Select Page

Skin Health

Back Clinic Skin Health Functional Medicine Team. An individual’s skin can reveal stories about their life, from the glow of pregnancy to the spots that surface from sun damage. People hear about protecting their skin from the sun’s rays, but many simple health moves can keep one’s skin in great shape. This is because skin provides a physical and chemical barrier between the outside environment and the inside tissues.

This barrier functions to protect underlying tissues from pathogens, chemicals, and environmental exposures. Structurally, the skin is comprised of two main layers, the epidermis, and the dermis. The epidermis, or upper layer, is responsible for the barrier functions of the skin. The dermis is the structural and nutritive support underneath the epidermis. Each layer has its own unique structure and function, and each has its own requirements. Various challenges for healthy skin include:

  • Photo-damage or exposure to ultraviolet (UV) light. Sunburn is the most common form.
  • Dry skin
  • Wrinkles
  • Healing Wounds
  • Aging

Nutritional status plays an important role in the maintenance of healthy skin. Skin nutrition may be enhanced directly through topical applications. Topical application of micronutrients can complement dietary consumption, leading to a stronger, healthier protective barrier of the body.

An Overview Of Lyme Disease

An Overview Of Lyme Disease


Many individuals plan fun outdoor activities when the weather is nice and warm during spring and summer. Hiking, swimming, or road trips are some of the activities many people do enjoy. Each activity provides new memories to enjoy and work with the body by incorporating the muscles, tissues, and ligaments through everyday movement. As fun as these outdoor activities are, the outdoors can be dangerous when you least expect it, as factors can cause damage to the body without even a person realizing it is happening. Today’s article looks at a bacteria called Borrelia burgdorferi, commonly known as Lyme disease, its symptoms, and available treatments for Lyme disease. We refer patients to certified providers specializing in therapies to help those with Lyme Disease. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

08_Pugliese Introduction to Lyme Disease

What Is Lyme Disease?

Have you noticed a rash that randomly appeared out of nowhere? How about feeling the effects of fatigue throughout the entire day? Or how about inflammatory issues affecting your joints? Some of these are signs and symptoms that you might be at risk of developing Lyme disease. The original description of how Lyme disease was manifested dates back to 1883 in Europe by the German physician Alfred Buchwald, who described it as now called ACA (acrodermatitis Chronica atrophicans), and research studies defined Lyme disease as a multi-organ animal-borne disease from ticks that affects the vital organs (skin, nerves, and heart) associated with the musculoskeletal system. Lyme disease is transmittable from either the tick itself or a tick-infested animal like a rodent or a deer. Lyme disease is quite difficult to diagnose since a tick can hide in tall, grassy, and woodsy areas that many individuals walk through and don’t recall ever getting a tick bite.


Symptoms Of Lyme Disease


Suppose an individual lives in a location where ticks are native and thrive. In that case, they may succumb to Lyme disease symptoms which vary depending on the severity and come in different stages: early, disseminated, and late.


Early Stages

When a tick has bitten a person, the skin develops an expanding red area that forms a bull’s eye circle rash known as erythema migrans. Some individuals don’t develop this type of rash, but it can be at more than one place on their bodies. Other symptoms that are potentially involved with erythema migrans in the early stages of Lyme disease include fatigue, headache, neck stiffness, and swollen lymph nodes are accompanied.


Disseminated Stages

Studies have shown that Lyme disease may manifest in the involvement of the musculoskeletal system. If a person hasn’t treated the tick bit within a couple of weeks, this disease goes to a disseminated stage where the vital organs and muscles begin to be affected. During this stage, Lyme disease can mimic other symptoms like joint inflammation associated with rheumatoid arthritis. When people suffer from a tick bite and have not been treated, it can affect the joints by mimicking inflammatory joint swelling, causing individuals to be at risk of developing arthritis. Lyme disease also may trigger fibromyalgia symptoms in the individual’s body, causing them to be in immense pain.


Later Stages

If Lyme disease hasn’t been treated for months, it can affect the surrounding nerve roots and joint structures. Lyme disease may trigger inflammatory markers in the blood-brain barrier that may overlap with neurological disorders like Bell’s palsy (temporary paralysis on one side of the face) and trigger sensory-motor dysfunction in the arms and legs. Studies reveal that the central and peripheral nervous systems affected by Lyme disease may be at risk of developing meningitis. This means that the spine al cord could potentially be involved with Lyme disease if not treated as soon as possible.

An Overview Lyme Disease-Video

Have you been experiencing swelling around your joints? How about feeling a tingling sensation running down your arms and legs? Have you been waking up with neck stiffness? Some of these are signs that you could be at risk of developing Lyme disease. The video above gives an introduction to what Lyme disease is and how it affects the body. Lyme disease is a multi-systemic disease transmitted by an insect known as a tick. This insect thrives in tall, grassy, woodsy areas and can be mistaken for a poppy seed due to its small size. Many individuals don’t realize that they have Lyme disease from a tick until the symptoms have begun to affect the body. Luckily there are ways to treat Lyme disease and prevent it from creating havoc on the body.

Treatments Available For Lyme Disease


Lyme disease is treatable as many physicians prescribe antibiotics to individuals that have Lyme disease. The antibiotics will attach themselves to the bacteria from Lyme disease and eliminate it from the body in the early stages. Other treatments like chiropractic care may also help alleviate the associated symptoms of Lyme disease. How does chiropractic care correlate with Lyme disease? Well, chiropractic care is not just for the back; it can help improve the function of the central nervous system. As mentioned earlier, Lyme disease can mimic other symptoms like joint inflammation. When a person gets their spine adjusted, it can help relieve the stiffness from the surrounding muscles and reduce aches and pain in the body. Some of the ways to prevent Lyme disease include:

  • Wearing light, breathable clothing (long pants, long shirt, hat, gloves, etc.)
  • Use insect repellent
  • Avoid walking through long grass
  • Check clothing (They like to attach to anything)
  • Remove them with a tweezer (Grasp them gently near their head or mouth)



Enjoying the warmer weather is great for many individuals that want to do fun outdoor activities. However, it can be fatal when factors begin to damage the body without even the person realizing it. Lyme disease is a multi-organ disease transmitted by an insect known as a tick. This tiny insect can attach to any exposed skin and cause many symptoms that can affect the body. Many individuals who a tick has bitten are at risk of developing inflammatory symptoms that mimic other chronic issues. These untreated issues can overlap with chronic diseases but can be treatable if caught early. Available treatments like antibiotics and chiropractic care may help manage the symptoms. At the same time, the necessary precautions can prevent the tick from infecting the body so that you can enjoy the outdoors.



Biesiada, Grażyna, et al. “Lyme Disease: Review.” Archives of Medical Science : AMS, Termedia Publishing House, 20 Dec. 2012,

Dabiri, Iman, et al. “Atypical Presentation of Lyme Neuroborreliosis Related Meningitis and Radiculitis.” Neurology International, PAGEPress Publications, Pavia, Italy, 2 Dec. 2019,

Skar, Gwenn L, and Kari A Simonsen. “Lyme Disease – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 6 May 2022,

Steere, A C. “Musculoskeletal Manifestations of Lyme Disease.” The American Journal of Medicine, U.S. National Library of Medicine, 24 Apr. 1995,


The Gut-Skin Connection On Relieving Psoriasis

The Gut-Skin Connection On Relieving Psoriasis


The skin and the gut have a unique connection. The gut system is home to trillions of microorganisms that help metabolize the body’s homeostasis while keeping the immune system functioning for the body to be working correctly. The skin has its set of functions as well as it is the largest organ and helps protect the body from external factors from harm. When these disruptive factors start to affect either the gut or the skin, it can lead to numerous conditions that cause the body to be dysfunctional. When the gut becomes affected by these disruptive factors, it can cause gut disorders and inflammation, affecting the skin and causing disruptions. Today’s article will discuss a skin disorder known as psoriasis and how the gut-skin connection is affected by psoriasis. Referring patients to certified, skilled providers who specialize in gastroenterology treatments. We provide guidance to our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is critical for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer


Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

16B - Smith Module IV GI Health and The Skin Part I

What Is Psoriasis?


Do you have severe itching along your face and arms? Do certain foods seem to aggravate your digestive tract or skin? Or have you experienced any gut disorders that are affecting your wellbeing? Many of these symptoms are signs of inflammatory issues affecting the gut and are associated with a skin disorder known as psoriasis. Research studies have defined psoriasis as a chronic inflammatory skin disease that is an autoimmune process in which abnormal differentiation and hyper-proliferation of the epidermis occur with redness and scaling. Psoriasis affects about 2% of the general population in the world and is an autoimmune process driven by abnormally activated helper T cells. Additional studies have mentioned that psoriasis is sustained by inflammation that causes the keratinocyte proliferation to be uncontrollable and has dysfunctional differentiation. The inflammatory pathways activate psoriasis in different body locations, causing the individual to become miserable because they are itching and becoming miserable.

An Overview Of Psoriasis-Video

Do you have scaly, patchy lesions in certain areas of your body? Do you feel any gut issues affecting you constantly? Do you feel inflammatory effects disrupting your gut and skin? Many of these conditions are signs that you are experiencing gut disorders associated with a skin disorder known as psoriasis. The video above explains how the gut and skin are affected due to psoriasis and how to heal it naturally. Research studies have mentioned that when the individual is suffering from psoriasis-prone skin, it is due to the alternation of the gut microbiota. When a person scratches the area where psoriasis is formed, it might damage the skin and cause the bacteria to colonize while invoking inflammation to occur in the affected area. Additional research has found that gut disorders like IBD (inflammatory bowel disease) and psoriasis are interlinked due to the increased interaction of inflammatory receptor pathogens disrupting the body’s immune cells.

How The Gut-Skin Connection Is Affected By Psoriasis


The gut is home to trillions of microorganisms that help metabolize the body’s homeostasis while regulating the immune system. Since the body inhabits microorganisms in various locations, including the skin and gut, it helps maintain homeostasis. The skin helps protect the body from external factors and has bidirectional communication with the gut system. However, like with any autoimmune process, it always starts with the gut. Research studies have mentioned that psoriasis is a multifactorial chronic skin disease that infiltrates the body’s immune cells, causing an increase in skin inflammation and making a person’s life miserable. With the gut system also being inflicted by inflammatory markers, many suffering individuals will experience IBD, SIBO, and other gut disorders that can disrupt the body. Additional information has shown that changes in the microflora in the gut-skin axis from genetic or environmental factors can contribute to various diseases. But when these factors begin to cause an increase in inflammatory markers in the body, it can affect a person’s quality of life through habits that make them miserable.



The body needs the gut and skin to maintain homeostasis and metabolize the immune system. The gut microbiota helps transport the nutrients that the body needs and regulates the body’s immunity, while the skin protects the body from outside factors while being the largest organ. The gut and skin have a bi-directional connection that allows them to keep the body from suffering from dysbiosis. When disruptive factors affect either the gut or the skin, it can lead to many disorders and make a person’s life miserable. The skin suffers from a condition known as psoriasis, a chronic inflammatory disease that causes itchy, patchy lesions that can affect the areas around the body. Psoriasis is associated with gut disorders, as many factors aggravate the inflammatory markers and can be a nuisance if not treated early. Incorporating small changes that benefit both the gut and skin health can help relieve the individual from psoriasis and bring back their quality of life.



Chen, Lihui, et al. “Skin and Gut Microbiome in Psoriasis: Gaining Insight into the Pathophysiology of It and Finding Novel Therapeutic Strategies.” Frontiers in Microbiology, Frontiers Media S.A., 15 Dec. 2020,

De Francesco, Maria Antonia, and Arnaldo Caruso. “The Gut Microbiome in Psoriasis and Crohn’s Disease: Is Its Perturbation a Common Denominator for Their Pathogenesis?” Vaccines, MDPI, 5 Feb. 2022,

Ellis, Samantha R, et al. “The Skin and Gut Microbiome and Its Role in Common Dermatologic Conditions.” Microorganisms, MDPI, 11 Nov. 2019,

Nair, Pragya A, and Talel Badri. “Psoriasis.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 6 Apr. 2022,

Olejniczak-Staruch, Irmina, et al. “Alterations of the Skin and Gut Microbiome in Psoriasis and Psoriatic Arthritis.” International Journal of Molecular Sciences, MDPI, 13 Apr. 2021,

Rendon, Adriana, and Knut Schäkel. “Psoriasis Pathogenesis and Treatment.” International Journal of Molecular Sciences, MDPI, 23 Mar. 2019,


A Healthy GI Can Relieve Atopic Dermatitis

A Healthy GI Can Relieve Atopic Dermatitis


The skin is the largest organ in the body and encounters numerous factors that can either benefit or harm the body. The skin helps protect the organs and intestines in the gut system, keeps the musculoskeletal system structure functional, and even helps the nervous system send out signals for motor-sensory functions to the rest of the body. The skin is associated with the gut system as the gut microbiota host trillions of beneficial gut flora that send out nutrients to help promote tissue growth, improve the body’s immunity, and metabolize skin health by protecting it from disruptive pathogens. When these pathogens cause inflammatory issues in the gut system, it can affect the body’s skin, brain, and immune health by making them dysfunctional. Today’s article will look at a skin condition known as atopic dermatitis, how it affects the gut-skin system, and what treatments are available for relieving gut issues and atopic dermatitis in individuals. Referring patients to certified, skilled providers who specialize in gastroenterology treatments. We provide guidance to our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is critical for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer


Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

16A - Smith Module IV GI Health and The Skin Part I

What Is Atopic Dermatitis?


