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Psoriasis can cause unpleasant, painful, and inconvenient flare-ups, which those experiencing for a long time are all too familiar. The first-line treatment of patients with psoriasis is a topical steroid cream to help decrease skin inflammation and dryness. However, relying on topical steroid creams to manage the symptoms is more often doing more harm than good to skin health and furthermore does not address the pathogenesis of psoriasis flare-up. The main issue is that in the short term, the use of topical corticosteroid creams can disrupt the delicate balance of the skin microbiome, resulting in pH imbalance, reduced immune protection and increasing inflammatory skin disease. The skin cell membrane becomes vulnerable to disruption, and transepidermal water loss (TEWL) rises, resulting in dry, dehydrated, and irritated skin lesions. In the long term, the disruption impacts the skin cell membrane integrity and results in various skin conditions such as thinning skin, stretch marks, easy bruising, discolouration, acne, rosacea and dermatitis. The concern is, as there is no known cure to give psoriasis patients, the application of topical steroid creams is damaging the homeostasis of the skin microbiome and contributing to the epidermal immune cells over-activation that exacerbates the creation of raised psoriatic lesions resulting in dry, flaky skin appearing on the scalp, elbow, or knees. Therefore, the best approach to treating chronic plaque psoriasis symptoms such as dry, flaky, itchy skin is to deal with the underlying cause, rather than applying cream and disturbing the skin microbiome, which will only create further ageing skin concerns due to the dehydration of the skin and lack of skin cell integrity.

What is the underlying cause of psoriasis?
Taking active steps to understand what has triggered the auto-immune response is essential to addressing the root cause of psoriasis. As psoriasis is not a skin disease, the redness and flaky skin are clues and a symptom of systemic inflammation due to adaptive immune responses. Several studies have identified gut microbiota dysbiosis as possible triggers or causes for recurrent episodes of psoriasis. More research is needed to determine how specific changes in the human gut microbiome contribute to psoriasis, but therapies to restore healthy skin and gut microbiota may offer a new approach to psoriasis patients. Taking proactive measures to discover what has triggered the auto-immune response can help with skin and gut health.

What is the most effective treatment for psoriasis?
As we have established, managing the discomfort of psoriasis with over-the-counter medication will create further long-term skin conditions. When looking for a long-term remedy to psoriasis, consider the skin and gut microbiota as they are inextricably linked.

To address the root cause of psoriasis:
• Balance pH levels to increase absorption of nutrients
• Eliminate the contributors that trigger the auto-immune inflammation
• Support immune system and gut repair

How to balance pH levels
The skin microbiota prefers a neutral pH level so the beneficial bacteria can thrive on absorbing essential nutrients placed on the skin, protecting against external toxins, and responding to pathogens or bacteria invasion. Using topical steroid cream on the skin will raise skin pH to become more alkaline, which impacts the natural barrier function of the skin cell membrane, causing dry, flaky skin, which reduces the ability to absorb nutrients from nutrient-dense serums and creams put on the skin to nourish and hydrate. Therefore, as an alternative to applying topical steroid creams, look to manage and maintain optimal pH levels on the skin.

Use micellar water and milk or oil cleansers to clean the skin, as they do not contain high levels of a foaming agent called Sodium Laureth Sulfate. The main issue with this ingredient is alkaline and will raise the skin's pH from the natural level of pH 4.7 up to over 7 or 8 depending on the chemical formula and the other ingredient in the products, resulting in drying out the skin. Similarly, if the stomach pH is too neutral, its acidity decreases, and it can't absorb nutrients from meals. Stomach acid needs an acidic pH level to break down food via digestive enzymes to deliver nutrients into the blood and protect the gut lining.  If the pH in the gut is too alkaline due to over-the-counter medications, such as antacids, the quality of food consumed, stress levels, and how much the food is chewed will lead to dysbiosis in the gut microbiome. Over time this leads to leaky gut syndrome, a condition where molecules of food, bacteria, and other toxins pass through the gut lining into the bloodstream, triggering an immune-related inflammatory response.

Best way to eliminate the contributors that trigger auto-immune inflammation
The skin microbiota prefers a neutral pH level so the beneficial bacteria can thrive on absorbing essential nutrients placed on the skin, protecting against external toxins, and responding to pathogens or bacteria invasion. Using topical steroid cream on the skin will raise skin pH to become more alkaline, which impacts the natural barrier function of the skin cell membrane, causing dry, flaky skin, which reduces the ability to absorb nutrients from nutrient-dense serums and creams put on the skin to nourish and hydrate. Therefore, as an alternative to applying topical steroid creams, look to manage and maintain optimal pH levels on the skin.

The most common foods that cause inflammation in the gut lining are:
• Dairy – cow's milk
• Gluten and gluten-free products
• Sugars, such as fructose corn syrup and sucrose
• Artificial sweeteners, such as aspartame

The most common skin ingredients that cause inflammation in your skin cells are:
• Formaldehyde
• Phthalates
• Sodium Lauryl Sulfate
• Ethanolamine

Supportive nutrients for the gut and skin with psoriasis
After the pH balance has been reached and the triggers removed, the consumption of essential nutrients to support the immune system, restore the gut lining, and skin cell membrane may begin.

Supportive nutrients for the gut and skin-
Zinc: helps to regulate the over-activity of immune cells, is a part of collagen and keratin formation and is essential for wound healing.
Sulphur: plays a vital role in the structure of proteins and enzymes, assists with detoxification, and helps to reduce inflammation.
Niacinamide (vitamin B3): helps reduce redness, inflammation, and itchiness associated with psoriasis.
Collagen: a protein that helps maintain the skin's elasticity and strength.
Glutathione: a powerful antioxidant that helps heal the gut and skin and protects the skin from free radical damage, inflammation, and UV radiation.
Probiotics: beneficial bacteria that support gut health, help regulate the immune system, and assist with reducing inflammation.

In summary, the best way to reduce dry, flaky skin from psoriasis is to address the root cause of the immune-mediated inflammation response, more often caused by the quality of the food eaten and the skincare products put on the skin. Over the counter medication will only address the current symptoms, not a chronic systemic inflammatory response. In the long term, quick-fix remedies cause other longer-term issues such as thinning skin, discolouration and ageing skin due to lack of hydration and the absorption of nutrients.  There are various ways to support the gut and skin microbiome with good nutrition, skincare and supplements, but the most important takeaway is to address the root cause of the inflammation, not the symptom.

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