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If you wonder “Can psoriasis go away?”, believe that psoriasis is more than just a “skin problem,” and want to know about integrative psoriasis treatment options (that your doctor doesn’t talk about), this conversation is for you!
Psoriasis symptoms are often blamed by conventional doctors on your genes, stress or some unknown factor driving inflammation in your body and skin. But more current research suggests otherwise, underscoring why you must look deeper for root cause answers lurking under the surface.
And there’s pretty widespread confusion about what is and is not helpful for Psoriasis treatment – partly due to this significant rift between the conventional and integrative approaches.
For example, does alcohol really make Psoriasis worse?
Is it possible to take psoriasis medication AND simultaneously work on root causes? Or do you have to pick one?
Is it just sun exposure that is helpful for Psoriasis, or can light treatments be helpful too?
If you have Psoriasis, should you be worried about health issues in other organ systems so you can be proactive?
These questions (and more) make up the basis for today’s conversation with a dermatologist who believes that Psoriasis is more than just a “skin problem”!
In this episode, I’m joined by returning guest + friend of the show, Dr. Mamina Turegano, to discuss the deeper connections between psoriasis, inflammation, and whole-body health.
Dr. Mamina Turegano, MD, is a triple board-certified dermatologist, internist, and dermatopathologist practicing at Sanova Dermatology in the greater New Orleans area, specializing in medical and cosmetic dermatology. She has a special interest in evaluating how nutrition, lifestyle, sleep, and other environmental factors can play a significant role in inflammation, psoriasis treatment, aging, and cancer.
In addition to providing skincare tips and knowledge on dermatological conditions through her social media platforms, she shares her Japanese mom’s anti-aging tips, which incorporate holistic and traditional Japanese beauty practices. She’s also the co-author of The Holistic Psoriasis Management and Nutrition Guide – out now!
This empowering conversation will give you hope that psoriasis doesn’t have to be a life sentence.
Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android
In This Episode:
- Can psoriasis go away? (And why is it more than just a skin condition?)
- Common health conditions linked to psoriasis symptoms that doctors don’t tell you about
- Are weight loss and lifestyle changes worth trying to improve your psoriasis rash (and can they help you get off psoriasis medication?)
- The role of GLP-1 medications (like Ozempic) in psoriasis treatment
- Alcohol, fatty liver disease, and how they impact psoriasis symptoms
- Phototherapy + Psoriasis: Is it worth it to try?
- How to get an at-home UVB device paid for through your insurance
- The latest on Psoriasis medication: topical psoriasis treatment options, biologics, and Otezla (how to decide what’s right for you)
- Why conventional medications + integrative strategies can (and should) work together
- Is it possible to eventually taper off psoriasis medication when root causes are addressed?
Quotes
“Psoriasis can be a blessing in disguise, almost like the canary in the coal mine, because it's alerting you that there's inflammation happening in your body.”
“Alcohol sets off this whole inflammatory cascade [with] certain inflammatory markers that play a huge role in psoriasis – one of the biggest is TNF-alpha.”
Links
Find Dr. Mamina online | Instagram | Twitter | Facebook | TikTok
GET THE BOOK → The Holistic Psoriasis Management + Nutrition Guide: Natural Solutions to Treat and Relieve Your Symptoms
Discover Dr. Mamina’s podcast – Skin Deep MDs Podcast
Healthy Skin Show ep. 283: Is Your Rash Actually Shingles? w/ Dr. Mamina Turegano
Healthy Skin Show ep. 217: Health Concerns Linked to Psoriasis (You SHOULD Know About)
Healthy Skin Show ep. 373: What Causes Scalp Psoriasis + That Awful Itchy Scalp? w/ Dr. Jenny Bennett
394: Can Psoriasis Go Away? Latest Integrative Psoriasis Treatment Ideas w/ Dr. Mamina Turegano {FULL TRANSCRIPT}
Jennifer Fugo (00:37.383)
Dr. Mamina, it is such an honor to have you back here on the show to talk about psoriasis treatment. I'm glad you're back.
Mamina Turegano (00:48.825)
Oh my gosh, thank you so much for having me. I loved chatting with you last time, and very excited to be here again.