Have you experienced inflammation around your gut or in certain areas of your skin? Do issues like SIBO, IBD, leaky gut, or bloating become more frequent? Do certain foods trigger inflammatory markers in your skin and gut? The numerous signs and symptoms are due to a skin disorder known as atopic dermatitis. Atopic dermatitis or eczema is a pruritic, hereditary skin disorder. The lifetime prevalence is 10% to 20%, with many cases starting as a baby and rising to 20% to 40% as adults continue to have atopic dermatitis. Research studies have defined atopic dermatitis as one of the most common skin diseases that cause chronic inflammation in the skin. The pathophysiology of atopic dermatitis is both complex and multifactorial. It involves the elements of barrier dysfunction, alterations in cell-mediated immune responses, IgE-mediated hypersensitivity, and environmental factors that cause flare-ups. Additional research studies have mentioned that the pathology of atopic dermatitis is being looked at as the skin’s structural abnormalities and immune dysregulation play their roles as this condition progress. Other genetic changes have also been identified, altering the skin’s barrier function, resulting in an atopic dermatitis phenotype. The imbalance of Th2 to Th1 cytokines is observed as it alters cell-mediated immune responses. Atopic dermatitis can promote IgE-mediated hypersensitivity in the skin as part of its development. This can also be due to the environmental factors that be the causing development of atopic dermatitis.


How Does It Affect The Gut-Skin Connection?

Since atopic dermatitis is a chronic inflammatory skin disease, many factors do come to play in its development. For example, food allergies cause atopic dermatitis in 25% to 50% of children. Some of the food allergens that are commonly linked to atopic dermatitis include:

  • Eggs
  • Soy
  • Milk
  • Wheat
  • Fish
  • Shellfish
  • Peanuts

One of the other factors that can cause the development of atopic dermatitis is gut issues. Research studies have shown that any alterations in the gut microbiome due to atopic dermatitis affect the immune system balance in the body. When the gut microbiome becomes altered, it affects metabolite production and reduces the body’s immune system. When bacteria overgrowth in the GI tract, it has been suggested as a causative factor in allergic diseases, including atopic dermatitis. Another factor is when individuals consume trans fats, which increase the development of atopic dermatitis since they interfere with the metabolism and use of essential fatty acids.

The Microbiome Of Atopic Dermatitis-Video

Have you experienced inflammation in your digestive tract or particular areas of your skin? Does your body feel fatigued constantly? Do you have any gut issues or disorders that are affecting your health? Most of these symptoms are signs that you are experiencing atopic dermatitis caused by gut issues. Research studies have found that various factors can trigger atopic dermatitis, affect the immune system, and disrupt the gut microbiota. The video above explains the microbiome in atopic dermatitis and how it affects the gut, skin, and the entire body. Luckily there are available treatments to relieve atopic dermatitis and gut disorders from wreaking havoc on the body.

Treatments For Relieving Atopic Dermatitis & The Gut


When a person begins to find treatments for relieving atopic dermatitis usually involves:

  • Early diagnosis.
  • Skin barrier function support.
  • Mitigation of cutaneous inflammation.
  • Concomitant risk stratification

Another way that many individuals can alleviate atopic dermatitis is with a healthy GI tract. This will help many individuals suffering from a food allergy, asthma, allergic rhinitis, and environmental allergies to relieve atopic dermatitis from progressing further. A study showed that probiotics and prebiotics are essential in preventing food allergies and eczema. Probiotics and prebiotics help replenish the beneficial bacteria in the gut and regulate the immune system. This prevents atopic dermatitis from stopping progressing and restor the body back.



Many factors cause atopic dermatitis progression to become severe, as it is crucial to find the root cause of the flare-ups and alleviate them at the source. Overall having gut issues associated with atopic dermatitis is no laughing matter. When the gut microbiome is being affected by inflammatory disorders, it can disrupt the immune system and cause atopic dermatitis to develop on the skin. Incorporating probiotics and prebiotics can help replenish the gut bacteria and figure out what causes the inflammatory symptoms to spike up from certain foods will benefit the gut and the skin to become healthier.



Fang, Zhifeng, et al. “Gut Microbiota, Probiotics, and Their Interactions in Prevention and Treatment of Atopic Dermatitis: A Review.” Frontiers in Immunology, Frontiers Media S.A., 14 July 2021,

Kapur, Sandeep, et al. “Atopic Dermatitis.” Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology, BioMed Central, 12 Sept. 2018,

Kim, Jung Eun, and Hei Sung Kim. “Microbiome of the Skin and Gut in Atopic Dermatitis (AD): Understanding the Pathophysiology and Finding Novel Management Strategies.” Journal of Clinical Medicine, MDPI, 2 Apr. 2019,

Kolb, Logan, and Sarah J Ferrer-Bruker. “Atopic Dermatitis – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 13 Aug. 2021,

Lee, So Yeon, et al. “Microbiome in the Gut-Skin Axis in Atopic Dermatitis.” Allergy, Asthma & Immunology Research, The Korean Academy of Asthma, Allergy and Clinical Immunology; The Korean Academy of Pediatric Allergy and Respiratory Disease, July 2018,


The Gut Skin Connection Affecting Acne

The Gut Skin Connection Affecting Acne


The body is always going through many factors that constantly test the durability that can affect the entire microbiome itself. The gut helps the body’s homeostasis by metabolizing the nutrients that provide the energy for functionality. The gut system is home to trillions of microorganisms that communicate to the brain systemendocrine systemimmune system, and skin to ensure that it is healthy. When disruptive factors enter the gut system, they can cause various issues that can make the dysfunctional body while affecting its communication with the body’s axis. Today’s article focuses on a skin condition that everyone has suffered in their lives known as acne and how the gut-skin axis is being affected by acne. Referring patients to certified, skilled providers who specialize in gastroenterology treatments. We provide guidance to our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is critical for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer


Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

16A - Smith Module IV GI Health and The Skin Part I

What Is Acne Vulgaris?


Have you noticed bumps along your face, especially in the nose, forehead, and cheek regions? How about inflammatory reactions that are affecting your skin? Do issues like GERD, IBS, leaky gut, or SIBO affect your gut? Most of these issues are due to disruptive factors that affect the gut-skin connection and cause a skin condition known as acne vulgaris. Everybody suffers from acne when they are young, and it is a common condition with follicular papules or comedones and inflammatory papules and pustules. Research studies have shown that acne vulgaris is an inflammatory disorder triggered by many factors that can cause it to become aggravated and inflamed. Some of the contributing factors that can cause acne vulgaris to form due to the following:

  • Infection (Propionibacterium acnes)
  • Tissue inflammation
  • Plugging of hair follicles due to epidermal hyperproliferation
  • Hormone imbalance
  • Endocrine disorders
  • Excess sun exposure

Other research studies have shown that other factors like gut disorders can also affect the development of acne vulgaris. Acne vulgaris can be associated with the emotional factors that affect the brain and the gut’s inflammatory factors as they go hand in hand. When a person becomes stressed or anxious, their skin will flare up and develop acne around some skin regions. Additional studies have mentioned that emotional factors like stress and anxiety can alter the gut microbiota and increase intestinal permeability. When gut disorders start to contribute to skin inflammation, it can aggravate acne to develop and form on the skin.

Gut Health & Acne- Video

Have you experienced gut disorders that seem to affect your quality of life? Have you noticed that particular foods you consume are not sitting well in your gut system? How about feeling overly stressed and anxious that acne forms around your face? The video above explains how the gut microbiome affects a person when making dietary changes that can provide beneficial results to the gut microbiota. Research studies have found that the intestinal microbiota is essential for forming acne lesions while being responsible for proper immunity and defense of the microorganisms. The GI tract and acne condition are closely associated because they provide the neuroendocrine and immune functions to the body. 

The Gut-Skin Axis & How It Affects Acne


Since the gut is the host to trillions of bacteria, its primary job is to maintain constant communication with the skin to dampen unnecessary inflammatory markers that can cause the skin to break out. Research studies have found that the gut-skin axis, when affected by acne, produces significantly higher metabolites that generate ROS (reactive oxygen species) and induce inflammation in both the gut and skin. Additional research has shown that the gut microbiome plays an essential role in skin disorders and vice versa. When changes affect either the gut or the skin, it can drastically change a person’s outcome in life. Say, for instance, dietary habits that cause inflammation in the gut. This is due to processed foods that cause the gut to become inflamed and make the skin begin the development of acne in different portions of the skin. Research shows that the gut microbiome can vastly influence the immune system by regulating it. This builds a tolerance to dietary changes in the gut to promote acne-free skin. So incorporating a low-glycemic-load diet has been linked to improved acne, possibly through gut changes or attenuation of insulin levels.



Overall, the gut plays a massive role in the body in its homeostasis as it helps the body metabolize the nutrients to keep it functioning and moving. The gut microbiota also has bidirectional communication with the skin as common skin disorders like acne tend to show up. Acne is very common amongst individuals, especially in younger individuals, as it can affect their moods and cause changes to their mental health and their gut health. Incorporating small changes like eating healthy food, maintaining a stress-free environment, and even exercising can help not only lower gut inflammation but also clear up the skin from acne.



Bowe, Whitney P, and Alan C Logan. “Acne Vulgaris, Probiotics and the Gut-Brain-Skin Axis – Back to the Future?” Gut Pathogens, BioMed Central, 31 Jan. 2011,

Chilicka, Karolina, et al. “Microbiome and Probiotics in Acne Vulgaris-A Narrative Review.” Life (Basel, Switzerland), MDPI, 15 Mar. 2022,

De Pessemier, Britta, et al. “Gut-Skin Axis: Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions.” Microorganisms, MDPI, 11 Feb. 2021,

Lee, Young Bok, et al. “Potential Role of the Microbiome in Acne: A Comprehensive Review.” Journal of Clinical Medicine, MDPI, 7 July 2019,

Salem, Iman, et al. “The Gut Microbiome as a Major Regulator of the Gut-Skin Axis.” Frontiers in Microbiology, Frontiers Media S.A., 10 July 2018,

Sutaria, Amita H, et al. “Acne Vulgaris.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 8 May 2022,


Want Clearer Skin? Take Care Of Your Gut

Want Clearer Skin? Take Care Of Your Gut


As everyone knows, the gut helps the body metabolize nutrients and vitamins that it needs to function correctly. The gut system also allows the body’s immunity to perform while staying in communication with the brain. The gut helps sends signals back and forth to regulate the body’s hormones signals and other beneficial substances that the body requires. The gut is also in communication with the largest organ in the body, which is the skin. When intolerable factors start to wreck the gut and cause chaos inside the gut system, it disrupts the brain signals in the nervous system and can also take a toll on the skin. Today’s article will focus on a skin condition known as rosacea, how it affects the gut system, and what is the gut-skin connection. Referring patients to certified, skilled providers who specialize in gastroenterology treatments. We provide guidance to our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is critical for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer


Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

16A - Smith Module IV GI Health and The Skin Part I

What Is Rosacea?


Have you felt any gut disorders like IBS, leaky gut, or GERD affecting your mid-section? How about redness around your face, especially the nose and cheek areas? Does your skin seem to feel tender to the touch in certain areas? Most of these symptoms are related to a chronic inflammatory disease known as rosacea. It is usually indicated by genetic and environmental components that can trigger rosacea initiation on the skin. Rosacea is generally aggravated by dysregulation of the body’s innate and adaptive immune system. Research studies have mentioned that rosacea is usually developed by lymphatic dilation and blood vessels exposed to extreme temperatures, spices, or alcohol which causes rosacea to affect the cheeks and nose. Not only that, but genetics, immune reaction, microorganisms, and environmental factors lead to various mediators such as keratinocytes, endothelial cells, mast cells, macrophages, T helper type 1 (TH1), and TH17 cells.


How Does It Affect The Gut System?

