Dr. Tsilimidos Gerasimos MD, PhD 
Metabolomic Medicine

Psoriasis is a chronic, inflammatory dermatopathy, autoimmune condition, mainly due to immune system disorder. Hereditary (genetic) factors seem to be involved in the appearance of psoriasis, but this is not always necessary.

Equally men and women are affected (about 2% of the general population).
Typically, the age of onset of the disease is between 20-35 years, but the disease can occur at any age.

The most common form of psoriasis is multiple sclerosis (common), which affects 80% of patients with psoriasis. The most frequent localizations of the rash include the elbows, scalp and knees, while the most common symptoms are scarring and pruritus, while stress is the main cause of worsening of the disease.

Other forms are pustular, dandruff, erythrodermal, etc.

It may be accompanied by other systemic diseases such as:

• Obesity and metabolic syndrome - a study in Korea in approximately 420,000 obese patients revealed 11,054 cases of psoriasis in a follow-up period of 8.5 years. Significant findings are the characteristics of people with psoriasis who were predominantly male, elderly and smokers. They also had more elevated blood pressure, blood glucose and hypertriglyceridemia values ​​compared to obese people without psoriasis.
• Psoriatic arthritis is a distinct form characterized by the coexistence of clinical manifestations of arthritis and occurs in up to 25% of patients with psoriasis. It causes inflammation in the joints with more frequent localization on the wrists, knees, ankles and neck. It usually affects the tips of the fingers of the hands and legs and may also affect the spine.

Elevating factors that can trigger or exacerbate psoriasis are:

• Infection (Streptococcal)
• Drug-co-administration (antidepressants, b-blockers, etc.)
• Wound
• Hormonal factors
• Stress
• Alcohol / smoking

Metabolic factors related to psoriasis
Psoriasis has been associated with insulin resistance. According to a study by the University of Copenhagen's Dermatology Clinic, patients with psoriasis have an increased risk of developing type 2 diabetes. Insulin resistance causes chronic inflammation that favors the occurrence of both psoriasis and other autoimmune conditions. People suffering from psoriasis have a significantly increased predisposition to develop insulin resistance and then diabetes.

Psoriasis also relates to lack and resistance to vitamin D. Studies have highlighted the importance of vitamin D3 in the treatment of psoriasis. Administration at high doses of up to 35,000 IU for several months reduced the symptoms of patients with psoriasis to an impressive extent.

Clinical manifestations of psoriasis

It usually appears as a red layer of skin covered with white stains. Some forms of psoriasis are characterized by the formation of vesicles (pustular psoriasis), or by total inflammation and redness of the skin (erythrodermic psoriasis), or by inflammation of the joints, in combination with psoriatic lesions (psoriatic arthritis).

Psoriasis can also cause itching and burning sensation.

Diagnosis of psoriasis

Most of the cases are diagnosed during the clinical examination of the skin affected by the disease, as psoriatic lesions are characteristic of their morphology and their localization. However, if the disease develops, or changes to another form, or is accompanied by other conditions, a biopsy (biopsy) of the affected skin (biopsy) is required. In psoriatic arthritis radiographic imaging is also very useful.

The psychological burden of the patient due to psoriasis is often greater than the clinical picture.

Psoriasis affects the appearance of the body as well as the patient's sociality because the patients themselves and the environment (relatives, friends, labor) may not know that psoriasis is not contagious. Therefore, it can be an obstacle to sports, fun and social activities, and generally creates problems of anxiety disorder and low self-esteem.

Psoriasis may also coexist with other diseases such as:

• Type 2 diabetes mellitus
• Cardiovascular diseases
• Idiopathic inflammatory bowel diseases (Crohn, ulcerative colitis)
• Chronic kidney disease, etc.

The essential solution is to restore the normal functioning of the body and to manage the causes of the problem.

How to deal

To address pathological conditions related to psoriasis it is necessary to identify factors by conducting metabolic examinations, which allows us to help with accurate interventions in lifestyle and nutrition in order for the organism to return to its normal functioning.

