Alternative Care Options for Inflammatory Diseases

Sara M. Wilchowski, DMSc, PA-C

Working as a dermatology physician assistant for over a decade, I consider myself an “externist,” as dermatology encompasses a wide array of diseases. I am passionate about ensuring the patient as a whole is considered during the exam. I ask myself, what could be driving this disease? It was more than just treating the cutaneous aspect of the disease, as several have well-known and established internal pathologies. My neologism also led me down a fascinating road of utilizing additional options for caring for my patients. As pathomechanisms of diseases have improved due to advances in technology, so has the broad understanding of how deficiencies can alter the body’s natural function. Therefore, novel therapeutic approaches are being explored. Several supplements have garnered significant attention for their anti-inflammatory, antioxidant, and immunomodulatory properties offering complementary options for dermatologic interventions.

There are several topical medications for a wide array of diseases, and this is a common place for treating patients in dermatology. Vitamin D has been used in psoriasis with well-established benefits, however, as medicine advances, we understand there are more significant implications to this previously proven skin disease with several systemic comorbidities. Additionally, acne is commonly seen concomitantly with insulin resistance and polycystic ovarian syndrome. It is vital to recognize these and treat the whole patient. 

Vitamin D

Most known for its role in bone health, vitamin D has gained considerable attention over the last few years for its immunomodulatory and anti-inflammatory effects. As dermatology providers, we understand how the skin plays a role in vitamin D synthesis. Still, studies have yielded that vitamin D is responsible for modulating over two hundred inflammatory cytokines.¹ Not only are low levels of vitamin D associated with an increase in B cell proliferation and autoantibody production, but also in the inhibition of IL-17, Dendritic cells, TNF-α, IL-1β, IL-6, and IL-8, which are key inflammatory cytokines found in several dermatologic diseases.² It has been established that vitamin D deficiencies are linked to inflammation.

Nutrient deficiencies are typically the product of dietary inadequacy and impaired absorption, among other factors, and there are differences in threshold values for what is considered adequate and therefore, further studies need to be conducted. However, one study suggests that 25-(OH)D levels of 75 or higher may be needed for the several physiological functions of this sunshine vitamin.

Curcumin

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This polyphenol is more than just the active component of turmeric, it also has various pharmacological benefits. Several studies have shown it has the ability to inhibit several cytokines such as TNF-α, IL-6, and NF-kB, in addition to decreasing inflammatory biomarkers such as superoxide dismutase and C-reactive protein.³ Interestingly, down-regulating NF-kB can in turn decrease TH-17 production. These anti-inflammatory benefits play a significant role in several dermatologic diseases, but also can improve outcomes in photoaging and wound healing due to the free radical scavenging properties.

Lifestyle Changes

I never used the word “diet” in the clinic, as that signifies a negative connotation. Instead, I discuss it as modifying one’s lifestyle. The goal is to ensure long-lasting changes such as increasing the number of fruits, vegetables, and whole grains and decreasing processed food. Studies have also shown that eliminating certain foods for some individuals can help with their disease. In one study with psoriasis patients, eliminating gluten led to an over 50% reduction in their lesions, and several patients were cleared.⁴ Additionally, for patients suffering from acne, discussing low glycemic index foods aids in balancing hormones. For the motivated patient, starting with lifestyle changes, the addition of a supplement, as well as a pharmaceutical, could be considered. Lastly, working collaboratively with other healthcare providers, such as dieticians, may be appropriate for some patients.

The Rabbit Hole

There are several studies which can easily be obtained for further reading utilizing a quick PubMed search as well as several CME opportunities available. The American College for Lifestyle Medicine as well as Learn Skin offer online courses, some of which are free. It is important to have a working knowledge of nutraceuticals prior to implementing them clinically. 

As for me, discussions on lifestyle modification with patients were my favorite while working in the clinic. Several patients appreciated these conversations, as lifestyle modifications are often not classically discussed. Little did I know this would lead to an influx of new patients yearning for a similar approach. I have a passion for education, and providing the appropriate lifelong education to patients can help them make better choices. This approach also fits with my motto as a PAnot just to get my patients better, but to get them well.

Disclosure

Wilchowski is an MSL with Arcutis Biotherapeutics.

References

1. Yamamoto EA, Jørgensen TN. Relationships between vitamin D, gut microbiome, and systemic autoimmunity. Front Immunol. 2020;10:3141. Published 2020 Jan 21. doi:10.3389/fimmu.2019.03141 
2. Barrea L, Savanelli MC, Di Somma C, et al. Vitamin D and its role in psoriasis: an overview of the dermatologist and nutritionist. Rev Endocr Metab Disord. 2017;18(2):195-205. doi:10.1007/s11154-017-9411-6
3. Dehzad MJ, Ghalandari H, Nouri M, Askarpour M. Antioxidant and anti-inflammatory effects of curcumin/turmeric supplementation in adults: a GRADE-assessed systematic review and dose-response meta-analysis of randomized controlled trials. Cytokine. 2023;164:156144. doi:10.1016/j.cyto.2023.156144
4. Afifi L, Danesh MJ, Lee KM, et al. Dietary behaviors in psoriasis: patient-reported outcomes from a US national survey. Dermatol Ther (Heidelb). 2017;7(2):227-242. doi:10.1007/s13555-017-0183-4