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Psoriasis and Hashimoto’s hypothyroidism, two seemingly unrelated conditions, have a surprising connection that could change the way we understand and treat these ailments. Recent research has uncovered potential links between the two, including autoimmune and genetic associations and the impact of thyroid hormones on psoriasis development. Studies also suggest that having psoriasis could increase the risk of developing thyroid disease. In this article, we look at this surprising relationship and discuss medical, nutritional, and lifestyle treatments that can provide a better quality of life for those affected by these conditions.
Psoriasis is a chronic, immune-mediated disease where systemic inflammation causes skin cells to grow faster than usual, resulting in raised, scaly patches on the skin. Psoriasis is believed to be a combination of genetic and environmental factors.
According to the National Psoriasis Association, there are several common types of psoriasis, including:
- Plaque psoriasis: the most common type, plaque psoriasis, is characterized by dry, itchy, raised skin patches (plaques) covered with scales. These are often located on the elbows, knees, lower back, and scalp.
- Nail psoriasis: causing pitting, abnormal nail growth, and nail discoloration.
- Guttate psoriasis: characterized by small lesions that develop after a strep throat infection.
- Inverse psoriasis: causing smooth, red patches in the folds of the skin, such as the armpits, groin, and under the breasts.
- Pustular psoriasis: characterized by white, pus-filled blisters surrounded by red skin.
In addition to skin symptoms, inflammation caused by psoriasis can affect other organs and tissues in the body, and people with psoriasis may also experience psoriatic arthritis and problems with cardiovascular and mental health.
Psoriasis is characterized by dry, thick, red, raised patches on the skin, often covered with silvery-white scales. The patches can be itchy, painful, and may crack or bleed. In some cases, the patches may join together, affecting more extensive areas of skin.
Psoriasis may also cause nail changes, such as pitting, cracking, discoloration, and separation from the nail bed. Some people with psoriasis also experience joint pain, stiffness, and swelling, known as psoriatic arthritis.
The triggers for psoriasis are different for each person to person, but some common triggers include:
- Cold, dry weather
- Stress
- Infections, such as strep throat and tonsillitis
- Skin injuries, such as cuts, bruises, and burns
- Alcohol consumption
- Smoking
Psoriasis can be diagnosed through a combination of a physical examination, medical history, and sometimes a skin biopsy. Here are the steps involved in diagnosing psoriasis:
Physical examination: A healthcare provider, usually a dermatologist, will examine your skin, scalp, and nails for signs of psoriasis. They will look for inflamed, red, raised areas, scales, and other symptoms such as thickening, yellowing nails, or nail pain. During the examination, the dermatologist may also ask about your symptoms and medical history, including whether someone in your family has been diagnosed with psoriasis.
Medical history: Your healthcare provider may ask you questions about your health and medical and family history, such as whether you experience symptoms such as itchy or burning skin, had a recent illness or experienced severe stress, take certain medicines, or have relatives with the disease. Telling your doctor about any other conditions you have been diagnosed with and if you are taking medication also helps diagnose psoriasis.
Skin biopsy: Most of the time, dermatologists can diagnose psoriasis by examining the skin, nails, and scalp. However, a dermatologist may sometimes recommend a skin biopsy to confirm the diagnosis. During this test, the dermatologist will remove a small piece of skin for lab testing to distinguish psoriasis from another cause of a rash.
Psoriasis is a chronic condition with no cure, but various treatment options are available to manage its symptoms. The treatment choice depends on the severity of the psoriasis and how responsive it has been to previous treatments and self-care measures. Here are some of the treatment options
Topical treatments
Topical treatment is the standard of care for treating mild to moderate psoriasis. It involves applying creams, ointments, lotions, gels, foams, sprays, or shampoos directly to the skin. The most frequently prescribed medications for this type of treatment are topical corticosteroids, available in various formulations, including creams, ointments, lotions, gels, foams, sprays, and shampoos.
Some of the topical corticosteroids used to treat psoriasis include:
- Clobetasol propionate (Cormax, Temovate)
- Betamethasone dipropionate (Diprolene)
- Fluocinonide acetonide (Lidex)
- Hydrocortisone butyrate (Locoid)
- Hydrocortisone valerate (Westcort)
- Triamcinolone acetonide (Kenalog)
Other topical medications used to treat psoriasis include:
- Salicylic acid, which helps reduce the scale and soften psoriasis plaques
- Vitamin D analogues
- Calcineurin inhibitors like pimecrolimus (Elidel) and tacrolimus (Protopic)
- Coal tar
- Dithranol (anthralin)
Oral medications
Oral medications are used for systemic treatment of psoriasis. They include:
- Methotrexate, such as Otrexup, Trexall, Rasuvo, Jylamvo, RediTrex
- Biologic medications, including Adalimumab (Humira), adalimumab-adbm (Cyltezo), brodalumab (Siliq), certolizumab pegol (Cimzia), etanercept (Enbrel), etanercept-szzs (Erelzi), guselkumab (Tremfya), infliximab (Remicade), ixekizumab (Taltz), risankizumab-rzaa (SKYRIZI), secukinumab (Cosentyx), ustekinumab (Stelara)
- Non-biologic systemic medications, including Cyclosporine (Sandimmune, Neoral) and apremilast (Otezla)
- Other medications, such as Deucravacitinib (Sotyktu)
Light and sunlight therapy
Light therapy, also known as phototherapy, is a treatment that uses specific types of light to improve the symptoms of psoriasis. It works by reducing skin inflammation and slowing down the production of skin cells. Doctors may recommend light therapy when a person has moderate to severe psoriasis or when other treatments have not been effective.
In addition, brief, daily exposures to sunlight (known as heliotherapy) might improve psoriasis. However, it’s essential to talk with your healthcare provider about the appropriate amount of sun exposure and to use sunscreen on areas that don’t have psoriasis.