Jennifer Fugo (00:55.215)
I know, we had a great conversation about shingles, which is actually really important, I'll link that up in our show notes for those of you who missed that episode. Today, we're actually going to be talking about all things psoriasis: psoriasis treatment, psoriasis symptoms, signs of psoriatic arthritis, psoriasis medication, etc. which I haven't actually focused on this in quite a while. So I think it's a really timely opportunity for us to kind of dive into this, especially because you recently co-authored a book called The Holistic Psoriasis Management and Nutrition Guide. And I think a lot of what I found in that book, so thank you so much for sending a copy, was really informative, really helpful, especially for people, whether you're at the beginning of your journey, or you're somewhere in the middle trying to figure out what options are best for you, I thought it was really great.
So I would love to start out with talking about some of the connections within your body. Because most people who get diagnosed with psoriasis, it appears that many of them are not told that there are these things called comorbidities, or other types of diseases or disorders, that I guess, would you say they sometimes occur at an increased rate because of psoriasis? Like how would you describe that?
Mamina Turegano (01:53.133)
Yes, so a lot of people think psoriasis is a skin disease, which of course it is, but it's actually, there's a lot happening in the whole body when you see psoriasis. And I almost tell patients, psoriasis can almost kind of be like a blessing in disguise, it can almost be kind of like the canary in the coal mine because it's alerting you that there's inflammation happening in your body. And yes, you bring up a really good point. So psoriasis has definitely been found to coexist with other inflammatory conditions like cardiometabolic diseases. People with cardiac disease, so coronary artery disease, people are at higher risk for having strokes, your carotid arteries being affected. And then people are also at higher risk, you know with that you get high cholesterol, also high chances of having obesity, as well as diabetes.
And metabolic syndrome too, in general, metabolic syndrome is a combination of different risk factors with high blood pressure, and obesity, and your cholesterol numbers, and they also look at your waist circumference, all of those contribute to something called metabolic syndrome, and then that puts you at higher risk for these conditions. So it's interesting, because people probably have never gotten, I'll have young patients who've never gotten their cholesterol checked or things looked at like that, and people will be more proactive about their health with a psoriasis diagnosis when it's something, a subject that we talk about in the office.
And with psoriasis too, I mean, for me as a derm, I think everything's connected. Like when I look at any kind of skin disease, I'm like, okay, you know, I'm like, that could be probably related to your migraines. But I do notice a pattern too, with people with psoriasis. I see higher rates of things like hypothyroidism, there's higher rates of depression, and I see more hair loss. And I think that the pathophysiology and the inflammatory pathways that contribute to psoriasis, also the root causes behind that, are contributing to these other conditions as well.
Jennifer Fugo (04:40.903)
So it's possible then that it's sort of like an inflammatory overlap. Do you know what I'm saying? It's like, oh, you have this picture over here and so it might show up as psoriasis rash, and then maybe a few of those are gonna like overlap into, I don't know, like you were saying, hair loss, or Hashimoto's thyroiditis, or something like that where, I mean, I had a client once who was extremely depressed. She had pretty bad psoriasis on her hands. She didn't have psoriatic arthritis, but I could just tell she was like, I mean, like a point of depression that was like, I'm concerned for you, her husband was concerned. It turned out, when I was like, I think you should get all these labs run, one of which was TSH, her TSH was 33.
Mamina Turegano (05:23.352)
Oh, jeez. Yeah, that makes sense.
Jennifer Fugo (05:30.149)
Yeah. So thyroid health is really important. And I think most people with psoriasis, while they may be looking for these connections that you talked about, like, oh, well, it's a whole body disease, some think it's just their skin and that it might manifest down the road as psoriatic arthritis. But what do you generally see, like in your practice and your experience with psoriasis? Are there any one or two big comorbidities that you tend to see the most in psoriasis?
Mamina Turegano (06:06.926)
I would say that the majority of my patients with psoriasis are overweight or obese. Majority, not everyone of course, but I do see that correlation. And they're probably on medication for one other thing, whether it's high blood pressure or high cholesterol. So yes, I do see that pattern.
Jennifer Fugo (06:31.641)
Interesting. So there's this interesting picture that you're like, oh, yeah, you have this too, this kind of has started. I've also wondered, and I don't have any, I think it may have been touched on in your book, because you guys covered so much in this book, by the way, which I love.
Mamina Turegano (06:50.222)
Yes, we tried to make it pretty comprehensive for anyone with psoriasis, or anyone who wants to know more about it.
Jennifer Fugo (06:58.415)
Yeah. And you have really wonderful patient vignettes that I think help the reader, no matter whether you're new to psoriasis, you're a parent of somebody going through this, so you're learning about this for your child, your spouse, whomever, or maybe even you're a provider of some sort, and you want to understand from a more integrative perspective how this information could be helpful. I find the patient vignettes really fascinating. I always love, like, how does this show up in real life, you know?