Since rosacea is developed through exposure to high temperatures, spices, or alcohol, research studies have shown that particular food and drinks cause the inflammatory cytokines to become triggered in the face. Additionally, many trigger factors can directly communicate to the cutaneous nervous system; neurovascular and neuro-immune active neuropeptides are lead to the manifestation of rosacea lesions. Some of the other triggers that can cause rosacea to develop is an unhealthy gut system. A study showed that more than 50% had low stomach acid among patients who had both rosacea and dyspepsia. The bacteria H.pylori resides in the stomach and has been recognized to trigger inflammation and gastrin-induced flushing, thus causing rosacea. Additional studies have mentioned that rosacea individuals will experience some gut disorders to occur. Since the gut system can succumb to various factors, it can affect the gut’s composition and trigger rosacea. Since the gut microbiota has influenced the body’s homeostasis, it can also influence the skin. When there are factors that trigger the intestinal barrier of the gut, it can affect the skin, causing the inflammatory cytokines to proceed with the development of rosacea.

Uncovering The Gut-Skin Connection-Video


Does your skin feel flushed due to extreme temperatures or consuming spicy food? Have you experienced gut disorders like SIBO, GERD, or leaky gut? Has your skin seemed to break out even more than it should? Your skin could be affected by your gut microbiota, as the video above shows what the gut-skin connection is and how they work with each other. Research studies have shown that since the gut microbiome is the key regulator of the body’s immune system, it plays a vital role in various skin disorders. This means that when environmental factors affect the gut’s microbiome, it also affects the skin through dysbiosis. 

What Is The Gut-Skin Connection?


As stated earlier, the gut system is home to trillions of microorganisms that help metabolize the body’s homeostasis, including the largest organ, the skin. Research studies have found that when the gut microbial and the skin communicate with each other. It creates a bidirectional connection. The gut microbiome is also an essential mediator of inflammation in the gut and affects the skin. When there are factors like insulin resistance, imbalances in the sex hormones, gut inflammation, and microbial dysbiosis wrecking the gut system, the effects can cause the pathology of many inflammatory disorders to affect the skin. Any changes to the gut can also affect the skin as the gut consumes food to be biotransformed into nutrients that the body needs. But when food allergies and sensitivities affect the gut, the skin also gets involved, causing skin disorders like rosacea.



Overall the gut makes sure that the body is functioning correctly by metabolizing nutrients from consumed foods. The gut system has a connection to not only the brain and immune system but also the skin. The gut-skin connection goes hand in hand as factors that affect the gut can also affect the skin in developing skin disorders like rosacea. When a person is suffering from gut disorders, their skin is also damaged by factors like stress, food sensitivities, and skin disorders that can become a nuisance. This can be alleviated through small changes like reducing stress, eating healthy foods, and exercising, which are beneficial for relieving gut and skin disorders for individuals who want to get their health back.



Daou, Hala, et al. “Rosacea and the Microbiome: A Systematic Review.” Dermatology and Therapy, Springer Healthcare, Feb. 2021,

De Pessemier, Britta, et al. “Gut-Skin Axis: Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions.” Microorganisms, MDPI, 11 Feb. 2021,

Farshchian, Mehdi, and Steven Daveluy. “Rosacea.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 30 Dec. 2021,

Kim, Hei Sung. “Microbiota in Rosacea.” American Journal of Clinical Dermatology, Springer International Publishing, Sept. 2020,

Mikkelsen, Carsten Sauer, et al. “Rosacea: A Clinical Review.” Dermatology Reports, PAGEPress Publications, Pavia, Italy, 23 June 2016,

Salem, Iman, et al. “The Gut Microbiome as a Major Regulator of the Gut-Skin Axis.” Frontiers in Microbiology, Frontiers Media S.A., 10 July 2018,


How Collagen Improves Body Composition

How Collagen Improves Body Composition

Do you feel:

  • Redden skin, especially in the palms?
  • Dry or flakey skin or hair?
  • Acne or unhealthy skin?
  • Weak nails?
  • Edema?

If you are experiencing any of these situations, then your collagen peptides might be low.

There have been new studies on how collagen can improve body composition when it is combined with daily exercises. Collagen in the body has a unique amino acid composition that plays an essential role in the body’s anatomy. Collagen protein is a concentrated source of glycine, proline, and hydroxyproline, and when it is being compared to all the other dietary proteins, it makes collagen a potential practical choice as a structural protein.


In a 2015 study, researchers have demonstrated how efficient collagen supplements can improve body composition in active males. The results show how each male individuals are participating in weight training at least three times a week and have to supplement with at least 15 grams of collagen peptides to achieve maximum health. The assessments that the test provide are strength test, bioimpedance analysis (BIA), and muscle biopsies. These tests make sure that the male individuals are performing well after taking the collagen supplements, and the results show how their body mass had an increase of fat-free body mass. Another study showed how collagen protein supplementation when it is combined with resistance training that can increase muscle mass and muscle strength with the elderly as well as people with sarcopenia.

Beneficial Properties With Collagen

There are many beneficial properties that collagen supplements can provide to the body when it is consumed. There are hydrolyzed collagen and gelatin and can help improve a person’s skin structure. Even though there are not many studies on collagen supplements, there are excellent promises for the areas on the body. They are:

  • Muscles mass: Collagen supplements, when combined with strength training, can increase muscle mass and strength in the body.
  • Arthritis: Collagen supplements can help people with osteoarthritis. Studies show that when people osteoarthritis take collagen supplements, they discovered a massive decline in the pain they were experiencing.
  • Skin elasticity: In a 2014 study, it stated that women who took collagen supplements and has shown improvements in skin elasticity. Collagen can also be used in topical treatments to help improve the appearance of a person�s skin by minimizing fine lines and wrinkles.

Not only collagen supplements provide beneficial properties to the specific areas on the body, but there are the four main types of collagen and what is their roles in the human body as well as their functions:

  • Type 1: Type 1 collagen took account of 90% of the body’s collagen and made up of densely packed fibers that provide structures to the skin, bones, connective tissues, and teeth that are in the body.
  • Type 2: Type 2 collagen is made up of loosely packed fibers that are found in the elastic cartilage, which helps cushion the joints in the body.
  • Type 3: Type 3 collagen helps support the structure of the muscles, organs, and arteries that make sure that the body is functioning correctly.
  • Type 4: Type 4 collagen is found in the layers of everyone�s skin and helps with the filtration in the body.

Since these four types of collagen are in the body, it is essential to know that collagen can naturally decrease over time with age since the body will produce a lesser lower quality of collagen. One of the visible signs of decrease collagen is when the skin on the human body becomes less firm and supple as well as weaken cartilage due to aging.

Factors That Can Damage Collagen

Even though collagen can decrease naturally with age, many factors can destroy collagens that are harmful to the skin. The harmful factors can include:

  • Sugar and Carbs: Refined sugars and carb can interfere with collagen�s ability to repair itself on the skin. So by minimizing sugar and carb consumption in the body, it can reduce the effects of vascular, renal, and cutaneous tissue dysfunction.
  • Sun Exposure: Even though getting enough sun can help a person enjoy the day, however, being exposed to the sun for an extended period can cause damaged to the skin and destroy collagen peptides. The effects of overexposure of the sun can cause the skin to photo age and produce oxidative stress in the body.
  • Smoking: When a person smokes, it can reduce collagen production in the body, causing the body to have premature wrinkles, and if the body is wounded, the healing process will be slower and can lead to ailments in the body.
  • Autoimmune Diseases: Some autoimmune diseases can also damage collagen production like lupus.


Collagen is vital for the body as it helps the skin be gentle and firm. Naturally, it will decrease as a person gets older, so taking collagen supplements can make sure that the body can function correctly. When harmful factors are affecting the body, they can stop or even damage collagen production and accelerate the process of premature wrinkles from forming, making a person look older than they are. Some products can help the body’s cellular activity by providing more excellent stability, bioavailability, and digestive comfort.

The scope of our information is limited to chiropractic, musculoskeletal, and nervous health issues or functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or disorders of the musculoskeletal system. Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.


Bosch, Ricardo, et al. �Mechanisms of Photoaging and Cutaneous Photocarcinogenesis, and Photoprotective Strategies with Phytochemicals.� Antioxidants (Basel, Switzerland), MDPI, 26 Mar. 2015,

Danby, F William. �Nutrition and Aging Skin: Sugar and Glycation.� Clinics in Dermatology, U.S. National Library of Medicine, 2010,

Jennings, Kerri-Ann. � Collagen – What Is It and What Is It Good For?� Healthline, 9 Sept. 2016,

Jurgelewicz, Michael. �New Study Demonstrates the Benefits of Collagen Peptides for Improving Body Composition Combined with Exercise.� Designs for Health, 31 May 2019,

Knuutinen, A, et al. �Smoking Affects Collagen Synthesis and Extracellular Matrix Turnover in Human Skin.� The British Journal of Dermatology, U.S. National Library of Medicine, Apr. 2002,

Proksch, E, et al. �Oral Supplementation of Specific Collagen Peptides Has Beneficial Effects on Human Skin Physiology: a Double-Blind, Placebo-Controlled Study.� Skin Pharmacology and Physiology, U.S. National Library of Medicine, 2014,

Schauss, Alexander G, et al. �Effect of the Novel Low Molecular Weight Hydrolyzed Chicken Sternal Cartilage Extract, BioCell Collagen, on Improving Osteoarthritis-Related Symptoms: a Randomized, Double-Blind, Placebo-Controlled Trial.� Journal of Agricultural and Food Chemistry, U.S. National Library of Medicine, 25 Apr. 2012,

Zdzieblik, Denise, et al. �Collagen Peptide Supplementation in Combination with Resistance Training Improves Body Composition and Increases Muscle Strength in Elderly Sarcopenic Men: a Randomised Controlled Trial.� The British Journal of Nutrition, Cambridge University Press, 28 Oct. 2015,

Modern Integrative Wellness- Esse Quam Videri

By informing individuals about how the National University of Health Sciences provides the knowledge for future generations, the University offers a wide variety of medical professions for functional medicine.



The Top 9 Foods To Protect You From The Sun El Paso, TX.

The Top 9 Foods To Protect You From The Sun El Paso, TX.

The most important thing about summer is the food. Hotdogs and burgers on the grill and the seasonal fruits and vegetables that are ripe for the picking.� As much as we love the summer sun, it is still dangerous and can be harmful to our skin. We still put on sun cream, wear hats, and wear sun-protective clothing, but, did you know that certain foods can help heal your skin from sun damage and when possible can be eaten raw.

In the previous article, we talked about the 9 nutrients your skin needs to be protected from the harmful sun�s rays. Here is the top 9 food that will protect you from the sun and perfect for the summer.


When we think of vitamin C, our minds think of any citrus fruit like oranges, lemon, limes, and grapefruit. But did you know that guava contains vitamin C as well? In fact, guava contains about 5 times more of vitamin C as much as any citrus fruit.

Guava contains about 228.3 mg of vitamin C and has antioxidants that attack free radicals and helps boost your immune system. Vitamin C has been known to battle scurvy. Plus guava can help improve your skin. By eating the fruit or using the guava leaves, your skin will be toned and the antioxidants from the fruit can keep your skin glowing, fight wrinkles and reduce signs of premature aging.

Sweet Potato:

Who doesn�t love potatoes? We eat them as fries, baked, saut�ed, mashed and use them as filling for pies. The sweet potato is no exception. There are many variations of sweet potatoes as they come in orange, white, and purple, depending on where you get them from and which region.

The sweet potatoes we are familiar with have an orange hue due to the carotenoids; which gives us that lovely orange color and has antioxidants to protect our skin from sun damage. Not only that but; sweet potatoes are very high in vitamin A, which is very good when they are cooked. Some people say that potatoes are known to be very starchy and can be used to soothe a sunburn by drawing out the heat from the skin.


11860 Vista Del Sol, Ste. 128 The Top 9 Foods To Protect You From The Sun El Paso, TX.


Strawberries and Blueberries:

Both of these berries are great on their own but together, they are the dynamic duo to help our bodies combat the sun. Blueberries are richly filled with antioxidants as they combat the free radicals in our systems and can reduce the chances of cancer showing up.

Strawberries are really great as they are called �nature�s natural sunblock.� They contained about 108% of vitamin C as well as ellagic acid, which cleans up the free radicals and reduce sun-damaged pigmentation.� The Journal of Agricultural Food Chemistry stated that strawberries have anthocyanins, which gives the fruit its lovely red color to protect our cells.

Green Tea:

Who doesn�t love green tea? Not only it contains L-theanine, but it has many astounding health benefits that are wonderful and protects our body. Green tea can be consumed or used as a topical cream to soothe and hydrate your skin from the harsh sun rays. Green tea is jammed packed with vitamins B2 and E, as well as large amounts of polyphenol including, EGCG (Epigallocatechin Gallate).

These polyphenols help our inflammatory system repair our DNA from anything harsh in our bodies. Plus green tea has been known to lower the risk of various types of cancers.


