification, of the offending substance.
If eliminating the “top 9” list of allergens for a month or 2 does not significantly improve your skin, try a few days of water only or fresh juice only fasting to see if your skin starts to clear.  Sometimes this is miraculously helpful.  Fish oil is one of the most important nutrients for the skin.  My favorite is a cold-pressed wild Alaska salmon product available at Costco, Sam’s and Trader Joe’s.  Because Pure Alaska Omega (brand name) wild salmon oil is so minimally refined, the absorption is far superior to any other fish oil I’ve found on the market currently.
As well as being a skin emollient that works from the inside out, fish oil (the Omega 3 content) is a potent anti-inflammatory.  Most itchy, flaky skin complaints are at least in part due to irritated, inflamed skin cells.  An easy way to promote a natural anti-inflammatory effect is with tasty kitchen herbs, especially turmeric, ginger, cumin, anise, fennel, basil, rosemary, garlic and thyme.  All these tasty seasonings can block the inflammatory white blood cells (cytokines) responsible for psoriasis and other skin afflictions.  New research connects a high salt diet (especially when folks frequently choose canned foods or eat “fast foods”) with many auto-immune diseases, including psoriasis.  The February 2013 issue of Nature reports on a study of 100 healthy people.  The researchers noticed that when  people in the study visited fast food restaurants more than once a week, they saw a marked increase in levels of destructive inflammatory cells, which the immune system produces to respond to injury or foreign invaders, but which attach healthy tissues in autoimmune diseases.  This may lead to a treatment option, speculates the researchers, which involves manipulating the specific reactive cell (T helper 17, or Th17 cell).  As a naturopathic physician, I would recommend not waiting for a drug that can manipulate Th17, but to start today avoiding offending substances to your particular immune system that inappropriately triggers cell reactivity.
Many patients with psoriasis are low in B vitamins, including folic acid.  This can be confirmed with a blood test measuring Homocysteine, a break-down by-product of the amino acid Cysteine, which requires the B vitamin family for processing.  High homocysteine (above 7) suggests folic deficiency or malabsorption, and also confers an increased risk of cardiovascular disease. Another test, methylmalonic acid, if high, confirms B12 deficiency.  Ask your doctor about this.  Blood levels of B12 and folic acid are inadequate for measuring tissue stores.
Also check your Vitamin D3 blood level, which should be 60-90 ng/mL.  Oral doses up to 8000 IUs daily are safe, and this level of supplementation may be required for up to a year to bring your levels up.  Typically skin problems (as well as mood, joint and of course bone loss issues) improve with optimal Vitamin D3 levels.  Don’t take Vitamin D2, which has been produced as a drug — it’s way more expensive and doesn’t work nearly as well for most people.

Be aware that some natural products can aggravate psoriasis, and should be avoided: echinacea, inula, burdock, biotin, ginseng and for some doses of Vit C higher than 500 mg daily.


Finally, as with most diseases, stress management is critical.  Try to get exercise and fresh air daily.  Get counseling if you are having trouble changing bad habits.  Connect — don’t isolate.