Mamina Turegano (07:30.37)
Oh, good. I'm so glad because by the way, that was like one of the hardest parts of the book, I thought. I was like, man, okay, and it was all of the authors putting together their vignettes, but I was, yeah, it took me a while to get all my stories. So I'm glad.
Jennifer Fugo (07:48.432)
Yeah, your ducks in a row and everything is there. Yes.
Mamina Turegano (07:50.386)
Yes, I'm glad that it helped.
Jennifer Fugo (07:51.207)
Yeah. So I wonder if, too, when someone is overweight and they have, we'll just call it essentially what it is, excess fat storage, there's a lot of interesting perspectives on how that can contribute to inflammation in the body in and of itself. So I wonder if, so I think this is a good question for you. If you see a patient reduce weight, so they actually lose weight, so we're not talking even just maybe five pounds, like we're looking at a sizable amount of weight, maybe 20 pounds, 40 pounds. I just talked to a client yesterday who lost 40 pounds in the last six months, I was like, yay, that's amazing.
Mamina Turegano (08:36.206)
That's amazing. Yeah.
Jennifer Fugo (08:46.219)
And he is feeling so much better. So do you find that weight loss does help the severity of psoriasis symptoms?
Mamina Turegano (08:50.658)
Definitely. I think it plays a huge role, and I think you bring up a really good point because yes, fat cells like adipose tissue can contribute to inflammation. And there's a lot of other things associated with it as well, like their diet may be a little bit more inflammatory and that can be contributing to more inflammation in the body, and maybe they're not exercising as much and movement is so important for decreasing inflammation.
But yes, I can't tell you, I'm just thinking right now of a patient example that I have, it's actually mother-daughter, they're adorable, they were both overweight, they both had psoriasis, and they both actually got on GLP-1 agonists, I don't know if it was Ozempic specifically. But I mean, they look like completely different people, and then the mom ended up getting a facelift, so she looks amazing because that's one of the things with rapid weight loss is the sagging skin that you can get.
Jennifer Fugo (09:42.8)
Yeah.
Mamina Turegano (09:48.896)
But anyways, they look amazing, and the daughter, she had pretty bad scalp psoriasis and we have now, like over the last year, we've been tapering her off of Skyrizi, which is a biologic, risankizumab. And the last time I saw her, which was like in the last couple of weeks, she had not been on it. It's a dose that you get every three months, but she hadn't been on it for like five or six months and everything's looking amazing.
Jennifer Fugo (10:10.715)
Wow. I just have to stop you, because I think most people have never heard that you could taper off a psoriasis medication possibly.
Mamina Turegano (10:25.504)
Right, because you're told that it's a chronic disease that you have to live with for the rest of your life, right? And people are on biologics indefinitely. There's no like, all right, this is how long, there's no set period that you're on a biologic. It's not like antibiotics, where you're just on it for a certain period of time, or Accutane, or something like that. This is like, there's no end date in sight. And I've been able to do that with a few patients who've been able to manage other aspects of their health, so it's really inspiring.
Jennifer Fugo (10:57.805)
I love that. That is so wonderful to hear, because I've seen clients in my practice get better, but it's nice to also hear a doctor talk about that because I think it helps make the journey feel realer for the person who's struggling with this. I do want to ask your opinion, though, about the GLP-1s.
Mamina Turegano (11:13.666)
Totally.
Jennifer Fugo (11:26.801)
I mean obviously you gave this great case example. Do you feel like these medications, which are like all the rage now, can they be helpful for psoriasis rash? Do you think that you have to have, like how did they, if you don't mind sharing, and obviously respecting HIPAA and everything like that, but what is the way, if somebody wanted to try a GLP-1 and possibly wanted to see if their insurance would cover it, is a dermatologist the right person to help them with that? So all that good stuff.
Mamina Turegano (11:55.254)
Yeah, good question. Yeah, derms are not, I think, as trained in that field yet. And actually, I do know of a couple of derms who do prescribe it to patients. But in general, it's not in our wheelhouse. But I think as we're seeing more studies come out, because I think right now we have some interesting preliminary studies showing the benefits of GLP-1s in the setting of psoriasis as well as another skin condition, hidradenitis suppurativa. Interesting, both of those diseases are worsened in situations where there is, when people gain more weight, when there's more obesity. So it makes sense that it works.
