Skin deep: a whole-body approach to psoriasis

Psoriasis isn’t just about what you can see on the skin. Catherine Morgan explores what happened when one man looked beyond his symptoms – and what his experience could teach us about taking a more personalised approach to managing the condition.

Psoriasis is a chronic, immune-mediated inflammatory skin condition that causes dry, itchy, sore and flaky patches. These commonly appear on the scalp, chest, tummy and back, bottom, arms and elbows, lower legs and knees, but can affect almost any part of the body. Symptoms typically come in periods of flare-ups and remission and can have a profound physical and emotional impact.

Although psoriasis can develop at any age, it often begins between the ages of 15 and 25 or 50 and 60. The NHS states that psoriasis ‘cannot be cured, but there are treatments to help manage your symptoms’.

But what happens when you look beyond the skin?

For 25-year-old James*, looking beyond his visible symptoms became an important part of his journey. Working with registered nutritional therapist and ION graduate Victoria (VJ) Hamilton, he explored how his diet, digestion, lifestyle and wider health might fit into the picture, taking a more personalised approach to his healthcare.

When psoriasis takes hold

James did not experience significant skin problems during childhood, but developed cystic acne as a teenager, which was treated with Roaccutane. Around the same time, his first psoriasis lesion appeared.

The condition became more established around 2020, initially affecting his scalp – one of the more persistent areas – before gradually spreading to his arms, shins, back, hands, feet and groin.

James had tried topical steroids, which initially helped but became less effective over time. He later trialled acitretin but felt that his psoriasis became worse while taking it.

While James’s initial PASI (Psoriasis Area and Severity Index) score – a measure used to assess the severity and extent of psoriasis – indicated moderate psoriasis, his DLQI (Dermatology Life Quality Index) told a different story. The score revealed that, despite the clinical classification, his psoriasis was significantly impacting his quality of life.

James also experienced persistent dry skin and scalp inflammation, reduced energy, and joint pain and stiffness, as well as tonsil stones and digestive symptoms.

Looking beyond the skin

Hamilton, who specialises in chronic and autoimmune conditions, started by taking a detailed look at James’s health and symptoms. This included his diet, lifestyle, medication history, psoriasis distribution, digestive function, energy levels and joint symptoms, helping her to build a picture of the wider factors that might be influencing his health.

His progress was monitored using his PASI and DLQI scores, alongside changes in his skin, energy, digestion and overall quality of life.

Functional testing included a comprehensive stool analysis, alongside nutritional and metabolic assessment, food sensitivity testing and urinary mycotoxin screening (for toxins produced by certain moulds).

Putting the pieces together

The results highlighted gut dysbiosis, possible issues with protein and fat digestion, oxidative stress and increased nutritional support needs relating to riboflavin, folate and methylation. Several moderate food reactions were also identified, alongside the presence of ochratoxin A, a mycotoxin produced by certain types of mould and one of the more common mycotoxins found in food.

“These findings fitted with his fatigue, digestive symptoms and wider inflammatory picture and helped to shape the nutritional and supplement programme,” explains Hamilton. “My working model was that his psoriasis reflected the interaction between immune susceptibility, gut microbial imbalance, digestive and barrier function, nutritional needs, mitochondrial stress and environmental and lifestyle influences.

The information enabled Hamilton to take a layered approach: supporting digestion and nutrient absorption, improving microbial balance, strengthening barrier integrity, supporting cellular energy and inflammatory resolution, and helping him gradually rebuild his overall resilience,

“No single factor was presented as the sole cause of his psoriasis,” she says. “The aim was to identify the areas placing the greatest pressure on his system and address them in a practical, prioritised way alongside his conventional medical care.”

Building a personalised plan

Hamilton, who has been practising for seven years, began by moving James towards a nutrient-dense, anti-inflammatory diet centred on good-quality protein, a wide variety of colourful vegetables, healthy fats and polyphenol-rich foods.

“Because James’s food diary and test results suggested that he was eating several of the same foods very regularly, selected foods were temporarily removed and others placed on a 72-hour rotation,” says Hamilton.

“The purpose was to reduce repeated immune exposure while maintaining as much variety as possible, rather than leaving him on a highly restrictive diet long term.”

Hamilton worked on increasing protein at each meal to provide the building blocks needed for skin repair, tissue recovery and energy.

Supplements were introduced to support areas of James’s health that needed attention, including vitamin D status, digestion, inflammatory balance, skin and cell-membrane health, antioxidant protection and joint comfort.

