psoriasis and skin disorders
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Skin disorders and psoriasis. The effect of fasting and calorie-restriction
 

Effect of weight loss on the severity of psoriasis: a randomized clinical study.
Jensen P1, Zachariae C, Christensen R, Geiker NR, Schaadt BK, Stender S, Hansen PR, Astrup A, Skov L. JAMA Dermatol. 2013 Aug;149(8):997.
Psoriasis is associated with adiposity and weight gain increases the severity of psoriasis and the risk of incident psoriasis. Therefore, we aimed to measure the effect of weight reduction on the severity of psoriasis in obese patients with psoriasis. Sixty obese patients with psoriasis from our dermatology outpatient clinic were enrolled in a prospective randomized clinical trial in which they were allocated to a control group or an intervention group. 
Setting: University hospital outpatient dermatology clinic.
We included 60 of 69 eligible overweight patients with psoriasis (body mass index [calculated as weight in kilograms divided by height in meters squared], 27-40; aged 25-71 years). The intervention group received a low-energy diet (LED) (800-1000 kcal/d) for 8 weeks to induce weight loss, followed by 8 weeks of reintroduction of normal food intake, reaching 1200 kcal/d. The control group was instructed to continue eating ordinary healthy foods.

MAIN OUTCOMES AND MEASURES: Psoriasis Area and Severity Index (PASI) after 16 weeks, with Dermatology Life Quality Index (DLQI) as a secondary end point.

RESULTS:
The median PASI for all patients was 5.4 (interquartile range, 3.8-7.6) at baseline. At week 16, the mean body weight loss was 15.4 kg (95% CI, 12.3-18.5 kg; P < .001) greater in the intervention group than in the control group. The corresponding mean differences in PASI and DLQI, also in favor of the LED group, were -2.0 (95% CI, 4.1 to -0.1; P = .06)
and -2.0 (95% CI, -3.6 to -0.3; P = .02), respectively.
CONCLUSIONS AND RELEVANCE:
Treatment with an LED showed a trend in favor of clinically important PASI improvement and a significant reduction in DLQI in overweight patients with psoriasis.
TRIAL REGISTRATION:
clinicaltrials.gov Identifier: NCT01137188.


According to Dr. Joel Fuhrman M.D. clinical observations (Fasting and Eating for Health, St. Martin’s Griffin, New York, 1995) psoriasis and psoriatic arthritis also respond favorably to the combination of fasting and dietary intervention. In one medical study, eight out of ten patients noted improvement in their psoriasis after a short fast (seven to ten days). Most patients’ psoriatic lesions improve if they fast long enough. Substantial results often require a long fast (14 to 30 days), maintenance of a thin body, and a careful diet after the fast is completed. Dr. Fuhrman frequently note that when people with psoriasis and eczema fast, the results of their liver-function tests routinely elevated early and then normalize as the fast is taken to completion. Without he normalization of the liver from the detoxifying effect of a more prolonged fast (three to five weeks), reappearance of skin lesions may occur upon reintroduction of food. Invariably when the psoriasis suffers overeats and puts on too much fat after fasting. The problem once again emerges. 

A fasting and vegetarian diet treatment trial on chronic inflammatory disorders.
Acta Derm Venereol 1983;63(5):397-403.
Lithell H, Bruce A, Gustafsson IB, Hoglund NJ, Karlstrom B, Ljunghall K, Sjolin K, Venge P, Werner I, Vessby B. 
Twenty patients with arthritis and various skin diseases were studied on a metabolic ward during a 2-week period of modified fast followed by a 3-week period of vegetarian diet. During fasting, arthralgia was less intense in many subjects. In some types of skin diseases (pustulosis palmaris et plantaris and atopic eczema) an improvement could be demonstrated during the fast. During the vegan diet, both signs and symptoms returned in most patients, with the exception of some patients with psoriasis who experienced an improvement.The concentrations of lactoferrin in serum reflect the turnover and activity of neutrophil leukocytes. When this protein was initially increased it fell to normal values in most cases. The improvement or impairment of signs and symptoms was related to the lactoferrin levels in serum.


