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The sun is vital for life on earth. It provides energy essential for the metabolism of plants and animals and Vitamin D production in humans. However, the sun’s beneficial rays are also harmful when they shine on human skin at ultraviolet (UV) levels above present international guidelines that limit exposure time for all people before burning. Sunlight alters immune function by influencing the release of nitric oxide2 and cytokines such as interferon-gamma, tumor necrosis factor-alpha, and interleukin-103 from keratinocytes6 and melanocytes. These alterations may trigger psoriasis or worsen its symptoms. Before knowing how sunlight impacts psoriasis let’s know about psoriasis in detail.
What is psoriasis?
Psoriasis is a skin disease that causes red, lumpy patches called plaques to develop on the skin. Plaques are areas of inflammation and excessive production of skin cells, in most cases at the base of a hair follicle. Psoriasis can be mild or severe in different people with many identified types, including plaque, guttate, inverse, pustular, and may have erythrodermic psoriasis. Although it may appear anywhere on the body, this condition usually appears on the elbows, knees, and trunk. Areas most commonly affected by psoriasis include:
- The back of arms (underneath the scapular region).
- The front part of thighs or shins.
- Small joints like knuckles.
In addition to scaling of the skin, psoriasis may also cause discomfort and pain. The plaques are separated by red, inflamed borders, with each lower plaque smaller than the preceding one. Psoriatic nails can be seen in about 20 percent of patients with this condition thickened, discolored, pitted, or ridged. Psoriasis is generally viewed as an incurable disease that requires ongoing management to keep symptoms under control.
What are the symptoms of psoriasis?
1 Skin lesions- Red scaly patches called plaques, 5 to 8 mm in diameter, covered with silvery scales. Plaques may vary in number and location on the body.
2 Nails changes- Nails become pitted, grooved, or ridged.
3 Skin thickening- It can occur around some regions of your joints, such as your knuckles and other body parts like elbows and knees.
4 Psoriatic arthritis- Inflammation of the joints that can happen along with psoriasis, or you can also get psoriatic arthritis without psoriasis.
5 Eye or mouth sores- Raised red patches on the lips, mouth, and around eyes
6 Inflammation of the lower bowel- This happens when a person has an increased risk of developing guttate psoriasis.
How does sunlight impact psoriasis?
Exposure to ultraviolet (UV) light is the most common cause of an exacerbation in psoriasis. Ultraviolet radiation induces psoriatic plaques, decreases the number of T-regulatory lymphocytes, and increases the number of skin-infiltrating dendritic cells4. Sunlight exposure may also increase immunoreactive tumor necrosis factor-alpha7, which causes inflammation to worsen, inducing keratinocyte hyperproliferation8 due to DNA damage, which leads to the development of psoriatic lesions suppress keratinocyte proliferation via activation of p53 pathways9, which prevents reoccurrence after remission.
Ultraviolet A (UVA) rays are responsible for triggering or worsening psoriasis symptoms because they penetrate deeply into the skin’s layers to cause inflammation, suppress immune cells activity, and alter keratinocytes growth. These rays also sensitize melanocyte receptors to ultraviolet B (UVB) rays which are more potent than UVA rays at inducing DNA damage resulting in cell death10. Because this type of radiation penetrates only the outer layer of the epidermis, psoriatic lesions can heal if UVB exposure can be blocked or limited11.
How much sunlight can be helpful for psoriasis?
Regular doses of sunlight induce Vitamin D synthesis in the human body, which reduces symptoms associated with psoriasis-like itching, swelling, redness, and scaling12,13. This evidence leads doctors to prescribe sunbathing or phototherapy when other treatments fail to work. Sunlight can be helpful, but its harmful rays should be avoided as much as possible.
What are the benefits of sunlight if I have psoriasis?
- Ultraviolet B (UVB) radiation suppresses cutaneous T-cell activity and reduces the severity of psoriatic lesions by reducing the number of infiltrating CD8+ cells, which are responsible for cytotoxic reactions in the skin.