And so I think there's a lot of promise to it, and I would love to be able to prescribe it. I just, yeah, I usually would refer, or suggest it to the patient as a potential thing to look at. But I think that when it comes to GLP-1 agonists, I don't want them to only rely on that as their way to lose weight or help their psoriasis. I think it's important that they have other things in place for their health, whether it's incorporating exercise, incorporating a healthy, non-inflammatory diet, because I think that's when it will work the best, the GLP-1 agonist.
Jennifer Fugo (13:17.447)
And what if somebody has psoriatic arthritis or signs of psoriatic arthritis? Do you think that weight loss is also beneficial in that particular instance? I guess it also might depend on the joints that are affected.
Mamina Turegano (13:27.97)
Yeah, I think, well, you know, we can get joint pain because of weight itself. And we see that, actually, interestingly more so in things like osteoarthritis, where the actual weight of the human is affecting the joint, and that's why there's pain and inflammation. But with psoriatic arthritis, it's random joints that are affected, oftentimes in the hands, ankles, lower spine. And I still think that losing weight will help with that too because as we've mentioned, with increased adipose tissue can come increased inflammatory markers and all the other things associated with that too, whether it's diet, lack of exercise, et cetera. Because it's all similar pathophysiology with inflammation.
And I do know of, actually I was just talking with Dr. Tyna Moore yesterday, and she uses GLP-1 agonists for people with psoriatic arthritis. She practices more regenerative medicine and helps people a lot with pain, and she, I feel like, is one of the experts in GLP-1 and she uses it often for psoriatic arthritis.
Jennifer Fugo (14:39.175)
I want to ask you this, because I think alcohol is kind of another complicated, it's a complicated relationship with psoriasis. And I oftentimes get the question, do I really need to go cold turkey and cut it all out, or is there some wiggle room here? So what are your thoughts on alcohol consumption if you have psoriasis symptoms and psoriasis rash?
Mamina Turegano (15:06.838)
I mean, for me, so for those who don't know, alcohol, we have a lot of established evidence that alcohol worsens or can trigger psoriasis flares, and that could be for many reasons. And it's been shown even a small amount can affect psoriasis. So in an ideal setting, yes. It's hard to go, I know for many people it's hard to go cold turkey, but alcohol just sets off this whole inflammatory cascade. It sets off certain inflammatory markers that play a huge role in psoriasis, like one of the biggest ones is TNF-alpha. And so even a small amount can affect psoriasis. So it's one of those things where you just gotta weigh the pros and cons.
Jennifer Fugo (15:58.63)
Yeah.
Mamina Turegano (16:00.644)
Like, do you wanna have psoriasis, or do you wanna have just a tipsy fun night out? You know what I mean? Whatever is a priority for you. I think that it's much better if you just have a random, like if you drink sporadically here and there as opposed to drinking chronically, that's where we're seeing way more issues. But, yeah, abstaining altogether would ideally be the best.
The other thing with alcohol is we see a high incidence of fatty liver disease in people with psoriasis. It's very common, and we don't need anything else hurting your liver. Alcohol is only going to make things worse, it's going to make your liver worse. Your liver is already struggling if you have psoriasis. So decreasing that burden is so important.
Jennifer Fugo (16:59.589)
Yeah.
Mamina Turegano (17:08.24)
And then we know that there's a huge connection with your gut, and your gut microbiome, and psoriasis too, and alcohol affects that as well. So yes, it's tough. And it's kind of cool though, I feel like there's been this trend, at least in this country I feel like, amongst younger people moving away from alcohol events, being alcohol-free, and people turning towards other things, like other fun activities that don't need alcohol
Jennifer Fugo (17:20.537)
Yeah. I also sometimes think too, because my husband and I don't drink very often, and I remember in earlier days, I always kind of felt like, oh, we're going out, you have to have a drink. And now I mean, we have a wine, we're part of a wine club, and have so much wine downstairs. I'm like, we don't ever drink this. Because for me, I don't care what I'm drinking, I don't need the drink to be the thing that makes socializing easier, or a dinner. If I'm gonna have it, it's because it's a special occasion or whatever. So I might have a glass of wine once a month, maybe.
Mamina Turegano (17:43.832)
Exactly. Yeah, if that.
Jennifer Fugo (18:11.537)
And so I think it's worthwhile to ask the question, if you really feel like you can't go out without having alcohol or you can't, you know, it's one thing to go, well, I enjoy it, I like it. I totally understand that, but everything that we like is not always good for us. And if you're really struggling with stopping, that might be an opportunity to speak with somebody about what the reasons are that are kind of preventing you from making that change. Because I do think it's, I think it's a helpful thing.