Dynamics of keratinocytes in vivo using HO labeling: a sensitive marker of epidermal proliferation state.
J Invest dermatol 2004 Sept: 123 (3): 530-6

Hsieh EA, Chai CM, de Lumen BO, Neese RA, Hellerstein MK.
Department of Nutritional Sciences and Toxicology, University of California-Berkeley, Berkeley, CA 94720, USA.
A heavy water ((2)H(2)O) labeling method recently developed to measure cell proliferation in vivo is applied here to the measurement of murine epidermal cell turnover and to investigate conditions in which keratinocyte proliferation is either inhibited or stimulated. The technique is based on incorporation of (2)H(2)O into the deoxyribose moiety of deoxyribonucleotides in dividing cells. Label incorporation and die-away studies in cells isolated from C57BL/6J mouse epidermis revealed the replacement rate to be 34%-44% per wk (half-life of 1.6-2 wk). The kinetics provided evidence of a non-proliferative subpopulation of cells (10%-15% of the total) within the epidermis. Topical administration of 7,12-dimethylbenz(a)anthracene and 12-O-tetradecanoylphorbol-13-acetate for 3 wk increased epidermal cell proliferation by 55% in SENCAR mice. Topical addition of lunasin, an anti-mitotic agent from soy, decreased epidermal cell proliferation modestly though significantly (16% given alone, 9% given with carcinogens). Caloric restriction (by 33% of energy intake) for 4 wk decreased the epidermal cell proliferation rate by 45% in C57BL/6J mice. In summary, epidermal cell proliferation can be measured in vivo using (2)H(2)O labeling in normal, hyper- and hypo-proliferative conditions. Potential applications of this inherently safe method in humans might include studies of psoriasis, wound healing, chemopreventive agents, and caloric intake.


Dermathology (Regulative therapy: treatment with nonspecific stimulants in dermatology in traditional and modern perspectives)
[Article in German] Asefi M, Augustin M
Forsch Komplementarmed. 1999 Apr;6 Suppl 2:9-13.
Universitats-Hautklinik Freiburg.
Stimulation or regulation therapies are old therapeutic procedures based on models reaching back to traditional medical faculties in ancient times and in the Middle Ages. Among this heterogeneous group are acupuncture, purgative procedures (especially the Aschner methods), autohemotherapy, fasting therapy, homeopathy, microbiological and physical therapies. The basic principle underlying all of these procedures is that stimulants applied in proper doses to the organism elicit counterregulation. The counterregulation stimulates 'self-healing processes' within the organism. The efficacy of stimulation therapies was originally deduced mostly from traditional explanatory models which have lost their relevance for modern medicine. However, it has been found in applications in dermatology that many of these stimulation therapies can lead to clinical improvement in selected indications and that modern explanatory models can be found for these effects. This presentation reports on exemplary applications of stimulation therapies in dermatology. Traditional and modern concepts of action are compared.


A fasting and vegetarian diet treatment trial on chronic inflammatory disorders.
Indications for fasting Skin diseases Acta Derm Venereol 1983;63(5):397-403
Lithell H, Bruce A, Gustafsson IB, Hoglund NJ, Karlstrom B, Ljunghall K, Sjolin K, Venge P, Werner I, Vessby B.
Twenty patients with arthritis and various skin diseases were studied on a metabolic ward during a 2-week period of modified fast followed by a 3-week period of vegetarian diet. During fasting, arthralgia was less intense in many subjects. In some types of skin diseases (pustulosis palmaris et plantaris and atopic eczema) an improvement could be demonstrated during the fast. During the vegan diet, both signs and symptoms returned in most patients, with the exception of some patients with psoriasis who experienced an improvement. The concentrations of lactoferrin in serum reflect the turnover and activity of neutrophil leukocytes. When this protein was initially increased it fell to normal values in most cases. The improvement or impairment of signs and symptoms was related to the lactoferrin levels in serum.