“Following his stool-test findings, the plan developed to include more targeted support for gut microbial balance and intestinal-barrier integrity,” she explains. This included a time-limited antimicrobial phase alongside gut and digestive support. “Rather than treating the microorganisms identified on the test in isolation, we considered whether they fitted with his wider picture of psoriasis, inflammation, digestion and immune activity.”

James’s mycotoxin results also prompted a closer look at potential dietary sources of ochratoxin A. Coffee was a particular focus, so he was advised to switch to a mycotoxin-tested coffee or replace it with matcha. As James was already making good progress, Hamilton says there was no need to introduce a more intensive mould-focused protocol.

Lifestyle recommendations were also part of the plan, including getting outside in the morning for daylight exposure, staying well hydrated, regular movement, and incorporating joint-mobility exercises. As James’s energy improved, he gradually returned to morning runs and regular gym sessions.

The plan evolved in response to his symptoms and test findings, but the overall aim remained the same: to create a more supportive environment for immune regulation while making the programme practical and sustainable.

The turning point

The changes were encouraging.

Within a couple of months of starting the programme, James began to notice a difference in his skin. By around four months, he estimated that his psoriasis had improved by approximately 80%. The changes didn’t happen overnight but developed gradually over time.

“He initially reported approximately 80% improvement, and by our final appointment this had increased to around 90%,” says Hamilton.

“His back and arms became largely clear, with only occasional small, dry patches. His scalp had been slower to respond but had also improved significantly.

“His energy improved considerably, allowing him to restart morning running and attend the gym three to four times per week. His tonsil stones became less frequent, and he was able to be more flexible with his diet without experiencing a significant return of his psoriasis.”

It is difficult to know which part of the programme made the biggest difference, but James’s experience highlights what a personalised, multi-layered approach can look like in practice.

Making change sustainable

For James, the recommendations have proved sustainable.

However, Hamilton says the goal was never to restrict his diet indefinitely.

“Temporary food removal and rotation were used to reduce repeated exposure and gather information, while the longer-term aim was to maintain a varied, nutrient-dense diet with adequate protein and plenty of plant diversity,” she explains.  

The more targeted interventions, including the antimicrobial gut protocol, were introduced as defined therapeutic phases rather than permanent requirements.

“His ability to return to exercise and tolerate occasional dietary deviations without a major flare suggests that the programme has helped him build greater resilience,” she says.

“This is an important measure of sustainability because long-term progress should allow someone more freedom, not make them increasingly fearful or dependent on a perfect routine.”

What James’s story tells us

This case reinforced for Hamilton the importance of joining the dots without trying to address everything at once.

The tests helped build a picture that went beyond the skin, highlighting factors that could also relate to James’s digestive symptoms and low energy.

For Hamilton, the value of the functional approach was not about finding one single cause of psoriasis, but about putting the different pieces of James’s health picture together and deciding where to focus first.

“It is rarely one food or supplement that makes the difference,” says Hamilton. “In James’s case, progress appeared to come from the combined effect of improving diet quality and variety, supporting digestion and gut health, addressing relevant nutritional needs and gradually rebuilding his energy and resilience.” 

The case also reinforced the importance of a proportionate approach. Although James’s mycotoxin test identified ochratoxin A, Hamilton chose to reduce potential dietary exposure rather than introduce an extensive mould protocol.

Similarly, the temporary food removal and rotation were not intended to become a permanent restrictive diet. As James improved, the focus shifted towards variety, flexibility and long-term resilience.

This is an important part of the personalised nutrition approach: looking at the person in front of you rather than assuming that the same protocol will be appropriate for everyone with the same diagnosis.

Hamilton stresses that not everyone with psoriasis needs extensive functional testing, multiple supplements or a highly restrictive diet. Test results should be interpreted alongside symptoms, medical history and response to intervention, with the overall programme tailored to the individual.

And there is one aspect of psoriasis that should never be overlooked.

Persistent joint pain, swelling or morning stiffness can be signs of psoriatic arthritis, so it is important to speak to your GP or specialist promptly for assessment.

For James, looking beyond his skin helped him explore the wider picture of this health condition and identify changes that felt both meaningful and sustainable.

His experience is just one case, but it illustrates the potential value of taking a personalised, whole-body perspective: asking not only what does the condition look like? but also what else is happening for this individual, and where might we be able to support them?

Disclaimer:

This article is for informational purposes only and is not intended to replace medical advice, diagnosis, or treatment. The story shared is based on one individual’s experience and outcomes may vary. Always consult with a qualified healthcare professional before making changes to your diet, supplements or treatment plan.

*The client’s name has been changed to protect his privacy.