And I'm so glad you brought up the fatty liver issue because the liver comorbidity problem is so significant with psoriasis. And alcohol is already hard enough on your liver as is. It also, depending on how much you consume, will deplete a lot of nutrients, and we already know that there tends to be a lot of nutrient deficiencies that show up in psoriatic cases. So I just think it's like a storm, a perfect storm, so to speak.
Mamina Turegano (19:04.225)
Yeah, totally. And you were talking about your decreasing alcohol or not having it as much. After I got pregnant, I abstained altogether. And it wasn't even like I was drinking that much, I was maybe, I was just drinking for social reasons and it ended up being like a couple of drinks a month or something. But after abstaining and then just through breastfeeding, I was like, I'm just gonna stay away still. I mean, I feel so much better. And it's not like I even drank that much, but I just think everything is so much better, health-wise.
Jennifer Fugo (19:32.754)
Yeah, health-wise, yep. And also I wanted to ask you about phototherapy, because I think sometimes patients might not be told about this, and then there's all these different light units that you can buy on the internet, especially with the rise of red light therapy and the popularity of that. But they get them mixed up, they’re like, is UVB light the same as red light? So can you talk a little bit about the different light options, and what you know and see has been most helpful?
Mamina Turegano (20:03.8)
Yes. For sure, I am a huge fan of light therapy, and I love that you're bringing this up because yes, a lot of patients don't know that it's an option for psoriasis, and it's something that insurance can cover kind of psoriasis treatment option, it's a prescription. And it is great because you don't have to worry about any internal immunosuppressive, systemic side effects. It's literally a light treatment, and there's different forms of it. The most commonly prescribed form of light therapy is, it's like you're standing in a light box, it kind of feels like a tanning bed, you're standing in it.
And I want to be very clear about what light therapy is, because it's very different from sunlight, it's very different from tanning beds. Light therapy for psoriasis uses a specific wavelength of UVB light called narrowband UVB. It's 320 nanometer wavelength. And this wavelength targets a specific layer in your skin where there are certain immune cells that it affects and modulates, decreases, so that you're having less inflammation in your skin. And it's great because it's not the wavelength that contributes to skin cancer. So, you know, the sunlight does have this wavelength in it. That's why sun also helps with the skin and then sun helps with vitamin D production and metabolism too, so that's how sun helps with psoriasis as well. But light therapy is great because it's this targeted wavelength that really targets that specific layer in the skin that is responsible for a lot of the inflammation with psoriasis. There's also PUVA, which is a specific wavelength of UVA light. That one, not all centers or clinics offer that because that one's for more severe cases and you do have an increased risk for skin cancer with that one. So the traditional one is with UVB.
Now, not all derm clinics have light therapy in their practice. Larger centers do. When I practiced in DC, we had it there, but I don't have it in my current practice in New Orleans. But what's really interesting, and you should, if your dermatologist doesn't have it, you should definitely ask your dermatologist about having a device at home. You can get a literal light box, it looks like a tanning bed, in your home. You can also get handheld devices if you have localized psoriasis. If you have full body psoriasis, I do recommend the full body light box treatment. But yeah, if it's just on your scalp or just on your hands, you could also get a type of wand where you could just focus on the areas. And insurance can cover these things. It's kind of annoying as a derm, you have to fill out all these forms and stuff, but it exists.
Jennifer Fugo (22:52.367)
Yeah, one of my clients recently was able to get this, she said it looks like a comb or a brush and it's a UVB wand that she can move over her scalp, because she has scalp psoriasis, and it was completely covered by insurance, so she was pleasantly surprised.
Mamina Turegano (23:06.659)
Nice. Love it.
Jennifer Fugo (23:19.249)
And her derm had never suggested it. She had heard it, Dr. Jenny Bennett had talked about this on the Healthy Skin Show in a previous episode. And so she went and asked her derm and she was like, oh my gosh, I got this device and it was totally paid for by my insurance. So I think these are helpful things. Do you think that red light therapy is as helpful, or is it helpful in a different way than these options?
Mamina Turegano (23:38.666)
Yeah, I think theoretically it can be helpful. I don't know of any studies of it, specifically looking at it in psoriasis, but we do know that red light helps with inflammation in the skin. And so I could see it being potentially beneficial. I would love for there to be more studies with it. I don't think it hurts to use, you know?