Oatmeal is one of those foods that we all eat for breakfast. However, did you know that oatmeal can be used to soothe sunburns and exfoliate sun-damaged skin? Not only that but when oatmeal is finely grounded it is known as �colloidal oatmeal.�

You may have seen this type of oatmeal in the health/medical section in your local stores and it may be called, �Aveeno.� �Colloidal oatmeal has been approved by the FDA since 2003 and has been used as a topical ointment for anyone with eczema. Anyone with eczema experiences an abundance of itchiness when they are overly exposed by the sun�s rays or due to the heat of the summer knows this all too well.

With colloidal oatmeal, it helps relieve the symptoms of eczema by being applied with water and gently patting the topical on the source of eczema to lower the inflamed skin, thus calming it down.


Cucumbers are used for anything that we can think of. In the spa, in our salads, or as a wonderful snack. This green vegetable is packed with vitamins C and K as well as, caffeic acid and potassium. Not only that but cucumbers are made up of 96% of water, which is very refreshing and great for the skin. Since our bodies lose water when we sweat and cucumbers actually replenishes our water intake and�helps cool off our bodies when we are sunburned.


Just like strawberries, tomatoes contain lycopene, which gives tomatoes that gorgeous red color and has vitamins C. K1, and B9 and potassium. Tomatoes can be eaten raw and are rich with antioxidants that help balance our bodies pH balance. As well as, protecting our skin from the sun.


Oh, watermelon� not only you are the most consumed fruit for the 4th of July but you are one of the best summer fruits to be consumed. Watermelons contain not only vitamins A, B6 and C; but they also contained lycopene like tomatoes. Which helps our skin from photoaging from the sun but it�s in the top 30 most hydrating foods, next to cucumbers with 92% of water for excellent hydration properties for our skin.


Carrots are not only good for our eyes but did you know that carrots are jammed pack with beta-carotene, which turns to vitamin A when we eat it. Plus the sun exposure gives carrots vitamin C to help us protect our skin. Carrots have a wonderful source of carotenoids to produce photoprotection for our skin health.

Here at the clinic, we strive to inform our patients about the nutrients that food provides to our bodies. As well as, making our patients feel good with whole, nutritious options. Whether it is by adjustments or leading them to different food options for a healthy life, these top 9 foods not only help protect your skin from the sun but they also taste really good. So enjoy the summer months but remember to eat your photoprotective food.


NCBI Resources

A healthy diet is the cornerstone of good health.�You should maintain a diet�that includes lean meats, fresh fruits and vegetables, and whole grains. The key is choosing fresh, seasonal foods that are local to your area. Foods grown in their season have certain vitamins and minerals that the body needs for the time of year in which they are ripe and ready.




14 Powerful Health Benefits of Guava:

Authors’ Perspective: What is the Optimum Intake of Vitamin C in Humans?:

10 Proven Health Benefits of Blueberries:

Strawberry extract protects against UVA rays:

Soothe the Central Nervous System with L-Theanine:

10 Proven Benefits of Green Tea:

Anti-inflammatory activities of colloidal oatmeal (Avena sativa) contribute to the effectiveness of oats in the treatment of itch associated with dry, irritated skin:

Contribution of Water from Food and Fluids to Total Water Intake: Analysis of a French and UK Population Surveys:

Tomatoes protect against the development of UV-induced keratinocyte carcinoma via metabolomic alterations:

Watermelon lycopene and allied health claims:

Photoprotection by dietary carotenoids: concept, mechanisms, evidence and future development:

9 Essential Nutrients For Healthy Skin El Paso, TX.

9 Essential Nutrients For Healthy Skin El Paso, TX.

Everyone in the world wants healthy skin. We see it advertised on television with lotions and vitamin supplements. When we exercise and change our eating habits, we see our skin getting firmer with the foods we consume. However, whenever we are stressed, anxious, consuming junk food, or staying out in the sun too long; our skin takes a huge toll on our body. Our skin is the largest organ that covers our entire skeleton structure. When we expose our skin to harsh environments or have skin ailments that we contracted during our birth, our skin is depleted with the certain nutrients that our skin needs.


11860 Vista Del Sol, Ste. 128 9 Essential Nutrients For Healthy Skin El Paso, TX.


Glutathione is known as the �wonder drug� for skin lightening. For some darker toned individuals, it will lighten up their natural melanin. This stigma has been popularized by media influences so people can have �porcelain skin.� However, glutathione actually made up of three amino acids:

  • Glutamine
  • Glycine
  • Cysteine
11860 Vista Del Sol, Ste. 128 9 Essential Nutrients For Healthy Skin El Paso, TX.


This powerful antioxidant fights off free radicals in our immune system and is compatible with Vitamin E and C. For a natural way to make sure that your body keeps the glutathione nutrients when you get older with age, here are some vegetables that are enriched with glutathione:

  • Garlic
  • Onions
  • Avocado
  • Cabbage
  • Okra
  • Spinach
  • Kale
  • Cauliflower


Omega-3s is one of the most common supplements that is known for healthy skin. This supplement keeps the body healthy as well as preventing inflammation. Omega-3s are mostly in:

  • Fish
  • Legumes
  • Walnuts
  • Avocados
  • Eggs
  • Spinach

But, there are certain limitations on taking Omega-3 supplements if you have a seafood allergy or an egg allergy. People with these types of food allergens can talk with their physician about taking the omega-3 supplements in a pill form in low dosages or eat omega-3 enriched food.

Other patients with omega-3 deficiency have been known to have psoriasis, thus using a topical lotion infused with omega-3s have been known to calm down the inflammation.

Vitamin E:

Vitamin E is one of the oldest and most trustworthy supplements that has been used for 50 years and more in dermatology. This supplement works together with Vitamin C to combat against the sun; which is harmful to our skin.

Certain food groups that contain Vitamin E and Vitamin C are excellent sources for your overall health.


This supplement combined with chondroitin has been the combo duo to improve the hydration of the skin as well as reducing wrinkles and healing wounds on our skin.


Biotin is the three-for-one supplements that target your nails, hair, and skin. This supplement can be found in vitamin pills at your local stores and is highly recommended by dermatologists. However, some people have biotin and zinc deficiency that can be linked to skin abnormalities, thus, biotin plays an important role in our skin health.

You can either take the vitamin pill or incorporate certain food groups like eggs, nuts, whole grains, some dairy products, and certain vegetables in your diet to get the beneficiary nutrients to keep your skin healthy.


Also known as vitamin B3, has been known to support skin health. This nutrient has many beneficial effects to promote skin wellness. It is one of the most essential nutrients we consume since our bodies can�t produce it on their own. Some of the food groups are in the meat department and vegetarian department:

  • Mushrooms
  • Potatoes
  • Legumes
  • Whole grains
  • Meat
  • Fish
  • Eggs
  • Milk

Vitamin A:

Vitamin A is filled with nutrients as it contains beta-carotene, thus it is mostly fruits and vegetables that contain this supplement. This supplement plays an important role as it helps repair any skin deficiencies and eye health. Some of the foods that boost up vitamin A are:

  • Carrots
  • Broccoli
  • Cantaloupe
  • Squash

Vitamin C:

Vitamin C is one of the most top tiers of improving skin health and has many beneficial factors in our immune system. Some patients develop scurvy when they don�t have enough vitamin C in their system. It is mostly found in citrus fruit, which is one of the best ways to consume the vitamin into your system.

But, there is a catch when you are taking vitamin C. Vitamin C when exposed to light, can oxidize and become unstable. So if you are taking the supplement, it should be stored in a dark place and the PH should be at 3.5.


Zinc is one of the supplements that support healthy skin. This micronutrient can protect our skin from the sun and supports our inflammatory system. Some of the food that actually can help us prevent sun damage and give us a zinc supplement boost include seeds, meat, shellfish, dairy and dark chocolate.

When our skin needs these 9 nutrients, they are thanking us for taking the time to get the necessary supplements to make sure our bodies are still functional and that we live a long healthy life. Granted that the media has televised about many ways to promote skin health, but it actually starts with eating the right foods that our body craves. When we eat processed food and ingest artificial sugars into our bodies, we feel sluggish, our skin takes a toll on the lack of nutrients we are not giving and so many health problems that we will face.

Yes, we can take topical creams and lotions to nourish our skin and combat the dryness that our skin faces. But that can only go for so long unless we change our eating styles. Some people may freak out because they hear the word, �diet� and are limited to what they can eat. However, when it�s a health issue and our physicians tell us that we need to eat healthier, we give it a go. Therefore, eating right is a lifestyle choice and it starts with these 9 nutrients to make sure our largest organ is taken care of as well as the rest of our body system. When we cut back on the bad food and focusing on good food, our bodies feel so much better.


NCBI Resources

Living a healthy lifestyle and eating your basic food groups; whether it be plant-based or omnivorous, as well as, exercising a couple of times out of the year. A bad healthy lifestyle is eating processed food and not exercising, which leads to obesity and cardiac arrest. Depending on the person and the efforts that they are willing to maintain a healthy lifestyle, they can achieve longevity by taking care of their gut first and foremost.





Decreased skin-mediated detoxification contributes to oxidative stress and insulin resistance:

Glutathione for skin lightening: a regnant myth or evidence-based verify?:

Study on the use of omega-3 fatty acids as a therapeutic supplement in the treatment of psoriasis:

Protective effect against sunburn of combined systemic ascorbic acid (vitamin C) and d-alpha-tocopherol (vitamin E):

20 Foods That Are High in Vitamin E:

Glucosamine: an ingredient with skin and other benefits:

Skin manifestations of biotin deficiency:

9 biotin-rich foods to add to your diet:

Nicotinic acid/niacinamide and the skin:

20 Foods That Are High in Vitamin A:

Topical L-ascorbic acid: percutaneous absorption studies:

Innovative uses for zinc in dermatology:


Psoriasis: Conventional And Alternative Treatment

Psoriasis: Conventional And Alternative Treatment

Psoriasis Abstract

Psoriasis is a common T-cell-mediated immune disorder characterized by circumscribed, red, thickened plaques with an overlying silver-white scale. It occurs worldwide, although the incidence is lower in warmer, sunnier climates. The primary cause of psoriasis is unknown. During an active disease state, an underlying inflammatory mechanism is frequently involved. Many conventional treatments focus on suppressing symptoms associated with psoriasis and have significant side effects. This article reviews several of the researched natural approaches to psoriasis treatment, while addressing its underlying cause. (Altern Med Rev 2007;12(4):319-330)


Recent genetic and immunological advances have greatly increased understanding of the pathogenesis of psoriasis as a chronic, immune-mediated inflammatory disorder. The primary immune defect in psoriasis appears to be an increase in cell signaling via chemokines and cytokines that act on upregulated gene expression and cause hyper-proliferation of keratinocytes. A new understanding of this complex disease has catalyzed the development of targeted biological treatments. These revolutionary therapies are not without potential risk, however. A review of alternative natural therapies provides some options for increasing safety and efficacy in the management of psoriasis. Psoriasis � Pathophysiology, Conventional, and Alternative Approaches to Treatment Michael Traub, ND, and Keri Marshall MS, ND


The prevalence of psoriasis varies widely depending on ethnicity. Psoriasis occurs most commonly in Caucasians, with an estimated occurrence of 60 cases per 100,000/year in this population. Its prevalence in the United States is 2-4 percent, although it is rare or absent in Native American and certain African-American populations. While common in Japan, it is much less common in China, with an estimated incidence of 0.3 percent. The prevalence in the general population of Northern Europe and Scandinavia is 1.5-3 percent. Women and men are equally affected by this condition. The observation that latitude affects prevalence is most likely related to the beneficial effect of sunlight on the disease.1 Although psoriasis can occur at any age, the mean age of onset for chronic plaque psoriasis is estimated at 33 years, with 75 percent of cases initiated before age 46.2 The age of onset appears to be slightly earlier in women than men. Longitudinal studies suggest spontaneous remission may occur in about one-third of patients with psoriasis.3


Until recently psoriasis was considered a disorder of epidermal keratinocytes; however, it is now recognized primarily as an immune-mediated disorder. In order to properly understand the immune dysfunction present in psoriasis, it is imperative to understand the normal immune response of skin. Skin is a primary lymphoid organ with an effective immunological surveillance system equipped with antigen presenting cells, cytokine synthesizing keratinocytes, epidermotropic T cells, dermal capillary endothelial cells, draining nodes, mast cells, tissue macrophages, granulocytes, fibroblasts, and non-Langerhans cells. Skin also has lymph nodes and circulating T lymphocytes. Together these cells communicate by means of cytokine secretion and respond accordingly via stimulation by bacteria, chemical, ultraviolet (UV) light, and other irritating factors. The primary cytokine released in response to antigen presentation is tumor necrosis factor-alpha (TNF-?). Generally, this is a controlled process unless the insult to the skin is prolonged, in which case imbalanced cytokine production leads to a pathological state such as psoriasis.