Alternative and natural remedies
Some people have found relief from itching, burning, and redness by using alternative skin treatments such as aloe vera, tea tree oil, and apple cider vinegar. However, more research is needed to determine their effectiveness. Some people report success with homeopathic treatments for psoriasis, including sulfur and nickel.
Nutrition and lifestyle changes
A variety of dietary and lifestyle changes may help with the symptoms of psoriasis. These are discussed later in this article.
Research has shown an association between psoriasis and thyroid diseases, including Hashimoto’s thyroiditis. Here are some key points about the relationship between psoriasis and Hashimoto’s thyroiditis.
Psoriasis and thyroid diseases are both autoimmune conditions where the body’s immune system mistakenly attacks healthy cells. In psoriasis, the skin and nails are attacked by the immune system. In Hashimoto’s, the target of the attack is the thyroid gland. This shared characteristic may explain why they often occur together.
Both conditions appear to be triggered by a combination of autoimmunity in patients, genetic predispositions, immunological dysregulation, and inflammation.
Psoriasis and Hashimoto’s thyroiditis also share some common risk factors, such as family history, female gender, and specific genetic markers. These shared risk factors may contribute to the observed association between the two conditions.
An analysis of the relationship between psoriasis and thyroid diseases has shown a link between psoriasis and thyroid hormone anomalies, such as hypothyroidism and hyperthyroidism. This suggests that imbalances in thyroid hormones may contribute to developing or worsening psoriasis.
Multiple studies have shown a positive association between psoriasis and Hashimoto’s thyroiditis, indicating a higher prevalence of one condition in individuals with the other. For example, a meta-analysis of 39 articles found a significant link between psoriasis and autoimmune thyroid disease, including Hashimoto’s thyroiditis.
While the association between psoriasis and Hashimoto’s thyroiditis is well-documented, more research is needed to fully understand the underlying mechanisms and develop targeted treatment approaches for individuals with both conditions.
Another meta-analysis revealed that autoimmune thyroid disease (AITD) was more prevalent in patients with psoriasis than in the general population.
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Several dietary changes could help someone with both hypothyroidism and psoriasis by reducing chronic inflammation and calming autoimmunity. These include the following.
Eat a balanced, antioxidant-rich whole-foods diet
Focus on a diet rich in fruits, vegetables, and whole grains to help reduce inflammation throughout the body. Make sure your diet is rich in antioxidants such as vitamins A, C, and E, as well as carotenoids, flavonoids, and polyphenols.
Consider a gluten-free diet
Some studies suggest that a gluten-free diet may help improve thyroid function and reduce psoriasis symptoms in people with Hashimoto’s thyroiditis, an autoimmune condition that can cause hypothyroidism.
Consider the Autoimmune Protocol (AIP) diet
The Autoimmune Protocol (AIP) diet is an elimination diet that aims to reduce inflammation and symptoms of autoimmune diseases by identifying and avoiding specific trigger foods. Evidence suggests that the AIP diet may help reduce inflammation and symptoms of certain autoimmune diseases, including psoriasis and Hashimoto’s.
Avoid trigger foods
While there is no specific diet that will cure psoriatic disease or Hashimoto’s hypothyroidism, some people find that certain foods can trigger additional problems and flare-ups.
Soy and goitrogenic foods: Large amounts of soy and goitrogenic foods like raw cruciferous vegetables (broccoli, cauliflower, cabbage, etc.) may interfere with the production of thyroid hormone.
Nightshade vegetables: While not proven, some people with psoriasis and autoimmune Hashimoto’s report improvement in symptoms when cutting back on nightshade vegetables like tomatoes, potatoes, and peppers.
Excessive caffeine and alcohol: These can interfere with thyroid hormone absorption and should be consumed in moderation.
Dairy: Some people with psoriasis and Hashimoto’s hypothyroidism may be sensitive to dairy, so avoiding or limiting these foods may be beneficial.
Processed and sugary foods: Highly processed foods and sugary snacks can contribute to inflammation and should be limited.
Several lifestyle recommendations can also be helpful for people with psoriasis and hypothyroidism.
Exercise regularly
Exercise is a potential lifestyle change intervention that may be effective in treating psoriasis and reducing the symptoms of Hashimoto’s hypothyroidism. Regular physical activity can help reduce inflammation, improve cardiovascular health, and promote energy and overall well-being. Choose activities that you enjoy and can incorporate into your daily routine.
Maintain a healthy weight
Obesity is associated with an increased risk of psoriasis and can worsen symptoms. It’s also an exacerbating factor for fatigue and further weight gain in people with Hashmoto’s hypothyroidism. If you are overweight, losing weight through a combination of diet and exercise may help reduce the severity of your symptoms.
Manage stress
Stress can trigger psoriasis and Hashimoto’s flare-ups and worsen symptoms. Find healthy ways to manage stress, such as practicing relaxation techniques, engaging in hobbies, or seeking support from friends, family, or a therapist.
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Given the link between psoriasis and thyroid diseases, many researchers recommend regular screening for thyroid conditions in psoriasis patients. Paloma Health’s at-home thyroid test kit provides a convenient way to screen for hypothyroidism from the comfort of home, offering comprehensive testing for four biomarkers, including thyroid-stimulating hormone (TSH), Free Thyroxine (Free T4), Free Triiodothyronine (Free T3), and Thyroid Peroxidase (TPO) antibodies, providing a complete overview of your thyroid function. The kit is easy to use, with a quick 5-minute blood sample collection, and delivers secure results directly to you in around a week. Additionally, Paloma Health offers end-to-end hypothyroidism care, treatment, and support, including medical care for hypothyroidism and nutritional coaching services, to guide you in managing your thyroid condition effectively.
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