Jennifer Fugo (24:00.719)
Right, right.
Mamina Turegano (24:13.69)
They can be pretty expensive so I would just, you know, look into getting an insurance. If you have psoriasis, I would try to see if insurance could cover something that we know works for sure. But if you have a red light mask hanging around, or an LED panel, I mean, I don't think it hurts.
Jennifer Fugo (24:19.323)
Yeah, I don't think it hurts either. My preference is always to get one with both infrared and near infrared. And I'm like, why not turn it on at the same time? It'll help more deeper tissue and it'll help the skin, so why not?
Mamina Turegano (24:31.842)
Yeah, I mean, we definitely know that there's data that it can help with arthritis, I don't know which forms of arthritis. But yeah, so it seems like it would be great for psoriatic arthritis.
Jennifer Fugo (24:45.189)
Yeah. Well, another thing I wanted to ask you in terms of just like psoriasis treatment, and this is where I think sometimes people get overwhelmed. Because they'll go to their doctor, they're really struggling, right? They might have tried the diet thing, they're trying to do a lot of different things, but they're really struggling. And obviously then, if we start having joint involvement, that's a kind of like totally different situation altogether and, I think, increases the urgency for a higher level of intervention.
What should someone who has no knowledge of medications, you're trained on this, there's immunosuppressants, there are now these biologic drugs, there's Otezla, which I feel like is kind of different. What should somebody know, or consider, or ask if their derm, or even just they’re thinking, like maybe they need some medication to help them?
Mamina Turegano (25:46.51)
Yeah, so when it comes to prescription medicines for psoriasis, it definitely depends on the extent of psoriasis that you have. If it's very localized, you can get away with topical treatments, and we could kind of briefly go over the different types of topical treatments there are. And then if you do have, like I would say if you have more than 10% body surface area, you definitely would qualify for a systemic medicine. So think of like the palm of your hand is like 1%. So think 10%, 10 palms-worth of body surface area. And then like if you have scalp psoriasis too, of course there's topical treatments. If it's pretty severe, topical treatments can get really annoying for people to use on their scalp, so this is where systemic medicines would become more helpful. And then if you have psoriatic arthritis, if you have nail involvement, psoriatic nail disease happens in about 30% of people with psoriasis, then systemic medicines are gonna be more effective in that regard.
Now, when it comes to the types of psoriasis medication there are, they all are essentially anti-inflammatory medicines. So with topical medicines, the most commonly used class are steroid medicines. We like these because they work pretty quickly, but they are not a good long-term solution. So if you ever are prescribed steroid creams, you can use them, we usually say for up to two weeks and give it a break because it can thin out your skin. Also, if you do have a lot of body surface area, which is another reason why we say it's better to do systemic, but if you do have a lot of body surface area, you can absorb it systemically. You can absorb the steroid systemically, and that's worse for you than biologics, actually. Systemic steroids, we never do for psoriasis actually, because people get really bad rebound psoriasis. But topical steroids, we do a lot.
Then there have been, fortunately, in the last couple years, like two new non-steroidal creams that have come out. Prior to that, we would use this class of medicines called calcineurin inhibitors, like tacrolimus and pimecrolimus, which were great because they weren't steroids, they didn't work as well as steroids, they weren't as fast acting, but they were great for maintenance. And then vitamin D creams, vitamin D analogs like calcipotriene is something that we would also use often with psoriasis. But yeah, in the last two years, there's tapinarof cream and roflumilast, which is Zoryve.
Jennifer Fugo (28:09.575)
Zoryve, I was gonna say, I have a client on Zoryve, yeah.
Mamina Turegano (28:12.672)
Yeah, and those work very differently, but those are nice options for patients. And there was another one, oh yeah, Tazorac, tazarotene, which we think of as for acne or for anti-aging, but psoriasis is a disorder where you have abnormal keratinocyte proliferation or skin cell proliferation, so that's why you see these thick, scaly plaques on the body and the scalp. So Tazorac helped regulate that skin cell proliferation, so that's also another great topical psoriasis treatment option.
But I usually kind of put out the fire with a topical steroid, and then maintain with a non-steroidal. And then if you have psoriasis on your scalp or in areas with more moisture, like your armpits or your groin, I also do a topical anti-yeast product, something like a shampoo for the scalp, like ketoconazole shampoo or ketoconazole cream for those areas, because yeast is a huge contributor as well to psoriasis.