Debate continues whether psoriasis is an autoimmune disorder or a T-helper 1 (Th1) immune dysfunction. T-cell activation, TNF-?, and dendritic cells are pathogenic factors stimulated in response to a triggering factor, such as a physical injury, inflammation, bacteria, virus, or withdrawal of corticosteroid medication. Initially, immature dendritic cells in the epidermis stimulate T-cells from lymph nodes in response to as yet unidentified antigen stimulation. The lymphocytic infiltrate in psoriasis is predominately CD4 and CD8 T cells. Adhesion molecules that promote leukocyte adherence are highly expressed in psoriatic lesions.4 After T cells receive primary stimulation and activation, a resulting synthesis of mRNA for interleukin-2 (IL-2) occurs, resulting in a subsequent increase in IL-2 receptors. Psoriasis is considered a Th1-dominant disease due to the increase in cytokines of the Th1 pathway � interferon gamma (IFN-?), IL-2, and interleukin 12 (IL-12) � found in psoriatic plaques.

The increased IL-2 from activated T cells and IL-12 from Langerhans cells ultimately regulate genes that code for the transcription of cytokines such as IFN-?, TNF-?, and IL-2, responsible for differentiation, maturation, and proliferation of T cells into memory effector cells. Ultimately, T cells migrate to the skin, where they accumulate around dermal blood vessels. These are the first in a series of immunologic changes that result in the formation of acute psoriatic lesions. Because the above-described immune response is a somewhat normal response to antigen stimulation, it remains unclear why the T-cell activation that occurs, followed by subsequent migration of leukocytes into the epidermis and dermis, creates accelerated cellular proliferation. Upregulated gene regulation may be a causative factor. Vascular endothelial growth factor (VEGF) and interleukin-8 released from keratinocytes may contribute to the vascularization seen in psoriasis.5

Dendritic cells appear to be involved in the pathogenesis of psoriasis. One type of dendritic cell involved is the Langerhans cells, the outermost sentinel of the immune system that recognizes and captures antigens, migrates to local lymph nodes, and presents them to T cells. The activation of T lymphocytes releases pro-inflammatory cytokines such as TNF-? that lead to keratinocyte proliferation. This hyperproliferative response decreases epidermal transit time (the approximate time it takes for normal maturation of skin cells) from 28 days to 2-4 days and produces the typical erythematous scaly plaques of psoriasis. This understanding of pathogenic mechanisms has led to the development and therapeutic use of TNF-? blocking agents.

About 30 percent of individuals with psoriasis have a family history of the disease in a first- or seconddegree relative. At least nine chromosomal susceptibility loci have been elucidated (PSORS1-9). HLA-Cw6 is a major determinant of phenotypic expression. An association with the PSORS has been found with functional polymorphisms in modifier genes that mediate inflammation (e.g., TNF-?) and vascular growth (e.g., VEGF).6

It is known that psoriasis develops in bone marrow transplant recipients from donors with psoriasis, clears in recipients from donors without psoriasis, and that immunosuppressive drugs are effective in reducing psoriasis.7,8 Given the genetic predisposition to this disease, what can be done to reduce the genetic expression besides resorting to immunosuppressive therapies? A naturopathic approach consists of dietary modification,�therapeutic fasting, omega-3 supplementation, topical natural medicines, herbal medicine, and stress management.

Pizzorno and Murray propose the above-mentioned �unidentified antigens� result from incomplete protein digestion, increased intestinal permeability, and food allergies; bowel toxemia (endotoxins); impaired liver detoxification; bile acid deficiencies; alcohol consumption; excessive consumption of animal fats; nutrient deficiencies (vitamins A and E, zinc, and selenium); and stress.9 These hypotheses, although plausible, have not been adequately tested.


Psoriasis is associated with several co-morbidities, including decreased quality of life, depression, increased cardiovascular risk, type 2 diabetes mellitus, metabolic syndrome, cancer, Crohn�s disease, and psoriatic arthritis. It remains unclear whether cancers, in particular skin cancer and lymphoma, are related to psoriasis or to its treatment. Phototherapy and immunosuppressive therapy can increase the risk of non-melanoma skin cancer, for example.10

Of particular concern is the observed link between psoriasis and cardiovascular disease. Evidence indicates psoriasis is an independent risk factor for cardiovascular disease.11 Dyslipidemia, coronary calcification, increased highly sensitive C-reactive protein (CRP), decreased folate, and hyperhomocysteinemia are found with significantly higher frequency in psoriasis patients.12 Inflammation is the common theme underlying both conditions, characterized by the presence of pro-inflammatory cytokines and endothelial activation.

The inflammatory processes underlying psoriasis also suggest the possibility of omega-3 fatty acid, folate, and vitamin B12 deficiencies, which are also often found in cardiovascular disease.13 High homocysteine and decreased folate levels correlate with Psoriasis Area and Severity Index (PASI). A rapid skin cell turnover rate in psoriasis may result in increased folate utilization and subsequent deficiency.14 The author of one study concludes: �Dietary supplementation of folic acid, B6, and B12 appears reasonable in psoriasis patients, particularly those with elevated homocysteine, low folate and additional cardiovascular risk factors.�15

Psoriatic arthritis is a clinical condition occurring in 25 percent of individuals afflicted with psoriasis.16 In approximately 10 percent of this population, the arthritic symptoms precede the skin lesions. Psoriatic arthritis often presents as seronegative inflammatory arthritis, with a classic presentation consisting of oligoarthritis, distal interphalangeal joint involvement, dactylitis (inflammation of the digits), and calcaneal inflammation.

Opinions conflict whether the skin condition and arthritis represent a differing manifestation of the same disease. Genetic evidence, immunological studies, and treatment response variability suggest they may be two different conditions, perhaps with similar underlying inflammation and immune irregularity.17,18

Although palmoplantar pustulosis (PP) is often described as a subtype of psoriasis, different demographics and genetic analysis suggests a different etiology than psoriasis. On appearance, PP has yellowbrown sterile pustules that appear on palms and soles. Only 25 percent of those affected report chronic plaque psoriasis. PP occurs more frequently in women (9:1/ female:male) and 95 percent of affected people have a current or previous history of smoking. As a result, PP may be considered a co-morbid condition rather than a distinct form of psoriasis.19

Diagnostic Criteria

Psoriasis is classified into several subtypes, with the chronic plaque (psoriasis vulgaris) form comprising approximately 90 percent of cases. Sharply demarcated erythematous silvery scaling plaques occur most commonly on the extensor surface of the elbows, knees, scalp, sacral, and groin regions. Other involved areas include the ears, glans penis, perianal region, and sites of repeated trauma. An active inflammatory case of psoriasis can demonstrate the Koebner phenomenon in which new lesions form at a site of trauma or pressure.

In the future, chronic plaque psoriasis might be found to consist of several related conditions with distinct phenotypical and genotypical characteristics, providing an explanation for its variable response to therapy, especially with biologic agents.

Inverse psoriasis occurs in intertriginous sites and skin folds and is red, shiny, and usually without scaling. Sebopsoriasis, which is often confused with seborrheic dermatitis, is characterized by greasy scales�in the eyebrows, nasolabial folds, and postauricular and presternal areas.

Acute guttate psoriasis occurs in children, adolescents, and young adults approximately two weeks after an acute beta-hemolytic streptococcal infection, such as tonsillitis or pharyngitis, or a viral infection. It manifests as an erythematous, papular eruption with lesions less than 1 cm in diameter on the trunk and extremities. Acute guttate psoriasis is usually self-limited, resolving within 3-4 months. One study indicated only one-third of individuals with guttate psoriasis develop classic plaque psoriasis.20

Pustular psoriasis (von Zumbusch) is also an acute psoriatic eruption. The patient presents with fever and small, monomorphic, painful, sterile pustules, often precipitated by an intercurrent infection or the abrupt withdrawal of systemic or superpotent topical steroids. It can be localized to the palms and soles (palmar-plantar psoriasis) or it can be generalized and potentially life-threatening.

Erythrodermic psoriasis, also life threatening, involves the entire body surface and can result in hypothermia, hypoalbuminemia, anemia, infection, and high-output cardiac failure.

Psoriatic nail disease occurs in approximately 50 percent of psoriasis patients and most commonly manifests as pitting. Other nail changes can include onycholysis, discoloration, thickening, and dystrophy.

Risk Factors

Development of psoriasis involves interaction of multiple genetic risk factors with environmental factors, such as beta-hemolytic streptococcal infection, HIV, stress, and medications (e.g., beta-blockers and lithium). As previously mentioned, folate and vitamin B12 deficiency can also predispose. In addition, there is evidence that alcoholism, cigarette smoking, obesity, type 2 diabetes mellitus, and metabolic syndrome increase risk for developing psoriasis.

With the exception of VEGF, no biomarkers have been found as reliable predictors of psoriasis activity. CRP, soluble adhesion molecules, and soluble cytokine receptors have been investigated but do not correlate with severity.21

Conventional Treatment

Conventional treatment of psoriasis is based on the degree of severity. Mild and limited psoriasis treatment includes topical corticosteroids, tars, anthralin, calcipotriene (a vitamin D3 analog), tazarotene (a retinoid), and phototherapy. Physicians can set realistic expectations for therapy, giving the patient control over the disease without expectation of complete cure. Scalp psoriasis usually responds to salicylic acid shampoos.

Narrow-band UVB is less effective but safer than psoralen plus ultraviolet A (PUVA), which carries with it an increased risk of skin cancer. Sun exposure is another form of phototherapy. UV exposure reduces antigen presenting and affects cell signaling, favoring development of T-helper 2 (Th2) immune responses. Antigen-presenting Langerhans cells are decreased in both number and function.22

A topical combination of calcipotriene and betamethasone (Taclonex�) has shown greater efficacy in severe psoriasis than monotherapy with either alone.23

Patient compliance must be considered when developing a treatment plan. The use of less messy topical solution and foam preparations of topical corticosteroids and calcipotriene (compared to ointments and creams) can improve compliance.

Systemic treatment of severe psoriasis usually involves the use of oral retinoids, methotrexate, cyclosporine, and biological agents that can significantly impact other bodily systems.

The oral retinoid acitretin is teratogenic and is converted to etretinate with concomitant alcohol ingestion. Etretinate has a longer half-life and is more teratogenic than acitretin. Female patients must use two forms of birth control and must not become pregnant for at least three years after treatment. Because of possible interaction with oral contraceptives, St. John�s wort (Hypericum perfoliatum) should be avoided. Other adverse effects include mucocutaneous effects, elevated triglycerides, alopecia, and hepatitis. Treatment with acitretin requires frequent monitoring of blood counts, comprehensive metabolic profiles, and urinalysis. Strategies to reduce acitretin toxicity include intermittent use, reduction of maintenance dose to every other day or every third day, combination treatment with PUVA or topical calcipotriene, low-fat diet, aerobic exercise, fish oil supplementation, and as stated above, alcohol avoidance.

Methotrexate (MTX) is the most commonly used systemic agent for psoriasis and, because it has been available for 35 years, most dermatologists are comfortable with its use. Methotrexate inhibits dihydrofolate reductase (resulting in a deficiency of active folic acid) and induces adenosine A1, a potent anti-inflammatory agonist. Its mechanism of action may be even more complex, evidenced by the fact that caffeine inhibits MTX�s anti-inflammatory effects in rheumatoid arthritis but not in psoriasis or psoriatic arthritis.24 The most common serious adverse effects of MTX are myelosuppression and liver fibrosis. While myelosuppression does not frequently occur, patients using MTX often report symptoms of headache, fatigue, and nausea. Folate supplementation reduces the incidence of megaloblastic anemia, hepatotoxicity, and gastrointestinal intolerance. Although folic acid and folinic acid appear to be equally effective, folic acid is more cost effective.25 However, a recent double-blind study of 22 psoriasis patients stable on long-term MTX therapy revealed folic acid reduced MTX�s efficacy in controlling psoriasis. Patients were randomly assigned to receive 5 mg/day folic acid or placebo for 12 weeks. The mean PASI increased (worsened) in the folic acid group, from 6.4 at baseline to 10.8 at 12 weeks. In the placebo group, the mean PASI fell from 9.8 at baseline to 9.2 at 12 weeks (p<0.05 for the difference in the change between groups).26

Cyclosporine, a potent and toxic drug, is sometimes considered for cases not controlled with acitretin, PUVA, or MTX, but is contraindicated in patients with abnormal renal function, poorly controlled hypertension, hepatic dysfunction, or immunosuppression. Prolonged use inevitably results in renal damage. Blood pressure and creatinine monitoring is essential.

