Psoriasis: Much More Than a Skin Disease — The Connection to the Immune System, the Gut, and Lifestyle

We are used to thinking of our skin as an external envelope.

Something we cleanse, nourish, provide moisture, and try to keep its healthy appearance.

But sometimes the skin tells us about processes occurring much deeper in the body.

Psoriasis is an especially interesting example.

From the outside it can look like red areas covered with white-silvery scales, mainly on the elbows, knees, scalp, and sometimes also in other areas of the body.

But psoriasis is not just a problem of dryness or skin cell accumulation.

It is a chronic inflammatory disease mediated by the immune system, and its effects may be broader than what we see on the skin surface.

In recent years researchers are also interested in the connection between psoriasis and the digestive system, the gut microbiome, nutrition, and metabolic processes.

So what really causes psoriasis? Is there a connection between gut health and skin flares? And what can be done to support the skin alongside suitable medical treatment?

What exactly is psoriasis?

Psoriasis is a chronic inflammatory disease appearing when the immune system activates inflammatory pathways affecting the skin cells.

One of its most common forms is called Plaque Psoriasis.

It manifests in thickened, defined plaques, often covered with scales.

On light skin the plaques can look pink or red, while on darker skin they may look purplish, brown, or darker than the surrounding skin.

Sometimes itching, burning, pain, and cracks in the skin also appear.

It is important to know that psoriasis is not a contagious disease.

It cannot be caught from touch, from using the same towel, or from being near a person suffering from it.

And it is definitely not caused by poor hygiene.

What happens inside the skin during a flare?

In healthy skin, epidermis cells are created in the deeper layers and gradually move to the surface.

The whole process usually lasts several weeks.

In psoriasis, inflammatory activity causes significant acceleration in the proliferation and maturation of skin cells.

As a result, cells accumulate on the surface and the scales characteristic of the disease are created.

But the rapid proliferation of cells is only part of the picture.

Behind the process is complex activity of the immune system.

Immune cells, including T cells, participate in creating inflammatory signals affecting the skin cells.

Among the important molecules in the process are IL-17, IL-23, and TNF-alpha.

These molecules are called cytokines — proteins serving to transmit messages between cells in the immune system.

When certain pathways operate in an unbalanced manner, they can contribute to the formation of inflammation and the changes in the skin.

This understanding greatly changed the treatment of psoriasis.

Instead of focusing only on removing the scales, modern medicine can, in suitable cases, also treat the inflammatory pathways driving the disease.

Why is psoriasis considered a systemic disease?

In the past psoriasis was mainly regarded as a skin disease.

Today we know that in some people it is also connected to additional health conditions.

One of them is Psoriatic Arthritis.

This is an inflammatory disease that can cause pain, swelling, and stiffness in the joints, and sometimes also affect tendons and their attachment areas to bones.

Not everyone suffering from psoriasis will develop arthritis, but it is important to know the possibility.

In addition, psoriasis, especially when more severe, is connected to a higher prevalence of obesity, metabolic syndrome, type 2 diabetes, and cardiovascular diseases.

Connections to a higher prevalence of depression and anxiety were also found.

It is important to emphasize that not all these connections prove that psoriasis itself directly causes the other diseases.

Sometimes it is a matter of shared risk factors and inflammatory mechanisms overlapping between the conditions.

But the meaning is clear: when treating psoriasis, it is worth addressing general health and not only the appearance of the skin.

The connection between psoriasis and the digestive system

One of the most intriguing fields in research is the connection between the gut and the skin.

The concept Gut–Skin Axis describes the possible interactions between the digestive system, the microbiome, the immune system, and the skin.

Trillions of microorganisms live in our digestive system.

This population, called the gut microbiome, participates in breaking down food components, producing various substances, and regulating immune activity.

Because psoriasis is a disease mediated by the immune system, researchers are trying to understand whether changes in the gut microbiome are also connected to disease activity in the skin.

