Why is psoriasis so difficult to treat?

Psoriasis is not just a skin problem. It’s an immune problem. 

This is why it’s incredibly frustrating when everyone keeps treating where the problem is presenting (the skin), and no-one is looking at WHY the immune system is acting out.


What does the immune system do to the skin?

Psoriasis involves a dysfunctional immune system and abnormal skin cell turn-over. The hyperactive immune system affects the skin, causing the skin cells to proliferate about 5x faster than normal. This results in multiple immature cells reaching the surface of the skin and piling up to form plaques.

The red-coloured plaques are one of the key features of psoriasis. These red plaques often have well-defined borders, capped with silvery-white scales. The plaques can be located anywhere on the body, but they are typically seen over the elbows, knees, scalp and low back area. Other features associated with psoriasis can include changes to the nails, such as pitting.

What can be done?

There are multiple ways to address psoriasis. Obtaining a thorough medical history is important, as the triggers for each individual case of psoriasis are unique.

A history of reflux, low stomach acid, infections (such as staphylococcus, strep throat or Helicobacter Pylori), a skewed immune response, poor gut health and poor liver function are crucial to address.

Overgrowth of certain types of bacteria or fungus on the skin can also contribute to the development of psoriasis.

Psoriasis should NOT be considered just a skin condition. It falls into the autoimmune category and has important implications for the rest of the body. People with psoriasis MUST address the immune system and the underlying reason why it has become hyperactive. Liver health should be monitored, as there is increased risk for developing non-alcoholic fatty liver. Thyroid problems such as Hashimoto’s are also common. Psoriasis patients can be at a higher risk for joint manifestation of the disease (such as psoriatic arthritis) as well as at higher risk for cardiovascular events.


We can't just fix your skin; we must fix your overall health

Stress is commonly associated with psoriasis, acting as a catalyst for the onset, as well as exacerbation of the condition. Psychodermatology is an emerging field which looks at the impact on the interaction between the mind, the brain and the skin. The brain and the skin originate from same layer in embryo, and are under the influence of the same hormones and neurotransmitters.

For more information on the brain-skin connection, check out our article:

The severity of psoriasis is found to be ever fluctuating. The course of the disease is punctuated by spontaneous flare-ups and remissions, frequently linked to stressful incidents in 68% of adult patients. In addition, patients with psoriasis report more frequent traumatic experiences in childhood and through adulthood (1).

Psoriasis being a chronic and often disfiguring condition, makes it highly associated with depression and those with it also suffer a marked impairment in quality of life (2,3).

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1. Psychiatric issues in dermatology, part 1: Atopic dermatitis and psoriasis. Prim Psychiatry. 2008;15:35–8.

2. National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening.
Kimball AB, Gladman D, Gelfand JM, Gordon K, Horn EJ, Korman NJ, Korver G, Krueger GG, Strober BE, Lebwohl MG, National Psoriasis Foundation. J Am Acad Dermatol. 2008 Jun; 58(6):1031-42.

3. Factors affecting sleep quality in patients with psoriasis. Gowda S, Goldblum OM, McCall WV, Feldman SR J Am Acad Dermatol. 2010 Jul; 63(1):114-23.