Under the Skin – Managing Chronic Skin Disorders Through Lifestyle
Can diet and lifestyle play a role in managing the symptoms of a chronic skin disorder? If you struggle with the symptoms of a chronic skin disorder such as psoriasis or atopic dermatitis, chances are that you’ve tried just about everything to treat the problem. From topical ointments and creams to various prescription drugs, numerous products promise to relieve symptoms, but few can deliver on that promise. In order to manage these conditions, it helps to understand a little more about them first.
Since the twentieth century, inflammatory skin disorders have become increasingly common, such as atopic dermatitis – a disease that affects both males and females equally and accounts for 20% of all dermatologic referrals. According to the National Institutes of Health (NIH), atopic dermatitis affects 15-30% of children and 2-10% of adults in developed countries. And as many as 7.5 million Americans (approximately 2.2 percent of the population) have psoriasis. Worldwide, it’s estimated that 125 million people (2 to 3 percent of the total population) have psoriasis.
Atopic dermatitis (a common type of eczema) is an inflammatory, chronically relapsing, non-contagious and pruritic (causing an unpleasant, itchy sensation) skin disorder. 'Atopic' refers to a tendency to develop allergy conditions. 'Dermatitis' means swelling of the skin.
The most common symptoms of atopic dermatitis are dry and itchy skin, rashes on the face, inside the elbows, behind the knees, and on the hands and feet. Scratching can cause the skin to redden, swell, crack, or develop lesions that 'weep' clear fluid. Crusting, scaling, and thickening of the skin may develop. When people with atopic dermatitis are exposed to sensitizing irritants or allergens, inflammation-producing cells become active. These cells release chemicals that cause itching and redness. Scratching and rubbing the skin further exacerbates potential skin damage.
Common irritants and allergens can significantly worsen symptoms of atopic dermatitis. Exposure to wool, synthetic fibres, soaps, cleaners, perfumes, makeup, chlorine, solvents, dust, sand and cigarette smoke can aggravate the skin, as can common allergy-causing substances from food, plants, and air conditions. There are some data to suggest that certain vaccines can also worsen symptoms, especially the smallpox vaccine, which can cause serious problems.
Often confused with atopic dermatitis, psoriasis [pronounced sore-EYE-ah-sis], is a chronic disease of the immune system that varies from person to person, both in severity and how it responds to treatments. There are various forms of psoriasis with plaque psoriasis being the most common. Other forms are:
- Guttate [GUH-tate], characterized by small dot-like lesions
- Pustular, characterized by weeping lesions and intense scaling
- Inverse, characterized by severe inflammation
- Erythrodermic [eh-REETH-ro-der-mik], characterized by intense shedding and redness of the skin.
Currently, there is no single test to diagnose atopic dermatitis or psoriasis. Both atopic dermatitis and psoriasis symptoms range from mild to moderate to very severe. While the exact causes of these disorders have yet to be discovered, we know that the immune system and genetics play major roles in their development. In the case of psoriasis, most researchers agree that the immune system is somehow mistakenly triggered, which speeds up the growth cycle of skin cells among other immune reactions.
In spite of the prevalence of chronic skin conditions, common myths and misconceptions abound. The social stigma against those suffering from skin disorders is often a direct result of mistaking the disorder symptoms for a contagious disease. With a relative lack of public awareness, skin disorders can be a significant source of stress and anxiety for those suffering from the disease – with both physical and psychological factors.
Individuals with psoriasis are at an elevated risk to develop other chronic and serious health conditions such as heart disease, inflammatory bowel disease and diabetes. People with severe psoriasis also have an elevated risk of heart attack.
Managing lifestyle effectively may help to reduce the incidence of the other conditions or 'co-morbidities' associated with psoriasis. Maintaining an active lifestyle, avoiding irritants such as cigarette smoke, and maintaining a healthy weight with a diet rich in fruit and vegetables (which may decrease inflammation in the body), are all measures that can have a positive impact on managing symptoms. Additionally, it is essential that doctors and healthcare practitioners monitor all patients who may be at risk for comorbidities and provide referrals when indicated.
There is evidence that food allergens, such as milk, nuts, cheese, nightshade plants (e.g., tomatoes, eggplant, white potato), gluten, yeast, soy, and corn, can exacerbate skin disorder symptoms. If a food allergy is suspected, physician-supervised introduction of the food following a period of food elimination may be necessary to determine if symptomatic food allergy is present. Identifying specific food allergens may be difficult since other potential allergens such as infection, heat, and humidity may be difficult to control.
Changing the diet may not always relieve symptoms but can be helpful, however, when the medical history, laboratory studies, and specific symptoms strongly suggest a food allergy. Although dietary elimination or restriction is a personal decision, it should be done with care. Unless properly monitored by a physician or dietician, diets with many restrictions can contribute to serious nutritional deficiencies, especially in children.
There is strong scientific evidence that probiotics can play a therapeutic role in treating eczema; similarly, Vitamin D supplementation, and monitored UV light therapy may bring some relief for those with psoriasis. Good scientific evidence also exists in regards to plant-based therapies such as aloe and evening primrose oil, as well as therapeutic treatment with Para-aminobenzoic acid and Phenylalanine (an essential amino acid). Unfortunately, studies of many other alternative treatments have resulted in unclear or conflicting scientific evidence.
It is important to note that there are few absolute clinical standards when using alternative treatments for skin disorders; patients should work closely with a health practitioner to monitor the effects of alternative treatments, since it may be necessary to adjust dosage or combine treatments for maximum efficacy.
Although the symptoms of skin disorders can be difficult and uncomfortable, the disease can be successfully managed. People with atopic dermatitis and psoriasis can lead healthy, productive lives. The keys to quality of life lie in being well-informed; awareness of symptoms and their possible cause; and developing a partnership involving the patient or care-giving family member, medical doctor, and other health professionals.