In certain studies differences were found in the composition of gut bacteria between people with psoriasis and people without the disease.

But here it is important to me to be precise.

A difference in the composition of gut bacteria does not prove the microbiome is the cause of psoriasis.

It is possible that some of the changes are connected to the inflammation itself, nutrition, medications, or other factors.

As of today, there is no routine microbiome test allowing diagnosis of the cause of psoriasis or choosing a proven treatment through it.

Research is advancing, but it is still early to determine that psoriasis begins in the gut.

What is the connection between psoriasis and inflammatory bowel diseases?

Here the connection is more established.

Studies found that people with psoriasis are at increased risk of certain inflammatory bowel diseases, including Crohn's disease and ulcerative colitis.

Among people with inflammatory bowel diseases, a higher prevalence of psoriasis was also found.

One of the possible reasons is overlap between genetic and immune mechanisms.

Certain inflammatory pathways, including the IL-23 pathway, participate in processes connected to both groups of diseases.

However, it is important to remember these are different diseases, and their treatments are not always identical.

In fact, certain medications affecting IL-17 and suited to psoriasis may worsen inflammatory bowel disease in some patients.

Therefore it is very important that the dermatologist also know other medical problems, especially if symptoms exist in the digestive system.

If you suffer from chronic diarrhea, persistent abdominal pain, blood in the stool, or unexplained weight loss, it is worth seeking medical evaluation and not assuming it is only food sensitivity.

Is psoriasis connected to "leaky gut"?

In recent years the expression "leaky gut" became very common on social networks.

Medically, there is a phenomenon called increased intestinal permeability.

The meaning is changes in the function of the barrier separating the gut content from the tissues around it.

Researchers are examining whether in some people with psoriasis there are changes in gut permeability, and whether they are connected to inflammatory processes.

In some of the studies interesting findings were found, but the picture is still not unequivocal.

There is currently no proof that increased gut permeability is the central cause of psoriasis, or that a treatment called "sealing the gut" can cure the disease.

Therefore it is worth being careful about detox programs, unbased tests, and supplements promising to cure psoriasis through repairing the gut.

Our body is much more complex than one simple explanation.

Can nutrition affect psoriasis?

This is one of the most important questions in my eyes.

We know nutrition affects metabolic health, body weight, and various risk factors connected to inflammation.

But can it also affect the severity of psoriasis?

The answer is that in some cases, yes.

However, there is currently no single diet proven to cure psoriasis.

The effect of nutrition varies between people, and the evidence is stronger regarding some interventions than others.

Mediterranean diet: can it help?

A Mediterranean diet is based mainly on vegetables, fruits, legumes, whole grains, olive oil, nuts, and fish.

This is an eating pattern researched extensively in the context of cardiovascular health.

Observational studies found a connection between higher adherence to a Mediterranean diet and lower psoriasis severity in some populations.

But such a connection does not prove the diet alone reduces disease activity.

It is possible that body weight, physical activity level, and other lifestyle habits also affect the results.

And nevertheless, a Mediterranean diet is a good choice for general health, especially because people with psoriasis may be at increased risk of certain metabolic factors.

I believe this is a much more balanced approach than sweeping avoidance of entire food groups without a medical reason.

And what about gluten?

Some women tell that their psoriasis improved after they stopped eating gluten.

Is there a scientific basis for this?

In some people with psoriasis a higher prevalence of markers connected to celiac or immune sensitivity to gluten was found.

Small studies found that in certain groups, especially in people with certain antibodies, a gluten-free diet may be connected to improvement in the skin condition.

But the evidence is still limited.

There is no sweeping recommendation for everyone suffering from psoriasis to stop consuming gluten.

If celiac is suspected, it is important to perform medical evaluation before stopping eating gluten, because early avoidance of it may affect the test results.

If there is no celiac or other medical reason, it has not been proven that a gluten-free diet will benefit everyone suffering from psoriasis.