Suppressive effects on allergic contact dermatitis by short-term fasting.
Toxicol Pathol. 2001 Mar-Apr;29(2):200-7
Nakamura H, Kouda K, Fan W, Watanabe T, Takeuchi H.
Department of Public Health, Hamamatsu University School of Medicine, Shizuoka, Japan.
Fasting alters various hormonal and immune conditions. It has been reported that delayed type immune response to the injection of keyhole limpet hemocyanin was depressed by short-term fasting. In this study, we adopted the computer-assisted image analyzer for histopathological analysis and evaluated the influence of short-term fasting on allergic contact dermatitis induced by 2,4-dinitrofluorobenzene (DNFB). Mice were sensitized by painting of DNFB to the abdomen. After the sensitization, mice were challenged by DNFB painting to the ear. Fasting started 24 hour before (48-hour fasted group) or immediately after (24-hour fasted group) the challenging. Fasting without DNFB treatment did not induce remarkable change of ear thickness, ear tissue, serum albumin, serum total protein, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase. or serum creatine phosphokinase. In contrast, lasting suppressed the increment of ear thickness in the DNFB-treated group in this study. We could also demonstrate, using the computerized image analyzer, that both lymphocyte infiltration and the edema in the dermis were suppressed in fasted mice treated with DNFB. Further, edema in the dermis was inhibited more strongly in 48-hour fasted mice than in 24-hour lasted mice. These findings indicate that short-term fasting induce histopathological changes in the state of contact dermatitis.


Fasting diet therapy for chronic urticaria: report of a case.
J Dermatol. 1992 Jul;19(7):428-31
Okamoto O, Murakami I, Itami S, Takayasu S.
Department of Dermatology, Oita Medical University, Japan.
We used fasting diet therapy with a 28-year-old woman with chronic urticaria who responded only to systemic administration of glucocorticosteroids. The rashes began to decrease on the third therapeutic day and completely disappeared on the 11th day. Although the eruptions relapsed three days after the termination of the therapy, they were milder than previous ones. We also discussed the possible efficacy of fasting diet therapy for chronic urticaria as reported in the literature.

A restricted-calorie diet inhibited the development of pre-cancerous growths in a mouse model of skin cancer.
(Source: chinaview.cn April 14)
Calorie restriction is reducing the activation of two signaling pathways known to contribute to cancer growth and development, a new study by U.S. researchers has shown. A restricted-calorie diet inhibited the development of pre-cancerous growths in a mouse model of skin cancer, reducing the activation of two signaling pathways known to contribute to cancer growth and development, a new study by U.S. researchers has shown. An obesity-inducing diet, by contrast, activated those pathways, a research team from the University of Texas' Anderson Cancer Center reported at the American Association for Cancer Research annual meeting Monday. "These results, while tested in a mouse model of skin cancer, are broadly applicable to epithelial cancers in other tissues," said the report's senior author John DiGiovanni. Cancers of the epithelium -- the tissue that lines the surfaces and cavities of the body's organs -- comprise 80 percent of all cancers. Calorie restriction and obesity directly affect activation of the cell surface receptors epidermal growth factor (EGFR) and insulin-like growth factor (IGF-1R). These receptors then affect signaling in downstream molecular pathways such as Akt and mTOR. Calorie restriction or negative energy balance inhibits this signaling, while obesity or positive energy balance enhances signaling through these pathways, leading to cell growth, proliferation and survival. Dietary energy balance refers to the relationship between caloric intake and energy expenditure. Previous research, both experimental and epidemiological, suggests that chronic positive energy balance, which can lead to obesity, increases the risk of developing a variety of cancers, while negative balance often decreases risk. "These new findings provide the basis for future translational studies targeting Akt/mTOR pathways through combinations of lifestyle and pharmacologic approaches to prevent and control obesity-related epithelial cancers in humans," DiGiovanni said.

