Managing chronic inflammation with psoriasis

Nancy Carteron, M.D., FACR

Although the exact cause of psoriasis is unknown, doctors consider it an immune-mediated inflammatory disease. This means that inflammation is at the root of this condition.

Up to 3% of adults in the United States have psoriasis. It causes skin symptoms, such as raised plaques and discoloration, and can also affect other parts of the body, such as the joints and eyes.

Experts believe inflammation is the common factor that can affect these different areas.

What causes inflammation in psoriasis?

In people with psoriasis, immune system dysfunction causes inflammatory cells to build up in the middle layer of the skin, known as the dermis. The condition also speeds the growth of skin cells in the epidermis, the outer skin layer.

Typically, skin cells grow and flake off in the span of a month. This process speeds up to just a few days in people with psoriasis. Instead of shedding, skin cells pile up on the skin’s surface, leading to uncomfortable symptoms such as raised plaques, scales, swelling, and redness or discoloration.

Even though psoriasis is a skin condition, the inflammation associated with psoriasis affects the entire body. It can increase the risk of heart disease, cancer, inflammatory bowel disease, and psoriatic arthritis.

Is there a way to treat inflammation?

Although inflammation in psoriasis is due to immune system dysregulation, studies suggest that people can reduce this inflammation through lifestyle and dietary changes. This can help reduce symptoms and improve quality of life.

Using these methods, many people who have psoriasis can maintain remission, which is a long period without experiencing psoriasis symptoms.

Additionally, certain medications to treat psoriasis work by reducing inflammation. These include topical corticosteroids, injectable biologics, and oral medications.

Everyone with psoriasis is different. Some people will require more extensive treatment than others.

How to manage inflammation

While there is currently no cure for psoriasis, the following habits may help reduce psoriasis-related inflammation and increase a person’s chances of experiencing remission.

Eating a nutritious diet

Diet is strongly linked to systemic inflammation. Studies suggest that certain inflammatory dietary patterns can increase the risk of psoriasis and worsen symptoms.

A nutritious diet looks different for everyone. However, the following steps may help a person establish one:

• Avoiding inflammatory foods: Certain foods and beverages contain pro-inflammatory substances that increase inflammation and trigger psoriasis symptoms. Examples include soda and ultra-processed foods such as salty snacks, sweets, and processed meat products.
• Considering an anti-inflammatory diet: Diets that are rich in fruits, vegetables, and other nutritious foods consistently reduce psoriasis symptoms. For example, a 2018 study of 35,735 people, including 3,557 with psoriasis, suggested that those who followed a Mediterranean-style diet had less severe psoriasis compared with people who did not.

Maintaining a moderate weight

Obesity is a risk factor for psoriasis development. People with psoriasis who have overweight or obesity may also experience more severe symptoms than people with a moderate weight.

Weight loss may reduce inflammatory markers and help reduce psoriasis symptoms in people with excess body weight.

A 2020 study found that people with psoriasis and overweight or obesity who reduced their body weight by 12% through a 10-week program experienced a 50–75% reduction in psoriasis severity. Participants experienced an average weight loss of 23 pounds.

Implementing other healthy habits

Several habits can help reduce inflammation and improve psoriasis symptoms, such as:

• Avoiding or quitting smoking: Smoking significantly harms a person’s health and worsens inflammatory diseases, including psoriasis.
• Reducing alcohol intake: Excessive drinking can contribute to inflammation and worsen psoriasis symptoms.
• Staying active: Avoiding long periods of sitting may help with reducing psoriasis symptoms. One research review suggested that people with psoriasis who live sedentary lives have more severe symptoms compared with people who exercise regularly.
• Getting enough sleep: Not getting enough sleep can lead to a pro-inflammatory state in the body. Studies suggest that poor and inconsistent sleep can increase inflammation markers in the blood. Experts recommend adults get 7–9 hours of sleep per night for optimal health.
• Managing stress levels: Prolonged stress makes the immune system overactive and contributes to a pro-inflammatory state. Up to 88% of people with psoriasis report stress as a trigger for their symptoms. Using stress-reducing techniques such as meditation and yoga may help.

When to seek medical help

Anyone experiencing a psoriasis flare who is interested in learning ways to reduce psoriasis symptoms and inflammation may wish to consider speaking with their healthcare team, including their dermatologist.

They can recommend treatment methods based on symptom severity and provide recommendations for diet and lifestyle changes that may help lower inflammation and reduce psoriasis symptoms. They may also suggest taking vitamins or supplements.