Body weight and the connection to inflammation

This is an important subject, and precisely here there is more significant evidence.

Our fat tissue is not only an energy reservoir.

It is also a hormonally and immunologically active tissue.

Fat cells and additional cells located in the tissue can produce substances participating in regulating inflammatory processes.

Obesity is connected to increased risk of psoriasis and higher disease severity in some people.

In addition, excess weight may affect the response to some treatments.

Studies showed that in people with excess weight or obesity, weight loss can improve psoriasis severity and sometimes also the response to treatment.

But it is important to me to emphasize that not everyone suffering from psoriasis suffers from excess weight.

And thin women can also develop significant disease.

The approach to weight should be medical and personal, and not a matter of criticism of body appearance.

Is there a connection between vitamin D and psoriasis?

Vitamin D participates in various processes in the body, including regulating the activity of the immune system.

Some studies found lower vitamin D levels in people with psoriasis.

But the connection is complex.

Low vitamin D levels can be affected by many factors, including body weight, sun exposure, nutrition, and general health condition.

It has not been proven that oral vitamin D supplements consistently improve psoriasis in all patients.

Therefore there is no reason to take high doses of vitamin D just to treat psoriasis.

If deficiency is suspected, you can consult a doctor regarding the need for testing and suitable supplementation.

It is interesting to know that there are also topical preparations for treating psoriasis based on vitamin D analogs, like calcipotriene.

But these are medications acting locally in the skin, and their effectiveness does not imply that taking vitamin D supplements will bring the same result.

Which factors can trigger a flare?

Psoriasis is a disease sometimes characterized by periods of improvement and flares.

In some people, factors preceding worsening can be identified.

Psychological stress

Stress can affect nervous and immune systems, and it is considered one of the possible factors for worsening psoriasis.

But it is not the only cause of the disease, and it is not correct to say a person is ill with psoriasis because they are stressed.

Infections

Certain infections, especially streptococcal throat infection, can be connected to an outbreak of guttate psoriasis, called Guttate Psoriasis.

Skin injury

In some people, a scratch, rubbing, burn, or other skin injury may lead to the appearance of new psoriasis lesions in the injured area.

This phenomenon is called the Koebner Phenomenon.

Smoking and alcohol

Smoking and excessive alcohol consumption are connected in some studies to increased risk or higher psoriasis severity.

Reducing alcohol and stopping smoking are also important for general health.

Certain medications

Certain medications may trigger or worsen psoriasis in some people.

If you suspect a connection exists between a medication and a flare, it is important to consult the doctor and not stop treatment on your own.

Can stress create a cycle worsening the disease?

One of the complex things in psoriasis is the connection between the skin condition and the psychological feeling.

A flare can cause itching, discomfort, sleep disturbance, and sometimes also a feeling of embarrassment or harm to self-confidence.

The stress created following the condition may affect quality of life, and in some people also worsen the disease symptoms.

Thus a cycle can be created in which the physical condition and the psychological condition affect each other.

Therefore it is important in my eyes to also address sleep, emotional support, and stress reduction as part of the overall coping.

Not because this is a psychological disease.

But because body and soul affect each other, especially when living with a chronic disease.

How is psoriasis treated medically?

Psoriasis treatment depends on the type of disease, its severity, the body areas involved, and its effect on quality of life.

Topical treatments

In mild to moderate cases, medical preparations for application can be used, including topical steroids, vitamin D analogs, and additional treatments according to the treated area.

Phototherapy

In some cases, controlled ultraviolet light treatment is used, usually narrow-band UVB, under medical supervision.

It is important to distinguish between medical phototherapy and uncontrolled tanning in the sun or tanning beds.

Sunburns may actually worsen psoriasis.

Systemic treatments

In moderate to severe disease, or when there is significant harm to quality of life, systemic medications can be considered.

Some act on the immune system in broader ways, and others are biological medications targeting certain inflammatory pathways, like IL-17, IL-23, or TNF-alpha.