­Psoriasis

Psoriasis is a chronic inflammatory disease caused by excessive immune activity of the T-cells in the skin. It usually ranges from mild to severe and occurs in both children and adults of both genders. It is not a contagious disease, it manifests as reddish or silvery patches on the skin surface of the scalps, palms and soles of feet. It also occurs in other areas but this is less common. About 2% of the world population suffers from psoriasis, 10% of which begins before the age of 10.

Mechanism of occurrence

The T-cells are cells responsible for immune response in the body, they exist to protect the body against foreign substances, however in the case of psoriasis the T-cells become over-active resulting in excessive release of the susbtabce cytokines which causes excessive growth of skin. This excessive skin growth in turn results in an increased rate of dead skin cells being deposited on the skin surface appearing as rather disfiguring patches. Psoriasis could be plaque, gutate, pustular ot erythrodemic. Each type ischaracterized by severity and nature of occurrence.

Treatments

There are a variety of options for treatment of psoriasis. These includes use of drugs, phototherapy, topical creams and calorie restriction. Management of psoriasis is based on a patient to patient basis and the choice of treatment recommended include factors such as age, severity, nature, effect on psychology of patient, effect on quality of life of patient, available options and general preference. Combination of MTX and calcipotriosis have been shown to be effective treatment for psoriasis. Although the mechanism of action of drugs acting against psoriasis is yet to be fully established, some findings point to a link with the bacteria streptococcus pyrogenes such that antibiotics acting against these bacteria and caring for the skin against this bacteria is an option for treatment.

Topical therapies used include corticosteroids, vitamin D analogs (calcipotren and calcitrion), calcineurin inhibitors (such as tacrolimus and pimecrolimis) and Anthralin, stemic therapeutics include retinoids, methotrexate cyclosporine, antibiotics, biologics such as etanercept, infiximale and alalimumab and Usktekinumab, Etanercept, Infiximab, Ustekinumab. A range of drugs and topical for treatment of psoriasis available at www.my-lifespan.com.

Psychological stress has also been indicated as a possible trigger for occurrence of psoriasis. Avoiding fatigue and maintaining a healthy body system could help to reduce the severity and occurrence of the disease. Furthermore, psoriasis has also been linked with co morbidities such as cardiovascular diseases and arthritis pointing to possibility of treatments used for these conditions could also apply to management of psoriasis.

Psoriasis and Calorie restriction

Various studies have looked into treatment of psoriasis using calorie restriction. Apart from newly reported 25year long study on monkeys that show the benefit of restricted diet on reduced mortality and age related diseases, there are a number of studies on both humans and lab animals which show that fasting and restricted diet are an effective treatment for skin diseases such as psoriasis. In one study led by Dr H Lithell in 1983, 20 patients who had various skin diseases including those with psoriasis, showed significant improvement following a 2 weeks fasting period which was followed by 3 weeks on vegetarian diet. The fasting had a stronger and more lasting effect on the skin conditions however during the vegetarian diet stage the signs and symptoms of the skin diseases returned for most of the skin conditions study except for psoriasis. Thus indicating that fasting and restricted diet had notable effect on psoriasis in particular.  In another study an open trial on 20 adult patients showed results which indicate controlled vegetarian diet as an effective treatment for atopic dermatitis, a condition which like psoriasis is also characterized by skin inflammation. In the study striking change in skin condition was observed after 2 months on the vegetarian diet and the severity of the condition was notably ameliorated. More recent studies present novel method of measuring cell proliferation rate which could be used as a measure of effectiveness of treatment on conditions such as psoriasis. The results presented in the study showed calorie restriction to reduce cell proliferation by 45% compared to topical administration of lunasin which reduced cell proliferation by 16% when administered alone.

 
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