Addressing psoriasis with a gluten free diet and removing other inflammatory food allergens may be an important dietary strategy as part of a holistic treatment protocol.
Psoriasis is a formidable global health issue, casting its shadow over a staggering 100 million individuals worldwide, as per the WHO Global Report on Psoriasis (1). Its incidence, ranging from 0.09% to 11.43%, exhibits geographic and ethnic variability. In Europe, Nordic populations bear a greater burden than their Mediterranean counterparts, and Caucasians are more prone to it than Asians and African Americans (1).
History of psoriasis
Since the time of the renowned Greek physician Hippocrates, who first described this ailment around 460 BC, the medical community has diligently sought to unravel the enigma of its origins. Today, much about the causes of psoriasis remains a mystery. While there is a genetic predisposition, it is the influence of external/internal triggers and risk factors that precipitate its onset. It is only when these factors come into play that inflammatory processes seize the skin cells, causing uncontrolled proliferation. The dermatological manifestations of psoriasis are diverse, with psoriasis vulgaris, also known as plaque-type psoriasis, being the most prevalent. Typically, affected areas include the elbows, knees, and scalp, but manifestations can also emerge in other locations such as the eyelids, ears, mouth, lips, hands, feet, and nails. Clinical features, especially the size and distribution of psoriatic lesions, allow for the classification of psoriasis into plaque, guttate, pustular, and erythrodermic types (2–5).
Psoriasis can have a profound impact on quality of life, leading to reduced work productivity, physical disability, depression, and impaired social relationships (6,7).
Environmental factors can exacerbate symptoms and intensify the disease’s severity. Often, several risk factors conspire to trigger psoriasis, including psychological stress, skin injuries, infections (e.g., Staphylococcus aureus, Helicobacter pylori, Candida sp., Streptococcus sp., or HIV), hormonal fluctuations, medication (e.g., lithium, TNF inhibitors), smoking, or alcohol consumption. Notably, excess abdominal fat, which fuels inflammatory processes, stands out as a significant risk factor for psoriasis (8). Obesity promotes a low-grade inflammatory state, with adipose tissue serving as an active endocrine organ impacting inflammation, glucose metabolism, lipid metabolism, and insulin-related processes. The relationship between obesity and psoriasis appears bidirectional, with obesity predisposing to psoriasis and psoriasis contributing to obesity (9).
Systemic Inflammation
Inflammation is not confined to psoriatic skin but has been shown to affect various organ systems. Consequently, psoriasis should be viewed as a systemic condition rather than a purely dermatological ailment. It is unsurprising that physicians frequently diagnose accompanying diseases in psoriasis patients. Individuals with psoriasis often grapple with heightened hyperlipidemia, hypertension, coronary artery disease, type 2 diabetes, increased body mass index (BMI), and metabolic syndrome. The severity of psoriasis correlates with diabetes and cardiovascular disease, with psoriasis potentially increasing the risk of myocardial infarction and stroke (10–13). Up to 35% of psoriasis patients develop chronic inflammatory arthritis, known as psoriatic arthritis, leading to joint deformities and disability (14).
Adopting an anti-inflammatory lifestyle can empower psoriasis patients to mitigate the frequency and severity of relapses. This lifestyle includes a suitable diet, weight management, abstinence from alcohol and tobacco, and effective stress management.
The Mechanism of Psoriatic Skin Lesions
At the core of psoriasis lies persistent inflammation, sparking uncontrolled keratinocyte proliferation, dysfunctional cell differentiation, and an accelerated skin renewal process. Psoriasis is categorized as a T-cell-mediated inflammatory skin disease, with T cells (specialized white blood cells) and Langerhans cells (immune cells residing in the epidermis’s lowest layer) playing pivotal roles. Langerhans cells constantly monitor the skin environment for potential threats, sensing any “danger” that may arise. When danger is detected, immune cells are dispatched to gather information about the intruder, enabling the body to initiate an inflammatory response, which may manifest as an allergic reaction or the formation of scar tissue.
In psoriasis, Langerhans cells mistakenly internalize the body’s own cells, misclassifying them as threats (autoantigens). These cells then journey from the epidermis through the lymphatic system to lymph nodes, where they present the autoantigens to T cells. Once T cells recognize these autoantigens through specialized receptors, they become activated and release an array of cytokines as signaling molecules. The result is skin inflammation, marked by redness, swelling, and itching, sustained by ongoing immune cell activation and cytokine release (Interleukins such as IL1β, IL17, IL22 IL23, and TNF-α). As the body attempts to heal the inflamed area, skin cells (keratinocytes) multiply excessively, migrating too swiftly from the lower to the uppermost skin layer. This accelerated cell renewal leads to the accumulation of immature cells on the skin surface, manifesting as scales that form patches or plaques (2,10,13,15).