Metabolomic Analysis^® test conducted in our clinics identifies early disorders of the body as well as the different factors of psoriasis, due to endogenous (DNA) and exogenous factors (diet, exercise, stress), accurately capturing the body's deficiencies, helping individualized etiology and prevention. According to Harvard Medical School, metabolomic analyses are the most accurate method of assessing the health of a person.

It is a modern tool of Precision Medicine that detects very small molecules that take part in the chemical reactions of the cells of the body and provides accurate data for the treatment and prevention of diseases such as psoriasis, psoriatic arthritis and other autoimmune diseases.

Factors concerning:

• the toxic burden on the body
• the antioxidant capacity of the body
• deficiencies in minerals, amino acids, vitamins and omega 3 fatty acids
• the metabolism of proteins, carbohydrates, lipids
• the intestinal microbe
• the state of the gut flora
• gastrointestinal inflammation
• the body's ability to produce energy (mitochondrial function)
• the functioning of the nervous system, and
• in addition to the stressors behind the condition, often overlooked when managing the disease.

Almost all psoriasis is accompanied by intense changes in mood that replenish and exacerbate the disease.

Examination Results & Treatment

The usual treatment includes topical ointment treatments, the use of phototherapy treatments or medication (oral or injectable) as a systemic therapy to relieve symptoms.

The main objective of treating psoriasis is to restore the metabolic balance and the affected cellular structures of the skin. This is achieved through precise nutritional interventions, lifestyle changes, stress management and nutritional deficiencies. Correcting body deficiencies in vitamins and other elements, restoring metabolism and regulating insulin resistance at normal levels change the course of the disease and improve the quality of life of patients.

The treatment for the restoration of normal body function and the treatment of psoriasis is formulated according to the deficiencies, dysfunctions, imbalances and needs of the organism identified by Metabolomic Analysis^®. It includes, along with symptomatic treatment, the administration of special supplements, vitamins, trace elements, amino acids and customized nutritional plan.

The gradual recovery of the above factors brings about a steady improvement in the normal functioning of the body rather than a gradual deterioration because the body is genetically programmed to be healthy.

To Your Health!

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References:

• Psoriasis, vitamin D and the importance of the cutaneous barrier’s integrity: An update. Carlo Mattozzi, Giovanni Paolino, Antonio Giovanni Richetta, Stefano CalvieriJ Dermatol. 2016 May;43(5):507-14. doi: 10.1111/1346-8138.13305. Epub 2016 Mar 12.
• Patients with psoriasis are insulin resistant. Gyldenløve M1, Storgaard H2, Holst JJ3, Vilsbøll T2, Knop FK4, Skov L5. J Am Acad Dermatol. 2015 Apr;72(4):599-605. doi: 10.1016/j.jaad.2015.01.004. Epub 2015 Feb 1.
• An update on psoriasis and metabolic syndrome: A meta-analysis of observational studies. Sanminder Singh, Paulina Young, April W. Armstrong; Published: July 18, 2017. https://doi.org/10.1371/journal.pone.0181039
• Psoriasis and insulin resistance: a review. Rhea Fitzgerald, Muriel Sadlier, Maureen Connolly and Anne Marie Tobin, Ireland. Christopher T. Ritchlin, M.D., M.P.H., Robert A. Colbert, M.D., Ph.D., and Dafna D. Gladman, M.D. N Engl J Med 2017; 376:957-970March 9, 2017DOI: 10.1056/NEJMra1505557
• Psoralen and ultraviolet a light therapy for psoriasis. Robert S. Stern, M.D. N Engl J Med 2007; 357:682-690August 16, 2007 DOI: 10.1056/NEJMct072317
• Treatment of Psoriasis. Review. Malcolm W. Greaves, M.D., Ph.D., and Gerald D. Weinstein, M.D. N Engl J Med 1995; 332:581-589March 2, 1995 DOI: 10.1056/NEJM199503023320907
• Vitamin D and the Skin: An Update for Dermatologists. Kechichian E1,2, Ezzedine K3,4. Am J Clin Dermatol. 2017 Oct 9. doi: 10.1007/s40257-017-0323-8. PubMED