- UV exposure may decrease keratinocyte proliferation rates via p53 pathways, resulting in some relief from scaling and erythema associated with psoriasis.
- Vitamin D synthesis induced by sunlight exposure may relieve itching, inflammation, and pain from psoriasis.
- Sunlight can help psoriasis patients who suffer from vitamin D deficiency17
- Exposure to natural sunlight provides psychological benefits that improve mood18
- Sunbathing or phototherapy exposure may improve the effectiveness of systemic therapies used to treat psoriasis.
- Patients who have psoriasis are less likely to have other diseases associated with vitamin D deficiency because sunlight increases the ability of our body to synthesize adequate amounts of vitamin D.
- Sunlight exposure has been shown to improve glycemic control in patients with diabetes mellitus.
What precautions should be taken while going out in sunlight if I have psoriasis?
1 Use sunscreen lotion if you are going out on a sunny day, SPF of at least 15 is recommended by WHO. But it doesn’t completely protect from harmful UVB rays. You can use sunscreens containing titanium or zinc oxide, which protects fully from UVA and UVB radiation.
2 Always wear protective clothing such as wide-brimmed hats, long-sleeved shirts, and pants to cover up exposed skin areas; this reduces the chances of developing psoriatic lesions since they are most common on parts of the body that are exposed to sunlight.
3 Reduce exposure time by spending most of it in the shade if your psoriasis is severe since ultraviolet B radiation can suppress immune cells activity and increase keratinocyte proliferation rates. Always wear protective clothing even when you’re out for a walk on a cloudy day. Cloudy days have high levels of UV rays too.
4 Avoid tanning beds as they emit high levels of UVA and UVB radiation which increases the risk of developing skin cancer later in life or worsens symptoms associated with psoriasis.
5 If possible, stay indoors during the times of the day when there is intense sunlight, i.e., sunrise/sunset, because these are the times when ultraviolet B rays are at their peak.
6 Never sunbathe or use a sunlamp because they emit high ultraviolet A and B radiation which increases the risk of developing skin cancer.
What are the other ways to prevent psoriasis triggers?
- Avoid consuming alcoholic beverages: Alcohol can cause psoriasis symptoms to relapse by increasing immunoreactive tumor necrosis factor-alpha levels.
- Limit stress: Researchers found that people with moderate stress had better overall control of their psoriatic symptoms than those who were less stressed.
- Exercise regularly: Exercise helps maintain overall health, reduces symptoms associated with psoriasis, and increases the quality of life.
- Maintain an average body weight:According to one study, people with psoriasis are more likely to be overweight or obese at diagnosis.
- Sleep well at night: Researchers found that people who didn’t get enough sleep each night had higher levels of human leukocyte antigen (HLA), associated with psoriasis.
- Eat a healthy diet: Foods like fresh vegetables, lean meat, whole grains, and fruits are essential for providing the nutrients needed to maintain optimal health.
- Avoid smoking: Smoking increases inflammation and the risk of cardiovascular disease. It is also responsible for speeding up the aging process of skin cells leading to more outbreaks.
- Use sunscreen before sun exposure:Sunscreen should be water-resistant, include protection against UVA and UVB rays, and have an SPF 30 or higher.
- Take supplements with omega 3 fatty acids: Omega 3 essential fatty acids help control inflammation that triggers psoriasis.
What are the other factors that can trigger psoriasis?
- Infections: Viruses like the human herpes virus or bacterial infections of streptococci or staphylococci can cause psoriasis to flare up.
- Stress:Researchers found that people with moderate stress had better overall control of their psoriatic symptoms than those who were less stressed.
- Autoimmune diseases: like rheumatoid arthritis, lupus, and inflammatory bowel disease may also trigger psoriasis flares.