Effective psoriasis treatment must address the underlying causes and alleviate the body’s systemic inflammatory burden. This can be achieved through nutritional adjustments, such as those guided by the ImuPro test.
Psoriasis and Gluten Free Diet
A gluten-free diet (GFD) has shown promise in alleviating psoriatic symptoms. Several studies have examined the impact of a 3-month GFD on psoriasis severity, particularly in patients with elevated antigliadin antibodies (AGA). In one study, 73% of AGA-positive psoriasis patients experienced improvements in their psoriasis area and severity index (PASI) following the GFD (25). Another clinical trial demonstrated a reduction in tissue transglutaminase expression in psoriasis patients with AGA positivity after adopting a GFD (26). Numerous reports have documented the swift resolution of skin lesions and complete clearance of psoriasis symptoms with a GFD (27–32).
Additionally, many healthcare providers advocate for diets tailored to individuals based on tests for delayed food hypersensitivities, such as ImuPro, as an effective treatment for psoriasis.
Clinical study: IgG Food Allergies and Psoriasis
Several years ago, ImuPro conducted a clinical observational study to gather evidence on the efficacy of the ImuPro Complete in patients with various conditions that may indicate food intolerance, including psoriasis, neurodermatitis, headaches/migraines, overweight/obesity, fatigue, rheumatic diseases, or gastrointestinal complaints. A total of 938 patients participated in this trial and eliminated IgG-positive foods for eight weeks. Among the 201 patients initially reporting psoriasis, 118 (59.2%) experienced significantly reduced psoriatic symptoms in the subsequent documentation. Comparable improvements were also observed for other inflammatory skin conditions, including acne, neurodermatitis, and itchiness (60.8%, 66.9%, and 72.5%, respectively) (33).
The results of the ImuPro observational study show that an individualized anti-inflammatory nutrition should be a considered as first line intervention, affecting disease severity and management of patients with psoriasis.
References
1. World Health Organization
- Global report on Psoriasis. Glob. Rep. Psoriasis (2016).
2. Psoriasis Pathogenesis and Treatment
- Ogawa, E., Sato, Y., Minagawa, A. & Okuyama, R. Pathogenesis of psoriasis and development of treatment. J. Dermatol. 45, 264–272 (2018).
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- Lee, E. B., Wu, K. K., Lee, M. P., Bhutani, T. & Wu, J. J. Psoriasis risk factors and triggers. Cutis 102, 18–20 (2018).
4. Diagnosis and Management of Cutaneous Psoriasis
- Brandon, A., Mufti, A. & Gary Sibbald, R. Diagnosis and Management of Cutaneous Psoriasis: A Review. Adv. Skin Wound Care 32, 58–69 (2019).
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7. Psychological Profile of Patients with Psoriasis
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9. Obesity and Psoriasis: Inflammatory Nature of Obesity and Therapeutic Implications
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16. Weight Loss and Achievement of Minimal Disease Activity in Patients with Psoriatic Arthritis – Di Minno, M. N. D. et al. Weight loss and achievement of minimal disease activity in patients with psoriatic arthritis starting treatment with tumour necrosis factor α blockers. Ann. Rheum. Dis. 73, 1157–62 (2014).
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20. Psoriasis Patients with Antibodies to Gliadin – Michaëlsson, G. et al. Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet. Br. J. Dermatol. 142, 44–51 (2000).
21. Gluten-Free Diet in Psoriasis Patients with Antibodies to Gliadin – Michaëlsson, G., Ahs, S., Hammarström, I., Lundin, I. P. & Hagforsen, E. Gluten-free diet in psoriasis patients with antibodies to gliadin results in decreased expression of tissue transglutaminase and fewer Ki67+ cells in the dermis. Acta Derm. Venereol. 83, 425–9 (2003).
22. Rapid Regression of Psoriasis in a Coeliac Patient after Gluten-Free Diet – Addolorato, G. et al. Rapid Regression of Psoriasis in a Coeliac Patient after Gluten-Free Diet. Digestion 68, 9–12 (2003).
23. Osteomalacia Associated with Cutaneous Psoriasis as the Presenting Feature of Coeliac Disease – Frikha, F., Snoussi, M. & Bahloul, Z. Osteomalacia Associated with Cutaneous Psoriasis as the Presenting Feature of Coeliac Disease: A Case Report. Pan Afr. Med. J. 11