Ulcerative colitis and psoriasis are two inflammatory, autoimmune conditions. It’s not uncommon for UC patients to develop psoriasis as an extra-intestinal manifestation (EIM), and those with psoriasis have an increased risk of developing UC, and an even higher risk of developing Crohn’s disease. The conditions overlap, share similar inflammatory pathways, and appear to have similar causes.
What is Psoriasis?
Psoriasis is a chronic autoimmune condition in which skin cells multiply much faster than normal. Because of this sped-up process, old skin cells don’t have time to fall off before the production of new cells, causing a buildup of skin. This buildup leads to patches of red, bumpy rashes and scales. The condition is generally cyclical, with flares that subside after a while.
Psoriasis can appear anywhere on the body but typically manifests on the scalp, elbows, knees, hands, feet, neck, face, and lower pack. The affected patches can be itchy and extremely uncomfortable, making it difficult to focus or sleep well.
Signs of Psoriasis
Common symptoms of psoriasis include:
- Inflamed patches of skin
- White-silver scales on red patches (this may be gray depending on your skin tone)
- Dry, itchy skin that can crack and bleed
- Soreness or burning around the patches
- Painful joints
Who is at Risk of Developing Psoriasis?
Researchers currently believe psoriasis is driven by two main factors: genetics and the immune system.
If a family member has psoriasis, you have an increased risk of developing the condition. You may have a predisposition to psoriasis, but it may only affect you when triggered by an environmental factor.
Common triggers of Psoriasis:
- Cuts, burns & bites
- Severe sunburn
- Excessive stress
- Dry, cold weather
- A preexisting autoimmune disorder
- Smoking & alcohol consumption
- Certain medications (lithium, blood pressure drugs & antimalarial drugs)
- Withdrawal from corticosteroids
What’s the Link Between Ulcerative Colitis & Psoriasis?
There is a definite association between UC and psoriasis. Firstly, psoriasis is a common extraintestinal manifestation of IBD. Secondly, those with psoriasis are more likely to be at risk of developing UC as systemic inflammation can impact internal organs.
UC and psoriasis are both inflammatory conditions involving the abnormal activation of immune pathways, leading to an increase in inflammatory cytokines. Both also appear to be driven by generics, immune dysfunction, environmental stressors, changes in the composition of gut bacteria, and a lack of bacterial diversity.
The Skin & the Gut
Research on gut and skin microbiota is a relatively recent field, but studies have observed that gut microbiota dysbiosis is a possible trigger for flares of psoriasis. Gut dysbiosis means there is an imbalance of healthy and pathogenic bacteria, and it is one of the leading contributors to the development of UC. Gut dysbiosis also contributes to ‘intestinal permeability, which triggers the inflammatory immunological response experienced by IBD patients.
Essentially, the same causes of chronic inflammation in the intestine can also cause chronic skin inflammation.
How to Treat UC & Psoriasis
Treatments for UC and psoriasis differ, but biological medication is suggested for both conditions, as biologics target the immune system to prevent the abnormal activity of immune-related inflammatory responses.
Another way to treat both conditions is to work with a dietician to improve your diet and lifestyle. Diet and stress management are vital for supporting our health, especially when recovering from ulcerative colitis. Poor diet and stress are leading triggers of flare-ups for both conditions.
If you suffer from UC and psoriasis, you should consult a nutritionist to ensure you absorb the nutrients you need to support your health and recovery.
Firstline treatment for psoriasis generally involves topical creams and ointments applied to the affected patches of skin. You may also want to apply emollients directly to the affected area. Emollients reduce water loss, help with itching, and moisturize and protect the skin.
For mild-to-moderate psoriasis, steroid creams and ointments can help reduce the inflammation and slow down the abnormal production of skin cells.
Other forms of treatment include:
- Vitamin D analogs
- Calcineurin inhibitors
- Coal tar
- Non biologic drugs such as Methotrexate, Ciclosporin, Acitretin
What’s the Outlook for Psoriasis?
Psoriasis doesn’t cause constant symptoms, but rather a cycle of flare-ups and remission. Many patients experienced long periods of remission, especially with the correct treatment and diet and lifestyle changes.
If you have severe psoriasis along with another disease, a psoriasis flare may exasperate your other condition.
The following may influence the severity of your symptoms:
- Alcohol consumption
- Kidney disease
- Cardiovascular and respiratory diseases