Q: My skin is flaky and itchy and nothing I’ve tried seems to help. Do you think I have psoriasis, and if so, what can I do for it? —Hannah, Dallas
A: Yes, it’s very possible that your flaky, itchy skin is due to psoriasis, the rapid turnover of skin cells that typically appears as silvery scales on elbows, knees, the scalp, and in the groin area. Sometimes the nail bed is involved, resulting in yellow discoloration and thick, pitted nails. Joints can be affected too (this is called psoriatic arthritis). All forms of psoriasis tend to worsen with alcohol consumption, smoking, eating lots of animal fat and protein (particularly from red meat), and a lack of zinc, selenium, and vitamins A, D (which is especially important), and E. Typically, psoriasis is worsened by stress, constipation, and poor digestion. Some common drugs also worsen psoriasis: nonsteroidal anti-inflammatories (such as ibuprofen), antimalarial medicines, ACE inhibitors, beta-blockers, and lithium; steroid withdrawal can also exacerbate the disease.
The first order of business with any skin complaint is to look at your diet. Anything that goes into your mouth should be optimally digested and assimilated without the help of the immune system. Very often, however, our digestive systems reject foods, requiring help from the immune system to properly detoxify or clear the offending substance (or substances) from the body. Therefore, an elimination diet is a must when it comes to treating any skin disturbance. The top food irritants (and a good list to strictly eliminate for six to 12 weeks) are dairy products, wheat in all forms, corn (the more refined the worse, as in high-fructose corn syrup), soy (nearly ubiquitous in processed, dry food), and nightshade vegetables (tobacco, potatoes, tomatoes, eggplant, and chile and bell peppers).
The ABCs of Healthy Skin
If eliminating these top food allergens does not significantly improve your skin, try a few days of water-only or fresh-juice-only fasting to see if your skin starts to clear. Sometimes, this is miraculously helpful.
Fish oil is one of the most important nutrients for the skin. My favorite is a cold-pressed wild Alaska salmon product. Because wild Alaskan salmon oil is so minimally refined, the absorption is excellent. The omega-3 content in fish oil is a potent anti-inflammatory, as well as being a skin emollient that works from the inside out. Most itchy, flaky skin complaints are due in part to irritated, inflamed skin cells. An easy way to promote a natural anti-inflammatory effect is with tasty kitchen herbs, especially turmeric, ginger, cumin, anise, fennel, basil, rosemary, garlic, and pomegranate seeds. All these seasonings can block the inflammatory white blood cells responsible for psoriasis and other skin afflictions.
Many patients with psoriasis are low in B vitamins, including folic acid. You can confirm this with a blood test for homocysteine, a by-product of cysteine breakdown. Cysteine is an amino acid that requires B-complex vitamins for optimal processing. A high homocysteine level (above 7) suggests a B-vitamin deficiency or malabsorption; it also confers an increased risk of cardiovascular disease. Ask your doctor for the appropriate blood test.
You should also have your blood levels of vitamin D3 checked—they should be 60 to 90 nanograms per milliliter. Oral doses up to 8,000 international units daily are safe, and this level of supplementation may be required for up to a year to bring your levels up. Typically, skin problems (as well as mood, joint, and bone-loss issues) improve with optimal vitamin D3 levels. Avoid vitamin D2—it’s far more expensive and doesn’t work nearly as well as the D3 form for most people.
Be aware that certain natural remedies, including echinacea, inula, burdock, biotin, ginseng, and high doses of vitamin C (500 milligrams or more daily), can actually aggravate psoriasis in some cases.
Another possible cause of your skin problems is eczema, which is characterized by itchy or flaky skin. Eczema is usually some kind of dermatitis, which simply means skin inflammation from a topical irritant or the greasy type that happens on the eyelids and/or scalp. The latter is called seborrheic dermatitis, which frequently is a fungal problem. Any topical treatments that contain salicylic acid, menthol, tea tree oil, vitamin E, and/or aloe can help soothe eczema symptoms as you work on cleaning up your diet (and yes, an elimination diet is also helpful for eczema). Ask someone at your local health food store to help you find a product with any of these ingredients.
Finally, as with most diseases, stress management is critical. Try to get exercise and fresh air daily. Get counseling if you are having trouble changing bad habits.