These treatments greatly changed the options available to people with psoriasis.

They can bring significant improvement and even almost clear skin in some patients.

But choosing the treatment requires medical evaluation, because every medication has advantages, risks, and personal considerations.

And what is the role of skincare products?

Here it is important to me to make a clear distinction between treating the disease and supportive care.

Psoriasis is an inflammatory disease mediated by the immune system.

A moisturizer cannot alone repair the immune pathways driving it.

But correct care can be a very important part of daily coping.

Skin with psoriasis may be dry, rough, irritated, and sometimes also cracked.

Regular use of suitable moisturizing preparations can help reduce dryness, soften scales, and improve the feeling of comfort.

How should skin with psoriasis be cared for?

1. Gentle cleansing

Choose a cleansing preparation that does not over-dry the skin.

It is better to avoid aggressive soaps and strong rubbing.

2. Lukewarm showers

Very hot water may worsen dryness and itching in some people.

Short showers in lukewarm water may be more comfortable for the skin.

3. Applying moisture after bathing

After the shower, while the skin is still slightly damp, it is worth applying a suitable moisturizer.

This can help reduce water loss from the skin.

4. Choosing ingredients suited to sensitive skin

Preparations containing ingredients like glycerin, petrolatum, or ceramides may help maintain moisture and the protective barrier of the skin.

Not every ingredient suits every condition, so it is worth checking the skin's response.

5. Avoiding unnecessary irritation

Strong peelings, rubbing with body brushes, and heavily fragranced products may cause irritation in some people.

Especially during a flare, it is better to choose a simple, gentle routine.

6. Do not remove scales by force

Even if the scales bother aesthetically, do not try to peel them by force.

Skin injury may cause bleeding, pain, and sometimes also trigger new lesions.

If there is a need to soften or remove thick scales, it is worth consulting a dermatologist regarding suitable preparations.

Can a moisturizer prevent flares?

Regular use of moisture may improve the skin condition and reduce dryness and discomfort.

But there is no proof that a moisturizer alone prevents all psoriasis flares.

The disease is affected by complex immune mechanisms, so even well-cared-for skin can pass through periods of worsening.

In my eyes, it is important to avoid unrealistic promises.

A good skincare product can support the skin, but it does not replace medical treatment of the disease itself.

Our approach at OrOrgani

At OrOrgani we believe correct care begins with understanding the skin and respecting its condition.

When it comes to skin with psoriasis, this approach is especially important.

There is no need to fight the skin.

There is no need to dry it by force.

And there is no need to try to remove every scale through rubbing.

The skin needs gentle cleansing, moisture, protection, and avoidance of unnecessary irritation.

Our moisturizer intended for skin with psoriasis was developed with thought about the need for daily support of dry, rough skin.

The goal of such care is to help maintain moisture, soften the skin, and improve the feeling of comfort.

It is important to me to emphasize this is supportive care, and not a medication curing psoriasis or replacing treatment determined by a dermatologist.

I believe the best approach combines suitable medical treatment, lifestyle habits supporting general health, and a care routine respecting the skin.

In summary: Psoriasis is not only what we see on the skin

Psoriasis is a chronic inflammatory disease mediated by the immune system.

The lesions we see on the skin surface are the external expression of more complex processes.

In recent years research reveals interesting connections between psoriasis and the digestive system, the microbiome, metabolic health, and additional inflammatory diseases.

But it is important to distinguish between research connections and factors proven unequivocally.

We still cannot say all psoriasis begins in the gut, or that a certain nutritional change can cure the disease.

What we do know is that suitable medical treatment can significantly improve the skin condition, and that a healthy lifestyle and gentle care can support daily coping.

I believe our skin is not an enemy to fight. It is part of a complex system deserving understanding, treatment, and patience.

And sometimes, the best way to treat what we see from the outside is to better understand also what occurs inside.

With love,
Nurit
OrOrgani

With love,
Nurit Rozenblat
OrOrgani

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