Jennifer Fugo (29:06.085)
On the skin, like topically, and/or internally?
Mamina Turegano (29:09.932)
Well, I think that there's probably yeast overgrowth in the gut, but definitely topically.
Jennifer Fugo (29:13.959)
I agree.
Mamina Turegano (29:14.231)
Yes, yes. That's another mechanism, I think, behind alcohol too, like think alcohol can worsen the yeast load in the body and on the skin, and sugar as well. So I talk about that a lot with patients, but yeah, so an anti-yeast product topically.
Jennifer Fugo (29:32.449)
What do you think of the biologic medications for psoriasis treatment? How do you feel about them, what's your experience been?
Mamina Turegano (29:35.008)
Yes. Totally. So, let's see, I've been treating patients for like 16 years and initially, when it came to biologics, we just had the TNF-alpha inhibitors, there was an anti-IL-1. But anyways, the TNF-alpha inhibitors, so the two most popular ones that you've probably heard of are Humira and Enbrel, and those were like the mainstay treatments for psoriasis, but those came with issues. Like those could increase your risk of certain cancers like lymphoma and skin cancers, which is frustrating. And then we also had to really monitor blood work closely with them, we have to monitor your liver, hepatitis, check for hepatitis, we have to monitor your tuberculosis status. These were more immunosuppressive. When you block TNF-alpha, you're blocking a pretty large portion of your immune system.
And it's been amazing, in the last 10 years we've had like an explosion of the newer generation of biologics, anti-IL-17 and anti-IL-23, or 12 and 23, and these are things like Cosentyx and Taltz, secukinumab and ixekizumab, gosh it's a whole other language.
Jennifer Fugo (30:49.001)
They are, sometimes it's a mouthful.
Mamina Turegano (30:59.998)
It's so hard. And then there's Skyrizi which is risankizumab, and there's Tremfya which is guselkumab, and they have been a game changer. And I think people kind of have a bad taste in their mouth because they've heard probably bad things about Humira and Enbrel, which are still great drugs, but it's funny, I never prescribe those now. Because not only are these newer agents way more effective, like you can get 90% to 100% clearance with these guys, which you know you wouldn't get with Humira or Enbrel, and the safety profile is so much better. We still check tuberculosis status just because it was something carried over with the TNF-alpha inhibitors, but it doesn't really increase your risk of tuberculosis, it doesn't increase your risk for cancers. It's still technically an immunosuppressant, but it blocks a specific immune marker that is a smaller part of your immune system so it's less immunosuppressive.
But yeah, it's not something I would take lightly, it's something that you still have to have a good discussion with your doctor, they still should go over all the side effects with you. But I thank God every day for these new generation biologics, because I feel so much better, like just in my conscience prescribing them because they're just way safer. And what was the other thing I was going to say about them? And also the dosing schedule is so much better, like they're every two to three months, which makes your quality of life so much easier. You don't have to take this medication every day.
For people who are scared about immunosuppression, even just the small immunosuppression, there's medicines like Otezla, which are not considered immunosuppressive. They're actually considered more immunomodulatory, which is less scary-sounding. It's funny, I think there's more side effects with Otezla, though, than biologics. One of the biggest side effects is GI symptoms like diarrhea, so I would just be cautious if you're prone to that. Also slightly higher risk of depression and migraines.
Speaking of GI stuff, if you are prone to inflammatory bowel disease, which I think more patients that we realize have.
Jennifer Fugo (32:54.993)
Yep, there's a little big connection there.
Mamina Turegano (33:12.908)
There's a big connection, and it's all connected. But I think, so the anti IL-17 biologics that I referred to, Cosentyx and Taltz, potentially can increase the risk for IBD, so we stay away from those in those who are at risk for that. But otherwise, most people are great candidates, even people who've had a history of cancer, which we were scared to do with Humira and Enbrel, but now we're more okay with the newer agents.
Jennifer Fugo (33:19.078)
Yeah. And can I ask you, if someone has, let's say they're covered pretty extensively with plaques and they have a diagnosis of psoriatic arthritis, what would clear or improve first? And can you have improvement in the joints if you go on these medications? Because I will say, we've said before on the show that the medications will save the joints, it will sort of stop the progression of damage because we can't fix the damage that happens.
Mamina Turegano (33:59.022)
You can't fix the damage. Yeah.