- Occupational factors: like metalworking fluids, resins, glues, organic solvents (paint thinner, petroleum benzene), insecticides (paraquat), and some non-stick cooking sprays may also result in exacerbations of psoriasis symptoms.
- Alcohol consumption: is also reported to be an aggravating factor for some people with psoriasis.
- Specific medications: like lithium carbonate, antimalarials, birth control pills, anti-inflammatories, beta-blockers, and ACE inhibitors may also trigger psoriasis symptoms.
- Injuries:cuts and bone fractures could also worsen your condition if you already have a weakened immune system responsible for preventing your skin cells from growing too fast.
- Heat and sweating: cold and dry weather may also trigger psoriasis symptoms in some people.
- Strenuous exercise: can cause physical trauma to flare up symptoms of psoriasis, although this is rare.
- Sunlight exposure: Although sunlight promotes vitamin D production, intense sunlight triggers flares in many people with psoriasis. Therefore, you should take adequate precautions before exposing your skin to the sun unprotected by sunscreen or protective clothing.
What is the risk associated with the skin because of sunlight?
- Skin Cancer: Intense exposure to ultraviolet radiation can lead to several skin cancers, including melanoma and basal cell carcinomas.
- Skin Discoloration:Excessive exposure to ultraviolet light causes brown or gray patches on the skin that may look like lesions caused by psoriasis. This condition is known as post inflammatory hyperpigmentation, which may persist for many years even after successful treatment of psoriasis. The risk here is that people will mistake it for active psoriasis lesions, leading them to start an unnecessary treatment regimen.
- Photoaging:Sunlight damages elastin fibres in the skin, causing fine lines and wrinkles, dryness, loss of elasticity, and sagging skin which also looks similar to some forms of psoriasis.
- Ultraviolet radiation can also trigger psoriatic skin lesions in people at high risk of developing the condition while normalizing skin lesions in people with plaque-type psoriasis.
What are some natural therapies or home remedies that you can use to treat mild cases of psoriasis?
- Fish Oil Supplements:Taking fish oil supplements regularly has been reported to help reduce symptoms of psoriasis. However, more study is needed before a definitive conclusion on its effectiveness for this purpose. You should take about 3 grams of fish oil supplements daily with your main meal, although this dosage may vary depending on what brand you use and the intensity of your condition, so with your health care provider first before taking it for this purpose. You should also note that fish oil supplements can cause side effects like belching, heartburn, nausea, and loose stools, so if you experience any of these after taking it, then reduce your intake until they subside or try a different source of fish oil instead.
- Chamomile: Drinking chamomile tea has been found to help relieve mild cases of psoriasis. However, drinking up to 3 cups daily is required before its beneficial effects can be felt. It would help if you did not go over this amount because drinking too much may worsen your condition instead.
- Tea Tree Oil: Applying tea tree oil to the affected area has been found to help control mild cases of psoriasis. However, you should first test this treatment on a small part of your body before using it for the entire area to make sure you are not allergic to it. Also, avoid ingesting tea tree oil because it is highly toxic when taken internally and could cause skin irritation or other bothersome side effects that may worsen your condition.
- Ginkgo Biloba: Taking ginkgo Biloba supplements regularly has been found to help reduce symptoms of psoriasis. However, more study is needed before a conclusive result can be reached on this matter. You should take about 60 milligrams (mg) of ginkgo Biloba supplement once daily with your main meal, and you should continue taking it until the condition has cleared.
- Homeopathic treatment for psoriasis: As everyone knows, psoriasis is a chronic disorder, which is very difficult to cure with allopathy. According to homeopathy doctors, psoriasis patients have a typical feature as a whole, and their symptoms vary from patient to patient. There are remedies available in homeopathy that help psoriasis patients according to individual reaction patterns following the overall characteristics of the patient as a whole. For that matter, please consult a registered homeopathy doctor regarding your disease case, and he will choose one single and best homeopathic remedy for you. You can book an appointment through OHO Homeopathy for more information.