Biological agents block T-cell activation and TNF-?. Alefacept (Amevive�) interferes with T-cell activation and reduces circulating CD 45 RO+ T cells. This drug is a fusion protein of the Fc receptor of human IgG1 and LFA3, a co-stimulatory ligand, which interacts with CD2 on the surface of T-cells. CD4 cells must be monitored weekly during treatment with this agent.

Efalizumab (Raptiva�) is a humanized antibody to CD11 that interferes with T-cell trafficking into inflamed tissues and prevents T-cell activation. Although it is rapidly effective, rebound may occur.

TNF-? blockers downregulate proinflammatory gene expression and reverse the psoriatic phenotype. Etanercept (Enbrel�) is a fusion protein directed against soluble TNF-?. Infliximab (Remicade�) is a mouse/human chimeric monoclonal antibody against soluble and cell-bound TNF-?, while adalimumab (Humira�) is a human monoclonal antibody against TNF-?. These TNF-? inhibitors are administered by injection and have been associated with the induction of various autoimmune phenomena. Like TNF-? itself, TNF-? inhibitors can have both proinflammatory and anti-inflammatory activities. Just because a particular agent blocks TNF-?, it does not necessarily benefit psoriasis. If a patient is genetically predisposed to overproducing TNF-?, blocking it may not be sufficient to produce benefit.27 Possible risks of TNF-? blockers include reactivation of latent tuberculosis, hepatotoxicity, lymphoma, and congestive heart failure.

Challenges that remain with biologics for psoriasis include: (1) understanding the predominant mechanism in psoriasis and psoriatic arthritis; (2) understanding different patient responses to therapy; (3) predicting clinical response before or early in therapy; (4) developing oral, inhaled, and topical formulations; and (5) determining whether treatment alters longterm outcome.

Fumaric acid is the primary psoriasis therapy in Germany. It decreases T-cell dependent cytokines, but is not as effective as other conventional treatments, and carries a high risk of toxicity and gastrointestinal intolerance.

Providing rotational and combination therapies increases efficacy and decreases toxicity of treatment. The future may bring stem-cell therapy and gene-based therapies, including �antisense� treatments that directly inhibit psoriasis-specific genes. However, the adverse effects and toxicity of conventional psoriasis treatments necessitate safer and effective natural treatments that can be used as alternatives or in an integrative fashion.

Natural Treatments For Psoriasis


An evidence-based approach suggests psoriasis, essentially an inflammatory disorder, should benefit from an anti-inflammatory diet, identification, elimination and/or rotation of allergenic foods, and therapeutic fasting.28-30 Although there is no published data on food allergy avoidance, many psoriasis patients show increased sensitivity to gluten and their psoriasis symptoms improve on a gluten-free diet.31 Measurement of antibodies to tissue transglutaminase and gliadin can help identify this subgroup. Evidence also suggests maintaining a healthy weight benefits psoriasis patients, since psoriasis positively correlates with increased body mass index.32

The balance between proinflammatory and anti-inflammatory eicosanoids is influenced in large part by the type of dietary fatty acids consumed. An antiinflammatory diet consists basically of an emphasis on �good fats� (cold water fish, nuts, seeds, olive oil, other high quality oils), whole grains, legumes, vegetables, and fruits and the avoidance of �bad fats� (saturated animal fats, trans fats, fried and processed foods, poor quality oils) and refined carbohydrates. In addition, an excessive amount of omega-6 fatty acids in the diet can contribute to an inflammatory response.33 The primary sources of dietary omega-6 oils are vegetable oils such as corn, soy, safflower, and sunflower, while the primary sources of arachidonic acid are meat, eggs, and dairy.

Prostaglandin E2 (PGE2) is a prominent eicosanoid derived from the omega-6 fatty acid arachidonic acid. A dominant action of PGE2 as a messenger molecule is to enhance sensitivity in pain neurons, increase swelling, and constrict blood vessels. Over-consumption of omega-6 oils provides excess substrate for the synthesis of PGE2, which drives an aggressive and sustained inflammatory response. Prostaglandin E3 (PGE3) is�derived from the omega-3 fatty acid, eicosapentaenoic acid (EPA). Higher levels of PGE3 reduce sensitivity to pain, relax blood vessels, increase blood flow, and support the body�s natural anti-inflammatory response (Figure 1).

psoriasis illustration

While both PGE2 and PGE3 are necessary for proper homeostasis, the relative amounts of these competing messenger molecules either contribute to or mitigate chronic inflammatory syndromes. EPA is thought to act by competing with arachidonic acid for binding sites on cyclooxygenase-2 (COX-2), producing a less potent inflammatory mediator, therefore reducing inflammation.34

Prior to the Industrial Revolution, there were no significant sources of omega-6 vegetable oils in the diet. Most cultures consumed diets low in these oils and high in fish or range-fed beef or bison higher in omega-3s, creating a ratio of omega-6:omega-3 that was approximately 3:1. The Industrial Revolution brought with it the knowledge and tools to refine vegetable oils, resulting in a rapid shift in dietary habits for most Western cultures. The ratio of omega-6:omega-3 was quickly pushed toward the current estimate of as high as 11:1 omega-6:omega-3.35 The human body has not been able to genetically adapt to this dramatic shift in fatty acid consumption.

Many modern cultures consume copious amounts of vegetable oils, mostly in processed foods. For example, soy oil production for food consumption increased 1,000-fold between 1909 and 1999.36 In addition, livestock, poultry, and farmed fish are being fed cornmeal and soy-based feed, which raises the omega-6 content of the meat and fish. When farm animals are raised on grass, worms, or other natural diets, the tissues are naturally higher in omega-3 fatty acids.37

The beef industry touts �marbling� in finished beef products, which is due to the corn and soy feed. Corn- and soy-fed cattle have a higher omega-6 fatty acid content compared to grass-fed cattle. While grassfed cattle can contain up to 4-percent omega-3 fatty acids, corn-fed cattle typically contains 0.5-percent omega-3s.37

The standard American diet supplies an average omega-6:omega-3 ratio of approximately 11:1. A vegetarian-based diet may put an individual at risk for�eating high amounts of vegetable oils and soy products, and low amounts of fish, which can tip the balance toward a pro-inflammatory state. Reducing dietary vegetable oils and increasing the omega-3 fats EPA and docosahexaenoic acid (DHA) by consuming fatty fish such as cod, salmon, mackerel, and sardines can benefit individuals experiencing chronic inflammatory conditions.33

Several herbs used as seasonings, including turmeric, red pepper, cloves, ginger, cumin, anise, fennel, basil, rosemary, garlic, and pomegranate, can block nuclear factor-kappaB (NF?B) activation of inflammatory cytokines.38

Dietary approaches that modify fatty acid intake can influence the eicosanoid profile in such a way that inflammatory processes such as arachidonic acid production and T-cell activation are dampened, while cytokines such as interleukin-4 (the primary cytokine responsible for stimulating a Th2 immune response) are upregulated.34

Nutritional Supplementation

Essential Fatty Acids

Essential fatty acids (EFAs) influence the pathophysiology of psoriasis in three ways: first, EFAs impact the kinetics of cell membranes; second, EFAs impact dermal and epidermal blood flow via improved endothelial function; and third, EFAs act as an immunomodulating agent through their impact on eicosanoids. EFAs are used as basic substrates in the development of the phospholipid bi-layer in virtually every cell in the human body, including the dermis and epidermis. They create structural integrity that regulates fluidity, which impacts cell transport, messenger binding, and cell communication. Omega-3 fatty acids can act both directly and indirectly on endothelial function by reducing mononuclear cell cytokines such as IL-1 and TNF?, 39 decreasing formation of chemo-attractant protein platelet-derived growth factor (PDGF), increasing bioavailability of nitric oxide, and reducing expression of adhesion molecules. The cumulative effect modulating these bioactive mediators is to prevent vascularization, or new blood vessel growth within the psoriatic plaque, while simultaneously allowing improved perfusion of dermal tissue.

Components of both natural and acquired immunity, including the production of key immune modulators, can be affected by omega-3 and -6 fatty acid intake, as discussed above. Immunomodulatory effects of omega-3 fatty acids include suppression of lymphoproliferation, CD4+ cells, antigen presentation, adhesion molecule presentation, Th1 and Th2 responses, and pro-inflammatory cytokine production.34

Several studies have demonstrated the benefit of intravenous or oral supplementation of fish oil for psoriasis.40-42 In a study by Mayser et al, intravenous infusions of omega-3 fatty acids led to an increase in the anti-inflammatory leukotriene B5 (LTB5) within 4-7 days of starting treatment, when compared to control patients.43 In this trial, patients received either an omega-3 or omega-6 preparation twice daily for 10 days. No side effects were noted.

EPA competes with arachidonic acid (AA) for 5-lipoxygenase and produces LTB5, which is only one-tenth as potent as the inflammatory mediator leukotriene B4 (LTB4). Levels of LTB4 have been shown to be elevated in psoriatic plaques and demonstrate chemotactic properties necessary for infiltration of leukocyte and keratinocyte proliferation.43

Ziboh�s review article on omega-3s and psoriasis references six studies conducted using oral fish oil supplementation with mixed results. Unfortunately, original references cannot be found. Two studies were double-blind and placebo-controlled, using 1.8 g EPA and DHA over courses of eight weeks and 12 weeks. The eight-week study demonstrated benefit in itching, scaling, and erythema, while the 12-week study showed no benefit.44

Three open studies were conducted, providing 10-18 g EPA and DHA daily for eight weeks. All studies showed improvement, with two studies demonstrating mild-to-moderate and one study demonstrating moderate-to-excellent improvement in scaling, itching, and lesion thickness. One open study combined with a low-fat diet showed a significant reduction in psoriatic symptoms.44,45

Several studies have explored the use of topical fish oil at varying EPA concentrations. Some studies reported benefits, including a reduction in plaque thickness and scaling.46,47 In one study by Puglia et al, fish oil extracts and ketoprofen were applied topically to�psoriatic lesions, with an observed reduction in erythema.48 The most significant drawback to topical fish oil application is compliance due to the odor.

Fish oil has also proven to be beneficial in autoimmune joint conditions such as rheumatoid arthritis (RA).49 While fish oil supplementation has not been used in clinical trials for the treatment of psoriatic arthritis, it may be beneficial in treating this condition, which has many similarities to RA, including a common underlying inflammatory mechanism and immune dysfunction.


Methotrexate therapy results in a folate deficiency. As mentioned above, in patients receiving MTX for psoriasis, folate supplementation reduced the incidence of hepatotoxicity and gastrointestinal intolerance but might impair the efficacy of MTX.24 When supplementing with folic acid or the active forms, folinic acid or 5-methyltetrahydrofolate, the recommended dose is 1-5 mg/day.

Bioactive Whey Protein Isolate

XP-828L is a novel dietary supplement made of a protein extract derived from bovine whey that has recently been shown to be beneficial in psoriasis.50,51 The bioactive profile of XP-828L is likely due to the presence of growth factors, immunoglobulins, and active peptides found in this specific whey extract. An in vitro study demonstrated XP-828L has immune-regulating effects, including inhibiting the production of Th1 cytokines such as IFN-g and IL-2, which may make it effective in treating T-helper 1-related disorders, such as psoriasis.52

An open-label study was conducted on 11 adult patients with chronic, stable plaque psoriasis on two percent or more of total body surface area. Study participants received 5 g twice daily of XP-828L for 56 days. Evaluations using PASI and Physician�s Global Assessment (PGA) scores were made on the initial screening day and again on days 1, 28, and 56. At the conclusion of the study, seven of the 11 subjects had a reduced PASI score that ranged from 9.5 percent to 81.3 percent.50 The results of a larger double-blind,�placebo-controlled study of 84 individuals with mildto-moderate psoriasis showed XP-828L (5 g/day for 56 days) significantly reduced the PGA score compared to placebo (p<0.05). No adverse affects were noted from any study participants in either study.50,51

Vitamin D

It has been established that patients with disseminated psoriasis have significantly decreased serum levels of the biologically active form of vitamin D, 1-alpha,25-dihydroxyvitamin D3 (1-?,25(OH)2D3; calcitriol) compared to age- and sex-matched controls and also compared to patients with moderate psoriasis.53 Whether this is a contributing factor to psoriasis or a result of the disorder has not been elucidated.