Jennifer Fugo (34:21.095)
So I want to underscore that, because I think sometimes people with psoriatic arthritis think that there's like, well, I can get it back. And it's like, no, no, no, unfortunately, we're not there. So what's your thoughts on that in terms of what would most likely improve first, what would a timeline kind of look like? And can the joints, maybe if you have a lot of pain, would a biologic help the joints be less painful?
Mamina Turegano (34:24.334)
Definitely. The biologics, these same biologics I mentioned, the newer class, definitely Humira and Enbrel have been used extensively for psoriatic arthritis, but the newer class agents, we have now studies that those are also very effective in psoriatic arthritis. So a lot of rheumatologists are prescribing it for patients with psoriatic arthritis. I will prescribe it, obviously, if patients have both skin and joint disease. Sometimes with psoriatic arthritis, I forget which medicines it is, you do need a slightly aggressive dose, so it can be a little bit more stubborn than regular psoriasis, but both can clear pretty easily with biologic treatment. And the timeline varies. It usually is within like two months, which is amazing. Especially, well, definitely with the IL-17s, that's really fast acting. And then, yeah, I mean, three to four months with the others.
Jennifer Fugo (34:57.969)
Oh, wow. Yeah, I think one thing that's also helpful, and I would love your perspective on it. My experience has been, but obviously I'm a clinical nutritionist, so I'm not prescribing medications, I'm not advising clients on medications. There's times where I'm like, hey, I think we need to talk about, you gotta go back to your doctor, you're really suffering. Sometimes I'm the person initiating that conversation, because I know they really wanna do it naturally, I get that, but it's also quality of life.
Mamina Turegano (35:44.406)
Totally quality of life, yes.
Jennifer Fugo (35:49.401)
Yeah, and then with psoriatic arthritis, this is a whole different ball of wax.
Mamina Turegano (35:53.474)
Yes, the erosions, like you said, can be permanent, so important.
Jennifer Fugo (35:54.137)
Yeah. So my experience has been that even if someone goes on these medications, we can still do so many integrative things that are driving inflammation under the surface while you are on psoriasis medication. What's your feelings on that?
Mamina Turegano (36:13.206)
Yes, I am all about it. And yes, it's like, that is my love, my passion is integrative medicine. It's like, let's try to get you to feel better, both just mentally and physically with these medicines while we fix your gut, while we do all these other things to get your life back on track in whatever way it is. Because those things take so much longer, fixing the gut takes so much longer.
Jennifer Fugo (36:41.711)
It does.
Mamina Turegano (37:00.464)
And it's also how motivated the person is to implement all of these changes. Some people, it takes a while. So before more damage is done, whether it's with the joints or before, so that you can feel confident to go outside in shorts. And the conventional medicines play such a huge role with that, like lives are changed, people are so much happier. But yeah, I think it's so important that while that's happening, now that you feel better in that way, it motivates people to work on these other aspects of their life. So I think these meds play a huge role with that.
Jennifer Fugo (37:24.079)
Yeah. And I love the fact that you are in alignment with that idea, that we could use the meds if we need to, to improve quality of life, while at the same time being able to utilize a lot of these integrative strategies. And I think I just need to say it again, because I thought that was so amazing that you shared that, that it is potentially possible down the road to possibly wean off of these.
Mamina Turegano (37:48.024)
Yes, totally. I definitely believe it.
Jennifer Fugo (37:50.587)
I think that gives people hope. So I wanna make sure that people can connect with you, obviously. You've got a huge following, you're on TikTok, and Instagram, and YouTube. I'll make sure to put all of your links up so people can connect with you. And then we've got your great new podcast that you're doing, called the Skin Deep MDs podcast. So we'll put a link to that.
Mamina Turegano (37:58.188)
Yes, thank you.
Jennifer Fugo (38:20.167)
And then you've got this book called The Holistic Psoriasis Management and Nutrition Guide, which is available now. And we'll put a link to where you can get it, because I’d imagine it's pretty much available everywhere.
Mamina Turegano (38:27.022)
Yes, yes. Thank you.
Jennifer Fugo (38:36.802)
Yeah, thank you so much for sharing all of this today. I really am so glad that you were able to come back to the show. And I really appreciate your enthusiasm for blending options and giving people more options than just, it's this one way, and that's it.
Mamina Turegano (38:47.17)
Yeah, no, I loved all your questions and I think that having discussions like this and people to hear these discussions, I think gives people more hope and just more knowledge and feeling more empowered to get the right treatment for themselves. So thank you so much for having me.
Jennifer Fugo (39:04.327)
Awesome!