Keratinocytes in the epidermis convert 7-dehydrocholesterol to vitamin D3 in the presence of UVB. Sunlight, UVB phototherapy, oral calcitriol, and topical vitamin D analogs are effective therapy for psoriasis due to vitamin D�s anti-proliferative and pro-differentiating actions on keratinocytes.54-56

Calcitriol-binding to vitamin D receptors (VDR) in the skin modulates the expression of a large number of genes including cell cycle regulators, growth factors, and their receptors. Polymorphisms of the VDR gene are associated with psoriasis and may predispose to the development of psoriasis and resistance to calcipotriol therapy, as well as contribute to liver dysfunction in patients with psoriasis.57

Given vitamin D�s importance in psoriasis, cancer, inflammatory diseases, and other conditions, it has been suggested by some investigators that recommendations for sun protection and skin cancer prevention may need to be re-evaluated to allow for sufficient vitamin D status. A recent study showed abundant sun exposure in a sample of adults in Hawaii did not necessarily ensure vitamin D adequacy, which points to the need for vitamin D supplementation to achieve optimal blood levels.58

Studies have demonstrated that oral vitamin D can be safely taken in daily doses of up to 5,000 IU, with some experts recommending up to 10,000 IU daily to correct a deficiency.59-61 Oral and topical vitamin D, sunlight, and UVB phototherapy have shown considerable efficacy in the treatment of psoriasis.56

Topical Treatments Of Psoriasis

Several topical treatments for psoriasis may provide benefit, including calcipotriene (Dovonex�; a synthetic vitamin D3 analogue), Berberis aquifolium cream (10%)62 (Psoriaflora�; Relieva�), curcumin gel (1%), Aloe vera, and a flavonoid-rich salve (Flavsalve�).

Curcumin gel yielded 90-percent resolution of plaques in 50 percent of patients within 2-6 weeks; the remainder of the study subjects showed 50- to 85-percent improvement. Curcumin was found to be twice as effective as calcipotriol cream (which generally takes three months to exert its full effect). The mechanism of curcumin is as a selective phosphorylase kinase inhibitor, thereby reducing inflammation through inhibition of NF?B.63

A controlled trial of Aloe vera extract cream (0.5%) in 60 patients for 4-12 months demonstrated a significant clearing of psoriatic plaques (82.8%) compared to placebo (7.7%) (p<0.001). In addition, the PASI decreased to a mean of 2.2.64

The scaliness of psoriasis benefits from the use of emollients. Intercellular lipids such as ceramides (lipid molecules composed of fatty acids and sphingosine) play an important role in the regulation of skin-water barrier homeostasis and water-holding capacity. It has been shown that ceramides are decreased in the psoriatic epidermis. Newer ceramide-containing emollients (e.g., CeraVe�, Mimyx�, Aveeno Eczema Care) have shown benefit in psoriasis and may improve skin barrier function and decrease water loss.65

Botanical Influences

A Chinese herbal formula (Herose� Psoria Capsule) has demonstrated safety and efficacy in the treatment of severe plaque psoriasis.66 Herose consists of rhizoma Zingiberis, radix Salviae miltiorrhizae, radix Astragali, ramulus Cinnamomi, radix Paeoniae alba, radix Codonopsis pilosula, and semen Coicis. In an openlabel trial, 15 subjects took four Herose capsules (450 mg each) three times daily for 10 months. The investigator evaluated the PASI and therapeutic response to Herose for each patient. The formula is intended for warming the yang and promoting blood circulation.

Lifestyle Interventions

Lifestyle factors such as cigarette smoking and alcohol consumption are associated with severity of psoriasis.67 Physical activity and outdoor activities (taking precautions not to sunburn) are beneficial.68 Bathing and sunbathing at the Dead Sea for four weeks resulted in a decrease of PASI of 81.5 percent, a 78-percent decrease in keratinocyte hyperplasia, and almost total elimination of T lymphocytes from the epidermis, with a low number remaining in the dermis.69

Stress management can benefit individuals with psoriasis. Subjects who listened to a guided meditation tape while undergoing phototherapy cleared four times faster than those who received phototherapy only, as judged by two independent dermatologists. Psoriasis status was assessed in three ways: direct inspection by clinic nurses; direct inspection by physicians blinded to the patient�s study condition (tape or no-tape); and blinded physician evaluation of photographs of psoriasis lesions. Four sequential indicators of skin status were monitored during the study: a First Response Point, a Turning Point, a Halfway Point, and a Clearing Point. Subjects in the tape groups reached the Halfway Point (p= 0.013) and the Clearing Point (p=0.033) significantly more rapidly than those in the no-tape condition, for both UVB and PUVA treatments.70 Finally, psychotherapy can be an essential adjunct for individuals with persistent unresolved psychological issues such as anxiety, depression, and the psychosocial stress of this chronic skin disease.


Psoriasis is characterized by T-cell activation that releases pro-inflammatory cytokines such as TNF-?, leading to keratinocyte proliferation and the typical skin lesions of psoriasis.

The conventional approach to psoriasis consists of utilizing topical and/or oral corticosteroids, other immunosuppressant drugs, oral retinoids, UV light, and several (not necessarily novel, having been used previously for Crohn�s and RA) biological agents. Although these treatments can be highly effective at controlling the disease, none are universally safe and effective, and each carries a considerable risk profile.

There is some evidence for the use of dietary modification and fish oil to decrease inflammation in psoriasis. More research is warranted to clarify the use�of these and various topical botanical therapies and lifestyle interventions for improving clinical symptoms, decreasing the phenotypic expression of psoriasis, and providing safe and effective treatments.



1. Griffiths CEM, Camp RDR, Barker JNWN.
Psoriasis. In: Burns DA, Breathnach SM, Cox N,
Griffiths CE, eds. Rook�s Textbook of Dermatology. 7th
ed. Oxford: Blackwell; 2005:35.1-35.69.
2. Nevitt GJ, Hutchinson PE. Psoriasis in the
community; prevalence, severity and patients belief
and attitudes towards the disease. Br J Dermatol
3. Farber EM, Nall ML. The natural history of psoriasis
in 5600 patients. Dermatologica 1974;148:1-18.
4. Robert C, Kupper TS. Inflammatory skin diseases,
T cells and immune surveillance. N Engl J Med
5. Simonetti O, Lucarini G, Goteri G, et al. VEGF is
likely a key factor in the link between inflammation
and angiogenesis in psoriasis: results of an
immunohistochemical study. Int J Immunopathol
Pharmacol 2006;19:751-760.
6. Capon F, Munro M, Barker J, Trembath R. Searching
for the major histocompatibility complex psoriasis
susceptibility gene. J Invest Dermatol 2002;118:745-
7. Wahie S, Alexandroff A, Reynolds NJ, Meggit SJ.
Psoriasis occurring after myeloablative therapy and
autologous stem cell transplantation. Br J Dermatol
8. Eedy DJ, Burrows D, Bridges JM, Jones FG.
Clearance of severe psoriasis after allogenic bone
marrow transplantation. BMJ 1990;300:908.
9. Pizzorno JE, Murray MT. Textbook of Natural
Medicine. 3rd ed. St. Louis, MO: Churchill
Livingstone; 2006:2080.
10. Lindelof B, Eklund G, Liden S, Stern RS. The
prevalence of malignant tumors in patients with
psoriasis. J Am Acad Dermatol 1990;22:1056-1060.
11. Mrowietz U, Elder JT, Barker J. The importance of
disease associations and concomitant therapy for the
long-term management of psoriasis patients. Arch
Dermatol Res 2006;298:309-319.
12. Rocha-Pereira P, Santos-Silva A, Rebelo I, et al.
Dyslipidemia and oxidative stress in mild and in
severe psoriasis as a risk for cardiovascular disease.
Clin Chim Acta 2001;303:33-39.
13. Ludwig RJ, Herzog C, Rostock A, et al. Psoriasis:
a possible risk factor for development of coronary
artery calcification. Br J Dermatol 2007;156:271-276.

14. Vanizor Kural B, Orem A, Cimsit G, et al.
Plasma homocysteine and its relationships with
atherothrombotic markers in psoriatic patients. Clin
Chim Acta 2003;332:23-30.
15. Malerba M, Gisondi P, Radaeli A, et al. Plasma
homocysteine and folate levels in patients
with chronic plaque psoriasis. Br J Dermatol
16. Zachariae H. Prevalence of joint disease in patients
with psoriasis: implications for therapy. Am J Clin
Dermatol 2003;4:441-447.
17. Ho P, Bruce IN, Silman A, et al. Evidence for
common genetic control in pathways of inflammation
for Crohn�s disease and psoriatic arthritis. Arthritis
Rheum 2005;52:3596-3602.
18. Pitzalis C, Cauli A, Pipitone N, et al. Cutaneous
lymphocyte antigen-positive T lymphocytes
preferentially migrate to the skin but not to the joint
in psoriatic arthritis. Arthritis Rheum 1996;39:137-
19. Asumalahti K, Ameen M, Suomela S, et al. Genetic
analysis of PSORS1 distinguishes guttate psoriasis
and palmoplantar pustulosis. J Invest Dermatol
20. Martin BA, Chalmers RJ, Telfer NR. How great
is the risk of further psoriasis following a single
episode of acute guttate psoriasis? Arch Dermatol
21. Creamer D, Allen MH, Groves RW, Barker JN.
Circulating vascular permeability factor/vascular
endothelial growth factor in erythroderma. Lancet
22. Zanolli MD, Camisa C, Feldman S, et al. Psoriasis:
the high notes on current treatment. Program of the
American Academy of Dermatology, Academy 2000;
August 5, 2000; Nashville, TN.
23. Kaufmann R, Bibby AJ, Bissonnette R, et al. A new
calcipotriol/betamethasone dipropionate formulation
(Daivobet) is an effective once-daily treatment for
psoriasis vulgaris. Dermatology 2002;205:389-393.
24. Swanson DL, Barnes SA, Mengden Koon SJ, elAzhary
RA. Caffeine consumption and methotrexate
dosing requirement in psoriasis and psoriatic arthritis.
Int J Dermatol 2007;46:157-159.
25. Strober BE, Menon K. Folate supplementation during
methotrexate therapy for patients with psoriasis. J
Am Acad Dermatol 2005;53:652-659.
26. Salim A, Tan E, Ilchyshyn A, Berth-Jones J. Folic acid
supplementation during treatment of psoriasis with
methotrexate: a randomized, double-blind, placebocontrolled
trial. Br J Dermatol 2006;154:1169-1174.
27. Fiorentino D. The yin and yang of TNF-(alpha)
inhibition. Arch Dermatol 2007;143:233-236.
28. Wolters M. Diet and psoriasis: experimental data and
clinical evidence. Br J Dermatol 2005;153:706-714.
29. Brown AC, Hairfield M, Richards DG, et al. Medical
nutrition therapy as a potential complementary
treatment for psoriasis � five case reports. Altern Med
Rev 2004;9:297-307.
30. Lithell H, Bruce A, Gustafsson IB, et al. A fasting
and vegetarian diet treatment trial on chronic
inflammatory disorders. Acta Derm Venereol
31. Chalmers RJ, Kirby B. Gluten and psoriasis. Br J
Dermatol 2000;142:5-7.
32. Naldi L, Parazzini F, Peli L, et al. Dietary factors and
the risk of psoriasis. Results of an Italian case-control
study. Br J Dermatol 1996;134:101-106.
33. Adam O, Beringer C, Kless T, et al. Antiinflammatory
effects of a low arachidonic acid diet
and fish oil in patients with rheumatoid arthritis.
Rheumatol Int 2003;23:27-36.
34. Calder PC. n-3 Polyunsaturated fatty acids,
inflammation, and inflammatory diseases. Am J Clin
Nutr 2006;83:1505S-1519S.
35. Yehuda S.Omega-6/omega-3 ratio and brain-related
functions. World Rev Nutr Diet 2003;92:37-56.
36. Sirtori CR. Risks and benefits of soy phytoestrogens
in cardiovascular diseases, cancer, climacteric
symptoms and osteoporosis. Drug Saf 2001;24:665-
37. Marchello MJ, Driskell JA. Nutrient composition of
grass- and grain-finished bison. Great Plains Research
38. Aggarwal BB, Shishodia S. Suppression of the
nuclear factor-kappaB activation pathway by spicederived
phytochemicals: reasoning for seasoning. Ann
N Y Acad Sci 2004;1030:434-441.
39. Yaqoob P. Fatty acids as gatekeepers of immune cell
regulation. Trends Immunol 2003;24:639-645.
40. Bittiner SB, Tucker WF, Cartwright I, Bleehen SS. A
double-blind, randomised, placebo-controlled trial of
fish oil in psoriasis. Lancet 1988;1:378-380.
41. Gupta AK, Ellis CN, Tellner DC, et al. Double-blind,
placebo-controlled study to evaluate the efficacy
of fish oil and low-dose UVB in the treatment of
psoriasis. Br J Dermatol 1989;120:801-807.
42. Mayser P, Mrowietz U, Arenberger P, et al. Omega-3
fatty acid-based lipid infusion in patients with
chronic plaque psoriasis: results of a double-blind,
randomized, placebo-controlled, multicenter trial. J
Am Acad Dermatol 1998;38:539-547.
43. Mayser P, Grimm H, Grimminger F. n-3 fatty acids in
psoriasis. Br J Nutr 2002;87:S77-S82.
44. Ziboh VA. The role of n-3 fatty acids in psoriasis. In:
Kremer J, ed. Medicinal Fatty Acids in Inflammation.
Basel, Switzerland: Birkhauser Verlag; 1998:45-53.

45. Calder PC. n-3 Polyunsaturated fatty acids,
inflammation and immunity: pouring oil on troubled
waters or another fishy tale? Nutr Res 2001;21:309-
46. Zulfakar MH, Edwards M, Heard CM. Is there a role
for topically delivered eicosapentaenoic acid in the
treatment of psoriasis? Eur J Dermatol 2007;17:284-
47. Richards H, Thomas CP, Bowen JL, Heard CM.
In vitro transcutaneous delivery of ketoprofen and
polyunsaturated fatty acids from a pluronic lecithin
organogel vehicle containing fish oil. J Pharm
Pharmacol 2006;58:903-908.
48. Puglia C, Tropea S, Rizza L, et al. In vitro
percutaneous absorption studies and in vivo
evaluation of anti-inflammatory activity of essential
fatty acids (EFA) from fish oil extracts. Int J Pharm
49. Cleland LG, James MJ. Fish oil and rheumatoid
arthritis: antiinflammatory and collateral health
benefits. J Rheumatol 2000;27:2305-2307.
50. Poulin Y, Pouliot Y, Lamiot E, et al. Safety and
efficacy of a milk-derived extract in the treatment of
plaque psoriasis: an open-label study. J Cutan Med
Surg 2005;9:271-275.
51. Poulin Y, Bissonnette R, Juneau C, et al. XP-828L
in the treatment of mild to moderate psoriasis:
randomized, double-blind, placebo-controlled study. J
Cutan Med Surg 2006;10:241-248.
52. Aattouri N, Gauthier SF, Santure M, et al.
Immunosuppressive effect of a milk-derived extract.
12th International Congress of Immunology and 4th
Annual Conference of FOCIS. Montreal, Canada;
July 18-23, 2004.
53. Staberg B, Oxholm A, Klemp P, Christiansen C.
Abnormal vitamin D metabolism in patients with
psoriasis. Acta Derm Venereol 1987;67:65-68.
54. Reichrath J. Vitamin D and the skin: an ancient
friend, revisited. Exp Dermatol 2007;16:618-625.
55. Osmancevic A, Landin-Wilhelmsen K, Larko O,
et al. UVB therapy increases 25(OH) vitamin D
syntheses in postmenopausal women with psoriasis.
Photodermatol Photoimmunol Photomed 2007;23:172-
56. Perez A, Raab R, Chen TC, et al. Safety and efficacy
of oral calcitriol (1,25-dihydroxyvitamin D3) for the
treatment of psoriasis. Br J Dermatol 1996;134:1070-
57. Okita H, Ohtsuka T, Yamakage A, Yamazaki
S. Polymorphism of the vitamin D(3) receptor
in patients with psoriasis. Arch Dermatol Res
58. Binkley N, Novotny R, Krueger D, et al. Low vitamin
D status despite abundant sun exposure. J Clin
Endocrinol Metab 2007;92:2130-2135.
59. Grant WB, Holick MF. Benefits and requirements of
vitamin D for optimal health: a review. Altern Med
Rev 2005;10:94-111.
60. Hollis BW. Circulating 25-hydroxyvitamin
D levels indicative of vitamin D sufficiency:
implications for establishing a new effective dietary
intake recommendation for vitamin D. J Nutr
61. Vieth R, Bischoff-Ferrari H, Boucher BJ, et al. The
urgent need to recommend an intake of vitamin D
that is effective. Am J Clin Nutr 2007;85:649-650.
62. Gulliver WP, Donsky HJ. A report on three recent
clinical trials using Mahonia aquifolium 10% topical
cream and a review of the worldwide clinical
experience with Mahonia aquifolium for the treatment
of plaque psoriasis. Am J Ther 2005;12:398-406.
63. Heng MC, Song MK, Harker J, Heng MK. Druginduced
suppression of phosphorylase kinase activity
correlates with resolution of psoriasis as assessed
by clinical, histological and immunohistochemical
parameters. Br J Dermatol 2000;143:937-949.
64. Syed TA, Ahmad SA, Holt AH, et al. Management
of psoriasis with Aloe vera extract in a hydrophilic
cream: a placebo-controlled, double-blind study. Trop
Med Int Health 1996;1:505-509.
65. Lew BL, Cho Y, Kim J, et al. Ceramides and cell
signaling molecules in psoriatic epidermis: reduced
levels of ceramides, PKC-alpha, and JNK. J Korean
Med Sci 2006;21:95-99.
66. Yuqi TT. Review of a treatment for psoriasis using
Herose, a botanical formula. J Dermatol 2005;32:940-
67. Chodorowska G, Kwiatek J. Psoriasis and cigarette
smoking. Ann Univ Mariae Curie Sklodowska [Med]
68. Schiener R, Brockow T, Franke A, et al. Bath PUVA
and saltwater baths followed by UV-B phototherapy
as treatments for psoriasis: a randomized controlled
trial. Arch Dermatol 2007;143:586-596.
69. Hodak E, Gottlieb AB, Segal T, et al. Climatotherapy
at the Dead Sea is a remittive therapy for psoriasis:
combined effects on epidermal and immunologic
activation. J Am Acad Dermatol 2003;49:451-457.
70. Kabat-Zinn J, Wheeler E, Light T, et al. Influence
of a mindfulness meditation-based stress reduction
intervention on rates of skin clearing in patients
with moderate to severe psoriasis undergoing
phototherapy (UVB) and photochemotherapy
(PUVA). Psychosom Medicine 1998;60:625-632.

Close Accordion
10 Home Remedies That Beat Skin Creams for Sunburn

10 Home Remedies That Beat Skin Creams for Sunburn

Summer’s officially just a week away, and millions of Americans are facing high odds of suffering from sunburn in coming months.

If you catch too many rays and wind up looking like a lobster, head straight to your kitchen. No kidding. Here are some surprising home remedies to soothe the burn that are as good as — or better than — commercially available skin creams and lotions:

Cucumbers: These vegetables are rich in vitamin C and caffeic acid, both of which help to soothe irritated skin and reduce swelling. Cukes also have compounds with analgesic properties to numb pain. You can slice cold cucumbers and apply them to burned areas. Better yet, make a paste by mashing or blending a couple of cucumbers and apply it chilled.

Lettuce: The greens have painkilling compounds that can take the sting out of sunburn. Boil the leaves in water, then strain and chill the liquid. Apply the fluid with cotton balls.

Potatoes: These tubers have been used throughout history to ease burns, bites, scrapes, and other skin problems. Blend one or two until they get pasty — you may have to add a splash of water — then chill the paste and apply via cotton balls.

Honey: This remedy for burns goes back to ancient Egyptian times. Honey reduces inflammation, provides nutrients to the damaged tissue and seals in moisture. It also has antiseptic properties. Just spread some of the sweet stuff where it hurts.

Apple cider vinegar: A common home remedy for a variety of problems from poison ivy to acid reflux to allergies, the cider also works on sunburn. You may want to dilute it a little since one of the active ingredients, acetic acid, may sting when applied. Use cotton balls or soak a washcloth in the solution for more coverage.

Coconut oil: You can use this for both protection — it has a sun protection factor (SPF) somewhere between 5 and 10 — and relief if you just stay out too long without any other sunscreen. Apply it directly to sunburned areas and you can feel its soothing effects as its medium-chain fats are absorbed into your skin and work their healing magic.

Oatmeal: Regular rolled oats will do just fine as the oatmeal’s polysaccharides will help to heal your skin. Put about 2 cups into a clean tube sock and add it to a tub of tepid water. Let it soak a few minutes, then climb in. Squeeze out the sock every few minutes, which will turn the water cloudy. When you’re done, air dry or pat yourself off gently with a soft towel.

Yogurt: Yogurt contains probiotics and proteins that will help to heal your skin. Make sure the yogurt is plain with no flavoring and also that it has live, active cultures. Spread it around the burned areas, let it sit for about five minutes, then rinse it off with tepid water.

Witch hazel: The tannins from the plant’s liquid extract reduce inflammation, kill bacteria and repair damaged skin. Use cotton balls or a clean cloth to dab it on sore areas. Reapply as needed.

Aloe vera: The gel from the fleshy leaves of this plant is rich in glyconutrients that soothe and heal all kinds of skin problems, including burns. Slice open a leaf and the gel will ooze out. Apply it directly to sunburned areas.

When suffering from sunburn, also be sure to drink plenty of water, because you’re probably dehydrated too. And try to avoid harsh soaps that will wash away the natural oils of your skin and further dry it out.

Of course, the best sunburn remedy is prevention. That means staying out of the sun during peak hours, typically between 10 a.m. and 2 p.m. And dermatologists strongly recommend wearing a hat, covering exposed areas with clothing and using sunscreen with a SPF of 15 or higher.

Look for sunscreen labeled “full spectrum” to make sure it screens out both UVA and UVB rays. But beware that a lot of sunscreens have toxic chemicals. Your best bet is to check out the Environmental Working Group’s Skin Deep database online to find the safest products.

Seniors Face Steep Costs for Many Generic Skin Creams

Seniors Face Steep Costs for Many Generic Skin Creams

Prices for generic topical steroids to treat skin conditions like eczema and psoriasis are on the rise, and many seniors may pay more for generic medications than the brand-name versions, a U.S. study finds.

Researchers compared average out-of-pocket patient costs as well as spending by Medicare, the U.S. health insurance program for people 65 and older, for several commonly prescribed topical corticosteroids that have been used for decades to treat a wide variety of inflammatory skin conditions.

Medicare Part D, the drug benefit program, spent $2.3 billion on topical steroids between 2011 and 2015, the study found. During that period, spending surged 227 percent while the number of prescriptions increased just 37 percent.

If doctors had prescribed the cheapest version when a variety of similarly effective options were available, Medicare could have saved $944.8 million, the researchers calculate.

Patients could have saved a lot too; seniors’ annual out-of-pocket spending for topical steroids grew from $41.4 million to $101.8 million, 146 percent, during the study period.

“Patients often have difficulty paying for their medications and many patients on Medicare are retired and on fixed incomes,” said senior study author Dr. Arash Mostaghimi, a dermatology researcher at Harvard Medical School and Brigham and Women’s Hospital in Boston.

“Paying extra for their medications may mean going without other medications or sometimes food,” Mostaghimi said by email.

Generics accounted for almost 98 percent of total spending on topical steroids during the study period, the researchers report in JAMA Dermatology.

In theory, generic drugs are supposed to come on the market after brand-name versions lose U.S. patent protection and help lower prices by increasing competition. The study of topical steroid costs, however, offers one look at a much more complex and confusing reality.

For the study, researchers examined costs for drugs grouped based on potency, or how much medication is blended into the ointments and creams. They sorted drugs into five classes, with one being the most potent and five being the weakest potency.

Costs grew at the slowest rate, 23 percent, for the weakest steroids, the study found. By contrast, costs rose the most, 604 percent overall, for the most potent group of steroids.

Within that group of most potent steroids, the steepest increase in average user costs was for clobetasol propionate (Temovate), which is used to treat itching and inflammation from skin issues caused by allergic reactions, eczema and psoriasis. During the study, user costs for this drug climbed by more than 605 percent.

Limitations of the study include the lack of data on certain drug manufacturer rebates that might help lower costs, the authors note. Researchers also didn’t know if doctors had certain clinical reasons for choosing specific versions of similar medicines.

Still, the study illustrates something doctors already see all the time: that these costs often take a toll on patients, said Dr. Joslyn Kirby, author of an accompanying editorial and a dermatology researcher at Penn State Hershey Medical Center.

One challenge for doctors is that they can’t always see what different steroids of similar potency cost when they prescribe the drugs, because that’s not in electronic medical records, Kirby said by email.

“I ask my patients to contact me and let me know if the medication I prescribed during the appointment is too expensive when they go to the pharmacy,” Kirby added. “I need my patients to know that it’s ok to tell me that something is too expensive, because I can work with our staff to find an alternative or a solution.”


Simple Ways To Detox Your Skin For Spring

Simple Ways To Detox Your Skin For Spring

Simple Ways To Detox Your Skin For�Spring

With spring here, and summer around the corner, this is the perfect time to revamp your anti-aging and skin care routine. The following tips provide a multipronged approach to jump-start your healthy changes!

Eating a diet rich in vegetables, fruits, legumes, nuts, seeds, and whole grains while minimizing processed/prepackaged foods can improve your complexion. Diversity within these wholesome�

View On WordPress